DISCOVER PD-10.06.2014.docx

DISCOVER Program Description

1. INTRODUCTION

Through Government of the Republic of Zambia (GRZ) leadership, the National Health Strategic Plan (NHSP) 2011-16 identifies interventions in HIV/AIDS, tuberculosis (TB) malaria, maternal and child health, and birth spacing services as major public health priorities that must be supplied as close as possible to where people live, work, and go to school to enable Zambia to achieve the health-related Millennium Development Goals (MDGs). The NHSP 2011-16 emphasizes that the aforementioned services should be acceptable, cost-effective, and affordable and be supplied equitably to both males and females to meet their unique needs.

USAID’s Country Development Cooperation Strategy (CDCS) reflects its response to the Government of the Republic of Zambia (GRZ)’s National Strategic Plan 2011-2015, based on the epidemiologic profile of TB, HIV, malaria, and childhood illnesses and the unmet need for family planning in Zambia. It is aimed at assisting the Zambian Government’s efforts to improve the capacity for planning, managing, and implementing the national HIV/AIDS, malaria, family planning and child health continuum of response by government ministries, the National AIDS/STI/TB Council, and civil society organizations. It will support the efficient and effective control of the HIV epidemic, malaria, childhood illnesses and unplanned pregnancies in order to lay the foundation for sustainability.

For more than a decade, USAID/Zambia, in partnership with the GRZ and other cooperating partners, has advanced the supply of and demand for life-saving health products and services through social marketing. President’s Emergency Plan for AIDS Relief (PEPFAR/Zambia) has also achieved accelerated success in implementation of Voluntary Medical Male Circumcision (VMMC) activities, an evidence-based intervention that reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. USAID/Zambia has been at the forefront of the VMMC effort, including through support of the Partnership for Integrated Social Marketing (PRISM) project. PRISM provides a comprehensive package of VMMC services including counseling and testing for HIV (CT), management of sexually transmitted infections, the circumcision procedure itself, and post-surgical care. In 2013, the PRISM provided VMMC services to 60,000 clients through fixed (20%) and outreach (80%) sites. In addition, USAID/Zambia, through President’s Emergency Plan for AIDS Relief (PEPFAR funding, has scaled up its support of comprehensive HIV/AIDS facility-based services that have significantly contributed to rolling back the HIV/AIDS epidemic in Zambia. Support has focused on strengthening a national and community-based response; improving service delivery systems and institutions and implementing a broad portfolio of proven interventions. While the program has achieved significant success, there is now a clear need to further develop decentralized services in order to identify, clinically stage and initiate patients onto life-saving anti-retroviral therapy as early as possible. By providing these services in a decentralized manner, it is possible to both identify HIV affected populations earlier, as well as facilitate adherence to antiretroviral therapy through more efficient and convenient community-based delivery systems.

The District Coverage of Health Services (DISCOVER) Activity (referred to as the “Activity”) will support an innovative approach to scaling up VMMC services, as well as providing critical HIV/AIDS and TB services at non-conventional sites (non-public sector located sites operated directly by a USAID-supported implementing partner) within Zambia by capitalizing on the delivery platform for VMMC and socially marketed commodities. It will also expand family planning services in order to reduce the unmet need for family planning, integrating these services into HIV services. In addition, DISCOVER will build upon the PRISM project by increasing the distribution and sale of mature (socially marketed health services and products already being marketed by PRISM) socially-marketed health products and services by 50% (baseline: PRISM results for 2013), as well as introducing new products and services; and develop and implement context-specific strategies to achieve sustainability of socially-marketed health products and services.

Throughout implementation of the DISCOVER activity, USAID will continue working with the Ministry of Health (MoH) and the Ministry of Community Development Mother and Child Health (MCDMCH) in all ten of Zambia’s provinces to support approaches to scaling up VMMC services and the delivery of socially marketed commodities linked to improved health outcomes. DISCOVER will also prioritize the six USAID aligned provinces for expansion of non-conventional sites to include HIV/AIDS and TB services (Northern, Central, Copperbelt, Muchinga, North-Western, and Luapula provinces). DISCOVER specifically addresses the PEPFAR focus on delivering sustainable results with accountability, transparency and impact. Furthermore, this activity responds to the PEPFAR Blueprint “Creating an AIDS -free Generation” and specifically the “Roadmap for Saving Lives, and smart investments”.

[See Annex for additional BACKGROUND information]

2. ACTIVITY FRAMEWORK

USAID/Zambia will support the DISCOVER activity for five years committing up to $60 million to the pursuit of innovative, sustainable expansion of socially-marketed products and services to improve health outcomes related to, HIV/AIDS, family planning, malaria, and maternal and child health.

2.1 Geographic coverage or operational structure: Throughout implementation of the new DISCOVER activity, USAID will continue working with the Ministry of Health (MOH) and the Ministry of Community Development Mother and Child Health (MCDMCH) in all ten of Zambia’s provinces to support approaches to scaling up VMMC and FP services and the delivery of socially marketed commodities linked to improved outcomes. The project will also prioritize the six USAID aligned provinces for expansion of nonconventional sites to include HIV/AIDS and TB services.

2.1.1 National level: The DISCOVER Activity will have a national-level presence to supervise the Activity as well as work with the GRZ and other stakeholders on policy-related activities such as development of protocols and guidelines and coordination related to technical areas of focus mentioned above.

2.1.2 Sub-national level: The DISCOVER Activity will establish at least one non-conventional site in each province. The sites will serve as service centers for VMMC, CT, TB, and FP services. The sites will also provide the following HIV services: on site CD4 testing, chemistry tests, screening for sexually-transmitted infections (STIs), and HIV treatment to eligible clients identified through these sites (ambulatory clients only). The sites will also serve as hubs for outreach services for 190 outreach sites.

2.2 Services and Products

2.2.1 Services: The Activity will supply and promote the use of the following services: VMMC, CT, FP, HIV treatment and TB screening. To the extent possible, the DISCOVER Activity will address service delivery barriers that include poor infrastructure, low staffing and equipment; and poor access to health services in its area of influence. The DISCOVER Activity will deploy innovative social marketing strategies to increase awareness and use of these services by both males and females, emphasizing their unique gender needs.

2.2.2 Products: The activity will distribute and promote the following products: Male and female condoms, oral contraceptives, misoprostol, Clorin, ORS/Zinc formulation, and LLINs if malaria funds become available. The Activity will deploy innovative social marketing strategies to increase awareness and use of socially marketed health commodities to meet the unique needs of males, females, children, and under-privileged people. The DISCOVER Activity will work at the household, community, service delivery, and policy levels to eliminate barriers that constrain the adequate supply and informed demand for health supplies among females, males, children, and vulnerable people. Household and community barriers include low household incomes, gender inequities, and many other socio-economic determinants of health such as traditional beliefs, traditional medical practices and lately, the influence of evangelism. Expansion through new distribution sites will be necessary to reach demand particularly in rural areas

3. OBJECTIVES

The Activity will have three main objectives:

3.1 Rapid expansion of VMMC and Reproductive health/Family planning (RH/FP) services DISCOVER is the flagship voluntary medical male circumcision (VMMC) Activity for USAID. It will provide over 250,000 circumcisions to men and boys between the ages of 10 and 49 at over 200 non-conventional sites. Sites will be selected based on the prevalence of VMMC (percentage of VMMC eligible males in a catchment area who are actually circumcised) and the volume of clients requiring VMMC services. DISCOVER will identify 50 of the VMMC sites that will provide VMMC services together with HIV/AIDS and TB screening and active referral services (Objective 2). The VMMC sites will be assessed based on underserved populations, HIV epidemiology, and catchment area population estimates to determine which sites will become comprehensive HIV/AIDS service hubs. Discover will build on the success of PRISM to provide long-acting and reversible family planning services through non-conventional and public sector sites.

3.2 Scale-up of high-quality HIV and TB services at non-conventional sites Based on the criteria described in Objective 1 and in partnership with the Ministry of Health and the Ministry of Community Development Mother and Child Health, 50 sites will be selected to provide HIV/AIDS services and TB screening and active referral. All sites will provide VMMC, TB screening and referral, HIV testing and counseling, linkage to care, and socially marketed health products, while some of the sites will provide ART initiation and others will be sites for adherence and anti-retroviral (ARV) refills. All ARVs will be supplied through the GRZ.

3.3 Expand the supply and diversity of socially marketed health products DISCOVER will provide access to mature socially-marketed health products throughout Zambia at non-conventional sites (USAID-partner site not located within the public sector health facility), mobile sites, and where possible, at public health facilities. Condoms, contraceptives, long lasting insecticide bed nets, and Clorin (chlorine based treatment for water safety) have solid track records in uptake through social-marketing in Zambia. DISCOVER will also market an ORS/Zinc formulation and Misoprostol to treat diarrhea in children and to prevent post-partum hemorrhage respectively. DISCOVER will use the previous social-marketing program’s distribution numbers as a baseline from which to measure performance.

4. EXPECTED RESULTS

USAID/Zambia expects the following results and intermediate results to be achieved during the life of the DISCOVER Activity. The outputs and indicators listed under each objective are the minimum required; the Applicant is expected to propose additional indicators to appropriately capture Activity achievements.

Objective 1: Rapid expansion of VMMC and family planning (FP) services

IR 1: Provision of VMMC, and Reproductive health/family planning (RH/FP) services increased.

Select Outputs for Services:

· Number of providers trained to provide VMMC and RH/FP services at non-conventional sites increased

· Coverage of RH/FP and VMMC services through non-conventional sites increased (baseline being PRISM 2013 results)

· Contraceptive prevalence rate in the targeted catchment areas increased

· Prevalence of male circumcision in the targeted catchment areas increased

Select Indicator for services:

· Percentage of targeted sites providing RH/FP and VMMC services

· Percentage of targeted service providers trained in providing VMMC and RH/FP services

· Percentage of targeted clients provided with counseling in RH/FP

· Percentage of targeted clients provided with a long-acting and reversible RH/FP method

· Percentage of targeted people reached with FP/RH messages

· Percentage of targeted men circumcised as part of a comprehensive package of VMMC services

Objective 2: Scale-up of high-quality HIV and TB services at non-public sector located sites operated exclusively by a USAID partner (non-conventional sites) increased

IR2: Provision of HIV (counseling and testing, CD4 testing, and HIV treatment) and TB services at non-conventional sites increased

Select Outputs:

· Number of health providers trained to provide HIV and TB services at non-conventional sites increased

· Coverage of HIV and TB services through non-conventional sites increased (baseline being PRISM 2013 results)

· Non-conventional sites providing a comprehensive package of TB and HIV services

Select Indicators:

· Percentage of targeted clients provided with counseling and testing services (CT) and received their test result

· Percentage of CT clients tested as couples

· Percentage of clients tested for HIV with a positive result

· Percentage of HIV infected clients evaluated for HIV treatment eligibility

· Percentage of HIV treatment eligible clients initiated on HIV treatment

· Percentage of clients retained on HIV treatment after 12 months from treatment initiation Percentage of HIV-infected clients screened for TB

· Percentage of HIV-infected clients diagnosed with TB

· Percentage of TB/HIV-infected clients commenced on ART

· Percentage of targeted providers of services for training that is actually trained.

Objective 3: Expand the supply and diversity of socially marketed health products

IR 3: Supply and Diversity of Socially-Marketed Health Products Expanded

IR 3.1: Distribution and/or sales of Clorin, a point-of-use home water disinfecting solution to disinfect drinking water; ORS/Zinc formulation to treat diarrhea in children, male and female condoms to prevent HIV transmission and prevent unintended pregnancies; contraceptives to diminish the unmet need for family planning; insecticide treated nets to prevent malaria and misoprostol to prevent post-partum hemorrhage increased. The DISCOVER Activity will work with the GRZ and other stakeholders to ensure that Misoprostol is available through other funding entities other than USAID.

Select Outputs for Products:

· Number of outlets/geographic areas/regions for distributing socially-marketed products increased (baseline being PRISM 2013 results)

· Volume of products distributed increased (baseline being 2013 results)

· Number of socially-marketed health products expanded (beyond the currently socially marketed products under PRISM)

· Number of providers trained in distributing health products increased

Select Indicators for Products:

· Percentage of targeted private sector outlets distributing socially-marketed products

· Percentage of targeted new socially-marketed products introduced by the DISCOVER Activity

· Percent of targeted number of bottles of Clorin distributed

· Percentage of targeted number of liters of water disinfected

· Percentage of targeted number of diarrhea episodes potentially averted

· Percentage of targeted male/female condoms distributed

· Percentage of targeted number of LLINs distributed

· Couple Years of Protection (CYP)

· Percentage of targeted number of misoprostol tablets distributed

· Percentage of targeted number ORS/Zinc doses distributed

IR 3.2: Public and Private Sector Investment in Socially Marketed Products and Services Increased and Sustained

Select Outputs:

· As a direct result of the DISCOVER Activity interventions, private sector financing and/or corporate social giving for socially-marketed health products and services increased

· One or more socially-marketed health services and/or products available through the private sector

Select Indicators:

· Percentage of targeted number of private sector corporate entities partnering with the DISCOVER Activity to increase the availability and diversity of socially-marketed health services and products;

· Percentage of targeted number of private sector corporate entities partnering with the DISCOVER Activity to increase the use of socially-marketed health services and products.

· Percentage of socially-marketed products targeted for transfer to the private sector actually transferred.

5.0 Deliverables

5.1 Monitoring and Evaluation Plan

Rigorous monitoring and collection of activity-level output and outcome indicators by the Recipient is expected throughout the life of the DISCOVER Activity to enable performance monitoring. Timely and accurate data collection regarding cost, quality, distribution, appropriate use and client outcomes are critical components of this Activity. The DISCOVER Activity will be responsible for collection, analysis, and synthesis of data required by USAID/Zambia, USAID/Washington, and the MCDMCH/MOH for quarterly performance reporting. The DISCOVER Activity will be expected to participate in and collaborate with an independent mid-term project evaluation to be funded by USAID separately. The DISCOVER Activity will indicate specific early exercises to establish baseline proxy indicators at and/or below the level of intermediate results to establish baseline indicators for activities, especially in the first year of implementation. The DISCOVER Activity will contribute to USAID/Zambia's goal of Improving Health Outcomes in Zambia. To this end, the Recipient must collaborate and coordinate with other USAID-funded partner organizations or implementing partners working in Zambia on activities related to reproductive health/family planning, infectious disease/s, behavior change and supply chain management, as related to the Recipient's primary responsibilities under the DISCOVER agreement. The purpose of this collaboration is to coordinate implementation, avoid duplication, harmonize monitoring and evaluations, learn through joint site monitoring, and, critically, streamline technical assistance to the GRZ. USAID/Zambia may require the Recipient to work in close partnership with other USG implementing partners on select activities. At a minimum, this collaboration must include regular (at least quarterly) meetings at the national level and at the provincial level, based on the various implementing partners' geographic scopes. At the provincial level, the USAID's health systems strengthening (name TBD) activity will play a convening role among partners. Collaboration must also include active participation in an annual work plan presentation and discussion called by USAID/Zambia in December each year. As feasible, USAID/Zambia recommends activity co-location, joint site visits and joint meetings with the GRZ.

Within 90 days of the award;

The DISCOVER Activity must deliver to USAID/Zambia a comprehensive monitoring & evaluation plan, including the process for collecting baseline data to the AOR. The plan should demonstrate:

· How the Activity will measure the link between the distribution of health products and health services and the intended use and patient outcomes

· How the Activity plans to coordinate with other implementing partners.

· How gender-related interventions will be measured

5.2 Mobilization Plan: Within the first two weeks of the effective date of award, the Recipient (with its sub-partners) will prepare and submit a mobilization plan for USAID approval. This plan should describe a schedule for initiating and staffing the program during the first three months following award.

5.3 Work plans: Within 60 days of the effective date of this Agreement, and annually on December 15 thereafter, the Recipient shall submit an annual work plan and a detailed budget estimate associated with that plan, for USAID approval. This work plan must identify the planned activities and results in the coming year, the associated level of effort, and funding sources to be used for that work. The period for annual work plans shall be synchronized with the GRZ fiscal year, that is, January 1 to December 31. In the first and last years of the program, the partner will develop a partial year work-plan that coincides with the start and end dates of the program. The plan should include relevant activities to address identified gender issues that are likely to arise during the implementation of the DISCOVER award.

5.4 Environmental Mitigation and Monitoring Plan (EMMP): The Recipient shall develop the EMMP as part of the annual work planning process describing how the project will implement the conditions in the Initial Environmental Examination (IEE). This shall include training of Recipient staff and sub-partners, when appropriate. The EMMP shall be submitted to the AOR and Mission Environmental Officer with the initial Annual Work Plan within 60 days of the award effective date. The EMMP should include, where necessary, mitigation activities which improve occupational hygiene for both female and males taking their unique needs into account.

5.5 Branding and Marking Plan: The Recipient shall submit a Branding and Marking Plan for the Integrated Family Planning and Reproductive Health Project 30 days after the award effective date if the plan was not approved before award.

5.6 Sustainability plans

Sustainability is an inherent feature of all programming under this award. While marketing of commodities/services has improved over the last decade, there has not been a matching increase in private sector investment to expand and sustain the social marketing of health products/services. The next step to ensuring availability of affordable health products/services is to transfer socially-marketed health products to the commercial sector. Based on detailed market research, USAID expects to fund the development and implementation of strategies to ensure at least one socially marketed product continues to be available at a cost that Zambians can afford through the private sector. The commercial/private sector and the Government of the Republic of Zambia (GRZ) will be involved in the development and sustainability of a viable market for these health products.

The Recipient is expected to quantify the expected leverage of GRZ and private sector partners’ investments under this activity and to demonstrate clear linkages between their investment and the expansion and diversification of socially-marketed health services and products. In addition to establishing partnerships with the private sector to increase the availability of health services and products, this Activity will work with communities and local organizations to increase distribution and demand. USAID expects the Recipient to identify creative avenues for engaging the private sector including both promotional activities as well as distribution.

Within 120 days of the award:

The Recipient will provide the AOR with a detailed sustainability plan including detailed accounts of how the goal of transferring selected socially marketed health services and products to the private sector and forging partnerships with the private sector and corporate social giving are going to be achieved. The Recipient will provide the AOR with a detailed training plan for cooperating country nationals including plans to partner with local organizations/societies/universities in providing these trainings. The Recipient will also provide the AOR with a detailed plan for strengthening capacities of local organizations.

6.0 Reports

6.1 Progress Reports

6.1.1 Quarterly Reports: The Recipient shall report quarterly in relation to the annual work plan and the program description. Progress Reports shall be submitted 30 days after the first three fiscal year quarters to the AOR with a copy to the AO. The reports are due on January 31, April 30, and July 31. The progress report shall include:

a) A comparison of actual accomplishments with the goals and objectives established for the period. Whenever appropriate and the output of programs or projects can be readily quantified, such quantitative data should be related to cost data for computation of unit costs.

b) Reasons why established goals were not met, if appropriate.

c) Other pertinent information including, when appropriate, analysis and explanation of cost overruns or high unit costs.

d) Family Planning Compliance updates

e) Environmental Monitoring

f) Success stories if any. The success stories should be written for an audience without intimate knowledge of the activity.

g) Any gender issues resolved and/or encountered,

6.1.2 Annual Progress Report: The Recipient shall submit an annual progress report for the previous fiscal year. The results reported should be cumulative from October 1 to September 30 and is due on October 31 to the AOR with a copy to the AO. The fourth Quarter/Annual Performance Report shall follow the same format as the quarterly reports, but additionally shall focus on accomplishments, progress, and problems related to achievement of results, performance measures, indicators and benchmarks tied to the Annual Work Plan and the M&E plan targets for the quarter and the entire previous fiscal year. Additionally, the Annual Report must include an analysis of the Objective Performance Indicators and any other indicator data as well as a revision of annual target projections for the subsequent two fiscal years.

6.1.3 PEPFAR and other Reports:

a) PEPFAR Semi-Annual Progress Report (SAPR) and Annual Progress Report (APR) Reports: The Recipient shall submit PEPFAR-related results achieved within the six and twelve months of the USG Fiscal Year for the PEPFAR SAPR and APR respectively. The results are due three weeks after the last day of the reporting period. The AOR will provide guidance on the layout and content of this report.

b) PEPFAR Expenditures Analysis Reports: The Recipient shall complete and submit Form DS-4213, PEPFAR Program Expenditures to the AOR each year by October 31. (This requirement will take effect once OMB approves the final DS-4213 form). The AOR will provide guidance on the layout and content of this report.

c) Semi-annual Portfolio Reviews: The Recipient shall brief the USAID/Zambia Health team and members of the Finance, Procurement, and Executive Office teams in person two times each year. The briefing requires a PowerPoint presentation presenting all semi-annual and cumulative results against previously agreed program targets, selected accomplishments for the previous six months, challenges, and projected procurement actions for the next six months.

d) The Recipient shall submit information described above (indicators, results, targets, performance narratives, geo-locations, and success stories) to Dev-Results, the web-based database used by USAID/Zambia. This information shall be submitted within fifteen days of the semi-annual portfolio review presentations.

e) Lessons learned: No later than 36 months after the effective award date, the Recipient shall create lessons-learned and best practices information base for sharing with USAID/Zambia and other stakeholders

6.1.4 Financial Reporting

The Recipient must submit quarterly financial reports to USAID within 30 calendar days following the end of each quarter using the Office of Management and Budget SF-425. Financial reports are due January 31, April 30, July 31, and October 31. The SF 425 (and SF 425a if necessary) must be submitted via electronic format to the Agreement Officer’s Representative (AOR), the Agreement Officer (AO), and the USAID/Zambia Financial Management Office. The Federal Financial Report (FFR/SF-425) is available in PDF or Excel format at the OMB website: http://www.whitehouse.gov/omb/grants_forms/.

7.0 Program Income

The Recipient is expected to generate income from the sale of socially marketed products and services. Activity income will be re-invested into the Activity in furtherance of the objective of the DISCOVER Activity with concurrence from USAID.

8.0KEY PERSONNEL

The Chief of Party, Deputy Chief of Party, Finance and Administration Director and Strategic Information Advisor positions are key personnel positions.

Key Personnel Minimum Qualifications

a. The Chief of Party (COP) will head the project team and make regular reports to the USAID Agreement Officer’s Representative (AOR). The Chief of Party will be responsible for the overall management and implementation of the project. S/he will supervise project implementation and ensure that the project meets its planned results. The Chief of Party will represent and coordinate with all cooperating organizations and be the point of contact for all purposes of this project.

The COP must have an advanced degree (Masters or PhD) in Public Health or a relevant field from an accredited university. S/he must have at least 5 years of project management experience of public health projects. S/he must have at least 4 years in a senior level management position. S/he should have demonstrated capacity to build and maintain productive working relationships with a wide network of partners and stakeholders; broad technical understanding of public health, particularly maternal and child health, family planning, HIV, and reproductive health programming. S/he will have proven leadership and management skills to effectively achieve the Activity results described in the Program Description. S/he should have demonstrated exemplary diplomatic and interpersonal skills to manage a diverse team. The ideal candidate will have a demonstrated track record of his/her ability to foster collaboration with the GRZ and other donor funded projects. Experience and skills in financial management and performance monitoring are essential. The Chief of Party must be Zambian, fluent in English and must possess excellent oral and written communication skills.

b. The Deputy Chief of Party is responsible for providing technical oversight to Activity operations. This includes providing overall technical guidance for planning, implementation and monitoring of the activities. This position will require a dynamic individual capable of translating public health data and evidence into practice into effective marketing and demand creation activities in the public and private spheres.

The Deputy Chief of Party will be required to possess a Bachelor’s Degree in any of the following disciplines: Medicine, Nursing, Health Science or their equivalent Bachelor’ Degree alongside a Master’s Degree in public health or other relevant clinical discipline. S/he must have at least 5 years of project management experience in any or all the following areas: maternal and child health, HIV/AIDS, family planning and reproductive health, and tuberculosis. The ideal candidate must have at least 5 years working in a senior technical position for a public health and/or international development project.

c. The Finance Director is a long term position responsible for overseeing the finance and administration functions of the project and ensuring compliance with project and USAID procedures. S/he will work closely with the COP and the Technical Services Director and other district staffs to ensure project resources are effectively and efficiently budgeted and managed.

The Financial Director should have a Bachelor’s Degree in business or accounting alongside any of the following professional membership; ACCA or ZICA, or their equivalent. A Master’s Degree in a related field is also preferred. S/he should have at least 5 years professional experience managing financial and contractual aspects of development projects.

d. The Strategic Information (SI) Advisor is responsible for overseeing monitoring and evaluation activities for the Activity. In addition, the SI Advisor will provide strategic and technical direction to improving data collection and the overall evidence-base for social marketing under Objective 4 of the Activity.

The SI Advisor should have a Bachelor’s Degree, and preferably a Master’s Degree in Public Health or a related field. S/he should have at least 5 years of professional experience in monitoring and evaluation, preferably with a donor-funded project, and analysis of strategic information.

9. Acronyms Antenatal clinics (ANCs) Country Operating Plan (COP) Government of the Republic of Zambia (GRZ) Health Management Information System (HMIS) HIV counseling and testing (CT) Intermediate Result (IR) Intrauterine contraceptive Devices (IUCDs) Long-lasting insecticide-treated bed nets (LLINs) Millennium Development Goals (MDGs) Ministry of Health (MOH) Ministry of Community Development Mother and Child Health (MCDMCH) National AIDS/STI/TB Council (NAC) National Health Strategic Plan (NHSP) Partnership for Integrated Social Marketing (PRISM) Population Health and Nutrition (PHN), Population Services International/Society for Family Health (PSI/SFH) Voluntary medical male circumcision (VMMC)

ANNEX 1:

A.2 Background

According to the 2007 Demographic and Health Survey (DHS), family planning services reach only a third of sexually active couples resulting in high overall unmet need for family planning at 27 percent. While awareness of Family Planning (FP) among Zambians is high, knowledge has not translated into use of FP services.[footnoteRef:1] Modern contraceptive use remains low at 33 percent and is of particular concern for young women aged 15-19. This cohort’s birth rate in Zambia is one of the highest in sub-Saharan Africa with 28 percent of teenage girls having begun childbearing.[footnoteRef:2] The top five causes of child mortality have consistently been malaria, respiratory infection, diarrhea, malnutrition, and anemia.[footnoteRef:3] Although the majority of children receive immunizations and vitamin A supplementation, only about half have access to improved drinking water sources and use oral rehydration fluids for diarrhea. Zambia’s HIV epidemic has stabilized, but prevalence remains one of the highest in the world. Overall HIV prevalence among adults (ages 15-49) is 14.3 percent, with 16.1 percent among women and 12.3 percent among men. Zambia is classified as a malaria high-burden country. Although malaria prevalence by microscopy and anemia have shown a general downward trend since 2010, parasite prevalence declined from 16 to 15 percent and severe anemia declined from 9 to 7 percent between 2010 and 2012.[footnoteRef:4] An estimated 4.2 million new cases were reported in 2011, with 4,800 deaths reported due to the disease. Among children under age five, prevalence is 14 percent, and the disease accounts for 36 percent of hospitalizations and outpatient attendance nationwide.[footnoteRef:5] [1: According to the 2007 DHS, 97% of all women and 99% of all men had heard of FP.] [2: Zambia Demographic and Health Survey (DHS) 2007.] [3: Zambia Demographic and Health Survey (DHS) 2007.] [4: Zambia National Malaria Indicator Survey (MIS) 2012] [5: Zambia Health Management Information System (HMIS) 2011 6 Available at: http://www.usaid.gov/zambia/newsroom/key-documents]

A.3 United States Government Health Programming in Zambia

USAID continues to provide financial and technical support to Zambia to accelerate achievement of the following health-related MDGs: to reduce child mortality; to improve maternal health; and to combat HIV/AIDS, malaria, and other diseases. USAID and its partners contribute to achievement of these MDGs through its Country Development Cooperation Strategy (CDCS)6, the related intermediate result (IR): Health Status of Zambians Improved, and three sub-intermediate results:

Health Services Delivery Improved;

Health Systems Accountability Strengthened; and Community Health Practices Improved.

The intermediate and sub-intermediate results are achieved by activities implemented by the Population Health and Nutrition (PHN), the HIV/AIDS Multi-Sectoral, Economic Development, and Education Offices of USAID/Zambia.6

A.4 Activities implemented by the previous USAID-social marketing program/activity, the Partnership for Integrated Social Marketing (PRISM) PROGRAM

In response to the MCDMCH and MOH’s public health priorities in child health, family planning/reproductive health, HIV/AIDS, STIs, and malaria, USAID/Zambia’s previous social marketing program provided the following support through Population Services International/Society for Family Health (PSI/SFH) under the Partnerships for Integrated Social Marketing (PRISM) program:

A.4.1 Maternal and Child Health: In the area of maternal and child health, USAID/Zambia supports the marketing of Clorin, a branded home water treatment solution to reduce diarrhea-related child morbidity and mortality. The production of Clorin has been contracted out to Pharmanova, a Zambian pharmaceutical manufacturing company. Clorin has become popular among Zambian households (both rural and urban) to the extent that an average of 2 billion liters of water is treated every year. In addition, USAID/Zambia procures and distributes Long Lasting Insecticide treated Nets (LLINs) in antenatal clinics (ANCs) to pregnant women and children under five in rural Zambia. USAID/Zambia further supports on a limited basis, distribution of misoprostol through trained health workers to prevent post-partum hemorrhage among women who are not able to deliver in the facilities.

A.4.2 Family Planning: USAID/Zambia expands family planning choices for Zambians through the social marketing and distribution of branded contraceptives. The program distributes approximately 2 million cycles of branded oral contraceptives through the commercial sector and community distributors and 60,000 long-acting and reversible family planning methods through the New Start sites and public health facilities per year. Contraceptives are procured directly by USAID/Zambia through the Central Contraceptive Procurement Project. USAID supports 2,060 condom outlets throughout the country. In 2013, the program marketed 30 million male condoms.

A.4.3 New Start Services: USAID/Zambia supports a network of branded services known as “New Start” clinics, which provide HIV counseling and testing, male circumcision and family planning services. The network comprises ten fixed sites (two in Lusaka and one in each of the following towns: Kasama, Mongu, Mansa, Kitwe, Ndola, Livingstone, Chipata, and Solwezi) and ten mobile units. The fixed sites also serve as administrative hubs for other services. These are rented space. If these spaces were program owned, they would contribute to sustainability of services well beyond the life of the program.

A.4.3.1 Counseling and Testing: The network provides HIV counseling and testing services to over 200,000 clients per year through fixed New Start sites (20%) and outreach activities (80%). The network has great potential to do on-site CD4 testing, accessory lab testing (including sexually transmitted infections) and providing ambulatory (out-patient services) treatment for sexually transmitted infections and for HIV positive patients qualifying for treatment.

A.4.3.2: Voluntary Medical Male Circumcision (VMMC): The program provides a comprehensive package of VMMC services including CT, management of sexually transmitted infections, the circumcision procedure itself, and post-surgical care. In 2013, the program provided VMMC services to 60,000 clients through fixed New Start sites (20%) and outreach sites (80%). The activity has a robust quality assurance plan comprising quality improvement and quality assurance plans to ensure safety of clients. Each New Start site with its associated outreach sites have a covering GRZ surgeon to ensure that clients requiring special attention are attended to by a surgeon onsite or at the main hospitals.

A.4.3.3: Family Planning: The New Start sites provide family planning services including long acting and reversible contraception (LARC) and have potential to provide female and male sterilization.