Results for Development (R4D) is a non-profit organization and leader in the field of international development, based in Washington, D.C. R4D strengthens systems and markets that support well-nourished, healthy, and educated people. Through engaging with local change agents, which includes government agencies, the private sector and civil society organizations around the world — R4D drives impact by supporting sustainable financing; identifying and scaling innovations that work; shaping markets to improve access to, and appropriate use of, life-saving commodities; improving public-private engagement; increasing citizen participation and governance; facilitating collaborative and adaptive learning; and using data for decision-making. R4D has ministerial-level relationships and programs in over 55 countries and technical partnerships with over 75 organizations worldwide.
R4D’s Market Shaping Practice area works with change agents to ensure that markets are transformed sustainably to drive increased access to (and improve appropriate use of) essential commodities, such as childhood pneumonia diagnosis and treatments, maternal health supplies, anti-malarial bed nets, HIV/AIDS medicines, nutrition supplements, and books. R4D achieves this by aligning priorities and incentives of key market actors including policymakers, procurers, manufacturers and financiers at the global and country levels to develop and execute solutions for underserved markets at scale.
R4D Program Overview:
R4D’s Market Shaping Practice has a growing portfolio of projects in Uganda aimed at increasing access to essential maternal, newborn and child health (MNCH) products. Specifically:
i. Increasing access to childhood pneumonia treatments in high-burden countries:
Approximately 900,000 children under the age of five (U5) died from pneumonia-related causes in 2015 globally – more than from HIV/AIDS, tuberculosis and malaria combined – despite the existence of an effective World Health Organization (WHO)-recommended treatment: amoxicillin dispersible tablets (amox DT). Although amox DT has many advantages over previous treatment options – such as simplified dosing and supply chain requirements, and a relatively low cost (about $0.50 per course of treatment in the public sector) – access to this life-saving commodity remains abysmally low in many low- and middle-income countries. Given the large burden of pneumonia and the fact that about 70 percent of pneumonia cases are left untreated every year, it is essential that high-quality, affordable amox DT is made available to all affected children.
To address this challenge, since 2014, R4D has been implementing a multi-year project funded by the Bill and Melinda Gates Foundation (BMGF) and Good Ventures, recommended via GiveWell, focused on scaling up access to amox DT for the treatment of childhood pneumonia across public and private sectors in high-burden countries, beginning in Ethiopia and Tanzania. R4D’s work in Ethiopia and Tanzania leveraged in-depth market analyses — which identified underlying causes of the lack of appropriate access to amox DT – to then develop and implement country-specific strategies addressing regulatory, demand-side, supply-side, and financing barriers to amox DT scale-up. In-country work has included activities such as updating treatment guidelines, supporting the development of robust national quantifications, and providing technical assistance to mobilize domestic resources for amox DT. At the global level, R4D engages with Reproductive, Maternal, Newborn and Child Health advocates to prioritize childhood pneumonia and support resource mobilization efforts for child health commodities. Additionally, R4D regularly engages with high-quality global and local manufacturers and suppliers of amox DT to increase market transparency in high burden countries, and to share the business case for country-level drug registration, to ensure a readily accessible supply of the life-saving treatment.
As part of this work, from 2017 – 2018, R4D conducted market assessments in several other high-burden countries in Africa and Asia on the barriers inhibiting access to childhood pneumonia treatments, including Uganda, where pneumonia is the leading cause of mortality in children U5 and contributes to 17 percent of U5 deaths, resulting in approximately 15,000 deaths every year. The assessment revealed that Uganda has already made significant strides towards achieving established targets to address childhood pneumonia mortality, including updating essential medicines list and treatment guidelines with amox DT as well as prioritizing funding towards integrated community case management (iCCM) commodities, which include amox DT. However, despite this progress, stock-outs of amox DT remain an issue and there are critical market barriers that require solutions to drive further increases in access to pneumonia treatments.
Based on the market assessment in Uganda, R4D developed a strategy to address the identified market barriers and is currently implementing catalytic market shaping interventions to scale-up access to amox DT in Uganda to support the achievement of Government of Uganda’s goals around reducing under-5 mortality rates, including a goal to increase the percentage of children receiving treatment for pneumonia from 47 percent in 2017 to 85 percent in 2020.
ii. Increasing access to MNCH products:
Beginning in January 2019, R4D has started working on another project funded by BMGF which aims to address under-five and maternal mortality in sub-Saharan Africa (SSA), where access to life-saving health products remains suboptimal. Every year, more than 5.5 million children die prior to their fifth birthday and more than 300,000 mothers die due to pregnancy- or childbirth-related causes. Interventions exist that can prevent more than half of these deaths however, access to life-saving products for mothers, newborns and children under the age of five remains particularly low in SSA, where the majority of global under-five and maternal mortality occurs. While there is anecdotal evidence of barriers to MNCH product access, a full assessment of procurement inefficiencies is challenging to undertake, in part due to a lack of centralized information on financing, purchase volumes, pricing, quality, and overall process improvements.
Through collaborations with procurement agencies, national drug regulatory authorities, ministries of health, implementing partners, donors, and other stakeholders, R4D aims to systematically analyze quantification, financing and procurement data across 5 SSA countries – Ethiopia, Kenya, Nigeria, Tanzania, and Uganda – which in aggregate, procure large volumes of MNCH products, to unearth key opportunities for MNCH-related market improvements. The analysis and findings are intended to be used to support decision-makers in developing market-shaping strategies, towards increasing access to life-saving MNCH products and ensuring achievement of the Sustainable Development Goals to end preventable maternal, newborn and child deaths by 2030.
Scope of Work:
The Consultant in Uganda will lead on the implementation of ongoing catalytic market shaping interventions to increase access to amox DT in the public sector in Uganda, as well as the research and analysis efforts needed for the MNCH project.
In this role, the Consultant will work closely with a variety of country-level stakeholders and members of the R4D Market Shaping team in Washington, DC and East Africa to carry out the following list of indicative activities over the time frame from May 2019 through October 2019, with a possibility of extension.
Activities under childhood pneumonia treatment project, as outlined in a report agreed upon by the Government of Uganda and R4D in February 2019, based on a market assessment conducted by R4D in 2018:
- Create pathway towards development of robust national-level quantification for amox DT at the facility and community level: The Consultant will build on existing activities to support the development of a comprehensive national quantification for child health commodities that combines demand for IMNCI and iCCM commodities as well as incorporate both government and donor funding (e.g. funding from the Global Financing Facility). To support this process, the Consultant will review all relevant quantifications that include amox DT, analyze methodology and underlying data sources (e.g. DHIS II, stock status reports, etc.) to determine any challenges with the existing quantification process. Based on this assessment, the Consultant will lead on the development of an analytical tool (e.g. a dashboard) to house all relevant data and conduct ongoing analysis. This tool will be used to inform the MoH Quantification and Procurement Planning Unit (QPPU), NMS’ and other partner’s quantification process, and ultimately strengthen existing quantifications.
- Support efforts to improve procurement planning processes for amox DT. The Consultant will develop activities to support improvements in procurement planning processes, including engaging with critical stakeholders to ensure that forecasted volumes for amox DT and other child health commodities are appropriately incorporated into procurement plans.
- Develop analyses to support resource mobilization efforts for IMNCI and iCCM commodities: The Consultant will develop key analyses needed to support resource mobilization efforts, such as:
o Building upon existing funding gap analysis to incorporate: 1) resources needed for facility- and community-level commodities and 2) all existing and upcoming/committed domestic and international resources. This will entail obtaining detailed data on current and potential domestic and/or donor-supported financing sources with which child health commodities, including amox DT, can be procured as well as leveraging data on quantified needs.
o Leading the development of an investment case for facility- and community-level investment for amox DT incorporating disease burden, cost estimation, health impact estimation and economic benefit estimation, to make a case for increased investments in amox DT.
Activities under the MNCH project with a focus on Uganda:
- Collecting and analyzing financing, quantification and procurement data for MNCH products: The Consultant will obtain access to all relevant quantifications, procurement volumes, pricing information, as well as financing sources for MNCH products, for the past three years (2016, 2017, 2018), from key stakeholders, as well as analyze the data to identify high-volume and high-cost MNCH products being prioritized by both the government as well as donors in Uganda.
- Mapping the procurement process for MNCH products to identify key bottlenecks: The Consultant will conduct desk research and stakeholder interviews to map the procurement process for MNCH products and identify key inefficiencies along the way, including creation of procurement process maps and differentiating between processes where relevant, such as products procured by NMS versus donors, etc.
Activities spanning both the childhood pneumonia treatment and MNCH project:
- The Consultant will continue to cultivate existing relationships and establish new ones on behalf of R4D with key local change agents such as government agencies (e.g. the Ministry of Health, National Medical Stores), implementing partners (e.g. UNICEF, Management Sciences for Health, Clinton Health Access Initiative), civil society organizations (e.g. HEPS, Uganda National Health Consumers Organization), as well as donors (USAID, DFID, World Bank, etc.) to ensure enhanced co-ordination for the scale-up of amox DT as well as accessing financing and procurement data for MNCH products.
- The Consultant will attend recurring Technical Working Group (TWG) Meetings such as the MCH Cluster and iCCM sub-group meetings and present about R4D and our work at these meetings. In addition, depending on the need, the Consultant may also support with the establishment of memorandums of understanding (MoU) and other contractual agreements (e.g. formal letters requesting data access) with key government agencies and/or other partners to formalize collaboration.
- The Consultant will support additional activities that are deemed critical to ensure the success of the portfolio of work, e.g. attending internal team meetings and following up on tasks in a timely manner, reviewing MNCH related policy documents and resources, contribution to strategic decisions around changes in activities and/or the timelines associated with each, as well as support planning efforts for any trips made by R4D team members to Kampala.
- A dashboard (excel tool) with all relevant quantification and procurement related data for amox DT
- Funding gap analysis for amox DT with underlying data
- Return on Investment Analysis for amox DT with underlying data
- Financing, quantification and procurement data for MNCH products for 2016, 2017, 2018, including analysis on top fifteen MNCH products being quantified, procured and financed by both government and donors
- Procurement process maps for MNCH products
- Stakeholder engagement plan and clear meeting notes with key takeaways and next steps from stakeholder discussions
- BA in public health, public policy, economics, or related field
- At least seven years of experience working in the public health sector, particularly in Uganda
- Demonstrated track record of successfully creating and fostering partnerships across multiple partners within Uganda’s health sector, including the Ministry of Health and National Medical Stores, implementing partners such as UNICEF, donors such as USAID and DFID, as well as local civil society organizations
- Strong background in and knowledge of health commodities supply chain, including financing, quantification and procurement processes in Uganda, particularly for MNCH commodities
- Significant experience in collecting and analyzing financing, quantification and procurement data for health products
- Experience working independently as well as in a team environment, particularly as part of remote teams
Response Format and Delivery:
Qualified Consultant(s) should submit their CV and a proposal outlining their 1) overall approach, 2) detailed activities, 3) timelines for activities and deliverables, 4) daily rate and average availability per week in number of days, and 5) relevant experience, in no more than 5-7 pages. Consultants can apply as individuals and/or enlist the support of one other individual Consultant, based on proposed approach.
These materials should be sent to Anam Abdulla at [email protected]. The deadline for submission is April 12th, 2019.
Questions regarding the proposal format and correspondence should be directed to the attention of:
Program Officer, Market Shaping Practice
Results for Development Institute, Inc.
1111 19th Street NW, Suite 700
Washington, DC 20036
Please do not contact any member of the R4D board, management, and/or staff regarding this RFP, other than the contact provided above.
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