7200AA24RFI00010 - IHSS RFI 2.0.pdf

Request for Information Number:7200AA24RFI00010 Issuance Date: February 15, 2024 Closing Date: February 28, 2024; 11:59 PM EST (Washington, DC) Response email address: OHS_marketresearch@usaid.gov

Subject: Second Request for Information for USAID/Integrated Health Systems Strengthening (IHSS) Program

To: All Interested Respondents/Parties:

The United States Agency for International Development (USAID) through the Office of Health Systems (OHS) is publishing this second Request for Information to obtain information and input from all interested entities for the subject Integrated Health Systems Activity. The information will be used to help make planning decisions and may inform activity design to improve future development outcomes.

Through this Request for Information (RFI), issued to collect expert industry inputs solely for information-gathering and planning purposes, USAID seeks to enhance the design of the Integrated Health Systems Strengthening (IHSS) Activity. This RFI does not constitute a Request for Applications (RFA) or a Request for Proposals (RFP). Responses to this RFI are not applications or official proposals and will in no way be deemed to form any binding agreement with the RFI issuing authority. Please do not submit applications, proposals, or resumes as they will be discarded.

Proprietary information should not be sent. USAID may use any information provided without incurring any obligation. USAID reserves the right to, or not to incorporate any, some, or none of the comments received from this RFI into any subsequent solicitations or design documents. Any shared material (objectives, results framework, etc.) is in draft form for comment only.

This is a Request for Information (RFI) only. This RFI is an opportunity for USAID to obtain information from interested parties regarding the anticipated activities. Any drafts included are exclusively for the purposes of gathering feedback. This RFI must not be construed as a commitment by the U.S. Government to issue any solicitation, award any grant, cooperative agreement, or contract, or pay for any information submitted because of this request. Responders are solely responsible for bearing all expenses associated with preparation and submission of the response to this RFI. It is the potential responder's responsibility to monitor the site for the release of any further information. It should be noted that responding to this RFI will not give any advantage to any organization in any subsequent procurement. All types of organizations and firms are strongly encouraged to provide information/comments. Any information submitted in response to this mailto:OHS_marketresearch@usaid.gov

7200AA24RFI00010

notice is voluntary.

As reflected in USAID’s business forecast, the activity this RFI will most directly inform is currently contemplated with an award ceiling between USD 300M and USD 499.9M with a global scope of work, potentially ranging up to 30 countries concurrently. USAID anticipates field support buy-ins and potential focus on certain regions within the global programming. While these details are being contemplated, they are not finalized and should simply be considered context to this RFI.

INSTRUCTIONS

Responses (comments, suggestions, and enhancements) to this RFI are due by the closing date and time noted at the top of this letter. USAID seeks responses relating to the following:

● Organizational Capabilities

● RFI Technical Questions

Respondents follow the format of the response template (Attachment 1). All submissions must be in English. Please email that document with a Subject Line that includes “[RFI No.

7200AA24RFI00010]” to OHS_marketresearch@usaid.gov. Please note the file name for the response should be saved as “7200AA24RFI00010 (Respondent’s institution)”. Please see Page 1 of this RFI for submission date and contact information. Responders shall provide one (1) electronic copy of their response; electronic submissions, in Microsoft Word or Adobe Acrobat formats are acceptable.

Thank you for your interest in USAID’s activities. We encourage you to also visit WorkwithUSAID.gov. This is a free resource hub designed for new, current, and future partners to navigate how to work with USAID. The website also has the most common questions organizations frequently ask about engaging with USAID.

Sincerely, Imran J. Mahmud Contracting/Agreement Officer

Attachment 1: Request for Information (RFI) Response Template https://www.usaid.gov/node/509366 mailto:OHS_marketresearch@usaid.gov http://workwithusaid.gov/

I. INTRODUCTION

The purpose of the contemplated USAID –Integrated Health System Strengthening activity (IHSS) is to achieve sustainable and resilient health systems through locally-led, evidence-driven, and context-specific approaches to health system strengthening. These investments serve as the foundation for sustainable progress in the Bureau for Global Health’s priority areas of preventing child and maternal deaths, controlling the HIV/AIDS epidemic, and combating infectious diseases.

As a global leader in health system strengthening, USAID’s HSS investments are key to advancing Universal Health Coverage (UHC), primary health care (PHC), pandemic preparedness and global health security, and health system resilience. Effective HSS collaboration, learning, impact measurement, implementation, and capacity building are all critical to advancing global health and development goals and sustainably improving health outcomes.

II. DRAFT ACTIVITY BACKGROUND

The United States Agency for International Development’s (USAID) investments in health systems strengthening (HSS) consists of strategies, responses, and activities that are designed to sustainably improve country health system performance. A strong health system underpins all health investments and leads to greater resilience to advance health and well-being for all.

The COVID-19 pandemic created an increase in deaths that has resulted in the first global reduction in life expectancy in a century and brought renewed global attention to the long-term health and development importance of resilient health systems. As noted by President Biden, "When we strengthen health systems in far regions of the world, we reduce the risk of future pandemics that can threaten our people and our economy.” Failing to prepare for and address strains on the health system create long-term secondary impacts that make it harder for the system to recover and perform optimally. Therefore, sustaining and advancing health outcome achievements in USAID’s priority areas requires robust and intentional investments in cross-cutting, integrated HSS programming. This includes, but is not limited to, investing in primary health care (PHC) which serves as the foundation for achieving access to universal health coverage (UHC). The World Health Organization (WHO) has estimated that scaling up PHC interventions across low and middle-income countries (LMICs) could save 60 million lives and increase average life expectancy by 3.7 years by

2030.1 USAID is coordinating investments into PHC as a way of combating the recent global reductions in life expectancy, and to foster resilience and preparedness against future health threats. HSS investments provide the foundation for sustaining progress in PHC and towards achieving broader global goals, including all of the targets for Sustainable Development Goal (SDG) 3, to ensure healthy lives and promote well-being for all at all ages.2 HSS investments are central to achieving SDG target 3.8 (“Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable

1 WHO. Sept 2019. Countries must invest at least 1% more of GDP on primary health care to eliminate glaring coverage gaps. https://www.who.int/news/item/22-09-2019-countries-must-invest-at-least-1-more-of-gdp-on-primary-health-care-to-eliminate-glaring-coverage-gaps 2 UN Sustainable Development Goals. https://www.un.org/sustainabledevelopment/health/ essential medicines and vaccines for all”), but are similarly foundational to achieving the other SDG 3 goals. Within the USAID context, this activity will thus align with and advance relevant Agency initiatives and frameworks including the Bureau for Global Health’s Primary Impact initiative, the Global Health Workforce Initiative, and the existing framework for health system strengthening (Vision for HSS 2030).

By incorporating key considerations on a number of critical topics, the design also advances Agency initiatives related to gender equity (as relevant to the 2023 Gender Equality and Women's Empowerment Policy), vulnerable populations including youth (as relevant to the Youth in Development Policy), digital health (particularly as relates to the Vision for Action in Digital Health, which is complementary to the Vision for HSS); climate (USAID Climate Strategy 2022–2030);

collaborating, learning, and adapting (see USAID's CLA framework and USAID’s HSS Learning Agenda), persons with disabilities (see USAID’s Disability Policy, LGBTQI+ persons (see USAID’s LGBTQI Inclusive Development Policy), Indigenous peoples (see USAID’s Policy on Promoting the Rights of Indigenous Peoples), USAID’s Equity Action Plan, and diversity, equity, inclusion, and accessibility (DEIA) (Diversity, Equity, Inclusion, and Accessibility (DEIA) strategy).

III. DRAFT ACTIVITY OBJECTIVES

The purpose of the contemplated IHSS program is to accelerate countries’ HSS efforts and achieve sustainable and resilient health systems through locally led, evidence driven, and context-specific approaches to health system strengthening; the ultimate goal is to advance primary health care, accelerate progress toward universal health coverage, and improve health outcomes. Investments in HSS help USAID reach its priority global health goals of preventing child and maternal deaths, controlling the HIV/AIDS epidemic, and combating infectious disease, which directly contributes to strengthening global health security. Strong health systems are necessary for all people to achieve access to high-quality health services, which are essential for achieving sustainable improvements in health and promoting economic growth and democratic development.

USAID recognizes that further progress in reaching health outcomes requires well-coordinated HSS programming. This program has a particular focus on integrated HSS activities, which utilize a systems lens to work across health areas to address common system challenges and strengthen system-wide performance to promote sustainable improvements in health outcomes. This includes activities to promote financial protection, efficiency, and affordability of health services in general;

ensure the quality or availability of an essential package of prevention, promotion, treatment and care services; enhance equitable access to priority services by under-served, marginalized and other high priority groups; and ensure responsiveness to community expectations. In order to reach USAID’s HSS goals, programming should advance USAID’s three health systems outcomes of focus

- equity, quality, and resource optimization.3

3 The three priority outcomes per USAID’s Vision for HSS 2030 are: Equity. All people should have a fair opportunity to achieve their health potential; Quality. Care that is safe, effective, efficient, timely, people-centered, integrated and equitable; and Resource Optimization. Promoting resource optimization by identifying and strengthening constituent processes within local health systems, assisting stakeholders in determining the most appropriate allocation and use of resources within the system, and promoting availability of health system resources adequate to deliver high-quality, accountable and responsive care that emphasizes the needs of underserved and socially excluded populations. Health https://www.usaid.gov/sites/default/files/2024-02/FINAL%20PI%20TWO%20PAGER.pdf https://www.whitehouse.gov/briefing-room/statements-releases/2022/05/11/fact-sheet-the-biden-harris-administration-global-health-worker-initiative/ https://www.usaid.gov/global-health/health-systems-innovation/health-systems-strengthening/Vision-HSS-2030 https://www.usaid.gov/gender-policy https://www.usaid.gov/gender-policy https://www.usaid.gov/policy/youth https://www.usaid.gov/policy/youth https://www.usaid.gov/policy/digital-health-vision https://www.usaid.gov/global-health/health-systems-innovation/health-systems-strengthening/Vision-HSS-2030 https://www.usaid.gov/policy/climate-strategy https://usaidlearninglab.org/sites/default/files/resource/files/keyconcepts_twopager_8.5x11_v7_20160907.pdf https://www.usaid.gov/global-health/health-systems-innovation/health-systems/resources/learning-agenda https://www.usaid.gov/global-health/health-systems-innovation/health-systems/resources/learning-agenda https://www.usaid.gov/sites/default/files/2023-08/USAID-Disability-policy-paper-1997.pdf https://www.usaid.gov/sites/default/files/2023-07/USAID_LGBTQI-Inclusive-Development-Policy_August-2023_1.pdf https://www.usaid.gov/sites/default/files/2023-07/USAID_LGBTQI-Inclusive-Development-Policy_August-2023_1.pdf https://www.usaid.gov/sites/default/files/2022-05/USAID-IndigenousPeoples-Policy-mar-2020.pdf https://www.usaid.gov/sites/default/files/2022-05/USAID-IndigenousPeoples-Policy-mar-2020.pdf https://www.usaid.gov/sites/default/files/2022-05/Final_Equity_Action_Plan_USAID_word_version_of_plan_submitted_to_DPC.docx.pdf https://www.usaid.gov/about-us/diversity-equity-inclusion

Programmatic approaches to strengthening these outcomes should intentionally strengthen multiple aspects of the health system where appropriate. The six “building blocks” of HSS (service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership and governance) remain critical investment areas, but were not meant to be individualized into “siloed” areas of work or support. As WHO notes, “A health system is composed ‘of all organizations, people and actions whose primary intent is to promote, restore or maintain health’...A health system, like any other system, is a set of interconnected parts that must function together to be effective. Changes in one area have repercussions elsewhere. Improvements in one area cannot be achieved without contributions from the others. Interaction between building blocks is essential for achieving better health outcomes.”4 As such, integrated HSS activities generally address and impact - or at minimum consider the relevance of - multiple system functions simultaneously. Recent global consensus, via the 2018 Astana Declaration on Primary Health Care,5 the 2019 Declaration of the UN High-Level Meeting on UHC,6 and the 2023 Declaration of the UN High-Level Meeting on UHC,7 all reflect the need for a more integrated and outcomes-based approach to health systems. The activity is thus intended to provide technical assistance and global leadership to comprehensively and efficiently address multiple system components and help advance country PHC, UHC, and preparedness and resilience priorities.

This contemplated program seeks to address the root causes of complex health system challenges that exacerbate health inequities and negatively impact health outcomes. For example, improving health outcomes requires strong institutional arrangements across all levels of the health system, including well-functioning community health systems. Approaches within this activity might therefore address leadership and governance capacity and behaviors and work to incorporate evidence-based policy processes, mitigate corruption risks and strengthen accountability at both national and sub-national levels; simultaneously the activity might support the seamless integration of community health systems into the overall health system architecture with enhanced governance structures, well-established community engagement platforms, and promotion of country-led efforts to integrate community health workers (CHW) into human resource and health sector plans.

This contemplated program will focus on strengthening the entirety of the health system to meet population needs across all levels of care, from primary to tertiary care, depending on contextual needs. This includes a focus on the system strengthening necessary to advance PHC. PHC is widely regarded as the most inclusive, equitable and cost-effective way to achieve universal health system resources include, but are not limited to, human and financial resources, health care infrastructure, information resources, and medicines, and other health technologies.

4 WHO. (2007). Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes. Retrieved from https://www.who.int/ healthsystems/strategy/everybodys_business.pdf?ua=1 5 USAID. (2018). Joint Statement on Primary Health Care Implementation. Retrieved from https://www.usaid.gov/sites/default/files/Joint-Statementon-PHC-Implementation-10-26.pdf 6 Political declaration of the high-level meeting on Universal Health Coverage (2019). Retrieved from https://www.un.org/pga/73/ wp-content/uploads/sites/53/2019/07/FINAL-draft-UHC-PoliticalDeclaration.pdf 7 Political declaration of the high-level meeting on Universal Health Coverage (2023). https://documents-dds-ny.un.org/doc/UNDOC/GEN/N23/306/84/PDF/N2330684.pdf?OpenElement coverage (UHC) and creates more responsive health systems at lower or equivalent costs, with higher standards of quality, greater efficiencies, and with broader community acceptance. It is estimated that ninety percent of essential interventions necessary for UHC can be delivered using a PHC approach.8 Foundational health systems investments (in areas such as financing, the health workforce, governance, digital transformation, and more) support and sustain the delivery of equitable, efficient, and high-quality primary health services. As recognized by the Global Health Worker Initiative and the WHO, strong PHC is delivered by multidisciplinary teams of health workers across the public and private sectors. Per the WHO, “to progress towards universal health coverage, countries will need a health workforce that is aligned with population and community health needs and which is capable of adjusting to the growing demand for health care.”9 To be successful in this effort, the health workforce should be supported by an optimized health system that enables the workforce to provide greater service access and quality, comprehensive care that is whole-person-centered versus disease-centered. To be successful in strengthening PHC, achieving universal health coverage, and improving health outcomes, this award will need to optimize foundational system-wide functions with approaches that are evidence-based, contextually-specific, and locally-led.

Aligned with USAID’s definition of localization,10 this program should seek to put local actors in the lead, strengthen local systems, and be responsive to local communities. Implementation throughout the life of the activity will require a locally-led, whole-of-society approach, with close collaboration with key HSS stakeholders at the global, national, and local levels, including but not limited to country policymakers, the private sector, health service providers, continental and regional partner organizations, other donor representatives, community leaders, academic institutions, and other actors throughout the health system. It is expected that implementation will center country and community leadership and ownership in order to ensure program responsiveness to contextually-specific needs, strengthen local health system capacity and linkages between communities and health institutions, shift health system norms, and increase the likelihood of sustainability. The contemplated program should be intentional about integrating principles that promote improved health care access and quality for all populations, including marginalized and under-served communities and should seek ways to ensure health systems are designed for and by people. Inclusive, equitable, and accessible health care systems support the programmatic aim of ensuring that marginalized groups have equal access to quality health care across all levels of the health system. Operationally the program should center all aspects of identity, including gender, disability, etc. and should aim to increase social inclusion throughout implementation to promote gender and social equity and advance gender-transformative HSS. This program is intended to support the leadership transition of technical assistance to local partners

8 WHO Primary Health Care Fact Sheet November 2023, https://www.who.int/news-room/fact-sheets/detail/primary-health-care 9 Dussault G, Kawar R, Castro Lopes S, Campbell J. Building the primary health care workforce of the 21st century - Background paper to the Global Conference on Primary Health Care: From Alma-Ata Towards Universal Health Coverage and the Sustainable Development Goals. Geneva : World Health Organization; 2018.

https://www.who.int/docs/default-source/primary-health-care-conference/workforce.pdf 10 USAID defines localization as the set of internal reforms, actions, and behavior changes that we are undertaking to ensure our work puts local actors in the lead, strengthens local systems, and is responsive to local communities. See:

USAID Localization. https://www.usaid.gov/localization https://www.whitehouse.gov/briefing-room/statements-releases/2022/05/11/fact-sheet-the-biden-harris-administration-global-health-worker-initiative/ https://www.whitehouse.gov/briefing-room/statements-releases/2022/05/11/fact-sheet-the-biden-harris-administration-global-health-worker-initiative/ https://www.who.int/docs/default-source/primary-health-care-conference/workforce.pdf https://www.who.int/docs/default-source/primary-health-care-conference/workforce.pdf https://www.usaid.gov/localization who are best suited to meet the needs of diverse local populations, by promoting local innovation and solutions within HSS, and strengthening coordination and dialogue between local innovators, civil society and advocacy groups, and government partners. At the global level, strengthened collaboration and coordination across HSS global actors is also needed to advance effective, efficient, sustainable HSS practice.

HSS investments are crucial for strengthening health system resilience, defined as the ability to adapt, respond, and recover from shocks and stressors.11 This award is intended to support health systems to prepare for, mitigate and/or adapt to all emerging and potential challenges by strengthening their capacity to provide acceptable, accessible, quality care to the communities they serve every day, not only during times of shocks. Evidence shows that HSS activities designed in an inclusive manner best addresses the broad range of health needs that individuals, their families, and communities require - including resilience against public health threats such as infectious disease outbreaks, climate change, and other natural or manmade shocks.12 Health system absorptive, adaptive, and transformative resilience capacities should be developed in advance of crises in order to effectively respond to both acute, time-bound events, as well as to longer-term dynamics such as protracted population displacements or climate change. This activity can improve health system resilience capacity through a wide range of potential approaches. For example, integrating essential public health functions (EPHFs) into PHC systems can ensure systems are better positioned to proactively detect shocks and respond to surge support needs during an infectious disease outbreak,13 while fostering more effective health financing can enable more effective adaptive responses to climate change, and a strengthened health workforce can result in improved capabilities to respond to the effects of climate change on people’s health.14

Programmatic approaches undertaken within this contemplated activity should reflect USAID’s cross-cutting HSS priority related to strengthened monitoring, evaluation, research and learning (MERL). HSS MERL is essential to understanding how health systems and relevant multi-sectoral components interact and impact one another to produce health outcomes and health system changes,and how these changes can be sustained. It allows health system practitioners to

11 USAID. Considerations to Integrate Climate Change Mitigation and Adaptation into Health System

Programming. March 2022. https://www.usaid.gov/global-health/health-systems-innovation/health-systems/resources/considerations-integrate-climate-change-mitigation; USAID. Climate Change Impacts on Human Health and the Health Sector. March 2022. https://www.usaid.gov/global-health/health-systems-innovation/health-systems/resources/climate-change-impacts 12 Perry, H. B., Rassekh, B. M., Gupta, S., Wilhelm, J., & Freeman, P. A. (2017). Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 1. rationale, methods and database description. Journal of Global Health, 7(1), 010901. https://doi.org/10.7189/jogh.07.010901; Kruk, M. E., Porignon, D., Rockers, P.

C., & Van Lerberghe, W. (2010). The contribution of primary care to health and health systems in low and middle-income countries: A critical review of major primary care initiatives, Social Science & Medicine, Vol 70- Issue 6, (2010): Pg 904-911, https://doi.org/10.1016/j.socscimed.2009.11.025 13 Lugten E, Marcus R, Bright R, Maruf F and Kureshy N (2023) From fragility to resilience: A systems approach to strengthen primary health care. Front. Public Health 10:1073617. doi:

10.3389/fpubh.2022.1073617.

14 Mosadeghrad AM, Isfahani P, Eslambolchi L, Zahmatkesh M, Afshari M. Strategies to strengthen a climate-resilient health system: a scoping review. Global Health. 2023 Aug 28;19(1):62. doi: 10.1186/s12992-023-

00965-2. PMID: 37641052; PMCID: PMC10463427.

https://www.usaid.gov/global-health/health-systems-innovation/health-systems/resources/considerations-integrate-climate-change-mitigation https://www.usaid.gov/global-health/health-systems-innovation/health-systems/resources/considerations-integrate-climate-change-mitigation https://www.usaid.gov/global-health/health-systems-innovation/health-systems/resources/climate-change-impacts https://www.usaid.gov/global-health/health-systems-innovation/health-systems/resources/climate-change-impacts https://doi.org/10.7189/jogh.07.010901 https://doi.org/10.1016/j.socscimed.2009.11.025 understand the contribution or impact of HSS efforts. This includes strengthening the utilization of both standard and context-specific HSS indicators and metrics, including increasing systems’ capacities to generate and utilize relevant, timely data and evidence. For cross-country comparisons around common metrics, USAID endorses existing World Bank and World Health Organization efforts to track national progress15 16 toward UHC via two separate indices: service coverage and financial protection. However, strengthened metrics and approaches are needed to identify the contributions of HSS activities to system-wide changes across building blocks, and to improvements in health outcomes at the sub-national and national levels. HSS MERL is also essential for learning health systems17 that can adapt or rapidly respond to contextual and political changes and circumstances. Within USAID programs, creativity and flexible adaptive management capacity is required, based on real-time learning and evidence. This includes incorporating appropriate, timely HSS implementation research into programming to inform context-specific health system needs and approaches. This also incorporates data and evidence from other sectors as relevant for health systems decision-making. Embedding HSS research and learning approaches throughout implementation can not only improve individual programs, but also help to strengthen the global HSS evidence base (see, for example, USAID’s HSS Learning Agenda), and support valuable country-to-country learning and regional knowledge exchange opportunities.

Finally, this contemplated program will advance health sector integration and collaboration by providing opportunities for jointly-funded or collaborative work across health areas and with multi-sectoral partners. Implementation of effective HSS activities requires coordination and integration of efforts across relevant investment areas. Improving global, regional, national, sub-national, and multisectoral coordination and collaboration can enable timely responses to emerging health system challenges and improve the effectiveness of long-term programs. Systems approaches can help to prevent duplication or fragmented results, siloed interventions, and gaps in coordination towards larger HSS goals. Improved cohesion and partnership in HSS can help to enable alignment and harmonization within countries, maximize investments, and promote best practices. Multi-sectoral coordination can strengthen HSS investments in foundational areas such as (but not limited

to) coordinated digitalization investments across the system and improved governance of digital systems, comprehensive human resource and health information systems, comprehensive accountability systems, social and behavior change of health systems actors, and more can support the provision of integrated, client-centered primary care. Where appropriate, successful implementation will also entail the appropriate use of emerging technologies and innovations as a component of implementation approaches. Through this integrated approach, USAID aims to strengthen health systems so that countries are able to plan, fund, and manage their own continued progress towards a higher standard of health and health system resilience.

15 . Tracking Universal Health Coverage: 2021 global monitoring report. Geneva: World Health Organization and International Bank for Reconstruction and Development / The World Bank; 2021.

https://www.who.int/publications/i/item/9789240040618 16 WHO. (2019). Primary Health Care on the Road to Universal Health Coverage: 2019 Monitoring Report.

Retrieved from https://www.whoint/healthinfo/universal_health_coverage/report/uhc_report_2019.

pdf?ua=1 17 Sheikh K, Abimbola S, editors. Learning health systems: pathways to progress. Flagship report of the

Alliance for Health Policy and Systems Research. Geneva: World Health Organization; 2021. Licence: CC BY-

NC-SA 3.0 IGO.

https://www.usaid.gov/global-health/health-systems-innovation/health-systems/resources/learning-agenda https://www.who.int/publications/i/item/9789240040618

IV. DRAFT RESULTS FRAMEWORK

The intended result of the contemplated IHSS program is to achieve sustainable, equitable and resilient health systems through locally-led, evidence-driven, and context-specific approaches to HSS, thereby contributing to advancing PHC, accelerating progress toward UHC, and improving health outcomes. The desired results are outlined below in intermediate results 1-3 as well as each results’ components.

● Intermediate Result 1: Increased and equitable access to and use of quality health services that are responsive to population health needs.

● Intermediate Result 2: Strengthened leadership, governance, and management capacity to improve health system performance.

● Intermediate Result 3: Improved HSS learning and data and evidence generation, synthesis and utilization to strengthen health system policies and practice.

V. DRAFT ACTIVITY COMPONENTS

Intermediate Result 1: Increased and equitable access to and use of quality health services that are responsive to population health needs.

Component 1.1: Improved capacity of health systems to effectively quantify, mobilize, and use financial and other resources18 to efficiently achieve health objectives.

Illustrative Activities

a. Optimization of strategic purchasing approaches via insurance or contracting.

b. Expansion of the utilization of health technology assessments or other such assessments to support decision-making

c. Health resource tracking and analysis to improve health budget mobilization, execution, and planning

d. Strengthen the capacity to convene and coordinate resource use across multi-sectoral stakeholders.

Component 1.2: Strengthened health system capacity to develop a well managed, supported, and highly skilled workforce to meet countries’ health care needs.

18 Other resources, such as physical infrastructure, labor, supplies, equipment that contribute to a health production function.

Illustrative Activities

a. Expand and strengthen human resource for health (HRH) information systems and increase utilization of HRH data and other relevant data to provide evidence-informed HRH decision-making.

b. Support health training and educational institutions to strengthen learning platforms, educational content, and learning modalities that contribute to a high-performing health workforce.

c. Develop and implement policies, procedures, and regulations to support performance, well-being, motivation, and retention of the health workforce.

d. Support HRH strategic planning and strengthening of HRH management capacity.

e. Promote country-led efforts to integrate community health workers (CHW) into health workforce planning and management.

f. Support implementation of community health roadmaps to develop a community health workforce that is increasingly skilled, salaried, supplied, protected, and offered opportunities for career progression.

g. Build the capacity of the health workforce to address growing challenges such as climate resilience and climate mitigation.

Component 1.3: Optimized system design to enable behavioral factors that improve and sustain integrated models of equitable, quality care and improve client outcomes.

Illustrative Activities

a. Support systematic approaches to strengthening, embedding, and implementing quality improvement processes and approaches across the health system.

b. Apply social and behavior change theories and methods to address the underlying reasons for or facilitate shifts in health system actors’ performance and behaviors.

c. Evaluate health system structural interventions to influence system actor behavior, such as health provider behavior to improve quality by closing the “know-do gap,” or to shift norms and reduce corruption.

d. Develop and implement care models that respond to social determinants of health and that combat inequities in access for vulnerable populations.

e. Optimize networked, integrated care models with defined referral pathways that are comprehensive across the continuum of care.

f. Identify opportunities for applying a systems approach to integrate essential public health functions into primary health care.

Intermediate Result 2: Strengthened leadership, governance and management capacity to improve health system performance.

Component 2.1: Enhanced institutional arrangements, including transparent policies, systems, and processes, to increase efficiency and effectiveness of integrated health system performance and accountability.

Illustrative Activities

a. Improve coordination, planning, management, and performance monitoring arrangements between national and sub-national health authorities.

b. Support institutionalization of evidence-based policy processes and implementation at the national and sub-national level, including private sector providers.

c. Strengthen digital health governance including through alignment of digital-enabled activities to country plans and global digital health best practices.

d. Support development and implementation of national laws, policies, guidelines and strategies across all sectors relevant to strengthening quality of care and coverage across the health system.

e. Mitigate corruption risks by enhancing public financial management capacity, including support for fair procurement, stronger audit institutions and the prioritization of ethical standards, regulatory compliance, and transparency.

Component 2.2: Improved community health system integration into health system architecture to accelerate achievement of primary health care and health system goals.

Illustrative Activities

a. Enhance community-level governance structures that promote citizen voice, transparency and accountability in program planning and oversight.

b. Strengthen platforms for community engagement in local health center planning and oversight.

c. Strengthen community digital health systems and other relevant information systems that support integrated programming and health system decision making and quality care management, including both ongoingly and in response to changing environmental and political needs.

d. Strengthen referral and transportation systems from the community level to primary and referral levels of care.

Component 2.3: Improved leadership, governance, and management capacity for effective response and adaptation to both unanticipated shocks and ongoing health system stressors at all levels of the health system.

Illustrative Activities

a. Identify and strengthen health system functions, policies, strategies, and capacities needed to address and mitigate climate and health risks, for example strengthening health workforce management to utilize staff to meet evolving health needs.

b. Ensure effective use of data to inform contingency planning at the sub-national level, including to protect vulnerable populations in advance of possible crises, and to strengthen early warning systems.

c. Support mechanisms for cross-sectoral coordination for continuity of care during emergencies and protracted crises, and for restoration and maintenance of routine service delivery.

d. Support community capacity and resourcing to engage in local response systems aligned to community structures and to adapt to maintain functionality in response to shocks and stressors.

Intermediate Result 3: Improved HSS learning and data and evidence generation, synthesis and utilization to strengthen health system policies and practice.

Component 3.1: Strengthened HSS monitoring and evaluation through robust metrics, standards, systems, and approaches.

Illustrative Activities

a. Improve availability and use of globally-recommended and context-specific quantitative HSS metrics to monitor and evaluate health systems performance, and health outcomes.

b. Improve understanding and use of qualitative measures and application of mixed-methods approaches, to help understand health system challenges, opportunities, and outcomes.

c. Leverage tools and approaches, including digital technologies, to support health system performance monitoring, data quality improvement, data availability, visualization and interpretation and use at all levels of the health system.

Component 3.2: Strengthened capacity of government, local and regional partners for monitoring, evaluation, research and learning (MERL) for health systems strengthening.

Illustrative Activities

a. Develop training and resources on using context-appropriate methods and metrics in health system performance monitoring and evaluation, including complexity-aware mixed methods as appropriate.

b. Collaborate with local and regional partners to conduct timely implementation research that informs HSS practice and responds to context-specific evidence needs.

c. Build capacity of both local and regional partners and government entities across different health system levels, through specific capacity-strengthening approaches, to generate and utilize data and evidence to learn and adapt in response to new information and changes in the health system context.

d. Improve collaborative research agenda-setting processes.

Component 3.3: Increased knowledge synthesis, exchange and collaboration across local, regional and global HSS stakeholders to improve evidence translation and use.

Illustrative Activities

a. Advance global and country HSS learning agendas and support knowledge partnerships and evidence utilization among researchers, implementers, civil society, and policymakers.

b. Improve existing networks for HSS knowledge exchange to ensure that local voices are centered in HSS knowledge exchange agendas and can benefit from and/or lead knowledge exchanges to share and adapt local HSS knowledge.

c. Synthesize global, regional and local learning into knowledge products that can be tailored to the differing needs of local, regional and global HSS stakeholders and shared using tools and platforms that allow stakeholders real time access to HSS knowledge to address current needs.

VI. RFI QUESTIONS FOR RESPONSE

Questions on Organizational Capabilities

1. Organization Type: (current international partner, new international partner, locally established partner, non-profit, commercial entity, or nontraditional partner including local entities) - indicate all that apply. If you are registered in SAM, please include your UEI.

2. Organization’s geographic area of practice and country (or countries) of legal establishment.

3. Contemplated Role (Prime awardee, subawardee, consortium member, or potentially open to multiple role types)

4. If applicable, what is the largest U.S. Government (USG) award (Total Award Value) primed in the last 5 years? Please prioritize the most technically relevant awards, noting the award name, number, and total value. If your organization has not primed, list any relevant subawards. If you have not primed or subbed under a USG award, please indicate that.

Questions on RFI Technical Components

1. Are any of the priorities described in the draft program description and draft results framework unclear as written? If so, please identify areas for clarification. Note the illustrative activities are intended to be illustrative only and should not be a focus of this response.

2. Are there any priorities missing from the draft program description and draft results framework, including in the Intermediate Results, that needs to be addressed or incorporated to successfully achieve the program’s desired Results and Purpose? Note the illustrative activities are intended to be illustrative only and should not be a focus of this response.

3. If your organization has implemented or managed components of programs of similar size and scope described in the RFI, which includes meeting goals and targets across various country health programs, please briefly describe. Please note whether your organization was a prime or a subawardee.

4. If your organization has previously managed implementing programs or components of a program (as a prime or subawardee) that are of similar size and scope and/or that involved health system strengthening implementation, what aspects of costs/operations management or technical implementation posed the greatest challenge to program success? How did your program resolve these challenges and/or, if the challenges were not resolved, what are one or two key lessons learned for future program implementation.

https://www.usaid.gov/npi/npi-key-definitions

ATTACHMENT 1: Request for Information (RFI) Response Instructions and Template

INSTRUCTIONS PAGE

The total length of the RFI submission must not exceed 4 pages total (not inclusive of the cover page), with no more than one (1) page for Organizational Capabilities and no more than three (3) pages for the RFI Technical Components responses. Responses must be submitted using 12 point Arial font, 8.5 x 11-inch paper (letter-sized), single-spaced, with one-inch margins, no graphics, with each page numbered consecutively. Responses may include embedded links. Attachments beyond the page limit will not be reviewed.

Organizational Information (cover page)

Organization Name:

Submitter Name:

Submitter Title:

Submitter Email:

Organizational Capabilities Responses (no more than 1 page)

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RFI Technical Components Responses (no more than 3 pages):

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