Request for Proposal No.

: 1665-XX

Cost-Effectiveness and Cost Utility Analysis

for Weekly Iron and Folic Acid Supplementation among Adolescent Girls Program
in Cimahi and Purwakarta Districts in Indonesia

Issued by the Nutrition International “NI” (formerly known as the Micronutrient Initiative)

Deadline for receipt of proposals at the NI:

Friday, 21 September 2018

17:00 West Indonesia Standard Time

NutritionIntl.org Page 1 of 16
RFP No: 1665-XX

Contents

1. REQUEST FOR PROPOSAL NOTICE ........................................................................................... 3

2. INTRODUCTION TO THE RFP ....................................................................................................... 3
3. GENERAL INSTRUCTIONS AND CONSIDERATIONS.................................................................. 5
4. CONFLICT OF INTEREST .............................................................................................................. 5
5. GENERAL DISCLOSURES ............................................................................................................. 6
6. SUBMISSION OF PROPOSALS ..................................................................................................... 6
7. RECEIPT, EVALUATION AND HANDLING OF PROPOSALS ....................................................... 7
8. SELECTION CRITERIA................................................................................................................... 7
9. GUIDELINES FOR PREPARING PROPOSALS ............................................................................. 8
Part 1: Covering Letter and Declaration ............................................................................................. 9
Part 2: General and Technical Proposal ............................................................................................ 9
Part 3: Financial Proposal ................................................................................................................ 10
ANNEXURE – A TERMS OF REFERENCE ......................................................................................... 11
ANNEXURE – B TEMPLATE OF PROPOSED BUDGET ................................................................... 16

NutritionIntl.org Page 2 of 16
RFP No: 1665-XX

1. REQUEST FOR PROPOSAL NOTICE

1.1 Request for Proposals

Nutrition International, a non-profit organization dedicated to eliminating vitamin and mineral

deficiencies worldwide, invites proposals from competent Organizations or Agencies to
conduct “Cost-effectiveness and Cost utility analysis for weekly IFA supplementation among
adolescent girls in Indonesia”. The submission deadline is Friday, 21 September 2018.

2. INTRODUCTION TO THE RFP

2.1. Nutrition International is an Ottawa-based, international not-for-profit organization dedicated

to ensuring that the world's most vulnerable especially women and children in developing
countries get the vitamins and minerals they need to survive and thrive. Working with
impacted families, communities and nations, we are improving lives of close to 500 million
people in more than 70 countries across Asia, Africa and Latin America.
Nutrition International (NI) (formerly known as the Micronutrient Initiative), a renowned
International Development organization based out in Ottawa, Canada, has a commitment to
eradicate global ‘hidden hunger’ by implementing interventions that focus on women and
children in developing countries. It aims to generate innovative and sustainable solutions to
reduce vitamin and mineral deficiencies among women, newborns, and children. It builds on
robust evidence-based research and evaluation in order to demonstrate excellent return on
investment of scaling-up highly cost-effective micronutrient interventions. NI aspires to be a
global center of excellence in technical and programmatic support in this field.

In collaboration with key stakeholders such as governments, private sectors and civil society
groups, NI seeks to tackle the aforementioned problems that affects one third of the world’s
population. NI engages in tailoring health and nutrition strategies as well as up-scaling
existing program in various regions in the globe including Africa, Asia, the Caribbean, Latin
America and the Middle East. NI’s international Board of Directors directs its interventions
that reach approximately 500 million people in more than 70 countries.

One of NI’s key strategic goals is to enhance the global impact of micronutrient interventions
by generating cutting-edge knowledge and utilizing it to develop sound policies and
programmes while consolidating political will to achieve its vision. NI aspires to position itself
as a global center of excellence in generating scientific research in the field of micronutrient
programmes. It provides quality assurance for research and programmes while disseminating
and translating new knowledge to influence and improve national and global policies and
programmes. NI provides guidance and support on existing and future programme
evaluations and coordinates the analysis and utilization of evaluation activity results.

Background and rationale:

The prevalence of anaemia among adolescent girls and women of reproductive age (15-24
years) at national level is 18.4% (RISKESDAS, Basic Health Research, 2014). However, the
data from screening of junior-high school children in Cimahi and Bandung districts in 2013
revealed the prevalence of anaemia among adolescents in the range of 40-50% (DHO,
NutritionIntl.org Page 3 of 16
RFP No: 1665-XX

Cimahi, 2013). The data from screening of junior-high school children in Cimahi and
Bandung districts in 2013 revealed the prevalence of anaemia among adolescents in the
range of 40-50% (DHO, Cimahi, 2013). Based on national guidelines (MoH, 1998), it was
recommended to give one IFA tablet weekly for 16 weeks consecutively, plus one IFA tablet
daily during menstruation for 10 days to adolescent girls. However, the program was not
implemented as envisaged, and giving supplements during menstruation is not feasible or
highly acceptable. Some of the reasons for this are; lack of availability of IFA tablets, limited
promotion of the intervention and no clear channel for distribution. The MOH has updated the
national guideline on prevention and anemia control among adolescent girls at the end of
2016. The updated guideline is aligned with WHO recommendation in aspects of dosing
regimen; however, the formulation is not updated. Indonesia. now recommends weekly IFA
tablets throughout the year with a dosage of 60 mg elemental iron and 400 microgram folic
acid (WHO recommends Iron: 60 mg of elemental iron and Folic acid: 2800 μg (2.8 mg)
Supplementation should be given for a minimum of 6 months per year. As a minimum
scheme one supplement should be given per week with 3 months of supplementation
followed by 3 months of no supplementation after which the provision of supplements should
restart), alternatively supplementation may follow the school calendar year. In the current
supplementation scheme, it is weekly once for 52 weeks in a year.
Since end of 2016, the estimation for IFA supplements by government is forecasted and
calculated based on expected population of pregnant and postpartum women and limited
supplies IFA supplements for the adolescent girls. In 2017, the MoH has targeted to supply
IFA tablets to cover 20% of school going adolescent girls. The District Health Office (DHO)
advocates to other sectors such as education/ school to provide IFA tablets for adolescent
girls at school, while the health sector only promotes the benefits of consumption of IFA
supplementation and risk of anaemia, however the provision of IFA tablet is still not available
for all schools.
Therefore, NI Indonesia proposed a trial on Weekly Iron and Folic Acid (WIFA)
supplementation for school-going adolescent girls to reduce the prevalence of anaemia
among them and reinstate the focus of district and national government on the IFA
supplementation program for adolescent girls for improved health outcomes.

The program was demonstrated in two districts of West Java province. This program is now
planned to be scaled up two provinces of west Java and Banten in Indonesia with a change
in the program strategies.

Nutrition International plans to commission a Cost–effectiveness analysis (CEA) and Cost

Utility Analysis (CUA) for its WIFA program in Indonesia. It is the other major form of
economic evaluation that compares the economic costs with the benefits expressed in
“natural” units like years of life gained or quality adjusted years of life gained. The units
expressed are particular to a specific sector; for the case of health interventions, health
benefits are expressed in units such as health episodes, deaths, or disability-adjusted life-
years averted [Drummond et al., 1997; Gold et al., 1996; Tan-Torres Edejer et al., 2003].
CBA, CUA and CEA can assist public policy-makers in deciding how best to allocate funds
between competing projects or programmes. The purpose of CEA is a comparison of
alternative health interventions in order to identify those that make the most productive use of
resources. In this regards, the Incremental cost effective ratios (ICER) need to be computed.

NutritionIntl.org Page 4 of 16
RFP No: 1665-XX

The DALYs and QALYs need to be computed. DALYs for a disease or health condition are
calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the
population and the Years Lost due to Disability (YLD) for people living with the health
condition or its consequences. The disability-adjusted life year (DALY) is a measure of
overall disease burden, expressed as the number of years lost due to ill-health, disability or
early death. The QALY was developed because a comprehensive measure of health is
needed that allows comparisons of interventions that deal with different diseases. In the last
20-25 years, CEA has become an integral part of decision-making in many health agencies
around the world, and the reference case has been a powerful organizing principle and a
popular name for the resulting standards. Those agencies, like Australia's Pharmaceutical
Benefits Advisory Committee (PBAC), the Canadian Agency for Drugs and Technologies in
Health (CADTH), and the United Kingdom's National Institute for Health and Care Excellence
(NICE), each have their own guidelines for economic evaluations, which are designed to
promote comparability across the studies that inform their recommendations. This TOR
outlines the scope and activities to be carried out in these cost effectiveness and cost utility
analysis.

2.2. This Request for Proposals (RFP) and particularly the Guidelines for Preparing
Proposals that follow, are designed to help Respondents to produce proposals that are
acceptable to the NI, and to ensure that all proposals are given equal consideration. It is
essential, therefore, that respondents provide complete information, in the attached formats
and on the terms specified.

3. GENERAL INSTRUCTIONS AND CONSIDERATIONS

3.1. These instructions should be read in conjunction with information contained in the enclosed
Terms of Reference (TOR), and in any accompanying documents within this package.

3.2. This Request for Proposals (RFP) is to “Cost-effectiveness and Cost utility analysis for
Weekly Iron and Folic Acid Supplementation among Adolescent Girls Program in
Cimahi and Purwakarta Districts in Indonesia”.

3.3. NI is not bound to accept the lowest priced, or any, proposal. NI reserves the right to request
any (or all) Respondent(s) to meet with the NI to clarify their proposal(s) without commitment,
and to publish on its website answers to any questions raised by any Respondent (without
identifying that Respondent).

3.4. Respondents are responsible for all costs associated with the proposal preparation and will
not receive any reimbursement from the NI.

4. Conflict of Interest

4.1. Respondents must disclose in their proposal details of any circumstances, including personal,
financial and business activities that will, or might, give rise to a conflict of interest. This
disclosure must extend to all personnel proposed to undertake the work.

NutritionIntl.org Page 5 of 16
RFP No: 1665-XX

4.2. Where Respondents identify any potential conflicts they must state how they intend to avoid
any impact arising from such conflicts. The NI reserves the right to reject any proposals
which, in the NI’s opinion, give rise, or could potentially give rise to, a conflict of interest.

4.3. With respect to this condition, please be advised that the organizations that may fall within the
scope of this evaluation will include those below, with which any association must be
disclosed:
a. Nutrition International (NI)
b. The Donor who is the primary funding source for the procurement

5. GENERAL DISCLOSURES
5.1. Respondents must disclose:

5.1.1. If they are or have been the subject of any proceedings or other arrangements
relating to bankruptcy, insolvency or the financial standing of the Respondent
including but not limited to the appointment of any officer such as a receiver in
relation to the Respondent personal or business matters or an arrangement with
creditors or of any other similar proceedings.

5.1.2. If they have been convicted of, or are the subject of any proceedings, relating to:

a. criminal offence or other offence, a serious offence involving the activities of a

criminal organization or found by any regulator or professional body to have
committed professional misconduct.
b. corruption including the offer or receipt of any inducement of any kind in relation
to obtaining any contract, with the NI, or any other contracting body or authority
c. failure to fulfil any obligations in any jurisdiction relating to the payment of taxes.

6. SUBMISSION OF PROPOSALS
6.1 The Technical (only includes detail of previous survey, team composition, detailed
methodology and sample calculation) and financial proposal along with all requisite
documentation must be received in English by NI no later than Friday, 21 September 2018.

6.2 For any clarification required, please write an email to: proposalsindonesia@nutritionintl.org
with subject line including the words “CEA WIFA RFP No. 1665-XX”.

6.3 The technical and financial proposal in two separate files shall be put into a covering email
specifically indicating with subject line “Proposal for CEA WIFA RFP NO. 1665-XX” need to
be sent to email: proposalsindonesia@nutritionintl.org

6.4 Only email bids will be accepted. Only those short-listed will receive an acknowledgment and
will be called for a personal interaction, at their own cost. The interaction will be held at the NI
office in Jakarta, Indonesia.

6.5 Late proposals will not be accepted in any circumstances. Proposals received after the due
date and time will not be considered.

NutritionIntl.org Page 6 of 16
RFP No: 1665-XX

7. RECEIPT, EVALUATION AND HANDLING OF PROPOSALS

7.1. Once a proposal is received before the due date and time, the NI will:

7.1.1. Log the receipt of the proposals and record the business information
7.1.2. Review all proposals and disqualify any non-responsive ones (that fail to meet the
terms set out in these instructions), and retain the business details on file with a note
indicating disqualification
7.1.3. Evaluate all responsive proposals objectively in line with the criteria specified below
7.1.4. Inform Respondents within 6 business days of the evaluation decision being made.

7.2. The NI reserves the right:

7.2.1. To accept or reject any and all proposals, and/or to annul the RFP process prior to
award, without thereby incurring any liability to the affected Respondents or any
obligation to inform the affected Respondents of the grounds for NI's actions prior to
contract award, and
7.2.2. To negotiate - with Respondent(s) invited to negotiate - the proposed technical
approach and methodology, and the proposed price based on the Respondent’s
proposals.
7.2.3. Amend this RFP at any time.

8. SELECTION CRITERIA
8.1. Following criteria will be adopted to short list the proposals and identify suitable agencies
for the assignment. Out of the total scores 60% weight is assigned to technical and 40% to
the financial proposal. For detail, please see table 1.

Table 1: Proposal Scoring Criteria for selection of agency

Proposals
Assessment Category: Technical Proposal Weights

Capacity of Firm (A) 50% 0.0 0.0 0.0 0.0 0.0

Firm's ability to complete preparatory work
30%
(recruitment, training and finalization of tools)

Recognition and acceptance of firm among

35%
stakeholders
Adequate Professionals / Staff / Resources
35%

Realistic Plan and ability to accomplish the

50%
task (B)

Firm's clarity about methodology to be adopted

35%
to undertake the study

Firm's plan (incl. realistic timelines) for

30%
completing the study

NutritionIntl.org Page 7 of 16
RFP No: 1665-XX

Firm's ability to complete the task as per NI

35%
expectation mentioned in the TOR

Total Score - Technical Proposal (A+B) 100% 0.00 0.00 0.00 0.00 0.00

Overall weightage of Technical Proposal – 60%

Assessment Category: Financial

Presented reasonable estimate of fees 25%

Takes into consideration all potential field

30%
expenses (i.e. no obvious omissions)

Presented realistic estimate for field expenses 25%

Reasonable estimate for completing the

20%
research, analysis, report writing expenses

Total Score - Financial Proposal 100% 0.00 0.00 0.00 0.00 0.00
Overall weightage of Financial Proposal – 40%
Total Weighted Score (Technical + Financial) 0.00 0.00 0.00 0.00 0.00

8.2. The Evaluation Team may, in its sole discretion, establish a short-list of Respondents
based on the Technical Scores of the Respondents (the “Short-listed Respondents”) for
the purpose of conducting interviews. If NI short-lists the Respondents, it will short-list the
Respondents with the highest scores.

8.3. Only the Short-listed Respondents will be interviewed. The number of Respondents short-
listed for an interview is in the sole discretion of NI.

8.4. Interviews of Short-listed Respondents will be carried out by the Evaluation Team or a
sub-group of the Evaluation Team. The Evaluation Team will score each Short-listed
Respondent based on the quality of the Respondent’s interview (the “Interview Score”).

8.5. The successful Respondent will be expected to enter into a Contract with the N I for
the duration of the Work. In the event of a Contract award, all the terms and conditions
of the RFP, including the Respondent’s response, will normally form part of the
Contract.

9. GUIDELINES FOR PREPARING PROPOSALS

9.1 Language: Proposals must be submitted in English.

9.2 Structure: Proposals must be set out in four main parts:

Part 1: Covering Letter and Declaration

NutritionIntl.org Page 8 of 16
RFP No: 1665-XX

Part 2: General and Technical Proposal

Part 3: Financial Proposal

Part 1: Covering Letter and Declaration

Proposals must be accompanied by a covering letter on company-headed paper showing the full
registered and trading name(s), trading and registered office address and business number of the
Respondent. The letter must be signed by a person of suitable authority to commit the Respondent to
a binding contract. It must quote the RFP number and title, and include the following declarations:

a. We have examined the information provided in your Request for Proposals (RFP) and offer
to undertake the work described in accordance with requirements as set out in the RFP.
This proposal is valid for acceptance for 6 months and we confirm that this proposal will
remain binding upon us and may be accepted by you at any time before this expiry date.

b. We accept that any contract that may result will comprise the contract documents issued
with the RFP and be based upon the documents submitted as part of our proposal.
c. Our proposal (Technical and Financial) has been arrived at independently and without
consultation, communication, agreement or understanding (for the purpose of restricting
competition) with any other Respondent to or recipient of this RFP from the NI.

d. All statements and responses to this RFP are true and accurate.

e. We understand the obligations regarding Disclosure as described in the RFP Guidelines

and have included any necessary declarations.

f. We confirm that all personnel named in the proposal will be available to undertake the
services.

g. We agree to bear all costs incurred by us in connection with the preparation and
submission of this proposal and to bear any further pre-contract costs.

h. I confirm that I have the authority of [insert name of company] to submit this proposal and
to clarify any details on its behalf.

Part 2: General and Technical Proposal

The General and Technical section should be structured as follows:

 Section 1: Your understanding of the TOR provided with this RFP. You may also propose
qualifications to the TOR that you consider may enhance the value of the outcome to the NI.

 Section 2: Technical Response: a concise description of the methodology and approach that are
proposed for the delivery of the TOR and an implementation plan in the form of a work breakdown
analysis. This should describe the activities to be undertaken, the deliverables / outputs and the
milestone and completion dates (grouped by phase where appropriate). The dependency of any
activities and associated results on earlier results needs to be clearly indicated.

NutritionIntl.org Page 9 of 16
RFP No: 1665-XX

 Section 3: Personnel Profile: names, designation and Curricula Vitae (CV) of personnel
assigned to work on the Project. CVs must not exceed 3 pages, but must include:
o a brief summary of the professional competencies of the individual relevant to the
Scope of Work/TOR
o a chronological list of relevant professional experience starting with the most recent and
showing key achievements / responsibilities
o brief details of qualifications educational / technical / professional / other
o language competencies other than English (if required to undertake the ToR)

 Section 4: Personnel Inputs: include name of personnel, and person days with reference to
activity to be undertaken. Do not include any reference to fees. This will constitute a
confirmation that all personnel will be available to provide the required services for the duration
of the contract

 Section 5: Company Information: proof of incorporation for registered incorporated entities,

proof of registration for registered entities.

Section 6: Previous experience: documentation demonstrating the Respondent’s experience

in the proposed area of work. This should include contact details for key clients who may be
contacted in respect of the Respondent’s relevant prior work.

Part 3: Financial Proposal

 The Financial proposal must contain the expected budget for accomplishing the complete
work with detailed breakup. All amounts quoted must be in IDR. The Respondent
should provide a detailed budget, based on the format attached as Annexure-B.

 Fees should be inclusive of all VAT, Taxes, Insurance and standard training
management/overhead cost.

 Please note that no fees are payable for travel days.

NutritionIntl.org Page 10 of 16
RFP No: 1665-XX

ANNEXURE – A

TERMS OF REFERENCE

Terms of Reference
of

Cost-Effectiveness and Cost Utility Analysis

for Weekly Iron and Folic Acid Supplementation among Adolescent Girls Program
in Cimahi and Purwakarta Districts in Indonesia

Introduction to Nutrition International

Nutrition International (NI) formerly known as the Micronutrient Initiative (MI), a renowned International
Development organization based out in Ottawa, Canada, has a commitment to eradicate global ‘hidden
hunger’ by implementing interventions that focus on women and children in developing countries. It aims to
generate innovative and sustainable solutions to reduce vitamin and mineral deficiencies among women,
newborns, and children. It builds on robust evidence-based research and evaluation in order to demonstrate
excellent return on investment of scaling-up highly cost-effective micronutrient interventions. NI aspires to
be a global center of excellence in technical and programmatic support in this field.

In collaboration with key stakeholders such as governments, private sectors and civil society groups, NI
seeks to tackle the aforementioned problems that affects one third of the world’s population. NI engages in
tailoring health and nutrition strategies as well as up-scaling existing program in various regions in the globe
including Africa, Asia, the Caribbean and Latin America. NI’s international Board of Directors directs its
interventions that reach approximately 500 million people in more than 70 countries.

One of NI’s key strategic goals is to enhance the global impact of micronutrient interventions by generating
cutting-edge knowledge and utilizing it to develop sound policies and programmes while consolidating
political will to achieve its vision. NI aspires to position itself as a global center of excellence in generating
scientific research in the field of micronutrient programmes. It provides quality assurance for research and
programmes while disseminating and translating new knowledge to influence and improve national and
global policies and programmes. NI provides guidance and support on existing and future programme
evaluations and coordinates the analysis and utilization of evaluation activity results.

Background
The prevalence of anaemia among adolescent girls and women of reproductive age (15-24 years) at
national level is 18.4% (RISKESDAS, Basic Health Research, 2014). However, the data from screening of
junior-high school children in Cimahi and Bandung districts in 2013 revealed the prevalence of anaemia
among adolescents in the range of 40-50% (DHO, Cimahi, 2013). The data from screening of junior-high
school children in Cimahi and Bandung districts in 2013 revealed the prevalence of anaemia among
adolescents in the range of 40-50% (DHO, Cimahi, 2013). Based on national guidelines (MoH, 1998), it was
recommended to give one IFA tablet weekly for 16 weeks consecutively, plus one IFA tablet daily during
menstruation for 10 days to adolescent girls. However, the program was not implemented as envisaged,
and giving supplements during menstruation is not feasible or highly acceptable. Some of the reasons for
this are; lack of availability of IFA tablets, limited promotion of the intervention and no clear channel for
distribution. The MOH has updated the national guideline on prevention and anemia control among
adolescent girls at the end of 2016. The updated guideline is aligned with WHO recommendation in aspects
of dosing regimen; however, the formulation is not updated. Indonesia. now recommends weekly IFA
tablets throughout the year with a dosage of 60 mg elemental iron and 400 microgram folic acid (WHO
recommends Iron: 60 mg of elemental iron and Folic acid: 2800 μg (2.8 mg) Supplementation should be
given for a minimum of 6 months per year. As a minimum scheme one supplement should be given per

NutritionIntl.org Page 11 of 16
RFP No: 1665-XX

week with 3 months of supplementation followed by 3 months of no supplementation after which the
provision of supplements should restart), alternatively supplementation may follow the school calendar year.
In the current supplementation scheme, it is weekly once for 52 weeks in a year.
Since end of 2016, the estimation for IFA supplements by government is forecasted and calculated based
on expected population of pregnant and postpartum women and limited supplies IFA supplements for the
adolescent girls. In 2017, the MoH has targeted to supply IFA tablets to cover 20% of school going
adolescent girls. The District Health Office (DHO) advocates to other sectors such as education/ school to
provide IFA tablets for adolescent girls at school, while the health sector only promotes the benefits of
consumption of IFA supplementation and risk of anaemia, however the provision of IFA tablet is still not
available for all schools.
Therefore, NI Indonesia proposed a trial on Weekly Iron and Folic Acid (WIFA) supplementation for school-
going adolescent girls to reduce the prevalence of anaemia among them and reinstate the focus of district
and national government on the IFA supplementation program for adolescent girls for improved health
outcomes.
The program was demonstrated in two districts of West Java province. This program is now planned to be
scaled up two provinces of west Java and Banten in Indonesia with a change in the program strategies.

Nutrition International plans to commission a Cost–effectiveness analysis (CEA) and Cost Utility Analysis
(CUA) for its WIFA program in Indonesia. It is the other major form of economic evaluation that compares
the economic costs with the benefits expressed in “natural” units like years of life gained or quality adjusted
years of life gained. The units expressed are particular to a specific sector; for the case of health
interventions, health benefits are expressed in units such as health episodes, deaths, or disability-adjusted
life-years averted [Drummond et al., 1997; Gold et al., 1996; Tan-Torres Edejer et al., 2003]. CBA, CUA and
CEA can assist public policy-makers in deciding how best to allocate funds between competing projects or
programmes. The purpose of CEA is a comparison of alternative health interventions in order to identify
those that make the most productive use of resources. In this regards, the Incremental cost effective ratios
(ICER) need to be computed. The DALYs and QALYs need to be computed. DALYs for a disease or health
condition are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the
population and the Years Lost due to Disability (YLD) for people living with the health condition or its
consequences. The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed
as the number of years lost due to ill-health, disability or early death. The QALY was developed because a
comprehensive measure of health is needed that allows comparisons of interventions that deal with different
diseases. In the last 20-25 years, CEA has become an integral part of decision-making in many health
agencies around the world, and the reference case has been a powerful organizing principle and a popular
name for the resulting standards. Those agencies, like Australia's Pharmaceutical Benefits Advisory
Committee (PBAC), the Canadian Agency for Drugs and Technologies in Health (CADTH), and the United
Kingdom's National Institute for Health and Care Excellence (NICE), each have their own guidelines for
economic evaluations, which are designed to promote comparability across the studies that inform their
recommendations. This TOR outlines the scope and activities to be carried out in these cost effectiveness
and cost utility analysis.

Outcome measures in Cost-Effectiveness Analyses (CEA):

Examples of outcome measures reported are:
• Cases detected (cervical cancer);
• Symptom-free days (asthma);
• Cases prevented (myocardial infarction)

Broadest possible outcome measure in CEA: life years gained

• Cost per additional cancer detected
NutritionIntl.org Page 12 of 16
RFP No: 1665-XX

• Cost per myocardial case prevented

• Cost per additional life year gained
Outcome Measures in Cost-Utility Analyses (CUA)
• Quality-Adjusted Life Years (QALYs)
• Disability-Adjusted Life Years (DALYs)
Incremental cost-effectiveness ratio (ICER):
• Cost per QALY gained
• Cost per DALY averted
Outcome Measures in Cost-Benefit Analyses (CBA)
• Health outcomes are valued in monetary terms

Incremental Cost-effectiveness Ratio (ICER)=

Objective
To conduct a detailed cost-effectiveness and cost utility analyses including technical and economic
feasibility of the scaling up of these programs to the entire 34 provinces in the country. The specific
objectives are to:
 estimate the Incremental Cost – Effectiveness Ratio (ICERs)
 compare the monetary cost of the intervention with the monetary value of the outcome in terms of
increased productivity and lower healthcare system costs
 understand the additional budgetary allocations required by the provincial and central Governments
of Indonesia
 influence and motivate the policy makers in allocating additional resources.
 compare it across different countries in the Asia and Africa region, where Nutrition International is in
operation

Scope of Work
Suggested Summary of Steps in Measuring Costs
 Collect appropriate budget documents (financial statements, proposal budgets, other). Identify the direct
costs of the program or intervention. Allocate a portion of shared and overhead costs, such as
management salaries, to the intervention or program. Add all direct and indirect costs that are to be
included.
 Fixed costs : Total remains constant regardless of the volume of activity or numbers of patients served
for example, special piece of equipment used for all interventions, Variable costs, Costs that increase or
decrease with changes in volume of activity
 Identify all of the benefits of the program. 2. Group them into: a) those to be formally included in the
benefit-cost ratio calculation; b) those to be used to supplement and reinforce the CBA; c) those that
are less important and can be excluded. 3. Measure your results and convert them to dollar savings,
using secondary data, if needed. 4. Identify and measure those benefits that can’t be expressed in

NutritionIntl.org Page 13 of 16
RFP No: 1665-XX

terms of dollars. 5. Combine Canadian and US dollar savings and non-dollar benefits to explain the
effectiveness of the program.
 Review, assess and document the program.
 Undertake scoping assessment of manufacturing and procurement of micronutrients like; WIFA, IFA,
Zinc, Vitamin A, MNP scoping study to map the local production and importation of WIFAS specifically
for adolescent girls in accordance with the WHO recommended formulation and country situation
 Assess estimated requirements of additional budgetary allocation by the Government of Indonesia.
 Develop guidelines for the scaling up of the program
 Identify the role of development partners including NI to strengthen the program.
 Presentation of the key findings and recommendations of the analysis at a high level stakeholders
meeting, academia, civil society representatives and development partners, for consensus and
agreement.

Timeline
October 2018 to February 2019.

Deliverables
1. All raw data in hard and electronic form in excel and other relevant software like; WHO-CHOICE tools,
PopMod, One health tool or TreeAge.
2. Hard and soft copy versions of the report in both narrative and power point presentation.
The report will cover the following including an executive summary,
 Review of existing program activities.
 Scoping assessment of manufacturing and procurement of IFA for pregnant women and WIFA
for adolescent girls, Zinc and Vitamin A assessment for the technical and economic feasibility,
MNP for children and women
 Guidelines and procedural manual for scaling up of the intervention
 Potential role for development partners and NI
 Recommendations.
3. Presentation to stakeholders
4. Final Report
5. Policy and advocacy briefs

Required Expertise
For the purpose of this assignment, the consultant or consultancy agency should have the following:
 Agency/Consultant with at least 5-7 years of experience in conducting similar assignments including
desk review and cost-effectiveness studies, preferably for nutrition and health research studies.
 Agency/Consultant should also have post-graduate or equivalent qualification/ degree in Economics
and/or Public Health or Nutrition with substantial experience with cost-effectiveness analytics
 Experience in providing consulting services and excellent track record of completion of tasks according
to timelines.
 Agency/Consultant should have excellent reporting and writing skills.

NutritionIntl.org Page 14 of 16
RFP No: 1665-XX

References and additional resources and guidance

CEA/ CUA/ CBA

WHO-CHOICE Methods report the costs and effects of a wide range of health interventions in the 14
demographic sub-regions of WHO (world divisions made based on geographical location and demographic
profiles). The results of these cost-effectiveness analyses are assembled in sub-regional databases.
PopMod:
o http://www.who.int/choice/cost-effectiveness/methods/en/
o http://www.who.int/choice/publications/p_2003_popmod_fourstate.pdf?ua=1

OneHealth Tool: is a software tool designed to strengthen health system analysis and costing and to
develop financing scenarios at the country level. The primary purpose of the tool is to assess health
investment needs in low- and middle-income countries, for a planning horizon of 3-10 years into the
future. https://www.internationalhealthpartnership.net/en/tools/one-health-tool/
and http://www.avenirhealth.org/software-onehealth
http://www.who.int/choice/publications/p_2003_generalised_cea.pdf
http://www.eunethta.eu/sites/5026.fedimbo.belgium.be/files/2015-04-29-ECO-GL_Final%20version_0.pdf
https://www.nice.org.uk/Media/Default/About/what-we-do/Into-
practice/Costing_Manual_update_050811.pdf
http://www.who.int/choice/toolkit/cost_it/en/
https://www.herc.ox.ac.uk/research/design-and-evaluation-of-healthcare-systems/?keyword=cost-
effectiveness-analysis

QALYs
http://www.who.int/mental_health/media/en/76.pdf
http://euroqol.org/
https://www.aaos.org/uploadedFiles/EQ5D3L.pdf

NutritionIntl.org Page 15 of 16
RFP No: 1665-XX

ANNEXURE B
TEMPLATE OF PROPOSED BUDGET

SUMMARY (Total Proposed Budget)

No ITEMS Amount (IDR)
1 Personnel Fees
2 Expenses
Subtotal 1+2
Overhead cost
Total Proposed Budget

Detailed Proposed Budget

No Activity Quantity Unit Cost/Unit Amount (IDR)

A PERSONNEL FEES

Name:
1 Days x
Position:

Name:
2 Days x
Position:

3 (add as needed) Days x

Subtotal A. PERSONNEL FEES

B EXPENSES (please adjust and specify all detailed expenses, for example meeting packages, travel, etc)

1 Consultation meeting packages

2 Travel

3 Communication

4 Reporting

5 (add as needed)

Subtotal B. EXPENSES
Subtotal A+B
Overhead cost
Total

NutritionIntl.org Page 16 of 16