Amendment 1.pdf

NOFO # 72038624RFA00004, Amendment # 1

Amendment # 1 Issuance Date: October 2, 2024

Concept Note Submission Closing Dates: October 29, 2024 @ 5:00 P.M. IST

Subject: Amendment # 1 Notice of Funding Opportunity (NOFO):72038624RFA00004

Program Title: Health Systems Strengthening (HSS) Activity

Dear Prospective Applicants:

The purpose of this Amendment # 1 is to respond to questions( (Attachment 2) and make resulting changes through to the NOFO issued for the Health Systems Strengthening (HSS)

Activity, 72038624RFA00004 (Attachment 1).

Except as specifically indicated, all terms and conditions of the NOFO - 72038624RFA00004 remain unchanged.

Sincerely, Bryan Moody

Agreement Officer

Office of Acquisition and Assistance

USAID India

List of Attachments:

1. Amendment to NOFO Contents

2. Questions from interested parties and USAID Responses mailto:bmoody@usaid.gov

Attachment 1: Amendment to the NOFO Contents

1. On Page 9 : Replace the diagram with

2. On Page 10 : Section 4. Priority Geographies : Add ‘USAID does not expect the activity to be limited to the indicated priority geography. It is expected that the majority, not all, of the activity will be in the priority geography, including the aspirational districts and aspirational blocks in the mentioned states. If other USAID projects have good models, approaches and platforms that can be replicated elsewhere, including the indicated priority geography, engagement with such USAID projects will be encouraged.’ after the paragraph ‘Working with these existing USAID projects…with a global audience.’

3. On Page 15 : Section 7. c) Leverage : Replace section entirely with: ‘We expect at least

1:1 leverage in cash and preferably 1:2 to 1:5 leverage, or more, (including cash and in-kind) from the implementing partners, with the additional funds leveraged from government programs, quasi government entities, private sector and financial markets.

In the leverage ratio, USAID share is “1”, against which at the very least the applicant is expected to contribute an equal proportion (1:1). There is, however, no limit in how much an implementing partner/consortium can leverage although USAID funding is at most $20 million. Leverage, both cash and in-kind, from government as well as private sector, is defined as non-US Government resources that contribute to the project activities within the project period in the project geographies, and are resource inputs to the planned activities and milestones.

Although a minimum 1:1 leverage is expected, the indicated USAID funding should be seen as “seed funding” to strengthen, scale up, and sustain health systems and ecosystem platforms, approaches and funds beyond the project period, which ultimately increases access to quality healthcare, reduces out-of-pocket health expenditure and impacts the reduction of under-50 mortality. Hence, a much larger leverage is envisaged than what is indicated. The concept note is expected to include robust approaches to achieve this higher leverage ratio.’

4. On Page 16 : Replace ‘1+2+2 year break up of the activity period’ with ‘2+ 3 Year break up of the activity period’.

5. On Page 24: Section D.4 - Application Formats: Replace ‘Please see subsections D.5 and

D.6, below, for information on the content specific to the application’ with ‘Please see subsections D.5 below for information on the content specific to the application’.

6. On Page 36 : Section E.2 Review and Selection Process : Replace ‘After concept paper/s have been accepted, detailed activity design discussions between USAID and the applicant will begin and continue throughout the remainder of the process.’ with ‘After the final concepts are received from the applicants, incorporating suggestions given during the presentation stage, these will be reviewed against the merit review criteria one final time and the most likely successful applicant will be chosen to proceed for the co-creation stage.’

7. On Page 36 : Section E.2 “Phase 4: Request for final documents” : Replace section entirely with “At the end of the Co-Creation, the most likely successful applicant will be requested to submit final documents that incorporate the feedback from USAID and the representatives from the government, private sector and the marginalized communities during the co-creation workshop. Detailed requirements will be included in the letter requesting final documents. The final documents will be reviewed for merit in achieving this NOFO’s Program Description (Section A) and will receive a pass, fail, or comments with request to resubmit.”

8. On Page 47: Under Section G - “Federal Awarding Agency Contracts’ Please add an additional Point of Contact under point 1. “Bhawna Chadha, Acquisition and Assistance

Assistance, USAID India, bchadha@usaid.gov.”

End of Attachment # 1 mailto:bchadha@usaid.gov

Attachment 2: Questions from interested parties and USAID Responses

1. If a partner has secured funding from government programs, would USAID consider this as part of the match funding? For instance, if the government allocates funds to a specific program with our advocacy/interventions, can that be counted as part of the contribution to match USAID’s funding? Or would USAID prefer cash contributions from partners?

USAID Response: Please refer to Attachment #1 para 3 of this Amendment #1.

2. Does the funding from the partner need to already be secured or can we even include ‘projected’ funding that the partner will mobilize in future?

USAID Response: No, the funding from partners need not be secured at the concept note stage, but a clear and robust plan to secure funding should be included in the concept note.

3. In scenarios where a larger leverage ratio (e.g., 1:2 or 1:5, as mentioned in the RFP) is required, we wanted to clarify whether USAID anticipates contributing the larger share. For example, in a 1:5 ratio, would USAID provide the majority (e.g., $1 million) while the applicant or their partner contributes a smaller portion (e.g., $200,000), or is it expected that the leverage ratio reflects a larger non-USAID share?

USAID Response: Please refer to Attachment #1 para 3 of this Amendment #1.

4. There has been a mention of in-kind contributions. Could you clarify what types of in-kind contributions are typically considered acceptable in match funding? Does that encapsulate indirect cash, or the money ‘leveraged’?

USAID Response: In kind contributions that contribute to the project activities will be considered towards the 1:1 leverage. This can include all resources that will be used by the project to deliver the results, including but not limited to experts and consultants, tools and technologies, media space, knowledge products developed by the project partners/contributors and used by the project to deliver the results. Unbilled indirect expenses may count towards in-kind contributions, however they must be verifiable on a cash basis. See 2 CFR 200.306 and

ADS 303.3.10.3.

5. Is this opportunity a locally led grant or is FCRA compliance a requirement for an applicant organization to apply for this grant?

USAID Response: This solicitation is a full and open competition, open to national and international, for-profit and nonprofit entities. But the concept should clearly show how localization will be integrated in the project approaches and management structure. The applicant is expected to ensure compliance to Indian laws, including FCRA.

6. While:

● Pg 25 mentions the term ‘funds leveraged’ in the past tense and that this should be explicitly stated on the cover page of the concept note.

● Pg 37 states - Approaches to raise private (philanthropic and commercial capital) and government resources to realize at least a 1:1 match with USAID funding – will be evaluated in the technical approach

● Pg 15 states We expect at least 1:1 leverage in cash and preferably 1:2 to 1:5 leverage (including cash and in-kind) from the implementing partners, with the additional funds leveraged from government programs, quasi government entities, private sector and financial markets.

● Our questions are :

a) For cash leverage, must we demonstrate that funds are already secured and documented in the proposal, or is it acceptable to outline a plan to secure the necessary cash leverage during the project's duration?

USAID Response: No, the funding from partners need not be secured at the concept note stage, but a clear and robust plan to secure funding should be included in the concept note.

b) Would this mean an additional leverage of 1:2 (or up to 1:5), an additional USD 40-100M coming from government programs, quasi-government entities, the private sector and financial markets? How would we then read Pg 37, where it clubs both the private and government resources and mentions 1:1

USAID Response: Please refer to Attachment #1 para 3 of this Amendment #1.

c) Could you elaborate on the "1 + 2 + 2" year activity period mentioned on page 16? How does this structure align with funding provided for the first two years and a possible extension for an additional three years?

USAID Response: Please refer to Attachment #1 para 5 of this Amendment #1.

d) Regarding page 26, when identifying four to five critical positions/key personnel, do these need to match the key personnel roles listed on page 19 (Project Director, MEL Lead, Health Systems Lead, Community Lead, Private Sector and Financing Lead), or can we propose different critical positions?

USAID Response: Different key positions may be proposed, but the functions of program management, MEL, health systems, community processes, private sector and financing should be covered by the proposed positions.

e) Regarding the exclusion of "routine service delivery, training, and supervision functions," could you clarify the boundaries of this exclusion? For example, is training government officials on operationalizing integrated public health laboratories permissible under this activity as part of system strengthening?

USAID Response: “Routine functions” refer to activities that are the core responsibilities of the public and private systems, and therefore will not be encouraged to be undertaken using USAID funds. Training of government officials is inherently the responsibility of the government of India and USAID resources should not be put directly towards that. However, USAID resources could be used towards seeding new skills, knowledge or behaviors into the existing government system by demonstrating process or product innovations, developing/adapting the training modules and plans, or preparing a set of trainers with newer skills can all be part of the project activities.

f) How should we interpret the level of effort (LoE) percentages assigned to each result area? Do these percentages reflect the relative importance or priority of the components, and will they impact how proposals are assessed or scored? Will this affect the evaluation if our proposal addresses all result areas but prioritizes some with a lower cumulative LoE?

USAID Response: Yes, the LoE reflects the relative importance/priority of the components and indicates the expected distribution of resources/budget across the components over the entire period of performance (of five years). The LoE need not be the same every year and may vary from year to year, but should reflect the indicated proportion over the entire duration of the activity (five years).

g) Regarding Result 4, which involves integrating national health programs like HIV, TB, and AMR into insurance programs, could you clarify whether innovative models linking antimicrobial resistance (AMR) to insurance of private sector healthcare facilities would be acceptable, given that AMR integration into insurance programs is not part of the current national strategy (NAP

AMR)?

USAID Response: Yes, innovative models linking antimicrobial resistance to private insurance models will be considered. But it is also expected that the activity will engage government insurance programs to also look at integrating AMR.

h) On pages 9-10, USAID outlines existing and future projects with which the USAID HSS project will work. Could USAID please clarify the expectations for partnership and collaboration outside the HSS priority geographies? For example, working with some of these existing USAID projects and activities will necessitate working in the geographies where these activities are present

USAID Response: USAID does not expect the activity to be limited to the indicated priority geography. It is expected that the majority, not all, of the activity will be in the priority geography, including the aspirational districts and aspirational blocks in the mentioned states. If other USAID projects have good models, approaches and platforms that can be replicated elsewhere, including the indicated priority geography, engagement with such USAID projects will be encouraged.

i) On pages 4 and 13, USAID notes that risk underwriting from the US International Development Finance Corporation (DFC) and other bilateral/multilateral financial institutions will assist in accelerating innovative models and approaches, especially in the private sector.

Could USAID please clarify the role of the implementing partner in engaging DFC and other financial institutions for risk underwriting?

USAID Response: The implementation partner is expected to flag opportunities or need for such risk underwriting, along with identifying the possible financial institutions and indicative portfolio of investment (pipeline). USAID will introduce such organizations to DFC and DFC will engage and negotiate with them directly. In case DFC finalizes the guarantee or investment agreement, USAID will coordinate with DFC to align the technical assistance provided under this HSS activity.

j) On page 8 the NOFO refers to partnering with the government, the private sector, civil society and CBOs to assist them to “test and scale up” models and approaches to achieve the stated goals. Recognizing that the activity aims to “accelerate and scale up, and not incubate and seed” innovative approaches, could USAID provide clarification on whether IPs should be looking at only scaling existing models or is there a scope to demonstrate, showcase results and scale (as noted under ‘test and scale’ p.8)?

USAID Response: The preference is for scaling an existing model. In case demonstration is taken up, it should not be for “proof of concept” but for establishing the operational and economic feasibility of a proven model by demonstrating at sufficient scale. It is encouraged to look for models already tested for “proof of concept” and take these up for market and business feasibility support and scale up.

k) On page 35, the NOFO states: “A concept paper is determined to be acceptable if it proposes a sound approach and USAID has strong confidence that the applicant understands the requirement and will be successful in performing with no government intervention based on the criteria below, which are listed in descending order of importance.” Could you please clarify the term “with no government intervention” further? Our understanding is that this project aims to leverage the large private healthcare system through the public healthcare system, making it essential to work closely with the government in most result areas.

USAID Response: Here, “government” refers to the US Government. It is envisaged that the partner/consortium will be able to implement the program on its own, with no additional support from the US Government except for the USAID funding and “substantial involvement” as referred to in section B.5 of the NOFO.

l) It would be helpful to get more clarity on the underlying assumptions, causal linkages, and the evidence base that supports this theory of change. It's not entirely clear how the suggested activities and result areas are expected to lead to the desired impact of reducing under-50 mortality. A more detailed explanation of the pathways and assumptions would help prioritize interventions. For example, if there is an implication of prioritizing interventions linked to NCDs to impact under-50 mortality, that is unclear in the language. A clearer understanding of this will help design the model and strategy.

USAID Response: This is a cross-cutting health systems activity and does not necessarily focus on any particular type or group of causes of under-50 mortality. The funding flavor includes maternal and child health (MCH), family planning (FP), tuberculosis (TB), and global health security (GHS). As a cross cutting activity, it can address NCDs also. Further, the design acknowledges that there are multiple ways of addressing the causes of under-50 mortality in India, but this activity prioritizes the systems approach, aiming to strengthen a resilient health system, including both public and private) that is affordable and easily accessible to all, including the marginalized population segments. Hence, it looks at strengthening the primary healthcare system with strong secondary/tertiary linkages (result areas 1 and 2), facilitated by sustainable, market-based, financing and climate resilient solutions (result areas 3, 4 and 5).

m) On page 10, does the emphasis on scaling existing USAID-supported innovations mean proposals must focus exclusively on models previously invested in by USAID, or can we include new solutions that address market needs but haven't been supported by USAID before?

USAID Response: New solutions can also be suggested for support under this funding, but looking at previous USAID supported innovations is also encouraged. The point is investing in those solutions expected to yield the maximum achievable results, irrespective of who developed or tested them.

7. On p.4 (section A.1), the NOFO states “This acceleration of innovative models and approaches, especially in the private sector, will be assisted by risk underwriting from the US International Development Finance Corporation (DFC) and other bilateral/multilateral financial institutions.” Could USAID please provide additional clarifications on the expected role of the DFC in this HSS Activity?

USAID Response: The partner is expected to flag opportunities or need for such risk underwriting, along with identifying the possible financial institutions and indicative portfolio of investment (pipeline). USAID will engage DFC directly for the actual partnership, in coordination with the implementing partner and the identified financial institutions. DFC underwrites loan portfolios (based on an agreed borrower definition) or may disburse loans (at individual entity level or portfolio level). DFC determines independently if it will fund an underwriting/loan applicant.

8. On p. 8 (section A1), the NOFO states “The activity will partner with the government, the private sector, civil society and community-based organizations to assist them to test and scale up models and approaches to achieve the stated goals.” Could USAID indicate whether Memoranda of Understanding or any type of agreements have been signed with the above-mentioned entities that affect this NOFO?

USAID Response: No agreement has been signed with any public or private entity for the scale up support previously. That is an activity envisaged to be carried out under this HSS activity.

9. Under section A3 (Partnering with other USAID projects), on p.9 and 10,what activities are proposed for partnership with the USAID Indo-Pacific office so that those can be budgeted and covered in the concept note?

USAID Response: USAID Indo-Pacific office is part of the India Mission and no financial implication is expected to engage that office. The engagement is expected to be non-financial, at the technical level, for consultations and coordination. The HSS project can factor in staff time for such coordination work, apart from travel and event costs, if any such event/travel is planned to showcase Indian health solutions to third countries.

10. Please clarify how partner financial turnover will be assessed and factored in for eligibility and leveraging (under section A.7.c [Activity parameters leverage] and section C [Eligibility]), to achieve a 1:1 cash and 1:2 to 1:5 leverage (cash &kind)?

USAID Response: Partner “financial turnover” is not a criteria for technical assessment of applicants and is not mentioned in the NOFO. For further details on “leverage”, Please refer to Attachment #1 para 3 of this Amendment #1. To determine if the applicant is a new partner (receiving less than $25 million in the last five years from USAID), USAID will check its own record to determine that. A risk assessment will be conducted on the apparently successful applicant before an award is made, and “financial turnover” could be a component of consideration to understand if the organization can realistically achieve its proposed operating structure and programmatic goals.

11. In addition to the mentioned TB, HIV, MCH, FP, GHS (ID) national health programs (NHPs) and the National Program on Climate Change and Human Health (NPCCHH), are there any other NHPs that HSS would cover?

USAID Response: The HSS program is driven by the Indian health systems’ needs, including those of the flagship programs like NHM, Ayushman Bharat, PMABHIM, ABDM, apart from the mentioned national programs. Also, the activity can be expanded to other national programs that have substantial bearing on the under-50 mortality and the health system resilience.

12. On p.9, section B5 of the NOFO indicates, “Recipient to obtain AOR’s approval prior to hiring the key personnel on the following Key Personnel Positions, to achieve the award's objectives: 1. Project Director 2. Monitoring, Evaluation & Learning (MEL) Lead 3. Health Systems Lead 4. Community Lead 5. Private Sector and Financing Lead”.

However, on p.26, section D.4.1. (Phase 1 - Concept Paper Format), the NOFO requires the applicant to “additionally, identify four to five positions/ key personnel that would be critical to accomplishing the outcomes outlined in the Concept Technical Approach and describe the qualifications for each position and why it is critical to successful implementation of the project.” Could USAID please confirm whether the positions mentioned in section B5 are the key personnel positions that the applicant must include in their staffing and management plan?

Could USAID also confirm whether the applicant should name/propose candidates in the concept paper?

USAID Response: The four to five key personnel mentioned in D.4.1.D include the key personnel indicated in B5. The applicant may propose a different set of key personnel, provided the functions indicated in B5 regarding key personnel (program management, MEL, health systems, community processes and private sector/financing) are covered by the proposed key personnel.

The four to five key personnel proposed, will need prior AOR approval for final hiring. The “additional” mentioned in D.4.1.D is with reference to the proposed four to five key personnel being in addition to the expertise leveraged by partnering with other local Indian government and private organizations.

13. Could USAID please indicate the approximate start date?

USAID Response: The tentative award date of the new HSS award is April/May 2025, dependent on the review, co-creation, final proposal submission and all other pre-award checks being completed by that time.

14. Could USAID please send the Local Compensation Plan for India?

USAID Response: It will be shared with the Apparent Successful Applicant during phase 4.

15. Please clarify how many applicants will be invited to the co-creation phase? Ref:SECTION E: APPLICATION REVIEW INFORMATION, Phase 3 - Co-Creation Workshop, Pg 36 Only the most likely successful applicant(s) from the Phase 2 Merit Review will be invited to join the (co-creation phase).

USAID Response: It depends on the discussions and outcome of phase-2.

16. Will the entire funding be awarded as one Project or will it be possible for more than one project to be awarded through this NOFO.

USAID Response: USAID may decide to go ahead with single or multiple awards under this NOFO. It has not been decided yet.

17. We would like to address an important concern regarding the current exclusion of Bihar and Uttar Pradesh. Both states are recognized as having some of the lowest Human Development Index (HDI) rankings in India.

According to the latest HDI estimates from 2021, Bihar has an HDI of 0.571 and ranks 35th among Indian states, while Uttar Pradesh has an HDI of 0.592, ranking 33rd.

These rankings highlight significant gaps in healthcare access and workforce development that need urgent attention.

We believe that including these states would not only enhance the impact of the proposed healthcare training programs but also contribute significantly to improving health outcomes in regions that are most in need.

USAID Response: Although the majority of the effort is envisaged in the mentioned geographies, it does not exclude other important geographies, provided the government and private stakeholders in those other geographies mutually agree with USAID to jointly work on the larger healthcare ecosystem strengthening with the ultimate aim at reducing under-50 mortality.

18. Can a for-profit apply as a prime?

USAID Response: Yes. Profit/fee may not be a line item in the budget, however.

19. If an organization applies as Prime, can it also apply as Sub-Member? If yes, is there a limit to how many consortia?

USAID Response: Please refer to section C.1: Eligibility information. There is no limit indicated to the number of consortia that an organization can be a part of. An organization may apply as the prime under one application, and as a sub under different primes’ applications. A prime cannot be a sub under its own prime award.

20. If an Indian entity applies as Prime, how will it disburse funds to other partners (owing to FCRA regulations of India)?

USAID Response: It is the responsibility of the applicant to ensure compliance with local laws, including FCRA.

21. Will there be a co-creation workshop?

USAID Response: Yes

22. Will the entire grant be given to one consortium or broken into smaller grants?

USAID Response: This depends on the final application and the pre-award reviews and negotiations.

23. Do all aspects of the proposal have to be addressed by one consortium?

USAID Response: Yes

24. What is the number / name of preferred Tier 2/3 towns and is it geography agnostic or should they be in the same states as those mentioned?

USAID Response: This is not decided by USAID and will be dependent on the concept note.

These towns should preferably be in the indicated priority states, but can be outside also, dependent on need, scope proposed by applicant and project resources (USAID resources and the leveraged resources, together).

25. Can we choose to work in any 1 geography (of the preferred states) or the intervention should include all of them?

USAID Response: The organization should include all, and should also have scope to respond to any other geography prioritized by the government at the national level.

26. As per the passage shared below, the highlighted section (yellow) reads contrary to the cash as well as cash and in-kind commitment. Is it that the resources can be raised during the course of intervention? Pls clarify.

C.2. Leverage is defined as anything of value that is measured, financial contributions, third party contributions, donated services or property, or intellectual property. USAID/India encourages the applicant to leverage resources from either private or public resources. The applicant will work towards leveraging resources- programmatic and financial, from both the private and public partners to enable the activity to engage in interventions that are of shared interest and that are sustainable and will enable the interventions to be continued after the Activity ends.

We expect at least 1:1 leverage in cash and preferably 1:2 to 1:5 leverage (including cash and in-kind) from the implementing partners, with the additional funds leveraged from government programs, quasi government entities, private sector and financial markets. This implies USAID will fund up to 50% of the indicated TEC.

USAID Response: Please refer to Attachment #1 para 3 of this Amendment #1.

27. This Health Systems Strengthening activity aims to leverage digital health technologies.

Could you please specify types of digital technologies? Is AI and MedTech included? (Section A

1. Purpose, page 4)

USAID Response: Any digital health solution that yields return on investment inline with the TOC are welcome, including AI and MedTech.

28. Some text on the Theory of Change diagram is illegible. Can USAID kindly provide the diagram with full text? (Section A.2, page 9)

USAID Response: Please refer to Attachment #1 para 1 of this Amendment #1.

29. Is the coordination meant for the exchange of knowledge, or will it also involve resource sharing? What kind of linkages and partnership is expected with the USAID Climate Resilient Cities in India and WASH opportunities? (Section A 3. Partnership with other projects, page 9)

USAID Response: Coordination may include sharing of knowledge and knowledge tools as well as “aligning” respective work plans, activities and budget to ensure complementary and remove any potential duplication.

30. Which are the priority districts/blocks in the specified geographies? (Section A 4. Priority geographies, page 10)

USAID Response: Priority will be given to aspirational blocks, but not necessarily be restricted only to these/blocks.

31. Due to the multidisciplinary nature of the activity, it will require multiple implementing partners, either as a consortium or as subcontracted agencies, with specialized skill expertise across domains. Can you clarify if there is a limit to the number of organizations per consortium? (Section A 5.)

USAID Response: It is up to the applicant/consortium to decide.

32. Expand public health disease surveillance: Are there any linkages expected with the Integrated Health Information Platform (IHIP)? (Section 5, Result 1: page 11)

USAID Response: To include all existing and planned government platforms covering disease, zoonotic and environmental surveillance including the IHIP.

33. Does the demonstration and scale up innovative models also include ones already proven to be effective and developed by key institutions, outside the consortium? (Section 5, Result 1: page 11)

USAID Response: We welcome including any models that have the evidence base and will yield the maximum achievable results.

34. Section B.4 refers to the following key positions: 1. Project Director 2. Monitoring, Evaluation & Learning (MEL) Lead 3. Health Systems Lead 4. Community Lead 5. Private Sector and Financing Lead. Section D.4.1 D states: “Additionally, identify four to five positions/ key personnel...” Can USAID confirm if the applicant should meet the key personnel positions of Section B, or propose key personnel according to section D? (Section B.4, page 19 &

Section D.4.1-page 26)

USAID Response: The four to five key personnel mentioned in D.4.1.D include the key personnel indicated in B5. The applicant may propose a different set of key personnel, provided the functions indicated in B5 regarding key personnel (program management, MEL, health systems, community processes and private sector/financing) are covered by the proposed key personnel.

The four to five key personnel proposed, will need prior AOR approval for final hiring. The “additional” mentioned in D.4.1.D is with reference to the proposed four to five key personnel being in addition to the expertise leveraged by partnering with other local Indian government and private organizations.

35. As per the NOFO, an organization may submit only one (1) concept paper under this notice of funding opportunity. However, organizations participating as a member of a consortium may elect to participate in another consortium under a different concept paper.

Could you please clarify if an organization is submitting the concept paper as a lead, can it also participate as a member in another consortium/s? (Section C3. Page 21)

USAID Response: Yes

36. Does USAID require names/ CVs of four to five personnel that would be critical to accomplishing the outcomes outlined in the Concept Technical Approach? Or can we indicate profiles and qualifications only at this stage?

What are USAID requirements around Gender Equity Disability and Social Inclusion (GEDSI) for the key positions? (Section D, page 26)

USAID Response: Indicate the profiles only, at this stage.

37. Can USAID confirm that the “cover letter” referred to on page 23 differs from the “cover page” referred to on page 25? (Section D.3, page 23; Section D.4.1, page 25)

USAID Response: As is clearly mentioned under D.3 (page 23), “Applicants may choose to submit a cover letter in addition to the cover pages”.

38. In the third paragraph it is stated that “No other documents/annexures are being requested currently...” Under point A it is stated that for “Type of Organization [please include certification of incorporation as Annex].” There are also other annexures requested on page 27.

Can USAID confirm that the applicant should provide the certification of incorporation as an annex to the concept paper? (Section D.4.1, page 23 and page 27)

USAID Response: Yes, certification of incorporation for the prime is needed to establish the legal status of the applicant organization. Other annexures mentioned are in relation to the concept submitted and not related to the organization.

39. Can USAID confirm if there is a difference between the Table of Contents that needs to be included in the concept paper, and the request to “B. Include major sections and page numbering to easily cross-reference and identify the information below.” (Section D.4.1, page 23)

USAID Response: Page numbers and sections are throughout the application and table of contents is at the beginning.

40. Will USAID consider extending the concept paper length to 10 pages? (Section D.4.1, page 23)

USAID Response: No

41. Can USAID confirm how many applicants it expects to down select for phases 2, 3, and 4 respectively? (Section E.2, page 35)

USAID Response: There is no fixed number. Applicants will be selected on the merit of the concept submitted as per the criteria provided

42. Will USAID allow additional opportunities for questions if an applicant progresses to subsequent phases?

USAID Response: There is scope for addressing questions and clarifications, both by applicants and USAID, at the concept presentation and co-creation stage.

43. Various links throughout the NOFO do not work, especially in Annexure 2. Can USAID kindly provide the links or associated documents?

USAID Response: Links to the following documents given below. All other links in Annexure 2 found working.

USAID 2023 Gender Equality and Women’s Empowerment Policy ADS Chapter 205 Sample Registration System statistical report 2013

44. Can we go beyond the mentioned states (MP, Odisha, Jharkhand, Chhattisgarh, Assam) and urban areas (Mumbai, Delhi, Bengaluru)

USAID Response: No Indian states are excluded. Although the majority of the effort is envisaged in the mentioned geographies, it does not exclude other important geographies, provided the government and private stakeholders in those other geographies mutually agree with USAID to jointly work on the larger healthcare ecosystem strengthening with the ultimate aim at reducing under-50 mortality.

45. If an organising who is going as a PR, can the same be a sub PR to another consortium?

USAID Response: Yes, please refer to section C.1 https://www.usaid.gov/sites/default/files/2023-03/2023_Gender%20Policy_508.pdf https://www.usaid.gov/sites/default/files/2023-04/205.pdf https://censusindia.gov.in/nada/index.php/catalog/34788/download/38476/SRS_STAT_2013.pdf

46. Can a Sub PR be part of multiple consortiums for the same scope of work

USAID Response: Yes

47. Is it required to disclose resource partnerships in concept note?

USAID Response: Yes, indicate the partners/platforms that you are planning to use as resource partners. It is, however, not necessary to have the formal partnership in place at the application stage.

48. Given this health-systems strengthening focus – and emphasis to drive multiplier effects for all resources invested, we request USAID to consider a contracting approach rather than a Fixed Amount Cooperative Agreement:

○ This would open the door for both nonprofit and commercial entities to participate, broadening the pool of innovative partners and bringing fresh, cutting-edge solutions to support USAID/India’s mission

○ This will enhance competition and ensure access to the best-in-class services that align with the project’s ambitious goals.

○ This will provide the best value to the U.S. Government and put execution risk on the contractor to deliver in the specified time frame

○ This will help prioritize success factors that seek deep local and global private sector experience; and

○ Lay greater emphasis on speed to delivery (weeks not months) and technical capabilities (breadth and depth)

USAID Response: We thank you for the suggestion, but USAID has determined it to be Fixed Amount cooperative agreement after considering all factors.

a) We understand that the intention of providing priority geographies is to build on and accelerate existing USAID efforts.

○ While there be significant learnings from USAID efforts in the priority geographies for the rest of the country, there may also be exemplars in other states that the priority geographies can learn from. Is USAID open to exploring other states as for this project – either as exemplars for learning and/ or for transforming health systems

USAID Response: No Indian states are excluded. Although the majority of the effort is envisaged in the mentioned geographies, it does not exclude other important geographies, provided the government and private stakeholders in those other geographies mutually agree with USAID to jointly work on the larger healthcare ecosystem strengthening with the ultimate aim at reducing under-50 mortality.

b) We understand the emphasis on localization and the engagement with local partners.

We are an Indian entity, legally organized under Indian laws. Please clarify who is considered a local partner.

USAID Response: This solicitation is a full and open competition, open to national and international, for-profit and nonprofit entities. But the concept should clearly show how localization will be integrated, including local organizations and communities, in the project approaches and management structure. More on the agencies perspectives on localisation can be found at https://www.usaid.gov/localization

c) Evaluation in Phase 1 talks about how USAID is looking for confidence that the applicant “can perform with no government intervention” – our understanding is that this means that the applicant is accountable to deliver the outlined scope - and not that the government machinery cannot be involved at all.

USAID Response: Here, “government” refers to the US Government. It is envisaged that the partner/consortium will be able to implement the program on its own, with no additional support from the US Government except for the USAID funding and “substantial involvement” as referred to in section B.5 of the NOFO.

d) We request the following clarifications on the Merit Review criteria of the concept papers:

○ Can you please provide the distribution of weightage (out of 100%) for the 3 criteria – 1). Technical Approach, 2). Mgmt. & Institutional Capabilities, 3).Staffing Approach & Key Personnel

○ What is the minimum marking cutoff for a concept paper to be deemed as “Conditionally Acceptable” and move to the Oral Presentation stage?

○ Could USAID provide more clarity on how the Co-Creation Workshops will be conducted? Over what time duration would these be held, and what would be the evaluation criteria here?

USAID Response: The evaluation is envisaged to be more qualitative than quantitative, and per E.2.1 “Applications will be reviewed and evaluated in accordance with the following criteria, and the technical approach will be weighted more heavily, while the other factors will be weighted equally.” After the final concepts are received from the applicants and oral presentations delivered, there will be a final review against the merit review criteria and the most likely successful applicant will be chosen to proceed for the co-creation stage. Please refer to Attachment #1 para 6 and 7 of this Amendment #1. The co-creation workshop will be held for 3-4 days, focussing on finalizing the applicant’s PD and coming up with costed milestones for the base period of two years. After co-creation, the most likely successful applicant will submit a final, full application for review on a pass, fail, or comments with request for revision basis.

e) Concept paper format (page 27):

○ We request USAID to consider the organization's relevant previous experiences related to health systems, from the last 10 years (instead of 5 years) while assessing Institutional Capacity and History of Performance. This will help USAID assess sustained impact of system strengthening initiatives over a longer period of time

USAID Response: Five years is minimum, all previous years would be considered.

f) Given the extensive scope of the RPF, we request extending the page limitation of the submission from 8 to 15 pages.

○ Extend “Concept Technical Approach” section from 5 pages to 10 pages – allowing sufficient opportunity to lay out the approach for each of the 5 result areas with clarity and adequate detail.

○ Extend “Institution Capacity and History of Performance” section from 1.5 pages to 3.5 pages – allowing sufficient opportunity for all partners, particularly in multi-party consortiums, to showcase their breadth and depth of capabilities.

○ Does USAID have any limitations on what or how much can be included in the Annexures? What is the evaluation process of the Annexures?

USAID Response: No extension in the number of pages is envisaged. Further details can be laid out during the concept presentation stage.

49. The NOFO mentions “north eastern states - particularly Assam - central Indian States - Odisha, Jharkhand, MP and Chhattisgarh- and urban areas including tier 2 and tier 3 towns and mega conglomerates - Mumbai, Delhi and Bengaluru “ as priority geographies (pg. 10) For urban interventions, do the tier 2 and tier 3 cities identified for project activities need to be from the mentioned states only? Or can the tier 2 and tier 3 cities be from other (relatively more) urbanised States?

USAID Response: These towns should preferably be in the indicated priority states, but can be outside also, dependent on the need or scope proposed by the applicant and project resources (USAID resources and leveraged resources, together).

50. For mega conglomerates, does the intervention site need to be within the city boundary only? Or can it be the surrounding area. For example: instead of Mumbai, can it be Mumbai Metropolitan Area (MMR)?

USAID Response: City and the suburbs both may be included.

51. Within a city, can the interventions be focused on vulnerable pockets of the city only where the urban marginalized population resides? Or is the intervention expected to cover the entire city population?

USAID Response: Preference is for scaling models and approaches that prioritize the vulnerable and marginalized/left out populations.

52. Can projects, interventions, partners and funding from similar work in other States (not currently mentioned under priority geographies - Pg. 10) be shown as leverage

USAID Response: It will be considered leverage if the final project scope includes those states also.

53. While Result 5 in Pg 13 states‘ increased adaptation and mitigation of climate and environmental shocks affecting the health system’, the illustrative activities does not indicate any form of community engagement. Are activities in this area limited to system level interventions only?

USAID Response: Sustainable community level approaches, models and platforms may also be included, in coordination with other USAID interventions and projects in the urban and climate-health space.

54. In accordance with “Section C, C1. Eligibility” – It is said that USAID’s organizations that have not previously received financial assistance from USAID. Will there be a preference for or against organizations with or without previous funding from USAID?

USAID Response: No. This is a full and open competition, and all types of organizations are welcome to apply. There is no preference between those that have worked with USAID versus those that have not worked with USAID..

55. There is no specific mention of social and behavioral change approaches and outcomes. Please clarify.

USAID Response: Health systems strengthening involves multitude of approaches and levels, all of which can be considered. The concept should clearly lay out pathways to achieve health system strengthening on a sustainable basis that can reduce the under-50 mortality.

56. Is social and behavioral change approaches and outcomes something that USAID see’s as a key component under one of the pillars? Will/can that be considered as a key indicator, especially when we speak about adaptation?

USAID Response: All result areas can have social and behavior change interventions and indicators.

57. Within the definition of leverage, Is the selected agency required to raise any match funds? Does free air time count as dollars leveraged?

USAID Response: The requirement is for leverage not matching funds. Free airtime for approved project activities (at work plan stage) can be considered as leverage.

58. Figure depicting the theory of change (page 9): The figure is partially blurred. We request a figure with better clarity.

USAID Response: Please refer to Attachment #1 para 1 of this Amendment #1.

59. Project break-up: Page 15/16 mentions “Also, given the 1+2+2 year breakup of the activity period, progress feedback will be looped-in to plan for next stages in the first and third year.” However, as per information provided on Pages 17 and 18, it appears that the project has two phases: Base Period (2 years) and Renewal Period (3 years). Please clarify if the project break up is indeed 2 + 3, and not 1+2+2.

USAID Response: Please refer to Attachment #1 para 5 of this Amendment #1.

60. Leverage: It has been mentioned that the Mission expects “at least 1:1 leverage in cash” and that “USAID will fund up to 50% of the indicated total estimated cost.”

a. Based on your ratios, does this mean that for a $20M funding ceiling, the

Mission expects the implementing partner to leverage $20M in cash “from government programs, quasi government entities, private sector and financial markets’?

b. Could you please clarify what contributions from these partners would constitute “cash”?

c. How will an implementing partner be responsible in case the 1:1 cash leverage target is not met due to circumstances beyond their control?

d. Is there a breakup of this leverage between the Base and Renewal periods?

USAID Response:

a. Yes

b. Cash contribution will be seen as actual cash put in the project by the government and/or the private sector, with any of the consortium partners, or as a “fund” created as pooled fund arrangement or listed in the financial market.

c. Leverage targets will be constituted as milestones before the award, spread over the period of performance. USAID payments may be linked to achieving those milestones.

d. No. The breakup is expected to be provided by the applicant.

61. Concept Paper Cover Page: Would the Total amount leveraged, including from what source(s) need to be specific?

USAID Response: It should be specific as possible to give confidence to USAID regarding its achievability. Also, as leverage will be constituted as milestones before the award is made, spread across the period of performance; it will be good to have a more concrete idea of the sources and how to tap those sources.

62. The theory of change document is not readable clearly. We would request if an improved version can be shared.

USAID Response: Please refer to Attachment #1 para 1 of this Amendment #1.

63. Result 3: Sub-point 1 mentions “ Strengthen public-private integration to boost access, affordability, and quality of care (e.g public-private partnership management, strategic purchasing etc), especially for “primary impact collaboratives” and AMR alliances”. Can you please elaborate what is meant by “primary impact collaboratives”.

USAID Response: This refers to collaborations formed under USAID’s primary impact initiative more can be found at https://www.usaid.gov/global-health/primary-impact and other existing AMR initiatives.

64. The merit review criteria mentions “Applicant being successful in performing with no government intervention”. Can you please elaborate on this aspect further in terms of what is expected as government intervention.

USAID Response: Here, “government” refers to the US Government. It is envisaged that the partner/consortium will be able to implement the program on its own, with no additional support from the US Government except for the USAID funding and “substantial involvement” as referred to in section B.5 of the NOFO.

65. Section C - Eligibility Information - C.1 Eligible Applicants: Eligibility for this NOFO is open to all eligible and qualified U.S., local and international nongovernmental entities.

There could be some for-profit organizations that are well placed to deliver this as a lead entity or a consortium partner. In the case of such organizations, we request you to consider a fixed price contract at the agreement stage.

USAID Response: Thank you for the suggestion. As mentioned under C.1, “USAID reserves the right to determine the type of assistance instrument…”

66. Section A – Project Description - Outcome, Results and Key Deliverables The expected impact, outcomes, key results, and illustrative activities are given below. Impact: Under-50 mortality in India reduced.

• We believe…