1- NOFO 72068724RFA00008 USAID Soroka signed.pdf

Issue Date : December 5, 2024 Deadline for Questions : January 10, 2025 Closing Date : February 10, 2025 Closing Time : 23:59, GMT+3 (Madagascar Time) Subject : Notice of Funding Opportunity (NOFO) Number: 72068724RFA00008 Program Title : Surveillance, Operational Research, and Optimization of Knowledge-sharing for Action activity, SOROKA Activity Federal Assistance Listing Number : 98.001

Greetings, The United States Agency for International Development (USAID) is seeking applications for a Cooperative Agreement from qualified entities to implement the “USAID Soroka” Activity. Eligibility for this award is restricted to Local Entities.

USAID intends to make one award to the applicant who best meets the objectives of this funding opportunity based on the merit review criteria described in this NOFO subject to a risk assessment. Eligible parties interested in submitting an application are encouraged to read this NOFO thoroughly to understand the type of program sought, application submission requirements and selection process.

To be eligible for award, the applicant must provide all information as required in this NOFO and meet eligibility standards in Section B of this NOFO. This funding opportunity is posted on www.grants.gov, and may be amended. It is the responsibility of the applicant to regularly check the website to ensure they have the latest information pertaining to this NOFO and to ensure that it has been downloaded from the internet in its entirety.

USAID bears no responsibility for data errors resulting from transmission or conversion process. If you have difficulty registering on www.grants.gov or accessing the NOFO, please contact the Grants.gov Helpdesk at 1- 800-518-4726 or via email at support@grants.gov for technical assistance or if you need assistive technology and are unable to access any material on this site.

Unless an exception in 2 CFR 25.110 applies, applicants must comply with 2 CFR 25 requirements to obtain a Unique Entity Identifier (UEI) and register in the System for Award Management (SAM.gov), as applicable. See Section E, Submission Requirements and Deadlines, for more information. The registration process may take many weeks to complete. Therefore, applicants are encouraged to begin registration early.

Please send any questions to the point(s) of contact identified in Section A.4. The deadline for questions is shown above. Responses to questions received prior to the deadline will be furnished to all potential applicants through an amendment to this notice posted to www.grants.gov.

English is the official language of all award documents. In the event of inconsistency between any terms of this NOFO and any translation into another language, the English language version will control.

Issuance of this notice of funding opportunity does not constitute an award commitment on the part of the Government nor does it commit the Government to pay for any costs incurred in preparation or submission of comments/suggestions or an application. Applications are submitted at the risk of the applicant. All preparation and submission costs are at the applicant’s expense.

Thank you for your interest in USAID programs.

Sincerely, Orion Yeandel Agreement Officer http://www.grants.gov/ mailto:support@grants.gov http://www.grants.gov/

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TABLE OF CONTENTS

Contents

SECTION A: BASIC INFORMATION

1. Executive Summary

2. Estimate of Funds Available and Number of Awards Contemplated

3. Start Date and Period of Performance for Federal Awards

4. Agency Points of Contact

5. Acquisition and Assistance Ombudsman

6. Authorized Geographic Code

SECTION B: ELIGIBILITY

1. Eligible Applicants

2. Cost Sharing

SECTION C: PROGRAM DESCRIPTION (Please see the French translation of this section in Annex 8)

I. Project Summary

II. Background and Problem Statement

III. Project Relationship to USAID and Country Strategy

IV. Technical Approach and Scope

V. Implementation Requirements

VI. Program principals

VII. Plans

VIII. Acronyms:

SECTION D: APPLICATION CONTENT AND FORMAT

1. General Content and Form of Application

2. Technical Application Format

3. Business Application Format

SECTION E: SUBMISSION REQUIREMENTS AND DEADLINES

1. Questions and Answers

2. Submission Requirements

3. Unique Entity Identifier (UEI) and SAM.gov Registration

SECTION F: APPLICATION REVIEW INFORMATION

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1. Responsiveness Review

2. Merit Review Criteria

3. Review and Selection Process

4. Risk Review

SECTION G: AWARD NOTICES

SECTION H: POST-AWARD REQUIREMENTS AND ADMINISTRATION

1. Administrative & National Policy Requirements

2. Nature of the Relationship between USAID and the Recipient

3. Reporting Requirements

4. Program Income

5. Environmental Compliance

6. Climate Risk Management

SECTION I : OTHER INFORMATION

ANNEX 1 - BUDGET TEMPLATE (See attached)

ANNEX 2 - STANDARD PROVISIONS

REQUIRED STANDARD PROVISIONS FOR NON-U.S. NONGOVERNMENTAL

ORGANIZATIONS

ANNEX 3 - INITIAL ENVIRONMENTAL EXAMINATION

ANNEX 4 - GENDER ANALYSIS

ANNEX 6. USAID Madagascar updated Country Development and Cooperation Strategy

(CDCS)

ANNEX 7. REVISED IN-COUNTRY PER DIEM, LODGING, AND TRANSPORTATION

PAYMENTS TO GOVERNMENT OF MADAGASCAR OFFICIALS, CIVIL SOCIETY

ORGANIZATIONS, AND PRIVATE SECTOR STAFF AND STIPENDS FOR COMMUNITY

HEALTH VOLUNTEERS

ANNEX 8 TRADUCTION FRANÇAISE DUFRENCH VERSION OF THE PROGRAM

DESCRIPTION

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SECTION A: BASIC INFORMATION

1. Executive Summary

SOROKA is a Malagasy word which constitutes the root of the verb “misoroka”, meaning “to prevent”, corresponding to the aim of surveillance. SOROKA can be the acronym of the specific objectives of the project: Surveillance, Operational Research, and Optimization of Knowledge-sharing for Action activity.

The SOROKA activity is expected to be a $7.5 million award for five years from March 2025 to March 2030. SOROKA's main objective is to advance the health of the Malagasy people through improvements in capacity-building and coordination and execution of data collection, management, synthesis, and use for public health action. Following the RISE project, SOROKA will enhance local capacity and expand leadership within the Ministry of Public Health (MOPH) to detect threats to global health security, and to plan and conduct emergency outbreak response. It will reinforce the country's capacity to plan, implement, and disseminate locally led research and evaluations, and increase public sector capacity to use epidemiologic and surveillance data for public health action.

SOROKA will be the main activity of USAID/Madagascar’s Health Office for research on malaria, MNCH (mother, neonatal, and child health), WASH (water, sanitation, and hygiene), and GHS (global health security), for program evaluation, biological surveillance including AMR (antimicrobial resistance), emergency responses to health threats and institutionalization of epidemiology and laboratory data use for decision making. SOROKA will also provide targeted and need-based cross-sectorial training for the MOPH staff throughout its implementation. In general, SOROKA is intended to cover all HPN program elements, particularly malaria, MNCH, GHS and WASH.

2. Estimate of Funds Available and Number of Awards Contemplated

USAID intends to award one Cooperative Agreement(s) pursuant to this notice of funding opportunity

(NOFO).

Subject to funding availability and at the discretion of the Agency, USAID intends to provide $7,500,000.00 in total USAID funding over a five (5) year period.

3. Start Date and Period of Performance for Federal Awards

The anticipated period of performance is five (5) years. The estimated start date is March 17, 2025.

4. Agency Points of Contact

Johanesa Rakotoniaina Acquisition & Assistance Specialist, USAID Madagascar jrakotoniaina@usaid.gov Lot 207 A, Point Liberty - Andranoro Antehiroka - Antananarivo 105, Madagascar

Fy Rafam’Andrianjafy Acquisition & Assistance Assistant, USAID Madagascar frafamandrianjafy@usaid.gov Lot 207 A, Point Liberty - Andranoro Antehiroka - Antananarivo 105, Madagascar

5. Acquisition and Assistance Ombudsman

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The A&A Ombudsman helps ensure equitable treatment of all parties who participate in USAID’s acquisition and assistance process. The A&A Ombudsman serves as a resource for all organizations who are doing or wish to do business with USAID. Please visit this page for additional information:

https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman

The A&A Ombudsman may be contacted via: Ombudsman@usaid.gov

6. Authorized Geographic Code

The geographic code for the procurement of commodities and services under this program is 935.

Except as may be specifically approved in advance by the Agreement Officer, all commodities and services that will be reimbursed by USAID under this award must be from the authorized geographic code specified in this NOFO, and must meet the source and nationality requirements set forth in 22

CFR 228.

SECTION B: ELIGIBILITY

1. Eligible Applicants

Eligibility is restricted to Local entities and organizations that have received less than $25 million in USAID funding, at any tier, over the past five years; or for global health awards the organization has received less than $25 million in U.S. Government funding at any tier, over the past five years . As defined in Section 7077 of Public Law 112-74, the Consolidated Appropriations Act, 2012 (P.L. 112-74), as amended by Section 7028 of the Consolidated Appropriations Act, 2014 (P.L. 113-76), and included by reference in subsequent appropriations acts, local entity means an individual, a corporation, a nonprofit organization, or another body of persons that—

1) is legally organized under the laws of;

2) has as its principal place of business or operations in; and

3) is (A) majority owned by individuals who are citizens or lawful permanent residents of; and (B) managed by a governing body the majority of who are citizens or lawful permanent residents of a country receiving assistance. For purposes of this definition, “majority-owned’ and “-managed by” include, without limitation, beneficiary interests and the power, either directly or indirectly, whether exercised or exercisable, to control the election, appointment, or tenure of the organization's managers or a majority of the organization's governing body by any means.”

Faith-based organizations are eligible to apply for federal financial assistance on the same basis as any other organization and are subject to the protections and requirements of Federal law.

Additionally, USAID welcomes applications from organizations that have not previously received financial assistance from USAID.

Interested and eligible applicants may submit no more than one (1) application under this NOFO.

2. Cost Sharing

Cost Sharing is not required for this activity.

SECTION C: PROGRAM DESCRIPTION (Please see the French translation of this section in Annex 8)

This funding opportunity is authorized under the Foreign Assistance Act (FAA) of 1961, as amended.

The resulting award will be subject to 2 CFR 200 – Uniform Administrative Requirements, Cost https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman mailto:Ombudsman@usaid.gov

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Principles, and Audit Requirements for Federal Awards, and USAID’s supplement, 2 CFR 700, as well as the additional requirements found in Section F.

I. Project Summary

SOROKA is a Malagasy word which constitutes the root of the verb “misoroka”, meaning “to prevent”, corresponding to the aim of surveillance. SOROKA can be the acronym of the specific objectives of the project: Surveillance, Operational Research, and Optimization of Knowledge-sharing for Action activity.

The SOROKA activity is expected to be a $7.5 million award for five years from Oct 2024 to Sept 2029.

SOROKA's main objective is to advance the health of the Malagasy people through improvements in capacity-building and coordination and execution of data collection, management, synthesis, and use for public health action. Following the RISE project, SOROKA will enhance local capacity and expand leadership within the Ministry of Public Health (MOPH) to detect threats to global health security, and to plan and conduct emergency outbreak response. It will reinforce the country's capacity to plan, implement, and disseminate locally led research and evaluations, and increase public sector capacity to use epidemiologic and surveillance data for public health action.

SOROKA will be the main activity of USAID/Madagascar’s Health Office for research on malaria, MNCH (mother, neonatal, and child health), WASH (water, sanitation, and hygiene), and GHS (global health security), for program evaluation, biological surveillance including AMR (antimicrobial resistance), emergency responses to health threats and institutionalization of epidemiology and laboratory data use for decision making. SOROKA will also provide targeted and need-based cross-sectorial training for the MOPH staff throughout its implementation. In general, SOROKA is intended to cover all HPN program elements, particularly malaria, MNCH, GHS and WASH.

II. Background and Problem Statement

II.1. Country and Health situation

Madagascar is the world’s fifth largest island, situated in the Indian Ocean off the coast of southern Africa. Despite considerable natural resources, its population of 27 million [1] has one of the world’s highest poverty rates with a GDP per capita of $ 516. About 3/4 of the population lives on less than $1/day. Its development is negatively impacted by enormous social and economic challenges due to recurrent political crises, weak governance, inadequate human and physical capital development.

Climate crises and extreme vulnerability to external shocks are increasing and exacerbating poverty.

These situations and slow economic growth have halted development and investments.

The Ministry of Public Health's (MOPH) budget is 5.5% of the government budget in 2023, far below the Abuja convention target of 15%. This budget is mainly dedicated to the management costs, while the vertical programs are inadequately funded and are primarily supported by external donors;

therefore, the health budget is heavily dependent on donors. The MOPH runs 23 Regional Health Offices and 115 District Offices. The Madagascar health system is organized in 4 tiers for service delivery: 1) the first tier is composed of more than 40,000 community health workers (CHWs), providing services in accordance with the recent Community Health Strategy (USAID currently supports around 18,000 CHWs in 12 of the 23 regions); 2) the second tier is made of 2,812 public basic health centers (CSB), offering basic health care packages that are complementary and more comprehensive than those offered by CHWs; 3) the third tier is composed of level 1 and level 2 district referral hospitals (CHRD), and 4) the fourth tier is composed of regional referral hospitals and university hospitals (CHU). The frequent turn-over at all levels of the MOPH constitutes a challenge for

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MNCH: Maternal mortality has stagnated at 426 maternal deaths per 100,000 live births over the past twenty plus years. Maternal deaths are mainly due to complications of pregnancy or birth-related complications. Alarmingly, a third of this maternal mortality occurs among adolescents. In 2018/2019, the country faced one of the world’s worst measles outbreaks, with 244,569 cases and 1,080 deaths;

Certified polio free in 2018, weaknesses in Madagascar’s service coverage have resulted in an upsurge of vaccine-derived poliovirus type 1 (cVDPV1).

Malaria: 100% of the Malagasy population is at risk for malaria, which was the second most frequent reason for health facility visits and the second most reported cause of in-hospital mortality in Madagascar in 2022 (NMP, 2023). Since 2017, Madagascar has been experiencing increasing malaria incidence, despite increased coverage of malaria prevention activities and expansion of case management. The number of facility-reported malaria cases increased from 1.95 million in 2020 to

2.34 million in 2021 before decreasing to 1.67 million in 2022 and then increased to over 3 million in 2023. Anopheles gambiae s.l. is the predominant vector. First-line antimalarial drugs are still very effective as revealed by drug efficacy studies in 2018,2020, and 2022, but the risk of resistance to first line antimalarial drugs is high, given emerging evidence of partial artemisinin resistance in nearby countries.

Global Health Security: Madagascar is highly vulnerable to infectious diseases, including plague. More than half of the infectious diseases are zoonotic (spread between animals and people), and deforestation is one of the main culprits for the growing risk of zoonotic diseases from increased human-animal contact. Madagascar lacks the proper workforce to respond to emerging infectious diseases and health emergencies. Madagascar’s overall health security preparedness is below average as measured by multiple reporting tools. For instance, Madagascar’s average score was 48% for the State Part -Self Assessment Annual Reporting Tool (SPAR) and only 34% for the last Joint External Evaluation (JEE). The country struggles with endemic zoonotic diseases, such as plague, and is vulnerable to emerging infectious diseases and threats.

II.2. Prior USAID investments

Since 2013, USAID has invested over $13.5 million to support surveillance, research, infection prevention and control in Madagascar. The Surveillance and Data Management activity (SDM) was a $5.5 million award over six years (October 01, 2013– September 30, 2019) that supported the MOPH’s fever sentinel sites (FSS), operational research (OR) related to malaria and MNCH, and the MOPH’s infectious disease response for emergencies including the pneumonic plague outbreak of 2017. In 2019, a $8 million Research, Innovation, Surveillance, and Evaluation activity (RISE) was awarded and will end in 2024. The goal of RISE is to foster public health decision-making based on scientific evidence. Three main tasks were chosen that were of public health relevance to Madagascar: reduce malaria deaths and cases under the U.S. President’s Malaria Initiative (PMI); prevent child and maternal deaths; and combat infectious diseases including plague surveillance and disease outbreak response. RISE provided training related to epidemiology and research to 901 participants, including 675 MOPH staff. RISE conducted several operational research (OR) projects related to malaria and MCH, as well as several program evaluations and surveillance activities, the therapeutic efficacy study (TES) of first-line antimalarial medications used in Madagascar (TES 2020 and 2022), the bio-efficacy of insecticide-treated mosquito nets (ITNs) distributed during the mass distribution campaigns (2018 and 2021), and an assessment of the quality of drinking water sources in 281 sites located at health facilities and communal water sources in 13 regions, to determine the primary chemical contaminants and levels of fecal pollution. Monitoring WASH quality has generated data about water quality in

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USAID/ACCESS and USAID/RANO WASH intervention areas, as well as some JIRAMA (jiro sy rano malagasy, national society for electricity and water) facilities. These data have proven useful in understanding water quality in general in these regions and offering the Ministry of Water and Hygiene, the MOPH, and USAID the opportunity to reflect on how to approach water source selection and water treatment, both in small decentralized water sources, and in medium or larger sized water supply systems.

RISE supported biological surveillance systems (BSS) in 21 basic health facilities for an early detection and prompt disease control outbreak in accordance with international health regulations. Illnesses under surveillance include malaria, plague, influenza, COVID-19, arboviruses, febrile diarrhea, acute flaccid paralysis, febrile skin rashes, and foodborne illness. During the COVID-19 pandemic, RISE has performed more than 68,000 COVID-19 PCR tests (12 percent of national tests) and is the main partner of the MOPH on their public health response to plague. As part of GHS, RISE continued to support plague season preparedness, surveillance, diagnosis and comprehensive management, and initiated AMR and tick borne disease surveillance in 2024.

The USAID-funded SDM and RISE projects preceding the SOROKA project have significantly contributed to the reinforcement of surveillance and research and capacity building, with the implementation of the CSB-R (health facilities that perform biological surveillance), the mobilization of the mobile laboratory, the reinforcement of the laboratory testing capacity during the plague and COVID outbreak, the completion of operational research, the surveillance of water quality, and the training of MOPH staff.

II.3. Problem statement

Madagascar continues to face significant infectious disease threats, including vaccine preventable disease outbreaks, and emergency response draws resources away from building a functional health system.

Surveillance: In addition to the COVID-19 pandemic, Madagascar has recently been affected by various epidemics including pneumonic plague, dengue fever, and rift valley fever (RVF), which underscore the importance of an early warning notification system, detection, and prompt decision-making. The Direction de la Veille Sanitaire, de la Surveillance Épidémiologique et Riposte (DVSSER) is the MOPH’s directorate in charge of surveillance. DVSSER’s national strategic plan for surveillance dated 2021- 2023 has not been revised and approved. DVSSER implements comprehensive surveillance for the Integrated Disease Surveillance and Response (IDSR) system, which collects and analyzes weekly reports from about 2,000 CSBs throughout the country to identify unusual events, though few of the CSBs utilize tablets for electronic reporting. USAID is supporting DVSSER to implement biological surveillance on malaria, arthropod-borne diseases, and influenza-like illness (ILI) in 26 CSB-R, though not enough to cover the entire country. Good laboratory functionality is an integral part of the infection surveillance and prevention system, allowing effective epidemiological surveillance and rapid intervention. The MOPH has just approved the laboratory development strategy, which will be led by the LA2M (Laboratoire d’Analyse Médical de Madagascar) in charge of coordinating the biological surveillance. However, with only seven hospitals in its network, the LA2M’s geographical coverage is limited. USAID has trained about 600 of MOPH’s staff on surveillance-linked topics, and the CDC and the IOC-funded FETP (field epidemiology training program) have trained hundreds of MOPH technicians, which is highly appreciated by the Minister of Public Health for concretely reinforcing disease surveillance and investigation.

However, insufficient human resources, particularly during epidemics; insufficient financial resources including for rapid outbreak investigation and response; infrastructure and logistics; weakness in governance, leadership and coordination of epidemiological surveillance activities; weakness in the

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One-Health and Emergency Response: The One Health approach (integration between human, animal, and environment health) is nascent in Madagascar. The Decree n⁰2023-1356 signed in October 2023 which formalized the one-health platform is evidence of the Government’s commitment and engagement to Global Health Security. Among the priorities is AMR (antimicrobial resistance) surveillance, due to misuse and overuse of antibiotics in humans and animals. In addition, there is a broad lack of capacity for zoonotic disease and AMR surveillance, and the response to health emergencies is not adequate. The ISAVET (veterinary epidemiology and surveillance), implemented by a USAID/FAO project is an opportunity to leverage surveillance using the One Health approach.

Research: In general, scientific research receives limited funding and engagement in Madagascar. The budget allocated to research is far below the expected 2% of the health budget programming and the 5% of development assistance in health . The MOPH has just appointed the INSPC (Institut National de Santé Publique et Communautaire) to coordinate research at MoPH, based on its role in training on public health. However, the MoPH research strategy is outdated (2016) and the lack of capacity to govern, coordinate and implement research, frequent turn-over at MOPH (including researchers) and lack of human resources negatively impact the capacity to implement high quality research. This stands in contrast to the Ministry of Higher Education that has developed a new research policy 2023- 2023 and has dedicated research bodies like the CNARP (Centre National de Recherche Pharmacologique) and the Universities. The Ministry of Livestock also maintains the FOFIFA (Centre National de Recherche Appliquée au Développement Rural), the entity in charge of research.

Overall, the capacity for data management, quality, and use for policy and programming is sub-optimal. Previous training on surveillance, research and outbreak investigation lacked systematic training follow-up to ensure that newly acquired skills and competencies have been used. In addition, pre-service training has not been adapted to the local context.

III. Project Relationship to USAID and Country Strategy

III.1. Relationship with the Country Development Collaboration Strategy (CDCS)

This activity will contribute to the Development Objective 1 of the Country Development Collaboration Strategy (CDCS) which is “Improved Human Capacity to Contribute to the Country’s Journey to Self-Reliance” and the intermediate result 1-1 “Sustainable Health Impacts Accelerated.”

III.2. Integrated Country Strategy (ICS)

This activity also contributes to the Integrated Country Strategy, specifically to the Mission Goal 3 “Madagascar and Comoros’ human capacity strengthened as a foundation for country-owned democratic governance, security, and development”, the Mission Objective 1.2 “Fundamental human rights promoted and protected, particularly for marginalized populations”, and the Management Objective 2 “Support services expanded to protect the health and safety of personnel, strengthen host country relationships, and allow for program monitoring”.

III.3. Relationship with global strategies

This activity will contribute to USAID’s Global Health goals of combating infectious disease and preventing child and maternal deaths (PCMD).

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- USG assistance for malaria control in Madagascar is funded through the U.S. President’s Malaria Initiative, PMI, which combats malaria through four major interventions: indoor residual spraying (IRS); promotion and distribution of long-lasting insecticide-treated bed nets (ITNs); intermittent preventive treatment of malaria in pregnancy (IPTp); and malaria diagnosis and treatment, with cross-cutting support for supply chain and health systems strengthening, social and behavior change, surveillance, monitoring and evaluation, and operational research. PMI’s global objective is to, by 2026, reduce malaria mortality by 33% and morbidity by 40% percent as compared to 2015 levels. PMI supports all four key interventions in Madagascar, and the four cross-cutting areas noted above. In addition, PMI has supported elimination-related activities and will soon support testing and treatment of Plasmodium vivax (Pv) cases in select districts with high Pv burden.

- The Maternal and Child Health and Nutrition Technical Roadmap is a framework that guides USAID's maternal and child survival programs to meet SDG 2030 targets. It serves as the foundation of USAID’s commitment to Prevent Child and Maternal Deaths alongside the Agency’s investments in family planning, malaria, and health systems strengthening. The strategy’s global performance is measured by six key indicators: (1) contraceptive prevalence rate; (2) contraceptive security; (3) under-five mortality; (4) births attended by skilled birth attendants; (5) Diphtheria, Pertussis and Tetanus final (DPT3) vaccination by age 12 months; and, (6) people protected from malaria with an insecticide-treated net (ITN).

- USAID’s GHS program fills critical gaps in building sustained and coordinated One Health capacities that incorporate linkages between human, animal, and environmental health. It works with countries to identify and address their highest priority gaps, with a special focus on specific JEE technical areas (Disease Surveillance, National Laboratory System, Human Resources, Antimicrobial Resistance, Zoonotic Disease, Biosafety and Biosecurity, Infection Prevention and Control, and Risk Communication and Community Engagement). In collaboration with countries and working with a unique set of multi-sectoral partners, the GHS Program strengthens preparedness and ensures capacities are in place to 1) prevent avoidable disease outbreaks, 2) detect threats early, and 3) respond rapidly and effectively when outbreaks occur.

- In support of the White House Action Plan on Global Water Security and the U.S. Government Global Water Strategy, USAID programs notably on strategic objectives #2 “Increase equitable access to safe, sustainable, and climate-resilient water and sanitation services and adoption of key hygiene behaviors”.

IV. Technical Approach and Scope

IV.1. Guiding principles

- Use of innovative and audience-appropriate approaches for data and information-sharing:

The timely availability, accessibility, and utilization of surveillance, evaluation and research findings across the key technical areas (malaria, PCMD, GHS, WASH) by the Government, donors, and USAID implementing partners (IPs) is critical to ensure high-quality, evidence-based health programming. To capture data from various sources, it is important to develop a platform for research data repositories, sharing and access among diverse audiences (e.g., USAID, PMI, MoPH, donors, implementing partners, and academic institutions). SOROKA will contribute to these efforts and will emphasize data use, analysis, sharing, dissemination, outbreak responses, and policy design.

- Balance the needs of stakeholders (including MOPH, USAID/PMI, academic institutions) and the applicant with a profile of a research institution:

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Research to address identified knowledge gaps and opportunities to improve services is essential for decision making. The Recipient will focus on research questions informed by stakeholders (e.g., MOPH, USAID, PMI, IPs, academic institutions) to increase their use for decision making by the MoPH.

The Recipient should also prioritize scientific publication and sharing, led by Malagasy authors, at national and international levels and ensure results are disseminated throughout the country. Finally, close collaboration and partnership with Donors (USAID and PMI) and MOPH including their direct involvement into the planning, execution and dissemination of research findings is key and will ensure the quality and compliance with USG and MOPH research policy.

- Self-reliance, localization, and sustainability plan:

For USAID, self-reliance entails a capacity to plan, finance, and implement solutions to foster local development. This activity, which will be implemented by local partners, will contribute to USAID’s localization priorities. By prioritizing local capacity building, the program aims to progressively reduce dependency on external aid, ultimately creating a pathway toward community-driven development where international assistance becomes increasingly unnecessary. Programs must measure their work by how far every investment moves them closer to that goal and the use of local solutions. While local leadership remains the cornerstone of this approach, short-term technical assistance from external partners may be utilized as needed to maintain high technical and programmatic standards..

- Leveraging funds

As funding constraints continue in the context of competing needs and priorities, this activity should develop strategies and tools to expand its resources and work with other donors to produce greater results. This requires a strong coordination and collaboration with the MOPH and Stakeholders working in technical areas targeted by this activity.

IV.2. Theory of change

If high-quality and context-appropriate surveillance, research, and evaluation activities are implemented with engagement and ownership of national institutions, AND

If local capacity to coordinate, conduct, and use data from high-quality surveillance, operational research, and program evaluation activities is improved, THEN

Surveillance, research, and evaluation data will be effectively leveraged by local actors to advance meaningful improvements in programming and policy for disease prevention and control.

IV.3. Activity Goal and Objectives

The activity goal is to advance the health of the Malagasy people through improvements in capacity-building for and coordination and execution of data collection, management, synthesis and use for public health action. This goal will be met through accomplishing four specific objectives:

1. Improve national surveillance capacity to rapidly and accurately detect outbreaks and priority health threats

2. Improve national capacity (human and organizational) to plan, implement and disseminate research and evaluations

3. Increase public sector capacity to use epidemiologic and laboratory data for public health action.

4. As a cross-cutting objective, the fourth objective is to sustainably improve human resource and institutional technical capacity for the surveillance of malaria and other conditions linked to global health security, maternal and child health, and WASH.

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IV.4. Intermediate Results & Illustrative Interventions

OS 1: Improve national surveillance capacity to rapidly and accurately detect outbreaks and priority health threats SOROKA will support the Government of Madagascar (GoM) to improve the quality and availability of surveillance data by building a center of excellence at MOPH level, for surveillance of human, zoonotic and environmental conditions which includes water quality assessment. In particular, it will focus on the following GHS goals:

1) Health Emergency Management as outlined by the WHO Joint External Evaluation (JEE) and the WHO IHR Benchmarks (international health regulation), and ensuring an exchange, analysis, and sharing of disease data for mapping, strategic planning, and decision making and

2) on building the GoM capacity to respond effectively and on time to infectious disease outbreaks.

SOROKA will continue to support biological surveillance of Arboviroses, arthropod-borne diseases, malaria (parasitology including pfhrp2/3 gene deletions, therapeutic efficacy studies [TES]), respiratory infections (ILI), measles, AFP (acute flaccid paralysis), and other health and environmental conditions as appropriate. Every activity planned should respond to country needs, fill critical gaps, and ensure GoM leadership and ownership, donor coordination and USAID and PMI access to data.

Illustrative activities per each intermediate result are presented in the table below:

Intermediate Results

1.1 Improve quality and

availability of surveillance data to answer key questions about human, zoonotic, and environmental conditions (including water quality).

1.2 Reinforce

coordination across surveillance stakeholders in Madagascar.

1.3 Bolster laboratory

surveillance capacity at national and peripheral levels.

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Illustrative Activities

-Promote institutionalization of data quality in the organizational culture -Conduct integrated data quality/ regular monitoring.

-Update/develop data governance policies including data ownership, storage, security, network of surveillance data/sites.

-Training on data quality -Operationalize two-way feedback-mechanisms (quality of data and use) -Strengthen event verification systems.

-Build on the experience of previous USAID activities WASH Quality monitoring to generate water quality data from a sampling of water sources in the previous and current USAID WASH activities regions.

-Leverage existing resources to build the DVSSER leadership in surveillance (strategy, methods, training, data modeling, platform/logistic for weekly data analysis with regions and districts) -Mapping of entities involved in the surveillance including roles, responsibility and technical/geographic scope.

-Support the coordination between MoPH specific programs and DVSSER.

-Collaborate with the Ministry of Livestock, Ministry of environment, and Ministry of Higher Education for the surveillance of GHS priorities diseases.

Support development of national policy, guideline, training, and supply chain management for adequate secured specimen collection -Maintain /Expand the quality and scope, coverage, and capacity of surveillance sites including CSB-R, LA2M network, entomological surveillance, AMR, water quality, environment impact on health (climate change).

-Digitization of surveillance systems (CSB-R, entomological surveillance, climate change and health) and networks

OS 2: Improve national capacity (human and organizational) to plan, implement and disseminate research and evaluations

Supporting the MOPH’s institutional and government capacity to plan and implement locally led research/evaluations will advance USAID’s localization strategy. Activities should ensure that both the MOPH’s research/evaluation governance and coordinating structures are in place and functional, local researchers are trained and have the tools and procedures to implement research and they are connected to other research institutions for learning. Some of these research questions have informed the Malaria Operational Plan (MOP) and Health Operational Plan (OP). Other research questions will be identified through establishing an MOH research agenda per technical area and input from Stakeholders.

Illustrative activities per each intermediate result are presented in the table below:

Intermediate Results 2.1 Improve institutional and governance capacity to develop public health research policies and coordinate and disseminate research activities

2.2 Improve the capacity

of local actors to conduct high-quality research and evaluation.

2.3 Conduct high quality, locally-led research and evaluation activities with national institution engagement, including testing or evaluating new tools/technologies, 72068724RFA00008- USAID Soroka Page 14 | 76 testing alternative deployment strategies of existing tools, to help address knowledge gaps.

Illustrative Activities -Improve the Leadership and organizational capacity of INSPC and/or other relevant MOPH entities in charge of research coordination.

-Development of strategic plans, SOPs, policies, and coordination committees related to conduct of research and dissemination of findings -Build research project management systems including capacity to respond to research funding opportunities.

-Support Webinar, Scientific conferences, Websites/social media and other relevant learning approaches.

-Provide training of researchers and support research managers on planning, conducting, analyzing, and disseminating research finds.

-Facilitate collaboration with national or international research institutions and learned societies.

-Develop/refine/update research questions and evidence-based policies & interventions needed especially for MCH, malaria, ID -Develop general and study-specific SOPs to ensure high-quality research.

-Effective research implementation -Apply appropriate analytical approaches (e.g., statistical methods, qualitative data analysis, other) to relevant data -Support post-emergency response evaluation -Conduct bio-efficacy of LLINs

OS 3: Increase public sector capacity to use epidemiologic and laboratory data for public health action.

SOROKA will support the MOPH to improve its capacity to interpret and disseminate data, develop tools, mechanisms and workforce to plan public health/emergency response. SOROKA is the USAID platform for timely outbreak response that addresses new/emerging challenges identified by USAID, MOH, PMI, and GHS. SOROKA will help the MOH to institutionalize joint (MOH and Partners) data (from surveillance, research, and epidemiology) analysis and review to inform policy.

Illustrative activities per intermediate result are presented in the table below:

Intermediate Results

3.1 Improve

capacity among local actors for data analysis and interpretation, including interpretation of surveillance and research data and assessment of

3.2 Improve

logistical and management capacity and readiness of health personnel and response teams to address public health emergencies.

3.3 Support local

actors to Implement appropriate public health responses to human, zoonotic, and environmental health threats.

3.4 Engage

national institutions in joint-data analysis to improve data use to inform policy

72068724RFA00008- USAID Soroka Page 15 | 76 emergency risk and readiness

Illustrative Activities

-Support innovative approaches (including new technology) and platform for data analysis, visualization, exchange and sharing (including for plague) for better use.

-Support elaboration and dissemination of risk maps.

-Support development and dissemination of weekly/monthly SITREP (situational report).

-Support the developing and coordination of preparedness plans.

-Establish/support early warning systems.

-Develop/ support emergency response plan, and

SOP

-Support implementation of response plans and operations.

-Support implementation of after-action review.

-Emergency funds mobilization and management skills -Optimize the mobile laboratory during emergency response

-Conduct knowledge transfer training (shift from scientific to operational language) -Policy brief development and dissemination -Promote culture of data use

OS 4: Sustainably improve human resource and institutional technical capacity for the surveillance of malaria and other conditions linked to global health security, maternal and child health, and

WASH.

There is still a significant shortage of health workers working in surveillance, epidemiologic research, and data analysis and use. The approach will be pre-service training (in collaboration with and support to the Universities) and per-service training. The Recipient will develop a need-based training plan, conduct training and follow-up through a consultative approach with key MOH stakeholders.

Intermediate Result 4.1 Improve quality of training on surveillance, research, and evaluation, based on local needs and in partnership with local experts:

Illustrative Activities

General

● Support to the Universities to update training curriculum

● Epidemiology and Biostatistics related training

● FETP

Malaria

● Malaria surveillance

● Malaria course (Paludologie)

ID-GHS

● Training related to the infection prevention and control

● Operational research training

WASH:

● Training of the regional MOH and MoWASH officials to implement national water quality monitoring plan

72068724RFA00008- USAID Soroka Page 16 | 76

IV.5. Key Personnel

The following positions are designated as Key Personnel. The proposed Key Personnel should reflect the communities SOROKA will serve and represent a diverse, gender balanced team. The roles and responsibilities and minimum qualifications for each Key Personnel position are described below:

Chief of Party: The Recipient must designate a Chief of Party who will serve as the main point of contact for the contract, providing vision, direction, leadership, and management for the project. S/he will serve as the project representative for all issues, concerns, or problems.

Chief of Party’s Qualifications:

● Master’s degree or higher in Public health, medicine or other relevant fields ●At least ten years of professional experience in the management of health-related activities, with at least three years of providing senior-level leadership (e.g., Project Director, Deputy Director) ●Fluent French oral and written communication skills is required; proficient Malagasy oral and written communication is required; proficient English oral and written communication skills is preferred

●Knowledge of U.S. Government or international development organization policies and procedures as they relate to international development is preferred.

Scientific Coordinator: The Recipient must designate a Scientific Coordinator who will manage the day to day coordination of the technical aspect of the project. S/he will facilitate tracking of milestones and deliverables, coordinate technical sessions with key stakeholders and ensure high technical standards for project products.

Scientific Coordinator’s Qualifications:

● Master’s degree in Public health, medicine or other relevant fields. A PhD is an asset.

●At least five years of professional experience in scientific research and publication ●At least five years of professional experience in management of health-related project, including data management

● Fluent French oral and written communication skills is required; proficient Malagasy oral and written communication is required; proficient English oral and written communication skills is preferred

Finance and Administration Specialist: The Recipient must designate a Finance and Administration Specialist responsible for overseeing all aspects of budgeting, financial management, and financial reporting; sub-contract management and procurements; human resources management;

asset management; logistics; and compliance with terms and conditions of the contract. This individual will be responsible for preparing financial reports for submission to USAID, ensuring funds expended are compliant with the U.S. Government regulations and policies, and ensuring systems and processes are implemented effectively to support implementation of the contract, including fraud and risk mitigation practices.

Finance and Administration Specialist’s Qualifications:

●Minimum of five years of experience in financial and administrative management for development projects is required.

●At least three years of experience in risk management and implementation of internal controls is preferred.

●Fluent French oral and written communication skills is required; proficient Malagasy oral and written communication is required; proficient English oral and written communication skills is preferred.

●Demonstrated familiarity with U.S. Government or international donors financial reporting and

72068724RFA00008- USAID Soroka Page 17 | 76 compliance requirements are required.

V. Implementation Requirements

V.1 Geographical coverage

All regions are prone to outbreaks and have weak and vulnerable response systems. SOROKA activities on surveillance, scientific research, program evaluation, and training will cover all 115 health districts in Madagascar, prioritizing the highest vulnerability and risk.

V.2 Timeline

The activities will start upon award. All of the activities will be implemented during the first year. The outbreak investigation and response will take place based on the needs. The scientific research will be reinforced during the preparation of scientific events, like conferences. As the SOROKA is the follow-on of the RISE project, no major challenges are expected for the first year of transition.

V.3 Collaboration

SOROKA will build on the achievements of the previous USAID-funded projects, like RISE, Impact Malaria, IDDS (infectious diseases detection and surveillance), etc. SOROKA also will have close collaboration with USAID-funded bilateral activities, such as ACCESS Miahy for the community surveillance, the MAHENIKA for the commodities and reagents, the Rano Maharitra for the WASH-related topics, and the One Health project for the technical complementarity. It will have as well collaboration with centrally-managed projects, like ARAKISA for the data use, the USAID-STRIDES for the coordination on laboratory development, the PMI EVOLVE for the entomology, and the PMI- REACH for the malaria elimination. The SOROKA activity will collaborate and coordinate with other entities outside USAID and some strategic Ministries within the GoM like the Ministry of livestock and the Ministry of Higher education and key development partners: the UN, Global Fund, World Bank, local NGOs, and the private sector.

V.4 Mechanism: Cooperative agreement

The principal purpose of the relationship with the Recipient and under the subject program is to transfer funds to accomplish a public purpose of support or stimulation of the Health Service Delivery.

Additionally, the specific research questions, the types and magnitudes of epidemics, and the type of outbreak response are undetermined at this time of design, leaving the flexibility for the Implementation Partner to refine activities, which will be feasible through an assistance instrument.

The mechanism for this activity will be a Cooperative agreement, as we anticipate substantial involvement of USAID and PMI.

V.5 Substantial involvement

-Approval of the Recipient’s Annual Implementation Plan: The Annual Implementation Plan is the agreement that details the specific activities that will operationalize the broader framework agreement of the award.