Request for Proposals: Value for Money Analysis of Tiko HIV Prevention and Care Services in South Africa
Role Summary
Tiko seeks proposals for a Value for Money analysis of their HIV prevention and care services targeting adolescents in South Africa.
Key Responsibilities
Tiko is an African non-profit organization partnering with governments, health providers, and local community-based organizations to reimagine healthcare systems for adolescent girls across sub-Saharan Africa. We turn fragmented services into a single, integrated ecosystem of accessible care for girls at risk of unintended pregnancy, HIV, and sexual violence – built around their lives and their choices. By tackling this urgent crisis affecting millions of girls today, together we can help create a future where every girl has the protection and power to choose who she decides to be.
Tiko was awarded a grant by the Elton John AIDS Foundation (EJAF) from October 2023 to June 2026, to reach, enrol, and refer adolescents and young people (AYP) aged 15-24 years living in informal settlements and townships of Ekurhuleni and the City of Johannesburg and City of Tshwane Districts in Gauteng Province to SRH and HIV services. These municipalities were selected in collaboration with the Gauteng Department of Health (GDoH) based on available insights that indicate that AYP experience a high incidence of HIV infection and unintended pregnancies; have high unmet need for contraception and antiretroviral therapy (ART); and face ongoing challenges with retention on both pre-exposure prophylaxis (PrEP) and ART. These districts also have large youth populations who may have mental health needs that require holistic service integration.
The Tiko programme aims to empower AYP aged 15-24 years to take charge of their sexual, reproductive, and mental health by encouraging them to access services at public facilities in their communities. Through Tiko, the public facilities are capacitated to provide youth-friendly services and are monitored via Tiko user reviews and feedback. The ultimate goal of the project is to contribute to universal access to HIV, sexual and reproductive health (SRH), and mental health services and products for AYP. The programme aims to both address the obstacles that youth face in accessing these services and products, and to drive sustained utilisation.
Tiko delivers integrated services through tech-enabled ecosystems that are made up of mobilisers, community-based organizations, healthcare providers, and retailers who together connect AYPs through the Tiko platform to family planning, HIV prevention and treatment, sexual violence screening and support, and health products, all at no cost to the AYP. Our model helps AYPs feel safe, supported, and in control – with trusted relationships, accurate information, and belief in themselves that many are experiencing for the first time. In South Africa specifically, Tiko operates an ecosystem approach that includes community-based organizations (CBOs) who deliver demand generation as well as some services (such as mental health and HIV testing), and public facilities that deliver contraceptive counselling and services, HIV testing, PrEP and ART.
While for most of the programme performance period (October 1, 2023–June 30, 2026), the public sector formed the bulk of service delivery infrastructure in South Africa, implementation through private sector providers was facilitated in the third year. Further, retail partners are also included in the ecosystem and they enable Tiko Miles redemption. When AYP access services and provide feedback, they earn Tiko Miles — our behavioral loyalty programme that rewards use of all services equally, including counseling. Miles are redeemed at partner retailers; these small rewards (~$0.50) encourage AYP to stay engaged in their care while also driving foot traffic to local retailers, who are reimbursed directly by Tiko.
Based on this model, the requested Value for Money (VfM) analysis must reflect what Tiko actually does and pays for. The VfM analysis should be scoped accordingly— measuring efficiency and value within health system costs that Tiko controls, finances, and counts towards impact achieved\*\*.\*\* The purpose of this analysis is to conduct a VfM/costing analysis of HIV, family planning, and mental health services and their associated outcome and impact measures.
The primary objective is to evaluate whether Tiko delivers additional public health value and system-level benefits when added as a complementary layer to existing public sector delivery systems in South Africa. The secondary objective is to assess whether Tiko performs better than alternative centralized, decentralized, community-based, and/or digitally-enabled delivery models that work similarly with the public sector during the implementation period.
The specific objectives of the analysis are to determine the following for the Tiko programme and, as applicable, relative to relevant comparators:
The VfM analysis should answer three distinct but interconnected questions:
Tiko seeks to engage a qualified partner to design and implement the VfM analysis across the City of Ekurhuleni, City of Johannesburg, and City of Tshwane districts in Gauteng Province. The selected consultant will be responsible for the end-to-end delivery of the assignment, including:
The analysis will cover the four dimensions of VfM:
The successful applicant will work under the guidance of:
As this is a secondary analysis, the study population reflects the population represented within existing data sources rather than primary respondents recruited for this assignment. This includes routine programme and platform data relating to AYP aged 15–24 years who are current Tiko users accessing family planning, HIV, and mental health services, together with available secondary data relating to Tiko programme mobilisers, affiliated CBO staff, and public sector service providers at Tiko-linked facilities. The consultant should propose a data extraction and analysis strategy that allows for disaggregated analysis by sub-district geography, age, and service modality, among others. Some data may be available from a concurrent analysis with a different scope and will be available to the successful applicant at time of inception.
The analysis will be implemented in the specified geographies of South Africa. At these locations, Tiko targets the most vulnerable AYP in urban and periurban settings, usually in informal settlements where Tiko links AYP to services within an integrated, tech-powered ecosystem (community, private, public sector) that also addresses access to contraceptive counselling and services, HIV prevention and treatment and mental health services. The consultant is expected to design the analysis plan with adequate service and cost related data within these geographies and to generate findings that are actionable at both country and sub-geography level.
The consultant will be responsible for delivering the following outputs:
The assignment is expected to run approximately five months from contract signing to final dissemination. The data capturing phase is expected to last approximately two (2) weeks, followed by analysis and reporting to support timely programme learning and decision-making.
The applications will be evaluated based on the outlined criteria below:
- Measure the effectiveness and outcomes (service uptake) of integrated services, or verify existing effectiveness data from other analyses.
- Determine cost-effectiveness and incremental value.
- Estimate budget impact and fiscal implications.
- Quantify cost savings of integrated care approaches at health system and individual levels.
- Estimate whether Tiko remains cost-effective under different scale and sustainability scenarios, including changes in service coverage, funding sources, service volume, and government financing.
- Assess the role of service integration, such as mental health integration, in increasing uptake and retention across services and associated cost savings.
- Produce context-specific evidence that supports policy integration and donor engagement, based on the combined findings from the current analysis and existing evidence.
- Public sector complementarity question\*: What additional value does Tiko generate when layered onto existing public sector delivery?\*
- Budget Impact / Government Co-financing: *What would it cost to maintain, partially absorb, or scale the most valuable Tiko functions after donor exit?*
- Alternative model comparison question: *Is Tiko more effective, efficient, scalable, and cost-effective than other centralized, decentralized, community-based, or digital solutions?*
- Conducting a comprehensive literature review.
- Developing a VfM framework tailored to HIV prevention and care and SRH services.
- Identifying and mapping key stakeholders and all data sources.
- Collecting and analysing cost and service uptake data using Tiko platform and relevant stakeholder data.
- Assessing (incremental) cost-effectiveness, efficiency, economic impact, equity, and sustainability.
- Synthesizing findings and developing scenarios with a detailed analysis report.
- Continuously refining the evaluation approach and analysis.
- Preparing a comprehensive evaluation report and presentation materials.
- Formulating strategic recommendations.
- Economy: Management efficiency of Tiko-attributable inputs.
- Efficiency: Conversion of resources into service outputs (e.g., cost per client impacted and cost per referral resulting in service uptake).
- Effectiveness: Achievement of service uptake (e.g. HIV test, PrEP initiation and continuation, ART initiation and retention, mental health improvement).
- Equity: Reach among and utilisation by underserved and vulnerable AYP populations.
- Impact team: To oversee the quality and completeness of secondary data sources, economic modeling, and methodology validation.
- Country Team: For facilitating access to existing programme, platform, and government data sources, and providing operational interpretation of findings (note: this is a secondary analysis; no new primary data collection from AYP or other respondents is anticipated).
- Impact and donor teams: For strategic oversight, stakeholder engagement, and dissemination of findings from this secondary analysis to government partners and other stakeholders.
- *Country: South Africa
- *Sub-geographies: Ekurhuleni, City of Johannesburg, City of Tshwane Districts
- *Expected data for analysis: Secondary analysis using Tiko platform, government available data, and also other implementing partners data, literature and global standard data sets
- *Deliverable 1: Inception phase
- *Output: Inception report with detailed analysis plan and methodology for each analysis.
- *Timeline: Week 2
- *Deliverable 2: Tool development
- *Output: Prepare details data/indicators matrix with required data sources
- *Timeline: Month 2 (2 weeks after feedback on inception report)
- *Deliverable 3: Ethical approval
- *Output: Ethics determination/waiver, as applicable
- *Timeline: Month 2
- *Deliverable 4: Data collection/ capture
- *Output: Data captured and recorded from all data sources
- *Timeline: Month 3
- *Deliverable 5: Analysis
- *Output: Preliminary findings of the analysis, including effectiveness, cost-driver analysis, and policy implications using VfM framework Benchmark data against public sector baselines and alternative models.
- *Timeline: Months 3 and 4; feedback provided within one week of receiving preliminary results
- *Deliverable 6: Advocacy Products
- *Output: Policy briefs, investment cases, and executive summaries for domestic financing and donor discussions.
- *Timeline: Month 5
- *Deliverable 7: Final outputs
- *Output: Final report, dissemination presentation, and brief with core operational and economic metrics defined in the framework.
- *Timeline: Month 5
- *Criterion 1: Experience, Skills, and Ability (40%)
- *Evaluation guidance: Relevance of past assignments, experience in VfM analysis for SRH/HIV/mental health programmes specific to adolescents, and qualifications of proposed key personnel.
- *Criterion 2: Implementation planning and South Africa delivery (40%)
- *Evaluation guidance: Demonstrated ability to implement programme economic analysis in South Africa, manage complex economic analysis with appropriate VfM frameworks/models, use of multiple data sources, and experience working with most vulnerable AYP and similar analysis.
- *Criterion 3: Financial Evaluation (20%)
- *Evaluation guidance: Proposals must include a detailed breakdown of all their professional and implementation fees
- *Total weighting: 100%
Minimum Requirements
The consultant is expected to utilize a mixed-methods approach based on the *VfM Framework*, including:
Interested consulting firms/researchers must demonstrate the capacity to design and analyse VfM among HIV, SRH, mental health, and integrated services in Sub-Saharan Africa. Applicants should clearly demonstrate the following:
- Effectiveness: Effectiveness will be assessed by measuring the additional value Tiko contributes to existing public sector service delivery compared with other complementary delivery models where appropriate. A costing analysis will first estimate the resources required to deliver Tiko's interventions, using only Tiko-attributable costs. These cost estimates will then be combined with programme uptake to assess cost-effectiveness through unit cost metrics (e.g., cost per HIV test, PrEP initiation, ART initiation, ART and PrEP retention, FP uptake and continuation, unintended pregnancies averted, and mental health improvement) and Incremental Cost-Effectiveness Ratios (ICERs), estimating the additional cost required to achieve one additional unit of health service uptake.
- Cost-saving and cost-efficiency analysis: The analysis will estimate avoided costs and increased efficiencies by comparing the Tiko-supported pathway with alternative approaches. It will assess savings from improved referral efficiency, reduced duplication, and earlier access to prevention and care services. In addition, cost-efficiency analysis will examine how effectively resources are converted into impact by assessing cost per user reached, and service uptake across delivery channels to inform resource optimization and sustainable scale-up.
- Cost Utility Analysis (CUA): Broader quality-of-life impacts are assessed using QALYs and DALYs, with particular relevance for mental health integration and integrated care pathways.
- Budget Impact Analysis (BIA): Assess affordability and scalability from government and donor perspectives — estimating the cost of adding Tiko as a complementary layer to public systems, national scale-up requirements, annual financing needs, and which costs should remain publicly financed versus co-financed or contracted through Tiko.
- Marginal Cost: Marginal cost analysis identifies the cost of serving one additional client and the point at which economies of scale emerge.
- Sensitivity and Scenario Analysis: Robustness is tested through deterministic sensitivity analysis, probabilistic sensitivity analysis using Monte Carlo simulations, and three operational scenarios: best-case (high uptake and efficiency), base-case (expected conditions), and worst-case (funding and operational constraints), with an additional policy integration scenario modeling government reimbursement.
- Mental Health Integration Sub-Analysis: A dedicated analytical strand will examine whether mental health users consume more integrated services; whether mental health support improves ART retention and adherence, contraceptive continuation, and PrEP uptake; and the incremental cost and benefit of integrated mental health. Methods will include regression analysis and other relevant analytical methods.
- Strong technical expertise in public health, health economics, and youth-focused impact studies.
- Demonstrated technical experience in VfM/economic analysis, specifically health economics, CEA/ICER, and budget impact analysis (BIA).
- Demonstrated experience conducting studies on SRH and HIV service uptake, continuation, or mental health service delivery, including analysis of initiation, continuation, and transitions across modalities.
- Familiarity with national SRH and HIV prevention and treatment guidelines and service delivery systems in South Africa.
- Experience working with AYP and other vulnerable populations in urban and peri-urban settings, including handling sensitive topics related to HIV risk, mental health, and sexual health.
- Technical capacity in secondary data collection approach, proficient in secondary and aggregated data analysis, and quantitative and qualitative analysis software (e.g. Stata, R, SPSS, NVivo).
- Experience producing high-quality analytical reports, with clear visualisations and actionable programme recommendations.
- Strong project management capacity, including planning, coordination, and delivery within agreed timelines and budgets.
- At least three references from similar assignments conducted in the last three (3) years, with contact details.
- A sample of recent work demonstrating analytical and reporting quality.
- Excellent written and verbal communication in English; proficiency in relevant South African languages (e.g. isiZulu, Sesotho, Afrikaans) is an added advantage.
- Experience in knowledge translation, dissemination, and publication is an added advantage.
Eligibility Criteria
Tiko invites proposals for analysis services; however, specific eligibility requirements for applicants are not stated.
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