Amendment No. 2_72061119R00002 Solicitation_USAID Family Health and Nutrition_03.19.21.pdf

March 19, 2021

Subject: Request for Proposals (RFP) Number 72061119R00002

USAID Family Health and Nutrition (FHN) Activity

Amendment 02

Dear FHN Offerors, The United States Agency for International Development (USAID) Mission to Zambia is amending the subject solicitation to respond to the requirements of the Foreign Assistance Waiver for National Defense Authorization Act (NDAA) Section 889.

Effective August 13, 2020, FAR 4.2102(a)(2) implemented the statutory prohibitions found in the

NDAA 889(a)(1)(B) for contracts that use covered telecommunications equipment or services. On November 19, 2020, the Director of National Intelligence provided a Foreign

Assistance Waiver to the NDAA 889 requirements that applies through September 30, 2022.

To reflect this, USAID/Zambia amends the solicitation to update Section F.2, "Period of

Performance". In addition, to reflect the Foreign Assistance Waiver period through September 30, 2022, USAID/Zambia amends the solicitation to include Clause H.36, “Prohibition on Contracting for Certain Covered Telecommunications and Video Surveillance Services or Equipment (Section

889) (January 2021)” and inserts a corresponding provision in Section L.8 of the solicitation.

USAID/Zambia requests that you review the amended RFP and the referenced changes also highlighted in yellow. If the terms of the amended RFP do not necessitate any changes to your cost and technical proposal, please send confirmation to the email address below. If the amended RFP necessitates changes to your technical or cost proposal, please re-submit your revised proposal, with the changes stemming from this request highlighted in yellow. All changes must be directly attributable to updated clauses from the solicitation.

Responses should be submitted to oaa-solicit-lusaka@usaid.gov, with the email title “FHN

Section 889 Amendment-02” and received no later than March 29, 2021 at 14:00 Lusaka Time.

Failure to comply with the submission date and time may result in a submission being deemed nonresponsive and it will not be considered. 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 revised proposal. Award of a Contract under this RFP is subject to availability of funds and other internal USAID approvals.

Sincerely, Mohib Ahmed

Supervisory Contracting Officer

Director Office of Acquisition and Assistance mailto:oaa-solicit-lusaka@usaid.gov

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE PAGE OF PAGES

2 153

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

03/19/2021

4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

6. ISSUED BY CODE 720611 7. ADMINISTERED BY (If other than Item 6) CODE

USAID/Zambia

Office of Acquisition and Assistance

Subdivision 694/Stand100

Ibex Hill Road, Kabulonga

P O Box 32481

Lusaka 10101

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

9A. AMENDMENT OF SOLICITATION NO.

72061119R00002 x

9B. DATED (SEE ITEM 11)

12/17/2018

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

CODE FACILITY CODE

THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

x The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, xis not extended.

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

Items 8 and 15, and returning 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.

11. ACCOUNTING AND APPROPRIATION DATA (If required)

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

CHECK ONE

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

ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation data, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

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

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

The purpose of this amendment is to respond to the requirements for the Foreign Assistance Waiver fo National

Defense Authorization Act (NDAA) Section 889 on use of covered Telecommunications Equipment. This amendment updates Section F.2 "Period of Performance" and include Section H.37 "Prohibition on Contracting for Certain

Covered Telecommunications and Video Surveillance Services (Section 889) (January 2021)"

All other terms and conditions remain unchanged.

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 .

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

Mohib Ahmed

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

16C. DATE SIGNED

March 19, 2021

Amendment 2 - Solicitation Number 72061119R00002

Family Health and Nutrition Activity

ACRONYM LIST

AMTSL Active Management of the Third Stage of Labor

CBD Community-Based Distributors

CBV Community-Based Volunteer

CDCS Country Development Cooperation Strategy

CHA Community Health Assistant

CHMIS Community Health Management Information System

CoC Continuum of Care

CP Cooperating Partners

DHIS2 District Health Information System 2

DHO District Health Office

ECD Early Childhood Development

EPI Expanded Program for Immunization

EU European Union

FP Family Planning

G2G Government to Government

GRZ Government of the Republic of Zambia

HCC Health Center Committees

HCP Health Care Provider

HSS Health Systems Strengthening

HTS HIV Testing Service

IMNCI Integrated Management of Newborn and Childhood Illness

IR Intermediate Result

KMC Kangaroo Mother Care

LARC Long Acting Reversible Contraceptives

MCDP (1,000) Most Critical Days Program

MCSP Maternal and Child Survival Program

MMR Maternal Mortality Ratio

MOH Ministry of Health

MPDSR Maternal and Perinatal Death Surveillance

MUAC Mid-Upper Arm Circumference

NACS Nutrition Assessments Counseling and Support

NAV Enterprise Resource Planning Software

NFNC National Food and Nutrition Commission

NHC Neighborhood Health Committee

NMR Newborn Mortality Ratio

ORS Oral Rehydration Solution

OVC Orphans and Vulnerable Children

PA Performance Assessment

PEPFAR President’s Emergency Plan for AIDS Relief

PHO Provincial Health Office

PMC Population Media Center javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','')

ACRONYM LIST (continued)

QA/QI Quality Assurance/Quality Improvement

RBF Results Based Financing

REC Reaching Every Child

RH Reproductive Health

RMNCAH&N Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition

SARAI Sexual and Reproductive Health for All Initiative

SBC Social and Behavior Change

SBH Systems for Better Health

Sida Swedish International Development Cooperation Agency

SM360+ Safe Motherhood 360+

SMGL Savings Mothers, Giving Life

SQA Service Quality Assurance

SRH Sexual and Reproductive Health

SUN Scaling Up Nutrition

TA Technical Assistance

TSS Technical Support Supervision javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','')

SECTION B - SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 PURPOSE

The purpose of the USAID/Zambia Family Health and Nutrition Activity is to implement the

Performance Based Work Statement (PBWS) as stated in Section C of this document.

B.2 CONTRACT TYPE AND SERVICES

This is a Cost-Plus-Fixed-Fee (CPFF) completion-type contract consistent with Federal

Acquisition Regulation 16.306(d)(1). The Contractor must provide the outputs and accomplish goals and objectives as described in Section C, and the deliverables as described in Section F in accordance with the performance standards specified in Section E, F and H.

B.3 ESTIMATED COST, FIXED 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 fixed fee, if any, is $TBD. The maximum fixed fee, if any, is $TBD. The estimated cost plus fixed fee, if any, is $TBD.

(b) Budget

The contractor will not be paid any sum in excess of the Total Cost-Plus-Fixed-Fee amount.

(b).1 The contract budget found herein, is based on the Contractor’s original proposal and/or final proposal revision, which was accepted by USAID through award of this contract. NOTE: The contractor will be required to notify the USAID COR of Budget

Line Item variation of 10% and request concurrence.

Line Item

Description

PERIOD

Yr. 1 Yr. 2 Yr. 3 Yr. 4 Yr. 5 Total All Years

Salaries and Wages

Fringe Benefits

Consultants

Travel, Transportation and Per Diem

Equipment and

Supplies

Subcontracts

Other Direct Costs

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Total Estimated Cost

Fixed Fee

Total Estimated

Cost Plus Fixed Fee

Contract Line Item Number Budget

ITEM

NO.

Supplies/Serv ices

(Description)

Qty Unit YR1

Total

Amount

YR2

Total

Amount

YR3

Total

Amount

YR4

Total

Amount

YR5

Total

Amount

All YRS

Total

Amount

CLIN

Service

Delivery

(Direct and

Indirect Costs)

Total Estimated Cost

CLIN

Fixed Fee

Total Cost-Plus Fixed

Fee

The contractor will not be paid any sum in excess ceiling price.

(b).2 The inclusion of any costs in the above cost categories does not obviate the requirement for prior approval by the contracting officer of cost items, any of the terms and conditions of this contract, including the applicable cost principles (see FAR52.216-

07, “Allowable Cost and Payment”); nor does it constitute a determination of allowability by the contracting officer of any item of cost, unless specifically stated elsewhere in this contract.

(b).3 The contractor agrees to furnish data that the contracting officer may request on costs expended or accrued under this contract in support of the budget information provided herein.

(c) Within the estimated cost-plus fixed fee (if any) 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 will not exceed the aforesaid obligated amount.

(d) In accordance with FAR 52.232-19, Availability of Funds, funds obligated hereunder are anticipated to be sufficient through o/a TBD.

B.4 PAYMENT FIXED FEE - FAR 52.216-8 (JUN 2011)

The Government must pay the Contractor for performing this contract the fixed fee specified in Section B.3. The payment of fee will be in accordance with the following fee schedule which is tied to the deliverable schedule as outlined in Section F.5 and provided below:

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The following is an illustrative table which will be filled in at time of award:

% OF FIXED FEE

No Deliverables Yr. 1 Yr. 2 Yr.3 Yr. 4 Yr. 5 TOTAL

All Key Personnel

Furnished 5% 5%

Decrease in % of maternal deaths 1% 1% 1% 1% 1% 5%

Decrease in % of neonatal deaths 1% 1% 1% 1% 1% 5%

5 Annual Work Plan 2% 2% 2% 2% 2% 10%

6 AMELP 1% 1% 1% 1% 1% 5%

Sustainability

Framework 6% 4% 4% 4% 4% 22%

Annual Planning Cycle

(MTEF) engagement, coordination and planning report

4% 4% 4% 4% 4% 20%

Quality Assurance

Surveillance Plan (QASP) 4% 4%

Periodic Progress Reports

Annual Progress

Reports 2% 2% 2% 2% 2% 10%

Other Reports

19 Final Activity Report 14% 14%

Total Fixed FEE 100%

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:

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[To be inserted at the time of Award]

Contractor Fringe

Rate %

Overhead

Rate %

G&A

Rate

PRIME (insert)

Type of Rate (insert) TBD TBD TBD

Base of Application (insert) TBD TBD TBD

Source: (insert) TBD TBD TBD

Period: (insert) TBD TBD TBD

MAJOR SUBCONTRACTOR(S)

(insert)

Type of Rate TBD TBD TBD

Base of Application (insert) TBD TBD TBD

Source: (insert) TBD TBD TBD

Period: (insert) TBD TBD TBD

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

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), FAR 52.216-8 (Fixed Fee) if applicable, and AIDAR 752.7003 (Documentation for Payment), may be reimbursable under this

[END OF SECTION B]

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SECTION C – DESCRIPTION/SPECIFICATIONS/PERFORMANCE BASED

WORK STATEMENT

C.1 ACTIVITY TITLE

The activity title is USAID Family Health and Nutrition.

C.2 OVERVIEW

The USAID Family Health and Nutrition activity will provide complementary technical assistance to a basket fund (“Sida Grant”) supported by USAID and the Swedish International

Development Cooperation Agency. The goal of this new activity is to strengthen the capacity of the Zambian public health system to sustainably deliver reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH&N) services through improved service-delivery capacity, strengthened health management and financial systems, and improved engagement of communities in health. The Family Health and Nutrition Activity will work in tandem with the Sida Grant to strengthen health services through the Government of the

Republic of Zambia (GRZ) led RMNCAH&N Continuum of Care Program (hereafter referred to as the RMNCAH&N Program).

The core focus of this activity is to build the capacity of the GRZ, communities, and local partners to implement high-quality, accessible health care. In addition to improving high-quality health care service delivery, the activity will strengthen the self-sufficiency of the health system through building improved public financial management, health management information systems, performance management, and community engagement for better accountability.

USAID is building resilience and advancing Zambia on the path to self-reliance by strengthening not just the ability to provide health care but improving the capacity of the health system to plan strategically through analyzing data to identify gaps, planning priority activities, and budgeting appropriately and efficiently.

C.3 SUCCESS

Zambia has achieved significant advances in the past decade in improving overall health status and in protecting vulnerable groups. Zambia’s recently released 2018 Demographic and Health

Survey Key Indicators Report shows the rates of infant, child, and maternal mortality have all been reduced to less than 40 percent of what they were in 2002, yet remain unacceptably high, and reflect challenges in the overall health sector.

Successful implementation will result in a strengthened Zambian public health system that is better able to deliver quality reproductive, maternal, newborn, child, and adolescent health and nutrition services in select provinces. This success will be measured by contribution to reduction of the Maternal Mortality Ratio from 252/100,000 to 100/100,000 live births and under five mortality rates from 61/1000 to 35/1000 over the life of the program in line with the

Zambia National Health Strategic Plan 2017-2021: ()http://dspace.unza.zm/handle/123456789/5113) javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','') http://dspace.unza.zm/handle/123456789/5113

C.4 LINK TO COUNTRY DEVELOPMENT COOPERATION STRATEGY

(CDCS)

USAID/Zambia’s new 2019-2024 Country Development Cooperation Strategy (CDCS) partners with the Zambian government, civil society and the private sector to advance the country’s self-reliance through more effective development choices and governance, enterprise-driven economic growth, and increased resilience among its vulnerable citizens. Over the last

34 years, USAID has supported and implemented programs that target economic growth, health, education, democracy and governance, and humanitarian assistance. The Family Health and Nutrition activity will contribute to the Development Objective 3, Capacity of Zambia’s

Government, citizens and the private sector increased to improve health outcomes and meet critical needs of vulnerable populations, Sub-Intermediate Result (IR) 3.1 Utilization of quality health, water, and sanitation services and prevention practices increased, IR 3.2 Health, water, and sanitation systems' effectiveness, capacity and sustainability strengthened, and IR 3.3

Capacity to protect vulnerable populations enhanced. The CDCS is available at https: //www.usaid.gov/zambia/cdcs.

C.5 KEY STAKEHOLDERS

Key stakeholders and partners in implementation of the RMNCAH&N Program, Sida Grant, and the USAID Family Health Nutrition Activity include government structures and community organizations and members. Implementation of the Family Health and Nutrition activity and the

Sida Grant in support of the GRZ RMNCAH&N Program requires close coordination and collaboration with key stakeholders. The following table lists key stakeholders and their respective roles and responsibilities in relation to the RMNCAH&N program:

Stakeholders Role

Ministry of Health

(MOH)

Implements the RMNCAH&N Program and executes the

Sida Grant; planning, implementation, and monitoring and evaluation of activities at national (central), provincial and district levels; as well as provision of technical and supervisory assistance across all levels.

Swedish Development

Cooperation Agency

(Sida)

Swedish Government’s aid agency. Oversees the Sida

Grant that currently supports the RMNCAH&N Program in Luapula, Muchinga, Eastern, and Southern provinces.

Sida, through the Embassy of Sweden in Zambia, manages disbursement of funds to the MOH based on milestones achieved at all levels of the RMNCAH&N program. USAID also provides financial support through the Sida Grant.

Department for

International

Development (DfID)

UK Government’s aid agency. Previously supported the

RMNCAH&N Program in Central and Western

Provinces.

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Clinton Health

Access Initiative

(CHAI)

Implements results-based financing (RBF) component of the current RMNCAH&N Program. Verifies results and provides feedback and recommendations on indicator performance for the districts.

RMNCAH&N Program

Steering Committee/

Interagency

Coordinating

Committee

The Steering Committee coordinates activities across the

RMNCAH&N Program, including the Sida Grant and future

Family Health and Nutrition Activity. Steering Committee

Members are comprised of a cross-section of stakeholders, including government, cooperating partners and implementing partners including non-governmental organizations.

Cooperating partners

Includes donors that provide funding to support

RMNCAH&N through pooled funds and technical assistance activities, and UN agencies engaged in providing technical assistance.

C.6 BACKGROUND

Zambia’s Seventh National Health Strategic Plan (7NDP) highlights that investments in health, water and sanitation are required to build a healthy population and drive socio-economic development. The National Health Strategic Plan 2019-2021 goal guides overall health activities in Zambia to provide equitable access to cost effective, quality health services as close to the community as possible.

RMNCAH&N Program, Sida Grant, and Complementary TA

The GRZ RMNCAH&N Program implements high-impact, evidence-based interventions to improve maternal, neonatal, child, and adolescent health and nutrition, across all provinces in

Zambia. It strengthens health systems at the national and sub-national levels, for effective health care delivery, and provides quality health services as close to the community as possible.

The Swedish Embassy and USAID currently support the RMNCAH&N Program through a grant to the MOH, managed by Sida. Eighty percent of activities are focused at the district level and below, with 20 percent support at the national and provincial levels in the four targeted provinces of Luapula, Muchinga, Eastern, and Southern. A set of commonly agreed upon service delivery indicators measure the Sida Grant program’s progress:

1. Antenatal care before 14 weeks of pregnancy.

2. Births attended by skilled health personnel.

3. Postnatal care within 48 hours of delivery.

4. Children up to 12 months of age receiving the full immunization package.

5. Uptake of modern contraceptive methods.

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USAID also supported implementation of the RMNCAH&N Program through technical assistance (TA) mechanisms including the Maternal and Child Survival Program

(https://www.mcsprogram.org/wp-content/uploads/eop/MCSP-EOP-Report-Combined.pdf) that supported high-quality health care delivery and Systems for Better Health that supported health systems strengthening. This activity also built on the Saving Mothers, Giving Life (SMGL) initiative (https://www.usaidassist.org/resources/saving-mothers-giving-life-final-report) that aligned USAID’s support to the MOH system, enabling more integrated service delivery, and sustainability of the program. USAID places an emphasis on enhancing sustainability and self-reliance through locally-led program implementation, decentralized capacity strengthening, improved mobilization and utilization of domestic resources, and increased private sector investment in health.

C.7 LINK TO OTHER PROGRAMS

The Family Health and Nutrition activities will complement other implementing partners in the targeted provinces, both geographically and technically as appropriate, and draw on lessons from other relevant RMNCAH&N activities. Current USAID-funded activities are described below.

Safe Motherhood 360+ Project (SM360+), 2015-2020

SM360+ is the flagship program for implementation of the SMGL initiative in 16 selected districts. SM360+ ensures that all women, newborns, and children most in need have equitable access to quality health care services that save lives through strengthening community and facility-based interventions. The goal is to reduce the maternal mortality ratio (MMR) and newborn mortality ratio (NMR) by 35 percent each, and the objectives include increasing institutional delivery, improving the quality of health care services, and strengthening service integration.

Sexual and Reproductive health for all Initiative (SARAI), 2015-2020

SARAI is USAID’s family planning project focused on reducing unmet need for family planning in three target provinces: Muchinga, Luapula, and Copperbelt. The goal is to increase the modern

Contraceptive Prevalence Rate (mCPR) by 2 percent annually through increased access to and improved quality of family planning and reproductive health (FP/RH) services. The objectives include: improving FP service delivery, strengthening FP service delivery systems and accountability, and increasing healthy FP/RH practices among women and their partners.

Breakthrough-ACTION, 2018-2020

The Breakthrough ACTION Zambia Project supports increased adoption and maintenance of healthy behaviors among Zambian individuals, families, and communities, with specific focus on

HIV, maternal and child health, family planning, malaria, and nutrition. The project operates at the national level as well as within targeted districts in Luapula, Muchinga, Central, and

Copperbelt provinces. The objectives include: 1) reduce barriers to adoption of priority social and individual behaviors; 2) strengthen functional linkages between health facilities and communities; and 3) improve capacity and commitment of Zambian institutions to fund, coordinate, design, implement, and evaluate effective social and behavior change (SBC) programming at the national and sub-national levels.

javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','') https://www.usaidassist.org/resources/saving-mothers-giving-life-final-report

USAID Community Radio Program, 2018-2021

The USAID Community Radio Program is a three-year project that designs and broadcasts radio serial dramas to support behavior change around key health and social issue areas in five provinces: Luapula, Muchinga, Central, Northern and Western. Using entertainment-education methodology for social behavior change communication (SBCC), the program will produce and broadcast 312 episodes through community and commercial radio stations in Bemba and Lozi languages.

Scaling Up Nutrition Technical Assistance (SUN TA), 2018-2025

The goal of SUN TA is to reduce stunting in 13 selected districts in four provinces (Central, Copperbelt, Luapula and Northern) over seven years through technical assistance. It is an integrated nutrition program which includes the following components: agriculture, water and sanitation, health, FP, early childhood development, and governance. It will be coordinated with a multi-donor SUN 2.0 Program in 17 districts in the remaining six provinces. This is a cross– ministry program that is implemented in accordance with the GRZ’s 1000 Most Critical Days

Program (MCDP) II.

Scaling Up Nutrition Learning and Evaluation (SUN LE), 2018-2025

The SUN LE activity supports learning and evaluation across all 30 SUN 2.0 districts to identify design and test approaches to reduce stunting and will monitor progress of SUN 2.0 interventions. The baseline for SUN districts was conducted in 2019 and that information will help inform nutrition-related interventions in RMNCAH&N Program areas.

USAID Evidence for Health (E4H), 2020-2024

E4H will strengthen the national Health Management Information System (HMIS) (data collection, analysis, and data use) from the national level down to the community. The activity will: 1) strengthen the national HMIS, 2) improve monitoring, evaluation, and research capacities within key government and non-governmental institutions, and 3) expand the evidence base for existing approaches to health programming in malaria, nutrition, family planning, maternal and child health, and HIV.

C.8 GUIDING PRINCIPLES

To improve delivery of RMNCAH&N services it is critical to coordinate across the full spectrum of stakeholders (see C5). This contract will follow these five guiding principles to position it for success:

1. Support a set of strategic priorities that align with the objectives and priorities of the

Seventh National Development Plan, the National Health Strategic Plan, and other relevant MOH and GRZ policies on health and nutrition.

2. Support the institutionalization of performance-based management and reporting through the utilization of Health Management Information System (HMIS) data for performance monitoring and quality improvement at all levels.

3. Place strong emphasis on coordination of efforts and activities across the MOH, CPs, and health implementers for greater efficiency and continuity of investments.

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4. Include national-level strategic support and implementation support at the provincial, district, facility, and community level to capitalize on existing opportunities and ongoing activities of other partners. A minimum of 80 percent of effort and funding of this contract will be focused at the district and community level, with the remaining maximum 20 percent focused at the national and provincial level.

5. Manage adaptively through continuous learning. Adaptation that is informed by knowledge gained through learning and recognize behaviors and incentives necessary to create change. Knowledge gained through learning shall influence decision making, resource allocation, and adaptation to contextual shifts. Application of new knowledge to implementation decisions should be reflected in the Annual Work Plan and Activity

Monitoring, Evaluation, and Learning Plan (AMELP).

C.9 SCOPE

The Family Health and Nutrition Program is expected to provide high-impact TA for the

RMNCAH&N Program in coordination with the Sida Grant. TA is defined as the provision of services that are targeted and action-oriented with a specific goal desired. To be effective this requires: the right entity engaged, appropriate commitment from all stakeholders, availability of resources, and alignment with mutual goals. The TA will be in response to demand-driven requests for assistance and also based on gaps and priorities identified, coupled with limited and targeted piloting of innovative and evidence-based approaches and interventions. This activity will work using a whole-of district approach across four provinces in Zambia (current:

Muchinga, Luapula, Southern, and Eastern) with the potential to increase geographic scope in future years. In addition, the activity will expand mentoring programs to fine tune and institutionalize skills and improve the quality and consistency of health services provided. The

Contractor will utilize adaptive management approaches (see description in Guiding Principles section C.8) to respond to assessments, reports, and implementation findings throughout the course of the award. While this feedback loop and adaptive implementation will take place throughout the implementation process, critical points of learning and reflection should also be utilized to improve overall program performance.

C.10 GOAL AND OBJECTIVES

Goal: The overall goal of the Family Health and Nutrition activity is to contribute to the reduction of Maternal Mortality Ratio from 252/100,000 to 100/100,000 live births and Under

Five Mortality from 61/1,000 to 35/1,000 live births over the life of the program in line with the

National Health Strategic Plan.

Objectives:

1. Improved capacity of the Ministry of Health (MOH) to deliver responsive, high-quality reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH&N) services.

2. Strengthened health systems at national and subnational levels to create an enabling environment for effective RMNCAH&N service delivery.

3. Increased community engagement in health service delivery.

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C.11 RESULTS FRAMEWORK

The following results framework provides an overall description of the goal and objectives of the program.

Goal: To contribute to the reduction of Maternal Mortality Ratio from 252/100,000 to 100/100,000 live births and Under Five Mortality from 61/1000 to 35/1000 over the life of the program in line with the

National Health Strategic Plan.

Objective 2: Strengthened health systems at national and subnational levels

Objective 1: Improved capacity of the MOH to deliver responsive high quality

RMNCAH&N services at Sub-national level

Objective 3: Increased community engagement in health service delivery

IR1.1 Health care provider skills improved

IR.2.1 Evidence-based governance and performance management interventions implemented

IR. 3.1 Community structures and leadership engaged

IR.1.2 Evidence based high impact interventions implemented imimplemented

IR.3.2 Accountability mechanisms strengthened

IR2.2 Public financial management of health resources improved

IR.2.3 Health information systems strengthened javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','')

The Contractor must provide a Theory of Change and clearly outline an approach that will achieve the goal and objectives through the sub-Intermediate Results (IRs), assessing the priority interventions described below. The list of priority interventions is not exhaustive, and other interventions may be proposed as relevant.

The Contractor must propose a comprehensive set of indicators, benchmarks, and targets under each of the objectives (or IR’s, as applicable) below. The indicators must be specific, measurable and achievable within the life of the activity and incorporate current health systems trends and be aligned with national, provincial and district targets.

Objective 1: Improved capacity of the MOH to deliver responsive high-quality

RMNCAH&N services at subnational levels.

IR 1.1 Health care provider skills improved

Priority interventions include TA for capacity building in mentorship, supportive supervision and development of necessary strategies, guidelines and job aids.

IR 1.2 Evidence-based, high-impact interventions implemented

Priority interventions to be implemented by facilities through TA support as needed include long acting reversible contraceptives (LARCs), postpartum family planning, youth-friendly sexual and reproductive health services, FP/HIV integration, early antenatal care registration, promotion of facility deliveries, prophylactic postpartum oxytocin/uterotonics/active management of the third stage of labor (AMTSL), basic and comprehensive emergency obstetric and newborn care, maternal and perinatal death surveillance (MPDSR), newborn resuscitation, kangaroo mother care, early initiation of breastfeeding, promotion of exclusive breastfeeding, integrated management of newborn and childhood illness (IMNCI), combined oral rehydration salts and zinc for childhood diarrhea, antibiotics for pneumonia, vitamin A supplementation, growth monitoring, increasing immunization coverage, early childhood development monitoring.

IR 1.3 Community health service delivery strengthened

Priority interventions to be implemented by facilities include facility and community based distribution of family planning commodities, improvement of community referral system, IMNCI, safe motherhood action groups (SMAGs), improvement of hygiene practices, school sensitization activities, and mobile outreach events.

Objective 2: Strengthened health systems at national and sub-national levels to provide an enabling environment for effective RMNCAH&N service delivery

IR 2.1 Evidence-based governance and performance management interventions implemented

Priority interventions include TA for developing and/or strengthening quality assurance/quality improvement (QA/QI) work plans, strengthening DHO and PHO staff performance management and technical support supervision skills.

IR 2.2. Public financial management of health resources improved javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','')

Priority interventions include key staff trained in prudent public financial management, improving timely execution and reporting of available and expended budget resources, ensuring transactions are conducted in NAV (enterprise resource planning software).

IR 2.3 Health management information systems strengthened

Priority interventions include monthly health facility data review meetings, quarterly district data review meetings, improved quality of data reports (including timeliness and completeness), DHO staff oriented on and utilizing the District Health Information System 2 (DHIS2)

Objective 3: Increased community engagement in health service delivery

IR 3.1 Community structures and leadership engaged

Priority interventions include events conducted by DHOs and health facilities to formally engage community-based organizations and traditional and faith leadership in health, strengthening functionality of Neighborhood Health Committees (NHCs) and Health Center

Committees (HCCs), increasing representation of adolescents, women, and other under-represented groups in NHCs and HCCs

IR 3.2 Accountability mechanisms strengthened

Priority interventions include participation of community-based organizations and/or traditional and faith leadership in quarterly data reviews, formal dissemination of health facility data and results to community members (public dashboards, meetings, etc.), community feedback mechanisms strengthened

C.12 ASSUMPTIONS

USAID/Zambia believes that through this activity the results will be achieved by the end of the five years given the following assumptions:

● GRZ is committed to improving the RMNCAH&N Program and will continue to invest in health, increasing its contributions to the health sector over the next five years. This includes adequately funding essential health commodities, including procurement and distribution, and ensuring sufficient availability of human resources for health.

● Donors continue to support the RMNCAH&N Program.

● The political and economic situation in the country remains stable.

● Community systems and structures continue to be engaged in the delivery of health care

Context monitoring will be used to track factors that trigger changes to the assumptions listed above. Program reviews and/or evaluation studies will test whether assumptions continue to hold and help explain why results are (or are not) being achieved.

C.13 IMPLEMENTATION

The Family Health and Nutrition activity includes the following tasks and related deliverables:

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● Provision of technical assistance, including support for development of GRZ district and provincial health office work plans

● Knowledge management and learning, documentation and dissemination of best practices and lessons learned

● Limited provision of direct implementation

● Performance management

C.13.A. Provide Technical Assistance (TA)

The Contractor will work in partnership with the MOH at multiple levels to ensure the best possible planning and implementation of the RMNCAH&N Program in coordination with the

Sida grant. The Contractor must provide technical assistance to the national, provincial, district, and facility levels in the development of RMNCAH&N Program work plans, identify priorities and best practices and address emerging challenges. In addition, the Contractor will support TA to the RMNCAH&N Program for analysis and dissemination of relevant research results to support evidence-based policy decisions. Family Health and Nutrition should focus on select health outcomes, while working to strengthen the whole continuum of care. All indicator data in this section, unless otherwise indicated, is from the 2018 ZDHS.

1. Health systems strengthening: The TA must include 1) performance management support to improve the utilization of key MOH systems and tools to assess and improve the performance of provinces, districts and facilities. e.g. for the annual planning, budgeting performance assessments and Technical Support Supervision (PA/TSS); 2) public financial management support to promote transparency and accountability in the use of grant funds and implement and maintain the Microsoft Dynamics NAV enterprise resource planning solution; and 3) health information systems support to improve generation and utilization of reliable health management information system (HMIS) data. In addition, the TA should support human resources for health through advocacy for efficient and effective utilization of all health workers, including the Community Health Assistants (CHAs) and provision of capacity development for in service and preservice curriculum development.

2. Community health: Recognizing the importance of both healthy and health-seeking behaviors, the TA must prioritize the following support as a cross-cutting approach to achieving outcomes in all RMNCAH&N priority areas: helping DHOs and health facilities to engage and strengthen community health structures and leadership, including support to and collaboration with HCCs and NHCs to ensure representation of diverse community members; assistance for planning and budgeting community activities; training and mentorship of district, facility, and community actors; support to analyzing and sharing of data for decision-making and accountability; and supporting districts and facilities to expand the reach of the health services and information through community volunteers. In addition, TA must provide support for strengthening accountability mechanisms and community feedback loops for ensuring quality service provision in the facilities.

3. Reproductive Health and Family Planning (RH/FP): Achievements in FP include an increase in the mCPR from 34 percent to 48 percent and a reduction in the unmet need for family planning from 27 percent to 20 percent. The national aim is to increase the mCPR to javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','')

58 percent and reduce unmet need to 14 percent by 2020. Distinct focus should be maintained on the family planning program. The Contractor must ensure that TA staff have expertise to support further expansion and strengthening of the contraceptive method mix at district level. In addition, TA must be provided to the national level MOH for interpretation of new research results to support evidence-based policy decisions. The TA must focus on improving quality service delivery through ongoing training and mentorship for health care providers to offer both short term and long-term contraceptive methods. In addition, TA will support community-based distribution of contraceptives, as appropriate, including a deliberate equitable approach for reaching the poorest and most vulnerable in society.

4. Maternal health: While significant progress has been made in the reduction in maternal morbidity and mortality in the last five years, the trends remain suboptimal. The SMGL initiative supported a reduction in maternal and newborn deaths, 41 and 36 percent respectively, demonstrating how high impact interventions around the 48 hours of labor and delivery contributes to improvements in health outcomes of women and newborns. The focus of the TA must be on improving timely care-seeking and the quality of service provision through supporting high-impact practices identified through the SMGL initiative, (for more information, see link at http://www.savingmothersgivinglife.org/docs/2017-

SMGL-Endline-Census-Final-Report.pdf) tracking of the interventions and indicators in section C.6, and lessons learned from global evidence. TA should build on and expand existing gains made and focus on gaps that remain, e.g. lifesaving skills, Maternal and

Perinatal Death Surveillance Response scale up, and respectful ante-natal and post-natal maternity care.

5. Newborn survival: Perinatal mortality remains a significant challenge country-wide, with fresh and macerated stillbirths continuing to show alarming increasing trends. Similarly, according to the 2018 ZDHS, newborn mortality accounts for a substantial proportion of all infant deaths, with rates of 27/1,000 and 42/1,000 live births respectively. This is an indication of gaps in service delivery during ANC and during labor and delivery periods and of delays in accessing care. The TA must focus on capacity strengthening to ensure staff is equipped with experience and expertise in essential newborn care in both facility and community interventions, e.g. Essential Newborn Care, Helping Babies Breathe. The TA must provide support to the different levels of government in prioritization of activities based on the identification of the causes and persistent gaps, e.g. birth asphyxia and identification of newborn danger signs in the community, in tracking relevant indicators, and, based on this information, contribute to the strengthening of the required interventions.

6. Child Health: Pneumonia and diarrheal disease still remain the highest causes of child morbidity and mortality. The TA must have a comprehensive focus on child health, prioritizing interventions for helping children thrive through prevention and treatment of child illnesses, e.g. IMNCI; the Expanded Program for Immunization (EPI); water, sanitation and hygiene (WASH); and early childhood development (ECD). The focus of the TA must be on improving the quality of service provision through supporting best practices for the management of diarrhea and pneumonia at the lowest levels possible, including at the community level. The TA must provide support to the GRZs rollout and implementation of javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','') updated Reaching Every Child (REC) guidelines to strengthen the routine immunization system and ensure districts support health facilities to develop, implement, and monitor relevant micro plans. In districts where there is overlap with the implementation of Gavi

Vaccine Alliance HSS grants, there should be clear linkages to effectively leverage, collaborate, and complement services.

7. Adolescent health: Adolescent sexual and reproductive health remains a huge challenge, with adolescent pregnancy (age 15-19) currently at 29 percent. 15-19-year-olds have the highest unmet need for FP of any age group in Zambia. They are also the age group least likely to be reached with messages on family planning through radio, TV, print, or interaction with a health care worker, despite having the highest overall media exposure. In addition, 15 to 19-year-olds are twice as likely to be underweight as older women, and about 50 percent more likely to give birth to low birth weight babies. The TA design must address these issues including adolescent nutrition and pregnancy, with guided evidence-based interventions and best practices to improve services for adolescents in line with the

MOH Adolescent Health Strategy. Specific focus must be on capacity strengthening through training and ongoing mentorship at both facility and community levels, engagement of community structures and systems, and linkages to other health services. There is a clear need to provide differentiated, inclusive, non-discriminatory and innovative models of service to better meet the health needs of adolescents including those in vulnerable households.

8. Nutrition: Stunting remains a major challenge with approximately 35 percent of Zambian children identified as stunted in the latest ZDHS Report. The TA should focus nutrition-related activities in non-Scaling Up Nutrition (SUN) Program supported districts. The TA must assess the quality of nutrition-focused interventions and identify gaps and areas for support both at community and facility levels for the management and prevention of chronic malnutrition. If possible, relevant components of the SUN approach could be implemented by TA partners in the RMNCAH&N Program districts. In overlapping SUN and

RMNCAH&N Program districts, Family Health and Nutrition should collaborate with SUN to identify areas where they could provide complementary support to enhance the achievement of results.

C.13. B Develop Sustainability Framework

Expanding capacity of the GRZ to more effectively analyze information, plan, budget, and implement high-quality health services is the foundation of this contract. Development of a sustainability framework for the Family Health and Nutrition activity is a key opportunity for the offeror, USAID, and other cooperating partners and the GRZ to align goals and expectations for this program. The framework must be developed in consultation with the

GRZ and incorporate sustainability in every phase of the project, illustrating key activities under

Family Health and Nutrition and how the Contractor will institutionalize and transfer this capacity, and align with USAID’s journey to…