Request for Proposal (RFP)
for
Undertaking An Action Research Study to Compare the
Adherence & Cure Rates of Tuberculosis in Paper-based
Monitoring vis-a-vis Mobile-based Monitoring
Section-I : Terms of Reference (ToR)
1. BACKGROUND
Tuberculosis has been identified as a major public health problem globally, that endangers
the lives of millions of people besides having devastating socio-economic impacts on the
community. The 1990 World Health Organization (WHO) report on the Global Burden of
Disease ranked TB as the seventh most morbidity-causing disease in the world, and expected
it to continue in the same position up to 2020. This is all the more distressing in view of the
fact that the disease is curable and the methods of treatment are also very cost effective.
About 60% of world’s tuberculosis (TB) cases are in the South-East Asia and Western Pacific
regions, and India and China together account for almost 40% of them. India is the highest
tuberculosis (TB) burden country in the world, accounting for nearly one-fifth of the global
incidence. Annually, it leads to the death of more than 250,000 people in the country.
With a view to eliminate the deadly disease, India launched the National Tuberculosis
Control Project (NTCP) in 1962. The programme was unable to make any significant
epidemiological impact. In 1992, the Government of India, together with the World Health
Organization (WHO) and the Swedish International Development Agency (SIDA), reviewed
the national programme and concluded that it suffered from managerial weaknesses, nonstandard treatment regimens, low rates of treatment completion, and lack of systematic
information on treatment outcomes. Around the same time, in 1993, WHO declared
Tuberculosis as a global emergency and devised the Directly Observed Treatment - Short
Course (DOTS) strategy and recommended that all countries adopt this strategy. In 1997, the
Government of India came up with the Revised National TB Control Programme (RNTCP)
which adopted the DOTS strategy for treatment.
Multi-drug Resistant TB (MDR-TB) is a more lethal form of the disease that occurs in patients
who fail to follow the treatment religiously. Drug-resistant TB has microbial, clinical, and
programmatic causes. From a microbiological perspective, the resistance is caused by a
genetic mutation that makes a drug ineffective against the mutant bacilli. An inadequate or
poorly administered treatment regimen allows drug-resistant mutants to become the
dominant strain in a patient infected with TB. Thus, it needs to be stressed that MDR-TB is a
man-made phenomenon – poor treatment, poor drugs and poor adherence lead to the
development of MDR-TB.As per estimates, every fifth TB patient is becoming resistant
towards TB treatment. Around 3% of the MDR cases eventually develop extremely drug
resistant TB, the more lethal version of MDR having no cure.
Every second Indian undergoing treatment for tuberculosis comes from Uttar Pradesh.
Considering that 17% of tuberculosis (TB) patients eventually become resistant to basic antiTB treatment, the risk of multi drug resistant TB (MDR TB) looms large over the state. RNTCP
recognises that implementation of a good quality DOTS programme is the first priority for TB
control in the country. Prevention of emergence of MDR-TB in the community is more
imperative rather than its treatment. The primary challenge of TB treatment is ensuring
adherence to the treatment regimen. Routinely reminding patients to keep an appointment
and actions taken when patients fail to keep an appointment.
"A review of nine high-quality trials involving 5,257 participants found that the included
trials show significantly better outcomes among those tuberculosis patients for which late
patient tracers and reminders are used". DOTS also attempts to do the same, but more often
than not it is looked at as a policing strategy, which is based on the mistrust on people’s
ability and sincerity to take the medicines regularly. In view of this, it is considered pertinent
to adopt a technology enabled strategy that can help in sending timely reminders to
patients, enabling real time monitoring of consumption of dosage by patients, and
identification of defaulters to ensure timely supervision and counselling. Mobile technology
interventions have a special significance in context of such programmatic interventions.
In view of this, the State of Uttar Pradesh seeks to engage an agency that can undertake a
comparative study of adherence and cure rates in usual DOTS programme and a mobile
enabled intervention using action research. Proposals invited from qualified agencies/
Consortiums, who can undertake the suggested action research to identify ways of
strengthening the functioning and effectiveness of current RNTCP approach.
2. OBJECTIVES OF THE ASSIGNMENT
This ToR is directed towards engaging a reputed agency/ Consortium for conducting an
action research for strengthening the existing RNTCP initiative in the state of Uttar Pradesh.
The action research should be directed at studying the feasibility and effectiveness of a
mobile technology enabled system for implementation & monitoring of RNTCP interventions
as compared to the routine paper-based monitoring being followed under the current DOTS
strategy. In view of this overarching goal the agency is required to achieve the following
specific objectives –

To design a mobile technology enabled system for implementation and monitoring of
DOTS strategy;

To implement the intervention on a pilot basis in three districts of the State, wherein
five blocks will be selected in each district. The intervention will cover 10 DOTS
centres per block and a total of 50 DOT centres per district will be covered.

The agency will have to take the similar sample size for the control group as well.

To assess the feasibility and effectiveness of the mobile enabled technology in
enhancing the rate of adherence to treatment among patients, and facilitating real
time tracking & monitoring of TB patients regularly;

To undertake a comparative analysis to study the specific advantages and disadvantages
of the proposed mobile technology intervention over the currently operational DOTS
strategy & manual record keeping to facilitate achievement of similar goals; and

To identify key enablers and barriers that influence the operationalization of the
proposed technology enabled system.
3. SCOPE OF WORK
The agency would be required to conceptualize and develop a mobile technology enabled
system of monitoring the TB cases. The intervention will cover three district out of five
districts namely, Amethi , Lucknow, Deoria, Sultanpur and Ambedkar Nagar. For piloting the
newly developed system, the agency will be required to partner with the concerned district
authorities to obtain the database about the existing TB patients and obtain necessary
permissions for piloting the proposed intervention. After creating the requisite systems and
infrastructure required for implementation, the newly developed technology enabled
system for monitoring TB cases will be implemented across the chosen districts for a period
of 12 months.
In order to conduct a comparative analysis of the feasibility and effectiveness of the technology
enabled system over the traditional paper based monitoring strategy, it is suggested that the
agency uses a quasi experimental case control design. The agency needs to measure the
outcomes and effectiveness of the new system as against the traditional systems in terms of
ensuring adherence of patients to the treatment regimen, ability to track cases in a cost effective
manner, default rates, cure rates, etc. They are required to undertake qualitative action-based
research to bring to light specific advantages and disadvantaged of the currently operational DOTS
strategy & manual record keeping over the proposed mobile technology intervention to facilitate
achievement of RNTCP goals. This research will also yield insight into the key enablers or barriers
that influence the operationalization of proposed technology enabled system in the State.
The indicators for performance of TB patient tracking and monitoring systems would have to
be designed to assess the impact of proposed strategies. Similarly, the quality of care
indicators and those measuring the health outcomes would be needed for evaluating the
effectiveness of technology enabled system over the traditional system. The indicators to be
included in the evaluation framework would cover all the aspects of project implementation,
starting from inputs, processes, outputs and ultimate outcomes of the intervention.
Out of five blocks in each district, at-least 10 DOTS centres will be monitored and tracked
using the research mobile based technology mechanism and at-least 10 DOTS centres will be
studied as control group wherein existing mechanism are being practiced. At the end of the
research, a comparative study will be generated to demonstrate the impact of technology in
increasing the effectiveness the system.
4. APPROACH &METHODOLOGY
The study should use a quasi-experimental design to develop a comparative picture of the
traditional paper-based monitoring systems for DOTS implementation and the mobile
technology enabled system to be used for the same. The districts where the action-research
is planned to be undertaken by piloting the newly developed system will form the
experimental/ intervention area for the project. The agency needs to identify a similar
control area where the traditional systems are being implemented to estimate the real
impact of the targeted intervention. The data obtained from routine implementation of the
pilot intervention needs to be compared against the secondary data obtained from the
paper-based system being used in the control districts.
Besides establishing the feasibility and effectiveness of the proposed system as against the
traditional one, the study also needs to capture qualitative information about the probable
advantages and disadvantages of both the systems. For this, the agency would need to
deploy qualitative research techniques for capturing beneficiaries’ as well as providers’
perspectives about the two systems in question. Experience of implementing the system in
the experimental area for a considerable period of time will help gain insights into the key
enablers and barriers that influence the operationalization of the proposed system and
possible ways of capitalizing on the enablers and overcoming the barriers.
5. TASKS TO BE PERFORMED
The major tasks to be performed under this assignment are —
(i)
Conduct a desk review including an analysis of documents, policy papers and other
study reports that have been produced in the past and are consistent with the
thematic area of the proposed assignment.
(ii)
Develop objectively verifiable indicators within the broad parameters of the RNTCP &
DOTS framework being followed under the program.
(iii)
Conceptualize, develop and test the mobile technology enabled system for monitoring
of TB patients that is designed to deliver information on the identified parameters.
(iv)
Develop action research plan and guidelines that will help elicit requisite information
from the stakeholders both on supply and demand sides of the proposed intervention.
(v)
Train and deploy requisite staff for facilitating implementation of the said project and
for collecting the required information for comparative analysis from the field.
(vi)
Implement the newly developed system in the identified experimental districts with
the help of trained staff.
(vii) Conduct routine monitoring of the pilot intervention and generate monthly reports
that will help chart the progress of the pilot.
(viii) Obtain required secondary data from the control areas and undertake a comparative
analysis of key indicators.
(ix)
Design instruments for capturing qualitative information from the providers as well as
beneficiaries from both the intervention and control areas. Initiate data collection by
using these instruments.
(x)
Conduct data analysis and prepare draft and final study reports.
6. KEY DELIVERABLES
The key deliverables for the proposed would include—

Inception Report

3 quarterly project progress reports

Draft Study Report

Final Study Report
7. DURATION OF ASSIGNMENT
The duration of the assignment will be 12 months from signing the contract. The agencies
need to devise phasing plans for designing, piloting, and monitoring the proposed
interventions, and incorporate the same in their proposals. At the end of this duration, the
selected agency would be required to submit a report describing the pilot intervention and
the key findings generated out of the proposed action research.
8. PAYMENT TERMS
The distribution of payment will be done as per the following schedule—
Milestones
Submission and Acceptance of Inception
Report
Payment Tranches
25%
[Against Bank Guarantee of equivalent amount]
Submission and Acceptance of 3 Quarterly
Progress Reports (10% per quarter)
30%
Submission and Acceptance of Draft Report
25%
Submission and Acceptance of Final Report
20%
Section-II : Instructions to Consultants
1. ELIGIBILITY CRITERIA
The eligibility criteria for hiring an agency for “Undertaking An Action Research Study to
Compare the Adherence & Cure Rates of Tuberculosis in Paper-based Monitoring vis-a-vis
Mobile-based Monitoring” shall be as follows –
 The agency must be a registered entity (Society Registration Act) with at least 3 years
of survey & research experience in the area of public health & related disciplines.
(Copies of work orders or satisfactory execution certificates of at least two completed
assignments related to public health must be attached).

Preference will be given to agencies having empanelment with UP Government/
Government undertaking and memberships of any bilateral Chamber of Commerce,
preferably on technologies.

Preference will be given to agency/ consortium who have developed some mobile
applications or done technological intervention (at-least two in running condition).

The agency must have people with experience in the area of TB prevention, treatment
and diagnostic in the State of UP or India.

In order to enhance their eligibility, the agencies must have ISO certificate and
association with other firms. The "Association" may take the form of a Consortium or
a Joint Venture (JV) with internationally acclaimed organisations operating in the
related sector. In case an Agency enters into either a Consortium or a JV for bidding,
it must clearly state the same in its Technical Proposal.

The agency should have a permanent and well equipped office set-up in the Lucknow
State of Uttar Pradesh.

The agency must have undertaken works totalling to a minimum of Rs. 1 crore in the
last three financial years i.e. 2012-13, 2013-14 and 2014-15. (Copies of the audited
financial statements for the last three years must be enclosed).

The agency should not have been blacklisted by any Government agency or public
sector undertaking. (A self-declaration on the company’s letter head must be
submitted).
2. FORMAT FOR SUBMISSION OF PROPOSALS
The agencies meeting the eligibility criteria are invited to submit their Technical and
Financial Proposals, as per the following sets of instructions—
A.
Technical Proposal: The agencies shall include the following information in their
technical proposal—
i.
Eligibility Statement;
ii.
Outline of their relevant experience on projects of similar nature as per the format
annexed herewith (Copies of work orders shall be attached for each assignment
undertaken by the agency);
iii.
Curriculum Vitae of the individual key staff (Team Leader, Subject Matter
Specialists, Data Analyst, Field Officers, etc.);
iv.
A technical document including the approach, methodology and detailed work
plan for carrying out the assignment;
v.
Any comments or suggestions on the scope of work aimed at its improvement;
vi.
Manpower and infrastructure details of the agency/consortium.
vii. Earnest Money Deposit (EMD) of Rs. 3,00,000/- (Rupees three lakh only) in the
form of a bank guarantee/fixed deposit receipt issued by a nationalized bank and
valid for 3 months (90 days) from the date of submission of the bids. In case the
agency submits an FDR, the same should be hypothecated in the name of the
authority.
B.
Financial Proposal: The agencies shall be required to build a detailed break-up of the
costs on various heads, such as, development of requisite mobile technology enabled
system, selection & training of required project staff, implementation costs, data
processing, report writing, honoraria and boarding & lodging of the project team
members. The agency has to prepare these break-ups & provide Mission only the unit
cost for covering each TB case under the proposed study. The cost quoted should be
inclusive of all taxes.
3. SUBMISSION OF BIDS
The agencies are required to submit a signed and complete Proposal comprising of the
documents mentioned above. The submission can be done by post or by hand by the due
date and time. In case, the proposal is not submitted by the due date and time, the same
shall be returned unopened.
An authorized representative of the Consultant shall sign all the pages of both Technical and
Financial Proposals and the same should be numbered. The authorization of signing the
proposal shall be in the form of a written power of attorney attached to the Technical
Proposal.
A Proposal submitted by a Joint Venture shall be signed by all members so as to be legally
binding on all members, or by an authorized representative who has a written power of
attorney signed by each member’s authorized representative. However, in case of a
Consortium, an authorized representative of only the Lead Agency shall sign the proposal.
The Technical and Financial Proposals should be submitted in separate sealed envelopes
superscribing ‘Technical Bid’ and ‘Financial Bid’. These two envelopes should then be placed
in a THIRD (outer) envelope and properly sealed.
The Outer Envelope should be superscribed as “Technical & Financial Bids for Undertaking
An Action Research Study to Compare the Adherence & Cure Rates of Tuberculosis in
Paper-based Monitoring vis-a-vis Mobile-based Monitoring”. Besides, it must necessarily
bear the complete name and address of the bidder. The bids should be delivered to the
address below not later than the date and time mentioned in the tender notice.
Addressed to:
Member Secretary,
Centre for Health Action Research and Training (CHART),
SIHFW Campus, C- Block Indira Nagar, Lucknow 226016
OPENING & EVALUATION OF BIDS
The technical bids shall be opened in the presence of the bidders or their authorized
representatives who choose to be present. The bids will be opened and evaluated by a
technical review committee constituted for the purpose. For the same, date & venue shall
be mentioned in the tender notice.
The committee will evaluate the technical bids based on the aforementioned eligibility
criteria. Agencies adjudged to have met the eligibility criteria, shall be further considered for
evaluation of their technical proposal. The agency should obtain 75 percent marks in their
technical proposal to qualify for the next step of opening of their financial proposal.
Financial proposals shall be opened and evaluated by the committee. An agency will be
finally selected for the award of work in accordance with the Combined Quality and Cost
Based Selection (QCBS) procedure. The weightage for the Technical Proposal would be 70%
while that for the Financial Proposal would be 30%.
The evaluation criteria for the Technical Proposal is as follows—
Criteria for Awarding Marks
S.
No.
Particulars
Max. Marks
Total Marks
A. Qualifications of Project Team
i.
Team Leader
20 Marks
ii.
Other Experts
 Project Research Director
 Monitoring and evaluation expert
 Research analyst
 Operation expert
20 Marks
40 Marks
B. Relevant Work Experience
i.
Work Experience of Undertaking Similar Assignments
C.
15 Marks
15 Marks
Project Understanding & Execution
i.
Understanding of the Objectives
2 Marks
ii.
Approach & Methodology
5 Marks
iii.
Appropriateness of Work Plan & Timelines
5 Marks
iv.
Adequacy of Manpower Deployed for Undertaking the
assignment
3 Marks
Total [Minimum Qualifying > 75 % marks]
15 Marks
70 Marks
The Member Secretary, CHART reserves the right to reject any or even all proposal(s)
without assigning any reasons thereof.
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