Amendment # 1 NOFO 72062125RFA00001 - USAID Thamini Afya.pdf

Date: December 2, 2024

Subject: Notice of Funding Opportunity Number (NOFO): 72062125RFA00001, Amendment No. 01

Dear Prospective Applicant, The purpose of Amendment No. 1 to the NOFO is as follows:

1. Provide answers to questions submitted on November 20, 2024 (see Appendix 1);

2. Revise the submission date (see highlighted changes in Appendix 2); and,

3. Revise application instructions in Section D (see highlighted changes in Appendix 2).

This amendment does not obligate USAID to execute an award, nor does it commit USAID to pay any costs incurred in the preparation and submission of applications. Furthermore the U.S.

Government reserves the right to reject any and all applications, if such action is considered to be in the best interest of the U. S. Government. All other terms and conditions remain unchanged.

Sincerely, Ashley Burgin Agreement Officer Office of Acquisition and Assistance USAID Tanzania

NOFO No. 72062125RFA00001 - Amendment No. 1 USAID Thamini Afya (Value Your Health)

Appendix 1: Questions and Answers

QUESTIONS AND ANSWERS

1. On page 20 of the NOFO, “Sub IR 3.1 The Activity will implement all SBC interventions at national level to avoid duplication of efforts across partners and stakeholders, access economies of scale in mass or social media or address social and behavioral determinants that cut across health areas such as norms, stigma and discrimination or agency. This national level implementation will serve to create an enabling environment and reinforce

SBC interventions taking place at the community or facility level.” Could USAID clarify which and/or how many campaigns and interventions within the platforms we need to provide TA to?

USAID Response: The number of SBC interventions and TA supported by USAID Thamini Afya will depend on need and funding. The Activity is expected to establish nimble operations to support numerous activities on the design, implementation, monitoring, and evaluation spectrum simultaneously.

2. On page 38 of the NOFO, USAID requests "The applicant must provide information regarding its recent history of performance for all its cost-reimbursement or fixed price contracts, grants, or cooperative agreements, including any fixed amount awards involving similar or related programs, not to exceed three years as follows." This may pose an undue burden on USAID's review committee considering global presence and extensive operational history. Would USAID consider limiting the requirement to the 5 most relevant past performance references, as is customary in many solicitations?

USAID Response: Past performances should be limited to the five most relevant past performance references within the past three years.

3. In light of USAID’s emphasis on localization and the need to engage and collaborate meaningfully with local partners to align with these priorities, we kindly request a one-week extension to the proposal submission deadline.

USAID Response: USAID has revised the deadline to December 16, 2024 at 17:00 East Africa

Time (EAT)

4. On page 23 of the NOFO (and elsewhere), it is stated that the Activity will include buy-ins from multiple health areas. Would you please clarify the nature of these buy-ins?

Appendix 1: Questions and Answers

USAID Response: Buy-ins from multiple health areas means that funding will be awarded to the

Activity from different health areas. The Activity will be responsible for supporting the following health areas: HIV, malaria, TB, family planning, MCH, and global health security SBC interventions based on the amount of funding received for each health area. Funding from various health areas will be combined to form the total estimated amount for this award.

5. Will these buy-ins include additional funding for Thamini Afya Activity programs and activities?

USAID Response: No, the total estimated amount for the USAID Thamini Afya Activity is

$16,450,000 and all activities should be within that total amount.

6. Is the awardee responsible for identifying potential buy-ins and marketing Thamini Afya to these health programs?

USAID Response: No. Buy-ins are not additional funding and the Activity will not need to promote itself to expand the health areas that are supported. Within the total estimated amount, the Activity should be able to support multiple health areas.

7. Given the project’s national focus, are there priority regions and councils for the project’s first year(s)?

USAID Response: The focus for this Activity is at national level. Priority regions will depend on the health area(s) that need SBC interventions. For Global Health Security, this Activity will support national and sub-national level SBC interventions with specific regions communicated as work plans are developed. The Activity is expected to establish nimble operations to support various regions as needed.

8. Is the project responsible for conducting new research to fill gaps in SBC interventions?

USAID Response: Sub-IR 3.3, “Intermediate and behavioral outcomes are routinely monitored and evaluated”, includes process, outcome, and impact evaluations of SBC interventions.

However, the actual implementation of evaluations will be determined by need and availability of funding. Sub-IRs 2.1 and 2.2 include collection of primary evidence, where necessary, to inform adaptation of existing SBC interventions and design of new SBC interventions.

Appendix 1: Questions and Answers

9. Could USAID please share the gender analysis completed May 2024 and mentioned on

NOFO page 24? Is this gender analysis the basis for the detailed gender analysis that will be conducted in the early stages of project implementation (see NOFO page 25)?

USAID Response: No, USAID will not be sharing the gender analysis completed in May 2024 and it does not need to be the basis for a detailed gender analysis.

10. Does USAID Tanzania have a preferred template for Past Performance References for this application? If so, could this be shared?

USAID Response: No, USAID Tanzania does not have a preferred template. Applicants should provide the required information listed in the NOFO.

11. We request at least a 15-day extension to the proposal deadline.

USAID Response: See response to question #3

12. Would USAID permit applicants to use a 10-point font for text boxes?

USAID Response: 10-point font can only be used for graphs, charts, tables and text boxes.

13. Could USAID kindly clarify whether applicants should submit the Certificate of

Incorporation and Registration as an annex as part of the Technical Application or Business

Application?

USAID Response: The Certificate of Incorporation and Registration should be submitted as an annex to the Technical Application.

14. Could USAID kindly provide recent reports and/or evaluations from the Breakthrough

Action project in Tanzania? Many of these reports do not appear on the Development

Clearinghouse Exchange (DEC)

USAID Response: The Development Experience Clearinghouse is a comprehensive, but not exhaustive source of information.

15. Could USAID clarify whether there should be a MEL section included in the 15-page technical approach, or should MEL (text, approach, etc.) only be in the Annex, (MEL indicator Matrix)?

Appendix 1: Questions and Answers

USAID Response: Per the NOFO: “The Applicants must submit their overall monitoring approach as an indicator matrix that should be included as an annex. This matrix should contain the proposed indicators for each intermediate result, indicator type (output, outcome etc), data source, frequency of data collection, and baseline data. The annex will not be counted in the page limit.”

16. Could USAID kindly clarify whether there are any subsections required within the technical approach, as no guidance is given?

USAID Response: There are no requirements for subsections.

17. Could USAID kindly clarify how many past performances applicants should provide? The current guidance in the NOFO requests all in the past three years which for some organizations could amount to several dozens of active and past projects.

USAID Response: See response to question #2

18. Could USAID kindly clarify if the expectation is that USAID Thamini Afya will be responsible for designing all SBC materials to be used by USG service delivery partners? Would this design of materials be limited to graphic designs such as posters and behavior change strategies for various health areas or does USAID intend USAID Thamini Afya also produce them in large quantities in print and electronic formats and distribute them? Will USG service delivery partners be responsible for printing and distribution?

USAID Response: Yes, USAID Thamini Afya will be responsible for designing of all SBC interventions which will be implemented by USAID Thamini Afya, which may also include materials, for all USG-supported service delivery partners, depending on need and available funding. The design will not be limited to only graphic design and behavior change strategies for various health areas. In some cases USAID Thamini Afya will be expected to print SBC materials and electronic format and distribute them at national and sub-national levels. In other cases, the USG-supported service delivery partner or Government of Tanzania may support costs associated with printing and distribution.

19. Could USAID kindly clarify if the expectation under IR3.2 is that USAID Thamini Afya will be responsible for implementing SBC interventions sub-nationally at the community and facility level for all global health security (GHS) interventions?

Appendix 1: Questions and Answers

USAID Response: Yes, USAID Thamini Afya will be responsible for the implementation of global health security SBC interventions nationally and sub-nationally at the community and facility level in a sub-set of regions which will be determined by USAID Tanzania.

20. Could USAID kindly clarify whether under IR3.2 the phrase “as needed” in the following sentence applies to both GHS and other health areas, or just other health areas? “The

Activity will implement SBC interventions sub-nationally at the community and facility level for all global health security (GHS) interventions and for other health areas, as needed.”

USAID Response: “As needed” applies to other health areas. Implementation of SBC interventions for GHS nationally and sub-nationally at community and facility level is mandatory.

21. Could USAID kindly clarify whether there are priority districts or geographic areas for community level implementation under IR3.2 that USAID Thamini Afya will be responsible for supporting?

USAID Response: Priority districts or geographic areas for community level implementation will be communicated by USAID Tanzania during annual work planning. The Activity is expected to establish nimble operations to support various regions as needed.

22. Could USAID kindly clarify how they envision USAID Thamini Afya working with the

Zanzibar Ministry of Health under this activity?

USAID Response: The support in Zanzibar is to provide technical assistance to the Health

Promotion Unit of the Ministry of Health and the government health programs including HIV and malaria in the design (IR2), management (IR1), and coordination (IR1) of SBC interventions.

23. Could USAID kindly clarify what the intended outputs are from IR 2.1 and IR 2.2? Under IR2, does USAID intend this activity to supply data-driven, theory-informed SBC interventions for use by the Government of Tanzania and USG service delivery partners, or should it concentrate its efforts on ensuring data being used by the Government of Tanzania and

USG service delivery partners to create new and enhance existing SBC interventions?

USAID Response: Under IR2, USAID expects USAID Thamini Afya to design theory-informed, evidence-based SBC interventions for the Government of Tanzania and USG-supported service delivery partners. The nuance between Sub-IR 2.1 and Sub-IR 2.2 is that Sub-IR 2.1 involves the use of primary and secondary evidence and routine monitoring data to revise / revamp / update

Appendix 1: Questions and Answers

/ adapt existing SBC interventions, while Sub-IR 2.2 involves the use of primary and secondary evidence and routine monitoring data to develop new SBC interventions. The SBC interventions are the output (per language used in IR2), not the data.

24. Can USAID please consider allowing applicants to use Calibri 11 pt font for tables in the technical application?

USAID Response: 10-point font can be used for graphs, charts, tables and text boxes.

25. On page 12 of the NOFO it states that "SBC approaches should be used in improving demand creation for screening and testing of precancerous lesions among women living with HIV (WLHIV) aged 18 and above." Can USAID please confirm if Thamini Afya can also use SBC approaches to increase uptake of the HPV vaccine?

USAID Response: Yes.

26. Can USAID please confirm that only the prime applicant needs to complete the

Certifications, Assurances, Representations, and Other Statements of the Recipient?

USAID Response: Yes, only the prime applicant needs to complete Certifications, Assurances, Representations and Other Statements.

27. Can USAID please confirm that references for each key personnel may be included on a separate page and that they are not included in the two-page limit per CV?

USAID Response: Yes, the references for each key personnel may be included on a separate page and are not included in the two-page limit for the CV.

28. Page 29 of the NOFO it states that “The Applicants must submit their overall monitoring approach as an indicator matrix that should be included as an annex. This matrix should contain the proposed indicators for each intermediate result, indicator type (output, outcome etc.), data source, frequency of data collection, and baseline data.” Could USAID please confirm that applicants may include a brief narrative description of the proposed monitoring approach in the MEL Indicator Matrix to complement the matrix of indicators?

USAID Response: Yes, applicants may include a very brief narrative description (not to exceed one page).

Appendix 1: Questions and Answers

29. Would USAID consider extending the application deadline by one week due to the US

Thanksgiving holiday?

USAID Response: See response to question #3.

30. Can USAID please clarify to what extent Zanzibar will be a geographic area of focus for this activity?

USAID Response: See response to question #22.

31. On page 29 of the NOFO, under “e) Technical Approach (15 pages maximum) can USAID specify if the offeror should follow the order of the description provided, i.e., “...Applicant’s key strategies, planned activities, and approaches, and the rationale for selecting the strategies and activities the Applicant will implement to accomplish...”, or can it be in a different order?

USAID Response: Applicants may structure their technical approach as they choose, there is no required order.

32. On page 20, C.5 Monitoring, Evaluation, and Learning notes MEL Plan, could USAID clarify if the MEL Plan is just in the annex or will pages be allotted in the technical to describe the

MEL Plan.

USAID Response: See response to question #15.

33. Could USAID confirm the geographic locations for the project? Does USAID have priority areas in Tanzania and/or Zanzibar to focus on for showing results and scale-up?

USAID Response: See response to questions #7 and #21

34. On page 31 the NOFO instructions requests “A list of three (3) references for each key personnel,” would USAID prefer to have the references with each CV as page 3 rather than separate annex?

USAID Response: Please adhere to the instructions stipulated in the NOFO.

Appendix 1: Questions and Answers

35. In the Executive Summary, SBC challenges, alignment with USG priorities, theory of change, and under Sub IR 1.1, “SBC actors” are mentioned. Can USAID define the breadth of SBC actors envisioned? Does this include all actors, from GOT, IPs, local organizations, etc.?

USAID Response: Yes, the list includes all actors from the Government of Tanzania (GOT), implementing partners (IPs), local organizations, and private sector, etc.

36. On page 29 “e) Technical Approach (15 pages maximum) it states, “This matrix should contain the proposed indicators for each intermediate result, indicator type (output, outcome etc.), data source, frequency of data collection, and baseline data.” On page 21 under C.5 Monitoring, Evaluation, and Learning, it also states, “The MEL plan must include at least one indicator per activity-level outcome, with baseline values or plans to collect baseline data and annual targets that are ambitious yet realistic.” Can USAID clarify if the offeror is expected to have baseline data across IRs, or a combination of baseline data and plans to collect baseline data based on the proposed indicators?

USAID Response: See response to question #15.

37. On page 31, G. MEL Indicator Matrix. Should the indicators be grouped by IR or by behavioral focus?

USAID Response: The Applicants should group the indicators by IRs.

38. On page 20, IR 3, does USAID anticipate GHS as the only focus of this IR or will other areas be considered?

USAID Response: IR 3 includes all health areas, not only global health security (GHS).

39. Could USAID clarify what type of SBC GHS activities should be included and budgeted for in this Activity vs. the recently awarded USAID Tanzania Usalama wa Afya Duniani award.

USAID Response: This being SBC award, expectation is the Applicant will propose GHS SBC interventions to complement USAID Tanzania Usalama wa Afya Duniani activities which don’t include SBC activities.

40. On page 18, Sub IR 1.1, the NOFO states “The Activity will also support defining roles and responsibilities of all SBC actors with the aim of minimizing duplication of efforts.” Can

Appendix 1: Questions and Answers

USAID please clarify who entails “all SBC actors?” Are they all the actors within HPS and

MOH or does this refer to all actors across national, regional and community levels?

USAID Response: See response to question #35

41. One of the outcome indicators for this Activity is an “Increase in GOT capacity to coordinate, finance, manage and track SBC activities as measured by the percentage increase in GOT-managed SBC implementation, monitoring, and evaluation activities.” Can

USAID clarify the outcome? Is the outcome changes in the government’s ability to manage

SBC activities or is it the percentage increase in government funding for SBC activities

(which is mostly outside the control of this Activity).

USAID Response: The outcomes entails everything including government ability to manage and coordinate SBC activities and ability of the GOT to fund, implement, monitor, and evaluate SBC activities.

42. The indicator “Percentage increase or decrease in the practice of targeted health behaviors and behavioral determinants among people reached with SBC interventions” refers to achieving changes in behaviors and their determinants which will largely depend on government commitment, government availability of financial resources, government staff capacity in SBC, M&E, etc. While this Activity can encourage improvements in health behaviors, much of the achievement of this Activity depends on the government and its commitment to SBC. Is it expected that Activity staff be held accountable for the government’s level of commitment?

USAID Response: No, the Activity will not be held for anything outside the scope.

43. Through this Activity, will USAID encourage the GOT to adopt a wide range of SBC approaches (which provides implementers options for increasing the uptake of optimal behaviors but is expensive and time consuming) or is a more limited (potentially less effective but easier to adopt) set of approaches envisioned?

USAID Response: Applicants should propose SBC approaches that will best support the results framework and address the guiding principles of this NOFO.

44. Would USAID consider the use of Program Impact Pathways to complement USAID’s results framework?

Appendix 1: Questions and Answers

USAID Response: There is no limitation on complementing USAID’s results framework; however, applicants must adhere to all the requirements of the NOFO.

45. Sub-IR 3.1 says “The Activity will implement all SBC interventions at national level to avoid duplication of efforts across partners and stakeholders.” Does this mean that any SBC activity implemented by the government and/or implementing partners will be scaled up nationally or does it mean that only the most promising SBC approaches (as demonstrated by the programmatic evidence) will be scaled up?

USAID Response: The Activity will be responsible for implementing SBC activities which are approved by the Ministry of Health (MOH). It is not necessary that all SBC activities which are implemented by the government and/or implementing partners should be scaled up nationally by this Activity.

46. In section C.6 (Guiding Principles), USAID mentions that “the Activity’s fundamental achievements must be sustained beyond the life of the Activity.” Does USAID expect the awardee to demonstrate this? If so, how will this be done after the Activity has ended?

USAID Response: The activity should be designed and implemented with sustainability of processes and outcomes in mind.

47. Could USAID provide more details on the requested Certificate of Compliance.

USAID Response: The Certificate of Compliance is only required if your organization’s systems have been certified by USAID/Washington’s Office of Acquisition and Assistance (M/OAA). If your organization has not received this certification, then this document does not need to be submitted.

Appendix 2

Issue Date: November 7, 2024 Deadline for Questions: November 20, 2024; 17:00 EAT Closing Date: December 16, 2024 at 17:00 EAT

Subject: Notice of Funding Opportunity Number (NOFO) 72062125RFA00001 Amendment 01

Program Title: USAID Thamini Afya (Value your Health)

Federal Assistance Listing Number: 98.001

Greetings, The United States Agency for International Development (USAID) is seeking applications for a cooperative agreement from qualified entities to implement USAID/Tanzania activity entitled “USAID Thamini Afya (Value Your Health)”. Eligibility for this award is not restricted, see Section B of this NOFO for eligibility requirements.

Subject to the availability of funds and continued relevance of the Activity to USAID’s programming, USAID/Tanzania intends to provide up to $16,450,000.00 in total funds to be allocated over a 5-year period to the applicant who best meets the objectives of this funding opportunity based on the merit review criteria described in this NOFO, subject to a risk assessment. Eligible parties interested in submitting an application are encouraged to read this NOFO thoroughly to understand the type of program sought, application submission requirements, and selection process.

To be eligible for award, the Applicant must provide all information as required in this NOFO and meet eligibility standards in Section B of this NOFO. This funding opportunity is posted on www.grants.gov and may be amended. It is the responsibility of the Applicant to regularly check the website to ensure they have the latest information pertaining to this 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.

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

Appendix 2

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 usaidtzco@usaid.gov with the point(s) of contact identified in Section A.4 copied. 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, Ashley Burgin Agreement Officer mailto:usaidtzco@usaid.gov

Appendix 2

Table of Contents

SECTION A: BASIC INFORMATION

SECTION B: ELIGIBILITY

SECTION C: PROJECT DESCRIPTION

SECTION D: APPLICATION CONTENT AND FORMAT

SECTION E: SUBMISSION REQUIREMENTS AND DEADLINES

SECTION F: APPLICATION REVIEW INFORMATION

SECTION G: AWARD NOTICES

SECTION H: POST-AWARD REQUIREMENTS AND ADMINISTRATION

SECTION I: OTHER INFORMATION

ANNEX 1 - SUMMARY BUDGET TEMPLATE

ANNEX 2 - STANDARD PROVISIONS

ANNEX 3 - ABBREVIATIONS AND ACRONYMS

Appendix 2

SECTION A: BASIC INFORMATION

A.1 Executive Summary

The goal of the USAID Thamini Afya (Value your Health) Activity (“Activity”) is to increase the practice of desired health behaviors by individuals (including healthcare providers), households, and communities by (IR 1) strengthening SBC capacity and coordination of SBC actors; (IR 2) designing theory-informed, evidence-based SBC interventions; and (IR 3) implementing, monitoring, and evaluating SBC interventions nationally and sub-nationally.

To achieve IR 1, this Activity will strengthen the capacity of Government of Tanzania (GOT) counterparts at the national level, the Ministry of Health (MOH)/Health Promotion Section (HPS), Health Programs, and President’s Office-Regional and Local Government (PO-RALG), and at the sub-national levels (regional and district levels) to better manage and sustain social and behavior change (SBC) interventions. This Activity will improve SBC coordination systems by ensuring that clear roles and responsibilities of each SBC actor are well defined and strengthen the capacity of GOT actors in managing the interventions. The Activity will also strengthen the SBC technical capacity of the U.S. Government (USG) service delivery partners that support sub-national implementation of SBC interventions at the community and facility levels. To achieve IR 2, this Activity will support design of SBC interventions using best practices, revamping current approved SBC interventions supported by GOT, and ensuring that approved interventions are responsive to the needs of the community and driven by data and evidence.

To achieve IR 3, the Activity will implement, monitor and evaluate SBC interventions at the national and sub-national level (as needed).

All SBC interventions in Tanzania must be guided by relevant GOT policies. The Activity will be aligned with the U.S. President’s Malaria Initiative Strategy, End Malaria Faster, the PEPFAR 5-year strategy, USAID’s priorities in family planning and Global Health Security (GHS) and other relevant U.S policies and strategies. To ensure adequate coordination of SBC activities, GOT will thoroughly review, approve and keep an inventory of all SBC interventions and tools developed under this project before they are disseminated at the national and sub-national levels. This Activity will work closely with other donors and local actors to avoid redundancies or duplication of SBC interventions by defining roles and responsibilities of each actor and ensuring that SBC interventions are well harmonized. This can be achieved by engaging all responsible stakeholders from the government, donors, service delivery partners who are implementing at the community level, and private sector, including media. The Activity will engage and directly involve USG service delivery (USAID and interagency) partners implementing SBC interventions at the sub national/ community level to ensure that designed SBC interventions (which are done at national level) are data driven through incorporating information on the remaining gaps from communities. This Activity will be responsible for collecting, monitoring, and analyzing data from the service delivery partners implementation at the community to inform decisions to be made at national level.

Appendix 2

USAID/Tanzania anticipates that this Activity will include a range of health areas such as malaria, maternal health, newborn and child health, global health security, family planning, tuberculosis, emerging diseases, and HIV. It may also address cross-cutting health issues such as WASH and nutrition and others as deemed appropriate.

To ensure that this Activity is achieving the desired results and able to demonstrate meaningful progress, USAID/Tanzania expects at a minimum the following essential outcome/impact level indicators to be monitored:

● Increase in GOT capacity to coordinate, finance, manage and track SBC activities as measured by the percentage increase in GOT-managed SBC implementation, monitoring, and evaluation activities.

● Percentage increase or decrease in the practice of targeted health behaviors and behavioral determinants among people reached with SBC interventions.

● Improved awareness of antimicrobial resistance (AMR) and behavior change among health workers and the general public.

A.2 Estimate of Funds Available and Number of Awards Contemplated

USAID intends to award a 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 $16,450,000 in total USAID funding over a five-year period.

A.3 Start Date and Period of Performance for Federal Awards

The anticipated period of performance is five (5) years. The estimated start date will be March 2025.

A.4 Agency Point of Contact

Gloria Matau Acquisition & Assistance Specialist Email: gmatau@usaid.gov USAID/Tanzania 686 Old Bagamoyo Road, Msasani P. O. Box 9130 Dar es Salaam, Tanzania and

Ashley Burgin Agreement Officer Email: aburgin@usaid.gov USAID/Tanzania mailto:gmatau@usaid.gov mailto:aburgin@usaid.gov

Appendix 2

686 Old Bagamoyo Road, Msasani P. O. Box 9130 Dar es Salaam, Tanzania

A.5 Acquisition and Assistance Ombudsman

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

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

A.6 Authorized Geographic Code

The geographic code for the procurement of commodities and services under this program is Code 935 (any area or country including the recipient country 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]

THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY.

https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman

Appendix 2

SECTION B: ELIGIBILITY

B.1 Eligible Applicants

Eligibility for this NOFO is not restricted.

All U.S. and non-U.S. public, private, for-profit, and nonprofit organizations, as well as institutions of higher education, parochial, and other non-governmental organizations are eligible to submit an application. Further, the organization must be a legally recognized entity under applicable law.

Additionally, USAID welcomes applications from organizations that have not previously received financial assistance from USAID.

Each applicant organization is limited to one application submission as the prime applicant.

There is no limitation on being included as a potential sub-awardee. USAID discourages the use of exclusive teaming arrangements.

B.2 Cost Sharing

Cost Sharing is not required for this Activity.

[END OF SECTION B]

THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY.

Appendix 2

SECTION C: PROJECT DESCRIPTION

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

C.1 Goal

The Activity will support individuals (including healthcare providers), households, and communities to adopt and maintain the practice of desired health behaviors by (IR 1) strengthening SBC capacity and coordination; (IR 2) designing theory-informed, evidence-based SBC interventions; and (IR 3) implementing, monitoring and evaluating SBC interventions nationally and sub-nationally.

The Activity will contribute to the achievement of the development objectives outlined in the USAID/Tanzania Country Development Cooperation Strategy 2020-2025 (CDCS)1, as well as the USAID Bureau for Global Health’s strategic priorities of preventing child and maternal deaths;

achieving and sustaining epidemic control; and combating infectious diseases2.

C.2 Background and Development Challenges

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

a. SBC Challenges

Tanzania has made remarkable progress in the expansion of primary health care, with services reaching most communities and households in both urban and rural areas. However, despite such significant progress, Tanzania still suffers the double burden of communicable and non-communicable diseases. Early healthcare seeking behaviors at the individual, household

3 https://thinkbigonline.org/action/document/download?document_id=416

2 https://www.usaid.gov/global-health

1 https://www.usaid.gov/tanzania/country-development-cooperation-strategy https://www.usaid.gov/tanzania/country-development-cooperation-strategy https://www.usaid.gov/global-health https://www.usaid.gov/global-health https://thinkbigonline.org/action/document/download?document_id=416

Appendix 2 and community levels remains a challenge due to individual behaviors, social cultural norms, provider’s attitudes and community engagement. Healthcare providers biases, norms and attitudes continue to influence a patient’s sustained uptake of services. This often unwelcoming atmosphere and poor communication between providers and patients compounded with barriers such as cultural and traditional factors lead to low utilization of health services.

Appropriate, well coordinated, designed, implemented, monitored and evaluated SBC interventions targeting individual behaviors, social cultural norms, providers’ attitudes and community engagement are critical to improving health behaviors towards increase in health services uptake. Over the years, coordination of SBC interventions has remained a key challenge.

Within the public sector, the Health Promotion Section (HPS), which falls under the Ministry of Health (MOH), is responsible for serving as the main national-level government entity overseeing and ensuring the quality of all SBC interventions for health. The government Health Programs under the MOH such as National Malaria Program (NMCP), National TB and Leprosy Program (NTLP), National AIDS, STIs and Hepatitis Control Program (NASHCoP), Reproductive and Child Health Section (RCHS) should be working closely with HPS on SBC design, guidelines and policy development, and monitor implementation of SBC interventions. However, some of the Health Programs often implement their own SBC interventions without working through HPS leading to inefficiencies and inconsistent messaging. Additionally, lack of clear roles and division of responsibilities vertically between national entities, such as MOH, Health Programs, and PO-RALG, and sub-national government entities, such as local government authorities (LGAs) and Regional and Council Health Management Teams (R/CHMTs), further add to fragmentation and create redundancy in efforts.

Additional SBC coordination challenges exist when trying to work with a multitude of stakeholders that involve non-governmental actors such as civil society and the private sector.

The expertise and interests of the government, private sector, and civil society must be taken into account in determining who plays what role. Actors from these sectors must work together to build and operationalize a sustainable SBC framework. Although government stewardship of the process is critical, the private sector must be incentivized and be given the latitude to play a more significant role in creating a sustainable outcome. Private media houses, printers and publishers, professional organizations, community-based organizations, faith-based organizations, and civil society organizations will need to collaborate and coordinate interventions with the MOH and other relevant ministries.

Limited technical and management capacity of the MOH/HPS, PO-RALG, and Health Programs hinder SBC interventions at all levels. Although there have been improvements in recent years such as the design of integrated NAWEZA and SITETEREKI platforms and the FURAHA YANGU campaign, some government health programs still rely on outdated and sub-optimal approaches such as Information, Education and Communication (IEC). Designing targeted and effective SBC based on evidence remains a challenge with limited capacity to monitor and evaluate interventions.

Appendix 2

In sum, the existing SBC key challenges in Tanzania include: (1) lack of strong coordination of SBC interventions at the national, regional and local government levels, including across sectors; (2) lack of clear roles and responsibilities of SBC actors; (3) limited GOT technical and management capacity to manage SBC interventions at all levels; (4) lack of capacity to design theory-informed, evidence-based SBC interventions; (5) lack of capacity to implement, monitor and evaluate SBC interventions at different levels; (6) limited engagement of the private sector; and, (7) inadequate use of data for decision making.

These challenges impact the quality, efficiency, effectiveness, and sustainability of SBC interventions and limit synergies of SBC interventions implemented by the various health programs, such as malaria, HIV/AIDS, TB, among others. A well coordinated SBC activity is needed to assure quality SBC interventions align with national strategies and program standards.

In this regard, this Activity will play a pivotal role in strengthening systems and processes that improve quality and enhance coordination of SBC activities at national and subnational levels, across different disease areas.

b. Health Sector Challenges

Global Health Security

Global Health Security (GHS) focuses on building a country’s capacity to prevent, detect, and respond to emerging infectious disease threats with a One Health lens - at the intersection of human, animal and environmental health. SBC strategies have been used in disease prevention, risk mitigation and response to strengthen risk communication and community engagement (RCCE). Disease prevention and risk communication have been critical for addressing the behavioral and social aspects of health risks that precede and follow a public health emergency.

To maintain the gains made during the COVID-19 response and to address the persisting gaps, SBC approaches must be integrated into the preparedness and response agenda from the outset. In addition, a priority area is to reduce antimicrobial resistance (AMR) and improve infection prevention control (IPC), thus further elevating the importance of targeting healthcare providers (of both animals and people) within GHS. In clinical settings in Tanzania, the prevalence of multidrug-resistant (MDR) bacteria ranges from 25% to 50%. About two-thirds of isolates from wound infections at Muhimbili National Hospital were found to be MDR. Limited sporadic studies conducted to assess hand hygiene standards among healthcare providers revealed low compliance ranging between 6.9% and 24%, whereas compliance in using alcohol rub was 41%. Both AMR and the spread of infections are rooted in a lack of awareness and harmful practices, so RCCE can play a key role in helping to mitigate their impacts.

Family Planning and Reproductive Health

Modern Contraceptive Prevalence Rate (mCPR) in Tanzania has slightly decreased from 32 percent in 2015-16 (2015-2016 Tanzania Demographic and Health Survey and Malaria Indicators https://dhsprogram.com/pubs/pdf/FR321/FR321.pdf

Appendix 2

Survey [2015-2016 TDHS-MIS])4 to 31 percent in 2022. More married women (32%) in Tanzania mainland use modern methods of family planning than their counterparts in Zanzibar (17%) (2022 TDHS-MIS)5. According to the 2022 TDHS-MIS, the unmet need for family planning remains high at 21 percent, with marked geographical variations. Though nearly all married women and men aged 15-49 years (98%) report having knowledge about modern contraceptive methods, this has not translated into a high rate of contraceptive use, especially among all women where we see a contraceptive prevalence of 31 percent. Among married women, the contraceptive prevalence is 38 percent and among sexually active unmarried women, it is at 45 percent (2022 TDHS-MIS). Demand for family planning among currently married women aged 15–49 in Tanzania has slightly decreased from 61 percent in 2015–16 (2015-2016 TDHS-MIS) to 59 percent in 2022 (2022 TDHS-MIS). Utilization of family planning and reproductive health services is influenced by a range of factors including social-cultural beliefs and practices, gender norms and dynamics (including intra household decision making), gender inequality, healthcare provider biases, intimate partner and gender-based violence, knowledge and attitudes, and access to services. Improving family planning and reproductive health in Tanzania requires SBC interventions that address these factors and create an enabling environment for family planning and reproductive health promotion, demand creation and uptake.

HIV

The UNAIDS 95-95-95 targets for 2025 call for 95 percent of all people living with HIV to be aware of their HIV status, 95 percent of those aware of their status to be on antiretroviral treatment (ART), and 95 percent of those on ART to achieve viral load suppression (VLS). On a national level, Tanzania has met the second of the three targets ahead of 2025, demonstrating access to and uptake of robust treatment programs among those who are aware of their HIV-positive status.

Tanzania has made remarkable gains since the 2016-2017 Tanzania HIV Impact Survey (2016-2017 THIS)6, in which progress toward UNAIDS 95-95-95 targets was at 61 percent, 94 percent, and 87 percent. Notably, the 2022-2023 Tanzania HIV Impact Survey (2022-2023 THIS)7 estimated that among people aged 15 years and older living with HIV in Tanzania, only 83 percent are aware of their status while 98 percent of those who are aware of their HIV status are on ART, and 94 percent of those on ART are virologically suppressed. However, disparities exist by sex and across age bands and regions. Among adults who know their HIV status, 85 percent are women and 78 percent are men (2022-2023 THIS). The 2022-2023 THIS also showed that viral load suppression among all adults living with HIV was 78 percent (81 percent among women compared to 72 percent among men). Younger adults were less likely to achieve viral load suppression than older adults.

7 https://phia.icap.columbia.edu/wp-content/uploads/2023/12/THIS-SS_5DEC2023.pdf

6https://phia.icap.columbia.edu/wp-content/uploads/2020/02/FINAL_THIS-2016-2017_Final-Report__06.21.19_for -web_TS.pdf

5 https://dhsprogram.com/pubs/pdf/PR144/PPR144.pdf

4 https://dhsprogram.com/pubs/pdf/FR321/FR321.pdf https://dhsprogram.com/pubs/pdf/FR321/FR321.pdf https://dhsprogram.com/pubs/pdf/PR144/PPR144.pdf https://phia.icap.columbia.edu/wp-content/uploads/2020/02/FINAL_THIS-2016-2017_Final-Report__06.21.19_for-web_TS.pdf https://phia.icap.columbia.edu/wp-content/uploads/2020/02/FINAL_THIS-2016-2017_Final-Report__06.21.19_for-web_TS.pdf https://phia.icap.columbia.edu/wp-content/uploads/2023/12/THIS-SS_5DEC2023.pdf

Appendix 2

There are also marked variations in HIV prevalence by age, sex, and region, with a higher prevalence among women and in certain regions of mainland Tanzania. HIV prevalence is below one percent in all the regions of Zanzibar. Enhanced case finding by addressing behavioral and structural barriers among populations who are unaware of their HIV-positive status or outside of the care system remains an important program intervention to address gaps in the first 95.

The 2022 TDHS results show that less than half of women and men (42% and 38%, respectively) aged 15–24 have comprehensive knowledge of HIV prevention. Closing these gaps and others will require addressing these factors and others such as social norms and stigma through targeted SBC and innovative applied behavioral science interventions. These approaches will help to “move the needle” toward epidemic control and to complement structural interventions such as differentiated service delivery.8

In Tanzania, cervical cancer ranks first in both incidence and mortality, accounting for 24.2% of new cancer cases and 23% of cancer-related deaths in 2022 (Global Cancer Observatory, 2022).

More than 99% of cases of cervical cancer are caused by infection with human papillomavirus (HPV); and the HPV vaccine can prevent up to 90% of all cervical cancer cases. Women living with HIV (WLHIV) are at higher risk of persistent HPV infection and are six times more likely to develop precancerous lesions that advance to cervical cancer. As part of USG’s Go Further Ending AIDS and Cervical Cancer, SBC approaches should be used in improving demand creation for screening and testing of precancerous lesions among women living with HIV (WLHIV) aged 18 and above.

Malaria

Human behavior, including use of insecticide treated nets (ITN), care-seeking for fever, attendance at antenatal care (ANC) clinics, use of intermittent preventive treatment of malaria in pregnancy (IPTp), and adherence to national guidelines by healthcare providers, is critical to achieving malaria control and elimination objectives. In Tanzania, the prevalence of these behaviors among priority populations varies, as do the individual, social, and structural factors that influence these behaviors. The 2022 TDHS-MIS indicated that on the mainland, 64% of children and 66% of pregnant women slept under an ITN the night before the survey, care was sought for 78% of children under five with fever, 65% of women attended the recommended four ANC visits during their last pregnancy, and 60% of women received two or more doses of IPTp during their last pregnancy in the two years preceding the survey against the recommended standard by NMCP which is 85% by 2025. In Zanzibar, the 2022 TDHS-MIS indicated that 66% of children and 66% of pregnant women slept under an ITN the night before the survey, care was sought for 81% of children under five with fever, and 79% of women attended four ANC visits during their last pregnancy. In 2022, the U.S. President’s Malaria Initiative9 supported the implementation of the Malaria Behavior Survey (MBS)10 to better understand the factors that

10 https://malariabehaviorsurvey.org/

9 www.pmi.gov

8 2022-2023 THIS

https://dhsprogram.com/pubs/pdf/PR144/PPR144.pdf https://www.state.gov/partnership-to-end-aids-and-cervical-cancer/ https://www.state.gov/partnership-to-end-aids-and-cervical-cancer/ https://www.pmi.gov/ https://malariabehaviorsurvey.org/

Appendix 2 influence the practice of these behaviors. According to the mainland MBS, the following behavioral factors were associated with consistent ITN use: perceived self-efficacy, favorable attitudes towards net use (aOR 2.98, p-value <0.0001), and supportive descriptive community norms (aOR 2.26, p-value <0.0001). Similar results were found in Zanzibar: perceived self-efficacy (aOR 6.09), favorable attitudes toward net use (aOR 3.36), supportive descriptive community norms (aOR 2.15), favorable attitudes (aOR 1.67), and perceived susceptibility (aOR 1.43) were associated with consistent ITN use. The survey report for mainland Tanzania11 and survey report for Zanzibar12 include similar data for factors influencing other priority malaria behaviors.

Maternal, Newborn, and Child Health

Tanzania has made significant strides in maternal and child health (MCH) indicators. The percentage of women who had the recommended four or more ANC visits increased from 38 percent in the 2010 TDHS to 48 percent in the…