APS 72049223APS00001 Amendment 1-AO SIGNED.pdf

Subject: Universal Health Care Project

Annual Program Statement (APS) Number:

72049223APS00001

APS Issuance Date: August 1, 2023

APS Ques�ons Submission Closing Date: August 21, 2023, 1:00 PM Philippine Time

APS Amendment Issuance Date: December 18, 2023

APS Closing Date: July 31, 2024

Dear Prospec�ve Applicants:

The purpose of this Amendment 1 to the Annual Program Statement (APS) is to update the APS to reflect changes (highlighted in yellow ) impacted by the responses to ques�ons raised during prior Q&As for Addendum 1 to 3.

All other terms in the APS remain the same.

Sincerely, Jennifer L. Crow

Supervisory Agreement Officer Regional Office of Acquisi�on and Assistance USAID/Philippines

JENNIFER LYNN

CROW (affiliate)

Digitally signed by JENNIFER LYNN CROW (affiliate) Date: 2023.12.17 08:30:45 +08'00'

TABLE OF CONTENTS

SECTION A: PROGRAM DESCRIPTION 4

SECTION B: FEDERAL AWARD INFORMATION 1 8

SECTION C: ELIGIBILITY INFORMATION 20

SECTION D: CONCEPT PAPER SUBMISSION INFORMATION 22

SECTION E: APPLICATION REVIEW INFORMATION 28

SECTION F: FEDERAL AWARD ADMINISTRATION INFORMATION 29

SECTION G: FEDERAL AWARDING AGENCY CONTACT(S) 32

SECTION H: OTHER INFORMATION 33

ATTACHMENT 1: CONCEPT PAPER COVER PAGE 34

ATTACHMENT 2: DEFINITIONS: 35

ATTACHMENT 3: USEFUL RESOURCES 39

ATTACHMENT 4: ILLUSTRATIVE EXAMPLE OF FULL APPLICATION INSTRUCTIONS 40

SECTION A: PROGRAM DESCRIPTION

This funding opportunity is authorized under the Foreign Assistance Act (FAA) of 1961, as amended. The resul�ng award will be subject to 2 CFR 200 – Uniform Administra�ve Requirements, Cost Principles, and Audit Requirements for Federal Awards, and USAID’s supplement, 2 CFR 700, as well as the addi�onal requirements found in Sec�on F.

A.1 Title

Universal Health Care Project (UHCP)

A.2 Overview

The U.S. Agency for Interna�onal Development (USAID) Mission in the Philippines is pleased to announce the Universal Health Care Project (UHCP) Annual Program Statement (APS), which aims to achieve improved health outcomes of underserved and vulnerable Filipinos, 1 in alignment with the United States Government (USG), USAID, and Philippine government objec�ves to achieve Universal Health Care (UHC). The UHCP is intended to be a suite of awards built to strategically improve na�onal and local health systems in the Philippines across an integrated health por�olio. The UHCP will address challenges facing the health system in the Philippines by focusing on health systems strengthening (HSS), improving the quality of service delivery, and the adop�on of posi�ve social norms and behaviors. Project ac�vi�es will implement focused health systems interven�ons to achieve key U.S. government objec�ves for tuberculosis (TB), family planning / adolescent reproduc�ve health (FP/ARH), HIV/AIDS, global health security (GHS), health systems and other emerging public health concerns. Working together and in structured coordina�on, the awards under the UHCP will contribute towards a more resilient and equitable health system. USAID an�cipates gran�ng six to seven new awards under this APS; this could change depending on needs and qualified applica�ons. The BARMM Resilience Ac�vity is not currently scheduled to be part of this APS.

Cri�cal to the success of the UHCP APS is the par�cipa�on of a broad and inclusive range of stakeholders including public, private, academic ins�tu�ons, and civil society organiza�ons.

These stakeholders can provide a deep understanding of regional and local challenges, health integra�ve solu�ons, and cross-cu�ng programming, building towards flexible and responsive health programs that con�nuously learn and adapt to effec�vely and sustainably reach USG, USAID, and Philippine government objec�ves. The UHCP will also build towards commitments around locally-led development as it iden�fies, builds the capacity of, and partners with local

1 The working defini�on of “underrepresented,” “at-risk,” “vulnerable,” or “marginalized” groups, as referenced in the document, “ Suggested Approaches for Integra�ng Inclusive Development Across the Program Cycle and in Mission Opera�ons Addi�onal Help for ADS 201 ”, is people who are typically denied access to legal protec�on or social and economic par�cipa�on and programs (i.e., police protec�on, poli�cal par�cipa�on, access to healthcare, educa�on, employment), whether in prac�ce or in principle, for historical, cultural, poli�cal, and/or other contextual reasons. Such groups may include, but are not limited to, women and girls, persons with disabili�es, LGBTQI+ people, displaced persons, migrants, indigenous individuals and communi�es, youth and the elderly, religious minori�es, ethnic minori�es, people in lower castes, and people of diverse economic class and poli�cal opinions. In addi�on, The Philippine Development Plan 2017-2022 iden�fied certain individuals and groups as having inherent vulnerabili�es. These are the poor and transient poor, children, women, persons with disabili�es (PWDs), indigenous peoples, overseas Filipinos (OFs) and their families, and older persons.

and indigenous organiza�ons. 2 These awards intend to streamline coordina�on and communica�on between USAID and cri�cal health system stakeholders by reducing the focus on health areas and increasing the focus on system strengthening and empowering communi�es and individuals to exercise their agency to improve health outcomes. The integra�on of health programs will ensure more effec�ve and efficient implementa�on, maximize technical assistance in priority convergence sites, and promote improved coordina�on among implemen�ng partners.

Collabora�ng, Learning and Adap�ng (CLA) is a key component of the APS and addenda.

Applicants are advised to include their plans for CLA in their technical approach. Each addendum will include detailed informa�on about what should be included in the submission.

Refer to A.7 Collabora�ng, Learning and Adap�ng.

A.3 Background

Country Background

The Government of the Philippines faces key challenges in its health sector to provide quality, accessible and equitable healthcare to the over 100 million Filipinos living in the country. These challenges include global health crises and natural disasters, dispari�es in local health systems performance, and gaps in the con�nuum of care. More than three years into the COVID-19 pandemic, the na�onal and local government units (LGUs) con�nue to struggle to catch up on the delivery of essen�al health services and to recover from the disrup�on created by the pandemic. Underserved popula�ons, especially those from the lowest income quin�les, con�nue to suffer from a high prevalence of TB (including mul�drug resistant TB or MDR-TB), a concentrated and growing HIV epidemic, high unmet need for family planning, high teenage pregnancy rates, and preventable maternal and newborn deaths, due to limited adop�on of healthy behaviors, weak health systems and governance, and inadequate service delivery. The private sector is the preferred provider by most Filipino people and engagement with public health providers is limited, thus missing the opportunity to expand primary care services.

While the Philippines Department of Health (DOH) is the country’s technical healthcare authority, the delivery of health services is a func�on devolved to local government units. DOH does not have direct control over implementa�on of health programs and provision of health care services at the local level, only serving as a steward to support LGUs through its Centers for Health Development (regional offices) and DOH-retained hospitals in different administra�ve regions. 3 With a decentralized health system, the Philippines requires addi�onal assistance to effec�vely allocate financial and human resources to provide services that align with health needs and priori�es. 4 Over the years, the DOH has provided direct support to LGUs in the form of public health commodi�es, human resources for health (HRH) augmenta�on, capital outlays for local health facili�es, and even premium subsidies to support the enrollment of poor Filipinos in the Na�onal Health Insurance Programs, which drove the upward trend in the

4 Dodd, Warren, et al. “ Governance of community health worker programs in a decentralized health system: a qualita�ve study in the Philippines. ” BMC Health Services Research. May 12, 2021.

3 Health Policy Development and Planning Bureau. “ Budget Briefer. ” 2021.

2 U.S. Agency for Interna�onal Development “ USAID Vision for Health System Strengthening 2030. ” March 29, 2021.

na�onal health budget in the past years.

Addi�onally, frequent ins�tu�onal disrup�ons have hampered progress at the Philippine Health Insurance Corpora�on (“PhilHealth”), which is envisioned to be the principal funder of health system reforms. PhilHealth faces challenges in registering indigent clients, , accredi�ng public and private primary care facili�es, and �mely processing and sufficient payment of reimbursements, leading to barriers in healthcare access. These ins�tu�onal challenges have hindered PhilHealth from fulfilling its mandate to provide financial risk protec�on for Filipinos. 5

In response to these challenges, the new Secretary of Health issued an eight-point priority agenda to support the execu�on of the health goals in the Philippine Development Plan (PDP) and the a�ainment of the Presiden�al direc�ves in health. These include access to quality health care, preven�on of priority diseases TB and HIV, improved response to emergencies, strengthened preparedness and response to poten�al pandemics, digital technology, improved condi�ons of human resources for health (HRH), and mental health.

Health System Strengthening

The COVID-19 pandemic exposed key systems weaknesses and gaps across the Philippines health sector. The Philippines Government vowed to learn from the lessons of the pandemic as it strives to build more resilient health systems that are well-equipped to deliver quality health services and prepared to respond to future pandemics and disasters. The new PDP (2023-2028) puts forward a roadmap for achieving strengthened resilience in the health sector. However, chronic challenges persist in workforce development, UHC Law opera�onaliza�on, devolu�on of responsibili�es to local governments, and public financial management, including the inability to fully ensure financial risk protec�on. Furthermore, the Philippines s�ll faces challenges with fragmented health systems, weak informa�on systems and logis�cs and supply chain management, and difficulty in integra�ng various public health programs at the primary care level.

Health systems and development programs are increasingly moving towards and reorien�ng their approach to support integra�on through regula�ons and policies, including from the Philippines’ Department of Health. The UHCP aims to contribute to sustainable health outcomes through a strong focus on addressing the fragmenta�on of health systems and to opera�onalize the health systems objec�ves of USAID and the Philippines Government as envisioned by Republic Act 11223 or the Universal Health Care Law. The UHCP will par�cularly focus on building the capabili�es of LGUs to manage their local resources and provide adequate health services with a special focus on primary healthcare, TB, FP, HIV, and GHS. It will likewise assist DOH, PhilHealth, and its regional offices to be�er support local health systems strengthening and program implementa�on through evidence-based policies, resources, and sufficient technical assistance. Furthermore, the UHCP will foster community par�cipa�on in health policy and governance, which is a key driving force in achieving and sustaining improved health systems and has varied throughout the past decades. The renewed commitment to pursue Universal Health Care offers an opportunity to move towards be�er health outcomes among all

5 Dayrit, Manuel M, et al. “The Philippines Health System Review.” Health Systems in Transi�on. Vo. 8, No. 2. 2018.

popula�on groups; financial risk protec�on for all, especially the poor, marginalized and vulnerable; and a responsive health system which contributes to Filipinos feeling respected, valued, and empowered.

Tuberculosis

TB remains a priority public health concern in the country. According to the 2022 Global Tuberculosis Report, there are an es�mated 741,000 incident TB cases and approximately 165 Filipinos die every day due to TB. 6 However, treatment coverage is at only 43 percent. In 2021, an es�mated 1.5 percent of new and 26 percent of retreatment cases had MDR-TB /rifampicin-resistant TB (RR-TB). In the Philippines, where nearly 10 million people reside in urban slums, poverty and other social determinants are major drivers of TB endemicity. The urban poor, undernourished, children, elderly, people with HIV, diabetes, and with other health risks including smoking, substance and alcohol abuse and those who are detained or imprisoned (“people deprived of liberty [PDLs]”) are more vulnerable to TB disease. 7 Addi�onally there is low demand for essen�al TB screening, tes�ng, and treatment. These challenges are �ed directly to the na�onal government and LGUs’ capacity to provide adequate HRH, financing, supply chain, and coverage. 8 USAID supported the implementa�on of the Philippine Strategic TB Elimina�on Plan Phase 1 (2018-2023) and a joint program review evaluated its impact, opportuni�es and challenges. 9 The Na�onal Coordina�ng Commi�ee for TB (NCC TB) sought to enhance the PhilSTEP into a comprehensive, mul�-sectoral ini�a�ve through the Philippine Accelera�on Ac�on Plan for TB (PAAP-TB). The PAAP-TB aligns NCC members’ organiza�onal plans, policies and programs to support TB elimina�on efforts including social protec�on, educa�on, civil society, and private sector engagement. USAID supported the development of PAAP to ensure that the Philippines TB elimina�on goal by 2030 is achieved. The Philippines’ strategy for TB elimina�on aims to achieve a 15 percent reduc�on in mortality and 12 percent reduc�on in TB incidence. Key efforts are needed focused on case no�fica�on, treatment success, and preven�on of MDR-TB, while suppor�ng overarching system reforms. The Marcos administra�on has iden�fied TB as a priority issue, commi�ng to support interven�ons to reduce its burden in the country. The Philippines is on the list of high burden countries, i.e. focus countries for global ac�on on TB, HIV-associated TB and drug-resistant TB, where progress is most needed to achieve the targets set in WHO’s End TB Strategy, and the poli�cal declara�on of the United Na�ons (UN) high-level mee�ng on TB. USAID also lists the Philippines as a priority country under the Global Accelerator to End TB. 10 The USAID Global TB Strategy (2023-2030) is well-aligned with the PAAP-

TB vision of a TB-free Philippines. 11 , 12 USAID’s TB por�olio in the Philippines aims to work with partners to reach every Filipino with tuberculosis, cure those in need of treatment, prevent new

12 The Philippine Accelera�on Ac�on Plan For Tuberculosis (PAAP-TB)

11 USAID Global TB Strategy (2023-2030)

10 USAID Global Accelerator to End TB

9 Philippine Department of Health. 2020. “Updated Philippine Strategic TB Elimina�on Plan - Phase 1: 2020-2023.”

8 Department of Health, 2019 Philippines TB Joint Program Review

7 Flores, et al. “ The Social Determinants of TB in the Philippines. ” The Lancet. January 2022.

6 World Health Organiza�on Global Report TB 2022 infec�ons and progression to ac�ve TB disease, while scaling-up innova�ons in detec�on, care, and treatment, and fostering local ownership to sustain TB programs that contribute to overall pandemic preparedness. USAID works closely with the Global Fund to Fight AIDS, TB and Malaria, in its TB elimina�on efforts in the Philippines.

HIV/AIDS

The Philippines has one of the fastest growing HIV epidemics in the Asia-Pacific Region 13 with an es�mated 158,400 people living with HIV as of 2022. 14 The impact of the ongoing HIV epidemic dispropor�onately affects key popula�ons — specifically transgender women, gay men, and other men who have sex with men – who comprise more than 80 percent of cases in the HIV registry. 15 More than 50 percent are among the young popula�on aged 25-34 years old and cases are heavily concentrated in the Na�onal Capital Region, CALABARZON, and Central Luzon.

COVID-19 stalled the country’s progress towards achieving epidemic control with case finding at only 65 percent, treatment reten�on at 66 percent, and viral load suppression at 27 percent as of December 2022, falling substan�ally short of the global 95-95-95 goals. 16

The na�onal and local HIV programs face addi�onal health systems challenges that undermine the effec�ve scale-up of service delivery and high-quality HIV preven�on, tes�ng, and care and treatment services as a result of gaps in financing, procurement and supply chain management, and quality improvement. 17 Through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program, the Philippines officially began implementa�on in 2020 with the broad goals to reach the global 95-95-95 targets 18 in the country and in partnership with the Department of Health and the efforts of four U.S. agencies. 19 To complement this work, USAID will con�nue suppor�ng community-led monitoring, advocacy, and key systems interven�ons aimed at improving procurement and supply chain management and sustainable financing at the na�onal and local government unit levels.

Global Health Security

The Philippines con�nues to face challenges in responding to public health emergencies, which became more evident during the COVID-19 pandemic, due to limited resources, weak capacity, and poorly equipped facili�es. Gaps in HRH at all levels affected pandemic response, delivery of other essen�al health services, and vaccina�on roll-out. The Philippines is a signatory to the Interna�onal Health Regula�ons (IHR) and led the conduct of a Joint External Evalua�on (JEE) in 2018 which iden�fied areas for improvement in the preven�on, detec�on, and response to

19 PEPFAR Philippines implemen�ng U.S. agencies currently include USAID, U.S. Centers for Disease Control and Preven�on (CDC), U.S. Health Resources and Services Administra�on (HRSA), and U.S. Department of Defense (DOD).

18 “ UNAIDS 2025 AIDS Targets - 95-95-95. ” 95 percent of people living with HIV know their status; 95 percent of HIV posi�ve individuals are on treatment; 95 percent of those on treatment are virally suppressed.

17 Ibid.

16 HIV, AIDS, and ART Registry of the Philippines, DOH-EB, December 2022

15 Department of Health - Epidemiology Bureau. Spectrum Es�mates and AIDS Epidemic Model. May 2022.

14 “Global AIDS Update 2018 Miles to go: Closing Gaps, Breaking Barriers, Righ�ng Injus�ces.” UNAIDS.

13 The Philippine Accelera�on Ac�on Plan For Tuberculosis (PAAP-TB ) emerging infec�ous diseases. 20 USAID supports the Philippines as a new GHS intensive support partner, to strengthen its capacity to prevent avoidable outbreaks; detect threats early; and respond rapidly and effec�vely when outbreaks occur through the One Health approach.

The Philippines is ranked 57 among 195 countries on the 2021 Global Health Security Index, a ranking based on countries’ health security capaci�es and preparedness to respond to future epidemic and pandemic threats. In order to achieve the priori�es on Global Health Security, 21 na�onal and local government units must strengthen their ability to prevent, detect and respond to disease outbreaks. Launched in 2019, the GHS ini�a�ve guides the U.S.

government’s work ini�ally in 19 priority countries and in 16 sub-technical areas spanning animal and human health, agriculture, and security with the aim of suppor�ng at least 50 countries by 2025. USAID will strengthen its contribu�on to Agency and GHS goals through its programming to boost country capacity and workforce development through the interagency to prevent, detect, and respond effec�vely to infec�ous disease threats.

Family Planning

High rates of adolescent and unplanned pregnancies were further exacerbated by the COVID-19 pandemic. Approaches to family planning and teenage pregnancy remain as a “medical” model despite a need to focus on social behavior change communica�on and the need to integrate with cross-cu�ng areas such as climate/environment, conflict, posi�ve youth engagement, social welfare, educa�on, gender equity and inclusion. The Philippines’ annual popula�on growth rate, es�mated at 1.5 percent (2022), remains one of the highest among the Associa�on of Southeast Asian Na�ons (ASEAN) countries. 22 The most recent NDHS (2022) showed the total fer�lity rate has decreased to 1.9, which is below replacement level. However, dispari�es remain between women in rural and urban areas, those with low educa�on, as well as wealth quin�les. Use of modern family planning methods is very low among sexually ac�ve unmarried women. The adolescent pregnancy rate decreased from 8.6 percent in 2017 to 5.4 percent in 2022. However, there is a pronounced gap across socio-economic status with two out of 100 adolescents in the wealthiest quin�le having ever been pregnant compared to 10 out of 100 adolescents in the poorest quin�le. While the number of births to 15-19 year olds declined by 33 percent over 2016 to 2022, the number of births to below 15 year olds increased by 22 percent, sugges�ng a need

22 “ Health Nutri�on and Popula�on Sta�s�cs. ” World Bank DataBank..

21 Global Health Security Agenda .

20 World Health Organiza�on, Joint External Evalua�on of IHR core capaci�es Republic of the Philippines 2018.

to improve social protec�on among girls and adolescents. 23 These shi�s necessitate an approach of looking beyond a health perspec�ve and towards social determinants such as educa�on, skills, and employment to contribute to economic growth by a�aining a demographic dividend. When a woman has children too early in life, the health of the mother and baby are at risk. Early pregnancies prevent adolescents from realizing their full poten�al to be produc�ve members of society. The es�mated net effect of early childbearing in the Philippines due to lost opportuni�es and foregone earnings can be as high as 33 billion pesos (US$ 63.2 million) 24 annual losses for the country. 25 , 26

The Philippines renewed its commitment to provide sustained funding for the voluntary FP program to accelerate reduc�on of unmet needs among underserved women and girls and reduce teenage pregnancy through the Family Planning 2030 (FP2030) ini�a�ve. USAID will work with the na�onal and local government agencies to expand strategies to address social determinants of health affec�ng adolescents and strengthen the implementa�on of the Reproduc�ve Health Law.

Maternal and Child Health and Nutri�on The 2022 NDHS showed an increase in infant (22 per 1000 live births) and neonatal mortality (15 per 1000 live births) a�er years of significant decline. 27 High maternal deaths are con�nuously reported in disadvantaged areas like the Bangsamoro Autonomous Region of Muslim Mindanao (BARMM) where there is a significant weakness in the health systems.

Nutri�on remains to be a major health issue in the Philippines with stun�ng affec�ng close to 30% of the children under 5, seeing modest decline in the past 30 years. 28 The country s�ll ranks high in terms of prevalence both regionally and globally. Undernutri�on in the early years of life, which is more prevalent among lower socio-economic groups, hampers long term development and prosperity. The burden on the Philippines economy brought by childhood undernutri�on was es�mated at US$4.4 billion or 1.5% of the country’s GDP. 29 These sta�s�cs demonstrate the unfinished challenge of ensuring maternal, newborn, infant, and child health and nutri�on, which the UHCP is well-posi�oned to address, especially as USAID/Philippines has iden�fied food security as one of its priori�es.

Drug Rehabilita�on USAID has also played a lead role with other development partners, such as WHO and UNODC, to expand evidence-driven, voluntary, community-based drug rehabilita�on programs aligned with the Dangerous Drugs Board approved policies on the provision of client care. This intends to strengthen the public health oriented approach to substance use, which is essen�ally a mental health issue, and to mainstream CBDR into the country’s mental health programs.

29 UNICEF.“Economic Consequences of Undernutri�on in the Philippines: A Damage Assessment Report”, 2017

28 World Bank (2021) Undernutri�on in the Philippines: Scale, Scope, and Opportuni�es for Nutri�on Policy and Programming

27 Philippine Sta�s�cs Authority (PSA) and ICF. 2022. 2022 Philippine Na�onal Demographic and Health Survey (NDHS): Key Indicators Report.

26 “ P33B in poten�al income lost due to teen pregnancy. ” UNFPA. Aug. 22, 2016.

25 Herrin, Alejandro N. “ Educa�on, Earnings and Health Effects of Teenage Pregnancy in the Philippines. ” UNFPA Philippines. July 2016.

24 Average 2016 exchange rate (USD 1 to PhP 47.492).

23 Philippine Sta�s�cs Authority (PSA) and ICF. 2022. 2022 Philippine Na�onal Demographic and Health Survey (NDHS): Key Indicators Report.

Rela�onship to the USAID Philippine Country Development Coopera�on Strategy (CDCS) 2019- 2024

The UHCP APS will contribute to the USAID Philippines CDCS 2019-2024 (below) and other US Government development priori�es in the country. This new APS takes into considera�on the results of the 2022 CDCS mid-course stocktaking while building in flexibility to changing priori�es and new opportuni�es in the health sector.

A.4 Statement of APS Theory of Change, Purpose, and Expected Results

Theory of Change: If health system performance and resilience are improved, high quality and responsive health services are delivered, and posi�ve social norms and behaviors are adopted, then underserved and vulnerable Filipinos will have improved health outcomes and enhanced quality of life. A graphic or illustra�on for the Theory of Change can be done but will be counted towards the page limit.

Purpose: The purpose of the UHCP is to improve health outcomes of underserved and vulnerable Filipinos.

The vision is that individuals, par�cularly underserved and vulnerable popula�ons, will gain control of their own health, have con�nuous access to evidence-based informa�on and affordable, quality services and commodi�es, and benefit from a more responsive and resilient health system.

For USAID, this translates into developing stronger partnerships with na�onal and local government, private sector, and local organiza�ons towards for�fica�on and ins�tu�onaliza�on of healthy norms, services, and health systems. For the underserved, it means engaging with a host of providers of informa�on and services relevant to their age, social, and cultural mores, and health needs. For service providers, it means adop�ng state-of-the-art approaches and technology to improve their effec�veness, reach, and service coverage. For systems strengthening, it means deeper engagement with the local actors and local systems that are crucial to con�nued achievement and sustainability of overall health outcomes.

The UHCP will contribute to the sustained and coordinated mul�-sectoral approach focusing on locally-led development and will pivot towards a more transforma�ve model that seeks to address cri�cal social determinants of health, including educa�on, skills development, and employment, as well as animal and environmental health, to mi�gate future impacts of macro-and micro shocks to health systems. The UHCP will focus on increasing the effec�veness of stakeholder interac�ons, recognizing that social accountability and engagement is par�cularly cri�cal in health policy. USAID will con�nue to support the policy process and poli�cal economy of health systems investment, which are dynamic and constantly evolving in response to changing circumstances and emerging challenges. Addi�onally, the UHCP will approach health programming with the understanding that government, civil society, and other stakeholders must possess the skills necessary to ac�vely engage in all aspects of the policy process to support the development and implementa�on of sound health governance, finance and management capacity.

Expected Results: The APS and its addendum awards are expected to contribute to the results iden�fied below. Each addendum will clearly state the objec�ves and results that proposals must cover. When applicants choose to submit a concept note for one or more addendums, they should be responsive to the desired outcome or expected results of each individual addendum.

Result 1: Posi�ve Social Norms and Behaviors Adopted

Strengthening posi�ve social norms and healthy behaviors will be achieved by providing informa�on and ac�vi�es, and developing new local partnerships that influence social norms and allow individuals to make informed choices about how to protect their health, sustain the prac�ce of healthy behavior, and access health services when needed.

1.1 Individual adop�on of healthy behaviors improved;

1.2 Community ownership and par�cipa�on in healthy behavior improved;

1.3 Advocacy to demand quality health services and protec�on of individual rights and security strengthened; and

1.4 Mul�-sectoral partnerships expanded.

Result 2: Responsive and High Quality Services Delivered

USAID will place emphasis on improving the quality of primary health care services using pa�ent- centered approaches to diagnose, provide care and treatment, and mentor health care providers. The Project will also contribute to iden�fying, developing, and implemen�ng innova�ons to improve the quality of health services.

2.1 Quality preven�ve, clinical, and laboratory services integrated;

2.2 Human resources for health skills and competencies built;

2.3 Innova�on, research and development; and

2.4 Quality of health services through pa�ent-centered and inclusive approaches improved.

Result 3: Health Systems Resilience Improved

Under this sub-purpose, selected func�ons of the health system – health workforce development, provision of commodi�es, regional and local governance, and financial risk planning and budge�ng – that are considered cri�cal by the Department of Health, USAID and other stakeholders will be for�fied, ins�tu�onalized, and sustained.

3.1 Governance capacity and evidence-based decision-making improved;

3.2 Sustainable and efficient financing enhanced;

3.3 Access to quality, safe, effec�ve medical products expanded;

3.4 Human resources for health (HRH) organiza�on, quality, and performance improved;

and

3.5 U�liza�on of quality health informa�on for decision-making enhanced.

A.5 Guiding Principles The implementa�on of the Universal Health Care Project shall be guided by the following principles:

Innova�ons and Evidence-Based Implementa�on . Refers to tes�ng and scaling-up new, nontradi�onal, state-of-the-art approaches and technologies to achieve healthy behaviors, strengthen client-centered care and ins�tu�onalize cri�cal health systems reforms. Also refers to collec�ng, measuring, and using data and evidence to develop policies and interven�ons.

Capacity-building. Refers to strengthening local ins�tu�ons, transfer of technical skills, and promo�ng appropriate policies at all levels of the health system to move towards significant, posi�ve change in the health system as a whole. As a result, the Philippine health system will absorb, ins�tu�onalize, and sustain technical and systems approaches to meet the needs of the vulnerable and the underserved.

Sustainability . Refers to the ability of a country, working across its sectors (government, civil society, ci�zens, private sector) to solve its own development challenges. This needs the re-orienta�on of donor assistance to be�er support the country to achieve its health goals through appropriate policies and systems reforms. Includes recogni�on that this process requires changes in management of resources, both human and financial, and a change in culture within the health system regarding what can be accomplished on a sustained basis without recurrent donor support.

Locally led development. Refers to the process in which local actors develop solu�ons, and bring the capacity, leadership, and resources to make those solu�ons a reality. This entails establishing new partnerships with local communi�es, schools and academic ins�tu�ons, health care organiza�ons, public and private providers, professional socie�es as well as faith-based, non- governmental, and civil society organiza�ons to mul�ply the impact of programs in FP/ARH, HIV, GHS, and other health priori�es that may be iden�fied in the future.

Inclusive development and Diversity Equity Inclusivity, and Accessibility (DEIA). In designing new approaches, the engagement of vulnerable and underrepresented groups will be a priority including but not limited to women and girls, LGBTQI+ people, migrants, indigenous individuals and communi�es, and persons with disabili�es. This also aligns well with the posi�ve youth development approach, which aims to create a more enabling environment towards improved assets, agency, and contribu�ons of young people (ages 10-29). In addi�on, through DEIA, USAID commits to improving diversity and enhancing inclusion and equity for everyone in the workplace and strengthening accountability for promo�ng and sustaining a diverse workforce and inclusive workplace culture.

Gender Equality and Women’s Empowerment. Refers to the integra�on of transforma�ve gender programming to support policies and programs that promote equality and achieve program objec�ves. In order to promote gender equality and women’s empowerment, an in-depth analysis of the issues rela�ve to gender dispari�es in the provision and u�liza�on of FP/ARH, TB, HIV, and GHS services shall be ar�culated and gender responsive and transforma�ve strategies proposed to address the issues iden�fied. Ac�vi�es are envisioned to transform gender rela�ons within and outside the household, by changing a�tudes of men, women, and adolescents at the community and societal level. This approach will a�empt to promote gender equality by: 1) fostering cri�cal examina�on of inequali�es and gender roles, norms, and dynamics; 2) recognizing and strengthening posi�ve norms that support equality and an enabling environment; 3) promo�ng the rela�ve posi�on of women, girls, and marginalized groups; and

4) transforming the underlying social structures, policies, and broadly held social norms that perpetuate gender inequali�es. Projects should aim to concretely demonstrate how women and girls in all their diversity—including those of the lesbian, gay, bisexual, transgender, queer, intersex, plus (LGBTQI+) community, will be empowered by strengthening their ability to make and put into ac�on health and other cri�cal life choices.

Private Sector Engagement - Refers to the approach to planning and programming through which USAID and its government partners consult, strategize, align, collaborate, and implement with the private sector including private hospitals, pharmaceu�cal companies, health maintenance organiza�ons, and other businesses for greater scale, sustainability, and effec�veness of health and development programs.

Climate Resilience and Conflict-sensi�ve Assistance . Refers to the ability of the health system to manage and mi�gate climate risks and disrup�ons in the delivery of health services brought about by conflict. Strategies to establish resilient health systems and programming that are equipped to respond to adverse public health events, including emerging public health threats, climate and conflict-related shocks should be considered.

A.6 Geographic and Target Popula�on

USAID will review and analyze exis�ng and recent province and city-level data on a host of cri�cal indicators including health outcomes, disease burden, performance metrics, and contextual informa�on to determine the geographic site-level support necessary for achieving maximum health outcomes among the most vulnerable popula�ons, while also op�mizing resources. This analysis will contribute to the selec�on of provinces and ci�es which will take into considera�on USG priori�es as well as inputs from the host government, the private sector, and civil society. The final determina�on of the sites will be one of the key milestones of the co-crea�on process. Two categories of sites are defined below:

Convergence sites . These are provinces and highly urbanized ci�es where two or more priority global health ac�vi�es (mainly TB and FP/ARH, and to the extent possible HIV, GHS, and if funding is available, nutri�on and child immuniza�on) will operate. By providing technical assistance with a strong health systems focus that assists the DOH to realize its UHC vision and connects all USAID-priori�zed programming, the gains in health outcomes are sustained by high performing health systems across key func�onal areas (i.e., planning and organiza�on, strategic informa�on systems, finance, human resources for health, leadership and governance, and supply chain management).

In convergence sites, the Health Systems Strengthening ac�vity will serve as the lead in strengthening cri�cal health system components.

Focus sites. Sites under this category are secondary areas with specific programma�c needs and will focus on improving service-delivery models of the priori�zed health area (either TB, FP, GHS, HIV or other funded health element) and aims to provide support to LGUs and na�onal and regional actors required to reach USAID targets. In focus sites, the implemen�ng mechanism will have program-specific and health systems components that will be aligned with the HSS strategies. Ac�vi�es working in focus sites are expected to be able to support health system strengthening interven�ons that would contribute to the achievement of program goals.

Specific HSS strategies to be implemented will depend on the context and priority needs of these sites. In focus sites where it is envisioned that the HSS ac�vity will not have a presence, other ac�vi�es will lead the health systems work in close coordina�on with the HSS ac�vity.

Note that Convergence and Focus sites will be determined during a process of co-crea�on.

Several factors will be considered in determining these sites including but not limited to disease burden, magnitude of unmet need, socio-poli�cal context, etc.

A.7 Collabora�ng, Learning, and Adap�ng The UHCP is expected to contribute to USAID/Philippines’ CDCS commitment to a mul�faceted collabora�ng, learning, and adap�ng (CLA) approach to development. As the UHCP APS will u�lize different USAID funding streams to achieve programma�c objec�ves, CLA mechanisms on health systems strengthening will be cri�cal. The CLA approach is about understanding that development efforts yield more effec�ve results if they are coordinated and collabora�ve, and test promising, new approaches in a con�nuous yet rapid, targeted search for genera�ng improvements and efficiencies and building on what works. Applicants can refer to usaidlearninglab.org for addi�onal resources on CLA at USAID.

CLA creates the condi�ons for fostering broader development success by:

● Collabora�ng: The UHCP Ac�vi�es will collaborate with and/or directly engage na�onal and local government units, private sector, civil society, professional organiza�ons, academic ins�tu�ons, interna�onal experts, communi�es, schools, youth groups, faith-based organiza�ons, and other donors and interna�onal organiza�ons. All USAID Health ac�vi�es working in convergence sites will represent themselves as “One USAID”.

Cognizant of both the value of social determinants of health in achieving desired outcomes and breadth of programma�c interven�ons for strengthening health systems, the UHCP Ac�vi�es will substan�ally coordinate with other USG or other complementary ac�vi�es working in different sectors like educa�on, environment, and economic development and democra�c governance, par�cularly on various areas where interest coincides.

● Learning: Genera�ng and feeding new learning, innova�ons and performance informa�on back into the program strategy to inform program management, design, USG policy dialogue opportuni�es and funding alloca�ons; (e.g. crea�ng pauses for reflec�on within the ac�vity implementa�on scheme, engaging stakeholders for shared ‘learning moments’, conduc�ng analy�cal review of exis�ng and/or new evidence that may support or contradict common understanding).

● Adap�ng: Transla�ng learning (from within the implementa�on experience or external sources) and considering changing condi�ons, along the lines of the risks, assump�ons and game changers, into strategic and programma�c adjustments (e.g. adjus�ng work plans to account for contextual shi�s or tacit learning from a team’s experience, while clearly and explicitly capturing and sharing the ra�onale for adjustments along the way.)

Mechanisms will be put in place to formally and informally solicit short-loop feedback from data sources, na�onal and local government partners, as well as from key stakeholders and beneficiaries, and these will be used consistently as inputs to CLA ac�vi�es for the dura�on of this Project. A mid-term whole of project evalua�on will likewise be conducted to assess project performance in rela�on to objec�ves set, guide course correc�on to improve implementa�on, scale up promising prac�ces, and understand the contribu�ons of USAID investments in the health sector.

As such, USAID/Philippines’ CLA approach fundamentally builds upon the monitoring and evalua�on tasks and requirements outlined above, accessing and analyzing data and lessons learned gathered through that process as the founda�on of learning. At the same �me, CLA is envisioned as a pathway to build a learning organiza�on and learning prac�ces, at the ac�vity team level, but also across USAID por�olios, and with partners and stakeholders. Thus, the recipient will devote sufficient staffing a�en�on to integrate collabora�on, learning and adapta�on throughout programma�c approaches, while addressing specific coordina�on, research and monitoring and evalua�on requirements as outlined above.

[End of Sec�on A]

SECTION B: FEDERAL AWARD INFORMATION

B.1 Funding The es�mated amount likely to be available for each award will be referenced in each addendum. USAID reserves the right to fund one, more than one, or none of the concept papers submi�ed in response to any addenda.

B.2 Period of Performance for Federal Awards The an�cipated period of performance for each award may vary and will be stated in the addenda.

B.3 Contents and organiza�on of Concept Papers The technical scope of what is to be addressed in each concept paper will be outlined in each addendum to this APS. Applicants must propose approaches to achieve all stated objec�ves and the respec�ve sub-objec�ves under each objec�ve. Organiza�on of concept papers and submission instruc�ons are included later in this APS. Where instruc�ons in this APS differ from instruc�ons in future addenda, instruc�ons in the addenda take precedence.

B.4 Geographic Code The geographic code for the procurement of commodi�es and services under this APS is 937, defined as the United States, the recipient country, and developing countries other than advanced developing countries, but excluding any country that is a prohibited source.

B.5 Type of Award and Substan�al Involvement All awards made as a result of this APS and subsequent addenda will be assistance awards.

USAID/Philippines an�cipates awarding grants or coopera�ve agreements. USAID/Philippines will state the type of award in each addendum but reserves the right to change the award type at any �me based on the recipient’s experience managing donor funded awards.

USAID/Philippines may also award a fixed amount award instead of a grant or coopera�ve agreement 30 . USAID may also issue renewal awards or transi�on awards. Awards will be subject to ADS 300 and 303. Awards to PIOs will be subject to compliance with ADS 308.

The recipient will operate in accordance with the terms and condi�ons of the grant or coopera�ve agreement. USAID/Philippines may decide to be “substan�ally involved” in implementa�on of awards, and therefore award a coopera�ve agreement. Coopera�ve agreements are iden�cal to grants except with coopera�ve agreements, USAID may be substan�ally involved in implemen�ng the award. Each addendum will state the type of award or awards to be made, and if a coopera�ve agreement, what substan�al involvement will be included in the award. Examples of substan�al involvement are below:

21 A Fixed Amount Award is appropriate for suppor�ng projects with very specific and defined elements, when the USAID Agreement Officer is confident that a reasonable es�mate of the actual cost of the overall effort can be established, and USAID can define accomplishment of the purpose of the grant through defined milestones. USAID’s policy concerning Fixed Amount Awards can be found in ADS 303.3.25 at h�p://www.usaid.gov/ads/policy/300/303

● Approval of the recipient’s implementa�on plans.

● USAID/Philippines’ ability to immediately halt an ac�vity if the recipient does not meet detailed performance specifica�ons (for example, construc�on specifica�ons).

● Review and approval of one stage of work, before work can begin on a subsequent stage.

● Review and approval of substan�ve provisions of proposed subawards or contracts.

● USAID/Philippines involvement in the selec�on of and approval of key recipient personnel.

● USAID/Philippines and recipient collabora�on or joint par�cipa�on, such as when the recipient’s successful accomplishment of objec�ves would benefit from USAID/Philippines’ technical knowledge.

● USAID/Philippines’ monitoring to permit specific kinds of direc�on or redirec�on of the work because of the interrela�onships with other projects or ac�vi�es.

● Direct opera�onal involvement or par�cipa�on to ensure compliance with statutory requirements such as civil rights, environmental protec�on, and provisions for people with disabili�es.

● Requirements established prior to award that limit the recipient’s discre�on with respect to the scope of services offered, organiza�onal structure, staffing, mode of opera�on, and other management processes, coupled with close monitoring or opera�onal involvement.

B.6 Emergency Response Provision The Philippines is vulnerable to natural hazards, epidemics, and sociopoli�cal instability. These challenges, whether natural or human made, can quickly and significantly set back development gains in the Philippines. Hence, implemen�ng partners should have the capacity to respond to these challenges by mobilizing resources, redirec�ng funds, or suppor�ng new ac�vi�es, which may include construc�on, at the request of USAID/Philippines that may vary considerably from those ac�vi�es in the approved award. Responses may include coopera�ng with other U.S.

government departments, agencies or personnel, or assistance to Philippine government and other key stakeholders, and revision of geographic focus.

Accordingly, awards resul�ng from this APS and addenda will allow redirec�on of the Program Descrip�on or funds to support ac�vi�es to address unknown and unan�cipated challenges and disaster events. Any use of this provision must be mutually agreed upon by USAID and the Recipient. Prior to any use of this provision, the Recipient and USAID shall iden�fy ac�vi�es to be carried out and the cost of such ac�vi�es, and obtain wri�en concurrence from the AOR, with specific repor�ng instruc�ons, and approval from the Agreement Officer.

The scope and deliverables expected from the realignment of ac�vity resources will be mutually agreed upon by USAID/Philippines and the Recipient.

[End of Sec�on B]

SECTION C: ELIGIBILITY INFORMATION

C.1 Eligible En��es USAID seeks maximum compe��on for all awards, in which case U.S. and non-U.S. public, private, for-profit, and nonprofit organiza�ons, as well as ins�tu�ons of higher educa�on, and non- governmental organiza�ons will generally be eligible to submit a concept paper under each addendum. However, under one or more addenda, eligibility may be restricted to local Philippine en��es or other en��es to foster capacity of local organiza�ons. Regardless of eligibility, applicants are encouraged to priori�ze local labor for posi�ons at every level and department in their submissions. Each addendum will specify and define eligibility.

Regardless of eligibility, concept papers must be from a legally recognized organiza�onal en�ty under applicable law, legally registered in a country within geographic code 937 (the United States, the recipient country, and developing countries other than advanced developing countries, but excluding any country that is a prohibited source per ADS 310.3.1.1). Geographic code and compe��on or eligibility are not related. Recipients and subrecipients, as well as supplies and equipment, must adhere to geographic code 937. Concept papers from individuals will not be accepted nor reviewed.

For-profit firms may par�cipate under this APS pursuant to 2 CFR 200.400(g) unless prohibited as stated in an addendum. However, it is USAID policy not to award profit to prime recipients and subrecipients under assistance instruments. Though profit is not allowed for sub-awards, the prohibi�on does not apply when the recipient acquires goods and services in accordance with 2 CFR 200.317 -326, “Procurement Standards.” This is discussed more specifically in ADS 303sai “Profit Under USAID Assistance Instruments,” which can be found at this link:

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

Each applicant must be found to be a responsible en�ty before receiving an award. The Agreement Officer (AO) may determine that a pre-award survey, a Non-U.S. Organiza�on Pre- Award Survey (NUPAS), or En�ty Eligibility Check is required in accordance with ADS 303.3.9.1, and if so, will establish a survey team to conduct an examina�on that will determine whether the applicant has the necessary…