LRPS-2024-9190078 "for competitive management of 2 Urban PHC clinics (Aalo clinic) service in Dhaka North City Corporation(DNCC) & Narayangonj City Corporation(NCC)”

UNICEF

LRPS-2024-9190078 "for competitive management of 2 Urban PHC clinics (Aalo clinic) service in Dhaka North City Corporation(DNCC) & Narayangonj City Corporation(NCC)” Request for proposal

Reference: LRPS-2024-9190078

Beneficiary countries or territories: Bangladesh

Registration level: Basic

Published on: 17-May-2024

Deadline on: 05-Jun-2024 11:00 (GMT -6.00)

Description

TERMS OF REFERENCE FOR INSTITUTIONAL CONTRACT

Title

Urban PHC clinic scheme operator

Purpose

To ensure competitive management of 4 PHC clinic (Aalo Clinics) services in 3 city corporations as per Essential Service Package guideline and standards

Location

Dhaka (DNCC, DSCC), Gazipur City Corporation

Estimated Duration

Aug 2024 – Dec 2025

Reporting to the Technical Supervisor of this assignment

Dr. Margub Aref Jahangir (Health Officer) for overall contract, and

Monira Parveen (Nutrition Officer) for the Nutrition Component

1. Background

The rapid growth of the urban population in Bangladesh, particularly in slum areas, poses significant challenges for social services such as health, nutrition, and education. Currently, around 40.5[1] percent of Bangladeshis live in urban areas, but within the next 20 years, this urban population is expected to nearly double, reaching 117.8 million by 2045.

Unfortunately, social services, including primary healthcare (PHC), have not been able to keep up with the pace of urbanization. This is particularly concerning for the poorest and most vulnerable, such as migrant slum dwellers, who face significant barriers in accessing basic services and their rights. The urban PHC services in Bangladesh are fragmented and have been primarily operated through time-bound projects for more than two decades.

One of the main issues is the lack of coordination and gaps in policies and strategies among the relevant line ministries, namely the Ministry of Health and Family Welfare (MoH&FW), the Ministry of Local Government, Rural Development, and Cooperatives (MoLGRD&C), and Local Government Institutions (LGIs). This hinders the transition from project-based approaches to a more sustainable program model for delivering urban health services, including Essential Service Packages (ESP).

As a result of the fragmented and donor-dependent nature of PHC services in urban areas, the population is forced to seek healthcare from the rapidly growing private sector. This reliance on private healthcare leads to high out-of-pocket expenses, with approximately 70 percent[2] of healthcare expenses being paid directly by individuals. Addressing these challenges requires a comprehensive and integrated approach. It is crucial to strengthen coordination among the relevant ministries and establish a sustainable program model for urban health service delivery, including PHC and ESP. This would help bridge the gaps in accessing healthcare services and reduce the financial burden on the population. Furthermore, preventive health and nutrition care services are extremely inadequate. Unlike rural, there are no community-based system/approach in place to raise awareness and service seeking behaviors on health and nutrition. Additionally, investments in improving public healthcare infrastructure, capacity and community-based platform/channels as well as initiatives to address the social determinants of health and nutrition in urban areas, are essential to ensure the well-being of the growing urban population in Bangladesh.

With the generous support of the Embassy of Sweden, UNICEF started the implementation of the project "Strengthening Urban Health Systems for Comprehensive Primary Health Care (PHC) for the Most Deprived Women and Children" between August 2019 and August 2023. The project successfully addressed all four objectives; i) Strengthening urban Health Systems; ii) development of an innovative model for urban Primary Health Care delivery focusing poorest and most vulnerable/segregated population; iii) improving coverage of urban PHC; iv) policy advocacy based on evidence, good practices and lessons learned.

Following the project’s successes, particularly the Urban PHC Clinic model (also known as Aalo Clinics) the Government of Bangladesh (MoH&FW) working to develop a Primary Health Care (PHC) Operation Plan under the 5th health sector program and urban PHC will be part of it, with the required number of PHC (1011, as estimated by Primary Health Care Operational Plan) will be built. These clinics have demonstrated an ideal way to deliver PHC services for the urban population and have created a replicable and scalable model, which is liked by all stakeholders, for the Government. Since the Government’s Operation plan is in the development stage, therefore, the Aalo Clinic model should continue at least for two more years, if not more, to act as a practically observable and visible model for the demonstration of PHC delivery in urban settings of Bangladesh.

Based on the developed model, the present ToR is to support the GoB in the development of a competitive and sustainable system to manage Aalo Clinic to empaneled physicians/ health workers whereby promotive, preventive and curative health services are awarded and the clinics have a level of autonomy to ensure efficient use of resources while providing quality Primary Health Care. The clinics will be part of the health system and essential commodities, such as medicines, vaccines, FP commodities, nutrition equipment and supplies including micronutrients supplements, will be sourced from the Ministry of Health and family Welfare.

2. Objectives, Purpose and Expected Results

The objective of assignment is to continue a competitive and sustainable system for management of the 4 Aalo Clinics including the empanelment of physicians/health workers and establishing comprehensive management of Primary Health Care Centers.

2.1 Specific Objective

The specific objectives of the assignments are:

To establish/continue the efficient financial and administrative management system for 4 urban PHC clinics (Aalo Clinic) and outreach points to cover essential PHC services in the targeted catchment area.
To set up 4 clinics and required outreach points with necessary arrangements and recruit health workforce maintaining the minimum standard for delivering selective health services.
To maintain established Open MRS for patient records, real time data management and monitoring
To ensure effective health and nutrition services delivery of selective essential health and nutrition services in urban PHC clinics and outreach areas
To mobilize the targeted community for social awareness for service utilization and selected disease screening
To mobilize the targeted community (using structured protocol) for preventive maternal, adolescent and child nutrition service seeking behaviors, referrals of pregnant women and under-five children for receiving the specific critical routine primary health care including nutrition specific services from the trained providers at the Aalo clinics and outreaches
To conduct household visits for critical case (including SAM) follow-ups, LBW detection and KMC and courtyard session for raising awareness on the recommended health-WASH-nutrition practices.
To provide outreach health and nutrition promotion and prevention services, ensure EPI integrated GMP and IYCF counselling in coordination with City Corporation led EPI Vaccinator/Outreach points in the targeted community.

2.2 Expected Result

The expected results of assignment – The contractor will achieve the below results in coordination with Mayor’s office, City Corporation and Ward Health and Education Committees, and with Ministry of Health and Family Welfare (DGHS/DGFP/DGNM),

Continuation of Financial and Administrative management of 4 urban PHC clinics (Aalo Clinics) in the designated wards (catchment areas) of 4 city corporations, with necessary changes, as required. The contractor will support GOB for establishment and management of functioning clinic and establish effective linkage with primary healthcare in private sector. Urban PHC clinics should be set as per standards and guidelines provided by UNICEF and Government of Bangladesh. The Contactor will also recruit staffs and workers fulfilling the minimum qualification criteria, set up IT systems for patient registration, administration, account management, tele medicine including empaneling General Physicians, recruitment of staff and health workers. The contractor will establish a Cost-effective fiscal management system as guided by Pay-for-performance (P4P) principle. The contractor will set up ICT based claim management for preparation and verification of claim.
Quality primary healthcare services are provided, and additional requirement of the contractor will ensure effective delivery of selective essential health and nutrition services as per standards in the 4 urban PHC clinics including community outreach services. The contractor will facilitate capacity building of service providers through training courses provided by UNICEF and GOB. Quality Primary Healthcare should be ensured as per the Essential Service Package (ESP) for promotive, preventive, and curative care for the population in the catchment area – e.g., Maternal, Newborn, Child and Adolescent health services (MNCAH), Safe delivery (NVD), Immunization, Nutrition, Non-Communicable Diseases, Family Planning, limited Point of Care Diagnostics, Primary care of accidental and burn injuries. The contractor will establish effective supply chain management system for Essential medicines and logistics, through the Ministry of Health and Family Welfare, i.e., the contractor will receive the required commodities from the MoHFW. The contractor will conduct monitoring and supervision of day-to-day activities of Urban PHC Clinics including medicine and other supplies management and community out-reach services, ensuring quality and accountability of services using Continuous Quality Improvement (CQI) framework. Referral system for complicated cases and ICT based Integrated Health Management Information System (IHMIS) will be established with support from UNICEF and GOB.
Using the Open MRS, for patient records on curative services, beneficiaries recording on preventive services, DHIS2 reporting, real time data management and monitoring. This will help the system for future integration with the Government system.
Targeted Community Mobilization for social awareness through community volunteer for service utilization, pregnant mother registration, detection of home-based PNC, Low birth Weight (LBW) and KMC services and specific disease screening i.e., Hypertension, Diabetes and other public health important conditions.
The contractor will imply appropriate community based preventive service delivery approach with established referral mechanism between community-outreach-Aalo clinics-Hospitals.

3. Description of Assignment

3.1 Scope of Work

The contractor will continue 4 urban primary health care clinics (Aalo Clinics) where the Urban Health Surveillance System is operational (icddr,b)[3]:

Aalo Clinic, Korail, Dhaka North City Corporation (DNCC) (Ward # 19, DNCC)
Aalo Clinic, Shyampur, Dhaka South City Corporation (DSCC) (Ward # 58, DSCC)
Aalo Clinic, Dhalpur, Dhaka South City Corporation (DSCC) (Ward # 49, DSCC)
Aalo Clinic, Gazipur, Gazipur City Corporation (near Tongi) (Ward # 49, GCC)

These clinics will provide primary health care as per essential health services (ESP) and refer complicated cases including Severe Acute Malnourished (SAM) children with medical complications to the hospitals and nearby of the public health system through establishing referral linkages and follow-up actions.

The Aalo clinics being piloted in low-income households and outside of the UPHCSDP. Each of the areas has on average 140,000 population of which approximately 20,000 slum and 120,000 is non-slum. The clinics will be operational in or close to the slum area. As the scheme will be universal irrespective of poor and non-poor or slum and non-slum.

3.2 Description of tasks:

Specific tasks under this assignment are as follows:

Continue providing primary health care including nutrition specific services to the pregnant, adolescent and under-two children according to Government approved Essential Service Packages (ESP) through both clinic and outreach.
Community Outreach platform is to be strengthened to increase the coverage specially for the preventive services (i.e., GMP, IYCF counselling)
Redefine the catchment areas if needed in the ward for each Aalo clinic.
Register the population in catchment area, supported by ICT system and UHDSS data base of icddr,b (where relevant).
Targeted community mobilization for social awareness for service utilization and selected disease screening
Identify the respective City Corporation led EPI platforms for ensuring GMP and IYCF counselling services for all the children coming for EPI.

Financial and administrative management of the 4 clinics:

Continue services urban PHC clinics as per set standards in hired premises or in a space owned by City Corporation or Ministry of Health & Family Welfare within the catchment area.
Empanelling GPs and recruiting staff as required as per the guidelines and Provider management:

Selection of qualified GPs/Health workers as per agreed/set criteria
Empanelment of GPs/Health workers as per plan

IT systems support by using Open MRS for patient registration & cueing, administrations, accounts management, quality assurance of services, Tele-medicine etc.
Claim management (preparation + verification) and fund disbursement following the approved guidelines.
- Establish ICT based claim management system.
- Digitized billing and payment system for the employees
- Type of Services:

3.3.1 Health and Nutrition Services: Primary Health care services of ESP

Maternal, neonatal, child and adolescent health care including Normal Vaginal Delivery (NVD), essential newborn care and EPI services,
Home based follow-up on critical cases (including postnatal care) and LBW-KMC services.
Family Planning
Maternal, Infant, Child and Adolescent Nutrition including growth monitoring & promotion, micronutrient supplement distribution and Counselling Services
Communicable Diseases
Non-Communicable Diseases (NCD)
Management of other common condition

3.3.2 Investigation Services: In terms of POCD (Point of Care Diagnostics) there will be provision of collecting the pathological samples from Aalo Clinics. Some tests should be available in Aalo Clinics-

CBC
ECG
Glucose RBS
RME (urine test)
HBsAg
HbA1C
Blood grouping
Serum Creatinine
Lipid profile
Smart POCD-based tests
Pregnancy Test
Ultrasonogram
HIV/Dengue/ COVID Screening (Subject to availability of the supply from the Government)

The diagnostic tests which are not available in Aalo clinics should be linked with other referral labs, i.e., tertiary hospitals or private labs, which will send the reports in the respective Aalo Clinic digitally.

Referral Services: The hospitals that will be considered for referral facilities of Aalo clinics would be-

Kurmitola General Hospital for Aalo Clinic, Korail,
Mugda General Hospital for Aalo Clinic, Dhalpur,
Dhaka Medical College Hospital for Aalo Clinic, Shyampur and
Shaheed Ahsanullah Master General Medical Hospital, Nagar Matrishadan for Ershadnagar Aalo Clinic, Gazipur

These hospitals will be considered as referral facilities for OPD for services that are not available at Aalo Clinic, emergency, IPD including severe acute malnutrition (SAM) management services. Necessary initiatives need to be taken to make agreement with theses referral hospitals to ensure service delivery of referral patients. Digital platform will be established to maintain referral and back referral services and track patients.

3.3.4 Outreach services

Covering the floating/inaccessible population in the community for PHC
Covering all eligible enlisted pregnant women, children 0-59 months old mobilized from the community for the preventive care services.
Registration and screening (POCD) of reported beneficiaries using smart devices.
Motivating and referring the patients to the Aalo clinic as needed.
Counseling to clients as needed.
Outreach services including GMP, IYCF counselling, SAM screening, and awareness-raising sessions on maternal, infant & young child nutrition (MIYCN) should be provided at the community outreach platforms through the paramedic and volunteers respectively.

3.3.5 Domiciliary services

Registration of the entire household of the catchment population within 2 months
Identification of the priority HH based on the initial registration (eligible couples for FP, pregnant mothers and families with children <5 and NCD patients)
Targeted domiciliary visits at least 20 households daily by each volunteer-
- Household visits of newborns and their mothers on day 1, 2, 3, 7, 28 after birth.
- Screening for malnutrition, NCD
- Health Education and health promotion messages
- Counselling on ANC, PNC, Nutrition, EPI, Growth monitoring, family Planning, NCD and other health issues.
- Identification of gender-based violence cases, necessary referrals and overall assistance.
- Appropriate referral to the Aalo clinic and follow up
Conduct courtyard meetings with community members in the catchment area
Coordinate with various health and family planning service providers in respective areas

3.4 Modality of service delivery:

Specified curative service consultations should be provided in clinics by General Physicians (GPs) for the catchment population following relevant protocols of the diseases/conditions/symptoms.
NVD service should be provided by diploma midwives.
Maternal Nutrition, IYCF Counselling and health education/promotion services should be provided at the clinic by qualified paramedics.
Preventive health & nutrition counselling service by a dedicated counsellor at the clinic site
Out-reach and domiciliary services should be provided at the community through the paramedic and volunteers respectively.
Monthly health & nutrition promotional day by rotation for each community (targeted households with pregnant women and under-five children)
EPI services should be provided at the clinic by qualified Nurse.
Patients should be referred to the prior listed hospitals/facilities for the cases which cannot be treated in Aalo clinic.
Capacity building of service providers should be done as per national norms through introductory courses for GP/Urban PHC clinics.
Equip the Urban UHC clinics with required (basic) equipment.
Establish essential medicines and PHC services through supply chain management system for each Urban PHC clinics.
Establish management, monitoring and supervision of day-to-day activities of Aalo Clinics including healthcare services, medicine and other supplies management, maintain HMIS, ensuring quality and accountability of services using Continuous Quality Improvement (CQI) framework.
Establish ICT based Integrated Health Management Information System (IHMIS) through OpenMRS including treatment protocol management, tele-medicine, stock management of essential medicines and supplies, linked to billing and payment.
The medicines and medical supplies, including vaccines, FP commodities, micronutrients will be mobilized according to needs through Government sources.
Maintain coordination with Mayor’s office, City Corporation and Ward Health and Education Committees, and with Ministry of Health and Family Welfare (DGHS/DGFP/DGNM), including the oversight of community out-reach services and mobilization activities.

3.5 Settings and Equipment

3.5.1 Clinic Settings:

Catchment Area Designation:

Every clinic must have a designated catchment area.

Operating Hours:

The clinic should operate from 8:30 AM to 9:00 PM daily, divided into two shifts.

Facility Requirements:

General Practitioners Rooms: A clinic must have at least two general practitioners’ rooms to accommodate patient consultations.
Labor room: A separate labour room for Normal Vaginal Delivery.
Nutrition and Health Promotion Corner/Room: A separate space dedicated to promoting nutrition and overall health awareness.
Screening Room/Corner: A designated area for health screenings, assessments, and early detection of health issues.
EPI (Expanded Program on Immunization) Room: A room specifically for administering vaccines and managing immunization programs.
GMP are IYCF counselling services are to be provided to all children attending EPI
Registration Corner: A designated area for patient registration and administrative tasks.

Specialized Rooms:

Laboratory Room: The clinic should have at least one separate room for laboratory testing.
Medicine Storage Room: A separate room for safe storage of medications, ensuring proper inventory management.

Patient Waiting Area:

A clinic must provide a comfortable waiting room with seating arrangements. Patients can wait here before their appointments.

Infection Prevention and Control (IPC):

The clinic must strictly adhere to IPC protocols. This includes maintaining hygiene, sterilization, waste disposal, and infection prevention measures.
3.5.2 Outreach settings

The contractor or bidder will arrange some suitable sites/outreach spots with the negotiation with community people. The outreach spots should be changed and increased time to time based on the response and feedback from local community. The location information should be announced in the community prior to the date.

Physical presence of outreach team, white apron with Aalo Clinics logo-attired female paramedics, multiple teams should be used to cover at least two spots a day, six days a week.
Additional help, (i.e., porters) can used to carry and install required Accessories for the outreach.
Newly designed and decorated tents.
Physical contact/communication with local people by outreach team.
Coordination with UHDSS field team.
Displaying video clips on several health awareness issues.
Use of hand-held Megaphones.

3.5.3 Domiciliary Setting

The community volunteers would visit households for identifying people in need, i.e., Pregnant women, newborns, sick newborns, children for immunizations & malnutrition and adolescents and NCD patients. Home visits may also be used to deliver some vital Health Education Massages- importance of ANC, Intuitional Deliveries, Post Natal Care (PNC), family planning, Nutrition and NCD.

3.6

A clinic must have following health workforce:

Consultation services will be provided by BMDC registered doctors having at least two years of working experience.
Normal Vaginal Delivery will be provided by diploma midwives.
Nutrition and health promotion services will be provided by a medical-qualified paramedic.
Screening services will be provided by a medical-qualified paramedic.
Laboratory services will be provided by a medical technologist having three years working experience.
Outreach program will be provided by qualified paramedics.
EPI service will be provided by a qualified Nurse.
Community Volunteers for domiciliary service by household registration for pregnant mothers, newborns & children and adolescents.

3.7 ICT arrangement

The contractor assumes responsibility for implementing an efficient ICT infrastructure that facilitates recording, registration, monitoring, and interoperability, in-line with MIS of DGHS/MoHFW standards. The following key components are part of this arrangement:

Patient Registration and Administration:
- Establish robust ICT systems using Open MRS to manage patient registration, administration, and accounts.
- Ensure seamless integration with other modules for comprehensive patient services.
Claim Management System:
- Develop an ICT system dedicated to claim management.
- This system should handle claim preparation, verification, and related processes.
Stock Management of Essential Medicines and Supplies:
- Implement ICT systems that link stock management to billing.
- Efficiently track essential medicines and supplies to optimize healthcare delivery.
Outreach Service Mobile App:
- Create a mobile app using OpenSRP specifically for outreach services.
- Enable healthcare workers to provide services beyond healthcare facilities.
Patient Service Data Integration with Shared Health Record (SHR):
- Ensure full integration of patient service data with the Shared Health Record.
- This integration enhances continuity of care and data sharing across healthcare providers.
Artificial Intelligence (AI) Integration:
- Incorporate AI capabilities into the prescription and other relevant modules.
- Leverage AI for improved diagnostics, personalized treatment recommendations, and efficiency.
Real-Time Data Monitoring Dashboard:
- Maintain and operate a real-time dashboard for monitoring critical data.
- Enable timely decision-making and performance assessment.

4. Deliverables

Deliverables

Items covered/Included

Time frame

Continuation of 4 Urban PHC Clinics (Aalo Clinics) with facility readiness

Coordination with DGHS, DGFP, CC and respective Ward committees to collaborate with relevant authorities to ensure smooth operations.
Explore existing clinics or renting space for the clinics, if necessary
Registration of population in catchment area
Targeted Community mobilization for service utilization, pregnant mother registration and specific disease screening i.e., Hypertension, Diabetes and other public health important conditions
Set-up clinics as per SOP
- Equipment (with UNICEF support)
- Supplies (use current supply chain for Aalo clinics through the health system, including nutrition)
Maintenance of the existing IT system with digital cueing for beneficiaries
Branding and awareness raising of the clinics