72061524RFI00001_USAID KEA SBC Activity_2023-10-30_final.pdf

Request for Information (RFI)

Reference: RFI No. 72061524RFI00001 Issue Date: October 30, 2023 Response Due Date: November 10, 2023, at 17:00 Nairobi, Kenya Time Title: USAID/Kenya and East Africa Social Behavior Change Activity

THIS IS A REQUEST FOR INFORMATION ONLY. It is not a solicitation and is not to be construed as a commitment by the U.S. Government or the U.S. Agency for International Development (USAID) to issue any Notice of Funding Opportunity (NOFO) or solicitation or to ultimately award a contract or assistance agreement on the basis of this RFI.

The United States Government, represented by the USAID Mission to Kenya and East Africa (USAID/KEA) through the Office of Population Health and Nutrition (HPN) is seeking feedback from responsible international and Kenyan organizations – including, but not limited to, private for-profit, private not-for-profit, non-governmental organizations and community-based organizations – that could potentially support services and activities in social behavior change (SBC) in Kenya. As a result of this RFI, USAID/KEA will have a better and more complete understanding of the pool and composition of organizations that could potentially contribute to USAID’s in-country SBC programs.

This RFI is an attempt to reach out to the market to determine the scope of industry capabilities and interest and will be treated as information only. Responses to this notice are not applications and cannot be accepted by the Government to form a binding agreement.

Responses to this RFI are strictly voluntary, and USAID will not pay respondents for the information provided in response to this RFI. Responses to this RFI will not be returned, and respondents will not be notified of the result of the review.

If a NOFO or solicitation is issued, it will be announced publicly at a later date and all interested parties must respond to that NOFO/solicitation announcement separately from any response to this announcement.

This RFI does not restrict the Government’s approach on a future funding opportunity or solicitation. USAID/KEA is in the process of designing these activities. No decision has been made regarding the type of instrument that will be used (e.g. acquisition or assistance). For this reason, this RFI will be posted on the Federal grants and contracts websites: www.grants.gov and www.sam.gov. Please continue to monitor these sites for any updates to this RFI.

Sincerely, Sandra Jansen Agreement/Contracting Officer http://www.grants.gov/ http://www.sam.gov/

ATTACHMENT 1

RFI Concept

USAID/Kenya and East Africa Social Behavior Change Activity

Background:

Across health areas, success depends on human behavior, essentially on the increased practice of positive behaviors and decreased practice of harmful behaviors. The ability, opportunity, and motivation of individuals (including providers), households, communities, and societies to adopt and maintain the practice of positive behaviors and reduce or abandon the practice of harmful behaviors is influenced by individual, social, and structural factors. Social and behavior change (SBC), 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 aim to affect key behaviors and social norms by addressing their individual, social, and structural determinants (factors). SBC is grounded in several disciplines, including systems thinking, strategic communication, marketing, psychology, anthropology, and behavioral economics”, can be used to identify and address the factors that influence the behaviors that impact health outcomes.

The following situation analyses for some key USAID Kenya and East Africa (KEA) health programming areas highlight the role of human behavior, and, therefore, SBC:

Malaria

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. For example, in 2022, USAID Kenya supported the implementation of the Malaria Behavior Survey (MBS)1 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% of individuals in households with sufficient access to ITNs (one ITN per two members) used them. Access to an ITN is the primary factor that influences ITN use, however, the MBS also revealed that respondents with high perceived self-efficacy to use nets and favorable attitudes towards net use and care, as well as those who reported that they listen to the radio at least once weekly, had significantly increased odds of consistent net use. Specific to care-seeking for fever, according to the MBS, among caregivers, 33% reported that a child under age five had a fever in the two weeks preceding the survey and 50% of children under age five with fever reportedly received both prompt and appropriate care. After adjusting for socio-demographic characteristics, caregivers who engaged in interpersonal communication about malaria with spouse/partner and had favorable perceptions of community health workers were more likely to seek prompt and appropriate care for a child under five who had a fever in the two weeks prior to the survey. Specific to ANC attendance and IPTp uptake, according to the MBS, among women with a live birth in the two years preceding the survey, 99% reported attending at least one ANC visit, 82% at least four ANC visits, and 13% at least eight ANC visits. Among these women, IPTp use ranged from 87% for the first dose to 48% for the third dose. Attendance at ANC visits was significantly and positively associated with IPTp uptake. Additionally, across adjusted models, favorable IPTp attitudes were consistently and positively associated with intentions for early ANC, for four or more ANC visits, and for eight or more ANC visits.

Family Planning

Modern Contraceptive Prevalence Rate (mCPR) in Kenya has steadily increased from 39% in 2008-09 to 57% in 2022. However, Unmet Need for modern contraceptives and teenage pregnancy rates remain high at 14% and 15%, 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 FP, negotiate safe sex, and reduce intimate partner violence. Utilization of FP/RH services is influenced by a range of issues including social-cultural beliefs and practices, gender norms, knowledge and attitudes, and access to services. Supply-side interventions are not sufficient alone to fully improve Kenyan sexual and reproductive health at an individual or population level. Improving FP/RH in Kenya requires consistent SBC activities that help address gender inequality, intimate partner and gender-based violence, and create a supportive enabling environment for FP/RH promotion and utilization. Developing an appropriate SBC program for FP/RH requires an understanding of the target audience and the underlying determinants of positive FP/RH behavior and perceived benefits of changed behavior. Certain populations in Kenya are of key priority in targeted SBC programming, for example, recent research conducted by USAID’s Agency for All project in Kenya demonstrated low rates of self-efficacy and reproductive agency among youth in Kenya, a critical target demographic to improve FP/RH behaviors and outcomes. Target audience for FP/RH programs can be categorized as: a) people directly affected e.g., women of reproductive age, men, and adolescent and youth; b) people directly influencing those who are directly affected e.g., community social networks, community opinion leader, and service providers; and c) people indirectly influencing those who are directly affected e.g., policymakers. It is essential to understand the key barriers to FP/RH uptake by the audience segment to inform social behavior change objectives and strategies, particularly among Kenyan youth and marginalized populations who currently have little access and utilization rates of FP/RH services.

Maternal, Child, and Newborn Health

Kenya has made significant strides in maternal, newborn and child health (MNCH) indicators. The Kenya demographic health survey (KDHS 2020)2 showed a significant increase in live births assisted by skilled providers, from 41% in 2003 to 89% in 2022, vaccination coverage rate for basic antigens gradually increased from 77% in 2008/2009 to 80% in 2022, stunting levels decreased from 26% to 18% 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 dowry 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 participation in decision making. 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.

With regards to under five mortality, pneumonia accounts for 16% 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% in Kenya, which is below the recommended 90% global coverage. There are various factors that affect health seeking behavior including availability of services, access to services, socio-cultural beliefs, level of awareness of the service 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.

HIV

Despite a reduction in new HIV infections in Kenya, the country continues to have high rates of HIV incidence among some populations and typologies and in some geographical regions. The most affected populations include Female Sex Workers (FSWs) estimated at 27%, and 28% among Men who have Sex with Men (MSM). An analysis of the distribution of new infections showed that most new infections in 2021 were among women compared to men. The National Strategic Plan 2021/2022- 2026/20273 highlights the importance of communication for social and behavior change in demand creation for services, and transforming harmful socio-cultural norms, values, beliefs and practices. It identifies behavioral, socio-cultural, and structural factors as critical determinants of HIV risk in the different population groups, which requires responses tailored to diverse needs. The HIV SBC strategies identified in the HIV National Strategic Plan includes building capacities of IPs, and stakeholders in SBC at National, County and community levels, addressing the main drivers of HIV transmission tailored to specific needs and circumstances of groups at high risk, use a combination of scientifically proven risk-reduction strategies, such as one-on-one counseling, small-group programmes, and community education to encourage people to adopt safer sexual behaviors and avoid risky drug use, a campaign for male involvement and AYPs, champions for HIV prevention to engage in communication for awareness and advocacy and using multi-media channels targeting different populations, including innovative use of social media, radio and television, community dialogue, interpersonal communication and other community approaches. In HIV programming SBC plays a crucial role before services (motivates clients to access services), during services (improves the clients-providers interaction) and after the services (boosts adherence and maintenance).

Tuberculosis (TB)

Kenya has made significant progress in reducing the incidence of tuberculosis by steadily increasing the number of cases detected and reducing TB mortality over the years. Despite these achievements, the country has not managed to diagnose all people with TB; 32% 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, increasing 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. Key SBC activities towards achieving the desired outcome will include raising awareness of TB at all levels, demand creation targeting the key and vulnerable populations, addressing barriers to uptake of TB services and treatment completion, addressing stigma and discrimination, and designing targeted messages and material for specific audiences. SBC interventions will use a mix of interpersonal, group and mass media channels including participatory methods to engage all relevant stakeholders including health care workers, community health promoters, political and key groups leaders, community and civil society organizations and vulnerable groups to provide information and motivation for behavior change.

Global Health Security

SBC strategies in Kenya have been used to contribute to prevention, risk mitigation and response by strengthening risk communication and community engagement. 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, communication must be integrated into the preparedness and response agenda from the outset. A well-coordinated, timely and strategic communication 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. The experiences of the USAID funded CORE Group Polio Partnership (CGPP) and Community Epidemic and Pandemic Preparedness (CP3) programs community engagement activities in Kenya have established that a strong risk communication component means that rumors can be detected early, community concerns and barriers to desired behaviors can be identified and addressed promptly. One of the eight core functions outlined in the International Health Regulations (IHR) is that countries have the capacity to implement risk communication. Risk communication is defined by the IHR as both the broad-based communication of potential risk, and community engagement with affected communities. SBC activities will therefore increase the capacity of Kenya institutions to effectively engage stakeholders and communities to identify high risk behaviors associated with priority zoonotic diseases and other emerging threats and mitigate the impact of future health events.

Overall purpose of the social behavior change (SBC) activity

USAID KEA plans to continue supporting the implementation of SBC activities and building on previous SBC investments, including integration of SBC into service delivery, to accelerate the adoption and sustained practice of desired health behaviors by individuals (including providers), households, communities, and societies to drive positive health outcomes. The purpose of a potential new SBC activity would be to improve health and development outcomes through increased coverage of high-quality, evidence-informed social and behavior change programming that can be sustained.

Despite decades of investment 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), 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--or the same old, same old--rather than the implementation of evidence-based activities and influence the range of individual, social, and structural factors that influence individual, household, and community health behaviors).

The ability, opportunity, and motivation of individuals (including providers), households, communities, and societies to adopt and maintain the practice of positive behaviors and reduce or abandon the practice of harmful behaviors is influenced by individual, social, and structural factors. Provider behavior is influenced by a range of factors, including individual factors, personal relationships, professional relationships, community context and social norms, workplace environment, health system governance, and country and geopolitical context.

To accelerate progress toward USAID and Government of Kenya goals and objectives, a better understanding of the individual, social, and structural factors, including cultural and contextual factors, that influence the practice of health behaviors is required. This requires collecting data on the individual, social, and structural factors that influence health behaviors, designing activities that address those factors, monitoring changes in those factors throughout implementation, and making changes to activities based on data. Subsequently, the development of evidence-based and theory-informed programs and activities, and better coordination across programs and activities is required to support individuals (including providers), households, and communities to practice positive health behaviors.

In addition, the capacity of local organizations, community-based, faith-based, and civil society organizations, and national and sub-national Government of Kenya entities must be strengthened to design, manage, monitor, and evaluate innovative, evidence-based SBC activities intended to address the factors that influence individual, social, and structural factors that influence health behaviors. Government of Kenya entities must be able to identify opportunities for SBC interventions in service delivery and encourage collaboration between SBC and service delivery entities and vice versa.

USAID is seeking information from stakeholders to help refine the scope of a potential new activity. The potential new SBC activity will focus on increased coverage of high-quality, evidence-informed SBC programming and evidence generation across health and development areas. It may also work to ensure that local systems and organizations support and are increasingly capable of funding, designing, implementing, and managing this SBC programming.

ATTACHMENT 2

INSTRUCTIONS TO RESPONDENTS FOR SUBMISSION

Submission of Responses: Responses (comments, suggestions, and enhancements) to this RFI are due to the USAID/KEA/OAA Points of Contact identified below by November 10, at 17:00 Nairobi time. Interested parties shall submit an electronic copy of their responses in either Microsoft Word or Adobe Acrobat formats. No Google documents will be accepted. The agency server is unable to accept *zip files and therefore respondents may not send any files in this format. Please email responses to hpnsolicitations@usaid.gov with the subject title, “RFI No. 72061524RFI00001 USAID/KEA Social Behavior Change Activity”.

USAID is interested in learning about the capabilities and structure of organizations conducting social behavior change activities in Kenya. The responses you provide will only be used for informational purposes and are NOT intended to be used for selection or evaluation of any organization.

FORMAT FOR RESPONSES TO REQUEST FOR INFORMATION (RFI)

Name of Organization: __________________________________

Organization’s Address: _________________________________

Organization’s Point of Contact:

Name: _______________________________________________

Title/Position: _______________________________________________

Phone Number: _______________________________________________

Email Address: _______________________________________________

Organization’s Website (if any): __________________________________________

1. Please provide a brief description of your organization’s capacity (e.g. experience, team composition, demonstrated results) in social and behavior change, including design, implementation, monitoring, and evaluation of new and emerging social and behavior change approaches, in Kenya and the East Africa region. (Maximum 0.5 page) mailto:hpnsolicitations@usaid.gov

2. Based on your organization’s knowledge and experience, what are some key approaches or activities that could contribute to the achievement of this potential new Activity’s goal to “to accelerate the adoption and sustained practice of desired health behaviors by individuals (including providers), households, communities, and societies to drive positive health outcomes”? (Maximum 0.5 page)

3. Coordination with service delivery partners, both USAID-funded and other, is critical to the success of both social and behavior change and service delivery interventions. Based on your organization’s knowledge and experience, what are some best practices for collaborating with service delivery partners to achieve shared outcomes and accelerate impact? (Maximum 0.5 page)

4. Collection, analysis, and use of formative research and monitoring data are critical for successful design, implementation, and adaptive management of social and behavior change interventions. Based on your organization’s knowledge and experience, what are some innovative data collection approaches, including approaches that shorten the time frame from conceptualization to implementation, to design, implement, monitor, and evaluate social and behavior change interventions? (Maximum 0.5 pages)

5. A key component of this potential new Activity will include technical, organizational, and systems capacity strengthening of local organizations, community-based, faith-based, and civil society organizations, and national and sub-national Government of Kenya entities. Based on your organization’s knowledge and experience, what are some key approaches to strengthening the capacity of Kenyan organizations? (Maximum 0.5 page)

6. How does your organization maintain its own capacity, e.g. stay abreast of emerging social and behavior change approaches and evidence from behavioral science? (Maximum 0.5 page)

7. Is your organization’s interest in submitting an application/proposal to USAID as a prime recipient/contractor and/or a subrecipient/subcontractor?

☐ Prime recipient/contractor ☐ Subrecipient/subcontractor ☐ Both Prime & Sub

8. Does your organization meet the USAID definition of “local entity”?

Local entity means an individual, a corporation, a nonprofit organization, or another body of persons that: (1) is legally organized under the laws of; (2) has as its principal place of business or operations in; (3) is (A) majority owned by individuals who are citizens or lawful permanent residents of; and (B) managed by a governing body the majority of who are citizens or lawful permanent residents of Kenya.

☐ Yes ☐ No ☐ Not Sure

Briefly describe why you believe your organization meets the local partner definition:

9. In what year was your organization established?

10. How is your organization registered in Kenya?

☐ Registered as ☐ Not currently registered

11. Please provide information on the size of your organization:

1. Number of full-time employees

2. Number of part-time employees

3. Number of offices (if multiple)

4. Approximate total annual operating revenue. Please use an average from the most recent three fiscal years.

☐ < $50,000 ☐ $50,000 - $249,999 ☐ $250,000 - $749,999

☐ $750,000 - $999,999 ☐ $1-5 million ☐ >$5,000,000

e. Approximate total general reserves. Please use an average from the most recent three fiscal years.

☐ < $5,000 ☐ $5,000 - $49,999 ☐ $50,000 - $99,999

☐ $100,000 - $249,999 ☐ $250,000-499,999 ☐ >$500,000

12. Please list the different written organizational policies and procedures that your organization maintains and the year in which the policies and procedures were last reviewed and/or updated. Listed below are some examples, but your organization is not limited to listing only these nor must it list them if it does not have the policies.

Financial Policies and Procedures: 20XX Human Resources Policies and Procedures: 20XX Records Management Policies and Procedures: 20XX Procurement Policies and Procedures: 20XX Cybersecurity or IT Policies and Procedures: 20XX Grant/Subaward Policies and Procedures: 20XX

13. Has your organization ever implemented an activity of similar scope and size through a grant, cooperative agreement, contract or other mechanism from any donor or funding organization?

If so, complete the below table, adding or deleting rows as necessary:

Source/Donor Total Award Amount (in USD)

Duration of award (in years)

Year of start (e.g., 2020)

Year of completion (e.g., 2023)

1.

2.

3.

4.

5.

14. Does your organization have experience in issuing and managing grants/contracts and/or sub-grants/subcontracts?

If yes, please provide a range of the values of the subawards/subcontracts that your organization issued.

15. Would your organization have the technical and management skills, capacity, and experience to effectively implement the potential new SBC activity?

If your answer is Yes or Not Sure, please describe what kind of technical or operational assistance/support that your organization would need to help it gain the right skills and capacity, and over what time frame in terms of months/years? (Maximum 0.5 page)