TERMS OF REFERENCE (ToR)
SITUATIONAL ASSESMENT ON PRIVATE SECTOR INVOLVEMENT IN TUBERCULOSIS SERVICES
Consultancy-Situational Assessment on Private Sector Involvement in TB Services
Federal Government of Somalia Member States and Somaliland
Type of contract
Short term Consultancy
1st April 2021
Duration of Assignment
Tuberculosis (TB) is a communicable disease that is a major cause of ill health, one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent. The disease typically affects the lungs (pulmonary TB) but can also affect other sites (extra pulmonary TB).
An estimated 10.0 million (range, 8.9–11.0 million) people fell ill with TB globally in 2019. Geographically, Africa accounted for 25% of the people who developed TB in 2019.
In 2019 the total number of TB cases notified in Somalia was 16,918, a number almost identical to that of to 2018 (16,673). Case notification rate has improved between 2009 and 2019 by about 50%; yet almost three fifths of the increase (30%) has to be credited to the natural population growth, the mean annual increase thus being about 2%.
For the year 2019, the World Health Organization (WHO) estimates the TB mortality rate in Somalia, including HIV+TB, at 170 (110-260) per 100k population.
Somali TB Program
TB control service provision is managed under the National Tuberculosis Programme (NTP) within the Ministry of Health (MOH). However, after the collapse of the central government in Somalia in 1990, TB control service provision have been implemented through key partners who consist primarily of international and national Non-Governmental Organizations (NGOs) with WHO providing the technical expertise in collaboration with Somalia government. From 2004, TB control has mainly been funded by the Global Fund for AIDS, Malaria and TB (GFATM). World Vision Somalia (WVS) is the principle recipient.
Further, the government contributes to the implementation through provision of infrastructure, security support and facilitation of the implementing partners involved in the TB control.
Despite being at its infancy stage and the complex political and security in the country, the Somali government has made progress in TB control and management. Access to TB services has generally improved through an increase in the TB Management Units (TBMUs) and laboratory network for microscopy services implemented according to the Stop TB Partnership global DOTS strategy. With uninterrupted funding from the Global Fund since 2004, access to TB services and treatment have increased from 12 TBMUs in 1995 to 96 by December 2020. This number of TBMUs is even according to international standards low with one TBMU for 160,000 inhabitants. According to WHO Global Report 2018, the treatment coverage in 2017 was 42%, meaning that about 20,000 active TB cases remained untreated. TB treatment coverage was even lower in MDR TB cases (14%). The treatment success rate for bacteriologically confirmed DS TB patients is about 86% below the 90% global target. MDR-TB treatment success rate is about 79%.
In 2019, the government finalized the development of the third National TB 2020-2024 strategic plan. This was followed by the completion of the 2021-2025 Monitoring & Evaluation (M&E) plan that will guide the implementation of the strategic plan. The Strategic Plan contributes to the Somali Health Policy goal of improving the health status of the population through health system strengthening interventions and providing quality, accessible, acceptable and affordable health services that facilitate moving towards Universal Health Coverage (UHC) and accelerate progress towards achieving the health-related Sustainable Development Goals (SDGs).
The new National Strategic Plan (NSP) 2020 -2024 has strategies that mainly focuses on enhancing access to Drug Sensitive (DS) and Drug Resistant (DR) TB services via integration of the TB program, to the extent possible, in general health services compounded by much closer collaboration with the private sector, and by strengthening the collaboration with the community, preferably with locally adapted activities.
The strategy further focuses on the strengthening of the laboratory network, on the Latent Tuberculosis Infection with a comprehensive Tuberculin Skin Testing component, and on the control of TB in key and vulnerable groups.
Finally, interventions and activities are proposed for strengthening advocacy, the M&E component, supervisions, the human right component, and operational research.
Without diminishing the TB control and management progress made in Somalia, TB program has not expanded as desired. There has been a slow progress in improving the existing infrastructure to increase their capacity as well as establishing new health facilities to meet the community needs and ensuring quality of the services. Required additional resources in terms of workforce, infrastructures, equipment and supplies have been limited. At present, the Global Fund supported TB program is implemented by World Vision International Somalia Program (WVS) working in with implementing partners. The Somalia Global Fund Steering Committee (GFSC) and the TB Coordination Team (TBCT) provide the Country Coordination Mechanism (CCM) for the program.
According to Oxfarm Policy Management study on private sector health systems in Somalia in 2018, they showed that private sector got TB drug supplies from another private for profit companies which might pose the risk of counterfeit TB drugs or use TB drugs over the counter.
Private Sector Involvement in TB Services
TB is preventable and curable, but current efforts to find, treat and cure everyone who gets ill with the disease fall short. Globally, of the 10 million people who fell ill with TB in 2019, only 7.1 Million new cases were reported to have been newly diagnosed and notified. This translates to approximately 2.9 Million missed cases. This gap is due to a combination of underreporting of people diagnosed with TB and under diagnosis (if people with TB cannot access health care or are not diagnosed when they do). Closing gaps and ensuring early access to diagnosis and treatment will require strengthened and expanded private provider engagement including multisectoral action. Engaging private providers is also essential for reducing unnecessary deaths and suffering caused by inappropriate treatment, slowing the emergence of drug resistance caused by substandard care, reducing transmission by shortening delays to treatment, reducing catastrophic costs and impoverishment, and accelerating uptake of new tools. It is also in line with the End-TB strategy pillar 2 that is supportive of engaging all care providers and the TB community in TB prevention and control. This will include multisectoral action and establishment of multisectoral accountability framework.
Situational Assessment on Private Sector Involvement in TB services in Somalia
The Somalia 2020-2024 TB Strategic plan focuses on among other interventions enhancing access to DS and DR TB services via integration of the TB program, to the extent possible, in general health services compounded by much closer collaboration with the private sector and by strengthening the collaboration with the community, preferably with locally adapted activities. World Vision Somalia as the principle recipient of the Global Fund for AIDS, Malaria and TB (GFATM) seeks to carry out a systematic process to gather, analyze, synthesize and communicate data to inform planning decisions. The situational assessment report will inform World Vision, Global fund and Somali NTP’s on way forward for engagement with private sector to harness the full potential of private providers in TB services provision.
B. METHODOLOGY & PROCESS
Objective and Scope of Work
The main objective of the consultancy is to carry out a situational assessment on private sector involvement in TB services in Somaliland, Puntland and Federal Government of Somalia.
The specific Objectives of the consultancy are:
· To determine the current situation in regards to Private Sector Involvement in TB services in Somalia
· Establish the factors that influence the current situation both positively and negatively
· Make recommendations on actions that can be taken to positively influence the engagement for better collaboration between state and non- state actors in TB services provision
· Assess the capacity of private sector that can enable them engage in Tb management and their willingness and their level of engagement in TB program.
Rationale of the situational assessment
The situational assessment will help in developing a basis of understanding of the environment in which TB interventions will be delivered in Somalia. It will also identify existing opportunities that can be developed into strategic alliances with other stakeholders for a collaborative and efficient delivery of TB services.
Scope of Review
The assessment will cover the National TB Programs and involving partner organizations, including key private health service providers and other stakeholders including the Government and the community.
Assessment region: Federal Member States and Somaliland
Assessment population: Private health service providers, partner organizations, the Government and the community.
Assessment duration: One month
The successful consultant, in close collaboration with World Vision Somalia and MoH will carry out a situational assessment on private sector involvement in TB services. Interviews will be conducted with the private sector health providers, the Government and the community. The successful proposal will be reviewed by the technical research team before commencement of the exercise. A constant communication with World Vision Somalia will be ensured. Upon completion of the assessment, the consultant will make recommendations on ways to positively enhance engagement between state and non-state actors in TB servicer provision in Somalia. The assignment report on the assignment will also be presented to the technical team before a final report is printed and submitted to World Vision for final approval.
· At inception, the consultant is expected to submit a detailed inception report and plan on how assessment will be carried out including a comprehensive methodology.
· Detailed situational assessment report
· Final consultancy report both in soft and 5 hard copies including all data sets used during the assessment
· Development of a National PPM costed plan by end of March 2021.
Deliverables, reporting and project schedule **
Participation at the start‐off meeting at World Vision Premises together with Ministry of Health – FGS and Somaliland; and the detailed report on the discussions and conclusion of the kick‐off meeting, including the key issues discussed and decisions made (to be delivered two weeks after the kick‐off meeting).
The updated project work plan for the entire duration of the contract, including general methodological approach, milestones and timelines in accordance with the objectives of the project and decisions of the kick‐off meeting.
The two‐page synopsis of the project outlining the general scope and purpose of the project to the relevant stakeholders for their information about the project (to be delivered two weeks after the kick‐off meeting).
The work plan, including study protocol, describing study design, methodological approach, analysis plan, expected outputs and timelines
Detailed high quality summary report on the assignment performed (to be delivered according to the approved project work plan or 1 moth before expiring of the contract).
High quality summary report on the assignment performed (to be delivered 1 month before the end of this contract).
A detailed report that should include review findings, realistic and achievable recommendations and next plan of action. The intended target audience for the reports are:
TB programme implementers and policy makers at national &international level as well as World Vision Somalia.
The consultant should respect the leadership role of the Ministry of Health and Human Services of Federal Governmen of Somalia and Somaliland; and will have an initial and regular interactions and sharing information and progress update with MOH to provide some information and guidance on the analysis and development of the action plan. MOH-FGS will also play a critical role in engaging and coordinating with other key development partners through existing coordination mechanism and/or adhoc taskforce team for this assignment.
Since WHO has technical mandate for TB, the results need to have the approval or at least an acknowledgement from World Health Organization Somalia. In this regard, World Vision will share the Terms of Reference with WHO Somalia. World Vision will also share the methodology of the study, the framework, results and analysis with WHO Somalia once the consultant provides them.
Immediately after completion of the assignment, a summary report should be presented for discussion by the main stakeholders – (WV, MoH, WHO).
Once this is agreed then the final report will be printed.
C. MANAGEMENT OF THE ASSESSMENT
While executing this assignment, the consultant and the parties involved shall be guided by the protocol summarized in the matrix below:
Stakeholder / role
Undertake the assignment based on the approved design and methodology and timeline
GF/PR technical team
Initiate the TOR and seek approval from WVS
Lead the technical recruitment of consultant
Provide technical and managerial leadership to the consultant throughout the study process
WV QA / GF Technical team / NTP
Technical reviews to the ToR, Inception report, study design & methodology
Participate in the technical evaluation of consultants
Review draft report and recommend approval or non-approval
Supply Chain Manager
Advertise and complete bid selection processes
WVS QA / GF Technical team / WHO / NTP
Review of the study findings
*Required Expertise and Qualifications
· Candidate must be a master’s degree holder preferably in statistics, public health, epidemiology or a comparative field.
· A PhD degree in any of the fields above is an added advantage
· Competency in situational assessments and knowledge on TB programming and reporting.
· Should have minimum of 5 years’ experience in carrying program situational assessments (Present 2 recent reports)
· Candidate with previous experience in conducting similar assignments in the region will have an added advantage
Language requirement and Corporate competencies
· Have excellent knowledge of both written and spoken English and be computer literate
· Familiar with Somali cultures, norms and customs
· Demonstrate integrity by modelling the World Vision’s values and ethical standards
· Ability to establish and maintain good working relations with colleagues in a multicultural environment.
World Vision will provide logistical support, including visa application, facilitation in arranging meetings with partners and relevant authorities. The consultant will be provided with an air ticket to and from the country of origin to Somalia. World Vision will also cover food and accommodation costs including vehicles required to carry out field assignments.
Mandatory Requirements evaluation
a. Provide a certified copy of a certificate of business registration, Certificate of incorporation, business license or similar document (Companies/Organizations)
b. Provide a certified copy of tax registration, tax clearance certificates or similar documents (Companies/Organization)
c. Individual tax registration documents (for individual consultants)
d. Provide information on ownership structure (Name of directors of the company / Owner) (Companies/Organization)
e. Provide last two years of audited financial statements or tax filing, or similar documents (Companies/Organization)
f. Provide references from previous clients for similar works.(At least three)
Note – Applicant who will not meet the above mandatory requirement will not be considered for Technical Evaluation.
Letter of interest in submission of a proposal
A detailed technical proposal clearly demonstrating a thorough understanding of this ToR and including but not limited to the following;
· Consultant/Company Profile**
· Description of methodology and sample size determination**
· Demonstrated previous experience in similar assignments and qualifications outlines in this ToR **
· Proposed data management plan (collection, processing and analysis)**
· Proposed timeframe detailing activities and proposed work plan**
· Team composition and level of effort of each proposed team member (Include CVs of each team member)**
A financial proposal with a detailed breakdown of costs for the study quoted in United States dollars.
As part of the Consultant selection process, the best candidates will be requested to prepare draft inception report and make a presentation of the same to the Global Fund Technical Team to inform the final decision on award of the Contract.
All interested bidders/consultants are requested to submit their Technical Proposals and Financial Proposals in Separate documents as attachments (Bidders who will combine both technical and financial proposals shall be disqualified) via email [email protected] on or before **1st April 2021*. Bids received after deadline shall not be considered.***
Email title should be;- SITUATIONAL ASSESMENT ON PRIVATE SECTOR INVOLVEMENT IN TUBERCULOSIS SERVICES
Your financial proposal should have your consultancy fees, payment terms and Credit period. Financial proposal should not be part of the technical proposal, it should be a separate document.
Provision of Taxation as per the Revenue Authority on Technical Fees:
A 5% withholding tax is levied on the payment of technical services fees (as well as professional and management fees) where the services are provided by a resident/resident firm in Kenya. If payment is done to an entity outside Kenya, relevant tax regulations will be applied.
The rate is 20% where the service provider is a non-resident/non-resident firm, unless an applicable tax treaty provides otherwise. Consultant firms must be able to demonstrate their tax compliance status at the time of bidding for this assignment as WVS will only engage with tax compliant individuals/firms. The proposal that complies with all the requirements, meets all the evaluation criteria and offers the best value for money shall be selected and awarded the contract. Any offer that does not meet the requirements shall be rejected.**
 Treatment coverage is the proportion of notified cases among the estimated incident cases.