Request for Proposal for Technical Development and Production Support for Electronic Immunization Registry (EIR) for MOHCDGEC

Transcription

1 Request for Proposal for Technical Development and Production Support for Electronic Immunization Registry (EIR) for MOHCDGEC 12 October 2016 BID Initiative, Tanzania

2 Request for Proposal RFP # Technical Development and Production Support for Electronic Immunization Registry (EIR) for the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) - Tanzania I. Summary of Deadlines Activity Due Date Release of Request for Proposal (RFP) Wednesday 12 th October 2016 Confirmation of interest due Monday 17 th October 2016 Proposals due Monday 24 th October 2016 Evaluation of proposals Monday 31 st October 2016 Announcement of decision Friday 4 th November 2016 II. PATH Statement of Business PATH is the leader in global health innovation. An international nonprofit organization, we save lives and improve health, especially among women and children. We accelerate innovation across five platforms vaccines, drugs, diagnostics, devices, and system and service innovations, that harness our entrepreneurial insight, scientific and public health expertise, and passion for health equity. By mobilizing partners around the world, we take innovation to scale, working alongside countries primarily in Africa and Asia to tackle their greatest health needs. Together, we deliver measurable results that disrupt the cycle of poor health. Learn more at III. Project Background and Purpose of the RFP A. Background The BID Initiative is a global initiative led by PATH and funded by the Bill & Melinda Gates Foundation. It is grounded in the belief that better data, plus better decisions, will lead to better health outcomes. Its vision is to empower countries to enhance immunization and overall health service delivery through improved data collection, quality, and use. Reaching this vision requires investments in information system products, practices, people, and packaging. 1

3 The BID Initiative is unique. It is designed to partner with countries in Africa through the BID Learning Network (see to introduce information system products and immunization practices that can be tested in a few demonstration countries, packaged for dissemination, and then deployed at scale in many countries. The BID Initiative also starts with the premise that it will build new information system products or practices only as a last resort. Instead, investments will be made to embrace and extend existing information system products and investments already made by donors and national governments in immunization best practices wherever possible. Tanzania s MOHCDGEC has strengthened its immunization programs, yet systemic problems such as identifying the under-vaccinated and unvaccinated children continue to stall efforts. Tanzania continues to face challenges related to data quality and has identified a few of the problems that are of highest priority: Accurate denominator Defaulter tracing Unique identification of children Complexity of data collection forms Data visibility The source used to estimate number of clients for each clinic is provided by National Bureau of Statistics. However, in practice, the actual client numbers in any given catchment area often vary widely from the estimated numbers. Ability to identify children that may not have received their full dosing regimen. Individuals are associated with a particular health facility, so if they receive services from another clinic, their full immunization history may not be captured accurately. The complexity of data collection and reporting forms increases the burden on health workers and the chances of errors. It is practically impossible to review data from clinics at the village or even district levels, especially stock status. Unfortunately, information systems and a culture of evidence-based decision-making that would help solve these operational issues and provide actionable information to users are very weak. While technological capabilities and internet/network connectivity are improving rapidly in Tanzania, effective and affordable information systems that automate national immunization data collection and support delivery of routine child health services (e.g., immunizations, nutrition screening, and counseling) for health workers have not yet been built or deployed at scale. Information and computer technology (ICT) systems for the national health management information system (HMIS), monthly immunization reporting, and supply chain logistics are not interoperable with one another nor linked into an emerging national-level ehealth architecture. 2

4 B. BID Initiative Tanzania Objectives The main objective of BID Initiative Tanzania is to improve immunization system performance through improving data collection system and use practices. The specific objectives of the Initiative are: 1. Improving immunization data quality and availability. 2. Increasing data use and decision skills at all levels of the health system. 3. Building motivation to use data to improve performance. 4. Increasing capacity to monitor performance. After a series of discussions with MOHCDGEC and health workers at national, regional, district, and health facility levels, the following interventions were identified as solutions to addressing the immunization system challenges as well as meeting broad and specific objectives of the BID Initiative in Tanzania. Introduction of a national electronic immunization registry (EIR) that would register all children eligible for immunization using their demographic details and immunizations. Generating reports from the EIR: These are expected to be automated, simplified reports produced as part of the EIR registry at all levels of the health system, including health facilities limited by infrastructure such as electricity and internet connectivity, to provide visibility into performance and increase use of data for decision-making. Enabling significantly improved stock management routine: Introduce an automated mechanism for supply chain system through the EIR with tools to improve vaccine stock visibility across all level of the health system. Introduction of unique identifier numbers on child health cards so as to simplify child identification during immunization sessions and across health facilities. Facilitating targeted supportive supervision for health workers at selected facilities to address systemic issue and practices. Establishing peer support networks within and across the health system for crosscutting peer learning and support. Establishing community birth registration to capture all newborns (especially for home births) via short message service (SMS) registration to link them to the full registration with the EIR for routine immunization purposes. 3

5 C. Purpose of this Scope of Work PATH is soliciting proposals from qualified firms with capacity to provide technical development and production support for electronic immunization registry (EIR) for the MOHCDGEC. There is a requirement to have in place a locally-based firm that will sustainably provide ongoing development and production support for EIR being rolled out in selected regions and potentially scaled to the whole of Tanzania. The suitable selected firm will be expected to build a team with capacity to provide ongoing support throughout the product lifecycle, with support contracts renewed and reviewed annually, initially not exceeding the duration of the BID initiative, and later transitioned to the Ministry. The MOHCDGEC expects the locally-based selected firm to support the product as an open source. IV. Scope of Work The selected vendor will be required to perform the following tasks: Work with the BID Initiative s development partner (Mohawk College) and interoperability partner (IntraHealth International) to understand, identify, and support development of interoperability requirements and data flows with external systems and exchange data through the implementation of the standards-based OpenIZ interoperability framework. Participate fully in testing Mohawk College s development codes, bug fixes, additional releases, deployment support, and beta releases as well as providing timely feedback of test results to MoHCDGEC key staff and BID Initiative Implementation Team. Thoroughly understand the background and development of EIR by actively participating in Mohawk College s knowledge transfer activities to BID Initiative and MoHCDGEC key staff on the functionality, troubleshooting, sustainable helpdesk structure, and maintenance of the EIR system. Participate fully in sessions by Mohawk College in system handover, training for daily operational system support, final documentation, and reports. Provide post-deployment production support of the EIR for the covered regions and escalating to Mohawk College resolved issues for potential expansion of OpenIZ and or unresolved issues for technical support. Expected Deliverables Inception report with a plan and approach narrating detailed understanding of the current and future support requirements after meeting key stakeholders: MoHCDGEC ICT, Presidents Office - Regional Administration & Local Government (PORALG) ICT, local government authorities in Arusha, PATH, Mohawk College, and IntraHealth. 4

6 Support plan for the live sites that is with Electronic Immunization Registry (EIR) for the Ministry for all districts/regions that have been deployed/covered by BID implementation. Plan to accommodate new sites as BID covers other regions in the country. V. Proposal Requirements - Financial Provide itemized costs for the entire assignment based on the scope of work and expected deliverables outlined in Section IV. The final scope of work may be subject to negotiation. Financial proposal should include itemized costs for key elements of the scope of work, including: Rate of the key staff that will be working under this assignment. Estimated total level of effort and associated costs. Estimated schedule of anticipated expenses (e.g., travel, supplies, outside resources). Indicated standards support working hours with response times to incidents with proposed service level parameters. Estimated cost for a workshop or meeting which will explain to key government personnel how the support arrangement will work. Special Note on Indirect costs Indirect costs are overhead expenses incurred as a result of the project but not easily identified with the project s activities. These are administrative expenses that are related to overall general operations and are shared among projects and/or functions. Examples include executive oversight, existing facilities costs, accounting, grants management, legal expenses, utilities, and technology support. However, the selected vendor will need to submit proof that an indirect charge is their established practice and the same rate is applied to all funding, otherwise it will be disallowed. Proof of the rate must be in the form of a Negotiated Indirect Cost Rate Agreement with the United States Agency for International Development, or the three most recent annual audit reports that document the indirect rate. Indirect rate allowances: These rates are maximum allowances. If the organization has lower rates, the lower rates should be used. To the extent that indirect costs are applicable, they are subject to the following limits: Up to 10% for US universities and other academic institutions. Up to 15% for non-us academic institutions, and all private, voluntary, and nongovernmental organizations, regardless of location. No indirect costs will be paid to US Government agencies, other private foundations and for-profit organizations. Rates apply both to the primary grantee, sub guarantees, and subcontracts that are part of the proposal. Please note, in so far as possible, identifiable (allocable) costs should be documented and justified in the proposal as direct costs, including those for dedicated ongoing project management and support. 5

7 VI. Proposal Requirements Technical Provide a narrative on your technical approach to accomplish the scope of work and deliverables per section IV, including: Description of pre and post software development and application support approach. Discussion of support for project management and roles of project support team. Timeline to meet the deliverables. Potential risks and mitigating strategies. Identification of major internal and external resources. Responses to vendor questions (as applicable) listed in Appendix A. Evaluations of development and system support as listed in Appendix B. Provide information on your overall qualifications, including: Organization profile explaining relevant experience of related work. Qualifications of key members of the proposed project team (attach CVs and provide details of back-up/standby teams). Number of years in business. If your organization has more than one location, please indicate these qualifications for the site that is responding. VII. Proposal Evaluation Criteria The following is a list of significant criteria against which proposals will be assessed. The criteria are not listed in order of priority. 1. Technical a. Ability to support development and testing all releases. b. Support matrix for the software development pre and post development and methodology to be used. c. Proposed work plan. d. Demonstrable commitment to documentation such as incidence reporting and documentation of resolutions, troubleshooting guides, and frequently asked questions. References to other sites are also acceptable. e. Project management and project progress monitoring and reporting systems. f. Ability to instill and commission ITIL principles in Service Management: Service Support and Service Delivery (ITIL, formerly an acronym for Information Technology Infrastructure Library, is a set of practices for IT service management (ITSM) that focuses on aligning IT services with the needs of business.) g. Demonstrated understanding of the requirements. 2. Experience a. Past experience in related projects. b. Experience of proposed project management and technical staff. c. Number of successful implementations. d. Demonstrable on the ground, on-site, in-country support capability, with office personnel, technical teams, and team management / leadership preferably with 6

8 experience working in the public sector (health sector within immunization is a strong preference). e. Demonstrable experience of planning, reporting solutions, scaling deployment, and support solutions beyond one region in the country. f. Demonstrable skills and experience in server side, web development, and Android mobile development. g. Demonstrable skills and experience with immunization registry development. h. Strong desire to collaborate with immunization registry product vendor. i. Demonstrable experience in supporting and working with not-for-profit sectors, government departments, and also academic institutions where IT development is one of the core activities. j. Demonstrable awareness of technical architecture within the health sector. 3. Other due diligence: Workable arrangements in place for premises exchange visit and brief meeting up with their key technical personnel. 4. Costs (as detailed in Section V) a. Realism of costs or technical staff compared to their technical experience or expertise. b. Budget reflecting a clear understanding of the work. c. Reasonableness of cost. Note: PATH reserves the right to include additional criteria. VIII. Instructions and Deadlines for Responding A. BID Contacts: Procurement Contact Persons: Fay Venegas, fvenegas@path.org, Abdallah Shamte, ashamte@path.org Program Contact Person: Henry Mwanyika, hmwanyika@path.org B. Confirmation of interest: Please send a statement acknowledging receipt of this solicitation and your intent to respond no later than Monday 17 th October Send the confirmation to the contacts listed above. C. Proposals due: Monday 24 th October 2016 Completed proposals should be submitted by to the contacts listed above. The subject line of the should read: Re: Technical Development and Production Support for Electronic Immunization Registry (EIR) for the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) We advise that you send files and documents commonly recognized by Microsoft Office or PDF format. We will not accept responsibility for resolving technical transmission problems with proposals. A hard copy of the proposal should not be sent. Your proposal should only include information specific to accomplishing the scope of work. All correspondence should be through s and no phone calls will be entertained. 7

9 D. Selection of short-list BID Initiative reserves the right to select a short list from the bids received. BID has the option to interview and discuss specific details with those candidates who are on the short-list. E. Conclusion of process Successful applicants will be notified of decision by Friday 4 th November, Final award is subject to the terms and conditions included in this solicitation as well as successful final negotiations of all applicable terms and conditions affecting this work. IX. Terms and Conditions of the Solicitation A. Notice of non-binding solicitation PATH reserves the right to reject any and all bids received in response to this solicitation, and is in no way bound to accept any proposal. B. Confidentiality All information provided by PATH as part of this solicitation must be treated as confidential. In the event that any information is inappropriately released, PATH will seek appropriate remedies as allowed. Proposals, discussions, and all information received in response to this solicitation will be held as strictly confidential, except as otherwise noted. C. Communication All communications regarding this solicitation shall be directed to appropriate parties at PATH indicated in Section VIII. A. Contacting third parties involved in the project, the review panel, or any other party may be considered a conflict of interest, and could result in disqualification of the proposal. D. Acceptance Acceptance of a proposal does not imply acceptance of its terms and conditions. PATH reserves the option to negotiate on the final terms and conditions. We additionally reserve the right to negotiate the substance of the finalists proposals, as well as the option of accepting partial components of a proposal if appropriate. E. Right to final negotiations PATH reserves the option to negotiate on the final costs and final scope of work, and also reserves the option to limit or include third parties at PATH s sole and full discretion in such negotiations. F. Third-party limitations PATH does not represent, warrant, or act as an agent for any third party as a result of this solicitation. This solicitation does not authorize any third party to bind or commit PATH in any way without our express written consent. G. Proposal Validity : Proposals submitted under this request shall be valid for 90 days from the date the proposal is due. The validity period shall be stated in the proposal submitted to PATH. 8

10 Appendix A: Vendor Questions Vendor Questions 1. How many branch offices do you have in Tanzania? How many near Arusha? 2. How many technical resources are available to support this project? 3. What is your capacity to support software on a Windows platform (C#.NET)? 4. Describe your familiarity and experience with Xamarin and Hybrid application architecture. 5. Describe your familiarity with HL7 messaging (FHIR and v2). 6. What is your capacity for technical support (i.e. call center)? 7. Describe your familiarity with data warehousing and reporting. 8. How do you propose to handle support requests such as a ticketing system and whether this is online? It is expected that the eventual support team is able to provide support regarding: 1. Tier 1 support to end users and the PATH team to use standard responses to fix and diagnose issues. 2. Tier 2 support to provide basic software and non-software (e.g., reports, forms, etc.) changes. 3. Tier 3 support such as collecting server side logs and diagnosing server issues and addressing them as appropriate (e.., changing configurations, setting security policies, etc.). 4. Device configuration and support. 5. Data migration and validation support. The support team should be able to field all support issues with the exception of severe architectural defects. 9

11 Appendix B: Development and System Support Questions (Application Support) Development and System Support Questions 1. What is your largest supported site? 2. How many supported users per installation/site? 3. How many records in the supported backend database? 4. How many users can use the supported system at the same time? 5. What components of your supported platform are proprietary? 6. What components your supported platform use commercial off-the-shelf software? 7. What components or installations of your supported sites are open source? 8. What service-level agreement for uptime do you guarantee each month? 9. How many hours of maintenance is the system unavailable each month and when are those typically scheduled? 10. How often are updates or upgrades released? 11. How would you support the integrated Tanzania Immunization Electronic Registry? 12. Can you provide examples of how you have done similar assignments before? 13. Describe your approach and available features that provide security and privacy of data. 14. Describe your backup and restore functionality. 15. What training and support services do you provide? 16. What language(s) does your supported or developed application support? What is your experience and in house skillset for system and database updates? 17. What is the annual support maintenance costs or any other relevant licensing fees? 18. By how much are the supported costs expected to increase annually? 19. What remote support tools do you use and for how long? 20. Account for your Tanzania-based experience working with and supporting international vendors products/installation. 10

12 Frequently Asked Questions - BID Initiative Tanzania 1. Why is the BID Initiative working in Tanzania? Tanzania was identified as a strong country partner after an evaluation of several sub- Saharan African countries. The evaluation process included a preliminary desk review, followed by in-depth analysis of demographics, governance, EPI data, ehealth infrastructure, political environment, and other factors. We also factored in existing resources that would allow the initiative to be successful such as a strong base for the immunization program and enthusiasm from health workers. After an initial round of scoping visits followed by in-depth visits to potential implementation sites, Tanzania emerged as a demonstration country partner. 2. Why did you choose Arusha as a testing region? Based on discussions with the Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), the Arusha region was selected as a test site based on immunization challenges due to its porous border with Kenya; its mix of urban, peri-urban, and rural settings; and its pastoral communities. 3. Where will the Initiative be implemented in Tanzania apart from Arusha? We are actively seeking additional resources to help Tanzania plan for national scale. We will implement in phases and once scaled in Arusha, the BID Initiative will expand to the rest of Northern Zone including Tanga, Kilimanjaro, and Manyara regions. Additionally, the MOHCDGEC will own a portion of implementation to other regions to ensure sustainability of the initiative. The decisions around which regions will be covered after the Northern Zone will be mutually determined by the BID Initiative and the Tanzanian government. 4. How many facilities will be reached during the implementation phase and how long will this phase last? The BID Initiative, in partnership with the MOHCDGEC, and collaborating with relevant Arusha Regional Medical Office, have identified 241 facilities in Arusha Region for the initial implementation phase. This phase will likely be completed in the end of Visit our website s interactive map to view our progress facility by facility. 5. How is the BID Initiative working with the Tanzanian government? From the beginning, the BID Initiative has closely partnered with the MOHCDGEC through the Immunization and Vaccine Development (IVD) Program. We didn t predefine solutions, but instead worked closely with the Tanzanian government to identify challenges in immunization and interventions that can sustainably address these challenges. We are in regular contact with the government to provide updates around the BID Initiative s progress. 11

13 6. What immunization issues is the BID Initiative trying to address? Working in partnership with the MOHCDGEC, the BID Initiative identified a number of critical data-related challenges that need to be addressed which includes: Inaccurate or uncertain denominators for calculating immunization rates. Difficulty identifying children who do not start immunization or who drop out (defaulter tracing). Poor data visibility into supplies at the facility level to district-level data and stock. Complex data collection forms and tools. Insufficient supply chains and logistics. Inadequate data management and use capacity at all levels of the health system. 7. How will the BID Initiative help to improve the ability of the immunization program to reach all children in Tanzania? The BID Initiative will help improve the ability of the immunization program to identify and reach all children through a package of interventions including a new national electronic immunization registry system to ensure no child misses a scheduled vaccine. Health workers will have visibility into all child immunization records, whether a child visits a different facility, and will be notified if a scheduled vaccine is missed. All births will be registered into the system, allowing health workers to follow up if a child never comes to the health facility for their initial vaccines. Additionally, health workers will be empowered to use the data available to them to make evidence-based decisions, thus creating a data-use culture. Finally, supply chain and logistics interventions such as barcodes on all levels of the vaccine supply chain for tracking and visibility into stock across the districts will ensure facilities have adequate vaccine supply and no patients are turned away due to a stock out. 8. What interventions are going to be implemented to address Tanzania s immunization challenges and improve service delivery? Electronic immunization registry: A standards-based electronic immunization information system to track children and their vaccination records. New births are entered into the registry via computer at hospitals or SMS from health centers or village leaders. Immunization registry (paper-based): Modified paper-based version of the electronic immunization registry to register immunizations for a facility s specific catchment area, and then scanned into the national electronic system at the district level. All facilities will have visibility into the data for their area, providing notifications of missed vaccines. Supply chain management: Facility stock data will be entered into the electronic immunization registry, which then syncs to the national vaccines information management system (VIMS). In low-volume facilities, data will be gathered on paper forms and entered into the electronic systems at the district level. 12

14 Micro-training videos: Short training videos facilitated by health workers, for health workers, capturing successful best practices and innovations to improve data use at facilities. Data visualization/dashboards: Customized web-based or paper-based dashboards include the most functional and relevant information at each level of the health system (facility to national) on a monthly basis. Peer networking: Communication forums established between facilities to increase informal interaction between health workers, encouraging peer-supported problem solving, and providing access to data champions. Data use campaign: Educational communication materials such as posters and brochures that encourage behaviour change to create a local data-use culture and demonstrate the value of data use in support of other interventions. Targeted supervision: District-level Immunization Officers (DIVO) will use improved data and monthly reports from facilities to target monthly, onsite one-on-one capacity building with identified under-performing facilities. Workflow redesign: Adjustments required to accommodate innovations and solutions, general process flow improvements, and job aids to provide best practices and streamline immunization service provision. District data use guide: Electronic-based or paper-based guide to support new technologies and paper-based forms on how to use data (targeted at both data producers and users), establishing a baseline understanding across each level of the health system. Data use video games: Analytical tools in the form of video games to improve staff decision making capacity. Pre-existing video games can be readily accessed through cell phones or computers. 9. How will ordinary Tanzanians benefit from the BID Initiative? Ordinary Tanzanians will directly benefit from the BID Initiative through an improved immunization system that will streamline processes to decrease long wait times and reduce time spent at the clinic. Additionally, the national immunization registry will ensure every child receives their lifesaving routine vaccinations and can be identified and located if they don t show up for a scheduled immunization. Close coordination of health facility catchment areas and the ability for health workers to use data to better plan for immunization services will also reduce unnecessary stock outs and build confidence in the health system. Over time, we believe that the BID Initiative will help increase actual immunization coverage in Tanzania, resulting in healthier families and communities. 13

15 10. How will the initiative be sustained after the BID Initiative is complete? From the start, the BID Initiative was designed to be country-owned, country-led with sustainability and scale being critical to success. We will closely partner with the MOHCDGEC to implement BID Initiative interventions with a clear plan in place for how the Tanzanian government can take ownership of the initiative and continue scaling to other parts of the country beyond the BID Initiative s funding cycle. These interventions have to be cost effective or they will not be sustained. We will carefully measure the total costs of the interventions to help the MOHCDGEC determine which ones are the best value for money and should be scaled. 11. How many years is the project going to last? The BID Initiative is funded through mid-2018, thereafter the government and other implementing partners will assume implementation and sustainability in both technical and financial aspects, unless additional funding is secured. 12. What will happen to the current immunization data sources such as facility immunization registers? All children visiting a health facility will be registered in the electronic system and given a barcode. The health workers will also update the paper registers until Tanzania switches to the electronic system. We are working with the MOHCDGEC to determine when they will be able to make the switch to no longer have the health workers fill out the paper registers. 13. With all the patient data you will have access to, how are you ensuring patient privacy? The MOHCDGEC and the BID Initiative have committed to adhere to and maintain the health information of every patient under Tanzania government law and international standards. The data will be accessed only by people who are in the health sector and either working under the MOHCDGEC and/or has the mandate to review health data under his/her authority. 14. What security measures are in place with the electronic immunization registry? The registry is built with robust security standards in place. No one is allowed to access the system without the password and only authorized staff will be able to access the system. 14

16 15. How long will it take to have the electronic immunization registry up and running? The electronic immunization registry was developed over a six month period and was initially tested in six health facilities before beginning roll out to all health facilities across our test region of Arusha in June Where did you test interventions, how did the testing go, and what type of interventions were tested? In Tanzania, we tested and fine-tuned interventions in six facilities in the Arusha Region in the districts of Meru and Arusha City. This testing phase included the following: Designing and testing online, Short Message Service (SMS), and paper registration of children into the immunization register. Designing and testing paper registers for low-volume facilities. Developing a data-use guide to improve data reporting accuracy. Developing data-use campaign messages to build a data-use culture and encourage health workers to use data. Encouraging peer networking among health workers using social network platform WhatsApp. 17. What will be accomplished during facility visits (touches)? Every touch will cover a certain range of activities to ensure successful implementation and a smooth roll out of interventions. These activities will include, but are not limited to training, installing equipment, a provision of new tools for the electronic or paper register, and others. Before the touches begin, a baseline survey will be conducted to accurately reflect future progress. 18. What is the responsibility of health workers during the touches? Health workers will help prepare all the data needed for our baseline assessment and will facilitate access to back enter immunization data for each child currently in the paper system. Health workers will also attend onsite trainings to learn how to successfully use BID Initiative interventions and provide feedback on the interventions as we move through implementation. 19. Why UAG was developed and what is the way forward? After Arusha was chosen as the testing region, district authorities selected members for a User Advisory Group (UAG) to play a critical role in the design, fine-tuning, and prioritization of proposed solutions and interventions that aim to improve immunization data quality and use. The UAG helps to ensure the proposed and implemented solutions are sustained by the people who will use them, involving end users early and often is critical. This also was initiated to create a sense of ownership which is crucial to the success of any initiative. 15

17 The BID Initiative aims to address the various challenges identified by the Immunization and Vaccine Development (IVD) program and other stakeholders. The UAG will partner with BID Initiative to provide valuable input and feedback that will strengthen our solutions and prioritize which set of solutions to roll out across all health facilities in the region, and eventually across the country. The UAG provides an opportunity for users to get involved in the planning and decisionmaking processes at an earlier stage and a more strategic level. It offers enthusiastic and committed members a unique opportunity to represent the needs and views of users in discussions about identified solutions and interventions. The UAG had 15 members who are from all levels of the health system in the Arusha Region. The group is co-chaired by the Arusha Regional Immunization and Vaccine Officer (RIVO) and the BID Initiative s Senior Representative. Health workers from four testing facilities which are Mareu, USA River, Ngarenaro, and Kaloleni were selected to represent other health workers in the region. These facilities were chosen because of their characteristics, for example Ngarenaro is the busiest facility in Arusha City. The UAG meets regularly and provides input on topics such as supply chain, data collection, service delivery, and community involvement to strengthen the development of BID Initiative interventions. 16