This is a new activity under COP09.

Activity Narrative: RFP for Infrastructure construction (contract health centers, housing, labs, etc)

The PEPFAR program has already made a considerable contribution to infrastructure development In

Mozambique. By July 2008, it had supported the renovation or construction, and equipment, of fifteen

laboratories, forty-eight health centers and maternity units, twenty-five hospital consulting rooms, three staff

houses, and twenty-three administrative offices. In addition, thirty-four transportable pre-fabricated

laboratories and diagnostic facilities had been deployed and equipped. A further fifteen houses, seven

maternity units, five health centers and one rural hospital are scheduled for completion by the fall of 2009.

This work was implemented through PEPFAR's Clinical Treatment and Laboratory Partners.

.

The Public Works sector in Mozambique is quite strictly regulated. Technical standards ensure that

buildings are properly designed and fit for purpose, and materials meet minimum standards. Engineers and

supervisors must be appropriately qualified and registered. The procedures for Contract award through

public tender, aimed at ensuring transparency, are rigorous. PEPFAR funded building projects are also

subject to USG legislation, such as the Foreign Assistance Act, and environmental scrutiny. Consequently,

the several PEPFAR Partners currently involved in infrastructure development have had to hire full time

technical staff to manage their small infrastructures programs, or retain expensive consultants on a project-

by-project basis.

COP09 will, for the first time, treat infrastructure development as a discrete rather than embedded program

area, with appropriate budgetary provision, and a program structure designed to improve the speed, quality

and cost-effectiveness of implementation. These arrangements will relieve PEPFAR's Clinical Treatment

and Laboratory Partners of much of the burden of managing activities somewhat removed from their

primary fields of excellence. Two new mechanisms will be employed: Direct Contracting (see "RFP for

Infrastructure - contracts direct - training centers, warehouses), and Centrally Managed (the activities

described here).

This RFP provides for the selection, by open tender, of one or more firms to manage and implement the

majority of medium-sized PEPFAR-funded infrastructure projects. They will be responsible for standardizing

designs and specifications in accordance with best practice and the latest MOH requirements, and drafting

tender documents, in line with USG and Mozambican legislation. The objective is to produce project

packages that can be replicated widely and efficiently, minimizing cost overhead through economies of

scale. There may be exceptional cases where existing structures can be rehabilitated to a satisfactory

standard, rather than building new. This approach will be adopted if the criteria of fitness for purpose and

maintainability can be achieved, and cost savings are significant.

The overall aim of this RFP is to achieve carefully targeted and sustainable improvements to the Health

Service Infrastructure which: 1) provide an essential enabling environment for PEPFAR partners' core

activities, and 2) fit well with MOH plans and policy, and the programs of other donors. To this end, priorities

will be established jointly with MOH, Provincial Health Departments, the Department of Defense, and USG

Health Partners.

Training Centers

Human resource constraints have proven the single greatest threat to meeting PEPFAR prevention, care

and treatment targets in Mozambique. The Minister of Health has affirmed that the lack of human resources

is one of the greatest problems encountered by the public health system, and has personally requested that

USG support expansion and equipment of Health Sector Training Centers. As per the new Human

Resource Development Plan 2008-2015, Mozambique aims to produce within the 2009-2013 period an

additional 10,473 medium-level workers, at least an additional 3,022 basic-level health workers and a

minimum of 3,000 Community Health Workers (APEs).

To this end PEPFAR will finance at least one new training center and work with the MOH and partners on

expanding and equipping existing training centers per government guidance. The Global Fund will support

three centers within the next two years, and other donors are also planning to contribute.

Type II Rural Health Centers

MOH strategy for delivering health services to the rural population focuses on expanding the current

network of approximately 1,000 Type II Health Centers to approximately 1,400, each serving no more than

10,000. The basic Type II Center employs two staff, a nurse and maternity assistant. In areas of high

population density larger Type I Centers may employ up to thirteen technical staff and five auxiliaries, and

serve a population of 30,000. The designs are such that Type II RHCs may be progressively expanded to

Type I, on a modular basis.

This activity provides for the rehabilitation or construction of up to fifteen Type II RHCs.

Laboratories and Dispensaries

Up to five Type II RHCs will be expanded (modules added) to provide dispensaries, and/ or to

accommodate laboratory equipment, some of which is currently housed in temporary containers.

Staff Housing

Two Type II staff houses will be built or rehabilitated at each RHC site, up to thirty total.

Military Medical Facilities

Activity Narrative: Up to four military medical facilities will be rehabilitated, under an agreement between the Department of

Defense and GOM.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Construction/Renovation

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: