Request for Proposals: Value for Money Analysis of Tiko HIV Prevention and Care Services in South Africa

**1. Background**

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.

**2. Purpose of VfM analysis**

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:

- 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.

**3. Research/Analysis Questions**

The VfM analysis should answer three distinct but interconnected questions:

- **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?*

**4. Scope of Work**

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:

- 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.

The analysis will cover the four dimensions of VfM:

- **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.

**5. Methodological Requirements**

The consultant is expected to utilize a mixed-methods approach based on the *VfM Framework*, including:

- **Effectiveness:** Effectiveness will be assessed by measuring the additional value Tiko contributes t