Terms of Reference for Local Consultant to Develop a Financial Sustainability Plan for the Rwanda Medical Supply Ltd (RMS)
Palladium is a global leader in the design, development and delivery of Positive Impact - the intentional creation of enduring social and economic value. We work with foundations, investors, governments, corporations, communities and civil society to formulate strategies and implement solutions that generate lasting social, environmental and financial benefits.

Terms Of Reference
Local Consultant to Develop a Financial Sustainability Plan for the Rwanda Medical Supply Ltd (RMS)
Company Information
Palladium is a global leader in the design, development, and delivery of Positive Impact - the intentional creation of enduring social and economic value. We work with foundations, investors, governments, corporations, communities, and civil society to formulate strategies and implement solutions that generate lasting social, environmental, and financial benefits. For the past 50 years, we have been making Positive Impact possible. With a team of more than 2,500 employees operating in 90 plus countries and a global network of more than 35,000 technical experts, Palladium has improved - and is committed to continuing to improve - economies, societies and most importantly, people's lives.

Project Summary
Palladium is implementing the Rwanda Integrated Health Systems Activity (RIHSA), a three-year USAID-funded task order (720-696-20-F-00001) designed to support the Ministry of Health in strengthening Rwanda’s health system to provide quality health care for Rwandans while building the capacity of the Government of Rwanda (GOR) to move away from a donor-financed health system towards a self-reliant system. The project is aimed at achieving two major objectives:
• Reduce financial barriers to health care through a mix of public and private interventions and provide tools for improved domestic resource mobilization and improve health care financing for the GOR.
• Improve the quality of essential health services at national, facility and community levels utilizing a health systems approach.
Through a focus on financing and quality, USAID-RIHSA provides technical assistance to the GOR on various strategies, tools and approaches that will allow Rwanda to sustainably fund its healthcare system and provide quality care at all levels. The Activity is implemented by a consortium led by Palladium International LLC (Palladium) in partnership with RTI International, the Council for Health Service Accreditation of Southern Africa (COHSASA), Zenysis Technologies, and the Rwanda Agency for Accreditation and Quality of Healthcare (RAAQH).


Background and Justification
Achievement of Universal Health Care (UHC) is a key priority for the Government of Rwanda (GOR), and various policies, strategies, processes, and structures have been put in place towards this goal. The UHC agenda embodies the health rights of all Rwandans as enshrined in the national constitution (Article 41)[1].
The people-centred focus of the Vision 2050 (“The Rwanda We Want”) manifests this health right in its socio-economic development strategies. Complementary to this is the current Health Sector Strategic Plan (HSSP IV) which has the objective to ensure universal accessibility (in geographical and financial terms) to equitable and affordable quality health services (preventative, curative, rehabilitative and promotional services) for all Rwandans. One of the priorities of the HSSP IV is to ensure sustainable access to quality, affordable, and efficacious medicines, and medical products by ensuring sustained availability of medical products and health technologies, as well as strengthening the capacity in supply chain management systems.

The incorporation of the Rwanda Medical Supply Limited (RMS) as a state-owned enterprise (SOE) is timely as it is strategically positioned to contribute towards the strategic objectives of the HSSP IV. For instance, the RMS seeks to be the leading supplier of health products and medical technologies to the Rwandan public through cost-efficient supply chain management and has the objective “to ensure availability of medicines, medical supplies, and consumables in the right quantity, with the acceptable quality, to the right place and customers, at the right time and with optimum cost to the Rwandan population”. RMS plans to achieve this by managing the medicines supply chain in the country through procurement, storage and distribution of drugs, medical supplies, and consumable to all public health facilities.

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To fulfil its goals, the RMS will need to improve its processes, infrastructure, internal human capacities, strategic purchasing, and overall financial strength. Currently, for example, due to the lack of resources to expand its storage capacity and related logistics (including transportation), the RMS is unable to leverage economies of scale and strategically purchase bulk supplies of essential medicines and medical commodities. If these supply chain challenges persist, the healthcare system in Rwanda will not be able to address the increasing occurrence of drug stock outs at health facilities, hence compromising the quality of health care provision and exposing households to the risk of catastrophic health expenditures.
To date, the RMS have depended on external funding to finance some of its activities. Its current strategic plan maps out a sustainable pathway to the future, but there is no clear financial sustainability plan defining and identifying current and future sustainable streams of revenue to the company. Thus, with support from USAID Rwanda Integrated Health Systems Activity (RIHSA), RMS is commissioning the development of a comprehensive Financial Sustainability Plan to explore and define both a medium and a long-term financing plan.

Purpose and Statement of Work
The goal of this technical assistance is to support the RMS to identify core opportunities to increase their financial sustainability, through a detailed review of current revenue streams and activities to identify a clear plan. The financial sustainability plan will be completed in direct coordination with the RMS to promote recommendation adoption and feasibility of accomplishment within the current structure. To support this, RMS will provide detailed financial, operational and technical information to assist in conducting a detailed mapping of current activities and revenue streams being managed throughout its network. Based on this information, mapping of current and future revenues and operations need to be completed.
1. Financial mapping of current operations will be conducted by functional activity: procurement/supply planning, warehousing operations at both national and regional levels (e.g., receiving, storing/put-away, routine stock checks), transportation management (e.g., route planning, driver salaries and per diem, truck purchase and depreciation), MIS tools (warehouse, transportation, financial management systems), and administration (e.g., accounting, human resources [HR]). Mapping will identify areas of efficiency/inefficiency and discussion will focus on areas taking the most and least resources as measured by industry key performance indicators (KPI). As a result, opportunities for cost containment opportunities and efficiency gains will be recommended to the RMS.
2. Revenue mapping of all streams (current and potential) will need to be identified by client or client type (donor, I/NGO and public and private sector). Based on the revenue streams, there will need to be a review of what is needed to win and maintain these revenues in terms of space, fleet, systems, and human resources. Each stream will require resources to plan, source, deliver, return, and enable operations.

Based on this cost and revenue mapping exercise, key recommendations on how to obtain, where to invest and when to scale current operations will be presented to RMS. Strategic planning tools like the business model canvas could provide tools in presenting ideas and ways to stimulate internal discussion with RMS. This could be coordinated with management in a retreat or off-site setting that will encourage company leadership to discuss their ideas in an open and non-judgmental environment.
As recommendations are presented and accepted by the RMS, the selected recommendations will be investigated for financial success through evidence-based scenario planning. This will include:
1.Profitability analysis on each recommendation against the investment needed to obtain and maintain the proposed activity as financially viable
2.Project the long-term impact of the recommendation on RMS’s sustainability
3.Identify the tools required to make the recommendation possible
4.Work with RMS to identify a lead implementer of the recommendation
5.Provide guidance to RMS financial personnel on how to track the progress of the recommendation for senior management oversight
With this scenario planning, support RMS to identify the priority recommendations with the strongest growth potential. Each priority intervention will be defined, along with impact, cost of investment and opportunity for growth within the financial sustainability plan considering current and future opportunities.

Expected deliverables
The table below lists the seven key deliverables that will be required from the consultant to complete the financial sustainability plan:
# Activities Description Timeframe
1 Identify strategic planning tool Business model canvas, SWOT analysis or another interactive business planning tool to be agreed upon First 15 days of contract
2 Schedule and host a one-day
off-site management meeting Discuss issues from the business canvas and uncover five to eight ideas that RMS’s management team has identified. Rank these opportunities in terms of potential and feasibility First 30 days of contract
3 Review of historical
financial statements Analyse audited financial statements to evaluate cost rationalization opportunities. Evaluate inventory efficiency ratio 15 days after receipt of audited financial statements
4 Scenario Analysis Revisit the opportunities uncovered in the management off-site to begin to develop and assess potential investment scenarios Month 2
5 Develop and refine financial projection model - Using the historical financial statements as data for a model base case, begin developing a five-year projection model that incorporates the ability to evaluate an aggressive and conservative case
- a business analytical framework for e.g., net present value (NPV) evaluating investments associated with the revenue streams identified
- Ensure that the modelling capability is transferred to RMS staff Month 2-3
Final report Submit a final report that contains results from the analysis, proposes recommendations and guides RMS on next steps to accomplish them Month 5
Estimated Level of Effort
The Sustainability Plan is expected to be developed through a collaborative effort between the USAID RIHSA staff (based in Rwanda and at the Palladium HQ) and two consultants (an international and a local one). The International consultant will be the lead subject matter expert. This assignment is expected to be implemented within five months with a total level of effort (LoE) of not more than 45 working days for the international consultant and 45 days for the local consultant. The table below shows the breakdown of responsibilities and estimated LoE in number of days:

# Activities Local Consultant
(LOE in number of days) International Consultant
(LOE in number of days)
1 Analyse and map out all the operations and revenue streams (both current and potential) of RMS, including financial statements 6 4
2 Field data collection including RSMs data, health sector relevant data, stakeholders’ feedback, market assessment etc 12 5
3 Review the expense of the RMS to identify cost containment opportunities 10 5
4 Evaluate RMS inventory efficiency ratio as well as the cost rationalization opportunities by benchmarking against comparable companies locally or regionally 3 5
5 Develop and refine a financial projection model
- Including design, a business analytical framework for e.g., net present value (NPV) evaluating investments associated with the revenue streams identified 2 5
6 Conduct a profitability analysis of the RSM and propose concrete strategies to improve the financial viability/position of the company 2

8
7 Provide evidence-based scenarios for the sustainable financing of the RMS
- incl. a summary describing the priority growth opportunities. 5 9
8 Final Reporting – describing the activities, accomplishments, and next steps 5 4
Total LOE 45 45
All associated logistics costs including the arrangement of meetings, workshops and travel will be a reimbursable cost and or directly paid by Palladium.
Contract Type
This consultancy will be a fixed price deliverable-based contract. Acceptance of the deliverables will be determined by the management of the RMS and the RIHSA Health Financing Director. Final approval will be required by the Chief of Party.
Selection Criteria
The applicant must be a local consultant with extensive local experience in medical products supply chain as well as experience in financial analysis. Applications will be evaluated based on the consultant’s technical capacity and price.
# Evaluation Criteria Weight (%)
1 The quality of the application and technical proposal 15
2 Applicant’s relevant capacity and demonstrated experience in past performance in conducting similar or related assignment as well as demonstrated ability to conduct financial analysis 20
3 Qualifications of the consultant 20
4 Understanding/familiarity with the Rwandan medical products supply chain, health systems and policies 25
5 Price 20
Total Score 100

All proposals received will be reviewed based on the above evaluation criteria. Negotiations will be held with the candidate that scores the highest number of points using the criteria above.
The application proposal should include:
1. A description of how the tasks of the assignments will be successfully accomplished
2. A description of the applicant’s relevant capacity and past performance, which should include a description of at least three recent similar work undertaken, accompanied by client references who may be contacted. The name, position and contact details (phone number and email) should be included for each reference.
3. The qualifications of the applicant which should include an updated CV (no more than 4 pages) of the consultant and copies of academic credentials
4. Understanding/familiarity of the Rwandan health system and medical products supply chain which includes a 1-page maximum description of the candidate’s past involvement or support to the country’s health system.
5. Cost Proposal detailing the price per deliverable, inclusive of all logistical costs, including transportation, accommodation, data collection and printing costs. The price should include applicable taxes.

Profile of the Local consultant
The international consultants must meet at least the following minimum requirements:
• A degree in health economics, finance, economics, business administration, public health, supply chain management or related degree, with proven work experience
• Knowledge and experience in medical products supply chains and health systems strengthening in Rwanda and experience collaborating with government agencies and development partners.
• Track-record of successful implementation of similar financial sustainability planning or analysis work, preferably in the health sector
• Experienced conducting credit and investment analysis of historical financial statements to evaluate liquidity, inventory management and cost structure
• Demonstrated expertise developing financial projection models
• Conversant with the operational procedures and standards of international development organizations/institutions, along with excellent diplomacy skills
• Fluency in English with excellent written communication skills

Submission Procedure
Interested candidates are invited to Visit the following website: https://palladium.csod.com/ux/ats/careersite/2/home/requisition/16274?c=palladium and submit their application by 20th October 2022.