RFP - “Endline survey for reducing diagnosis delay and improving TB care-seeking pathways in Durg, Chhattisgarh, 2022

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Building on a lifetime of public service, President Clinton established the Clinton Foundation on the simple belief that everyone deserves a chance to succeed, everyone has a responsibility to act, and we all do better when we work together. For more than two decades, those values have energized the Foundation’s efforts to address big challenges, create new opportunities, and make a difference in people’s lives across the United States and around the world.

As an operating foundation, our programs and the partnerships we build work to expand economic opportunity, improve public health, confront the climate crisis, and inspire citizen engagement and service. The Foundation also operates the Clinton Presidential Center in Little Rock, which enhances these efforts by providing year-round educational and cultural programming and is home to the Clinton Presidential Library and Museum.

About the Proposal

India has the world’s highest incidence of TB with a quarter of all global patients. Around 2.69 million people fell ill with TB in 2018 while deaths were around 449,000. More than 50% of the patients seek care in largely unregulated private sector1 . Though TB has been declared a notifiable disease & drugs come under the restricted drug list, there are still significant gaps on account of under-reporting, delayed diagnosis, while patients face unsupported treatment & catastrophic out-of-pocket expenditure.

 Recognizing the need to engage the private sector, the NSP (2017-25) advised to “go where the patient goes”. Over the past few years, NTEP has rolled out a slew of initiatives to support private sector engagement

• Establishment of Patient-Provider Support Agency in major urban districts
• Provision of free diagnostics & drugs for patients in the private sector
• Financial incentives for private providers & treatment supporters along with nutritional support to all patients

 Most of the private sector engagement initiatives are directed towards GPs and specialists, managing large volumes of TB patients. However, patients have a complex care pathway and delays occur at the patient level where home remedies or a chemist consultation is sought and also at a health system level where diagnosis or testing is delayed. The GPs and specialists, managing large volumes of TB patients are rarely the first touchpoints for a patient, these are the touchpoints where diagnosis finally occurs. It is usually the pharmacists or AYUSH providers who are first approached by patients seeking care. While pharmacists rarely examine a case beyond providing symptomatic relief1 , AYUSH providers use biomedicines & diagnostic tests for acute conditions but usually require several visits to even begin suspecting TB2 .

Objectives

The endline study is planned to be designed and executed in similar scope and setup as the baseline study. A research agency would be hired to conduct the study and would be responsible for getting IRB approval, hiring the survey team, cleaning, and analysing the data and presenting a final report with findings. The primary objective of the end-line assessment is to capture the program specific indicators, compare them against established benchmarks and measure progress. The specific objectives of the assessment are described below:

Main Objectives

• Use baseline results as a benchmark to compare care seeking touch points, patient pathways and related delays
• Understand change in care-seeking behaviour after the project intervention

Sub Objectives

• Map the care seeking touch points and time taken from initial onset of symptoms to treatment initiation including time spent at each stage
• Understand the symptoms and severity at each stage, details of treatment prescribed or tests suggested.
• Understand the patient behaviour at each stage and the reasons for delays in care seeking and switching providers, factors influencing their pathways as well as basis of selection of the provider

 Deliverables:

The research agency will provide WJCF with a specified set of deliverables. The deliverables include but are not limited to: –

• Discuss and co-develop the work plan for the study with inputs from WJCF
• Finalize data collection questionnaires and guides in consultation with WJCF research team, pretesting the tools and translating the tools in the local language
• Prepare, facilitate, and obtain all the necessary ethical approvals and human research clearance from an approved Institutional Review Board (IRB)
• Select and train researchers needed for the study. For the qualitative phase ensure the researchers have prior relevant experience conducting such interviews.
• Prepare the fieldwork and logistical plan
• Any equipment needs– agency will be supplying the any equipment that will be used for data collection
• Training materials and field manuals (to be reviewed and approved by CHAI prior to finalization)
• Oversee and manage data collection and fieldwork and reporting the progress as well as challenges faced
• Provide a weekly update on research progress
• Share the final data files and transcripts for the study
• Compare the difference between the baseline and end-line across various metrics
• Analyze the data and share insights
• Prepare the final report for the study for dissemination

How to Apply

If your agency decides to submit a proposal in response to this RFP, shall send a confirmation of interest email, not later than 20th September, 2022 to the email address indiaadmin@clintonhealthaccess.org The proposal must be submitted by electronically at the email id indiaprocurement@clintonhealthaccess.org latest by 28th September 2022 by 23:59 IST.  latest by 28th September 2022 by 23:59 IST.

For any queries on the RFP, kindly address your mail to: indiaadmin@clintonhealthaccess.org latest by 20th September, 2022 23:59 IST .

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