Government of Lesotho Ministry of Health: Request for Expression of Interest


World Bank-supported Nutrition and Health Systems Strengthening Project (NHSSP)

Terms of Reference

Gap Assessment of Equipment in Regional and District Hospitals in Lesotho and procurement support to fill gaps agreed

Bid Ref: LS-MOH-151706-CS-CQS

Issue Date 27-02-2020


The Ministry of Health of Lesotho with the support of the World Bank seeks to hire a consultancy firm to conduct a gap assessment of basic medical equipment of regional and district hospitals measured against, among others the latest and most relevant WHO checklist for basic equipment. 

Lesotho has 17 district/regional hospitals in the public and church-owned sector: 2 of regional and 15 of district hospitals. District/regional hospital have a size of slightly more than 100 beds. There is a 425-bed PPP referral hospital network at the apex of the healthcare system that is not part of this assessment. Among these facilities, patients’ referrals are very inefficient. The PPP referral hospital network accommodates 53 percent of inpatients with a bed occupancy rate of 74 percent on average. The rest of the hospitals in the country is busy with an average of 32 percent bed occupancy rate. On Human Resource for Health, doctors seem to be seriously under-staffed in comparison to the WHO AFRO regional average.

A recent assessment suggests that, owing to investments by government and US government support, structural quality remains satisfactory at primary and tertiary levels, but not at the secondary level: critical gaps in laboratory testing and functional equipment are found in district and regional hospitals.

The new World Bank NHSSP will support district/regional hospitals with the provision of medical equipment to ensure hospitals have the relevant basic equipment available to treat patients. While 138 out of 145 health facilities have been refurbished and equipped by the Millennium Challenge Corporation, there are still equipment gaps reported in regional and district hospitals. Based on these investments, structural quality remains satisfactory at these levels of care. In fact, gaps in the availability of key amenities – such as water, electricity, bio-medical waste management, drugs storage safety are not large. However, half District hospitals assessed reported non-functioning of many of clinical equipment, some comprising very basic apparatus. Among other guiding tools, the assessment will use the latest and most relevant WHO checklist for basic equipment and the treatment of diseases referenced in the Lesotho Health Benefit Package (being developed with the support from the World Health Organization (WHO)) that might be complemented by a quick review of the country’s epidemiologic profile based on most recent data. Based on this gap assessment, the World Bank-supported Nutrition and Health Systems Strengthening Project (NHSSP) will procure medical equipment identified in the gap assessment and affordability. The NHSSP will also continue to provide training to improve quality of care.

Objective of Study

The objective of this assessment is to: 

  1. Develop the target of equipment based on the outcome of the two-phase assessment, and plans and tool development
  2. Inform the equipment needs of each facility factoring in patients’ load, type of patients, staffing capacities, accountability, incentives, service, maintenance, asset management, costs and benefits. In particular, the consultant will do an option analysis for Lesotho district hospitals over the operability of the Cylinder oxygen; Oxygen generator for the entire hospital, and bedside oxygen concentrators. The analysis would include criteria such as size of the hospital, whether the hospital has existing oxygen pipelines, distance from suppliers. The consultant will also explore the option (rapid assessment) of establishing a Prehospital and Emergency Care Services including: first responder and rescue services, pre-hospital ambulance services, hospital-based emergency care, and, the underlying communications, dispatch and information systems.
  3. Provide a framework for drafting of bidding documents for the procurement of the equipment to fill the gaps identified, under the NHSSP procurement regimen as agreed upon in the Government – World Bank financing agreement. The bidding documents will include at a minimum: specifications, pricing schedules, evaluation criteria and model conditions. The consultant will also propose drafts of call for Expression of Interest, and Request for Proposals. These documents will be issued by the Government. Risk mitigation measures will apply to avoid potential conflicts of interest between the firm conducting the equipment gap assessments and candidate firms bidding for equipment supply.

The assessment should ultimately produce a priority list of equipment that would yield maximum value for money for hospital care in the country. 

Approach and Methods

The gap assessment will include quantitative and qualitative data targets, collection and analysis. 

  1. Determine the target to measure the gap against the latest and most relevant WHO checklists of basic equipment and any other relevant references that would be agreed upon. The inception report will include versions and checklist sections that would guide the gap assessment. These will be presented and agreed upon with the Government.
  2. Collecting quantitative and descriptive data, including among other things:
  • Conduct a remote desk review of existing information related to the hospital equipment stock, gap against target agreed between the World Bank and the Government and planned investment with Government of Lesotho own resource and other donors.
  • Review previous procurement results in comparable settings with Lesotho of key equipment bought for the hospitals and determine what happened to the equipment to inform how this equipment is best bought, retained, controlled and maintained to ensure ongoing good asset management. 
  • Extract and analyze existing hospital administrative data, as well as data collected in monitoring reports of hospitals (by government and donors).
  • Physically conduct hospital and audit/review to obtain data on existing equipment, their relevance, and their status.
  1. Qualitative interviews with key informants: Conduct key informant interviews with hospital managers, staff, asset controllers, equipment auditors and Ministry of Health authorities (asset management) to complement the quantitative analyses. 

Data Analysis 

The data analysis on the equipment should ultimately respond to the following question/concern:

  • For each of the 17 regional/district hospitals assessed, in order of priority, what is the list of equipment that would allow it to optimally operate and meet the target established?
  • Provide an indication of the framework for drafting of bidding documents to be used to procure/lease the necessary equipment. The bidding documents will include at a minimum: specifications, pricing schedules, evaluation criteria and model conditions. The consultant will also propose drafts of call for Expression of Interest, and Request for Proposals. These documents will be issued by the Government. Risk mitigation measures will apply to avoid potential conflicts of interest between the firm conducting the equipment gap assessments and candidate firms bidding for equipment supply.

Presentation and Reporting

The gap target (point 1 above) shall be submitted to the MOH in the form of a written report referring to the appropriate equipment target to be applied and to be applied. The equipment target shall be prioritized by most critical. Once the gap target is approved by MOH (with support from the Bank), the consultant shall begin the gap assessment against the approved target set.

The gap assessment shall be submitted to the MOH in the form of a written report detailing an executive summary, and a comprehensive report detailing as a minimum: 

  • the methodology used to compile the report
  • the agreed target for gap measurement (reminder of the benchmark set to establish gaps); 
  • the gaps found at each hospital;
  • the likely costs of filling gaps for each hospital;
  • the benefits of filling the gaps for each hospital;
  • any observations on government vision, existing equipment control/asset management and other stakeholders;
  • recommendations for future asset management of equipment identified in the gap analysis;
  • if equipment identified requires ongoing maintenance contract support, detail the estimated ongoing maintenance costs over the anticipated life of the equipment
  • Provide an excel spreadsheet annex listing each equipment gap found across Lesotho for all hospitals together, detailing among other things the equipment, quantity, the priority, the benefit summary, the hospital, the estimated purchase price, the estimated ongoing maintenance cost and a total life cost (adding price and maintenance together). This must be in a format that can easily be sorted by the Ministry of Health so they can order the spreadsheet by any combination of among other things, equipment category, specific type, priority, quantity, purchase price, benefit summary, maintenance costs, and/or total life cycle cost. This spreadsheet must able to support MOH in analyzing costs, priorities and producing the final schedule of equipment to buy in a consolidated manner. 
  • Providing another excel spreadsheet annex with the source findings, analysis and a thoroughly detailed set of data/information for each hospital.
  • A presentation of the study findings shall be made to the MOH and the World Bank to accompany finalization of the deliverables. This will include a power point of the methodology, gap target, findings, analysis and recommendation that can be shared with the MOH and the Bank. 
  • The above report, excel spreadsheets, methodology used, findings and power points etc will also be made freely available to the MOH and World Bank for learning and potential use in other projects.

Workplan and Deliverables calendar

The work plan is divided into two phases. The first phase will consist of conducting and validating the gap assessments, and the second one will incorporate the Government vision and other expectations in the gap assessment.

The table below summarizes the set of deliverables:

Phase 1

Finalize gap target measures: initial list of references to be usedApr. 15, 2020

Present an inception report which includes findings from the desk review, and a detailed method and plan for stakeholders’ consultations and hospital-based data collectionMay. 20, 2020

Data collection in 17 hospitals finalized and cleanedApr 6, 2020

Validated report and tools on the gap assessment and procurement plans Apr 30, 2020
Phase 2

Incorporation of Government vision and other expectations in the gap assessment and proposed procurement plan and toolsJul. 23, 2020

Validated final report and presentationAug. 15, 2020

Duration of Consultancy and Staff Requirements

The consultancy will be for the period from April 15, 2020 to August 15, 2020.


The consultants will mobilize a strong team of medical and public health professionals who have experience with research public health and hospital issues in developing countries and specifically familiar with medical technology/equipment.  

The team must have:

Key staff Qualifications

  1. Researcher, Healthcare delivery system specialist or equivalent qualification with a minimum of Master’s degree, and
  2. Medical Technologist – Specialist/ Medical Equipment Planner with a tertiary qualification.

Experience and requirements

  • Professional staff with at least 5 equipment gap assessment in level 2/3 hospitals;
  • Previous experience (at least 5 year’s / at least 1 evaluation in each area – Public health facilities & medical technology) with evaluation of public health system and medical technology/medical equipment management program in low-income countries, including medical equipment asset management;
  • Ability to conduct interviews in English;
  • Presence in Maseru, Lesotho and readiness to stay in Lesotho for extended period of time required to design, conduct and validate the surveys.
  • 5 years’ experience in writing unbiased specifications, bidding documents and procurement of the basic medical equipment envisaged under the scope of this project
  • No conflict of interest with the Ministry, Hospitals under the scope of this project, medical equipment agents, suppliers and/or manufacturers  


The Consultants will work under the guidance and supervision of the MOH team, the Project Implementation Unit, with support from the World Bank. 

The critical success factors for this project are (or Key performance indicators are):

  1. Quality of the consultations and field visits
  2. The feasibility of the targets
  3. The quality of the written deliverables (e.g. the framework to be used in the bidding process)


Attention of interested Consultants is drawn to paragraph 1.9 of the World Bank’s Guidelines: Selection and Employment of Consultants by World Bank Borrowers, January 2011 (revised July 2014). (“Consultant Guidelines”), setting forth the World Bank’s policy on conflict of interest.  

The Consultancy will be selected in accordance with the Consultant Qualification Selection (CQS) method set out in the Consultant Guidelines.

Further information can be obtained at the address below during office hours 0800 to 1630 hours from Monday to Friday.

All applications should be in English and must be properly filled in and be couriered with the subject “Expression of Interest for “Gap Assessment of Equipment in Regional and District Hospitals in Lesotho and procurement support to fill gaps agreed” or hand delivered to the below address.

Expressions of interest must be delivered in a written and hard Copy form to the address below in person, or send via electronic mail below on or before 19th March, 2020 1200 hour Local time.

Attn: Moeketsi M-Procurement Specialist and copy Procurement Manager 

Procurement Unit, Ground Floor, Ministry Of Health Headquarters ,Corner Constitution Road & Linare Road P. O. Box 514, Maseru 100, Lesotho, Tel:(+266) 27323277 or email. [email protected]

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