John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 REQUEST FOR PROPOSAL FIXED PRICE GOODS OR SERVICES (FIELD) RFP NO: 14_036 PART A: COVER PAGE ISSUED TO: USAID | DELIVER Project website and advertised in country SUBJECT: Request for Proposal for a subcontract to conduct a facility level stock status survey and assessment in Madagascar The USAID | DELIVER PROJECT (herein referred to as “the Project”) under John Snow, Inc. (JSI) is soliciting proposals for the provision of Subject services as described in the attached Statement of Work. The Project is funded by the U.S. Agency for International Development (USAID) and is subject to all applicable Federal Acquisition Regulation (FAR) and AID Acquisition Regulations (AIDAR). Please submit your most competitive proposal in accordance with the attached instructions, with all required certifications. Any subcontract issued as a result of this RFP will be subject to all instructions, certifications, terms and conditions, and specifications included in this RFP. This solicitation document includes the following parts: PART A: COVER PAGE ................................................................................................... 1 PART B: INSTRUCTIONS ............................................................................................... 2 PART C: STATEMENT OF WORK ................................................................................. 6 This document is a request for proposals only, and in no way obligates the Project or USAID to make any award. Award(s) made subsequent to this solicitation will be subject to the terms and conditions described herein. All proposals, inquiries, and correspondence, including the RFP number, pertaining to this solicitation are to be directed to the attention of: Benjamin Hatch John Snow, Inc. USAID | DELIVER PROJECT 1616 North Fort Myer Drive Arlington, Virginia 22209, USA Fax: 703/528-7480 benjamin_hatch@jsi.com ___________________________________________ M. Vanden Bossche Contract Administrator __________________ Date 1 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. PART B: INSTRUCTIONS a) DEFINITIONS Offeror: The individual or firm providing proposals for the supplies or services requested under this RFP Subcontractor: The individual or firm awarded the services requested under the RFP in the form of a subcontract b) PROPOSAL DEADLINE AND REQUIREMENTS The Offeror shall submit a proposal addressing the terms and conditions of this RFP by 5:00 pm EST time on October 3, 2014 to the name and address as provided in Part A. Cover Page. Questions should be submitted no later than 5:00 pm EST September 19, 2014 to the email address above. The Technical and Cost Proposals should be submitted separately in two clearly marked PDFs to the email address above. The written proposal should not be of excessive length and must contain the following information: i) Technical Volume A concise technical proposal on how the Offeror will carry out the activity with a detailed work plan and schedule of tasks. Also provide past performance references for the last three years, including the following: name of firm, name of contact, address of firm, telephone number of firm, email for firm, dollar amount of contract for each reference. A set of relevant attachments to the proposal (optional) which further document or explain the Offeror’s approach and qualification, e.g. institutional brochure, etc. A description of the Offeror’s capability and experience in undertaking this task. ii) Cost Proposal A fixed price, total cost proposal for completion of the work described in the Statement of Work A fixed price for each category of deliverable, each of which will be considered a fixed price budget for that specific segment of work. Please provide financial statements for the last three fiscal years. Please provide proof of business registration 2 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. JSI RESERVES THE RIGHT, IN ITS SOLE DISCRETION, TO MODIFY THE REQUEST, TO ALTER THE SELECTION PROCESS IN ANY WAY, TO ASK FOR ADDITIONAL INFORMATION FROM Offerors, TO REJECT ANY AND ALL PROPOSALS AND/OR TO MODIFY OR AMEND THE SCOPE OF THE PROPOSALS SUBMITTED. THE RELEASE OF THIS RFP IS NOT A COMMITMENT TO AWARD A CONTRACT. Each Offeror acknowledges and agrees that the preparation of all materials for submittal to JSI and all presentations made by the Offeror are at the Offeror’s sole cost and expense, and JSI shall not, under any circumstances, be responsible for any cost or expense incurred by an Offeror. All documentation and/or materials submitted with a proposal shall become and remain the property of JSI. c) OFFER VALIDITY The Offeror's technical and cost proposals must remain valid for not less than 60 calendar days after the deadline specified above. Proposals must be signed by an official authorized to bind the Offeror to its provisions. d) FINANCIAL RESPONSIBILITY Offerors which are firms and not individuals, must certify in the proposal submitted to the Project that they have the financial viability and resources to complete the proposed activities within the period of performance and under the terms of payment outlined in the Statement of Work. The USAID | DELIVER PROJECT reserves the right to request and review the latest financial statements and audit reports of the Offeror as part of the basis of the award. e) NEGOTIATIONS The Offeror's most competitive proposal is requested. It is anticipated that any award issued will be made solely on the basis of an Offeror’s proposal. However, the Project reserves the right to request responses to additional technical, management and cost questions which would help in negotiating and awarding a subcontract. The Project also reserves the right to conduct negotiations on technical, management, or cost issues prior to the award of a subcontract. In the event that an agreement cannot be reached with an Offeror the Project will enter into negotiations with alternate Offerors for the purpose of awarding a subcontract without any obligation to previously considered Offerors. f) REJECTION OF PROPOSALS The Project reserves the right to reject any and all proposals received, or to negotiate separately with any and all competing Offerors. Offerors whose proposals are not selected will be notified in writing. g) INCURRING COSTS The Project is not liable for any cost incurred by Offerors during preparation, submission, or negotiation of an award for this RFP. The costs are solely the responsibility of the Offeror. h) CANCELLATION The Project may cancel this RFP without any cost or obligation at any time until issuance of a Subcontract. 3 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. i) SUBCONTRACT AWARD i) Selection Criteria Proposals will be evaluated first to ensure that they meet all mandatory requirements. Proposals that fail to meet these requirements will receive no further consideration. A non-responsive proposal to any element may be eliminated from consideration. For the purpose of selection, the evaluation will be based on an integrated assessment of the proposal, including, but not limited to, the following: Technical capability and expertise a. Track record in undertaking large health data collection projects in Madagascar or other country of similar demographics; b. Past Performance References with contact information (note that locations may be contacted or visited). c. Evidence of technical capacity to manage all aspects of this project with qualified personnel (detailing number of people in each team and qualification). Responsiveness to the RFP Ability to meet the deliverables requirements Business status certification Cost/budget proposal Additional criteria include: A Technical Proposal containing a detailed description of how the vendor proposes to undertake the survey, specification of mobile data collection platform and devices, a workplan and schedule, and the human resources and management structure to support the implementation of the technical strategy. CVs should be provided for all staff and managers to be allocated to the activity. Past performance references and qualifications should be provided to demonstrate the vendor’s capacity to execute their proposed technical strategy. Attachments 1-6 of the RFP are required certification and must be signed and submitted by the Offeror as attachments to their proposal. A detailed project workplan: a. Timelines and methodology for executing all the activities and deliverables detailed in the Statement of Work; b. A clearly articulated data management and quality assurance strategy for the project; c. A risk management plan and concrete guidelines to ensure safety of its own workforce when undertaking the Project activities outlined in this RFP; d. A profile of the management and supervisory teams (including their CVs) that will be assigned to this project. Evidence of ability to establish a team of experienced data collectors that will be able to collect and collate data at the service delivery points (SDPs) during the required time frame (November December, 2014). 4 REQUEST FOR PROPOSAL RFP NO: 14_036 iii) John Snow, Inc. Evidence of availability of laptops and smartphones for the data collectors to use during the field work for the stock status survey and data quality audit. Demonstrated readiness to begin training on/around November 5 and data collection on November 10, 2014. A Cost Proposal containing a line item breakdown of the activities detailed in the workplan. All costs should be provided in Ariary and adhere to the other requirements detailed above in the PROPOSAL DEADLINE AND REQUIREMENTS section. Contract Type The contracting document will be a Fixed Price Purchase Order (PO) to be awarded once a Subcontractor has been selected. The awarded PO will include a statement of the total fixed price; the scope with stated deliverables and due dates; the guiding USAID FAR and AIDAR clauses; and invoicing information. Please be advised that under a fixed price PO the work must be done within the specified total price. Any expenses incurred in excess of the agreed upon amount in the purchase order will be the responsibility of the Subcontractor and not that of JSI or USAID Therefore, the Offeror is duly advised to provide its most competitive and realistic cost proposal to cover all foreseeable expenses related to the tasks outlined in the Statement of Work. j) REPRESENTATIONS AND CERTIFICATIONS The proposal shall be accompanied by any requested representations or certifications signed by an authorized official of the Offeror. 5 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. PART C: STATEMENT OF WORK The Statement of Work for this RFP is as described below: a) BACKGROUND The Malagasy Ministry of Public Health (Ministère de la Santé Publique, MSP) has requested technical support from USAID | DELIVER PROJECT (the project) to conduct a robust assessment of the national supply chain system and national medical stores (SALAMA) to document commodity availability and management at different system levels (e.g. national, regional, district, and health facility). Findings from this assessment will help identify and document areas of weakness and strength and form the basis for future interventions to strengthen the supply chain for essential health commodities in Madagascar. b) OBJECTIVES OF THIS WORK The main objective of this activity is to identify the key gaps, challenges and opportunities for improvement of the supply chain operations managed by the MSP and partners. The findings of this assessment will be used to: 1) provide MSP, USAID, and other stakeholders in Madagascar with information on the availability of publicly-managed commodities and logistics information at the central, regional, district, and health facility levels; 2) evaluate supply chain performance monitoring and evaluation indicators; and 3) draft the Project M&E plan. Through the involvement of MSP staff and other governmental and non-governmental partners, during this in-depth assessment we will engage Malagasy health systems that will benefit from Project assistance. The specific objectives of the assessment include: Provide information on key supply chain performance indicators. Assess the availability of selected health products, including malaria, HIV/AIDS, essential medicines, and family planning commodities (listed in attachment 8). Determine a baseline for benchmarking current system performance and measuring the success of upcoming project interventions. Identify key points to strengthen the supply chain system and help shape the next steps needed for supply chain improvements. c) WORK PLAN i) Survey Design A cross sectional quantitative study will be conducted at approximately 700 selected SDPs within approximately 75-80 selected districts in approximately 14 selected regions in Madagascar. Data will be gathered through observations, physical inventory counts, assessment of SDP records, and by conducting interviews with relevant facility personnel on the day of visit. The survey will use an adapted version of the Logistics Indicator Assessment Tool (LIAT) and National Supply Chain Assessment Tool (NSCAT). These are standardized tools developed by the USAID | 6 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. DELIVER PROJECT and SCMS Project and are applied in many countries around the world. (See Attachment 10 for a draft of the paper-based tool.) Using both observations and interviews, the survey will: • Determine the stock status of key malaria, family planning, HIV/AIDS, and essential medical products (“tracer commodities”), including stockouts on the day of the visit and in the last six months, as well as duration and frequency of stockouts; (See attachment 8 for proposed list of commodities) • Assess the ability of districts and sub-districts to manage various supply chain functions, including storage conditions, maintenance of information systems (including logistics records and reports), distribution to lower levels, training and routine monitoring, and logistics capacity of personnel. ii) Sampling The survey will cover a representative sample of warehouses and SDPs managed by SALAMA and partners in each selected district, at the district warehouse, district hospital, and community health center levels, as well as the main SALAMA warehouse at the national level. The total sample size is estimated at about 700 facilities, taken from within approximately 75 selected districts within the approximately 14 selected regions. Within these districts, the sample will consist of the following (numbers given are approximate, and subject to change): 1 national storehouse 75 district storehouses 75 district hospitals 250 community health centers at the CSB1 level 275 community health centers at the CSB2 level Random selection of districts was done a using 2-step probability proportionate to size (PPS) technique. See Attachment 9 for a list of the proposed regions and districts (subject to change). The selection of districts and facilities will be carried out by the project in consultation with MSP and private partners. The complete list of public and private facilities in each state will be used as a sampling frame. It should be noted that neither the sample size nor identified districts are final and are subject to change before final contract(s) is signed. iii) Data Collection Instrument An adapted version of the LIAT and NSCAT (standardized quantitative data collection tools designed by the USAID | DELIVER PROJECT and SCMS) will be used to assess supply chain system performance and commodity availability in Madagascar. The tool will be modified to adjust for the Malagasy context and include MSP/SALAMA-specific implementation indicators. Finalization of the tool will be facilitated by the Awardee(s), in partnership with the project. See Attachment #10 for a paper-based draft version of the tool. The tool will be adapted for use through a mobile data collection process. The data collection system, as well as the type of devices used during field work, must be specified by the Offeror in their Technical Proposal. At a minimum, the platform as well as devices should allow for data collection to occur in real-time (i.e. data 7 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. is submitted to a database within 12 hours of collection) and work in an offline/out of network mode. The platform should also allow for programming of single or multiple choice responses; text, date, and numeric fields; required responses; and programmed logic/skips based on responses. The platform should also allow for easy transference so that data can be analyzed using a statistical software package (i.e., STATA, SPSS). It is expected that some interviews will be administered in Malagasy. The process for translation and integrated into the data collection system will be finalized once the Offeror(s) has been selected and specifications of the platform and devices are known. iv) Data collection The Subcontractor will be responsible for the recruitment and training of data collectors, collection of the data, and conducting data cleaning. The training of trainers of the data collectors will be provided over a 5 day period by the project staff, in close conjunction with the Subcontractor. Data collectors will be trained on basics of supply chain, field work techniques and how to fill in all of the instruments appropriately. Pretesting of the questionnaire will also be carried out as part of the training. The pre-test will be used to evaluate the clarity and appropriateness of certain concepts of the questionnaire and the mastery of the interviewers with the concepts. After the pre-test, modifications will be made to the tool prior to its use in the survey. Data collection in Madagascar will be carried out according to the schedule developed by the Subcontractor, and is to be submitted as part of their Technical Proposal. The project will review, provide feedback, and adjust activity timelines in collaboration with the selected Offeror(s). A final field work schedule, including team movement plan and dates shall be resubmitted prior to the start of data collection. Supervisors are expected to ensure that data collectors understand and follow the data collection instrument, perform checks during the data collection phase to ensure that data collected are accurate and that data collectors are following expected protocols, document any deviation from expectations, and provide timely corrective action. Data management and cleaning The Subcontractor will be responsible for managing all aspects of the data, including, but not limited to, tracking completion rates, ensuring accuracy of collected data by validating 5-10 percent of results through follow up and ensuring that the data collection instrument was accurately followed, including skip patterns. The Offeror should provide a detailed data management plan as part of their Technical Proposal. A final clean dataset should also be made available prior to the start of analysis. Variables and values should be clearly labeled in French within the dataset itself or an accompanying codebook. d) ROLES AND RESPONSIBILITIES Subcontractor(s) Duties and Responsibilities Adapt the finalized assessment tool for use through a mobile electronic data collection process. Identify and hire team(s) of qualified data collectors and supervisors (20-30). Data collectors 8 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 should have experience conducting facility based surveys, have familiarity with medicines and healthcare (i.e. pharmaceutical background), be fluent in French and Malagasy and ideally be familiar with using “smart phones” for data collection. Organize and co-facilitate a 4-5 day training workshop for data collectors and supervisors on survey implementation, including the assessment protocol and tools to be used and pilot testing of the tool. Organize all aspects of field work logistics and supervise survey data collection for the duration of the activity. This includes developing a schedule for site visits, coordinating vehicles and communications, assigning facilities to teams, and accommodations for data collectors while in the field. Clean data based on skip patterns and filters in assessment questionnaire and provide general management of data entry component of the survey. Respond to questions and/or requests for more information by the project as needed during the course of this survey, notify project staff of any issues with data collection or quality, and inform the project of any changes in the timeline for delivery of products associated with this survey. USAID | DELIVER PROJECT Duties and Responsibilities Overall study design, including sampling frame and selection of study sites. Develop and finalize data collection tools. Serve as co-facilitators in the training workshop for data collectors on survey implementation, including study methodology, and use of cell phones. Participate and provide guidance in pre-testing of tools. Provide letters of introduction to facilitate the field work with health bureaus and health facilities. Provide supervision during first week of data collection. Review all data to ensure quality and that survey was conducted according to the guidelines. Effect payments on accomplishment of the task according to contract and deliverables. e) DELIVERABLES AND DUE DATES Due Date Deliverable # Deliverable October 31, 2014 1 Paper-based tool programmed into electronic forms (to be submitted before start of data collection training) prior to the training of data collection teams October 31, 2014 2 Field work implementation plan (to be submitted before start of data collection) Weekly during data collection 3 Weekly reports on data management progress, including reports of quality check results 2 weeks following end of data collection 4 Cleaned source data files, variables named and labeled in French, to be submitted within two weeks of completion of data collection activities 2 weeks following end of data collection 5 Overall narrative report that outlines the field work and the data cleaning, to be submitted within two weeks of completion of data collection activities 3 weeks following end of data collection 6 Completed final data tables based on analysis plan and submitted in data table shells provided by the project, to be submitted within three weeks of completion of data collection activities. Specific due dates for deliverables will be determined following selection of the Offeror (s) and included in the final contract. 9 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. 10 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. PART D: ATTACHMENTS TO THE RFP 1. Certification Regarding: Prohibition on the Promotion or Advocacy of the Legalization or Prostitution or Sex Trafficking (Acquisition) (June 2010) Practice of 2. Contractor Code of Business Ethics (April 2010) 3. Information Regarding Responsibility Matters (April 2010) 4. Certification of Toxic Chemical Release Reporting (August 2003) 5. Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions (Sep 2007) 6. Certification Regarding Debarment, Suspension, or Proposed Debarment (December 2010) 7. Draft list of key indicators 8. Draft list of products 9. Draft list of regions and districts included in the survey 10. Draft Supply Chain Indicators Assessment Tool (SCIAT) for Madagascar assessment 11 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 ATTACHMENT 1 REQUIRED CERTIFICATION As a condition of accepting a subcontract under this RFP, the selected vendor is required to certify to the following mandatory clause: Prohibition on the Promotion or Advocacy of the Legalization or Practice of Prostitution or Sex Trafficking (Acquisition) (June 2010) (a) This contract is authorized under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Pub.L. No. 108-25), as amended. This Act enunciates that the U.S. Government is opposed to prostitution and related activities, which are inherently harmful and dehumanizing, and contribute to the phenomenon of trafficking in persons. The contractor shall not use any of the funds made available under this contract to promote or advocate the legalization or practice of prostitution or sex trafficking. Nothing in the preceding sentence shall be construed to preclude the provision to individuals of palliative care, treatment, or post-exposure pharmaceutical prophylaxis, and necessary pharmaceuticals and commodities, including test kits, condoms, and, when proven effective, microbicides. (b)(I) Except as provided in (b)(2) and (b)(3), by its signature of this contract or subcontract for HIV I AIDS activities, a non-governmental organization or public international organization awardee/sub awardee agrees that it is opposed to the practices of prostitution and sex trafficking because of the psychological and physical risks they pose for women, men, and children. [1 0] 10 The following footnote should only be included in awards to Alliance for Open Society International (AOSI), Pathfinder, or a member of GHC or InterAction (with the exception of DKT International, Inc.): (b)(2) The following organizations are exempt from (b)(I): the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Health Organization; the International AIDS Vaccine Initiative; and any United Nations agency. (b)(3) Contractors and subcontractors are exempt from (b)(I) if the contract or subcontract is for commercial items and services as defined in FAR 2.101, such as pharmaceuticals, medical supplies, logistics support, data management, and freight forwarding. (b)(4)Notwithstanding section (b)(3), not exempt from (b)(I) are contractors and subcontractors that implement HIV I AIDS programs under this contract or subcontract by: (i) providing supplies or services directly to the final populations receiving such supplies or services in host countries; (ii) providing technical assistance and training directly to host country individuals or entities on the provision of supplies or services to the final populations receiving such supplies and services; or (iii) providing the types of services listed in FAR 37 .203(b)( 1 )-( 6) that involve giving advice about substantive policies of a recipient, giving advice regarding the activities referenced in (i) and (ii), or making decisions or functioning in a recipient's chain of command (e.g., providing managerial or supervisory services approving financial transactions, personnel actions). (c) The following definitions apply for purposes of this provision: "Commercial sex act" means any sex act on account of which anything of value is given to or received by any person. "Prostitution" means procuring or providing any commercial sex act and the "practice of prostitution" has the same meaning. "Sex trafficking" means the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act. 22 U.S.C. 7102(9). 12 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. (d) The contractor shall insert this provision in all subcontracts. (e) Any violation of this provision will result in the immediate termination of this award by USAID. (f) This provision does not affect the applicability of FAR 52.222-50 to this contract. The Offeror (below named organization or firm) certifies that it has ( ) has not ( ) instituted a policy explicitly opposing prostitution and sex trafficking as required under this Request for Proposal and any possible subsequent subcontract. Offeror: _______________________________________ Authorized Signatory: _______________________________________ Print Signatory Name: _______________________________________ Title: _______________________________________ Date: __________________ 13 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 ATTACHMENT 2 REQUIRED CERTIFICATION As a condition of accepting a subcontract under this RFP, the selected vendor is required to certify to the following mandatory clause: CONTRACTOR CODE OF BUSINESS ETHICS (APR 2010) In accordance with FAR 52.203-13, CONTRACTOR CODE OF BUSINESS ETHICS (APR 2010) the subcontractor ____ has ____ does not have current active Federal contracts and grants with total value greater than $5,000,000. The subcontractor ____ is____is not a small business. The duration of the subcontract is____is not____ less than 120 days. The subcontractor has____does not have___ a Code of Business Ethics which has been provided to employees. The subcontractor is ___ is not___ exempt from the Code of Business Ethics. In accordance with the subcontractor’s Code of Business Ethics the contractor has ____does not have____a Business Ethics Awareness and Compliance Program that encourages and otherwise promotes a culture of ethical conduct and commitment to comply with the law and an internal control system that prevents and detects criminal conduct. In accordance with the Business Ethics Awareness and Compliance Program the subcontractor does___does not____ provide effective training to employees in this area. The subcontractor shall disclose, in writing, to the prime contractor and the agency office of the Inspector General (OIG), with a copy to the Contracting Officer, whenever, in connection with the award, performance, or closeout of this contract or any subcontract thereunder, the subcontractor has credible evidence that a principal, employee, agent, or subcontractor of the subcontractor has committed a violation of Federal Criminal law involving fraud, conflict of interest, bribery, or gratuity violations in Title 18 of the US Code or a violation of the civil False Claims Act. _____________________________________ Signature _____________________________________ Printed Name _____________________________________ Company Name _____________________________________ Date 14 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 ATTACHMENT 3 REQUIRED CERTIFICATON As a condition of accepting a subcontract under this RFP, the selected vendor is required to certify to the following mandatory clause: 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (APR 2010) (a) The offeror [ ] has [ ] does not have current active Federal contracts and grants with total value greater than $10,000,000. (b) If the offeror checked "has" in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (F APIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information: (l) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions: (i) In a criminal proceeding, a conviction. (ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more. (iii) In an administrative proceeding, a finding of fault and liability that results in(A) The payment of a monetary fine or penalty of $5,000 or more; or (B) The payment of a reimbursement, restitution, or damages in excess of $100,000. (iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1 )(i), (c)(1 )(ii), or (c)(1 )(iii) of this provision. (2) If the offeror has been involved in the last five years in any of the occurrences listed in (c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence. (d) The offeror shall enter the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in F APIIS as required through maintaining an active registration in the Central Contractor Registration database at http://www.ccr.gov (see 52.204-7). "Principal" means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions). ___________________________________________ Signature ___________________________________________ Printed Name 15 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. ___________________________________________ Company Name ___________________________________________ Date 16 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 ATTACHMENT 4 REQUIRED CERTFICATION As a condition of accepting a subcontract under this RFP, the selected vendor is required to certify to the following mandatory clause: 52.223.13 CERTIFICATION OF TOXIC CHEMICAL RELEASE REPORTING (AUG 2003) By signing this offer, the offeror certifies that: 1) As the owner or operator of facilities that will be used in the performance of this contract that are subject to the filing and reporting requirements described in section 313 of the Emergency Planning and Community Rightto-Know Act of 1986, (EPCRA) and requirement section 6607 of the Pollution Prevention Act of 1990 (PPA) (42 U.S.C. 13106), the offeror will file and continue to file for such facilities for the life of the contract the Toxic Chemical Release Inventory Form (Form R) as described in sections 313(a) and (g) of EPCRA and section 6607 of EPA; or 2) None of its owned or operated facilities to be used in the performance of this contract is subject to the Form R filing and reporting requirements because each such facility is exempt for at least one of the following reasons: (check each block that is applicable) 3) ( ) (i) The facility does not manufacture, process, or otherwise use any toxic chemicals listed in 40 CFR 372.65; 4) ( ) (ii) The facility does not have 10 or more full-time employees as specified in section 313(b)(1)(A) of EPCRA, 42 U.S.C. 11023(b)(1)(A); 5) ( ) (iii) The facility does not meet the reporting thresholds of toxic chemicals established under section 313(f) of EPCRA, 42 U.S.C. 11023(f) (including the alternate thresholds at 40 CFR 372.27, provided an appropriate certification from has been filed with EPA); 6) ( ) (iv) The facility does not fall within the following Standard Industrial Classification (SIC)codes or their corresponding North American Industry Classification System sectors: (A) Major group code 10 (except 1011, 1081, and 1094, (B) Major group code 12 (except 1241) (C) Major group codes 20 through 39. (D) Industry code 4911, 4931, or 4939 (limited to facilities that combust coal and/or oil for the purpose of generating power for distribution in commerce). (E) Industry code 4953 (limited to facilities regulated under the Resource Conservation and Recovery Act, Subtitle C (41 U.S.C 6921 et seq.), or 5169, or 5171, or 7389 (limited to facilities primarily engaged in solvent recovery services on a contract or fee basis); or ( ) (v) The Facility is not located in the United States or its outlying areas. ______________________________________ Signature ______________________________________ Printed Name ______________________________________ Organization and Date 17 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 ATTACHMENT 5 REQUIRED CERTIFICATON As a condition of accepting a subcontract under this RFP, the selected vendor is required to certify to the following mandatory clause: 52.203-11Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions (SEP 2007) Please complete OMB Standard Form LLL which is attached and the certification below: The offeror, by signing its offer, herby certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, and officer or employee of Congress, or an employee of a Member of Congress on its behalf in connection with the awarding of this contract. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to who payments of reasonable compensation were made. ___________________________________ Signature ___________________________________ Printed Name ___________________________________ Company ___________________________________ Date 18 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 ATTACHMENT 6 REQUIRED CERTIFICATION As a condition of accepting a subcontract under this RFP, the selected vendor is required to certify to the following mandatory clause: Protecting the Government’s Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment (DEC 2010) This is___is not___ a commercial subcontract. This subcontract is ___ is not___ for the procurement of offthe-shelf items. The total price of the subcontract is___is not___greater $30,000. The subcontractor or its principals have ____ or have not ____ been debarred, suspended, or proposed for debarment. ______________________________________ Signature ______________________________________ Printed Name ______________________________________ Company Name ______________________________________ Date 19 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 ATTACHMENT 7: DRAFT Table of Key Indicators (subject to change) Indicators Data Source(s) Stock Status Availability of products on the day of visit Physical inventory Percentage of facilities stocked out of products in the previous three months Stock records Average number of days a product was stocked out in the previous three months Stock records Average frequency of stockouts of a product in the previous three months Stock records Logistics Management Information System Recordkeeping Percentage of facilities with stock records available, by product Presence of stock records Percentage of stock records updated, by product Evidence of use of stock records in specified time period Percentage of facilities with accurate stock balances on stock records, by product Comparison of stock record balance and physical inventory count Storage Percentage of facilities that maintain acceptable storage conditions Percentage of facilities that maintained the recommended storage condition, for each storage condition Visual observation Visual observation 20 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 ATTACHMENT 8: DRAFT Product List (subject to change) Product: Lamuvidine Efavirenz Abacavire Cotrimoxazole comprimé 400/80 Cotrimoxazole flacon 200/40 ACT Nourrissons ACT Jeunes Enfants ACT Enfants ACT Adults Test de Diagnostic Rapide Amoxycilline 250mg flacon Fer Acide Folique comprime Paracetamol Antibiotic injectable (TBD) Vitamine A gelules Contraceptif oral combiné Contraceptif oral progestatif Contraceptif injectable Condoms Type: ARV ARV ARV ARV ARV Malaria Malaria Malaria Malaria Malaria DPLMT DPLMT DPLMT DPLMT DPLMT FP FP FP FP and HIV/AIDS 21 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 ATTACHMENT 9: DRAFT List of Regions and Districts Included (subject to change) Regions included: ALAOTRA MANGORO ANALAMANGA ANALANJIROFO ANOSY ATSIMO ANDREFANA ATSIMO ATSINANANA BETSIBOKA DIANA HAUTE MATSIATRA IHOROMBE MENABE SOFIA V7V VAKINANKARATRA Districts included: AMBALAVAO AMBANJA AMBATOLAMPY AMBATONDRAZAKA AMBILOBE AMBOASARY AMBOHIDRATRIMO AMBOHIMAHASOA AMPANIHY AMPARAFARAVOLA ANALALAVA ANDILAMENA ANDRAMASINA ANJOZOROBE ANKAZOABO ANKAZOBE ANOSIBE AN'ALA ANTANANARIVO ATSIMONDRANO ANTANANARIVO AVARADRANO ANTANANARIVO RENIVOHITRA ANTANIFOTSY ANTSIRABE I ANTSIRABE II ANTSOHIHY BEALANANA BEFANDRIANA NORD BEFOTAKA BELO/TSIRIBIHINA BENENITRA BEROROHA BETAFO BETIOKY BETROKA DIEGO II FARAFANGANA FARATSIHO FENERIVE EST FIANARANTSOA I FIANARANTSOA II IFANADIANA IHOSY IKALAMAVONY IKONGO IVOHIBE KANDREHO MAEVATANANA MAHABO MAMPIKONY MANAKARA MANANARA NORD MANANJARY MANDOTO MANDRITSARA MANJA MANJAKANDRIANA MAROANTSETRA MIANDRIVAZO MIDONGY MORAMANGA MOROMBE MORONDAVA NOSY BE NOSY VARIKA PORT BERGE SAINTE MARIE SAKARAHA SOANIERANA IVONGO TOLAGNARO TOLIARY I TOLIARY II TSARATANANA VANGAINDRANO VAVATENINA VOHIPENO VONDROZO 22 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. ATTACHMENT 10: DRAFT Supply Chain Indicators Assessment Tool (SCIAT) for Madagascar Introduction Introduce all team members and ask facility representatives to introduce themselves. Explain the objectives of this survey: Good day. My name is ________________. My colleague and I are representing the Minstry of Health on behalf of the USAID | DELIVER PROJECT. We are conducting a survey regarding the health commodity logistics system. We are looking at the availability of selected commodities and information about how they are stored. We are visiting selected health facilities throughout the country; this facility was selected to be in the survey. The objectives of the survey are to collect current information on stock status of key health products. This is not a supervisory visit and the performance of individual staff members is not being evaluated. The results of this survey will provide information to make decisions and to promote improvements. The survey has been/will be conducted again in the future to measure changes in the logistics system. [Add any additional objectives here.] We would like to ask the supply manager a series of questions about the products and supplies available at this facility. In addition, we would like to actually count selected products you have in stock today and observe the general storage conditions. Do you have any questions? Following the interview below. Ask the in-charge to introduce the team to the person managing commodities. Extend the invitation to the in-charge to stay with the team but explain that we are aware that they have other responsibilities. Offer to check back with him/her before leaving the facility. 23 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 NFORMATION ABOUT INTERVIEW Date: DAY/ MONTH/ YEAR Interviewer/s: _____________________________ _________________________________________ Section 1: Facility Services and Infrastructure FACILITY IDENTIFICATION Name of the facility__________________________ Facility location Region ____________________________________ Region ............................................... District ___________________________________ District ............................................... City/town: _________________________________ Code of the facility ...................................................... Facility Code ..................................... Facility Type: (1=Warehouse; 2=SDP) ..................... Warehouse/SDP................................. If SDP, mark type of facility: (1=General/District hospital; 2=CSB 1; 3=CSB 2 4=Other ____________) ..................................................................................... SDP Facility Type If Warehouse: mark level: (1=Central; 2=District) ..... Warehouse Facility Type ................... GPS coordinates Longitude: ________________________ Latitude: __________________________ Type of road access to facilities: None=0 ; Dirt=1 ; Graded/laterite=2; Paved=3 Road................................................... 24 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 Section 2a: Interview with Head of Facility (i.e. Chief Medical Officer) No. Question Code Classification Go To 101. Name and title and mobile phone number or Name: _____________________ health facility in-charge Title: _______________________ Mobile number: ______________ 102. Ask to see their mobile phone and note down phone model Brand:_______________ Model:________________ 103. Which mobile network do you use? (If more than one, select the one used primarily at the facility) 1. Airtel 2. Orange 3. Telma 104. In general, what is network coverage like at this facility 1. 2. 3. 4. 5. Excellent Good Fair Weak No Service 105. What is the primary source of power for this facility? 1. 2. 3. 4. 5. No Power Electricity from national grid Generator plant at the facility Portable generator at the facility Other (specify)_____________ 106. When power fails, what type of backup of power do you have to avoid break in cold chain? (Select all that apply.) A. Portable generator at the SDP B. Nearby facility C. Other (specify)_____________ Skip to 107 25 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 No. Question 107. Which types electronic/mobile communications technology are used in the facility on a routine basis (Select all that apply. Prompt respondent by asking “anything else” ) Code Classification A. B. C. D. E. F. G. Computer Mobile phone (basic) Mobile phones (smart) Tablets Internet-LAN Internet- Wi-Fi Other (specify)____________ H. None of the Above 108. How did the facility acquire these technologies? (Select all that apply.) 109. What are the main purposes for which the facility uses the ICT? (Select all that apply.) Go To Skip to 111 A. Staff members personal item B. Provided by government C. Provided by proprietor of facility D. Received as Donation E. Other.(specify) ____________ A. Patient registration B. Facility record keeping C. Individual patient records/Electronic Medical Record D. Diagnose patients E. Inventory/Supply chain management F. Health Insurance Claims and Reimbursement System G. Mobile money cash transfers and payments H. Routine communication I. Awareness and demand creation activities J. Health worker training K. Health worker monitoring and supervision L. Clinical consultation (long distance communication with experts) M. Other (specify)____________ 26 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 No. Question 110. IF INTERNET (LAN OR WI-FI) IS AVAILABLE ASK In general, how many week out of the month do you have network (internet) access? 111. Are any HIV/AIDS services (e.g. testing, care and treatment) available at this facility? If yes, what types? (Select all that apply.) Code Classification 1. 2. 3. 4. 5. A. B. C. D. E. Go To Always 2-3 weeks 1-2 weeks Less than 1 week No internet access at facility ICTC STI/RTI Clinics ART Centers No services provided at facility Not applicable (warehouse) Skip to 120 113. Are standard treatment guidelines for 1. Yes-hardcopy treatment of Opportunistic Infections (OI) 2. Yes- electronic copy available at this facility? (If yes, ask for copy 3. Yes, not verified and verify.) 4. No 114. Are standard treatment guidelines for 1. Yes-hardcopy treatment of Sexually Transmitted 2. Yes- electronic copy Infections (STI) available at this facility? (If 3. Yes, not verified yes, ask for copy and verify.) 4. No 115. Are written guidelines or SOPs for cold chain management available at this facility? (If yes, verify where guidelines or SOP manual is located in the facility.) 1. 2. 3. 4. 5. Yes-hardcopy Yes- electronic copy Yes, not verified No N/A no cold chain items maintained at facility 116. Are written guidelines or SOPs for BioMedical Waste management available at this facility? (If yes, verify where guidelines or SOP manual is located in the facility.) 1. 2. 3. 4. Yes-hardcopy Yes- electronic copy Yes, not verified No 27 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 No. Question 122. What challenges do you face transporting products to this facility? (Select all that apply.) Code Classification Go To A. Accessibility to good roads B. Funding for delivery or pickup to be carried out C. Access to vehicles D. Communication/planning with the facility responsible for issuing product to this facility E. Finding time to pickup F. Other, please specify __________ G. No issues 28 REQUEST FOR PROPOSAL RFP NO: 14_036 John Snow, Inc. Tableau 1. État du stock (spécifier un période de six mois complète et le jour de la visite) Colonne : 1. Nom de tous les produits autorisés qui vont être comptés 2. Unité de comptage pour le produit Note : Les colonnes 1 et 2 devraient être remplies avant que les questionnaires ne soient imprimés pour l’étude. 3. Que le produit soit ou non géré dans ce centre, répondez O pour oui ou N pour non. Notez que, pour certains produits, à certains niveaux, tous les centres devraient gérer le produit. Dans de tels cas, cette colonne devrait être marquée avec un O. 4. Enregistrez la quantité de produit dans un récipient (container) ouvert. Estimez la quantité de produit au quart, à moitié, aux trois quarts plein utilisant la plus petite unité de compte établie à la colonne 2. 5. Notez si le centre enregistre une rupture de stock du produit le jour de la visite, selon l’inventaire physique, répondez O pour oui ou N pour non. 6. Notez la quantité de produits périmés. Comptez tous les produits périmés le jour de la visite. S’il existe des produits qui sont presque périmés (d’ici à une semaine), notez-le dans la section des commentaires. 7. Vérifiez si la fiche de stock est disponible, répondez O pour oui ou N pour non. 8. Vérifiez si la fiche de stock a été mise à jour au cours des 30 derniers jours, répondez O pour oui ou N pour non. Note : Si la fiche de stock a été mise à jour la dernière fois avec un solde de 0 et que le centre n’a pas reçu de réapprovisionnement, considérez que la fiche de stock est à jour. 9. Notez le solde sur la fiche de stock. 10. Notez si le centre a eu une rupture de stock pour un produit au cours des 6 derniers mois complets avant l’enquête, répondez O pour oui ou N pour non. 11. Notez le nombre de fois où le produit s’est trouvé en rupture de stock au cours des 6 derniers mois complets avant l’étude selon les fiches de stock, si disponibles, sinon demandez à un informant clé. Notez la source d’information. 12. Noter le nombre total de jours où le produit était en rupture de stock au cours des 6 derniers mois complets avant l’étude. 13. Notez la quantité de produits distribués aux utilisateurs ou en provenance du local de stockage au cours des 6 derniers mois complets avant l’enquête. Note : si la réponse à la colonne 4 est N, notez NA dans cette colonne. 14. Notez le nombre de jours représentés par les données saisies (peut-être moins de 6) ; notez les jours pour lesquels on a enregistré des données, quelles qu’elles soient, y compris 0. Note : si la réponse à la colonne 4 est N, notez NA dans cette colonne. Mois de stock maximum_________________ Mois de stock minimum _________________ Intervalle de commande___________________________ Note : Pour tout produit pour lequel on a noté une rupture de stock au cours des 6 derniers mois (y compris le jour de la visite), prière de noter les raisons (par produit). 29 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 14_036 Note : Pour tout produit pour lequel on a noté une rupture de stock au cours des 6 derniers mois (y compris le jour de la visite), prière de noter les raisons (par produit). Est-ce que les fiches de stock et les rapports sont complétés en utilisant la plus petite unité de comptage ? (O/N) Produit Unités de comptage 1 2 Géré dans ce centre ? Inventaire physique — Local de stockage Rupture de stock aujourd’hui ? (O/N) Quantité de produits périmés Fiche de stock disponible? (O/N) Fiche de stock à jour ? (O/N) 3 4 5 6 7 8 Solde sur fiche de stock Rupture de stock derniers 6 mois (O/N) Nombre de ruptures de stock 9 10 11 Nombre total de jours Total noté (derniers 6 mois) Nombre de jours de données disponible s 12 13 14 Commentaires : 30 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: Tableau 2. Conditions de stockage Les articles 1-14 doivent être évalués pour tous les centres de santé pour les produits qui sont prêts à être distribués aux clients. Mettre une coche dans la colonne appropriée en fonction de l’inspection visuelle du local de stockage ; notez toute observation pertinente dans la colonne des commentaires. Pour obtenir un « oui, » tous les produits et cartons doivent répondre aux critères de chaque article. No 01 . 02 . 03 . 04 . 05 . 06 . 07 . 08 . 09 . 10 . Description No Oui Commentaires Les produits prêts à être distribués sont disposés de telle manière que les étiquettes d’identification et les dates de péremption et/ou de fabrication sont visibles. Les produits sont stockés et rangés permettant un comptage de premier-périmé, premier-sorti (PPPS) et une gestion générale. Les cartons et les produits sont en bon état et ne sont pas endommagés. Si les cartons sont ouverts, les produits ne sont pas humides ou craquelés par suite de la chaleur ou du rayonnement (lumières fluorescentes dans le cas de condoms, cartons stockés verticalement pour le Depo-Provera®). Le centre sépare toujours les produits endommagés et/ou périmés des bons produits et les supprime du stock. Les produits sont à l’abri de la lumière directe du soleil. Les cartons et les produits sont protégés de l’eau et de l’humidité en toute saison. La zone de stockage est exempte d’insectes et de rongeurs. (Vérifiez visuellement les traces de chauve-souris et/ou rongeurs [déjections ou insectes] dans la zone de stockage.) La zone de stockage est sécurisée par un verrou et une clé, mais est accessible pendant les heures de travail normales, avec un accès limité au personnel autorisé. Les produits sont stockés à la température adéquate conformément aux spécifications de température du produit. Le toit est maintenu en bon état pour éviter la pénétration de la lumière du soleil et de l’eau. 31 John Snow, Inc. REQUEST FOR PROPOSAL RFP NO: 11 . 12 . 13 . 14 . Le local de stockage est maintenu en bon état (propre, sans déchets, les étagères sont nettoyées et les boîtes correctement disposées). L’espace et l’organisation sont suffisants pour les produits existants et pour une éventuelle expansion (par exemple, réception de produits attendus dans un avenir proche). Le matériel de sécurité-incendie est disponible et accessible (tout article permettant de lutter contre le feu doit être pris en compte). Les produits sont stockés séparément des insecticides et des produits chimiques. Les normes supplémentaires ci-dessous peuvent être appliquées à toute installation suffisamment grande pour permettre l’empilement de plusieurs boîtes. No. 15. 16. 17. Description No Oui Commentaires Les produits sont rangés à 10 cm au moins au-dessus du sol. Les produits sont rangés à 30 cm au moins des parois et des autres piles. Les produits sont rangés sur une hauteur de 2,5 mètres maximum. Principes supplémentaires pour des questions spécifiques : Point 2 : Lorsque vous notez la bonne disposition des produits, tenez compte de la durée de vie de ces différents produits. Point 3 : Vérifiez les cartons pour voir s’ils ont été endommagés par une mauvaise manipulation. Vérifiez les produits à l’intérieur de cartons ouverts ou endommagés pour vous assurer qu’ils ne sont ni humides, ni craquelés sous l’effet de la chaleur ou du rayonnement (par exemple, du fait de lumières fluorescentes dans le cas des préservatifs), ni écrasés. Point 4 : Vérifiez que le centre supprime bien les produits endommagés ou périmés en respectant les procédures (qui peuvent varier d’un centre à un autre). Spécifiez si des procédures existent et décrivez-les. Point 7 : Il est important de vérifier que la zone de stockage ne présente aucune trace de rongeurs (déjections) ou d’insectes pouvant présenter un risque quelconque pour les produits. Point 8 : Ce point concerne un entrepôt fermé par un verrou ou un local fermé à clé à l’intérieur d’une clinique. Point 13 : Il n’est pas nécessaire que l’équipement de sécurité contre l’incendie réponde aux normes internationales en vigueur. Tenez compte de tout article identifié comme pouvant participer à la protection contre l’incendie (par exemple, seau d’eau, sable). Ne 32 REQUEST FOR PROPOSAL RFP NO: John Snow, Inc. considérez pas des extincteurs d’incendie vides et/ou périmés comme des équipements valables contre les incendies. 33