Request for Proposal for Primary Health Care Facility Assessment
Nigeria’s large population is served by a three-tier system for health facilities (tertiary, secondary and primary) which consists of both public and private health facilities. Currently, the majority of HIV/AIDS services are provided in the tertiary and secondary facilities managed by the public sector, which commands the majority of Nigeria’s resources and qualified staff. Since 1999, the Federal Government of Nigeria has placed high priority on HIV/AIDS prevention, treatment, care and support activities, bolstered by significant donor support for AIDS prevention and control. Despite the commitment and investment, the access to HIV care services remains low, especially for the urban poor and rural populations, served predominantly by primary health care facilities. This may affect the attainment of the Universal Access Target and Millennium Development Goals (MDGs).
Recognizing the inequity in service provision and the need to improve coverage for critical services such as antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), the Federal Government of Nigeria in collaboration with development partners, particularly United States government agencies, has developed a plan of action for broad access to ART drugs including PMTCT. The plan includes scale-up of service provision to the primary health care level.
The Nigeria Primary Health Care Facility Assessment will be carried out by MEASURE Evaluation team member John Snow, Inc. (JSI) at the request of United States government (USG) agencies in Nigeria. It will be a joint undertaking of the USG, the Federal Ministry of Health, the National Primary Health Care Development Agency (NPHCDA), and the National Agency for the Control of AIDS (NACA).
Implementation of Facility Survey
MEASURE Evaluation/JSI has been designated as the lead for the Primary Health Care Facility Assessment to determine the readiness status to initiate HIV Care, especially ART and PMTCT. MEASURE Evaluation/JSI is seeking proposals for the management of the implementation of the facility assessment:
Objectives of the Assessment
The success of the country’s immediate expansion of HIV care and services, especially ART and PMTCT services at the primary health care (PHC) facilities, will depend on (1) the service capacity of PHC facilities to provide the ART and PMTCT services, (2) the management systems to support a minimum standard of quality for HIV related services, and (3) the capacity of the HIV/AIDS and/or health sector logistics systems to provide a reliable and uninterrupted supply of the commodities required.
Therefore, the purpose of this assessment is to measure the preparedness and readiness of 280 primary health care facilities to provide quality HIV care services particularly ART, PMTCT and HIV counseling and testing across the 17 States and Federal Capital Territory with HIV prevalence above the national average.
The objectives of the assessment are to:
- Measure the current state of readiness of the primary health care facilities to initiate or expand ART and PMTCT as well as other HIV related services.
- Measure the extent to which an enabling environment has been created to support the facility in providing quality HIV services.
The Primary Health Care Facility Assessment will involve a census of all 280 PHCs already selected by the USAID and other USG partners as part of their scale-up plan for HIV/AIDS care services. This will include public and private PHC and cut across the different categories of primary health care centers.
The data will involve both qualitative and quantitative data.
Data will be collected through interviews with key informants and observation. Informed consent will be elicited from each key informant.
At the facility level, key informants will include managers and primary service providers for different HIV related services, including STI treatment and family planning. Availability of commodities, other resources, and system functioning (e.g., HMIS records, supervisory/quality assurance mechanisms) will be validated through observation. Service providers will be interviewed to ascertain relevant training and experiences related to HIV services. MEASURE Evaluation has developed the tools which would be shared with the organization selected for this particular activity.
A sample of 5% of facilities will be revisited for validation of initial data collection and rechecking specified data items. The recheck sample for each state will be randomly selected, stratified by facility type. Facilities where there are potential errors identified will also be revisited to check on questionable data items. The sample to be rechecked for data quality will be identified by the hired local organization responsible for the coordination of the assessment, with MEASURE Evaluation technical assistance. The Field Supervisors will carry out the re-interviews. They will not have access to the original data collection tools at the time of their recheck. The analysis of results from re-interviews will be carried out by MEASURE Evaluation/JSI and the Local Research Organization.
The data processing program will include internal checks on data consistency and range/response validity and source data will be rechecked or facilities revisited to clarify where needed.
Health Facility Survey
This survey will include, among others, assessments of the number and cadre of personnel available, equipment available, drugs, facility resources, etc.
The sample for the facility survey is to include:
All public and private comprehensive health care centers, primary health care centers, private health centers, maternity clinics, private clinics, and health clinics (note that the facility assessment does not link to any other survey) within 17 states selected by the USG agencies based on the HIV prevalence rate that is above national average. This encompasses 280 PHC facilities. The sample list will need to be updated during implementation to ensure that no PHC facilities were missed on the original list.
Activities and Responsibilities for the Local Research Organization
The Local Research Organization has overall responsibility for organizing and managing the field activities for the survey, in coordination with the MEASURE Evaluation/JSI Survey Coordinator and the Technical Advisor (TA). The Local Research Organization will be directly responsible to the MEASURE Evaluation/JSI Survey Coordinator, and the Country MEASURE Evaluation/JSI Survey Manager may be directed to provide oversight functions on the Local Research Organization
Specifically, the Local Research Organization will be responsible for the following activities:
1. Country adaptation of data collection tools
- Arrange and facilitate meetings with Official (FMoH (NASCP and NPHCDA), NACA and USG where relevant) technical persons to:
- country adapt the data collection instruments for HIV testing, PMTCT, ART, Clinical treatment of AIDS services
- country adapt the laboratory diagnostics module
- country adapt the HMIS sections within the data collection instruments
2. Survey set-up
- Identify potential data collectors and supervisors for training (numbers and background required will be provided by MEASURE Evaluation/JSI) and arranging for the selected persons to be available for the pretest and main training
3. Pretest and training
- Arrange all logistics for pretest and main training, including:
- coordination with NASCP and NPHCDA for their participation and introduction letters to facilitate access to facilities for training practice
- printing all questionnaires and training documents
- arranging venue and supplies
- facilitation of training and practice sessions
- revision of tools based on feed-back
- final selection of data collectors, team leaders, and Field Supervisors
- Arrange all logistics for field work including:
- Communicating with States about the survey and ensuring teams receive supporting letters and facilities are informed of the upcoming survey
- Ensuring availability of necessary cash and copies of data collection instruments to implement field work
- Making field work assignments
- Developing field work schedule and making recommendations for changes in order to improve the logistics and efficiency of the field activities to the survey TA and MEASURE Evaluation/JSI
- Ensuring data quality checks are carried out as per the protocol
- Ensuring field work is in full adherence to the protocol, including checking questionnaires for completeness prior to sending to Lagos for data processing
- Supervision of field work, using tools agreed upon with MEASURE Evaluation/JSI and TA
4. Data management in collaboration with MEASURE Evaluation/JSI
- Arrange all logistics for data management including identifying data entry staff and supervisors and ensuring adequate number of computers and database security
- Develop data entry screens and programs with internal range and consistency checks (TA will provide input for internal range and consistency checks)
- Identify possible data errors and develop a system for checking and making corrections as needed
- Clean database
- Producing frequency distributions for the respective data sets, as well as SPSS syntax
- Program tables developed with MEASURE Evaluation/JSI and TA
- Based on the current data element in the questionnaire, assume a data entry person will enter average of 5-questionnaire per day. This should guide in the estimation for the data entry clerks and budget as well as number of days. Remember to factor in the data cleaning and quality check. The in-country team will be required to spot-check the data entry regularly.
- Data validation
- The tabulation and presentation of the data will be performing by both the in-country-team and MEASURE Evaluation/JSI
Final dates will be agreed upon once the successful reserach organization is identified. It is expected that the data collection should be completed by not later than September 15, 2012 with concurrent entering of the completed tools to enable preliminary report to be submitted to the USG by September 30, 2012. Research organizations are requested to submit a timeline based on the following activities.
Timeline of activities
- Final questionnaires based on the comments and suggestions from pre-test (print and electronic copies)
- Cleaned and fully labeled data set (on CD or submitted electronically) in SPSS and/or STATA
- A copy of the codebook and any other data documentation for data analysis and entry
- All completed questionnaires submitted to MEASURE Evaluation office at Abuja (90, Nelson Mandela Street, Asokoro District, Abuja, Nigeria)
- Report describing pre-test results, data collection procedures, supervisor observations/comments, and limitations/problems encountered
- Participate the dissemination meetings
A detailed budget for each of these should include the following:
List daily rate and number of workdays for each category of staff (e.g., translator, interviewer, supervisor, data entry clerk, data analyst/statistician, and drivers). Please provide justification and a description of responsibilities for each category of staff.
Note: The adapted data collection tool will evaluate outpatient services related to HIV services, including TB, STIs and maternity. It will include observation of equipment, supplies and evidence of systems functioning as well as brief staff interviews with 6-12 staff (depending on the size of the facility) to ascertain training relevant to the HIV services. No client service observations or client interviews are expected.
It is assumed that a team of 2 data collectors will be able to complete 2 small, 1 large facility/day in urban areas and 1 facility/day regardless of size in rural areas. It is assumed that logistics will not allow the team to reach 2 facilities with sufficient time to complete data collection in the rural areas. The bidder must review the list of facilities and make assumptions of travel time that needs to be built into the costs. Assume that the 280 facilities are the final sample.
Also assume a pretest requiring 2 days of data collectors, and main training of 5 days.
Note: The budget will be revised based on the finalized number of facilities
List daily rate and number of workdays for each category of staff (e.g., interviewer, supervisor, data entry clerk, data analyst/statistician, and driver).
Provide information how the travel and transport will be provided during the field work. If vehicles will be rented, indicate the number of vehicles and number of days needed, estimated mileage and fuel cost per kilometer, vehicle maintenance and/or rental, if necessary.
Questionnaire production (unit cost per questionnaire * number of printed copies).
Assume the questionnaire is 45 pages and training manual 30 pages, totaling 75 pages. Key informant interviews are 4 pages.
List any other costs.
Selection Criteria for Proposals:
Proposals will be reviewed based on their overall technical merit. The following criteria will be used:
- Demonstrated capacity and experience of the organization to conduct similar surveys and to complete activities within the stipulated timeline
- Qualifications and experience of key survey personnel
- Budget clarity and justification
Interested and qualified research organizations should present bids directly to MEASURE Evaluation. All bids must be received no later than July 31, 2012. Bids may be submitted electronically to Alec Moore (firstname.lastname@example.org), with copy to Kola Oyediran (email@example.com). Alternatively, proposals may be mailed or faxed to:
16th Floor, 1616 N. Fort Myer Drive
Arlington, VA 22209
For further information contact Kola Oyediran through +1 703 310 5243, +1 703 981 0216 or email firstname.lastname@example.org
Bids are to include:
- A detailed description of the proposed activities (pretest and tool revision, training, monitoring of the field work, data quality assurance etc)
- Detailed budget;
- Résumés of the key personnel of the organization;
- Detailed description of data entry procedures, including software to be used and details of quality control procedures and procedures for data editing and cleaning; and
- Statement of organizational capacity including: 1) reports of similar surveys coordinated in the past six months (preferably) or in the past year.