Terms of reference for a Hospital Management Coach at

St. Francis Referral Hospital (01.11.2017 to 31.12.2019)

1 Terms and Abbreviation

Abbreviation Definition

AC Award Criteria

DSM Dar Es Salaam

PPO Federal Ordinance of 11 December 1995 on Public Procurement

FDFA Federal Department of Foreign Affairs

SC Suitability Criteria

SDC Swiss Agency for Development and Cooperation

SFH St. Francis Hospital

SFRH St. Francis Referral Hospital

ToR Terms of Reference

2 Purpose of This Document

This document contains the requirements relating to the mandate for project "St. Francis

Referral Hospital: 7F-07720.01." It serves as a template for the bidder to submit an offer.

Contracts are awarded according to the invitation to tender procedure according to Art. 35 of

the PPO.

3 Goal and Content of the Mandate

3.1 Background

St Francis Referral Hospital (SFRH) is located in Ifakara in the southern part of Tanzania.

The hospital is owned by the Diocese of Ifakara (formerly Diocese of Mahenge). The

longstanding Swiss presence in Ifakara on the grounds has resulted in numerous local

institutional partnerships. SFRH with Solidarmed and Swiss Development Agency for

Cooperation (SDC); Ifakara Health Institute (IHI) with Swiss TPH; the former Medical

Assistant Training Centre (MATC), now known as the Tanzania Training Centre for

International Health (TTCIH) with Swiss TPH, Norvatis Foundation with SDC; and the Edgar

Maranta School of Nursing (EMSN) with Solidarmed and SDC. More recently, the University

College of Health and Allied Sciences (SFUCHAS) was created and joined the health related

institutions, completing what is known today as the ‘Ifakara Cluster of hospital services,

academia and research’.

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Currently SDC is carrying out a comprehensive support program with the hospital, including

constructions, Technical Assistance in the provision of quality health care services, hospital

management and administration, provision of medical equipment and strengthening of ICT

system. A credit proposal in support of SFRH was approved on the 3rd April 2012. The

overall goal of the program is to support the hospital in the development of the range of

services which are expected of a regional referral structure, and provide a conducive

environment for training of students and research. The primary beneficiaries are the hospital

staff, the local partner institutions and the inhabitants from Kilombero valley in Morogoro

region and beyond, with a population of approximately 1 million. To-date, approximately half

the planned renovations and new buildings have been completed and partially equipped. A

quality of care improvement program and a partially operational hospital management

information system has been implemented.

3.2. Project Review and Feasibility Study

A mid-term external review was undertaken from January to April 2016. The review findings

revealed strengths and weaknesses in all components. The review, recommended the

undertaking of a feasibility study prior to continuing with further hospital upgrading support.

The Feasibility Study was conducted from November 2016 to February 2017. Among other

key recommendations, the Feasibility Study recommends “the hiring of a Hospital

Management Coach by the owner (Bishop) and work in his name with a clear mandate to

improve the financial situation and, overall planning and management at SFRH”. The Bishop

of Ifakara and the St Francis hospital management both agree with this recommendation and

endorse the recruitment of an external coach as management mentor to the Medical

Director.

3.3. Objective

The Hospital Management Coach will provide advice and mentorship to the medical director

to take all administrative and managerial steps necessary to implement the

recommendations arising out of the feasibility study and the external evaluation. He/She will

strengthen the hospital management’s financial management and business planning

capabilities through mentoring. He/she will develop and support the implementation of a

realistic business plan for the hospital as well as develop a debt management strategy.The

anticipated change management will include, but is not limited to develop financial

management data systems that will allow rational management decisions resulting in

decreases in expenditure, increases in income and stabilization of the current debt situation.

The fostering of setting up of an internal audit function is also part of the change

management process. The Coach will provide data driven support towards the negotiation of

service agreements between the Diocese and the Government of Tanzania’s PORALG

(President’s Office-Regional Administration and Local Government). Finally, he/she will

assist in the review of existing human resource, their profiles and capabilities; supporting HR

alignment by the medical director are considerd part of the change management process.

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3.4. Tasks and Deliverables

Under the direct supervision of the Medical Director, and in collaboration with the SFRH

management Committee (SFRH, SDC, Project Coordinator), the Coach will develop an

action plan to implement the objective of the mandate. In particular with regards to increasing

income, the Coach shall collect cost and profit centre ‘data’ from all units and services;

establish which services are generating income and propose ways to increase their patient

load; explore possibilities to generate additional income e.g. from NHIF, CHF and private

insurances; examine potential for training or research at SFH to be turned into a business

model.

3.4.1. Specific Tasks and Responsibilities

Financial Management and Business Model Establishment

a) Negotiate and establish a realistic and transparent debt relief (payment) plan with

creditors, so that all debts are rescheduled and settled; as part of that, a negotiated level of

debt relief by all creditors, also with Government of Tanzania, should be determined.

b) Create a cost/profit centre management approach for the hospital so that it starts looking

at all existing and potential specialised hospital services with a view to sustainability, with

adequate internal controlling mechanisms. Instill a culture and practice of data driven

management decisions regarding the operational running of the hospital e.g. cost / revenue

linked to specialised services, intensity of offering specialised services (daily, monthly, pop-

up clinics).

c) Create systems, preferrably electronic using the Government of Tanzania Hospital

Management Information System (GOT-HOMIS), that ensures reliable patient data linked to

cost and income for services provided. This should also result in expansion of cashless

hospital administration. Patient relevant data will allow the quantification of the financial

implications of exemptions, insurance reimbursements, adequacy of cost recovery through

CHF, NHIF, other health insurances, adequacy of service agreements with GOT for the

delivery of designated district hospital or specialised regional services. Furthermore, data on

ability and willingness to pay by the various user populations will be assembled.

d) Develop and facilitate the implementation of a cost recovering business plan for the St

Francis Designated (Town Council) District Hospital services with the following specific

aspects:

Coordinate service provision with Kibaoni Health Centre which also offers many

District Hospital (Kilombero District) services close-by.

Identify and improve the most needed and appreciated health services (basic or

specialised) having a big impact on care and/or income.

The standardization of the care logistics of these crucial services so as to improve the

quality of services and become more efficient (lowering costs), making services

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attractive again to patients and thereby make them more willing to come and to pay

for these as needed.

Collect data on patients served (see point c. above).

Re-negotiate level of user fees and cost sharing with DMO and Councils to allow the

transparent engagement through new Service Agreements with Town, Council and

Regional levels.

e) As to specialist services, develop specific business cases for the current ‘integrated’

specialist services. The “integrated” refers to a medical doctor with recognized clinical

specialisation who is providing specialised services when required. These “integrated”

service do not warrant the establishment of fully fledged “specialised” departments; negotiate

with the RAS and RMO from Morogoro on which ‘integrated’ specialist services SFH will

provide, how much the RAS will contribute (e.g. per patients treated/service provided), and

how much can be charged to patients etc. Assist SFH Management to negotiate and sign a

Service Agreement with RAS. If need and sustainability indicate that full-time specialist

services aren’t possible, explore shared specialists on specific days when these services

could be made available.

Human Resource Management: Optimizing Management and Efficiency

f) Apart from financial management duties, the Coach will also support change with regard

to Human Resource performance management in order to optimize efficiency and foster

ethical behavior of staff.

g) The coach will mentor the Medical Director and SFRH management Committee in the

need’s assessment for specialized staff once specialized departments have been shown to

be cost effective.

h) The Coach will support the identification of an appropriate recruitment strategy

(government payroll, directly employed, subcontracted) for the different services will need to

be established.

3.5. The duty station

The duty station of the position is Ifakara town in Morogoro region (latitude: -8° 07' 59.99" S;

longitude: 36° 40' 59.99" E). The duty station is a small urban location of 50’000 inhabitants.

Ifakara is situated in the Kilombero river seasonal floodplain, surrounded by large rural

communities engaged in cash crop and subsistence agriculture. Ifakara is approximately

600km west of Dar Es Salaam. Overland travel from/to Dar Es Salaam requires

approximately 10 hours car travel. Modern communication technologies and ATM banking

are available.

3.6. The mandate

This mandate contains three distinct levels of effort:

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Full Time up from November 2017 to May 2018

Two weeks every 6 weeks June to December 2018

Two weeks every 3 months January to December 2019

For the purpose of comparability, costs budgeted for the period between1st Nov to 31st May

2018 shall be indicated in the column referring to Year 1, the ones calculated for 1st June-

31st Dec 2018 under Year 2, and assignment consolidation costs for 2019 under Year 3.

Therefore, the volume of work is estimated to be 11 person-months. Contractors may not

charge more than for 8 hours in one day (160 hours = 1 person-month) as indicated in the

table below:

Year 1 (1

st Nov 2017 - 31

st May 2018)

Year 2 (1

stJune - 31

st Dec 2018)

Year 3 (1

st Jan - 31

stDec 2019)

Working

Days 140 days 40 days 40 days

Cost

The contracting authority reserves the right to use the services listed under options in full,

partially or not at all.

3.7. The profile

The Coach is appointed by the Bishop of Ifakara for an initial period of 2 years and two

months from Nov. 2017 to Dec. 2019.

The Coach reports directly to the Bishop appointed Hospital Management Committee with

second level supervisor being the Bishop of Ifakara.

The Coach advises and supports change management by the Medical Director when

implementing the recommendations of the feasibility study and those of the external

evaluation.

Qualifications:

University Degree, Master Degree preferable (in hospital administration, business

administration, health care management) or equivalent.

Experience:

Ten or more years of experience in hospital or large project management

Five or more years of experience in a senior health care management position.

Proven track record of people management and documented leadership skills

Three or more years working in non-profit health care, ideally in Tanzania

Proven skills and track-record in efficient hospital administration and in costing of health

care

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Proven track-record indicating that he/she has considerably improved the hospital or

department in which he/she was responsible, in terms of cost-effectiveness and quality of

services.

Working experience in Tanzania an advantage

Skills:

People management

Analytical, conceptual and strategic thinking

Motivate teams to achieve targets and to achieve organizational change

Negotiation, influencing and conflict management

Multi-cultural communication

Team player

Full fluency (written, oral, comprehension) in English required

3.8. Reporting Requirement

Monthly hospital management committee minutes will serve as monthly progress reports.

Annual analytical progress report. This report will be part of the consolidated annual

report of the SFRH project produced by the Project Coordinator.

A final report (font size 11, Arial, max. 30 pages including annexes) will include an

abstract/executive summary and a main report informing the key findings: achievements,

challenges and possible solutions, lessons learned and recommendations.

3.9. Accountability and Administrative Arrangements

The mandate will be financially supported by the Embassy of Switzerland through its Agency for Development and Cooperation - SDC.

3.10. Timelines for the Application (all deadlines are 23:59 East African Time (GMT+3))

The following are the critical time lines for the application of this mandate; it is the planned schedule at the time of the publication of the invitation for bids. The issuing authority reserves the right to make amendments.

Deadline Activity

15 August 2017 Publication of the mandate on: www.eda.admin.ch and invitations sent out to minimum 3 potential bidders

31 August 2017 Deadline for submission of questions by email

30 September 2017 Deadline for submission of offers

13 October 2017 Evaluation of offers

20 October 2017 Negotiations

23 October 2017 Awarding of mandate and notice to unsuccessful bidders

31 October 2017 Signing of the contract

1 November 2017 Mandate begins

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4. Formal Aspects of the Tender

4.2. Contracting Authority

The Embassy of Switzerland through its Agency for Development and Cooperation (SDC) - Tanzania manages the award procedure and is also the direct mandating party for the bidder. Physical and Postal Address: 79, Kindondoni Road, P. O. Box 2454, Dar es Salaam, Tanzania.

4.3. Type of Procedure

Procurement in the invitation to tender is in accordance with the Federal Ordinance of 11

December 1995 on Public Procurement, PPO, SR 172.056.11.

The award of contract cannot be contested.

Composition and Content of the Offer

Please respect the following structure for your offer and requested documents, which is

compulsory.

Chapter Description No.

pages

max

SC/ AC1

00 Cover letter with signature(s) 2 --

01 Form «Bidder Information» -- SC 1

02 Self-declaration supplier «Compliance with working

conditions»

-- SC 2

03 Acceptance GCB -- SC 3

04 Acceptance Electronic Bill -- SC 4

05 Legal documents -- SC 5

06 Bidder’s availability and ability to carry out the mandate -- SC 6

07 Qualification:

Self-declaration of bidder’s completion of University Degree --

SC 7

08 Experience

Name of company and address of contact person(s) and telephone numbers

Volume of the executed mandate

Description of the provided services

3 SC 8

09 Language Skills -- SC 9

1 Reference to Suitability Criterion (SC) or Award Criterion (AC)

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Chapter Description No.

pages

max

SC/ AC1

10 Approach -- AC 1

11 Experience -- AC 2

12 Financial Offer according to the budget form in annexes iv

and v (type B and for Local Mandate respectively)

-- AC 3

4.4. Budget

The offer must be established in USD. Please refer to the annexed budget template

published by the Swiss Federal Department of Foreign Affairs (for local and international

applicants respectively). It should be used as a reference in preparing the financial proposal.

No reimbursement can be made for the bidder's work in preparing and submitting his or her

offer.

Terms of Remuneration

Payment of invoices will be made on the basis of the acceptance, by the SFRH Review

Committee and the Client, of expected deliverables. Deliverables that generate payments are

identified above in section 3.4, subheading “Tasks and Deliverables” (page 2).

Fee rates

Please refer to footnote 1 for general guidance on budgeting.

Please note that all fee rates must cover:

Consultant’s overheads, profit and backstopping facilities such as general

administration and administration related to the services (management, personnel

administration, secretarial services, other support, etc.).

Accommodation and insurance.

International travel costs

Any additional personnel emoluments

Internal quality management and assurance,

Marketing (promotion, tendering, negotiations etc.),

HRD and business development.

Contractors may not charge more than for 8 hours in one day (160 hours = 1 person-month),

as indicated in section 3.6 above.

Local travel within Tanzania

Travel costs for mission to be undertaken by staff as part of the assignment away from the

base of operation in the country of the assignment. Such travel expenses may comprise:

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Travels by air/ground by the most appropriate means of transport and the most direct,

practicable route, and shall be on what corresponds to economy class using existing

discount schemes.

4.5. Contractual Terms

The contract to be concluded is subject to the general terms and conditions for mandate type

A and B (see Contract documents of the FDFA2). The general terms and conditions are

considered to be accepted when an offer is submitted. No subcontracting is allowed.

5. Suitability Criteria

The bidder can verify his or her ability to fulfil the mandate in technical and financial terms

and shall confirm this with a self-declaration.

No. Suitability criterion Verification

SC1 Information of bidder

The bidder has to fill in the bidder information.

Written

confirmation,

signed by the

bidder according

to annex i

SC2 Self-declaration supplier «Compliance with working

conditions»

Legal signature

on the self-

declaration

(annex ii Form

Declaration

working

conditions)

SC3 Acceptance GCB

The bidder shall explicitly confirm, without limitation or

modification, the acceptance of the FDFA’s General

Conditions of Business (GCB) as per annex iii of the

present tender document.

Written

confirmation

SC4 Acceptance electronic bill

Contractors are obliged to submit an electronic bill to the

FDFA if the contract value is above CHF 5’000 (excl. VAT),

except for local Contractors of the FDFA representations

abroad. Information on the electronic billing system is

available under the following link: www.e-

rechnung.admin.ch. The bidder shall confirm that he/she is willing to submit an

electronic bill to the FDFA.

Written

confirmation

2 https://www.eda.admin.ch/deza/en/home/partnerships-mandates/mandates-

contributions/information-downloads/contract-documents-fdfa.html

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SC5 Legal Status The bidder confirms to fulfill the legal requirements

according to his status.

Evidence

according the

legal status.

Legal persons and institutions Excerpt from the

commercial

register. Bidders

from abroad are

required to

present

comparable

current foreign

official

certificates (copy

of original; not

older than 3

months)

Natural persons

For Self-employed persons (*see information below)

This criterion is only to be met by self-employed persons,

whereby they submit valid proof (not older than two years)

of professional independence in accordance with 'AHV'

law.

Proof (not older

than two years)

provided by the

responsible

social insurance

authority at which

the

company/person

is registered

For Employed persons

Bidders who do not qualify as self-employed in accordance

with 'AHV' law and non-legal persons (AG, GmbH, etc.) are

considered as employed persons for whom the FDFA, as

contracting authority, must pay the statutory social

insurance contributions.

Declaration of

agreement that

all social

insurance

contributions are

to be paid by the

contracting

authority.

Indication of

'AHV' number

and date of birth.

Foreign nationals

who do not have

a 'AHV' number

only indicate their

date of birth.

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SC6 Self-declaration of bidder on availability and ability to carry

out our mandate for full duration from 1ST Nov 2017 to 31st

Dec 2019, as well as on the availability of resident and

work permit at the time of signing the contract

Application letter

SC7 Self-declaration of bidder’s completion of University degree

(master degree is preferable) in Hospital Administration,

Business Administration, Health Care Management or

equivalent.

Application letter

and Graduate

Certificate

SC8 Experience:

Self-declared experience with similar mandates, in Africa,

with contact details of five referees related to similar

projects undertaken in past.

Ten or more years’ experience in hospital management

Five or more years of experience in a senior health

care management position.

Three or more years working in the sector of non-profit

health care in Tanzania

Written proof of

the references

giving at least the

following data:

Name of company and address of contact person(s), telephone numbers and email contacts;

Time and place of execution of the mandate;

Volume of the executed mandate;

Description of the provided services;

The contracting

authority

reserves the right

to contact the

contact persons

indicated.

SC9 Language skills

The bidder engages to deploy only personnel able to

fluently communicate in English both orally and in writing

and are able to compile and supply the project results and

documentation in English. Ideally he/she has Swahili skills

fully supportive of daily work.

Written

confirmation with

clearly

understandable

documentation

about the

language skills of

the key persons.

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6. Award Criteria

Of the valid offers submitted, the contract will be awarded to the economically most favorable

bid. Proposals shall be evaluated using the principle of Quality and Cost Based Selection

with a weight of 80% given to the technical proposal and a weight of 20% to the financial

proposal. Offers will be assessed according to the following award criteria and weighting:

i) Technical Proposal Analysis

AC Key Staff Sub weighting Total weight

Technical proposal 80%

AC1 Approach 40%

AC 1.1 Demonstrated clear approach on

how to implement the mandate

50%

AC 1.2 Analytical, conceptual and strategic

thinking

25%

AC 1.3 People management and

motivate teams to achieve

targets and to achieve

organizational change

25%

AC2 Experience 40%

AC 2.1 Proven skills and track-record in

efficient hospital administration,

people management and

documented leadership skills

50%

AC 2.2 Proven track-record indicating that

he/she has considerably improved

the hospital or department in which

he/she was responsible, in terms of

cost-effectiveness and quality of

services.

50%

AC 3 Financial offer - Overall price 20 %

AC 3.1 The overall price is to be submitted

in USD only together with the

budget form as per Annexes 4.1

and 4.2. of the tender document

(budget form type A and B)

The overall amount (excl. VAT)

across the mandate will be

estimated using the following

formula:

Score= (Pmin×max.Points

P)

100%

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P = price of bid being assessed

P min = price of cheapest bid

max. Points = 5

Total 100 %

Each award criterion will be evaluated according to the following score table:

score Fulfilment and quality of the criteria

0 Cannot be established Information has no significance.

1 Very bad fulfilment Information is incomplete

Data quality is very poor

2 Bad fulfilment Information relates inadequately to the

requirements

Data quality is poor

3 Average fulfilment Information globally responds

inadequately to the requirements

Data quality is adequate

4 Good fulfilment Information focuses well on requirements

Data quality is good

5 Very good fulfilment Information clearly relates to the achievement

of outputs

Data quality is excellent

Total Score Determination

The total score of the Proposal shall be determined be weighting and adding the technical

and financial scores.

7. Additional points to be noted by the bidder

7.1. Address for Submission of Offers

E-mail Address: grace-patrick.qorro@eda.admin.ch with cc to

thomas.teuscher@eda.admin.ch

7.2. Language of documents, language of bids

The bid must be submitted in English. The documents are available in English.

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7.3. Answering Questions

Questions concerning the awarding of the mandate in question can be sent by 31 August

2017 (23:59 East African Time (GMT+3)) to the contact person named under point 7.1.

Please send in questions in writing by e-mail. The answers will be made available within 24

hours and will be made available to all known bidders.

7.4. Deadline for Submitting a Bid and Validity

The bid must be sent by email to the contact person named under point 7.1 by

30 September 2017 (23:59 East African Time (GMT+3)) at the latest with the following

note: Offer 7F-07720.01. The bid is valid for up to 90 days after the aforementioned date for

submission. Please submit the financial proposal in US$.

7.5. Negotiations

Remain reserved.

7.6. Confidentiality

All information of any kind that comes to the attention of the bidder in connection with the

tendered mandate of the awarding authority is to be treated as confidential. The content of

the present tender may only be made available to persons taking part in the preparation of

the bid.

The tender documentation may not be used for any other purposes than preparation of the

bid, even in extracts.

Bidders treat facts as confidential that are not public knowledge or publicly available. In

cases of doubt, facts are to be treated as confidential. This obligation to secrecy remains

valid even after conclusion of the tender procedure.

The awarding authority undertakes to maintain confidentiality about this bid towards third

parties subject to the reserve of statutory publication requirements.

7.7. Integrity Clause

Bidders undertake to take all necessary measures to avoid corruption, especially not to offer

or accept payments or other advantages.

Bidders who violate the integrity clause are required to pay a contractual penalty to the

contracting authority amounting to 10% of the contract sum or at least CHF 3,000 per

violation.

The bidder notes that a violation of the integrity clause leads as a rule to the cancellation of

the award or to early termination of the contract by the contracting authority for important

reasons.

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The Parties shall inform each other in case of any well-founded suspicions of corruption.

7.8. Protected Rights

All protected rights that arise from executing the mandate shall be transferred to the

contracting authority.

7.9. Reference Documents

SDC consultant’s external review report (Dr. Jeene Harry et al.)

SDC consultant’s feasibility study report (Geert Venneste et al.)

7.10. Annex

i. The bidder has to fill in the bidder information.

ii. Form: Declaration working conditions

iii. General Terms and Conditions (for mandate type A and B)

https://www.eda.admin.ch/deza/en/home/partnerships-mandates/mandates-

contributions/information-downloads/contract-documents-fdfa.html

Financial offer: Mandate B template attached (will have been shared by e-mail upon

expression of interest).

iv. Offer Form Type B

v. Local Mandate

vi. Project Mid-Term External Review Report

vii. Project Feasibility Study Report

a. Situational Analysis Report on Construction

b. Technical Report and Recommendations

c. Map - SFRH