Lesotho HSS PHC cGBV compiled RFI responses

General Information

Country:  LesothoCity/Locality:  MaseruPublication Date:  Jul 28, 2022Agency:  Millennium Challenge Corporation (MCC)Buyer:  
Original Language:  English

Contact Information

Address:  Lesotho Millennium Development Agency
Maseru
Lesotho

Bidding documents and attachments

• Questions and answers: HSS_PHC_cGBV complied RFI responses (333 KB; Jul 28, 2022)

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HSS
Question #3: Are there any parts of the scope, tasks, deliverables or personnel requirements that are unclear? If yes, please explain.
Technical
1. In several instances, the division of roles, responsibilities and deliverables between this contract and the other contracts within the larger HSS Project is unclear, particularly the Digital Health Contract and the Financing Health Service Delivery Results Contract. For example, between the Digital Health Contract and the HSS/PHC/cGBV Support, it is not clear which Offeror is responsible for defining data requirements, data flows, and alignment with policy, and for different aspects of data analysis and use by DHMTs. The HSS/PHC/cGBV Support RFI also states that Offerors for that contract are to “work closely with the Digital Health Contractor to expand the e-Register system,” which leaves ambiguity around the MCA’s expectations for each contract. Likewise, there are elements of DHMT budgeting, financial management and capacity building in this RFI (tasks under 4.2.4) that seem potentially duplicative with the scope of the Financing Health Service Delivery Results Contract and elements of communication and health promotion (tasks under 4.2.7) that may overlap with the Health Communications Service Provision contract.
a. We note your comments and will address the points raised as we review the SOW before the RFP is published.
In addition to the breakdown of roles and deliverables across contracts, it would be helpful to have more information on planned mechanisms for coordination between the contracts and the extent to which work planning will be done jointly.
b. Technical, administrative, and coordination oversight for the HSS Project will be provided by the MCA, HSS Project team. The MCA staff will be assisted in their mission by the MCA Support Contractor, hired to provide specialist technical support. MCA will establish a project steering committee, in close collaboration with the MOH to foster coordination in line with MOH priorities. The MCA’s expectation is the Contractors will work closely together to ensure synergies and efficiencies in delivering their individual contract requirements. The MCA staff will have an overview of all contracts through their role in approving workplans, deliverables, and participation in the steering committee and any TWGs.
2. As noted in the RFI, the US Government –particularly through PEPFAR –has substantial programming in Lesotho. While many of these activities are more narrowly focused on HIV and AIDS, they also address health systems issues, gender-based violence, information systems and data use more broadly in the health sector. For example, it is not clear if the existing Centers of Excellence will continue to be supported through PEPFAR and the timeframe for this work. It is also not clear if the HSS/PHC/cGBV Support contractor will be responsible for addressing any potential overlap with other programs or if the MCA is responsible for this coordination.
It is anticipated the MCA will participate in donor coordination activities to support synergies and reduce overlap and duplication of effort with other programs. The Contractor will have a role in coordination through their work with the Ministry of Health, and other ministries, and they will liaise with other implementing partners working on HSS/GBV issues. If either the MCA or contractor becomes aware of overlap or duplication of effort with other programs, the contract will be modified to prevent duplication.
3. There is substantial overlap between Short-term Outcomes 3.2 and 3.3, particularly 3.2.2 and 3.3 with their shared focus on data use. Furthermore, there is substantial potential for overlap between the scope of Short-term Outcome 3.3 under this contract and the scope of the Digital Health contract. A clearer articulation of the scopes and their parameters would help offerors focus their strategies on the intended objectives/outcomes and reduce confusion and the risk of duplication of effort when implementation commences.
Thank for your observations, we will review the SOWs to ensure greater clarity with respect to contractor roles and responsibilities in the final RFPs.
4. Under Task 4.2.1.3, the RFI states that “the Offeror will support DHMTs and facilities to advocate for the provision of these medications and supplies through existing pharmaceutical and medical supply systems” and “[a]ccording to the available resources... provide priority items as feasible.” It is unclear from the information provided how the status and structure of the existing pharmaceutical and medical supply systems informed the scope and deliverables of this task, particularly given the importance of sustainable health commodity availability to the effectiveness of PHC and the strength of the health system.
Thank you for your observation, the contractor will not be expected to address pharmaceutical and medical supply systems as part of the HSS/GBV SOW. This will be clarified in the RFP.
5. Is the Offeror expected to create a new COE or work within the existing COE to integrate other programs beyond HIV/AIDS and T.B.?
The contractor will create new COEs, in close collaboration with the MOH and DHMTs. Contractors can propose to expand existing COE.
6. Is the Offeror expected to conduct the training or support the local institutions to provide ongoing training (pre and in-service)?
The contractor will support and build capacity of existing local institutions to provide training (pre and in-service).
7. What criteria will be utilized to identify Village Health Posts and to develop an operational plan? Furthermore, what mechanisms will be fortified to ensure successful referral and linkages from Village Health Posts to health facility level?
The SOW does not envisage direct support to Village Health Posts nor the development of Health Post operational plans.
8. Considering the conscious and deliberate integration of cGBV into the health sector like never before, Lesotho’s health sector vis-à-vis the shortcoming in achieving health outcomes from investment, countries performance towards achieving the goals of UHC, and evolving state PHC and Village Health Worker Program, it would be helpful clarify intended institutional arrangements, and deliverables that are much more closely linked to stronger and resilient DHMT and facility-level health systems and health outcomes.
Thank you for your observation.
9. As the e-register becomes more inclusive of other diseases, which diseases shall be the priority to incorporate into the digital system and what is the timeline to introduce each?
This should be assessed by the HSS/PHC/cGBV Support contractor in collaboration with the MOH. Specifics should be included in the annual workplan.
10. Is the primary objective to integrate all described systems using one unique identifier into one interoperable environment and, thereafter, automate visual and reports?
Yes, this is the long-term goal to be achieved in collaboration with the DH contract.
11. Will this integrated platform become the EMR to be used by clinicians and other patient interfacing staff? Or is the primary ask intended to pull data from other systems into the eRegister (EMR) platform?
It is intended that the EMR platform will be used by clinicians and other patient facing staff. Other data will be pulled into the EMR to ensure clinicians and other patient facing staff have access to as much data as possible on individual patients.
12. Is there a possibility to use probabilistic matching within an interoperable environment to match and integrated all data sources?
The DH contractor will be responsible for creating the interoperable environment with the information systems.
13. Is there a plan to transition from paper registries in the future or will they remain the primary source of data?
The MOH’s long-term vision is that paper registers will be replaced by electronic registers. This project will contribute to this long-term vision.
14. Are there criteria for the development of Centers of Excellence for PHC?
It is envisaged the Health System Strengthening Project’s Centers of Excellence will be set up in consultation with the Ministry of Health, including setting out detailed criteria, support needs and timeframe. Establishing the COEs will be achieved in close coordination with the DHMTs.
15. Can a macro-organogram of the Ministry be provided indicating roles and responsibilities to understand how the DHMTs link up with the Ministry of Health?
Please refer to due diligence reports which were made available as part of the RFI.
16. Does the Ministry of Health have a Human Resources for Health plan or policy?
We understand the MOH does not have an active Human Resource plan or policy at this time.
17. Does the Ministry have an Essential Medicine List and Essential Medical Equipment List for district health services?
Currently there are no official/adopted lists of essential medicines or medical equipment at the district level.
18. Section 4.2.1.9 refers to support to the Lesotho Nursing Association. What is then the role of the Lesotho Nursing Council?
The LNC will play an advocacy role in support of prioritization of PHC. The nursing council will be involved in development and diffusion of CPGs, SOWs and training programs (in and pre-service).
19. Will the Counter Domestic Violence Law be made available as part of the RFP?
The cGBV law has not yet been gazetted but will be available to the public once it has been.
20. Can the role of [name of organization not included] in this project be outlined?
There are no plans to outline the role of specific partners in the SOW.
21. How will this project interact with all donor funded programmes?
The project, with and through the MCA, will interact through donor coordination mechanisms lead by the MOH and other relevant ministries.
22. Is there a list of all accredited health programme providers in Lesotho? Who accredits these programmes?
The MCA does not intend to provide such a list.
23. Is there an inter-ministerial structure to integrate the work in this compact?
The MCA (and MCC) will coordinate project activities with MOH and relevant ministries through the creation of a Project Steering Committee and mechanisms.
24. In this context, it does not clearly appear to us whether a management board will be set up in the context of the assignment.
Please see response to question 23.
25. More clarity of the roles and responsibilities of Offeror, contractor, MCC, MCA and MOH would be helpful.
Please refer to answer to question 1 b. above.
26. As many of the deliverables are already in the scope of services for DHMTs, it would be helpful to discuss the oversight structures that will facilitate more permanent change within DHMTs management and activities. What structures are involved so as to not develop parallel structures to work around the DHMTs that disappear after compact ends? Perhaps these plans will be part of phase 1?
The project intends to work through and strengthen the existing annual joint review and annual operations planning processes to strengthen DHMT management and activities. By the end of phase 1 the Contractor should propose oversight structures to ensure sustained, system reform.
27. What equipment is envisioned to be procured under this contract? Would the purchase of the equipment purchase be covered under the contract amount of ~$32M?
The list of equipment to be procured will be developed jointly by the contractor and the MOH. The cost of equipment procurement is included in the overall project ceiling amount.
28. While there is a clear focus on the Village Health Workers program it might be worth looking further into the areas of Behaviour Change Communication and demand creation elements. Linked to this the issue of effective supply chains would be an area that could be reviewed. The PFM elements presumably will link through to the separate procurement mentioned. As well as national health accounts (NHA) our recent experience of conducting a Public Expenditure Tracking Study (PETS) in Bangladesh with a focus on district and sub-district levels demonstrated the value of this tool to complement the other PFM tools such as NHAs. The PETS quickly highlighted a range of blockages, challenges in the flow of funds and resources from central to district and down to health facilities. It also highlighted to challenges in supervision, procurement systems and the lack of training that existed. It is a quick tool and more focused on the detail of why expenditure is often low and late.
Offerors are encouraged to propose any methodologies capable of achieving optimal results for the project.
29. Can you provide more information about how this opportunity and, particularly, the support to strengthen DHMTs will be reinforced through the Financing Health Service Delivery Results granting mechanism? Will either mechanism be responsible for designing the performance-based grants to DHMTs? We have expertise in designing performance-based aid programs (that promote a ‘learning by doing’ approach) and would be interested to understand if and how that scope will be managed among the mechanisms.
Yes, it is hoped that the coordinated efforts of all procurements under the HSS project will be mutually supportive. The coordination will be provided by the MCA as described above.
Personnel
30. It is unclear if the same key personnel are required for the Pre-Compact Phase and the Compact Phase, or if those listed are only for the Compact Phase. Also, given the long time period between proposal submission and the start of the Compact Phase, it is also not clear if and how proposed key personnel can be changed if necessary.
The key personnel requirements apply to both pre-Compact and Compact phases of the project.
31. Given the challenges the Offeror may face in identifying key personnel meeting all stipulated requirements, can the Offeror propose non-Lesotho citizens/residents?
Yes. There is no requirement that key personnel be Lesotho citizens. It is anticipated however that key personnel will be reside in Lesotho during the contract period.

Contractual
32. If the contractor selected for the base period will automatically continue into the option years, barring any performance issues, or if there will be a separate procurement process for the Compact Phase.
Dependent upon satisfactory performance during the base period, the same contractor will be contracted for the implementation of the option year(s). LMDA/MCA has the unilateral right to go back out to the market with an open procurement.
33. The extent to which base period assessments may result in changes to the larger project scope and how that will be addressed in the option year contracts.
Changes, as deemed necessary or desirable, will be addressed through the annual workplan process for each of the option years.
34. When and on what criteria the decision to exercise each option year will be made by the MCA, and how far in advance the contractor will be informed.

This decision will be made based on the performance of the consultant, their ability to maintain the original staff, perform the work per the contractual deliverables on time and achieving the work through high quality deliverables.
The following documents can be found on the MCC website and may be useful to potential Bidders:
MCC Guidance to Accountable Entities on Technical Reviews and No-Objections | Millennium Challenge Corporation
MCC Program Procurement Guidelines | Millennium Challenge Corporation
35. How the payment schedule will be structured and negotiated
The payment schedule is a technical component to be proposed by Bidders. The contractor’s work will be paid against deliverables per the agreed payment schedule.
36. We request that any procurement that is subsequently released provide for a brief question and answer period to allow for questions on either the technical or financial aspects of the procurement and related submission requirements.
The MCA will provide a period for submissions of questions and answers as part of the RFP release process.

Question #7: What questions do you have on the Scope, Tasks, Deliverables, Personnel or other parts of this RFI?
Technical
Pre compact phase
1. Will the two phases (Pre-Compact / Compact) be contracted separately or are these just two project periods within the same contract? Or would the contract be one contract, which, on the basis of a full assessment by MCA after completion of phase one of the contractor’s performance, the same contractor would be asked to continue to be in charge of phase two?
Dependent upon satisfactory performance during the base period, the same contractor will be contracted for the implementation of the option year(s). LMDA/MCA has the unilateral right to go back out to the market.

2. Can the MCA confirm if Pre-Compact Task 4.1.4 on page 18 is inclusive of GBV services? If so, is the research also intended to address possible barriers to service uptake (including social and cultural barriers) in addition to drivers of demand related to VHWs and health worker staff?
Yes. The research mentioned is to build on existing knowledge - (data - survey information) that has been established as part of this work and to conduct relevant research to address those barriers in each district - while there may be homogeny between districts there may be district specific barriers which need to be identified.
3. Can the MCA specify the scope of the services to be included in Pre-Compact Task 4.1.6 on page 18, given the multi-sectoral nature of GBV services?
It is expected that the contractor will review existing work conducted as part of the C-TIP assessment and/or any other relevant assessments prior to conducting a mapping exercise to understand available service providers of GBV in each district.

4. Also in Pre-Compact Task 4.1.6, the RFI makes a reference to collaboration with a C-TIP assessment contractor for the Market-Driven Irrigated Horticulture) Project. Can the MCA clarify the planned timeline for MDIH contracting and if this mapping exercise will also be in the scope of that project?
The C-TIP assessment will be conducted in 2022 and available to the contractor.

5. In Pre-Compact Task 4.1.8on page 19, the RFI indicates that the Offeror will support the MOH to conduct a national health accounts (NHA) exercise. Can the MCA clarify the type of support that is envisioned here (i.e., technical guidance, logistical/administrative support, analytical support) and if the cost of the NHA exercise is to be covered by the Offeror?
The contractor will cover the cost and provide support to the MOH as needed to conduct the NHA with all three types of support mentioned.
6. Besides producing a donor and partner analysis as part of the ‘Base’ stage (see 2 above), we would like to propose a national multi-sectoral consultation process early on in Phase 1. The purpose of such a meeting would be to get all partners to agree to align to one national plan. This would involve all state and non-state actors at all levels of the health system, importantly including district offices, other government departments (considering the GBV focus) and the private sector. This seminal event will be key to ensuring a coordinated and coherent effort to achieve project success. Awareness raising for PHC. Linked to the point above, we note that raising awareness about the importance of PHC, VHWs etc. using radio and TV is only scheduled in Phase 2. We would like to suggest that this activity is moved to early on in Phase 1 to heighten awareness of PHC and the economic rationale for it with the aim of influencing health workers, other government departments, national treasury, and other influential decision makers. In our opinion, for this reform effort to work it needs a whole of government, whole of health partnership approach, and this could happen earlier on in the project than is currently planned. In addition, to complement this awareness raising for PHC, we suggest that the cost benefit analysis work (essentially the investment case for PHC), be brought forward into Phase 1. This will serve as a key policy influence tool to convince decision makers to prioritize PHC to reap the associated economic benefits.
Offerors are encouraged to propose any methodologies they wish to support project implementation and results.
7. It is outlined that the provision of the defined support will be in two phases. While Phase 2 will be composed of five option years, how long is Phase 1 as base period envisaged to last?
The length of Phase 1 depends on both when the final Contract is awarded and when the Compact begins. Therefore, the time period is an estimate. If the Compact is substantially delayed, the Offeror may have a longer period for the assessment, however they should plan to have the assessment completed within 6 months.
8. To which extend will the Pre-Compact Tasks (Points 4.1.1 to 4.1.9) of Phase 1 con-tribute to the three short-term outcomes? In how far is Phase 1 presented in Figure1 "HSS Project Logic Model"?
All tasks have been defined based upon their contribution to HSS Project short term outcomes.
Implementation period
9. On page 15, the RFI references a “national M&E policy in the offing.” Does the MCA have any further information on the likely timing and scope of this policy, as this impacts the expected task of supporting the development of an integrated M&E framework for the heath sector?
At this time MCA has no further information on the M&E policy.
10. In reference to capacity building on the e-Register system, the RFI states on page 16-17 that “The Offeror will ensure the institutions or individuals trained as teachers [by the Digital Health Contractor] will provide training and capacity development to support end users such as nurses, clinicians, data entry clerks, and DHMT staff.” Can the MCA clarify if the end user training is to be financed through this contractor the Digital Health contract? Additionally, is this training intended to cover only new/expanded functionalities or also the existing HIV and TB modules supported by PEPFAR?
The end user training will be a collaboration with the Digital Health Contractor and will be tailored to different audiences who will be using and supporting the system.
11. Under Compact Task 4.2.4.3 on page 25, it indicates that the Offeror must “work with local training institutions to develop the necessary curricula and collaborate with those training institutions to provide training to address identified needs.” Is this intended to be done through sub-contracts and financed through the HSS/PHC/cGBV Support contract budget? There is a similar activity on page 26(4.2.5.2) –is this also expected to be done through sub-contracts to pre-service and in-service institutions in Lesotho?
Support to local training institutions is envisaged through subcontracts and/or grants.
12. Provide training on GBV to health staff, law enforcement and civil society Task/Deliverable: 4.2.5.4 Question: The narrative description for this task specifies training for health workers and advocating for training for the other sectors. Can you please clarify if the training expected to be conducted by the Offeror is to be for health workers only, or also for other sectors?
This training is to be provided for health workers only. However, the Contractor must ensure the training will enable referral with other services, thus collaboration across sectors is expected, including through the Anti-GBV Coordination Forum.
13. Can the MCA clarify if the Offeror is to directly provide training to DHMT staff on cash planning and accounting under Compact Task 4.2.4.4, which states that the Offeror should “support the MOH to support the DHMTs to capacitate their staff”?
The contractor will not conduct the training directly, instead it is anticipated that counterparts will lead trainings with the support of the contractor.
14. We would like to know if there is a commitment to any particular training approach?
Offerors are encouraged to propose the training approach(es) of their choosing.
15. For the tasks listed under section 4.2 of the Compact Tasks starting on page 19, can the MCA clarify if these are focused on all health facilities or on both public and private facilities?
The HSS/PHC/cGBV project will focus on MOH and GoL subvented health facilities.
16. In Compact Task 4.2.1.1, the Offeror is expected to identify “staff supported by donors.” Can the MCA clarify how this is being defined in this context and what it includes? The footnote references only data clerks and records assistants, but donor-funded programs in Lesotho have a range of clinical and non-clinical staff.
All donor funded/supported staff are to be considered.
17. The activities outlined in 4.2.1.1 and 4.2.1.2 are critically important but major undertakings within the health sector. Realignment of staff, equipment/commodities and operating budget in alignment with the Essential Health Package is a major analytical undertaking (especially given the quality and accessibility of existing data sources) and an even larger reform agenda that will require buy-in from leaders in several ministries and significant commitment at the technocratic level to advance these reforms. Will there be any performance-based grant making opportunities under MCA at the central level to help to align Government focus around these activities?
Detailed design of results-based financing tool will take place in the Pre-compact stage by the FHDR contractor.
18. In Compact Task 4.2.1.3 on page 20, the RFI states that the Offeror must “work with the DHMT to develop a priority list of equipment to be addressed through the Offeror’s resources and potentially through RBF incentives. The HSS/PHC/cGBV budget anticipates approximately US$ 2 million for equipment purchases for health facilities.” Can the MCA clarify: 1) if the $2 million for equipment is included within the ceiling for this contract; 2) if the results-based financing (RBF) incentives are also included within the $2 million; and 3) if the Offeror would be responsible for designing and implementing the RBF incentive mechanism?
Yes, the $2 million is within the overall HSS/PHC/cGBV Support contract ceiling. The RBF incentive payments are a separate budget and will be paid directly to the selected beneficiaries by the MCA based on verified data confirming results and performance. The RBF will be designed and implemented under a separate procurement from the MCA.
19. In Compact Task 4.2.1.3 on page 20, the RFI indicates that a “priority list of medications” will be developed and that “According to the available resources, the Offeror will provide priority items as feasible.” Can the MCA clarify: 1)if the priority list is to be developed by the MOH or by the Offeror; 2)if the Offeror would be expected to procure priority medications, or only equipment and consumable supplies; and 3) if the Offeror’s budget would be used to procure medications?
The Contractor will be expected to develop the list jointly with the MOH. The Contractor will not procure medicines under this procurement.
20. In Compact Task 4.2.1.4on page 20, it states that the Offeror will “ensure MOH systems are established and used to disseminate updated CPGs and SOPs and train MOH staff before they are used.” Is the dissemination and training to be financed through this contract or directly by the MOH?
Dissemination will be financed through the contract.
21. In Compact Task 4.2.1.5on page 20, the RFI references referral guidelines and protocols for public and CHAL facilities. Can the MCA confirm if Red Cross facilities are also included in this task? Similarly, are Red Cross facilities included in Compact Task 4.2.3.5 on page 24?
Yes, they are included in these tasks, as are all MOH/GOL subvented facilities.
22. In Compact task 4.2.1.8 on page 22, can the MCA confirm that the Centers of Excellence (COEs) are to be additional to those that are already in operation (through Baylor)? And are only new COEs to be used for the development and testing of benchmarks, standards and SOPs in this task?
The contractor will create new COEs, in close collaboration with the MOH and DHMTs. Additionally, existing COEs can also function as COEs for the new CPGs and SOPs.
23. Compact Task 4.2.1.9 on page 22 refers to a milestone-based grant to the Lesotho Nurses Association. Can the MCA clarify the amount of funding envisioned for this grant and confirm if this is included within the contract ceiling?
This grant will be $25,000 for each year of the contract and is included in the budget ceiling.
24. In the tasks under 4.2.2 (VHWs) on page 22-23, there are several references to inclusion of a GBV module. Can the MCA clarify if this is referring to modules to be included within relevant SOPs, or if this refers to a training module?
The reference is to clinical guidelines and SOPs such as WHOs “Responding to Intimate Partner Violence and Sexual Violence against Women”.
25. Also, are Compact Tasks 4.2.2.1 and 4.2.2.2 referring to the same module or two distinct modules?
The modules are not the same.
26. Is the technical working group referenced in Compact Task 4.2.3.1 on page 23 intended to be separate from the existing Anti-GBV Coordination Forum?
It is proposed that technical working groups will be created for the integration of clinical GBV guidelines that will involve DHMTS and other relevant stakeholders. They will be required to go into more detail than is required for the Anti-GBV Coordination Forum, but progress and updates will be reported in the larger Coordination Forum. It is not the intention to replace the Anti-GBV Coordination Forum.
27. Is the baseline referenced in Compact Task 4.2.3.3 on page 23 conducted and paid for by the Offeror, or is the assistance referred to intended to be technical guidance only?
The baseline will be conducted by and paid for by the Contractor.
28. Under Compact Task 4.2.3.5 on page 24, the RFI references an MOH GBV focal point. Can the MCA confirm if this focal point is already in place?
Yes, the GBV Focal Point for the MOH is the Adolescent Health Director.
29. Task 4.2.4.5 on page 25 includes an assessment of the IFMIS and the CBMS. This task is also included in the Digital Health RFI. Which contractor will be responsible for conducting the assessment?
The HSS/PHC/cGBV Contractor, in consultation with the Digital Health Contractor, will assess the use of IFMIS and CBMS by the DHMTs and MOH overall, and determine how these systems can improve management of the healthcare system. This will be provided as guidance to and agreed upon with the Digital Health contractor, including requirements and recommendations for interconnectivity/interoperability as well as defining data and reporting requirements that the DH contractor will make available to users. In parallel, the Digital Health Contractor will assess if and how IFMIS/CBMS can be interconnected/interoperable with the health management systems and how the data and reporting requirements will be met to achieve the agreed objectives.
30. Can the MCA clarify the difference between the training on VHW management under Compact Task 4.2.5.3 on page 26 and 4.2.2.2on page 23?
Thank you for this observation. This will be clarified in the RFP.
31. Given that systems for collecting and managing GBV data (and for linking health data to financial data) are not yet in place and will only begin to be developed during the Compact Phase, would the MCA reconsider the stated requirement for analysis of GBV data linked to expenditures beginning in Year 2?
Thank you. This request will be considered for the final SOW included in the RFP.
32. Is the support to the National University of Lesotho under Compact Task 4.2.6.4 to be done through a sub-contract or is the Offeror only expected to provide technical assistance?
The Offeror should propose how to achieve Task 4.2.6.4: Support the National University of Lesotho (NUL) Department of Economics to publish and present the HSS cost-benefit analysis at least twice to highlight the importance of PHC service delivery and the economic rationale for its prioritization.
33. Can the MCA clarify the implementation support envisioned under Compact Task 4.2.6.7 for publishing of data, and what role if any the Digital Health contractor is expected to play in this activity?
The Offeror, in consultation with the Digital Health contractor, should propose how to achieve Task 4.2.6.7: Support the MOH and BoS to establish and implement an approved policy where the GOL makes current and historical government health data and health spending data publicly available in machine readable format on a government website(s). The Digital Health Contractor will support the GOL to implement the methods and processes required to structure and deidentify the data sets once they have been defined and verify they are ready to be published on government websites in a machine readable format, and transfer the knowledge for these methods and processes to the GOL. Considering technical recommendations from the Digital Health Contractor related to data cleaning and structuring needs, the Offeror should support the MOH and BOS to ensure a system is in place where health data is made public within 6 months of collection.
34. Can the MCA clarify the division of labor between the Health Communications Service Provision contract or Compact Tasks 4.2.7.2 and 4.2.7.3 on page 27-28?
The HSS/PHC/cGBV contractor will support the MOH to initiate an annual process for identifying and prioritizing communication needs for the year for all programs and departments within the MOH. When the MOH Education Unit has identified a communication’s need and determined it is a priority for production, they will communicate to the Communications Service Provision contractor specifics such as: key messages, desired behavior change, preferred medium for communication (e.g. social media, poster, radio spot, etc..). The Communications Service Provision contractor will design the communication material specified, pre-test the material and once approved, final the product and if required, duplicate/print the material.
35. Deliverable 27 on page 33 is to “Implement policies and regulations to transfer greater purchasing and decision-making authority to DHMTs.” Given that the contractor does not have the mandate to implement this kind of policy, can the MCA clarify this deliverable?

The Contractor will provide technical assistance on the content and development of the systems, guidelines, or protocols to operationalize or implement MOH policies. Specifically the Contractor will support the MOH to support the DHMTs to capacitate their staff on cash planning and preparation of cash requests and ensure these are done accurately and timely to minimize delayed implementation of AOP activities (Task 4.2.4.4) Also, the Contractor will develop and implement a comprehensive plan to strengthen DHMT and district hospital ability to account for and track revenue and spending more efficiently (Task 4.2.4.5).

36. Under 4.2.1.8, the offeror will support the GoL to establish CoEs to support strengthening of PHC services. At present, the description reads to suggest the CoEs will be focused on clinical personnel and service delivery.
We will attempt to clarify in the RFP that under Task 4.2.1.8 the Contractor will work with the MOH to establish regional Centers of Excellence (CoE) to strengthen the delivery of PHC services.

37. We recognize that some parts of the scope can be implemented at a national scale, for example establishing an enabling policy environment and the standardization of clinical guidelines and SoPs. However, given the number and complexity of interventions, would MCC consider using a model district approach to test the PHC strengthening and decentralized activities in a more focused way and then a phase to scale-up? One consideration might be to leverage off the already identified “Centers of Excellence” and broaden the scope of interventions in the districts where these are centers are located and turn them into ‘model districts’. Whilst this approach would enable focused support and provide lessons before scaling up, we do also recognize that Lesotho is a relatively small country, and with careful planning and government support, national scale at once may be possible.
It is expected that interventions will be implemented in all 10 districts.
38. Is there scope for inclusion of biomedical engineering and health technology management services, in the form of specialised CoE for Health Technology management to underpin the clinical work done by the compact? Having recently established Tanzania’s first CoE in Biomedical Engineering, Touch understands that working equipment and effective health technology management systems and processes are crucial to enabling clinical services to run at capacity and with high quality–without working equipment and structures to maintain it, many interventions in the compact risk being significantly less effective.
Offerors are free to make such suggestions in their responses to the RFP.
39. Has there been consideration for a wider national health quality improvement intervention more comprehensive than what is envisaged for the Centers of Excellence?
Offerors are encouraged to propose any methodologies capable of achieving optimal results for the project. MCA is open to and encourages creativity in the approaches to be employed by the contractor.
40. Will HSS/PHC/cGBV be implemented nationwide or in specific regions/districts?
This contract will be implemented nationwide.
41. Implement a campaign to inform the community about the relevant community-level elements of the GBV services and referrals. Task/Deliverable: 4.2.3.3 Question: Are there expectations/parameters on the type of media expected to be used in the campaign, i.e., mass media, mid‐media, social media, etc.?
Offerors are expected to propose an evidence-based case for the type of media to be used, with variations expected by location or audience. Data from the DHS can be used to establish how and who people trust to receive information.
42. Is the HSS project logic model informed by the WHO HSS building blocks framework? If so, how does this fit into the overall national Health system?
The WHO HSS Building Blocks were initially used as a framework to analyze the strengths and weakness of the Lesotho health system and narrow the focus of the HSS project on components where MCC’s five-year investment could create impact.
43. Can MCC please provide additional details on the scope and parameters of Short-term Outcome 3.2.2 versus 3.3 versus elements of the Digital Health contract with respect to support for data use and intended outputs/outcomes?
Improved quality and use of data is a cross-cutting theme across both contracts. The Digital Health Contractor will ensure data used for patient referral is adequately linked to the correct patient record to improve quality patient care. Additional parameters will be defined during the assessment phase on data validation, use, and data aggregation across the HMIS and e-Register system.
44. In the RFP it would be interesting to have some further explanation on the relationship between the LMDA and contractors. What will be the reporting lines and how will performance and progress under each procurement be managed/assessed. How the coordination of the various components (as divided up by procurement) would work together. We see the importance of each component and recognize that the various contractors will need to be very collaborative. It will be interesting to see how the work under the MCA Health Systems Technical Assistance procurement links with this procurement (HHS/GBV) as this appears to be linked to an oversight function.
Technical, administrative, and coordination oversight to the HSS Project will be provided by the MCA, HSS Project team. The MCA staff will be assisted in their mission by the MCA Support Contractor, hired to provide specialist technical support. MCA will establish a project steering committee, in close collaboration with the MOH to foster coordination in line with MOH priorities. The MCA’s expectation is the Contractors will work closely together to ensure synergies and efficiencies in delivering their individual contract requirements. The MCA staff will have an overview of all contracts through their role in approving workplans, deliverables, and participation in the steering committee and any TWGs.
45. Is there a dedicated Project Management or Change Management methodology that shall be followed throughout the project?
Offerors are encouraged to propose any methodologies capable of achieving optimal results for the project.
46. Gender-based violence technical counterparts within the Lesotho Millennium Challenge Account: Is it envisioned that there will be a member of the MCA who will serve as a focal point on the counter gender-based violence component for the project, or if not, who (functionally) will be the primary point of contact for GBV-related activities?
Yes, there will be an MCA cGBV focal point.
47. Gender transformative approaches may take time to demonstrate population-wide impact. In view of this, are plans for follow-on to this project under consideration?
The Health and Horticultural Compact is for a 5-year term only.
48. How can the contract emphasize the need to introduce approaches that can be sustained after the contract has ended? For example, under compact task number 15, there is a call to introduce mechanisms to motivate health workers to improve performance. This is critically important, as performance management and accountability present significant opportunities for improvement. Can this (and similar) statement(s)be further tied to domestic resource availability and feasibility for continued financing?
Yes bidders are encouraged to suggest strategies and approaches based upon sustainability considerations.
49. Do the existing pharmaceutical and medical supply systems have PHC-specific mandates and associated goals/targets? What role do private sector pharmacies and distributors play at the PHC level?
It is not expected that the contractor will address pharmaceutical supply systems or issues.
Personnel
50. Will Key Personnel be required to dedicated 100% LOE to this project, or will shared LOE with other donors/project be allowable?
It is expected that key personnel will be dedicated to the project at 100% LOE.
51. Is there a % requirement for the employment of Basotho in the execution of this contract?
There will be no percentage requirement for employment of Basotho in the future RFP. The Compact is an international treaty that includes the MCC Program Procurement Guidelines as part of it. This means that the local procurement law will not apply.
52. Is there a requirement for the employment of women and people living with disabilities?
It is expected that contractors would have policies in place to ensure diversity, equity and inclusion are addressed and all hiring policies are compliant with national policies and laws.
53. Will MCA assist with work permits for expats expected to work in Lesotho on a semi-permanent and/or full-time basis?
This will be clarified in the final RFP.
54. Concerning the personnel and staff identified in the document:
a. Is it expected that the three key personnel work full time and be based in Lesotho?
Please see response to question #48 above.
b. We also understand that the profile of the key personnel will be evaluated at the stage of the tender, but the profile for the other positions will not be evaluated?
Offerors are encouraged to propose as staffing plan that will be evaluated by the TEP as part of the technical proposal. The 3 key personnel will be evaluated considering the qualification criteria. Offerors can identify other personnel that they consider essential for the successful implementation of the contract and provide information regarding these personnel in their offers.

c. Will it be required to have a District Coordinator in all 10 districts of Lesotho?
Offerors are welcome to propose the staffing mix and structure capable of achieving optimal results for the project.

55. Are any staffing position closed to local entities in line with the USG’s current dispensation of localization?
No.
56. Under point 6, "Qualifications and Experience of the Offeror and Key Experts", it is not indicated whether the profiles of the key personnel shall be national or international. Can we assume it may be either?
Offerors may propose both national and/or international key personnel.
Contractual
57. Since it is a fixed price, can overhead costs be included?
Yes, overhead costs can be included.
58. Concerning the budget: could you specify whether the costs linked to the procurement are intended to be covered by the overall budget for this assignment?
Yes, the costs for equipment (approximately US$2 million) are included in the overall budget for this contract.
59. Can MCC please specify what the term “equipment” encompasses for this activity? For example, on page 21, the RFI states, “The HSS/PHC/cGBV budget anticipates approximately US$ 2 million for equipment purchases for health facilities.”
Offerors may consider equipment to mean anything that will be required to correctly implement the CPGs and SOPs rolled out in support of improved availability and utilization of PHC services.
60. Can the Negotiated Indirect Cost Rate Agreement (NICRA) be used?
The Compact is an international treaty that includes the MCC Program Procurement Guidelines (PPG) as part of it. The PPG does not mention NICRA and it is the policy that applies. We anticipate the RFP to be fixed price and Offerors will use indirect cost rates they deem to be competitive.
61. Will withholding tax apply for non-Lesotho entities?
This will be clarified in the final RFP.
62. Will MCA or LMDA provide office space, non-human resources and equipment?
No.
63. Does the MCA have a target for awarding a percentage of these contracts to local/regional entities? Small businesses?
No.
Bidding process
64. Question 4 states that “Sub-contractors are not considered by the technical evaluation panel.” Could MCC clarify this point and how applications are evaluated and scored if a joint venture is not formed but multiple organizations apply as a part of a consortia? Would the prime organization be required to omit partner names without a joint venture?
A formalized joint venture (where all firms participating in the joint venture are jointly and severally liable) or the intent to form a joint venture is acceptable at the time of proposal submission. The MCA will not require joint ventures or other forms of mandatory association between firms in the RFP.
A consortium of organizations that elect to submit a proposal in a prime contractor and subcontractor arrangement, may include subcontractor names. However, the past performance of the subcontractor organizations will not be evaluated by the TEP.
To prevent a prime organization from being awarded a contract based on expertise and experience brought by a subcontractor, to whom they are not legally associated with, the past experience of subcontractors cannot be considered by the TEP.
Key personnel, regardless of their association with an organization, will be evaluated against the qualification criteria in the RFP. Non-key personnel, regardless of their association with an organization, will be evaluated by the TEP as part of the technical proposal.
65. Are Offerors eligible to respond to multiple RFPs under the HSS Project?
Yes.
66. What are the parameters to develop a joint venture?
This expertise must be brought by the applicants.
67. In a joint venture, how are different entities recognized when each entity will have its own organizational structure, policies, systems, personnel, etc.
This expertise must be brought by the applicants.
68. We understand that the Compact was signed in March 2022, the date of its start is not specified in the Request for Information (RFI), could you clarify which date it is planned to be?
The Compact was signed on May 12, 2022. The Compact’s term will start on the date that certain conditions precedent have been satisfied. These conditions are listed in Section 7.2 of the Compact, which is available on MCC’s website. It is expected that these conditions precedent will be satisfied by the end of the 2023 calendar year, but may require additional time.

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