DHS-8_RFP_Package_Revised_02.08.2018.Final.pdf

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED

ORDER UNDER DPAS (15 CFR 700)

RATING PAGE OF PAGES

4 229

2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7200AA18R00003

4. TYPE OF SOLICITATION

SEALED BID (IFB)

X NEGOTIATED (RFP)

5. DATE ISSUED

01/18/2018

6. REQUISITION/PURCHASE NUMBER

REQ-GH-18-000004

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

USAID Office of Acquisition & Assistance

M/OAA/GH, SA-44

1300 Pennsylvania Avenue NW Washington, DC 20523

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and See Section L.6 copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the depository located in N/A until 4:00 PM ET local time March 1, 2018

(Hour) CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

11. TABLE OF CONTENTS

(Date)

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 4-4 X I CONTRACT CLAUSES 107-124

X B SUPPLIES OR SERVICES AND PRICES/COSTS 11-15 PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

X C DESCRIPTION/SPECS./WORK STATEMENT 16-57 X J LIST OF ATTACHMENTS 125-125

X D PACKAGING AND MARKING 58-60 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 61-61 X

K

REPRESENTATIONS, CERTIFICATIONS AND

OTHER STATEMENTS OF OFFERORS

126-150

X F DELIVERIES OR PERFORMANCE 62-78

X G CONTRACT ADMINISTRATION DATA 79-90 X L INSTRS., CONDS., AND NOTICES TO OFFERORS 151-186 X H SPECIAL CONTRACT REQUIREMENTS 91-106 X M EVALUATION FACTORS FOR AWARD 187-194

OFFER (Must be fully completed by offeror)

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within____ 240 ____calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

AWARD (To be completed by government)

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

10 U.S.C. 2304 (c) ( ) 41 U.S.C. 253 (c) ( )

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTERED BY (If other than Item 7) CODE 25. PAYMENT WILL BE MADE BY CODE

26. NAME OF CONTRACTING OFFICER (Type or print)

Alisa J. Dunn

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97) Prescribed by GSA - FAR (48 CFR) 53.214(c)

10. FOR

INFORMATION

CALL:

A. NAME

Samantha Lee Pierre

B. TELEPHONE (NO COLLECT CALLS) C. E-MAIL ADDRESS

spierre@usaid.gov AREA CODE

NUMBER

567-4517

EXT.

13. DISCOUNT FOR PROMPT PAYMENT

(See Section I, Clause No. 52.232.8)

10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS (%)

14. ACKNOWLEDGEMENT OF AMENDMENTS

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated):

AMENDMENT NO. DATE AMENDMENT NO. DATE

15A. NAME

AND

ADDRESS

OF

OFFEROR

CODE

FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER

(Type or print)

15B. TELEPHONE NUMBER 15C. CHECK IF REMITTANCE ADDRESS

IS DIFFERENT FROM ABOVE - ENTER

SUCH ADDRESS IN SCHEDULE.

17. SIGNATURE 18. OFFER DATE

AREA CODE NUMBER EXT.

mailto:spierre@usaid.gov

Table of Contents

PART I – THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE 11

B.2 CONTRACT TYPE AND SERVICES 11

B.3 ESTIMATED COST, FEE AND OBLIGATED AMOUNT [TO BE COMPLETED AT

TIME OF AWARD] 11

B.4 CONTRACT BUDGET 13

B.5 INDIRECT COSTS AND ADVANCED UNDERSTANDING ON CEILINGS [TO BE

COMPLETED AT TIME OF AWARD] 13

B.6 COST REIMBURSABLE 14

B.7 LABOR 14

B.8 MULTI-YEAR CONTRACT 14

SECTION C - STATEMENT OF WORK

C.1 BACKGROUND: THE HISTORY OF THE DHS PROGRAM 16

C.2 DHS-8 OPERATING CONTEXT 30

C.3 CONTRACT OVERVIEW 33

C.4 REQUIREMENTS 35

C.5 STAFFING AND MANAGEMENT 46

C.6 IMPLEMENTATION 48

SECTION D - PACKAGING AND MARKING

D.1 AIDAR 752.7009 MARKING (JAN 1993) 58

D.2 BRANDING STRATEGY, IMPLEMENTATION PLAN AND MARKING PLAN 58

SECTION E- INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE 61

E.2 INSPECTION AND ACCEPTANCE/RESPONSIBLE OFFICIAL 61

SECTION F - DELIVERIES OR PERFORMANCE

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE 62

F.2 PERIOD OF PERFORMANCE 62

F.3 PLACE OF PERFORMANCE 62

F.4 PERFORMANCE STANDARDS 62

F.5 REPORTS AND DELIVERABLES OR OUTPUTS 63

F.6 CONTRACTOR PERFORMANCE MONITORING AND SUPPORT 71

F.7 KEY PERSONNEL 72

F.8 AIDAR 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT

EXPERIENCE DOCUMENTS (SEPT 2013) (ACQUISITION AND ASSISTANCE

POLICY DIRECTIVE 13-02, ISSUED SEPT. 4, 2013) 76

SECTION G - CONTRACT ADMINISTRATION DATA

G.1 AIDAR 752.7003 DOCUMENTATION FOR PAYMENT (NOV. 1998) 79

G.2 CONTRACTING OFFICER (CO) 80

G.3 CONTRACTING OFFICER’S AUTHORITY 81

G.4 CONTRACTING OFFICER'S REPRESENTATIVE (COR) 81

G.5 CONTRACTOR’S PRIMARY POINT OF CONTACT 81

G.6 PAYING OFFICE 81

G.7 ACCOUNTING AND APPROPRIATION DATA 81

G.8 TECHNICAL DIRECTIONS/RELATIONSHIP WITH USAID 81

G.9 PAYMENT OF FEE 83

G.10 AWARD FEE EVALUATION PLAN 85

G.11 AWARD FEE EVALUATION PROCEDURES 85

G.12 PERFORMANCE EVALUATION AREAS 87

G.13 AWARD FEE DETERMINATION 88

G.14 AWARD FEE POINT ASSIGNMENT GUIDE 88

G.15 CONTRACTOR PERFORMANCE EVALUATION REPORT 89

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1 EMPLOYMENT OF THIRD COUNTRY NATIONALS (TCN’S) AND

COOPERATING COUNTRY NATIONALS (CCN’S) (AIDAR 722.170) 91

H.2 ADDITIONAL REQUIREMENTS FOR PERSONNEL COMPENSATION 92

H.3 DEFENSE BASE ACT (DBA) INSURANCE 92

H.4 AUTHORIZED GEOGRAPHIC CODE 95

H.5 CONSENT TO SUBCONTRACT 95

H.6 SUBCONTRACTING PLAN AND THE SF 294 – SUBCONTRACTING REPORT

FOR INDIVIDUAL CONTRACTS AND SF 295 – SUMMARY CONTRACTING

REPORT 95

H.7 INTERNATIONAL TRAVEL APPROVAL 95

H.8 FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL

CONFERENCES (JAN 2002) 96

H.9 752.229-71 REPORTING OF FOREIGN TAXES (JULY 2007) 96

H.10 752.222-70 USAID DISABILITY POLICY (DEC 2004) 97

H.11 CONSCIENCE CLAUSE IMPLEMENTATION (ACQUISITION) –

SOLICITATION PROVISION (FEBRUARY 2012) 98

H.12 CONDOMS (ACQUISITION) (SEPTEMBER 2014) 98

H.13 PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE

LEGALIZATION OR PRACTICE OF PROSTITUTION OR SEX TRAFFICKING

(SEPTEMBER 2014) 99

H.14 ORGANIZATIONAL CONFLICT OF INTEREST 100

H.15 302.3.5.22 SUBMISSION OF DATASETS TO THE DEVELOPMENT DATA

LIBRARY (DDL) (OCTOBER 2014) 101

H.16 302.3.5.19 USAID-FINANCED THIRD-PARTY WEB SITES (NOVEMBER 2017)

H.17 HUMAN RIGHTS VIOLATIONS AND SANCTIONS PROGRAM IN BURMA

(JUNE 2015) 104

H.18 ENVIRONMENTAL COMPLIANCE AND MANAGEMENT 105

H.19 EXECUTIVE ORDER ON TERRORISM FINANCING 106

PART II - CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE 107

I.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) 112

I.3 52.204-1 APPROVAL OF CONTRACT (DEC 1989) 114

I.4 52.216-24 LIMITATION OF GOVERNMENT LIABILITY (APR 1984) 114

I.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) 114

I.6 52.222-35 EQUAL OPPORTUNITY FOR VETERANS (OCT 2015) 114

I.7 52.222-36 EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES (JUL

2014) 115

I.8 52.222-42 STATEMENT OF EQUIVALENT RATES FOR FEDERAL HIRES (MAY

2014) 115

I.9 752.245-70 GOVERNMENT PROPERTY—USAID REPORTING REQUIREMENTS

(JULY 1997) 116

I.10 752.252-70 PROVISIONS AND CLAUSES TO BE COMPLETED BY THE

OFFEROR (MAR 2015) 118

I.11 752.7006 NOTICES (APR 1984) 118

I.12 752.7007 PERSONNEL COMPENSATION (JUL 2007) 119

I.13 752.7027 PERSONNEL (DEC 1990) 119

I.14 752.7036 USAID IMPLEMENTING PARTNER NOTICES (IPN) PORTAL FOR

ACQUISITION (JULY 2014) 120

I.15 752.7037 CHILD SAFEGUARDING STANDARDS (AUG 2016) 122

I.16 752.7038 NONDISCRIMINATION AGAINST END-USERS OF SUPPLIES OR

SERVICES (OCT 2016) 124

PART III – LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J - LIST OF ATTACHMENTS

PART IV - REPRESENTATIONS AND INSTRUCTIONS

SECTION K - REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS

K.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE 126

K.2 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (JAN 2017) 126

K.3 52.204-20 PREDECESSOR OF OFFEROR (JUL 2016) 131

K.4 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT

2015) 132

K.5 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

K.6 52.209-11 REPRESENTATION BY CORPORATIONS REGARDING

DELINQUENT TAX LIABILITY OR A FELONY CONVICTION UNDER ANY

FEDERAL LAW (FEB 2016) 136

K.7 52.219-1 SMALL BUSINESS PROGRAM REPRESENTATIONS (OCT 2014) 136

K.8 52.222-22 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FEB 1999)

K.9 52.222-25 AFFIRMATIVE ACTION COMPLIANCE (APR 1984) 140

K.10 52.222-26 EQUAL OPPORTUNITY (SEP 2016) 141

K.11 52.225-20 PROHIBITION ON CONDUCTING RESTRICTED BUSINESS

OPERATIONS IN SUDAN--CERTIFICATION (AUG 2009) 144

K.12 52.227-15 REPRESENTATION OF LIMITED RIGHTS DATA AND RESTRICTED

COMPUTER SOFTWARE (DEC 2007) 145

K.13 52.230-1 COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION

(OCT 2015) 145

K.14 52.230-7 PROPOSAL DISCLOSURE—COST ACCOUNTING PRACTICE

CHANGES (APR 2005) 148

K.15 AAPD 15-01A 52.203-98, PROHIBITION ON CONTRACTING WITH ENTITIES

THAT REQUIRE CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS-

REPRESENTATION (APR 2015) 149

K.16 AGREEMENT ON, OR EXCEPTIONS TO, TERMS AND CONDITIONS 149

K.17 AUTHORIZED NEGOTIATORS 149

K.18 SIGNATURE 150

SECTION L - INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

L.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE 151

L.2 52.215-1 INSTRUCTIONS TO OFFERORS – COMPETITIVE ACQUISITION (JAN

2017) (ALTERNATE I – OCT 1997) 152

L.3 52.216-1 TYPE OF CONTRACT (APR 1984) 156

L.4 52.233-2 SERVICE OF PROTEST (SEP 2006) 156

L.5 GENERAL INSTRUCTIONS TO OFFERORS 157

L.6 DELIVERY INSTRUCTIONS 158

L.7 INSTRUCTIONS FOR THE PREPARATION OF THE TECHNICAL PROPOSAL 158

L.8 INSTRUCTIONS FOR THE PREPARATION OF THE COST PROPOSAL 171

L.9 INSTRUCTIONS FOR THE PREPARATION OF THE BRANDING STRATEGY,

IMPLEMENTATION PLAN, AND MARKING PLAN 186

L.10 OFFER VALIDITY 186

SECTION M - EVALUATION FACTORS FOR AWARD

M.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE 187

M.2 GENERAL INFORMATION 187

M.3 EVALUATION FACTORS 187

M.4 DETERMINATION OF COMPETITIVE RANGE 193

M.5 SOURCE SELECTION 193

M.6 CONTRACTING WITH SMALL BUSINESS CONCERNS AND

DISADVANTAGED ENTERPRISES 193

ATTACHMENT J.1 – CONTRACT BUDGET (to be inserted at award)

ATTACHMENT J.2 – SMALL BUSINESS SUBCONTRACTING PLAN (to be inserted at award)

ATTACHMENT J.3 – IEE

ATTACHMENT J.4 – DHS-7 PERFORMANCE MONITORING PLAN (PMP) INDICATORS

ATTACHMENT J.5 - ACRONYM LIST

ATTACHMENT J.6 – PAST PERFORMANCE REFERENCE FORM

ATTACHMENT J.7 – AID FORM 1420-17

ATTACHMENT J.8 – BRANDING IMPLEMENTATION STRATEGY AND MARKING

PLAN [to be inserted at time of award]

PART I – THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

The DHS-8 contract will continue to be USAID's primary implementation mechanism for demographic and health data collection. The purpose of this contract is to improve the collection, analysis, and dissemination of population, health, and nutrition data and to facilitate use of these data for planning, policy-making, and program management. The contract will achieve the following results further described in Section C:

Result 1: Improved tools, methods, partnerships, and technical guidance to collect quality population, health, and nutrition data.

Result 2: Increased in-country individual and institutional capacity for identification of data needs and for survey design, management, and data collection to meet those needs.

Result 3: Improved availability of DHS Program survey data and information.

Result 4: Advanced analysis and synthesis of DHS Program survey data.

Result 5: Improved facilitation of DHS Program data use among stakeholders worldwide.

B.2 CONTRACT TYPE AND SERVICES

This is a Cost- Plus- Award- Fee (CPAF) Contract for an estimated duration of five (5) years.

Under the contract, the contractor will furnish all personnel, materials, equipment, supplies, services (except as expressly set forth in this contract as furnished by the Government) and perform all activities necessary for, or incidental to, the performance of objectives described in Section C, F, and J.

B.3 ESTIMATED COST, FEE AND OBLIGATED AMOUNT [TO BE COMPLETED AT

TIME OF AWARD]

(a) Total Estimated Cost of Contract Line Item Number 1 (CLIN1)

(a)(1) The total estimated cost for the performance of work required hereunder, exclusive of fee (if any), is $TBD. The total base fee (if any) is $TBD. The total estimated cost plus the total base and award fee amount (if any) is $TBD.

(a)(2) The maximum award fee is $TBD.

(a)(3) The base fee is $TBD.

(a)(4) The estimated cost plus all possible fees, if any, is $TBD.

(b) Total Estimated Cost of Contract Line Item Number 2 (CLIN2)

Award fee will not be assessed on CLIN2.

(b)(1) The total estimated cost for the performance of work required hereunder, exclusive the total base fee amount (if any) is $TBD.

(b)(2) The base fee is $TBD.

(b)(3) The estimated cost plus all possible fees, if any, is $TBD.

(c) Total Estimated Cost ((CLIN1 + CLIN2)

(c)(1) The total estimated cost for the performance of work required hereunder, exclusive the total base and award fee amount (if any) is $TBD.

(c)(2) The maximum award fee is $TBD.

(c)(3) The base fee is $TBD.

(c)(4) The estimated cost plus all possible fees, if any, is $TBD.

Total estimated cost for the performance of work specified in Section C, Section

F, Deliverables, and Attachment J.1 of this contract

Maximum award fee

Base fee

Estimated cost plus all possible fees

CLIN1

CLIN2

CLIN1 + CLIN2* N/A

*Award fee will not be assessed on CLIN2.

(d) Obligated Amount

(1) The amount currently obligated and available for reimbursement of allowed costs incurred by the Contractor for performance hereunder is $______________. The Contractor must not exceed the aforesaid amount and may not bill for advance payment of fee.

B.4 CONTRACT BUDGET

The contract budget captures the final negotiated cost elements for the performance of the work required, and is set forth in Attachment J.1 (to be inserted at time of award).

B.5 INDIRECT COSTS AND ADVANCED UNDERSTANDING ON CEILINGS [TO BE

COMPLETED AT TIME OF AWARD]

Pending establishment of revised provisional or final indirect cost rates, allowable indirect costs must be reimbursed on the basis of the following negotiated provisional or predetermined rates and the appropriate bases for prime contractors and their major subcontractors.

Offeror Fringe Rate

Overhead Rate %

Overhead Ceiling Rate %

G&A Rate

G&A Ceiling Rate %

PRIME (Insert Name) Base of Application Source: (insert) Period: (insert)

MAJOR

SUBCONTRACTOR(S)

(Insert Name (s))

Base of Application Source: (insert) Period: (insert)

*Special Note: The un-shaded columns in the indirect cost table are the current approved indirect cost rates for the prime and major subcontractor(s).

The Contractor will make no change in its established method of classifying or allocating indirect costs that impacts this contract without the prior written approval of the Contracting Officer.

Reimbursement for indirect costs must be at final negotiated rates, but not in excess of ceiling rates specified above.

The Government must not be obligated to pay any additional amount associated with indirect costs above the ceiling rates established in the contract. If the final indirect cost rates are less than the negotiated ceiling rates, the negotiated rates will be reduced to conform to the lower rates. This advance understanding must not change any monetary ceiling, cost limitation, or obligation established in the contract.

Note: Contractors are allowed to recoup indirect costs (OH, G&A, etc.) as other direct costs if it is part of the contractor’s usual accounting procedures, consistent with FAR Part 31 and the contactor’s NICRA.

B.6 COST REIMBURSABLE

The U.S. dollar costs allowable will be limited to reasonable, allocable and necessary costs determined in accordance with FAR 52.216-7, Allowable Cost and Payment, FAR 52.216-8 Fixed Fee, USAID Acquisition Regulation (AIDAR) 752.216-70 Award Fee, and AIDAR 752.7003, Documentation for Payment.

B.7 LABOR

Compensation of personnel under this contract or any resulting subcontract must be in accordance with AIDAR 752.7007 Personnel Compensation (July 2007), the full text of which is in Section I.

B.8 MULTI-YEAR CONTRACT

The ceiling is considered non-severable, and is therefore a multi-year contract as defined in FAR

17.103. This contract is subject to the requirements of FAR 17.106.

This is a Cost- Plus- Award- Fee (CPAF) type contract where the contractor is authorized to be reimbursed for all costs which are allowable in accordance with FAR 52.216-7, “Allowable Costs and Payment”. Therefore, the contractor will not incur any costs which would have been amortized over the life of the contract should be cancelled in accordance with FAR 52.217-2.

Therefore, the cancellation ceiling established pursuant to FAR 17.106-1(c)(1) for each program year is detailed in the table below.

In the event that the Government cancels requirements for services in subsequent program years under this contract, the following conditions will apply: [Amount and dates to be filled in at time of award]

Cancellation Dates:

Contract Year 2: DATE TBD, [Award year + 1 year] Cancellation Ceiling: TBD Contract Year 3: DATE TBD, [Award year + 2 years] Cancellation Ceiling: TBD Contract Year 4: DATE TBD, [Award year + 3 years] Cancellation Ceiling: TBD Contract Year 5: DATE TBD, [Award year + 4 years] Cancellation Ceiling: TBD

The cancellation dates and ceiling amounts will be established at the time of award. The amounts will be based on the nonrecurring costs to be incurred by the awardee, which would be applicable to, and which normally would be amortized over the life of the contract, and the items or services to be furnished under the multi-year requirement.

END OF SECTION B

SECTION C - STATEMENT OF WORK

C.1 BACKGROUND: THE HISTORY OF THE DHS PROGRAM

C.1.1 Introduction: The Role of Reliable and Timely Health Data and Information

The U.S. Agency for International Development (USAID) has long recognized that the timely collection, analysis, and use of data are crucial for program planning, monitoring and evaluation, and for informing policy decisions. Over the past five-plus decades, USAID has sponsored a wide range of health-related data collection activities, including support for censuses, civil and vital statistics, health management information systems, and household- and facility-based surveys, as well as support for indicator development and data use for decision making.

Of these activities, USAID’s leadership and continued support of the Demographic and Health Surveys (DHS) Program remains of high importance and focus. As the longest enduring international program for the collection, analysis, dissemination, and use of health survey data, The DHS Program assists participating countries to implement household and facility-based surveys, to analyze data stemming from these surveys, and to facilitate use of these data to support evidence-informed decision making, advocacy, and accountability among program managers, policymakers, researchers, and citizens.

Over the years, data needs for health-related monitoring, evaluation, and program planning have increased substantially. The number of donors, private sector investors, and other global health stakeholders has expanded rapidly, as has the overall level of health aid, pace of out of pocket health expenditures, and scope of domestic resource mobilization. This increase in aid, expenditures, and domestic resources, coupled with greater attention to accountability and aid effectiveness, has stimulated greater demand for quality data to inform evidence-based decision making, including resource allocation and investment. Indeed, as the recent Ebola and Zika epidemics have shown, health sector data are vitally needed to anticipate, monitor, and respond to health threats. These data are also needed to ensure accountability and foster transparency at global, national, and subnational levels, especially in terms of resource allocation, information sharing, and risk communication.

The Sustainable Development Goals (SDGs) (see https://sustainabledevelopment.un.org/sdgs) have also increased attention to the need for adequate systems to monitor progress and help to ensure that “no one is left behind.” Meanwhile, country-level decentralization and health sector reforms are placing further emphasis on subnational data relating to program quality, cost, cost-effectiveness and efficiency, and impact, particularly as related to universal health coverage.

https://sustainabledevelopment.un.org/sdgs

U.S. Government (USG) policies and initiatives are also contributing to the overall increase in data demand at both the country and headquarters levels. The USG Updated Foreign Assistance Standardized Program Structure and Definitions (see https://www.state.gov/f/releases/other/255986.htm#HL7) links program areas with their elements and definitions in order to enable the monitoring and evaluation of the effectiveness of U.S.

foreign assistance. The major thrusts of USAID’s global health work—preventing child and maternal deaths, expanding family planning access to 120 million additional users by 2020, controlling the HIV/AIDS epidemic, and combatting infectious diseases—specify goals and targets across health and disease areas and promote monitoring and evaluation for learning and accountability to maximize efficiency and sustainable impact. The same is true for the major global health presidential initiatives implemented by USAID—the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Presidential Malaria Initiative (PMI). In addition, global partners such as Gavi: the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis, and Malaria require data to monitor and evaluate the effectiveness of program activities. Finally, joint efforts of the USG, United Nations, World Bank, other development partners, and national governments—such as the current thrust to achieve universal health coverage with support from the newly established Global Financing Facility—have additional data requirements.

Beyond the increase in donor and global partner demand, the health profiles of many low- and middle-income countries are changing and, consequently, the type and scope of data needed for health programming are evolving. For instance, differences in health conditions imply differences in data needs across countries and regions. While countries in sub-Saharan Africa typically request data be collected on maternal and child health, nutritional status, HIV/AIDS, and malaria; countries in Eastern Europe increasingly request data be collected about risks to adult health such as smoking, environmental hazards, drug abuse, obesity, and chronic diseases.

Data on non-communicable diseases among people of all ages are being requested by low-, middle-, and high-income countries alike. Moreover, countries across the world have experienced an increased demand for information about the characteristics of health services and health systems, as well as data on rights/empowerment and gender, including sex disaggregation.

Such changes in health profiles and data needs are compounded by environmental and other security challenges that are leading to increased migration, displacement, and instability. These population changes also produce new data needs, including the need to capture and disaggregate data from populations living in insecure settings.

The ability to respond adequately to changing data needs while ensuring data quality and accessibility has long been an important feature of The DHS Program. The next iteration of the Program, DHS-8, will continue this flexibility in response to data needs while maintaining high quality standards and building local capacity to collect, analyze, and use survey data.

Furthermore, the major programmatic elements for which The DHS Program is known— technical assistance for quality household and facility-based data collection, analysis, dissemination, and use; technical leadership to develop and adapt survey methodologies to meet existing and emerging data needs; and active encouragement of data analysis and use through https://www.state.gov/f/releases/other/255986.htm#HL7 capacity strengthening activities, data visualization tool development and roll out, and online archiving of data and indicators for free public access and use—will remain hallmarks of DHS-8.

The DHS Program website, www.dhsprogram.com, provides additional detail about the content, coverage, history, publications, and accomplishments of The DHS Program to date.

C.1.2 The Evolution of The DHS Program

USAID places a high premium on the collection, analysis, and dissemination of timely, quality, nationally-representative health data for the purposes of program planning, monitoring, evaluation, and policy making, and has invested in such programs for 45 years, beginning with its collaboration with the United Nations Population Fund and the International Statistical Institute to launch the World Fertility Surveys (WFS) in 1972. Based on the success of the WFS and a growing need for timely data for program planning and policy decisions, USAID supported two survey data collection projects that were smaller in scope and content: the Contraceptive Prevalence Survey (CPS) implemented by Westinghouse from 1977 to 1985, and the CPS project (also known as the Family Planning/Maternal Child Health Surveys or Reproductive Health Surveys) implemented by the Centers for Disease Control and Prevention (CDC) from 1975 to 2011. At the conclusion of the WFS in 1984, USAID launched The DHS Program as a technical assistance program to help host countries conduct quality, nationally-representative health surveys that collect cross-nationally comparable data.

C.1.2.1 DHS-1 to DHS-3

The first three phases of The DHS Program—DHS-1 (1984-1989); DHS-2 (1988-1993); and DHS-3 (1992-1997) —shared a common vision of The DHS Program: to provide technical assistance for quality surveys, technical leadership to advance survey methodologies, and active encouragement of data analysis. Over time, The DHS Program's standard household-based survey evolved. For example, during DHS-1, the standard survey expanded with the inclusion of anthropometric measures, the addition of the men's survey, and the development and implementation of the first optional modules, including maternal mortality and female genital cutting. During DHS-2, domestic violence questions were added to the standard questionnaire and the survey was implemented in increasingly more countries. DHS-3 witnessed similar changes, including the addition of biomarker testing, such as anemia and vitamin A deficiency, and the addition of the women's status module.

C.1.2.2 MEASURE Phases I-III DHS (or DHS-4 to DHS-6)

To respond to increasing demand for enhanced collaboration across USAID-funded health data activities, in 1996, USAID developed a package of monitoring and evaluation activities known as Monitoring and Evaluation to Assess and Use Results (MEASURE). MEASURE was http://www.dhsprogram.com/ designed to create a partnership to bring together the efforts of five USAID projects to improve health data quality and data collection methodologies, the data collection process, data analysis, data dissemination and use activities, as well as efforts to build capacity in each of these areas.

The Activity Objective of the first phase of the MEASURE Program (MEASURE Phase I), implemented from 1997 to 2003, was "to improve and institutionalize the collection and utilization of data for monitoring and evaluation of host country programs and for policy decisions." The component projects of MEASURE Phase I included: MEASURE DHS+ (which would have been named DHS-4 had it continued the original nomenclature), MEASURE Evaluation, MEASURE Communication, and Participating Agency Service Agreements with both the Bureau of Census (BUCEN) and with the Division of Reproductive Health of the Centers for Disease Control and Prevention. MEASURE Communication, with its focus on data dissemination and information communication, was the one component of the results package that was completely new at the time of the design. It was designed as a separate component to place greater emphasis on the data and information communication function.

There were two subsequent phases of MEASURE—MEASURE Phase II (2003-2008) and MEASURE Phase III (2008-2013), and the scope, focus, and programmatic components of the Program continued to change over the years. The concept for MEASURE Phase II drew from the results of the "MEASURE Results Package Evaluation and Pre-design Study" conducted by the POPTECH Project in June 2001.1 Compared to MEASURE Phase I, MEASURE Phase II more strongly emphasized two areas: generating demand for data and facilitating use of data.

The Activity Objective was modified to be "to improve collection, analysis and presentation of data to promote better use of data in planning, policymaking, managing, monitoring and evaluating population, health, and nutrition programs." Along with the change in framework, a change in the implementation arrangement was made for MEASURE Phase II. The communication function was eliminated as a separate component and was, instead, incorporated into each of the other four components: MEASURE Phase II DHS, MEASURE Phase II Evaluation, MEASURE Phase II BUCEN, and MEASURE Phase II CDC. The intent of this integration was to make data dissemination and use an integral component of the work of each of the MEASURE Phase II projects. In MEASURE Phase III, the Activity Objective and the four programmatic components remained unchanged from Phase II. In comparison to previous phases, however, MEASURE Phase III placed special emphasis on capacity building and helping host countries move toward sustainability in all aspects of data collection, monitoring, evaluation, and analysis. Additionally, the reproductive health survey work conducted by MEASURE/CDC was phased out in Phase III. As a result, The DHS Program became the only

1 Seltzer et al. MEASURE Results Package Evaluation and Pre-Design Study, May 2001.This document is available at www.poptechproject.com as publication number 2001-019-004.

http://www.poptechproject.com/

USAID Bureau for Global Health (GH) program of technical assistance for international health survey data.2

C.1.2.3 DHS-7

The seventh, and current, iteration of The DHS Program, DHS-7, began in September 2013 and continues through September 2018. Unlike the past three project cycles, DHS-7 does not carry the MEASURE prefix. USAID made this departure for two main reasons. First, the additional collaborative facilitation from USAID originally promoted via the MEASURE relationship was no longer needed as the MEASURE projects grew to have independent, ongoing collaboration and professional contact with one another. Second, recognizing the unique identity of each of the remaining three MEASURE projects, USAID supported omission of the MEASURE prefix in order to improve differentiation of the three projects by audiences within and external to

USAID.

There are several other ways in which DHS-7 differs from the past. First, recognizing that strong demand for DHS data now exists globally and across many host countries3, demand creation for data is no longer a result as it was in previous DHS Program iterations. Similarly, because DHS is increasingly seen as a global good, and its implementation now represents one of the best examples of interagency and international collaboration, collaboration is no longer a result.

Rather, collaboration is a guiding principle (further described in Section C.3.1). Recognizing other recent trends, including the growing need to facilitate effective interpretation and use of DHS data by host country nationals in order to encourage evidence-based decision making, DHS-7 places increased emphasis on strengthening analytical capacity in participating countries.

Given advances in host country survey implementation capacity, DHS-7 also increasingly uses South-to-South technical assistance where appropriate. Finally, acknowledging program planners' and policy makers' need for enhanced analyses and syntheses of existing data coupled with the increased availability of high-quality, rich datasets from myriad sources, including from countries that have collected multiple rounds of DHS, sophisticated analyses and syntheses of existing data are undertaken by DHS-7 in order to build the knowledge base and foster deeper understanding of health issues.

2 For additional information about MEASURE Phase III DHS, please see the project evaluation report, “External evaluation of the MEASURE phase III demographic and health surveys (DHS) project: final report”. This document is available as document PD-ACT-785 at https://dec.usaid.gov.

3 Note: While demand for household survey data is strong, demand for Service Provision Assessment (SPA) data remains low, as elucidated in the DHS-7 midterm evaluation referenced below (see Section C.3.1). DHS-8 will include a focus on ensuring that key stakeholders are aware of SPA utility and are making use of SPA data, as appropriate, further described herein.

https://dec.usaid.gov/dec/GetDoc.axd?ctID=ODVhZjk4NWQtM2YyMi00YjRmLTkxNjktZTcxMjM2NDBmY2Uy&rID=MzIyMjE4&pID=NTYw&attchmnt=VHJ1ZQ==&uSesDM=False&rIdx=Mjg4MTY0&rCFU=

C.1.3 Survey Types and Content

Since its inception in 1984, The DHS Program has provided technical assistance to host country partners in the implementation of 390 surveys in 90 countries. Since MEASURE Phase II DHS (DHS-5), each Program cycle has generally supported surveys in 45-50 countries. Historically, about half of these surveys were conducted in Sub-Saharan Africa, with the rest having been conducted primarily in Asia and Latin America. More recently, with the expansion of Malaria Indicator Surveys (MIS), surveys in sub-Saharan Africa have comprised about 60 percent of all DHS Program surveys. In terms of other regional trends, over the past decade, the number of surveys in Asia has expanded while the number of surveys in Latin America and Caribbean (LAC) has declined as LAC countries transition away from development assistance and increasingly implement their own national household surveys. DHS-7, for example, has so far supported 17 surveys in Central, South, and Southeast Asia whereas DHS-5 supported 9 in the region. Conversely, DHS-5 supported 9 surveys in LAC while MEASURE Phase III DHS (DHS-6) supported 7 and DHS-7 has supported even fewer to date—5 surveys.

The DHS Program has always adapted its survey instruments to respond to countries' specific data needs, while also maintaining accessibility and comparability over time and across countries. Consequently, over the past 33 years, the scope of DHS Program surveys has expanded in terms of both sample size and content. At the beginning of The DHS Program, the sample size of each standard DHS was typically about 5,000 households. As a result of increasing demands for sub-national level estimates, the sample size of most DHS-implemented national surveys has increased. For example, standard DHS implemented between 2008 and 2011 had a median sample size of approximately 11,000 households. Those implemented between 2012 and 2017 had a median sample size of approximately 14,000 households.

The range and depth of topics has also expanded. Initially, respondents were only women of reproductive age and survey topics consisted mainly of fertility, family planning, and maternal and child health. Today, nearly all surveys also include male respondents, allowing for a better understanding of family dynamics and health, and data are collected on a wide variety of topics that include anemia, maternal and child nutritional status, geographic location, HIV, male circumcision, and blood pressure measurement. Though this expansion has resulted in availability of more diverse health data, the pressure exerted by stakeholders to add more questions and modules has led to increasing sizes of DHS questionnaires and increasing response time required of interviewees. Decisive steps were taken in DHS-6 to reduce the length of the core questionnaires by 31 percent. More recently, with the core questionnaire revision of DHS- 7, steps were taken to ensure that core questionnaire modifications had zero impact on survey length.

In responding to changing data needs, The DHS Program has been flexible without sacrificing data quality. In so doing, The DHS Program has garnered a strong reputation as a source of reliable health indicator data that is comparable within and between countries.

As detailed below, several different types of surveys have been conducted by The DHS Program, including: standard Demographic and Health Survey (DHS); Interim Demographic and Health Survey (Interim DHS); AIDS Indicator Survey (AIS); Malaria Indicator Survey (MIS); and Service Provision Assessment (SPA). Each survey type includes a standard set of indicators, has core questionnaires and data tabulation plans, and offers guidance for conducting surveys, designing sampling frames, and calculating sample sizes.

C.1.3.1 Household Surveys

Standard DHS: The standard DHS is a nationally representative household survey with a large sample size of typically 16,000 households (mean)4, ranging from ~4,000 to ~600,000 households in the outlier, India. Generally conducted every four to five years, DHSs provide data for a wide range of indicators in the areas of population, health, and nutrition. In order to collect data that are comparable across countries, standard core questionnaires have been developed along with survey manuals that describe the rationale for inclusion of certain questions or sections. The development of the survey manuals has ensured that similar questionnaire and survey procedures are followed in each country. The survey manuals include topics such as sampling, field staff training, interview procedures and quality control. Three core questionnaires—household, female individual, and male individual—form the backbone of the questionnaires that are applied in each country (see the description of the instruments in the Questionnaire Design sub-section). Questionnaires can be tailored to meet the data needs of host countries and donors by adding questions and/or deleting questions perceived to be irrelevant to a particular country situation. To accommodate requests for information on special topics that are not contained in the core questionnaires and to achieve some level of comparability across countries that apply them, optional questionnaire modules have been developed on a series of topics, including out-of-pocket health expenditures, domestic violence, female genital cutting, fistula, adult and maternal mortality, injury and accidents, disability, male child circumcision, and non-communicable diseases. Additionally, to meet the need for prevalence data on myriad health conditions, including HIV, anemia, malaria, and more, standard DHSs also frequently make use of biomarker testing (further described below) using comparable methods and tests across countries and time to promote cross-national and cross-temporal comparison.

AIS: The AIS was developed to provide countries with a standardized tool to obtain indicators for effective monitoring of national HIV/AIDS programs. The design for the AIS was guided by the need to have a survey protocol that would provide, in a timely fashion and at a reasonable cost, the information required for meeting HIV/AIDS program reporting requirements, including the collection of PEPFAR and UN General Assembly Special Session on HIV/AIDS indicators.

The AIS consists of two survey instruments – the household questionnaire and the individual

4 Note: the average sample size has grown substantially over time with a mean of ~10,800 households in the 1990- 1999 period, ~14,900 in the 2000-2009 period, and ~16,300 in the 2010-2016 period).

questionnaire. The household questionnaire is administered to identify eligible men and women for individual interviews and obtain information on basic characteristics of the household and its members. The individual questionnaire, administered to both men and women, is designed to obtain information on individual background characteristics, patterns of marital unions, sexual behavior, coverage of HIV testing, and knowledge and attitudes related to HIV/AIDS. HIV testing is conducted among eligible men and women. Since the AIS was developed in DHS-5, The DHS Program has supported implementation of 11 AIS, only 1 of which has been supported to date in DHS-7. Due to the waning demand for AIS, it is not expected that DHS-8 will continue to undertake HIV/AIDS-specific surveys. Nevertheless, elements of the AIS—including HIV testing—will continue to be incorporated into standard DHS based on country need and demand.

MIS: The MIS was developed in the mid-2000s by the Roll Back Malaria Monitoring and Evaluation Reference Group Survey and Indicator Task Force, in close collaboration with The DHS Program. Designed to obtain information required to meet the program reporting requirements of the President's Malaria Initiative in a timely manner and at a reasonable cost, the MIS is a nationally representative survey for assessing malaria-related indicators, including coverage of insecticide-treated mosquito nets, coverage of indoor residual spraying of insecticide to kill mosquitos, type and timing of treatment of high fever in children under five years of age, diagnostic blood testing of children under five years of age, and intermittent preventive therapy (IPT) among pregnant women. Generally, MIS sample sizes are much smaller than DHS, with 6,000 households on average included in the sample. There are two main MIS survey instruments – the household questionnaire and the individual questionnaire. The household questionnaire is administered to identify women of reproductive age and children under five years of age who are eligible for anemia and malaria testing. The household questionnaire also yields information on the dwelling unit, indoor residual spraying of dwelling, and bed net ownership and use. The individual questionnaire is administered to eligible women 15-49 to obtain information on background characteristics, birth history, IPT during the last pregnancy, incidence of fever in children under five years of age, and treatment patterns. Blood samples are collected for anemia testing and rapid diagnostic malaria testing. The number of MIS supported via The DHS Program tripled from DHS-5 to DHS-6 (from 3 to 10 MIS) and has continued to increase in DHS-7 (15 MIS to date). The number of MIS conducted via DHS-8 is expected to remain at a similar level as DHS-7.

Interim DHS: Since the interval between two standard DHS is about five years, and recognizing that situations may arise that require more frequent data for program or policy decisions, an interim DHS was made an available option. Like the standard DHS, interim DHS are nationally representative with cross-nationally comparable indicators. However, unlike the standard DHS, the questionnaires for the interim DHS are supposed to be shorter, the sample sizes smaller, and the implementation cost lower. Nevertheless, the uptake of interim DHS has been infrequent and experience has shown that interim surveys end up being as large and expensive as regular DHS because countries and donors often want nearly all indicators across all geographic regions.

Moreover, with the advent of other health initiatives (like PMI) and other survey data collection platforms (see Section C.1.5) there has been an increase in survey data available between rounds of the standard DHS, thus making the need for the interim DHS even less frequent. At this time, no interim DHS are expected to be conducted via DHS-8.

Special Surveys: Special country and global-level data needs demand creative survey solutions beyond those described above. The DHS Program has responded to such needs by creatively adapting its methods and approaches. For example, the demand for more frequent data, which continues to grow, led to the creation of a continuous survey approach. This approach is currently being used in Peru and Senegal. Similarly, benchmark surveys were conducted in Nepal and India to respond to program needs in those settings. The DHS Program has also conducted specialized and issue-specific surveys in response to country specific data needs, including the Health Issues Survey in Egypt, Health Examination Survey in Uzbekistan, Young Adult Reproductive Health Survey in Indonesia, Maternal Health Survey in Ghana, and Afghanistan Mortality Survey. To meet ever increasing data needs, survey types and methodologies must continue to be innovated and honed under DHS-8.

Household Survey Designs

Sample Design: The DHS Program was designed to provide reliable estimates for population, health, and nutrition indicators at national, rural-urban, and regional levels. In recent years, in part because of the increasing trends toward decentralization and lack of strong health information systems, country and donor-driven demands for indicators at subnational levels have increased, resulting in larger sample sizes. Meanwhile, increasing financial support from non- USAID sources has often led to demand for indicator data for specific geographic locations where such donors have ongoing health programs. In response, The DHS Program has sometimes implemented nested sampling designs that over-sample selected populations without biasing national or regional estimates. These data demand trends will likely continue to escalate;

as decentralization grows, and donor collaboration increases, so too will requests requiring more sophisticated sampling designs.

Questionnaire Design: Currently, three types of core questionnaires - household, women, and men - are used to elicit responses needed for deriving core indicators for health and population programs. The household questionnaire is used to collect information on the characteristics of the household and its members, including anthropometric data, and to identify members who are eligible for the individual women and men questionnaires. Household members eligible for individual interviews include women of reproductive age (15-49 years) and, in selected surveys, men typically 15-59 years of age. In some countries, only women are interviewed. The individual questionnaires include information on a variety of topics, including marriage, fertility, family planning, reproductive health, child health, and HIV/AIDS. A central purpose of the core questionnaires is to provide data for use in cross-country and regional analyses as well as contribute to data aggregation at the global level. Each of the three core questionnaires is supported by a series of optional modules, each addressing a key health program area. Optional modules are selected for use depending upon country needs. Use of optional modules enables the data collection program to respond to specific needs at the country level without conducting multiple surveys. While this approach has enabled The DHS Program to meet core data needs and country specific needs simultaneously, it has the potential disadvantage of leading to a lengthy questionnaire that is daunting for respondents and interviewers alike. There has been no solid evidence that respondent fatigue is an issue to date, however, this possibility has become an increasing concern. Towards the beginning of each phase of The DHS Program, the core questionnaires and optional modules are revised to ensure that data collected are policy-relevant, programmatically useful and are used, while preserving data quality and comparability. The most recent core questionnaire revision (undertaken in 2014) resulted in the addition of a fourth core questionnaire—the interviewer questionnaire. Data from this short questionnaire of survey fieldworkers can be used to explore survey data quality and identify interviewer characteristics associated with quality.

C.1.3.2 Facility-based Surveys

Service Provision Assessment: The Service Provision Assessment (SPA) is a nationally representative survey of formal health facilities that provides a comprehensive, cross-sectional overview of availability of services, capacity to provide quality services, and quality of care.

The SPA consists of four survey instruments – the facility inventory of resources, the provider questionnaire, the observation protocol, and the exit interview questionnaire. The facility inventory includes the core Service Availability and Readiness Assessment (SARA) questionnaire5 (see http://www.who.int/healthinfo/systems/sara_introduction/en/) and is used to assess facilities' capacity to provide basic services at both the overall facility-level as well as the health element-specific level. It is used to collect data on basic infrastructure, standard precaution for infection control, laboratory capacity, and availability of clinical guidelines, basic equipment, medicines, and commodities. The three other instruments are used to collect data on service delivery by health providers. Specifically, the provider interview questionnaire is used to assess human resources such as training and supervision as well as background characteristics of providers.