Issued by FHI 360, Alive & Thrive

Request for Proposals (RFP) For Understanding opportunities and challenges of delivering maternal, infant and young child nutrition (MIYCN) services in urban maternal, newborn, and child health (MNCH) facilities in Dhaka City Issued on: August 17, 2018 Issued by FHI 360, Alive & Thrive Title: Understanding opportunities and challenges of delivering maternal, infant and young child nutrition (MIYCN) services in urban maternal, newborn, and child health (MNCH) facilities in Dhaka City Proposal Deadline: September 14, 2018 Anticipated Period of Performance: October 1, 2018 May 16, 2019 1. Background 1.1. Alive & Thrive Alive & Thrive (A&T) is an initiative to save lives, prevent illness, and ensure healthy growth and development through improved maternal, infant and young child nutrition (MIYCN) best practices. Good nutrition in the first 1,000 days, from conception to two years of age, is critical to enable all children to lead healthier and more productive lives. During 2009 2017 (Phase I and II), A&T has established the proof of concept that the improvement of MIYCN practices at scale is possible through large scale programs in several countries in Asia and Africa. Today, A&T is building on the successes and learning of Phases I and II, reaching new countries and regions, and improving the overall enabling environments for nutrition policy/advocacy and programming. A&T is funded by the Bill & Melinda Gates Foundation and the governments of Canada, Ireland and Madagascar, and is managed by FHI 360. 1.2 Institutional arrangements for urban health care Urbanization is occurring rapidly in Bangladesh. Although most of the population remains rural, 23 percent of people now live in urban areas. 1 By 2050, the urban population is projected to account for more than half of Bangladesh s total population. 2 Slum settlements have proliferated as part of this trend, with a recent census counting approximately 14,000 slum settlements across the country. 3 Although these settlements differ in size, they share certain characteristics, including high 1 Government of Bangladesh 2014. Bangladesh Population & Housing Census 2011 National Report Volume-3: Urban Area Report. Dhaka: Bangladesh Bureau of Statistics, Government of Bangladesh. 2 UN DESA (United Nations Department of Economic and Social Affairs). 2015. World Urbanization Prospects: The 2014 Revision. New York: United Nations. 3 Government of Bangladesh 2015. Preliminary Report on the Census of Slum Areas and Floating Population 2014. Report, Bangladesh Bureau of Statistics, Government of Bangladesh, Dhaka.

population densities, a large share of migrants from rural areas, inferior public water and sanitation services, and poor-quality housing. The institutional arrangements for urban primary health care (PHC) primarily with the Ministry of Local Government, Rural Development and Co-operatives (MOLGRDC), Ministry of Health and Family Welfare (MOHFW), and the urban local bodies (ULBs) comprising the city corporations (CCs) and municipalities (pourashavas). According to the Local Government (City Corporation) Act 2009 and Local Government (Municipalities) Act 2009, the CCs and municipalities are responsible to maintain public health, and establish and operate hospitals, PHC centers, dispensaries, and mobile health units for urban people. Urban PHC is predominantly run under the private sector, which offers a range of staff from pharmacists to highly trained specialists. The urban areas provide a contrasting picture of availability of different facilities and services for secondary and tertiary level health care. Medical clinics and diagnostic centers have become numerous all over the country, while PHC facilities and services for the urban population at large and the urban poor, in particular, are inadequate. A number of NGOs and voluntary organizations are playing a role as PHC providers. Funded by several donor agencies, the NGOs contribute significantly to the provision of public health as well as PHC services in urban areas. Additionally, there are a few not-for-profit self-financed NGOs with limited donor contributions providing public health and PHC services. Additionally, there are public secondary and tertiary level hospitals, including Mother and Child Welfare Centers (MCWCs) under MoHFW with services catering to urban people. A number of tertiary level multi-disciplinary public facilities including MNCH services (Medical College Hospitals) are also important provider. Further, a few poverty alleviation projects within urban areas targeting urban poor (e.g. national urban poverty reduction Program of the United Nations Development Programme [UNDP]) address awareness raising on nutrition. 1.4 Nutrition situation in urban Bangladesh An urban-rural divide in Bangladesh are reflected in health and nutrition indicators, and even in instances where the urban population fares better, their health and nutrition indicators are still suboptimal. Among women ages 15 49 years, 12 percent are underweight. Among urban women who had a live birth in the past three years, nearly 80 percent received antenatal care (ANC) from a medically trained provider. However, less than half of urban women who had a live birth in the past three years (46 percent) received 4+ ANC visits. Institutional delivery rates among urban women are higher than rural women (57 percent vs. 31 percent, respectively); however, four in ten urban women still deliver at home. Women in urban areas are twice as likely as women in rural areas to deliver by cesarean section (C-section) at 38 percent and 18 percent, respectively. Fewer newborns are breastfed within one hour of birth in urban areas (45 percent) compared to rural areas (53%). Bangladesh Demographic and Health Survey 2014 reports that nearly thirty percent of the children under five are stunted in the urban areas. 4 In slums, this number goes up to half of the under-five children, compared to one-third for non-slum urban areas. 5 Only one in every four children (26 percent) of age 6 23 months in slums is fed with proper IYCF practices, compared with 40 percent for non-slum children. 4 1.5 Alive and Thrive urban maternal, infant, and young child nutrition (MIYCN) model 4 National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF International. 2016. Bangladesh Demographic and Health Survey 2014. Dhaka, Bangladesh, and Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF International. 5 Government of Bangladesh (GoB) (2014). Country Nutrition Paper Bangladesh. International Conference on Nutrition 21 years later,19-21 November 2014. Rome, Italy.

Considering the high rates of undernutrition in urban areas, A&T envisions to promote an urban model for delivering MIYCN counseling services in selected maternal, newborn, and child health (MNCH) service settings. Elements of urban MIYCN model Nutrition counseling to pregnant women on dietary diversity, consumption of iron folic acid supplements, and consumption of calcium supplements Weight monitoring of pregnant women Age-specific counseling on infant and young child feeding to pregnant women/caregivers of children <2 years of age Community mobilization to create demand for the service Standardization and branding of the facility set up to deliver the counseling sessions Endorsement by government authority (e.g. IPHN) to set standards, branding and accreditation process for good service delivery 1.6 Rationale There is limited knowledge on the urban context regarding facility-based MIYCN services. To design and the implement the package, it is important to understand both the demand side and supply side factors that would shape and influence the delivery of the MIYCN model. Therefore, A&T intends to undertake formative research to: - understand the urban context which will inform the design of the urban MIYCN interventions to improve the delivery of MIYCN services in NGO-run MNCH facilities - improve demand for MIYCN services and flow of beneficiaries to such facilities to get services However, A&T envisages that the MIYCN model will be taken up by the government and scaled up in government-run facilities, as well as in donor-supported community-based programs in the future. Therefore, the formative research will encompass urban context as a whole, including government and NGO-run facilities, and other stakeholders with potential to implement MIYCN counseling services. 2. Scope of Work 2.1 Objectives General objective To understand opportunities and challenges of delivering MIYCN services in urban MNCH service facilities, and improving demand for MIYCN services in Dhaka City. Specific objectives The Scope of Work is divided into two components. Component #1 is related to assessment at the facility-level, while Component #2 is related to assessment at the beneficiary-level. The specific objectives for each component are listed below. Vendors/Organizations are encouraged to apply for one or both components. Component #1: Facility level assessment 1. To better understand the health system s capacity for delivering quality MIYCN services through existing infrastructure, including NHSDP and other NGO-run primary and secondary level facilities City Corporation hospitals and other public health secondary care facilities MCWC For-profit facilities and private providers

Areas of assessment: a) Service delivery: i) Availability and utilization of MIYCN services by pregnant women and mothers of children <2 years of age (ANC, delivery, postnatal care [PNC], well and sick child visits) ii) Practices of frontline workers (FLWs) who deliver MIYCN services and adherence to MIYCN-related standard operating procedures (SOPs) (e.g. Baby Friendly Hospital Initiative [BFHI]) and good practices (counseling, weight/growth monitoring, iron folic acid [IFA] and calcium supplement distribution) iii) For delivery, MIYCN practices (e.g. BFHI SOPs for early initiation of breastfeeding and skin-to-skin contact) for normal and C-section delivery iv) Availability of dedicated nutrition counseling area within the facility b) Supply chain and logistics i) IFA and calcium supplements ii) Availability of job aids and anthropometric tools for nutritional assessment (e.g. functional weighing scales) c) HMIS and use of data i) Availability and use of registers and reporting mechanisms for MICYN services across Health and Family Planning ii) Data production, data review, flow and use of information d) Workforce for MIYCN service delivery i) Roles and service contact points (ANC, PNC, sick child visits, etc.) ii) Training status of FLWs in key MIYCN topics iii) Motivational factors and barriers to deliver MIYCN services iv) FLWs perceptions/beliefs, knowledge and self-efficacy related to MIYCN services v) Mandate and designated activities for community referrals and linkages vi) Demand generation (1) Facility to community bi-directional referrals and linkages (outreach to community services or community mobilization activities) (2) Identify opportunities for partnering with groups supporting community health and nutrition to strengthen continuum of care for MIYCN services including reach, intensity and feasibility (e.g. self-help groups as a platform within the UNDP government project) (3) Identify opportunities to use mass media, social media and mobile platforms for MIYCN social mobilization and communications Component #2: Beneficiary level assessment

The beneficiary level assessment will be conducted among slum and non-slum dwellers. The specific objectives are to: 1) Identify practices, perceptions, misconceptions, barriers, and facilitators that influence maternal nutrition practices during pregnancy (i.e. consumption of IFA tablets, consumption of calcium supplements, adequate weight gain, dietary diversity, ANC attendance) and beliefs and cultural norms related to infant and young child feeding practices (i.e. early initiation of breastfeeding, exclusive breastfeeding, timely introduction of complementary foods, continued breastfeeding at one year, dietary diversity, and meal frequency). 2) Identify key stakeholders influencing MIYCN behaviors, including who takes decisions about the care and feeding practice of the pregnant women and infant and young children; and assess relative level of influence of each stakeholder on MIYCN behaviors and practices 3) Understand what are the current trusted and most effective existing communication channels for MIYCN information (i.e. community workers, mass media, mobile phones, social media, women s/husbands forums, self-help groups, families, peers, community or religious leaders, medical professional and other social influencers to What are desired communication channels to establish for MICYN information. 4) Identify opportunities for partnering with community health and nutrition groups to strengthen continuum of care for MIYCN services (e.g. Self-help groups as a platform within the UNDP government project). 2.2 Geographical scope The project will be conducted in the urban areas of Dhaka City. 2.3 Methodology The methodology should be outlined by the vendor/organization in their proposal. A&T values the inclusion of methods that are consultative and participatory as part of a collective problem-solving process. Using consultative research methods will improve the odds dramatically that the subsequent solutions are not only viable and feasible but also desirable. The goal of consultative research is to identify feasible, acceptable, and effective strategies to improve behaviors, with program beneficiaries playing an active role in the process. This research could include methods like interviews and observations with health staff, journey mapping and social network analysis to better understand how caregivers get information and make choices related to IYCF, co-creation workshops with facility staff and end users to understand how they envision the MIYCN model to be set-up, and other innovative techniques. 2.4. Sample size and selection Sample size to be outlined by the vendor/organization in their proposal based on research objectives. 2.5 Activities Under the guidance of A&T, the selected vendor/organization will perform the following activities: 1. Define design, methods, data collection tools, and data analysis plan in close consultation with A&T 2. Develop a timeline to complete the tasks in scheduled time 3. Field test the draft instruments and finalize with feedback from A&T 4. Collection of data 5. Prepare translated transcripts and analysis of data

6. Entry of any quantitative data (if any) into computer 7. Finalize the report (in English) after review by A&T 8. Slide deck of key findings 3. Anticipated Deliverables and Timeline Deliverable Timeline Detailed time plan 4 October 2018 Protocol and tools finalization 15 October 2018 Obtain IRB from credible authorities 15 December 2018 Preliminary findings/ Outline of the report 31 March 2019 Transcripts, clean data set (if any) 30 April 2019 Draft report 30 April 2019 Final Report 16 May 2019 Slide deck of key findings 16 May 2019 Proposal Instructions and Deadline Responses to this RFP should be submitted by email to the A&T project to the attention of smabdullah@fhi360.org and zmahmud@fhi360.org no later than September 14, 2018 at 5 p.m. (Dhaka time). Offers received after this date and time will not be accepted for consideration. FHI will acknowledge receipt of your proposal by email. Proposals must be submitted in electronic format. Any questions or requests for clarification need to be submitted in writing to the same email addresses by August 31, 2018 at 5 p.m. (Dhaka time). Answers will be shared with all firms. No telephone inquiries will be answered. Vendors/Organizations are encouraged to apply for one or both components of the Scope of Work (Component #1: Facility level assessment and/or Component #2 Beneficiary level assessment). A&T s preference is to contract one vendor/organization for both components for the following reasons: continuity and cohesiveness of the findings as they relate to the full set of elements of the urban MIYCN model (see Section 1.5); cost-efficiencies; and reduced management burden. However, we recognize that the two components differ in technical area (facility vs. beneficiary), and qualified vendors may excel in one technical area than the other. Due to this, A&T will consider applications for one or both components of the Scope of Work. In order to be considered, PROPOSALS must include the following: I. Capability Statement not to exceed three pages, indicating size of the agency, staff strength, proof of past experience in similar capacity, work with donor organizations and/or the Government of Bangladesh etc. a. The organization should have proven record of designing and conducting formative research in the field of health and/or nutrition services in Bangladesh. b. The agency should have prior experience of research work in urban Health system. c. The agency should have prior experience of working with Government of Bangladesh Health system and private practitioners. d. The organization should have trained staffs for relevant research work e. The organization should have capacity and techniques that will be used for supervision of field work and development of tools. f. Procedures for ensuring compliance with ethical standards.

II. III. IV. Staffing names, brief (1/2 page) bio sketch of key personnel, including their experience, awards won/international recognition, past work on this type of project; percentage of agency staff time of principals and managers, and information regarding who will be managing this account. If more than one component is being proposed, please submit separate staffing lists by component. Client list with names of contact person at three recent (within the past 2 years) organizations for whom you have implemented relevant intervention package. If more than one component is being proposed, please submit separate client lists by component. Approach: not to exceed five pages, indicating the approach the organization will utilize to conduct the study/assessment including: a. Detailed timeline for various specific activities that will be done to complete the assignment. b. Timeline should be plotted on week by week basis during the assignment period showing key steps and activities, including A&T staff reviews and preparation of deliverables NOTE: The narrative including the data analysis plan should be no longer than 3-5 pages excluding the timeline. If more than one component is being proposed, please submit separate narrative approaches by component. V. Budget detailed budget for the above scope(s) of work (broken down into labor cost or personnel costs, and other line items with an explanation of how the unit costs were reached, detailed travel costs, and other direct costs). Submit using FHI 360 template that is available upon request and from the website aliveandthrive.org. Unit costs, number of units, and unit description must be provided for every line item. Please provide breakdown of costs included in the indirect charges, percentages will not be accepted. Provide the budget in an excel sheet in Bangladeshi Taka. To the extent that overhead costs are applicable, they are subject to the following limits: 0% for government agencies and other private foundations Up to 10% for U.S. universities and other academic institutions Up to 15% for all other non-u.s. academic institutions and all private voluntary and nongovernment and for-profit organizations, regardless of location Indirect cost rates (and the limitations) apply both to the primary applicant organization and any sub-grantees and/or sub-contractors that are part of the proposal. If the organization has lower indirect rates, the lower rates should be used. Please include VAT in the cost proposal as FHI 360 is not VAT exempt. If more than one component is being proposed, please submit separate budgets by component. Criteria for Evaluation: A&T anticipates issuing one or more fixed-price purchase order(s) to the offeror(s) whose proposal is most advantageous, cost and other factors considered. A fixed price contract calls for one firm price, not subject to any adjustment based on the contractor s cost experience in performance of the contract. This fixed-price is established at the outset, when the contract is negotiated and signed. Proposals will be evaluated pursuant to the following criteria. Selection will be on a best value basis. If applicable, short listed firms may be called for an interview to discuss shortcomings with immediate response from their end. Technical and Cost Scores 100 points max

1. Approach (Understanding of the tasks outlined in the RFP; methodology/strategy for the research) 35 points 2. Capability and institutional experience in Bangladesh in carrying out relevant research of documented international standard (including past performance and references) 25 points 3. Staffing plan and qualifications of key personnel 15 points 4. Completeness, Appropriateness and Reasonableness of the cost proposal 20 points 5. Proposal that includes the Scope of Work s Component #1 and Component #2 5 points Committee will take into consideration clarity and accuracy of budget presentation, details of the budget and budget notes, price, and cost effectiveness. Withdrawal of Proposals Proposals may be withdrawn by written notice, email or facsimile received at any time before award. Termination of Contract A&T has the right to terminate the contract at any time during the contract period with a 30-day notice period. False Statements in Offer Offerors must provide full, accurate and complete information as required by this solicitation and its attachments. Proposals become the property of FHI 360. Award and Notification of Selected Proposals FHI 360 will not compensate offerors for preparation of their response to this RFP. Issuing this RFP is not a guarantee that FHI 360 will award a contract. FHI 360 reserves the right to issue a contract based on the initial evaluation of offers without discussion. FHI 360 may choose to award a contract for part of the activities in the RFP. FHI 360 may choose to award a contract to more than one offeror for specific parts of the activities in the RFP. Negotiations will commence with a discussion of the proposal, schedule of activities, and staffing. Agreement must then be reached on the final proposal, staffing, logistics and reporting. Special attention will be paid to clearly define the inputs required from FHI 360 to ensure satisfactory implementation of the assignment. Changes agreed upon will then be reflected in the budget and budget narrative, using proposed unit rates. Having selected the agency on the basis of an evaluation of proposed key professional staff among other things, FHI 360 expects to negotiate a contract on the basis of the staff named in the proposal and, prior to contract negotiations, will require assurance that these staff will be actually available. FHI 360 will not consider substitutions during contract negotiations except in cases of unexpected delays in the starting date or incapacity of key professional staff for reasons of health. FHI 360 may request from short-listed offerors a second or third round of either oral presentation or written response to a more specific and detailed scope of work that is based on the general scope of work in the original RFP.

FHI 360 has the right to rescind this RFP, or rescind an award prior to the signing of a contract due to any unforeseen changes in the direction of the donor, be it funding or programmatic. FHI 360 reserves the right to waive any deviations by offerors from the requirements of this solicitation that in FHI 360 opinion is considered not to be material defects requiring rejection or disqualification; or where such a waiver will promote increased competition and if such action is considered to be in the best interest of FHI 360 client organization, the Bill & Melinda Gates Foundation. Please do not include examples of your work although you may include a website(s) for us to review that reflects your work. If FHI 360 requires additional materials, we will request those materials during the review process. Should FHI 360 choose to make an award, all deliverables produced under said award shall be considered the property of FHI 360. Please note that if you consider that your firm does not have all the expertise for the assignment, there is no objection to your firm associating with another firm to enable a full range of expertise to be presented. However, joint ventures between firms on the shortlist are not permitted without the prior approval of FHI 360. The request for a joint venture should be accompanied with full details of the proposed association and confirming joint and several liabilities. Should FHI 360 choose to make an award, assignment from award of contract will be subject you to normal tax liability in Bangladesh. Kindly contact the concerned tax authorities for further information in this regard if required.