Tender Description

Terms of Reference (TOR) for Infrastructure works for Damal Cafimad Supported Health Facilities in Nugaal region of Puntland, Somalia

Project Name:  Damal Project

Location of services: Nugaal region (Garowe, Burtinle, Eyl, Dangorayo and Godobjiiraan Districts)

Background and Context Analysis

The “Improving Healthcare Services in Somalia (Damal Caafimaad)” project, led by Population Services International (PSI), with partner CARE, will work closely with the Ministry of Health (MOH), Puntland State of Somalia, local authorities, federal government structures, the World Bank, other Damal Caafimaad partners, the Somalia health and nutrition cluster sector groups, communities, civil society, the public sector, and existing donor-funded projects to improve access, coverage, and quality of essential health and nutrition services and address the leading causes of mortality and morbidity in the Nugaal region. The Team is poised to deliver results, with local and global experience in health system strengthening and integrated service delivery; a footprint at regional, district, and community levels; deep relationships with government; and proven capabilities in grant and contract management.

Building on the achievements and experiences of Somalia’s previous and ongoing essential package of health services (EPHS) efforts, the Team will implement an MOH-led program centered around system strengthening and resilience building, working with stakeholders to alleviate barriers through innovative approaches that strengthen health system capacity and expand access and continuity of EPHS services. All project activities are underpinned by a nested approach to person-centered care and health systems strengthening, built on the principles of quality of care (QoC), equity, and resource optimization.

About the Project

Compared to other regions of Somalia, the Nugaal health system is relatively strong, with well-structured and defined levels, each offering a range of services. However, due to recurring humanitarian crises and many internally displaced persons (IDPs) in the region, most resources are diverted towards emergency-oriented and humanitarian activities. Funding continues to constrain the reach and resilience of the health system, with only 41% of people being reached with any component of the EPHS. Further investment is needed across all health system levels to fill gaps in human resources and training and to close disparities in access between urban and rural areas. Moreover, local authorities need more support to meet EPHS standards for quality assurance, supply chain management, emergency preparedness, and data management and use.

For the people of Nugaal, cost and distance are major barriers to access. 72% of women in Nugaal face at least one problem accessing health care; the majority (63%) perceive lack of money as a barrier, 58% cite the distance to the facility as a challenge, while 42% mention not wanting to go alone as a deterrent[1]. Access to EPHS is further obstructed by behavioral barriers. For example, community attitudes and beliefs, lack of health information, male dominance in decision-making, and distrust of modern health practices (e.g., immunization, family planning) limit the reach of EPHS. Improving equitable access to service, quality of services, and increasing health-seeking behaviors requires innovative solutions to both structural and behavioral barriers.

Past EPHS programs made strides in closing these gaps and our Team builds on the successes and lessons of previous investments to offer an approach that is truly responsive and tailored to the health system’s needs. We will introduce a more horizontal, integrated, and MOH-led program, which will include embedded subnational capacity, multi-method capacity building activities, and work with government, communities, civil society, the public sector, and existing donor-funded projects in a “whole of society” approach to system strengthening and resilience building. Recognizing that resources are finite and prioritization is implicit in this effort, we will prioritize solutions likely to have the greatest impact on major health problems, solutions that are cost-effective in addressing problems faced by the majority of the population in Nugaal, and solutions that can be scaled and support quality access for nomadic, rural, and urban populations.

Project objectives

Infrastructure and Maintenance of Health Facilities (D4). The Team will improve both physical facility infrastructure and use of existing space. The Team will follow the WHO SARA assessment tool already in use by MOH to address gaps/build on planned infrastructure improvements and medical equipment maintenance and supplies. The Team will also use the DHIS2-based HNQIS Integrated Supportive Supervision checklist to support MOH in assessing health facility infrastructure more routinely through supportive supervision (checklist will be updated with MOH to include climate smart questions). The Team will prioritize improvements in electricity, water, sanitation (including separate male/female toilets), private areas for the provision of GBV services, and basic disability access such as rails and ramps, perimeter wall fencing, and ensuring waiting areas are adequately shaded. The Team will manage facility maintenance and repair and all physical assets under a comprehensive Health Facility Maintenance Plan. As a secondary priority, the Team will explore lower-cost, high-impact interventions to increase provider motivation and retention, such as dedicated break areas for health-care workers. PSI’s human centered design (HCD) process will help identify such solutions. The Team will link closely with third-party monitoring (TPM) quality measurement exercises, and the National Health Professional Council to ensure quality and will explore introducing a ‘quality badge’ to promote quality accountability.

In relation to the proposed project activities, CARE expects high-quality work from the successful vendor/s in all infrastructure sites under this intervention in the realization of value for money. CARE WASH engineers will provide the required BOQs and designs that are specific to each Health facilities, PHUs, Hospitals, Latrines, solar systems, incinerators, disability ramps and water connection systems based on the priority needs of the successful vendor/s. Some of the key Construction/rehabilitation activities under this project will include:

• Construction/rehabilitation of Health facilities, PHUs and General hospitals.
• Repair/replacement of the water reticulation piping networks
• Provision of Solarization system
• Construction/repair of the water storage facilities.
• Construction/repair of Latrines
• Construction of waste management system/incinerators and placenta pits.  
• Construction/repair of disability ramps

To ensure the quality of work and adherence to the BOQs and designs, CARE WASH engineers will be supervising the infrastructure works during the implementation period and will issue a certificate of completion confirming the successful completion of the construction/rehabilitation and quality of work by the vendor/s.

Below are the details of the proposed infrastructure works for the Health facilities of the Nugaal region.

Skills Required

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