Context

The Regional Procurement Support Office/Frankfurt (RPSO) is a forward-based activity of the Office of Logistics Management - Office of Acquisitions Management - A/LM/AQM.

RPSO's main objective is to provide Foreign Service posts worldwide with a responsive and efficient procurement and contracting resource.

RPSO has partnered with Centers for Disease Control and Prevention for the delivery of PEPFAR funded construction contracting for all target countries. The magnitude of construction projects frequently exceeds the $50,000 threshold for CDC Procurement and Grants Office warrants.

Original working solutions outlined the use of Botswana Government design teams and thus did not include allowances for unforeseen internal program barriers which made delivery of design services impracticable. As a result, RPSO was asked to consider engaging the process to award Indefinite delivery/indefinite quantity (IDIQ) contracts for Commercial Design and Project Management services, which will be used to finalize the design work to be taken over from the Government of Botswana's Department of Building and Engineering Services (DBES) in January 2010.

Goals and Objectives

In order to ensure the best use of financial resources and provision of the most suitable infrastructure, RPSO has been enlisted to utilize their contracting warrants for CDC's medical development. Portable buildings are sometimes more expensive than design/build structures making the RPSO mechanism more conducive to providing future expandability for the Ministry of Health

Major Activities

RPSO will provide infrastructure assistance to the PEPFAR portfolio through new funds as well through the use of unspent funds from previous fiscal years. RPSO projects touch many aspects of the PEPFAR portfolio, including construction projects benefiting blood safety, pediatric treatment, TB/HIV, OVC, laboratory infrastructure, and the renovation of the PEPFAR office.

Buildings which can be expanded are better suited to the placement of ancillary use by other partners under the Partnership Framework. Design functionality gives consideration to best-use, best-value planning. This clearly provides value added contributions to the healthcare system by incorporating stakeholder input in design rather than purchasing off-the-shelf solutions which often are inflexible and come with intrinsic maintenance costs.

Approved PEPFAR activities are developed by the BOTUSA Building and Design Coordinator with input from the Ministry of Health, cross-coordinated with DBES, and approved by operational partners who will ultimately manage activities in the completed structure.

Regulatory limitations of the Botswana Public Procurement process make it impossible to ensure the integrity of U.S. Federal Acquisition standards. RPSO has approved the mechanism by which commercial project design and management contracts are put in place allowing it to monitor service delivery while minimizing inefficiency and ensuring quality oversight on behalf of the USG and CDC.

Each RPSO project is cross coordinated with all partners to ensure function and cost efficiencies are met. The formalized USG interagency relationship ensures monitoring of USG procurement is done by USG direct involvement as opposed to USG GOB substantial input only.

10.C.OV14: RPSO - Nutrition Rehabilitation for OVC - 350,000.00

THIS IS A CONTINUING ACTIVITY REQUIRING ADDITIONAL FUNDING: 08-T1105 & 07-C0803; 08-T1105 In FY07, USG funds supported the design and construction of a single rehabilitation unit for malnourished children infected and affected by HIV/AIDS at Princess Marina Hospital (PMH) in Gaborone. This project development is ongoing. The rehabilitation unit will serve several purposes: -Affected children will be served by the unit for supportive care and proper nutrition management. -As a training center, family care givers will learn the proper nutrition for infected and malnourished children. -NGOs/ CBOs/FBOs working with OVC will refer needy cases to the Unit and their staff will get proper advice and regular training. -The Unit will provide office space for the project staff. The increased costs of building materials and services made the amount budgeted for the PMH Nutrition Center ($800,000) insufficient to support the construction of such a unit fully. As RPSO will not authorize contracting without a fully funded government cost estimate, additional funding was sought to meet the revised estimate per unit, which is $1 million. In FY08, the USG Botswana requested an additional $1.2 million. The additional $200,000 went towards the completion of the PMH center and $1 million was earmarked for the construction of the second unit in Francistown. Original estimates did not include design services, because DBES was developing construction tender documents and designs at no cost. In the interim, the Government of Botswana (GOB) has been unable to deliver a comprehensive construction package. At this time, an IDIQ for Commercial Design and Project Management will be used to finalize the design work taken over from DBES in January 2010. The Francistown client has requested that additional consultation rooms be added to the original design. Geographic and topographic surveys are underway to determine the location of the buildings at the NRH and this will have an impact on the final design. Project cost-sharing will reduce the mobilization and management expenses, as this structure will be built with three other buildings on the same site. Additional funding will cover A & E costs and round out the funding of the additional rooms. An additional $250,000 is required for these services in Francistown. The Gaborone design requires no design change, but will need $100,000 to pay for the commercial design audit and project management costs.

10.T.PT03: RPSO - Pediatrics Clinic - 100,000.00

CONTINUING ACTIVITY UNDER A PERFORMANCE PASS: ONGOING ACTIVITY FOR WHICH ADDITIONAL FY2010 FUNDS ARE REQUESTED; 07-T1108; 08-T1108 As per request from the Ministry of Health, the clinic will be built in Francistown at Nyangabgwe Referral Hospital, and not in Gaborone. Botswana was one of the first countries in Africa to establish a national ART program. Provision of free treatment was built around an 'ART site' model, consisting of a hospital supported by satellite screening clinics. Beginning in January 2002, ART sites were rolled out in a phased manner. By end of September 2009, 108,288 patients were on treatment in the public sector, of which 61.6% were females. About 6.7% of the patients were children. It has been noted that the development of care and treatment programs for children has lagged behind that of adult care and treatment. A further 13,378 patients had been out-sourced from the public sector to the private sector under the Government of Botswana's out-sourcing program. Another 18,637 patients were being treated in the private sector of the country, comprised of the Medical Aid Schemes and the workplace programs. This adds up to a total of 140,303 patients currently receiving HAART in Botswana, which amounts to 86.8% of the projected 161,700 adults and children in need of ART for the year 2009. There were about 1,832 new clients started on HAART in September 2009 of which 74.2% were initiated in clinics. In FY10, the USG will commence the construction of a new pediatrics building on space adjacent to the pediatrics ward at Francistown's Nyangabgwe Referral Hospital. There are multiple needs for this building, all of which complement services for or directly serve children. When complete, this facility will provide, in its first year of functioning, an access pathway to HIV care and treatment for approximately 200 newly diagnosed HIV-infected children. It will provide care for 3,000 children with HIV and co-morbidities, such as TB and other OIs. As a training clinic, more than 250 HCWs, medical students, interns, and residents will be trained for general and HIV-related pediatrics. Challenges result from the fact that most of the attention to pediatric HIV care has focused on the prevention of vertical transmission in the PMTCT program and on the Early Infant Diagnosis program with referral to treatment and care of HIV-positive babies in the first two months of life. Those HIV-positive children who have survived infancy and early childhood are often unidentified and moving through life with suboptimal health. The system is not actively screening these older children for HIV and OIs to prevent illness through early identification and care. These secondary prevention activities need a programmatic and facility focus. Though initially funded in previous years, this project will require additional commercial design services, since DBES will only hand over the Architectural Drawing Set in January 2010. The previously reviewed concept will have to go through a full electrical, mechanical and civil design before it is complete. FY10 funding includes the addition of 16% funding for these professional fees. Preliminary design work to date will reduce A & E pre-contract services. This design will be used in conjunction with the Pediatric IDCC and Nutrition Center to be located on the same site. Cost sharing of external works layout will reduce need for redundant design services.

10.X.SS38: RPSO - Renovation/expansion MOH - $169,553

THIS IS A CONTINUING ACTIVITY REQUIRING ADDITIONAL FUNDING IN FY2010; 07-X1508; 08-X1508

Due to the rapid growth of the Emergency Plan and increasing staff, the HHS/CDC/BOTUSA offices need to be expanded. Funding will be reserved for RPSO to plan and develop additional space on Ministry of Health property where the current offices are located. Once the initial investment is made, for this expansion, the offices will be rent free with water and electricity being paid for by the Ministry of Health.

Additional $100,000 funding for design and construction of new Entry Gate, Drive, and Carpark to serve as the central access way for the new Nyangwabe Referral Hospital development plan. Currently the BOTUSA team is not able to easily access the hospital grounds for our site. Additionally, clinical trials participants have no place to enter or park without passing through hospital labs. Includes complete commercial design services and project management fees. NOTE: This project will be completed prior to construction of other buildings at NRH.

Additional $69,553.00 car park surfacing. The area needs a drainage and surfacing solution which will also prevent flooding of the HPR labs and allow for paving under this new project. Total bid was $150k, but we will attempt to negotiate a lower bid. BOTUSA Building and Design Coordinator has designed and will manage the project to reduce costs.

10.P.BS05: RPSO - Construction of the Regional Blood Transfusion Center in Francistown - 300,000.00

The current Francistown blood transfusion laboratory is operating from a porta cabin on the Nyangabgwe Hospital premises while the processing of specimens is performed on a small bench. Meanwhile, the blood bank in Maun is renting space in the city center and has been seeking a new location for quite some time. In FY08, PEPFAR funds were granted to assist in the construction of a regional blood transfusion center in Francistown as well renovate a building in Maun to serve as the new blood bank. Implementation of these projects was delayed in FY09 due to organizational setbacks with the Government of Botswana's Department of Building and Engineering Standards (DBES), which affected design coordination and service delivery. Though design work was initiated by DBES, a general site survey was inconclusive in determining site suitability for the delivery of client-based requirements. However, preliminary concept designs were submitted and approved by the Francistown Council with a stipulation that put limits on the allowable space for on-site parking. Underground parking will help to resolve any public access problems while providing service bays for the back-up power generator and refrigeration components for 24-hour cold storage, which was required in the preliminary design. Storm water drainage and flood abatement requirements had to be added, which increased project price. Required geotechnical and topographic surveys have yet to be conducted because the requirement is normally associated with design phase tasking, which is currently the responsibility of DBES. Per regulations, funds cannot be authorized to commit to expenditure reimbursement without a contractual mechanism in place. As a result, DBES has not moved forward and design has stalled. To move the projects forward, DBES will turn over the design completion and project development to RPSO, who will task the project design to a contracted Architect and Engineering (A & E) team for completion. A & E services are estimated at $160,000.

10.T.LS02: RPSO - National Health Laboratory Infrastructure Support - 1,534,373.00

THIS IS A CONTINUING ACTIVITY REQUIRING ADDITIONAL FUNDING IN FY2010: 07-C0714; 07-T1202; 08-T1202 Renovation of the National Health laboratory: $1,000,000 The National Health Laboratory (NHL) in Botswana does not have the capacity to develop policies, evaluate new kits and equipment, carry out surveillance of communicable diseases, conduct training, and provide onsite assistance and monitoring of the laboratory network. In past fiscal years, PEPFAR supported the move of the clinical testing capacity from the NHL to the Princess Marina Hospital laboratory. The building, however, does not fit the minimum requirements of a National Public Health Laboratory with Biosafety level 3, which include molecular testing and other specialized tests to monitor the surveillance of communicable diseases and the ability to serve as a center of excellence, which would include training and quality assurance capabilities. Funds are requested during FY10, therefore, to support the renovation of the NHL in order to transform it into an integrated public health laboratory. The renovation will be done in different phases and this year's funds will serve to estimate the magnitude for A & E design, including assessment, reports, surveys, permits, utility deposits, and architectural expenses. The initial phase of renovation is expected to be $850,000. TB Reference Laboratory Francistown: $234,773 In FY07, funds were given to develop a TB Reference Laboratory in Francistown to support the TB diagnostic and monitoring services in the northern part of Botswana. FY10 funds are requested to top up the allocated budget in order to cover the A & E services, design management, and architectural work. MLG District Laboratory: $300,000 FY08 and FY09 funds were allocated to construct four prefabricated laboratories for the MLG, but the funding was not sufficient to cover the construction of the four facilities due to increasing costs. FY10 funds are requested to support the commercial design and project management, as well as architectural design of these facilities. Construction will occur in two phases: I: Phase 1: Laboratories will be constructed at Letlhakeng, Tlokweng, Area "W", Nata District. II: Phase 2: If funding is sufficient, laboratories will be constructed in Mogoditshane and Block 9 (Gaborone).

10.C.TB02: RPSO - Infection control (2 districts) - 250,000.00

THIS IS A CONTINUING PROJECT REQUIRING ADDITIONAL FUNDING IN FY10; 07-C0717; 08-C0709; 08-C0702 Infection control policies are currently being developed with FY07 funds. PEPFAR funds supported the renovation of a TB isolation ward at the HHS/CDC/BOTUSA site in Gaborone, which will be staffed by PMH personnel. With funding from the GFATM, the MOH constructed a TB isolation ward at Bamalete Lutheran Hospital in Ramotswa. FY07 Plus Up funds were requested for the installation of a prefabricated building at a district hospital that will be selected by the MOH. FY08 funds were requested to procure two prefabricated buildings to be converted into isolation wards for TB patients at sites to be determined by the MOH. Prevention of TB infection in congregate settings is a major component of the collaborative TB/HIV activities. These activities, therefore, will support Botswana's Round 5 TB grant from the GFATM, which among other goals, seeks to strengthen TB/HIV collaborative activities. The need for isolation wards is widespread and location priorities are being considered. In the interim, the DBES has been working on design considerations and is preparing concept plans for BOTUSA. It was determined, however, that one additional TB isolation ward with a clinic and feeding area would be built for the prison in Gaborone, instead of the two isolation wards in the districts. The design will require special considerations and additional funding requirements to meet inmate and staff personal security standards, incorporate tamper proof safety materials, and allow for gender segregation. Building in a high security environment will require additional construction process considerations. Design and project management services and costs will be above the norm due to the security, permits, and bonds. The DBES is working on an initial concept design, but this will have to go to the IDIQ A & E in January 2010. Economic trends have increased the per structure costs in the interim. Additional design and code considerations have made the original concept too costly and new construction is currently more cost effective. The new estimate for the prison ward is $250,000. The total for A & E services ($70,000) will be reduced, because the two locations will have the same design. The construction of TB isolation wards in prisons will increase the collaboration between the Ministry of Health and the Department of Prison Services in the Ministry of Home Affairs in the area of TB control (referrals, treatment, trainings, and infection control). The construction of a TB isolation ward will strengthen national TB infection control, one of the main strategies to reduce the transmission in congregate settings with high HIV prevalence rates. One of the goals of Botswana's Round 5 TB grant from the GFATM is to strengthen TB/HIV collaborative activities. TB infection control is a major component of these interventions. The provision of a functional TB isolation ward at one of the major prisons in Botswana will, therefore, contribute to the national TB control efforts and provide a model for improving facilities in other major prisons around the country. Periodic screening of inmates and prison staff will be introduced to monitor the incidence of TB in this setting. Case notification and treatment outcome monitoring will be conducted, according to national TB program guidelines, to evaluate the success of the program.