Role :   REQUEST FOR PROPOSAL: TB and Medical Oxygen Landscape assessment in Cameroon
Location :   0. National
Company URL :   https://www.clintonfoundation.org/

Description:

Date: 13th January 2025

REQUEST FOR PROPOSAL: TB and Medical Oxygen Landscape assessment in Cameroon

1.    Background
In Cameroon, significant challenges exist in healthcare delivery, particularly concerning medical oxygen accessibility and tuberculosis (TB) diagnostic capacity. TB continue to be significant public health problem in Cameroon. In 2021, for instance, nearly 50,000 new cases of TB. The notification rate was 85 cases per 100,000, highlighting significant under-reporting. The prevalence of TB is particularly high among the 25-44 age group with stark regional variations, marked by high prevalence rates in Adamawa and the East regions. Co-infection rates with HIV are high, estimated at 20.3%. Despite these staggering TB statistics, access to TB care and treatment continue to be limited in the country. Indeed, according to some sources, only 9% of the population have adequate access to TB services. Additionally, in 2021 over 50% of new TB cases went undiagnosed. The reasons for these gaps appear to be multi-factorial, including insufficient training in non-TB diagnostic centers, limited use of diagnostic tools like GeneXpert (28.5% usage), inadequate infrastructure in TB-MDR sites and gaps in TB data management among others. These are further compounded by gaps in research on high-risk populations, inadequate TB-HIV program coordination, aging TB-MDR treatment facilities, staff shortages and disparities in geographic access. Addressing these challenges would be essential to improve TB detection, particularly in underserved areas, and strengthen overall TB management and control efforts in Cameroon. In 2016, the World Health Organization (WHO) recommended the use of chest X-ray forscreening and triage of target population groups at risk of developing TB. Subsequently in 2021, WHO issued its first recommendation for using artificial intelligence (AI) technology for those >15yrs to interpret chest X-rays for TB-related abnormalities, based on the latest evidence. Recent advances in X-ray technology have led to ultra-portable digital X-ray devices (UP-XR)that can be battery-powered and carried in a small case, backpack, or
even hand-held. The market for digital radiography equipment and computer-aided detection (CAD) solutions for TB is evolving dynamically, with a significant number of equipment manufacturers and CAD developers now entering the market. When combined with CAD software, UP-XR systems can interpret x-ray images in real-time using AI. Consequently, they enable sensitive and specific TB screening in remote and hard-to-reach communities where healthcare facilities are either nonexistent or often have very limited essential infrastructure, like reliable electricity and internet. Beyond TB, UP-XR systems have applications in various medical diagnoses. To better understand existing chest X-ray platforms and determine optimal
placement for new screening platforms, CHAI plans to support the national TB Programme to conduct a mapping exercise for digital chest X-ray systems, including CAD to establish coverage, functionality and utilization of the existing systems.

Asides problems with diagnosis, patients with TB faces challenges accessing treatment, including live-saving medical oxygen, which is vital is correcting hypoxemia and hypoxia. To address gaps in medical oxygen, CHAI supported the Government to develop a National Strategic Plan for the Provision of Medical Oxygen (NSPMO), which was designed to expand oxygen access in the country. Significant progress has been made in implementing the plan, including installation of large scale oxygen plants in 5 strategetically located tertiary hospitals in Cameroon. In Addition, CHAI in collaboration with the department of Projects and studies at the ministry of public health are setting up a VIE tank in Limbe regional Hospital, with plans to established a hub-and-spoke model to enable the hospital bottle and deliver oxygen to satellite facilities in the region. The Clinton Health Access Initiative is seeking for suitable independent consultants or firms, with established track record in conducting health systems assessments to give her develop a robust strategy to expand diagnosis of TB with new generation devices as well as design an oxygen delivery system in Cameroon.

Overview of Clinton Health Access Initiative.
The Clinton Health Access Initiative (CHAI) is a global health organization that operates at the nexus of government, business, and health. CHAI’s approach hinges on its trusted relationships with governments to drive change across entire health systems. For over two decades, CHAI has been committed to saving lives and improving health outcomes in low- and middle-income countries (LMICs) by enabling the government and private sector to strengthen and sustain quality health systems. CHAI currently operates in  40 countries, driving efficient and effective disease response by providing quality prevention, diagnostic and treatment services to all who need them.
Objectives: This RFP has two principal objectives:
1.    Conduct a comphrensive national dCXR/CAD network assessment, covering equipment locations, regulatory pathways, HR capacity, CAD calibration needs, and maintenance/service coverage and complete standard CXR checklist to inform procurement planning.   
2.    Conduct a comphrensive Oxygen delivery assessment covering, oxygen needs by facilities surrounding Limbe Regional Hospital, distance from Limbe Regional Hospital, Current Oxygen Prices in these facilities, types of oxygen sources and other related parameters.  
2.    Participation in the request for proposal
Participation in this Request for Proposal (RFP) is open to independent contractors and companies legally established in Cameroon. Eligible participants must demonstrate substantial experience in health-related data collection, particularly in tuberculosis diagnostic capacity and the expansion of oxygen access, as well as strong relationships with the Government, especially the National TB progamme and the Global Fund Management Unit. Proposals should include evidence of previous work in these areas, highlighting technical expertise and successful project outcomes.

3.    Scope of Work-
3.1 Landscaping digital chest x-rays coverage
1.    Work with NTP, in-country TB partners and other relevant stakeholders (e.g.,radiology associations and hospitals) to map out digital chest X-ray and CAD coverage in the country.
2.    Establish the functionality of the existing chest X-ray fleet, including any service and maintenance and warranty contracts
3.    Outline the screening algorithms, indications for use, and where possible the
4.    utilization rate of chest X-rays for TB services and wider health service uses.
5.    Identify and document any information and expertise gaps and how to address this, at all levels of the health system.
6.    Develop recommendations for placement, connectivity and expansion of digital chest X-ray platforms at all levels of the health system
  
3.2. Landscaping Medical Oxygen Delivery system in Limbe
1.    Work with Limbe Regional Hospital and the Department of Projects and studies at the MOH to evaluate the availability of medical oxygen within a 5-10 kilometer radius of Limbe Regional Hospital.
2.    Assess the demand for oxygen, including the number of patients requiring oxygen, types of oxygen most requested, and costs incurred by patients in all facilities identified in the catchment area.
3.    Analyze the electricity infrastructure in health facilities, focusing on its capacity to support oxygen production and delivery systems.
4.    Examine healthcare providers’ capacity to use and maintain oxygen-related equipment and implement emergency protocols involving oxygen use.
5.    Propose recommendations to improve oxygen distribution and utilization in lower-level health facilities, particularly district hospitals.
3.3. Deliverables:
Deliverable #1: A comprehensive National digital chest X-ray network assessment covering (but not limited to):
•    Type and location of digital chest X-ray equipment used by the TB program.
•    Regulatory pathways for both chest X-rays and CAD
•    Human resource capacity for chest X-rays and CAD
•    CAD TB threshold calibration (requirement and expertise to calculate and interpret
•    results)
•    Level of coverage/implementation and utilization for chest X-rays
•    Technical support, service and maintenance coverage for chest X-rays and CAD.

Deliverable #2: Completion of the Global Fund CXR checklist

Deliverable #3 : A comprehensive assessment report covering (but not limited to):
•    Facility needs, types of oxygen most requested, and costs incurred by patients.
•    Type of Oxygen source most appropriate for each facility, taking into consideration distance, availability of electricity etc.
•     Healthcare staff capacity on oxygen utilization, maintenance, and emergency protocols.
Deliverable #4: Dissemination of Results:
o    Presentation of findings to key stakeholders, including CHAI, the Ministry of Health, and other relevant parties.
o    Development of actionable recommendations to enhance medical oxygen accessibility and TB diagnostic capacity in Cameroon.
o    Two publishable manuscripts- one on Oxygen and One on TB diagnostic landscaping.

6. Proposal Requirements:
The bids for this tender should contain the following:
1-    Clear and detailed proposals of the data to be obtained and methodology used.
2-    Administrative and tax documents (Business registration document, taxpayer card, attestation of non-indebtedness, attestation of localization, bank attestation). Company profile registered address, functional email address, telephone number, and point of contact for the entity.
3-    Financial proposal signed by the authorized representative of the bidding company or independent consultant.
4-    Letter of support for the Ministry of Public
5-    Valid MOU with the Minitry of Public Health

NB: Evaluators will neither make assumptions nor draw inferences regarding missing or incomplete information. The submission of incomplete information could result in the rejection of the proposal.
5. Bids Expiration
The bid expires after the deadline below.
6. Evaluation Factors and Criteria
Minimum requirements:
The minimum technical requirements that will be evaluated as “technically acceptable” or “technically not acceptable” are the following:
•    Minimum requirement 1: Understanding of the Scope of Work and technical approach
•    Responsiveness to the Scope of Work: Proposals will be assessed on the extent to which the proposal is responsive to and meets the criteria detailed in the scope of work
•    Approach: Proposals will be assessed on the extent to which the proposed approach, methodology and workplan reflects a clear understanding of the nature of the work to be undertaken and the environment in which the work must be performed. As well as a clear understanding of the CHAI operating model.
•    Minimum requirement 2: Experience and Past Performance
•    Ability to demonstrate relevant past experience operating across global partner landscape and with national stakeholders.
•    Relevant professional experience working in public health including national TB and disease control programs.
•    Ability to collaborate across the global and national partner landscape
•    Previous experience conducting diagnostic network optimization/assessments work in developing countries.
•    Previous experience engaging with Global Fund, including processes at the country-level, and experienced with in-country programmatic implementation.
•    Proposed team of experts should demonstrate their ability to provide the services. The bidder is required to submit:
o    Evidence that they have undertaken similar work in other organizations.
o    Three up-to-date references who can vouch for the quality of work previously done.
•    Minimum requirement 3: Expertise and Qualifications of proposed personnel
•    Proposals will be assessed on the extent to which the bidder is demonstrated to have personnel the necessary expertise.
o     Proficiency in English French is mandatory, knowledge Knowledge of local languages would constitute an added advantage.
o    Demonstrated ability to effectively interact with various stakeholders including government officials, project implementers, project beneficiaries, among others.
o    Excellent oral communication and writing skills, interpersonal skills, and the ability to work in a team setting with people of diverse backgrounds and points of view.
7. Submission of Bids
Each bid written in French or English should be emailed to:
chaicameroonprocurement@clintonhealthaccess.org no later than February 19th , 2025, at 5:00 pm and should be labeled:
TB and Medical Oxygen Landscape assessment in Cameroon
8. Additional Information
Additional information can be obtained during working hours through this address: nforghab@clintonhealthaccess.org or at CHAI– Cameroon, HS Jean Paul II Boulevard, Tsinga Sous-Prefecture Yaoundé.

 The Country Director