Assessment of procurement of ophthalmic items (equipment, instruments, consumables, and supplies) and ophthalmic equipment maintenance management

The Fred Hollows Foundation

The Fred Hollows Foundation is a not-for-profit, charitable organization based in Australia founded in 1992 with a core focus of supporting eye health in developing countries. The Foundation provides comprehensive eye care and training support to over 20 countries worldwide. The support provided for the partners includes but not limited to the facilitation and funding for outpatient consultations, medical treatment, eye surgeries, trainings (at primary, secondary and tertiary levels), infrastructure support (including provision of ophthalmic and ophthalmic-related items, eye care centre constructions and renovations), heath systems strengthening, gender mainstreaming, maintenance of an integrated health program, fundraising events, researchers and advocacies and other key tasks to improve eye heath in the countries the foundation supports.

The Fred Hollow’s Foundation work in Africa

The Foundation has worked in Africa to develop comprehensive eye health service delivery in collaboration with local governments with our work focuses on training of health cadres, screening for visual impairment and eye disease provision of treatment and provision of equipment and infrastructure in countries such as Ethiopia, Kenya, Eritrea, Rwanda, Burundi, Tanzania, Uganda and Cameroon. The Foundation has worked in a variety of health care settings across Africa and in partnerships with local governments, local colleges of ophthalmology, other INGOs and at regional level with International Agency for the Prevention of Blindness (IAPB).

Ophthalmic items procurement and equipment management situation in Africa (Relevant evidence and rationale for the study/evaluation)

In resource limited settings, lack of proper management of medical items limited the capacity of health institutions to deliver adequate health care. In such settings, it is common to see critical ophthalmic items are either not available at all or not consistently available from the local market, very protracted importation processes, purchasing devices with bids and preference for cheap price against quality, lack of training on how to operate devices, less sense of accountability, staff work overload and lack of installation, repair and maintenance experts, and inappropriate referral system. This has created huge problems to sustainably provide quality eye care due to disruption of services to the public in a sustainable manner.

Health systems throughout the world and particularly in developing countries are struggling with the challenge of how to manage health-care delivery in relation with resource constraints. The availability and utilization of various eye care instruments, equipment, consumables, and supplies at all levels of the health care system has been emphasized for effective and efficient service delivery. Different studies have shown that the top two bottle necks for equitable, accessible and quality eye care delivery in developing nations like Ethiopia, Kenya, Rwanda and the others are HReH (in terms of low number of all ophthalmic cadres compared to the population, inequitable distribution, lack of incentives, low productivity and the like) and inadequate ophthalmic items provision and maintenance (ophthalmic and ophthalmic related equipment, instrument, consumables and supplies).

The challenge of effective ophthalmic equipment management are a lack of comprehensive equipment management resources and systems and standardised maintenance policies both at partner level and across The Foundation. The challenges related with this includes non-standardized equipment procurement by partner institutions, inadequate number and quality of equipment and instruments for the service associated with low functionality.

The MOH of Ethiopia document, for instance, revealed that only 72% of medical equipment found in Addis Ababa public hospitals and a third in rural hospitals are functional and in some regional hospitals functional equipment are near to 50%. It is also known that the rising number of the non-functional equipment are due to poor equipment handling and utilization, frequent power surges, the age of the equipment, lack of operator training, lack of preventive maintenance, lack of spare parts, lack of maintenance capacity, and minimal knowledge regarding sophisticated equipment. Hence, as healthcare delivery continues to expand and improve in developing countries and an increasing number of state-of- the-art medical equipment is introduced, a system which can support and manage this medical technology must be in place.

The Proposed Study Purpose

The Foundation is currently planning to explore and identify the challenges across the current practices of medical/ophthalmic items procurement and medical equipment management and maintenance through engaging an experienced consultant or a group of consultants.

The overall purpose of this consultancy service is to understand and analyse the challenges on the supply chain management, procurement processes and maintenance of ophthalmic and ophthalmic related items functions in the various partner institutions in the FHF supported countries in Africa. We anticipate that this assessment will come up with identification of major gaps and challenges in relation to availing adequate and diverse ophthalmic items, ophthalmic equipment management and maintenance and more importantly, propose a doable and practical solutions and generate evidence to advocate for policy change

Setting

This project will generally assess the ophthalmic items procurement practises and equipment maintenance management systems and policies across The Foundation, with a specific focus on those currently utilised by The Foundation in support of its African partners, given the contextual nuances and challenges facing the region. Major focus will be given to the most challenged African countries The Foundation supports which includes Ethiopia, Eritrea, Kenya, Rwanda, Burundi, Uganda and Tanzania, nevertheless, if the consultants found it necessary, they can focus on selected key clinical service providing partners in Ethiopia and Kenya.

Specific objectives

National ophthalmic equipment and supply challenges and opportunities in Africa

• Generate evidence on the main challenges associated with ophthalmic equipment availability, supply chain, standardization, training, utilization, maintenance, and overall management.
• Identify opportunities to address challenges and recommendations for the role FHF might play

FHF procurement practices, guidelines and processes

• Review current FHF procurement practices, guidelines and processes and the support given by the foundation and medical team in relation to medical equipment purchases, storage utilization and maintenance across different African countries.
• Identify recommendations to address gaps and areas for improvement. This should include but not be limited to:

1. How the foundation could develop its own essential equipment, instrument and supplies lists or adopt global standards.
2. How the foundation can support countries in which critical ophthalmic items are lacking from local market and how it should be sought from overseas market.
3. How the medical team can be engaged and support for improvement of ophthalmic and ophthalmic related items procurement, supply chain and equipment maintenance and management system.
4. whether central procurement is beneficial/or not compared with outsourcing or partnering with others for medical equipment purchases and management (where it makes business sense);
5. How FHF can leverage economies of scales for negotiating better terms and pricing; and
6. How FHF can establish preferred suppliers for the management and maintenance of its existing equipment.

Approaches/ methodologies

The assessment is expected to be carried out based on primary and secondary data collections. The detailed study methodology, approaches and a well-designed survey format are expected from the consultant/s, nevertheless, the below are suggested to be part of the approaches.

To generate evidence and recommendations relating to national ophthalmic equipment and supply challenges and opportunities in Africa:

Site visits and stakeholder interviews – Primary data collection could include focused physical visits of eye health institutions and KII from representatives of the following stakeholders: discussions with the foundation’s relevant program and project managers, procurement specialists and logistics and other relevant people from the various African country offices of the foundation. Relevant government institutions who play a key role on supply chain and equipment maintenance. The primary data collection may include approaching government stakeholders (MoH), pharmaceutical companies and other entities supporting importation and distribution of medical items in selected countries. Interviewing ophthalmological and optometrist societies may add value in some countries. Assuming that there aren’t many ophthalmic item suppliers of repute, some of them could be contacted to get their input about where their products are marketed and the challenges they face in supplying and maintaining them, this should consider ground realities and current and potential suppliers given an indication as to how they could expand their reach.

Review of equipment policy, strategy and plans at the national, subnational and facility level, in relation with ophthalmic items procurements and equipment maintenance.

To review and generate recommendations relating to FHF procurement practices, guidelines and processes:

• Focus group discussions and/or surveys – Relevant stakeholders’ analysis with procurement and equipment maintenance including FHF- global office, and country offices. The focus could be understanding what is known by stakeholders about FHF positions, policies and processes, user experience of these guidelines and processes, stakeholder support needs and suggestions for improvement.
• Guidelines, position statements, policy and process review – examining FHF’s documented guidance relating to procurement to determine what is captured and where the gaps exist.
• Interviews and development of several detailed case studies – As part of collecting primary data, consider including one or two case stories from two African country offices: The stories may combine one successful procurement and equipment maintenance story and the other one a story which shows the various aspects of the challenges. The stories will be developed through closely exploring the procurement processes, questionaries to identify functionality and non- functionality proportion status. Investigate if there is any service available for supporting equipment and instrument maintenance and end users training through either biomedical engineers or technicians.
• Interviewing staff of peer organisation to understand their practices, guidelines and processes Compare and contrast the procurement processes of like-minded organizations (International eye care organizations like CBM, Orbis, HCP, LFTW and others) and other major health INGOs. This should be followed by analysis of their practises against what the foundation is currently doing to identify strengths and gaps and develop recommendations referencing best practices aiming for key process improvements.

Audience for the findings

• Audience of the findings will be FHF business ops division, medical team, program division, procurement and operations divisions, relevant people at the respective country offices. Some of the results can also be shared to partner government institutions as it is found appropriate.

Deliverables

1. Workplan. The consultant/s are initially expected to come up with detail work plan including methodology, a well-designed survey format, detail work assignment of the team, schedule and detailed budget.
2. Key assessment result: Key results of partner assessment on major challenges, gaps and opportunities on areas of ophthalmic and ophthalmic related items procurement, supply chain and equipment management system.
3. Recommended solutions: Indicate best method/s of procurement/ supply chain management plan, provide a detailed analysis of advantages and disadvantage of central vs local procurement, compare also outsourcing vs hiring expert at country or cluster level or partnering with other entities that do have the expertise on procurement and equipment maintenance system. Recommendations also on the support need to be rendered to country offices and partner institutions by the foundation in general and by the medical team in particular to alleviate the current challenges.

Presentation of the draft results and recommendations through a power point to the procurement steering committee prior to submitting the final report. The content of this presentation should include methods used, key results, analysis of results, major conclusions, and key recommendations. The consultants/s are expected to facilitate the discussion with FHF representatives to take up feedback and comments and incorporate it in the final paper.

Final report presenting the results of all data collection and analysis activities, and recommendations. Note: The consultants are expected to regularly engage with the procurement steering committee throughout the project.

Timeline

• The assessment should be carried out over 180 Calander days period. Finalization of TOR, advertisement, selection of consultants and contractual agreement may take about 30 days. Carrying out the consultancy service should be carried out in 150 Calander days. Nevertheless, the timing of the consultancy service can be extended upon a mutual consent. The final report is expected to be completed before end of August 31, 2024.
• Below is the detailed schedule and activity.

Activity Time Frame

1.

• Finalize TOR and advertisement. 30 days
• Submission of technical and financial proposal.
• Interview with shortlisted candidates.
• Sign contract with the selected consultant/s

2 30 days

• Inception report development
• Feedback on Inception report
• Collect feedback

3

• Recruitment and trainings of data collectors 90 days
• Data Collection
• Analysis and develop first draft
• Submit first draft 10 days

4

Facilitate a virtual meeting between consultant/s and FHF to 10 days

review first draft of the result and get feedback

5

Submission of final paper 10 days

Before August 31, 2024

1.REVIEW TEAM & QUALIFICATIONS

The Foundation seeks to engage the services of an independent registered organisation, consultant/s, who have the following experiences and expertise.

Qualifications

The consultant or team lead must:

• Be registered as a business.
• Hold a university degree or equivalent in procurement, supply chain and biomedical engineering or related field.

Experience

• Minimum 10 years of experience in bulk procurement, supply chain management
• Extensive experience in comprehensive equipment management system including maintenance.
• Demonstrated experience working in low- and middle-income country settings.
• Demonstrated experienced working with various health INGOs.
• Demonstrated experience working directed with health facilities to develop policies, processes, SOPs on procurement and biomedical equipment management.

Skills

• Situational analysis, baseline assessment and evaluation design
• Quantitative and qualitative analysis of documents
• Interviewing for baseline assessments and evaluation projects
• Excellent written and English skills required or excellent analytical, writing and presentation skills.
• Strong interpersonal and communication skills.

2. APPLICATION PROCEDURES

Interested applicants are requested to submit the technical and financial proposal by 15th March 2024. The following documents should be submitted via email to the assigned contact person.

1. A Cover Letter, signed by a duly authorized representative of the Applicant’s organization, mentioning the total bid amount.
2. A Technical Proposal
3. A Financial Proposal
4. Profile and track record of organization and team Short-listed applications will be contacted for interview.

3. CONFIDENTIALITY

The evaluator/s agrees to not divulge confidential information to any person for any reason during or after completion of this contract with The Foundation. Upon completion or termination of this contract, the evaluator/s undertake to return to The Foundation any materials, files or property in their possession that relate to the business affairs of The Foundation.

4. INTELLECTUAL PROPERTY

All intellectual property and/or copyright material produced by the evaluator/s whilst under contract to The Foundation remain the property of The Foundation and will not be shared with third parties without the express permission of The Foundation. The evaluator/s are required to surrender any copyright material created during the term of the contract to The Foundation upon completion or termination of the contract.

5. INSURANCE

Any consultants involved in this evaluation will be required to have in place insurance arrangements appropriate to provision of the requirements in this Terms of Reference including travel insurance.

6. OTHER

The evaluator and evaluation team is expected to maintain high professional and ethical standards, and comply with The Foundation’s Research Ethics and Data Management Policy. The Foundation is committed to ensuring a safe environment and culture for all people, including children, with whom we come in contact during the course of our work. All members of the evaluation team will be required to comply with The Foundation’s Safeguarding People Policy, and sign the Safeguarding Code of Conduct.