SOURCES SOUGHT
R -- Maternal and Child Health - Ethiopia
- Notice Date
- 1/3/2012
- Notice Type
- Sources Sought
- NAICS
- 541990
— All Other Professional, Scientific, and Technical Services
- Contracting Office
- Department of Health and Human Services, Centers for Disease Control and Prevention, Procurement and Grants Office (Atlanta), 2920 Brandywine Road, Room 3000, Atlanta, Georgia, 30341-4146
- ZIP Code
- 30341-4146
- Solicitation Number
- 2012-41048
- Archive Date
- 1/25/2012
- Point of Contact
- Gwendolyn Pace, Phone: 7704882436
- E-Mail Address
-
dvv1@cdc.gov
(dvv1@cdc.gov)
- Small Business Set-Aside
- N/A
- Description
- Request for model-based evaluation of the health impact and costs of maternal health interventions in Ethiopia and strategic options for their combination, prioritization, and scale-up. 1 INTRODUCTION / PURPOSE To most effectively leverage Ethiopia's national commitment to reducing maternal mortality, it is essential to find feasible, affordable, and cost-effective strategies that are based on evidence and that account for local factors. Doing so will require considering many complex questions, many of which involve making decisions in the face of limited or nonexistent information. These types of questions cannot be answered by any single clinical study. Rather, they lend themselves to a modeling approach taken from decision science that can combine data and information from many different empirical studies. Decision science provides a way to address these kinds of issues within the framework of a specific setting, allowing for consideration of existing infrastructure and resources. Such an approach can also combine information from a wide variety of sources, extrapolate costs and health effects beyond the context of a single clinical study, and evaluate multiple potential interventions. For these reasons, this is an appropriate methodology to estimate the clinical, population-level, and societal benefits associated with strategies to improve the safety of pregnancy and childbirth in Ethiopia, taking into account the costs and feasibility of alternative interventions and their operational complexity. This study will synthesize relevant available data and carry out model-based analysis within a decision-analytic framework in order to provide information to the Government of Ethiopia on the likely health impacts, costs, and cost-effectiveness of different policy options for health system strengthening related to MCNH. 2 BACKGROUND Ethiopia has an estimated total population of 79.8 million. Rapid population growth exacerbates critical gaps in basic health services delivery. The Country's administration set up is divided into 9 regions and 2 city administrations. The regional states and city administrations are further divided into 817 Woredas (Districts). The Woredas are further divided into roughly 16,253 rural and urban kebeles. Kebele is the smallest administrative unit in the country. It was announced in late January 2011, that Ethiopia has set a new goal of reducing the MMR to 276 by 2014, down from 590 in 2008. Over the last decade Ethiopia has made reduction of maternal mortality and improvements in overall maternal health one of its primary goals. More recently, it has reinforced its commitment to meeting MDG 5, as well as its own internal objectives set out in the Health Sector Development Program III announced in 2005, and Health Extension Program (HEP) introduced in 2003. Beyond its central goal of improving maternal health, HEP's objectives include a shift in health resources from urban to rural areas, promotion of gender equality in accessing health service, and the use of Health Extension Workers (HEWs) to help bridge the gap between the lowest level health facilities and local communities, all of which will have a beneficial impact on lowering the number of maternal deaths. Initial focus has been placed on expanding access to family planning, active management of third stage labor, partnerships with TBAs, and expansion of the referral centers. Further expansion and scaling up in the following areas is critical: skilled birth attendance, post natal care, contraceptive prevalence rates, and facilities with functioning EmOC services. Many women who die in childbirth are young and healthy, and most maternal deaths are preventable with basic obstetrical care. The five leading direct causes of maternal death are bleeding, infection, high blood pressure, prolonged labor and complications resulting from unsafe abortion, although indirect causes of maternal death are substantial in Ethiopia as well (e.g., HIV, malaria, severe anemia). Knowing where to best strengthen the health system is crucial for reaching MDG 5 and other Government of Ethiopia health goals. However, the information necessary to know where to strengthen the health system is difficult to observe directly. Evaluating the consequences of health system interventions for MCNH events, with a time course that spans a number of years and clinical events that occur repeatedly over a number of years (e.g., pregnancy) is challenging for a variety of reasons: • It is often impossible to observe within the confines of a single study the complete course of a health problem or an extended series of repeated events • Even the best available data are generally based on surrogate markers and intermediate endpoints • It is often not feasible to conduct randomized controlled trials of every potential preventive and treatment approach • The information required to develop policies and regulations requires synthesizing data from many sources Computer-based models make it possible to surmount some of these challenges. They can be used to extend information from empiric studies by extrapolating patterns beyond the time horizon of clinical trials; they can provide a formal framework for synthesizing data in an internally consistent and epidemiologically plausible way; and they can be used to assess many different strategies and interventions - including variations on how they are delivered - that would not be possible to assess in a single clinical study. Therefore, this study is proposed to provide information to the Government of Ethiopia on different data based scenarios for health system strengthening related to MCNH. 3 PROJECT OBJECTIVE Adapt an existing proven policy modeling framework and associated tools for application to strategic planning for maternal health policy in Ethiopia. In collaboration with the Federal Ministry of Health and the Ethiopian Health and Nutrition Research Institute apply the framework and model to provide strategic information regarding the planning, management, and evaluation of programs and policies to reduce maternal and neonatal mortality. Examples of questions in Ethiopia: • Assuming adequate facilities, health infrastructure, and skilled human resources will not be available in all settings in Ethiopia, can we provide interim guidance to policy makers? • How can improvements in family planning and access to safe abortion contribute to strategies to reduce maternal mortality? Are there phased approaches to scaling-up maternal services that will be more and less efficient (i.e., cost-effective) and affordable? • What are the fundamental drivers of the effectiveness, cost-effectiveness, and affordability of specific packages of interventions and services? What are the potential benefits and economic efficiencies of intermediate facilities (e.g., birthing centres) that permit women to be closer to referral centers at the time of delivery? • What is the optimal design of a short-term plan in the context of a long-term strategic approach? What is the impact and cost-effectiveness of providing clean delivery kits, and will it be more effective to have kits be facility-based or woman-based in terms of accessibility at delivery? • Given that appropriate data is readily available, what are the differences in potential decisions for different regions in Ethiopia and what is the national impact because of regional differences? 4 SCOPE OF WORK The research approach will be highly tailored to Ethiopian context, using the latest data from program monitoring and evaluation, special studies, population surveys, other standard demographic and epidemiological projection models, supplemented by targeted data collection of local expert opinion. • To contextualize the approach to Ethiopian situation, comprehensive search and synthesis of existing peer-reviewed and gray literature, data sets, and expert opinion should be supplemented with focused primary data collection in areas where critical data gaps exist possibly including quantification of emergency obstetrics care availability and quality, description of the referral system for delivery, estimation of delays or barriers to maternal health care, and cost of care to households and government. • The approach will consider and appropriately account for urban/rural (and possibly pastoralist and regional) heterogeneity of disease burdens, health risk, health infrastructure, and access to care. • Model assumptions will be vetted and validated through analytic checks and stakeholder process. • The approach will evaluate the baseline situation, as well as selected sets of interventions--addressing research questions formed through a process that ensure relevance to local decision makers. • Outcomes projected for various strategic scenarios will include maternal deaths by cause, lifetime risk of maternal death, maternal mortality ratio, utilization of family planning, utilization of SBA, birth centers, EmOC, and other childbirth-related services, total fertility rate (TFR), and may include fraction of households not exceeding target family size, and fraction of maternal deaths attributable indirect causes such as anemia and infectious disease comorbidities, fraction of maternal deaths attributable to particular system failures in problem recognition, transportation to EmOC, facility access, or facility quality/capacity. • For each strategic scenario, the approach will also estimate program cost, net costs, and cost-effectiveness 5 TASKS OF THE CONTRACTOR Four are to be addressed under this task order. The first task is a scoping workshop to determine the final research questions to be addressed by the model. The second of these tasks is the adaptation of a proven maternal health policy simulation model to the Ethiopian context. The purpose of the second task will be to synthesize demographic, epidemiological, programmatic, and economic information in a policy model calibrated to reflect in rich detail the baseline situation in Ethiopia with respect to maternal health risks and behaviors, healthcare availability, and expected outcomes. The third task of under this task order focuses on simulation of policy scenario analysis using the Ethiopia-contextualized model. Policy scenarios will be designed to provide insight relevant to policy issues confronting local decision makers. The information generated will be of sufficient quality that it can assist country teams in strategic discussion regarding attainment of MDG5 and other health goals. The fourth task addressed dissemination of the model results for Ethiopia. 5.1 TASK 1: Scoping workshop Subtask 1.1: Facilitate the Technical Working Group (TWG) workshop between the USG and partner government and other local stakeholders to present the (generic) model, and identify locally-relevant research questions to supplement or modify core analysis. Subtask 1.2: Prepare a Work plan informed by the discussion and agreements reached during scoping workshop. Work plan to include a primary data collection plan and a description of the set of specific research/policy questions to be addressed in analysis. 5.2 TASK 2 : Adaptation of a proven maternal health policy modeling framework and associated tools to the Ethiopian context The awardee will work closely with the partner and PEPFAR country team on a series of steps, which will include the following activities: Subtask 2.1: Identifying and synthesizing existing data sources Subtask 2.2: Design and assist with application of tactical focused primary data collection (rapid assessments) to inform key model parameters. With input from data collection partners, contractor will develop or adapt existing data collection protocol and create a written manual for data collectors including data collection instruments. Awardee will assist with preparation of documents for any necessary local ethics board reviews. Subtask 2.3: Estimate projected health outcomes and costs of baseline situation over medium and long-term time horizon. Subtask 2.4:. Document data gathering methods, data sources used, data synthesis methods, model structure, model assumptions, calibration methods, and performance of the final Ethiopia-specific maternal health policy model. Subtask 2.5: Facilitate review of Ethiopia-specific model by the TWG, USG, partner government, and other local stakeholders. 5.3 TASK 3 : Conduct analysis of policy scenarios using the Ethiopia-calibrated model Subtask 3.1: Using the model, simulate a range of policy options established during scoping workshop (subtask 1.1) and documented in work plan (subtask 1.2). Subtask 3.2: Prepare a detailed technical report of findings with an executive summary 5.4 TASK 4: Dissemination Subtask 4.1 Present findings to EHNRI and the TWG for refinement. Subtask 4.2: Present findings to Ethiopia MoH in collaboration with EHNRI and the TWG. Subtask 4.3: Produce presentation slides describing the activity and its findings Subtask 4.4: Produce a 2-4 page ‘brief' describing the activity and its findings to specifications provided by project officer. Subtask 4.5: Present findings at conference/workshop or meeting identified by project officer. 6 DELIVERY SCHEDULE Tasks/Subtasks Work Requested Due Date TASK 1 : Scoping workshop Subtask 1.1 : Facilitate workshop between the USG and partner government and other local stakeholders to present the (generic) model, and identify locally-relevant research questions to supplement or modify core analysis. Work Requested: (1) Meeting agenda, handouts, and presentations. (2) Attendance and presentation at workshop by 2 key personnel. Due Date: 45 days from Award Subtask 1.2 : Prepare a Work plan informed by the discussion and agreements reached during scoping workshop. Work plan to include a primary data collection plan and a description of the set of specific research/policy questions to be addressed in analysis Work Requested: Written summary of workshop and revised project work plan Due Date: 15 days following workshop TASK 2: Adaptation of a proven maternal health policy modeling framework and associated tools to the Ethiopian context Subtask 2.1 : Identify and synthesize existing data sources and local experts Due Date: 90 days from Award Subtask 2.2 : Design and assist with application of tactical focused primary data collection (rapid assessments) to inform key model parameters. Work Requested: Written data collection protocol and manual for data collectors including data collection instruments. Due Date: 90 days from Award Subtask 2.3: Estimate projected health outcomes and costs of baseline situation over medium and long-term time horizon. Subtask 2.4 :. Document data gathering methods, data sources, data synthesis methods, model structure and assumptions, calibration methods, and performance of the final Ethiopia-specific maternal health policy model. Work Requested: Written documentation of Ethiopia-specific model Due Date: 180 days from Awrd (contingent on data collection by partner by 120 day from award. Subtask 2.5: Facilitate review of Ethiopia-specific model by USG and partner government and other local stakeholders. TASK 3 : Conduct analysis of policy scenarios using the Ethiopia-calibrated model Subtask 3.1 : Using the model, simulate a range of policy options established during scoping workshop (subtask 1.1) and documented in work plan (subtask 1.2). Subtask 3.2: Prepare a detailed technical report of findings with an executive summary Work Requested: Detailed technical report of findings with an executive summary Due Date: 210 days from Task Order Award TASK 4: Dissemination Subtask 4.1: Present findings to EHNRI and TWG Subtask 4.2 : Present findings to Ethiopia MoH. Work Requested: Meeting agenda, handouts, and presentation Due Date: 210 days from Award Subtask 4.3: Produce presentation slides describing the activity and its findings Work Requested: (1) Attendance and presentation at workship by 1 key personnel (2) Presentation Slide deck with narrative talking points Dute Date: 240 days from Award Subtask 4.4: Produce a 2-4 page ‘brief' describing the activity and its findings to specifications provided by project officer. Work Requested: Research Brief Due Date: Within 240 days of Award Subtask 4.5: Present findings at conference/workshop or meeting identified by project officer. Work Requested: Attendance and presentation by at least 1 key personnel at at least 2 meetings (up to 1 of which could be in Ethiopia) Due Date: Within 1 year of Award
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