72061524RFA00004_USAID KEA SBC Activity_FINAL.pdf

Issue Date: Wednesday, April 3, 2024 Deadline for Questions: Wednesday, April 10, 2024 Pre-Application Conference: Monday, April 22, 2024 Closing Date: Friday, May 3, 2024 Closing Time: 12 noon East Africa Time

Subject: Notice of Funding Opportunity (NOFO) Number: 72061524RFA00004

Program Title: USAID Kenya and East Africa (KEA) Social and Behavior Change (SBC) Activity

Federal Assistance Listing Number: 98.001

Ladies/Gentlemen:

The United States Agency for International Development (USAID) is seeking applications for a cooperative agreement from qualified entities to implement the USAID/KEA SBC Activity. Eligibility for this award is restricted to Kenyan organizations.

USAID intends to make an award to the applicant(s) who best meets the objectives of this funding opportunity based on the merit review criteria described in this NOFO, subject to a risk assessment. Eligible parties interested in submitting an application are encouraged to read this NOFO thoroughly to understand the type of program sought, application submission requirements and selection process.

To be eligible for award, the applicant must provide all information as required in this NOFO and meet eligibility standards in Section C of this NOFO. This funding opportunity is posted on www.grants.gov, and may be amended. It is the responsibility of the applicant to regularly check the website to ensure they have the latest information pertaining to this notice of funding opportunity and to ensure that the NOFO has been received from the internet in its entirety. USAID bears no responsibility for data errors resulting from transmission or conversion process. If you have difficulty registering on www.grants.gov or accessing the NOFO, please contact the Grants.gov Helpdesk at 1- 800-518-4726 or via email at support@grants.gov for technical assistance.

USAID may not award to an applicant unless the applicant has complied with all applicable unique entity identifier and System for Award Management (SAM) requirements detailed in Section C.3. The registration process may take many weeks to complete. Therefore, applicants are encouraged to begin registration early in the process.

http://www.grants.gov/ mailto:support@grants.gov

Please send any questions to the point(s) of contact identified in Section D. The deadline for questions is shown above. Responses to questions received prior to the deadline will be furnished to all potential applicants through an amendment to this notice posted to www.grants.gov.

Issuance of this notice of funding opportunity does not constitute an award commitment on the part of the Government nor does it commit the Government to pay for any costs incurred in preparation or submission of comments/suggestions or an application.

Applications are submitted at the risk of the applicant. All preparation and submission costs are at the applicant’s expense.

Thank you for your interest in USAID programs.

Sincerely, Sandra Jansen Agreement Officer

TABLE OF CONTENTS

SECTION A: PROGRAM DESCRIPTION 1

SECTION B: FEDERAL AWARD INFORMATION 15

SECTION C: ELIGIBILITY INFORMATION 19

SECTION D: APPLICATION AND SUBMISSION INFORMATION 21

SECTION E: APPLICATION REVIEW INFORMATION 36

SECTION F: FEDERAL AWARD ADMINISTRATION INFORMATION 38

SECTION G: FEDERAL AWARDING AGENCY CONTACT(S) 44

SECTION H: OTHER INFORMATION 45

ANNEX 1 - SECTION A PROGRAM DESCRIPTION (KISWAHILI) 46

ANNEX 2 - STANDARD PROVISIONS 60

ANNEX 3 - ABBREVIATIONS AND ACRONYMS 62

ANNEX 4 – INITIAL ENVIRONMENTAL EXAMINATION (IEE) 66

SECTION A: PROGRAM DESCRIPTION

This funding opportunity is authorized under the Foreign Assistance Act (FAA) of 1961, as amended. The resulting award will be subject to 2 CFR 200 – Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, and USAID’s supplement, 2 CFR 700, as well as the additional requirements found in Section F.

I. ACTIVITY GOAL

The USAID/KEA SBC Activity (“Activity”) will support individuals (including service providers), households, and communities to adopt and maintain the practice of priority health behaviors by (IR 1) identifying and addressing individual, social, and structural factors that influence priority health behaviors; (IR 2) increasing the availability and use of evidence for design, implementation, monitoring, evaluation, and learning; (IR 3) strengthening Government of Kenya (GOK) systems, structures and policies to improve coordination, collaboration, and learning for SBC interventions; and (IR 4) strengthening the individual, organizational, and systems level technical capacity to design, implement, and monitor SBC interventions.

The Activity will contribute to the achievement of the development objectives outlined in the USAID/Kenya and East Africa (KEA) Country Development Cooperation Strategy (CDCS)1, as well as to the USAID Bureau for Global Health’s strategic priorities of preventing child and maternal deaths; achieving and sustaining epidemic control; and combating infectious diseases2.

II. BACKGROUND AND DEVELOPMENT CHALLENGES

Across health areas, success depends on human behavior. The ability, opportunity, and motivation of individuals (including service/health providers), households and communities to adopt and maintain the practice of priority behaviors is influenced by individual, social, and structural factors. Evidence-based, theory-informed social and behavior change (SBC) interventions increase the ability, opportunity, and motivation of individuals (including health service providers) to adopt and sustain priority behavior by addressing the internal, individual , social, and structural factors that influence those priority behaviors. SBC is defined by the USAID Bureau for Global Health as “a systematic, evidence-driven approach to improve and sustain changes in behaviors, norms, and the enabling environment. SBC interventions address the individual, social, and structural factors3 that influences the practice of target behaviors. SBC is grounded in several disciplines, including systems thinking, strategic communication, marketing, psychology, anthropology, and behavioral economics”.

https://www.usaid.gov/kenya/cdcs https://www.usaid.gov/global-health https://thinkbigonline.org/action/document/download?document_id=416 https://www.usaid.gov/kenya/cdcs https://www.usaid.gov/global-health https://www.usaid.gov/global-health https://thinkbigonline.org/action/document/download?document_id=416 https://thinkbigonline.org/action/document/download?document_id=416

A. Health Sector Challenges

Malaria

Kenya is moving towards achieving the 2023 Malaria target of increasing utilization of appropriate malaria interventions to at least 80 percent. However, there are opportunities to address further the barriers to the increased utilization of appropriate malaria interventions using SBC. Some of the most important human behaviors associated with malaria control and elimination include use of an insecticide treated net (ITN), care-seeking for fever, attendance at antenatal care (ANC) clinics, use of intermittent preventive treatment of malaria in pregnancy (IPTp), and adherence to national guidelines. The prevalence of these behaviors among priority populations varies, as do the individual, social, and structural factors that influence these behaviors. In 2022, U.S.

President’s Malaria Initiative (PMI) Kenya supported the implementation of the Malaria Behavior Survey (MBS)4 to better understand the prevalence of these behaviors and the factors that influence the practice of these behaviors. According to the MBS, specific to ITN use, almost one third (31%) of available ITNs in the household were not used the night preceding the survey, and only 80 percent of individuals in households with sufficient access to ITNs (one ITN per two members) used them. Specific to care-seeking for fever, according to the MBS, among caregivers, 33 percent reported that a child under age five had a fever in the two weeks preceding the survey and 50 percent of children under age five with fever reportedly received both prompt and appropriate care. Specific to ANC attendance and IPTp uptake, according to the MBS, among women with a live birth in the two years preceding the survey, 82 percent reported attending at least four ANC visits and 13 percent at least eight ANC visits. Among these women, IPTp use ranged from 87 percent for the first dose to 48 percent for the third dose.

Family Planning and Reproductive Health

Modern Contraceptive Prevalence Rate (mCPR) in Kenya has steadily increased from 39 percent in 2008-09 to 57 percent in 2022. However, Unmet Need for modern contraceptives and teenage pregnancy rates remain high at 14 percent and 15 percent, respectively, with marked geographical variations. Though nearly all women and men (99%) report knowledge about modern contraceptive methods, this has not translated into high contraceptive prevalence rates, especially among youth and marginalized populations, as persistent gaps remain in individual self-efficacy and positive social norms to use family planning (FP), negotiate safe sex, and reduce intimate partner violence. Utilization of family planning and reproductive health services is influenced by a range of issues including social-cultural beliefs and practices, gender norms (including intra household decision making), knowledge and attitudes, and access to services.

Supply-side interventions are not sufficient alone to fully improve Kenyan sexual and https://malariabehaviorsurvey.org/ reproductive health at an individual or population level. Improving family planning and reproductive health in Kenya requires consistent SBC interventions/strategies that help address gender inequality, harmful gender norms, intimate partner and gender-based violence, and create a supportive enabling environment for family planning and reproductive health promotion, demand and utilization.

Maternal, Newborn and Child Health

Kenya has made significant strides in maternal, newborn and child health (MNCH) indicators. The Kenya demographic health survey (KDHS 2020) showed a significant increase in live births assisted by skilled providers, from 41 percent in 2003 to 89 percent in 2022, vaccination coverage rate for basic antigens gradually increased from 77 percent in 2008/2009 to 80 percent in 2022, stunting levels decreased from 26 percent to 18 percent between 2014 and 2022. Under-5 mortality also declined from 115 deaths per 1,000 live births in 2003 to 41 deaths per 1,000 live births in 2022. However, there are vast disparities, pointing to inequalities attributed to financial, geographical, educational, and social-cultural factors. The maternal mortality ratio and neonatal mortality rates have also stagnated. Disrespectful care and delay in accessing care is a major contributor to MNCH morbidity and mortality. The World Health Organization (WHO) identifies gender as a key parameter of health. Gender inequalities often result in health risks for women and girls, and addressing these inequalities leads to a better understanding on how unequal power relations contribute to poor health-seeking behaviors and negative health outcomes.

Traditional cultural norms limit children, women, and girls’ access to service delivery. A gender analysis report by the USAID Afya Halisi (Real Health) Activity revealed the perception that men had some level of control over their wives’ bodies especially when bride wealth had been paid. The implication was that women were not expected to complain—even when unwell. They were expected to make extra efforts to serve in the home and to always fulfill their duties as wives and mothers. Women’s limited decision and controlled access to resources contribute to their inability to access services for themselves and their children. There is a need to engage men and women and identify ways to increase women’s influence over decision making concerning their health. Early sexual debut amongst adolescents and youth increases the risk of sexually transmitted infections and early pregnancy, which is associated with school dropout and decreased access to economic opportunities and resources. Adolescent pregnancy increases the risk of maternal mortality and morbidities including complications of unsafe abortion, prolonged labor, delivery, and postnatal period (maternal and infant nutrition).

With regards to under five mortality, pneumonia accounts for 16 percent of all child deaths and is the second biggest killer of children under five years. Healthcare-seeking levels for acute respiratory infections is at 67 percent in Kenya, which is below the recommended 90 percent global coverage. There are various factors that affect health seeking behavior including availability and access of information and services, socio-cultural beliefs, amongst others. With regards to childhood immunization, demand side barriers to immunization include parents' lack of knowledge about childhood vaccinations, fears about vaccine safety, vaccine hesitancy, and lack of transportation. Caregivers may not be aware of the threat of vaccine-preventable illness or that safe and effective vaccines are available against these diseases.

With regards to sepsis, Neonatal healthcare-associated infections (HAI) are associated with increased morbidity, mortality, long hospital stay, and costs. When resources are limited, addressing HAI through infection prevention and control (IPC) requires prioritizing interventions to maximize impact. According to Kenya National Infection Prevention and Control Policy for Health Care Services (2021), functional IPC committees and quality/ Work Improvement Teams at facility level need behavioral change approach targeting HCWs to continuously improve maternal, neonatal and child health outcomes.

Water Sanitation and Hygiene (WASH) and Menstrual Hygiene Management

(MHM)

Kenya has seen improvements in its WASH access rates over recent years, with water services growing at a faster pace than sanitation. According to 2019 data from the Kenya National Bureau of Statistics (KNBS), national rates of open defecation declined from

13.6 percent in 2009 to 7.4 percent in 2019, while the rates of surface water as a drinking source declined from 26.7 percent in 2009 to 24.1 percent in 2019 (KNBS, 2009 and 2019). The 2020 UNICEF and WHO Joint Monitoring Programme (JMP) reports that 61 percent of Kenyans now have access to basic water services, 32 percent have access to sanitation services and 26 percent have access to basic hygiene services. There is evident inequality between rural and urban populations that is further exacerbated by gender inequality. Women of reproductive age, (from 15 to 49 years-of age) have an additional potential vulnerability as they must manage menstrual periods, and therefore have specific WASH needs. In many social and cultural contexts menstruation is associated with stress, shame and embarrassment, and with taboos that negatively impact and reinforce gender inequities and social exclusion. Every month, women and girls require access to menstrual materials to manage bleeding, private facilities to change menstrual materials, bathing facilities, clean water, toilet paper and/or soap and water to wash and dry themselves, and soak, wash, dry and/or dispose of used materials.

The divide in access between urban and rural areas is especially stark in the area of sanitation. In urban areas, 57 percent and 29 percent of Kenyans have access to safely managed water services and basic water services, respectively, and 51 percent of Kenyans in rural areas have at least basic access to water services. The access rate to at least basic sanitation services is 35 percent in urban areas, and in rural areas, the access rate is a meager two percent (2%). The JMP data do not include informal settlements.

HIV

On a national level, Kenya is moving closer to achieving the 2030 UNAIDS 95-95-95 targets. However, inequities among the various populations persist. For example, among children living with HIV (CLHIV), it is estimated that 74 percent know their status of which only 74 percent are on treatment with viral suppression at 64 percent. High Interruptions in treatment (IIT) and sub-optimal viral suppression among certain segments and in certain counties suggest adherence challenges. In particular, rates of IIT are almost twice as high among adolescents and young people (AYP) as among the generation population. The rate of IIT is highest among men 20-39 years old (Source: President’s Emergency Plan for AIDS Relief (PEPFAR) data). Closing these gaps and inequities will require targeted SBC and innovative applied behavioral science interventions to “move the needle” toward epidemic control and to complement structural interventions such as differentiated service delivery. As one of the first twelve countries to join the Global Alliance to End AIDS in Children by 2030, Kenya has developed a country road map to focus interventions on pregnant and lactating women (PLW), children, and adolescents.

Despite an overall reduction in new HIV infections in Kenya, the country continues to have high rates of HIV incidence among some populations and in some geographical regions. The most affected populations include Female Sex Workers (FSWs) with a prevalence estimated at 27 percent and Men who have Sex with Men (MSM) with a prevalence estimated at 28 percent. These key populations face stigma and experience gender-based violence. An analysis of the distribution of new infections showed that most new infections in 2021 were among women compared to men.

Tuberculosis

Kenya has made significant progress in reducing the incidence of tuberculosis (TB) by steadily increasing the number of cases detected and reducing TB over the years.

Despite these achievements, the country has not managed to diagnose all people with TB; 32 percent of incident TB cases were missed in 2022. This gap is even bigger among key and vulnerable populations including People living with HIV, children below 15 years and those with Drug Resistant TB. The treatment coverage gap also remains high with only half of those eligible for treatment reached in 2022. According to the prevalence survey of 2016, the majority of people affected by TB included men of the productive age;

25-34 years and women aged above 65 years. Other vulnerable groups for TB include health care workers and people in congregate settings like prisoners and refugees. SBC strategies for TB will promote appropriate health seeking behavior and access to quality care. These are beneficial in increasing case finding for TB among vulnerable populations, improving treatment coverage and enhancing quality of care for favorable outcomes. Ultimately, this will lead to a reduction in the TB incidence and morbidity and mortality related to TB.

Global Health Security

Global Health Security (GHS) focuses on human and animal health and the environment and their interrelationships. SBC strategies in Kenya have been used to contribute to prevention, risk mitigation and response by strengthening risk communication and community engagement (RCCE). These components have been shown to be crucial to addressing the behavioral and social aspects of health risks that precede and follow a health emergency. To maintain the gains made during the COVID-19 response and to address the persisting gaps, SBC approaches must be integrated into the preparedness and response agenda from the outset. A well-coordinated, timely and strategic RCCE strategy and implementation plan can manage people’s expectations during an emergency and assist response efforts. Affected communities need to be engaged, have their concerns understood and addressed, and offered appropriate support to make the required changes. In addition, a priority area is to reduce antimicrobial resistance (AMR) and improve infection prevention control (IPC), thus further elevating the importance of targeting providers (of both animals and people) within GHS.

B. USAID/KEA Health SBC Activities to Date

USAID/KEA has long supported implementation of SBC activities, both through standalone SBC mechanisms and integrated SBC and service delivery mechanisms.

Past and current USAID/KEA supported standalone SBC mechanisms include: Agency for All5, Breakthrough ACTION6, and Health Communication and Marketing (HCM) Activity7. Documents related to these past and current mechanisms may be available on the USAID Development Experience Clearinghouse8 (DEC).

Current integrated SBC and service delivery mechanisms include:

● Malaria: PMI Kinga

● FP and MNCH: Stawisha Pwani, SCOPE/World Relief,Nuru Ya Mtoto, Tumikia

Mtoto, Jamii Tekelezi, USAID 4 The Child,

● WASH: Tujenge Jamii, Fahari Ya Jamii,Boresha Jamii

● Nutrition: Boresha Jamii,AMPATH Uzima, Stawisha Pwani,Tujenge Jamii,Imarisha

Jamii

● HIV: Imarisha Jamii, Fahari Ya Jamii, Tujenge Jamii, Stawisha Pwani,Dumisha

Afya, AMPATH Uzima, Imarisha Jamii, Tujitegemee

● TB: TB ARC II

● GHS: CORE Group Polio Partnership (CGPP), Community Epidemic and

Pandemic Preparedness (CP3), Transformational Strategies for Farm Output Risk Mitigation (TRANSFORM), and Mission Support for Journey to Self Reliance Pivot

(MSP).

C. SBC Context in Kenya

Within the Ministry, SBC related activities fall within the Directorate of Health Promotion and Education (DHPE), part of the State Department of Public Health and Professional

Standards. DHPE aims to strengthen national health communication and advocacy and empower communities by addressing social determinants of health, promoting positive change, and improving overall well-being. The DHPE has two divisions: a Division of

Health Information, Education, and Communication (IEC) and a Division of Health

Promotion and Advocacy. The restructuring also included the creation of five sections:

https://geh.ucsd.edu/agency-for-all/ https://breakthroughactionandresearch.org/?s=kenya https://2017-2020.usaid.gov/sites/default/files/documents/1860/HCM_PS_Kenya_factsheet_2019.pdf https://dec.usaid.gov/dec/home/Default.aspx https://geh.ucsd.edu/agency-for-all/ https://geh.ucsd.edu/agency-for-all/ https://breakthroughactionandresearch.org/?s=kenya https://2017-2020.usaid.gov/sites/default/files/documents/1860/HCM_PS_Kenya_factsheet_2019.pdf https://2017-2020.usaid.gov/sites/default/files/documents/1860/HCM_PS_Kenya_factsheet_2019.pdf https://dec.usaid.gov/dec/home/Default.aspx policy, capacity strengthening, monitoring and evaluation, IEC material development, and advocacy. Within these sections, the DHPE has identified the following priorities:

● Policy: Finalizing health promotion strategy, finalizing revised national health promotion strategy, and finalizing development of health communication guidelines and RCCE guidelines.

● Capacity Strengthening: Developing behavior change communication training curriculum, RCCE curriculum, and human-centered design training curriculum.

● Monitoring, Evaluation and Learning: Developing a standardized tool for monitoring activity implementation, developing a system for monitoring activity implementation, and implementing monitoring approaches.

● IEC Material Development: Finalizing development IEC material development guidelines, developing an online system for storing and exchanging materials.

● Advocacy: Finalizing development of advocacy guidelines.

Due to a lack of financial and human resources, the DHPE’s capacity to coordinate SBC activities across the MOH is limited. Individual health area programs within the MOH have more financial and human resources for the design, implementation, monitoring, and coordination of SBC activities, especially health area programs supported by the Global Fund.

D. SBC Programming Challenges

Despite decades of investment in SBC across health areas, progress has stalled.

Programmatic challenges that may have impacted progress include siloed implementation (i.e. service delivery and SBC activities often implement alongside each other without meaningful collaboration, little to no coordination within USAID or the MOH), lack of insights or contextual understanding (i.e. a one-size fits all approach is applied from community to community without consideration for the individual, social, and structural factors that influence health behaviors), and limited innovation (i.e. continued implementation of the same communication-based interventions, such as health communication and health promotion which assume health is the main motivation for behavior change, rather than the implementation of evidence-based activities that address the range of individual, social, and structural behavioral factors ).

III. OBJECTIVES AND EXPECTED RESULTS

A. Theory of Change

As illustrated in Figure 1 below, the theory of change for the Activity is IF individual, social, and structural factors that influence priority health behaviors are identified and addressed through SBC interventions, IF the availability and use of evidence for design, implementation, monitoring, evaluation, and learning of SBC interventions is increased and IF GOK systems, structures, and policies to improve coordination, collaboration, and learning are strengthened and IF individual, organizational, and systems level technical capacity to design, implement, and monitor SBC interventions is strengthened THEN individuals (including providers), households, and communities will adopt and maintain the practice of priority health behaviors.

Figure 1: USAID/KEA SBC Activity Theory of Change

B. Results Framework

As shown in Figure 2 below, the Goal of the Activity is as follows:

Figure 2: USAID/KEA SBC Activity Results Framework

To achieve the goal, IRs, and sub-IRs outlined in the results framework above, the Activity will use theory-informed, evidence-based SBC best practice as well as evidence uptake, knowledge management, capacity strengthening, and system strengthening best practices. All of the activities supported by the Activity should reflect the current state of SBC in Kenya as well as GOK and USAID/KEA priorities.

IV. RELATIONSHIP TO USG AND GOK PRIORITIES

A. Alignment with USG Priorities

The Activity is aligned with USAID/KEA’s CDCS 2020-2025. The CDCS places Kenyan citizens in the driver’s seat of their own development with an overarching five-year goal that Kenya’s competitive private sector, resilient communities and civil society organizations, and citizen-responsive public sector better collaborate to drive improvements to well-being and inclusive growth that promotes sustainability. The Activity aligns with CDCS Development Objective 1 which focuses on improving key systems such as health, governance, and markets; and Development Objective 2, which aims to enhance the resilience of vulnerable populations and environments. Similarly, by addressing specific internal, social, and structural factors that influence health outcomes, the Activity will contribute to the increased utilization of health services, improved health-seeking behavior, strengthening stakeholder coordination structures, and the strengthening of community health services which are among the envisioned results in the USAID/KEA Kenya Health Systems Strengthening Project Design Document.

The Activity is also aligned with the U.S. President’s Malaria Initiative Strategy, End Malaria Faster9; the PEPFAR strategy, Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 203010; USAID Global Tuberculosis Strategy 2023-2030 11; and Primary Impact12. The Activity is aligned with USAID’s priorities in family planning13 and GHS14.

The Activity should adhere to the guidance outlined in the PMI Technical Guidance15.

The Activity is aligned with The 2023 Gender Equality and Women’s Empowerment Policy (Gender Policy)16.

B. Alignment with GOK Priorities

The Activity is aligned with and contributes to the following GOK strategy and guidance documents: Kenya Health Sector Strategic Plan 2018–2023; Kenya Health Policy https://d1u4sg1s9ptc4z.cloudfront.net/uploads/2021/10/10.04Final_USAID_PMI_Report_50851.pdf https://www.state.gov/pepfar-five-year-strategy-2022 https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/publications/usaid-global-tuberculosis-strategy-2023-https://www.usaid.gov/global-health/health-systems-innovation/health-systems-strengthening/primary-health-care https://www.usaid.gov/global-health/health-areas/family-planning https://www.usaid.gov/global-health/health-areas/global-health-security https://d1u4sg1s9ptc4z.cloudfront.net/uploads/2023/02/PMI-FY-2024-Technical-Guidance.pdf https://www.usaid.gov/sites/default/files/2023-03/2023_Gender%20Policy_508.pdf https://d1u4sg1s9ptc4z.cloudfront.net/uploads/2021/10/10.04Final_USAID_PMI_Report_50851.pdf https://d1u4sg1s9ptc4z.cloudfront.net/uploads/2021/10/10.04Final_USAID_PMI_Report_50851.pdf https://www.state.gov/pepfar-five-year-strategy-2022/#:~:text=Fulfilling%20America%27s%20Promise%20to%20End,public%20health%20threat%20by%202030 https://www.state.gov/pepfar-five-year-strategy-2022/#:~:text=Fulfilling%20America%27s%20Promise%20to%20End,public%20health%20threat%20by%202030 https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/publications/usaid-global-tuberculosis-strategy-2023-2030 https://www.usaid.gov/global-health/health-systems-innovation/health-systems-strengthening/primary-health-care#:~:text=USAID%20Launches%20Primary%20Impact,Kenya%2C%20Malawi%2C%20and%20Nigeria https://www.usaid.gov/global-health/health-systems-innovation/health-systems-strengthening/primary-health-care#:~:text=USAID%20Launches%20Primary%20Impact,Kenya%2C%20Malawi%2C%20and%20Nigeria https://www.usaid.gov/global-health/health-areas/family-planning https://www.usaid.gov/global-health/health-areas/global-health-security https://d1u4sg1s9ptc4z.cloudfront.net/uploads/2023/02/PMI-FY-2024-Technical-Guidance.pdf https://www.usaid.gov/sites/default/files/2023-03/2023_Gender%20Policy_508.pdf https://www.usaid.gov/sites/default/files/2023-03/2023_Gender%20Policy_508.pdf https://d1u4sg1s9ptc4z.cloudfront.net/uploads/2021/10/10.04Final_USAID_PMI_Report_50851.pdf https://www.state.gov/pepfar-five-year-strategy-2022 https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/publications/usaid-global-tuberculosis-strategy-2023-2030 https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/publications/usaid-global-tuberculosis-strategy-2023-2030 https://www.usaid.gov/global-health/health-systems-innovation/health-systems-strengthening/primary-health-care https://www.usaid.gov/global-health/health-areas/family-planning https://www.usaid.gov/global-health/health-areas/global-health-security https://d1u4sg1s9ptc4z.cloudfront.net/uploads/2023/02/PMI-FY-2024-Technical-Guidance.pdf https://www.usaid.gov/sites/default/files/2023-03/2023_Gender%20Policy_508.pdf

Framework 2012-2030; MOH Health Promotion Strategy 2023-2028; Kenya AIDS Strategic Framework II 2020/2021-2024/2025; Kenya AIDS Strategic Framework II 2020/2021-2024/2025 Communication Strategy; HIV and STI Surveillance Strategy 2020-2024; HIV Drug Resistance Testing Strategy 2020-2024; Kenya HIV Prevention Revolution Roadmap; Kenya National Action Plan for Health Security (NAPHS) 2019- 2023; Kenya Malaria Social and Behavior Change Strategy 2022-2027; Kenya Malaria Behavior Survey Report 2022; and IHR/JEE Version 3.0, section R5.

In addition, the SBC Activity is aligned to the DHPE and its expected results within the next five years. These include the establishment of health promotion policies, increased awareness and adoption of healthy behaviors, enhanced stakeholder and community engagement, improved monitoring systems, and increased awareness of social determinants of health. The expected impact includes enhanced multi-sectoral approaches in health, reduced spread of diseases, increased demand for preventive health services, empowered communities to address health challenges, and reduced health inequalities among different populations. These efforts aim to empower communities and address health challenges in a comprehensive and equitable manner.

V. GUIDING PRINCIPLES

A. Integration

As previously mentioned, USAID/KEA anticipates that the Activity will include buy-ins from multiple health areas, including malaria, HIV, family planning and reproductive health, MNCH, TB, and GHS. Where logistically possible and technically feasible, the Activity is encouraged to explore the design and implementation of integrated SBC interventions. SBC integration can be carried out by segmenting priority populations and by designing SBC interventions according to life stage (e.g., adolescents and young adults), addressing shared behavioral determinants (e.g., gender norms), or leveraging gateway behaviors (e.g., ANC visits) to name a few commonly used approaches to SBC integration. An additional approach to integration may be to integrate SBC interventions for priority health behaviors into other sectors including education or agriculture.

However, where it is not logistically possible or technically feasible, SBC interventions focused on a single health area are acceptable.

B. Coordination with Service Delivery

SBC must be coordinated with service delivery programs. The Activity must work collaboratively with USAID-supported and GOK service delivery activities where there is geographic overlap. The Circle of Care17 model provides a useful framework for the role of SBC before, during and after services are provided. As described below, the Activity’s engagement with USAID-supported service delivery partners will depend on the health area and geographic focus area.

https://breakthroughactionandresearch.org/circle-of-care-model/

C. Best Practice SBC

USAID/KEA embraces and insists on the use of a theory-informed and evidence-based approach to determine the SBC interventions that are best suited to address the internal, social, and structural factors identified through formative research that influence the behaviors underpinning the achievement of health outcomes. The Activity should. extend beyond conventional SBC practices, such as health promotion and communication, to encompass a broader range of methodologies. These include human-centered design (HCD), community engagement, behavioral economics, promoting changes in provider behavior, managing infodemics, facilitating peer-to-peer support, and utilizing digital media platforms. An iterative process using co-creation with members of target populations and stakeholders, or, at minimum, pre-testing is expected.

D. Strategic Partnerships, Collaboration, and Coordination

While the Activity will work with the relevant health area programs for some activities, the Activity is expected to work directly with the HPD to achieve the goal and IRs outlined in the results framework above.

USAID is committed to a multi-faceted collaborating, learning, and adapting (CLA) approach to development. The Activity should establish strong and active collaboration and coordination between members of the target populations, communities, county governments, private sector entities, community-based organizations, faith-based organizations, civil society organizations, MOH, and other relevant ministries, other USG-funded activities, and other development partners. Opportunities for collaboration and coordination include but are not limited to co-creation, joining planning and management, joint monitoring, and joint support supervision.

E. Increased Involvement of the Private Sector

The Activity should, where appropriate, engage the private sector in the design and implementation of SBC interventions. Private sector engagement may include, for example, involvement of private sector health facilities or private sector health providers in interventions, use of private sector entities to extend coverage of SBC interventions, or establishment of public-private sector partnerships to decrease costs, leverage private sector expertise, or increase coverage of SBC interventions.

VI. GEOGRAPHIC SCOPE

The Activity will support activities at the national and sub-national levels in Kenya. At the national level, the Activity will support the DHPE, as well as, if applicable, health or disease area programs. Generally, the Activity will implement activities associated with IR 1 and IR 2 at the national and sub-national levels and activities associated with IR 3 and IR 4 at the national level.

The Activity will accomplish its goal and IRs through two modalities:

● For some health areas, the Activity will implement SBC activities sub-nationally alongside and in collaboration with USAID-funded service delivery mechanisms.

● For other health areas, the Activity will not implement SBC activities sub-nationally but will instead support USAID-supported service delivery mechanisms to design and implement SBC activities.

Currently, USAID/KEA is supporting implementation of activities for malaria at the national level and in 8 focus counties, for family planning and maternal, newborn, and child health at the national level and in 13 focus counties, for global health security at the national level and 26 focus counties, for HIV at the national level and in 34 focus counties (7 focus counties for DREAMS and 25 focus counties for OVCs), for TB at the national level and in 16 focus counties. The geographic focus areas of these activities are subject to change based on availability of funding and epidemiology. The Activity is expected to support malaria SBC activities at the national level and in all 8 focus counties, family planning and maternal, newborn, and child health SBC activities at the national level and in all 13 focus counties, global health security SBC activities at the national level and in a subset of focus counties to be determined through epidemic risk mapping, HIV SBC activities at the national level and in a subset of focus counties based on specific population needs, and TB SBC activities at the national level and in 16 focus counties.

Figure 3: Map of USAID/KEA focus counties by health area.

VII. GENDER, YOUTH AND SOCIAL INCLUSION

Structural, social, and individual factors can present barriers and opportunities that drive or influence behavior. Identifying behaviors, understanding barriers and opportunities, and developing interventions all require understanding context specific values, needs, and norms to change knowledge, attitudes, beliefs, and practices. The Activity will be building on recommendations made in the USAID Kenya gender analyses. Some of the key findings revealed that harmful gender norms impact use of family planning, influence how to negotiate safe sex and perpetuate intimate partner violence and prevalence of other forms of gender-based violence. Socio-cultural beliefs and practices, norms, knowledge and attitudes further limit children’s, women’s, and girls’ access to services, leading to differential gendered distribution and burden of new HIV infections, TB and malaria cases. Women's limited decision and controlled access to resources contribute to their inability to access and utilize RMNCH services for themselves and their children.

Based on these findings, USAID/KEA will in addition complete a gender analysis to be conducted by the successful applicant at the start of implementation and use the findings to integrate recommendations throughout implementation, M&E as required gender analysis as required in ADS 205 and the 2023 gender equality and women’s empowerment policy to further inform the implementation of the planned SBC interventions.

The applicant is expected to demonstrate that they fully understand and subscribe to USAID’s gender policy, to address gender-related attitudes, norms and behaviors that influence health choices and outcomes. The applicant should also describe how management structures, systems, and processes will ensure that proposed SBC interventions are reflected at all levels to ensure sustained normative and social change.

Special attention should ensure that communication on demand for and utilization of health services and/or the messaging around positioning of benefits does not intentionally or unintentionally reinforce or take advantage of gender inequalities and stereotypes. The needs and issues of under-reached populations will also be strongly considered. This analysis is expected to map out how best to reach these key sub-populations and integrate the findings into work plans and interventions.

Given that 80 percent of Kenya's population is under the age of 35, it is imperative for the Activity to promote and support engagement with youth in health programming. Youth participation is essential for driving behavior change in health. Therefore, the Applicant must integrate and monitor innovative approaches to engage with youth across all result areas. These approaches should not only address the challenges faced by youth but also involve and support young people in decision-making, management, and leadership roles within the Activity.

SBC plays a crucial role in addressing social inclusion by promoting behaviors and attitudes that foster inclusion and acceptance within communities. The application must aim to create a more equitable and inclusive society that includes but is not limited to combating discrimination based on gender, race, ethnicity, disability, or other factors, and empower individuals and communities to challenge stereotypes, promote empathy, and embrace diversity. This Activity will engage stakeholders at various levels, including government agencies, civil society organizations, and local communities.

[END OF SECTION A: PROGRAM DESCRIPTION]

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SECTION B: FEDERAL AWARD INFORMATION

1. Estimate of Funds Available and Number of Awards Contemplated

USAID intends to award one (1) Cooperative Agreement pursuant to this notice of funding opportunity. Subject to funding availability and at the discretion of the Agency, USAID intends to provide up to $14,950,000 in total funding over a five-year period.

USAID reserves the right to make multiple awards or no award(s) at all through this opportunity. Furthermore, USAID reserve the right to: (a) reject any or all applications,

(b) accept other than the lowest cost application, and (c) waive informalities and minor irregularities in applications received.

The base amount for this award is expected to be approximately $6.25 million. In addition to this base amount, the Cooperative Agreement will include an unfunded budget allocation for three (3) opportunity modules of up to $8.7 million, inclusive of indirect costs, as follows:

• Opportunity Module A: $TBD

• Opportunity Module B: $TBD

• Opportunity Module C: $TBD

This unfunded budget allocation for the opportunity modules is not guaranteed. The opportunity modules will enable USAID to respond to unforeseen windows of opportunity that emerge over the course of implementation. Potential windows of opportunity may include buy-ins to the Activity from malaria, HIV, FP/RH, MNCH, TB, and GHS. These opportunity modules are intended to support the expansion of programming to additional health sector areas and geographic scope, as well as increase the scale of implementation. USAID/KEA may invoke the opportunity modules to implement additional interventions at any point in the life of the activity.

Opportunity modules may be exercised only at the discretion of the Agreement Officer and are contingent upon availability of funds, which may include other funding elements and reporting requirements. Use of the opportunity module will require administrative approval in accordance with the terms and procedures of the award.

Applicants may budget up to 10 percent of the base amount of the award (and of each opportunity module) for the purpose of strengthening the capacity of the recipient organization and/or its partners. If the Applicant anticipates budgeting for local capacity strengthening, it must provide a plan on how it intends to use the funds and what the expected outcomes will be. See Section D. Application Review Information, Sub-section 3b. Detailed Preparation and Submission Guidance, Phase 2 - Oral Presentations for further guidance.

All funding will be provided on an incremental basis, subject to the availability of funds and successful performance. USAID reserves the right to change the funding amounts, cycle, and terms of the agreement as a result of availability of funding, U.S. Government requirements, or Recipient performance. If such changes occur, USAID will notify the Recipient.

2. Expected Performance Indicators, Targets, Baseline Data, and Data Collection

Applicants must propose performance indicators, targets, and baseline sources per Section A above. See additional guidance in Section D.3.b. Detailed Preparation and Submission Guidance and Section F.3. Reporting Requirements.

3. Start Date and Period of Performance for Federal Awards

The anticipated period of performance is five (5) years. The estimated start date is September 2024.

4. Substantial Involvement

USAID anticipates requiring substantial involvement under this program to assist the Recipient in achieving the supported objectives of the agreement. The intended areas of substantial involvement may include, but are not limited to, the following:

• Approval of the recipient’s implementation plans The Recipient must submit Annual Work Plans (AWP) that present the overall strategic approach to the program and set annual priorities for the given implementation year. The Recipient must obtain USAID approval of the AWP, and any amendments to it, to ensure compliance with stated goals, milestones, and outputs.

• Approval of Specified Key Personnel The Recipient must obtain USAID approval for the positions designated essential to the successful implementation of the activity as “Key Personnel”. USAID reserves the right to determine the relevance of education and experience for all Key Personnel positions.

• Review and Approval of Subawards USAID shall have substantial involvement in the criteria and selection of sub‐award recipients through means of collaboration and joint participation. The Recipient must obtain the Agreement Officer’s prior approval for the sub-award, transfer, or contracting out of any programmatic scope under this award. The term ‘subaward’ includes both sub-agreements and contracts under assistance.

The Recipient must obtain the Agreement Officer’s prior approval of substantive provisions of proposed subawards or contracts (defined in 2 CFR 200).

Any subawards to foreign governmental organizations or parastatal of any amount must be approved by the AO and may warrant additional clearances in accordance with ADS 303.3.21.b & c.

• Approval of International Travel Prior written approval by the Agreement Officer is required for all international travel directly and identifiably funded by USAID under this Award. The Recipient must present to the Agreement Officer or the Agreement Officer's Representative, an itinerary for each planned international trip, showing the name of the traveler, purpose of the trip, origin/destination (and intervening stops), and dates of travel, as far in advance of the proposed travel as possible, but in no event less than three weeks before travel is planned to commence. The AOR will review and concur with the recipient’s international travel request, and the Recipient shall obtain the AO’s prior approval before incurring any expenses related to international travel.

• Approval to Perform Work under Opportunity Modules The Recipient must obtain AO approval in writing prior to performing work under the opportunity modules.

• Agency, Recipient, and Subrecipient Collaboration When the Recipient’s successful accomplishment of program objectives can benefit from USAID’s technical knowledge and strategic relationship with local government stakeholders, the AO may authorize the collaboration or joint participation of USAID and the Recipient.

• Agency Monitoring to Permit Specific Kinds of Direction or Redirection The AO may authorize specific direction or redirection, including of the geographic scope, based on emerging needs, host government priorities, and the interrelationships with other U.S. Government-funded activities. All such direction or redirection must be within the program description budget, and other terms and conditions of the award.

5. Authorized Geographic Code

The geographic code for the procurement of commodities and services under this program is 935. This means the United States, the recipient country, and developing countries other than advanced developing countries, but excluding any country that is a prohibited source. The list of countries designated as Prohibited Source Countries is found at http://www.usaid.gov/ads/policy/300/310mac.

6. Nature of the Relationship between USAID and the Recipient

The principal purpose of the relationship with the Recipient and under the subject program is to transfer funds to accomplish a public purpose of support or stimulation of the USAID/KEA SBC activity which is authorized by Federal statute. The successful http://www.usaid.gov/ads/policy/300/310mac

Recipient will be responsible for ensuring the achievement of the program objectives and the efficient and effective administration of the award through the application of sound management practices. The Recipient will assume responsibility for administering Federal funds in a manner consistent with underlying agreements, program objectives, and the terms and conditions of the Federal award.

[END OF SECTION B– FEDERAL AWARD INFORMATION]

SECTION C: ELIGIBILITY INFORMATION

1. Eligible Applicants

Eligibility for this NOFO is restricted to Kenyan organizations. These eligibility requirements apply to only the principal applicant.

Only local Kenyan organizations as defined below are eligible to be the Recipient for award. USAID defines a “local entity” as an individual, a corporation, a nonprofit organization, or another body of persons that:

(1) Is legally organized under the laws of; and

(2) Has as its principal place of business or operations in;…