Amendment No.01 - APS Addendum No.1 - Bebas TB.pdf

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

U.S. Embassy Jakarta

Jl. Medan Merdeka Selatan 3‐5

Jakarta 10110, Indonesia

USAID.gov

Issue Date:

Subject:

March 6, 2023

Amendment No. 01

APS Addendum No. 1 Under APS No. 72049723APS00001 ‐ Accelerating

Elimination of TB in Indonesia

Opportunity Title: Bersama Menuju Eliminasi dan Bebas dari TB (BEBAS‐TB)

The purpose of this Amendment No. 01 is to provide USAID/Indonesia’s responses to the questions received by the due date provided in the subject APS Addendum as detailed in

Attachment 1. The updated APS Addendum 1 with yellow highlighted is under Attachment 2.

Thank you for your interest in USAID Programs.

Sincerely, /s/

Mohib Ahmed

Supervisory Agreements Officer

Director, Office of Acquisition and Assistance

USAID/Indonesia

APS No. 72049723APS00001: Accelerating Elimination of TB in Indonesia

APS Addendum No. 1: Bersama Menuju Eliminasi dan Bebas dari TB (BEBAS‐TB)

Amendment No. 01

ATTACHMENT 1

QUESTIONS AND ANSWERS

Technical

Question 1. In the IR 1.1 Active TB case finding scaled up in facilities it is stated: “…The Activity will assist the NTP in improving TB case detection rates by scaling up an effective active case finding (ACF) approach at the facility level, therefore addressing missed opportunities to find TB cases and reduce delays in providing prompt treatment to TB patients. If deemed appropriate to the situation, integrated COVID‐19 and TB screening would be continued as per national guidelines…” Can USAID please clarify if this means that TB screening should be limited to integrated screening of COVID‐19 only? How about screening of HIV positive populations?

Other immunocompromised populations? Pregnant women?

USAID Answer: No, TB screening will not be limited to only integrated screening of COVID‐19 that was just an illustrative example. We encourage expanded TB case finding in line with existing WHO and Government of Indonesia (GOI) guidelines.

Question 2. Is the BEBAS‐TB program meant to be a more vertically implemented TB‐only program, as an addition to other TB related programs that are currently implemented in Indonesia, or is it USAID’s expectation to also include HIV integrated activities in the program implementation and IRs?

USAID Answer: BEBAS‐TB is a comprehensive program that will provide assistance to the Government of Indonesia (GOI) at the national and subnational level for TB response, where appropriate we encourage collaboration with other relevant programs (including but not limited to high‐risk patients, maternal and child health, key affected populations, people living with HIV, and etc).

Question 3. Will TB and HIV program joint linkage with the maternal health and child health programs for TB and HIV care and prevention among neonate children, children under 5 and pregnant women be prioritized and implemented (mainly at primary care level)?

USAID Answer: Please refer to the response in Question 2.

Question 4. Can USAID please clarify if integration of TB screening and surveillance into RMNCAH surveillance system is to be included in the BEBAS‐TB program’s scope?

USAID Answer: Please refer to the response in Question 2.

Question 5. Will BEBAS‐TB also consider addressing substance abuse (tobacco smoking, alcohol excess consumption, drug use/abuse) among the general population, youth, and other vulnerable and at‐risk populations?

USAID Answer: Please refer to the response in Question 2.

Question 6. D.4. Page 20: On page 20 of the addendum USAID says that “all selected indicators will be sourced from a standard list” – does this mean no custom indicators will be used for BEBAS‐TB performance monitoring?

USAID Answer: We expect organizations to source indicators from the standard Performance Based Monitoring and Evaluation Framework (see link below). If needed, organizations can propose custom indicators to reflect specific activities if the standard list of indicators does not suffice.

Link: https://www.usaid.gov/global‐health/health‐areas/tuberculosis/resources/news‐and‐ updates/global‐accelerator‐end‐tb/pbmef

Question 7. Does USAID envision applicants being responsible for revising the National Health Insurance (BPJS) payment system as part of this activity?

USAID Answer: No.

Question 8. In the APS Addendum, under Section E.2, Criterion 3 – Partners and Institutional Capacity on page 21, USAID writes, “The degree to which the applicant clearly outlines its roles and responsibilities and of its sub awardees or key partners.” Could USAID please define key partners under this solicitation?

USAID Answer: Please see the highlighted updates.

Page Limits

Question 9. Would it be permissible to include an Acronym Page that is not part of the page limit? Would USAID allow applicants to include a table of contents and acronym list that do not count against the 12‐page limit for the concept note?

USAID Answer: Please see the highlighted updates.

Question 10. Appendix 1‐ C. Page 25: In the outline of the Monitoring and Evaluation section, USAID lists the maximum as three pages and asks for a one page visual of the Theory of Change translated into a results framework. In order to account for these requirements, will USAID expand the maximum page limit to 4 pages?

Would USAID consider increasing the allotted length of the Monitoring and Evaluation section as applicants need to describe their theory of change; results; monitoring, evaluation, and learning approach; and a one‐page results framework here?

USAID Answer: Please see the highlighted updates.

Question 11. Appendix 1‐C. Page 25: In order for USAID to best evaluate and read the visual of the one‐page Theory of Change/Results Framework diagram, can the page be larger than the standard 8.5” x 11” dimensions?

USAID Answer: No.

Question 12. Would USAID consider increasing the allotted length of the Technical Approach section as applicants need to describe their proposed approach to achieve the program’s overarching goal and seven objectives (including 19 intermediate results) here?

USAID Answer: No.

Question 13. In the APS Addendum, under Appendix I, Section D – Partners and Institutional Capability, would USAID consider increasing the allotted length of the section as applicants need to describe the roles and responsibilities of their partners; a staffing and management plan; and an organizational chart here? Is the staffing plan and organizational chart to be included in the two‐page limit for the Section D or can these be added as an Annex?

USAID Answer: No.

Question 14. On page 24, USAID stipulates that no annexes will be considered. However, there is also a request for a budget summary, a one‐page Theory of Change diagram, a staffing plan, and organizational chart. Are these requested items to be included within the page limitation?

USAID Answer: Please see the highlighted updates.

Budget Summary

Question 15. Can USAID confirm that the one‐page budget summary does not count towards the 12‐page limit for the concept note? Is there a budget template that has to be used to present the budget summary?

USAID Answer: Budget summary is no longer required, see highlighted updates.

Question 16. In the APS Addendum, Section B, under Approval of Specified Key Personnel on page 16, USAID writes, “the key personnel positions will be determined during the co‐creation

Amendment No. 01 phase.” Can USAID please confirm that applicants should not propose key personnel names or positions during phase 1 of the concept note?

USAID Answer: Applicants may include in their discussion the key personnel positions but must not include the names of these key personnel.

Question 17. In the APS Addendum, under Section C ‐ Eligibility Information on page 18, there is reference made to geographic code 937. However, per ADS 310, the provision of assistance (grants and cooperative agreements) is not limited to the authorized geographic code. Could USAID further clarify and explain if this restriction applies to subawards? Can applicants partner with organizations from outside of the US and Indonesia?

USAID Answer: Only U.S. Organizations are eligible to submit applications under this Addendum and be considered as prime recipients for award. However, prime applicants may partner with other US organizations, local (Indonesian) organizations and other non‐US organizations from developing countries other than advanced developing countries. Sub‐ awards will be subject to prior USAID approval.

Question 18. In the Umbrella APS, Section C, 4. Exclusivity on page 17, states: “To maximize the number of competitive applications, prime applicants must not enter into exclusivity agreements with proposed sub‐awardees.” Can USAID please confirm that the exclusivity prohibition for sub‐awardees also applies to the APS Addendum? If so, could USAID please clarify if the exclusive prohibition applies only to local organizations or to both US and local organizations?

USAID Answer: Yes the exclusivity prohibition for sub‐awardees in the Umbrella APS also applies to the sub‐awardees in the APS Addendum, and covers both US organizations, local (Indonesian) organizations and other non‐US organizations from developing countries other than advanced developing countries.

General

Question 19. Is procurement permitted as part of this solicitation?

USAID Answer: It is up to the organization to determine what is appropriate to implement its activities as long as this is consistent with its technical approach. If the procurement of commodities is an integral component of the technical approach, then this will be considered for approval.

Question 20. Could USAID please provide an estimated timeline of the procurement process (I.e., Decisions on phase 1 and timeline between phase 1 and phase 2)?

USAID Answer: Decisions on Phase 1 will depend on the merits of the concept paper received.

Shortly after the selection of an Apparently Successful Applicant, a request for a full application will be made. Applicants should anticipate a rapid response rate, pending the number of concept papers received.

Question 21. On page 22, USAID lists the evaluation methodology. Does the engagement of local organizations receive a higher selection value?

USAID Answer: Please see the highlighted updates.

Question 22. What will be the connection of this call with the upcoming World Bank loans on TB in Indonesia and the GFATM round 2024‐2026? Will it share project locations with those two big initiatives, or will it be in different regions that those two programs?

USAID Answer: USAID is not at liberty to inform applicants about the specific locations of the World Bank loan and the GFATM activities for 2024‐26. When proposing BEBAS‐TB activities, applicants should plan for coordination and cooperation with the World Bank loan as well as the GFATM project, as well as with other domestic and internationally funded TB activities.

Collaboration and partnership with other programs is recommended to ensure coordination and avoid duplication of efforts.

Question 23. When and how will the co‐creation be done? Will it impact on the originally proposed sub‐partners? Will it also facilitate new partnerships with those engaged in the co‐ creation?

USAID Answer: The Apparently Successful Applicant will be invited to the co‐creation and collaboration process to identify and develop the activities that will help achieve the results desired under this Addendum; identify and incorporate additional partners (if needed); and determine respective roles and responsibilities related to the implementation of those activities. The co‐creation process builds on a Concept Paper that has strength and potential; it is not intended to replace the Applicants’ initiative or build new concepts or partnerships from the ground up. At its sole discretion, USAID reserves the right to conduct co‐creation at any stage, before or after the submission of full application.

Question 24. When is the expected final award likely to be?

USAID Answer: As soon as practicable understanding that the issuance of award is subject to the availability of funds and the interest and requirements of USAID, as well as the viability of the eventual full application received.

Amendment No. 01

Question 25. On page 12, USAID states that the most recent GoI policy on digital health transformation led by the Center for Data and Information (Pusdatin) through the Digital Transformation Office (DTO). Question: When will this regulation be launched?

USAID Answer: The Digital Health Transformation Strategy/Policy has been launched and is publically available (please see the link below).

Link: https://dto.kemkes.go.id/ENG‐Blueprint‐for‐Digital‐Health‐Transformation‐Strategy‐ Indonesia%202024.pdf

Note: Please see changes to APS Addendum No. 1 Bebas TB in ATTACHMENT 2. Text highlighted in yellow indicates new or revised text in accordance with Amendment No.01 of APS Addendum No. 1.

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

U.S. Embassy Jakarta

Jl. Medan Merdeka Selatan 3‐5

Jakarta 10110, Indonesia

USAID.gov

ATTACHMENT 2

Issuance Date: February 09, 2023

Questions Due Date and Time: February 23, 2023; 10:00 AM, Jakarta Time

Closing Date and Time to submit Concepts: March 30, 2023; 10:00 AM, Jakarta Time

Federal Assistance Listing Number: 98.001 Foreign Assistance for Programs Overseas

Subject: APS Addendum No. 1 under the existing Accelerating Elimination of TB in Indonesia, APS No. 72049723APS00001

Opportunity Title: Bersama Menuju Eliminasi dan Bebas dari TB (BEBAS‐TB)

Dear Interested Applicants:

Pursuant to the authority granted in the Foreign Assistance Act of 1961, as amended, the

United States Government (USG), represented by the United States Agency for International

Development (USAID), the Indonesia Mission, is announcing the first addendum issued under the Accelerating Elimination of TB in Indonesia APS for the “BEBAS‐TB” activity that will support all seven objectives under the APS within two selected within at least two selected provinces in

Indonesia.

Through this BEBAS‐TB APS Addendum, USAID Indonesia disseminates information to interested applicants so they may develop and submit Concept Papers in response to and to be considered for USAID funding. This Addendum describes and provides:

● The type of activities for which Concept Papers will be considered;

● Available funding, process and requirements for submitting Concept Papers;

● The Criteria for evaluating Concept Papers; and

● Other information and documentation or resources required for this Addendum

Issuance of this APS Addendum does not constitute an award or commitment on the part of the

USG, nor does it commit the USG to pay for costs incurred in the preparation and submission of concept papers or applications. Issuance of award is subject to the availability of funds and the interest and requirements of USAID, as well as the viability of eventual Full Application(s) received.

APS Addendum No. 1 – BEBAS TB

Based on the submitted Concept Paper, USAID Indonesia will determine whether to request a

Full Application from an eligible organization. To be competitive, the Concept Paper submission must be fully responsive to all directions under this Addendum, and the overall APS except when specifically noted otherwise in this Addendum.

To be eligible for award, the Applicant must provide all information as required and meet eligibility standards of this APS. This funding opportunity is posted on www.sam.gov and www.grants.gov, and may be amended. It is the responsibility of the Applicant to ensure that the entire “umbrella” APS and APS Addendum have been downloaded from either of the websites in its entirety as USAID bears no responsibility for data errors resulting from transmission or conversion process. In case of difficulty registering on www.grants.gov or accessing the APS, please contact the grants.gov Helpdesk at 1‐800‐518‐4726 or via email at support@grants.gov for technical assistance.

All submissions (including questions) must be emailed to the Point of Contact indicated at

Section D of this addendum by the date and time indicated on this cover letter. Responses to questions received prior to the deadline will be furnished to all potential applicants through an amendment to this notice posted on www.sam.gov and www.grants.gov

Thank you for your interest in USAID Indonesia programs.

Sincerely, /s/

Mohib Ahmed

Supervisory Agreements Officer

Office of Acquisition and Assistance

USAID/Indonesia

Note: Text highlighted in yellow indicates new or revised text in accordance with Amendment

No.01 of APS Addendum No. 1

TABLE OF CONTENTS

ACRONYMS 4

SECTION A – PROGRAM DESCRIPTION 5

SECTION B – FEDERAL AWARD INFORMATION 15

1. ESTIMATE OF FUNDS AVAILABLE AND NUMBER OF AWARDS CONTEMPLATED 15

2. START DATE AND PERIOD OF PERFORMANCE FOR FEDERAL AWARD 15

3. AWARD TYPE AND SUBSTANTIAL INVOLVEMENT 15

SECTION C – ELIGIBILITY INFORMATION 18

ELIGIBILITY APPLICANTS 18

SECTION D – CONCEPT PAPERS SUBMISSION INFORMATION 19

1. AGENCY POINT OF CONTACT (POC) 19

2. QUESTIONS AND ANSWERS 19

3. APPLICATION PROCESS 19

4. PROJECT DESIGN, MONITORING, EVALUATION AND LEARNING 19

SECTION E – CONCEPT PAPERS MERIT REVIEW INFORMATION 21

1. REVIEW OF CONCEPT PAPERS 21

2. MERIT REVIEW CRITERIA 21

3. ADDITIONAL CONSIDERATIONS 22

4. EVALUATION METHODOLOGY 22

SECTION F – FEDERAL AWARD ADMINISTRATION INFORMATION 23

1. FEDERAL AWARD NOTICES 23

2. REPORTING REQUIREMENTS 23

APPENDIX I ‐ CONCEPT PAPER TEMPLATE 24

ACRONYMS

ACF Active Case Finding

ADS Automated Directives System

AO Agreement Officer

AOR Agreement Officer’s Representative

APS Annual Program Statement

CDCS Country Development Cooperation Strategy

CFDA Catalog of Federal Domestic Assistance

CFR Code of Federal Regulations

DO Development Objective

DR TB Drug Resistant TB

FAA Federal Foreign Act

FAA Fixed Amount Award

GoI Government of Indonesia

ICS Integrated Country Strategy

HSS Health System Strengthening

MoH Ministry of Health

MDR TB Multidrug Resistant Tuberculosis

NGO Non‐governmental Organization

NTP National Tuberculosis Program

OAA Office of Acquisition and Assistance

PoC Point of Contact

SDG Sustainable Development Goal

TB Tuberculosis

TPT TB preventive treatment

USAID United States Agency for International Development

SECTION A – PROGRAM DESCRIPTION

This Addendum calls for Concept Papers for BEBAS‐TB activity. This Addendum is issued under the existing Accelerating Elimination of TB in Indonesia Annual Program Statement, APS No

72049723APS00001. All interested organizations should carefully review both the Addendum and the APS.

This funding opportunity is authorized under the Foreign Assistance Act (FAA) of 1961, as amended. The resulting awards will be subject to 2 CFR 200 – Uniform Administrative

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

A. Background & Problem Statement

Please refer to the Accelerating Elimination of TB in Indonesia APS as the country context is provided there.

B. Activity Description

BEBAS‐TB will be the first addendum issued under the Accelerating Elimination of TB in Indonesia APS. BEBAS‐TB will support all seven objectives under the APS within two selected within at least two selected provinces in Indonesia (to be determined at a later time in consultation with the Ministry of Health). In publishing this Addendum, USAID is seeking responses from eligible organizations to achieve the following objectives in collaboration with the MOH, Global Fund, and other relevant development partners working in TB.

C. Theory of change

Interested organizations will be requested to develop and include a theory of change in the concept notes they submit in response to this addendum.

D. Goal and Objectives

Goal: To assist the Government of Indonesia in addressing the TB epidemic and achieving 2030 TB elimination targets.

Objectives:

1. Enhanced capacity for TB case finding IR 1.1. Active TB case finding scaled up in facilities IR 1.2 TB detection among high‐risk groups and underserved populations improved in communities

IR 1.3 Childhood TB screening and detection expanded IR 1.4 Contact investigation increased and expanded

2. Improved quality of TB screening and diagnosis IR 2.1 Novel digital radiological screening and laboratory technologies introduced IR 2.2 Quality of TB laboratory services and diagnostic tools improved IR 2.3 TB diagnostic network and connectivity solutions expanded

3. Improved quality of TB service delivery IR 3.1 Effective adherence tools introduced and treatment monitoring improved IR 3.2 Primary health care for provision of integrated DS and DR‐TB services explored IR 3.3 Quality TB care expanded IR 3.4 Novel TB treatment regimens scaled up

4. Prevention of TB optimized IR 4.1 Testing for TB infection strengthened IR 4.2 Delivery of TB preventive therapy for all eligible populations expanded IR 4.3 Infection Prevention and Control (IPC) implemented across all settings IR 4.4 TB prevention campaigns sustained

5. Strong and resilient health system to accelerate TB elimination IR 5.1 Financing mechanism for TB control sustained IR 5.2 Health information system for TB enhanced IR 5.3 TB drugs and commodities secured

6. Community participation in implementing development activities strengthened IR 6.1 Partnership with communities in designing, implementing and monitoring TB program leveraged

7. Implementation research to improve TB control

1. Enhanced capacity for TB case finding

At the national level, the activity will be expected to provide technical assistance to the national TB program with a focus on scaling up proven approaches, introducing innovations in case finding strategies, and supporting policy development and implementation in alignment with international standards. The activity will also support dissemination of new regulations and evidence‐based initiatives across Indonesia.

For the subnational level, the activity will be expected to implement the following IRs:

IR 1.1 Active TB case finding scaled up in facilities

The Activity will assist the NTP in improving TB case detection rates by scaling up an effective active case finding (ACF) approach at the facility level, therefore addressing missed opportunities to find TB cases and reduce delays in providing prompt treatment to TB patients.

If deemed appropriate to the situation, integrated COVID‐19 and TB screening would be continued as per national guidelines. This intervention will include efforts to ensure early diagnosis to those who are suffering from TB without the typical symptoms. For this purpose, the activity will build upon lessons learned from past and ongoing USAID investments in the TB program in countries with similar contexts with Indonesia.

IR 1.2 TB detection among high‐risk groups and underserved populations improved in communities

This activity will improve and expand community base active case finding approaches among high risk and marginalized groups. This includes promoting screening for TB infection and disease among these high risk and underserved groups and people living in hard‐to‐reach areas and requiring TB screening outreach in their communities.

IR 1.3 Childhood TB screening and detection expanded

This activity will support the NTP in addressing systemic challenges with detecting TB among children (especially child contacts of adult TB patients), implement novel or improved technologies for TB testing and diagnosis among children. This activity will work with local health authorities to strengthen TB diagnosis in children by increasing access to innovative rapid molecular testing and improving the health system’s capacity for clinical diagnosis.

IR 1.4 Contact investigation increased and expanded

Evidence suggests that each patient with active TB disease, before enrollment on appropriate treatment can infect as many as 10 close contacts per year. However, screening and testing for TB among household and close contacts in Indonesia requires significant attention and expansion. This activity will assist local health authorities to plan and implement effective TB contact investigation strategies.

2. Improved quality of TB screening and diagnosis

At the national level, the activity will be expected to provide technical assistance to the national TB program with a focus on utilizing the most accurate tools to screen and diagnose individuals for TB, particularly rapid molecular diagnosis. This activity will support NTP to introduce innovations based on global evidence and best practices in TB screening and diagnosis and to develop strategies and policy development according to international standards. The activity will also support dissemination of new regulations and evidence‐based initiatives across Indonesia.

For the subnational level, the activity will be expected to implement the following IRs:

IR 2.1 Novel digital radiological screening and laboratory technologies introduced

According to the latest TB Prevalence Survey, as many as 40% of people with TB in Indonesia do not have specific TB symptoms. Therefore, this activity will implement cost effective and systematic TB screening interventions and increase access to new technologies such as portable digital x‐ray with artificial intelligence (AI). Also, in order to support the TB diagnosis confirmation, the activity will support the NTP of Indonesia to scale up rapid molecular tests, bring novel diagnostic technologies and promote the implementation of new diagnostic platforms that are easily available and affordable for TB patients. The activity will also improve specimen transport as well as patient referral systems for both public and private providers.

IR 2.2 Quality of TB laboratory services and diagnostic tools improved

This activity will support the National Referral Laboratories (NRLs) and NTP as well as laboratories at the provincial and district level to maintain quality standards, introduce new measures to maintain quality and provide support for continuous quality assurance. Also, the activity will support local health authorities with providing needed capacity building to professional staff and establishing linkages between laboratories on different system levels.

IR 2.3 TB diagnostic network and connectivity solutions expanded

This activity will support local health authorities to improve rapid and accurate diagnosis of TB using a reliable, well‐organized, and effectively operated diagnostic network. This activity will work to improve all levels of the TB laboratory hierarchy: from microscopy smear sites to rapid molecular tests, to DST and whole genome sequencing, and will also include strengthening TB laboratories in the private sector. In addition, this activity will work on the screening and diagnostic connectivity network including X‐ray stations, where screening for TB is performed as well as ensuring sample transportation systems are reliable and reporting is done in real‐ time.

3. Improved quality of TB service delivery national TB program with a focus on improving the quality of TB service delivery for both DS‐ and DR‐TB care, introducing and piloting new approaches and treatment regimens, and bringing international best practices to the country. Provided support will be focused on assisting policy and guidelines development and dissemination of these materials across the country.

For the subnational level, the activity will be expected to implement the following IRs:

IR 3.1 Effective adherence tools introduced and treatment monitoring improved

As there are multiple factors influencing the TB epidemic, there is an increased need to apply a patient‐centered model to achieve universal access to quality TB care for all. Understanding that treatment adherence is the cornerstone of good treatment outcomes, expanded use and fine tuning of innovative solutions such as digital adherence monitoring tools, social and psychological support, and counseling are needed to sustain good‐quality programs. This Activity will also support incorporation of social support for TB patients into patient‐centered TB care, including integrating patient support into TB care management to improve treatment completion, management of adverse drug reactions, and prevention of treatment interruption which leads to development of drug resistant TB.

IR 3.2 Primary health care for provision of integrated DS and DR‐TB services explored

TB care service delivery in Indonesia is organized via hospitals and primary health care (PHC) facilities, where patients are not only diagnosed, but also enrolled on appropriate treatment and supported throughout the treatment journey. However, DR‐TB care historically has been organized via parallel structures due to its complexity and needed attention to the adverse drug reactions that patients experience. With the DR‐TB treatment becoming all‐oral and shorter, a full integration of DS‐ and DR‐TB care will allow true patient‐centered treatment delivery at the PHC level. At the same time, PHCs have multiple other responsibilities for delivering essential care to adults and children and project support would be needed to assist health staff to transition to a new structure, gain new knowledge and skills. This activity will provide educational and technical support to selected districts to pilot a comprehensive model of TB service delivery and generate evidence to support future implementation and scale‐up.

IR 3.3 Quality TB care expanded

While the national average for treatment success rate for DS‐TB remains high, a further gap analysis and targeted improvement in underperforming districts is needed. For DR‐TB, a number of essential programmatic gaps have persisted over the last several years, including:

high rates of initial lost‐to‐follow up, poor treatment adherence and low treatment success rates for both adults and children. The activity will adopt and leverage learnings derived from USAID’s work in integrating community‐based DR‐TB support into clinical‐centered care, and explore opportunities to expand the model to public health systems and other non‐ governmental health care settings. Additionally, to ensure continuity of care for TB patients with comorbidities, the activity will assist in pursuing joint collaboration between TB and other diseases/health issues, e.g., HIV, MNH, and diabetes mellitus, to build an integrated model of care.

IR 3.4 Novel TB treatment regimens scaled up

In the last couple of years, several novel treatment regimens for DS‐ and DR‐TB have been introduced and approved by the WHO. All of them are shorter in duration and include all‐oral medications, which will allow easier treatment administration and better compliance from the patients’ side. Quick uptake and rapid scale up of the novel regimens will allow NTP to increase treatment coverage while improving treatment results for both adults and children. This activity will help to scale up selected regimens in priority districts in public and private clinics.

4. Prevention of TB optimized national TB program in introducing novel TB infection (TBI) diagnostic and screening tools, pilot and evaluate the effectiveness of the new approach for TB prevention treatment (TPT), followed by assisting the NTP in developing/updating evidence‐informed policies based on global recommendations and support the dissemination of evidence‐based TB prevention initiatives across Indonesia.

As for subnational level, the activity is expected to implement the below IRs:

IR 4.1 Testing for TB infection strengthened

Indonesia introduced testing for TBI several years ago, however it is still implemented at a small scale through donor‐supported activities. The Indonesia NSP reflects ambitious goals for TPT initiation, but these goals cannot be achieved without several essential elements, one of which is testing for TB infection. This activity will help leverage efficient laboratory practices to perform TBI tests, explore collaboration models between the secondary and primary health care in optimizing TBI management, generate most feasible approaches for better TPT coverage and rapidly roll it out in the priority areas.

IR 4.2 Delivery of TB preventive therapy for all eligible populations expanded

Timely and appropriate TPT along with contact investigation are essential components of epidemic control. The Activity will assist in securing supply of TPT drugs at health facilities and increase uptake of new and shorter TPT regimens by eligible populations. To ensure reliable access for TB screening and preventive treatment to all risky individuals, this activity will also support in promoting integration with other health programs, such as HIV, diabetes, and etc.

for seamless access to TB screening and TPT administration among the immunocompromised individuals.

IR 4.3 Infection Prevention and Control (IPC) implemented across all settings

One of the important components of TB prevention is Infection Prevention and Control (IPC) activities aimed at preventing air particles containing mycobacteria to reach healthy individuals via personal, administrative, or environmental measures. While an integration of IPC to prevent TB transmission has long been included in the national TB program, adoption of the approach across the health care system in Indonesia remains inadequate. With the increasing involvement of public ‐ private providers and local organizations in TB activities, this activity will assist adapting the national IPC policies into subnational action plans that include administrative, environmental, and personal protective measures in health facilities, congregate settings, communities, and households. Moreover, this activity will also assist in translating the strategy into IPC activities in various settings to minimize TB transmission.

IR 4.4 TB prevention campaigns sustained

The disruption of the entire health system caused by the COVID‐19 pandemic garnered significant public attention and provided an opportunity to improve understanding about the disease. The pandemic provided examples of the essential contribution of health education in fighting the infectious disease by promoting protective behaviors. Building on the models of consolidated public health education during the COVID‐19 crisis, this activity will assist in leveraging health promotion about TB, particularly in ensuring that a wealth of information about TB is available to the public. Multisector coordination should be a substantial component in rolling out the intervention to ensure the effective delivery of key TB messages across all sectors. Additional emphasis under this sub objective will be increased efforts in educating communities about TPT to advance awareness and acceptability among the targeted beneficiaries and health providers. In support of this effort, this Activity will work in robust collaboration with another USAID activity, PREVENT TB, to increase demand for TPT through a behavior change communication intervention.

5. Strong and resilient health system to accelerate TB elimination national TB program to address key elements in the health system components influencing TB response in the country, such as health financing, supply chain management, health information system, and human resource development. Provided support will be focused on assisting with the development of policies, norms and regulation and dissemination of them across the country, as well as developing innovative digital solutions for capacity building. To sustain and increase political commitment, this activity will assist local players to form local TB partnerships at the district and province levels and provide needed support to the national Stop TB partnership to be active and sustainable. In addition, this activity will partner and collaborate with Kemenko PMK to support the national and sub‐national network of CSOs and patients’ organizations.

For the subnational level, the activity will be expected to implement the following IRs:

IR 5.1 Financing mechanism for TB control sustained

Funding for TB control in Indonesia continues to fall short of the estimated funds needed to achieve optimal TB targets. Even before the COVID‐19 crisis, the establishment of a robust social protection system that effectively mitigated catastrophic costs due to TB remained lacking. The pandemic worsened financing for TB activities by distorting health spending priorities at multiple levels.

This activity will continue supporting the country’s ongoing efforts in exploring innovative financing mechanisms that ensure equitable access to a wide range of TB services, thereby eliminating catastrophic costs due to considerable out‐of‐pocket expenses incurred for accessing TB care. While this intervention is ideally incorporated into Indonesia's National Health insurance scheme, this activity will also have the ability to anticipate additional local financing mechanisms aimed at securing financial support for TB patients and supporting local organizations to implement TB activities that contribute to improved TB outcomes.

IR 5.2 Health information system for TB enhanced

SITB, the current national TB surveillance system introduced in 2020 and scaled up nationwide, requires continued actions to improve its functionality. In addition, many other digital TB applications, namely, WIFI TB which simplified TB reporting by General Practitioners (GPs) and private clinics, connectivity solutions such as Epicenter and GXAlert that provided immediate TB test results to providers, and SOBAT TB, a digital mobile app for TB self‐screening and diagnosis referral, require further refinement. These systems lack interoperability to facilitate efficient TB recording/reporting and data maintenance by both public and private health providers. The use of accurate information generated by these systems is essential to inform strategic and timely decision making at all levels. This activity will collaborate with USAID’s Country Health

Information Systems and Data Use (CHISU) activity, implemented by JSI, to continue efforts to improve optimal SITB operations while ensuring alignment of USAID support on digital TB technology(ies) with the most recent GoI policy on digital health transformation led by the Center for Data and Information (Pusdatin) through the Digital Transformation Office (DTO).

IR 5.3 TB drugs and commodities secured

Successful TB management requires strengthening of the entire health system, including supply chain management to ensure uninterrupted supply of quality assured TB drugs and commodities to TB patients whenever they are needed. For this, the availability of a strong system in forecasting, procurement, tracking and monitoring the supply chains of TB drugs and commodities is pivotal. This Activity will support provincial and district health offices with improving the TB supply chain management system so that it allows for reliable forecasting methods, drug quality assurance, timely distribution of drugs and commodities, and prevention of overstocking and drug stock outs. In addition, this activity will work with both public and engaged private facilities to prevent stockouts of medicines and supplies.

6. Community participation in implementing development activities strengthened

A successful TB program requires both the government and community to actively take responsibility in planning, implementing, and monitoring TB control activities. Therefore, at the national level, this activity will be expected to work in partnership with key stakeholders and communities to strengthen the capacity of organizations for TB control and promote supportive regulation and resources for broader community involvement.

For the subnational level, the activity will be expected to implement the following IRs:

IR 6.1 Partnership with communities in designing, implementing and monitoring TB program leveraged

This activity will engage communities in shaping policy on patient‐centered programs, delivering quality community‐based TB care, and advancing the community’s potential in other TB management roles. This activity will include strengthening the role of the community in TB detection and treatment, gaining new technical knowledge, utilizing novel diagnostic and treatment technologies and obtaining new practical skills.

7. Implementation research to improve TB control

This objective will provide targeted technical support at the national level only. The activity will be expected to provide technical assistance to the Ministry of Health to plan, conduct operational research activities and analyze and use data derived from this research. Also, it will identify prominent TB research centers across the country, provide capacity building and technical assistance for performing OR studies on key topics relevant to the TB situation. In addition, this Activity will promote stronger collaboration between the national TB research network (JETSET TB), research centers, academia, and national TB stakeholders in translating the evidence generated by their members into policies that align with TB program priorities.

E. Geographic Focus

The proposed geographic locations for the Accelerating Elimination of TB in Indonesia APS are North Sumatra, Banten, DKI Jakarta, West Java, Central Java, East Java, and South Sulawesi provinces. The selections are based on the highest TB burden provinces and prioritized within the eight priority provinces under USAID’s Country Development Cooperation Strategy (CDCS) 2020‐2025 and the next CDCS. This Activity, BEBAS‐TB, will support all seven objectives under the APS within two selected within at least two selected provinces in Indonesia (to be determined at a later time in consultation with the Ministry of Health). BEBAS‐TB will work in at least 50% of the number of districts based on its TB burden in the selected provinces. During implementation, USAID reserves the right to adjust the geographic focus based on disease burden or responding to the host government's request.

F. Private Sector Engagement

Applicants will be expected to explore potential collaborations that leverage private sector funding/co‐investment with USAID/Indonesia for the TB control program. In addition, applicants will need to envision the role of the private sector (including but not limited to private healthcare providers, laboratories, clinics, pharmacies, businesses, corporations, small or medium enterprises or firms, relevant industry/business associations, chambers of commerce, and other private sector entities, as they are deemed relevant) in the BEBAS‐TB activity to achieve the activity goal.

Expected Results:

The Accelerating Elimination of Tuberculosis in Indonesia APS aims to contribute to an overall decline in TB incidence, prevalence, and mortality in Indonesia

At minimum, this Activity BEBAS‐TB, will also list, monitor, and report on the following USAID standard indicators1:

● TB Detection Rate

● Childhood TB Notifications

● Private Sector TB Notifications

● Contact Investigation Coverage Rate

● TB Preventive Treatment (TPT) enrollment

● Proportion of Domestic Financing for TB

● Drug‐Resistant TB Notifications

1https://www.usaid.gov/global‐health/health‐areas/tuberculosis/resources/news‐and‐updates/global‐accelerator‐ end‐tb/pbmef

● Drug‐Resistant TB Treatment Success Rate

● TB Treatment Success Rate

● Bacteriological Diagnosis Coverage Rate ‐ Pulmonary TB

[End of this Section]

SECTION B – FEDERAL AWARD INFORMATION

This APS Addendum is calling for concepts submission, with the deadline indicated in the cover page. All interested organizations should carefully review both the umbrella APS Number

72049723APS00001 for the Accelerating Elimination of Tuberculosis (TB) in Indonesia as well as this Addendum. Important information contained in the umbrella APS is not repeated in the

Addendum.

1. ESTIMATE OF FUNDS AVAILABLE AND NUMBER OF AWARDS CONTEMPLATED

Subject to availability of funds, USAID Indonesia anticipates awarding one (1) Cooperative

Agreement under this Addendum with a total estimated budget not to exceed $70,000,000.

All funding will be provided on an incremental basis subject to the availability of funds and successful performance. USAID reserves the right to change the funding amounts, cycle, and terms of the agreement as a result of availability of funding, USG requirements or recipient performance. Should such changes occur, the recipient will be notified accordingly.

2. START DATE AND PERIOD OF PERFORMANCE FOR FEDERAL AWARD

The anticipated period of performance for an award made under this Addendum is five (5) years.

3. AWARD TYPE AND SUBSTANTIAL INVOLVEMENT

The award resulting from this Addendum is a Cooperative Agreement. The Cooperative

Agreement will contain substantial involvement. This substantial involvement will be through the Agreement Officer (AO), except to the extent that the AO delegates authority to the

Agreement Officer’s Representative (AOR) in writing. The intended purpose of the substantial involvement during the award is to assist the recipient in achieving the supported objectives of the agreement. The Cooperative Agreement may have some or all the following substantial involvement.

● Approval of the Recipient’s Annual Implementation Plans/work Plans

The Annual Implementation Plan, and any subsequent revisions, are subject to approval by the AOR prior to implementing substantive work for each year of the Agreement. The annual implementation plan communicates how and when the recipient will complete project activities. This plan will be developed in partnership between the recipient and the

AOR team. The AOR will ensure that the implementation plans fit within the scope, goals, terms and conditions of the agreement.

● Approval of Specified Key Personnel

The key personnel positions will be determined during the co‐creation phase. Key personnel positions will require concurrence from the AOR and approval from the

Agreement Officer (AO). Maximum five positions are considered as key personnel.

● Agency and Recipient Collaboration or Joint Participation

3.1 Approval of recipient’s monitoring and evaluation plans

This describes USAID involvement in monitoring progress toward the achievement of program objectives during the performance of the project, including written guidelines for the content of annual reports and final evaluations.

While an illustrative Activity Monitoring, Evaluation, and Learning (MEL) Plan could be requested in the full application submission, the final Activity MEL Plan will be developed in consultation with USAID post‐award. During the initial project planning period, the awardee will work closely with USAID to establish major milestones, program monitoring indicators, as well as baseline data and performance targets which will demonstrate successful achievement of the results addressed in the cooperative agreement.

3.2 Collaborative involvement in selection of advisory committee members

If the program establishes an advisory committee that provides advice to the recipient, USAID will participate as a member of this committee. Advisory committees must only deal with programmatic or technical issues and not routine administrative matters.

3.3 Concurrence on the substantive provisions of sub‐awards

The recipient must obtain AO’s prior approval for the sub‐award, transfer, or contracting out of any work under an award. The term ‘sub‐awards’ includes both sub‐agreements and contracts under assistance. Some of the sub‐award approval responsibilities may be delegated to the AOR. Please note that any sub‐awards (sub‐agreements or contracts) to foreign governmental organizations or parastatals of any amount must be approved by the

AO and may warrant additional clearances.

3.4 Monitor to authorize specified kinds of direction or redirection because of interrelationships with other projects

Activities will be included in the program description, negotiated in the budget, and made part of the award. Note: the AOR will provide review of the proposed change, and the AO is the only individual who can provide approval for this element of substantial involvement

● Agency Authority to Immediately Halt an Activity

The AO may immediately halt an activity when identified specifications are not met.

SECTION C – ELIGIBILITY INFORMATION

ELIGIBILITY APPLICANTS

Only U.S. Organizations from the authorized geographic code (937) may participate under this

Addendum. USAID will not accept applications from individuals. All applications must be legally recognized organization entities under applicable law.

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

SECTION D – CONCEPT PAPERS SUBMISSION INFORMATION

1. AGENCY POINT OF CONTACT (POC)

The POC for information about this Addendum is:

Ms. Yulian Christanti

A&A Specialist

Office of Acquisition and Assistance (OAA)

USAID Indonesia

Email at applications‐indonesia@usaid.gov and cc to ychristanti@usaid.gov

2. QUESTIONS AND ANSWERS

All questions regarding this Addendum should be submitted in writing via email with a subject line of “APS Addendum BEBAS‐TB Questions” only to the email address identified above by the deadline stated on the cover page.

3. APPLICATION PROCESS

PHASE 1: CONCEPT PAPERS SUBMISSION AND REVIEW

Appendix 1 provides a Concept Paper Template for Applicants to submit in writing via email to the assigned POC listed above by the closing date indicated in the cover page of this

Addendum.

Upon the closing date, concept papers will be evaluated against the merit review criteria as described in SECTION E of this Addendum.

PHASE 2: FULL APPLICATION BY INVITATION ONLY

USAID will only accept a full application from the apparently successful applicant. USAID will issue a Request for Full Application (RFA) and will provide complete instructions for submission.

NOTE: At its sole discretion, USAID reserves the right to conduct co‐creation at any stages, before or after the submission of full application.

4. PROJECT DESIGN, MONITORING, EVALUATION AND LEARNING

The ability to effectively monitor activities, evaluate their impact, and learn from the experience depends on the thoughtful and…