7200AA19APS0001 - Addendum 05 Key Affected and Vulnerable Populations (KAP) Ethiopia.pdf

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

ANNOUNCEMENT

CALL FOR CONCEPT PAPERS

ADDENDUM 05

Local Organizations Network (LON) for Key affected and vulnerable populations (KAP) in Ethiopia

Under Existing

TB LOCAL ORGANIZATIONS NETWORK (LON)

ANNUAL PROGRAM STATEMENT APS No.: 7200AA19APS00001

This is an Addendum to the above stated Annual Program Statement (APS) 7200AA19APS00001.

All interested organizations should carefully review both this Addendum AND the full APS announcement, Amendment 5, as described below.

/s/ 04/21/2022 Abibou Oussantidja, Agreement Officer

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

ANNOUNCEMENT

CALL FOR CONCEPT PAPERS

ADDENDUM 05

Local Organizations Network (LON) for Key affected and vulnerable populations (KAP) in

Ethiopia

Under Existing

TB LOCAL ORGANIZATIONS NETWORK (LON)

ANNUAL PROGRAM STATEMENT APS No.: 7200AA19APS00001

CATALOG OF FEDERAL DOMESTIC ASSISTANCE (CFDA) NUMBER: 98.001

ISSUANCE DATE: April 21, 2022

CLOSING DATE OF QUESTIONS: May 06, 2022 (5:00 PM Ethiopia time)

CLOSING DATE OF CONCEPT PAPERS: May 28,2022 (5:00 PM Ethiopia time)

PLEASE NOTE: This is an Addendum to an existing Annual Program Statement (APS)

7200AA19APS00001. All interested organizations should carefully review both this

Addendum AND the full APS announcement, Amendment 5, which can be found here.

Important information contained in the full worldwide announcement is not repeated in this specific Addendum.

This program is authorized in accordance with Foreign Assistance Act of 1961, as amended.

Through this Addendum 05 to the Local Organization Network Project (LON) Annual Program Statement (APS) No. 7200AA19APS00001, the United States Government, as represented by the U.S. Agency for International Development Mission in Ethiopia (USAID/Ethiopia) is providing additional specifications for the submission of Concept Papers from eligible local entities proposing activities in Ethiopia.

Concept Papers submissions for Ethiopia should aim to support the National TB Priorit ies in alignment with Government, Tuberculosis(TB)-Leprosy National Strategic Plan (TBL NSP 2021-2025) of Ethiopia by Implementing focused TB/multi-drug resistance (MDR)-TB interventions for key affected and vulnerable populations targeted to improve access to TB/MDR-TB diagnostics, treatment, prevention, and support services; high impact TB case finding including mobile Community TB care, improving access to rapid TB diagnostics, MDR- TB and TB prevention, and support increased linkage between community based programming and the existing health structures (formal and informal) and TB programming in pastoralist regions and community health program. The activity will be supported and implemented at the national level (National TB Program) and selected regions within Ethiopia, with key affected and vulnerable populations in Afar, Somali, Benishangul-Gumuz (B/Gumz), and Gambella.

https://www.grants.gov/web/grants/search-grants.html?keywords=7200AA19APS00001

(Operational definition of key affected and vulnerable populations; Population groups that are either categorized as people with increased exposure to TB due to where they live or work, or people with limited access to quality TB services, people at increased risk due to biological or behavioral factors)

USAID anticipates awarding one cooperative agreement with a ceiling not to exceed $9,800,000.00 for a period of five years. USAID reserves the right to fund any or none of the applications received. Actual funding amounts are subject to availability of funds.

Publishing this Addendum does not commit USAID to make any awards. USAID also reserves the right not to follow a co-creation process and request full application from the applicants successful at concept paper stage.

I. Purpose

USAID is seeking Concept Papers from eligible local organizations in Ethiopia to address the specific objectives of LON for Key affected and vulnerable populations (KAP) in Ethiopia that are provided in Section II of this Addendum. Unless otherwise stated herein, all terms and conditions of the LON APS Amendment 5, apply. Information provided in the Concept Paper should address the objectives and Activity description presented in the following sections.

II. Activity Description

1. Background

The LON in Ethiopia will focus on TB case finding in pastoralist regions with particular emphasis on:

● High impact TB/MDR-TB case finding interventions/strategies including expansion of newer rapid TB diagnostic technologies, utilization or deployment of mobile TB diagnostic vans, and engagement of the private sector in TB programming,

● Rollout of TB prevention services including Tuberculosis preventive treatment, Improving TB program management with Integration of community TB care program into the pastoralist health extension program with engagement of local organization.

● Improve TB program management with the engagement of local organization and anchoring TB program within the district health system and community health structure

2. Overview

Utilization of local organizations is critical to eliminate TB in Ethiopia. Additionally, the Tuberculosis Local Organizations Network (TB LON) is a key component of the USAID Global Accelerator to End Tuberculosis. The TB LON mechanism works to improve the effectiveness and acceptability of the community TB care model for right-based and locally tailored TB services for all segments of the community following the framework of Global USAID’s new business model-Accelerator to END TB in alignment with the country’s health systems organization in order to meet the UN target of treating 40 million people by 2022.

TB LON in Key affected and vulnerable populations (TB LON KAP) in Ethiopia will be a critical activity that will provide tailored interventions to key affected and vulnerable populations. The Activity aims to improve the effectiveness and acceptability of the community TB care model through empowering community for improved early and equitable access to right based, introducing, and scaling up locally tailored TB services with focus on the most underserved and marginalized community segments including but not limited to pastoralists, mobile community like migrant workers, refugees, urban slum residents, miners and drought affected populations.

TB LON promotes the use of locally generated solutions to tailor USAID’s TB responses to meet the needs of patients and communities through addressing TB stigma and discrimination. TB LON engages and leverages local resources from civil society, private sector, communities, including faith-based partners by partnering directly with local entities to provide accessible services, resulting in increased diagnosis and treatment success rates.

USAID’s investments are most successful when they are coupled and aligned w ith strong commitments from local governments and partners. To accelerate action, TB LON KAP will leverage additional domestic resources from the Government of Ethiopia (GOE), private sector partners, and other local organizations.

3. Problem Statement

Despite the remarkable results and concerted efforts to end TB, Ethiopia remains to be one of the high burden countries with a third of susceptible and more than half of drug resistant incident TB cases annually missed by the health system. In Ethiopia, the key determinants of TB risk, risk drivers and service barriers to early detect and treat TB significantly varies by regional state owing to the differences in the geographic, population dynamics, and administrative boundaries of the country as reflected in national TB data for the past ten years, therefore warranting the need for tailored TB programming in key affected and vulnerable geo-settings.

Literature also supports pastoralist and other underserved communities residing in such geo -settings are often disproportionately left uncovered with the standard services nor the TB control services are accessible, acceptable, and flexible to the local community’s lifestyle. Moreover, the paucity of evidence to understand the dynamics of TB epidemiology in the face of multitudes of risk drivers in such settings warrants rigorous research to ensure access to the services and to END

TB from Ethiopia.

Unaddressed human rights issues and gender inequalities as TB service barriers : unaddressed TB related cultural myths, misconception, gender-influence and influences of tribal leaders and role traditional healers known to adversely affect early health seeking behavior of communities to TB. Furthermore, populations residing in these regions are known for their intimacy with livestock that predisposes them not only to higher rates of Bovine and Mycobacterium Latent TB infections and TB diseases but also it serves as a potential source of perpetuating TB transmission among susceptible individuals.

Prevailing TB vulnerabilities and the impact of repeated natural shocks : the recurrent conflicts and natural shocks, in particular severe droughts and population increase alarmingly threatening the communities of low-land resulting food insecurity and associated malnutrition, increased poverty with risk for financial hardship to pay for health services that drives forced migration to the under-developed cities and even population displacements and large cross-border refugee settlements which are all known risk factors for advancement of Tuberculosis infection to disease.

Furthermore, for many residents in these low-land geo-settings, artisan mining provides an alternative economic source for long. Nonetheless, with continued depletion of surface mining, miners are digging wells for mining which predisposes them for respiratory silicosis- a known strong risk factor for development of Tuberculosis both in the current and ex-miner communities

Limited Health systems capacity for TB programming in developing regions and lowlands in

Ethiopia: despite the significant improvements, the TB service provision in the underserved pastoral lowlands, hotspots for migration/refuge, and investment corridors is limited in number and service delivery capacity. Most existing Health facilities operate under substandard state with lack of trained personnel, TB diagnostics capability, and other health infrastructure limitations.

Health facilities in the remote and peripheral areas are often inaccessible for TB programmatic support and often lack institutional capacity and flexibility to respond to local contexts including seasonal mobility, conflict, and climatic changes. Furthermore, private care providers and other local community organizations barely exist. With the recent growing unreliability of the rural pastoral life, rapid urbanization of the poor and vulnerable segment of pastoral communities in search of economic opportunities with urban slums centers concentration and settlements in the peri-urban cities to overstretch the already underdevelopment housing conditions, social services resulting in marginalization and service inequalities including TB and other health services.

TB LON KAP Activity is expected to further explore and address key determinants of TB, promote use of locally proven solutions and anchor TB program into the local governments health (woreda and zone) and community health system for equitable access to essential TB services to the underserved communities in these geo-settings. With this investment, USAID intends to narrow the regional TB service provision inequalities and performance disparities to help the country realize its END TB targets.

Country Context: Ethiopia is a large land-locked country on the horn of Africa neighboring countries with fragile geo-political situations with frequent cross-broader population movements often as seasonal mobility as an adaptive lifestyle for the seasonal weather fluctuations, and at times, as forced migration/displacements.

Population, Population distribution, and settlements in Ethiopia: With over 112 million estimated population in 2020, Ethiopia is Africa’s second most populous country composed of predominantly young population (43% under 15 years and 60% below 30 years). Estimated 80% of total population reside in rural areas relying on Agricultural livelihood. With an annual population growth rate of 2.5 percent (2015), Ethiopia’s population is estimated to reach 150 million by 2035 (World Population Prospects, 2015 Revisions, United Nations (UN)). Owing to the country’s wide geographic ranges, availability of natural resources and main livelihood means, the vast majority of agrarian population(-80%) resides in high density in the central highlands where regular seasonal rainfall exists to support the majority smallholder farmers for crop production as livelihood, whereas the remaining population resides with sparse density in the country’s peripheral vast low lands- 61% of the total land size; where the western lowlands of large uncultivated lands is inhabited by small rural agrarian population and the eastern and southern arid resource scarce lowlands are predominated by the pastoralists lifestyle relying on livestock as main livelihood.

Regional context and cross-border movement of the population: Ethiopia is important in the regional geo-political landscape, neighboring with Eritrea on the north, Djibouti and Somalia on the East and south-eastern, Sudan and South Sudan on the west and south-western, and Kenya on the south part. There is a long term seasonal cross-border population movements, first, population settlements in the peripheral areas are often by communities of same tribes, Second, as way of life to adapt with the seasonal extremes of weather fluctuations, and the final third of concern is the forced population cross-border migration/displacements following recurrent and severe shock- in particular to droughts and armed conflicts. As of November 2021, Ethiopia is Africa's second largest country to host 815,000 refugee populations displaced by conflicts, political events, and civil wars in neighboring countries (UNHCR portal, 2021). There are also an estimated 450,000 internally displaced Ethiopians within the territories following recurrent and severe shocks from climate change resulting from severe droughts, loss of livestock and from armed tribal and political conflicts.

Political and Administrative structures: The country’s political and administrative structures have seen major reforms in the past with the current federal structure that mandates decentralization of power and decision-making authorities primarily to the regional estate governments and then to woreda/city administrations. At present, the country's political and administrative structure is composed of a federal central government and eleven regional estate governments and two city administrations. It is further divided into 97 zones, 1016 woreda and 16,000 kebele administrations.

Economic and social development context: Ethiopia, over the recent decades, has implemented a series of policies to realize its economic growth and transformation agenda. The economy is predominantly dependent on agriculture with real gross domestic product (GDP) growth rebounding to nine percent in 2019. Ethiopia still ranks as one of the poorest countries, with a per capita income of $850 and poverty rate of 30%. The government’s vision is to reach middle-income status with an estimated gross national income per capita of US$1,560 by 2025.

State of regional inequalities on economic and social development: Despite the rapid acceleration in the national level economic transformation and performance indices, the country has also observed regional disparities towards the observed economic contribution and the consequent social developments critical not only for sustaining the achievements but also to ensure both geographic and population level inequalities for the most vulnerable and underserved population segments of the country. For instance, the observed poverty decline is not cons istent across all the quantiles and performance on key SDG indices including access and coverages to key public services including education and health show gross inequalities.

The state of Developing Regional states (DRS) in Ethiopia : The Ethiopian constitution, in 1991, recognized the four underserved regions and designated them as regional estates of Afar, Somali, Benishangul-Gumuz and Gambella to address the longstanding political marginalization and promote the social inclusion in politics, governance, economic developments and hence brings social developments in these geo-settings for equitable access to public social services to all population segments. These regions are mainly located in peripheral lowlands – account a cumulative of 50% of total land size hosting an estimated ten percent of the country’s population-known to be predominantly shock-prone with underdeveloped basic social sectors that remains to record a much slower progress in the country’s recent economic developments and transformation compared to other regions.

The performance on a number of GTP/MDG and basic services delivery indicators is lower in the developing regional states (DRS) than the national average. For example, gross enrolment rate (GER) stood at 26.2% in Afar and 32.7% in Somali, while the national average was 95.6% in

2007/8 (EMIS). Under-five mortality was 157 in Benishangul-Gumuz (B/Gumuz) and 156 in Gambella in 2005 while for the nation it was 123 per 1000 live births in the same period (DHS, 2005). There were more severely underweight children in DRS (Somali, 17.8%; and B-G, 15.4%) than the national average (11.1%, DHS, 2005).

Access to the basic social services is at their lowest level in these regions when compared to other neighboring regions. For example, in Afar, the GER in Primary schools is 29.88% with that for girls at 22.65%. At the secondary level, the GER is 7.42% and that for girls is 6.26%.

The literacy rate of men and women ages 15–49 in Afar is 50.8 percent and 23.7 percent and in Ethio-Somali, the comparable rates are 56.7 percent and 12.4 percent, respectively, which is lower than the national average of 69 percent for men and 42 percent for women.

Immunization against BCG, DPT, polio and measles was the lowest at 0.6% and 2.8% in Afar and Somali regions, respectively whereas the national average was 20.4% (DHS, 2005). The BCG vaccination coverage for children ages 12–23 months with Afar (15 percent coverage) and Ethio- Somali (22 percent).

Likewise, trends of END TB performances shows gross inequalities and underachievement on most core TB indicators. For instance, According to ARM2019, the regional TB case detection rates was below 69 percent of the national performance with 43 percent for Benishangul-Gumuz, 56 percent for Somali and 68 percent for Afar while Gambella used to report in excess of 100% showing the regional burden for resources due to the large Refugee population in the region.

Tuberculosis context and National responses priorities in Ethiopia: Global TB report for 2020 shows Ethiopia is one of the thirty high TB, TB/HIV, and multi-drug resistant (MDR-TB) burden countries in the world with estimated 157,000 incident TB cases, 1,400 estimated MDR-TB cases and 24,000 estimated TB related deaths in 2019. In 2019, Ethiopia notified 111,000 Susceptible and 658 Drug resistant TB cases leaving behind around 44,000 people with TB and 742 people with drug-resistance TB annually perpetuating the community level transmission and increasing the risk of delayed diagnosis if not die from the illness.

National Strategic plan and priorities to End TB 2021-2026: The latest strategic plan document is the country’s expression of commitment for UNHL 40X20 targets and to the broader global commitment to end TB by 2035 by reducing TB incidence by 90%, TB associated mortality by

95% and avoid financial hardship to household of TB patients. The national program has set to achieve the END TB 90(90)90 milestones for 2025 with intensified and concerted efforts with TB stakeholders and the communities of at-risk and disadvantaged populations likely to be exposed and develop TB and hence suffer from its deleterious consequences. National End TB key priority interventions includes but not limited to establish equitable access to quality assured comprehensive TBL diagnostic and therapeutic services to all people with TB both at health facilities and community levels and by engaging all relevant stakeholders, as well; To optimize use of high-impact and robust practices to find all missing people with TB; To prevent and treat all TB infections and diseases with patient sensitive treatment support through tailored differential model of care including use of digital technologies; to promote the human right, gender, social and financial protection of TB affected and under-served population and support resilient and functioning systems for TB including adaptation of TB programming approaches to the population dynamics and geographic contexts of the at-risk population and emerging issues such as COVID- 19 pandemics.

National initiative on Finding the missing people with TB from key affected population

The national TB program of Ethiopia launched its first version of “National operational guidance on TB programming for key affected population document that defines National level Key affected population for TB and presents the priority list of population groups along with a three-years implementation plan to accelerate the progress towards ENDTB90(90)90 milestones for 2020.

In spite of the policy guidance and the importance of these initiatives for the success of the USAID’s Accelerator program and the national END TB plan, the existing efforts on key population programming remains at its nascent level. Moreover, USAID Ethiopia strongly believes financing the TB LON key affected population activities in the historically underserved developing regions: Afar, Benishangul-Gumuz, Gambella and Somali Regions which account for 9.2% of the total population and 50% of the surface area of the country could help not only to reaching the underserved Key populations for TB but also serve as the programming learnings for the broader END TB programming efforts of the country.

4. Activity Description

The TB LON KAP activity aims to understand and address human-rights issues and other service level barriers preventing Key affected TB communities from early access of quality TB services in four historically underdeveloped regions and neighboring zones of other regions of Ethiopia.

This activity will have major focus on empowering the local community for meaningful engagement for their health within the country’s flagship community health extension program for strengthening of the Community TB care program that reduces TB stigma and promote health seeking behaviors of the community, with particular attention to underserved, marginalized and the most at-risk key population segments likely to suffer from the dire consequences of TB and to their households through building the capacity and commitments of local TB programs for citizen responsive TB programming.

Goal

The goal of this activity is to reduce the magnitude of TB/MDR-TB with a reduction of TB incidence and mortality by 20% and strengthen/establish in-country capacity of local partners on TB programming in key population settings to accelerate the regional progress to End TB by 2035 from Ethiopia.

Major Activity Objectives:

● To detect and treat of 75% of estimated TB/MDR-TB cases and latent TB infection (LTBI) by improving community contribution from designated key affected communities

● To improve TB and MDR-TB treatment success rate to 90 and 80 percent respectively

● To build the organization capacity of (at least four) networks of local community organizations that will provide continuous service/technical support to key affected communities for betterment of TB services.

Description of Activities:

TB LON activity works to improve the effectiveness and acceptability of the community TB care model for human right-based and locally tailored TB services for all segments of the community following the framework of Global USAID’s Accelerator to END TB for high impact TB interventions and build local capacity (local government and local organization) for citizen’s responsive TB services organized under the following key technical areas to achieve end of project key results as described below:

IR 1: Improved access to high impact TB /MDR-TB case finding services

TB LON KAP intends to reach the most vulnerable and at-risk key affected population for TB by ensuring early access and utilization TB/MDR-TB services tailored to local contexts; access to DST including to quality assured rapid molecular TB diagnostic services, access to standard treatment and prevention services, access to high impact TB/MDR-TB case finding services, and TB system strengthening including anchoring TB program within the structure of local government and local organizations.

Expected results:

● Improved Access and utilization of rapid molecular diagnostic including access to DST

● Improved TB /MDR-TB case detection and community contribution

● Improved TB prevention therapy coverage, including community based TPT

IR 2 Ensured access to effective and acceptable care and support for all segments of TB patients

The Ethiopian National TB program has the latest treatment policy that meets the latest global TB treatment recommendation and use of newer TB drugs that shorten treatment length and promote patients’ acceptability for successful completion.

The promotion of patient-centered care and support strategies that are culturally acceptable and tailored to individual lifestyles to ensure optimal degree of adherence remains the mainstay of treatment to achieve favorable outcomes.

TB LON KAP will implement patient-centered care and adherence services by supporting use of locally proven, culturally sensitive, and differentiated adherence strategies (e.g., digital adherence technologies and introducing Community based treatment support services with particular emphasis to pastoral communities that practices cross-border/regional movements & those residing in hard-to-reach geographical settings). In addition, it is expected to build the capacity of the local health workforce and program experts/ coordinators with training and provision of tool kits on the latest national TB treatment protocols and standards of care.

Expected results:

● Improved TB/MDR-TB treatment success rate

IR 3. Improved local TB program capacity for Citizen responsive community TB services

Cognizant of existing poor social service developments and limited health service delivery capacity, the implementer should support the capacity of local administrations using woreda -led TB programming with emphasis to community TB care services and TB inf ormation systems. TB LON should also support empowering the local community and local organizations engagements in TB through organizational capacity development for resilient TB programming. Furthermore, TB LON is also encouraged to support local TB programs to establish collaborative TB programming with the relevant authorities for delivery of integrated TB interventions in health service delivery for refugees, Artisan Miners, prisoners and humanitarian and emergency health services responses.

Expected end results:

● Improved TB program management capacity in the supported woreda administration

● Improved organizational capacity of supported local organizations in the TB key population programming and sustainability

5. Guiding Principles

The full, detailed development of this TB LON activity project design and implementation approach and workplan will be carried out through mission-led co-creation processes with the engagement of key stakeholders including representatives from the TB key affected communities, TB survivor associations, and National TB program to facilitate implementation, address key challenges to accelerate project’s achievement of its end results. Nonetheless, the careful consideration of the following overarching principles of designing a key population programming are critical to ensure success – Targeted and flexible TB programming, multi-stakeholder and participatory, patient-centered, human rights-based, gender-responsive and evidence-based:

5.1. Targeted and flexible TB programmatic approaches

Cognizant of the complex diversities in regional/local population characteristics including culture, gender role, living style, economic status that might influence the early health service seeking behaviors, TB risks and drivers of TB epidemiology among the different communities in the targeted regions. The project design of this TB LON KAP needs to have the required flexibility for refining and adapting the project’s design and implementation approach with high impact TB interventions tailored for the local contexts of the targeted population (most vulnerable, underserved, and at-risk population).

5.2. Empowering the Community ownership and participation

Ensuring community ownership, empowerment, and participation is a critical dimension of work to identify and alleviate the barriers faced by key affected and vulnerable populations in accessing services.

Civil society organizations involvement should also be encouraged to contribute freely both their knowledge of and practical experience working with key populations.

Programming of any targeted interventions requires proactive use of a participatory approach with all stakeholders and key affected communities or their representative to maximize opportunities in understanding of TB epidemiology and determinants, and design sensible tailored TB programs.

5.3 Gender Responsive approaches

Gender analysis and gender-responsive programming are very crucial to address the TB/MDR-

TB needs of marginalized and key affected segments of the population. Yet, with TB now the leading cause of death for women globally, there is an increasingly urgent need for TB control programs to understand more about the gender dimensions of the disease in which the risks and effects of TB are determined by sex and gender roles as core component of TB interventions based on gender equality and human rights.

Designing targeted TB interventions, in particular to key affected populations, should be gender-sensitive that recognizes the gender dimensions and encourages their active participation during planning and implementations to address the gender specific vulnerabilities and needs of both men and women who are living with or at risk of TB. Gender mainstreaming, when applicable, should be a key focus of the program with, for example, the encouragement of fifty per cent participation of women in development of community TB interventions.

5.4 Multi Sectoral and integrated TB responses

Cognizant of the prevailing socio-economic determinants of Tuberculosis fueling TB epidemic in these under-developed regions, this TB LON KAP activity should work for intensified actions from and beyond the ministry of health to mainstream TB as the core policy and functions of all relevant non-health sector actors.

The national TB program has identified key non-health sectors including mining sectors, Urban development, ARRA, agricultural sectors, Pastoral development programs, Ministry of

Education, Prison administration authority, Charity and civil society organizations, Community-based organization, etc. and plans to establish an effective coordinating mechanism that defines “essential minimum TB packages” and support mainstreaming at all implementation levels.

Strengthening of TB service integration into relevant sister programs that serve priority key populations for TB such as HIV, Child Health services, Nutrition programs, Refugees, One health initiatives are critical in order not to miss opportunities to all reach people with TB.

5.5 Evidence driven and contributing to systems

Capacity development of regional, Zonal and woreda level government on TB programming for key affected population through identifying, prioritizing and designing of a comprehensive TB responses pertaining to the needs of specific key affected populations requires the program manager to gather evidences to understand biological, behavioral, social determinants of the disease as well as identifying key service barriers, human right issues and gender differences required to be addressed for an equitable early access to health services.

In addition, any targeted interventions to key populations must be Results based management will be a guiding principle of the program with strong attention to the development of clear and well understood program strategies that are well evaluated in a participative way (with capacity for evaluation being built at regional government level), project activities reviewed by quarter, program implementation monitoring, and a clear evaluation design focusing on strategic questions to generate evidence towards developing intervention packages that is scaled -up to the general END TB program strategy.

III. Eligibility information

Local non-governmental entities are eligible to submit a concept paper. USAID welcomes and encourages concept papers/applications that include organizations as sub-partners for technical assistance and organizational capacity building. USAID welcomes concept papers from organizations which haven’t previously received financial assistance from USAID TB funds as a prime. Only local entities are eligible for award as a prime. Definition of “local entity” as an organization, a corporation, or another body for persons that:

1. Is legally organized under the local Ethiopian law.

2. Has its principal of place of business or operations in Ethiopia; and

3. Is the majority owned by individuals who are citizens or lawful permanent residents in Ethiopia, and

4. Is managed by a governing body, the majority of whom are citizens or lawful permanent residents of Ethiopia.

The majority owned and managed by Ethiopians and /or permanent residents of, 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.

The recipients must be a responsible entity and have the necessary organizational experience, accounting system, operational controls, and technical skills/knowledge/ability to achieve the expected objectives of the addendum and comply with the terms and conditions and standards of the award and USAID.

It is the responsibility of applicant organizations to be compliant with the local Government’s regulations for receiving US government funds through a federal assistance program.

Concept papers from organizations that do not meet the above eligibility criteria will not be reviewed and evaluated. Individuals are not eligible to apply for this addendum/APS.

USAID Ethiopia strongly encourages concept papers from potential partners to the US government who meet the above eligibility criteria. Such organizations are strongly advised that they will be required to undergo a pre-award responsibility determination, a process to determine fiscal responsibility (whether the prospective recipients have the necessary organization, experience, accounting and operational controls, and technical skills-or ability to obtain the -in order to achieve the objectives of the project and comply with the terms and conditions of the award. While for profit organizations may participate, pursuant to 2CFR 200.400(g) it is USAID policy not to award profit to prime recipients and subrecipients under the assistance instruments. However, while profit is not allowed for sub-awards, the prohibition does not apply when the recipient acquires goods and services in accordance with 2 CFR 200.317-326, “Procurement Standards.” This is discussed more in detail in ADS 303sai “Profit Under USAID Assistance Instrument'' which can be found at this link: https://www.usaid.gov/sites/default/files/documents/1868/303sai.pdf

IV. Additional Considerations

Prior to submitting a Concept Paper, applicants should ensure that submissions are in line with the US Government Global TB Strategy and Ethiopia’s National TB leprosy strategic Plan (TBL NSP 2021-2025) . Successful Concept Papers will also align closely with the broader priorities of

USAID/Ethiopia.

USAID /Ethiopia is especially interested in promoting new local partnerships or projects.

USAID/Ethiopia is greatly interested in concept notes from organizations that have experience working in developing regions (pastoralist regions) to deliver the expected results.

V. Concept Paper Template and Submission

USAID/Ethiopia is responsible for the review process and management of any awards issued under this Addendum.

Concept Papers, Full Applications, and management of any awards issued under this Addendum will be managed in accordance with the process described in the umbrella LON APS announcement.

https://www.usaid.gov/sites/default/files/documents/1868/303sai.pdf https://drive.google.com/drive/folders/1xcH-aGWTWEVwbLU-lDLK5jU0c9ZS6Q8Q https://drive.google.com/drive/folders/1xcH-aGWTWEVwbLU-lDLK5jU0c9ZS6Q8Q

a. Concept Paper Content and Template

● The Concept Paper must be specific, complete, presented concisely and written in

English. The Concept Paper must demonstrate the Applicant’s capabilities and expertise with respect to achieving the objectives.

● Based on the activities proposed by the Applicant, the proposed award size and duration must be specified in the Concept Paper. Proposed award duration can be less than or up to five years.

● The concept Paper must follow the template provided below. Excluding the cover page, the Concept Paper must not exceed ten (10) pages, using Times New Roman 12-point font, on standard A4 paper size, and single spaced with no less than one-inch margins and pages numbered consecutively. 10-point font can be used for graphs and charts. Any pages submitted beyond the ten-page limit will not be evaluated.

● Additional documentation, such as annexes, charts and graphs that exceed the ten pages will not be reviewed. USAID will not review any information provided in links in the Concept Paper.

● The Concept Paper must be submitted in PDF format.

USAID TB LON CONCEPT PAPER TEMPLATE

A. Cover Page – to the extent possible or applicable, please complete the following questions below: [Note that #1-9 shall be submitted as a cover page, not included in the ten-page limit for the Concept Paper.]

1. Proposed Activity Name/Title: _________________________________________

2. Proposed Period of Performance (i.e., start date and end date): ________________

3. Overall Estimate of Funding Requested (in USDs, not to exceed $9.8 million):

4. Applicant Organization Name: _________________________________________

5. Applicant Contact Person (name, title, phone, email): ________________________

6. Full Address for Applicant Organization: ________________________________

7. Type of Organization (e.g., non-US, multilateral, private, for-profit, non-profit, date of incorporation, and place of incorporation, etc.):

8. Name(s) of Partner(s) (Applicants that are Implementing Partners will name Resource

Partner(s) (if any) here): ___________________________________________________

9. Unique Entity Identifier from System for Award Management (SAM): ___________

Note: USAID may not award to an applicant unless the applicant has complied with all applicable requirements in www.sam.gov to get the Unique Entity Identifier from System for Award Management (SAM). The applicant is required to:

1. Provide a Unique Entity ID for the applicant.

2. Be active in www.sam.gov before the award.

http://www.sam.gov/ http://www.sam.gov/

The registration process may take many weeks to complete. If your organization does not have a Unique Entity ID or is not registered in SAM when submitting a concept paper, the applicants are encouraged to begin the process early. If an applicant has not fully complied with the requirements above by the time USAID is ready to make an award, USAID may determine that the applicant is not qualified to receive an award and use that determination as a basis for making an award to another applicant.

B. Concept Introduction: (1 page) Identify the TB problem you will address, linking it to the problem statement described above and briefly describe your intervention for tackling this problem. Describe why there is a strategic need for your concept, how it differs from alternatives and any relevant gender-specific considerations for the problem or solution.

C. Beneficiaries: (½ page) Describe the types of benefits the intervention will produce and the types and range of people who will benefit from this intervention. Does this concept meaningfully engage key affected populations in all proposed stages of the concept so as to enhance th eir ability to determine their own priorities? Has it or can it be adapted to reach both women and men? How can the concept be scaled up to reach more people?

D. Geographic Location: (½ page) In what location(s) (e.g., regions, district/woreda, city) are you proposing to operate under this proposed partnership, and reaching approximately what total population? Describe key elements of and actors in the value chain or intervention in the geographic location(s) in which you propose to work. What are the biggest challenges and opportunities?

E. Intervention approach: (2½ pages) Building on the introduction, propose a Theory of Change for how this intervention will produce the desired impact in the focus area(s) identified. Briefly describe critical barrier(s) or problem(s), related to your focus area(s) that your concept addresses. Be sure to include information describing why the approach is creative or innovative, how it is potentially scalable, and evidence to support it as a tested solution or as an intervention likely to have a significant development impact, and how it will be sustained. The analysis should consider population demographics, disease burden, geography, and present a reasonable theory of change. The concept paper should demonstrate current knowledge of the primary challenges related to TB implementation among key affected populations of the developing (pastoral) regions, and a strong understanding of the opportunities for and barriers to achieving the project purpose.

F. Intervention results: (2 page) As specifically as possible, describe the anticipated outputs, outcomes, results and/or impact of the proposed intervention. What is the key, quantifiable metrics related to your project’s performance or expected performance? What is the scale needed to achieve results sufficient to address the problem? What are the baselines that you will measure before the project begins?

G. Partner roles: (1 page) If applicable, describe and define the role of any other entities in the partnership. This must include a description of how roles will be divided and managed efficiently.

This should also discuss partnership with the private sector and health service providers other than the formal public system including but not limited to refuge and internally displaced people administration.

H. Applicant capacity: (1 ½ page) Describe organizational capacity – technical, managerial, financial, etc. – to carry out the proposed intervention. Describe the business model for your innovation. Describe the experience of your organization in the past five years and its relevance to the TB LON KAP description

b. Concept Paper Submission

● All Concept Papers must be submitted by the closing date listed on page 1 of this

Addendum. Submissions received after the specified closing date will not be eligible for review.

● The subject line of concept paper email submissions must indicate:"[APS number], Addendum Title ‘Local Organizations Network (LON) for Key affected and vulnerable populations (KAP) in Ethiopia’, and applicant’s name in the subject line [Organization

Name]"

● Concept Papers must be submitted by email to LON@usaid.gov and caddis@usaid.gov.

VI. Merit Review Process for Concept Papers

All concept papers received by the deadline stated on page 1 of the Addendum will be reviewed for eligibility and compliance with the instructions for submission prior to evaluation against the merit review criteria described below. Those concept papers that are complete and comply with the instructions for submission will be forwarded to the Selection Committee (SC). The SC will then conduct a merit review of the concept papers.

The final selection of successful concept papers will be determined by the AO. A concept paper is determined to be successful if it receives a “Pass” based on the merit review criteria specified below

VII. Merit Review Criteria

Concept papers to this addendum (Addendum #05) will be assessed based on the merit review criteria. The following technical criteria are listed in descending order of importance:

1. The extent to which the concept paper proposes a creative, technically sound, and programmatically feasible implementation with realistic goals and objectives, sound methodology to measure intended results/outcomes, and demonstrates a strong understanding of program gaps, limitations, and opportunities related to the operational elements and future recommendations.

2. The extent to which the proposed objectives and interventions are aligned to the priorities of the health sector in the proposed regions, including having a significant development mailto:LON@usaid.gov mailto:caddis@usaid.gov impact, potential for scale up and sustainability of the proposed interventions and engagement of the appropriate health authorities, key affected and vulnerable communities, community structures and other stakeholders.

3. The extent to which the proposed activities have theoretical and practical significance in terms of global and national strategy to end Tuberculosis.

4. The extent to which the concept paper demonstrates relevant technical expertise needed to achieve the proposed results, institutional capability, technical, financial, and efficient management capacity with clear description of partners.

Note: This Addendum serves primarily to outline the goals and priorities of USAID in making an award under the LON APS. More comprehensive information regarding the application and review processes (including Concept Paper submission, co-creation, Full Application, and Evaluation stages) can be found in the umbrella LON APS, located here under the most recent “Full Announcement Amendment #7”. Applicants are advised to refer extensively to both documents in preparing Concept Papers.

VIII. Questions and Further Assistance

Questions regarding the substance and objectives of this Addendum should be directed to

LON@usaid.gov and caddis@usaid.gov prior to the Questions submission due date on page 1.

Questions regarding the substance and terms of the LON APS umbrella should be directed to LON@usaid.gov using the subject line “Question - LON APS Umbrella”.

IX. References:

1. United States Government Global Tuberculosis Strategy | 2015-2019.

2. Partnering With Local Organizations to END TUBERCULOSIS. [website] Partnering with Local Organizations to End Tuberculosis | US Agency for International Development

3. FMOH. 2018. Finding Missed TB cases in Ethiopia: Operational guide and National plan for 2018-2020.

4. WHO, 2015. The end TB Strategy: Global strategy and targets for tuberculosis prevention, care, and control after 2015.

5. FMOH. 2020. Tuberculosis and Leprosy National strategic plan document 2021-2026.

6. UNHCR portal on Refugees and Asylum seekers in Ethiopia as of November 2021.

Accessed on Feb 2021 https://data2.unhcr.org/en/documents/details/90203

7. Health sector transformation plan (HSTP II) of Ethiopia, 2020/21- 24/25.

8. WHO. 2015. Implementing the end TB strategy: the essentials.

9. The Stop TB Partnership. 2019. The Paradigm Shift 2018-2022

10. The Strategic Initiative to Find the Missing People with TB. [Website]. Geneva: Stop TB

Partnership; 2018. https://stoptb-strategicinitiative.org/ https://www.grants.gov/web/grants/search-grants.html?keywords=Local%20organizations%20network https://www.grants.gov/web/grants/search-grants.html?keywords=Local%20organizations%20network mailto:LON@usaid.gov mailto:caddis@usaid.gov mailto:LON@usaid.gov https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/news-and-updates/lon-partnering-end-tb#:~:text=Through%20LON%2C%20USAID%20will%20partner,progress%20on%20their%20Journey%20to https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/news-and-updates/lon-partnering-end-tb#:~:text=Through%20LON%2C%20USAID%20will%20partner,progress%20on%20their%20Journey%20to https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://data2.unhcr.org/en/documents/details/90203 https://data2.unhcr.org/en/documents/details/90203 https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://drive.google.com/drive/folders/1mrgeKK4aIc3FzQJC87ss62P3fQo-zSkw https://stoptb-strategicinitiative.org/ https://stoptb-strategicinitiative.org/

11. Key populations [Website]. Geneva: The Global Fund to Fight AIDS, Tuberculosis and

Malaria; 2019. https://www.theglobalfund.org/en/key-populations/

[END OF ADDENDUM 05 TO LON…