APS 72049223APS00001 Amendment 2-SIGNED.pdf

Subject: Universal Health Care Project

Annual Program Statement (APS) Number:

72049223APS00001

APS Issuance Date: August 1, 2023

APS Questions Submission Closing Date: August 21, 2023, 1:00 PM Philippine Time

APS Amendment 1 Issuance Date: December 18, 2023

APS Amendment 2 Issuance Date: May 31, 2024

APS Closing Date: July 31, 2024

Dear Prospective Applicants:

The purpose of this Amendment 2 to the Annual Program Statement (APS) is to update the APS to reflect changes (highlighted in yellow) impacted by the responses to questions raised for Addendum 4.

All other terms in the APS remain the same.

Sincerely, Jennifer L. Crow

Supervisory Agreement Officer Regional Office of Acquisition and Assistance USAID/Philippines

TABLE OF CONTENTS

SECTION A: PROGRAM DESCRIPTION 3

SECTION B: FEDERAL AWARD INFORMATION 16

SECTION C: ELIGIBILITY INFORMATION 18

SECTION D: CONCEPT PAPER SUBMISSION INFORMATION 20

SECTION E: APPLICATION REVIEW INFORMATION 26

SECTION F: FEDERAL AWARD ADMINISTRATION INFORMATION 27

SECTION G: FEDERAL AWARDING AGENCY CONTACT(S) 30

SECTION H: OTHER INFORMATION 31

ATTACHMENT 1: CONCEPT PAPER COVER PAGE 32

ATTACHMENT 2: DEFINITIONS: 33

ATTACHMENT 3: USEFUL RESOURCES 38

ATTACHMENT 4: ILLUSTRATIVE EXAMPLE OF FULL APPLICATION INSTRUCTIONS 39

SECTION A: PROGRAM DESCRIPTION

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

A.1 Title

Universal Health Care Project (UHCP)

A.2 Overview

The U.S. Agency for International 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 objectives to achieve Universal Health Care (UHC). The UHCP is intended to be a suite of awards built to strategically improve national and local health systems in the Philippines across an integrated health portfolio. 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 adoption of positive social norms and behaviors. Project activities will implement focused health systems interventions to achieve key U.S. government objectives for tuberculosis (TB), family planning / adolescent reproductive health (FP/ARH), HIV/AIDS, global health security (GHS), health systems and other emerging public health concerns. Working together and in structured coordination, the awards under the UHCP will contribute towards a more resilient and equitable health system. USAID anticipates granting six to seven new awards under this APS; this could change depending on needs and qualified applications. The BARMM Resilience Activity is not currently scheduled to be part of this APS.

Critical to the success of the UHCP APS is the participation of a broad and inclusive range of stakeholders including public, private, academic institutions, and civil society organizations.

These stakeholders can provide a deep understanding of regional and local challenges, health integrative solutions, and cross-cutting programming, building towards flexible and responsive health programs that continuously learn and adapt to effectively and sustainably reach USG, USAID, and Philippine government objectives. The UHCP will also build towards commitments around locally-led development as it identifies, builds the capacity of, and partners with local

1 The working definition of “underrepresented,” “at-risk,” “vulnerable,” or “marginalized” groups, as referenced in the document, “Suggested Approaches for Integrating Inclusive Development Across the Program Cycle and in Mission Operations Additional Help for ADS 201”, is people who are typically denied access to legal protection or social and economic participation and programs (i.e., police protection, political participation, access to healthcare, education, employment), whether in practice or in principle, for historical, cultural, political, and/or other contextual reasons. Such groups may include, but are not limited to, women and girls, persons with disabilities, LGBTQI+ people, displaced persons, migrants, indigenous individuals and communities, youth and the elderly, religious minorities, ethnic minorities, people in lower castes, and people of diverse economic class and political opinions. In addition, The Philippine Development Plan 2017-2022 identified certain individuals and groups as having inherent vulnerabilities. These are the poor and transient poor, children, women, persons with disabilities (PWDs), indigenous peoples, overseas Filipinos (OFs) and their families, and older persons.

https://usaidlearninglab.org/sites/default/files/resource/files/additional_help_for_ads_201_inclusive_development_180726_final_r.pdf https://usaidlearninglab.org/sites/default/files/resource/files/additional_help_for_ads_201_inclusive_development_180726_final_r.pdf https://usaidlearninglab.org/sites/default/files/resource/files/additional_help_for_ads_201_inclusive_development_180726_final_r.pdf and indigenous organizations.2 These awards intend to streamline coordination and communication between USAID and critical health system stakeholders by reducing the focus on health areas and increasing the focus on system strengthening and empowering communities and individuals to exercise their agency to improve health outcomes. The integration of health programs will ensure more effective and efficient implementation, maximize technical assistance in priority convergence sites, and promote improved coordination among implementing partners.

Collaborating, Learning and Adapting (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 information about what should be included in the submission.

Refer to A.7 Collaborating, Learning and Adapting.

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, disparities in local health systems performance, and gaps in the continuum of care. More than three years into the COVID-19 pandemic, the national and local government units (LGUs) continue to struggle to catch up on the delivery of essential health services and to recover from the disruption created by the pandemic. Underserved populations, especially those from the lowest income quintiles, continue to suffer from a high prevalence of TB (including multidrug 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 adoption 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 function devolved to local government units. DOH does not have direct control over implementation 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 administrative regions.3 With a decentralized health system, the Philippines requires additional assistance to effectively allocate financial and human resources to provide services that align with health needs and priorities.4 Over the years, the DOH has provided direct support to LGUs in the form of public health commodities, human resources for health (HRH) augmentation, capital outlays for local health facilities, and even premium subsidies to support the enrollment of poor

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

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

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

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06452-x https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06452-x https://doh.gov.ph/sites/default/files/publications/2021-Budget-Briefer.pdf https://www.usaid.gov/global-health/health-systems-innovation/health-systems-strengthening/Vision-HSS-2030

Filipinos in the National Health Insurance Programs, which drove the upward trend in the national health budget in the past years.

Additionally, frequent institutional disruptions have hampered progress at the Philippine Health Insurance Corporation (“PhilHealth”), which is envisioned to be the principal funder of health system reforms. PhilHealth faces challenges in registering indigent clients, , accrediting public and private primary care facilities, and timely processing and sufficient payment of reimbursements, leading to barriers in healthcare access. These institutional challenges have hindered PhilHealth from fulfilling its mandate to provide financial risk protection for Filipinos.5

In response to these challenges, the new Secretary of Health issued an eight-point priority agenda to support the execution of the health goals in the Philippine Development Plan (PDP) and the attainment of the Presidential directives in health. These include access to quality health care, prevention of priority diseases TB and HIV, improved response to emergencies, strengthened preparedness and response to potential pandemics, digital technology, improved conditions 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 operationalization, devolution of responsibilities to local governments, and public financial management, including the inability to fully ensure financial risk protection. Furthermore, the Philippines still faces challenges with fragmented health systems, weak information systems and logistics and supply chain management, and difficulty in integrating various public health programs at the primary care level.

Health systems and development programs are increasingly moving towards and reorienting their approach to support integration through regulations 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 fragmentation of health systems and to operationalize the health systems objectives of USAID and the Philippines Government as envisioned by Republic Act 11223 or the Universal Health Care Law. The UHCP will particularly focus on building the capabilities 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 better support local health systems strengthening and program implementation through evidence-based policies, resources, and sufficient technical assistance. Furthermore, the UHCP will foster community participation in health policy and governance, which is a key driving force in achieving and sustaining improved health

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

systems and has varied throughout the past decades. The renewed commitment to pursue Universal Health Care offers an opportunity to move towards better health outcomes among all population groups; financial risk protection 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 estimated 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 estimated 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 Additionally there is low demand for essential TB screening, testing, and treatment. These challenges are tied directly to the national government and LGUs’ capacity to provide adequate HRH, financing, supply chain, and coverage.8USAID supported the implementation of the Philippine Strategic TB Elimination Plan Phase 1 (2018-2023) and a joint program review evaluated its impact, opportunities and challenges.9 The National Coordinating Committee for TB (NCC TB) sought to enhance the PhilSTEP into a comprehensive, multi-sectoral initiative through the Philippine Acceleration Action Plan for TB (PAAP-TB). The PAAP-TB aligns NCC members’ organizational plans, policies and programs to support TB elimination efforts including social protection, education, civil society, and private sector engagement. USAID supported the development of PAAP to ensure that the Philippines TB elimination goal by 2030 is achieved. The Philippines’ strategy for TB elimination aims to achieve a 15 percent reduction in mortality and 12 percent reduction in TB incidence. Key efforts are needed focused on case notification, treatment success, and prevention of MDR-TB, while supporting overarching system reforms. The Marcos administration has identified TB as a priority issue, committing to support interventions to reduce its burden in the country. The Philippines is on the list of high burden countries, i.e. focus countries for global action 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 political declaration of the United Nations (UN) high-level meeting 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-

10USAID Global Accelerator to End TB

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

8Department 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 Organization Global Report TB 2022 https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/news-and-updates/global-accelerator-end-tb https://ntp.doh.gov.ph/download/joint-program-review-2019-report/ https://discovery.researcher.life/article/the-social-determinants-of-tuberculosis-in-the-philippines/38275ff5f07b3a63b486493e5c10ea74 https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022

TB vision of a TB-free Philippines.11,12 USAID’s TB portfolio in the Philippines aims to work with partners to reach every Filipino with tuberculosis, cure those in need of treatment, prevent new infections and progression to active TB disease, while scaling-up innovations in detection, 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 elimination efforts in the Philippines.

HIV/AIDS

The Philippines has one of the fastest growing HIV epidemics in the Asia-Pacific Region13 with an estimated 158,400 people living with HIV as of 2022.14 The impact of the ongoing HIV epidemic disproportionately affects key populations — 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 population aged 25-34 years old and cases are heavily concentrated in the National 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 retention at 66 percent, and viral load suppression at 27 percent as of December 2022, falling substantially short of the global 95-95-95 goals.16

The national and local HIV programs face additional health systems challenges that undermine the effective scale-up of service delivery and high-quality HIV prevention, testing, 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 implementation in 2020 with the broad goals to reach the global 95-95-95 targets18 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 continue supporting community-led monitoring, advocacy, and key systems interventions aimed at improving procurement and supply chain management and sustainable financing at the national and local government unit levels.

Global Health Security

The Philippines continues 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 facilities. Gaps in HRH at all levels affected pandemic response, delivery of other essential health services, and vaccination roll-out. The Philippines is a signatory to the

19 PEPFAR Philippines implementing U.S. agencies currently include USAID, U.S. Centers for Disease Control and Prevention (CDC), U.S. Health Resources and Services Administration (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 positive individuals are on treatment; 95 percent of those on treatment are virally suppressed.

17 Ibid.

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

15Department of Health - Epidemiology Bureau. Spectrum Estimates and AIDS Epidemic Model. May 2022.

14 “Global AIDS Update 2018 Miles to go: Closing Gaps, Breaking Barriers, Righting Injustices.” UNAIDS.

13 The Philippine Acceleration Action Plan For Tuberculosis (PAAP-TB)

12 The Philippine Acceleration Action Plan For Tuberculosis (PAAP-TB)

11USAID Global TB Strategy (2023-2030) https://aidstargets2025.unaids.org/ https://doh.gov.ph/sites/default/files/statistics/EB_HARP_December_AIDSreg2022.pdf https://www.unaids.org/sites/default/files/media_asset/miles-to-go_en.pdf https://paaptb.com/ https://paaptb.com/ https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/publications/usaid-global-tuberculosis-strategy-2023-2030

International Health Regulations (IHR) and led the conduct of a Joint External Evaluation (JEE) in 2018 which identified areas for improvement in the prevention, detection, and response to emerging infectious 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 effectively 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 capacities and preparedness to respond to future epidemic and pandemic threats. In order to achieve the priorities on Global Health Security,21 national and local government units must strengthen their ability to prevent, detect and respond to disease outbreaks. Launched in 2019, the GHS initiative guides the U.S.

government’s work initially in 19 priority countries and in 16 sub-technical areas spanning animal and human health, agriculture, and security with the aim of supporting at least 50 countries by 2025. USAID will strengthen its contribution to Agency and GHS goals through its programming to boost country capacity and workforce development through the interagency to prevent, detect, and respond effectively to infectious 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 communication and the need to integrate with cross-cutting areas such as climate/environment, conflict, positive youth engagement, social welfare, education, gender equity and inclusion. The Philippines’ annual population growth rate, estimated at 1.5 percent (2022), remains one of the highest among the Association of Southeast Asian Nations (ASEAN) countries.22 The most recent NDHS (2022) showed the total fertility rate has decreased to 1.9, which is below replacement level. However, disparities remain between women in rural and urban areas, those with low education, as well as wealth quintiles. Use of modern family planning methods is very low among sexually active 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 quintile having ever been pregnant compared to 10 out of 100 adolescents in the poorest quintile. 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, suggesting a need to improve social protection among girls and adolescents.23 These shifts necessitate an approach of looking beyond a health perspective and towards social determinants such as education, skills, and employment to contribute to economic growth by attaining 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 potential to be productive members of society. The estimated net effect of early childbearing in the Philippines due to lost opportunities and foregone earnings can be as high as 33 billion

23 Philippine Statistics Authority (PSA) and ICF. 2022. 2022 Philippine National Demographic and Health Survey (NDHS): Key Indicators Report.

22 “Health Nutrition and Population Statistics.” World Bank DataBank..

21Global Health Security Agenda.

20World Health Organization, Joint External Evaluation of IHR core capacities Republic of the Philippines 2018.

https://psa.gov.ph/sites/default/files/2022%20NDHS%20Key%20Indicators%20Report.pdf https://databank.worldbank.org/source/health-nutrition-and-population-statistics https://www.usaid.gov/sites/default/files/2022-05/USAID_Global_Health_Security_Agenda_September_21_Final.pdf https://www.who.int/publications/i/item/WHO-WHE-CPI-2019.57 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 reduction of unmet needs among underserved women and girls and reduce teenage pregnancy through the Family Planning 2030 (FP2030) initiative. USAID will work with the national and local government agencies to expand strategies to address social determinants of health affecting adolescents and strengthen the implementation of the Reproductive Health Law.

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

Nutrition remains to be a major health issue in the Philippines with stunting affecting close to 30% of the children under 5, seeing modest decline in the past 30 years.28 The country still ranks high in terms of prevalence both regionally and globally. Undernutrition 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 undernutrition was estimated at US$4.4 billion or 1.5% of the country’s GDP.29 These statistics demonstrate the unfinished challenge of ensuring maternal, newborn, infant, and child health and nutrition, which the UHCP is well-positioned to address, especially as USAID/Philippines has identified food security as one of its priorities.

Drug Rehabilitation USAID has also played a lead role with other development partners, such as WHO and UNODC, to expand evidence-driven, voluntary, community-based drug rehabilitation 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 essentially a mental health issue, and to mainstream CBDR into the country’s mental health programs.

Relationship to the USAID Philippine Country Development Cooperation Strategy (CDCS) 2019- 2024

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

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

28World Bank (2021) Undernutrition in the Philippines: Scale, Scope, and Opportunities for Nutrition Policy and Programming

27 Philippine Statistics Authority (PSA) and ICF. 2022. 2022 Philippine National Demographic and Health Survey (NDHS): Key Indicators Report.

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

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

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

https://openknowledge.worldbank.org/server/api/core/bitstreams/109a9f76-1d3f-587b-8f0a-0f0a54021cdd/content https://psa.gov.ph/sites/default/files/2022%20NDHS%20Key%20Indicators%20Report.pdf https://philippines.unfpa.org/en/news/p33b-potential-income-lost-due-teen-pregnancy-0 https://philippines.unfpa.org/en/publications/education-earnings-and-health-effects-teenage-pregnancy-philippines

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 positive social norms and behaviors are adopted, then underserved and vulnerable Filipinos will have improved health outcomes and enhanced quality of life. A graphic or illustration 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, particularly underserved and vulnerable populations, will gain control of their own health, have continuous access to evidence-based information and affordable, quality services and commodities, and benefit from a more responsive and resilient health system.

For USAID, this translates into developing stronger partnerships with national and local government, private sector, and local organizations towards fortification and institutionalization of healthy norms, services, and health systems. For the underserved, it means engaging with a host of providers of information and services relevant to their age, social, and cultural mores, and health needs. For service providers, it means adopting state-of-the-art approaches and technology to improve their effectiveness, reach, and service coverage. For systems strengthening, it means deeper engagement with the local actors and local systems that are crucial to continued achievement and sustainability of overall health outcomes.

The UHCP will contribute to the sustained and coordinated multi-sectoral approach focusing on locally-led development and will pivot towards a more transformative model that seeks to address critical social determinants of health, including education, skills development, and employment, as well as animal and environmental health, to mitigate future impacts of macro-and micro shocks to health systems. The UHCP will focus on increasing the effectiveness of stakeholder interactions, recognizing that social accountability and engagement is particularly critical in health policy. USAID will continue to support the policy process and political economy of health systems investment, which are dynamic and constantly evolving in response to changing circumstances and emerging challenges. Additionally, the UHCP will approach health programming with the understanding that government, civil society, and other stakeholders must possess the skills necessary to actively engage in all aspects of the policy process to support the development and implementation of sound health governance, finance and management capacity.

Expected Results: The APS and its addendum awards are expected to contribute to the results identified below. Each addendum will clearly state the objectives 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: Positive Social Norms and Behaviors Adopted

Strengthening positive social norms and healthy behaviors will be achieved by providing information and activities, and developing new local partnerships that influence social norms and allow individuals to make informed choices about how to protect their health, sustain the practice of healthy behavior, and access health services when needed.

1.1 Individual adoption of healthy behaviors improved;

1.2 Community ownership and participation in healthy behavior improved;

1.3 Advocacy to demand quality health services and protection of individual rights and security strengthened; and

1.4 Multi-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 patient- centered approaches to diagnose, provide care and treatment, and mentor health care providers. The Project will also contribute to identifying, developing, and implementing innovations to improve the quality of health services.

2.1 Quality preventive, clinical, and laboratory services integrated;

2.2 Human resources for health skills and competencies built;

2.3 Innovation, research and development; and

2.4 Quality of health services through patient-centered and inclusive approaches improved.

Result 3: Health Systems Resilience Improved

Under this sub-purpose, selected functions of the health system – health workforce development, provision of commodities, regional and local governance, and financial risk planning and budgeting – that are considered critical by the Department of Health, USAID and other stakeholders will be fortified, institutionalized, 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, effective medical products expanded;

3.4 Human resources for health (HRH) organization, quality, and performance improved;

and

3.5 Utilization of quality health information for decision-making enhanced.

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

Innovations and Evidence-Based Implementation. Refers to testing and scaling-up new, nontraditional, state-of-the-art approaches and technologies to achieve healthy behaviors, strengthen client-centered care and institutionalize critical health systems reforms. Also refers to collecting, measuring, and using data and evidence to develop policies and interventions.

Capacity-building. Refers to strengthening local institutions, transfer of technical skills, and promoting appropriate policies at all levels of the health system to move towards significant, positive change in the health system as a whole. As a result, the Philippine health system will absorb, institutionalize, 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, citizens, private sector) to solve its own development challenges. This needs the re-orientation of donor assistance to better support the country to achieve its health goals through appropriate policies and systems reforms. Includes recognition 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 solutions, and bring the capacity, leadership, and resources to make those solutions a reality. This entails establishing new partnerships with local communities, schools and academic institutions, health care organizations, public and private providers, professional societies as well as faith-based, non- governmental, and civil society organizations to multiply the impact of programs in FP/ARH, HIV, GHS, and other health priorities that may be identified 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 communities, and persons with disabilities. This also aligns well with the positive youth development approach, which aims to create a more enabling environment towards improved assets, agency, and contributions of young people (ages 10-29). In addition, through DEIA, USAID commits to improving diversity and enhancing inclusion and equity for everyone in the workplace and strengthening accountability for promoting and sustaining a diverse workforce and inclusive workplace culture.

Gender Equality and Women’s Empowerment. Refers to the integration of transformative gender programming to support policies and programs that promote equality and achieve program objectives. In order to promote gender equality and women’s empowerment, an in-depth analysis of the issues relative to gender disparities in the provision and utilization of FP/ARH, TB, HIV, and GHS services shall be articulated and gender responsive and transformative strategies proposed to address the issues identified. Activities are envisioned to transform gender relations within and outside the household, by changing attitudes of men, women, and adolescents at the community and societal level. This approach will attempt to promote gender equality by: 1) fostering critical examination of inequalities and gender roles, norms, and dynamics; 2) recognizing and strengthening positive norms that support equality and an enabling environment; 3) promoting the relative position of women, girls, and marginalized groups; and

4) transforming the underlying social structures, policies, and broadly held social norms that perpetuate gender inequalities. 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 action health and other critical 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, pharmaceutical companies, health maintenance organizations, and other businesses for greater scale, sustainability, and effectiveness of health and development programs.

Climate Resilience and Conflict-sensitive Assistance. Refers to the ability of the health system to manage and mitigate climate risks and disruptions 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 Population USAID will review and analyze existing and recent province and city-level data on a host of https://www.youthpower.org/positive-youth-development https://www.youthpower.org/positive-youth-development critical indicators including health outcomes, disease burden, performance metrics, and contextual information to determine the geographic site-level support necessary for achieving maximum health outcomes among the most vulnerable populations, while also optimizing resources. This analysis will contribute to the selection of provinces and cities which will take into consideration USG priorities as well as inputs from the host government, the private sector, and civil society. The final determination of the sites will be one of the key milestones of the co-creation process. Two categories of sites are defined below:

Convergence sites. These are provinces and highly urbanized cities where two or more priority global health activities (mainly TB and FP/ARH, and to the extent possible HIV, GHS, and if funding is available, nutrition and child immunization) 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-prioritized programming, the gains in health outcomes are sustained by high performing health systems across key functional areas (i.e., planning and organization, strategic information systems, finance, human resources for health, leadership and governance, and supply chain management).

In convergence sites, the Health Systems Strengthening activity will serve as the lead in strengthening critical health system components.

Focus sites. Sites under this category are secondary areas with specific programmatic needs and will focus on improving service-delivery models of the prioritized health area (either TB, FP, GHS, HIV or other funded health element) and aims to provide support to LGUs and national and regional actors required to reach USAID targets. In focus sites, the implementing mechanism will have program-specific and health systems components that will be aligned with the HSS strategies. Activities working in focus sites are expected to be able to support health system strengthening interventions 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 activity will not have a presence, other activities will lead the health systems work in close coordination with the HSS activity.

Note that Convergence and Focus sites will be determined during a process of co-creation post-award. Several factors will be considered in determining these sites including but not limited to disease burden, magnitude of unmet need, socio-political context, etc.

A.7 Collaborating, Learning, and Adapting The UHCP is expected to contribute to USAID/Philippines’ CDCS commitment to a multifaceted collaborating, learning, and adapting (CLA) approach to development. As the UHCP APS will utilize different USAID funding streams to achieve programmatic objectives, CLA mechanisms on health systems strengthening will be critical. The CLA approach is about understanding that development efforts yield more effective results if they are coordinated and collaborative, and test promising, new approaches in a continuous yet rapid, targeted search for generating improvements and efficiencies and building on what works. Applicants can refer to usaidlearninglab.org for additional resources on CLA at USAID.

https://usaidlearninglab.org/

CLA creates the conditions for fostering broader development success by:

● Collaborating: The UHCP Activities will collaborate with and/or directly engage national and local government units, private sector, civil society, professional organizations, academic institutions, international experts, communities, schools, youth groups, faith-based organizations, and other donors and international organizations. All USAID Health activities 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 programmatic interventions for strengthening health systems, the UHCP Activities will substantially coordinate with other USG or other complementary activities working in different sectors like education, environment, and economic development and democratic governance, particularly on various areas where interest coincides.

● Learning: Generating and feeding new learning, innovations and performance information back into the program strategy to inform program management, design, USG policy dialogue opportunities and funding allocations; (e.g. creating pauses for reflection within the activity implementation scheme, engaging stakeholders for shared

‘learning moments’, conducting analytical review of existing and/or new evidence that may support or contradict common understanding).

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

Mechanisms will be put in place to formally and informally solicit short-loop feedback from data sources, national and local government partners, as well as from key stakeholders and beneficiaries, and these will be used consistently as inputs to CLA activities for the duration of this Project. A mid-term whole of project evaluation will likewise be conducted to assess project performance in relation to objectives set, guide course correction to improve implementation, scale up promising practices, and understand the contributions of USAID investments in the health sector.

As such, USAID/Philippines’ CLA approach fundamentally builds upon the monitoring and evaluation tasks and requirements outlined above, accessing and analyzing data and lessons learned gathered through that process as the foundation of learning. At the same time, CLA is envisioned as a pathway to build a learning organization and learning practices, at the activity team level, but also across USAID portfolios, and with partners and stakeholders. Thus, the recipient will devote sufficient staffing attention to integrate collaboration, learning and adaptation throughout programmatic approaches, while addressing specific coordination, research and monitoring and evaluation requirements as outlined above.

[End of Section A]

SECTION B: FEDERAL AWARD INFORMATION

B.1 Funding The estimated 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 submitted in response to any addenda.

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

B.3 Contents and organization 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 objectives and the respective sub-objectives under each objective. Organization of concept papers and submission instructions are included later in this APS. Where instructions in this APS differ from instructions in future addenda, instructions in the addenda take precedence.

B.4 Geographic Code The geographic code for the procurement of commodities 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 Substantial Involvement All awards made as a result of this APS and subsequent addenda will be assistance awards.

USAID/Philippines anticipates awarding grants or cooperative agreements. USAID/Philippines will state the type of award in each addendum but reserves the right to change the award type at any time based on the recipient’s experience managing donor funded awards.

USAID/Philippines may also award a fixed amount award29 instead of a grant or cooperative agreement. USAID may also issue renewal awards or transition 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 conditions of the grant or cooperative agreement. USAID/Philippines may decide to be “substantially involved” in implementation of awards, and therefore award a cooperative agreement. Cooperative agreements are identical to grants except with cooperative agreements, USAID may be substantially involved in implementing the award. Each addendum will state the type of award or awards to be made, and if a cooperative agreement, what substantial involvement will be included in the award. Examples of substantial involvement are below:

29 A Fixed Amount Award is appropriate for supporting projects with very specific and defined elements, when the USAID Agreement Officer is confident that a reasonable estimate 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 http://www.usaid.gov/ads/policy/300/303 http://www.usaid.gov/ads/policy/300/303

● Approval of the recipient’s implementation plans.

● USAID/Philippines’ ability to immediately halt an activity if the recipient does not meet detailed performance specifications (for example, construction specifications).

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

● Review and approval of substantive provisions of proposed subawards or contracts.

● USAID/Philippines involvement in the selection of and approval of key recipient personnel.

● USAID/Philippines and recipient collaboration or joint participation, such as when the recipient’s successful accomplishment of objectives would benefit from USAID/Philippines’ technical knowledge.

● USAID/Philippines’ monitoring to permit specific kinds of direction or redirection of the work because of the interrelationships with other projects or activities.

● Direct operational involvement or participation to ensure compliance with statutory requirements such as civil rights, environmental protection, and provisions for people with disabilities.

● Requirements established prior to award that limit the recipient’s discretion with respect to the scope of services offered, organizational structure, staffing, mode of operation, and other management processes, coupled with close monitoring or operational involvement.

B.6 Emergency Response Provision The Philippines is vulnerable to natural hazards, epidemics, and sociopolitical instability. These challenges, whether natural or human made, can quickly and significantly set back development gains in the Philippines. Hence, implementing partners should have the capacity to respond to these challenges by mobilizing resources, redirecting funds, or supporting new activities, which may include construction, at the request of USAID/Philippines that may vary considerably from those activities in the approved award. Responses may include cooperating 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 resulting from this APS and addenda will allow redirection of the Program…