Amendment 02_NOFO_72048225RFA00002_SMCHC.pdf

RFA Issuance Date: October 25, 2024 Deadline for Questions: November 6, 2024 RFA Amendment Date: December 3, 2024 Deadline for Applications: December 6, 2024, 9:00 a.m, Bangkok Time

Subject: Notice of Funding Opportunity (NOFO) Request for Application (RFA) No. 72048225RFA00002 RFA Amendment No. 2

Activity Title: Strengthening Malaria Control for High-Risk Communities (SMCHC)

Dear Potential Applicants:

The purpose of this amendment to the NOFO is to incorporate changes as follows:

1. Include an Opportunity Node in the resultant award to promote program flexibility, adaptive management and responsiveness to dynamic operating environments, and

2. Revise the NOFO as a result thereof. The NOFO with highlighted changes (in yellow) is also attached with this Amendment.

All other terms and conditions indicated in the above-mentioned solicitation issued on October 25, 2024 remain unchanged. Thank you for your interest in USAID programs.

Sincerely, -s-

Bruce Gelband Agreement Officer USAID/Burma/OAA

Issue Date: October 25, 2024 Deadline for Question: November 6, 2024 Closing Date: December 6, 2024 Closing Time: 9.00 a.m. Bangkok Time

Subject: Notice of Funding Opportunity (NOFO) Number: 72048225RFA00002

Activity Title: Strengthening Malaria Control for High-Risk Communities

Federal Assistance Listing Number: 98.001 USAID Foreign Assistance for Programs Overseas

Greetings, The United States Agency for International Development (USAID) is seeking applications for a cooperative agreement from qualified entities to implement the Strengthening Malaria Control for High-Risk Communities Activity. Eligibility for this award is not restricted.

USAID intends on engaging in a pre-award co-design process and intends to make an award to the applicant 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 B 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 downloaded 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 Support Center at 1-800-518-4726 or via email at support@grants.gov for technical assistance or if you need assistive technology and are unable to access any material on this site.

Unless an exception in 2 CFR 25.110 applies, applicants must comply with 2 CFR 25 requirements to obtain a Unique Entity Identifier (UEI) and register in the System for Award Management (SAM.gov), as applicable. See section E, Submission Requirements and Deadlines, for more information. The registration process may take many weeks to complete. Therefore, applicants are encouraged to begin registration early.

Please send any questions to the point(s) of contact identified in Section A.4. The deadline for questions is shown above. Responses to questions received prior to the deadline will be http://www.grants.gov mailto:support@grants.gov furnished to all potential applicants through an amendment to this notice posted to www.grants.gov.

Issuance of this NOFO 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, /s/

Bruce Gelband Agreement Officer

SECTION A: BASIC INFORMATION 6

A.1 EXECUTIVE SUMMARY 6

A.2 ESTIMATE OF FUNDS AVAILABLE AND NUMBER OF AWARDS CONTEMPLATED 6

A.3 START DATE AND PERIOD OF PERFORMANCE FOR FEDERAL AWARDS 6

A.4 AGENCY POINT OF CONTACT 6

A.5 ACQUISITION AND ASSISTANCE OMBUDSMAN 7

A.6 AUTHORIZED GEOGRAPHIC CODE 7

SECTION B: ELIGIBILITY INFORMATION 8

B.1 ELIGIBLE APPLICANTS 8

B.2 COST SHARING OR MATCHING 8

SECTION C: PROGRAM DESCRIPTION 9

C.1 OVERVIEW 9

C.2 BACKGROUND 9

C.3 PROBLEM STATEMENT 12

C.4 ACTIVITY DESCRIPTION 13

C.5 EXPECTED PERFORMANCE INDICATORS, TARGETS, BASELINE DATA, AND DATA

COLLECTION 17

C.6 SPECIAL CONSIDERATIONS 18

C.7 SUBSTANTIAL INVOLVEMENT 22

SECTION D: APPLICATION CONTENT AND FORMAT 23

D.1 GENERAL CONTENT AND FORM OF APPLICATION 23

D.2 PHASE 1: CONCEPT APPLICATION 23

D.3 PHASE 2: CO-CREATION AND FULL TECHNICAL AND COST APPLICATION SUBMISSION 28

SECTION E: SUBMISSION REQUIREMENTS AND DEADLINES 29

E.1. QUESTIONS AND ANSWERS 29

E.2 SUBMISSION REQUIREMENTS 29

E.3 UNIQUE ENTITY IDENTIFIER AND SAM.gov REGISTRATION 30

SECTION F: CONCEPT APPLICATION REVIEW INFORMATION 31

F.1 RESPONSIVENESS REVIEW 31

F.2 PHASE 1: CONCEPT APPLICATION MERIT REVIEW CRITERIA 31

F.3 PHASE 2: CO-CREATION AND FULL TECHNICAL AND COST APPLICATION 32

SECTION G: AWARD NOTICES 34

SECTION H: POST-AWARD REQUIREMENTS AND ADMINISTRATION 35

H.1 ADMINISTRATIVE & NATIONAL POLICY REQUIREMENTS 35

H.2 NATURE OF THE RELATIONSHIP BETWEEN USAID AND THE RECIPIENT 35

H.3 REPORTING REQUIREMENTS 35

H.4 PROGRAM INCOME 39

H.5 ENVIRONMENTAL COMPLIANCE 40

H.6 OTHER REQUIREMENTS 41

SECTION I: OTHER INFORMATION 49

ATTACHMENT 1: STANDARD PROVISIONS 50

ATTACHMENT 2: INITIAL ENVIRONMENTAL EXAMINATION 52

ATTACHMENT 3: ABBREVIATIONS AND ACRONYMS 61

Amendment No. 2 NOFO No. 72048225RFA00002

Strengthening Malaria Control for High-Risk Communities

SECTION A: BASIC INFORMATION

A.1 EXECUTIVE SUMMARY

The Strengthening Malaria Control for High-Risk Communities (SMCHC) Activity will expand and strengthen malaria services in high burden communities in Burma and Thailand. SMCHC will strengthen and work through local organizations including community-based organizations (CBOs) in areas where people are at risk of malaria due to increasing malaria incidence. SMCHC contributes to the U.S. President’s Malaria Initiative’s (PMI’s) strategic objectives of reducing malaria deaths and cases in high-burden countries and eliminating malaria in the Greater Mekong Subregion (GMS). The Activity will also work to achieve the Agency’s goals to increase localization by delivering services through local partners and building their capacity for increased impact, ownership, and sustainability of malaria control and prevention services reaching high-risk populations and communities.

A.2 ESTIMATE OF FUNDS AVAILABLE AND NUMBER OF AWARDS CONTEMPLATED

USAID intends to award one 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 $18,000,000.00 in total USAID funding over a five-year period, which includes an Unfunded Budget Allocation or “Opportunity Node” of $3.0 million inclusive of indirect costs.

This unfunded budget allocation of $3.0 million is not guaranteed. The opportunity node is intended to facilitate the prompt expansion of programming should circumstances warrant.

Circumstances warranting the expansion of activities include expanding the geographic focus of implementation, intensifying an element(s) of the activity or responding to unforeseen risks or crises within the broad activity objectives described herein. The Opportunity Node will be activated through a bilateral modification to this award and will only be made available at the sole discretion of USAID.

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.

A.3 START DATE AND PERIOD OF PERFORMANCE FOR FEDERAL AWARDS

The anticipated period of performance is five years. The estimated start date will be within the second quarter of fiscal year 2025.

A.4 AGENCY POINT OF CONTACT

Name: Ms. Nalinee Wichetthumsak Title: Acquisition and Assistance Specialist

Strengthening Malaria Control for High-Risk Communities

Email: nwichetthumsak@usaid.gov

A.5 ACQUISITION AND ASSISTANCE OMBUDSMAN

The A&A Ombudsman helps ensure equitable treatment of all parties who participate in USAID’s acquisition and assistance process. The A&A Ombudsman serves as a resource for all organizations who are doing or wish to do business with USAID. Please visit this page for additional information: https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman

The A&A Ombudsman may be contacted via: Ombudsman@usaid.gov

A.6 AUTHORIZED GEOGRAPHIC CODE

The geographic code for the procurement of commodities and services under this program is 935 which means that the Recipient will be allowed to procure commodities and services from any area or country including the recipient country, but excluding any country that is a prohibited source.

[END OF SECTION A]

mailto:nwichetthumsak@usaid.gov https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman mailto:Ombudsman@usaid.gov

Strengthening Malaria Control for High-Risk Communities

SECTION B: ELIGIBILITY INFORMATION

B.1 ELIGIBLE APPLICANTS

Eligibility for this NOFO is not restricted.

While for-profit firms may participate, pursuant to 2 CFR 200.400(g), it is USAID policy not to award profit to prime recipients and subrecipients under assistance instruments. However, while profit is not allowed for sub-awards, the prohibition does not apply when the recipient acquires goods and services in accordance with 2 CFR 200.317-327, “Procurement Standards.”

This is discussed more specifically in ADS 303sai “Profit Under USAID Assistance Instruments” which can be found at this link.

Faith-based organizations are eligible to apply for federal financial assistance on the same basis as any other organization and are subject to the protections and requirements of Federal law.

Additionally, USAID welcomes applications from organizations that have not previously received financial assistance from USAID. Each applicant must be found to be a responsible entity before receiving an award. The Agreement Officer (AO) may determine that a pre-award survey is required in accordance with ADS 303.3.9.1 to determine whether the applicant has the necessary organization, experience, accounting and operational controls, and technical skills – or ability to obtain them – in order to achieve the objectives of the program and comply with established U.S. Government standards, laws, and regulations. Applicants who do not currently meet all USAID requirements for systems and controls may still be eligible under special award considerations and should not be discouraged from applying. The prime recipient is encouraged to promote involvement of “underutilized” partners and local organizations in the implementation of this activity.

Each organization is limited to one application submission under this NOFO as the prime Applicant. There is no limitation on being included as a potential sub-awardee across multiple applications. The use of exclusive teaming arrangements is strongly discouraged. USAID will not accept applications from individuals.

B.2 COST SHARING OR MATCHING

There is no cost share requirement for the award issued under this NOFO.

[END OF SECTION B]

https://www.usaid.gov/about-us/agency-policy/series-300/references-chapter/303sai

Strengthening Malaria Control for High-Risk Communities

SECTION C: 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 H.

C.1 OVERVIEW

The Strengthening Malaria Control for High-Risk Communities (SMCHC) Activity will expand and strengthen malaria services in high burden communities in Burma and Thailand. SMCHC will strengthen and work through local organizations including community-based organizations (CBOs) in areas where people are at risk of malaria due to increasing malaria incidence. SMCHC contributes to the U.S. President’s Malaria Initiative’s (PMI’s) strategic objectives of reducing malaria deaths and cases in high-burden countries and eliminating malaria in the Greater Mekong Subregion (GMS). The Activity will also work to achieve the Agency’s goals to increase localization by delivering services through local partners and building their capacity for increased impact, ownership, and sustainability of malaria control and prevention services reaching high-risk populations and communities.

C.2 BACKGROUND

Malaria Epidemiological Situation

Between 2012 and 2019, Burma made substantial progress towards malaria elimination, reducing cases by 88% and deaths by 97%. However, disruptions in malaria prevention and case management services caused by COVID-19 in 2020 and the February 2021 military coup, with resultant violence and collapse of the public health system have contributed to a 200% increase in malaria cases from 2019-2023. Since 2019, there has been an upward trend of malaria cases increasing annually. This exponential surge has led to Burma becoming the primary contributor to malaria in the GMS, accounting for 92% of the region’s cases in 2023, up from 53% in 2019.

Notably, malaria cases increased significantly along Burma’s border with Thailand, China, Bangladesh and India, with an increase of over 400% in Thailand’s border areas since 2021.

(Reference: WHO Mekong Malaria Elimination Epidemiological Reports).

Approximately 32 million people in Burma reside in areas that place them at risk for contracting malaria, 4.9 million of whom live in 52 townships along Burma’s international borders. In 2022, 72% of malaria cases (114,102) were reported from these 52 townships, representing a 163% increase in cases in these townships compared to 2019. Mobile, migrant populations are most at risk of malaria as they move between low and high transmission areas and have intermittent access to health services. Exposure to forested areas, where these risk populations may work or stay temporarily, increases their risk of malaria due to the higher prevalence of malaria infected mosquitoes, poor sleeping conditions and distance to health services.

Strengthening Malaria Control for High-Risk Communities

Widespread disruption to malaria services in the years following the COVID-19 pandemic and military coup, contributed to the spikes in malaria cases observed. For example, in 2023, 30% of the people suspected of having malaria received a positive test result in some PMI supported villages, where historically the average was around 5% of total suspected cases. The malaria upsurge is particularly apparent in 15 townships along the Thai-Burma border, where 60,829 cases constituted 38% of the total malaria cases for 2022.

The situation in Burma is a serious threat to the regional goal of eliminating malaria, and poses the risk of emergence and spread of multi-drug resistant malaria in neighboring countries and beyond. As people have become internally and externally displaced, they have been forced to live outdoors without personal protection tools, such as bed nets, and treatment services in the high burden areas, including inside Thailand. This has contributed to malaria making a dramatic comeback in Thailand since the military coup, with cases spreading into previously low burden areas in more recent months. The number of reported malaria cases in Thailand has increased more than five-fold from 3,266 in 2021 to 16,692 in 2023, with approximately 60% of these cases imported from Burma.

Post-coup Political Context and Health Service Delivery

The February 2021 coup d’état severely destabilized key social sectors, including health and education, and led to massive internal displacement of people, including ethnic minorities and communities living in hard to reach and high transmission areas. According to UNHCR, as of June 17, 2024, nearly 3.2 million people are internally displaced and more than 59,500 people1 remain displaced across borders without sufficient access to health services. In 2022, 50% of public sector health workers remained on strike to protest the coup, down from a peak of 75% in 2021. The strike, referred to as the Civil Disobedience Movement (CDM), created a huge vacuum across public sector facilities of qualified and experienced health workers, and has disrupted the functionality of community health activities. According to the available information, malaria service provision dropped by 46% in 2021 compared to 2020; reported testing decreased by 73% in public health facilities and by 36% at the community level (Burma Malaria Operational Plan FY2023). As of March 2024, more than 70% of healthcare workers are estimated to have left the country.2

The health commodity supply in conflict-affected areas is erratic due to a combination of factors, including security threats, travel restrictions and transportation difficulties. Stockouts of essential health commodities, including malaria commodities, are very common.

The health information management system in the Activity focus areas is fragmented and unable to provide reliable, timely and complete information on health determinants, health status and health system performance.

Alignment with USAID/Burma and USAID/RDMA’s Strategic Framework and PMI goals

2 https://www.thinkglobalhealth.org/article/myanmar-health-care-has-become-battleground

1 https://data.unhcr.org/en/country/mmr

Strengthening Malaria Control for High-Risk Communities

The SMCHC supports USAID/Burma’s 2024-2027 Strategic Framework (SF) goal of strengthening Myanmar’s pathway to a prosperous, inclusive democracy amid a brutal civil war. The Activity contributes to the SF’s Development Objective 3 (DO3): Prevent and Respond to Health Crisis to Save Lives amidst Myanmar’s Failing Public Sector. In line with DO3, working with community and community based organizations, SMCHC will support all three intermediate results (IRs); 1:

Deliver life-saving health services to underserved and at-risk populations; 2: Strengthen ailing health systems to improve quality and reach of services and; 3: Mobilize and empower communities to promote and secure the health of their people- to deliver lifesaving health services to under-served and at risk populations in high transmission areas in Burma. This Activity also supports USAID/Regional Development Mission in Asia (RDMA)’s “Regional Development Objective 4: Regional Response to Health Threats Improved” and USAID/PMI’s strategic objective of reaching the unreached and most vulnerable populations.

The Activity is part of the U.S. President’s Malaria Initiative’s goal of working with PMI-supported countries and partners to further reduce malaria deaths and substantially decrease malaria morbidity toward the long-term goal of elimination. With partners, PMI will maximize program efficiency by addressing five focus areas; reach the unreached, strengthen community health systems, keep malaria services resilient, invest locally, and innovate and lead.

The Activity will also work to achieve PMI and USAID goals to increase localization building capacity at the local level for increased impact, ownership, and sustainability. The Activity contributes to the U.S. Embassy Integrated Country Strategy (ICS) objective aimed at mitigating sources of fragility and transnational health threats by promoting healthy and resilient people, and the ICS sub-objective to improve Burma’s capacity to prevent, detect and respond to infectious disease threats.

Geographic Focus

SMCHC will primarily support malaria prevention and control activities in high transmission townships, across Tanintharyi Region, Mon State, Kayin State and Kayah State, as well as on the Thai side. Analysis of the malaria situation over the past four years found that over 70% of malaria cases came from 52 townships of which, in 2022, 53% of the cases (60,829 out of 114,102) were reported from 15 townships. Thus, SMCHC will focus activities on these 15 townships, found in Tanintharyi (5), Mon (1), Kayin (4), Kayah (3), Kachin (1), and South Shan (1) regions/states. The program will also remain open to expanding to townships and affected provinces/districts in Thailand along the border depending on the malaria transmission, service gaps, resource availability and programmatic needs driven by the epidemic situation.

In Burma, the township is the administrative unit for malaria control, and the townships to be supported under this Activity will be finalized following consultations with other malaria donors (the Global Fund and Access to Health (A2H)), and implementing partners including local organizations and CBOs operating in the area to ensure coordinated, comprehensive coverage of malaria services. Consultations and coordination may also be needed with relevant Provincial and District Health Offices in Thailand.

Strengthening Malaria Control for High-Risk Communities

Development Partners

While PMI is the second largest donor to Burma’s malaria program, there are many other donors and partners in the health sector with whom PMI and the applicant will need to coordinate with to increase effectiveness of interventions and reduce duplication of efforts.

Gender and social inequality

There are many ways in which gender can influence who gets malaria and how it is treated.

Biological susceptibility, social, economic and cultural factors influence malaria risk, vulnerability, infection and severity. For example, women and children are biologically more susceptible to malaria infection whilst social norms may influence risk and exposure to malaria due to gendered occupational and domestic roles. In the Greater Mekong Subregion (GMS), malaria has tended to be concentrated in young men. For women, studies suggest that their risk is heightened during outdoor work such as collecting water, fuel, cooking and agricultural activities, and during pregnancy.

Gendered social and cultural norms also influence whether, how, where and when people access and adhere to malaria prevention tools, services and treatment, for example women may lack information, agency and the financial means to seek malaria services and men may be reluctant to use a mosquito net when traveling away from the home as this is perceived a woman’s domestic task. Other considerations for how gender may affect malaria risk and access to services include: economic and decision-making power, geographic and logistical barriers, healthcare infrastructure and availability, cultural and linguistic barriers and transportation.

Gender responsive strategies are therefore crucial in malaria programs in Burma’s high burden areas, particularly due to the unique political, security, social and economic dynamics in the region and how these affect different groups.

Addressing the aforementioned challenges requires a multifaceted approach that includes improving the health care delivery system, providing contextually appropriate services, and empowering women within their communities to participate in health decision-making processes. Community health workers (CHWs) can play a pivotal role in overcoming the challenges faced by women in accessing malaria services in the Burmese high transmission areas.

Due to ethnic and cultural diversity it is important to address social norms, roles, and inequalities affecting health outcomes which are vital for improving access to quality services for all at-risk populations, boosting community participation and ultimately, reducing malaria morbidity and mortality.

C.3 PROBLEM STATEMENT

Malaria transmission is increasing significantly in certain high burden areas where hard-to-reach and mobile and migrant populations and communities are at greatest risk, lack access to effective services and are increasingly exposed. The critical challenges and barriers to

Strengthening Malaria Control for High-Risk Communities accelerating malaria control and prevention services in high transmission areas of Burma include:

● Weak and fragmented health care delivery systems in hard to reach and high malaria transmission areas due to armed conflicts, which have disrupted health commodity distribution systems, health information systems, and health service delivery programs.

● Shortage of trained health workers, particularly at the community level and limited number of functioning health facilities that are close/accessible to the affected communities.

● Limited availability and access to quality malaria prevention and treatment services, particularly among hard-to-reach communities and forest goers in high transmission areas.

● Heightened risk factors for people in malarious areas, including: insufficient knowledge of malaria transmission and importance of prevention strategies, inadequate shelter/housing which increases mosquito exposure, suboptimal use of prevention and treatment services, and lack of contextually appropriate approaches and tools for social behavior change efforts.

Targeted strategies to reach at-risk populations and innovative approaches to strengthen local health systems and deliver services are essential to reduce malaria morbidity and expand malaria prevention and control efforts. These approaches must be contextualized for conflict settings and designed to reach high risk mobile and underserved communities, and tailored to ensure affected communities are willing and able to use these interventions appropriately.

Development Hypothesis

IF coordinated malaria prevention, diagnostic, and treatment services are expanded for the communities in high-burden and hard to reach areas in Burma AND community-led health systems are strengthened THEN the malaria surge in those communities will be controlled and malaria morbidity and mortality will be reduced.

C.4 ACTIVITY DESCRIPTION

PURPOSE

The purpose of the Strengthening Malaria Control for High-Risk Communities (SMCHC) activity is to reduce malaria morbidity and mortality through the most effective interventions that strengthen the health care delivery system, expand access to malaria control and prevention services and activities, and increase the demand and use of these services to reduce the malaria burden in high risk populations and communities.

OBJECTIVES

The objectives of SMCHC are:

Strengthening Malaria Control for High-Risk Communities

1. To expand access to high-quality malaria preventive, diagnostic, and treatment services

2. To strengthen the capacity of local health systems and health workers including community health workers, to deliver malaria services to under-served populations

3. To increase the demand for and uptake of malaria preventive, diagnostic, and treatment services

SMCHC will strengthen and improve the capacity of local organizations and CBOs in supported areas to lead, plan, manage, and implement malaria prevention and control interventions, using an approach that promotes local ownership, sustainability, and builds local-level health systems.

SMCHC will build the knowledge and skills of the health workforce in project areas, assist with optimizing the management of commodity supply chains, and improve malaria surveillance systems in order to better inform and target malaria interventions. This Activity will improve access to, and quality of malaria case management and vector control interventions, such as bed nets and repellents, complemented by targeted social behavior change interventions. The Activity specifically aims to develop more effective methods to reach high-risk populations and communities, including remote and hard-to-reach populations, forest-goers, mobile and migrant populations within the focus states/regions/provinces.

The Activity will be planned, implemented, and monitored in close coordination with other PMI-funded partners, including those in Thailand; other USG partners, and other development partner programs, engaging at the township, state/region levels. SMCHC will engage communities, humanitarian organizations, the private sector, local organizations, CBOs and civil society groups throughout implementation. Finally, a flexible and adaptive approach tailored to the local context will be needed to optimize current interventions and explore innovative approaches and promising new tools.

Objective 1: To expand access to high-quality malaria preventive, diagnostic, and treatment services

Malaria control in high transmission areas, especially areas experiencing a surge in malaria cases, requires expanded malaria case management and vector control interventions delivered through community based, facility based and private sector channels. Local and community-based health services must be in place to provide full access to accurate diagnosis and effective treatment for everyone at risk of malaria on both sides of the border. Innovative, effective and targeted approaches in the delivery of malaria control and response are needed to reach high risk populations and communities including those that are mobile. The strategies shall address the whole spectrum of malaria case management down to community levels, accurate diagnosis, adherence to established Malaria Treatment Guidelines (MTGs) for falciparum and non-falciparum malaria, patient adherence to complete treatment, malaria case reporting, and appropriate follow up. Effective malaria control requires achieving universal coverage of vector control interventions for at-risk populations. Insecticide treated nets (ITNs), including hammock nets, are a core malaria prevention measure in Burma, widely used to reduce transmission and provide personal protection. In addition, PMI technical guidance supports the procurement of selected U.S. Environmental Protection Authority (USEPA) registered topical repellents and promotes their use for migrant and mobile workers in elimination settings in the Greater Mekong Sub region. The Activity shall support periodic mass

Strengthening Malaria Control for High-Risk Communities

ITN distributions targeting endemic villages, and ad hoc targeted and reactive distributions in the event of outbreaks, confirmed transmission foci in target areas. Support is also required for continuous ITN distribution channels, particularly through antenatal clinics (ANC), schools, mobile clinics and community gatherings. The Activity is also expected to support procurement and distribution of quality-assured malaria commodities, including ITNs and topical repellents for mobile forest workers, supplied through special malaria clinics and volunteers at forest entry points. In addition, implementation of novel vector control tools and personal protection measures as appropriate for at-risk, high-exposure populations will be supported as directed by

PMI.

Illustrative Expected Results

● Increased number of malaria service delivery points

● Increased number and quality malaria testing and treatment services, accessible to the affected communities

● Decreased test positivity rates among at-risk and target groups

● Increased number of at-risk populations protected through vector control interventions

Illustrative Indicators

● Total Number of tested and confirmed malaria cases (Rapid Diagnostic Test (RDT) and/or Microscopy)

● Test positivity rate disaggregated by community, health facility and private facilities

● Number of severe malaria cases and malaria related deaths

● Total number of confirmed P. vivax cases that received radical cure with primaquine

● Number of ITNs/topical repellents distributed to beneficiaries

Objective 2: To strengthen the capacity of local health systems and health workers including community based health workers to deliver malaria services to high risk, under-served populations and communities.

Malaria control, prevention and elimination require coordinated, well-functioning health system components. The health systems in the Activity target areas currently face many challenges.

These challenges are both input related (e.g. human resources, physical infrastructure, lack of commodities and financial resources) and functional (supply chain, health management information system, supportive supervision, and project management). The health workforce needs support to acquire additional technical competencies, knowledge and skills to lead malaria control and elimination efforts, including but not limited to enhanced capacity for program planning, implementation, management and monitoring and evaluation. Local community based organizations and community health/malaria workers are critical to delivering services to high risk populations and communities, as they are on the front lines experiencing the increase in malaria transmission and identify most of the malaria cases. Support for strengthening community/malaria health workers’ malaria knowledge and competence in

Strengthening Malaria Control for High-Risk Communities delivering services is a critical aspect of strengthening the overall health systems for improved malaria control and response.

Illustrative Expected Results

● Strengthened human resource capacity of local organizations and CBOs for malaria services, leadership, coordination, and program management.

● Procurement and distribution of quality assured malaria treatment and prevention commodities.

● Improved health commodity management and supply chain system.

● Improved health information systems and malaria surveillance to inform and target malaria interventions.

● Improved community/malaria health workers knowledge and competency in malaria treatment and response

Illustrative Indicators:

● Number of community/malaria health workers trained and retained per quarter.

● Increased competence of community/malaria health workers in malaria case management

● Percentage change in correct performance of diagnostic (RDT) steps pre- and post-training

● Number of malaria RDTs purchased with US Government (USG) funds.

● Number/percentage of facilities/service delivery points with no stock outs of first line treatments for 3 months.

Objective 3: To increase the demand for and uptake of malaria preventive, diagnostic, and treatment services

The design and implementation of evidence-based, innovative, and appropriate Social and Behavior Change (SBC) strategies and tools are key to boosting the utilization of malaria interventions. The strategies and tools shall address the whole spectrum of malaria interventions including care seeking, appropriate use of services, patient adherence as well as provider adherence to established malaria guidelines, appropriate follow up, and reporting. SBC strategies engage at multiple levels, ranging from individual interaction to community-level activities that create an enabling environment for using health services. Consideration for maximizing SBC activities to effectively reach high risk, mobile populations and communities will be critical. SMCHC will implement SBC strategies through a variety of channels, employing messaging in appropriate languages and interventions that are tailored to the specific priority audiences. SBC activities will motivate and enable people to seek and use malaria prevention, testing, and treatment services, and to adhere to approved malaria treatment regimens.

Illustrative Expected Results

● Increased use of malaria prevention methods, especially among at-risk populations

● Increased uptake of malaria testing and treatment

Strengthening Malaria Control for High-Risk Communities

Illustrative Indicators

● Number and type of SBC activities carried out on prevention methods

● Number of people reached through SBC activities

● Percentage of people who sought treatment within 24 to 48 hours after the onset of fever

● Percentage of people who have slept under an ITN the previous night disaggregated by children under five, pregnant mothers, and those that own an ITN.

Across each of these objectives, the crosscutting theme localization will be present.

Programmatic innovations will include interventions adapted to a complex conflict environment, whilst innovative tools, such as digital tools and dashboards to enhance surveillance, topical and potentially spatial repellents for vector control, non-traditional case management approaches, for example mobile clinics to reach high risk populations and communities will be piloted and/or implemented. In terms of localization, malaria commodities will be procured locally where possible, and capacity building of local organizations and CBOs to strengthen health service delivery will be a key focus.

C.5 EXPECTED PERFORMANCE INDICATORS, TARGETS, BASELINE DATA, AND DATA

COLLECTION

Measuring Progress

Rigorous monitoring and collection of input, process, output and outcome indicators by the Activity is expected throughout the life of the Agreement to enable performance monitoring.

The Activity’s monitoring, evaluation and learning (MEL) plan will provide a basis to track progress against the indicators and targets. The Agreement Officer’s Representative (AOR) will conduct periodic performance reviews to monitor the progress and achievement of indicator targets and/or completion of major tasks under this Agreement.

Measurable results and targets will be determined as a result of a baseline analysis and progress against targets will be reported on a quarterly basis. Results and targets will be revisited on an annual basis as part of the work plan process to ensure that success factors are being assessed and addressed appropriately.

Data Analysis and Use

The Activity is expected to use data to monitor progress towards agreed results/targets, to evaluate outcomes and impact, and to effectively manage and adjust interventions based on evidence. A baseline survey will be conducted within the first three months of the activity award. It will serve as a reference point for measuring progress throughout the activity lifecycle.

Despite challenges such as limited information and data access, conducting a situation analysis and baseline survey helps establish the baseline effectively. The survey will guide the selection of appropriate targets for the indicators to track desired outcomes.

The Activity shall:

Strengthening Malaria Control for High-Risk Communities

i. Conduct a situation analysis and/or baseline survey to establish the baseline and set annual targets of selected performance indicators.

ii. Use available malaria surveillance data and program information for continuous epidemiological monitoring, for routine quarterly and annual reporting, and for program decision making.

iii. At the request of PMI, conduct secondary analyses of program and epidemiological data including other donor program data, population-based surveys, and other special surveys.

The performance indicators will be finalized during co-development and MEL plan approval. The selected organization will need to carefully select those indicators based on their applicability to the intervention, feasibility of data collection, and produce data on the indicators at the frequency and level of disaggregation required by USAID; indicators may increase in number and/or levels of disaggregation over time as the program nears control of malaria. Quantitative and qualitative approaches to measure changes and will be used to guide interventions.

Monitoring, Evaluation and Learning (MEL) consideration

Monitoring, Evaluation and Learning (MEL) is critical to the successful implementation of the Activity. USAID/Burma, in conjunction with the wider USG efforts in Burma, and USAID/RDMA, as needed, will evaluate progress by monitoring selected indicators and assessing these in relation to the targets and overall outcomes set by the Activity. Data quality is a critical component of the Activity and thus must utilize systems to ensure data quality and must be prepared for data quality assessment.

The Activity will establish a rigorous monitoring and evaluation system for the program, including adequate staffing, technical support and systems for routine data collection. The Recipient will work closely with USAID/Burma and RDMA to refine indicators, performance targets for each indicator based on the most recent results and finalize a MEL plan that monitors progress towards achieving project objectives and results according to USAID guidelines. If the situation permits, the Activity will also work closely with USAID/Burma and RDMA to identify a process for the development and prioritization of studies/assessments and/or operations research questions that may resolve malaria control operational bottlenecks.

The recipient will be responsible for establishing the baseline of the performance monitoring indicators, data collection and analysis required by USAID for performance reporting and sharing the information in a timely manner with USAID/Burma. Relevant information sharing will create opportunities to discuss progress, identify constraints and find solutions with appropriate stakeholders. Reporting includes quarterly basis program data pertaining to surveillance, prevention, treatment and system strengthening for malaria control and prevention with sufficient levels and granularity to measure the progress and achievements.

The required frequency of reporting indicators varies, with some indicators reported monthly and quarterly, while others are reported semiannually or annually.

C.6 SPECIAL CONSIDERATIONS

C.6.1 EXISTING STRUCTURES

Strengthening Malaria Control for High-Risk Communities

SMCHC shall support existing health administrative and operational units in project areas and support health system improvement and build capacity and skills at all levels without creating parallel structures. Malaria control and prevention policy, guidelines, and strategies are to be reviewed, improved in consultation with stakeholders and implemented in the supported states/region. The intent is to equip States/Region health entities to take over ownership and implementation of all malaria control and prevention activities. Township/village structures, local organizations, CBOs, and community groups are also important for sustainability of the program. To the extent possible, the Activity shall partner with local institutions or individuals to capitalize on local knowledge and expertise and build local capacity.

Capacity strengthening, local ownership and sustainability are core principles of USAID. The Activity will incorporate capacity strengthening and transfer of knowledge and skills to local institutions and professionals. The Activity will work with the relevant state/region public health programs, and other relevant and recognized entities to achieve its objectives. At the state/regional level, the Activity is expected to work directly with the relevant health programs and actively participate in existing coordination structures. Coordination is expected at all levels and with a wide range of stakeholders in order to minimize duplication, fill the service gaps and share best practices.

The Activity shall also work at the township and community levels and with relevant stakeholders to achieve the program goal, build consensus and partnerships, and pave the way for malaria control. As feasible, USAID/Burma recommends Activity co-location, joint site visits, and joint meetings with CBOs.

C.6.2 GENDER AND INCLUSIVE DEVELOPMENT

USAID is committed to create opportunities for everyone to contribute to and benefit from development regardless of age, sex, ethnic origin, health status, family structure, sexual orientation, education, employment, income, housing, food security, safety, or any other dimensions of human diversity.

Promoting gender equality and advancing the status of women and girls is vital to achieving USAID’s development objectives. It is USAID policy that all applicants must mainstream and integrate gender into their interventions. Therefore, the applicant will be expected to demonstrate compliance with USAID Policy ADS 205, and should explicitly state how this activity supports the gender policies and strategies of the United States and the Government of Burma.

The Recipient should conduct a Gender Equality and Social Inclusion (GESI) Analysis prior to implementation. Improving gender equity in malaria programs is essential for effective and sustainable malaria control and elimination. Based on the GESI analysis, the Recipient will draft and submit an initial Gender and Inclusive Development Action Plan (GIDAP) in order to ensure that gender and social inclusion are embedded throughout the activity. Here are some strategies that will be included in the GIDAP, that SMCHC will implement:

1. Gender-Responsive Planning and Implementation:

● Integrate gender-responsive approaches in all aspects of malaria programming

Strengthening Malaria Control for High-Risk Communities

● Design interventions that address the specific needs and challenges faced by both men and women, girls and boys

2. Data Collection, Analysis and Use:

● Collect, analyze and monitor sex-disaggregated data on malaria to better understand gender disparities related to malaria and malaria interventions and how best to tailor activities to address these.

● Use tools like the Malaria Matchbox to promote more equitable and inclusive malaria strategies.

3. Community Engagement:

● Engage both men and women in community education and mobilization efforts with a gender transformative approach and appropriate methods and materials

● Train community health workers, ensuring a balance of men and women, to reach out to all segments of the population.

4. Access to Care:

● Ensure that both men and women have equal access to malaria prevention and treatment tools, such as rapid diagnostic tests, insecticide-treated nets and repellents.

● Address barriers that women may face in accessing healthcare, such as the need for husband's permission or cultural reluctance to see male health workers.

5. Focus on Vulnerable Groups:

● Pay special attention to the needs of pregnant women, who are particularly vulnerable to malaria.

● Implement strategies to increase the uptake of intermittent preventive treatment in pregnancy (IPTp) and distribution of bed nets to pregnant women.

6. Leadership and Representation:

● Promote women's leadership in malaria programs at all levels, from community health workers to community support groups.

7. Policy and Advocacy:

● Advocate for policies that support gender equality in health care access and decision-making.

● Work with local and regional entities to integrate gender considerations into malaria control policies and programs.

8. Education and Awareness:

● Raise awareness about the importance of gender equity in malaria prevention and treatment.

● Provide education on the use of malaria prevention and treatment services to risk groups both men and women.

C.6.3 COLLABORATING, LEARNING AND ADAPTING (CLA)

This activity is expected to contribute to USAID/Burma’s commitment to a multi-faceted Collaborating, Learning and Adapting (CLA) approach to development. The CLA approach is based on the understanding that development efforts yield more effective results if they are coordinated and collaborative, test promising, new approaches in a continuous yet also rapid, targeted search for generating improvements and efficiencies, and build on what works and

Strengthening Malaria Control for High-Risk Communities eliminate what doesn‘t. CLA creates the conditions for fostering broader development success by:

● Collaborating: Facilitating collaboration internally and with external stakeholders to promote increasingly national-led socio-economic development; e.g. enhancing existing stakeholder engagement into learning platforms, substantially coordinating with other USG- or other complementary activities to ensure complementarity and reduce overlap, while also facilitating learning among activities (to reduce the collective cost while enhancing shared results faster); programs that are complementary to this activity

● Learning: Generating and feeding new learning, innovations, and performance information back into the system to inform program management, design, USG policy dialogue opportunities and funding allocations; (e.g. Creating pauses for reflection within the activity implementation scheme, engaging stakeholders for shared ‘learning moments’, conducting analytical review of existing and/or new evidence that may support or contradict common understanding);

● Adapting: Translating learning (from within the implementation experience or external sources) and considering changing conditions, along the lines of the risks, assumptions and game changers, into strategic and programmatic adjustments. (e.g. adjusting work plans to account for contextual shifts or tacit learning from a team’s experience, while clearly and explicitly capturing and sharing the rationale for adjustments along the way).

C.6.4 IMPLEMENTATION FRAMEWORK

Successful malaria program implementation demands a multi-disciplinary approach and diverse group of expertise. A dedicated program and technical team with expertise and experience in health programming within humanitarian assistance settings is essential. Additionally, robust coordination and collaboration between PMI Burma and PMI USAID Regional Development Mission Asia (RDMA) as well as with different stakeholders in Burma and Thailand are critical. By fostering collaboration and leveraging diverse expertise, it could enhance the collective impact and work towards controlling malaria in these challenging regions. To achieve these goals, formation of a consortium of partners would be beneficial.

C.6.5 UTILIZATION OF SUBAWARDS

The…