cdc-rfa-dp16-1603.pdf

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

Nutrition Strategies to Address Micronutrient Deficiencies

CDC-RFA-DP16-1603

Application Due Date: 12/29/2015

Nutrition Strategies to Address Micronutrient Deficiencies

CDC-RFA-DP16-1603

TABLE OF CONTENTS

Overview Information Federal Agency NameA.

Funding Opportunity TitleB.

Announcement TypeC.

Agency Funding Opportunity NumberD.

Catalog of Federal Domestic Assistance (CFDA) NumberE.

Dates

Letter of Intent Deadline1.

Application Deadline2.

Informational Conference Call for Potential Applicants3.

F.

Executive Summary Summary Paragraph1.

G.

I.

Full Text Funding Opportunity Description

A.1. Background 1.

A.2. CDC Project Description 2.

A.

Award Information B.1. Funding Instrument Type 1.

B.2. Funding Activity Category 2.

B.3. Fiscal Year 3.

B.4. Approximate Total Fiscal Year Funding 4.

B.5. Approximate Project Period Funding 5.

B.6. Total Project Period Length 6.

B.7. Expected Number of Awards 7.

B.8. Approximate Average Award 8.

B.9. Award Ceiling 9.

B.10. Award Floor 10.

B.11. Estimated Award Date 11.

B.12. Budget Period Length 12.

B.13. Funds Tracking 13.

B.14. Direct Assistance 14.

B.15. Indirect Costs 15.

B.

Eligibility Information C.1. Eligible Applicants 1.

C.2. Additional Information on Eligibility 2.

C.3. Justification for Less than Maximum Competition 3.

C.4. Other 4.

C.5. Cost Sharing or Matching 5.

C.6. Maintenance of Effort 6.

C.

Application and Submission Information D.1. Required Registrations 1.

D.2. Request Application Package 2.

D.3. Application Package 3.

D.4. Submission Dates & Times 4.

D.5. CDC Assurances and Certifications 5.

D.6. Content and Form of Application Submission 6.

D.7. Letter of Intent 7.

D.8. Table of Contents 8.

D.9. Project Abstract Summary 9.

D.10. Project Narrative 10.

D.11. Work Plan 11.

D.12. Budget Narrative 12.

D.13. Tobacco and Nutrition Policies 13.

D.14. Intergovernmental Review of Federal Programs 14.

D.15. Funding Restrictions 15.

D.16. Other Submission Requirements 16.

D.

Application Review Information E.1. Review and Selection Process 1.

E.2. Anticipated Announcement and Award Dates 2.

E.

Award Administration Information F.1. Award Notices 1.

F.2. Administrative and National Policy Requirements 2.

F.3. Reporting 3.

F.4. Federal Funding Accountability and Transparency Act of 2006

4.

F.

Agency Contacts G.

Other Information H.

Glossary I.

II.

Part I. Overview Information

A. Federal Agency Name:

Centers for Disease Control and Prevention

B. Funding Opportunity Title:

Nutrition Strategies to Address Micronutrient Deficiencies

C. Announcement Type:

This announcement is only for non-research international activities supported by CDC. If research is proposed, the application will not be considered. Research for this purpose is defined at:

http://www.cdc.gov /od /science /integrity /docs /cdc -policy -distinguishing -public -health -research -nonresearch.pdf.

D. Agency Funding Opportunity Number:

CDC-RFA-DP16-1603

E. Catalog of Federal Domestic Assistance (CFDA) Number:

93.649

F. Dates:

1. Due Date for Letter of Intent: N/A

2. Due Date for Applications: 12/29/2015

3. Date for Informational Conference Call: N/A

G. Executive Summary:

1. Summary Paragraph:

The purpose of this FOA is to help assure optimal health among vulnerable populations and reduce the worldwide burden of micronutrient deficiencies by improving micronutrient nutrition. This will be done by working collaboratively with an established organization that has a presence in most, if not all, countries throughout the world and is actively involved in the implementation of nutrition and micronutrient programs globally focused on infant/young child nutrition issues. In cooperation with CDC, this organization will provide leadership, expertise, and support in helping vulnerable populations receive and consume adequate amounts of necessary vitamins and minerals. Major functions to be performed include providing leadership to develop recommendations and inform country-specific nutrition strategies; program design and nutrition monitoring and evaluation; and building in-country capacity to implement standardized national nutrition programs and micronutrient interventions. Key strategies include collaborating with ministries of health (MOH) and other key implementers in developing countries; developing models and tools to guide and implement program monitoring, evaluation and surveillance systems; providing training and technical assistance at national and regional levels. It is expected that this work will result in implementation and evaluation of methods to ascertain and improve nutritional/micronutrient status, and of promising food based fortification and complementary feeding strategies, and improved dietary intake of undernourished populations, particularly infants, young children and reproductive age women.

Over the course of the 5 year collaboration, work will focus on several key activities to improve micronutrient status including food fortification, use of home fortification products, micronutrient supplementation during pregnancy, vitamin A supplementation, and promotion of community based infant and young child feeding strategies.

a. Eligible Applicants: United Nations Children's Fund (UNICEF)

b. FOA Type: Cooperative Agreement

c. Approximate Number of Awards: 1

d. Total Project Period Funding: $3,750,000

e. Average One Year Award Amount: $750,000

f. Number of Years of Award: 5

g. Approximate Date When Awards will be Announced: January 2, 2016

h. Cost Sharing and/or Matching Requirement: Cost sharing or matching funds are not required for this program

Part II. Full Text A. Funding Opportunity Description

1. Background

CDC’s International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program works with global partners by providing CDC’s skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable populations and build evidence for programs that are effective both in the U.S. and throughout the world. Established by the CDC in 2000, the program focuses primarily on helping eliminate deficiencies in iron, vitamin A, iodine, folate, and zinc, deficiencies which affect nearly one-third of the world's population with devastating consequences. The burden of micronutrient deficiencies faced in the world today is enormous:

Iron deficiency is a leading cause of global disease, robbing more than 2 billion children of intellectual development, lowering IQ, and contributing to 25% of maternal deaths in developing countries.

Iron deficiency is a problem in the U.S. as well with an estimated 20% of low income children aged 1-2 years and 16% of pregnant women estimated as iron deficient.

Iodine deficiency is the leading cause of preventable mental retardation and causes brain damage in nearly 18 million newborns each year.

Vitamin A deficiency produces blindness in about 500,000 children and claims the lives of almost 670,000 children aged 5 years and younger.

Folate deficiency causes severe birth defects in approximately 150,000 newborns each year Approximately 1/3 of the world's population lives in areas of high-risk for zinc deficiency, which contributes to as many as 800,000 child deaths per year.

Poor Infant/Young Child Nutrition (IYCN) and breastfeeding practices contribute to poor nutrition and micronutrient status and higher rates of infection in children 0-59 months.

CDC's goal is to work collaboratively to achieve optimal health among vulnerable populations (especially infants, young children, and pregnant women) by improving micronutrient nutrition globally, with a particular focus on iron, vitamin A, iodine, folate and zinc. This FOA helps carry out the program’s goals by supporting the planning and implementation of assessments of the burden of micronutrient deficiencies in select countries, the implementation of country-specific interventions, and the design and implementation of systems to monitor and evaluate interventions, using the monitoring data to improve the function and success of these programs. It also provides support for updating recommendations, and translating them into guidance, developing frameworks, and providing leadership and support to improve the function of important global initiatives, such as the Iodine Global Network, in order to eliminate micronutrient deficiencies.

In an examination of economic solutions to ten of the world´s biggest challenges, the 2008 Copenhagen Consensus concluded that combating malnutrition in undernourished children, specifically providing vitamin A and zinc, provides the most beneficial return on investment. Every dollar spent creates benefits worth $17. In addition, the 2013 Lancet Series on Maternal and Child Nutrition looked at the impact of scaling 10 nutrition-specific interventions, such as micronutrient supplementation and promotion of breastfeeding, targeted to reduce under-nutrition in women and children. The Lancet series documented that if these 10 interventions were scaled-up to 90% population coverage, an estimated 900,000 lives could be saved in 34 countries with high burden of nutritional deficiencies; the prevalence of stunting could be reduced by 20%; and the number of children with stunted growth and development would be reduced by 33 million.

There are numerous evidence-based interventions that can be used in combatting micronutrient deficiencies, including fortification of staple foods items, provision of multiple micronutrient supplementation to pregnant women, provision of home fortification products such as multiple micronutrient powders (MNPs) or pastes to be added to children’s’ foods, and proper introduction of appropriate infant and young child nutrition practices.

Despite the development and existence of evidence-based global strategies to reduce micronutrient malnutrition, there are major challenges to implementing these. More needs to be done to improve the implementation of programs that scale up these evidence-based strategies and increase both access and reach, to significantly decrease the consequences and burden of http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.copenhagenconsensus.com/Home.aspx micronutrient malnutrition.

The capacity to implement high quality micronutrient deficiency reduction programs varies across countries but is often inadequate in countries with the highest burden of deficiencies.

Through this FOA countries will be identified and supported, based on a demonstration of need, interest, and commitment to develop and implement country based burden assessments, interventions, and monitoring and surveillance systems. This FOA will be used to identify the main knowledge gaps, to develop resources to fill those gaps, and to develop replicable models for monitoring and evaluation.

References:

Black RE, et al the Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet. 2013; 382(9890):

427-451.

Black, Robert E et al. Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet. 2008; 371(9608): 243 – 260.

Bhutta Z, Evidenced-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet. 2013; 382 (9890): 452 – 477.

Copenhagen Consensus Center. Copenhagen Consensus 2012 – Outcomes. Denmark: Copenhagen Business School. http://www.copenhagenconsensus.com.

www.cdc.gov/immpact

a. Statutory Authorities Public Health Service Act , Title 42, Sections 307 and 301 U.S.C. 241I and 241(a).

b. Healthy People 2020 This FOA contributes to the Healthy People 2020 focus area to improve public health and strengthen U.S. national security through global disease detection, response, prevention, and control strategies ( https://www.healthypeople.gov/2020/topics-objectives/topic/global-health).

c. Other National Public Health Priorities and Strategies N/A

d. Relevant Work This FOA builds on current CDC program activities being conducted under CDC-RFA-DP09-0911 Cooperative Agreement number DP-002282 in improving nutrition status to eliminate micronutrient malnutrition in countries around the globe through the reduction of vitamin and mineral deficiencies.

2. CDC Project Description

A.2.a. Approach The below logic model (and attached) is a depiction of the FOA's general approach. The strategies and outcomes of the logic model are stated broadly to capture the variety of activities and http://www.copenhagenconsensus.com http://www.cdc.gov/immpact https://www.healthypeople.gov/2020/topics-objectives/topic/global-health

The below logic model (and attached) is a depiction of the FOA's general approach. The strategies and outcomes of the logic model are stated broadly to capture the variety of activities and outcomes that are associated with the projects of this FOA. Activities listed in each project can be associated with one or more strategies presented in the logic model.

*These are outcomes for which the awardee will be held responsible.

Strategies Functions/Activities Short Term Outcomes Intermediate Outcomes Long Term Outcomes

Program strategies will primarily be evidence-based global nutrition interventions that can be performed in-country by awardee in collaboration with CDC.

Key nutrition program strategies for the reduction of micronutrient deficiencies in infants, young children, and women of reproductive age include:

• Home fortification (i.e.

micronutrient powders)

• Infant and Young Child Nutrition (i.e. community IYCN programs)

• Staple food fortification

• Vitamin A supplementation

• Iron and folic acid supplementation or multiple micronutrient supplementation for pregnant women

• Salt iodization

Function 1: Leadership:

• Co-convene with global partners to develop and disseminate recommendations, guidelines, frameworks

• Actively participate in key global nutrition initiatives to inform the direction of micronutrient and infant and young child nutrition (IYCN) focused strategies within countries (including breastfeeding and complementary feeding)

Function 2: Program design and monitoring and evaluation (M&E):

• Develop and implement micronutrient interventions and monitoring and evaluation systems

• Develop and implement infant and young child nutrition (IYCN) interventions and assessments

• Assist countries to conduct high quality micronutrient and nutrition assessments and develop monitoring systems

• Develop replicable M&E models

Function 3: Capacity Building:

• Facilitate and develop workshops and webinars for scaling-up micronutrient and IYCN interventions

• Develop toolkits, manuals and other resources

• Document key global micronutrient strategies (including peer reviewed publications)

Leadership:

• Global nutrition collaborations strengthened and key micronutrient and IYCN interventions promoted and adopted within countries*

• Guidelines and frameworks utilized by multiple countries globally*

Program design and monitoring and evaluation (M&E):

• High quality programs (which includes high coverage and adherence) with a focus on M&E, surveillance, and assessments implemented in select priority countries*

Capacity Building:

• Availability and reach of technical resources increased for use globally by program implementers*

• Knowledge base of micronutrient interventions increased among program implementers and other health practitioners*

Leadership:

• Increased reach of key nutrition program strategies*

Program design and monitoring and evaluation (M&E):

• Replicable country models for M&E, surveillance and assessments for micronutrient and infant and young child nutrition (IYCN) program improvement implemented*

Capacity Building:

• Capacity to implement micronutrient and infant and young child nutrition (IYCN) programs enhanced at in-country national and regional levels *

More effective utilization of resources at country and global level

Sustainable monitoring and evaluation and surveillance systems

Improved intake and diminished loss of vitamins and minerals at the population level

Improved nutritional status of population

Improved development, performance, and productivity of individuals

i. Problem Statement At least half of children worldwide ages 6 months to 5 years suffer from one or more micronutrient deficiency, and globally more than 2 billion people are affected. Effective micronutrient interventions aimed at reducing the morbidity and mortality linked to chronic under-nutrition, fostering optimal growth and development, and improving nutritional status in populations, particularly in the most vulnerable groups, are needed and are being implemented or planned at various levels in many countries.

Diets which lack adequate amounts of essential vitamins and minerals, such as iron, iodine, vitamin A, folate and zinc lead to these deficiencies with devastating consequences. There are a variety of reasons why intake of these key nutrients is insufficient, including a lack of diverse and high quality foods and poor infant and young child nutrition practices (IYCN), such as early initiation of complementary feeding and inadequate feeding frequency. In addition to inadequate intakes of micronutrient-rich foods, impaired absorption or utilization of nutrients in these foods is due partly to infection and parasitic infestation, which also increase metabolic needs for many micronutrients. Malnutrition contributes substantially to the global burden of disease, causing 3.1 million child deaths annually or 45% of all child deaths.

There is a critical need to address micronutrient malnutrition in vulnerable populations to help prevent and control chronic diseases and other conditions. Key nutrition program strategies include micronutrient supplementation, food fortification (including home-based fortification efforts), and infant and young child nutrition programs. Based on lessons learned, this FOA seeks to improve the intake of micronutrients through strengthening global nutrition collaborations, the development of guidelines and frameworks for interventions, and implementation of strategies that impact maternal and child under-nutrition outcomes, to increase access and coverage of key programs. Additionally, there is a need to develop replicable models for program monitoring and evaluation, surveillance, and assessments to improve program quality and facilitate scale-up.

References:

Bhutta Z, Evidenced-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet. 2013; 382 (9890): 452 – 477.

www.cdc.gov/immpact

ii. Purpose The purpose of this FOA is to reduce the worldwide burden of micronutrient deficiencies by helping vulnerable populations receive and consume adequate amounts of necessary http://www.cdc.gov/immpact

The purpose of this FOA is to reduce the worldwide burden of micronutrient deficiencies by helping vulnerable populations receive and consume adequate amounts of necessary micronutrients (vitamins and minerals). This FOA aims to work collaboratively with an established organization that is recognized for its presence in most, if not all, countries throughout the world and is actively involved in the implementation of nutrition and micronutrient programs globally focused on infant/young child nutrition issues to assure optimal health among vulnerable populations by improving micronutrient nutrition and thus reducing the worldwide burden of micronutrient deficiencies.

iii. Outcomes As reflected in the logic model, the awardee is expected to show measureable progress made toward short-term and intermediate outcomes for this five-year project period. Each activity focuses on one or more of these outcomes, as specified in the “Outcomes” section of the program descriptions in the attached logic model.

The short-term outcomes to be achieved include:

•Global nutrition collaborations strengthened and key micronutrient and Infant and Young Child Nutrition (IYCN) interventions promoted and adopted within countries •Guidelines and frameworks utilized by multiple countries globally •High quality programs (which includes high coverage and adherence) with a focus on monitoring and evaluation (M&E), surveillance, and assessments implemented in select priority countries •Availability and reach of technical resources increased •Knowledge base of micronutrient interventions increased The intermediate outcomes to be achieved during this project period include:

•Increased reach of key nutrition program strategies •Replicable models for M&E, surveillance and assessments for micronutrient and infant and young child nutrition (IYCN) program improvement implemented in selected countries •Capacity to implement micronutrient and infant and young child nutrition (IYCN) programs enhanced at national and regional levels

iv. Funding Strategy N/A

v. Strategies and Activities Despite the enormity of the problem, there are many evidence-based interventions that can drastically reduce the burden of micronutrient deficiencies. Strategies under this FOA include micronutrient supplementation, food fortification (including home-based fortification efforts), and infant and young child nutrition programs. Key program interventions to improve micronutrient status include vitamin A supplementation for children 6-59 months, salt iodization, zinc supplementation for children suffering from diarrhea, fortification of staple food vehicles with micronutrients (for example, wheat flour with iron and folic acid), and iron or multiple micronutrient supplementation for pregnant women. Specific approaches in Infant and Young Child Nutrition (IYCN) programs include community-based strategies to promote exclusive and continued breastfeeding through two years of age and appropriate introduction of complementary foods, optimal frequency of feeding and dietary diversification of complementary foods. A key strategy within IYCN is home fortification as the addition of micronutrient powders or pastes to a child’s food improve the nutritional composition of their diet, improves growth, and leads to increase in nutritional status. This section provides examples of work that will be carried out during the project timeframe. The awardee will work with CDC to define the exact activities and work plan on an annual basis. All the strategies and activities broadly focus on the areas outlined in the logic model and fall under three main functions: Leadership, Program Design/Monitoring and Evaluation (M&E), and Capacity Building. Evidence-based nutrition strategies that have been shown to reduce micronutrient deficiencies include, but are not limited to:

•Home fortification (e.g. micronutrient powders) •Infant and Young Child Nutrition (e.g. community IYCN programs) •Staple food fortification ( such as flour, oil, rice, sugar, maize, country specific staples and condiments) •Vitamin A and zinc supplementation •Iron and folate supplementation or multiple micronutrient supplementation for pregnant women •Salt iodization The main types of activities expected to be conducted under the three major functions over the course of the 5-year project period include:

Function 1: Leadership

1. Co-convene with global partners to develop recommendations, guidelines, frameworks Major activities should include identifying key areas where further guidance is needed to help improve the quality of the micronutrient-focused programs being implemented globally, organizing the necessary meetings and consultations, and coordinating the development of the guidance documents and the wide dissemination of such products. An example of the kind of consultation and guidance needed might be on the identification of better and more affordable field methods for iodine status. Such work could greatly enhance selected countries’ abilities to more effectively monitor their programs if there are better and more affordable field methods available.

2. Actively participate in key global nutrition initiatives to influence the direction of micronutrient and infant and young child nutrition focused strategies CDC actively participates and provides support to several networks and technical advisory groups that address micronutrient deficiencies and nutrition. Through the cooperative agreement, the awardee will work with and through the main global networks, such as, but not limited to, the Food Fortification Initiative (FFI), the Home Fortification Technical Advisory Group (HFTAG), the Iodine Global Network (IGN), Global Alliance on Vitamin A (GAVA) to further strengthen and promote effective strategies more widely to reduce micronutrient deficiencies and increase access to and coverage of well designed, effective programs. The awardee will be expected to actively participate in these kinds of prominent networks, have a leadership presence, and provide significant experience and expertise in helping to strengthen and guide such nutrition initiatives.

Function 2: Program design and monitoring and evaluation(M&E)

3. Develop and implement nutrition and micronutrient interventions and their program monitoring and evaluation systems Activities include working with CDC to identify, prioritize and support countries, particularly countries where there is a higher burden of micronutrient deficiencies, to support the implementation of high quality nutrition and micronutrient interventions. Work may involve a) an analysis of quantitative and qualitative data to determine micronutrient status and needs of the populations identified, b) conduct feasibility assessments, c) assess relevant knowledge, attitudes and practices of target populations, health professionals and other relevant entities, d) assess the infrastructure needed for various intervention strategies and delivery platforms, e) conduct formative work to aid program design and develop any necessary behavior change intervention components, f) develop and implement a robust monitoring system, and g) conduct baseline and end line surveys to assess the impact of the intervention on the nutritional and micronutrient status of the population.

4. Provide technical assistance to conduct high quality micronutrient and nutrition assessments, and develop and implement monitoring systems In countries identified and supported by the awardee and CDC, provide technical assistance to support the design and implementation of robust systems to monitor and evaluate the progress of the intervention and their impact on the micronutrient status of the population. Selected countries should a) implement or have existing population based micronutrient deficiency programs in the core areas identified above and b) demonstrate national/regional support to maintain monitoring systems after the initial development.

5.Develop replicable Monitoring and Evaluation models One long term outcome of the cooperative agreement is to develop M&E models for various interventions (e.g., home fortification) that have been successfully implemented in several countries and enable programs to be scaled up and be sustainable. Countries should also be selected with this outcome in mind. Function 3: Capacity building

6. Facilitate and develop workshops and webinars for scaling-up micronutrient and IYCN interventions In order to effectively increase the number of high quality programs being implemented and achieve the goal of improving micronutrient status of populations, building capacity across organizations and in countries is critical. Major activities will include a) providing technical assistance to identified, priority countries, b)developing workshops and webinar series on topics such as planning effective interventions, how to scale up programs, developing behavior change interventions, and designing monitoring and evaluation systems. Specific workshops and webinars may also be needed to respond to issues that might arise, for example formulation issues related to home fortification products. Workshop series on broader areas, such as monitoring and evaluation may also be necessary, to be able to provide assistance on more specific areas within a topic. The awardee will work together with CDC to determine what workshops and webinars are needed to build capacity in the most critical areas.

7. Develop toolkits, manuals and other resources

In addition to workshops and webinars where more direct and interactive technical assistance can be provided, technical assistance resources such as toolkits and manuals will also be developed. Once replicable monitoring systems have been designed and implemented, resource materials to enable other countries to implement similar systems will need to be developed and disseminated.

8. Document key global micronutrient and IYCN strategies All activities implemented as part of the cooperative agreement will need to be documented and disseminated. Documentation can be in the form of a) case studies, b) peer-reviewed papers/communications, c) guidelines, d) proceedings, or) reports. Where possible multiple forms of documentation should be used to increase the visibility, document lessons learned, and facilitate use of the information/knowledge generated.

1. Collaborations

a. With CDC-funded programs:

This is not applicable to this FOA.

b. With organizations external to CDC:

The awardee must involve at least two of the following global private sector or institutional organizations as critical and core partners: the Micronutrient Initiative, WHO, Global Alliance for Improved Nutrition (GAIN), Emory University, (where the secretariat of the Food Fortification Initiative is housed), Micronutrient Forum, Global Alliance for Vitamin A (GAVA), USAID, World Food Programme (WFP), CDC Foundation, Scaling Up Nutrition (SUN) or SPRING. The proposed alliance must leverage and mobilize private sector assets, expertise, resources and contributions. Where possible applicants should enclose MOU and/or MOA to verify existing collaborations with any of the aforementioned partners.

2. Target Populations High priority target populations are infants, young children and women of reproductive age (with a focus on pregnant and lactating women), within countries identified as having a high burden of micronutrient malnutrition. These groups tend to be the most vulnerable to micronutrient malnutrition. Infants and young children are particularly at risk for micronutrient malnutrition, because of their high nutrient needs and vulnerability due to infection. For many micronutrients, including the main five (iron, vitamin A, iodine, zinc and folate), the focus of many programs such as fortification and supplementation is targeted towards these groups.

The awardee will need to select evidence based programmatic approaches that are capable of addressing micronutrient and nutritional deficiencies suitable for the populations identified above. Approaches will also need to take into consideration any environmental, social and geographical factors that may impact the success of the program.

Inclusion:

This FOA contributes to the Healthy People 2020 focus area to improve public health and strengthen U.S. national security through global disease detection, response, prevention, and control strategies.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy Applicants will be required to submit a draft evaluation and performance measurement plan as part of the funding application. The awardee must provide a more detailed evaluation plan within the first year of programmatic funding with assistance and support from CDC. The evaluation and performance measurement plan will focus on the extent to which strategies are implemented as planned (process evaluation) and progress on short-term and intermediate-term outcomes as reflected in the FOA logic model. It will include a limited number of process and outcome performance measures identified by CDC that awardees will be required to report on annually. Awardees may propose additional performance measures to report on as part of their evaluation and performance measurement plan. It is expected that the applicant will develop performance measures for each accountable outcome as outlined in the logic model.

The evaluation and performance measurement plan will be designed to answer the following questions:

1) What was the increased reach of the key nutrition program strategies implemented?

2) How many countries were able to implement models for assessments, M&E and surveillance systems for key program strategies with the potential to be replicated in other countries?

3) How was capacity to implement micronutrient and infant and young child nutrition (IYCN) programs enhanced at national and regional levels?

ii. Applicant Evaluation and Performance Measurement Plan

c. Organizational Capacity of Awardees to Execute the Approach Applicant(s) must possess the capacity to provide programming that utilizes evidence-based and/or best practices to inform global nutrition policy, guidelines, and recommendations.

Applicant(s) should be experienced in methods employed to monitor nutritional indicators and to strengthen the use and value of nutritional surveillance systems that feed into other informational systems at global and national levels. Applicant(s) should possess the capability to sustain some or all project activities after Federal financial assistance has ended. The Applicant(s) should be a key partner in global initiatives such as Scaling Up Nutrition (SUN), the Standing Committee on Nutrition (SCN), and Renewed Effort Against Child Hunger (REACH). Applicant(s) must have a platform for reaching all countries interested and/or involved in global under-nutrition strategies and offices and/or presence in UN countries and regions. Organizational capacity includes skill sets to carry out activities and strategies such as program and performance management, vitamin and mineral expertise, data linkage, epidemiologic expertise, communication/material development, evaluation, performance monitoring, financial reporting, management of travel requirements, development of staffing plans, workforce development and training, management of direct assistance, and experience in implementing scalable and sustainable programs. While the Applicant(s) will have significant presence globally in the area of infant and young child and maternal nutrition and micronutrients, they should also have experience working with other sectors, such as Education, Water, Sanitation and Hygiene, and Social Protection as all of these often have a nutrition/micronutrient dimension.

d. Work Plan Applicant(s) should provide a work plan that includes objectives of the cooperative agreement, with specified strategies and activities under each objective, and indicators, timeline and responsible parties for each activity. For the first year a detailed work plan should be submitted, and applicant must also provide a general summary of work plan activities for Years 2-5 in narrative form.

At a minimum, the work plan should demonstrate how the outcomes, strategies, activities, timelines, and staffing/collaborations work together. Additional information on performance measures, data sources, and target population can also be included. At the end of the budget year, the awardee will be expected to report on the extent to which proposed short-term objectives have been achieved; the progress of any products against established schedules and indicators; the efficiency and effectiveness of project implementation; the short and long-term sustainability of the results; and any measurable impact.

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and awardees, site visits, and awardee reporting (including work plans, performance, and financial reporting). HHS grants policy specifies the following HHS expectations for post-award monitoring for grants and cooperative agreements:

Tracking awardee progress in achieving the desired outcomes.

Insuring the adequacy of awardee systems that underlie and generate data reports.

Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities:

Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

Ensuring that awardees are performing at a sufficient level to achieve objectives within stated timeframes.

Working with awardees on adjusting the work plan based on achievement of objectives and changing budgets.

Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Other activities deemed necessary to monitor the award, if applicable.

These may include monitoring and reporting activities as outlined in HHS grants policy that assists grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk grantees.

All these activities should be included in routine and ongoing communication between CDC and awardee.

f. CDC Program Support to Awardees CDC will provide substantial involvement beyond site visits and regular performance and financial monitoring during the project period. Substantial involvement means that the awardee can expect a programmatic partnership in carrying out the effort under the award.

CDC will work in partnership with the awardee to enable the success of the cooperative agreement in the following areas:

Technical assistance:

CDC staff will work in collaboration with the awardee on each of the activities defined in the work plan. Depending on the nature of the project CDC will ensure that people assigned from CDC have specific subject matter expertise, for example in program monitoring, technical assistance, or laboratory skills. CDC staff will also provide assistance in the developing of the annual work plans and in monitoring progress towards the strategic plan.

CDC will provide technical assistance to the awardee and in-country staff on data collection and analysis, as well as guidance on any lab related activities such as specimen collection needed in micronutrient assessments. CDC will help to identify global lab capabilities, plan and provide necessary trainings and support, and build capacity where required.

Information sharing:

CDC will facilitate the sharing of lessons learned throughout the 5-year cooperative agreement. Program information, such as case studies, lessons learned, evaluation results will be shared through reports, guidance developed, peer-reviewed publications, conferences and other meetings, working groups etc.

B. Award Information

1. Funding Instrument Type: Cooperative Agreement CDC's substantial involvement in this program appears in the CDC Program Support to Awardees Section.

2. Funding Activity Category: HL

3. Fiscal Year: 2016 Estimated Total Funding: $3,750,000

4. Approximate Total Fiscal Year Funding: $750,000

5. Approximate Project Period Funding: $3,750,000

6. Total Project Period Length: 5 year(s)

7. Expected Number of Awards: 1 Single Eligibility Justification (SEJ) submitted for United Nation's Children's Fund (UNICEF). Approved SEJ is attached in supporting documents.

8. Approximate Average Award: $750,000 Per Budget Period

9. Award Ceiling: $1,000,000 Per Budget Period

10. Award Floor: $0 Per Budget Period

11. Estimated Award Date: 12/15/2015

12. Budget Period Length: 12 month(s)

Throughout the project period, CDC will continue the award based on the availability of funds, the evidence of satisfactory progress by the awardee (as documented in required reports), and the determination that continued funding is in the best interest of the federal government. The total number of years for which federal support has been approved (project period) will be shown in the “Notice of Award.” This information does not constitute a commitment by the federal government to fund the entire period. The total project period comprises the initial competitive segment and any subsequent non-competitive continuation award(s).

13. Funds Tracking The funds will be tracked by BAC number and CAN number at the division OD admin code level. The CAN number will be provided by FMO when funds are received and will be tracked through the IRIS budget system and NIH Impac II commitment system. The NIH eTA system (ImpacII) is a reporting and estimation tool that supports daily budgetary tasks and provides up-to-the-minute access to grant information and budget data.

14. Direct Assistance Direct assistance is not available through this FOA.

15. Indirect Costs Indirect Costs are an allowable cost through this FOA.

Indirect costs will not be reimbursed under grants to foreign organizations, international organizations, and foreign components of grants to domestic organizations (does not affect indirect cost reimbursement to the domestic entity for domestic activities). The CDC will not reimburse indirect costs unless the recipient has an indirect cost rate covering the applicable activities and period.

C. Eligibility Information

1. Eligible Applicants

Eligibility Category: Others (see text field entitled "Additional Information on Eligibility" for clarification)

2. Special Eligibility Requirements

Single Eligibiliity Justification (SEJ) was submitted and approved for United Nations Children’s Fund (UNICEF). Signed SEJ approval is attached in the supporting documents.

3. Justification for Less than Maximum Competition

This is a re-compete of an expiring FOA with United Nations Children's Fund (UNICEF) that was previously approved as a single eligibility award. Micronutrient malnutrition is pervasive throughout the developing world, and no organization, other than UNICEF, has the operational mission, structure, and recognition to carry out micronutrient activities in virtually every affected country.

There is a critical need to address micronutrient malnutrition in vulnerable populations to help prevent and control chronic diseases and other conditions. Key nutrition program strategies include micronutrient supplementation, food fortification (including home-based fortification efforts), and infant and young child nutrition programs. Based on lessons learned, this FOA seeks to improve the intake of micronutrients through strengthening global nutrition collaborations, development of guidelines and frameworks for interventions, implementation of strategies that impact maternal and child under-nutrition outcomes, and increasing access and coverage of key programs. Additionally, there is a need to develop replicable models for program monitoring and evaluation, surveillance, and assessments to improve program quality and facilitate scale-up.

This work cannot successfully accomplished without working with UNICEF, an established organization that is uniquely positioned within the United Nations (UN), has a presence in most, if not all, countries throughout the world, and is actively involved in the implementation of nutrition and micronutrient programs globally focused on infant/young child nutrition issues. UNICEF has a unique position as the technical agency for maternal and child health within the United Nations, with access to all national health promotion and disease prevention programs and potential program sites through its regional offices located in 7 regions (Central and Eastern Europe and the Commonwealth of Independent States, East Asia and the Pacific, Eastern and Southern Africa, Latin America and Caribbean, Middle East and North Africa, South Asia, West and Central Africa), located in over 190 country offices throughout the world.

The UNICEF country-based offices are able to support direct development, implementation, delivery, monitoring and evaluation of public health programs and services in nearly every developing country in the world. They establish formal ties with the host governments, including the Ministry of Health, through agreements that contain mutually-agreed upon priorities and commitments of UNICEF and the host government.

The UNICEF regional offices guide this work and provide technical assistance to country offices as needed. They also provide a structure and focal point for the development and evaluation of cross-country activities to address problems and needs common to multiple countries in the region thus providing an established structure through which CDC resources can be used effectively and efficiently.

UNICEF has previously developed various guidelines, monitoring systems and tools, and conducted and coordinated surveillance and best practice initiatives, disseminated information and expertise on nutritional deficiencies, recommended and advocated for improved policies and programs that have specific relevance to the objectives of this program announcement and which have the potential to advance knowledge that benefits the United States of America and other countries around the globe. UNICEF also has extensive experience working in the specific area of micronutrient malnutrition.

CDC has limited ability to change micronutrient deficiencies on a global scale on its own. A key strategy of CDC is to leverage the strength and resources that UNICEF has, that CDC does not have. This includes UNICEF's: (1) recognition among the world agencies as the technical agency for maternal and child health - key in the ability to work main global networks and help gain attention and inform change, (2) alliance with host governments, including Ministries of Health - key in the ability to build bridges to work in and sustain interventions in countries with high burdens of micronutrient deficiencies; and, 3) active involvement in infant/young child nutrition issues - key in understanding the complex issue of malnutrition and micronutrient deficiencies and coordinating a multisectoral response to deliver solutions.

UNICEF offers unique opportunities to increase and expand infant and young child micronutrient efforts through its regional and country-specific presence in the world, extensive experience and staff skills in addressing nutrition environments in other countries, and ability to expand the reach or programs to vulnerable populations.

The inability to continue collaborations with UNICEF would stall progress made to date, and cause a loss of credibility and momentum imperative to global progress. It would reduce CDC's continued progress in fighting malnutrition and micronutrient deficiencies - work that is vital to child development, disease prevention, and good health. It would, for example, hamper the ability to develop/adapt culturally appropriate guidelines for high risk countries; eliminate the ability to expand the evidence-based intervention of flour fortification; limit CDC's ability to provide technical assistance to Ministries of Health in monitoring and evaluating health outcomes and the implementation of evidence based interventions; drastically hamper CDC’s ability to assist governments to standardize, spread, and sustain successful programs for children 6-59 months of age and women of reproductive age (15-49 years), and limit our ability to continue to build the evidence for programs that are effective in the U.S. and throughout the world.

4. Other

CDC will accept and review applications with budgets greater than the ceiling of the award range.

5. Cost Sharing or Matching

Cost Sharing / Matching Requirement: No Cost sharing or matching funds are not required for this program. Although there is no statutory match requirement for this FOA, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

6. Maintenance of Effort

Maintenance of Effort (MOE) is not required for this program.

D. Application and Submission Information

1. Required Registrations An organization must be registered at the three following locations before it can submit an application for funding at www.grants.gov.

a. Data Universal Numbering System:

All applicant organizations must obtain a Data Universal Numbering System (DUNS) number. A DUNS number is a unique nine-digit identification number provided by Dun & Bradstreet (D&B). It will be used as the Universal Identifier when applying for federal awards or cooperative agreements.

The applicant organization may request a DUNS number by telephone at 1-866-705-5711 (toll free) or internet at http:// fedgov.dnb. com/webform/ displayHomePage.do. The DUNS number will be provided at no charge.

If funds are awarded to an applicant organization that includes sub-awardees, those sub-awardees must provide their DUNS numbers before accepting any funds.

b. System for Award Management (SAM):

The SAM is the primary registrant database for the federal government and the repository into which an entity must submit information required to conduct business as an awardee.

All applicant organizations must register with SAM, and will be assigned a SAM number. All information relevant to the SAM number must be current at all times during which the applicant has an application under consideration for funding by CDC. If an award is made, the SAM information must be maintained until a final financial report is submitted or the final payment is received, whichever is later. The SAM registration process can require 10 or more business days, and registration must be renewed annually. Additional information about registration procedures may be found at www.SAM.gov.

c. Grants.gov:

The first step in submitting an application online is registering your organization at www.grants.gov, the official HHS E-grant Web site. Registration information is located at the “Get Registered” option at www.grants.gov.

All applicant organizations must register at www.grants.gov. The one-time registration process usually takes not more than five days to complete. Applicants should start the registration process as early as possible.

Step System Requirements Duration Follow Up

1 Data Universal Number System

(DUNS)

1. Click on http:// fedgov.dnb.com/webform

2. Select Begin DUNS search/request process