72061119R00002 Solicitation_USAID Family Health and Nutrition_Final_04.08.20.pdf

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

Subdivision 694/Stand 100 Ibex Hill Road

PO Box 320373

Lusaka, Zambia – 10101 infozambia@usaid.gov

USAID.gov

April 08, 2020

Subject: Request for Proposals (RFP) Number 72061119R00002

USAID Family Health and Nutrition Activity

Dear Prospective Offerors, The United States Agency for International Development (USAID) Mission to Zambia is seeking proposals to improve the capacity of the public health system to sustainably deliver responsive, quality reproductive, maternal, newborn, child, and adolescent health and nutrition across four provinces of Zambia through the

USAID Family Health and Nutrition Activity as described in the attached Request for Proposals (RFP).

This procurement will be conducted under full and open competition procedures pursuant to Part 15 of the

Federal Acquisition Regulation (FAR), under which any type of organization is eligible to compete.

USAID anticipates the award of a Cost-Plus-Fixed-Fee Completion-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 range in the amount of $25 - $35 million. Although a range is provided, this does not mean that Offerors should necessarily strive to meet the maximum amount estimated. Offerors must propose realistic and reasonable costs for the work described in their proposals. 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.

Action Date Time Submission/Location

Questions Due April 30, 2020 14:00 Lusaka Time oaa-solicit-lusaka@usaid.gov

Proposals Due June 10, 2020 14:00 Lusaka Time

Please refer to Section L for information regarding proposal requirements. Failure to comply with the submission date and time may result in a submission being deemed unacceptable, 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 by which proposals will be evaluated. Oral explanations or instructions given before award of the Contract will not be binding.

All questions related to the RFP must be submitted to oaa-solicit-lusaka@usaid.gov on the date and time indicated below. Unless otherwise notified by an amendment to the RFP, no questions will be accepted after this date.

Offerors are encouraged to read the entire solicitation, which includes all pertinent technical sections and the terms, conditions and instructions required for submitting proposals. Any empty fill-in spaces in Sections B through J will be completed by the Contracting Officer before final award.

mailto:infozambia@usaid.gov mailto:oaa-solicit-lusaka@usaid.gov mailto:oaa-solicit-lusaka@usaid.gov

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

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A

RATED ORDER UNDER DPAS

(15 CFR 700)

RATING

N/A

PAGE OF PAGES

1 148

2. CONTRACT NUMBER 3. SOLICITATION NUMBER

72061119R00002

4. TYPE OF SOLICITATION

SEALED BID (IFB)

X NEGOTIATED (RFP)

5. DATE ISSUED

04/09/2020

6. REQUISITION/PURCHASE NUMBER

REQ-611-20-000022

7. ISSUED BY CODE ZAMBIA 8. ADDRESS OFFER TO (If other than Item 7)

Same as Item 7

USAID Zambia

Subdivision 694/Stand 100 Ibex Hill Road

P. O. Box 320373

Lusaka 10101

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and 1 electronic copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the depository located in Submission Must be in two separate electronic formats (Technical and Cost) until 1400 local time

(Hour)

06/10/2020 (Date)

CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

10. FOR

INFORMATION

CALL:

A. NAME

Shachibonde Kasanda

B. TELEPHONE (NO COLLECT CALLS) C. E-MAIL ADDRESS

oaa-solicit-lusaka@usaid.gov AREA CODE NUMBER EXT.

11. TABLE OF CONTENTS

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM X I CONTRACT CLAUSES 77

X B SUPPLIES OR SERVICES AND PRICES/COSTS 04

X C DESCRIPTION/SPECS./WORK STATEMENT 08 X J LIST OF ATTACHMENTS 98

X D PACKAGING AND MARKING 23

X E INSPECTION AND ACCEPTANCE 26 X

K

REPRESENTATIONS, CERTIFICATIONS AND

OTHER STATEMENTS OF OFFEROR

X F DELIVERIES OR PERFORMANCE 27

X G CONTRACT ADMINISTRATION DATA 41 X L INSTRS., CONDS., AND NOTICES TO OFFEROR

X H SPECIAL CONTRACT REQUIREMENTS 46 X

M EVALUATION FACTORS FOR AWARD 143

OFFER (Must be fully completed by offeror)

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within 30 calendar days from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

AWARD (To be completed by government)

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

10 U.S.C. 2304 (c) ( ) 41 U.S.C. 253 (c) ( )

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTERED BY (If other than Item 7) CODE 25. PAYMENT WILL BE MADE BY CODE

26. NAME OF CONTRACTING OFFICER (Type or print)

Mohib Ahmed

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.2

13. DISCOUNT FOR PROMPT PAYMENT

(See Section I, Clause No. 52.232.8)

10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS (%)

14. ACKNOWLEDGEMENT OF AMENDMENTS

(The offeror acknowledges receipt of amendments to the SOLICITATION for offeror and related documents numbered and dated):

AMENDMENT NO. DATE AMENDMENT NO. DATE

15A. NAME

AND

ADDRESS

OF

OFFEROR

CODE

FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER

(Type or print)

15B. TELEPHONE NUMBER 15C. CHECK IF REMITTANCE ADDRESS

IS DIFFERENT FROM ABOVE - ENTER

SUCH ADDRESS IN SCHEDULE.

17. SIGNATURE 18. OFFER DATE

AREA CODE NUMBER EXT.

04/08/2020 javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','')

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

Travel, Transportation and Per Diem

Equipment and

Supplies

Subcontracts

Other Direct Costs

Indirect Costs

Total Estimated Cost javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','')

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:

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

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% 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:

[To be inserted at the time of Award] javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','')

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

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 75/1000 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.

javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','') http://www.usaid.gov/zambia/cdcs http://www.usaid.gov/zambia/cdcs http://www.usaid.gov/zambia/cdcs

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 USAID-funded activities 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.

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.

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 javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','') 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 Government of the Republic of Zambia to deliver responsive, high-quality reproductive, maternal, newborn, child, and adolescent health and nutrition 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.

C.11 RESULTS FRAMEWORK

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

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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 75/1000 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 MOH capacity to deliver high quality health services reproductive maternal, newborn, child and adolescent health services for health

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

IR.3.2 Accountability mechanisms strengthened

IR2.2 Public financial management of health resources improved

IR.2.3 Health information systems strengthened

IR.1.3 Community health service delivery 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 MOH capacity to deliver high-quality health 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. 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

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 javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','') 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 updated Reaching Every Child (REC) guidelines to strengthen the routine immunization system and ensure districts support health facilities to develop, implement, and monitor javascript:__doPostBack('ctl00$ctl00$body$homebody$RecentDocuments$C$RecentDocumentsControl$RecentDocumentResults$ctl00$DocumentNumberLink','') 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.