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Data Collection for a Nationally Representative Health Facility Survey Ethiopia Market Shaping Capacity Improvement Project II
November 2024 – September 2026
1. Study background and objectives
The Ethiopian Pharmaceuticals Supply Service (EPSS) is the Government of Ethiopia’s (GoE) pharmaceuticals procurement and supply agency, mandated to supply quality assured and affordable pharmaceuticals to public health facilities in a sustainable manner. In 2018, EPSS established the Quantification and Market Shaping Directorate (QMSD) to design and deliver interventions to increase access to health products, an approach known as market shaping. QMSD’s creation was an important milestone towards ensuring self-reliant and sustainable market shaping investments in the public health system.
Since September 2019, Results for Development (R4D) has been implementing the “Improve GOE Capacity – National Market Shaping for Essential Commodities” project (also known as the Ethiopia Market Shaping Capacity Improvement Project, or EMSCIP) with the aim to develop a system-level market shaping approach in Ethiopia. As part of this approach, QMSD proactively analyzes market shortcomings and implements solutions to address them across the full range of products EPSS procures. The effects from these national-level market shaping efforts should cascade down through the supply system and lead to improvements in the availability and stocking of health commodities at the last-mile, health facility level.
To track changes in availability, stocking, and data systems over time at the last mile, EPSS, the Ministry of Health (MoH), and R4D will conduct a prospective health facility survey that follows a nationally representative sample of accessible public health facilities over six rounds of data collection from November 2024 to September 2026. This effort will generate panel data that can help us better understand the connection between national-level market shaping efforts and the supply system at the facility level.
In each round, our primary focus will be to estimate the level of health product availability within facilities and to record how frequently stock outs occur. In the first round of data collection, we will also explore the reasons for, or root causes of, stockouts. This will involve examining the role played by key features of the supply system, such as the implications of the funding source for commodities; the influence of the indirect, pass-through delivery system; and the presence of the Dagu stock management system within facilities. This first round of data collection will be conducted in-person and measure availability for an extensive list of products. In subsequent rounds, we will utilize a remote data collection methodology (phone surveys) to continue tracking availability on shorter list of priority products from the first round.
2. Key tasks the data collection partner will undertake
Task 1: Onboard and develop the work plan
R4D will introduce the data collection partner to the EMSCIP II program and to the design of the commodity monitoring health facility survey. R4D will share key documents and facilitate onboarding sessions for the partner’s key staff members. The partner will then develop a detailed work plan, building on the draft work plan prepared in response to this RFP.
Deliverable: Detailed data collection work plan
Task 2: Recruit survey teams
The data collection partner will be responsible for recruiting supervisors and enumerators for a sufficient number of survey teams to complete the work. R4D may request to review the profiles and CVs of supervisor and enumerator candidates to ensure high quality and standards. The partner should provide a clear plan for retaining survey team members across survey rounds, or other methods for ensuring continuity of effort and quality across survey rounds.
Deliverable: Roster of staff with a description of roles and responsibilities
Task 3: Translate survey tools
R4D will provide the data collection partner with the survey tools in English. The partner will work with professional translators to translate and back translate the survey tools into Amharic (and other local languages, where appropriate and in consultation with R4D).
Deliverable: Translated survey tools
Task 4: Code survey tools
The data collection partner will code the survey tools using a digital data collection platform, such as SurveyCTO, and then test the tools as part of the piloting activities described in Task 5 below. The partner will first code the survey tools for the in-person first round and then will be expected to modify those tools, as needed, based on expert comments, to make them suitable for use during the remote follow-up rounds (see Task 10 below for more details).
Deliverable: Coded survey tools
Task 5: Train survey teams and facilitate piloting
The data collection partner will organize a training workshop prior to each data collection round, during which the partner will introduce the survey teams to the survey tools, facilitate mock interviews, and organize pilot interviews in non-sample public health facilities. R4D will support the data collection partner as the partner develops the training modules and will facilitate sessions during the training workshop, as needed. The data collection firm will also develop a field manual for supervisors and enumerators to follow during data collection. Following the training workshop, the partner will provide R4D with a training report that highlights the successes and challenges experienced during training and piloting and will work with R4D to incorporate reasonable changes to the survey based on training and piloting.
Deliverables: Training workshop schedule, field manual, training report, final version of field plan (i.e., description of how the partner will deploy teams to collect that data in an efficient, timely manner)
Task 6: Facilitate approvals at the sub-national level
R4D will obtain ethical approval for the study from an appropriate IRB institution prior to data collection and will collaborate with government partners at the federal level to obtain the necessary support and approval letters at the federal level. In coordination with R4D, the partner will be responsible for cascading the support and approval letters to the regional, zonal, district (woreda), and facility level.
Task 7: Conduct in-person data collection
The first round of data collection will begin in late November or early December 2024. Surveys will take place at comprehensive specialized hospitals, general hospitals, primary hospitals, health centers, health posts, and woreda offices (see below for additional details on the sample of facilities). The list below broadly describes the methods enumerators will use to collect data for this study:
1. Count and record the number of units available for each of the products from a pre-determined list of 20-40 focus products. Enumerators will physically visit store and dispensing unit shelves to directly count stock.
2. Review and extract information from bin cards, store ledgers, dispensing registers, Reporting and Requesting Forms (RRFs), and, where available, Dagu.
3. Interview health care workers at various locations in facilities (store managers, dispensing unit managers, facility in-charges, etc.). These semi-structured interviews will cover topics such as stock management and medicine dispensing practices, challenges faced while managing stock, and the facility’s interactions with other health system actors (EPSS, woreda offices, other health facilities, etc.).
At each facility in the sample, the partner’s survey team will conduct interviews with the facility in-charge, in each of the facility’s stores, and in each of the facility’s dispensing units. For small facilities, this would likely mean one interview of each type, for a total of three interviews. Larger facilities, such as hospitals, will likely have multiple stores and multiple dispensing units. The partner will be expected to comprehensively conduct interviews in each store and dispensing unit, which may entail 5-10 interviews in a single facility, depending on size. We anticipate the in-charge interview will take about 30 minutes to complete, each store interview will take about 1-2 hours, and each dispensing unit interview will take about 1 hour. This may require spending a full day at a single facility to complete all the necessary interviews. Enumerators should use tablets[1] to record responses and other data, as well as to make audio recordings, when appropriate.
As noted in Section 1 above, one area of focus for this study is understanding how the indirect, pass-through system influences availability and stocking trends. The study sample will, therefore, include woreda offices, as well. The interviews at the woreda offices will have similar goals as the facility interviews. The survey team will conduct a single interview in the store at each woreda office that will take about 1-2 hours.
Deliverable: Data collection report
[1] The partner will be responsible for providing tablets to enumerators. R4D will not provide tablets. All coded survey forms should be used on tablets only. Smartphones will not be an acceptable.
Task 8: Clean and submit data
The data collection partner will implement data quality checks; make necessary edits; translate text responses into English; rename and label variables; and otherwise prepare the data prior to sharing a fully cleaned dataset with R4D. R4D will be available for discussions during the cleaning process, as needed. This task should be completed within two weeks of the end of each data collection round.
Deliverables: Cleaned datasets in Stata .dta format
Task 9: Contribute to data analysis process
R4D will lead the analysis of the data collected through this study. However, during the analysis process, R4D may wish to draw on the partner’s direct knowledge of how the data was collected to aid in interpretation of the results. R4D would like the partner to be available for periodic check-ins during the analysis process and for the partner to potentially participate in the dissemination of findings, where appropriate.
Task 10: Conduct remote data collection rounds
Following the first in-person round, the data collection partner will conduct up to five additional data collection rounds every four months, culminating in a final follow-up round in July 2026 (i.e., approximately May 2025, Jul. 2025, Nov. 2025, Mar. 2026, Jul. 2026). These follow-up rounds will be conducted remotely using phone surveys. With this method, enumerators will call respondents and collect data through a phone conversation. They will record responses in the coded survey on a tablet, as in the in-person round. This will be a panel survey, so the sample facilities for each remote round will be the same set of facilities as in the first round, requiring the partner to track facilities and respondents across rounds.
The data to be collected in these rounds will be broadly similar to the data collected during the in-person first round. However, the structure of the interviews will be modified to make them feasible to conduct over the phone. The primary modification will be that enumerators will rely on respondents to independently collect the required information prior to data collection and then report it to the enumerator over the phone during the interview. The partner should create data quality protocols for ensuring respondents are consistently and accurately collecting and reporting this data. This should include protocols for both remote and in-person verification of data on a sub-set of sample facilities.
The data collection methods will be modified in the following ways to ensure feasibility:
1. Count and record the number of units available for each of the products from a pre-determined list of focus products.
Modifications:
· Ask the respondent to independently visit store and dispensing unit shelves prior to data collection and record data that they will then report over the phone to the enumerator.
· Reduce number of questions asked about each product.
· Reduce total number of focus products to less than 20 total.
2. Review and extract information from bin cards, store ledgers, dispensing registers, RRFs, and, where available, Dagu.
Modifications:
· Ask the respondent to independently review these data sources prior to data collection and record data that they will then report over the phone to the enumerator.
· Reduce number of questions asked about each product.
· Reduce the number of data sources consulted.
3. Interview health care worker about stock management.
Modifications:
· Conduct an interview with a respondent in each store of the facility.
· Reduce the number of questions asked about stock management.
If there are multiple stores at the facility, the enumerator will interview a separate respondent for each store. The respondent will report data from their store and from the dispensing units their store distributes to. We anticipate the store interview will take about 30-45 minutes to complete. Prior to data collection in each round, the survey team will contact the facility in-charge to obtain approval and consent to continue collecting data at the facility. We will not collect additional information about the facility during this interaction. Therefore, the facility in-charge interview will not be conducted during the remote rounds.
The partner will be expected to pilot the remote data collection approach, as well as the remote data quality protocols, during the first in-person round. Tasks 2, 4, 5, 6, 8, and 9 will be repeated for each data collection round, as needed.
Deliverables: Remote data collection piloting plan and remote data collection overall plan (including a description of data quality protocols)
3. Anticipated sample and timeline of activities
Sample of facilities
This study will collect data from a nationally representative sample of accessible health facilities across the catchment areas of EPSS’s 19 distribution hubs. Due to ongoing security considerations, it may not be feasible to access facilities in part or all of the catchment area for some hubs. R4D will coordinate with the data collection partner to discuss the feasibility of accessing facilities prior to the start of data collection. As part of the technical approach narrative, the partner should include any limitations on its ability to collect data in certain geographies. The anticipated sample, which will be confirmed prior to data collection and is subject to change, is as follows:
Comprehensive Specialized Hospitals
Number of facilities: 20
Interviews per facility (Task 7, in-person data collection)[1]: 6-10
Interviews per facility (Task 10, remote data collection)[2]: 3-5
General and primary hospitals
Number of facilities: 120
Interviews per facility (Task 7, in-person data collection): 5-7
Interviews per facility (Task 10, remote data collection): 2-4
Health centers
Number of facilities: 500
Interviews per facility (Task 7, in-person data collection): 4-6
Interviews per facility (Task 10, remote data collection): 1-3
Health posts
Number of facilities: 160
Interviews per facility (Task 7, in-person data collection): 3
Interviews per facility (Task 10, remote data collection): 1
Total, health facilities only (Number of facilities): 800
Woreda offices[3]
Number of facilities: 100
Interviews per facility (Task 7, in-person data collection): 14
Interviews per facility (Task 10, remote data collection): 1[4]
Total, all facility types (Number of facilities): 900
[1] As noted under Task 7 above, the number of interviews per facility will vary depending on the size of the facility. At a minimum, the partner will conduct interviews with the facility in-charge, one store, and one dispensing unit in each facility.
[2]As noted under Task 10 above, the number of interviews per facility during the remote rounds will be fewer than during the in-person, first round. However, there will continue to be multiple interviews for facilities that are large enough to have multiple stores. Enumerators will conduct separate interviews with each store.
[3] The sampling strategy for this study is based on an initial random selection of woredas. The survey team will then collect data from all the public facilities in the selected woredas, as well as the woreda office in those woredas.
[4] As noted under Task 7 above, data collection in woreda offices be done through a single interview conducted in the store of the woreda office.
Tentative data collection timeline
The activities for this survey are anticipated to last two years, starting later this year and concluding in 2026. The in-person first round will be followed by up to five follow-up rounds that take place every four months.
Table 2. Anticipated timeline
Oct. – Nov. 2024
Task 1: Onboard and develop the work plan
Task 2: Recruit survey teams
Task 3: Translate survey tools
Task 4: Code survey tools
Nov./Dec. 2024
Task 5: Train survey teams and organize piloting
Task 6: Facilitate approvals at the sub-national level
Nov. 2024 – Jan. 2025
Task 7: Conduct in-person data collection round
Jan./Feb. 2025
Task 8: Clean and submit data
Task 9: Contribute to data analysis process
Mar. 2025 – Sept. 2026
Task 10: Conduct remote data collection rounds every four months for a total of up to five rounds (approximately May 2025, Jul. 2025, Nov. 2025, Mar. 2026, Jul. 2026).
Tasks 2, 4, 5, 6, 8, and 9 will be repeated for each data collection round, as needed.
4. Data collection partner qualifications
The minimum qualifications for the data collection partner are:
· Locally registered in Ethiopia.
· Previous experience conducting surveys in public health facilities at all levels, including in hospitals, health centers, and health posts.
· Previous experience conducting surveys focused on the public health pharmaceuticals supply chain.
· Previous experience conducting surveys in across multiple regions of Ethiopia.
· Previous experience conducting phone surveys.
· Previous experience collaborating with the EPSS, MoH, and other MoH institutions.
· Previous experience collaborating with Government of Ethiopia partners at the regional and woreda levels, specifically to obtain approvals for data collection activities.
· Project supervisors fluent in English, Amharic, and local languages in targeted communities.
5. Proposal structure
Proposals submitted by data collection partners should include three components: a technical approach narrative response; four required annexes; and a budget for data collection activities. Proposals should be written in English and the budget should be in Ethiopian Birr (ETB). In the written, narrative response, the partner should provide a clear description of how they will facilitate the data collection activities for this survey. The response should include, at a minimum, the sections listed below and should be kept to a maximum of 10 pages. The four required annexes and the completed budget template are not included in the page limit.
1. Technical approach narrative: Ten-page written, narrative response that includes, at minimum, the following sections:
· Description of previous experience: Describe the partner’s past data collection work and qualifications. Please be sure to include details on:
o Public health and supply chain: Describe the partner’s experience conducting surveys in public health facilities in Ethiopia, highlighting any surveys focused on the pharmaceuticals supply chain.
o Phone surveys: Describe the partner’s specific experience conducting phone surveys.
o Facilitating approvals:Describe how the partner has coordinated with government officials at different levels to obtain approval for data collection.
· Description of training approach: Describe how the partner will structure and facilitate the training of both supervisors and enumerators. Provide details on topics that will be covered during the training and how the partner will facilitate piloting for both the in-person and remote (phone survey) methods.
· Proposed digital data collection platform: Identify which digital data collection platform the partner proposes to use for data collection (e.g., SurveyCTO, Kobo), as well as the partner’s capacity for programming and troubleshooting in this software.
· Proposed data quality control protocols: Identify how the partner will ensure the collection of high-quality data. Provide details on the use of back checks or other means of verifying the accuracy of data collected by survey enumerators. The partner should specifically outline how they will verify the accuracy of data during remote data collection.
2. Required annexes:
· Annex 1: Draft work plan Gantt chart: A Gantt chart outlining the key steps the partner will take to conduct the first in-person round of data collection and the first remote round of data collection.
· Annex 2: Proposed field team structure: A chart laying out the hierarchy of enumerator teams, including the number of enumerators at every level of the hierarchy. This chart should clearly lay out reporting structures to the designated R4D team member who will be overseeing field activities. The partner should also include a narrative with this chart describing how they will retain survey team members across survey rounds or otherwise maintain continuity of effort and quality across survey rounds.
· Annex 3: CVs of core team members: Include CVs for the following team members: (i) the overall activity lead and chief point of contact, (ii) survey manager(s), (iii) two survey supervisors and two enumerators (the supervisor and enumerator CVs can be drawn from past survey teams fielded by the partner to illustrate the backgrounds and skill sets the partner would look for when hiring for these roles).
· Annex 4: References: A list of at least three other organizations the partner has worked with in the past, or is working with currently, who could serve as a reference for the partner’s work. Include contact information for each organization.
3. Budget for data collection activities: A detailed estimate of costs in ETB for conducting data collection activities. The estimate should be inclusive of all costs associated with data collection across all six proposed rounds of data collection (one in-person round and five remote follow-up rounds). This should include, but is not limited to, salaries, food, lodging, and transport stipends for the survey teams; equipment (including tablets); translation fees; and costs associated with obtaining approvals. The estimate should be disaggregated by:
· Costs associated with preparation for the first round of data collection (inclusive of training and piloting).
· Costs associated with field activities for the first round of data collection.
· Costs associated with preparation for the first round of remote data collection (second round of data collection; inclusive of training and piloting)
· Costs associated with field activities for the first round of remote data collection (second round of data collection).
· Costs associated with each subsequent round of remote data collection (third to sixth rounds of data collection; costs do not need to be disaggregated between preparation and field activities for these rounds).
The attached template (Download “EMSCIP II Health Facility Survey Vendor Budget" here) may be used for the budget submission. The budget should be in ETB. R4D is a registered organization in Ethiopia and will only accept responses with pricing in ETB. All payments to the selected partner will be processed in ETB by the R4D Ethiopia Office. R4D will withhold the customary taxes. If the partner presents upon selection a Business Tax Identification Number (TIN) and valid Business License, R4D will withhold taxes at a rate of 2%. If no Business Tax Identification Number or valid Business License is provided, R4D will withhold taxes at a rate of 30%.
6. Evaluation of proposals and contracting
All proposals submitted by the submission deadline of October 11, 2024, will be scored and evaluated using the following criteria, each of which carries the specified weight.
Table 3. Evaluation criteria and weights
1. Technical approach narrative (45%)
Completeness: Did the proposal address all the required topics for the narrative listed in Section 5?
Overall understanding of the requirements: How well does the proposal respond to the requirements and expectations described in the RFP?
Description of previous experience: Does the proposal demonstrate the partner’s relevant experience, specifically related to public health, supply chain research, phone surveys, and approvals?
Approach to data quality controls: How well does the proposal describe the partner’s approach to data quality controls? Does the partner present a strong plan for verifying remotely-collected data?
2. Required annexes (10%)
Annex 1: Draft work plan Gantt chart
Does the Gantt chart include a comprehensive set of steps for data collection preparation and field activities?
How feasible is the proposed timeline?
Annex 2: Proposed field team structure
Does the annex provide a clear description of team member roles?
Does the chart show clear lines of responsibility and reporting?
Has the partner proposed an adequate number of survey teams to complete the work according to the timeline described in the Gantt chart?
Has the partner provided a clear plan for retaining survey team members or maintaining continuity of effort and quality across survey rounds?
Annex 3: CVs of core team members
Has the partner included CVs for all team members specified in Section 5?
Do the individuals proposed have the necessary skills and experience to carry out their roles?
Do the teams include individuals with experience conducting public health surveys?
Do higher-level team members have advanced degrees and previous experience managing complex research projects?
Annex 4: References
Does the annex include at least three references?
Do the references provide positive feedback on the partner’s work?
3. Budget for data collection activities (45%)
Completeness: Did the proposal include a comprehensive set of anticipated costs? No major costs have been excluded, and costs are presented in ETB.
Disaggregation: Are costs presented as specified in Section 5?
Value for Money: Does R4D see value for money, and are the costs reasonable?
Scoring and selection
Following the scoring of proposals, R4D will shortlist up to three data collection partners and conduct interviews to further assess the partners’ suitability for this data collection activity. R4D will select the final partner following these interviews, which will focus on the partners’ ability to clarify and expand on their technical approach and their ability to identify potential cost savings in the data collection budget. Once the selection is made, all partners who have submitted proposals will be notified of the result by email.
The selected partner will enter into a deliverables-based contract with R4D. The deliverables and payment schedule will be negotiated with the final selected partner.
7. General information
7.1. Procurement Protocol
R4D reserves the right to make all decisions regarding this RFP, including the right to reject any and all proposals received in response to this RFP. The data collection partner understands that the issuance of this RFP does not create any obligation on the part of R4D to enter into any contract or to undertake any other obligation with respect to the requirements referred to herein.
7.2. RFP Response Preparation Cost
All costs incurred by data collection partner in the preparation of its response to this RFP, and any oral presentations requested, shall be wholly absorbed by the data collection partner.
7.3. Contractual Obligations
The data collection partner’s response to this RFP, in the whole, in part or by reference, may be incorporated into any resulting contractual agreement at the sole discretion of R4D to ensure that all representations made by the data collection partner are legally binding.
For any questions regarding this Request for Proposal, please contact Azeb Fisseha (afisseha@r4d.org) and Taylor Salisbury (tsalisbury@r4d.org) by October 1, 2024.
Send your response and all accompanying materials to afisseha@r4d.org, tsalisbury@r4d.org, and lheinkel@r4d.org with the subject line “Response to EMSCIP Health Facility Survey: [Name of your organization]” by October 11, 2024.
Download RFP and the the budget template here.
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