INECD NOFO 72069621RFA00002.pdf

Issuance Date: December 30, 2020 Deadline for Questions: January 14, 2021 Concept Paper Closing Time and Date: February 8, 2021 5:00 PM Kigali Time

Subject: Notice of Funding Opportunity: 72069621RFA00002 Inclusive Nutrition and Early Childhood Development (INECD) Activity

Dear Prospective Applicants:

The United States Agency for International Development (“USAID” or the “Agency”) seeks concept papers from qualified entities for Inclusive Nutrition and Early Childhood Development (“INECD”) Activity in Rwanda, as further described in Section A of this Notice of Funding Opportunity (“NOFO”).

Eligibility for this award is not restricted.

USAID intends to make an award to the applicant who best meets the objectives of this funding opportunity based on the merit review criteria described in Section E of this NOFO subject to a risk assessment in accordance with ADS 303.3.9. Eligible parties interested in submitting a concept paper are encouraged to thoroughly read this NOFO to understand the type of program sought, concept paper submission requirements, and selection process.

To be eligible for award, the applicant must provide all information as required in this NOFO and meet eligibility standards in Section C of this NOFO. This funding opportunity is posted on www.grants.gov, and may be amended. It is the responsibility of the applicant to regularly check the website to ensure they have the latest information pertaining to this NOFO and to ensure that the NOFO has been received from the internet in its entirety. USAID bears no responsibility for data errors resulting from transmission or conversion process. If you have difficulty registering on www.grants.gov or accessing the NOFO, please contact the Grants.gov Helpdesk at 1-800-518-4726 or via email at support@grants.gov for technical assistance.

USAID will not award to an applicant unless the applicant has complied with all applicable unique entity identifier and System for Award Management (SAM) requirements detailed in Section D.8.g. The registration process may take many weeks to complete. Therefore, applicants are encouraged to begin registration early in the process.

Issuance of this NOFO neither constitutes an award commitment on the part of USAID nor does it commit USAID to pay for any costs incurred in the preparation or submission of any comments/ suggestions or a concept paper. Applicants submit concept papers at their own risk. All preparation and submission costs are at the Applicant’s expense.

Please send any questions to the point(s) of contact identified in Section D by the above deadline.

Responses to questions received prior to the deadline will be furnished to all potential applicants through an amendment to this notice posted to www.grants.gov.

Thank you for your interest in USAID programs.

Sincerely, Simone Cho Agreement Officer

Simone SEUNGHEE CHO (affiliate)

Digitally signed by Simone SEUNGHEE CHO (affiliate) Date: 2020.12.30 16:04:17 -05'00'

72069621RFA00002

INECD Activity

Table of Contents

SECTION A: PROGRAM DESCRIPTION 3

SECTION B: FEDERAL AWARD INFORMATION 16

SECTION C: ELIGIBILITY INFORMATION 18

SECTION D: APPLICATION AND SUBMISSION INFORMATION 19

SECTION E: APPLICATION REVIEW INFORMATION 38

SECTION F: FEDERAL AWARD ADMINISTRATION INFORMATION 41

SECTION G: FEDERAL AWARDING AGENCY CONTACT(S) 50

SECTION H: OTHER INFORMATION 51

ANNEX 1 - SUMMARY BUDGET TEMPLATE 52

ANNEX 2 - STANDARD PROVISIONS 53

ANNEX 3 - ABBREVIATIONS AND ACRONYMS 56

ANNEX 4 - INITIAL ENVIRONMENTAL EXAMINATION (IEE) 57

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 Introduction

Early childhood is a critical stage of human development, the time when nurturing care by families lays the foundation for life-long well-being. Good nutrition and health during pregnancy, lactation, and early childhood is essential to ensuring that children have the opportunity to grow and develop fully, including for preventing poor birth outcomes and life-long developmental delays or disabilities.1 To enable children to have the strongest foundation to reach their full potential in life and improve health and nutritional outcomes for women and children in the first 1,000 days requires a multi-pronged and multi-sectoral approach.

The INECD activity will promote nurturing and responsive care practices, especially in the areas of health, functioning, nutrition, and early childhood development (ECD) for caregivers and children. Specifically, the activity aims to improve health and nutrition outcomes among women of reproductive age and adolescents and improve infant and young child feeding practices. It also aims to address child development gaps and significant unmet physical rehabilitation and assistive technology (rehab/AT) and social inclusion needs for infants and children. The activity will focus on community-level service delivery, community-health facility linkages and district level capacity development, as well as address issues of inclusion and participation, including access to programs and services for children and adults with disabilities, in line with Government of Rwanda priorities.

This Program Description articulates a set of desired outcomes that build upon USAID/Rwanda’s history of implementing strong health and rehab/AT, nutrition, parenting and ECD, economic growth programming and its unique comparative advantages as a donor and a key partner.

A.2 Background

The INECD Activity is authorized under USAID/Rwanda’s THRIVE Project (2020-2025) Project Appraisal Document (THRIVE PAD) and contributes to USAID/Rwanda’s Country Development Cooperation Strategy (CDCS) for 2020-2025. The four Development Objectives (DO) of the strategy aim to improve health outcomes, improve learning outcomes, increase inclusive and sustainable private sector driven growth, and increase government responsiveness to citizen priorities. The CDCS is available at:

https://www.usaid.gov/sites/default/files/documents/1860/CDCS_Rwanda_February_2025_2.pdf

The INECD Activity contributes to DO1, Health outcomes improved, which addresses service utilization gaps by improving the quality of services delivered through both community and facility platforms and by encouraging the adoption of healthy behaviors through innovative social and

1 NECDP National Strategic Plan 2018-2024, page 4 behavioral change strategies. DO1 also seeks to address the needs of the most at-risk populations in Rwandan society: very young children, persons with disabilities, male and female victims of gender-based violence, and adolescent girls and young women, especially those who have already become mothers.

There are three intermediate results (IRs) that contribute to THRIVE DO1: 1) Health system strengthened for increased sustainability; 2) Improved utilization of health and nutrition services and adoption of key health behaviors including improved sanitation and hygiene practices; and 3) Strengthened capacity to address the health needs of high-risk individuals. The INECD activity will contribute to all three IRs and the following sub-intermediate results of the THRIVE PAD, while also emphasizing inclusion and ensuring the availability of services for all:

1.1 Strengthened financing and governance of the health system

1.2 Improved use of data for evidence-based decision-making

2.1 Improved quality of community-based services

2.2 Improved quality of facility-based services

2.3 Increased demand for services

2.4 Increased adoption of healthy behaviors

3.1 Increased effectiveness of ECD programs

3.3 Increased access to quality, sustainable rehabilitation and assistive technology services

A.2.1 Country and Sector Context

INECD will directly support and contribute to the Government of Rwanda (GOR) led efforts to combat malnutrition, stunting, and improve early childhood development. The INECD activity is in line with the following national policies and guidelines: 1) the National Child Development Agency (NCDA) Strategic Plan 2018 – 2024, which advocates for coordinated delivery of inclusive nutrition and ECD services, and adoption of health behaviors; 2) the National Nutrition Policy, a comprehensive framework for effective implementation and promotion of nutrition strategies and interventions for the entire population of Rwanda especially women and children; and 3) the National Community Based Rehabilitation Guidelines which advocates for the inclusion of persons with disabilities across all interventions and promotes the availability of and access to rehab/AT services. The NCDA Strategic plan defines integrated ECD services as services related to health, nutrition, education, sanitation, child protection, parenting, and disability services.

Globally, 250 million children under five years of age living in low- and middle-income countries are at risk of not achieving their development potential, with nearly one-third of all children around the world entering primary school without essential cognitive, social, functional, and emotional skills. Despite gains in reducing maternal and child health mortality in Rwanda, about 38% of children under five in rural areas are stunted, indicating that comprehensive approaches to ensure all children grow and thrive in inclusive nurturing environments have not been realized.

Furthermore, infants and young children with congenital conditions, impairments and/or disabilities are at high risk of not meeting their optimal nutritional status or their developmental potential and, consequently, are in risk of being excluded from educational and social opportunities. It is estimated that 15% of the world’s population has a disability, however, data are often not valid and/or disability is not disaggregated. A clear understanding of the extent that disability impacts families, especially as the result of poor nutrition, is unknown. Globally it is estimated that more than 50% of people requiring rehab/AT services do not have access; in low- and middle-income countries that number increases to 80%. Lack of access to and availability of rehab/AT services can significantly negatively impact an individual’s functioning, quality of life and well-being. Poor functioning is associated with a decreased capacity to work, lower income levels, poor educational outcomes, stigma and discrimination, and decreased inclusion in communities and society. A 2016 UNICEF study2 on children with disabilities and their right to education found that there was no formal system for identifying children with disabilities, and sources of data on disability vary greatly and have validity issues.

Maternal nutritional status during pregnancy and lactation and the quality and frequency of interactions between young children and their parents and caregivers are crucial for a child’s healthy growth and development. This includes access to quality counseling and support for safe, adequate, and diverse diets during antenatal and postnatal care, opportunities for stimulation, responsive parent-child interactions, child-directed/focused enrichment, early learning, and positive parenting.

Overall, maternal health during pregnancy in Rwanda needs improvement. According to the 2015 Rwanda Demographic and Health Survey (RDHS), only 3% of women took the recommended 90+ days of iron supplements during their last pregnancy, and 20% reported taking none. Furthermore, the 2018 Comprehensive Food Security and Vulnerability Assessment (CFSVA 2018) found that only 28% of Rwandan women between 15-49 years of age met the minimum dietary diversity for women (MDD-W), which corresponds to the consumption of five out of ten food groups; only 8% and 12% of women in the poorest and poor categories, respectively, meet the MDD-W. Parents and/or caretakers with disabilities may have less access to information on good parenting skills and/or accurate and appropriate health, rehab/AT, nutrition, ECD and/or WASH information and services.

Evidence shows that early childhood interventions that promote developmental stimulation in conjunction with nutrition and health services result in better outcomes for children than either alone. According to the 2015 RDHS, only 18% of children 6-23 months received a minimum acceptable diet (fed in accordance with all three recommended Infant and Young Children Feeding (IYCF) practices for breastfeeding, dietary diversity, and meal frequency); and over one-third of children 6-59 months were classified with any anemia. Increasing a child’s liquid and food intake during illness are important for preventing dehydration, but in Rwanda, this practice is particularly poor. According to the 2015 RDHS among children with diarrhea, over 50% are offered less liquids and over 60% are offered less food. The 2015 RDHS also estimated that less than two-thirds of children 36-59 months were developmentally on track in the domains of literacy-numeracy, socio-emotional, functional and learning. According to the 2016 UNICEF study, the 2014 school census showed a total of 24,862 children with disabilities in preschool, primary and lower secondary schools across all categories specified (UNICEF, 2016). Also, in 2016, the National Council of Persons with Disabilities and National Commission for Children conducted a National Assessment of Centres caring for Children with Disabilities in Rwanda, which found that enrollment in centers caring for children with disabilities has been increasing since 2013, yet records and monitoring are incomplete.3

Improved hygiene and sanitation behaviors, such as safe disposal of child's feces, handwashing with

2 https://www.unicef.org/esaro/Rwanda-children-with-disabilities-UNICEF-EDT-2016.pdf 3 https://www.ncc.gov.rw/fileadmin/templates/document/National_Assessment_of_Centres_Caring_for_CWDs.pdf soap or safe food practices, also impact the cleanliness and health of families. Despite moderate levels of access to water and very high coverage of latrines in Rwanda, sanitation and hygiene practices are still poor. The 2017 Joint Monitoring Program estimates that only 5% of households have a handwashing facility with soap and water on the premises and 86% have no handwashing facility at all. In the 2014 Knowledge, Attitudes and Practices (KAP) survey4, of the children who were observed defecating, only 8% defecated in the toilet or potty, only 28% of caretakers cleaned the child’s bottom and only 3% of caretakers washed their hands immediately after cleaning the child. In the same survey, while 100% of respondents knew that washing hands with soap before preparing food for children was important, only 28% felt it was commonly practiced by people in their community.

Household food security status plays a significant role in the nutrition outcomes of the household members in Rwanda. The 2018 Comprehensive Food Security and Vulnerability Assessment (CFSVA 2018) report in Rwanda highlights that 19% of Rwandan households are food insecure, of which 60% come from Ubudehe 1 and 2 (the poorest socio-economic categories in Rwanda), 65% of the households purchase their food from the markets and 40% have faced shocks and applied different ways to cope.

In Rwanda, linkages and referral systems between inclusive community-based nutrition, health, rehab/AT services and health facilities are weak and need improvement. Based on figures in quarterly and annual reports from USAID funded nutrition projects in Rwanda, around 1.5% of children in growth monitoring and promotion sites at village level are consistently identified with severe acute malnutrition every month and are referred to hospitals for rehabilitation and nutrition care. However, little is known about the counter referral and follow up back to the community level of these cases.

Recognizing the behavior change to achieve health, functional, nutrition, and ECD goals, USAID and the GOR have supported the development of many strategies, including the National Social Behavior Change Communication Strategy for Integrated ECD, Nutrition and WASH 2018-2024.

Insufficient family resources, skills, and capacity contribute to suboptimal health, nutrition, and development outcomes. Men are particularly disengaged with early learning and nurturing activities at home which is affecting early child stimulation. The role of harmful social norms and gender dynamics are essential to understand and address given the critical role a child’s environment and their relationship with their parents/caregivers play in their development and protection from adverse experiences.

In addition to the National Social Behavior Change Communication Strategy mentioned above, the GOR also developed the National Early Childhood Development Strategic Plan (2018-2024) to address these multi-sectoral challenges. This recently established government coordination body (NCDA) brings together key sectors and ministries (Prime Minister’s Office, MIGEPROF, MINAGRI, MINALOC, MINISANTE, MINEDUC, MINEMA, MININFRA) and across national and local government levels (Districts, Sectors, Cells, and Villages). Decentralized coordination structures for inclusive multi-sectoral nutrition activities were established as part of the district plans to eliminate malnutrition (DPEMs) in 2010, however, a 2019 joint assessment funded by

4 Knowledge, Attitudes and Practices Assessment on Early Nurturing of Children Report. Ministry of Health, Rwanda and UNICEF Rwanda, 2014.

USAID Gikuriro (CRS) and Hinga Weze (CNFA) showed that the establishment of the DPEM coordination committees in the districts did not happen immediately and did not expand to the sectors, cells, and villages as planned. Other findings from this assessment indicated that there are not enough human resources in the districts with adequate capacity and appropriate skills and knowledge to implement, coordinate, and supervise the DPEM activities, among other challenges.

The NCDA now brings another layer of complexity to the capacity, coordination, and management necessary for inclusive and comprehensive service delivery at the decentralized levels. The DPEM structures will need to integrate ECD and inclusion to reflect the NCDA’s new national strategic plan. Furthermore, stakeholder meetings and site visits conducted in 2019 in Rwanda demonstrated that many of the community based and home based ECD centers did not have enough space for child play and interaction, lacked or had polluted kitchens with soot and smoke in cooking spaces that affects child breathing, and lack of accessible water and clean latrines for children and their parents. In addition, the need for rehab/AT is largely unmet due to a number of factors such as: lack of prioritization, funding, or strategic planning at a national level; misconceptions that physical rehabilitation is a highly specialized service only for persons with disabilities, or that it is a “luxury” service that can be ignored in face of competing demands; lack of services and trained personnel;

lack of financing models and/or high out-of-pocket expenses; poor availability of appropriate and affordable assistive products; ineffective or under-utilized referral pathways; limited availability of data to drive evidenced based decisions; and limited leadership and governance capacity of national entities.

Lastly, the COVID-19 pandemic caused a global health crisis resulting in significant health and economic impacts on communities, families, and individuals. When countries around the world, including Rwanda, introduced lock down measures to control the spread of the virus, the first people to feel the consequences were pregnant and lactating women, children under five years of age and persons with disabilities. The immediate impact was on household income, limiting access to nutritious food and needed services. In Rwanda, this was mainly caused by an increase in food prices and loss of small businesses. It is projected that underweight and acute malnutrition for children under five in Rwanda will increase, leading to the loss of the gains the country had achieved in the last decade in childhood wasting and underweight as a result of the pandemic. Additionally, children and adults with disabilities are at greater risk for poorer health outcomes. The pandemic has shed light on the extreme stigma and discrimination that persons with disabilities face and, in some cases, led to denial of services. The long-term rehab/AT needs of persons recovering from COVID-19 are not fully understood yet, however, access to these services are key to optimizing function and increasing participation in community and family life and thus must also be included in the continuum of health care.

A.2.2 Relationship to USAID Strategies

This activity aligns with several global initiatives that shape USAID priorities and investments in Rwanda, including:

● USAID’s Multi-Sectoral Nutrition Strategy (2014-2025) which provides a framework for reducing chronic and acute malnutrition, especially during the critical 1,000-day window from pregnancy to a child’s second birthday across sectors, including health, nutrition, agriculture, and water, sanitation, and hygiene.

● The U.S. Government Strategy for International Assistance for Advancing Protection and Care for Children in Adversity (2019-2023) which reaffirms commitment to three evidence-based objectives to benefit the world’s most vulnerable children: 1) Build Strong Beginnings, 2) Put Family First, and 3) Protect Children from Violence, while also providing five guiding principles to inform programming.

● The U.S. Government Global Water Strategy and the USAID Water Development Implementation Plan envisions a water secure world, where people have sustainable supplies of water of sufficient quantity and quality to meet human needs and increased uptake of key hygiene behaviors. This activity will support increasing sustainable access and use of sanitation and the practice of key hygiene behaviors.

A.2.3 Geographical Focus

Geographic targeting will be refined during mission consultations with successful applicant(s) and stakeholders. However, the following criteria have been developed to identify up to ten districts that maximize programmatic impact of USAID investments, accelerate sustainable and inclusive programming and build on existing relationships.

• Current eight (8) districts under USAID nutrition, ECD and WASH activities that will end in

2020 and early 2021 o Kayonza, Ngoma, Nyabihu, Ruhango, Nyanza, Kicukiro, Nyarugenge, and

Rwamagana.

• Ten (10) Districts considered for the INECD activity and will contribute to USAID Rwanda’s

Hub approach (aiming to geographically concentrate activities to create synergies, better reach beneficiaries and build a closer relationship with stakeholders).

o Kayonza, Ngoma, Nyabihu, Ruhango, Nyanza, Kicukiro, Nyarugenge, Rwamagana, and two additional districts, Rutsiro and Rubavu, that have high stunting rates.

• The above listed districts are not supported by other donor partners which is appealing to USAID to avoid duplication of activities.

• High levels of child stunting, food insecurity, developmental delay or disability, and poverty.

A.3 Purpose and Theory of Change

Through this Activity, USAID/Rwanda aims to improve the health, functioning, nutritional status, and wellbeing of women of reproductive age and children under five years of age, with an emphasis on the 1,000-day window, strengthen inclusion of children and adults with disabilities, and improve positive parenting and child development. This requires a systems approach to increase the technical capacity and coordination of the national and sub-national authorities, health workers and other service providers, and improve the support families receive and provide.

As such, the Theory of Change states that:

IF national and sub-national capacity for coordination and implementation of the NCDA Strategic Plan 2018 – 2024, National Nutrition Policy, and National Community Based Rehabilitation Guidelines are strengthened, and

IF improved inclusive quality social, nutrition, health, ECD, and rehab/AT services are available, accessed and delivered, and

IF community and household members have the ability and resources to adopt healthy behaviors, THEN, the health and nutritional status of women of reproductive age, especially pregnant and lactating women, will improve and children under five will meet their growth and developmental potential.

To achieve this theory of change, efforts will be needed to support both supply- and demand-side efforts including service delivery to children and home and family support.

A.4 Proposed Outcomes and Results

The overall goal is to improve maternal, infant, child and adolescent nutrition, development, functional and health outcomes. Progress on this has been hampered by sub-optimal technical management and coordination capacity, especially at sub-national level; low quality and poor access to integrated community-based services (inclusive nutrition, health, ECD, rehab/AT, sanitation, protection, parenting); and sub-optimal household resources and skills to provide optimal nurturing care (health, nutrition, hygiene, and responsive care). To achieve this the activity has three overall objectives and associated intermediate results it expects to achieve.

Objective 1: Strengthened governance, coordination, and implementation of the National Strategic Plan for NCDA at the national, district, sector, cell and village level

While the GOR is committed to a comprehensive and integrated approach towards early childhood development, as laid out in the National Integrated ECD Strategic Plan 2018-2024, there are challenges to implementation especially at district, sector, and cell levels. These include unclear roles and responsibilities, shortages of human resources, inadequate funding, and low technical capacity for planning, budgeting, resource mobilization, and stakeholder coordination. In order to be fully functional, the existing DPEM committee structures need to be strengthened and expanded to enable them to carry out their duties as stipulated in the district plans. While action plans including Single Action Plan, DPEM, and performance contracts/imihigo at village level have been developed, tracked and reported at the national level, they still lack comprehensive and inclusive approaches for integrated health, nutrition, ECD, rehab/AT services.

The challenges of implementation at the district level are further complicated by multiple policies, strategies, and agendas of the different national social cluster ministries, especially for health, nutrition, ECD and rehab/AT. Coordination among these social clusters and the NCDA requires further strengthening to build synergies and ensure sufficient resources are available to the district, sector, and cell levels for delivering inclusive, multisectoral services.

Expected Results:

Intermediate Result 1.1: Increased capacities for planning, budgeting, and supervision of inclusive multi-sectoral services Intermediate Result 1.2: Improved coordination, monitoring and use of data for evidence-based decision-making Intermediate Result 1.3: Improved national level coordination between social cluster ministries responsible for promoting inclusive health, rehab/AT, nutrition, and ECD Intermediate Result 1.4 Increased capacity of local civil society to advocate and provide technical support to decentralized government institutions for inclusive integrated services Intermediate Result 1.5 Improved ownership of integrated ECD services in INECD supported Districts by GOR line institutions

Objective 2: Improved access to and availability of quality services that promote inclusive nurturing care

The NCDA promotes integrated services for families, women and children across many levels, including the community and facility level of the health system, at community and home-based ECD centers, and other community-based platforms. These services promote nurturing care.

Nurturing care by parents and other caregivers ensures children’s good health and nutrition, protects them from threats, and gives young children opportunities for early learning through interactions that are emotionally supportive, stimulating and responsive. There are challenges with implementing the NCDA’s strategy because not all services are available or delivered with high quality in all districts, and many vulnerable individuals and households lack access to services.

Facility-based providers and other frontline workers (community health workers (CHW)), friends of family, hygiene clubs, ECD caregivers, community-based rehab/AT workers) need stronger skills and supervision to deliver inclusive health, nutrition, rehab/AT and ECD services, identify developmental delays, and model responsive care. Furthermore, a strong referral and follow up mechanism between community-based platforms and other services is lacking. Coordination and collaboration with other USAID/Rwanda investments, like Ingobyi, which are working with the GOR to improve the country’s referral systems, will be crucial in complementing these efforts by strengthening the process for referrals originating and requiring follow up in the community.

Expected Results:

Intermediate Result 2.1: Strengthened quality of inclusive health, nutrition, rehab/AT and ECD services provided through community-based platforms Intermediate Result 2.2: Improved capacity and supervision of facility and frontline workers for early identification, referral, and follow-up of child developmental delays, impairment, disability, malnutrition, and other signs of illness Intermediate Result 2.3: Increased capacity and improved attitudes and practices of service providers to effectively counsel and support families with young children about providing nurturing care Intermediate Result 2.4: Strengthened sustainable quality community and facility based rehab/AT services, within the health system Intermediate Result 2.5: Strengthened community referral systems, linkages and follow up mechanisms between community and health facilities

Objective 3: Increased household resources and skills to provide optimal nurturing care and promote healthy growth and development

While improving access to and quality of health care services is critical, given that most of the care-taking of children under two in Rwanda takes place within the home, increased demand for services, adoption of optimal child rearing practices, and positive community norms to support those behaviors are needed. The INECD will engage men as active and equal participants in providing nurturing care for their children through positive parenting. Data from the 2015 RDHS and the KAP Survey Assessment of Early Nurturing of Children Report, 2014 illustrate the need to focus on improving behaviors related to integrated ECD.

Only 40% of pregnant women attended all four recommended ANC visits despite 91% of births occurring at health facilities. For mothers caring for a child with difficulty breathing, only 11% would seek care from a healthcare facility while 44% would take the child to an herbalist first. For young children, only 12% engaged in four or more learning activities with their mothers and only 3% engaged in learning activities with their biological fathers. In the 2014 KAP survey5, of the children who were observed defecating, only 8% defecated in the toilet or potty, only 28% of caretakers cleaned the child’s bottom and only 3% of caretakers washed their hands immediately after cleaning the child. Finally, while 100% of respondents knew that washing hands with soap before preparing food for children was important, only 28% felt it was commonly practiced by people in their community.

Although a variety of factors affect each of the above behaviors, they can be summarized by the following barriers: insufficient knowledge and skills among caretakers, inadequate informational, financial, and physical resources within the family, and community norms that negatively affect nurturing care behaviors. An effective social and behavior change (SBC) program should clearly identify the behaviors that would contribute to improved INECD with the rural Rwandan context, analyze the barriers and facilitators for each behavior and develop interventions that address those factors in a holistic manner.

And while SBC activities can improve knowledge and skills, address harmful norms, increase access to information and guide families to prioritize existing resources towards positive nurture and care, it must be coupled with interventions that address the physical and structural barriers (access to food, water, financing, etc.) that are critical for sustained behavior change. While the INECD activity will not directly address these challenges, it will collaborate with and connect participants to markets and other resources through USAID/Rwanda investments in water, sanitation and hygiene, food security and agriculture to complement the INECD SBC efforts.

Expected results:

Intermediate Result 3.1: Increased capacity, including greater knowledge, skills and problem-solving ability, of individuals and families to support healthy behaviors that contribute to nurturing care Intermediate Result 3.2: Improved community norms that support healthy behaviors, including male involvement in childcare practices and inclusive health and development Intermediate Result 3.3: Increased family resources to support healthy behaviors and provide nurturing care Intermediate Result 3.4: Increased demand for social services and adoption of improved behaviors including those within health and nutrition, sanitation, and hygiene, ECD, rehab/AT, child protection and social protection by families with young children

5 Knowledge, Attitudes and Practices Assessment on Early Nurturing of Children Report. Ministry of Health, Rwanda and UNICEF Rwanda, 2014.

A.5 Activity Parameters & Cross-cutting Principles

A.5.1 Activity Parameters

● Target Beneficiaries

○ Women of reproductive age, children under 5, with a focus on the first 1,000 days, families, adults and children with disabilities, adolescents and caregivers

● Partnership with the GOR

○ The activity will support the implementation of country-led policies, strategies and processes, and build on and strengthen GOR structures, institutions, and program ownership.

● Relationship with other USAID-funded Activities

○ As part of the THRIVE project, the Activity will be expected to coordinate and collaborate with other THRIVE health activities, as well as other USAID-funded economic growth, agriculture, and education activities. The activity under the THRIVE Project will also contribute to the new Mission “hubs” approach in selected districts to improve coordination, complementarity and impact maximization.

● Coordination and Collaboration with other Development Partners and Stakeholders

○ Coordination with the Rwanda Scaling Up Nutrition Multi-Stakeholder Platform, World Bank, UNICEF, Rehabilitation Technical Working Group, and other key stakeholders of the NCDA will be essential. Participation in GOR led coordination efforts at District level, including JADF and DPEM activities will be required.

● Local Partner Institution Engagement and Capacity Building

○ This Activity is grounded in the reality that achieving and sustaining any long-term development outcome depends on the contributions of multiple and interconnected actors, which includes the use of local systems. As such, the Recipient should identify opportunities for local ownership and strengthening GOR local government institutions and systems, and build local civil society capacity.

● Management/Implementation Approach As guided by the THRIVE PAD, most of the new USAID activities under design and other USAID IPs will be expected to:

○ Co-locate in districts to support hubs approach and maximize programmatic impact

○ Provide coordinated capacity development at decentralized level

○ Conduct joint work planning in partnership with each other, various District coordination teams, and other sectoral counterparts as appropriate.

○ Conduct joint work planning and coordinated policy engagement

○ Conduct mapping of district-level activities

○ Provide evaluation and learning opportunities around programmatic performance and impact of USAID investments

At the central level, INECD will be expected to conduct joint work planning, prepare joint presentations on implementation progress to GOR multiple times per year, and collaborate in the implementation of activities. This also includes collaborative joint monitoring of activities with

GOR and other stakeholders at both central and district level through USAID’s co-located investments in the regional district hubs. In addition, certain nutrition-sensitive economic growth (EG) activities will also participate in coordination and collaboration with INECD Activity as these activities support the larger enabling environment for the mission’s desired nutrition outcomes.

Involving implementing partners in the USAID learning activities, such as portfolio reviews or stocktaking efforts, as appropriate; and using the knowledge and learning gained from implementation, opportunities to reflect on performance, monitoring data, evaluations, knowledge about the context, and other sources to adjust interventions and approaches as needed.

A.5.2 Cross-cutting principles

A. Evidence-based: All interventions should make use of nationally recognized and recommended, evidence-based curricula, materials and approaches. The implementing partner will learn from and improve programmatic approaches based on rigorous research and field application; strengthen evaluation and learning; increase the documentation of implementation successes and failures; and disseminate promising practices and apply lessons learned.

B. Youth: While the emphasis on the INECD program will be on the first 1,000 days, adolescents will also be considered in a comprehensive programming approach.

C. Private Sector Engagement: Promote the substantial engagement of the private sector and increased coordination between the public and private sectors to improve the quality of complementary feeding for women and children, for example through national food fortification.

D. Gender Equality and Social Inclusion: In alignment with USAID’s Gender Equality and Female Empowerment Policy, USAID Rwanda seeks to promote gender equality through its activities. The activities undertaken by the INECD activity must incorporate results of relevant data analyses and address gender-specific gaps and constraints and implement gender-sensitive and gender transformative programming. Mitigating actions should be taken to ensure that all children and members of households can benefit from the program, that activities do not exacerbate gender inequalities, and that interventions aim to reduce gender-based violence, and promote positive parenting. The activity will contribute to these crosscutting gender priorities by helping to strengthen an enabling environment in which women and men and boys and girls can equally access, contribute, and benefit from the services.

E. Conflict Sensitivity and Do No Harm: A conflict sensitive approach takes into account and adjusts interventions according to the context, employing innovative approaches to avoid negative impacts and maximize positive ones. The INECD design must maximize positive and constructive dynamics in the context and communities in which proposed activities will be carried out. The project should ensure an adaptive management approach that is responsive to events on the ground and assures that INECD interventions do not exacerbate negative or destructive dynamics.

F. Sustainability: Where feasible, the Recipient should increase GOR capacity, CSOs to sustainably plan, coordinate, and finance multi-sectoral, integrated early childhood development interventions and access to rehab/AT services. The Recipient may need to review and strengthen public policies, programs, and services creating the conditions for the provision of nurturing care, particularly for children aged 0-3 years. Districts, Sectors, Cells and Villages create strong entry points for sustainability.

G. COVID19 Adaptations: Programming in the context of COVID-19 should prioritize the following: Protect the health workforce and the community; Sustain prevention and timely care-seeking; Deliver high-quality care effectively; Buffer disruptions to service delivery;

boost economic strengthening activities to cope; Promote a total market approach;

Maximize and utilize the best data / evidence.

A.6 Monitoring, Evaluation, and Learning

Few USAID priority countries are delivering an integrated package of nurturing care services. The INECD Activity represents a singular opportunity to evaluate, document, and disseminate lessons for the growing national, regional and global audience seeking to expand the Nurturing Care Framework and document results on the implementation of the NCDA Strategic Plan.

A.6.1 Collaborating, Learning, and Adapting (CLA)

USAID’s Collaborating, Learning, and Adapting (CLA) methodology is central to the overall project strategy and the Monitoring, Evaluation and Learning (MEL) approach. CLA allows a project to maintain a culture of learning that guides adaptation and improves the quality of project design and interventions. The Recipient will promote a strong ethos of generating and disseminating evidence and learnings that the Recipient expects will lead to improved and inclusive nutrition, ECD and health services.

Collaboration enables cross-sector integration, convergence, and effective interventions to maximize development resources and enhance development results. It is a key feature of the INECD activity, as described in the sections on strategic collaboration & coordination and layering. The recipient will collaborate with USAID-supported activities in common areas of operation and engage with stakeholders to deliver integrated services to targeted populations.

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. Knowledge generated by learning will be applied throughout programming to implementation approaches, processes, and stakeholder engagement.

Knowledge generated by learning should also be disseminated 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.

These sources will be used to develop and implement plans, manage adaptively, and contribute to the USAID/Rwanda knowledge base in order to improve development outcomes. A collaborating, learning, and adapting focus helps to ensure that programming is coordinated, grounded in evidence, and adjusted as necessary to remain relevant and effective throughout implementation. The Recipient will demonstrate adaptability that is informed by knowledge gained through learning, and recognize behaviors and incentives necessary to create change. Knowledge gained through learning will influence decision making, resource allocation, and adaptation to contextual shifts.

A.6.2 Activity Monitoring, Evaluation and Learning Plan

The MEL Plan is a management tool that includes a Monitoring, an Evaluation and a Learning section. The Monitoring section specifies indicators and the necessary methodologies to enable the Recipient and USAID/Rwanda to monitor the progress of activities towards achieving the stated objectives. The Monitoring section must include applicable Health HL.6, HL.8 and HL.9 nutrition indicators (https://2009-2017.state.gov/f/indicators/) and Social Service indicators ES.4-1 (Number of vulnerable persons benefiting from USG-supported social services), ES.4-2 (Number of service providers trained who serve vulnerable persons), and ES.4-3 (Number of USG-assisted organizations and/or service delivery systems that serve vulnerable persons strengthened). The Applicant should recommend custom indicators to monitor activity performance. Baseline values, as well as targets for each Fiscal Year and for the Life of the Activity should be included in the final MEL Plan.

The Evaluation section includes a brief description of any systematic collection and analysis of information as a basis for judgements to improve and inform decisions about programming. USAID may procure an independent impact evaluation of this award. While research questions may be submitted for consideration as part of the concept paper submission, Applicants should focus on formative and process evaluation questions and situational or needs assessments. Such internal evaluations (conducted by the Recipient) are subject to review and approval by USAID.

Finally, the Learning section indicates how the activity will address learning questions or knowledge gaps and identify ways to allow for adjustments as circumstances change or learning evolves. The Applicant should be clear on plans to utilize minimal but sufficient data to adaptively manage interventions.

Impact Evaluation: USAID may procure an external Impact Evaluation (IE) to test the theory of change embedded in this activity. While the external IE would be managed under a separate mechanism, the Recipient would be expected to work closely with the IE team to ensure that the final evaluation design is closely aligned with the proposed INECD activity. This relates in particular to the isolation of activity inputs for the outcomes being measured and the ability to establish control groups. In short, the Recipient must be flexible, open-minded, and committed to cooperating on the implementation of the IE that would inform key components of this activity. If an IE is commissioned, the co-creation workshop will include collaborative design together with evaluation experts to inform the theory of change. Additionally, the evaluation experts and Recipient would identify hypotheses to test with rigorous research and agree on the methods.

[End of Section A]

SECTION B: FEDERAL AWARD INFORMATION

B.1 Estimate of Funds Available and Number of Awards Contemplated

USAID intends to award one Cooperative Agreement pursuant to this NOFO. Subject to funding availability and at the discretion of the Agency, USAID intends to provide $38,000,000 in total USAID funding over a five-year period.

USAID reserves the right to fund activities incrementally over the duration of the award, if necessary, depending on the availability of funds, the level of performance against approved indicators, and their continued relevance to USAID programs.

B.2 Expected Performance Indicators, Targets, Baseline Data, and Data Collection

Performance indicators for this activity will be developed jointly by USAID/Rwanda and the Recipient and will be incorporated into the Cooperative Agreement.

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

The anticipated period of performance is five years. The estimated start date will be May 15, 2021.

B.4 Substantial Involvement

USAID/Rwanda anticipates a close working partnership with the Recipient for this award. USAID will exercise substantial involvement under this Cooperative Agreement in the following ways:

1. Approval of the Recipient’s Implementation Plans by the Agreement Officer’s Representative (AOR). The Agreement Officer (AO) delegates authority to the AOR to approve implementation plans.

2. Approval of the Recipient’s MEL Plan by the AOR.

3. The AO may immediately halt the activity if the Recipient does not meet identified performance targets (This includes authority to halt construction activities if construction specifications are not met).

4. USAID’s review and approval of the Recipient’s achievement after one year of implementation, before implementation can begin in subsequent year(s) during the period covered by the cooperative agreement.

5. USAID’s review and approval of substantive provisions of proposed subawards or contracts.

6. Approval of Specified Key Personnel as concurred on by the AOR and approved by the AO. The positions include:

a. Chief of Party

b. Deputy Chief of Party

c. Physical Rehabilitation Technical Advisor

d. Nutrition Technical Advisor

e. Early Childhood Development Technical Advisor

7. The Agency and Recipient collaboration and joint participation including USAID involvement as a member of advisory committee.

8. Agency monitoring to permit specific kinds of direction or redirection of the work because of the interrelationships with other projects or activities. All such direction or redirection must be within the program description budget, and other terms and conditions of the award.

B.5 Authorized Geographic Code

The geographic code for the procurement of commodities and services under this award 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. The list of countries designated as prohibited sources is found at http://www.usaid.gov/ads/policy/300/310mac.

B.6 Nature of the Relationship between USAID and the Recipient

The principal purpose of the relationship with the Recipient and under the subject program is to transfer funds to accomplish a public purpose of support or stimulation of the INECD activity which is authorized by Federal statute. The successful Recipient will be responsible for ensuring the achievement of the program objectives and the efficient and effective administration of the award through the application of sound management practices.