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RFP - Exploratory Study,Formative Research to Understand the Demand and Supply Side of the Iron Foli

Funds for NGOs Last date 22 Feb 2017

Activities: Research & Doc,Health/Nutrition,Others


Job id : 74025
RFP - an Exploratory Study/Formative Research to Understand the Demand and Supply Side of the Iron Folic Acid and Calcium Supplementation
Oranisation: Alive & Thrive (A&T)
Location: Uttar Pradesh, Bihar

For:  An exploratory study/formative research to understand the demand and supply side of the Iron Folic Acid and Calcium supplementation for use during pregnancy and post-pregnancy period in both the public and private health care delivery systems in Bihar and Uttar Pradesh.
 
Anticipated Period Of performance:       March 2017 to July 201
                       
Proposal Submission: February 22, 2017
 
Alive & Thrive scales up nutrition to save lives, prevent illness, and contributes to healthy growth and development through improved maternal nutrition, breastfeeding and complementary feeding. Our expertise is in scaling up, intensifying and raising the quality and coverage of evidence –based MIYCN interventions with an emphasis on social and behaviour change and policy support. In its first five years (2009 to 2014), Alive & Thrive demonstrated that innovative approaches to improving feeding practices could be delivered with impact and at scale in three contexts: Bangladesh, Ethiopia, and Viet Nam. Alive & Thrive is now supporting others to scale up nutrition by applying and adapting tested, proven approaches and tools in contexts such as Burkina Faso, India, Nigeria, and several Southeast Asian countries.
 
Alive & Thrive (A& T) initiative in India is supported by Bill & Melinda Gates Foundation and is working as Knowledge partner with government, other development partners, organizations, academia and professional bodies to provide technical support to national programs related to Maternal and Infant Young Child Nutrition(MIYCN).  A&T will contribute to strengthening policies and systems to deliver to women and children the nutrition they need for healthy lives. This will be achieved by providing high quality technical support for accelerating scale up and coverage of maternal and child nutrition interventions in high burden states of Bihar and Uttar Pradesh, and at the national level.
 
One of the priority areas of A & T’s work in India is providing technical assistance to strengthen the policy and program agenda of maternal nutrition.
 
Background:Iron, Folic acid, and calcium are important nutrients required for fetal growth and pregnant women’s health.  Haemorrhage, the leading cause of maternal mortality contributing to 38% of all maternal deaths in India (MMR Bulletin, Registrar General of India 2007-09) is greatly exacerbated by underlying anaemia in pregnant women. Iron deficiency anaemia is responsible for 18% maternal mortality (as per maternal and child undernutrition Lancet Series in 2008). It is estimated that about 20-40% of maternal deaths in India are due to anaemia; India contributes to about 50% of global maternal deaths due to anaemia.  Calcium deficiency can lead to pregnancy complications like preeclampsia and eclampsia which are leading causes of maternal mortality and also increases the risk of preterm birth, one of the leading causes for neonatal mortality.
 
Anaemia burden among pregnant women in India is high with 59% of pregnant women being affected with the condition.  Apart from other causes of anaemia, iron or folate deficiency is the most common cause, especially during pregnancy. Although, supplementation of diet with iron and folic acid (IFA) tablets has been a part of the Ministry of Health and Family Welfare Program for over three decades, levels of IFA intake during pregnancy remain low.  Revised operational strategy for IFA guidelines recommend 180 days of daily IFA (100 mg elemental iron and 500 mcg of folic acid) during pregnancy starting from 2nd trimester and for 180 days (six months) during postpartum period . 
 
National Guidelines also recommend oral calcium tablets to be taken twice a day (total 1g calcium/day)  starting from 2nd trimester of pregnancy up to six months in the post-partum period.
 
IFA and Calcium supplementation are part of the ANC services provided through various public health delivery platforms like Village Health and Nutrition Days at outreach level and ANC – PNC OPDs at facility level. The recently launched Pradhan Mantri Surakshit Matrutva Abhiyan (PMSMA) also recommends to improve quality ANC services in campaign mode on 9th of every month with voluntary support from the private sector.  Accredited Social Health Activist (ASHA) has to ensure provision of IFA supplements to pregnant women who are not able to come for regular antenatal check-ups through home visits. They also have to monitor compliance of IFA tablets consumption through weekly house visits.
 
Need for the exploratory study/research:Recently Iron Folic Acid and Calcium for pregnant women have been included under the essential drug list and are part of the high impact interventions for reducing maternal and under five morbidity and mortality as depicted in the 5 X 5 matrix under the RMNCH+A strategy. Government of India has strived towards improving the access to essential medicines through different initiatives like 1) Janani Shishu Suraksha Karyakram (JSSK) under which free medicines are to be made available at all public health facilities for pregnant women and children for the period from pregnancy to infancy, and 2) rate contracting for essential medicines with decentralization at the district and block level. Even after the launch of National Rural Health Mission (NRHM) in 2005 and now National Health Mission (NHM), which has increased the health budget and offered autonomy to states for ensuring access to services, including availability of medicines, little progress has been made as essential medicines remain unavailable and unaffordable for most of the population. There is need to understand the issues in the procurement and stock out situation of IFA and Calcium supply in health care facilities.
 
In both Bihar and Uttar Pradesh, high maternal anaemia prevalence and low iron and folic acid supplement (IFA) receipt and consumption have continued over time despite universal IFA supplementation program being implemented over long time. As per National Family Health Survey (NFHS)-4 Data (2014 - 15) Bihar, 29.7% received IFA and only 9.7% pregnant women consumed 100+ IFA tablets during their pregnancy (Rural: 9.4% & Urban: 12.3%). There is slight increase in the consumption pattern in comparison to NHFS-3 which was 6.3%. NFHS 4 data for UP is still not published and as per Annual Health Survey (AHS) 2011-12 in Uttar Pradesh, 9.7% of pregnant women consumed 100+IFA tablets during pregnancy wherein 8.3% reported from Rural and 16% from urban, while the RSOC  data suggests even lower rates for the receipt or purchase of IFA at 7.6% in UP and consumption at only 4.3 percent. The reason behind the poor receipt of IFA is the erratic supply in both the states.
 
If we talk of the coverage of Calcium tablet receipt, no large scale survey captures data on it. In low and mid-income countries including India, WHO estimates that medicines are on average, more available in the private sector than in the public sector. Also, the 71st round of the National Sample Survey Office data of India suggests that private doctors were the single most significant source of treatment in both the rural and urban sectors. In fact, more than 70% (72% in the rural and 79% in the urban areas) spells of ailment were treated in the private sector.  Even in the Empowered Action Group (EAG) states like UP and Bihar —which have been the focus of the NHM, the share of outpatient care by private sector (regulated and unregulated) is as high as 85 % and 86% respectively . The large and growing number of private pharmacies and other outlets available help to the fill the gap in access to essential medicines in health systems with weak public delivery systems as in Uttar Pradesh and Bihar. However, this sector is mostly uncontrolled, and there is less understanding on their role in terms of accessibility, availability and affordability of essential medicines. The questions arise:
 
Whether the essential medicines like IFA and Calcium are available at affordable prices in private sector?
 
What are the different formulations available and prescribed?
 
Is there a need and willingness among patients to pay for the cost of these essential medicines? 
 
Purpose:The purpose of this request for proposals (RFP) is to solicit proposals for conducting primary exploratory research to assess the acceptability, affordability, access with respect to private sector market, for Iron Folic Acid and Calcium supplementation during pregnancy and postpartum period; and for assessing the key bottlenecks in government procurement supply chain system in the district for IFA and Calcium in 2 districts each of Uttar Pradesh and Bihar.
 
Target groups: As the ultimate go/no-go decision to purchase IFA and Calcium from the private pharmacies is in the hands of beneficiaries themselves, the research should be able to shed light on decision making factors like the awareness and the desire to purchase, their purchasing potential, and what influence other family members have considering the low status of women in our society. How do the health care providers, especially doctors who are the key gatekeepers as far as prescriptions are concerned, influence the decision of the patients? This research should also try to broaden our understanding of the behavioural pattern of the Pharmacists or the medicine dispensers that exert control over purchase outcomes of patients. Also, how is the status of the district supply chain system for IFA and Calcium impacting the consumption and decision to purchase them from alternate private outlets?  
 
Objectives:   
To understand the need and willingness among clients (Pregnant women and her household members except husbands) to purchase IFA and Calcium from private pharmacies and providers in view of unavailability from the public health system, their affordability (purchasing capacity) and the behaviour pattern (motivators and de-motivators) surrounding the consumption of IFA for a longer period, and preferences for the IFA formulations and their consumption.  
 
To understand the prescription pattern for the IFA among the organised private health care providers and their influence on the clients for its consumption. 
To understand the status of availability and the formulations, composition, packaging and cost of the IFA with the private sector chemists, pharmacies and distributors.
To understand the bottle necks in the procurement and supply chain system under the Public Health department in the States of UP and Bihar in view of very low receipt of IFA and calcium from the system in Uttar Pradesh and Bihar 
Scope of Work:
 
Bidders are requested to submit a proposal describing the research methodology (mix method), sample design/plan, timeline of activities, budget, and a schedule of deliverables, as listed below.
 
Site selection: The research will be conducted in four districts (two each from UP and Bihar). The bidder should propose a method for selecting a suitable statistical sample to have district estimates. The bidder should also outline a method for developing a sampling frame and selection criteria in each district/study site to ensure study participants are appropriately identified and recruited.
Orientation of local stakeholders: The bidder should outline plans for a one-day meeting in each district to introduce the study to the local officials and stakeholders.
 
Development of the tools The bidder would be responsible for designing the research tools for relevant audiences to be reached and finalize the same with inputs from A & T.
 
Composition of field research team: The bidder should propose a Team Leader/Principal Investigator, and describe the size and composition of the field research teams and supervisory staff that would be employed in data collection (including their minimum qualifications), the method to be used for recruitment, and the roles of each staff member in detail.
 
Data collection training: All members of the field research teams should be trained jointly by A&T and staff of the organization implementing the research. The training agenda will be developed and finalized collaboratively with the A&T team. Please be sure to include plans for ethical training and procedures for protection of human subjects.
 
Procedures for data collection and management including quality assurance plan: All interviews are to be audio-recorded and at the end of each day the highlights are to be discussed with supervisors and recorded in handwritten notes. All the raw data files (in excel or SPSS) should be submitted to A&T. The bidder should outline logistic procedures, including methods of transportation, obtaining of ethical approvals, propose methods for supervision of the data collection teams, and discuss how the data will be organized, managed and secured, and how written transcripts and English translations will be produced. No data collection to take place without FHI360 IRB approval. Field work and collection of data can only start after acquiring FHI360 IRB approval.
 
Time frame:   The time frame for the proposed research is five months i.e. (March- July 2017)
 
Data analysis: The bidder will work jointly with the A&T team to analyse the data and produce reports. The bidder should propose the software or formatting of materials suitable for qualitative data analysis; a process for joint reviews with A&T with illustrative data syntheses to be performed by the bidder.  Please submit examples of proposed data synthesis and analysis.
 
A. Expected Deliverables:
 
Deliverable: 
Inception report, development of research tools and sharing with A &T for feedback.
Detailed logistic plan with time line, List of investigators hired with qualification, training agenda and materials for review by A&T.
Get local IRB approval and submit the documents to A&T. Support A&T in finalising protocol for seeking FHI US IRB approval.
Translated tools; pre-test report and suggestions for revision of tools; data collection training completed, and trainees successfully pass test on ethical procedures.
Completion of the survey/ qualitative study; sharing of Research report outline (tabulation plan, data analysis/syntheses draft) for A&T’s feedback
Sharing of draft detailed reports along with recommendations to A&T for feedback and finalization
The Final Report Submission 
No data collection to take place without FHI360 IRB approval.
 
B.   Submission Requirements:
 
To be considered, bidders must provide the following:
 
1. Proposal, including:
 
a)   Capability and Experience Statements: 
Agency profile with solid background/knowledge in public health, maternal and child health, nutrition and supply chain management.
Short bios on proposed key personnel and CVs. Include their experience on this type of research methodology, percentage of staff time of principals and managers, and information regarding who will be managing this account
Examples of solid experience in conducting studies and evaluations in this area of policy.
Show a demonstrated ability to submit and obtain ethics approval for similar research.
Show a demonstrated ability to reach and connect with policy makers (to determine regions of focus and obtain authorization for data collection).
b)   Methodology and Approach. The research agency shall provide the following (6 pages maximum): 
Methodology for Research e.g survey tools, focus group discussions, other methods including analysis strategy;
Logistics, including any requirements for special authorizations and the amount of time required to obtain;
Sampling strategy;
Languages of focus groups and/or in-depth interviews, including translation and local adaptation issues and any anticipated barriers;
Procedures for quality assurance and quality control;
Procedures of data analysis and integration;
Procedures for ensuring compliance with ethical standards; and
Estimated timeline. 
2.     Budget in the format provided by FHI.  All quotes must be in local currency. 
 

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