Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 2244
Country/Region: Tanzania
Year: 2008
Main Partner: U.S. Department of State
Main Partner Program: Regional Procurement Support Office - Frankfurt
Organizational Type: Other USG Agency
Funding Agency: enumerations.State/African Affairs
Total Funding: $9,372,111

Funding for Biomedical Prevention: Blood Safety (HMBL): $666,224

TITLE: Renovation, equipment and back up reagent and supplies procurement

NEED and COMPARATIVE ADVANTAGE: Tanzania has established a centralized blood transfusion

system that navigates around seven zonal blood centers. In 2006 and 2007, the Regional Procurement and

Support Office (RPSO) played a major role in the renovation, procurement, and installation of the equipment

necessary for the blood banks to be successful. All seven of these centers have been inaugurated and are

operational.

ACCOMPLISHMENTS: RPSO has been instrumental in the contracting aspect of major renovation

initiatives, and for equipping the seven operational zonal blood centers in order to effectively procure, test,

and collect blood for nationwide emergencies. In Fy08 RPSO will continue to play the procurement role of

blood equipment for blood processing as well as storage and distribution. Also will procure a back up stock

of reagent and test kits and other supplies for NBTS to avoid stock out.

ACTIVITIES: These activities will be funded through bilateral mechanism to complement Track 1.0 funding.

RPSO will provide procurement and contractual services for the acquisition and installation of equipment for

the NBTS. The seven zonal centers serve up to five regions each in blood services. Some regions are very

remote and difficult to access for the purpose of collecting and distributing safe blood. In order to facilitate

availability of safe blood, the Ministry of Health and Social Welfare (MOHSW), with assistance from Abbott

Foundation, are currently renovating all regional laboratories which include regional blood banks. NBTS will

equip thirteen of these regional blood banks with equipment for storage and distribution of blood to make it

accessible to district hospitals and health centers while ensuring maintenance of the cold chain. This will

facilitate availability of safe blood to more communities in the far-reaching corners of Tanzania.

Another initiative being considered regarding provision of a continuous supply of safe blood in FY 2008 is to

procure a back up stock of HIV test kits, reagents, and other supplies to supplement the amount acquired

from government sources.

With a rising increase in blood collection, there is a need to increase the efficiency of blood screening for

transfusion transmissible infections (TTIs). Utilizing automated screening equipment can increase

efficiency, while decreasing the necessity for trained personnel in manual application and decreasing the

likelihood for a margin of error (both of which plagued previous blood screening methods). There is a

palpable need for increased mass mobilization, advocacy for blood donation, and sensitization to reduce

stigma. These initiatives call for additional audio/visual equipment for zonal mobile teams. With extensive

experience in contractual and procurement programs commissioned by the USG, RPSO will facilitate the

procurement process and negotiate contractual services to meet and exceed the NBTS requirements.

Remote areas will be served even more conveniently with an additional 13 regional blood banks spread

throughout the country and continous availability of necessary reagents and supplies.

SUSTAINAIBLITY: Renovating and equipping the regional facilities will lead to sustainable availability of

safe blood in all regions and district health facilities. By increasing the number of zonal centers and safe

blood collection points, and through successfully addressing stigma concerns, more and more Tanzanians

will give blood and get tested. This will lead to sustainable repeat donor relationships in addition to people

finding out their status.

Funding for Care: TB/HIV (HVTB): $900,000

TITLE: Infrastructure improvements for TB/HIV at NTLP sites

NEED and COMPARATIVE ADVANTAGE: NTLP needs to increase and improve available clinical space to

meet the growing need for TB/HIV activities including provision of ARV and ensuring privacy, confidentiality

and quality TB/HIV collaborative services for the patients. Currently, most of the medical facilities that are

slated for this project have extremely limited TB clinical space and even less clinical space for HIV/AIDS

patients. Renovated and extended clinics will allow the health care workers to provide comprehensive care

to increased numbers of TB/HIV co infected patients, reduce patients time spent at health facility as the TB

and HIV/AIDS services will be provided at the same clinic. Provision of ART in TB/HIV clinics is part of the

TB infection control program as it reduces the risk of TB transmission to immunocompromised patients at

care and treatment clinics. Scale-up of TB/HIV services will be challenged with increased workload and

quality of the results. These challenges call for task shifting, human capacity building, strengthening system

quality and increasing capacity for acid-fast bacilli (AFB) microscopy, which should be supported by higher

volume equipment, Mycobacterium Growth Indicator Tubes (MGIT) and quality assurance. RPSO will assist

the NTLP program by procuring the MGIT equipment and its requisite reagents and supplies. The MGIT is a

high throughput short turn around mycobacterial liquid culture technology reducing the culture time from six

weeks to one week and breaking the dependence on the labor intensive microscopy as the only diagnostic

technology.

ACCOMPLISHMENTS: For FY 2007 funds, the Regional Procurement Support Office (RPSO) funds

managed by CDC staff are being used to renovate 10 designated clinics in the regions of Tanga, Iringa,

Morogoro and Shinyanga. Post renovation assessment of these initial projects will help NTLP make good

choices about their selections for future projects based on cost per project and increased number of

patients served.

ACTIVITIES: The Regional Procurement Support Office/Frankfurt (RPSO) is an arm of the Office of

Acquisitions Management - A/LM/AQM. RPSO's main objective is to provide Federal Agencies with

contracting resources and to support global initiatives such as the Global AIDS Program and PEPFAR.

RPSO will work in collaboration with CDC and the Ministry of Health in this activity. The activity will conform

to PEPFAR strategies of provision of comprehensive care for PLHA. Proposed physical infrastructure

improvements include upgrades of existing building space and addition of buildings in designated health

facilities to provide patient examination areas, simple laboratory spaces, medical dispensaries and

counseling and patient waiting rooms and the procurement of equipment. These projects will improve

patient flow, ensure confidentiality, improve and expand counseling services, upgrade hygienic laboratory

conditions to contribute to quality patient care and enhance delivery of TB/HIV services in the designated

sites.

Consolidating infrastructure improvements will take away administrative and management burden from

partners to allow a single country contact to oversee and coordinate the process for all RPSO procurements

across program areas in Tanzania. The added benefit will ensure quality and consistency of products and

services and ideally lead to cost efficiency with bulk purchasing. The in-country requisitioner will work with

identified technical leads to assist RPSO in their contracting responsibilities. Funding for the representative

is covered under the CDC management and staffing portion of the COP. RPSO has previously assisted

CDC Tanzania with laboratory improvements and equipment purchases. With 2008 funds RPSO will

renovate 10 TB Clinics within 10 Districts in 3 Regions. The clinics have been sected based on high burden

of TB and HIV. RPSO will also procure one MIGT liquid culture system to facilitate TB identification to cope

with increase in work load that will result from the scale up of TB/HIV activities.

LINKAGES: RPSO will work in close collaboration with Ministry of Health at the national level, regional,

district and health facility authorities

CHECK BOXES: The area of emphasis will be renovation and upgrading of Ministry of Health (MOH)

designated facilities to be able to provide integrated and quality TB/HIV collaborative services.

SUSTAINAIBLITY: The renovated TB clinics will be handled over to the district authorities who will be

charged with maintaining the buildings for sustainability.

Funding for Treatment: Adult Treatment (HTXS): $6,228,000

TITLE: Infrastructure Improvements for Care and Treatment Clinics

NEED and COMPARATIVE ADVANTAGE:

USG is assisting the Government of Tanzania (GOT) to increase and improve available clinical space to

meet the growing need for HIV care and treatment activities including provision of ARV and private space

for patient counseling and testing. Existing care and treatment clinics (CTC) are crowded and need

additional space to meet the increased patient load. New sites need renovation and addition of consultation

rooms in order to provide quality ARV services.

The Regional Procurement Support Office/Frankfurt (RPSO) is providing Federal Agencies with contracting

resources for renovation and construction of health care facilities. RPSO is working in collaboration with

USG PEPFAR team, the Ministry of Health and several USG care and treatment partners. Proposed

physical infrastructure improvements include upgrades of existing building space and addition of buildings

in designated health facilities to provide patient examination areas, simple laboratory spaces, medical

dispensaries, counseling and consultation rooms, sanitary facilities, dispensing pharmacies, reception

offices and patient waiting rooms. These projects will improve patient flow, ensure confidentiality, improve

and expand counseling services, upgrade hygienic laboratory conditions to contribute to quality patient care

and enhance delivery of care and treatment services in the designated sites.

ACCOMPLISHMENTS:

Two IDIQs (Indefinite Delivery Indefinite Quantity) contracts have been written and competed, which is the

first step for funding and planning the projects under a standardized mechanism. Initial meetings between

RPSO staff and USG PEPFAR Staff began in February 2007 but the final awards were not made until May

2007 for Architectural and Engineering Services and until June 2007 for Construction Company Services.

These IDIQs are valid for three years. For FY07 funds, RPSO funds managed by USG staff have been

awarded to three A&E firms for 29 individual Care and Treatment Clinics for three partners. We are

awaiting plus up funds to begin the remaining five projects for the fourth partner. In all, FY07 funds are

being and will be used to renovate 34 designated medical facilities in the regions of Arusha, Mwanza,

Kigoma, Tabora, Kilimanjaro, Dar Es Salaam, Pwani, Mara, Kagera and Shinyanga. Post renovation

assessment of these initial projects and the process will help partners make good choices about their

selections for future projects based on cost per project and increased number of patients served.

ACTIVITIES:

While the RPSO mechanism is still under evaluation and is not yet used across all USG partners in

Tanzania, it has potential for a system that runs effectively and can legally serve USG partners to

substantially improve infrastructure of medical facilities.

Consolidating infrastructure improvements will greatly reduce administrative and management burden from

partners to allow a single country contact to oversee and coordinate the process for all RPSO activities

across program areas in Tanzania.

As soon as better criteria for accepting projects have been established and cost-effectiveness has been

evaluated, a more standardized approach across USG for renovation and construction should be feasible.

The USG PEPFAR staff along with the A&E and construction firms engaged will be able to provide technical

guidance to partners in outlining their projects. Articulating needs and planning accordingly has been

difficult for partners in the past. By engaging highly trained and established professional teams there will

be more accountability in terms of procurement and services. The companies that have been selected to

design, manage and complete these projects are trusted and admired professionals in this industry and are

accountable towards RPSO, which should lead to timely completion of planned projects.

There have been ample challenges in using the RPSO established IDIQ for infrastructure development

activities within the PEPFAR program in Tanzania.

Although RPSO has advantages over non-centralized mechanisms, there are a couple of draw-backs. So

far, none of the planned projects has started yet, mainly because of the need for intense communication

before approval on various levels. Start of the first projects is anticipated for the beginning of October 2007.

For FY 2008 a total of 91 projects are planned, including two projects for >$ 1 million.

Although no final figures are available for evaluation, it became obvious that the RPSO mechanism is

costly. The main reason is that only a few firms in Tanzania are well versed in US Government legal

documentation and language and these firms are expensive. Costs were initially underestimated and led to

a smaller number of projects that could be initiated. The budget for RPSO increased substantially in FY

2007 to meet the ongoing needs.

LINKAGES:

RPSO activities are closely coordinated with Ministry of Health at the national, regional, and district level.

From the beginning of each project, local representatives of the medical facilities are interviewed regarding

local need, care and treatment partners are required to analyze their priorities within their regions and

government representatives at the MOH are consulted to make sure the project is meeting an important

need and the planned project is within the average standard.

CHECK BOXES:

The area of emphasis will be on the extension, addition, renovation and upgrading of MOH designated

facilities for ARV services. Priorities for renovation and construction are mainly based on clinical needs for

expanding ARV services. This can range from upgrading and expanding an existing site in order to

accommodate more patients, or renovation of a lower level health center where ARV services are planned

but can not be started due to limited space. The Care and Treatment partners in collaboration with the

MOH make the decision on which medical facilities to target and then prioritize from that list depending on

the resources available.

M&E:

In COP 08 this mechanism will be closely monitored and continually evaluated to provide the USG with data

that will be used to ensure good choices in terms of level of effort, resources and time vis-à-vis the number

of patients served. USG realizes that the RPSO mechanism is relatively expensive and less flexible than

local construction firms. However, this central mechanism is less prone to fraud and should deliver more

standardized quality outcomes. For minor renovations below a budget of $15,000, partners are encouraged

to engage local construction firms to the extent possible. During this year USG PEPFAR staff will collect

data to come up with additional criteria for future renovations and new construction projects.

Activity Narrative: After FY 2008 enough experience should be available to decide whether RPSO should be used for all USG

partners in future.

SUSTAINAIBLITY:

The renovated care and treatment clinics will be handed over to the district authorities who will be charged

with maintenance of the buildings. Almost all of these facilities are being built according to local designs so

that maintenance required is minimal. USG partners will monitor the maintenance process. All of the

facilities are being outfitted with sufficient electrical outlets so in the event computers begin to reach these

more remote areas they can easily be used in these facilities.

Funding for Laboratory Infrastructure (HLAB): $921,287

TITLE: Renovation, Procurement of laboratory equipment reagents and supplies for the National HIV

Quality Assurance Laboratory and Training Center in support of HIV/ADS Care and treatment.

NEED and COMPARATIVE ADVANTAGE: The renovation of the National quality assurance and training

center is completed and will serve as the National coordination center for quality assurance in the country.

The Regional Procurement Support Office facilitated the renovation and procurement of reagents and

equipment for the center in FY 2007 and has the necessary infrastructure developed to continue this activity

in FY 2008.

ACCOMPLISHMENTS: Since 2004 RPSO has handled several key contractual and procurement contracts.

These have included the renovation of the National quality assurance and training center; procurement of

the high volume zonal laboratory equipment and procurement of reagents and other lab commodities for the

National quality assurance and training center. With the FY 20O6 funding USG through RPSO purchased

high volume throughput equipment for CD4, Chemistry and Haematology and bulk reagents purchased for

the zonal referral hospitals; equipment,supplies and commodities for blood transfusion centres and the

quality assurance and training centre. RPSO was able to negotiate sustainable maintenance contracts

purchase for laboratory services equipment for the laboratory services.

ACTIVITIES: RPSO will procure equipment, reagents and supplies for the Quality Assurance and Training

Laboratory and facilitate contractual activities for the quality assurance and training laboratory.

To help support the establishment of Tanzania Field Epidemiology and Laboratory Training Program, funds

will go to purchase training supplies for participating laboratories, emergency response rapid response kits

and personal protective equipment.

LINKAGES: This activity links to activities under lab (MOH, CLSI, APHL,AIHA, ASCP, BMC, ART - TRACK

1 PARTNERS,DoD, FHI, SCMS, Global Funds. RPSO activiyies link to the prevention, care and treatment

by procurering equipment, reagents and supplies commodities required by different HIV/AIDS interventions.

The PMTCT, CT, CTC TB/HIV and the zonal, regional, districts and HIV testing sites

CHECK BOXES: N/A

M&E: N/A

SUSTAINAIBLITY: HHS/CDC Tanzania advocates for strong collaboration between MOHSW and

implementation lab partners to strengthen laboratory equipment and supplies procurement and

maintenance. Developing technical specifications and reagents projections and forecasting capacity

building will be strengthened for the MOHSW

Funding for Strategic Information (HVSI): $600,000

TITLE: Procurement of supplies for surveillance activities in Tanzania

ACCOMPLISHMENTS: Since 2004 RPSO has handled several key contractual and procurement contracts.

These have included the renovation of the National quality assurance and training center; procurement of

the high volume zonal laboratory equipment and procurement of reagents and other lab commodities for the

National quality assurance and training center. With the FY 20O6 funding through (the Lab program) USG

through RPSO purchased high volume throughput equipment for CD4, Chemistry and Haematology and

bulk reagents purchased for health facilities; equipment,supplies and commodities for blood transfusion

centres and the quality assurance and training centre.

ACTIVITIES: RPSO will procure reagents and supplies for the ANC Surveillance, HIV Drug Resistance

threshold survey and HIV Drug Resistance monitoring activities.

LINKAGES: This activity links to activities under SI. The procurement supports activities to be carried out by

NACP

SUSTAINAIBLITY: HHS/CDC Tanzania advocates for strong collaboration between MOHSW and

implementation lab partners to strengthen laboratory supplies procurement. Developing technical

specifications and reagents projections and forecasting capacity building will be strengthened for the

MOHSW

Funding for Health Systems Strengthening (OHSS): $56,600

TITLE: Procurement of Commodities for MOHSW Tanzanian Field and Epidemiology and Laboratory

Training Program (FELTP) through RPSO

NEED and COMPARATIVE ADVANTAGE:

Commodity requirements to support MOHSW are crucial to the success of the Tanzanian Field and

Epidemiology and Laboratory Training Program (FELTP). RPSO provides novel supply chain solutions for

these commodities.

ACTIVITIES: Specific activities in this area include the selection of commodities required for procurement.

This will be developed from the program work plan for the implementation of MOHSW activities under

FELTP. RPSO will utilize its central based procurement system to buy to undertake the procurement of

these commodities and deliver the requirements based on agreed plan. Procurement needed for equipment

and operations materials including 14 computers/laptops, office furniture and training supplies for fieldwork

for participating students.