Terms of Reference for the Implementation of Social Contracting of HIV Prevention Package of Services in Support of the National HIV Response

PREAMBLE

Social Contracting, without a universally adopted definition, is the domestic funding of civil societies/non-governmental organizations to deliver health prevention, treatment, care and support services. Recognizing the key role of the entire society in the HIV response, this unique social contracting opportunity presents itself as a first for Jamaica and is open to all eligible Non-Governmental Organizations and Civil Societies to improve delivery of HIV-related services through the use of innovative methodologies.

 

BACKGROUND

Between 2003 and 2017, funding for Jamaica’s national HIV response came mainly from external sources with the primary donors being the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the U.S. Government’s Presidents Emergency Plan for AIDS Relief (PEPFAR). For the periods 2015/16 and 2016/17, international donor funding was 51% of expenditure and 53.3% respectively, as outlined in the National AIDS Spending Assessment 2015-2017. Government of Jamaica spending for the said periods was 39% and 35.5% respectively. Over the last two to three years, Jamaica has been going through a period of transition caused by and the need to ensure a sustainable, government-owned HIV response. Most recently, the COVID19 pandemic has caused strains in the national HIV response, which jeopardize Jamaica’s progress in HIV, and in meeting the targets agreed by the Government of Jamaica in the 2021 Political Declaration on HIV/AIDS. There is now a move away from reliance on external funding for the national HIV programme to greater domestic investment. This transition is not unique to Jamaica and is currently happening in many low and middle-income countries. The process however involves some amount of challenges including those associated with implementing the HIV programme, particularly in key populations. Community engagement and empowerment are critical components of HIV programming, especially for key and vulnerable populations, and is considered an indication of readiness for a locally financed arrangement. Civil Society Organisations (CSOs) and other non-government organizations are usually the groups with whom governments collaborate to deliver HIV services to key communities due to their significant comparative advantage in reaching the communities they already serve.

A 2019 review of the legal and regulatory frameworks in place for the engagement of CSOs, confirmed that adequate systems are in place to support this type of arrangement through social contracting. A 2020 investigation of the cost of CSO-delivered prevention and support services also endorses social contracting as practicable and appropriate for a sustainable transition to a locally financed HIV response. Both these studies were done by Palladium’s Health Policy Plus (HP+ project) supported by USAID/PEFPAR. Similarly, Jamaica AIDS Support for Life (JASL) and the Caribbean Vulnerable Communities Coalition (CVC) examined policy options to sustain the HIV response in Jamaica and the Global Fund supported the Jamaica Civil Society Forum on HIV and AIDS to develop a Resource Mobilization Strategy. Both these documents speak to the urgent need to implement mechanisms and policies that enable the sustainable financing of integrated community responses including through Social Contracting and other public financing mechanisms

“Social Contracting” in its basic form refers to government’s engagement of civil society groups to deliver services which are in turn financed by domestic funds. The partnership is usually supported by the requisite policies and programmatic arrangements that ensure continuous capacity building and ownership on both sides. It has also been referred to as one policy reform aimed at maintaining the critical role of civil society in the HIV response. The Global Fund defines the term as “mechanisms that allow for government funds to flow directly to CSOs to implement specific activities”. These specific activities would correspond to achieving specific national targets and reaching populations.

 

INTRODUCTION

The Ministry of Health and Wellness (MOHW) is the pre-eminent Jamaican Government entity whose mandate is “To ensure the provision of quality health services and to promote healthy lifestyles and environmental practices”. Recognizing the key role of the entire society in the HIV response, the MOHW is seeking to partner with Non-Governmental Organisations, and Civil Society Organisations to improve delivery of HIV services to specific key and vulnerable populations using Social Contracting. This will be the mechanism for engaging entities to reach the target population in a more efficient and effective manner, and in response to the objectives outlined in the national strategic plan.

Jamaica has a concentrated HIV epidemic among transgender people/persons of Trans experience (TG), gay men and other men who have sex with men (MSM), and sex workers. The adult HIV prevalence in Jamaica stands at 1.4% with an estimated 32,000 PLHIV (UNAIDS estimates, 2020). At the end of December 2020, almost 16% of PLHIV (4,469 persons) were unaware of their status. In 2020, 618 new cases were reported to the MOHW, and 16% were among the ages of 15 to 24 seventy-six percent (76%) of the cases were reported in the parishes of St. Catherine, St. Ann, St. James, Westmoreland and Clarendon.

Traditionally the youth in high prevalence communities/unattached youth were reached by the regional health authorities while the other key populations were reached by CSOs. According to the MOHW 2020 Epi report 16% of the new HIV cases were among young person’s age 15-24 years. According to the MOEYI there are approximately 140,000 unattached youth in Jamaica.  Unattached youth are persons not engaged in any educational programs or employed. 1017 KAPB stated that 33% of youth were able to correctly identify ways to prevent the transmission of HIV.

The HIV prevalence among men who have sex with men has remained high for nearly three decades with the most recent 2018 survey indicating 29.6% and 51% among transgender women (876 survey, 2018). The prevalence among ANC patients 0.4%, FSW is 2%, prisoners 6.9% and STI attendees 4%.

Given the evidence, there is urgent need to escalate the national response to HIV/AIDS in order to achieve local and international HIV/AIDS targets. Specifically, in light of Jamaica’s commitment to:

  • The Sustainable Development Goal (SDG) 3 which has the ambitious target to end AIDS, tuberculosis and malaria by 2030.
  • The UNAIDS 90-90-90 goals to achieve epidemic control envisages that by the end of 2025, 90% of people living with HIV will know their HIV status, 90% of people who know their status will be accessing treatment and 90% of people on treatment will have suppressed viral loads. The country currently stands as 86-51-74.
  • The 2020-2025 National Strategic Plan for Jamaica has laid out key priorities and will contribute to achieving Vision for Health 2030.

 

The 2019 Global Fund Performance Review highlights the need to strengthen the implementation of the prevention packages and testing services among key populations. The Ministry of Health & Wellness has commenced the process towards engaging non-governmental organizations to provide HIV prevention and treatment services. The Jamaican Government will pilot Social Contracting in Jamaica over the period within 2021 to 2022 to determine the feasibility with moving forward with this mechanism for the country. This pilot will focus on outsourcing primary prevention services to and appropriate non-government/Civil Society partners.

 

OBJECTIVE

The overall objective of this programme is to control and prevent new HIV infections by making primary prevention support services more accessible to difficult-to-reach populations in collaboration with the Family Planning Service Division (FPSD) and National HIV/STI/TB Unit.  Specifically:

  1. MSM – Men who have Sex with Men (MSM) describes a behavior and is not an identity. It is men, including those who do not identify themselves as homosexual or bisexual, who engage in sexual activity with other men.
  2. TG – Transgender or Persons of Trans-experience (TG) are people have a gender identity or gender expression that differs from the sex that they were assigned at birth.
  • Unattached Youth – Youths aged 15 to 24 years old who are unemployed, not engaged in any form or education and who reside in high-risk communities.

The MOHW now invites eligible organisations that have successfully completed the Expression Of Interest (EOI) process to submit Technical and Financial Proposals to provide these services.

 

PACKAGE OF SERVICES and TARGETS

This Government is outsourcing 10% of the MSM national target; 10% of the TG national target and 10% of the unattached youth national targets over a 12-month period. Therefore, the social contracting is expected to reach the following allotted proportions over this period of implementation:

 

  PACKAGE 1 PACKAGE 2 PACKAGE 3
  MSM- 10% TG – 10% YOUTH – 10%
  Reach Test Reach Test Reach Test
Non-Government Organisation 12 months target 754 679 39 35 2323 2091

 

Service providers may bid on any or all three packages.

The MOHW requires the reached and test targets for each package/population to be achieved and bidding entities are expected to describe in the technical proposal the strategies to be engaged. The MOHW encourages innovative ideas regarding how these targets will be achieved. Joint ventures and partnerships among non-government parties are encouraged. Bids that do not speak to the achievement of each package in full will not be considered.

Some proposed areas of focused used in the national response to reach these key populations have included:

  • Peer to Peer Support
  • Community Outreach
  • HIV/Syphilis Testing & Counselling (HTC)
  • Linkage to Care
  • Provision of Condoms and Lubricants
  • Group interventions
  • Life Skills & Empowerment Training
  • Skills Building

 

APPLICATION REQUIREMENTS

Based on the general objective and the package of services and indicators outlined above, interested entities are encouraged to apply by developing and sharing

  • An implementation plan to increase the reach of programmes to targeted populations which corresponds to each package. The plan should detail:
    • The objectives of each intervention that will be undertaken by the firm
    • Specific interventions that will be used to reach the population
    • Types of services that will be offered to increase reach and testing
    • Methods that will be used to reach the populations that are defined in the national HIV prevention plan or new strategies; and
    • The human resources that will be required to implement the strategies as outlined
    • A monitoring and evaluation framework (expanded below)
  1. Monthly reports that will guide the detail the progress of activities. The service providing entity, as part of the general implementation plan will be required to support the Ministry of Health in the development and implementation of new strategies to support the expansion of the reach of the programme to the key populations that have been identified.
  2. Maintain accurate record of clients in a manner that protects their confidentiality

 

MONITORING & EVALUATION

A monitoring and evaluation framework will be developed to test the efficacy of interventions and provide data that will inform the change in the programme delivery over time. The M&E Framework will define the key metrics to achieve the overall targets as set out in this TOR related to the reach and delivery of services to the key populations. The Monitoring and Evaluation framework will detail:

  • The indicators of success that will be used to determine the achievements of the programme
  • The means of verification that will be used to determine the assessment of each indicator
  • The methodology for collecting and analysing data related to each indicator
  • The responsibilities for measurement

In addition, if an entity is successful, one interim implementation report that will guide the detail the progress of activities will be required, and to maintain accurate record of clients in a manner that protects their confidentiality.

 

DELIVERABLES KEY DELIVERABLES STANDARD TIMELINE

Deliverable number Description Payment schedule Timeline
# 1 Implementation plan and M&E framework

 

10% Within five (5) days of signing of contract
# 2 Two (2) interim implementation report

 

80% To tranches of payments
# 3 Final report- A detailed report on the consultancy and agreed deliverables 10% Due no sooner than day 355 and no later than day 360 of implementation period
  Total 100% Maximum of 360 calendar days

 

CONDITIONS OF CONTRACT

SELECTION METHOD This consultancy will be selected using a Quality and Cost Based Selection process as outlined in the Guidelines for Government Procurement Procedures
PERIOD OF CONTRACT 360 calendar days
PAYMENT METHOD Deliverable based contract
FUNDING

 

Funding will be provided by the Government of Jamaica.
REPORTING ARRANGMENS The consultant entity/firm will report to the Executive Director of the National Family Planning Board for the implementation of activities and work in collaboration with the National Family Planning Board (NFPB) and the National HIV/STI/TB Unit, Ministry of Health & Wellness,
SUPPORT The consultant entity/firm will be required to provide all tools of          trade facilitation in undertaking the assignment
INTELLECTUAL PROPERTY All information obtained during the delivery of this Consultancy is the property of the Ministry of Health and Wellness and requests to use same must be made in writing to the Permanent Secretary
TRAVEL Travel as required under this assignment is authorized and should be included in the bid price.

 

QUALIFICATIONS

Interested entities must satisfy the following requirements against which the proposals will be evaluated:

 

General (10%)

Description
Registered with the Company’s Office of Jamaica and/or the Department of Corporate and Friendly Society.  (10 points)
Possess a valid Tax Compliance Certificate (TCC) and/or Tax Compliance Letter (TCL) (35 points)
Have implemented at least three (3) successful projects related to Behaviour Change for the specific at risk populations. (30 points)
Be able to demonstrate an advanced understanding of HIV/AIDS issues and how innovative prevention strategies can assist in controlling the spread of the disease through published articles, research programmes and other engagements which form part of the firm’s body of institutional knowledge in this sector. (25 points)

 

Adequacy for the Assignment – Key Staff (40%)

Project Manager (40 Points) ·        Master Degree in Social Sciences or Related field

·        3 years’ experience in Project Management

·        2 years’ experience in the implementation of HIV/AIDS prevention strategies and programmes

or

·        First Degree in Social Sciences or related field

·        5 years’ experience in Project Management

·        5 years’ experience in the implementation of HIV/AIDS prevention strategies and programmes

or

·        Associate Degree in Social Sciences or related field

·        7 years’ experience in Project Management

·        5 years’ experience in the implementation of HIV/AIDS prevention strategies and programmes

Primary Prevention Intervention Coordinator

(30 Points)

·        Master Degree in Social Sciences or Related field

·        3 years’ experience in Primary Prevention Implementation

·        2 successful projects implemented

or

·        First Degree in Social Sciences or Related field

·        5 years’ experience in Primary Prevention Implementation

·        2 successful projects implemented

Monitoring and Evaluation Specialist

(30 points)

·        Master Degree in Social Sciences or Related field

·        3 years’ experience in development of M&E framework or research

or

·        First Degree in Social Sciences or Related field

·        5 years’ experience in development of M&E framework or research

Firms will be able to recommend non-key staff in the implementation of the proposal however these staff will not form part of the evaluation of the adequacy component of the assessment.

 

Methodology and Implementation Plan – 50%

Firms will be assessed on the creativity and innovations that are introduced in the implementation of strategies and interventions that are included in their proposals. 

 

SELECTION PROCESS

The Ministry reserves the right to accept or reject late applications or to cancel the present invitation partially or in its entirety. It will not be bound to assign any reason for not engaging the services of any applicant and will not defray any costs incurred by any applicant in the preparation and submission of Expressions of Interest.