Sl.No

Page No.

Clause No.

Heading

Tender requirements

Bidder's request (M/s.Piramal

Swasthya)

Bidder's request (M/s.Dhanush

Infotech Pvt Ltd)

Bidder's request (M/s. Quality

Healthcare Access Pvt Ltd )

Bidder's request

(M/s.IQVIA)

Bidder's request (M/s.Cerner Health Care)

Bidder's request (M/s. Ekam Foundation)

Can be read as

1 8 SECTION - V

Objectives

• 3% reduction in preventable neonatal mortality per quart• 3% reduction in preventable maternal mortality per quarter

Please clarify the reduction target aimed is facility based Maternal and Neonatal mortality or Overall state wide Maternal and Neonatal mortality?

In a state with near 100% institutional delivery, and even otherwise facility based reduction would result in overall reduction. The scope of work expected includes - intervention which is facility based and informing government with specific community based action that can result overall mortality. The payment and measure of outcome in mortality shall be facility based.

Andhra Pradesh Medical Services & Infrastructure Development Corporation, plot no 9, survey no 49, IT Park, Mangalagiri, Guntur District 522503 Email: aphmhidc@gmail.com

****Partnership proposal for Maternal & Neonatal Mortality Reduction (2018-2022)

Amendment No.3 dt:06.08.2018 to Tender Enquiry No. 6.1/APMSIDC/Equipment /2018-19, Dated: 27.06.2018

Clarifications requested by the bidders during prebid meeting on 12.07.2018

2 8 SECTION - V

Broad Scope of Work

Facilities Covered-SNCUs, NBSUs and Labour Rooms

Are Operation Theatres (OT) and NBCCs in OTs included in the scope ? As these are not mentioned in the list of facilities covered.

OTs & NBCCs are included in the list of facilities covered.

3 9 SECTION - V

Executive Summary

• 50% reduction in preventable neonatal mortality in the SNCUs over a 5 year period• 50% reduction in preventable maternal mortality in selected facilities over a 5 year period

Is the 50% reduction considered to each SNCU/Facility or on average for all SNCS/Facilities?

Overall 50% reduction in facility based preventable deaths in least possible time frame. However outcomes shall be measured as 3% quarterly decline.

4 9 SECTION - V

1. Executive Summary

practices in 39 district and Area hospitals. The intervention also focuses on improving adherence to protocols in 26 SNCUs across the state.

What are the selected 39 District and Area Hospitals of the Intervention? Can the list is available and be it provided?Are these 26 SNCUs from the selected 26 District and Area Hospitals?Service provider need to provide the service in above mentioned facilities or in all labor rooms, NBCCs, SNCU, NBSUs of CHCs, Area Hospital and district hospitals

The list of 39 (DH & AH) is furnished in the tender document.

5 9 SECTION - V

1. Executive Summary

Its is mentioned in the RFP as1. Executive Summary:50% reduction of preventable neonatal mortality in SNCUs & 50% reduction of preventable maternal mortality in selected facilities4.3 AIM:100% reduction of preventable neonatal mortality in SNCUs & 100% reduction of preventable maternal mortality in selected facilities

Is it 50% reduction or 100% reduction? Please clarify?If it is 100% reduction, Then 3% reduction per quarter from third quarter in 5 years is amounting to a total 50% reduction of preventable mortality.

It is 3% reduction per quarter

6 14 4.3 4.3 AIM Objectives of the Proposals

1. Improve quality of care for pregnant women, new-borns, and those with complications delivering in CHCs, Area Hospitals and District Hospitals.

Are all CHCs also to be included in the proposal?In the prior sections it was mentioned that Area Hospitals and District Hospitals ate included in the intervention scope.

All CHCs, Area hospital, District Hospitals, and Teaching Hospitals are included.

7 14 4.3 4.3 AIM Objectives of the Proposals

4. Establish mechanism for follow-up for postnatal care and sick new-borns post discharge

What type of follow up mechanism? Is it facility based or community based? If facility based, what is the level PHC/CHC/AH/DH based?

Community based with follow up in assured nearest referral hospitals..

8 14 4.3 4.3 AIM Objectives of the Proposals

In later phase, private sector will also be involved for appropriate management of common maternal and new-born complications and referral. They will be encouraged to participate in regional referral collaborative.

What is Regional Referral Collaborative? Is it a Teaching College /Tertiary Hospital in a particular district or region? The list will be provided by the Govt or the Bidder has to select?

The collaboration of various units with a specific region/zone/district as may be considered appropriate by the selected bidder.

9 15 4.5.1 4.5.1 Maternal and Perinatal Health

Identify and implement strategies to improve quality of care for mothers with complications, at CHCs, Area hospitals and District hospitals

Are all CHCs also to be included in the proposal?

All CHCs, Area hospital, District Hospitals, MCH wings and Teaching Hospitals are included. PHCs can also be included at a later date on the same cost matrix as approved for the selected bidder.

10 15 4.5.2 4.5.2 Care of Sick and LBW new-borns in SNCUs and NBSUs

Care of Sick and LBW new-borns in SNCUs and NBSUs

Are NBSUs also included in the Scope or proposal?

All NBSUs are included in the proposal.

11 16 4.5.3 4.5.3 State MNH PMMU will be established by the selected Service Provider/Knowledge Partner

A state Maternal and New-born Health (MNH) program management and monitoring unit will be established by the selected Service Provider/Knowledge Partner

Who has to establish the state Maternal and New-born Health (MNH) program management and monitoring unit ? The Implementing Agency or the Knowledge Partner (UNICEF)?

The selected service provider needs to set up which shall coordinate various technical works on behalf of service provider and shall be reponsible as signle point of contact. The sapce for the same shall be provided for by Health Dept. free of cost for the period of contract.

12 17 4.6 4.6 Scope of Work

8. Facilitate development of IT based system supporting the MNH program management unit for decision making

Need further clarity. Facilitating means just giving inputs for the development of IT system or Taking the responsibility to design and deploy the IT System?

Giving inputs.

13 27 SECTION - VII

V. Payment Stages

Payments penalty linked to the ultimate outcomes

3. The payments/invoice shall be outcome based and a 3% average quarterly decline for controllable death shall be required for quarterly payments. However, in case in a particular quarter the decline is less than 3%, 50%(Fifty Percent) payments shall be made, the balance shall be release after achieving the cumulative 6% targets over two

quarters.

*Implementing partner implements strategies approved by UNICEF & AP Govt through the existing government health infrastructure, workforce, logistics and program management systems. So linking payments to implementing partner alone with the ultimate outcome is unreasonable. *And the reduction of outcome trend usually will not be uniform as initial the reduction will be slow, then increase in the middle quarters and in last quarters again it will fall.*Instead the government can link the payments with the implementation metrics involved in the project. We request the government to consider this aspect.

As detailed above

14 14 4.3 4.3 AIM It is mentioned:This proposal focuses on strengthening secondary level care for the mother and new-borns and establishing linkages with tertiary care in next 5 years.And also it is mentioned that:4.3 AIM. The overall aim of the proposal is to accelerate reduction of maternal and new-born deaths in Andhra Pradesh between 2018 and 2022.

As per the RFP the period from 2018-2022 will become 4 years, But it is also mentioned 5 years.So we request Govt to please clarify the tenure of the project?

The contract of selected service provider is for 5 years.

15 34 FINANCIAL BID

FINANCIAL BID

Total financial assistance from external funding agencies being committed by applicant - 25%

We request Govt to relax this clause. Since it is difficult o bring in the financial assistance from external funding agenciesAlso we request govt. not to link the payment with the funding from the external agencies

Payment is not linked to financing from external/donor agencies. Neither it is mandatory to bring such financial support. However, weightage has been provided for such support.

16 33 APPENDIX -E

APPENDIX -E

In page no. 5 it is mentioned that:a) The tender shall be accompanied by Earnest Money Deposit (EMD) as specified in the Notice Inviting Tender (NIT) in online only. It is also mentioned in APPENDIX -EWe are enclosing Receipt No or Bank Draft/Bankers ChequeNo , Dated (amount ) towards tendercost/fee (if documents have been downloaded from website) and paid Rs…….. (Amount ) online

EMD to be paid online in eProcurement website or Bank Draft/Bankers Cheque. Please clarify?

EMD to be paid in online only.

17 27 SECTION - VII

Terms And Conditions

The Program Support cost per quarter spanning 60 months (20 quarters) is required to be quoted by the applicant agency in 'Full amount' GST.

Need clarity on Pricing. In Online portal, commercials are requested for individual items like LR, NBSU, SNCU on monthly basis. Requesting you to please clarify

The finacial bid comprises of 4 parts and they have weightage in calculation.

18 27 1 Other Terms & Conditions:

Selected Partner will make endeavours to procure funding from external donors. HM&FW Dept. shall support such applications and same to be deducted from the funds due from HM&FW dept. to avoid double payments for same work.

Request you to please elaborate

As per comments above

19 General Please clarify us on the detailed Scope of Work at each of the Facility, which is useful for us in costinga. Labour Roomsb. SNCUc. NBSU

Scope and selection of methods are applicant's choice. The proposal is outcome based on results.

20 Commercial Bid

• Cost for Program Support per SNCU per Month• Cost for Program Support per New Born Stabilization Unit per Month• Cost for Program Support per facility with Labour Rooms per Month

What are elements to be included for this cost element, like• Do we need to deploy any manpower?o At SNCUo At PHC/CHC/DHo o At State level• Do we need to install any Hardware equipment?• What kind of Software, we need to deploy at this facility to monitor the Support program at SNCU?• Does this cost include any Training?• Does this include any Support of SW?• Does this cost include any Travel?• Internet cost if any? What is the reporting format?

Quoted costs includes all activities that service provider may deem necessary to achive the target outcomes.

21 General What is the measurement approach? Manual? Through Software? Who will measure the metrics?

HMFW Dept shall measure outcomes.

22 General What is the reporting format?

Shall be developed in consultation with selected service provider

23 General Please confirm on the Project Duration• For 2018 – 2022 or• For a period of 5 years 2018 - 2023

5 years

24 Section 1 & 4.3Page No. 9 & 14

In Section 1 Executive Summary• 50% reduction in preventable neonatal mortality in the SNCUs over a 5 year period• 50% reduction in preventable maternal mortality in selected facilities over a 5 year period

Please confirm IMR/MMR reduction for the next five years is 50 % or 100%

As detailed earlier

25 5 Sect II4. 8

Preparation of Tender

Power of attorney in favour of signatory to tender documents and signatory to Manufacturer’s Authorisation letter.

It may be rephrased as ‘Power of attorney in favor of signatory to tender documents’

Power of attorney in favour of signatory to tender documents

26 5 Sect II4. 11.i

Preparation of Tender

A statement regarding similar services performed by them in last three years and user's certificate regarding satisfactory completion of such jobs as per proforma given in "Appendix -C"

section VII point 5 it is mentioned as minimum five years; which is contradictory.Request to keep minimum experience as three years.

Past experince of 3 years in similar works/projects/technical support to any project is needed. The project needs to be focussed on maternal and infant health.

27 8 Section V.1

SCOPE OF THE WORK/1. OBJECTIVES

3% reduction in preventable neonatal mortality per quarter3% reduction in preventable maternal mortality per quarter

a) Considering diversity of the facilities which the selected bidder will operate, many sub district level facilities (CHC, AH) will have near zero mortality; Hence, facility wise mortality may not be measurable. Can bidder assume that the reduction target is an average of all facilities operated by successful bidder?

Reduction is desired on average basis for the state

28 Section V.1

SCOPE OF THE WORK/1. OBJECTIVES

3% reduction in preventable neonatal mortality per quarter3% reduction in preventable maternal mortality per quarter

b) Can bidder assume that Government will ensure that the necessary infrastructure, equipment, Human Resource and capacity building of the staff is in place as per the available national guidelines (FBNC, labor room guidelines and MNH tool kit, Dakshata etc). If not, then let bidder know the future plan to provide

required resources.

Govt. shall continue to provide support needed for all programs.

29 Sec VII3.vi 1

Selected Partner will make endeavors to procure funding from external donors. HM&FW Dept. shall support such applications and same to be deducted from the funds due from HM&FW dept. to avoid double payments for same work.

a)Can bidder assume that in case the selected partner cannot secure funds from external donor partly or fully, HM&FW dept. will reimburse the payable amount?b)In case external donor fund for any activity out of the core scope (Example: Fund to strengthen technology), will it be adjusted with payable amount?

The dept. shall pay the selected bidder amount as per contract. Only if external funds are received, the same shall be adjusted.

30 Short term measure for even preventable death will be difficult, so initial six months to be allowed as moratorium period for baseline assessment and to settle down processes and operation.

a) 70% of invoice amount should be payable irrespective of decline considering fixed cost of operator and balance 30% may be linked to quarterly 3% decline target.

No change

31 b)We request to reimburse paymentson monthly basis considering major part of expenses are fixed in nature and are mostly manpower cost.

No change

Section VII. 3.vi

Terms & Conditions

The payments/invoice shall be outcome based and a 3% average quarterly decline for controllable death shall be required for quarterly payments. However, in case in a particular quarter the decline is less than 3%, 50%(Fifty Percent) payments shall be made, the balance shall be release after achieving the cumulative 6% targets over two quarters .

32 70% of invoice may be paid through direct transfer within 7 days of submission of bill and 30% after process verification within 30 days.

No change

33 General a) Let bidder know the requirement of minimum count and qualification of manpower to keep all bidders onto common understanding.

It is for the bidder to decide what is needed to achieve the required outcome

34 5 General b) Can bidder assume that there will be a central executive committee to support the operator to trouble shoot?

yes

35 10 General c) Can bidder assume that the target for decline is at facility level or average of all operated facilities?

yes

36 10 General d) Can bidder assume that the base line data will have sign off from operator and facility-in-charge at the start of operation?

Base line data can be taken from the facility incharge.

37 General e) Request authority to allow initial six months as moratorium period to successful bidderfor baseline assessment and as period of stabilization of operations.

3 months period is permitted.

38 General f) Request authority to allow Rs. One Crore as mobilization advance against bank guarantee to support operational cost. The advance can be adjusted in six equal installments from seventh month of operation.

No mobilization advance is provided for

39 General g)Request to allow experience of parent company to consider eligibility condition. Quality Healthcare ACCESS Private Limited, Indian entity, is a 100% subsidiary of ACCESS Health International.

It is permitted to show experience of parent company in the application provided the work has been in the area of maternal and infant/child health

40 General h) The scope includes the integration of various data sources – SNCU online and Maternal related information. This is very critical as it needs to be tracked individual basis. Request government to facilitate with the necessary integration.

Yes

41 General i) GoAP should pass on necessary orders in ensuring the Technology application is being used by the facilities.

yes

42 General j) Please allow a minimum 21 days to bidders to submit the bid from the date of publish of pre-bid query reply.

A minimum of 7 days from the publication of corrigendum shall be given

43 8 1 Scope Of The Work

• 3% reduction in preventable neonatal mortality per quarter, from quarter – 3 onwards after commencement of the contract• 3% reduction in preventable maternal mortality per quarter, from quarter – 3 onwards after commencement of the contract

The objective is to reduce preventable maternal and neonatal deaths by 3% on a quarterly basis –Please confirm the decision making authority who defines whether a maternal or neonatal death was preventable or not

Decision will be taken up by Maternal and Infant LifeLine cell set up by Govt. of AP

44 13 Point 4.2 Clause B page 13 of RFP –

Continue strengthening primary care and community based interventions

1. Improving and standardising essential obstetric and newborn care

in primary care.

Please define the scope of the inclusion of the private sector

Presently limited to Government facilities only.

45 13 Point 4.2 Clause B page 13 of RFP –

2. Strengthening antenatal care – risk reduction, identification and management; and management of antenatal complications

Please define the scope of the inclusion of the private sector

Presently limited to Government facilities only.

46 13 Point 4.2 Clause B page 13 of RFP –

3. Equitable access to health care in tribal regions

Please define the scope of the inclusion of the private sector

Presently limited to Government facilities only.

47 13 Point 4.2 Clause B page 13 of RFP –

4. Community based interventions to reduce burden of adolescent pregnancies

Please define the scope of the inclusion of the private sector

Presently limited to Government facilities only.

48 13 Point 4.2 Clause B page 13 of RFP –

5. Community based follow up of newborn care, including those discharged from SNCUs

Please define the scope of the inclusion of the private sector

Presently limited to Government facilities only.

49 13 Point 4.2 Clause B page 13 of RFP –

6. Inclusion of private sector for increasing accountability for quality of MCH care

Please define the scope of the inclusion of the private sector

Presently limited to Government facilities only.

50 9,14 Executive Summary & Aim

In Page No 9: 1. Executive SummarySpecifically, the project will focus on improving maternal and neonatal outcomes in select high load public health facilities in Andhra Pradesh

• 50% reduction in preventable maternal mortality in selected facilities over a 5 year period • 100% reduction in preventable neonatal mortality in the SNCUs over a 5 year period

Please confirm if the objective is 100% reduction or 50% reduction in maternal and neonatal mortality

There is no clarity on expected - preventable neonatal mortality and preventable maternal mortality reduction percentages for 2018-2022 period

A. 50% reduction in Maternal & Neonatal mortality B. Preventable and non Preventable deaths of both maternal & Neonatal will be decided by the subject experts of HMFW Dept. Govt. of AP

51 16 Scope of work

Capacity building for clinical knowledge and skills for essential obstetric and newborncare with focus on management of common maternal complications in antenatal wards and labour rooms, and newborns in labour rooms

Does the activities have to be conducted across all 155 facilities including capacity building and baseline assessment?

Capacity building and base line assessment is being done under DAKSHATA Programme at present

52 16 4.6 Scope of work

Capacity building for using standard treatment protocols in SNCUs

Does the activities have to be conducted across all 155 facilities including capacity building and baseline assessment?

The proposal is outcome based and the scope of acitivity includes everything which is proposed by service provider and approved by HMFW dept, AP

53 16 4.6 Scope of work

Rapid assessment of labour rooms, and preparing action plans for standardizing the labour rooms of the intervention facilities.

Does the activities have to be conducted across all 155 facilities including capacity building and baseline assessment?

The proposal is outcome based and the scope of acitivity includes everything which is proposed by service provider and approved by HMFW dept, AP

54 16 4.6 Scope of work

7. Conduct periodic audits for assessment of quality of services provided

Does the activities have to be conducted across all 155 facilities including capacity building and baseline assessment?

The proposal is outcome based and the scope of acitivity includes everything which is proposed by service provider and approved by HMFW dept, AP

55 16 4.6 Scope of work

Facilitate development of IT based system supporting the MNH program management unit for decision making

Please define this in terms of scope of activities involved

Facilitation means provision of inputs to government as and when necessary

56 16 4.6 Scope of work

Sensitization of private sector professionals

Please define this in terms of scope of activities involved

The proposal is outcome based and the scope of acitivity includes everything which is proposed by service provider and approved by HMFW dept, AP. Selected service provider is also encouraged to introduce technological innovations/interventions at its own cost, which can be included in the cost of the bid. These innovations can range from Newborn Hypothermia Monitoring Bracelet/bands/ Kangaroo Care Sling and other such innovations for maternal and infant/neo-natal health. Selected service provider is also expected to support government in effective utilization of supplies provided by government such as that constituents of Uterine Balloon Tamponade Kit through adequate training and adoption of innovations.

57 7. Standard operating protocols which are defined will lead to recommendations in terms of manpower, equipment, medicines, etc. If any of these are not available at the facility and leads to mortality in the target patient groups, please confirm that such mortality will not be part of scope of this engagement and agency will not be responsible / penalized for the same

The service provider is responsible for reduction of mortality which includes the work of bringing to the notice of government, all observations needed to be implemented by the government including gaps, if any.

58 27 3 8. Annexure 2 page 27 – point 3 subpoint iii –

The program support cost is mentioned to be quoted per quarter in full amount whereas the financial bid format (page34) asks for the quote facility wise per month

Cost to be quote is required to be quoted on per month basis

59 27 3 Other Terms & Conditions

2. The Information Technology requirement for data analysis and dashboard will be supported by the selected service provider.

2. The Information Technology requirement for data analysis and dashboard will be supported by the selected service provider. – please define this in detail the scope of activities that are expected to be performed

Analytics pertaining to maternal and infant care as may be needed to formulate strategies for reduction in mortality

60 27 3 Other Terms & Conditions

The payments/ invoice shall be outcome based and a 3% average quarterly decline for controllable death shall be required for quarterly payments. However, in case in a particular quarter the decline is less than 3%, 50%(Fifty Percent) payments shall be made, the balance shall be release after achieving the cumulative 6% targets over two quarters .

This clause details out the penalty in case the outcome achievement is <3% for one quarter. However, please let us know whether the target for next quarter will be relaxed if the outcome achievement is > 3% in a quarter.

Cost to be quote is required to be quoted on per month basis

61 5 3 Preparation of tender

Confirmation regarding furnishing Performance Security in case of award of contract.

Please share the prescribed format in which the bidder has to provide the confirmation regarding furnishing of performance security.

The bidder needs to confirm on the letter head that the bidder shall furnish Performance Security in case of award of contract.

62 General 1. What programs and where it has to be implemented to qualify the eligibility criteria for having 3 yrs experience in running a program at national level?

Maternal and/or child care program management/program support experience in any state in India

63 General 2. Is the service provider required set up any labour rooms or recruit any workforce?

No

64 General 3. How are we protected in case the program fails from the government end or by any of the service provider?

Govt. shall continue to provide support needed for all programs.

65 General What is the expenditure commitment quarter by quarter in Govt hospitals during this period towards mother and child hospitals

Govt. shall continue to provide support needed for all programs.

66 General What are the penalties if the consultants don’t achieve reduction

Govt. shall continue to provide support needed for all programs.