Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 10817
Country/Region: Mozambique
Year: 2009
Main Partner: To Be Determined
Main Partner Program: NA
Organizational Type: Implementing Agency
Funding Agency: USAID
Total Funding: $0

Funding for Health Systems Strengthening (OHSS): $0

This is a new activity under COP09.

Activity Narrative: RFP for Infrastructure - Contracts Direct (Training Center, Warehouses)

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: Centrally Managed (see "RFP for

Infrastructure construction - contract health centers, housing, labs, etc."), and Direct Contracting, the

activities described here.

Warehouses

Currently, the country is facing significant warehousing and distribution challenges, for which the USG

through SCMS is providing technical assistance and financial support. A September 2008 Warehousing and

Distribution Needs Assessment conducted by SCMS has identified a series of steps leading up to the

preparation of a 3-5 year Pharmaceutical Logistics Master Plan, that will cover the policy, infrastructure,

supply-chain, and financial needs of CMAM to achieve lasting improvements in HIV/AIDS commodity

security.

The Assessment identifies the poor physical state of Beira Warehouse, and its limited capacity, as major

constraints to the efficient distribution of pharmaceuticals within the central Provinces. It recommended that

the existing warehouse should be repaired, and a new extension built and fitted out.

The Northern Provinces are currently served by warehouses in Nampula. The MoH facilities are too small,

and in poor condition, so additional warehouse space is rented from a private company. The Ministry

intends to rationalize this situation by transferring operations to a new, purpose designed facility in Nampula

or Nacala.

The Global Fund has also committed to supporting warehouse upgrading and rationalization. PEPFAR will

work with the GF to leverage funds to best effect to implement both projects, Central and Northern.

A firm of Architect-Project Managers will be selected, by competitive tender, to draft plans, specifications

and tender documents for the projects, in line with USG and Mozambican legislation, and subsequently to

supervise construction.

USAID will let the Contracts through a Request for Proposals (RFP) process, adjudicated by a committee

including representatives of the Ministries of Health and Public Works.

Marracuene Training Center

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.

One of the Minister's priorities is to rehabilitate and convert a former mental hospital at Marracuene, Maputo

Province, to serve as an Institution for training mainly middle level health workers cadres. This center was

used in the past as an annex of the Health Sciences Institute (HIS) to train Maternal and Child Health Care

nurses.

The HIS is the largest health training institution in the country and trains nurses, clinical officers, lab,

pharmacy, preventive medicine, dentist, ophthalmologist, physiotherapy, health statistics and psychiatric

technicians. Also they provide specialization courses in different areas for health workers. In 2008, they are

running 27 courses of 30 students in each one. While these courses run at different times, the HIS campus

has only 7 classrooms, so other classrooms are rented at the secondary school near to the Central Hospital

of Maputo (CHM) and classrooms from CHM are being utilized as well. The HIS is sharing the campus with

ISCISA, a higher level training institution created in 2004, who also needs classrooms for their students.

Construction on the Marracuene site will make it possible for the MOH to move all students and faculty to a

new location, one that will be owned by the Government of Mozambique thereby eliminating payment of

rent as is being done now. The renovations to Marracuene will also include student accommodations which

are not available in the present location.

Activity Narrative: Plans for this project are in the final stages of development and should be released in November 2008. A

firm of Architect-Project Managers will be selected, by competitive tender, to review the plans and

specifications and prepare tender documents for the project in line with USG and Mozambican legislation,

and subsequently to supervise construction.

USAID will let the Contract through an RFP process, adjudicated by a committee including representatives

of the Ministries of Health and Public Works.

Provisional Budgets

Beira Warehouse Upgrade: $1,000,000

Northern Provinces Warehouse: $4,000,000

Marracuene Training Center: $5,000,000

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

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: