Request for Proposals (RFP) No 72061120R00005_MECH - 03242020-Amendment 1.pdf

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

Embassy of the United States of America

Subdivision 694/Stand 100 Ibex Hill Road

P.O. Box 320373, Lusaka, Zambia

March 31, 2020

Subject: Request for Proposals (RFP) No: 72061120R00005

USAID Maintained Epidemic Control of HIV (MECH) Activity-

Amendment 1

Dear Prospective Offerors:

The United States Agency for International Development (USAID) Mission to Zambia is seeking proposals to provide technical services described in the attached Request for Proposals (RFP).

This procurement will be conducted under limited competition to “Local Partners” for USAID

Maintained Epidemic Control of HIV (MECH) Activity valued between $85 and $95 million.

Definition of a Local Partner: Under the PEPFAR definition, to be considered a local partner, the offeror must meet the following criteria:

An entity (e.g., a corporation or partnership):

a) Must be incorporated or legally organized under the laws of, and have its principal place of business in, the country served by the PEPFAR program with which the entity is involved;

b) Must be at 75% beneficially owned at the time of application by individuals who are citizens or lawfully admitted permanent residents of that same country, per sub-paragraph (a); and

c) Where an entity has a Board of Directors, at least 51% of the members of the Board must also be citizens or lawfully admitted permanent residents of such country.

This RFP directly responds to the PEPFAR goal of transitioning to local organizations and the

USAID’s vision of a Journey to Self-Reliance by creating sustainable local capacity. For purposes of this RFP, “Principal Place of Business” means the primary location where the business is performed. In this case, the organization's principal place of business must be Zambia, for the prime.

USAID anticipates the award of a Cost-Plus-Award-Fee Type Contract for a maximum five (5) year period of performance as a result of this RFP. USAID anticipates that the total estimated cost will be between $85 and $95 million. The North American Industry Classification System

(NAICS) code for this solicitation is 541990. The authorized geographic code for the prime contractor of this procurement is 935.

The Government intends to conduct the evaluation as an Advisory Phased Procurement with two (2) phases. Participation in Phase I is a mandatory part of this acquisition. Interested offerors that do not participate in Phase 1 will not be considered for phase II. Proposals will be evaluated based on evaluation factor (s) for each Phase. At the conclusion of Phase I evaluation, advisory notification will be sent to all Offerors informing them of the evaluation results.

Offerors not deemed as viable competitors as a result of evaluation may still elect to participate in Phase II or may voluntarily withdraw their proposal from further consideration. Please refer to Section L for detailed information regarding offeror’s submission of proposals in Phase I and

Phase II based on the Government Advisory Notice

Action Date Time Submission/Location:

Questions Due March 19, 2020 14:00 Lusaka Time oaa-solicit-lusaka@usaid.gov

Phase I: Proposals Due April 30, 2020

[See Section L.5 (Phase I)]

14:00 Lusaka Time

Advisory Notice o/a May 12, 2020 14:00 Lusaka Time

Phase II: Proposals Due [Will be communicated via the advisory notice.]

[See Section L.5 (Phase II) and

L.6]

14:00 Lusaka Time

Failure to comply with the submission date and time may result in a submission being non-responsive, such that it will not be reviewed or evaluated. Faxed proposals are not acceptable, nor will they be reviewed or evaluated. Section M states the criteria for both Phase I and II by which proposals will be evaluated. This RFP in no way obligates USAID to award a Contract.

Nor does it commit USAID to pay any cost incurred in the preparation and submission of a proposal. Award of a Contract under this RFP is subject to availability of funds and other internal USAID approvals.

This RFP and any future amendments can be viewed and downloaded from www.beta.SAM.gov.

USAID bears no responsibility for data errors resulting from transmission or conversion processes. Further, be aware that amendments to solicitations are occasionally issued and will be posted on the same internet site from which you downloaded the solicitation. You are therefore advised to regularly check the above internet site for amendments.

Sincerely, Mohib Ahmed

Supervisory Contracting Officer

Director, Office of Acquisition and Assistance mailto:oaa-solicit-lusaka@usaid.gov http://www.beta.sam.gov/

(x)

72061120R00005 x x copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted ; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE

RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR

OFFER. If by virtue of this amendment you desire to change an offer already submitted , such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

720611

USAID/Zambia Embassy of the United States of America Subdivision 694/Stand 100 Ibex Hill Road P.O. Box 320373, Lusaka, Zambia

03/06/20200001

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended , by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

03/06/2020

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation data, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The Purpose of this amendment is to:

1. Provide a copy of the amended Solicitation with updated Sections highlighted in yellow;

and

2. Provide answers to questions submitted by various prospective offerors electronically by the questions due date

All other terms and conditions remain unchanged

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

Mohib Ahmed

STANDARD FORM 30 (REV. 11/2016)

Prescribed by GSA FAR (48 CFR) 53.243

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9 A or 10A, as heretofore changed, remains unchanged and in full force and effect .

03/31/2020 cnyanoka Highlight

Request for Proposals (RFP) No: 72061120R00005 Amendment #1

USAID Maintained Epidemic Control of HIV (MECH) Activity

ACRONYM LIST

7NDP Seventh National Development Plan

ACT Accelerating Children's HIV/AIDS Treatment Initiative

ADFHS Adolescent Friendly Health Services

AIDS Acquired Immunodeficiency Syndrome

APR Annual Performance Report

ART Antiretroviral Therapy

ARV Antiretrovirals

AU African Union

BCC Behavior Change Communication

BMI Body Mass Index

CACX Cervical Cancer

CDC Centers for Disease Control and Prevention CDCS Country Development Cooperation Strategy

CD4 Cluster of Differentiation 4

CHW Community Health Workers

COP Country Operational Plan

DMO District Medical Office

EID Early Infant Diagnosis eLMIS Electronic Logistics Management Information System eSCMIS electronic Supply Chain Management Information Systems

EMTCT Elimination of Mother-to-Child Transmission

FP Family Planning

FSW Female Sex Workers

G2G Government to Government

GRZ Government of the Republic of Zambia

HCT HIV care and treatment

HEPS High-Energy Protein Supplement

HIV Human Immunodeficiency Virus

HIV+ HIV positive

HMIS Health Management Information Systems

HTC HIV testing and counseling

ICE Information, Communication, Education

IMAM Integrate Management of Acute Malnutrition

IR Intermediate Result

IPTp Intermittent Preventive Therapy in pregnancy

ITN Insecticide-Treated Net

IYCN Infant and Young Child Nutrition

M&E Monitoring and Evaluation

MCDSS Ministry of Community Development and Social Services

MCH Maternal and Child Health

MDG Millennium Development Goals

MER Monitoring, Evaluation and Research

MNCH Maternal, Newborn and Child Health

MOA Ministry of Agriculture

MOH Ministry of Health

MUAC Mid-Upper Arm Circumference

MSM Men who have Sex with Men

MSL Medical Stores Limited

MTB/RIF Mycobacterium Tuberculosis/Rifampicin

MTCT Mother-to-Child Transmission

NAC National AIDS Council

NACS Nutrition, Assessment, Counseling and Support

NASF National AIDS Strategic Framework

NGO Non-governmental organization

NHSP National Health Strategic Plan

NMCC National Malaria Control Center

NSP National Strategy for the Prevention of HIV/AIDS in Zambia

OVC Orphans and vulnerable children

PAD Project Appraisal Document

PEPFAR President’s Emergency Plan for AIDS Relief

PHC Primary Health Care

PLHIV People Living with HIV

PLWHA People Living with HIV and AIDS

PMI President’s Malaria Initiative

PMO Provincial Medical Office

PMTCT Prevention of Mother-to-Child Transmission

RH Reproductive Health eMTCT Elimination of Mother-to-Child Transmission

RTK Rapid Test Kits

RUTF Ready-to-use therapeutic food

SAFE USAID SAFE: Supporting an AIDS-Free Era

SAPR Semi-Annual Performance Report

SIMS Site Improvement Monitoring System sdNVP Single dose of Nevirapine

SNU Sub National Unit

SOW Statement of work

TB Tuberculosis

TWG Technical Working Group

UNAIDS Joint United Nations Program on HIV/AIDS

USAID United States Agency for International Development

USAID/Z United States Agency for International Development/Zambia

VMMC Voluntary Medical Male Circumcision

WHO World Health Organization

ZDHS Zambia Demographic and Health Survey

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1. PURPOSE

The purpose of this contract is to implement USAID Maintained Epidemic Control of HIV

(MECH) in accordance with Section C.

B.2. CONTRACT TYPE

This is a Cost-Plus-Award-Fee (CPAF) type contract. The contractor shall provide results and outputs as described under Section C and other requirements of Section F and H in accordance with the performance standards specified herein.

B.3. ESTIMATED COST, AWARD FEE, AND OBLIGATED AMOUNT

In accordance with FAR Part 52.232-22 - Limitation of Funds:

(a) The estimated cost for the performance of the work required hereunder, exclusive of award fee, if any, is $TBD. The maximum award fee, if any, is $TBD. The estimated cost-plus award fee, if any, is $TBD.

(b) Within the estimated CPAF specified in paragraph (a) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the Contractor (and payment of fee, if any) for performance hereunder is $TBD. The contractor must not exceed the aforesaid obligated amount.

(c) Budget

NOTE: The contractor will be required to notify the USAID COR of Budget Line Item variation of 10% and request concurrence.

Contract Budget

Line Item

Description

PERIOD

Yr. 1 Yr. 2

Yr. 3

Yr. 4

Yr. 5

Total All Years

Salaries and Wages

Fringe Benefits

Travel, Transportation and Per Diem

Equipment and Supplies

Subcontracts

Consultants

Other Direct Costs

Indirect Costs

Total Estimated Cost

Award Fee

Total Estimated Cost

Plus Award Fee

Contract Line Item (CLIN)

ITEM NO SUPPLIES/SERVICES (DESCRIPTION) QTY UNIT UNIT PRICE

TOTAL

AMOUNT

CLIN

Service Delivery (Direct & Indirect Costs)

Estimated Cost

Award fee

Base Fee

Total Cost Plus Award Fee

(d) In accordance with FAR 52.232-19, Availability of Funds, funds obligated hereunder are anticipated to be sufficient through o/a TBD. Funding for this contract will be on an incremental basis, subject to the availability of funds.

B.4 PAYMENT OF AWARD FEE

The Contractor may earn and be paid all or a portion of an award fee for performance under this contract. The Government's purpose in granting an award fee is to encourage and reward superior contract performance.

The maximum award fee must be made available to the Contractor in five (5) increments, with the first evaluation occurring approximately one year after the award date and after final annual performance review (APR) data is submitted, reviewed and accepted into the PEPFAR DATIM system. The remaining four evaluations occurring annually following APR DATIM data submission, review and acceptance in December of a given year as specified below:

Contract Year Period*

(Start/End date)

Amount of Award Fee

Available

Contract Year 1 TBD at Award TBD

Contract Year 2 TBD at Award TBD

Contract Year 3 TBD at Award TBD

Contract Year 4 TBD at Award TBD

Contract Year 5 TBD at Award TBD

Maximum Award Fee

Available

TBD

* Period will be completed upon contract award.

The determination of the award fee, if any, earned by the Contractor must be in accordance with the Award Fee Evaluation Plan [Attachment J.1]. Unearned award fee cannot rollover from one award fee increment to the next award fee increment. The amount of award fee to be earned is a unilateral and subjective Government evaluation decision.

Payment of any award fee earned by the Contractor must not be subject to the withholding provisions of the clause of this contract entitled "Allowable Cost and Payment" (FAR 52.216-7).

B.5 INDIRECT COSTS

The Contractor is authorized to recover applicable indirect costs, if it is part of the contractor's usual accounting procedures, consistent with FAR Part 31, and Negotiated Indirect

Cost Rate Agreement (NICRA).

Pending establishment of revised provisional or final indirect cost rates, allowable indirect costs will be reimbursed on the basis of the following negotiated provisional or predetermined rates and the appropriate bases as below:

[To be inserted at the time of Award]

Contractor Fringe

Rate %

Overhead

Rate %

G&A

Rate %

PRIME (insert)

Type of Rate (insert)

Base of Application (insert)

Source: (insert)

Period: (insert)

MAJOR SUBCONTRACTOR(S)

(insert)

Type of Rate

Base of Application (insert)

Source: (insert)

Period: (insert)

NOTE: Insert additional indirect rates as needed for all primes and subcontractors in the above table.

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

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

NOTE: Major subcontractors are those subcontractors whose proposed costs exceed 20% of the Offeror’s proposed total cost or perform a key element of the RFP.

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

Reimbursement for indirect costs shall be at final negotiated rates.

B.6 COST REIMBURSABLE

The U.S. dollar costs allowable will be limited to reasonable, allocable and necessary costs determined in accordance with FAR 31 (Contract Cost Principles), 2 CFR Part 200 (Cost

Principles), FAR 52.216- 7 (Allowable Cost and Payment), AIDAR 752.216-70 (Award Fee) if applicable, FAR 52.232-20 (Limitation of Cost), FAR 52.232-22, (Limitation of Funds), and

AIDAR 752.7003 (Documentation for Payment), may be reimbursable under this contract.

[END OF SECTION B]

SECTION C - DESCRIPTION/SPECIFICATIONS/PERFORMANCE BASED WORK

STATEMENT

C.1 ACTIVITY TITLE

The activity title is USAID Maintained Epidemic Control of HIV (MECH).

C.2 OVERVIEW

The primary purpose of USAID MECH is to reduce HIV mortality, morbidity and transmission by achieving the UNAIDS and PEPFAR goal of 95/95/95 HIV treatment coverage and providing comprehensive HIV prevention and care and treatment maintenance services in Luapula, Muchinga and Northern provinces. Additionally, USAID MECH will strengthen public financial management systems in provinces where USAID has government to government agreements. In order to achieve these objectives, USAID MECH will strengthen systems and provide direct service delivery at the province, district, facility and community levels.

C.3 SUCCESS

Success will be measured by performance towards agreed upon targets described here and further expanded on in the performance monitoring plan. Achievement of these targets will result in HIV epidemic control during year one of the project and maintained epidemic control over the life of the project. In addition to ensuring that 95 percent of PLHIV know their status, 95 percent of those people are on treatment, and 95 percent of those on treatment are virally suppressed, this activity will be determined as successful if the services provided through the public health sector are of high quality. High quality means that services are provided to patients in environments that are respectful to patient needs, convenient and accessible, and meet minimum international quality standards.

C.4. BACKGROUND

Country Context

Zambia’s population is estimated at 18 million people. At 741,000 square kilometers Zambia is geopolitically divided into ten provinces and over 100 districts. Approximately 60 percent of the population lives in sparsely populated rural areas.

Zambia has made significant progress in managing its generalized HIV epidemic over the past decade, with notable achievements made in the past two years. By the end of the calendar year

2019, 1,065,657 of the approximately 1.2 million HIV positive individuals were on HIV treatment in health facilities supported by PEPFAR, with additional individuals on treatment in health facilities supported only by the Ministry of Health. Viral load suppression of those on treatment is estimated at 92%. Despite these significant achievements, gaps in services, particularly among pediatrics, young girls and men remain. If these populations do not achieve the targeted 90% treatment coverage, Zambia will not achieve HIV epidemic control as the virus will continue to infect new individuals.

In order to reach these priority populations the PEPFAR program has emphasized targeted index testing, primary prevention among young children, risk reduction among adolescents and young adults, and improved access to testing and treatment services in locations where patients prefer them. By aggressively pursuing these approaches, USAID anticipates that at least 81% of

PLHIV will be on treatment in early FY2020 in USAID supported provinces. In preparation of this major milestone, USAID programs will need to shift focus from aggressive case identification to maintaining high quality HIV treatment services for hundreds of thousands of patients, while ensuring that all patients adhere to their treatment and are retained in services.

Additionally, prevention efforts will need to continue to ensure that no children are born HIV positive, young girls stay HIV negative and discordant couples remain that way.

National Policy Context

Zambia’s Revised Seventh National Development Plan (SNDP) envisions equitable access to quality healthcare for all its citizens by 2030 and recognizes that a healthy population is critical to improved production and productivity. Additionally, the National Health Strategic Plan

(NHSP) promotes access, as close to the community as possible, to high quality and cost-effective health services. The key principles of the NHSP include availability of primary health care services, equity of access, affordability, cost-effectiveness, accountability, partnership, decentralization, leadership and a clean, caring and competent health care environment. The plan also identifies maternal, neonatal and child health, HIV/AIDS and sexually transmitted infections, tuberculosis and malaria as public health priorities. The Ministry of Health has multiple HIV specific policies that are particularly forward leaning and make Zambia a regional leader in creating a positive policy environment for achieving HIV epidemic control. These policies include rapid initiation of all HIV positive individuals on treatment, 6 month dispensing of ARVs and an aggressive transition to the tenofovir lamivudine dolutegravir combination

(TLD).

PEPFAR/USAID’s HIV/AIDS Response in Zambia

PEPFAR has categorized Zambia as a ‘Bucket 2’ country, meaning that HIV epidemic control is near, but significant effort is still needed to achieve it. This means that not only do hundreds of thousands of PLHIV need to be identified and initiated on treatment, but also that systems need to be put in place to ensure minimal loss to follow up and retention on treatment of over 95%.

As Zambia crosses the threshold for achieving HIV epidemic control, the program must transition from an emergency response to one that treats HIV as a chronic disease. This will mean making high quality services available in patient-friendly environments that are accessible.

PEPFAR and USAID/Zambia Projects in 2019/20

The overall PEPFAR/Zambia program is budgeted at approximately $435 million in COP19. The

PEPFAR program is comprehensive in that it provides services across the entire HIV continuum of care, and targeted in that it is concentrated in the geographic area that have the highest HIV burden. USAID and CDC administer HIV treatment projects that serve geographically distinct areas. Other USAID funded projects that will operate in the USAID MECH supported provinces to provide various HIV related services include the following:

1. The electronic Supply Chain Management Information System (eSCMIS) project supports the MOH endorse electronic Logistics Management Information System

(eLMIS) through training of MOH staff on the use of the system as well as deployment and development of the system. The eLMIS system is a foundational component of the country’s supply chain management system and allows health facility level stock visibility.

2. The Breakthrough Action project is a social and behavior change project working to increase the adoption and maintenance of health behaviors. This contributes to the broader goal of improved health and development outcomes, with a focus on behaviors related to HIV, MCH, FP, malaria and nutrition.

3. The USAID Community Health Assistant Support project trains, deploys and strengthens the management systems for community health assistants. Once deployed, these community health assistants work to improve access to quality health services by bringing services closer to beneficiaries.

4. The USAID DISCOVER-HEALTH project provides a variety of health services through newly constructed health posts and existing MOH facilities. These services include HIV counseling, testing and treatment, PreP, and VMMC in addition to MCH and FP services.

Newly constructed facilities are placed in areas with the greatest unmet need for services and target traditionally underserved populations.

5. The USAID Eradicate TB project supports the National TB Control Program to control

TB in Zambia by working at the community, national and provincial levels to strengthen

TB case finding, laboratory strengthening, and managing drug resistant TB.

6. The USAID Global Health Supply Chain – Procurement and Supply Management

(GHSC-PSM) project supports Zambia’s commodity distribution systems by providing technical assistance to improve inventory management, procures commodities for HIV, TB, MCH, FP and Malaria programs, and provides distribution and warehousing support.

This support is focused on the national and provincial levels.

7. USAID Supporting an AIDS Free Era (SAFE) provides comprehensive HIV treatment and prevention services in Copperbelt, Central and Northwestern provinces. MECH will provide the same services as SAFE in Luapula, Northern and Muchinga.

C.5 OBJECTIVES

USAID has identified nine objectives that must be met for the Activity to achieve the success mentioned above.

1. Ensure access to comprehensive HIV prevention interventions

2. Initiate 95 percent of those who tested positive on ART

3. Ensure that 95 percent of those on ART are virally suppressed

4. Reach 90 percent of eligible HIV positive adults and children with NACS and integrated voluntary family planning services in 95% HIV service delivery points.

5. Provide cervical cancer screening services for WLHIV at HIV service delivery locations

6. Provide tuberculosis preventive treatment

7. Strengthen M&E capacity at the facility, district and provincial levels for improved program management

8. Strengthen facility level commodity management to mitigate the risk of stock outs

9. Strengthen the public financial management systems of the Ministry of Health and

Ministry of Finance to enable the efficient use of direct G2G funds from USAID

C.6 GEOGRAPHIC SCOPE

Throughout the life of the activity, USAID may direct the MECH contractor to adjust targeted districts and facilities within the following three provinces: Luapula, Muchinga and Northern.

The level of effort for each district within these provinces will be determined by their priority classification. Priority classification ranking is determined by USAID/Zambia in coordination with the Office of the Global AIDS Coordinator (OGAC) based on epidemiologic data and the potential to curb the HIV epidemic. District classification definitions (scale-up, sustained, centrally supported, and attained), and district assignments are provided in Table 1 below.

Throughout the life of the activity, USAID may direct the MECH contractor to adjust its level of effort in targeted districts in other provinces other than the 3 mentioned depending on changing epidemiological factors.

Table 1: PEPFAR District Classification:

District Classification, definitions (scale-up, sustained, centrally supported, and attained), and district assignments

Province District Classification

Luapula Province Chembe District 2 - Scale-up: Aggressive

Luapula Province Chienge District 1 - Scale-up: Saturation

Luapula Province Chifunabuli District 7 - Attained

Luapula Province Kawambwa District 1 - Scale-up: Saturation

Luapula Province Lunga District 4 - Sustained

Luapula Province Mansa District 7 - Attained

Luapula Province Milenge District 5 - Centrally Supported

Luapula Province Mwansabombwe District 1 - Scale-up: Saturation

Luapula Province Mwense District 1 - Scale-up: Saturation

Luapula Province Nchelenge District 1 - Scale-up: Saturation

Luapula Province Samfya District 7 - Attained

Muchinga Province Chama District 1 - Scale-up: Saturation

Muchinga Province Chinsali District 7 - Attained

Muchinga Province Isoka District 1 - Scale-up: Saturation

District Classification, definitions (scale-up, sustained, centrally supported, and attained), and district assignments

Province District Classification

Muchinga Province Kanchibiya District 1 - Scale-up: Saturation

Muchinga Province Mafinga District 1 - Scale-up: Saturation

Muchinga Province Mpika District 1 - Scale-up: Saturation

Muchinga Province Nakonde District 1 - Scale-up: Saturation

Muchinga Province Shiwang'andu District 2 - Scale-up: Aggressive

Northern Province Chilubi District 5 - Centrally Supported

Luapula Province Chipili District 4 - Sustained

Northern Province Kaputa District 1 - Scale-up: Saturation

Northern Province Kasama District 7 - Attained

Northern Province Lunte District 7 - Attained

Northern Province Lupososhi District 1 - Scale-up: Saturation

Northern Province Luwingu District 1 - Scale-up: Saturation

Northern Province Mbala District 1 - Scale-up: Saturation

Northern Province Mporokoso District 7 - Attained

Northern Province Mpulungu District 7 - Attained

Northern Province Mungwi District 2 - Scale-up: Aggressive

Northern Province Nsama District 4 - Sustained

Northern Province Senga District 1 - Scale-up: Saturation

Definitions

Centrally Supported Do Nothing at facility level. Contractor work will through the district to achieve targets

Sustained ART coverage at 50-70%. Sustain the efforts in place to reach 95%

Scale-up: Aggressive ART coverage at 71-85%-Aggressive Approach needed to bring distict to

Saturation

Scale-up: Saturation Above 86%. Efforts directed towards achieving 95% for both age and sex

Attained Every age and sex is above 95%. Efforts directed at maintaining treatment for all

C.7 TECHNICAL FOCUS/GENERAL REQUIREMENTS

Contractor must respond to the specific technical areas listed below and must be consistent with the technical approaches and best practices identified in the most recent PEPFAR COP guidance.

C.7.1 Ensure access to comprehensive HIV prevention interventions

C.7.1.1 Ensure that 95 percent of HIV positive individuals know their HIV status;

C.7.1.2 Provide voluntary medical male circumcision (VMMC);

C.7.1.3 Provide pre-exposure prophylaxis to priority populations to avert new infections;

C.7.1.4 Eliminate mother-to-child transmission of HIV.

C.7.2 Initiate 95 percent of those who tested positive on ART

C.7.3 Ensure that 95 percent of those on ART are virally suppressed

C.7.4 Reach 90 percent of eligible HIV positive adults and children with NACS and integrate voluntary family planning services in 95% HIV Service delivery points

C.7.5 Provide cervical cancer screening services for WLHIV at HIV service delivery locations

C.7.6 Provide tuberculosis preventive treatment

C.7.7 Strengthen M&E capacity at the facility, district and provincial levels for improved program management to achieve the overall objective of 95-95-95

A sound monitoring and evaluation system is integral to the successful implantation of the tasks outlined. MECH’s monitoring and evaluation system will generate data that meets USAID’s data quality standards: validity, reliability, integrity, precision and timeliness. Data for indicators used for performance monitoring should be available at useful frequency, be current and be timely enough to influence management decision-making.

Ensuring that patient files are up-to-date and easily accessible is critical for both patient management and reporting results. MECH must ensure that supported facilities have adequate staff, training and infrastructure to routinely use both SmartCare, the eLMIS system and general

HMIS.

The ability to continuously generate data that details progress towards objectives is critical as it identifies areas that may need remedial action. MECH must:

● Conduct tailored assessments in order to understand the needs of partner communities and districts. This informs the development of appropriate implementation strategies

● Collect and submit monitoring, evaluation and reporting (MER) PEPFAR indicators for quarterly and annual performance reports using the prescribed systems (e.g. DATIM)

● Ensure that all MOH reports (HMIS and program) — are completed and sent on time

● Conduct customized data analysis in response to specific needs and requests

● Ensuring ALL (100%) of ART clients have active Smartcare files that are utilized for clinical care, date reporting and patient movement tracking

● Routinely monitor indicator trends and patterns through systematic analysis of data and implement adaptive management

C.7.8 Strengthen facility level commodity management to mitigate the risk of stock outs

Finding, initiating and retaining PLHIV on ART requires consistent access to ARVs and other commodities critical for providing comprehensive HIV services. MECH must ensure that at the facility level there are systems in place to efficiently and effectively manage HIV commodities and that staff are appropriately trained on these systems. MECH will not be responsible for supporting an electronic logistics management system as they will be the responsibility of a separate contractor.

C.7.9 Strengthen the public financial management systems of the Ministry of

Health and Ministry of Finance to enable the efficient use of direct G2G funds from

USAID

As part of USAID’s commitment to Zambia’s journey to self-reliance, USAID anticipates increasing funding directly from USAID to the Government of Zambia through the Ministry of

Health, using the direct G2G mechanisms. The purpose of G2G funding is to utilize host country government systems to address the HIV epidemic while strengthening local systems and increasing country ownership.

MECH will support this transition by building the public financial management capacity of SNUs where MECH operates. MECH must work with USAID to identify capacity building needs through review of existing Public Financial Management Risk Assessment Frameworks, Risk

Mitigation Plans, and routine update assessments.

Under this arrangement, the MECH contractor will support the MoH to gradually take up more direct services provision, and they (contractor) will implement specific activities defined in this

SOW to increase access to and utilization of HIV prevention and treatment services and provide technical assistance to strengthen the services provided by the GRZ.

Expected outcomes are:

● Improved budgetary systems (including the use of electronic financial systems) of the

Ministry of Finance (MOF) and MOH; and

● Improved procurement operations, including but not limited to, procurement planning, contract administration, and supplier management, of the MOF and MOH.

C.8 Indicators

Required indicators for each objective are listed below. Where required indicators are not currently available, illustrative indicators are listed. Full definitions for all PEPFAR indicators can be found in the most recent Monitoring, Evaluation and Reporting (MER) guidance from OGAC. Annual targets will be established during the PEPFAR Country Operational Plan development process and shared with the contractor on/about June 1st prior to the implementation period for a given fiscal year beginning on October 1. Targets for the geographic regions for MECH for the current Fiscal Year (FY 2020) have been included to provide context. MECH will not be expected to achieve FY2020 targets.

C.8.1 Objective 1: Ensure access to comprehensive HIV prevention interventions

Indicator Code

PEPFAR Indicator Code

Indicator Name FY20 Year 1 LOP Additional Indicator Information

Data source Data Collection Frequency

USAID Reporting Frequency

DATIM

Reporting Frequency

1.1 HTS_TST Number of individuals who received

HIV Testing Services (HTS) and received their test results, disaggregated by HIV result

201,928 TBD TBD See MER guidance for additional information.

HTS register, integrated/ or eMTCT register, SmartCare

Daily/Weekly/

Monthly

Weekly/Monthly Quarterly

1.2 HTS_INDEX Number of individuals who were

identified and tested using Index testing services and received their results

18,408 TBD TBD See MER guidance for additional information.

HTS Register Daily/Weekly/ Monthly

Weekly/Monthly Quarterly

1.3 HTS_TST_POS Number of individuals who received

HTS, received their results and tested positive

8,346 TBD TBD See MER guidance for additional information.

HTS Register Daily/Weekly/

Monthly

Weekly/Monthly Quarterly

1.4 HTS_RECENT Percentage of persons aged ≥15 years

newly diagnosed with HIV-1 infection who have a test for recent infection result of ‘recent infection’ during the reporting period

7,344 TBD TBD See MER guidance for additional information.

HTS Register Daily/Weekly/ Monthly

Weekly/Monthly Quarterly

1.5 HTS_SELF Number of individual HIV self-test kits

distributed

40,200 TBD TBD See MER guidance for additional information.

HTS Register Daily/Weekly/ Monthly

Weekly/Monthly Quarterly

1.6 VMMC_CIRC Number of males circumcised as part

of the voluntary medical male circumcision (VMMC) for HIV prevention program within the reporting period

55,919 TBD TBD See MER guidance for age disaggregation, circumcision technique and additional information.

Facility registers, patient files

Daily/Weekly/ Monthly

Weekly/Monthly Quarterly

Code

PEPFAR Indicator Code

Indicator Name FY20 Year 1 LOP Additional Indicator Information

Data source Data Collection Frequency

USAID Reporting Frequency

DATIM

Reporting Frequency

1.7 PREP_NEW Number of individuals who were newly

enrolled on oral antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period

699 TBD TBD See MER guidance for additional information.

Facility registers, patient files

Daily/Weekly/

Monthly

Weekly/Monthly Quarterly

1.8 PMTCT_STAT Percentage of pregnant women with

known HIV status at antenatal care

(includes those who already knew their HIV status prior to ANC), disaggregated by HIV result

58,343 TBD 95% Numerator:

Number of pregnant women with known HIV status at antenatal care (includes those who already knew their HIV status prior to

ANC).

eMTCT register, SmartCare

Daily/Weekly/ Monthly

Weekly/Monthly Quarterly

1.9 PMTCT_EID Number of infants born to HIV-

positive women who had a virologic

HIV test done within 12 months of birth

5,884 TBD 95% of infants born to

HIV-

positive women with a virologic

HIV test done within 12 months of birth

Numerator:

Number of infants who had a virologic HIV test within 12 months of birth during the reporting period.

Facility registers, patient files

Daily/Weekly/ Monthly

C.8.2 - Objective 2: Initiate 95 percent of those who tested positive on ART

PEPFAR Indicator Code

Indicator Name FY20 Year 1 LOP Additional Indicator Information

Data source Data Collection Frequency

USAID Reporting Frequency

DATIM

Reporting Frequency

2.1 TX_NEW Number of adults and children newly

enrolled on antiretroviral therapy

(ART)

8,346

TBD Number of adults and children newly enrolled on antiretroviral therapy (ART).

See MER guidance for additional information.

Facility ART registers, patient files or other databases

Daily/Weekly/M onthly

Weekly/Monthly Quarterly

2.2 TX_CURR Number of adults and children

currently receiving antiretroviral therapy (ART)

112,383

TBD 95% of PLHIV in geograp hic focus region

Number of adults and children currently receiving antiretroviral therapy (ART).

See MER guidance for additional information.

Daily/Weekly/M onthly

C.8.3 - Objective 3: Ensure that 95 percent of those on ART are virally suppressed

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information Data source

Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

3.1 TX_PVLS Percentage of ART patients with a viral load

result documented in the medical record and/or laboratory information systems (LIS) within the past 12 months with a suppressed viral load

D:

116,472

N: TBD

D: TBD

95% Numerator: Number of ART patients with suppressed VL results (<1,000 copies/ml) documented in the medical or laboratory records/LIS within the past 12 months

Denominator: Number of ART patients with a VL result documented in the medical or laboratory records/LIS within the past 12 months

See MER guidance for additional information.

Patient files, facility register s

Monthly Monthly Quarterly

C.8.4 Integrate voluntary family planning services into 95 percent of HIV service delivery locations

PEPFAR

Indicator

Code

Indicator Name FY20 Year 1 End of

Contract

Additional

Indicator

Information

Data source Data Collection

Frequency

USAID Reporting

Frequency

DATIM

Reporting

Frequency

4.1 FPINT_SITE Number of HIV service delivery points (SDP) at a site supported by PEPFAR that are providing integrated voluntary family planning (FP) services.

95% 95% 100% Number of facilities providing integrated FP services.

Program records

Quarterly Annually Annually

4.2 CUSTOM Number of new family planning users identified

at HIV service delivery points (ART clinics, ART corners, etc.) within sites supported by PEPFAR

N/A TBD TBD Disaggregation by: age-bands, method type and whether facility or outreach delivery mode required

Facility registers

Quarterly Annually N/A

C8.5 Provide cervical cancer screening services for WLHIV at HIV service delivery locations

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

5.1 CXCA_SC

RN

Percentage of HIV-positive women on

ART screened for cervical cancer

10,523 TBD TBD Patient files, facility registers

Monthly Monthly Quarterly

5.2 CXCA_TX

Percentage of cervical cancer screen-positive women who are HIV-positive and on ART eligible for cryotherapy, thermocoagulation or LEEP who received cryotherapy, thermocoagulation or LEEP

All screened positive

All screened positive

All screened positive

C.8.6 Provide tuberculosis preventive treatment

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of

Contract

Additional Indicator

Information

Data source Data

Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

6.1 TB_STAT Percentage of new and

relapse TB cases with documented HIV status, disaggregated by HIV result

95% 100% 100% Numerator: Number of new and relapse TB cases with documented HIV status, during the reporting period.

Denominator: Total number of new and relapsed TB cases, during the reporting period.

See MER guidance for additional information.

Patient files and facility registers

Monthly Semi Annual Semi Annual

Code

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

6.2 TB_PREV The number of ART patients

who completed a standard course of TB preventive therapy within the semiannual reporting period

37,778 TBD TBD See MER guidance Facility registers, patient files

Monthly Semi Annual Semi Annual

6.3 TX_TB Proportion of ART patients

screened for TB in the semiannual reporting period who start TB treatment.

TBD TBD Numerator

Number of ART patients who were started on TB treatment during the semiannual reporting period.

Denominator

Number of ART patients who were screened for TB at least once during the semiannual reporting period.

Facility registers, patient files

Monthly Semi Annual Semi Annual

C.8.7 Strengthen M&E capacity at the facility, district and provincial levels for improved program management to achieve the overall objective of 95,95,95

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information

Data source Data Collection

Frequency

USAID

Reporting

Frequency

DATIM

Reporting

Frequency

7.1 CUSTOM Percent of TX_CURR

patients reported in SmartCare

95% 98% TBD See MER guidance for age dissagregations, circumcision technique and additional information.

Facility registers, patient files

Monthly Quarterly Quarterly

7.2 CUSTOM Percent of USAID

supported facilities that hold quarterly data review meetings

90% 100% 100% Numerator: Number of USAID supported facilities conducting data review meetings

Denominator: Total number of MECH supported facilities

Minutes, program report

Quarterly Quarterly N/A

7.3 CUSTOM Percent of facility staff

trained in data management

100% 100% 100% Program records

Quarterly Quarterly N/A

C.8.8 Strengthen facility level commodity management to mitigate the risk of stock outs

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

8.1 CUSTOM Percent of facility level

staff trained in stock management

70% 100% 100% Program records Monthly Monthly N/A

8.2 CUSTOM Percent of facilities

reporting stock outs of key HIV commodities

70% >5% 0% eLMIS Monthly Monthly N/A

8.3 CUSTOM Percent of eligible

TX_CURR on 6 month

MMD

70% 85% 100% Facility registers, patient files, pharmacy registers

Weekly Monthly N/A

8.4 CUSTOM Percent of TX_CURR on

TLD

39% 75% 85% If another ARV regimen replaces TLD as the preferred first line option the indicator will be updated to reflect the change.

Facility registers, patient files, pharmacy registers

Weekly Monthly N/A

C.8.9 Strengthen the public financial management systems of the Ministry of Health and Ministry of Finance to enable the efficient use of direct G2G funds from USAID.

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

9.1 CUSTOM Percentage of Provincial

Risk Mitigation Plan Action Items that USAID is responsible for, are addressed within the plan year

N/A 100% TBD Numerator: Number of action items addressed Denominator: Total number of action items identified

Program reports

Monthly Annually N/A

9.2 CUSTOM Percentage of bank

reconciliations with employee signatures indicating bank statements reviewed

N/A 100% 100% Numerator: number of bank statements with employee signatures Denominator:

Number of bank statements

Program reports

Monthly Quarterly N/A

9.3 CUSTOM Percentage of

procurements included in the annual procurement work plan

N/A 100% 100% Numerator: Total procured according to the planned procurement Denominator:

Total planned procurements (The work plan is specific to G2G funds)

Program reports

Monthly Quarterly N/A

9.4 CUSTOM Percentage of MoH

employees receiving the correct DSA amount for trainings and meetings paid for through G2G funds (USAID program specific)

N/A 100% 100% Numerator: Number of MoH staff

Denominator: receiving correct amount of DSA

Number of MoH staff receiving DSA

Program reports

Monthly Quarterly N/A

9.5 CUSTOM Percentage of

equipment purchased using G2G funds, tagged and tracked using MECH system and included in the correct MoH in asset register

N/A 100% 100% Numerator: Number of equipment bought with G2G funds tagged, tracked using

MECH system and asset register

Denominator: Number of all equipment bought with G2G funds

Program reports

Monthly Quarterly N/A

C.9 ADDITIONAL REQUIREMENTS

C.9.1 Coordination with Other Initiatives and Implementing Partners

Contractor must seek opportunities to partner with others working in geographical areas of operation and in the range of services and products supported by the Project. All Project activities support MOH to achieve its health objectives and are closely coordinated through

MOH.

Coordination with the Ministry of Health will happen at the National, Provincial, District and

Site levels. National level coordination will focus on updating technical guidelines and addressing specific bottlenecks in the regulatory and policy environments to allow optimal HIV service delivery at the site level, Provincial level coordination will include regular data meetings to assess progress and identify target areas of focus, District level coordination will also include regular data meetings to assess progress and identify target areas for focus and site level coordination will be the primary level for providing service delivery and technical assistance support.

Contractor must further coordinate with the USAID regional level staff in implementation of programs. MECH is further expected to clearly outline its partnerships with other implementing partners working in Zambia particularly in the regions of interest

C.9.2 Monitoring and Evaluation

As indicated in section C.7.5, MECH’s monitoring and evaluation system must generate data that meets USAID’s data quality standards: validity, reliability, integrity, precision and timeliness.

Data for indicators used for performance monitoring should be available at useful frequency, be current and be timely enough to influence management decision-making. Monitoring and

Evaluation is critical to measuring progress of this contract and all data generated must support program objectives as well as being sharable among key stakeholders in an aggregate form not containing personally identifiable information. All efforts will support building capacity in the health facilities of operation and will connect to other host government efforts and hence promote sustainability.

C.9.3 Gender

Gender refers to the socially constructed roles, behaviors, activities and attributes that a given society considers appropriate for men and women. USAID is committed to promoting gender equality and female empowerment, and seeks to improve the lives of citizens around the world by advancing equality between women and girls and men and boys and empowering women and girls to participate fully in and benefit from securing better lives for themselves, their families and their communities. Desired outcomes are: (i) reduction of gender disparities in access to, control over and benefits from resources, wealth, opportunities, and services – economic, social, political, and cultural; (ii) reduction of gender-based violence and mitigation of its harmful effects on individuals; and (iii) increased capability of women and girls to realize their rights, determine their life outcomes, and influence decision-making in households, communities, and societies.

The incidence and prevalence of HIV is higher among females than males in most settings. From biological, socio-cultural, violence against women, legislature, education, knowledge and skills, economic inclusion, and stigma and discrimination considerations, women and young girls are more predisposed and/or more susceptible to acquisition of HIV than males (UNAIDS, 2002).