Second Urban Primary Health Care Project (UPHCP-II) Loan 2172-BAN (SF)/Grant 0008-BAN (SF)

Home , Bogra, Madhabdi

GOVERNMENT OF THE PEOPLE’S REPUBLIC OF BANGLADESH Ministry of Local Government, Rural Development and Cooperatives (MOLGRDC) Local Government Division

Second Urban Primary Health Care Project Project Management Unit (PMU) Nagar Bhaban, Room 620, Dhaka

Bid Document:

Letter of Invitation Instruction to Bidders Contract Agreement

For

Technical and Financial Proposals for Provision of Primary Health Care Services in Urban Partnership Areas Dhaka, Chittagong, Khulna, Rajshahi, Sylhet and Barisal City Corporations & Bogra, Comilla, Sirajgonj, Madhabdi and Savar Municipalities

Contract Package No.: …………………….

August 2005

GOVERNMENT OF THE PEOPLE’S REPUBLIC OF BANGLADESH Ministry of Local Government, Rural Development and Cooperatives (MOLGRDC) Local Government Division

Second Urban Primary Health Care Project (UPHCP-II) Loan 2172-BAN (SF)/Grant 0008-BAN (SF)

Second Urban Primary Health Care Project Project Management Unit (PMU) Nagar Bhaban, Room 620, Dhaka

LETTER OF INVITATION For Technical and Financial Proposals for Provision of Primary Health Care Services in Urban Partnership Areas of Dhaka, Chittagong, Khulna, Rajshahi, Sylhet and Barisal City Corporations & Bogra, Comilla, Sirajgonj, Madhabdi and Savar Municipalities

Issued to:

Seal of the Issuing Officer Signature of the Issuing Officer Draft 1

Government Of The People’s Republic Of Bangladesh Ministry of Local Government, rural Development and Cooperatives (MOLGRDC) Local Government Division

SECOND URBAN PRIMARY HEALTH CARE PROJECT (UPHCP-II) Project Management Unit (PMU) Nagar Bhaban, Dhaka, Room No. 620

Ref. No: ______Dated:

NOTICE INVITING PROPOSALS

Provision of Primary Health Care Services in Urban Partnership Areas of Dhaka, Chittagong, Khulna, Rajshahi, Sylhet and Barisal City Corporations & Bogra, Comilla, Sirajgonj, Madhabdi and Savar Municipalities

1. The Government of the People’s Republic of Bangladesh has received a loan and grant from the Asian Development Bank (ADB) and grant co-financing from the Government of United Kingdom and the Government of Sweden towards the cost of the Second Urban Primary Health Care Project (UPHCP-II). In addition, United Nations Population Fund (UNFPA) is providing parallel cofinancing for the Project. The ADB contribution to the Project will be financed under Loan No. 2172-BAN (SF) and Grant 0008-BAN (SF). The Local Government Division (LGD) of the Ministry of Local Government Rural Development and Cooperatives (MOLGRDC) is the Executing Agency for the Project, which is implemented by the Health Departments of the City Corporations of Dhaka, Chittagong, Khulna, Rajshahi, Sylhet, Barisal and Municipalities of Bogra, Comilla, Sirajgonj, Madhabdi and Savar. Part of the proceeds of this loan/grant will be applied to payments for six-year for city corporation areas of Dhaka, Chittagong, Khulna, Rajshahi, Sylhet, Barisal and five and half years for municipal area of Bogra, Comilla, Sirajgonj, Madhabdi and Savar for contracts (Partnership Agreements) to provide specified primary health care health services for the population of Partnership Agreement Areas (PAA). UPHCP-II is expected to close in December 2011.

2. The Second Urban Primary Health Care Project (UPHCP-II) purpose is to improve the health of the urban poor by improving access and changing the way in which health services are provided in urban areas. The primary objective is to reduce preventable mortality and morbidity especially among women and children, by strengthening the 2 Draft

urban primary health care (PHC) infrastructure, and insuring that the poor receive good quality preventative, promotive and curative heath services. The other objective is to sustain improvements in PHC by building the capacity of Local Government and changing the role of Government in the provision of health care services.

3. The UPHCP-II will continue to provide PHC services in Dhaka, Chittagong, Khulna, and Rajshahi utilizing the infrastructure created in the first Urban Primary Health Care Project (UPHCP-I). Around 110 primary health care centers (PHCCs) and 8 comprehensive reproductive health care centers (CHRCCs) were built under UPHCP-I in the above four city corporation areas. In addition, some additional infrastructure is proposed to be built in these for city corporation areas—8 PHCCs, 7 CRHCCs and upgradation of 4 PHCCs into CRHCCs. In the remaining two city corporations—Sylher and Barisal—and five municipal towns—Bogra, Comilla, Sirajgonj, Madhabdi and Savar—new 7 comprehensive reproductive health care centers (CHRCCs) and 42 primary health care centers (PHCCs) are expected to be built. UPHCP-II will contract out the delivery of a package of essential PHC services to NGOs and the private sector in 24 defined partnership areas, linking contract payments to health improvement results.

4. PHC Services means “Essential Service Package” plus some additional services as outlined in the Bid Document, that include (i) reproductive health, such as maternal care and nutrition, family planning, assistance for women survivors of violence; (ii) child health care, such as immunization, control of diarrhoeal disease and other childhood diseases, control of acute respiratory infections, and control of micronutrient deficiency; (iii) control of communicable disease such as tuberculosis, malaria, dengue fever; (iv) limited curative care and first aid for emergency medical care and the treatment of minor infections; and (v) Behavior Change Communication. UPHCP-II also received a grant from ADB for HIV/AIDS and infectious diseases control. With the support of this grant, the following activities will be undertaken through partnership agreements: (i) one voluntary counseling and testing center per each partnership agreement area; and (ii) control sexually transmitted infections (STI) and reproductive tract infections (RTI). For monitoring purposes, the grant funds and grant funded activities need to be tracked. Hence, the financial proposal and quarterly reporting by the contractors need to be done in such a way as to track the above two activities separately.

5. Greater emphasis compared to UPHPC-I is placed on making sure that services provided under UPCHP-II reach the poor. The partnership agreements will ensure that at least 30% of each service will be provided free to the poor, who will be identified through participatory poverty assessments and household listings conducted by the partner NGO. Pro-poor targeting will be an important aspect of the performance-based contracting. The poor will be provided free services, including free medicines. For the nonpoor, sliding user fees will be charged and drugs will be made available at 10–20% lower than market price. A baseline survey will be conducted by the partner NGO at the beginning of the partnership agreement to identify poor households in the partnership area. Poor households will be identified based on the social and economic indicators above. These households will be given entitlement health cards giving them free access to health services under the Project. The survey of the poor households will be updated annually. The partner NGOs will keep systematic records on the patients by poverty and gender, and will prepare quarterly reports of health service use by the poor, women, and adolescents.

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6. UPHCP-II gives emphasis on gender empowerment and equality. At least 50% of the health providers of the partner NGOs will be women. The female ward commissioners will be involved in community programs to raise awareness about services available in PHC and CRHC centers. Community health volunteers will include women, especially from poor communities. Of the chairs of ward PHC coordination committees, at least 30% will be women, and all the committees will have women members.

7. The Urban Primary Health Care Project, on behalf of the Local Government Division of the Ministry of Local Government, Rural Development and Cooperatives (the Client), now invites sealed bids from non-governmental organizations (NGOs), private agencies, and provider associations for the delivery of a defined package of primary health care services to specific urban partnership areas. Based on the “essential services package” (developed by Ministry of Health and Family Welfare) the government has defined objective standards for a contractor to meet that are similar to the targets of the UPHCP- II and consistent with the MOHFW national program guidelines. The Contractor will develop and implement a system ensuring the provision of these specific health services and the achievement of specific levels of improvement in coverage and quality by the end of six years.

8. A total of twenty four Partnership Areas will be established and twenty four contracts signed under the UPHCP-II during the six years of the project. This will occur in two rounds, the first taking place in 2005, when the bids for service delivery in seventeen Partnership Areas will be let, and the second in the year 2006, when contracts for the remaining seven areas will be tendered. The second round partnership areas to be tendered in 2006 are one partnership area each in Sylhet, Barisal, Bogra, Comilla, Sirajgonj, Madhabdi and Savar. Proposals for the provision of Primary Health Care Services in Urban Partnership Areas now are being sought for ten Partnership Areas in Dhaka, three in Chittagong, two in Khulna, and two in Rajshahi, for a total of seventeen areas to be contracted at this time. (DCCPA1 – DCCPA10, CCCPA 1-3, KCCPA1, KCCPA2, RCCPA1, and RCCPA2 (17 Packages)).

9. Bidders may submit bids for up to a maximum of four Partnership Areas, and any single bidder may only be awarded a maximum of three contracts. Bidders, who can deliver the specified services best, at the lowest price, will be awarded the contracts.

10. All Proposals and bids must be submitted in English.

11. To qualify for awarding of the contract, Bidders will need to meet the following minimum qualifying criteria:

(a) Evidence of having implemented projects with a total annual value equal to USD 100,000 or more for each of the previous three years, by the lead agency or in aggregate in case of a join venture;

(b) Evidence that the organization has sound financial accounting practices. (c) No consistent history of litigation or arbitration awards against the Bidder or associated organizations. (d) Minimum of eight years experience working with health systems and related activities, with at least five of these years in Bangladesh by Principal Bidder. (e) Registration with an appropriate agency of the Government of Bangladesh, entitling bidder to work in Bangladesh. 4 Draft

(f) Information on any commissions or gratuities, paid or to be paid relating to this bid and to contract execution if the bidder is awarded the contract. (g) Have gender balance in human resource composition. (h) ADB member country national

12. A Local Competitive Bidding will be conducted in accordance with Single stage, two- envelope bidding procedure will be used. Bidders are to submit simultaneously two sealed envelopes, one containing the Technical Proposal(s) and one the Financial Proposal(s). All bids must be received by 3 PM on ?? November 2005, in room 620, Nagar Bhaban, Fulbaria, Dhaka. At 4 PM on ?? November 2005 all bidders are invited to attend a public opening of the Technical Proposal envelopes in the UPHCP-II conference room adjacent to room 620 Nagar Bhaban, Fulbaria, Dhaka. At that time the names of all bidders whose proposals have been received will be recorded.

13. Initially only the technical proposals will be opened. The evaluation committee, convened by the UPHCP-II, will first examine the bidders’ qualifications, then evaluate the qualified technical proposals, and then open the financial proposals. Only the Technical Proposals of qualified bidders will be evaluated. Only the Financial Proposals of technically qualified bidders will be opened. The opening will be in the presence of the bidder's representatives who choose to attend at the time, place, and date advised by the Client.

14. The Client will not be responsible for any costs or expenses incurred by bidders in connection with the preparation or delivery of bids. Responsibility for timely delivery of Bids rests solely with the bidders. The UPHCP-II will make no allowance for any delays in proposal submission.

15. Bidders shall not engage in fraudulent or corrupt practices in competing for or executing an ADB-financed contract and if at any time ADB determines that a firm has engaged in corrupt or fraudulent practices (as defined in the “ADB Procurement Guidelines”) in competing for or executing an ADB-financed contract, this contract shall be terminated, and the firm declared ineligible for further ADB work.

16. Bidding documents may be purchased by interested eligible bidders upon submission of a written application to the office address given below and upon payment of a non- refundable fee of Tk. 6000. Bidding documents may be requested by fax and sent by courier for an additional courier fee for the set(s), equal to the cost incurred. Bidding documents will be available from 9 AM to 5 PM on all working days starting from 28 September 2005 up to 27 November 2005. Bidders may obtain bidding documents and further information from the office of the Client, at:

The Project Director Second Urban Primary Health Care Project Project Management Unit (PMU) Room #620, Nagar Bhavan Fulbaria, Dhaka, Bangladesh Tel: 9667791; Tel/Fax: 9667792 E-mail: [email protected]

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17. The payment may be made by Pay Order, Bank Draft, or money order to the Urban Primary Health Care Project, STD-14, Janata Bank, Nagar Bhaban Branch, Fulbaria, Dhaka.

18. Bidders should submit their bids: (i) to the address above (ii) on or before ?? November 2005 at 3:00 a.m, Bangladesh time, (iii) together with Bid Security of BDT 2,500,000 in favor of above address.

Signed: ______Project Director, UPHCP-II Room No-635, 6th Floor, Nagar Bhaban Fulbaria, Dhaka-1000, Bangladesh Phone: 880-2-9550917; fax: 9667792; Email: [email protected]

Dated:______2005

Ref. No.______

GOVERNMENT OF THE PEOPLE’S REPUBLIC OF BANGLADESH Ministry of Local Government, Rural Development and Cooperatives (MOLGRDC) Local Government Division

SECOND URBAN PRIMARY HEALTH CARE PROJECT (UPHCP-II) Project Management Unit (PMU) Nagar Bhaban, Room 620, Dhaka

INSTRUCTIONS TO THE BIDDERS (ITB)

For Technical and Financial Proposals for Provision of Primary Health Care Services in Urban Partnership Areas of Dhaka, Chittagong, Khulna, Rajshahi, Sylhet and Barisal City Corporations & Bogra, Comilla, Sirajgonj, Madhabdi and Savar Municipalities

TABLE OF CONTENTS

SECTION I: GENERAL INFORMATION...... 2 SECTION II: ELIGIBILITY TO BID...... 8 SECTION III: CONTENTS OF BIDDING DOCUMENTS ...... 10 SECTION IV: PREPARATION OF BIDS ...... 12 SECTION V: CONTENTS OF TECHNICAL PROPOSAL...... 13 AND FINANCIAL PROPOSAL...... 13 SECTION VI: THE BIDDING PROCESS...... 22 SECTION VII: EVALUATION OF BIDS ...... 27 SECTION VIII: AWARD OF CONTRACT ...... 30 APPENDICES...... 31 APPENDIX 1: EVALUATION CRITERIA FOR TECHNICAL AND FINANCIAL PROPOSALS...31 APPENDIX 2: TERMS OF REFERENCE FOR PARTNERSHIP AGREEMENTS...... 38 APPENDIX 3: SCOPE OF WORK IN PARTENSHIP AREA ACTIVITIES ...... 50 APPENDIX 4: PARTNERNSHIP AGREEMENT OBJECTIVES...... 61 APPENDIX 5: PERFORMANCE EVALUATION ...... 63 APPENDIX 6: EQUIPMENT, FURNITURE, CLINICAL SUPPLIES AND DRUGS ...... 68 APPENDIX 7: PROPOSAL FORMS ...... 78 APPENDIX 8: BASELINE SURVEY RESULTS...... 93 APPENDIX 9: PARTNESHIP AREA MAPS...... 94 APPENDIX 10: LIST OF ADB’S MEMBER COUNTRIES...... 95

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SECTION I: GENERAL INFORMATION

1.1 The Government of the People’s Republic of Bangladesh has received a loan and grant from the Asian Development Bank (hereinafter referred to as “ADB”) and co-financing from the Government of United Kingdom and the Government of Sweden towards the cost of the Second Urban Primary Health Care Project (UPHCP-II). In addition, United Nations Population Fund (UNFPA) is providing parallel cofinancing for the Project. The ADB contribution to the Project will be financed under Loan No. 2172-BAN (SF) and Grant 0008-BAN (SF). The Local Government Division of the Ministry of Local Government Rural Development and Cooperatives is the Executing Agency for the Project, which is implemented by the Health Departments of the City Corporations of Dhaka, Chittagong, Khulna, Rajshahi, Sylhet, Barisal and Municipalities of Bogra, Comilla, Sirajgonj, Madhabdi and Savar. Part of the proceeds of this loan/grant will be applied to payments for six-year for city corporation areas of Dhaka, Chittagong, Khulna, Rajshahi, Sylhet, Barisal and five and half years for municipal area of Bogra, Comilla, Sirajgonj, Madhabdi and Savar for contracts (Partnership Agreements) to provide specified health services for the population of Partnership Agreement Areas.

1.2 The Second Urban Primary Health Care Project (UPHCP) purpose is to improve the health of the urban poor by improving access and changing the way in which health services are provided in urban areas. The primary objective is to reduce preventable mortality and morbidity especially among women and children, by strengthening the urban primary health care (PHC) infrastructure, and insuring that the poor receive good quality preventative, promotive and curative heath services. The other objective is to sustain improvements in PHC by building the capacity of Local Government and changing the role of Government in the provision of health care services. The UPHCP-II will support provision of PHC services through performance-based contracting-out of PHC services. The contractor will provide essential services package plus (ESP+) services (Appendix 2, 3, 4) in the partnership agreement areas. These services will consist of (i) a HIV/AIDS voluntary counseling and testing (VCT) center for each partnership area; (ii) STI and reproductive tract infection (RTI) control; and (iii) other essential services package (ESP) plus. Subcomponents (i) and (ii) will be financed by the ADB grant and subcomponent (iii) by other financing.

1.3 The UPHCP-II will continue to provide PHC services in Dhaka, Chittagong, Khulna, and Rajshahi utilizing the infrastructure created in the first Urban Primary Health Care Project. Around 110 primary health care centers (PHCCs) and 8 comprehensive reproductive health care centers (CHRCCs) were built under UPHCP-I in the above four city corporation areas. In addition, some additional infrastructure is proposed to be built in these for city corporation areas—8 PHCCs, 7 CRHCCs and upgradation of 4 PHCCs into CRHCCs. In the remaining two city corporations—Sylher and Barisal—and five municipal towns—Bogra, Comilla, Sirajgonj, Madhabdi and Savar—new 7 comprehensive reproductive health care centers (CHRCCs) and 42 primary health care centers (PHCCs) are expected to be built. Two of the three partnership areas in Chittagong will be covered by the city corporation health department, while the remaining one area will be contracted out to a partner NGO, similar to UPHCP-I. UPHCP-II will contract out the delivery of a package of essential services to NGOs and the private sector in 24 defined partnership areas, linking contract payments to health improvement results. It also will build the capacity of the city corporation health Draft 3

departments to manage the health service contracts and to plan, finance, monitor, evaluate and coordinate health services in the urban areas.

1.4 PHC Services means “Essential Service Package” plus some additional services as outlined in the Bid Document, that include (i) reproductive health, such as maternal care and nutrition, family planning, assistance for women survivors of violence; (ii) child health care, such as immunization, control of diarrhoeal disease and other childhood diseases, control of acute respiratory infections, and control of micronutrient deficiency; (iii) control of communicable disease such as tuberculosis, malaria, dengue fever; (iv) limited curative care and first aid for emergency medical care and the treatment of minor infections; and (v) Behavior Change Communication. UPHCP-II also received a grant from ADB for HIV/AIDS and infectious diseases control. With the support of this grant, the following activities will be undertaken through partnership agreements: (i) one voluntary counseling and testing center per each partnership agreement area; and (ii) control sexually transmitted infections (STI) and reproductive tract infections (RTI). For monitoring purposes, the grant funds and grant funded activities need to be tracked. Hence, the financial proposal and quarterly reporting by the contractors need to be done in such a way as to track the above two activities separately.

1.5. Greater emphasis compared to UPHPC-I is placed on making sure that services provided under UPCHP-II reach the poor. The partnership agreements will ensure that at least 30% of each service will be provided free to the poor, who will be identified through participatory poverty assessments and household listings conducted by the partner NGO. Pro-poor targeting will be an important aspect of the performance-based contracting. The poor will be provided free services, including free medicines. For the nonpoor, sliding user fees will be charged and drugs will be made available at 10–20% lower than market price. A baseline survey will be conducted by the partner NGO at the beginning of the partnership agreement to identify poor households in the partnership area. Poor households will be identified based on the social and economic indicators above. These households will be given entitlement health cards giving them free access to health services under the Project. The survey of the poor households will be updated annually. The partner NGOs will keep systematic records on the patients by poverty and gender, and will prepare quarterly reports of health service use by the poor, women, and adolescents. Although the focus of the project will be the poor and the marginalised it will not be limited only to slum areas, because (i) the non-slum poor represent about 53 percent of all the poor living in the cities and suffer from poor health status, (ii) the non- slum poor also have limited access to PHC services, and (iii) some public health measures such as immunization have externalities and are only effective if the whole population is involved.

1.6. UPHCP-II gives emphasis on gender empowerment and equality. At least 50% of the health providers of the partner NGOs will be women. The female ward commissioners will be involved in community programs to raise awareness about services available in PHC and CRHC centers. Community health volunteers will include women, especially from poor communities. Of the chairs of ward PHC coordination committees, at least 30% will be women, and all the committees will have women members.

1.7 Clinical Wastes includes common waste and special waste (sharps and infectious, pathological, pharmaceutical, genotoxic, chemical, heavy-metal-containing, and radioactive waste). Medical solid waste—glassware, syringes, dressings, bandages, plasters, plastic syringes, and test swabs—accounts for 10–15% of clinics’ total solid 4 Draft

waste. The operation of health facilities will follow all applicable laws, MOHFW’s action plan for clinical waste management, ADB's environmental policies. Measures to improve CWM in the project clinics will include: (i) designation of a person in charge of waste management in each clinic; (ii) regular training for all staff; (iii) provision of color-coded, covered receptacles in strategic positions for separate categories of waste; (iv) daily internal collection and storage of containers within the clinic compound, which will be in a fenced, secured area; (v) collection and transportation of clinical waste containers by the city corporation and municipal conservancy department, and burial in separate pits for different wastes in a fenced, secured area of the municipal dumpsite; (vi) return of containers and invoice of services to the clinic, and (vii) cleansing of containers by the clinic. An operation and maintenance (O&M) plan and schedule will be prepared for each center, specifying environmental monitoring tasks (e.g., regular cleaning of external perimeter drains, ensuring that they are connected to off-site drains), frequency of monitoring, responsibilities, and costs. The O&M plan will be incorporated into the proposal and partnership agreement, and monitored as part of the assessment of partners’ performance.

1.8 The Urban Primary Health Care Project, on behalf of the Local Government Division of the Ministry of Local Government, Rural Development and Cooperatives (the Client), now invites sealed bids from non-governmental organizations (NGOs), private agencies, and provider associations for the delivery of a defined package of primary health care services to specific urban partnership areas. Based on the “essential services package” (developed by Ministry of Health and Family Welfare) the government has defined objective standards for a contractor to meet that are similar to the targets of the UPHCP- II and consistent with the MOHFW national program guidelines. The Contractor will develop and implement a system ensuring the provision of these specific health services and the achievement of specific levels of improvement in coverage and quality by the end of six years.

1.9 The services to be provided are defined in the Terms of Reference (Appendix 2), Scope of Work (Appendix 3) and Partnership Agreement Objectives (Appendix 4) all of which are an integral part of this document. Primary Health Care (PHC) Centers and Comprehensive Reproductive Health Care Centers (CRHCCs) constructed and equipped by UPHCP-I and UPHPC-II, in the Partnership Areas, will be used by the successful bidders. Health service delivery is being sought for the following map referenced Partnership Agreement Areas Maps are appended to the end of the bidding documents (Appendix 9).

1.10 The proposed project is a continuation of the first phase project. While the first project was implemented in Dhaka, Chittagong, Khulna and Rajshahi, which together have combined population of about 9 million people, representing 41 percent of Bangladesh's urban population, the present phase of the project will also cover the newer city corporations of Barisal and Sylhet and five municipalities of varying size, namely, Comilla, Bogura, Shirajgonj, Savar and Madhobdi. The new project areas contain about 6,94,000 population. In aggregate the project would therefore, cover about 10 million, i.e., 46% of the urban population, which is 7% of the total population of the country; the vast majority of who are slum dwellers. The details of six city corporation and five municipal towns to be covered under UPHCP-II is as follows:

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Name Number No. of No. of Population* of Wards Household Partners s hip Areas Male Female Total Dhaka City Corporation (CC) 10 130 1107000 3046000 2332000 5378000 Chittagong CC 3 50 430000 1164000 932000 2096000 Khulna CC 2 38 172000 412000 361000 773000 Rajshahi CC 2 39 75000 203000 180000 383000 Sylhet CC 1 27 50000 156000 129000 285000 Barisal CC 1 30 43000 108000 94000 202000 Comilla Municipality 1 18 31000 88000 80000 168000 Bogra Municipality 1 12 29000 78000 71000 149000 Sirajganj Municipality 1 15 26000 64000 62000 126000 Savar Municipality 1 9 28000 66000 59000 125000 Madhabdi Municipality 1 9 25000 68000 58000 126000 Total 24 63 139000 364000 330000 98,11,000 * As per the census of 2001

1.11 The Partnership Agreement Areas are summarized below (for maps see Appendix 9):

City/ Partner- Wards Map Ref. Bidding Municipalit ship Phase y Area Dhaka 1 76,80,81,82,83,84,86,87,88, 89/90, 90 DAK 1 Phase 1

Dhaka 2 66,67,68,69,70,71,72,73, 74,77,78, 79 DAK 2 Phase 1

Dhaka 3 56,,57,59,60, 61,62, 63, 64,65, 93 DAK 3 Phase 1

Dhaka 4 27, 28,29, 30, 31,32,33, 34, 36,75,85 DAK 4 Phase 1

Dhaka 5 22,23, 24,25,26,35, 53, 54,55 DAK 5 Phase 1 Dhaka 6 48, 49, 50,51, 52,58, 94 DAK 6 Phase 1 Dhaka 7 39,40,42,43, 44,45,46,47 DAK 7 Phase 1 Dhaka 8 9, 10,11, 12,13,14, 16,41 DAK 8 Phase 1

Dhaka 9 2,3,4,5, 6,7,8, 15 DAK 9 Phase 1

Dhaka 10 1, 17,18, 19, 20,21, 37,38, 91, 92 DAK 10 Phase 1

Chittagong 1 Covered by City Corporation Health Department CHT 1** Phase 1

Chittagong 2 Covered by City Corporation Health Department CHT 2** Phase 1

Chittagong 3 19, 20, 24, 28, 34 CHT 3 Phase 1 Khulna 1 KHU 1 Phase 1 Khulna 2 16,17,18, 21, 23, 25, 26 KHU 2 Phase 1 Rajshahi 1 RAJ 1 Phase 1 Rajshahi 2 RAJ 2 Phase 1 Borishal 1 All wards BOR 1 Phase 2 Sylhet 1 All wards SYL 1 Phase 2 Shirajgonj 1 All wards SHIR 1 Phase 2 6 Draft

Bogura 1 All wards BOG1 Phase 2 Comilla 1 All wards COM 1 Phase 2 Savar 1 All wards SAV 1 Phase 2 Madhobdi 1 All wards MADH 1 Phase 2 Note: Bold wards were covered under UPHCP-II I ** To be awarded to the Chittagong City Corporation without bid on a pro rata basis

Corrupt Practices

1.12 ADB’s Anticorruption Policy requires borrowers (including beneficiaries of ADB-financed activity), as well as bidders, suppliers, and contractors under ADB-financed contracts, observe the highest standard of ethics during the procurement and execution of such contracts. In pursuance of this policy, the ADB:

(a) defines for the purposes of this provision, the terms set forth below as follows: (i) “corrupt practice” means the offering, giving receiving, or soliciting, directly or indirectly, of any thing of value to influence the action of any party in the procurement process or the execution of a contract; (ii) “fraudulent practice” means a misrepresentation or omission of facts in order to influence a procurement process or the execution of a contract; (iii) “collusive practices” means a scheme or arrangement between two or more bidders, with or without the knowledge of the Borrower, designed to influence the action of any party in a procurement process or the execution of a contract; (iv) “coercive practices” means harming or threatening to harm, directly or indirectly, persons, or their property to influence their participation in a procurement process, or affect the execution of a contract; (b) will reject a proposal for award if it determines that the bidder recommended for award has, directly or through an agent, engaged in corrupt, fraudulent, collusive, or coercive practices in competing for the Contract; and (c) will sanction a party or its successor, including declaring ineligible, either indefinitely or for a stated period of time, to participate in ADB-financed activities if it at any time determines that the firm has, directly or through an agent, engaged in corrupt, fraudulent, collusive, or coercive practices in competing for, or in executing, an ADB- financed contract.

1.13 Good Governance and Transparency. Good governance and prevention of corruption are nonnegotiable preconditions for smooth, effective, efficient, and sustainable project implementation. In their absence, the urban poor—the main project beneficiaries—will be the main losers. Active accountability to service users is essential, as opposed to more routine 'participation' which could just be passive attendance at quarterly meetings by user representatives. The key dynamic should be that service users and their representatives know what the service level is supposed to be, and have an important voice in saying whether the service performance is good enough, and if not , why not. This will be a management tool as well as a monitoring indicator. Among others, the following steps are indicated in the Project to ensure good governance in the contract, which will be closely monitored as part of the contract.

(a) Use funds only for authorized purposes, and adhere to procurement schedule. Draft 7

(b) Be vigilant about the quality of procurement, and conduct regular field visits to check quality. (c) Use information technology to increase transparency, accountability, and efficiency in procurement. (d) Regularly assess accounting and internal control systems to monitor expenditures and other financial transactions and safe custody of project- financed assets. (e) Ensure that accounting and internal control systems are of acceptable standards. (f) Ensure accounting information adheres to accounting standards acceptable to client and maintain substantial documentation. (g) Submit audited and unaudited financial statements within an acceptable time limit. (h) Conduct an independent audit acceptable to client. (i) Pay special attention to stopping duplicate payments, tampering of invoices, adulteration of records, payments without supporting documents, misuse of funds, and payment of ineligible expenditures. (j) Conduct regular surveys of the quality of project services. (k) Conduct a public relations campaign to inform and educate the beneficiaries about project services. (l) Establish links between Project and civil advocacy organizations. (m) Ensure access to information at the health facilities and offices through notice boards, regular newsletters, a website, etc. (n) Support joint government and civil-society bodies such as ward primary health care (PHC) committees, city corporations, municipality. (o) Establish an effective grievance redress system and enable its effective functioning through wide publicity. (p) Use information technology to increase access to information and empower people. (q) Establish oversight and supervisory mechanisms to detect fraud and corruption. (r) Conduct annual financial disclosure of the project staff and regularly monitor project assets. (s) Adhere to annual plans and explain deviations, if any, and carefully analyze unusual items. (t) Follow government guidelines on investigating corruption. (u) Regularly assess institutional capacities to respond and take measures to prevent corruption. 8 Draft

SECTION II: ELIGIBILITY TO BID

2. Eligible Bidders

2.1 A Bidder may be a natural person, private entity, government-owned entity (subject to Instructions to Bid (ITB) Sub-Clause 2.5) or any combination of them with a formal intent to enter into an agreement or under an existing agreement in the form of a Joint Venture (JV). In the case of a JV:

(a) all parties to the JV shall be jointly and severally liable; and

(b) a JV shall nominate a Representative who shall have the authority to conduct all businesses for and on behalf of any and all the parties of the JV during the bidding process and, in the event the JV is awarded the Contract, during contract execution.

2.2 A Bidder, and all parties constituting the Bidder, shall have the nationality of an eligible country, in accordance with Appendix 10. A Bidder shall be deemed to have the nationality of a country if the Bidder is a citizen or is constituted, or incorporated, and operates in conformity with the provisions of the laws of that country. This criterion shall also apply to the determination of the nationality of proposed subcontractors or suppliers for any part of the Contract including related services.

2.3 A Bidder shall not have a conflict of interest. All Bidders found to be in conflict of interest shall be disqualified. A Bidder may be considered to have a conflict of interest with one or more parties in this bidding process, if they:

(a) have controlling shareholders in common; or

(b) receive or have received any direct or indirect subsidy from any of them; or

(d) have a relationship with each other, directly or through common third parties, that puts them in a position to have access to information about or influence on the Bid of another Bidder, or influence the decisions of the Client regarding this bidding process; or

2.4 A firm that is under a declaration of ineligibility by the ADB in accordance with ITB Clause 2, at the date of the deadline for bid submission or thereafter, shall be disqualified.

2.5 Government-owned enterprises in the Client’s country shall be eligible only if they can establish that they are legally and financially autonomous and operate under commercial law, and that they are not a dependent agency of the Client.

2.6 Bidders shall provide such evidence of their continued eligibility satisfactory to the Client, as the Client shall reasonably request Draft 9

2. Eligible Goods and Related Services

2.7 All goods and related services to be supplied under the Contract and financed by the ADB, shall have as their country of origin an eligible country of the ADB (see Section V, Eligible Countries).

2.8 For purposes of this Clause, the term “goods” includes commodities, raw material, machinery, equipment, and industrial plants; and “related services” includes services such as insurance, installation, training, and initial maintenance

2.9 The term “country of origin” means the country where the goods have been mined, grown, cultivated, produced, manufactured, or processed; or through manufacture, processing, or assembly, another commercially recognized article results that differs substantially in its basic characteristics from its imported components.

2.10 The nationality of the firm that produces, assembles, distributes, or sells the goods shall not determine their origin.

2.11 The bidder is expected to examine carefully the contents of the Bid Documents. Failure to comply with the requirements of bid submission may result in the Bid being rejected. Information must follow the indicated format and sequence of the Bid Document. 10 Draft

SECTION III: CONTENTS OF BIDDING DOCUMENTS

3. Sections of the Bidding Document

3.1 The Bidding Document consist of 2 parts. Part 1 is the Instructions to the Bidders; and Part 2 is the Contract Agreement. Part 1 consists of 7 Sections and 10 Appendixes and Part 2 consists of 5 sections and 8 Appendixes, which include all the Sections and Appendixes indicated below, and should be read in conjunction with any Addenda issued.

PART 1 INSTRUCTIONS TO THE BIDDERS (ITB) • Section I. General Information • Section II. Eligibility to Bid • Section III. Contents of Bidding Documents • Section IV. Preparation of Bids • Section V. The Bidding Process • Section VI. Evaluation of Bids • Section VII. Award Contract

• Appendix 1 Evaluation Criteria for Technical and Financial Proposals • Appendix 2 Terms of Reference for Partnership Agreements • Appendix 3 Scope of Work in Partnership Area Activities • Appendix 4 Partnership Agreement Objectives (Specific Measurable Results) • Appendix 5 Performance Evaluation • Appendix 6 Equipment, Furniture, Clinical Supplies and Drugs • Appendix 7 Proposal Forms • Appendix 8 Baseline Survey Results • Appendix 9 Partnership Area Maps • Appendix 10 List of ADB’s Member Countries

PART 2 CONTRACT AGREEMENT • Section I Specific Provisions • Section II Undertaking of the Client • Section III Undertaking of the Contractor • Section IV General Provisions • Section V Miscellaneous

• Appendix 1 Terms of Reference for Partnership Agreements • Appendix 2 Scope of Work in Partnership Area Activities • Appendix 3 Partnership Area Objectives • Appendix 4 Performance Evaluation • Appendix 5 Procedures for Resolving Implementation Issues

3.2 The Invitation for Bids issued by the Client is not part of the Bidding Document.

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3.3 The Client is not responsible for the completeness of the Bidding Document and its addenda, if they were not obtained directly from the Client.

3.4 The Bidder is expected to examine all instructions, forms, terms, and specifications in the Bidding Document. Failure to furnish all information or documentation required by the Bidding Document, may result in the rejection of the Bid.

4. Clarification of Bidding Document

4.1 A prospective Bidder requiring any clarification of the Bidding Document shall contact the Client in writing at the Client’s address indicated below. The client will respond in writing to any request for clarification, provided that such request is received no later than twenty-one (21) days prior to the deadline for submission of Bids. The Client shall forward copies of its response to all Bidders who have acquired the Bidding Document directly from it, including a description of the inquiry but without identifying its source. Should the Client deem it necessary to amend the Bidding Document as a result of a clarification, it shall do so following the procedure under ITB Clause 5.

5. Amendment of Bidding Document

5.1 At any time prior to the deadline for submission of the Bids, the Client may amend the Bidding Document by issuing addenda.

5.2 Any addendum issued shall be part of the Bidding Document and shall be communicated in writing to all who have obtained the Bidding Document directly from the Client.

5.3 To give prospective Bidders reasonable time in which to take an addendum into account in preparing their Bids, the Client may, at its discretion, extend the deadline for the submission of the Bids.

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SECTION IV: PREPARATION OF BIDS

6. Cost of Bidding

6.1 The Bidder shall bear all costs associated with the preparation and submission of its Bid, and the Client shall not be responsible or liable for those costs, regardless of the conduct or outcome of the bidding process.

7. Language of Bid

7.1 The Bid, as well as all correspondence and documents relating to the Bid exchanged by the Bidder and the Client, shall be written in English. Supporting documents and printed literature that are part of the Bid may be in another language provided they are accompanied by an accurate translation of the relevant passages in English, in which case, for purposes of interpretation of the Bid, such translation shall govern.

8. Documents Comprising the Bid

8.1 The Bid shall comprise two envelopes submitted simultaneously, one containing the Technical Proposal and the other the Financial Proposal, enclosed together in an outer single envelope.

8.2 Initially, only the Technical Proposals are opened at the address, date and time specified in ITB Clause 12.25 The Financial Proposals remain sealed and are held in custody by the Client. The Technical Proposals are evaluated by the Client. No amendments or changes to the Technical Proposals are permitted. Bids with Technical Proposals which do not conform to the specified requirements will be rejected as deficient Bids.

8.3 Financial Proposals of technically compliant Bids are opened in public at a date and time advised by the Client. The Financial Proposals are evaluated and the Contract is awarded to the Bidder whose Bid has been determined to be the lowest evaluated based on scores obtained in both Technical and Financial proposals of the substantially responsive Bid.

9. Bid Submission Sheets and Financial Proposal

9.1 The Bidder shall submit the Technical Proposal and the Financial Proposal using the appropriate Submission Sheets furnished in Appendix 7, Form 7 and 8. These forms must be completed without any alterations to their format, and no substitutes shall be accepted. All blank spaces shall be filled in with the information requested.

9.2 The Bidder shall submit, as part of the Financial Proposal, the Price Schedules for Goods and Related Services, according to their origin as appropriate, using the forms furnished in Appendix 7, Bidding Forms.

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SECTION V: CONTENTS OF TECHNICAL PROPOSAL AND FINANCIAL PROPOSAL

10. TECHNICAL PROPOSAL

10.1 Qualification of Firm. The following information must be provided for the principal bidder as well as for any organization with which the bidder would be associated for the purpose of providing the services. To qualify for awarding of the contract, bidders should meet the following minimum qualifying criteria:

(a) Evidence of having implemented projects with a total annual value equal to USD 100,000 or more for each of the previous three years. (b) Evidence that the organization has sound financial accounting practices. (c) No consistent history of litigation or arbitration awards against the Bidder or associated organizations. (d) Minimum of eight years experience working with health systems and related activities, with at least five of these years in Bangladesh by Principal Bidder. (e) Registration with an appropriate agency of the Government of Bangladesh, entitling bidder to work in Bangladesh. (f) Information from the bidder on any commissions or gratuities, paid or to be paid relating to this bid or to contract execution if the bidder is awarded the contract. (g) Be from an Asian Development Bank member-country.

10.2 General Information will be provided according to Form 1 (appendix 7).

10.2.1 The total size of the Technical Proposal should be no more than 100 pages, of which the Implementation Plan should be no longer than 20 pages. The Technical Proposal is to be: (i) provided on A4 paper, with 1 inch margins, (ii) 1.5-spaced typing, using a font of 11 points.

10.2.1.Information on the experience with health projects of a similar nature will have to be provided according to the guidelines specified in Form 3, Appendix 7. Bidders are only to include experience obtained by the firms or joint venture partners: experienced gained by individual consultants may be provided in their bio-data/curriculum vitae. The Bidder should be able to substantiate the claimed experience by providing contractual or other evidence if requested to do so by the Client prior to or during Contract negotiations.

10.3 Financial information will be provided according to Form 2 (appendix 7).

10.4 Experience: Past and present experience with projects of a similar nature (e.g. management of health care systems, health program implementation, where issues such as quality assurance, health care financing, provision of primary health services, etc. 14 Draft

were priorities) by the principal bidder and associated organization(s), if any, in developing countries, particularly in South Asia and especially, in Bangladesh. Assignment(s) completed earlier by individual experts working privately or through other organizations cannot be claimed as the experience of the principle bidder, or any associate(s) but can be claimed by the individuals themselves in their biodata. The bidder should be prepared to substantiate the claimed experience by providing contractual or other evidence if so requested by the Client anytime prior to, or, if selected, during contract negotiations (Form 3 - Appendix 7).

Implementation Plan

10.5 This section must be no longer than 20 pages, double spaced. The Implementation Plan should show an understanding of the events likely to go into and affect the delivery of the defined primary health care services in the project area (logistic difficulties, flooding, cyclone, periodic hartals, etc.) and demonstrate an understanding of the socio-economic aspects and major challenges faced by the respective city corporation and/or municipality in overseeing the delivery of urban PHC services and may not be modified later to allow for these expected events and challenges. The Implementation Plan should outline how the Bidder intends to fulfill the scope of work and reach the objectives within the Project time-frame, given all these situations.

10.5.1 The Plan should be developed with the knowledge that the following events are likely to occur, and thus, strategies to minimize the impact of these events on achieving the Scope of Work should be included.

(a) Logistic difficulties during the rainy season and annual flooding for some regions. (b) Periodic hartals (general strikes), during which regular transportation is inhibited and public life in some areas disrupted.

10.5.2 The Plan should indicate an understanding of local conditions (geographic and socio-political) under which the services will be provided. The Plan should demonstrate knowledge of the requirements and requisite tasks for fulfilling the Terms of Reference (Appendix 2) and Scope of Work (Appendix 3) and achieving the Partnership Area Objectives (Appendix 4).

10.5.3 The Plan must be presented using the following headings and should address the identified topics:

(a) Service and Population Coverage: Ensuring delivery of the ESP (as defined in Appendix 3) and appropriate referrals, with community coverage levels specified by the Client, and services provided to the poorest and most vulnerable sectors of the population. Due attention must be given to the activities carried out within the Partnership Area by other health service providers. Specific attention should be given to avoiding duplication and ensuring coverage of the entire area. (b) Strategy to Access the Poor: The implementation plan should lay out clearly how the Contractor will ensure at least 30% of the services reach the poor. This would include details of baseline survey of the households in the partnership agreement area, identification of the poor households, issue of health cards for the poor, outreach activities to cover the poor households, Draft 15

monitoring and evaluation mechanisms to ensure poor are adequately covered, and adequate provision in the financial proposals for baseline survey of the households, issue of health cards for the poor, provision for free medicines and other supplies for the poor patients, information management system to track the use of health services by the poor households. Details of identification of the poor and process to ensure access of services to the poor given in Appendix 3. (c) Strategy to ensure Gender Equity. The proposal should clearly state how the Contractor would ensure that at least 50% of the staff engaged are female, and how through outreach and other activities at least 75% of the services are accessed by women and children. (d) HIV/AIDS, STI and RTI. The proposal should separately discuss ADB grant financed activities including voluntary counseling and testing centers, outreach, identification, and treatment of STI and RTIs. (e) Outreach Activities. Number of households per outreach worker, gender of service promoter and volunteer and the geographical proximity; (ii) Qualification and TOR of outreach workers, service promoters and volunteers (in 4-6 bullets for each); (iii) Training programme to be conducted for all staff including the outreach workers and volunteers; (iv) Internal monitoring mechanism and indicators of the community outreach activities. Motivational and outreach activities should include methodology of implementing these activities in terms of/ in light of the (i) findings of the baseline survey/ situation (time/ period) analysis/participatory appraisal; (ii) household level and neighborhood group level activities and programs, and number of neighborhood level meetings to be conducted each month, (iii) types of basic information to be included in the package to disseminate basic information and strategy of reaching the poor and hardcore poor more specifically to vulnerable women and adolescent girls; (iv) coordination mechanism with non-partner NGOs’ and social mobilization programs, in the same slum areas, to reach the poor adolescent girls; (v) methodologies and activities to address social prejudice against the established health care systems, practices and norms; (vi) mechanism for internal monitoring of effective and quality health services to the poor through ward level committee; (vii) feedback mechanism from the patients to assess quality and effect of services (viii) Collaboration with the BCC partner etc. (f) Health Awareness and Sanitation Campaigns: (i) types of audio-visual traditional and popular media to be used for campaigns; (ii) Health awareness activities through government and NGO, primary schools, social and religious institutions; (iii) neighborhood/ward level activities for health/ sanitation awareness campaign. (g) Health service activities of the community level satellite, mini clinics, and outreach workers, targeting and monitoring mechanism and indicators. (h) Methods of record keeping and monitoring at the CRHCC/ CMC, PHCC/ CHC and peripheral level. (i) Mechanism of stakeholders participation in the management of CRHCC and PHCC including community involvement in the organising and managing of the same and in particular safe motherhood programmes. (j) Quality of Service: The Plan should outline how this issue has been addressed by the Bidder in the past, what lessons have been learned, and how quality can be provided at both the personal and organisational level. This should cover staff supervision, monitoring, training, timely availability of 16 Draft

logistics, and ensuring that professional standards of care are applied. Both provider and client perceptions and perspectives should be covered. QA should also outline how and what measures have been planned to control clinic waste and iatrogenic infections. Also how quality will be assessed (including structure for QA). (k) Health Care Financing: Strategies to minimize cost and maximize service delivery and coverage. For example, cost-recovery, cross-subsidies, community financing, insurance, etc. are encouraged by the UPHCP. (l) Collaboration with other Health Care Service Providers: the Plan should outline how duplication is to be avoided, and how collaboration will take place with other service providers working (both NGO, donor, private) in or around the PAA . Description of the referral set up might also be given. (m) Participation of Service Recipients in the Running of the Management: Plan on how the community and leadership will be involved in the running of the Partnership will be described by the bidder. One particular example may be the citizen score cards and routine display of up to date public disclosure about staffing, stock, facilities and fee rates which will improve accountability of the service providers. (n) Equity and other Cross-Cutting Issues: The Plan should outline how poverty and gender issues including violence against women will be addressed by the Bidder (both organisationally and in the community) to ensure that equitable service delivery takes place. Mechanism of how other equity issues will be addressed need to be stated. Some of which might be 1) raising of volunteers from the poor; 2) participation of women community leaders and ward commissioners in planning of community based solid waste management; 3) heading of >30% of ward PHC committees by women and adequate membership in them by the women.

(o) Environmental Issues: The Bidder should outline specific experience they have had with introducing environmental change, such as involvement in water, waste and sanitation projects in urban slums. Statements will be required on how sustainability of the project will be ensured in the light of environmental issues.

(p) Proposed Service Delivery Alliances: The Bidder should outline any proposed linkages at the local level for the delivery of referral or specialised services. In such cases, the way in which payments for such referrals or specialised services are to be made should be narrated. (q) Other Critical Issues identified, and strategies for addressing them.

10.6 Staffing. The proposal should reflect minimum level of staff for different levels of facilities prescribed under the ITB given in Appendix 2. Organizational Chart, including a staffing schedule that indicates planned place(s) of assignment for staff. The Organizational Chart must include Senior Staff by name, and other staff by designation or qualification (physician, nurse, etc.), clearly identifying staffing patterns planned for delivery of health services from PHC and maternity Centers, or other planned assignments. The staffing pattern should ensure that all the positions prescribed in Appendix 2 are fully reflected and budgeted in the financial proposal.

10.7 Biodata for all technical/managerial staff in the forms provided herewith as attachments, Biodata must be submitted for all staff on the organizational chart who are at the level of Draft 17

Project Manager, Deputy Project Managaer, Director of Finance and Administration, etc. plus Technical Experts and senior Staff. If Bids are submitted for more than one Partnership Area, the same biodata cannot be submitted for more than one Partnership Area unless it is specified that the position will be shared between Partnership Areas if two Partnership Areas are awarded.

10.8 Annual implementation plan for the six year period (ending in December 2011) indicating activities on the critical path showing milestones and critical dates in a GANTT chart for each year and a summary chart (MSPROJECT, TIMELINE, etc.).Procurement of goods and services should be indicated in the chart. This plan will be discussed in detail if the candidate is selected and included with the Final Approved Technical Proposal with Implementation Plan, which will be a major part of the Partnership Area contract.

10.9 List of planned purchases of capital goods and supplies (medications, computers, etc.) which are not to be provided by MOHFW, UPHCP, etc.. Purchases under the ADB funding component must follow ADB Guidelines for Procurement, and must be in agreement with the list provided in Appendix 6.

10.10 The goods to be supplied under the contract shall comply with the following provisions:

(a) the goods (including all computer hardware, software and systems, whether separately procured or incorporated within other goods) shall be designed to be used prior to, during and after the calendar year 2000 AD (year 2000). (b) Neither the performance nor functionality of the Goods shall be affected by dates prior to, during and after the Year 2000. (c) The Goods and the logic contained therein shall operate during each such time period without error relating to date data, specifically including any error relating to or the production of date data which represents or references different centuries or more than one century and the correct treatment of the year 2000 as a leap-year; and (d) The provision and use of the Goods shall not infringe or violate any industrial property or intellectual property rights of any third party.

10.11 Additional plans and comments designed to improve performance in carrying out the assignment.

10.12. Reaching the poor. The proposal should clearly describe how at least 30% of the services would be ensured to the poor. The partnership agreements will ensure that at least 30% of each service will be provided free to the poor, who will be identified through participatory poverty assessments and household listings conducted by the partner NGO. Pro-poor targeting will be an important aspect of the performance-based contracting. The poor will be provided free services, including free medicines. For the nonpoor, sliding user fees will be charged and drugs will be made available at 10–20% lower than market price. A baseline survey will be conducted by the partner NGO at the beginning of the partnership agreement to identify poor households in the partnership area. Poor households will be identified based on the social and economic indicators above. These households will be given entitlement health cards giving them free access to health services under the Project. The survey of the poor households will be updated annually. The partner NGOs will keep systematic records on the patients by poverty and 18 Draft

gender, and will prepare quarterly reports of health service use by the poor, women, and adolescents.

10.13 Gender Equity and Empowerment. The proposal should clearly describe how the gender equity and gender empowerment aspects of the project would be achieved, in addition to the following. UPHCP-II gives emphasis on gender empowerment and equality. At least 50% of the health providers of the partner NGOs will be women. The female ward commissioners will be involved in community programs to raise awareness about services available in PHC and CRHC centers. Community health volunteers will include women, especially from poor communities. Of the chairs of ward PHC coordination committees, at least 30% will be women, and all the committees will have women members.

10.14 Good Governance and Anticorruption Measures. The proposal should contain pro- active steps the bidder would take to ensure good governance and anti-corruption measures including those described herewith. Active accountability to service users is essential, as opposed to more routine 'participation' which could just be passive attendance at quarterly meetings by user representatives. The key dynamic should be that service users and their representatives know what the service level is supposed to be, and have an important voice in saying whether the service performance is good enough, and if not , why not. This will be a management tool as well as a monitoring indicator. Among others, the following steps are indicated in the Project to ensure good governance in the contract, which will be closely monitored as part of the contract.

(a) Use funds only for authorized purposes, and adhere to procurement schedule. (b) Be vigilant about the quality of procurement, and conduct regular field visits to check quality. (c) Use information technology to increase transparency, accountability, and efficiency in procurement. (d) Regularly assess accounting and internal control systems to monitor expenditures and other financial transactions and safe custody of project- financed assets. (e) Ensure that accounting and internal control systems are of acceptable standards. (f) Ensure accounting information adheres to accounting standards acceptable to client and maintain substantial documentation. (g) Submit audited and unaudited financial statements within an acceptable time limit. (h) Conduct an independent audit acceptable to client. (i) Pay special attention to stopping duplicate payments, tampering of invoices, adulteration of records, payments without supporting documents, misuse of funds, and payment of ineligible expenditures. (j) Conduct regular surveys of the quality of project services. (k) Conduct a public relations campaign to inform and educate the beneficiaries about project services. (l) Establish links between Project and civil advocacy organizations. (m) Ensure access to information at the health facilities and offices through notice boards, regular newsletters, a website, etc. (n) Support joint government and civil-society bodies such as ward primary health care (PHC) committees, city corporations, municipality. Draft 19

(o) Establish an effective grievance redress system and enable its effective functioning through wide publicity. (p) Use information technology to increase access to information and empower people. (q) Establish oversight and supervisory mechanisms to detect fraud and corruption. (r) Conduct annual financial disclosure of the project staff and regularly monitor project assets. (s) Adhere to annual plans and explain deviations, if any, and carefully analyze unusual items. (t) Follow government guidelines on investigating corruption. (u) Regularly assess institutional capacities to respond and take measures to prevent corruption.

10.13 Clinical Waste Management. The proposal should contain clearly how the bidder intends to deal with clinical waste. The proposal should describe, among other things, those mentioned below. Clinical Wastes includes common waste and special waste (sharps and infectious, pathological, pharmaceutical, genotoxic, chemical, heavy-metal- containing, and radioactive waste). Medical solid waste—glassware, syringes, dressings, bandages, plasters, plastic syringes, and test swabs—accounts for 10–15% of clinics’ total solid waste. The operation of health facilities will follow all applicable laws, MOHFW’s action plan for clinical waste management, ADB's environmental policies. Measures to improve CWM in the project clinics will include: (i) designation of a person in charge of waste management in each clinic; (ii) regular training for all staff;(iii) provision of color-coded, covered receptacles in strategic positions for separate categories of waste; (iv) daily internal collection and storage of containers within the clinic compound, which will be in a fenced, secured area; (v) collection and transportation of clinical waste containers by the city corporation and municipal conservancy department, and burial in separate pits for different wastes in a fenced, secured area of the municipal dumpsite; (vi) return of containers and invoice of services to the clinic, and (vii) cleansing of containers by the clinic. An operation and maintenance (O&M) plan and schedule will be prepared for each center, specifying environmental monitoring tasks (e.g., regular cleaning of external perimeter drains, ensuring that they are connected to off-site drains), frequency of monitoring, responsibilities, and costs. The O&M plan will be incorporated into the proposal and partnership agreement, and monitored as part of the assessment of partners’ performance.

10.14 Adequacy of Technical Proposal: Bidder’s technical capacity to mobilize key equipment and personnel for the contract consistent with its proposal regarding work methods, scheduling and material sourcing in sufficient detail and fully in accordance with the requirements stipulated.

10.15 Multiple Contracts and Resources: If multiple packages are bid for and the partner is successful the evaluation will include an assessment of the Bidder’s capacity (empirical judgment of the evaluation committee members) to meet the aggregate requirements regarding:

(a) Financial situation to tackle the multiple contracts 20 Draft

(b) Current contract commitments (name of contract, employer’s contact address, value of outstanding work in million Taka, estimated completion date, average monthly invoicing over last six months) (c) Cash flow capacity (source of present financing and amount in million Taka for running the office) (d) Equipment to be allocated (sufficiency of official and programmatic equipment and furniture), and (e) Personnel to be fielded, in particular in key positions (alternatives needs to be suggested)

11. FINANCIAL PROPOSAL

11.1 The Financial Proposal shall include all the Contractor’s obligations included in or reasonably inferred from the Bidding Documents for the cost of implementing the Project. This shall include all expenses to be incurred by staff hired directly or indirectly by the Contractor, other personnel expenses, transport, operating costs for the PAA (PHC services), and all other costs related to implementation of Project activities. The operating costs include per diem payments, salary, costs relating to ongoing training (both management and clinical), purchase of medicine and consumables, costs for maintenance and repair of equipment, vehicles, medicine, furniture, office, clinic, etc. and costs for outreach services (including local operating costs or purchase of bicycles or similar). Rental costs for the PHCC and CRHCC facilities including O & M, fuel, postage, utility bills, printings, conveyance should be included in the proposal for the entire 6 years of project.

11.2 Operating costs for the Partnership Area primary health care services will be included in the Financial Proposal. This includes per-diem payments, salary, costs related to training, purchase of medications and consumable supplies, and costs for maintenance and repair of equipment and buildings. The proposal will also include for rental of 1,300 sq. ft. clinic facilities, one per 50,000 population and one CHRCC of 3,000 sq. ft. after excluding the facilities built under UPHCP-I in four city corporation areas—Dhaka, Chittagong, Kulna and Rajshahi. It is expected that the health facilities would be built within three years, and hence rent may be costed for 36 months only.

11.3 The Financial proposal should include a calculation of the cost per client to meet the required ESP coverage along with the applicable assumptions and qualifications. Other relevant efficiency ratios also may be included. The financial proposal should contain cost per unit of important units of service delivery—ANC, Delivery Care, ARI treatment, etc. It should also contain cost per unit of staff, cost of running PHCCC and CRHCC per day.

11.4 The Financial Proposal should be submitted in a separate sealed envelope, using the Partnership Agreement Budget Format - Form 6 and the Proposal Submission Format - Form 7 and 8 (Appendix 7). The Client will provide the Bidder with a detailed list of medical equipment and consumables (contraceptives, vaccines, medications, etc.) that will be provided by the UPHCP, MHFW or other sources (Appendix 6) and are not to be included in the Financial proposal.

11.5 Payments to the Contractor may be upward adjusted based on changes in the consumer price index for Bangladesh published in the ADB's Asian Development Outlook or Key Indicators of Developing Asian and Pacific Countries, only if price inflation greatly Draft 21

exceeds reasonable estimates. The need to adjust payments will be determined by the Client in agreement with the ADB.

11.6 Currencies of Bid. Bid prices shall be quoted in Bangladesh Taka.

11.7 The Partnership Agreement Budget Format Form 6, Appendix 6, provides detailed specification of budget items that must be included and minimal levels of expenditure/costing of critical items. It is expected that the format will guide preparation of the Financial Proposal.

11.8 Bids shall remain valid for a period of ninety days (90 days) from the date of bid closing.

11.9 The Financial Proposal should clearly estimate, as a separate amount, the local taxes (including income tax and VAT), duties, fees, levies, and other charges imposed under the applicable law of Bangladesh, on the Bidder and all staff, sub-contracts and their personnel. The total Financial Proposal should include the taxation and other charges as well as the overall operational costs of Project implementation.

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SECTION VI: THE BIDDING PROCESS

12.1 Format and Signing of Bid. The Bidder shall prepare one original of the Technical Proposal and one original of the Financial Proposal as described in ITB Clause 10 and 11 and clearly mark each “ORIGINAL - TECHNICAL PROPOSAL” and “ORIGINAL - FINANCIAL PROPOSAL”. In addition, the Bidder shall submit copies of the Technical Proposal and the Financial Proposal clearly mark them “COPY NO… - TECHNICAL PROPOSAL” and “COPY NO…. - FINANCIAL PROPOSAL”. In the event of any discrepancy between the original and the copies, the original shall prevail.

12.2 For bidders who submit bids for more than one Partnership Area, there must be a separate Technical Proposal for each Partnership Area. A separate Financial Proposal must be submitted for each Partnership Area for which the bidder would like to be considered, as well as a combined Financial Proposal for the combination of two Partnership Areas if they are awarded together.

12.3 The original and all copies of the Bid shall be typed or written in indelible ink and shall be signed by a person duly authorized to sign on behalf of the Bidder. This authorization shall consist of a power of attorney authorizing the signatory of the bid to commit the bidder and shall be attached to the Bid. The name and position held by each person signing the authorization must be typed or printed below the signature. Bids submitted by an existing or intended JV shall include an undertaking signed by all parties (i) stating that all parties shall be jointly and severally liable, and (ii) nominating a Representative who shall have the authority to conduct all business for and on behalf of any and all the parties of the JV during the bidding process and in the event the JV is awarded the Contract, during contract execution.

12.4 Any interlineations, erasures, or overwriting shall be valid only if they are signed or initialled by the person signing the Bid.

12.5 The Technical and Financial Proposal(s) must follow the format indicated in Sections V (Clause 10 and 11).

12.6 All Financial Proposals shall be in Bangladeshi Taka, with the equivalent US Dollars indicated for comparison purposes only, at the current prevailing exchange rate (which should be specified).

12.7 Bids shall remain valid for a period of 90 days after the date of bid closing.

12.8 The deadline for submission of bids will be ??November, 2005. At any time prior to the deadline for submission of bids, the Client may, for any reason, whether at its own initiative or in response to a clarification requested by a prospective bidder, modify the bidding documents by issuing addenda.

12.9 Any addendum issued shall be part of the bidding documents, and communicated in writing or by fax to all clients of bidding documents. Prospective bidders shall acknowledge receipt of each addendum in writing by letter or fax to the Client. There will be no charge to bidders for any Addenda that may be issued.

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12.10 To afford prospective bidders reasonable time in which to take an addendum into account in preparing their bids, the Client may extend the deadline for submission of bids. If the deadline is extended, the new deadline shall be applicable for all bidders.

12.11 The bidder or a designated representative is invited to attend meetings that may be held to answer questions and clarify issues with regard to the bid. Bidders will be informed about such meetings and their timing and venue at least two weeks in advance. Non- attendance at meetings will not be a cause for disqualification of a bidder.

12.12 Bidders are requested to submit any questions in writing, by email or by fax so that they reach the Client prior to the meeting.

12.13 Minutes of the meeting(s), including the text of the questions raised and the responses given, will be transmitted within one week to all clients of the bidding documents. Any modification of the bidding documents which may become necessary as a result of the information meeting shall be made by the Client exclusively through the issue of an Addendum pursuant to Clause 5 and not through the minutes of the information meeting.

SUBMISSION AND OPENING OF BIDS

12.14 The original Proposal Submission Format (Form 7 and 8) and accompanying documents clearly marked "Original", plus 10 (10) copies must be received by the Client at the date, time, and place indicated in section 11.20. In the event of any discrepancy between the original and the copies, the original shall govern.

12.15 The original and all copies of the Bid shall be typed and shall be signed by the bidder or a person or persons duly authorized to sign on behalf of the bidder. Such authorization shall be indicated by written power-of-attorney accompanying the Bid. All pages of the Bid, except for unamended printed literature, shall be initialed by the person or persons signing the Bid. The name and position held by each person signing must be typed or printed below the signature

12.16 The bid shall contain no interlineations, erasures or overwriting except as necessary to correct errors made by the bidder, in which case such corrections shall be initialed by the person or persons signing the Bid.

12.17 The bidder shall seal the original copy of all the Technical Proposal(s) in one envelope clearly marked as "ORIGINAL-TECHNICAL PROPOSAL". The bidder shall seal the original copy of all Financial Proposal(s) in one envelope clearly marked as "ORIGINAL- FINANCIAL PROPOSAL". These proposals shall then be placed in one envelope marked "ORIGINAL". The address of the Client as stipulated in 12.19 as well as the address of the bidder shall be clearly marked on the outside of the envelope. The envelope should be sealed.

12.18 The bidder shall follow the same process for "COPY NO.1 TECHNICAL PROPOSAL" AND "COPY NO.1 FINANCIAL PROPOSAL", and place these proposals in an envelope clearly marked as "COPY NO.1". This process shall be followed for each submitted copy.

12.19 The original bid and 10 (ten) copies should be submitted to reach the following address not later than ?? November 2005, 15:00 hours (Dhaka time) to: 24 Draft

The Project Director, Second Urban Primary Health Care Project (UPHCP-II) Project Management Unit (PMU) Room #620, Nagar Bhavan Fulbaria, Dhaka Bangladesh Tel: 9667791 Tel/Fax: 9667792 E-mail: [email protected]

Bid reference Number "Loan No. ______]"

12.20 If all envelopes are not sealed and marked as required, the Client will assume no responsibility for the misplacement or premature opening of the bid.

12.21 Deadline for Submission of Bids

12.21.1.Bids must be received by the Client at the address and no later than the date and time indicated in the 12.19.

12.21.2.The Client may, at its discretion, extend the deadline for the submission of Bids by amending the Bidding Document, in which case all rights and obligations of the Client and Bidders previously subject to the deadline shall thereafter be subject to the deadline as extended.

12.22 Late Bids. The Client shall not consider any Bid that arrives after the deadline for submission of Bids, in accordance with ITB Clause 12.19. Any Bid received by the Client after the deadline for submission of Bids shall be declared late, rejected, and returned unopened to the Bidder.

12.23 Withdrawal, Substitution, and Modification of Bids

12.23.1.A Bidder may withdraw, substitute, or modify its Bid after it has been submitted by sending a written Notice, duly signed by an authorized representative, and shall include a copy of the authorization. The corresponding substitution or modification of the bid must accompany the respective written notice. All Notices must be:

(a) submitted in accordance with ITB Clauses 12.14 and 12.17 (except that Withdrawal Notices do not require copies), and in addition, the respective inner and outer envelopes shall be clearly marked “Withdrawal,” “Substitution,” “Modification”; and (b) received by the Client prior to the deadline prescribed for submission of bids, in accordance with ITB Clause 12.19.

12.23.2.Bids requested to be withdrawn in accordance with ITB Sub-Clause 12.23.1 shall be returned unopened to the Bidders.

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12.23.3.No Bid shall be withdrawn, substituted, or modified in the interval between the deadline for submission of bids and the expiration of the period of bid validity specified in ITB Clause 12.7 or any extension thereof.

12.25 Bid Opening

12.25.1.The Client shall conduct the opening of Technical Proposals in the presence of Bidders’ representatives who choose to attend, at the following address on ?? November 2005 at ?? time.

Second Urban Primary Health Care Project (UPHCP-II) Conference Room Project Management Unit (PMU) Room #620, Nagar Bhavan Fulbaria, Dhaka Bangladesh

12.25.2.The Financial Proposals will remain unopened and will be held in custody of the Client until the time of opening of the Financial Proposals. The date, time, and location of the opening of Financial Proposals will be advised in writing by the Client.

12.25.3.First, envelopes marked “WITHDRAWAL” shall be opened, read out, and recorded, and the envelope containing the corresponding Bid shall not be opened, but returned to the Bidder. No Bid shall be withdrawn unless the corresponding Withdrawal Notice contains a valid authorization to request the withdrawal and is read out and recorded at bid opening.

12.25.4.Next, outer envelopes marked “SUBSTITUTION” shall be opened. The inner envelopes containing the Substitution Technical Proposal and/or Substitution Financial Proposal shall be exchanged for the corresponding envelopes being substituted, which are to be returned to the Bidder unopened. Only the Substitution Technical Proposal, if any, shall be opened, read out, and recorded. Substitution Financial proposals will remain unopened. No envelope shall be substituted unless the corresponding Substitution Notice contains a valid authorization to request the substitution and is read out and recorded at bid opening.

12.25.5.Next, outer envelopes marked “MODIFICATION” shall be opened. No Technical Proposal and/or Financial proposal shall be modified unless the corresponding Modification Notice contains a valid authorization to request the modification and is read out and recorded at the opening of Technical Proposals. Only the Technical Proposals, both Original as well as Modification, are to be opened, read out, and recorded at the opening. Financial proposals, both Original as well as Modification, will remain unopened.

12.25.6.All other envelopes holding the Technical Proposals shall be opened one at a time, and the following read out and recorded : (a) the name of the Bidder; 26 Draft

(b) whether there is a modification or substitution; and (c) any other details as the Client may consider appropriate.

Only Technical Proposals and alternative Technical Proposals read out and recorded at bid opening shall be considered for evaluation. No Bid shall be rejected at the opening of Technical Proposals except for late bids.

12.25.7.The Client shall prepare a record of the opening of Technical Proposals that shall include, as a minimum: the name of the Bidder and whether there is a withdrawal, substitution, modification, or alternative offer. The Bidders’ representatives who are present shall be requested to sign the record. The omission of a Bidder’s signature on the record shall not invalidate the contents and effect of the record. A copy of the record shall be distributed to all Bidders.

12.25.8.At the end of the evaluation of the Technical Proposals, the Client will invite bidders who have submitted substantially responsive Technical Proposals and who have been determined as being qualified for award to attend the opening of the Financial proposals. The date, time, and location of the opening of Financial proposals will be advised in writing by the Client. Bidders shall be given reasonable notice of the opening of Financial proposals.

12.25.9.The Client will notify Bidders in writing who have been rejected on the grounds of being substantially non-responsive to the requirements of the Bidding Document and return their Financial proposals unopened.

12.25.10.The Client shall conduct the opening of Financial proposals of all Bidders who submitted substantially responsive Technical Proposals, in the presence of Bidders` representatives who choose to attend at the address, date and time specified by the Client. The Bidder’s representatives who are present shall be requested to sign a register evidencing their attendance.

12.25.11.All envelopes containing Financial proposals shall be opened one at a time and the following read out and recorded : (a) the name of the Bidder (b) whether there is a modification or substitution; (c) the Bid Prices, including any discounts; and (d) any other details as the Client may consider appropriate.

Only Financial proposals, discounts, and alternative offers read out and recorded during the opening of Financial proposals shall be considered for evaluation. No Bid shall be rejected at the opening of Financial proposals.

12.25.12.The Client shall prepare a record of the opening of Financial proposals that shall include, as a minimum: the name of the Bidder, the Bid Price (per PA if applicable), any discounts. The Bidders’ representatives who are present shall be requested to sign the record. The omission of a Bidder’s signature on the record shall not invalidate the contents and effect of the record. A copy of the record shall be distributed to all Bidders. Draft 27

SECTION VII: EVALUATION OF BIDS 13.1 Confidentiality

13.1.1 Information relating to the examination, evaluation, comparison, and postqualification of Bids, and recommendation of contract award, shall not be disclosed to Bidders or any other persons not officially concerned with such process until information on Contract award is communicated to all Bidders.

13.1.2. Any attempt by a Bidder to influence the Client in the examination, evaluation, comparison, and postqualification of the Bids or Contract award decisions may result in the rejection of its Bid.

13.1.3 Notwithstanding ITB 13.1.2, from the time of opening the Technical Proposals to the time of Contract award, if any Bidder wishes to contact the Client on any matter related to the bidding process, it should do so in writing.

13.4 The evaluation committee will be formed by the Ministry of LGRDC, according to UPHCP-II criteria. It will consist of individual members selected on basis of their technical qualifications. The grounds for selection are knowledge of the primary health care field, the different institutional structures and recent developments in Bangladesh in this area. The members will include staff of the City Corporation Health Department, the Ministry of Health and Family Welfare, the UPHCP-II PMU, the MOLGRDC, multilateral organizations and prominent NGOs. The evaluation committee members will determine whether the proposals are technically responsive according to pre-established written evaluation criteria. All bidders who achieve a minimum score will be considered technically responsive, as determined below.

13.5 The Client may conduct clarification meetings with each or any bidder to request clarification of issues that are raised when evaluating the Technical Proposal. However, no changes in the technical proposal may be made at this time.

13.6 A Technical Proposal Score will be given by each member, of the technical Evaluation Committee, using the point system specified in Appendix 1, which will be expanded to create a Technical Proposal scoring sheet on which all bidders and scoring criteria will be listed.. The Technical Proposal Score for a proposal will be the mean of the Technical Proposal Scores given for the specific proposal, by committee members. To be deemed technically responsive, the mean score for each section of the evaluation (Prior Experience, Quality of Staff, and Project Plan) must be at least 50% of the total score possible for each section, and the total mean score must be at least 60% of the total score possible for the Technical Proposal. This score will be defined as the Minimum Score to be Technically Responsive.

13.7 All Technical Proposals that achieve minimum score will be ranked in order of highest to lowest scores. The Evaluation Committee’s recommended ranking and Technical Proposals will be sent to ADB for their review and concurrence.

13.8 All financial proposals of bidders, who have reached the minimum score, will be opened by the evaluation committee. The bidders will be ranked according to the price they offer: the lower the bid the higher the ranking. The Financial Proposals for all bids which meet 28 Draft

the Minimum Score to be Technically Responsive will be opened in public. All technically responsive bidders will be notified of the date on which the Financial Proposals are to be opened, and are welcome to send a representative. This date is tentatively set at ?? December 2005, 15:00 but is subject to confirmation.

13.9 The Technical Proposal Score and the Financial Proposal will be used to calculate a Best Responsive Bid score, as described in Appendix 1. The bid that results in the highest Best Responsive Bid score will be offered the opportunity to enter into the Contract with the Client. Where more than one bid receive the same Best Responsive Bid score, the one with the highest Technical Proposal Score will be awarded the Contract.

13.10 The final selection of contractors will be subject to the approval of LGD and ADB. The Evaluation Committee report on the highest evaluated responsive bid and recommendations for awarding Partnership Agreement contracts will be sent to ADB for concurrence and to the MLGRD&C for clearance.

13.11 Where there are decisions regarding awarding Contracts for individual Partnership Areas versus Contracts for combinations of Partnership Areas, the Client reserves the right to make the choices which result in the highest overall Best Responsive Bid score for the group(s) of Partnership Areas being considered.

13.12 In case there is only one technically responsive bid for a particular Partnership Area, the bidder may be offered the opportunity to enter into immediate negotiation with the Client, provided that the Financial proposal is comparable to that of the winning bidder of a similarly sized Partnership Area.

13.13 A proposal will be treated as non-responsive (i) if any of the items requested in Sections I to VI above are omitted or not complied with; (ii) if in the opinion of the Client, such omissions and non-compliance will preclude the proposal from being evaluated in terms of the approved evaluation criteria, on the same basis and in direct comparison with other competing proposals. In addition to other possible items, the following requirements are specified: (a) Bidders and personnel from ADB member countries (b) GOB Registration Certificates (c) Prior 5 years experience working in Bangladesh (d) Minimum $100,000 value of annual work last 3 years (e) Audit Reports, last 3 years (f) Fraudulent and Corrupt Practices information and prevention (g) Signed CVs; (h) Expert proposed who is not a national of an ADB member country (i) Expert not certifying that information contained in the CV is accurate; (j) General information not provided (Form 1) (k) Financial Information not provided (Form 2) (l) Scope of Proposal missing sections, topics or requirements (m) Implementation Plan not following specifications and requirements • Organization Chart • GANTT Chart • Planned Purchases • Y2K compliance Draft 29

(n) Financial Proposal Format followed and all Information provided (o) Budget Format followed (p) Bid submitted in two sealed envelopes

13.14 Since the selection will be undertaken on a competitive basis, changes in the personnel proposed following evaluation of the Technical Proposals will only be allowed if the replacement person has equivalent or better qualifications and experience, and with concurrence of both the Client and the ADB. The Client reserves the right to immediately consider appointment of the next-ranked proposal if substitution personnel in the first-ranked proposal do not meet these criteria.

30 Draft

SECTION VIII: AWARD OF CONTRACT

14.1 The Client will award the Contract(s) to the bidder who has offered the Best Responsive Bid at the lowest price in accordance with the integrated scoring system described in Appendix 1. The Client may consider the Best Responsive Bid either singly for each Partnership Area, or in combination, where a bidder has submitted a bid for more than one Partnership Area.

14.2 The Client reserves the right to accept or reject any bid, and to annul the bidding process and reject all bids, at any time prior to award of Contract, without thereby incurring any liability to the affected bidder(s) or any obligation to inform the affected bidder(s) of the grounds for the Client's action.

14.3 Prior to expiration of the period of bid validity prescribed by the Client, the Client will notify the successful bidder by fax, confirmed by International Courier or registered letter, that its bid has been accepted. This Letter of Acceptance shall name the sum that the Client will pay the Contractor for execution of the works by the Contractor as prescribed by the Contract.

14.4 Upon successful agreement of terms of the Contract, worked out in the Final Approved Technical Proposal with Implementation Plan, the Client shall within one week inform the other Contractors that their proposals have not been selected.

14.5 The selected Contractor is expected to commence the Assignment on the date and at the location agreed to in the Contract.

Signing of Contract

14.6 Promptly after notification, the Client shall send to the successful Bidder the Agreement and the Special Conditions of Contract.

14.7 Within twenty-eight (28) days of receipt of the Agreement, the successful Bidder shall sign, date, and return it to the Client.

14.8 Failure of the successful Bidder sign the Contract shall constitute sufficient grounds for the annulment of the award. In that event the Client may award the Contract to the next lowest evaluated Bidder whose offer is substantially responsive and is determined by the Client to be qualified to perform the Contract satisfactorily.

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APPENDICES

APPENDIX 1: EVALUATION CRITERIA FOR TECHNICAL AND FINANCIAL PROPOSALS

A. General

1.1 Bidder’s qualifications will be examined to determine whether the Proposals are technically responsive according to pre-established written evaluation criteria. Only the Technical Proposals of qualified Bidders will be evaluated by the Tender Evaluation Committee (TEC). The Client may conduct clarification meetings with each or any bidder to request clarification of issues raised when evaluating the Technical Proposal. However, no changes can be made to the Technical Proposal at this time. A Technical Proposal Score (TPS) will be given by each member of the TEC, using detailed “marking criteria” based on the point system described in this section. The TPS for a proposal will be the mean of the TPS given for the specific proposal by TEC members. To be deemed technically responsive, the mean score for each section of the evaluation (prior experience, quality of staff, and project plan) must be at least 50% of the total score possible for each section, and the total mean score must be a least 60% of the total score possible for the Technical Proposal. This score will be defined as the minimum score to be technically responsive. All technical proposals that achieve the minimum score will be ranked in order of highest to lowest score. The TEC’s recommended rankings and the technical proposals will be sent to MOLGRDC and ADB for review and concurrence.

1.2 After the technical proposal assessment, all financial proposals of bidders who are deemed ‘technically responsive’ will be opened by the TEC in public. The bidders will be ranked according to the price they offer; the lower the bid, the higher the ranking. All technically responsive bidders will be notified of the date and time on which the financial proposals are to be opened, and may send a representative.

1.3 The technical proposal score and the financial proposal score will be used to calculate a ‘Best Responsive Bid’ score. For each Partnership Agreement, the bid that results in the highest ‘Best Responsive Bid’ score will be offered the opportunity to sign a contract with the Client. Where more than one bid receives the same Best Responsive Bid score, the one with the highest technical proposal score, will be awarded the contract. Final selection of contractors will be subject to the approval of LGD and ADB. In cases where there is only one technically responsive bid for a PAA, the bidder may be offered the opportunity to enter into immediate negotiation with the Client, provided that the Financial Proposal is comparable to that of the winning bidder for a PAA with a similar size population.

B. Evaluation of Technical Proposals

1.4 Proposal’s will be evaluated on the basis of 100 possible points for the Technical Proposals and 100 possible points for Financial Proposal for a total of 200 possible points. The following criteria will be used to evaluate the Technical Proposals.

32 Draft

1.5 Scoring of the Technical Proposal. The following criteria will be used to evaluate the technical proposals:

Table: Criteria for Evaluation of Technical Proposal Component/Subcomponent Points A. Prior Experience of Partner Relevant to this Project 30 1. PHC system administration(Provision of PHC services in Bangladesh), 10 management, and/or implementation 2. Implementation of quality assurance strategies: supervision, training, patient or 5 service quality review 3. Experience with health care financing: cost recovery, cross subsidies, community 5 financing, insurance plans 4. Experience in UPHCP-I or similar external-donor-funded large-scale health 7 projects serving women, the poor, and the very poor in urban areas 5. Experience of UPHCP-I or similar external-donor-funded projects having 3 provided services in the same partnership agreement area

B. Quality of Technical Consultant Staff 30 1. Overall background and experience of proposed technical consultant staff and 10 permanent health specialist staff on NGO payroll

2. Background and experience and recommendations of the proposed project 20 manager

C. Project Plan 40 1. Plan to provide PHC services and increase population coverage in the 20 partnership area (25 points) 2. Quality of service. Plans for supervision and monitoring, staff training, strategies 15 for ensuring that necessary drugs and supplies will be available to provide services and monitoring mechanisms (15 points) 3. Strategies for health care financing to achieve sustainability: cost recovery, cross 5 subsidies, community financing, insurance plans, etc. NGO = nongovernment organization, PHC = primary health care, UPHCP-I = Urban Primary Health Care Project (the first one).

C. Notes on Evaluation of Technical Proposal

1.6 Prior Experience. A special weighting is given to organisations which have worked in the PAA before, as they will have gained knowledge of the area, an understanding of its current systems, contacts with the community, have systems for management and control, and be aware of needed health care delivery improvements which are required and package, target, standards and strategies followed earlier.

1.7 Bidders must be able to outline the management systems they have in place including regular Management Information Systems (MIS) reporting, Quality Assurance (QA) systems, and outline how both clinical and management standards are maintained through routine reporting, visits, skill upgrading, regular reviews of service quality. In addition, reference should be made to addressing gender and equity issues, staff development, performance review and monitoring and innovations. Draft 33

The proposal should clearly state how the bidder will ensure pro-poor targeting. The partnership agreements will ensure that at least 30% of each service will be provided free to the poor, who will be identified through participatory poverty assessments and household listings conducted by the partner NGO. Pro-poor targeting will be an important aspect of the performance-based contracting. The poor will be provided free services, including free medicines. A baseline survey will be conducted by the partner NGO at the beginning of the partnership agreement to identify poor households in the partnership area. Poor households will be identified based on the social and economic indicators above. These households will be given entitlement health cards giving them free access to health services under the Project. The survey of the poor households will be updated annually. The partner NGOs will keep systematic records on the patients by poverty and gender, and will prepare quarterly reports of health service use by the poor, women, and adolescents.

1.8 Quality of Technical Staff. CVs of key staff must be provided, together with an outline of the suitability of these consultants for the UPHCP-II II work.

1.9 Project Plan, Understanding of Local Needs, Overall Approach. Bidders must show a clear understanding of the needs of the partnership area, as well as an understanding of the broader urban health context in Bangladesh. There is opportunity for the bidders to provide additional health services beyond those mandated by the ESP. These should be outlined in the tender document, together with the associated costs for adding on’ these elements of service delivery. Bidders should outline also how standards will be maintained, in both organisational and clinical areas, and how this is linked to monitoring and evaluation, and staff development and appraisal.

1.10 Ranking of Technical Bids. Detailed “MARKING CRITERIA”, i.e., a technical proposal scoring sheet has been prepared based on the detailed marking criteria, described above, which will be used by each member of the Tender Evaluation Committee to assess the PA technical proposals that have been submitted. Each member of the TEC will rank each tender on the above criteria. These scores will then be averaged, and the list of all tenderers will then be ordered with the bidder with the score closest to 100 ranked first, and so on.

2. Scoring of the Financial Proposal

1.11 Financial Proposals will be assessed on the completeness of the budget, prepared in accordance with the format provided in Appendix 7, Form 6, and on the adequacy of provision for all the services that are included in the implementation plan. Minimal levels are indicated in the detailed Budget Format, based on comparable projects in Bangladesh.

1.12 The following formula will be used to generate the financial score: the lowest-priced financial proposal for a particular partnership agreement area (among the technically responsive bids for that area) will be divided by the bidder’s financial proposal multiplied by 100 possible points to obtain the financial score of the specific bidder. The technically qualified bidder with lowest financial proposal would get a financial score of 100 points.

1.13 Example: 34 Draft

• Financial Proposal = Tk 117,000,000 • Lowest Financial Proposal among technically responsive bidders for that Partnership Area = Tk 72,000,000 • Total Financial Score would be: 72,000,000 ------= 0.61538 X 100 = 61.538 points 117,000,000

Total score for the bidders proposal will be calculated as follows:

Total points for the bidders Technical Proposal will be added to the total points for the bidders Financial Proposal, as described above. The heist evaluated proposal is that which comes closest to 200 possible points.

Example:

Technical Score= 76 points; Total Financial Score= 61.538

Total Score = 76 plus 61.5 = 137.5 out of 200 possible points

When Bids are submitted for more than one Partnership Area the Evaluated Bid will be calculated for each Partnership Area individually, using the technical evaluation and budget which was proposed by the Contractor. Also, the combined price will be calculated for each candidate which has bid for more than one Partnership Areas. The combined price will be compared with the price of the cheapest two individual bids and if it is lower, the contract will be awarded to the lowest combined offer. Draft 35

MARKING CRITERIA SHEETS Part 1: Qualification of Firm for Responsiveness

Name of Firm: ______

QUALIFICATION CRITERIA Submitted Yes No 1. Evidence of having implemented projects with a total annual value of US$100,000 during each of the past three years 2. Evidence of sound accounting practices (Audit reports for previous 3 years) 3. Evidence of no consistent history of litigation or arbitration awards against company or associated organizations. 4. Evidence of 8 years experience working with health-related activities?

5. Evidence of 5 years experience working with health-related activities in Bangladesh 6. Evidence of prior strong social mobilization activities and large scale health programs 7. Evidence of strong institutional capacity and health officer on permanent staff 8. Registration with an appropriate agency and entitled to work in Bangladesh 9 General information provided according to Form 1 10. Financial Information provided according to Form 2 11. Experience Information provided according to Form 3 12. Power of Attorney from all firms bidding as a consortia authorizing one firm to act on their behalf as the Principal Bidder, and a copy of the consortia agreement. 13. Signed CVs of key staff 14. Implementation Plan specifications and requirements 15. Proposed personnel/staff and staffing schedule 36 Draft

Part 2: Assessment of Qualified/Responsive Proposals

NAME OF EVALUATOR:______Evaluation Criteria Maximum Firm 1 Points A. Prior experience of Contractor relevant to this project (Based on Form 3) – 30 points

1. PHC System administration, management, and/or implementation (10 points) 10 Rating Indication: (a) total responsibility for PHC program- 10; (b) service delivery responsibility only- 8; (c) administrative/ management responsibility only- 6; (d) partial/shared responsibility (pro rata)- 2. Implementation of quality assurance strategies: supervision, training, patient or 5 service quality review (5 points) Rating Indication: (a) implementation of protocol-based quality assurance and control system (protocol attached)- 5; (b) implementation of quality assurance program –3; (c) partial/shared implementation (pro rata) 3. Experience with health care financing: cost recovery, cross-subsidies, 5 community financing, insurance plans (5 points) Rating Example: (a) implementation of program reaching the poor and the very poor report annexed mentioning year of the report)– 5; (b) implementation of program reaching the poor (report annexed mentioning year of the report) – 3; (c) partial/shared experience (pro rata) 4 Experience in UPHCP-1 or external donor funded large-scale health project(7 7 points) Rating Example*: (a) successful implementation of UPHCP-1 or similar project-7; (b) partially satisfactory implementation of UPHCP-1 project- 5; not so satisfactory implementation of UPHCP-II 1 - 2 5 Provided health services in the same partnership agreement area either under 3 UPHCP-1 or similar project (3 points) Sub- total (score) - A B. Quality of Technical Consultant staff – 30 points

1 Overall Background and experience of proposed Technical Consultant staff 10 and permanent health specialist staff on NGO payroll (10 points) Rating Indicative: (a) experience in management of CRHCC or similar facility - - 3 points; (b) experience as PHCC manager or similar facility -- 2 points; (c) experience of providing medical/technical/consultancy services in CRHCC or similar facility (3); (d) experience of providing medical/technical services in PHCC or similar facility (2) (score will be on a pro rata basis, based on the number of suggested PHCC managers who have previous experience); (e) 2 Background and experience and recommendations of the proposed Project 20 Manager - (20 points) Rating Indicative: (a) very successful prior experience of managing PHC project- 10; (b) successful prior PHC project management experience- 7; (c) partially successful PHC project management experience – 5; (d) not so successful PHC project management experience - 3

Sub- total (score) - B C Project Plan - 40 points

1 Plan to provide PHC services and increase population coverage in the Partnership Area - (20 points)

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Evaluation Criteria Maximum Firm 1 Points (a) service delivery systems that seem to be effective for provision of 8 ESP ((i) additional elements of ESP package (ii) coverage (iii) cost containment/ management efficiency (iv) meeting and reporting (v) coordination (vi) involvement of the community (vii) appropriate referrals and (viii) other services to the community (b) Targeting services to the poor and the very poor in the community 3 ensuring that the poorest members of the community receive appropriate PHC services (c) Collaboration with other Health Care providers 1 (d) Gender, equity and other Cross-cutting issues 2 (e) Environmental issues – 1 point 1 (f) Proposed Service Delivery alliances – 1 points 1 (g) Organogram – 1 points 1 (h) Annual Implementation Plan – 2 points 2 (i) GANTT chart – 1 point 1 2 Quality of services: - (15 points) (a) Plans for supervision, monitoring, staff training, and staff deployment 5 points (b) Plans for strategies for ensuring that necessary logistics are available 3 to provide services (c) Plan to ensure client satisfaction 2 (d) Plan to ensure good governance and active participation of community 5 in the management of health facilities 3 Strategies for health care financing to achieve sustainability: cost recovery, 5 cross subsidies, community financing, insurance plans, etc.

Sub- total (score) - C

Total (score): A+B+C

38 Draft

APPENDIX 2: TERMS OF REFERENCE FOR PARTNERSHIP AGREEMENTS A. Overview

2.1 The Government of the People’s Republic of Bangladesh has received a loan and grant from the Asian Development Bank (ADB) and grant co-financing from the Government of United Kingdom and the Government of Sweden towards the cost of the Second Urban Primary Health Care Project (UPHCP-II). In addition, United Nations Population Fund (UNFPA) is providing parallel cofinancing for the Project. The ADB contribution to the Project will be financed under Loan No. 2172-BAN (SF) and Grant 0008-BAN (SF). The Local Government Division (LGD) of the Ministry of Local Government Rural Development and Cooperatives (MOLGRDC) is the Executing Agency for the Project, which is implemented by the Health Departments of the City Corporations of Dhaka, Chittagong, Khulna, Rajshahi, Sylhet, Barisal and Municipalities of Bogra, Comilla, Sirajgonj, Madhabdi and Savar. Part of the proceeds of this loan/grant will be applied to payments for six-year for city corporation areas of Dhaka, Chittagong, Khulna, Rajshahi, Sylhet, Barisal and five and half years for municipal area of Bogra, Comilla, Sirajgonj, Madhabdi and Savar for contracts (Partnership Agreements) to provide specified primary health care health services for the population of Partnership Agreement Areas (PAA). UPHCP-II is expected to close in December 2011.

2.2 The UPHCP-II, on behalf of the Local Government Division of the Ministry of Local Government, Rural Development and Cooperatives, the executing agency for this project, will contract out the delivery of a defined package of primary health care services to specific urban partnership areas. Based on the “essential services package” (developed for the national Health Nutrition and Population Sector Program) the government has defined objective standards for a contractor to meet that are consistent with the MOHFW national program guidelines. The Contractor will develop and implement a system ensuring the provision of these specific health services and the achievement of specific levels of improvement in coverage and quality by the end of three years.

2.3 The Contractor will ensure that the specified health services, based on the national Essential Service Package (ESP) are provided and achieve the indicated levels of community coverage and quality of health services. The ESP consists of:

(i) Reproductive health care (ii) Child health care (iii) Communicable Disease Control (iv) Limited Curative Care (v) Behavior Change Communication

2.4 The SCOPE OF WORK (Appendix 3) of this document provides details on services to be provided in the Partnership Areas, both at Primary Health Care and Maternity Centers and through outreach. The Partnership Agreement Objectives (Appendix 4) defines the levels of achievement to be reached. Available national standards and protocols endorsed by the Ministry of Health and Family Welfare (MOHFW) are to be followed in providing the services.

Draft 39

2.5 All national initiatives (e.g. national immunization days, polio eradication campaign, Vitamin A Capsule Distribution, etc.) of the MOHFW will be supported by the Partnership Agreement. In the case of a new national health initiative, Partners will be required to deliver the new services in addition to those specified in their Partnership Agreements. An estimate of the additional cost to provide the new services will be provided to the City Corporations and the ADB by the Partner and will be reviewed during the annual review of costs. The Contractor will ensure that the national program technical protocols and guidelines for each of the programs are followed.

2.6 The Contractor will fulfill the program objectives by fielding and managing field and clinic-based staff, providing medications, vaccines, micro-nutrients, contraceptives and other supplies, and by developing and implementing appropriate project systems through which the services will be provided. Contraceptives and some other supplies will be supplied through the MOHFW logistics system.

2.7 Location of CHRCCs and PHCCs will be as advised by the UPHCP-II for rented buildings in new PA areas. The UPHCP-II will support the construction of health care facilities, and it is planned that there will be one center for every 50,000 population in those partnership areas where no facilities have been built under UPHCP-I. However, in most cases, newly constructed facilities will not be available for the Partners use at the beginning of the Partnership Agreements in the new areas of UPHCP-II—Sylher, Barisal, and five municipal towns. Partners will be required to lease facilities, approved by the Client, for use as primary health care centers, until the newly constructed facilities are available in these areas and those areas of UPHCP-I where no facilities were constructed in UPHCP-I for lack of land. Once newly constructed facilities are available in the Partnership Areas, the Partners will be granted use of these facilities solely for the delivery of health care services, free of rent. Maintenance of the building will be the responsibility of the Partner. Good maintenance of City Corporation buildings will be included in the composite index used to measure PA performance. At the conclusion of the agreement, the Partner will turn the health care building over to the City Corporation in good condition, with allowance for normal wear and tear.

2.8 The ground floor of one PHCC in each Partnership Area will be made available as the administrative office for the contractor. The PHCC chosen should be in a less commercial area. The estimated rental for this office will be included in the financial proposal. During the period before the UPHCP-constructed facility is available, the contractor should rent alternative premises of approximately the same size.

2.9 Partners will consult with the City Corporations, which will develop a simple method of referral of patients to hospitals and counter-referral to partnership health services, which will be used by the Partners. Such a system may involve color-coded forms for use by the Partners that ensures that referred patients are well received at the hospital and that a proper counter-referral note is made. For each service where referral will take place procedures will be established to verify, in the course of project monitoring that referrals were made and that referred patients received appropriate treatment. Establishment of the referral system will be the responsibility of the partners.

2.10 The Contractor will follow Government of Bangladesh Labor Laws

2.11 The Contractor will report to the UPHCP-II PIU, at the City Corporation, which is responsible for contract administration and management. Periodic monitoring will be 40 Draft

conducted by the City Corporation Health Department working with the PIU to ensure contract compliance.

2.12 A composite index of health system performance will be developed based on the Objectively Verifiable Indicators (Partnership Area Objectives - Appendix 4) as described in Appendix 5, Performance Evaluation. The Index will be used to determine overall contractor performance and eligibility for project bonuses. After three years, a mid-term evaluation will be conducted. This will be used to determine Partnership results and eligibility for contract bonuses. An evaluation at the completion of the contract will determine the levels of achievement of the contractor, using a controlled before-and- after design.

2.13 The final evaluation will follow the same methodology used for the baseline survey, where household survey responses are used to measure community coverage and facility surveys, qualitative surveys and health system reports and indicators are used to measure service delivery and system development results. The UPHCP-IIwill determine whether bonuses will be paid and the size of the bonuses in the partnership Agreement.

2.14 The Contractor will provide all necessary support and assistance for independent evaluations of the project and the Partnership Area. A list of anticipated data collection exercises follows. This list is not exclusive: if required in the course of activities, the Client may decide to carry out additional research.

(i) A baseline survey will be conducted, to measure coverage, with two follow-up surveys within the contract period.

(ii) The Quality of Care of services delivered will be measured through a survey of the health facilities and through household surveys.

(iii) A continuous record keeping will be required at each service outlet, using monitoring forms provided by the Client, in agreement with the Health Information System applied by the MOHFW. Complementary information, such as that referring to violence against women will be provided, including all items mentioned in the Scope of Work and Partnership Area Objectives. These data (which together form the UPHCP-IIHealth Service Information System) will be included in the quarterly reports.

(iv) After three years, a mid-term evaluation will be conducted to determine performance levels.

(v) An evaluation at the completion of the contract will determine the levels of achievement of the contractor. The final evaluation will follow the same methodology used for the baseline survey, where household survey responses are used to measure community coverage and health system reports and surveys are utilized for quality of care indicators.

(vi) Independent surveys will be held to obtain information on specialized medical issues and on qualitative issues referring to knowledge and attitudes. Services which are feasible without a permanent Health Center building, (e.g. those which can be reasonably provided using an outreach approach, or community mobilization, awareness building etc.) will also be evaluated. Draft 41

(vii) An evaluation of costs and results will be conducted to provide recommendations to the City Corporation and the MOHFW regarding sustainability. Data on costs, user fees and other cost recovery measures will be needed for this analysis.

(viii) Financial information will be provided as part of the quarterly reporting cycle.

B. Contractor Responsibilities

2.15 The contractor will establish systems that facilitate service delivery and minimize existing problems. These may include developing more efficient systems to address the following: (i) Logistic Management (ii) Delivery of contraceptives, medications, equipment, and supplies to the point of service (iii) Eliminating shortages (stock-outs) of medications and other supplies (iv) Maintenance and repair of equipment, furnishings, and buildings. (v) Continuous Quality Assurance (vi) Management Information System (MIS) (vii) Cost Management (viii) Supervision and Monitoring (ix) Referral (x) Revenue Management (xi) Local Body and Community Coordination

2.16 All of these systems, sub-systems and mechanisms are to be functioning at the PA level, in contract operations, and are linked to larger systems functioning at City and national levels. Contractors will be responsible for the development, adaptation and design of the project level sub-systems, and for the linkage of those sub-systems to the larger systems. The Project (UPHCP) will provide technical assistance to develop the capacity of the PA contractors to implement these systems. The capacity of the client (the CCHD, and the LGD) also will need strengthening to support the PA contractors and to monitor implementation of the systems.

2.17 User fees, cross-subsidies, community financing, insurance plans, and other health financing systems should be introduced for all services, as agreed in the PA contract or later developed during implementation. Health Financing systems should be described and approved by UPHCP-IIand the revenue applied against project costs and reported separately in the quarterly financial reports,

2.18 The Contractor will ensure that the health care delivery system addresses the following concerns: (i) That the poorest, under-served, and most vulnerable within the target population receive health services (ii) That the coverage of the population in the catchment area meets the targets specified in the Partnership Area Objectives; (iii) That quality of services meet generally recognized professional standards. (iv) That cost, in relation to effectiveness, is addressed. In addition to other health financing strategies, a system for user fees must be introduced.

42 Draft

2.19 The Contractor will have sole discretion regarding hiring health service delivery and supervisory staff and all personnel matters. The Final Approved Technical Proposal with Implementation Plan will contain a list of staff, designations, and work locations. The Contractor also may present a time-schedule for staff mobilization, and may change staff designations from health service delivery or supervision to fulfill other requirements and hire new staff at different stages of project implementation, etc.

2.20 The Contractor will ensure that all UPHCP-II reporting requirements (Health Information System, Financial, etc) as well as specific reports required by the Contract are met.

2.21 The Contractor will ensure the availability at service delivery points of all medications, contraceptives and supplies required to provide the specified health services. Contraceptives and some other supplies will be made available through the MOHFW logistics systems. However, the Contractor is responsible for ensuring that the supplies are available at service delivery points and is responsible for making up any deficiencies in the logistics system. Purchase of medications and supplies, if necessary, will follow the “ADB Guidelines for Procurement” and be according to the list in Appendix 6.

2.22 The Contractor will purchase drugs and clinical supplies through pre-qualified suppliers identified by the UPHCP. Furniture for administrative offices and clinics will be purchased locally and included in the Contractors financial proposal.

2.23 The Contractor will ensure that health facility, equipment, and supplies, are maintained at a level which enables health services to be provided in a safe and effective manner.

C. Data, Services and Facilities to be provided to the Client and the Contractor

C.I. Data

The UPHCP-II will provide:

2.24 Access to maps and overall population figures on blocks and neighborhoods to be served by each health center. A map of the area of competence of the City Corporation, indicating the boundaries of the Partnership Area and (foreseen) locations of health facilities. These data will be updated when new information on maps or construction sites becomes available to the PIU.

2.25 Copies of all research reports referring to the Partnership Area, available with the client, carried out with or without the collaboration of the Contractor.

2.26 A list of items, to be provided by the UPHCP, MOHFW and other sources, so that their cost can be excluded from the contractor’s financial quotation, and provision for their use can be made in the project work plan;

2.27 A list of pre-qualified suppliers of drugs and clinical supplies which are to be purchased by the Contractor;

The Contractor will provide:

2.28 A list of existing health facilities within the Partnership Area of the Contractor, including services delivered there, and indicating services for which referral can take place. Where Draft 43

there is no referral center within the boundaries of the Partnership Area, the nearest facility outside its boundaries will be indicated.

2.29 Quarterly reports to the UPHCP-II following the format provided for quarterly financial reporting and for health service monitoring. Special attention will be given to any deviation from annual plans. These quarterly reports will contain (i) a retrospective component, giving details of the preceding quarter as with respect to service delivery, as well as expenditures, (ii) a prospective component, giving details of expected activities and financial developments over the following three months.

2.30 The Contractor will be required to cooperate with other health care providers and to report on health-related activities in the Partnership Area by other organizations. This includes Government, NGO, and private hospitals and clinics. The Contractor will be responsible for coordinating where possible and reporting on all health activities in the Partnership Area.

2.31 The contractor will provide annual financial reports to the PMU, following the UPHCP-II project format. This will include information on any contributions either in cash or kind, which may affect the provision of health care for the district.

2.32 The Contractor will provide access to financial and service delivery records, to enable monitoring of the project and financial audit. The Contractor will ensure that financial records meet generally accepted accounting standards.

2.33 The contractor will provide access to all facilities by UPHCP-II and its representatives and assignees, to enable monitoring of the Project.

2.34 Pro-poor targeting is an important aspect of UPHCP-II with at least 30% of the health services provided under UPHCP-II to be provided to clients from poor households be identified at the beginning through a household survey and updated annually. The contractor will ensure that this goal is met in their respective partnership agreement areas.

C.II. Policies/Standards/Protocols

The UPHCP-II will provide:

2.35 Access to copies of any relevant policies or laws.

2.36 Copies of protocols and guidelines which have been specified for specific disease conditions (Tuberculosis, Malaria, etc.) or national program based activities (Immunization, breast feeding etc.). Any additional protocols or national guidelines that are developed during the implementation of this contract also will be provided.

2.37 Copies of Health Information System reporting forms, and instructions on how they are to be maintained.

2.38 A Technical Assistance Expert in Management Development and Training to work with the Contractors to support and assist project implementation. 44 Draft

The Contractor will provide:

2.39 Supporting documentation for any situations where there is a dispute which requires the intervention of the UPHCP, following the guidelines in Appendix C4.

C.III. Facilities and Personnel

The UPHCP-II will provide:

2.40 The City Corporation Health Director will work with the Contractor to facilitate a smooth transition between the existing Health System, and the assumption of responsibility for health services by the Contractor.

2.41 UPHCP-II will provide the Health Centers, from which center-based services, can be provided. Many of these will only be constructed during implementation of this Project. The UPHCP-II will keep the contractor informed as to the progress of health center construction in the PA area. The Partner will coordinate with the UPHCP-II PIU at the City Corporation to ensure that the completion and commissioning of the health center is coordinated with work schedules and requirements of the Contractor.

2.42 Contraceptives, Vaccines, and Micronutrients will be provided through the MOHFW logistics system, and the UPHCP-II will assist the contractor in obtaining the timely supply of these items. However, the contractor retains complete responsibility for the availability of supplies necessary to implement project activities.

The Contractor will provide

2.43 The UPHCP-II will be informed when the contracts of any staff are terminated and new staff recruited. This information will form part of the quarterly project reports

2.44 An estimate of when equipment and supplies to be provided by the UPHCP-II will be required. Delivery dates and components will be agreed between the Contractor and the UPHCP.

2.45 An inventory of all project equipment, with the condition on receipt noted, and identification numbers marked on equipment, for ease of identification. Upon completion of the contract all equipment will be accounted for, with reasonable depreciation and wear and tear. All UPHCP-purchased equipment and durable goods remain the property of the UPHCP-II and the disposition of these will be determined after the completion of the contract.

D. Comprehensive Reproductive Health Care Centers (CRHCCs)

2.46 The client will construct/ provide CRHCCs (also called “maternity centers”) at least one per PA area. These centers (10 to 20 bedded approximately) will provide, in addition to ESP defined appendix 3, : (i) Normal delivery care (ii) Comprehensive Emergency Obstetric Care Draft 45

(iii) Management of neonatal complications (iv) All available clinical contraceptive methods including permanent methods (v) Selected laboratory tests (vi) Possible RH and other related interventions as required for the referred cases from the PHC centers.

2.47 UNFPA grant support will include costs of the following (In case UNFPA grant support is not available, the UPHCP-II will provide the support separately):

(i) Physical preparedness of the OT and related area; (ii) Equipment with installation and maintenance; (iii) RH related Training; (iv) RH related BCC activities; (v) Consumable supplies; (vi) Printing of forms and formats; and (vii) Limited emergency transports.

2.48 The Contractors will not include costs for items mentioned above in their financial proposal. All costs that are not mentioned under UNFPA grant support, should be included in the financial proposal. This would include hiring of a space of about 3000 sft to be used as CRHCC before UPHCP II constructs one. For an even comparison among bidders this has to be estimated for the entire period.

2.49 The contractor will include, in the technical proposal, a phasing in plan for inception, contractor inputs and for the service components to be provided from the maternity centers (CRHCCs). This plan should be approved by the client and the UNFPA and will be subject to revision if deemed necessary.

2.50 Respective City Corporations may operate one or more maternity center/s, in addition to the maternity center to be operated by the contractor.

2.51 The Client will arrange:

(i) One year full time residential training for the Medical Officers and nurses on EOC & anaesthesia and (ii) Short term training courses on: (iii) clinical contraceptives (iv) management of RTI/ STD (v) management (vi) BCC for different levels of service providers. (vii) Contractor’s obligations will be to plan and recruit appropriate staff and ensure minimum staffing prescribed for the center and to device mechanisms to retain staff after they are trained.

2.52 The client will provide drugs, consumable clinical supplies, lab reagents to the contractor. It will be the obligation of the client to make all contraceptives available to the maternity centers (CRHCCs).

2.53 The bidder will adhere closely to the guidelines provided in the bidding document, PA contract in matters not spelled out in this section. However, systems, mechanisms and 46 Draft

procedures regarding management of UNFPA grant support will be devised by the client subject to approval of the UNFPA.

PA Management and Specialist Staff: Terms of Reference

2.54 Project Manager, PA

2.54.1 Functions (i) Assist/contribute in designing, planning, implementing, monitoring and evaluating the project activities and also in developing future strategies by making recommendations. (ii) Monitor project activities and supervise the work of supervisee staff directly through regular field visit and providing on-site technical assistance (hand on training) (iii) Organize and facilitate monthly staff meeting to review progress and develop actions for further improvements and reach the contract conditions (iv) Preparation of the annual work plan with target (quality, coverage and goals), budget and project implementation report. (v) Introduce Individual Performance Management (IPM) system into the project and facilitate annual staff appraisal system in a participatory manner (vi) Attend the Project related meetings to get informed on project activities, strategies, policies and goals and seek inputs and directions (vii) Closely work with PIU, PMU and MSU to seek inputs to effectively implement the project activities as per set standards and strategies. (viii) Coordinate with other agencies/offices

2.54.2 Person specifications. Masters or higher level qualification in social sciences or public health with at least 7 years working experience in management in the same area. Preference will be given to candidates having working experience in any project involved in PHC service delivery. Experience in quality assurance monitoring and supportive supervision is highly desirable. Experience is desirable in behavioral change communication and poverty focused program implementation. Experience in urban health programming will be an added advantage for this position. A degree in medicine would get priority, provided other conditions have been fulfilled.

2.55 Clinic Manager (CRHCC & PHCC), PA

2.55.1 Functions

(i) Overall management of the centre (ii) Monitor activities and supervise the work of supervisee staff and provide on-site technical assistance (hands on training) (iii) Ensure overall cleanliness of the centre (iv) Assist/contribute in developing and or introducing QA system for providing quality services to the clients (v) Develop and implement a strategy to reach the poor and involve the community in the management of the clinic Draft 47

(vi) Ensure all other systems are in place and well functioning, e.g., management information, personnel management, logistics management, financial management etc. (vii) Closely work with the Project Manager and other key staff for smooth running of the centre (viii) Organize monthly management and technical staff meeting to review the progress in reaching the contract conditions and identify potential problems and develop actions for further improvements (ix) Coordinate with other service providers to establish functional linkages and referral system

2.55.2 Person specifications. The Clinic Manager should be a physician having MBBS degree; MPH would be strongly preferred. Experience in hospital management would be also preferred. A female physician would get priority. Should have 5 years experience as GP or clinic manager in private sector/NGO managed hospital/clinics.

2.56 Other Specialised Staff. Specialist Physician for CRHCC and Paediatrician for CRHCC have to have degrees/diplomas as that of at least a Junior Consultant in the public sector facilities. Preference for Lab. Tech., Para-medic and Nurse would be given to those who have equal qualification as those of similar staff in an Upazila Health Complex. The minimum qualification, other-wise, would be at least 3 years experience of working as such in a private hospital/clinic/laboratory, after SSC with at least 6 months of training in the respective field. Office Asst. cum Accountant would be at least a bachelor with some course in accounting. Ambulance driver should have at least five years experience of driving some heavy vehicle. One who has experience of driving an ambulance for at least 6 months would be preferred.

2.57 Minimum Salary and Pay . All Bidders are to ensure that members of staff implementing their program in the PAA are paid at or above GoB’s present minimum pay rates including all benefits (house rent, allowances for: transportation, uniform, medical service, insurance, festival etc. where applicable) plus 5 % above the relevant basic salary to cover gratuity/ pension benefits given in the public sector. Yearly increment might be from 5 to 10% based on consumer price index and performance (according to the pay scale effective from January 2005) for the same functional position (not necessarily same designation or location) and in addition, at the very least, the minimum staffing guidelines given in this document are to be observed. In both cases, Bidders may staff their centres above the minimum staffing levels, and may pay above the minimum pay and salary scales. A system of staff provident fund with equal contribution from the employees and employer may be a good incentive for the staff commitment. This will also enhance PAs getting performance bonus (to be judged as an innovation).

2.58 Experience has shown that in some areas, sufficient pay incentive needs to be given to well experienced and technically capable staff to retain their services and also to inhibit the development of poor or inappropriate practices. In addition, those working on a Project lack some of the benefits offered to those covered by the MOHFW minimum pay scales, so it is reasonable for higher salary levels to be offered at times. A guiding principle for UPHCP-II II will be the development and maintenance of a high quality of care, and sustainability, so long term approaches which use highly qualified staff that are likely to remain with the PA - NGO for the six years of the Project are to be encouraged and corresponding remunerations estimated for six years.

48 Draft

2.59 Others

(i) Organogram – including a staffing schedule that indicates proposed locations of key staff. The organogram must include senior management and clinical staff by name, and other staff by designation or qualification (physician, nurse, etc.), clearly identifying staffing patterns planned for delivery of health services from PHCCs, CRHCCs, satellite centres and other methods.

(ii) Curriculum Vitae (CV/bio-data) of all senior staff plus technical experts and international staff, if any. If Bids are submitted for more than one Partnership Agreement Area, the same CV cannot be submitted for more than one PAA unless it is specified that the position will be shared between PAAs. However, in such cases, the CV must be included in each Bid for the respective PAA and remuneration apportioned accordingly.

(iii) Arbitrary termination of staff by the PA authority: No staff would be terminated by the Partners once they are recruited for more than 6 months. If there is valid ground for termination it will have to be referred to the PIU/PMU which will form neutral arbitration committee to decide upon the issue.

2.60 The following minimum level of staff was felt necessary at Partner Headquarters, CHRCC, PHCCs and outreach-level to ensure good quality health care services by the Contractor (Figure 1). The contractor is expected to budget costs for the minimum levels of staff shown below. However, the contractor may wish to propose additional staff over and above the minimum staff prescribed:

Figure 1. Minimum Staffing Pattern in a Partnership Area at HQ, CHRCC and PHCC Draft 49

PA NGO HQ h Project Manager 1 h Project Administrator 1 h Finance/Account Officer 1 h MIS/Documentation Officer 1 h Office Attendants 1 h Driver 1 h Cleaner 1

CRHCC PHCC h Physician 5 h Physician 1 h Specialist Physician 1 h Nurse/Paramedic 1 h Counselor 1 h Counselor 1 h Pediatrician/Nutritionist 1 h Aya/Cleaner 1 h Para-medic/Nurse 10 h Guard 1 h Lab technician 1 h Office Asst. & Accountant 1 h Clinic Manager 1 h Para-medic/Nurse 5 h Office Asst. & Accountant 1 h Field supervisor 1 h Ambulance Driver 1 Satellite/Mini Clinics in PHCC h Clinic Aide 4 h FWV/Paramedic 4 h Aya/Cleaner 4 h Service Promoter 4 h Guard 4 h Outreach Worker 4 Satellite/Mini Clinics in CRHCC h FWV/Paramedic 4 h Service Promoter 4 h Outreach Worker 6 50 Appendix 4

APPENDIX 3: SCOPE OF WORK IN PARTENSHIP AREA ACTIVITIES

A. Activities to be Undertaken by the Partnership Area Contractors by Facility Level

3.1 The contractor will implement a system ensuring the provision of specific health services through an organized program of activities. This Scope of Work described below will be undertaken in each of the partnership areas. The Contractor will organize the required activities in a work plan, develop project phasing and timetable, staffing plan and schedule, budget, etc to implement this scope of work,. The Activity list has been annotated to indicate activities which are CHRCC, PHCC and Outreach/Community/Household Based based. The Scope of Work is as follows:

Activities to be Undertaken by the Partnership Area CRHCC PHCC Outreach/ Contractors community/ household based I. Reproductive Health A. Antenatal Care 1. Register pregnant women X X X 2. Obtain antenatal history X X 3. TT vaccination X X X 4. Supplement with Fe/Folate X X X 5. Counsel women and husband / family on Nutrition, care X X X (rest) danger sign, clean delivery, Trained birth assistance, delivery planning, Preparation for possible emergency, breast feeding, and Contraception

6. Antenatal care (check weight, height, eyes, blood X X X pressure, edema, urine sample, blood sample) 7. Detect early, refer promptly women with danger signs/ X X X complications severe anemia 8. Provide supplementary nutrition to severely malnourished X pregnant women 9. Mobilize community to arrange transportation, blood X donors for obstetric emergencies, (blood will be supplied to EOC referral locations for screening prior to possible use) B. Delivery Care 1. Conduct clean and safe delivery by trained personnel X 2. Supplement lactating mother with Vitamin A X X X 3. Detect early and refer promptly women with Danger signs X X X or complications C. Postnatal Care 1. Counsel women/family on diet, danger signs (mother & X X X infant ), infant feeding, family planning, immunization Appendix 4 51

Activities to be Undertaken by the Partnership Area CRHCC PHCC Outreach/ Contractors community/ household based 2. Detect early and refer promptly women with danger X X X signs/complications D. Neonatal Care 1. Counsel women/family on diet, hygiene, cord care, X X X danger signs (mother and newborn), infant feeding, family planning, immunization 2. Health education for mothers on cleanliness care for the X X X newborn ( prevent hypothermia, initiate exclusive breast feeding) E. Menstrual Regulation (MR) and Post Abortion 1. Encourage use of FP methods X X X 2. Provide contraceptive supplies X X X 3. Detect complications and refer promptly X X X 4. Provide MR in limited number of HCs on medical grounds X only F. Adolescent Health 1. Counsel/create awareness of sexuality, safe sex, X X X menstruation, special nutritional and hygiene related needs to girls 2. Counsel young men on gender issues and proper respect X X for women 3. Identify and treat anemia in girls X X X 4. TT promotion amongst adolescent girls X X X G. Family Planning 1. Counsel on appropriate method X X X 2. Provide contraceptive supplies- pills, condoms, X X X injectables, IUDs (in limited number of HCs). 3. Refer clients for other methods (sterilization, IUD, MR, X X Norplant) 4. Treat/refer for side effects and complications X X H. Management and Prevention/ Control of STIs, RTIs & HIV/AIDS 1. Establish VCT centre (one per PA) X 2. Counsel on HIV/AIDS, STIs X X X 3. Education information on STI/HIV/AIDS & related X X X Infertility 4. Supply condoms X X X 5. Refer for complaints of vaginal discharge, lower X X abdominal pain, genital ulcers, swellings in groin in men 6. Follow syndromic approach X X 7. Partner management X X X II. Child Health 52 Appendix 4

Activities to be Undertaken by the Partnership Area CRHCC PHCC Outreach/ Contractors community/ household based A. EPI 1. Mobilize caretakers to have their children fully immunized X X X by 12 months of age 2. Conduct immunization sessions (DPT, BCG, measles, X X X Polio) 3. Surveillance and notification including acute flaccid X X X Paralysis, measles and neo-natal tetanus B. ARI 1. Treat pneumonia with oral antibiotics X X X 2. Advise caretaker on correct home care X X X 3. Detect, manage and refer severe cases X X X C. Diarhhoea 1. Detect, manage and refer severe cases with “danger X X X signs” 2. Advise caretaker on correct home care (fluids, feeding, referral) 3. Advise caretaker on prevention X X D. Measles 1. Detect, manage and refer severe/complicated cases X X X E. Malnutrition 1. Counsel pregnant & lactating women (+husband/ Family) X X X on diet. 2. Promote (& support) exclusive breast feeding, Correct X X X weaning and child feeding practices 3. Promote health and caring practices that prevent X X X Malnutrition 4. Provide elements such as GMP targeted supplementation X based on experienced of nutrition intervention projects, detection & referral of severe cases of malnutrition

5. De-worm (targeted) high risk children X X 6. Vit A for post partum lactating women and children X X X 7. Detect and manage children with night blindness & Refer X X other cases, supplement sick children 8. Monitor availability of iodized salt X 9. Promote consumption of iodized salt X X X 10. Detect and refer suspected iodine deficiency cases X X X 11. Iron Deficiency (Anemia) X X X III. Communicable Disease Control Tuberculosis Control 12. Detect and refer suspect cases (at clinic level) X X X 13. Support and promote DOTS X X Appendix 4 53

Activities to be Undertaken by the Partnership Area CRHCC PHCC Outreach/ Contractors community/ household based 14. Advise patients/families/close contacts on TB Symptoms X X and treatment compliance 15. Defaulter tracing X 16. Promote self-reporting of patients X X Leprosy Elimination 17. Detect and refer suspect cases X X X 18. Advise patient/families/close contacts on leprosy X X symptoms and treatment compliance 19. Carry out follow-up and default tracing X 20. Hh contact examination X 21. Promote self-reporting of patients X X 22. Provide multi drug therapy delivery X X IV. Limited Curative Care A. Provide Basic First Aid X X X 1. Common injuries (cut, burn, fracture, etc) B. Treat Medical Emergencies – Management and Referral of X X X

1. Pain, high fever, shock, asphyxia, poisoning, near drowning 2. Asthma, eye diseases, dental diseases, ear diseases X X 3. Other incidence of emergencies X X X V. Behavior Change Communication 1. Cross cutting all items categories above X X 2. Personal hygiene, hand washing X X VI. Assistance to women who are victims of violence 1. Identify and register cases, provide medical care X X X 2. Refer victims for legal assistance, counseling and Crisis X X X management 3. Provide psychological support X X X 4. Application of rape investigation kit X X 5. Increase community awareness X X

54 Appendix 4

B. Components of HIV/AIDS, STI and RTI related activities:

3.2 Voluntary Counseling and Testing (VCT) Centre: For each Partnership Agreement, there will be one VCT center operational from CHRCC. VCT will provide confidential counseling to enable people to make informed decisions about their HIV status and to take necessary actions accordingly. If a person decides to take the HIV test, VCT enables confidential testing. Counseling for VCT consists of pre-test, post-test, and follow-up counseling. VCT will benefit individuals and society as a whole by helping prevent HIV/AIDS and STI. Under the Project, VCT will follow the national policy established by the National STD/AIDS Committee and maintain functional linkages with other agencies/organizations providing HIV/AIDS related services.

3.3 STI and RTI Control: Services will be provided as a distinct component of the service contract with the NGOs and will include: (i) training of service providers and field workers on STI and RTI prevention and control; (ii) diagnosis and management of STIs, and female and male RTIs; and (iii) counseling, treatment, and motivating clients to bring their partners for treatment and counseling.

3.4 Behaviour Change Communication and Marketing (BCCM) for HIV/AIDS and STI Control: PA NGOs will include Behaviour Change Communication and Marketing (BCCM) component for HIV/AIDS related activities to: (i) improve the vulnerable population’s knowledge, attitudes, and behavior related to HIV and its economic impact; (ii) promote condom use, harm reduction strategies and safe sex; (iii) encourage voluntary counselling and HIV testing; (iv) encourage care-seeking for STIs; (v) increase knowledge of the link between TB, STIs and HIV/AIDS; (vi) empower vulnerable people to control their lives; and (vii) enable exertion of rights, tolerance and care toward people living with HIV/AIDS. Activities implemented by PA NGOs will help households prevent adult and child infectious diseases through changes in knowledge, attitudes, and practices.

3.5 Mainstreaming of HIV/AIDS component: Under PA agreement, all PA NGOs will ensure: (a) training on HIV/AIDS awareness building and HIV/AIDS prevention planning to staff at all level and (b) integrate HIV/AIDS issues into behavior change communication and marketing activities supported by the Project.

2.5 Monitoring and Evaluation. The monitoring system is based on monthly report of the partnership NGOs, to the PMU/PIU. This report will provide the basis for tracking and evaluating specific inputs (e.g., medicines, other supplies, financial inputs, HIV/AIDS related posters/IEC materials purchased/produced) and outputs (e.g., number of patients counseled and tested for HIV/AIDS, patients treated for RTI and STI). Moreover, an independent monitoring and evaluation firm will conduct 6 monthly monitoring report, household surveys at inception, midterm, and at the end, in addition to health facility surveys to evaluate the outcomes and impact of the HIV/AIDS interventions undertaken by PA NGOs. HIV/AIDS related activities and effects will form part of the scoring for evaluation for bonus.

3.6 Budgeting, Financing and Accounting. Separate budget will be estimated, prepared and given in the Financial Proposal following the same budget format as in Appendix 6. There is no minimum suggested to the prospective bidders for the expenditure plan and financial proposal for the HIV/AIDS and STI related activities. As already stated the Appendix 4 55

budget for this component will be borne by a grant from the ADB and therefore a separate accounting system has to be maintained for sending requirements, expenditure and accounting by the winning bidders.

C. Reaching the Poor and ensuring at least 30% of the services are accessed by the poor

3.7 The following criteria are proposed for identifying the urban poor in the Second Urban Primary Health Care Project (the Project), based on a combination of living conditions, nature of employment, monthly income, house rent, and food intake. This definition will be reviewed at project inception and at regular intervals to further fine-tune efficient pro- poor targeting.

Operational Definition of Very Poor and Poor Status of Indicators Indicators Very poor Poor Living conditions People living in very poor slums People living in ordinary slums (i.e., shanties); on the streets; near factories or waste dumps, riverbeds or hillsides; the population is floating

Nature of employment Casual and informal sector workers: garment Casual and informal sector workers: baby workers; hawkers; rickshaw and rickshaw van taxi or tempo drivers, small traders, taxi/ pullers; other manual car pullers; garbage or bus/private car drivers, factory workers, waste collectors; street sweepers; latrine shopkeepers, tailors, small businessmen cleaners; day laborers; maid servants; beggars; sellers of food or cigarettes on the street; disabled people; the unemployed; other vulnerable groups, e.g., sex workers

Monthly income Up to Tk500 Tk500–Tk700 (average per household member)

Rental status Rent up to Tk700 Rent over Tk700

Meal per day and Average one meal or two inadequate meals Two adequate or three inadequate meals cooking facilities per day; share cooking stove with other per day, or three adequate meals per day families

Other family Widows, households headed by females, Widows, households headed by women, characteristics migrants from rural areas in the last 2 years migrants from rural areas in the last 2 years

3.8 Baseline Survey of the Project Area. A baseline survey will be conducted by the Contractor at the beginning of the partnership agreement to identify poor households in the partnership area. Poor households will be identified based on the social and economic indicators above. These households will be given entitlement health cards giving them free access to health services under the Project. The survey of the poor households will be updated annually. A participatory appraisal will be conducted at the community level to assess the availability of health services; access to health services by the poor; and the social, financial, and physical barriers to their use by the poor.

3.9 Location of Health Facilities and Mini-Clinics. In order to facilitate their use by the poor, health facilities will be located in slums or close to slums or poor populations. 56 Appendix 4

Where land is scarce and health facilities cannot be located in or near slums, mini-clinics will operate in slums. Mini-clinics’ hours will be flexible to meet the needs of the poor. If necessary, they will be open during the evening.

3.10 Social Mobilization. At the beginning of the Project, in each ward, a launching or inception ceremony will introduce the health center facilities. A comprehensive community social mobilization program will be designed to disseminate basic information on project services and motivate the poor to use the health facilities. The program will include audiovisual and other innovative methods. Neighborhood meetings in slums and low-income areas will be organized periodically to explain all services available, rates of services, and free services for the poor. Networking with other NGOs in the area will be encouraged to strengthen pro-poor targeting. Ward-level primary health care committees with male and female ward commissioners, local leaders, members of youth clubs, civil society, NGOs, partner NGOs, and representatives of the poor will develop awareness campaigns for the poor and to monitor access to health services and their quality. The Project will support grassroots activities against social prejudice and other barriers that discourage use of health facilities by the poor and minorities.

3.11 Monitoring and Record Keeping. The partner NGOs will keep systematic records on the patients by poverty and gender, and will prepare quarterly reports of health service use by the poor, women, and adolescents. All the outputs, especially relating to services provided at CHRCC and PHCCs will be monitored and reported separately for poor and non-poor households so that key objective to provide at least 30% of the services to the poor is monitored and achieved.

3.12 Capacity Building. The field staff of the partner NGOs responsible for social mobilization, health education, and community volunteers will be oriented on the Project and pro-poor targeting. The field staff and volunteers will receive training in mobilizing the poor and generating demand for health services among them.

3.13 Enabling Environment for Good Governance and Transparency. The Contractor will ensure easy access to health-service-related information by the general public and the urban poor. It will use information bulletin boards outside health facilities to provide information on user fees and availability of free services to the poor, outreach activities, community-based organizations, and other cost-effective means.

D. Clinical Waste Management

3.14 The Contractors have special responsibility towards management of clinical waste generated in the clinics of the Project. Clinical wastes includes common waste and special waste (sharps and infectious, pathological, pharmaceutical, genotoxic, chemical, heavy-metal-containing, and radioactive waste). Medical solid waste—glassware, syringes, dressings, bandages, plasters, plastic syringes, and test swabs—accounts for 10–15% of clinics’ total solid waste. The operation of health facilities will follow all applicable laws, MOHFW’s action plan for clinical waste management, ADB's environmental policies. Measures to improve CWM in the project clinics will include:

(i) designation of a person in charge of waste management in each clinic; (ii) regular training for all staff; (iii) provision of color-coded, covered receptacles in strategic positions for separate categories of waste; Appendix 4 57

(iv) daily internal collection and storage of containers within the clinic compound, which will be in a fenced, secured area; (v) collection and transportation of clinical waste containers by the city corporation and municipal conservancy department, and burial in separate pits for different wastes in a fenced, secured area of the municipal dumpsite; (vi) return of containers and invoice of services to the clinic, and (vii) cleansing of containers by the clinic. An operation and maintenance (O&M) plan and schedule will be prepared for each center, specifying environmental monitoring tasks (e.g., regular cleaning of external perimeter drains, ensuring that they are connected to off-site drains), frequency of monitoring, responsibilities, and costs. The O&M plan will be incorporated into the proposal and partnership agreement, and monitored as part of the assessment of partners’ performance.

E. Gender

3.15 Gender Equity and Empowerment. The proposal should clearly describe how the gender equity and gender empowerment aspects of the project would be achieved, in addition to the following. UPHCP-II gives emphasis on gender empowerment and equality. At least 50% of the health providers of the partner NGOs will be women. The female ward commissioners will be involved in community programs to raise awareness about services available in PHC and CRHC centers. Community health volunteers will include women, especially from poor communities. Of the chairs of ward PHC coordination committees, at least 30% will be women, and all the committees will have women members.

F. Good Governance and Transparency

3.16 Good Governance and Transparency. The proposal should contain pro-active steps the bidder would take to ensure good governance and anti-corruption measures including those described herewith. Active accountability to service users is essential, as opposed to more routine 'participation' which could just be passive attendance at quarterly meetings by user representatives. The key dynamic should be that service users and their representatives know what the service level is supposed to be, and have an important voice in saying whether the service performance is good enough, and if not , why not. This will be a management tool as well as a monitoring indicator. Among others, the following steps are indicated in the Project to ensure good governance in the contract, which will be closely monitored as part of the contract.

(i) Use funds only for authorized purposes, and adhere to procurement schedule. (ii) Be vigilant about the quality of procurement, and conduct regular field visits to check quality. (iii) Use information technology to increase transparency, accountability, and efficiency in procurement. (iv) Regularly assess accounting and internal control systems to monitor expenditures and other financial transactions and safe custody of project- financed assets. (v) Ensure that accounting and internal control systems are of acceptable standards. (vi) Ensure accounting information adheres to accounting standards acceptable to client and maintain substantial documentation. 58 Appendix 4

(vii) Submit audited and unaudited financial statements within an acceptable time limit. (viii) Conduct an independent audit acceptable to client. (ix) Pay special attention to stopping duplicate payments, tampering of invoices, adulteration of records, payments without supporting documents, misuse of funds, and payment of ineligible expenditures. (x) Conduct regular surveys of the quality of project services. (xi) Conduct a public relations campaign to inform and educate the beneficiaries about project services. (xii) Establish links between Project and civil advocacy organizations. (xiii) Ensure access to information at the health facilities and offices through notice boards, regular newsletters, a website, etc. (xiv) Support joint government and civil-society bodies such as ward primary health care (PHC) committees, city corporations, municipality. (xv) Establish an effective grievance redress system and enable its effective functioning through wide publicity. (xvi) Use information technology to increase access to information and empower people. (xvii) Establish oversight and supervisory mechanisms to detect fraud and corruption. (xviii) Conduct annual financial disclosure of the project staff and regularly monitor project assets. (xix) Adhere to annual plans and explain deviations, if any, and carefully analyze unusual items. (xx) Follow government guidelines on investigating corruption. (xxi) Regularly assess institutional capacities to respond and take measures to prevent corruption.

G. The Essential Services Package

3.17 The Contractor will implement a system to ensure the provision of specific health services through an organized program of activities and provide quarterly reports on these activities. The Scope of Work described below will be organised in a work plan, to a timetable, with an associated staffing plan, budget, and any other needed inputs, to implement this scope of work. The activity list gives an indicative approach to whether the work is CRHCC based, PHCC based, or outreach, community, or household based. It is the responsibility of the Contractor to best organize the services according to the needs of the particular community, so that the location of the work can vary in accordance with quality and cost effectiveness considerations.

Appendix 4 59

ESSENTIAL SERVICE DELIVERY (D) UNDER HNPSP1 ESD Intervention Clients Services Component Reproductive Maternal Care Mothers Safe Motherhood, Antenatal Care, safe delivery (including by Health skilled Birth Attendants), Emergency Obstetric Care (EOC), peri- natal and post-natal including essential newborn care, prevention of unsafe abortion through safe MR services and maternal nutrition; Family Planning All men and Provision of contraceptive commodities (oral contraceptives, women condoms, injectable, and IUDs), Information and services for other options such as Norplant, vasectomy, tubectomy, menstrual regulation and natural family planning, and side effects information and how to deal with them. Maternal Nutrition Mother Maternal nutrition services, including pregnancy weight gain monitoring and targeted supplementation of underweight (BMI<18.5) pregnant women and lactating mothers, nutrition education and micronutrient supplementation as well as nutrition education and micronutrient supplementation for female adolescents and newly-wed. Assistance for Women Health workers will be able to properly refer survivors of violence women who are to the appropriate legal assistance, counseling, and crisis survivors of management services and provide immediate psychological violence support. Health workers will also detect cases of assault and increase community awareness of the issue. At each health center there will be at least one staff member capable of using the “rape investigation kits” Adolescent Health Boys and Information and health care services for adolescent boys and Care Girls girls between the age group 10 to 19 years. Prevention of RTI, All men and Information on preventing HIV/AIDS and other STDs, and STI and HIV/AIDS women treatment using both standard and syndromic approach. Child Health Immunization Children Immunization against diphtheria, tetanus, measles, polio, Care tuberculosis, hepatitis B and immunization of mothers with tetanus toxoid. Control of Diarrhea Children Case management using the Integrated Management of and other Childhood Illness (IMCI) approach and essential newborn care childhood diseases within public-sector health services and to facilitate its introduction at NGO facilities. Control of Acute Children Treatment of acute otitis media, pneumonia, and asthma through Respiratory appropriate case management, and educating mothers how to Infections identify the warning signs of pneumonia, appropriate treatment with antibiotics, control of asthmatic attacks, et c. Control of Children High-dose Vitamin A capsules for children 12 to 59 months and Micronutrient increase the coverage of therapeutic supplementation for Deficiency children with night blindness, measles, persistent diarrhea and severe malnutrition. iron for young children suffering from iron deficiency anemia, and promotion of the use of iodized salt. Introduction of growth monitoring system for children under 5 will be expanded. Communicable TB, Malaria, Children TB: Treatment for tuberculosis and other diseases common Disease Control Dengue, SARS, and adults among children and adults, including emerging infections such Kala-Azar, filariasis as dengue fever. and leprosy

*The Essential Service Package (ESP) was originally developed in 1996/97 as part the Health, Population Sector Program (HPSP) and was essentially seen as a rural service package. The key components of the ESP include reproductive health, child health, communicable diseases and limited curative care, which further sub-divide into 24 sets of family health interventions. The HNPSP’s Conceptual Framework proposed some modest updates to the ESP definition: adding focus on behavior change communication; reducing violence against women; emergency obstetric care; nutrition; and dengue. Additional services based on local needs that are specific to PA area would be included to constitute ESP + services to be provided. 60 Appendix 4

ESD Intervention Clients Services Component Malaria: Considering the situation of malaria, particularly in the endemic areas, it is a priority to increase accessibility to treatment through Early Diagnosis and Prompt Treatment (EDPT) and promoting use of insecticide treated mosquito nets (ITMN). The other focus is to combat the emerging drug resistance and ensuring availability of potential first line effective anti-malarial drugs (introducing Artemisinin combination therapy – Coartem). There is also need to improve surveillance, enhance diagnosis, and support capacity building especially for management of severe malaria Kala azar: Major interventions for kala azar in the next three years will include EDPT; ensuring uninterrupted supply of drugs (inj. SAG); introducing Rapid Diagnostics; Training of Medical Officers and Field personnel; and establishing effective surveillance mechanism. For Vector Control, provision of supply of alternative effective insecticide will be made available. SARS: Major interventions for dengue control will be developing a control programme with municipal involvement (Long term plan); establishing a responsive health care system for management of DF/DHF in all hospitals; mass awareness campaign for dengue vector control including environmental management; ensuring epidemiological and entomological surveillance. Effective efforts will be made to handle the management of SARS in collaboration with all concerned. Filariasis: Lymphatic filariasis control has been started in pilot phase in Panchgarh district, and will be gradually expanded to cover other affected districts so as to achieve elimination by 2005 Leprosy: Programmes for elimination of leprosy and control of soil transmitted helminthic infections will also continue during HNP period. Limited Curative First aid for injuries All Children Includes treatment of cuts, burns and fractures. Care and Adults Emergency care All Children Treatment and care for pain, snake bite, poisoning, shock and and Adults drowning Treatment of minor All Children Treatment of ear, eye and skin infections infections and Adults Behavior Strengthened All Children To develop client-oriented positive attitudes on part of service Change interpersonal and Adults providers, to enhance health seeking behaviors on part of users, Communications communication, promote healthy lifestyle behaviors, and to promote informed (BCC) raise awareness decision-making regarding the use of private-sector health care on existing ESP especially ESP, diagnostic services and therapeutic drugs. services, promote healthy lifestyle behavior and minimize gender inequalities

BCC = Behavior Change Communications, DF = , DHF = , EOC = Emergency Obstetric Care (EOC), EDPT = Early Diagnosis and Prompt Treatment, ESP = Essential Service Package, HIV/AIDS = human immuno-deficiency virus / acquired immuno-deficiency syndrome, IMCI = Integrated Management of Childhood Illness, ITMN = insecticide treated mosquito nets, IUD = intra-uterine device , MR =menstrual regulation , NGO = nongovernmental organization, RTI =reproductive track infection , STD = sexually transmitted disease, STI =sexually transmitted infection , TB = tuberculosis.

Appendix 4 61

APPENDIX 4: PARTNERNSHIP AGREEMENT OBJECTIVES

(Specific Measurable Results of Project Activities)

4.1 As a result of the UPHCP-II II Partnership Agreement, the following improvements will be observed in the coverage and quality of health care services in the Partnership Areas, by the end of the six-year contracts. They are preliminary, general urban area objectives. Baseline figures and objectives by Partnership Areas will be available in the Project Management Team Office in Dhaka and in the Project Implementation Units at the City Corporation/Municipality level. All the targets, to be achieved by 2011, are against 2000 benchmark.

1. Reproductive Health Care (i) 80% of complicated pregnancy cases will reach the first level of obstetric care; (ii) 100% of complicated pregnancies will have been referred from the first level of obstetric care to more sophisticated facilities; (iii) 75% of women who have been pregnant in the last 12 months will have had at least 1 antenatal visit with a professional health worker; (iv) The proportion of pregnant women delivered in institutions will have increased to 40%; (v) 90% of women who have delivered in the past 12 months will have received at least 2 doses of Tetanus Toxoid vaccine; (vi) 80% of eligible couples (married women of reproductive age 15-49) will be practicing modern methods of contraception; (vii) 70% of women have been delivered by a trained health worker; and (viii) 100% severely malnourished pregnant women provided supplementary nutrition.

2. Child Health Care (i) 50% reduction in child malnutrition; (ii) 60% decrease in the less than one and less than 5 years mortality rate each; (iii) 95% of children one year of age have been fully immunized ; (iv) 90% of children 9 months to 5 years of age will have received a vitamin A capsule in the last 6 months; (v) 80% of the children with diarrhoea will have been treated at home with ORS, increased fluids and continuous feeding. (vi) 90% of children less than 5 years old who had an episode of severe pneumonia/severe disease of Acute Respiratory Infection (ARI) during the past two weeks will have been taken to a health facility; (vii) 90% of children under 6 months of age are not given anything other than breast milk; (viii) Proportion of sick children less than 5 years of age seen at a community level health facility who receive correct case management for ARI and Diarrhoea increased to 85%.

3. Communicable Disease Control (i) 75% of the estimated TB case would have been identified and 85% of diagnosed Tuberculosis cases will have received and completed short course therapy and have become sputum negative; 62 Appendix 4

(ii) 5% reduction on malaria mortality every year on an incremental basis; (iii) Incidence of HIV infection among 15 – 25 years ANC clinic attendant women is less than 0.5% and declining; (iv) 100% of Primary Health Care Centres will be able to provide proper treatment of uncomplicated reproductive tract infections (RTI) and sexually transmitted disease (STDs), family planning services and other appropriate services. (v) 10% increase per year in treated STD cases on an incremental basis and equal numbers of men and women will have been treated for STDs.

4. Communication for Behaviour Initiative (i) 90% of the target population will know about the availability of modified PHC services from UPHCP-II II in the Partnership Area; (ii) 80% of adults of reproductive age will know about HIV/AIDS/STDs, and the means of prevention; (iii) 25% increase from baseline regarding safe sex behavior; (iv) 80% of mothers with children under 5 years will know 3 signs or symptoms of ARI that need referral/clinical intervention; (v) 95% of married women of reproductive age will know the signs of complicated pregnancy; (vi) 50% increase in awareness of measures to reduce violence against women (VAW); and role of CRHCC in reducing VAW. (vii) 70% of mothers of 6 months of age children will be fed appropriate weaning foods. (viii) 90% adults would use sanitary latrines. (ix) 50% increase in awareness on adolescent health related issues and necessary measures in reducing risk.

5. Health Center Specific Objectives (i) 100% of health centers will have at least one staff trained in violence against women, and adolescent girls related issues and counseling and aware of referral linkages; (ii) At least a 20% increase (50% for the new PAAs) from the baseline in the total score obtained on Standardized Supervisory Instrument that relates to quality of patient care, outreach activities, health center management efficiency (in terms of per capita patient cost), cleanliness, etc. (iii) At least 30% of all the services are provided to identified poor households in the partnership agreement area. (iv) 90% of all the services provided fall in the Essential Service Package. (v) 100% of poor people who are eligible and in need of health services for HIV/AIDS VCT, STI and RTI obtain services free.

6. Partnership Area Indicators (i) Average use of health centers is 0.2 visits per person per year in target areas; (ii) At least 12% (8% for the new PAAs) of the total cost of services is to be raised through user fees and other mechanisms by the end of the project period. (iii) All patient-related objectives will be met for the poorest 50% of the poor.

Appendix 4 63

APPENDIX 5: PERFORMANCE EVALUATION

5.1 Targets for project achievement and contractor bonuses will be based on the Partnership Area Objectives that the contractor has agreed to achieve. They are based on the MOHFW’s HNPSP Goals and Objectives (as described in the HNPSP Program Implementation Plan, July 2005), which focus on the achievement of the Bangladesh 2015 Millennium Development Goals (MDG). The “Essential Services Package” (ESP) plus other selected services was developed to define objective standards for Primary Health Care (PHC) coverage that Bangladesh is to achieve. UPHCP-II has adapted these to the urban situation and added the objectives committed in the ADB loan agreement. The Contractor, through the Partnership Agreement, agrees to implement a PHC system that will deliver specific health services and achieve specific levels of health coverage and quality in the Partnership Areas by the end of the PAA.

5.2 A composite index of health system performance will be developed based on the Partnership Area Objectives specified in the Partnership Agreements. The index will include coverage statistics for preventive services including immunizations, prenatal and postnatal care, family planning, health education, quality of care indicators, etc. An example of how such an index might be constructed is shown below:

weighting Findings in the Score for the Indicator Partnership indicator in the Area Partnership Area EPI coverage X 0.8 65% 52 Vitamin A coverage X 1.0 30% 30 Married Women knowing 3 modern methods of FP X1.0 (up to a 35 35 maximum of 60) Mothers knowing the danger signs of ARI and able to mix X1.0 (up to a 25% 25 ORS maximum of 50) Prenatal care coverage X 0.7 50% 35 Outpatient consultations per X 250 (up to a inhabitant per year maximum of 200 0.4 100 points) Score on health center X 1.0 65% 65 checklist Average score of poorest 50% on EPI, Vitamin A, prenatal X 1.0 48% 48 care, and outpatient consultations TOTAL = 390

5.3 This index will be used to determine overall contractor performance and eligibility for project bonuses. Data to calculate the composite index will be collected through household, community, and health facility surveys. Baseline figures will be determined for each Partnership Area, and also expected levels of improvement and achievement for two and four years of project work. Agreement between the Client and the Contractor on targets and bonus conditions will be a part of the Partnership Agreement

5.4 The Contractor agrees to achieve the total number of points indicated in the Partnership Agreement Contract and specified in the Partnership Area Objectives for the specific partnership area. While individual objectives will be set for all variables, it is the 64 Appendix 4

summary score for each topic (Reproductive Health Care, Child Health Care, Health Center Specific Objectives, etc. etc.) which is the final outcome measure. Thus, the points may be obtained through reaching a higher percentage in one variable, and a lower percentage in another. However, achievement of a minimum of 60% of the Objective for each variable is mandatory.

Payment of Bonuses

5.5 The Tables, beginning on the following page, will show baseline figures (from the baseline survey) in the Partnership Areas; the weighting of the Objective indicator necessary to produce the Score; the Findings in the Partnership Area; and, the Score for the Objective in the Partnership Agreement Area. (The scores now shown reflect PA objectives as actual baseline figures are not yet available).

5.6 Performance bonuses may be paid to partners who make significant improvements in the composite index of health system performance in their PA Areas. Bonuses may be paid twice, once after the mid-term review, and again at the end of the PA. The decision as to whether a bonus will be awarded will depend on the initial PA area composite index, and the amount of improvement in the index. The amount of the bonus will be determined on a sliding scale, based on the extent of improvement in the PA area index and the initial Index score in the PA. The Index is designed so that the Bonus level (1%, 3%, 6%) requires a greater increase in index scores in PAs starting from lower initial Index levels. An example of index scores which might be required to receive performance bonuses is shown below:

Initial Index score Amount of Bonus (as a % of contract) Level 1.5% 3% 6% A 200-299 450 525 650 B 300-399 560 650 780 C 400-499 700 780 850 D 500-599 750 825 880

5.7 For example, assume a PA area starts out at 350 (level B) on the index and the PA is awarded to a private group that bids $1.7 million. After three years, if the index has improved to 560, the contractor would receive a 1.5% bonus, equivalent to $25,500. If at the end of the contract, the index had improved to 780, the contractor would receive another bonus, this time valued at 6% minus 1.5%=4.5% of the contract, equivalent to $76,500. The UPHCP-II will determine whether bonuses will be paid and the size of the bonus. If after three years, the index is only 450, bonus would not be given. However, if the firm achieves 780 by sixth year, the firm is eligible for a bonus of 6% of the original bid amount.

5.8 Mid-term review and end of contract index figures will be determined on the basis of several measures of each variable. Household, community, and health facility survey data will be compared with PA record keeping statistics and with information from the Integrated Supervisory Instrument (ISI) used by the City Corporation staff to monitor performance. Appendix 4 65

EVALUATION OF PARTNERSHIP AGREEMENTS

Baseline Weighting Findings in Maximum Figures Partnership Score for (in %)* Agreement Partnership Area (in %) Agreement Area for weighting Partnership Area Objectives purposes 1 Reproductive Health Care 200 (i) 80% of complicated pregnancy cases will reach the first level of obstetric care; 50 (ii) 100% of complicated pregnancies will have been referred from the first level of obstetric care to more sophisticated facilities; 20 (iii) 75% of women who have been pregnant in the last 12 months will have had at least 1 antenatal visit with a professional health worker; 20 (iv) The proportion of pregnant women delivered in institutions will have increased to 40%; 30 (v) 90% of women who have delivered in the past 12 months will have received at least 2 doses of Tetanus Toxoid vaccine; 20 (vi) 80% of eligible couples (married women of reproductive age 15-49) will be practicing modern methods of contraception; 20 (vii) 70% of women have been delivered by a trained health worker; and 20 (viii) 100% severely malnourished pregnant women provided supplementary nutrition. 20 2 Child Health Care 200 (i) 50% reduction in child malnutrition; 20 (ii) 60% decrease in the less than one and less than 5 years mortality rate each; 30 (iii) 95% of children one year of age have been fully immunized ; 30 (iv) 90% of children 9 months to 5 years of age will have received a vitamin A capsule in the last 6 months; 20 (v) 80% of the children with diarrhoea will have been treated at home with ORS, increased fluids and continuous feeding. 25 (vi) 90% of children less than 5 years old who had an episode of severe pneumonia/severe disease of Acute Respiratory Infection (ARI) during the past two weeks will have been taken to a health facility; 25 (vii) 90% of children under 6 months of age are not given anything other than breast milk; 20 (viii) Proportion of sick children less than 5 years of age seen at a community level health facility who receive correct case management for ARI and Diarrhoea increased to 85%. 30 3 Communicable Disease Control 100 66 Appendix 4

(i) 75% of the estimated TB case would have been identified and 85% of diagnosed Tuberculosis cases will have received and completed short course therapy and have become sputum negative; 30 (ii) 5% reduction on malaria mortality every year on an incremental basis; 10 (iii) Incidence of HIV infection among 15 – 25 years ANC clinic attendant women is less than 0.5% and declining; 10 (iv) 100% of Primary Health Care Centres will be able to provide proper treatment of uncomplicated reproductive tract infections (RTI) and sexually transmitted disease (STDs), family planning services and other appropriate services. 30 (v) 10% increase per year in treated STD cases on an incremental basis and equal numbers of men and women will have been treated for STDs. 20 4 Communication for Behaviour Initiative 100 (i) 90% of the target population will know about the availability of modified PHC services from UPHCP-II II in the Partnership Area; 30 (ii) 80% of adults of reproductive age will know about HIV/AIDS/STDs, and the means of prevention; 20 (iii) 25% increase from baseline regarding safe sex behavior; 10 (iv) 80% of mothers with children under 5 years will know 3 signs or symptoms of ARI that need referral/clinical intervention; 10 (v) 95% of married women of reproductive age will know the signs of complicated pregnancy; 20 (vi) 50% increase in awareness of measures to reduce violence against women (VAW); and role of CRHCC in reducing VAW. 10 (vii) 70% of mothers of 6 months of age children will be fed appropriate weaning foods. 10 (viii) 90% adults would use sanitary latrines. 10 (ix) 50% increase in awareness on adolescent health related issues and necessary measures in reducing risk. 10 5 Health Center Specific Objectives 300 (i) 100% of health centers will have at least one staff trained in violence against women, and adolescent girls related issues and counseling and aware of referral linkages; 30 (ii) At least a 20% increase (50% for the new PAAs) from the baseline in the total score obtained on Standardized Supervisory Instrument that relates to quality of patient care, outreach activities, health center management efficiency (in terms of per capita patient cost), cleanliness, etc. 70 (iii) At least 30% of all the services are provided to identified poor households in the partnership agreement area. 100 Appendix 4 67

(iv) 90% of all the services provided fall in the Essential Service Package. 50 (v) 100% of poor people who are eligible and in need of health services for HIV/AIDS VCT, STI and RTI obtain services free. 50 6 Partnership Area Indicators 100 (i) Average use of health centers is 0.2 visits per person per year in target areas; 50 (ii) At least 12% (8% for the new PAAs) of the total cost of services is to be raised through user fees and other mechanisms by the end of the project period. 100 (iii) All patient-related objectives will be met for the poorest 50% of the poor. 50

Total 1000

68 Appendix 4

APPENDIX 6: EQUIPMENT, FURNITURE, CLINICAL SUPPLIES AND DRUGS Notes: (i) Quantities of items are listed for one PHCCC and one PA Administrative Office. (ii) Tubectomy, vasectomy, IUD, laboratory items have been estimated for a limited number of PHCCs only, since not all PHCCs are expected to provide relevant services. (iii) UPCHP will provide items under 1, 3, 4, and 6. (iv) MOHFW will provide items under section 7. (v) Contractor to provide items under sections 2, 5 and 8. (vi) Financial Proposal should NOT include items under Sections 1, 3, 4 and 7, as these are to be provided to the Contractor or any other that will be provided by relevant programmes. (vii) Procurements will have to be done from short listed suppliers of UPHCP-II II.

1. Medical equipment and instrument:

1.1 General Items: (Including First Aid, Minor surgery, e.g., abscess drainage, etc., and curative treatment for minor ailments) 1.1.1. Drum, Sterilizing, Cylindrical 290 mm Drum - 1 1.1.2. Tumbler 200ml/7 Oz, stainless steel - 2 1.1.3. Aspirator, Nasal, Infant size 30 m1 - 2 1.1.4. Bag hot-water & Ice combination 1ltr. Polypropylene - 2 1.1.5. Cup, Medicine 30 ml polypropylene - 4 1.1.6. Jar thermometer with cap polypropylene - 2 1.1.7. Pail diaper / cover 12ltr. Polypropylene - 2 1.1.8. Pump, breast, hand, rubber, bulb, glass / plastic ball - 1 1.1.9. Scale with trousers, infant, spring type, hanging - 1 1.1.10. Trousers, weighing, set of 4 for 014550 scale - 1 1.1.11. Speculum, nasal, Bosworth wire, stainless steel - 2 1.1.12. Speculum, nasal, child size, Vienna pattern 140 mm - 2 1.1.13. Airway, guedel, rubber, small, adult size 82 mm - 2 1.1.14. Airway, guedel, rubber, small, adult size 76 mm - 2 1.1.15. Forceps, dressing, spring type 155 mm SS - 2 1.1.16 Forceps, ear, spring type, angular wide 120 mm - 2 1.1.17. Forceps, tissue, spring type 1 x 2 teeth 145 mm - 4 1.1.18. Knife handle, surgical, for minor surgery #3 - 4 1.1.19. Holder, needle, straight, board-jaw mayo-HGR 200 mm - 2 1.1.20. Scissors, surgical, straight 145 SIB SS - 4 1.1.21. Stitch, cutting, scissor - 2 1.1.22. Undine, dropper (eye - irrigator) 60 ml glass - 2 1.1.23. Retractor, vaginal, Sims, medium, blade 32 x 80 mm SS – 2 1.1.24. Retractor, vaginal, Sims, small blade 25 x 63 mm SS - 2 1.1.25 Forceps, teeth – extracting, universal - 4 1.1.26. Instrument, Tray with lid - 2 1.1.27. Rack, test-tube, for 12 tubes wooden - 3 1.1.28. Brush for Iab-test-tubes, bristled, Dia 13 mm x 230 mm - 8 1.1.29. Mackintosh/rubber gown-as required - 4 1.1.30. Sphygmomanometer, aneroid 300 with cuff - 2 1.1.31. Stethoscope, Binaral, complete - 2 1.1.32. Thermometers - 8 1.1.33. Weighing machine (bathroom scale) - 1 1.1.34. Tongue Depressor (Metallic) - 8 1.1.35. X-ray view box (Tube light system) - 1 Appendix 4 69

1.1.36. Spot light (BD) - 2 1.1.37. Diagnostic set - 1 1.1.38. Surgical Drum - 1 1.1.39. Big Aluminium saucepan with cover to immerse all big trays – 1 1.1.40. Physical Examination table - 2 1.2. For Infection Prevention procedures: 1.2.1. Bucket with lid (15-20 liters)-1 1.2.2. Bucket without lid (15-20 liters)-2 1.2.3. Cup for measuring bleaching powder-I 1.2.4. Spoon (steel)-4 1.2.5. Utility gloves-I2 pair 1.2.6. Wooden stirrer-4 1.2.7. Incinerator, drum type - 1 1.3. For Injectable Service: 1.3.1. Used disposable syringe crushing equipment-l 1.3.2. Container for storing broken syringes and needles-I 1.4. For IUD service: 1.4.1. Sterilizer-Instrument, boiling type 320x170x100 rom, electric – 1 1.4.2. Basin, kidney 825 ml SS - 2 1.4.3. Cup, solution 180 ml stainless steel- 2 1.4.4. Sheeting, plastic, clear PVC 91 cm x 180 cm - 4 1.4.5. Brush, hard, surgeon's, white nylon bristles - 8 1.4.6. Flashlight, pre focused, 2-celled right-angled head 1.4.7. Forceps, hysterectomy, straight, pean 225 mm, SS 1.4.8. Forceps, sponge-holding, straight 200 rom 1.4.9. Forceps, uterine, tenaculum duplay, DBL-CVD 280 mm 1.4.10. Scissors, uterine, curved, Sims 200 mm SS 1.4.11. Sound, uterine, Simpson 300 mm, graduated in 20 mm 1.4.12. Speculum, vaginal, Bi-valve, Graves, small, SS 1.4.13. Speculum, vaginal, Bi-valve, Graves, medium, SS 1.4.14. Speculum, vaginal, Bi-valve, Graves, Large, SS 1.4.15. Gully pot - 2 1.4.16. Timer-1 1.4.17. IUD insertion table – 1 1.5. Tubectomy: 1.5.1. Tray, Instrument, dressing, w/cover 310 x 195 x 63 rom, SS 1.5.2. Forceps, dressing, spring type 155 rom SS 1.5.3. Forceps, Hemostat, straight Rochestr-pean 160 rom, SS 1.5.4. Forceps, hysterectomy, straight pean 225 rom, SS 1.5.5. Forceps, hemostat, curved, mosquito ha1stead 125 rom 1.5.6. Forceps, tissue, spring -type 1 x 2 teeth 145 mm 1.5.7. Forceps, tissue, babcock 20 cm 1.5.8. Forceps, tissue, fenestrated jaw, Duval145 rom 1.5.9. Forceps, uterine, tenaculum duplay, DBL-CVD 280 mm 1.5.10. Holder, needle, straight, narrow jaw, Mayo-HGR 180 rom 1.5.11. Knife handle surgical for minor surgery # 3 1.5.12. Retractors, abdomen, Richardson-Eastman D-E set of2 1.5.13. Scissors, surgical, straight 145 mm BB SS 1.5.14. Scissors, tonsil, curved, Metzenbaum, baby 150 mm, SS 1.5.15. Speculum, vaginal, Bi-valve, Graves, small, SS 1.5.16. Speculum, vaginal, Bi-valve, Graves, medium, SS 1.5.17. Clamp, taweljones, 9 cm 1.5.18. Retractor, Gen oper, langenbek, 60 x 20 rom 1.6. Vasectomy: 1.6.1. Instrument pan and covers SS 12 Y2 x 6 ~ x 4 with metal latch 1.6.2. Clumps, Towel, Backhans 3 Y2" 1.6.3. Control, syringe, lower lock 5 ml 1.6.4. Forceps, curved 5 12 box lock 1.6.5. Forceps, Allis, Intestinal standard pattern, box lock 1.6.6. Forceps, Kelly, Artery, straight 5 Y2 1.6.7. Handle, surgical, knife NO.3 1.6.8. Holder, Needle, Collier, book-lock 5" 70 Appendix 4

1.6.9. Scissors, Khapplvis, 4" curved 1.6.10. Scissors, Satare, blunt & blunt 4 Y2" 1.7. M.C.H.: 1.7.1. Tape, measure, 1.5 m 60 Vinyl-coated fibreglass 1.7.2. Urinary test set, complete 1.7.3. Pelvimeter, Collyer, External, Grand, cms inches 1.7.4. Stethoscope, foetal, pinard monaural 1.7.5. Thermometer, clinical, oral, dual, Cels/ Fahr scale 1.7.6. Thermometer, clinical, rectal, dual, Cels / Fahr scale 1.8. For EPI services: 1.8.1. Steam Sterilizer-l 1.8.2. Timer-1 1.8.3. Vaccine carrier with thermomiter-1 1.8.4. Ice packs-4 1.8.5. Syringe/needle Pickup Forceps-1 1.8.6. Items for hand washing (soap, soap case and brush) 1.8.7. Blue plastic bowl for keeping and washing 1.8.8. Ampule file (for cutting BCG and diluents ampoule) 1.8.9. Dropper for feeding vaccine-2 1.8.10. Small bowl (for keeping with distilled boiled water)-l 1.8.11. Pieces of cloth (for holding hot Steriliser and cleaning the table) 1.9. For ARI: 1.9.1. Thermometer-2 1.9.2. ARI case management chart-as per requirement 1.9.3. VIT-A Capsule- as per requirement 1.9.4. Small scissors (for cutting the capsule)- 1.9.5. Register for record keeping

1.10. For Laboratory: To perform the following tests: (i) Urine for Albumin and sugar (ii) HB estimation TC, DC (iii) ESR (iv) Wet mount test (v) Gram stain (vi) KOH test (vii) RPR test (viii) Urine RME (ix)Pregnancy test 1.10.1. Test tube stand (metallic)-1 1.10.2. Test tube holder-2 1.10.3. Test tubes-6 1.10.4. Spirit Lamp-l 1.10.5. Sahalis-Hellies Heamoglobinometer-l 1.10.6. Lancet (Sterile disposable prick needle)-500 1.10.7. Haemocytometer (full set )-1 1.10.8. ESR stand (set of 3)-1 1.10.9. ESR tube- 3 Germany 1.10.10. Tourniquet-l 1.10.11. Stainless steel, staining tray-l 1.10.12. Forceps (plain)-2 1.10.13. Microscope (binocular with 4 objectives)-1 1.10.14. Spot light for microscope-l 1.10.15. Centrifuge machine-l 1.10.16. VDRL shaker machine (Taiwan)-I 1.10.17. Reagent bottle of different sizes-I2 1.10.18. Cover Glass 22 x 22 rom-I box of 100 1.10.19. Beaker-4 1.10.20. Refrigerator (8.5 cft) with platform-I 1.10.21. Automatic Voltage stabilizer-I 1.10.22. Calculator for counting TC, DC etc-I 1.10.23. Measuring cylinder-4 1.10.24. Conical Flask-4 1.10.25. Graduated pipettes-6

Equipments and Instruments for each CRHCC

SL. No. Item 01 Ultrasonogram Appendix 4 71

02 FoetalDoopler 03 Foetal care/ Monitor (CTG) 04 Ventous Extractor 05 Diathermy Cautery 06 Wrigley's Forceps 07 Pulse- Oxy meter for OT 08 BP machine 09 Stethoscope 10 Paediatric Stethoscope 11 Phototherapy machine 12 Oxygen cylinder with flow meter 13 Baby sucker 14 Sucker 15 Big Instrument trolly 16 OT Table ( need replacement) 17 Labor Table (need replacement) 18 Generator/ IPS for post operative & ward 19 OT Light/OT Spot light(rechargable) 20 Autoclave (king size- gas operated) 21 Air Conditioner ( for OT& Labor room) 22 Incinerator- big with heavy metal 23 Fire Extinguisher( need replacement) 24 Rechargable light 25 Strilizer, boiling type 26 Amboo resuscitator 27 Mayo trolly 28 Thermometer 29 Thermometer: Jar 30 Liftr jar 31 Lifter 32 Surgical Drum: big 33 Surgical Drum: Medium 34 Surgical Drum: small 35 Flat Tray with lid: big 36 Flat Tray with lid: medium 37 Saline Stand 38 Single Spot Light 39 Baby Weighing machine 40 Bowl sponge 41 Bowl utility 42 Bowl stand (double) 43 Bed pan 44 Ice pack 45 Gloves Surgical 46 Gloves disposable 47 Gloves utility 48 Syringe disposable, 5cc,2cc 49 Gauge: as required 50 Cotton: as required IP 72 Appendix 4

51 Makintosh/Rubber gown 52 Plastic Bucket without lid( 15-20liters) 53 Plastic Bucket with lid( 15-20liters) 54 Plastic bowl(medium for ins. cleaning) 55 Plastic rack( for drying instruments) 56 Plastic Waste Receptacle 57 Timer, 60 minute with bazzer 58 Spoon( plastic/melamine) 59 Cup for measuring bleaching powder 60 Wooden stirrer 61 Incinerator 62 Brush nylon Others 63 MUAC tape 64 Measuring tape 65 Gauge;as required 66 Cltton:as required 67 Adesive plaster:as required 68 Catgut, chromic O:as required 69 Catgut, chromic 00:as required 70 Catgut, chromic 1:as required 71 Silk Dexan:as required 72 Needle 3/S, circular, cutting assorted pk/6 73 Needle ,stright, cutting assorted, pk/6 74 Gloves surgical : size 6.5, 7:as required 75 Disposable polythine gloves:as required 76 Bag of hot water and Ice combination 77 Disposable syringe 10cc 78 Disposable syringe 5cc 79 Disposable syringe 2cc 80 Ryles tubeTourniquet 81 Tourniquet as required 82 Catheter, Urethral, Foley's as required 83 Plain Cather as required 84 Metalic Catheter as required 85 Uro bag: as required 86 Buttefly needle: as required 87 I/V Cannula: as required 88 Hospital Bed 89 Bed Side Locker 90 Baby Cot 91 Wheel Chair 92 Pat. Trolly 93 Lilen Trolly 94 Refri. 95 TV 96 VCP 97 Medicine shelf 98 Chair Table ETC 99 Almirah Appendix 4 73

100 File Cabinet 101 Computer with printer 102 Fan (as required) 103 Water Filter 104 Instruments and clinical supplies for one PHCC* 105 Caeserean Section Set* 106 D&C Set* 107 Tubectomy Set* 108 NSV Kit Set* 109 Hysterectomy Set* 110 Normal Delivery Set* 111 Laboratory Supplies*

2. Supplies: 2.1. Clinical supplies 2.1.1. Knife, blade, surgical for minor surgery # 10 pkt 5 - 4 2.1.2. Suture, nylon, monofil, sterile 000 USP 76 rom 2.1.3. Suture, silk, black, set of 3 sizes 2.1.4. Suture, silk, black, size 000 USP 2 X 76 cm length 2.1.5. Suture, silk, black, size 1 USP2 x 76 em length 2.1.6. Suture, silk, black, size 3 USP 2 X 76 em length 2.1.7. Needle, suture, assorted, 6 each of5 types 2.1.8. Needle, suture, surgeons, regular, 3/8 circle 2.1.9. Cutting and round needle 2.1.10. Splint - board full - body 1.5 rn 2.1.11. Splint - board leg 750 mm 2.1.12. Splint - board ar 500mm 2.1.13. Triangular bandage cloth91 0 mm sides 2.1.14. Syringe, Hypo, insulin 1 ml /40-80 units lure glass 2.1.15. Syringe, Hypo, 10 Muller glass 2.1.16. Syringe, Hypo 5 Muller glass 2.1.17. Syringe, 2 Muller glass 2.1.18. Mask-8 2.1.19. Disposable syringes, 2cc and needles 2.1.20. Gloves, surgeon's, latex, size 6 Y2 2.1.21. Gloves, surgeon's, latex, size 7 2.1.22. Gloves, surgeon's, latex size 7 yz 2.1.23. Needle, suture, abdominal, Keith, straight, Needle, suture 3 /8 circle, round PT # 12 pkt of 6 2.1.24. Needle, Keith. Abdominal, triangular, Point Straight YZ" 2.1.24 .a. (6 needle per pakt) 2.1.25. Needles Mayo Y2", circle taper point, regular eye size 2.1.26. Needles, Hypodermic, 22 Gauge Y2", reusable (12 pkt) 2.1.27. Needles, Hypodermic 25 Gauge ~ " long, reusable (12 pkt) 2.1.28. Disposable syringes and needles - as required 2.1.29. Syringe, Hypodermic lure-lock 5 ml 2.1.30. Catheter, urethral, Nelaton, Solid tip, one eye, 14 FR 2.1.31. Lancet SS (Hedgedom needle) 75 mm 2.1.32. Syringe (BCG)-42 2.1.33. Syringe (DPT, Measles, TT)- 42 2.1.34. 5.0 ml syringe (for Mixing)- 4 2.1.35. 26-gauge needle (BCG)-50 2.1.36. 22 or 23 gauge needle (DPT, Polio, Measles and TT)-50 2.1.37. 18-gauge needle (for Mixing)- 8 2.1.38. Tourniquet latex rubber 75 crn - 4

74 Appendix 4

2.2. Laboratory supplies: 2.2.1. ESR fluid 3.8% Na Citrate-l bottle 2.2.2. Leishman stain-l bottle 2.2.3. KOH reagent 10%-2 bottles 2.2.4. For Gram stain 2.2.4.a. Crystal Violet 2.2.4.b. Gram's Iodine 2.2.4.c. Decolorizer (50/50 mixture of95% ethanol and Acetone) 2.2.4.d. Safranine 2.2.4.e. lmmersion oil 2.2.5. RPR ready test kit-100 test 2.2.6. Litmus paper (red and blue)-l pack 2.2.7. Methyline blue 2.2.8. Pregnancy test kit, Human, (Germany)-l kit of 100 test 2.2.9. Blotting paper-as per requirement 2.2.10. Cotton tipped swab-500 2.2.11. Disposable syringe (3cc) 2.2.12. Clean cotton-5 1bs 2.2.13. Rectified Spirit-2 lbs 2.2.14. Methylated spirit-5 lbs 2.2.15. Test tubes -2 doz. 2.2.16. Distilled water or, normal saline- 5 bottles 2.2.17. N/10 HCI-2 bottles 2.2.18. Benedict solution- 2 bottles 2.2.19. Glacial Acetic Acid 5,% - 1 bottle 2.2.20. Droppers-12 2.2.21. Glass slide-1 box of 100 2.2.22. Blood grouping kit - 1 2.3. Other supplies: 2.3.1. Torch light with batteries - 2 2.3.2. Gloves’ Hanger with clip-1 2.3.3. Bed with mattress- 1 2.3.4. Pillow with cover - 2 2.3.5. Bed sheet-4 2.3.6. Apron for doctor and paramedic - 4 2.3.7. Soap 2.3.8. Battery, alkaline, dry cell 'D' type 1.5 V 2.3.9. Soap case -8 2.3.10. Pen, vaccine card, register and tally sheet 2.3.11. IEC materials (poster, leaflet, flyer etc) 2.3.12. Spirit 2.3.13. Cotton 2.3.14. Gauze, bandage 2.3.15. Bleaching powder 2.3.16. Phenyl

3. Audio Visual Equipment 3.1. 25" Color TV - 1 3.2. TV trolley-1 3.3 Video Cassette Player - 1 3.4. Video cassettes on different items (ANC, PNC, Safe delivery, ARI, Diarrhoea, Breastfeeding, HIV/AIDS etc.) 3.5. Pelvic Model-l 3.6. Penis Model-l 3.7. Counseling Display Board-1

4. Electrical Equipment: (General Purpose) 4.1. Emergency Lantern (rechargeable)-2

5. Furniture: 5.1. For PHC Center: 5.1.1. Waiting chair, armless - 24 Appendix 4 75

5.1.2. Half secretariat table - 3 5.1.3. Table, side rack - 3 5.1.4. Revolving, arm chair – 2 5.1.5. Revolving, examination tool – 2 5.1.6. Arm chair - 2 5.1.7. Tool - 2 5.1.8. File cabinet - 3 5.1.9. Almirah - 1 5.1.10. Plain table - 2 5.1.11. Medicine shelf - 2 5.1.12. Dunneze - 4 5.1.13. White board 5.1.14. Notice/ display board 5.1.15. Easel board

5.2. For Project Admin. Office 5.2.1. Waiting chair armless – 24 5.2.2. Secretariat table - 3 5.2.3. Table, side rack - 3 5.2.4. Revolving, arm chair - 2 5.2.5. Revolving, examination tool- 2 5.2.6. Arm chair - 3 5.2.7. Stool- 2 5.2.8. File cabinet - 4 5.2.9. Almirah - 3 5.2.10. Bookshelf - 2 5.2.11. Computer table - 1 5.2.12. Table for Photocopier 5.2.13. White board 5.2.14. Notice/ display board Easel board

6. Equipment and vehicle for Project Admin. Office 6.1. Project vehicle 6.2. Telephone 6.3. Photocopier 6.4. Computer, printer with all accessories

7. Contraceptives, vaccines, medicines and micro-nutrients and others 7.1. Contraceptives: 7.1.1. Oral contraceptive pills 7.1.2. Condoms 7.1.3. IUDs 7.1.4. Injectable contraceptives (Nor plant and Depo) 7.1.5. NORPLANT 7.2. Vaccines: 7.2.1. All six or seven EPI vaccines 7.2.2. Tetanus Toxoid 7.3. Micro-nutrients: 7.3.1. Vitamin A 7.3.2. Iron/Folic acid 7.4 Others: 7.4.1 Medicine for DOTS 7.4.2 Medicine for leprosy 7.4.3 Medicine for HIV 7.4.4 Medicine for malaria and fileria (when required)

8. MEDICINES

SN Name of Medicine Form 1 Albendazole Tablet; 200mg 2 Aluminium Hydroxide Suspension; 200ml3 76 Appendix 4

SN Name of Medicine Form 3 Dexamethasone Tablet; O.5mg 4 Erythromycine.; Suspension 125ml; 100ml 5 Ferrous sulphate Tablet 6 Folic acid Tablet; 5 mg 7 Magnesium Hydroxide Suspension; 400mg/5ml; 100ml 8 Methyl Dopa Table 250 Mg 9 Phenobarbitone Tablet; 30mg 10 Primaquine Dry syrup; 125mg/5ml; 100mi 11 Phenoxymethl Penicillin Tablet;7.5mg 12 Promethazin Hydrochloride Dry syrup; 125mg/5ml; 100mi 13 Quinine Tablet; 300mg. 14 Quinine Injectable; 300mg/5ml 15 Riboflavine Tablet 16 Whitfield Ointment Ointment; 500mg 17 Chlorhexidine Solution; 0.05% 56ml Ointment; 18 Tetracycline eye ointment 1 % in 4 gm tube Tablet; 400mg 19 Albendazole Injectable; 12 lac IV per vial 20 Benzathine Penicillin Emulsion; 25% 21 Benzyl benzoate l20ml phial Tablet; 800+ 160 mg 22 Cotrimoxazole Inj.; 5 mg/ml in 2 ml ampoule Tablet 23 Diazepam Fe200mg+ Fo1200mg 24 Ferrous sulphate + Folic acid Tablet; 50mg 25 Fluconazole Tablet; 10mg 26 Hyoscine N Butyl bromide Inj.; 20 mg/ ml in 2 ml ampoule 27 Hyoscine N Butyl bromide Tablet; 400mg 28 Ibuprofen Tablet; 200mg 29 Ibuprofen Tablet; 400mg 30 Mebendazole Tablet; 100mg 31 Mebendazole Suspension; 100mg; 100mg/5ml; 30ml 32 Phenoxymethyl Penicillin Tablet; 250mg 33 Sulfadoxine -pyrimethamin Tablet; 525mg 34 Aspirin Tablet; 300mg 35 Chloroquine Tablet; l50mg 36 Diazepam Tablet; 5mg 37 Erythromycine Tablet; 250mg 38 Fluconazole Capsule; 150mg 39 Nalidixic acid Tablet; 500mg 40 Nalidixic acid Suspension; 300mg/5ml; 50m 41 Procaine Penicillin l Injectable; 4 lac IV vial 42 Amoxycillin Capsule; 250mg 43 Amoxycillin Suspension; 125mg/5ml; 100ml 44 Aluminium Hydroxide Tablet; 500mg 45 Ciproflexacine Tablet; 250mg 46 Ciprofloxacine Tablet; 500mg 47 Cotrimoxazole Tablet; 400 + 80 48 Cotrimoxazole Syrup 240mg/5ml; 60ml 49 Doxycycline Capsule; 100mg 50 Metronidazole Tablet; 200mg 51 Metronidazole Tablet; 400mg 52 Metronidazole Suspension; 200mg/ 5ml; 60ml 53 Salbutamol Tablet; 4mg 54 Paracetamol Tablet; 50mg Appendix 4 77

SN Name of Medicine Form 55 Paracetamol Suspension; 120mg/5mg/5ml; 60ml 56 Adrenaline Inj.; Img/ml, Iml ampoule 57 Ergometrine Tablet; 500mg 58 Ergometrine Injectable; 500mg/ml vial 59 Gentian Violet 0.05% Solution; bottle of 25 gm powder 60 Hydrochlorothiazide Table 25mg 61 IV fluids Cholera saline; 500ml 62 IV fluids Normal saline; 500ml 63 IV fluids Ringer's Lactate solution, 500m 64 IV fluids Hartman's Solution 500ml 65 ORS Sachet; composition for 0.5 litre solution 66 Phenobarbitone Injectable; 100mg/ml in 2 ml ampoule

APPENDIX 7: PROPOSAL FORMS

Form 1: General Information

(If this is to be a joint venture, the following information also must be provided for each partner, with a note indicating the lead partner)

1. Name of Organization (please mention names of all the partners if it is a consortium): ______

2. Address of Head Office (of the lead agency in case of a consortium) ______

3. Address of Local Office (if any): ______

4. Telephone: ______

5. Fax: ______

6. E-mail: ______

7. Contact Person: ______

8. Legal Status of Organization: Profit ______Non-Profit _____

9. Place of incorporation/registration ______

10. Year of incorporation /registration ______

(Certified copies of certificates of incorporation or registration must be attached)

11. Main Activities; projects/ programmes (describe activities and length of experience beginning in reverse calendar, ending in the present activities/projects) 1. ______Since from ………………..to ……………………

2.______Since from ………………..to ……………………

3.______Since from ………………..to ……………………

12. Litigation/Arbitration: Outline any history of litigation or arbitration from contracts executed over the last four years or currently under execution. For any such case, outline the year, name of contractor/employer, cause of litigation, matter in dispute, disputed amount and whether the award was for or against the bidder result.

Form 2: Financial Information

All individual firms and all partners of a joint venture must complete the information in this form. The information supplied should be the annual turnover of the Bidder (or each member of a joint venture), in terms of the amounts billed to clients for each year, for work in progress or completed, converted to US dollars at the rate of exchange at the end of the period reported. (Use a separate sheet for each partner of a joint venture.)

1. Name of Bidder/Partner______

2. Name of Banker ______Address of Banker ______Telephone ______Fax ______Contact Name and Title: ______

3. Annual Turnover data for the last three years: 2004 US$ ______Major sources(s) of funding

2003 US$______Major sources(s) of funding

2002 US$ ______Major sources(s) of funding

4. Attach certified copy of the summary of three (3) annual audited financial statements covering the past three years.

Name and Signature of Bidder: ______

Date: ______80

FORM 3: Major work (Last ten years) which Best Illustrates Qualifications of Organization

The following information should be provided for each reference project for which your organization, either individually or as a corporate entity or as one of the major organizations within a consortium, was legally contracted by a client as stated below. Use only one page for each experience (total number of pages not to exceed five for each of the partners in the suggested/ present consortium).

Project Name:: Country Project Location within Country Professional Staff Provided by your Organization (name the professions): No. of staff: No. of person-months: Name of Client:

Name of associated firm(s) if any: No. of person-months of professional staff provided by associated firm(s):

Start Date: (month/year)

Completion Date (month/year) Budget for Project (US$): Description of Project: Provide brief (2-3 sentences) description of project.

Summary of Relevant Experience (maximum 1 page for each area, single spaced, font 11 points, margins 1 inch, paper size A4

For each topic below, describe the experience of your organization, specifying the country and the years in which the work took place, in parentheses.

(i) Experience in ESP service delivery and in Management Of Primary Health Care Systems. This should mention linkages with Referral Hospitals, use of health centres, outreach (and describe its various forms) as well as management of health service staff.

(ii) Experience in providing Health Care Services For The Poor, including outreach workers, community volunteers, mini clinics/depots, social mobilization, etc.

(iii) Experience in implementing Quality Assurance Strategies. Outline also experience with staff performance appraisal systems, monitoring and evaluation, gender equity, and analysing overall productivity for the year.

(iv) Experience in development and/or implementation of Health Care Financing Strategies and in particular, experience with charging fees and using systems waiving fees for the poor and very poor.

(v) Experience of addressing gender and poverty issues and their health seeking behaviour

(vi) Other innovations, if any. 81 FORM 4A: Personnel/Staff Proposed for the Project

Composition of the Team: Personnel and the Task which would be Assigned to each Team Member

Technical/Managerial Staff

NAME AND PROFESSIONAL NAME AND ADDRESS OF POSITION / PRIMARY LOCATION QUALIFICATION EMPLOYER AND CONTACT FOR ASSIGNMENT/ YEARS OF (WITH TELEPHONE NUMBER) SERVICE

Support Staff

NAME AND PROFESSIONAL NAME AND ADDRESS OF POSITION / PRIMARY LOCATION QUALIFICATION EMPLOYER AND CONTACT FOR ASSIGNMENT/ YEARS OF (WITH TELEPHONE NUMBER) SERVICE

Note. Please make sure the minimum staffing suggested in Appendix 2 ( 2.60 point ) is fully ensured. 82

FORM 4B :Staffing Schedule

(Provide annual plan for 6 year period)

Name Positio Activities (include Total n posting location) Person Months Year 1 Year 2 Year 3 Year 4 Year 5 Year 6

QQ Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

FORM 5A: CURRICULUM VITAE TO BE SUBMMITED WITH PROPOSAL FOR PROJECT MANAGER

1. Proposed position - Project Manager (maximum 3 pages for nos. 1-8), single spaced, font 11 points, 1 inch margins, A4 paper)

2. Name ______

3. Date of Birth ______

4. Education: (degree, date conferred, school name and location and major subject or study)

5. Other training:______

6. Language(s) and degree of proficiency (excellent, good, satisfactory, poor): ______

7. Employment record: (Starting with present position, list in reverse order every employment for last six years, indicating:

a. Start and end dates of each employment b. Name of employer c. Employment status (employee of firm; consultant or advisor to firm, other) d. Position held e. Country in which employment was carried out. If multiple, or partially in main office and partially in other country, indicate total amount of time actually spent in each country and for each project/ programme f. Summary of experience using the provided headings below and with indication of the country in which the experience took place, in parentheses. (maximum ½ page, with the total number of page not exceeding three).

1. Experience in ESP service planning, delivery and in management of Primary Health Care Systems. This should mention use of health centres, outreach (and describe its various forms) as well as management of health service staff. 2. Experience in implementing Health Care Services For The Poor, Women, Children, Adolescents and Equity. 3. Experience in implementing Quality Assurance Strategies. 4. Experience of human resources development activities. 5. Experience in implementing Health Care Financing Strategies. 6. Experience in community mobilisation. 7. Innovations, if any

8. Name, position, phone number and e-mail address of 3 recent professional referees.

9. Certification:

I, the undersigned, certify that, to the best of my knowledge and belief, this curriculum vitae correctly describes my qualifications and experience. I understand that any willful misstatement described herein may lead to my disqualification or dismissal, if employed.

Signature: ______Date:______

FORM 5B: CURRICULUM VITAE FORMAT TO BE SUBMITTED WITH PROPOSAL

(All staff except Project Manager)

1. Proposed position in the Project ______

2. Name ______

3. Date of Birth ______

4. Education: (degree, date conferred, school name and location and major subject or study should be indicated)

5. Other training:______

6. Language(s) and degree of proficiency (excellent, good, satisfactory, poor): ______

7. Employment record: (Starting with present position, list in reversed order every employment for prior ten years, indicating: a. Start and end dates of each employment.

b. Name of employer

c. Employment status (employee of firm; consultant or advisor to firm, other)

d. Position held

e. Brief description of duties. Be sure to describe duties and responsibilities, which illustrate capability to handle the position for which you are being proposed for this contract.

f. Country in which employment was carried out. If multiple, or partially in main office and partially in other country, indicate total amount of time actually spent in each country or project/ programme.

8. Name, position, phone number and e-mail address of 3 recent professional referees.

9. Certification:

Signature: ______Date ______85

FORM 6: PARTNERSHIP AGREEMENT BUDGET FORMAT

Notes: (i) Forms 6A (Summary), Forms 6B (PA HQ), Form 6C (CHRCC) and Form 6D (PHCC) need to be submitted (ii) All the amounts are in Bangladesh Taka (iii) Minimum levels where specified are indicated on the sub-formats - bidders are free to propose higher levels to improve services, but expenditure must be at least at the minimum level specified for indicated items. (iv) Notes and assumptions to explain budget figures should follow the budget (use one or more pages as necessary)

Form 6A – SUMMARY SHEET (BASED ON COMPILATION OF FORMS 6B, 6C, 6D) Annual Budget Budget Categories Minimum 6 years levels Year 1 Year 2 total I. Investment Expenditure A. Equipment & Furniture B. Facility Renovation C. Staff Training D. Other TOTAL INVESTMENT : II. Recurrent Expenditure A. Salaries (with allowances, incentives, etc) 1. Project Office 2. CRHCC 3. PHCCs 4. Satellite clinics, mini-clinics, outreach, etc. Sub- Total B. Travel and Perdiem C. Training and Workshops D. Supplies and Consumables : 1. Office Supplies 2. Clinic Supply 3. other supplies 4. Medicines 5. Supplementary nutrition for mothers and children at CRHCC and PHCCs E. Emergency Medicine Fund F. HIV/AIDS VCT CENTER G. Other Direct Costs 1. Facility Repair and maint. 2. Electricity,Gas,Conservancy 3. Vehicle operation and maint. 4. Communication 86

5. Nutrition education materials/training 6. PHC education material & serv. 7. Clinics (satellite,mini-clinic and outreach costs) 8. Contractual Services 9. Facility Rental Costs 10. Other (Bank Charges, etc.) TOTAL RECURRENT COSTS : TOTAL EXPENDITURES (I + 2) III. Income Generation: A. Service Fees B. Cross Subsidies C. Community Financing D. Insurance income E. Other Total Income Generated IV. Taxes A. VAT B. Income Tax C. Others Total Allowance for Taxation

Form 6B- HEADQUARTERS COSTS BUDGET FORMAT UPHCP project-related costs for NGO HQ Annual Budget Budget Categories Minimum 6 year level Year 1 Year 2 total I. Investment Expenditure A. Equipment & Furniture 45,000 B. Facility Renovation 20,000 C. Staff Training 130,000 D. Other TOTAL INVESTMENT : II. Recurrent Expenditure A. Salaries : Project Manager 312,000 Project Officer 132,000 Finance/Accounting 132,000 MIS/Documentation Asst 120,000 Office Assistants 60,000 Driver 48,000 Cleaner 30,000 Sub- Total 834,000 B. Travel and Perdiem 40,000 C. Training and Workshops D. Supplies and Consumables : 1. Office Supplies 25,000 2. Clinic Supply 0 3. Other supplies 0 E. Emergency Medicine Fund 120,000 F. HIV/AIDS VCT Center G. Other Direct Costs 1. Facility Repair and maint. 25,000 2. Electricity,Gas,Conservancy 20,000 3. Vehicle operation and maint. 130,000 4. Communication 45,000 5. PHC education material & serv. 100,000 6. Clinics (sattelite clinic,mini-clinic and outreach costs) 7. Contractual Services 8. Facility Rental Cost 98,000 9. Other (Bank Charges, etc.) TOTAL RECURRENT COSTS : TOTAL EXPENDITURES :

Form 6C: CRHCC COSTS BUDGET FORMAT Annual Budgets Budget Categories Minimum Year Year 6 year Level 1 2 Total I. Investment Expenditure A. Equipment & Furniture 50,000 B. Facility Renovation 20,000 C. Staff Training 40,000 D. Other TOTAL INVESTMENT : II. Recurrent Expenditure A. Salaries : Physicians (5) 750,000 Specialist Physician (1) 180,000 FVW/Paramedic (5) 300,000 Pediatrician cum Nutritionist (1) 180,000 Counselor (1) 48,000 Clinic Aide (4) 190,000 Aya/Cleaner (4) 120,000 Guard (4) 120,000 Ambulance Driver (1) 48,000 Sattelite/mini clinics in CRHCC FVW/Paramedic (4) 240,000 Service Promoter (4) 170,000 Outreach Worker (8) 300,000 Sub- Total Salary B. Travel and Perdiem 70,000 C. Training and Workshop 25,000 D. Supplies and Consumables : 1. Office Supplies 15,000 2. Clinic Supply 25,000 3. other supplies 200,000 4. Medicines 600,000 5. Supplementary nutrition to mothers and children 200,000 G. Other Direct Costs 1. Facility Repair and maint. 35,000 2. Electricity,Gas,Conservancy 40,000 3. Vehicle operation and maint. 25,000 4. Communication 20,000 5. Nutrition education material/training 100,000 6. Clinics (satelite clinic,mini-clinic and outreach costs) 17,000 7. PHC education material & serv. 50,000 8. Contractual Services 90,000 9. Facility Rental Cost 220,000 9. Other (Bank Charges, etc.) TOTAL RECURRENT COSTS : 89

TOTAL EXPENDITURES :

Form 6D: PHCC COSTS BUDGET FORMAT Annual budget Budget Categories Minimum 6 year Level Year 1 Year 2 Total I. Investment Expenditure A. Equipment & Furniture 40,000 B. Facility Renovation 6,000 C. Staff Training 25,000 D. Other TOTAL INVESTMENT : II. Recurrent Expenditure A. Salaries : Physicians-1 125,000 Paramedics/Nurses-1 60,000 Counselor-1 48,000 Guards-1 30,000 Cleaners-1 30,000 Sattelite Clinics Under PHCC FVW/ Paramedic-4 240,000 Service Promotor-4 170,000 Outreach Worker-6 150,000 Sub- Total Salary B. Travel and Perdiem 50,000 C. Training and Workshop 25,000 D. Supplies and Consumables : 1. Office Supplies 15,000 2. Clinic Supply 10,000 3. Other supplies 120,000 4. Medicines 120,000 G. Other Direct Costs 1. Facility Repair and maint. 20,000 2. Electricity,Gas,Conservancy 20,000 3. Vehicle operation and maint. 3,000 4. Communication 20,000 5. clinics (Sattelite clinic, mini-clinic, and outreach costs) 5,000 6. PHC education material & serv. 50,000 7. Contractual Services 10,000 8. Facility Rental Cost 80,000 9. Other (Bank Charges, etc.) TOTAL RECURRENT COSTS : TOTAL EXPENDITURES :

Form 7: Technical Proposal Submitting Sheet

Date: LCB No.: Invitation for Bid No.: Alternative No.:

To: The Project Director Second Urban Primary Health Care Project Project Management Unit (PMU) Room #620, Nagar Bhavan Fulbaria, Dhaka, Bangladesh Tel: 9667791; Tel/Fax: 9667792 E-mail: [email protected]

We, the undersigned, declare that:

(a) We have examined and have no reservations to the Bidding Document, including Addenda No.: [insert the number and issuing date of each Addenda];

(b) We offer to supply in conformity with the Bidding Document and in accordance with the delivery schedule specified in the Schedule of Supply, the following Goods and Related Services [insert a brief description of the Goods and Related Services];

(c) Our Bid shall be valid for a period of [specify the number of calendar days] days from the date fixed for the bid submission deadline in accordance with the Bidding Document, and it shall remain binding upon us and may be accepted at any time before the expiration of that period;

(d) If our Bid is accepted, we commit to obtain a Performance Security in the amount [specify a figure between 5 and 10 percent ] percent of the Contract Price for the due performance of the Contract;

(e) Our firm, including any subcontractors or suppliers for any part of the Contract, has nationals from eligible countries [insert the nationality of the Bidder, including that of all parties that comprise the Bidder if the Bidder is a consortium or association, and the nationality of each Subcontractor and Supplier];

(f) We are not participating, as Bidders, in more than one Bid in this bidding process, other than Alternative Bids in accordance with the Bidding Document;

(g) Our firm, its affiliates or subsidiaries, including any Subcontractors or Suppliers for any part of the Contract, has not been declared ineligible by the ADB;

(h) We understand that this Bid, together with your written acceptance thereof included in your notification of award, shall constitute a binding contract between us, until a formal Contract is prepared and executed;

(i) We understand that you are not bound to accept the lowest evaluated bid or any other bid that you may receive.

Name: In the capacity of Signed: Duly authorized to sign the Bid for and on behalf of: Dated: 91

Form 8: Financial proposal Submission Sheet

Date: ICB No.: Invitation for Bid No.: Alternative No.:

We, the undersigned, declare that:

(a) We have examined and have no reservations to the Bidding Document, including Addenda No.: [insert the number and issuing date of each Addenda];

(c) The total price of our Bid, excluding any discounts offered in item (d) below, is: [insert the total Bid Price in words and figures, indicating the various amounts and the respective currencies];

(d) The discounts offered and the methodology for their application are: Discounts: If our Bid is accepted, the following discounts shall apply. [Specify in detail each discount offered and the specific item of the Schedule of Supply to which it applies.] Methodology of Application of the Discounts: The discounts shall be applied using the following method: [Specify in detail the method that shall be used to apply the discounts];

(e) The following commissions, gratuities, or fees have been paid or are to be paid with respect to the bidding process or execution of the Contract: [insert complete name of each Recipient, its full address, the reason for which each commission or gratuity was, or is to be, paid and the amount and currency of each such commission or gratuity. If none has been paid or is to be paid, indicate “none.”]

Name of Recipient Address Reason Amount

(f) We understand that this Bid, together with your written acceptance thereof included in your notification of award, shall constitute a binding contract between us, until a formal Contract is prepared and executed;

(g) We understand that you are not bound to accept the lowest evaluated bid or any other bid that you may receive.

Name: [insert complete name of person signing the Bid] In the capacity of [insert legal capacity of person signing the Bid] Signed: [insert signature of person whose name and capacity are shown above] Duly authorized to sign the Bid for and on behalf of: [insert complete name of Bidder] Dated: [insert date of signing] 92

Form 9: FORM OF BID SECURITY (BANK GUARANTEE)

WHEREAS, ______[Name of Bidder] (hereinafter called "the Bidder") has submitted his bid dated ______[Date] for the construction of ______[Name of Contract] (hereinafter called "the Bid").

KNOW ALL MEN by these presents that We ______[Name of Bank] of ______[Name of Country] having our registered office at ______(hereinafter called "the Bank") are bound unto ______[Name of Employer] (hereinafter called "the Employer") in the sum of ______64 for which payment well and truly to be made to the said Employer the Bank binds himself, his successors and assigns by these presents.

SEALED with the Common Seal of the said Bank this ____ day of ______20____.

THE CONDITIONS of this obligation are:

(1) If the bidder withdraws his Bid during the period of bid validity specified in the Form of Bid; or (2) If the Bidder having been notified of the acceptance of his Bid by the Employer during the period of bid validity:

(a) fails or refuses to execute the Form of Agreement in accordance with the Instructions to Bidders, if required; or

(b) fails or refuses to furnish the Performance Security, in accordance with the Instructions to Bidders, we undertake to pay to the Employer up to the above amount upon receipt of his first written demand, without the Employer having to substantiate his demand, provided that in his demand the Employer win note that the amount claimed by him is due to him owing to the occurrence of one or both of the two conditions, specifying the occurred condition or conditions.

This Guarantee will remain in force up to and including the date ______days after the deadline for submission of bids as such deadline is stated in the Instructions to Bidders or as it may be extended by the Employer, notice of which extension(s) to the Bank is hereby waived. Any demand in respect of this Guarantee should reach the Bank not later than the above date.

DATE ______SIGNATURE OF THE BANK ______

WITNESS ______SEAL ______

______(Signature, Name, and Address)

APPENDIX 8: BASELINE SURVEY RESULTS 94

APPENDIX 9: PARTNESHIP AREA MAPS 95

APPENDIX 10: LIST OF ADB’S MEMBER COUNTRIES

Countries within the Countries outside the Asian and Pacific Region Asian and Pacific Region Afghanistan Myanmar Austria Australia Nauru Belgium Azerbaijan Nepal Canada Bangladesh New Zealand Denmark Bhutan Pakistan Finland Cambodia Palau France China, People's Republic of Papua New Guinea Germany Cook Islands Philippines Italy Fiji Islands Samoa Luxembourg Hong Kong, China Singapore The Netherlands India Solomon Islands Norway Indonesia Sri Lanka Portugal Japan Taipei,China Spain Kazakhstan Tajikistan Sweden Kiribati Thailand Switzerland Korea, Republic of Timor-Leste Turkey Kyrgyz Republic Tonga United Kingdom Lao PDR Turkmenistan United States Malaysia Tuvalu Maldives Uzbekistan Marshall Islands Vanuatu Micronesia, Federated States of Viet Nam Mongolia

Source. http://www.adb.org/About/members.asp