Attachment J.1-PMI Uganda Malaria Control Activity SOO.docx

Statement of Objectives – 72061721R00002 PMI Uganda Malaria Reduction Activity

ATTACHMENT J.1- STATEMENT OF OBJECTIVE

C.1 PURPOSE

The purpose of the Presidential Malaria Initiative (PMI)’s Malaria Reduction Activity is to strengthen the capacity of malaria prevention and ownership of health at the community and household levels, while maintaining gains made at the health facility level in focus districts. Previous and current malaria programs have strengthened national, district, and health facility level strategy and technical capacities, but have not fully realized community and household prevention, diagnosis, and treatment of malaria. As the U.S. Government's flagship malaria activity in Uganda, this activity will improve technical, managerial, financial, and leadership capacity, as well as accountability at all levels of the health system to fill gaps in access and utilization of high-quality malaria services at the community level. Concurrently, this activity will continue to work with national and district leadership as well as health facilities to sustain the progress made to date and ensure oversight of community interventions. This activity will also support targeted private for-profit health facilities to improve malaria case management and reporting.

C.2 SCOPE

PMI will acquire services for a five-year to increase the prevention, diagnosis, and treatment of malaria in Uganda, and contribute to the goals of the Uganda Malaria Reduction and Elimination Strategic Plan 2021-2025 (UMRESP, Attachment J.8) of reducing malaria morbidity by 50 percent and malaria-related mortality by 75 percent by 2025.

This activity will build on the gains of the Malaria Action Program for Districts (MAPD) activity and those of the USAID Regional Health Integration to Enhance Services (RHITES) activities to strengthen community case management and prevention, as well as improve private not-for-profit health facilities engagement and surveillance.

The Contractor must establish or reinforce quality integrated community care management (iCCM) services and promote the demand for these services. Additionally, the Contractor must strengthen the existing link between District Health Management Teams (DHMTs), health facilities, Village Health Teams (VHTs), and lower-level leadership structures (e.g., Local Council Chairperson - LC1) in order to improve the availability and quality of malaria services at the community level. Increased support for community-level interventions and improved oversight will empower communities to engage with relevant actors and optimize health ownership in line with the Government of Uganda (GOU) Mass Action Against Malaria (MAAM) initiative. This approach will also increase the role of the Ministry of Local Governance (MoLG) with a focus on coordination between entities.

The uncoordinated private-for-profit health sector in Uganda lacks sufficient oversight by the Ministry of Health. This sector includes private health facilities and small drug shops that offer malaria services at a fee. The majority of the activity’s target population is rural and poor, and cannot afford private facility fees. This activity must work with the private-for-profit health sector facilities to improve accessibility to quality services especially in rural communities by supporting case management and reporting in small and medium private clinics, and by enforcing good practices in retail drug shops, especially in rural communities. As is outlined in Guiding Principle Four and in Section C.2.5.5 (Private Sector Engagement), the Contractor must apply strategies identified with the help of the Local Health System Sustainability (LHSS) project, to accelerate private sector investment and engagement in the health sector in Uganda. The approach must also consider youth-friendly services and respond to USAID/Policy Framework and Agency-wide Initiatives as outlined in section C.2.5.

Throughout the life of the award, the Contractor must support quality data collection and utilization at all levels and implement a data-driven approach to strengthen prevention and treatment of malaria through an appropriate mix of interventions. This must be in line with the epidemiological stratification outlined in UMRESP 2021-2025 and PMI’s technical guidance[footnoteRef:1], and with a focus on empowerment of communities and improved active surveillance. Using the outcome analysis from two analyses by Mission Measurement and GiveWell, which are further discussed under the Geographic Focus section (C.2.2), the Contractor must implement a mix of cost-effective interventions for each epidemiologic stratum. [1: PMI’s technical guidance https://www.pmi.gov/docs/default-source/default-document-library/tools-curricula/pmi-technical-guidance.pdf?sfvrsn=18]

C.2.1 Period of Performance

The period of performance is expected to be five (5) years from the effective date of the award.

C.2.2 Geographic Focus

PMI prioritizes the scale up of proven interventions in order to reduce the burden of malaria in highly affected regions. Consequently, this activity will increase the prevention, diagnosis, and treatment of malaria in the five most high burden regions of Uganda. These include West Nile, Acholi, Lango, Karamoja, and Busoga.

Additionally, PMI’s most recent strategy calls for flexible approaches tailored to local settings as well as appropriate analysis to determine what interventions provide best value for money. Key partners, such as the National Malaria Control Division (NMCD), the World Health Organization (WHO), and the Global Fund also emphasize the importance of targeted approaches based on local data tailored to each unique setting. To meet these strategic objectives, PMI/Uganda worked with Mission Measurement and GiveWell to support the prioritization of different interventions through their respective cost effectiveness models in the high burden regions.

Mission Measurement conducted an analysis (“PMI/Uganda: Analytical Study of the Cost Effectiveness of Interventions to Prevent, Detect and Treat Malaria in Uganda”, Attachment J.7) of primary and secondary data to develop a return on investment (ROI) model that can be used to explore the most cost-effective mix of malaria interventions among those outlined in the UMRESP given the fixed budget.

For the outcomes of interest, reduced malaria morbidity and reduced malaria mortality, the ROI model yields two primary results:

The link to access the Model, with additional instructions, is accessible online[footnoteRef:2]. [2: Malaria Intervention Return on Investment (ROI) Model https://missionmeasurementcorp-my.sharepoint.com/:x:/g/personal/epearson_missionmeasurement_com/EZ_cXF_5vTxKhQtwXq25z-oB4oY90EHOH0PsnXodH0GnKQ?rtime=Atv-T0222Eg ]

GiveWell conducted an analysis (Givewell Analysis Targeting Malaria Mortality, Attachment J.5) on the prioritization of districts for Community Case Management (CCM) in Uganda. The results are outlined in Figure 1. A key takeaway from this analysis is that targeting the most cost-effective districts is estimated to save more than twice as many lives as alternative approaches to targeting, at no additional cost.

Figure 1: Prioritization of CCM Malaria for all Ugandan districts

Using the Return on Investment (ROI) model developed by Mission Measurement and results of the analyses from GiveWell, and considering districts that already receive support for malaria control activities through the Global Fund and other donors, the Contractor must develop an approach implementing the most cost effective package of interventions in priority areas.

Given the shifting geographic burden of malaria due to population movement, changing weather patterns, and seasonality, the Contractor must also employ a flexible implementation model to respond to upsurges within other regions, if and when they occur.

C.2.3 Development Hypothesis

This activity is authorized under USAID/Uganda’s Resilience Project and is rooted in the philosophy that households that have the capacity to maintain/recover their well-being in the face of shocks and stresses are resilient, and that resilient communities are cohesive, inclusionary, and organized in such a way to strengthen household and community agency for development progress. Strengthened capacity to prevent malaria and increased ownership of health at the community and household levels will increase resilience. The following development hypothesis underpins this philosophy:

“If PMI improves data quality and usage; deploys the right mix of evidence-based interventions at the right time, place, and intensity; empowers and equips the community to own their health as an asset; and ensures sustainability of these gains; then, malarial morbidity and mortality will be reduced, resulting in improved quality and duration of life.”

C.2.4 Problem Statement

Previous and current malaria programs have strengthened national, district, and health facility strategy and technical capacities, but have not fully realized community and household prevention, diagnosis, and treatment of malaria. The problem is multifold: high-intensity transmission coupled with low-risk perception and ownership of health at the community and household levels, and inadequate use of surveillance data by health leadership for decision-making, lead to the persistence of malaria in Uganda.

The Contractor must contribute to the reduction of transmission intensity through decentralization of services to community and household levels, improved perception of risk of malaria and prevention among target communities, as well as strengthened surveillance data for decision-making.

C.2.5 Response to USAID/Policy Framework and Agency-wide Initiatives

The following Agency-wide initiatives are relevant to this activity.

C.2.5.1 Journey to Self-Reliance

To advance USAID’s policy[footnoteRef:3] to foster self-reliance, the activity will build the necessary institutional and technical capacity at all levels to achieve and maintain malaria control and eventual elimination in Uganda[footnoteRef:4]. The activity can achieve self-reliance by strengthening the community component of malaria prevention and treatment, scaling up innovative social behavior change (SBC) approaches and interventions, as well as actively engaging the community in taking personal responsibility for malaria prevention, diagnosis, and treatment, in line with MAAM principles. The activity must implement an approach to strengthen household and community prevention, diagnosis, and treatment of malaria with a focus on health ownership, consistent with building self-reliance. [3: https://www.usaid.gov/sites/default/files/documents/1870/WEB_PF_Full_Report_FINAL_10Apr2019.pdf ] [4: https://selfreliance.usaid.gov/country/uganda ]

C.2.5.2 Use of Local Systems

USAID’s Local Systems Framework[footnoteRef:5] defines USAID’s overarching approach to transforming innovations and reforms into sustained development. An integral part of this approach is strengthening local systems, which improves the durability and adaptability that allows actors and their interrelationships to accommodate shocks and respond to changing circumstances. The Local Systems Framework aligns with results to be achieved under Component 2 of this activity. [5: https://www.usaid.gov/policy/local-systems-framework]

C.2.5.3 Youth in Development

USAID’s Youth Policy[footnoteRef:6] outlines a conceptual approach to youth in development and provides guiding principles and operational practices in support of USAID’s efforts to mainstream youth in development, carry out more effective programs, and elevate youth participation. The GOU has a robust policy framework to support the establishment of youth-friendly services in the public health care system, however, there are significant challenges facing implementation. [6: https://www.usaid.gov/policy/youth]

According to Lalloo et al (2006) and Orish et al (2012), both referenced in the MAPD Youth Analysis[footnoteRef:7] (2017), malaria is the cause of 50 percent of deaths in sub-Saharan African school children. One quarter of Ugandan girls between the ages of 15 and 19 years have begun childbearing and existing data show that mothers under 20 years of age attend antenatal care at the same frequency as older age groups in which intermittent preventive treatment of malaria in pregnancy (IPTp) uptake is estimated at 45 percent. [7: https://pdf.usaid.gov/pdf_docs/PA00TDN6.pdf ]

Youth-targeted malaria programming is uncommon, unless it is one small component of other youth services. However, existing efforts to provide youth-friendly services, including those provided by non-governmental organizations (NGOs), present an opportunity for the more systematic integration of malaria prevention and treatment education as part of youth-focused programs. The Contractor’s approach must implement youth-appropriate services, in-line with USAID and GOU policy.

C.2.5.4 Private Sector Engagement In alignment with USAID's Private Sector Engagement Policy[footnoteRef:8], PMI has directed funds into the Local Health System Sustainability (LHSS[footnoteRef:9]) activity to identify opportunities and expand PMI's ability to engage with the private sector. The primary areas of focus for LHSS will be: [8: ] [9: https://www.abtassociates.com/projects/building-sustainable-resilient-health-systems ]

1) conducting a landscaping of private sector efforts in the health space in Uganda;

2) establishing a PSE guide/toolkit and grow the capacity of PMI staff and implementing partners to identify new opportunities; and,

3) identifying strategic priorities and actions for PMI and its partners to consider pursuing at the country, regional and global level based on the results of the landscaping assessment.

The Contractor must apply strategies to accelerate private sector investment and engagement in the health sector in Uganda as identified by the LHSS activity.

C.2.5.5 Digital Strategy

USAID’s Digital Strategy[footnoteRef:10] centers around two core, mutually reinforcing objectives: 1) improve measurable development and humanitarian assistance outcomes through the responsible use of digital technology in USAID’s programming; and 2) strengthen the openness, inclusiveness, and security of country-level digital ecosystems. USAID empowers people and communities to use digital technology to gain access to services, engage with each other, or pursue economic opportunities. [10: https://www.usaid.gov/sites/default/files/documents/15396/USAID_Digital_Strategy.pdf ]

The Contractor shall also consider the MOH eHealth Policy[footnoteRef:11] (2016), which recognizes the potential of information and communication technology (ICT) in transforming healthcare delivery by enabling information access and supporting healthcare operations, management, and decision-making, while also recognizing that there are significant barriers to effective use of data in decision making. [11: https://health.go.ug/sites/default/files/National%20eHealth%20Policy%202016_1.pdf]

PMI is contributing to Digital Square, an initiative funded and designed by USAID, the Bill & Melinda Gates Foundation, and other donors, which supports USAID missions to:

· map the landscape of digital health programs in their countries;

· support the design and implementation of digital health programs;

· harmonize multiple in-country digital health investments;

· ensure digital health programs are successful, scalable, sustainable, and interoperable; and,

· provide digital health support across all programmatic areas including HIV, TB, malaria, and maternal and child health.

In Uganda, Digital Square will start with an ecosystem assessment to understand how digital technologies are used in Uganda for community-based case management as well as data collection, reporting, and decision-making; then engage PMI, the NMCD, and other partners to prioritize opportunities for improvement; and finally support PMI, the NMCD, and partners to implement projects and address identified gaps.

The contractor must collaborate with Digital Square and consider identified gaps for implementation where appropriate.

C.3 BACKGROUND

Malaria is one of the most severe public health problems in Uganda. Despite progress in the fight against malaria, it remains highly endemic and a leading cause of morbidity and mortality. Uganda ranked third among African countries in estimated malaria cases and deaths during 2010–2018.[footnoteRef:12] [12: WHO, World Malaria Report 2019]

Malaria has a high intensity of transmission and is complicated by inadequate health care resources to address the prevention, diagnosis, and treatment of malaria. As a result, Malaria significantly impedes on the quality and average life expectancy of Ugandans. Currently, the country has stable, perennial malaria transmission in 90 to 95 percent of the country. In the rest of the country, particularly in the highland areas, there is low and unstable transmission with potential for epidemics.

Malaria prevention and control is a major U.S. foreign assistance objective, and PMI fully aligns with the U.S. Government's vision of ending preventable child and maternal deaths and ending extreme poverty. PMI delivers cost-effective, life-saving malaria interventions to further reduce malaria burden and assist countries in achieving malaria elimination. PMI/Uganda is an interagency initiative, led by USAID and implemented together with the U.S. Center for Disease Control and Prevention (CDC).

The PMI Strategy[footnoteRef:13] (2015-2020) sets forth a strategic approach for PMI through 2020. The new PMI Strategy (2021-2025) is under draft at the time of this solicitation. Malaria prevention and control is in line with the goals articulated in the draft Roll Back Malaria (RBM) Partnership’s second Global Malaria Action Plan[footnoteRef:14] (February 2018) and the WHO Global Technical Strategy[footnoteRef:15] (2016-2030). [13: https://www.pmi.gov/docs/default-source/default-document-library/pmi-reports/pmi_strategy_2015-2020.pdf ] [14: https://endmalaria.org/sites/default/files/RBM-Strategic-Plan-digital-JW-220218.pdf ] [15: https://www.who.int/malaria/publications/atoz/9789241564991/en/ ]

In Uganda, which is currently in its fifteenth year as a PMI focus country, PMI partners with the GOU, NMCD, and the Global Fund to implement malaria control interventions and provide vital commodities to vulnerable populations. The NMCD, organized under the Ugandan Ministry of Health (MOH), with contributions from major donors such as PMI and the Global Fund, is charged with providing quality-assured services for malaria prevention and treatment to all people in Uganda. The UMRESP 2021-2025, was developed through a participatory and consultative country process with multi sectoral stakeholders, including GOU ministries and departments, development partners, the private sector, national and international non-governmental organizations, research/academia, local/urban authorities and other sub-national stakeholders.

PMI/Uganda’s current flagship activity, MAPD, is approaching its final year of implementation. MAPD’s goal is to reduce the burden of malaria by increasing coverage and use of key malaria interventions in 52 districts, in line with the Uganda Malaria Reduction Strategic Plan 2016-2020 implemented by the NMCD and District Health Management Teams (DHMT).

The MAPD Learning Review[footnoteRef:16] (August 2019) revealed that community engagement is weak, and implementation may benefit from a shift in focus from the clinical-level to community-based interventions, while maintaining clinical gains. A recommendation from this review was to reach beyond the facility and focus the message of malaria prevention and treatment more rigorously at the community level. The MAPD Learning Review also documented low data use at district, health facility, and community levels; limited dissemination of quarterly and annual reports; and low reporting rates from the private sector. Particularly, the review concluded that improvement in the quality and use of community data was needed at community, health facility, district, and central levels. Another key recommendation was to develop a rollout plan for scaling up community reporting in the whole country as quickly as possible. This is in line with PMI technical guidance[footnoteRef:17] (2020), which states that activities need to strengthen quality reporting at all levels in support of PMI's focus on data use for decision-making. [16: https://pdf.usaid.gov/pdf_docs/PA00W7TP.pdf ] [17: https://www.pmi.gov/docs/default-source/default-document-library/tools-curricula/pmi-technical-guidance-(march-2016).pdf?sfvrsn=8 ]

As part of USAID’s commitment to gender equality and women’s empowerment outcomes in programming, USAID completed the Gender Analysis[footnoteRef:18] for Malaria Action Program for Districts in May 2017. This analysis examined how gender roles and responsibilities differentially affect malaria prevention and treatment for men, women and children in Uganda and the gender dynamics behind women’s, men’s, girls’, and boys’ differential exposures and responses. The Analysis provides recommendations to improve gender-sensitive responsiveness relevant to this activity. [18: https://banyanglobal.com/wp-content/uploads/2018/03/MAPD-Gender-Analysis-Report.pdf ]

The USAID RHITES activities, implemented in 75 districts of five regions (Southwest, East, East-Central, North-Lango, North-Acholi), aim to enhance integrated health services for HIV; malaria; TB; maternal, neonatal, and child health (MNCH); family planning and reproductive health; nutrition; and other primary care services for Ugandans. Activities under the RHITES project serve to increase the availability, accessibility, utilization, and quality of these integrated health services. The RHITES activities have reached or will reach completion by 2022; however, PMI will end its funding to RHITES in September 2021 in order to transition to a data-driven strategy that will consolidate malaria control efforts in the highest-burden regions in order to optimize impact and cost effectiveness. The PMI Malaria Reduction Activity will further malaria gains in geographic areas of overlap and strengthen surveillance in order to promptly respond to upsurges in areas with no direct malaria support.

C.3.1 Coordination with Host Country Counterparts and other USAID Implementers

The Contractor must provide grants under contract, including possible in-kind-grants to local governments as described in section C.4.2.

The Contractor must participate in national collaboration fora, including technical working groups, and USAID partner meetings. The Contractor must collaborate with USAID implementing partners with complimentary activities in implementation zones. This includes, but is not limited to, the following activities:

USAID Uganda Health Systems Strengthening (UHSS)

2019 -2024 UHSS is designed to improve community health worker support systems and community information systems by harmonizing community health management information systems. UHSS provides technical assistance to improve/create interoperability of Community Health Information Systems with District Health Information Systems-2 (DHIS 2). The Contractor must ensure complementarity of interventions and incorporation of Community Health Information Systems end-focus in their data driven approach when it comes to strengthening community systems for quality health services.

C.3.2 Other Donor Institutional Support to the Malaria Sector

The Global Fund and the UK Department of International Development (DFID) recently merged into the Foreign, Commonwealth, and Development Office (FCDO), are currently the main donors to the malaria sector, in addition to PMI. FCDO has recently announced that they will cease bilateral support to malaria in March 2021, which will leave PMI and the Global Fund as the two main funders of malaria interventions in Uganda.

Additionally, the NMCD, with support from the African Leaders Malaria Alliance (ALMA) and in partnership with the private sector and Rotarian Malaria Partners Uganda, recently set up a Malaria Free Uganda Fund to help mobilize local resources for malaria elimination.

For the past couple of years, the NMCD has also led efforts to bring multisectoral actors on board for the fight against malaria. This has resulted in multisectoral support and investments such as the creation of a Parliamentarian Forum on Malaria, which advocates for malaria policies and budget allocation at the highest level of different GOU ministries. This activity will aim to support and further these successes with a focus on working with the MoLG, the Ministry of Education and Sports, and the Ministry of Finance Planning and Economic Development (Mainstreaming Malaria in Multi-sectoral Budgets for FY 2020/2021, Attachment J.6).

C.4 OBJECTIVES

The goal of USAID/Uganda’s current CDCS is to contribute efforts that result in Uganda’s systems accelerating inclusive education, health and economic development. There are three Development Objectives (DOs) under the CDCS. This activity contributes to two of those, specifically:

DO1: Community and Household Resilience in Select Areas and Target Populations Increased; and, DO3: Key Systems More Accountable and Responsive to Uganda’s Development Needs.

USAID/Uganda 2016-2021 CDCS Framework:

Specifically, in the effort to strengthen the existing linkages among interventions at community, facility, and district levels for prevention, diagnosis, and treatment of malaria, this activity addresses the following components of USAID/Uganda’s CDCS as detailed further in the Results to be Achieved section below:

Under DO 1: Community and Household Resilience in Select Areas and Target Populations Increased

· Intermediate Result (IR) 1.3: Enhanced prevention and treatment of malaria and other epidemics among the most vulnerable

· Sub-Intermediate Result 1.3.1: Prevention and treatment scaled up

· Sub-Intermediate Result 1.3.2: New infections reduced

Under DO 3: Key Systems’ Accountability and Responsiveness to Uganda’s Development Needs Improved

· Intermediate Result 3.1 Leadership in development supported

· Sub-Intermediate Result 3.1.2: Leadership practices cultivated

· Intermediate Result 3.4 Enabling environment that supports functional systems improved

· Sub-Intermediate Result 3.4.2: Policy making processes and capacity strengthened

Development Objective 1: Community and Household Resilience in Select Areas and Target Populations Increased

Development Objective 3: Key Systems More Accountable and Responsive to Uganda’s Development Needs

C.4.1 Results the Contractor is to Achieve

The Contractor is responsible for achieving the results listed below. Uganda Learning Activity (ULA) conducted the first phase of an independent baseline (Baseline Assessment for an Anticipated PMI Malaria Reduction Activity, Phase I: Secondary Data Analysis, Attachment - J.2) in July 2020 for this activity; the second phase was completed in October 2020 (see, Malaria Reduction Activity Baseline Assessment Phase II Final Report, Attachment J.3). The contractor must use this baseline assessment as their reference point for assessing the progress and impact of this activity. PMI Uganda will conduct monitoring in accordance with Sections C.4.1.1 Activity Monitoring and Evaluation Plan (AMELP) and require deliverables as noted in the Quality Assurance Surveillance Plan (QASP) (Sections E and F). The contractor shall select among the indicators below, and can propose additional indicators, to populate a negotiated award fee schedule with proposed yearly performance targets.

The specific results to be achieved under this activity by Development Objective are as follows:

Component 1:

DO Number and Title:

DO 1: Community and Household Resilience in Select Areas and Target Populations Increased

DO1 measures to what extent community and household resilience is built in the targeted population. Households affected by malaria are less resilient due to shocks associated with illness. The increased investments in malaria control under this activity are expected to support communities and households to have reduced vulnerability and to manage risks associated with malaria. The Contractor must confirm training contractor targets following award, as these are heavily dependent on the proposed technical approach.

Component 1(a)

IR 1.3 measures the extent to which the activity contributes to the implementation of proven malaria prevention and control interventions, as well as contributions to enhancing early-warning systems and preparedness including supporting community and health facility surveillance for malaria so that USAID, GOU, and other donors can respond rapidly to outbreaks.

Results under Component 1(a)

Performance Indicators

activity

Component 1(a)(i)

Results under Component 1(a)(i) Performance Indicators

85%

1,426,810

Component 1(a)(ii)

Results under Component 1(a)(ii) Performance Indicators

Component 2 DO Number and Title:

DO3: Key Systems' Accountability and Responsiveness to Uganda's Development Needs Improved

This activity will support DO3 results aimed at enhancing leadership activities at national and local government levels. It will also support interventions aimed at providing an enabling environment that supports functional systems improvement. It is anticipated that the proposed technical approach will further define these indicators.

C.5.2.1 Component 2(a)

PMI/Uganda will promote leadership in development at community, local government, and national levels with the intention of supporting transformational leadership values such as equality, trust, collaboration, accountability, and integrity, as well as ethical and development-oriented perspectives. This result is aimed at allowing leaders to better serve the needs of their communities. PMI Uganda will use the following indicators to measure this intervention.

Results under Component 2(a) Performance Indicators

Component 2(a)(i)

Results under Component 2(a)(i) Performance Indicators

Component 2(b)

The activity will support the GoU in strengthening policy-making processes by strengthening the linkages among different stakeholders at local and national level through supporting activities such as: high quality data collection and analysis for malaria; convening malaria stakeholders to form joint agendas; improving the quality of dialogue between government and other stakeholders in developing and monitoring the impact of policies related to malaria activities; and supporting the creation of feedback loops in which monitoring and evaluation information informs needed policy adjustments.

Results under Component 2(b) Performance Indicators

Component 2(b)(i)

Results under Component 2(b)(i) Performance Indicators

C.4.2 Grants Under Contracts

This award will provide up to $4 million (not including administrative costs to oversee the awards) in grants to local community based organizations (CBO) and only in-kind grants to local governments (e.g. district governments) designed to contribute to the achievement of key program results as stipulated in the activity description above. The Contractor must not enter into grants with partner government entities (excluding “in-kind” grants, technical assistance and other activities provided to or on behalf of the partner government entity). The Contractor must develop grant activities while ensuring that such grants are managed and administered according to USAID/Uganda regulations and approaches, including in-kind support. A proportion of these grants may involve the private sector and include public-private partnership arrangement as seed grants to extend the reach of activities.

C.5 ADDITIONAL REQUIREMENTS

C.5.1 Collaborating, Learning and Adapting

Using the collaboration, learning, and adaptation (CLA) approach the Contractor, under direction from the COR, shall learn from and adapt implementation throughout the life of the activity to ensure the delivery of results. Given the shifting geographic burden of malaria due to population movement, changing weather patterns, and seasonality, the Contractor will be expected to employ a flexible implementation model to respond to upsurges when they occur.

Development work presents many opportunities to collaborate and engage with a broad set of stakeholders, to learn from both evidence and experience, and to adapt iteratively to unexpected results or changes in context. This is why USAID places collaborating, learning, and adapting at the center of its Program Cycle, both as a connector between, and an integrated part of the components.

Collaborating Collaboration enables cross-sector integration, convergence, and effective interventions to maximize development resources and enhance development results. The Contractor must collaborate with USAID-supported activities at national level and in common regions of operation as well as engage with stakeholders (defined in partnership with USAID COR) to deliver integrated services to target populations.

Learning Learning is intentional, systematic, and resourced. Sources for learning include data from monitoring, portfolio reviews, findings of research, evaluations, analyses conducted by USAID or third parties, knowledge gained from experience, stocktaking exercises, and other sources. The Contractor must review CLA sources available to them and request those that are not publicly accessible from the COR for consideration in the learning phase of CLA.

The contractor must use these sources to develop and implement plans, manage adaptively, and contribute to the USAID/Uganda knowledge base in order to improve development outcomes. A CLA focus helps to ensure that programming is coordinated, grounded in evidence, and adjusted as necessary to remain relevant and effective throughout implementation.

The contractor must apply knowledge generated by learning throughout programming to implementation approaches, processes, and stakeholder engagement. The contractor should also disseminate knowledge generated by learning to activity stakeholders, partners, and collaborators in an appropriate forum and format so that it may be translated into decisions and actions that enhance the success of approaches and interventions designed to achieve common intermediate results.

The Contractor must share information and knowledge generated by monitoring data, portfolio review results, research findings, evaluations, analyses, and experiences with other USAID implementing partners. The Contractor will apply actionable information and knowledge gained from collaborating partners to activity implementation in order to improve results.

USAID implementing partners must convene on a periodic basis to reflect on actions taken, exchange analysis, and propose decisions that affect implementation.

Adapting The Contractor must demonstrate adaptability that is informed by knowledge gained through learning, and recognize behaviors and incentives necessary to create change. Knowledge gained through learning must influence decision making, resource allocation, and adaptation to contextual shifts. Application of new knowledge to implementation decisions must be reflected in the Annual Work Plan and AMELP, Section C.4.1.1. The contractor may base decisions to adapt, but not limited to the following:

· extraneous changes in the operating environment (i.e., emergency or natural disaster, national policy changes);

· financial and human resource constraints;

· evidence that signals targets are unmet; and,

· emerging evidence that interventions are not working or could work better if adapted.

Any changes to the scope of the contract must be approved by the Cognizant Contracting Officer in a modification to the contract. Changes in technical approach may be approved by the COR by way of the COR’s authority to provide technical direction and approve Annual Work Plans.

C.5.1.1 Activity Monitoring and Evaluation Plan

The Contractor must develop an AMELP that describes how USAID and the Contractor shall monitor progress towards the results and use the information to make mid-course adjustments. At a minimum, the AMELP must identify appropriate activity indicators for each level of the results framework, show data sources, and describe how data will be collected/collated/acquired, analyzed, and presented to regularly inform performance. The plan must identify core indicators for every result and intermediate result/outcome and provide preliminary five-year performance indicator targets for these core indicators. The AMELP must, at a minimum, include the non-discretionary performance indicators included in Section C.4.1 above. Details of AMELP are provided in Section F.4.2.3 of the Request For Proposal (RFP). The AMELP will effectively track activities’ inputs and outputs and achievement of performance outcomes over the contract’s life.

C.5.2 Performance Evaluations

USAID shall initiate evaluations at any point during activity implementation, particularly if new information arises indicating that an evaluation is appropriate for accountability or learning (ADS 201.3.4.10). The COR will inform the Contractor as early as possible if this contract will be evaluated and will share the draft and final evaluation design completed by the evaluation team. The Contractor must facilitate access to data, documentation, personnel, and key stakeholders as appropriate for the completion of an external evaluation. Following the completion of an evaluation, the Mission will share the draft and final evaluation reports with the Contractor being evaluated and should coordinate with the Contractor on dissemination and utilization of evaluation findings (ADS 201.3.5.18).

C.5.3 Guiding Principles

USAID/Uganda’s fifteen Guiding Principles are designed to assist the Mission in implementing, monitoring, and adjusting the strategic approach and anticipated results outlined in the CDCS results framework and subsequent design, management, and monitoring tools. The activity will prioritize the following of the Guiding Principles, all of which are described more fully in Annex 4 of the CDCS[footnoteRef:19]: [19: https://www.usaid.gov/uganda/cdcs ]

· Apply a holistic approach to collaborating, learning, and adapting, as well as specific areas of focus for C, L, and A.

· Pursue broad and inclusive stakeholder engagement throughout the program cycle.

· Infuse inclusive development – including but not limited to gender empowerment – throughout the portfolio (ref: Gender Analysis[footnoteRef:20] for Malaria Action Program for Districts). [20: https://banyanglobal.com/wp-content/uploads/2018/03/MAPD-Gender-Analysis-Report.pdf ]

· Prioritize partnerships that enable Ugandan-led development, while leveraging USAID’s limited resources.

· Maintain a problem-driven focus, while ensuring all program approaches analyze and adjust to the local context, at whatever level required.

· Apply a facilitative approach to development, minimize direct service provision over time.

· Foster leadership as a lever for change – within the Agency, with partners, and with stakeholders.

C.5.4 Environmental Compliance

The Foreign Assistance Act of 1961, as amended, Section 117 requires that the impact of USAID’s activities on the environment be considered and that USAID include environmental sustainability as a central consideration in designing and carrying out its development programs. This mandate is codified in Federal Regulations (22 CFR 216) and in USAID’s Automated Directives System (ADS) Parts 201.5.10g and 204 (http://www.usaid.gov/policy/ADS/200/), which, in part, require that the potential environmental impacts of USAID-financed activities are identified prior to a final decision to proceed and that appropriate environmental safeguards are adopted for all activities. Contractor environmental compliance obligations under these regulations and procedures are specified in the following paragraphs of this RFP.

In addition, the Contractor must comply with host country environmental regulations unless otherwise directed in writing by USAID. In case of conflict between host country and USAID regulations, the latter shall govern.

USAID will not allow any activity funded under this contract to be implemented unless an environmental threshold determination, as defined by 22 CFR 216, has been reached for that activity, as documented in a Request for Categorical Exclusion (RCE), Initial Environmental Examination (IEE), or Environmental Assessment (EA) duly signed by the Bureau Environmental Officer (BEO). (Hereinafter, such documents are described as “approved Regulation 216 environmental documentation.”)

USAID approved an Initial Environmental Examination (IEE) (Filename: Uganda_Resilience_IEE_03092020) for Project funding this RFP. The IEE covers activities expected to be implemented under this contract. USAID has determined that a Negative Determination with conditions applies to one or more of the proposed activities. This indicates that if these activities are implemented subject to the specified conditions, they are expected to have no significant adverse effect on the environment.