Amendment 1 - Annex A - Strengthening Systems for Health Security Activity - RFA 72052725RFA00001.pdf

Issue Date: October 18, 2024 Business Day Date: November 07, 2024 Deadline for Questions: November 15, 2024 at 05:00 PM Lima Time Deadline for Applications: December 20, 2024 at 05:00 PM Lima Time

December 16, 2024 at 12:00 PM Lima Time

Subject: Notice of Funding Opportunity (NOFO) No. 72052725RFA00001

Program Title: Strengthening Systems for Health Security Activity (SSHS)

Greetings:

The United States Agency for International Development in Peru (USAID/Peru) is seeking applications for a Cooperative Agreement from qualified entities to implement the STRENGTHENING SYSTEMS FOR HEALTH SECURITY ACTIVITY (SSHS) program. Eligibility for this award is not restricted.

USAID intends to make one (1) 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.

Business Day

USAID/Peru is organizing a Business Day to provide a platform for presenting the activity's objectives and for the Government of Peru to outline its related priorities. The primary goal, however, is to encourage networking and collaboration among prospective applicants and stakeholders from various sectors.

The Business Day will take place on November 7, 2024 in Lima, Peru, with the venue to be confirmed within the next week at the DoubleTree by Hilton El Pardo in Miraflores, Lima, Peru.

Interested parties must RSVP by sending an email to Jose Castagnola at JCastagnola@usaid.gov by October 30, 2024 at 05:00 PM Lima Time with the subject line: USAID NOFO 72052725RFA00001 [Organization Name] – Business Day. Please include the full name, ID number, organization name, title and email of each guest in the RSVP. Only one to two guests can be accommodated.

Please be reminded that the Business Day is not specifically for Questions & Answers for the application, but a means to foster partnerships.

mailto:JCastagnola@usaid.gov

USAID NOFO No. 72052725RFA00001

STRENGTHENING SYSTEMS FOR HEALTH SECURITY ACTIVITY (SSHS)

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 NOFO and to ensure that it 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 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/

Dion Glisan Supervisory Regional Agreement Officer USAID/Peru http://www.grants.gov http://www.grants.gov mailto:support@grants.gov http://www.grants.gov

TABLE OF CONTENTS

SECTION A: BASIC INFORMATION 5

C.1. EXECUTIVE SUMMARY 5

C.2. ESTIMATE OF FUNDS AVAILABLE AND NUMBER OF AWARDS CONTEMPLATED 5

C.3. START DATE AND PERIOD OF PERFORMANCE FOR FEDERAL AWARDS 5

C.4. AGENCY POINT OF CONTACT 5

C.5. ACQUISITION AND ASSISTANCE OMBUDSMAN 6

C.6. AUTHORIZED GEOGRAPHIC CODE 6

SECTION B: ELIGIBILITY 7

B.1. ELIGIBLE APPLICANTS 7

B.2. COST SHARING 7

SECTION C: PROGRAM DESCRIPTION 8

C.1. CONTEXT 8

C.2. PROBLEM STATEMENT 9

C.3. THEORY OF CHANGE 9

C.4. RESULTS FRAMEWORK 9

C.5. MAGNITUDE OF CHANGE 18

C.6. MONITORING, EVALUATION, AND CONTINUOUS LEARNING 19

C.7. SUBSTANTIAL INVOLVEMENT 21

SECTION D: APPLICATION CONTENT AND FORMAT 23

D.1. GENERAL CONTENT AND FORM OF APPLICATION 23

D.2. TECHNICAL APPLICATION FORMAT 24

D.3. BUSINESS APPLICATION FORMAT 32

SECTION E: SUBMISSION REQUIREMENTS AND DEADLINES 45

E.1. QUESTIONS AND ANSWERS 45

E.2. SUBMISSION REQUIREMENTS 45

E.3. UNIQUE ENTITY IDENTIFIER (UEI) AND SAM.GOV REGISTRATION 46

SECTION F: APPLICATION REVIEW INFORMATION 48

F.1. RESPONSIVENESS REVIEW 48

F.2. MERIT REVIEW CRITERIA 48

F.3. REVIEW AND SELECTION PROCESS 50

F.4. RISK REVIEW 51

SECTION G: AWARD NOTICES 52

G.1. FEDERAL AWARD NOTICES 52

SECTION H: POST-AWARD REQUIREMENTS AND ADMINISTRATION 53

H.1. ADMINISTRATIVE & NATIONAL POLICY REQUIREMENTS 53

H.2. NATURE OF THE RELATIONSHIP BETWEEN USAID AND THE RECIPIENT 53

H.3. REPORTING REQUIREMENTS 53

ANNEX I - RESULTS FRAMEWORK 64

ANNEX II - SUMMARY BUDGET TEMPLATE 65

ANNEX III - STANDARD PROVISIONS 66

ANNEX IV - ABBREVIATIONS AND ACRONYMS 69

ANNEX V - INITIAL ENVIRONMENTAL EXAMINATION (IEE) 71

SECTION A: BASIC INFORMATION

C.1. EXECUTIVE SUMMARY

The purpose of this Strengthening Systems for Health Security Activity is to help Peru build robust capabilities in preventing, detecting, and responding to infectious disease and health threats to ensure national and global health security (GHS). This activity will operate at the national, regional, and local level; supporting Peru in developing and sustaining its own capacity to prevent, rapidly detect, effectively respond to, and ultimately recover from emerging infectious disease threats, allowing the Mission to reach Global, Agency, and Government of Peru (GOP) Global Health Security targets.

The Strengthening Systems for Health Security Activity will develop evidence-based and system strengthening interventions to meet the following three objectives:

● Objective 1: Better Prevention Of Infectious Diseases Through The Reduction Of Disease Transmission From Animals To Human Populations

● Objective 2: Better Detection Of Infectious Diseases Through Improved Surveillance Systems

● Objective 3: Effective Response To Infectious Disease Outbreaks Through A Skilled And Competent Health Security Workforce

This activity will be a Cooperative Agreement and awarded through a full and open competitive solicitation. Interested US and non-US organizations are encouraged to submit an application following the instructions as indicated in this NOFO. The Total Estimated Amount of the award is $19 Million, with an expected life of five years, beginning on or around early 2025.

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

USAID intends to award one (1) Cooperative Agreement pursuant to this Notice of Funding Opportunity (NOFO).

Subject to funding availability and at the discretion of the Agency, USAID intends to provide up to $19,000,000 (USD) in total USAID funding over a 5 (five) year period.

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

The anticipated period of performance is 5 (five) years. The estimated start date will be upon the signing of this award.

C.4. AGENCY POINT OF CONTACT

The Agreement Officer (AO) for this NOFO is:

Ms. Dion Glisan Supervisory Regional Agreement Officer USAID/Peru Email: dglisan@usaid.gov.

The Acquisition and Assistance (A&A) Specialist for this NOFO is:

Mr. Luis Garay A&A Specialist USAID/Peru Email: lgaray@usaid.gov

C.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.

C.6. AUTHORIZED GEOGRAPHIC CODE

The geographic code for the procurement of commodities and services under this program is 937 (the United States, the recipient country, and developing countries other than advanced developing countries, but excluding any country that is a prohibited source). Except as may be specifically approved in advance by the Agreement Officer, all commodities and services that will be reimbursed by USAID under this award must be from the authorized geographic code specified in this NOFO, and must meet the source and nationality requirements set forth in 22

CFR 228.

[END OF SECTION A – BASIC INFORMATION]

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

SECTION B: ELIGIBILITY

B.1. ELIGIBLE APPLICANTS

Eligibility for this NOFO is not restricted. U.S. and non-US organizations may participate under this NOFO.

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.

Interested and eligible prime applicants may submit no more than one (1) application under this NOFO. An organization can submit applications as a sub-partner for multiple prime applicants.

B.2. COST SHARING

USAID has established a minimum recipient cost share of 10% (ten-percent) of the Total Estimated Amount for both Local and Non-Local Organizations. Such funds may be provided directly by the recipient; other multilateral, bilateral, and foundation donors; host governments;

and local organizations, communities and private businesses that contribute financially and in-kind to implementation of activities at the country level. This may include contribution of staff level of effort, office space or other facilities or equipment which may be used for the program, provided by the recipient. For guidance on cost sharing in federal financial assistance see 2 CFR

200.306. Applicants may refer to Section D, Application Content and Format, regarding requirements for the submission of letters or other documentation to verify commitments to meet cost-sharing requirements.

For guidance on cost sharing in grants and cooperative agreements see 2 CFR 200.306 and see ADS 303.3.10. Specific for U.S. NGOs, see 2 CFR 200.306; and for Non-U.S. NGOs, all cost sharing will be subject to the Required as Applicable Standard Provision “Cost Share” in ADS 303mab.

[END OF SECTION B – ELIGIBILITY]

https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-D/section-200.306 https://www.usaid.gov/about-us/agency-policy/series-300/303 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-D/section-200.306 https://www.usaid.gov/about-us/agency-policy/series-300/references-chapter/303mab

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.

STRENGTHENING SYSTEMS FOR HEALTH SECURITY ACTIVITY

C.1. CONTEXT

Global Health Security (GHS) is the capacity to properly prevent, detect, and respond to health emergencies, including new and emerging infectious diseases. Health security is not limited to national boundaries, but must be addressed at regional and global levels. The high level of interconnectivity and rapid travel between different parts of the world facilitates the rapid spread of infectious diseases. For this reason, it is key that all countries in the world have strong health security capabilities to be able to contain an infectious disease at its origin before it becomes a larger health emergency. The GHS landscape in Peru is shaped by a complex interplay of various factors, including a high incidence of infectious diseases, inadequate healthcare infrastructure, sub-optimal epidemiological surveillance systems, and limited emergency response capabilities, among others. The country's geographical diversity, stretching from the Amazon rainforest to the Andes and coastal regions, increases the probability of the occurrence of emerging and re-emerging infectious diseases. Simultaneously, factors such as poor health governance, high turnover of authorities, poor stewardship from health leaders, corruption, and inadequate investment in health infrastructure and human resources further compound the challenges in demonstrating optimal health security capabilities. Peru's current health security context worsens existing equity gaps given that some groups (rural, urban poor, people with disabilities, etc.) are disproportionately at higher risk for and more exposed to infectious diseases. These factors complicate the planning, implementation, and sustainability of health security measures, heightening the vulnerability of the health system against public health emergencies and disease outbreaks.

Peru lacks an articulated system for Global Health Security (GHS). Previous responses to public health emergencies and outbreaks, such as COVID-19, dengue fever, and recently avian influenza, reveal these weaknesses. For instance, Peru's per capita death rate from COVID-19 was the worst in the world, far higher than any of its neighbors in South America and twice the rate of the United States. As of November 2021, Peru had experienced 670 deaths due to COVID-19 per 100,000 people (out of a total of 220,831 deaths) . Additionally, dengue fever has1 caused higher lethality rates in the first six months of 2024 than in previous years, and is spreading throughout the country. Peru’s poor GHS capabilities are exacerbated by other factors such as climate change, which increases the prevalence of vector-borne diseases, causes changes in ecosystems (leading to greater contact between animals and humans and a higher risk of zoonoses), and leads to the migration of populations towards more urban areas, which might not

1 WHO COVID-19 Dashboard. https://data.who.int/dashboards/covid19/cases https://www.niaid.nih.gov/research/emerging-infectious-diseases-pathogens have adequate health measures in place. Additionally, the country's geography (coast, highlands, and Amazon) makes it more difficult for the State to access more remote areas. Peru's decentralized health system suffers from the lack of coordination in the face of national health emergencies, as well as weaknesses in management and administration capacity, which generate inequities in the quality of and access to healthcare services. These examples make it clear that Peru is not prepared to contain a health emergency if one should emerge within its territory, becoming itself a threat to the region and to the world.

In 2005, the WHO published the International Health Regulations (IHR), which outline the basic capacities that a country must have to achieve good health security. There are several tools to evaluate health security capacities, all of them require a process carried out at the national level that evaluates a country's capacities to meet the requirements of the IHR. Some of these tools are self-administered like the States Party Self-Assessment Annual Report (SPAR) that is conducted annually, and others are carried out with the intervention of external evaluators such as the Joint External Evaluation (JEE) and the Voluntary External Evaluation (VEE). Peru has been consistently carrying out and reporting the results of its annual self-assessment (SPAR) to the WHO since 2012. It is noteworthy that, in the most recent 2023 SPAR, Peru's average score was 36%, far below the global (64%) and regional (64%) averages, demonstrating severe deficiencies in GHS. Peru’s 2023 States Parties Self-Assessment Annual Reporting (SPAR) Scores depict Peru’s existing, yet fragile, GHS capacity.

C.2. PROBLEM STATEMENT

Peru’s weak health system and poor capabilities to prevent, detect, and respond to infectious disease and other health threats compromise national and global health security, specifically given its weaknesses across three technical areas (Zoonotic Diseases, Surveillance, and Health Security Workforce).

C.3. THEORY OF CHANGE

This Activity is expected to work on testing the following theory of change:

IF risk of disease transmission from animals to humans is reduced, AND

IF disease surveillance systems are improved, AND

IF skills of Peru’s health security workforce are strengthened, THEN Peru will be able to better prevent, detect, and respond to infectious disease and health threats, reducing the severity and occurrence of pandemics and ensuring national and global health security.

C.4. RESULTS FRAMEWORK

The Strengthening Systems for Health Security Activity (SSHS) aims to help the Government of https://www.who.int/health-topics/international-health-regulations#tab=tab_1 https://extranet.who.int/e-spar/#submission-details

Peru’s build robust capabilities to better prevent, swiftly detect, and optimally respond to infectious diseases and other health threats to ensure national and global health security. To do so, this Activity aims to improve Peru’s GHS capabilities, while adopting a One Health approach, by addressing technical gaps in three priority areas through the following objectives:

C.4.1. OBJECTIVE 1: Improving the Prevention of Infectious Diseases through the Reduction of Disease Transmission from Animals to Humans (Zoonotic Diseases);

C.4.2. OBJECTIVE 2: Improving the Detection of Infectious Disease through Improved Disease Surveillance Systems;

C.4.3. OBJECTIVE 3: Improving the Response to Infectious Disease Outbreaks through a Stronger Health Security Workforce.

C.4.1. OBJECTIVE 1: IMPROVING THE PREVENTION OF INFECTIOUS DISEASES THROUGH THE

REDUCTION OF DISEASE TRANSMISSION FROM ANIMALS TO HUMANS (ZOONOTIC

DISEASES)

The ability to timely and effectively prevent infectious diseases is hampered because of Peru’s poor surveillance and detection capacity. By not having these strong systems in place, the risk of ZOONOTIC DISEASES, the transmission of diseases from animals to human populations (i.e spillover), greatly increases. In Peru, given that 60% of its territory is in the Amazon, the potential spillover of diseases from animals to humans is significant.

Furthermore, increased interactions between animals and humans due to urbanization, deforestation, illegal mining, poor livestock handling practices, and continued wildlife subsistence farming further increases the risk of disease spillover. For example, Peru, along with other countries in the region, is currently witnessing an increase in the number of cases of Avian Influenza (H1N1) affecting bird and animal species, increasing the risk to human populations. Peru lacks regulatory operating procedures that establish2 functional coordination mechanisms among the human, animal, and environment interfaces at national and sub-national levels when preventing and responding to zoonotic disease outbreaks. With limited structured information-sharing mechanisms among the One Health interfaces, and poor animal handling practices in formal and informal sectors, untimely detecting and responding to zoonotic diseases at their points of origin becomes much more challenging. To improve Peru’s capabilities to prevent zoonotic diseases, this Activity is to present a technical approach that can best support the GOP (national and sub-national [i.e. regional]) to properly prevent zoonotic disease transmission between animals and humans, develop context specific multisectoral3 health security mechanisms that promote coordination among the One Health sectors (human, animal, environment), track emerging and endemic priority zoonotic diseases, and improve multisectoral response capacity to zoonotic disease outbreaks at their points of origin.

3 Multisectoral: that includes all the governmental organizations involved in health security such us health sector, agricultural sector, environmental sector, defense sector, production sector among others

2 Leguia, M., Garcia-Glaessner, A., Muñoz-Saavedra, B. et al. Highly pathogenic avian influenza A (H5N1) in marine mammals and seabirds in Peru.

Nat Commun 14, 5489 (2023). https://doi.org/10.1038/s41467-023-41182-0 https://doi.org/10.1038/s41467-023-41182-0

C.4.2. OBJECTIVE 2: BETTER DETECTION OF INFECTIOUS DISEASES THROUGH IMPROVED

SURVEILLANCE SYSTEMS

When faced with a potential pandemic threat or disease outbreak, Peru has limited capacity to swiftly detect infectious diseases. To better detect infectious diseases, a strong surveillance system, one that connects the human, animal, and environment interfaces, is vital. Peru’s national SURVEILLANCE SYSTEM is weak, does not have early warning capacity, and is not coordinated across the human, animal, and environment sectors. This limits Peru’s capacity to analyze real time disease surveillance data, which prevents timely detection of an infectious disease outbreak at its origin. Further, disease surveillance system capacity is far weaker at the regional level (i.e. sub-national), where it is critically important to capture a potential outbreak at its onset to avoid further spillover. Peru lacks a comprehensive national strategy and standard operating procedures that establish early warning surveillance systems and its functions at national and regional levels. The lack of an interoperable surveillance system among the animal, human, and environmental health sectors, and between national, regional, and local level governments, increases the risk of infectious diseases and outbreaks going undetected.

Lastly, Peru’s existing system and its sub-optimal workforce are not able to account for how climate change is impacting disease transmission and incidence across the human, animal, and environment sectors. To improve Peru’s infectious disease surveillance systems, this Activity is to present a technical approach that can best support the GOP (national and sub-national [i.e. regional]) to strengthen existing disease surveillance systems across the human, animal, and environment sectors. This Activity is encouraged to improve early warning disease surveillance systems, making them interoperable and climate sensitive across the human, animal, and environment sectors, and improving government capacity to collect, analyze, and interpret data on disease occurrence and patterns. With a surveillance system that delivers reliable and timely disease data, Peru will be able to better track and monitor potential disease outbreaks at their points of origin. This Activity is encouraged to promote interoperability between the Peruvian diagnostic and the surveillance system at the national and regional level to effectively detect and respond to infectious disease outbreaks more holistically.

C.4.3. OBJECTIVE 3: EFFECTIVE RESPONSE TO INFECTIOUS DISEASE OUTBREAKS THROUGH A

SKILLED AND COMPETENT HEALTH SECURITY WORKFORCE

When infectious disease outbreaks do occur, Peru lacks skilled human resources who are well equipped to mount an informed and coordinated response to minimize social, economic, and health impacts. Furthermore, Peru lacks a formal workforce strategy that plans and budgets for the number of HUMAN RESOURCES, inclusive of the human, animal, and environment sectors, needed to prevent, detect, and respond to infectious diseases and manage the health security system, and one that uses a One Health approach. Peru’s current gaps in human resources inherently limit its GHS capabilities across all GHS priority areas, and its ability to prevent, detect, and respond to infectious diseases with surge support. A health security workforce may consist of an interdisciplinary group of professionals such as physicians and nurses, public health and environmental health specialists, veterinarians, forest scouts, epidemiologists, communication experts, and other professionals relevant to the human, animal, and environmental health sectors. The existing workforce lacks ongoing and standardized training programs, continuous learning opportunities, or educational curricula that incorporate the One Health approach, limiting their prevention and response capacity.

For existing workforce development programs, such as the Field Epidemiology Training Program (FETP), it primarily targets human health personnel, and not those working on the animal and environment sectors. Additionally, Peru lacks an inclusive and holistic training program founded on One Health principles for its health security workforce. This Activity is to present a technical approach that can best support the GOP (national and sub-national [i.e. regional]) in planning for, and building and strengthening its existing and emerging health security workforce, one that is occupationally diverse and skilled and inclusive of the human, animal, and environment sectors. To help meet this objective, the Activity is encouraged to not replace core functions of existing personnel to address workforce gaps, but rather support Peru in meeting its needs with existing and emerging human resources. The Activity is encouraged to partner with public and/or private academic institutions to not only incorporate a One Health foundation across educational curricula, but to foster the development of the new generation of health security professionals. Additionally, the Activity is encouraged to identify partnerships and innovative interventions with diverse sectors that may increase career pathways for individuals interested in entering the health security workforce.

See Annex I for Results Framework Diagram.

C.4.4. CROSS CUTTING

Particular attention should focus on building the capacity of existing and new human, animal, and health government authorities with decision making power, at the national and regional level, to increase their management capabilities needed to effectively prevent, detect, and respond to infectious diseases. The Activity is encouraged to improve leadership skills and administration capacity for health authorities and support them to better govern, lead, facilitate, and organize processes, procedures, and logistics that implement globally recognized tools, such as the National Action Plan for Health Security among others. The Activity is encouraged to enhance the ability of health authorities to efficiently implement policies, transparently allocate resources, use evidence for decision making, identify and close equity gaps, mobilize available local and donor resources, and coordinate responses to public health emergencies. By strengthening management capabilities, health authorities can better oversee disease surveillance and outbreak response, ultimately protecting public health and strengthening national and global health security.

C.4.5. EVENT DRIVEN HEALTH EMERGENCY RESPONSE

This Activity shall also have the flexibility to use funding from this award to support the GOP in mounting a response to infectious disease outbreaks and other health threats with prior approval from USAID. Should this occur, this Activity is encouraged to support the GOP to institutionalize and implement the 7-1-7 Global Goal for Early Detection and https://resolvetosavelives.org/prevent-epidemics/7-1-7-early-disease-detection/

Response of disease outbreaks. The 7-1-7 international benchmark dictates “no more than 7 days to detect a suspected infectious disease outbreak, 1 day to notify public health authorities to start an investigation, and 7 days to complete an initial response”.

C.4.6. GLOBAL HEALTH SECURITY AND ONE HEALTH AT USAID

This Activity is directly aligned with the USG’s 2024 Global Health Security Strategy and more specifically, with USAID’s Global Health Security Program (2023) goal of supporting countries and regions in developing and sustaining capacity to prevent, rapidly detect, effectively respond to, and ultimately recover from emerging infectious disease threats.

This Program Description is designed to capture a whole-of-society and One Health approach to support Peru’s progress in demonstrating capacity according to the global Joint External Evaluation Tool, Voluntary External Evaluation, and/or World Health Organization benchmarks. To advance USAID’s global targets, and based on global best practices and a country-specific GHS landscape, USAID/Peru has prioritized three IHR areas to strengthen for this Activity: P5. Zoonotic diseases, D2. Surveillance, and D.3.

Health Security Workforce (inclusive of the human, animal, and environment sectors).

Given the multisectoral factors contributing to infectious disease outbreaks and other health threats, better prevention, detection and response to such outbreaks can only be effective if they are multisectoral and through a One Health approach. According to the US Government’s 2024 Global Health Security Strategy, a One Health Approach is a collaborative, multisectoral, and transdisciplinary approach working at the local, regional, national, and global levels, with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and the environment.

Additionally, this Activity was designed conceptualizing One Health using the definition of the global Quadripartite Organization’s One Health Joint Action Plan (2022-2026).

C.4.7. PERUVIAN GOVERNMENT STAKEHOLDERS IN GLOBAL HEALTH SECURITY

The administrative and political system of Peru is decentralized by design between national and regional levels to facilitate decision-making and the provision of public services. The national government, located in Lima, manages national affairs such as foreign policy and the economy. At the regional level, the country is divided into 25 autonomous regions with their own governments that handle regional development and provision of social services such as healthcare and education. At the local level, provincial and district municipalities manage matters such as local infrastructure and public services. This decentralized system aims to promote administrative efficiency, although it faces challenges in intergovernmental coordination and equitable resource distribution.

At the national level, the key Peruvian governmental institutions for health security are the Ministry of Health (MOH) hosting the National Center for Disease Epidemiology, Prevention and Control (CDC-Peru), the National Institute of Health (INS) with the National Public Health Reference Laboratories, and all health programs. Currently, the CDC-Peru serves as the focal point for the International Health Regulations in Peru, and the MOH is coordinating with other ministries and the Presidency of the Council of https://resolvetosavelives.org/prevent-epidemics/7-1-7-early-disease-detection/ https://www.whitehouse.gov/wp-content/uploads/2024/04/Global-Health-Security-Strategy-2024-1.pdf https://drive.google.com/file/d/1BSY88QOBJ8qdsJqJ8CbDn6I3mG53FVYZ/view?usp=drive_link https://www.who.int/publications/i/item/9789240051980 https://www.who.int/publications/i/item/9789241515429 https://www.who.int/publications/i/item/9789241515429 https://www.whitehouse.gov/wp-content/uploads/2024/04/Global-Health-Security-Strategy-2024-1.pdf https://www.who.int/publications/i/item/9789240059139

Ministers to ensure multisector participation in health security. The Ministry of Agrarian Development and Irrigation (MIDAGRI) oversees the National Service of Agrarian Health (SENASA), responsible for sanitary aspects of domestic and industrial animal and plant production, and the National Forest and Wildlife Service (SERFOR), which oversees wildlife health. Moreover, the Ministry of Environment (MINAM) oversees animal health in natural protected areas through the National Areas Protected by the State Service (SERNANP). These ministries establish sectoral national policies and priorities and provide guidance for their implementation, including the formulation of protocols and guidelines determining how activities are performed by their decentralized governments in Regional Governments. However, political instability and high government official turnover at all levels of government has imposed multiple challenges that prevent a coordinated multisectoral and One Health approach.

The GOP has existing budgeting and planning systems in place that allow the public health system to operate at the national level and through regional governments.

However, these systems are weak, poorly funded, and most of the health authorities charged with managing them lack managerial, budgeting, and governance skills and capacity to execute their functions. Despite this setback, the GOP is committed to improving its health security capacity to meet the IHR. The country conducted a Prioritization of Zoonoses Workshop in November 2023, an important exercise that involved multisectoral participation across the human, animal, and environmental health sectors, in an effort to improve health security through a One Health approach. In the exercise, the GOP carried out a review and analysis of an initial list of thirty-five (35) zoonotic diseases, and identified five (05) as priorities for all sectors: rabies, avian influenza, leptospirosis, cystic echinococcosis/hydatidosis, and yellow fever.

C.4.8. HEALTH SYSTEMS STRENGTHENING PRINCIPLES

This Activity is designed to advance the core health system strengthening principles of USAID’s Vision for Health System Strengthening 2030 as they relate to GHS. These principles include promoting equity by identifying and addressing gaps impacting the disproportionately disadvantaged, ensuring quality by implementing globally recognized tools and metrics, optimizing existing resources efficiently and transparently, enhancing resilience to withstand and recover from natural and manmade shocks and stressors, using evidence-driven data for decision making, and fostering locally-led leadership among national and regional health authorities. In addition to the principles mentioned above, this Activity’s scope will have the flexibility to address gaps and needs across the health systems building blocks (governance, finance, human resources, information, service delivery, and commodities/supply chain) as they relate to global health security and this Program Description.

C.4.9. GEOGRAPHIC APPROACH

This Activity will have the flexibility to work at the national level, supporting the GOP in developing and implementing policies, standards, and procedures that advance GHS.

Additionally, this Activity is to operate at the regional (i.e. sub-national) level to support https://www.usaid.gov/policy/vision-health-system-strengthening https://apps.who.int/iris/bitstream/handle/10665/258734/9789241564052-eng.pdf regional, provincial, and district government health authorities, inclusive of animal and environment government authorities (i.e. One Health), to improve local level GHS capabilities. The applicant should propose five regions to work in, from which three will be selected during this Activity’s inception phase, post award. These regions must be identified using an evidence-based approach, and may consider the following parameters:

● Prevalence of Infectious Diseases: Regions with a high incidence of zoonotic diseases, vector-borne diseases, antimicrobial resistance, or other infectious disease outbreaks and threats.

● Deficiencies in Health Security Capabilities: Regions with significant weaknesses in surveillance systems, laboratories, outbreak response, according to previous GHS evaluations, as well as areas with a shortage of trained health personnel and limited resources.

● Potential Impact on Beneficiary Population: Densely populated regions or with large urban centers, where health threats and health equity gaps could have a broader impact if unattended, as well as areas with vulnerable populations at higher risk of infectious disease.

● Geographic and Logistical Accessibility: Regions difficult to access due to their remote location or lack of infrastructure, where health capabilities are more limited, as well as border areas with a high movement of people and goods.

● Commitment and Capacity of Regional Authorities: Regions with local government commitment and political will to implement health security measures. Areas with some institutional capacity and resources available to complement interventions are ideal.

C.4.10. INCEPTION PHASE

The awardee should develop an inception plan that outlines the key activities, milestones, and deliverables needed to prepare for implementation, during the first six months of the Activity (inception phase). The goal of this phase is to provide the Activity an opportunity to calibrate the overall programmatic approach, reconfirm stakeholder commitment, operationalize the Activity’s implementation and operational approach, and address any major changes that could have occurred since the release of the Notice of Funding Opportunity. The inception phase is intended to realign stakeholders on the project vision, goals, and outcomes; conduct a detailed baseline assessment of existing gaps in zoonotic diseases, diseases surveillance and health security workforce, at the national, regional level; reconfirm and develop new partnerships with key government, non-governmental, private sector, academia, and community actors; select the three priority regions for intervention based on data-driven analysis; hire the necessary staff to implement this Activity; and complete all documents and procedures required for this award (i.e. MEL PLan, Branding and Marking Plan, Health Equity Analysis, Environmental Monitoring and Mitigation Plan, etc.).

C.4.11. SMALL GRANTS FUND

This Activity is encouraged to promote locally-led development when designing and implementing its interventions by developing Health Security Site Improvement Plans (HSSIP) for its programming at the regional level.

The HSSIPs are meant to serve as tailored and context specific system strengthening roadmaps that are co-designed with health authorities, decision makers and stakeholders. HISSPs are encouraged to be developed using the best evidence-driven methodologies to identify technical gaps in a respective work site/location, and develop realistic interventions to close them. Co-developing and implementing HSSIPs are intentionally meant to help this Activity optimize existing resources and strategic planning processes that the GOP already has in place, but be able to provide targeted technical assistance to ensure results. HSSIPs are to be living documents, to be revisited on an annual basis to monitor progress and pivot when needed.

This Activity is encouraged to consider the following principles in mind when developing each tailored HSSIP and will have the flexibility needed on how to best implement them based on context and need:

1. Analyze health security system weaknesses at the national and/or regional level.

This analysis is encouraged to include an equity gap analysis that assesses and identifies groups disproportionately affected by, at risk of, or exposed to infectious diseases in the respective site. This Activity is encouraged to use a data driven approach and gather input from a participatory process involving relevant stakeholders, including national and/or regional health authorities and other non-government community members as appropriate. This analysis aims to help health authorities identify health security technical gaps and use data to develop interventions that aim to close them at the respective site.

2. Strengthen national and/or regional health authorities’ leadership capacity to identify, coordinate, mobilize, and manage government, private sector, donor and development partner resources to help close the identified gaps to the extent possible.

3. Utilize the findings from the health security analysis to assist health authorities in crafting practical, implementable, and evidence-driven HSSIPs aimed at addressing closing technical and equity gaps.

4. Support national and/or regional health authorities with technical assistance to implement the co-developed HSSIPs in the respective site.

To implement the HSSIPs, this Activity shall have a Small Grant Fund (SGF) that will set aside funding to award targeted grants designed to address technical gaps as needed.

These grants would provide funding for procuring services or commodities, or conducting interventions that aim to fill a health security technical gap identified in the HSSIP. The SGF will aim to improve health authorities’ capacity to respond swiftly and efficiently to urgent needs of their regions. The SGF will have a range between $1,000 - $50,000 and this Activity is to propose a robust system to support regional health authorities to develop, apply, implement, monitor, and close these grants. The SGF is meant to build local health authority capacity to be executors of resources to address self-identified gaps (i.e. localization). This Activity will manage the funds according to health authorities' proposals and the findings of the HSSIPs. Note that these grants are not to be used for construction nor will be directly transferred to local government authorities. Instead, the Activity is to manage and administer the use of funds accordingly.

C.4.12. LOCALIZATION

USAID defines localization as the set of internal reforms, actions, and behavior changes that USAID is undertaking to ensure its work puts local actors in the lead, strengthens local systems, and is responsive to local communities. This Activity is encouraged to include the principles of localization throughout its technical and implementation approach to the extent possible.

C.4.13. CLIMATE CHANGE AND ADAPTATION

Climate change intersects with health and global health security in many ways, including through direct (e.g., increased frequency and severity of weather events, leading to deaths and injuries) and indirect (e.g. changes to the epidemiology of infectious diseases) pathways. Climate resilient one health systems improve health security by increasing preparedness to respond to climate-induced infectious diseases and other health threats across human, animal, and environment health interfaces. The Activity is encouraged to consider climate change and adaptation in its technical and implementation approach, while keeping One Health in the forefront.

C.4.15. DIGITAL TECHNOLOGY

USAID’s Vision for Action in Digital Health presents a roadmap for how USAID can strategically support its partner countries as they strengthen the digital transformation of their health sectors, especially by encouraging careful planning, interoperability, strong governance, and long-term sustainability. This Activity is well aligned with the Vision as it is envisioned to develop evidence-based interventions that employ digital solutions to improve health security technical gaps, many of which depend on digitized technology (e.g. surveillance, laboratories, etc.).

C.4.16. PRIVATE SECTOR ENGAGEMENT

This Activity is aligned with USAID’s Private Sector Engagement Policy and is encouraged to make efforts to support its strategic approach to improving global health security through which this Activity can consult, strategize, align, collaborate, and implement with the private sector for greater scale, sustainability, and effectiveness. This Activity is encouraged to identify innovative and realistic opportunities to ensure that the private sector plays a critical role in developing Peru’s health security capabilities, specifically in preventing the spread of zoonotic disease, improving surveillance systems, and strengthening a skilled health security workforce through partnership with private academic institutions for example.

C.4.17. HEALTH EQUITY AND INCLUSIVE DEVELOPMENT

https://www.usaid.gov/localization https://www.usaid.gov/sites/default/files/2022-05/Considerations_to_integrate_climate_change_mitigation_and_adaptation_into_HSS_programming_508_Tagged_USAID_Mar_2022.pdf https://www.usaid.gov/policy/digital-health-vision#:~:text=USAID%20envisions%20a%20world%20in,live%20healthy%20and%20prosperous%20lives.

https://www.usaid.gov/work-usaid/private-sector-engagement

To foster inclusive development, this Activity is encouraged to use a health equity lens throughout its technical and implementation approach to reduce equity gaps and mitigate adverse health impacts on marginalized and under-resourced populations during and in between future infectious disease outbreaks. It is critical to track equity gaps among the human, animal, and environment sectors by paying special attention to geographical areas prone to disease outbreaks, specifically urban slums, hard-to-reach communities (across Peru's geographic regions), and densely populated neighborhoods and cities where underserved and demographically diverse populations reside and are in close proximity to livestock animals and wildlife. To address systemic barriers and promote an equitable health security system, this Activity is encouraged to consider interventions that address harmful social and structural norms that undermine effective infectious disease prevention and response efforts. The Regional Migration and Health Office conducted an analysis that reviews the intersections between global health security and four cross cutting themes; inclusive development (includes gender), migration, climate change, and the private sector. The inclusive development chapter of this analysis goes beyond conceptualizing public health, health security, One Health, and development challenges within the traditional binary and cis-gender lens of male and female dynamics (i.e. gender), but rather it takes a border and holistic approach by underscoring how equity gaps in global health security affect diverse populations (i.e women, indigenous peoples, LGBTQIA+, migrants, etc.). This Activity is encouraged to review this analysis specific to the Peruvian context and identify and propose the best technical approach to reduce the equity gaps when developing interventions aimed at improving Peru’s health security system capacity to better prevent, detect, and respond to infectious diseases.

C.5. MAGNITUDE OF CHANGE

With a $19 million investment over a course of five years, USAID expects the magnitude of change will be reflected by the progress Peru makes in closing gaps in the three technical areas USAID/Peru has identified:

C.5.1. ZOONOTIC DISEASES: Functional animal, human, and environmental health systems that work individually and collaboratively together through documented mechanisms of coordination and operational frameworks, using a One Health approach, and based on international standards, guidance and best practices, to minimize the transmission of zoonotic diseases to human populations.

C.5.2. SURVEILLANCE SYSTEM: Functioning and interoperable human, animal, and environment surveillance systems capable of identifying potential events of concern for public health and health security, and enhanced national and regional level capacity to analyze and link data from and between the different levels of the strengthened early warning surveillance system.

C.5.3. HEALTH SECURITY WORKFORCE: Prevention, detection and response activities conducted effectively and sustainably by a fully competent, coordinated, evaluated, and https://docs.google.com/document/d/13kVWlItynwIWYSZwO0Mwi2tzJHRq0XpVG4twKmfckLg/edit https://docs.google.com/document/d/13kVWlItynwIWYSZwO0Mwi2tzJHRq0XpVG4twKmfckLg/edit occupationally diverse multi sectoral workforce.

Specifically, the value of this investment will be represented by how the Activity supports the GOP’s overall efforts in obtaining and maintaining at least a score of 3 or 4 on a scale of 5, using globally recognized tools (i.e. voluntary external evaluation or joint external evaluation) that measures national health security capacity. Improving the scores for the three technical areas4 identified for this Activity should align with the various levels of health security benchmarks unique to that technical area. Each technical area has benchmark scores ranging from "1" (indicating that implementation has not occurred) to "5" (indicating that implementation has occurred, is tested, reviewed, and exercised, and that the country has a sustainable level of capability for the indicator). Progress towards these scores will reflect Peru’s updated capacity to prevent emerging infectious diseases more quickly, detect them more efficiently, and should outbreaks occur, respond more effectively to contain them, and reduce loss of life and impact on health systems.

C.6. MONITORING, EVALUATION, AND CONTINUOUS LEARNING

USAID expects this Activity to have a robust Monitoring, Evaluation and Learning (MEL) Plan that is fit-for-purpose to enable evidence-driven adaptation as outlined in ADS 201. The MEL Plan outlines the approaches to monitor this Activity’s implementation on an ongoing basis and ensure learning is captured to improve and pivot as needed. This Activity is encouraged to apply a variety of globally recognized and evidence-based MEL approaches and methodologies to ensure appropriate monitoring of the activity.