Communities Leading COVID-19 Response and Oxygen Ecosystem.pdf

Issue Date of this Addendum: August 7, 2020

QUESTIONS

Due Date & Time First Cycle: August 14, 2020 - 12:00 PM EDT*

CLOSING Date & Time Concept Paper First Cycle: August 24, 2020 - 12:00 PM EDT*

*Please note you can send Questions and your Concept Paper well in advance of this date to avoid any delays or IT challenges that might arise.

Subject: Global Health New Partnerships Initiative (NPI) COVID-19 Round

Activity Title: Communities Leading COVID-19 Response and Oxygen Ecosystem Solicitation # 7200AA20R000047

Point of Contact: COVID19_NPI@usaid.gov

Catalog of Federal Domestic Assistance: 98.001, Foreign Assistance for Programs Overseas

TO: All Interested Respondents/Parties:

Pursuant to the Foreign Assistance Act of 1961, as amended, the United States Government, represented by the U.S. Agency for International Development (USAID), Bureau for Global Health, Office of Maternal-Child Health invites interested Applicant(s) to submit Concept Paper(s) incorporating interventions that will build upon and expand USAID’s efforts to leverage the roles of communities to strengthen and adapt existing community health systems and the oxygen ecosystem (defined as the constellation of commodities, training, equipment and support needed for the production and distribution of oxygen, and its safe, appropriate and effective use) and to support national policies and implementation plans for COVID-19 preparedness and response (pharmaceutical and non-pharmaceutical interventions), and continuity of existing primary healthcare based on national and subnational guidelines and needs/priorities.

The Communities Leading COVID-19 Response and Oxygen Ecosystem is NOT a Request for Application (RFA), it is an Addendum published under the existing NPI GH APS to request Concept Paper(s). The existing NPI GH APS can be found here:

https://www.grants.gov/web/grants/view-opportunity.html?oppId=315120

[https://www.grants.gov/web/grants/view-opportunity.html?oppId=318376]. To be competitive, the Concept Paper submission must be fully responsive to all instructions under this Addendum.

Based on the submitted Concept Paper, USAID’s Global Health (GH) Bureau will determine whether to request a Full Application from an eligible organization. To be eligible for the award, the Applicant must provide all information as required and meet the eligibility standards of this Addendum. This funding opportunity is posted on www.grants.gov and may be amended. It is the responsibility of the Applicant to ensure that the entire Addendum with any subsequent amendments have been downloaded from www.grants.gov in its entirety as USAID bears no responsibility for data errors resulting from transmission or conversion process. In case of difficulty registering on www.grants.gov or accessing the Addendum please contact the www.grants.gov Helpdesk at 1-800-518-4726 or via email at support@grants.gov for technical assistance.

Please send any questions by the due date(s) to the point of contact identified on the cover page of this Addendum. Responses to questions received prior to the deadline will be furnished to all potential Applicants through an amendment to this Addendum posted to www.grants.gov.

Issuance of this Addendum does not constitute an award or commitment on the part of the U.S.

Government, nor does it commit the U.S. Government to pay for costs incurred in the preparation and submission of Concept Papers. Issuance of award is subject to the availability of funds and the interest and requirements of GH/MCHN as well as the viability of eventual Full Application(s) received.

Thank you for your interest in USAID programs.

Sincerely, Christopher A. Nikola Branch Chief, M/OAA/GH/OHA https://www.grants.gov/web/grants/view-opportunity.html?oppId=318376 http://www.grants.gov/ http://www.grants.gov/ http://www.grants.gov/ http://www.grants.gov/ mailto:support@grants.gov http://www.grants.gov/

SECTION I: FUNDING OPPORTUNITY DESCRIPTION

The U.S. Agency for International Development’s Bureau for Global Health (USAID/GH) is pleased to issue this COVID-19 Round (or “Addendum”) under the New Partnerships Initiative Global Health (NPI GH) Annual Program Statement (APS). Under this COVID-19 Round titled Communities Leading COVID-19 Response and Oxygen Ecosystem, USAID/GH is seeking Concept Papers that incorporate interventions that will build upon and expand USAID’s efforts to better connect communities and health systems, as part of the COVID-19 response as well as in strengthening and adapting existing health systems to their communities for COVID-19 preparedness and response. In particular, awards will support national, subnational, regional, and local policies and implementation plans to prioritize COVID-19 interventions along with continuity of existing primary health care, local needs, and priorities for response, recovery and resilience, including the oxygen ecosystem, defined as the constellation of commodities, training, equipment and support needed for the production and distribution of oxygen, and its safe, appropriate and effective use.

USAID is seeking to support Applicants via partnerships as defined under Section III of this Addendum. This is based on the belief that a larger and more diverse partner base will expand the available ideas, capabilities and networks needed to sustainably address challenges to the COVID-19 response and build capacity for recovery and resilience. Proposed interventions and activities within this Round will be consistent with USAID COVID-19 response priorities, with a particular focus on, but not limited to, strengthening and supporting health facilities and building their capacity and engagement with communities. A variety of interventions for COVID-19 will be supported.

Local and global partnerships with the private sector and civil society, including faith-based and community-based organizations, and in particular new and underutilized partners, who are capable of deploying (or integrating) activities and innovations to enhance national, subnational and local preparedness and response, are encouraged to submit Concept Papers. Such activities and innovations could, for example, include any of the following:

Oxygen ecosystem. Concept papers should focus on enhancement of the oxygen ecosystem, defined as the constellation of commodities, training, equipment and support, needed for the production and distribution of oxygen, and its safe, appropriate and effective use. This could include the provision of technical assistance and respiratory care to support quality services for hypoxemia detection and supplemental oxygen delivery for severe COVID-19 infected patients at the primary and second levels of care, as well as the tertiary level, including through the use of field hospitals; education, training, and mentoring/supportive supervision, especially of health workers, including for the safe, effective and appropriate use of oxygen in clinical settings at the primary, secondary and tertiary levels; and strengthening the capacity of existing facilities to safely and appropriately provide oxygen and oxygen related care. It could also include innovative or new respiratory diagnostics and oxygen generation technologies which offer significant advantages over conventional technologies and which are appropriate for developing country settings, and innovations in local oxygen supply and distribution chains.

Health ecosystem. Concept Papers focusing on activities to foster the creation, equipping or strengthening of a health ecosystem which extends beyond health facilities and improves integration with the community. These activities would include care, for example community-based maternity transport and care; long-term care and rehabilitation for patients with COVID-19 sequelae; local production of personal protective equipment (PPE) not destined for the U.S. market; public health and social protection measures; psychosocial and other support for families and communities; protection and support for survivors of violence and neglect related to COVID-19; and care at lower levels including home care, which would benefit patients, providers and the health system by decreasing the burden on higher levels of care and enabling patients to be cared for closer to their homes and communities.

Ultimately, COVID-19 Round activities must be consistent with national COVID-19 response plans, local community priorities and clinical best practices (as appropriate), while supporting the continuity of health care and building capacity for response, recovery and resilience. Specific response priorities are established by country governments and are available through consultation with Mission health staff and other in-country partners.

USAID anticipates issuing multiple awards under COVID-19 Round to Applicants that fall under any one of the Partnership Approaches located in Section III: Eligibility Information, and that have existing and ongoing capacity to work in the host country(ies) where they plan to work.

Award recipients must demonstrate that they have an existing presence within the local community, capacity to work in COVID-19 programmatic response areas, and existing relationships with governments, other civil society organizations, including faith-based and community-based organizations, health facilities and health networks and/or public, private and voluntary sector health care within their geographic areas of focus. The applicant’s programmatic approach must be reflective of the country or countries’ context and consistent with the Agency’s COVID-19 response priorities under this Addendum. More information can be found at https://www.usaid.gov/coronavirus.Target countries include: Ghana, Kenya, Malawi, Mozambique, Nigeria, Haiti, Afghanistan, Tajikistan, Bolivia, Ecuador, El Salvador, Guatemala, Honduras, Peru, South Africa. Bangladesh.

A. Background

On January 30, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of International Concern (PHEIC). Subsequently on March 11, 2020, WHO declared COVID-19 a global pandemic. USAID has played an important role in the response to this pandemic epidemic globally by quickly accessing reserve funding available to the government. While rapid response remains a critical piece of the response effort, USAID also recognizes the importance of community leadership, and of adapting and linking strong communities to health care and health systems. This will help build resilience to potential subsequent outbreaks of infectious disease including COVID-19, should this virus cycle between the northern and southern hemispheres annually, similar to other coronaviruses and influenza.

USAID also recognizes that organizations that are well established locally, know their populations and have technical skills related to the COVID-19 response needs likely already https://www.usaid.gov/coronavirus have gained the trust of communities and are most likely to be able to support response, recovery and resilience at the community level.

Applicants, especially those who are New and Underutilized Partners that are Locally Established Partners or Local Entities, may bring new and innovative approaches, and trusted relationships with governments, local networks, and communities which will enhance USAID’s investment, along with investments from other donors and funders. In addition, local partners may better be able to represent the voice and needs of all community members, including those who are often excluded from decision-making. Locally Established Partners are best positioned to build long term capacity as they are an integral part of the communities they serve and can help promote resilience to crises, including government transitions and instability. In order for these efforts to be successful and sustainable, Locally Established Partners will coordinate their efforts, where possible, with the host country government, local communities, the Ministry of Health, other key stakeholders, and development partners.

USAID has a long history of working with local partners. With the current focus on the Journey to Self-Reliance, there is an opportunity to further expand USAID’s partnerships with New and 1

Underutilized Partners that are Local Entities or Locally Established Partners, their health facilities, and their networks, in order to contribute to a whole of society approach to a sustainable, integrated healthcare system. Through USAID’s Effective Partnering and Procurement Reform (EPPR), part of the USAID’s Transformation process, USAID is making a 2 concerted effort to reach out to New and Underutilized Partners.

B. Technical Focus of COVID-19 Round

USAID’s Bureau for Global Health seeks partnerships with non-governmental organizations (NGOs) (e.g., civil society, private sector and faith-based organizations, consortia, academia, diaspora groups, social enterprises, national and international NGOs, health networks, health facilities, etc.) meeting the eligibility criteria, that can mobilize local and community assets and resources to sustain and scale promising and/or proven approaches. The latter should benefit all 3 community members in order to mount a joint response, recovery and resilience approach, particularly in the communities most at risk for COVID-19 transmission. A priority for this Round would be the use of innovative approaches to strengthen the oxygen ecosystem, and/or strengthening operationalization of the oxygen ecosystem in target countries with a focus on a systems approach to facility service delivery, with attention to increasing access to, and safe and appropriate utilization of, oxygen. This could include innovative approaches and technologies aimed at increasing the supply and distribution of oxygen; increasing the availability of pulse oximetry, positive pressure helmet ventilation devices, high-flow nasal cannula devices, arterial

1 According to USAID, 2018: “Self-Reliance” is a country’s ability to finance and implement solutions to its own development challenges. The two mutually reinforcing factors determining self-reliance are country commitment and country capacity. See: https://www.usaid.gov/selfreliance 2 USAID Effective Partnering and Procurement Reform (EPPR) 3 Evidence and experience for community health approaches may include peer review publications, grey literature, and other systematic and credible documentation of program experience (e.g., process documentation, participatory assessments, etc.).

https://www.usaid.gov/selfreliance https://www.usaid.gov/documents/1868/fact-sheet-effective-partnership-and-procurement-reform blood gas testing, and other commodities and equipment to improve the care of ill patients with COVID-19 in facilities; the use of field hospitals; quantification of oxygen, accessories and consumables at facility level; integration of oxygen into facility information systems; and training, support and mentoring of health workers. Applicants should also consider approaches to strengthening the health ecosystem, including through the provision of commodities, training and support for the care of people with active COVID-19, or complications thereof.

USAID recommends that potential applicants collaborate where possible with other implementing partners (including USAID/U.S. Government initiatives and partners, and multinational organizations, but also health associations and civil society organizations) supporting the national, subnational and local community response to COVID-19, but recognizes that this may not be possible in all locales or situations. Applicants must engage with local, regional and subnational health networks of providers and health facilities, including faith and community-based networks. They should also engage with existing community groups including community leaders, community health workers, community governance groups, churches, mosques, temples, women’s groups, organizations of persons with disabilities, child protection networks and others. Such engagement is essential for both the dissemination of information and for improved understanding of COVID-19 illness, including helping individuals understand when to seek health care, testing, referrals to health care and social services, social and behavioral change and to provide social support, and physical distancing, community quarantine and other measures to reduce transmission, and to facilitate continuity of critical health care. This includes health care for COVID-19 patients, including home health care, critical care, rehabilitation and USAID’s ongoing health development programs in Maternal and Child Health, Voluntary Family Planning, Tuberculosis, Malaria, HIV/AIDS and Neglected Tropical Diseases.

Applicants are encouraged to consider how accessible technologies and innovations can support proposed response efforts and where appropriate consider ways to overcome differential access to digital technology based on sex, and scaling or deploying open source and common digital programs that can be customized to address response efforts. USAID will not consider Concept Papers for new digital technology or proprietary digital solutions. Where appropriate, applicants should consider the use of proven and effective open-source software tools that have already been deployed in-country. Since the beginning of the COVID-19 pandemic, in many countries, health informatics software packages have already been adapted to include COVID-19 module tools and are already designed to support a wide range of response efforts. These include but are not limited to: epidemiologic data collection, including morbidity and mortality data disaggregated by age, sex, disability, and comorbidities; data analysis and dissemination;

screening, diagnosis, triage, protocol adherence, contact tracing, and surveillance; health workforce protection and management; patient care; data collection on outcomes and utilization of care; risk and behavior change communications (including to address misinformation), supply chain management; finance/payment/insurance systems; and laboratory systems. One of the main lessons learned from USAID’s Ebola response was that deploying new systems during a crisis was ineffective, difficult and costly. The fastest way to strengthen response efforts using data will be to leverage existing country-specific software to deploy COVID-19 specific interventions.

Applicants are encouraged to apply systems and social and behavior change approaches to engage communities in COVID-19 preparedness and response. This includes empowering individuals, families and communities to take ownership and responsibility for their health and the health of their communities, including through building health literacy, especially related to COVID-19 respiratory care, promoting effective participation in and use of the health system, and strengthening critical linkages between communities, community health workers (CHWs), primary, secondary and tertiary healthcare facilities (public, private including faith-based health institutions/organizations) and sub-national government. Building on, coordinating, and using all available assets and relationships in health and other sectors for COVID-19 response and continuity of essential health care are recommended.

Applicants should propose approaches that help to build and strengthen the oxygen ecosystem, or the health ecosystem, as noted above. Such approaches should also promote effective engagement of all community members in the COVID-19 response, including surveillance, implementation of possible pharmaceutical and non-pharmaceutical interventions, as well as oxygen, care for COVID-19 patients, increased awareness of risks for and signs/symptoms of COVID-19 infection, and associated problems including behavioral risks, increased violence, and child abuse. Approaches should also consider how increased community engagement can address such issues as restricted access to health care and continuity of care. Local strategies should link to district and national strategies, plans and policies with potential for scale up.

Through this Addendum, USAID will support relevant activities, as well as a citizen and community focus in one or more of the areas listed below. Applicants may submit concept papers that focus on helping to build and/or strengthen the oxygen ecosystem, or strengthen community partnerships and systems that address one or more of the following areas, as feasible and appropriate:

Result 1. Health workers have the resources and training needed to safely and appropriately use oxygen

Sample Activities:

● Health workers resources and training to safely and appropriately use oxygen: Health workers at all levels and in all cadres face challenges in the safe and appropriate use of oxygen. Despite the fact that oxygen is an essential commodity for health care, it is not widely available and in in-country surveys, health workers have expressed a need for training in its use. Activities could include technical assistance to help train, support and mentor health professionals in the safe and appropriate use of oxygen and the care of ill patients with COVID-19. Such training and support would optimally be carried out in person, or virtually, with online knowledge platforms and mentorship modules linking clinicians with expertise in caring for ill patients with COVID-19 to in-country health professionals. The use of oxygen can be associated with adverse effects, including patient injury due to improper use, inappropriate use in a patient for whom oxygen is not the correct therapy, inadequate monitoring, and unsafe use increasing the risk for fire and explosion. It is essential that health professionals have the resources and training needed to safely and appropriately use oxygen.

Activities to support these goals could include delivery mechanisms and procurement of a range of equipment, consumables, pharmaceuticals, and diagnostics (e.g., pulse oximeters, EKG machines, arterial blood gas kits, other items) related to oxygen ecosystems. Activities could also include strengthening laboratory capacity for the care of ill patients with COVID-19 and the provision of field hospitals to enhance health facilities’ isolation capacity.

Result 2. Community empowerment and ownership is increased and communities are effectively engaged and supported to lead select COVID-19 responses.

● Community health workforce: support existing cohorts of Community Health Workers

(CHWs) capable of being trained to address COVID-19 priorities in the areas of prevention, detection, and response, for example door-to-door testing and surveillance, especially 4 focused on homes and marketplaces and assistance to families caring for sick members, as well as support and guidance for individuals and families who are not able to access health care. Support motivation and incentives for these CHWs, as necessary, for example, analysis of workflows, task shifting opportunities, additional training and support, and additional supervision; and/or implement changes to national guidelines for CHW work intended to achieve these objectives. For task shifting, support training and recruitment for other community health worker cadres, such as social and mental health community health workers. Consider expanding the CHWs’ role and training to address COVID-19. This would include messaging and support for quarantine and isolation activities, including community quarantine, physical distancing, and alternatives to physical distancing; helping families care for patients with COVID-19, who are not critically ill, at home; helping families access services, such as food, personal assistance for persons with disabilities, and psychosocial support. Help train CHWs to recognize signs of abuse and neglect, especially of children, and to refer to social and other services or community groups tasked with protection.

● Community groups and structures: build the organizational and skills capacity, and strengthen the leadership roles of community groups, structures, and social networks to work with the health system to effectively prevent the spread of, and care for people with, COVID-19. Such collaboration should establish connections between local communities, local government, primary, secondary and tertiary healthcare facilities and networks, and CHWs. Collaboration and support should focus on those activities required to prevent the spread of SARS-CoV-2, including identification of individuals with COVID-19, monitoring for the onset of severe disease, and providing essential care for them. Collaboration and support could as well include human centered design; development and dissemination of prevention messages; testing and reporting; locally appropriate strategies for isolation and quarantine, including community quarantine, and innovative alternative strategies, developed in collaboration with local, regional or national authorities; strategies for infection prevention and control; strategies to optimally care for ill patients with COVID-19; including out-of-hospital early diagnosis and treatment to reduce the risk of progression to respiratory

4 Ballard, M., Bancroft, E., Nesbit, J., Johnson, A., Holeman, I., Foth, J.,... Palazuelos, D. (2020, April 22). Priorities for the Global COVID-19 Response: the Role of Community Health. BMJ Global Health (forthcoming) https://doi.org/10.17605/OSF.IO/JA5ZN https://doi.org/10.17605/OSF.IO/JA5ZN failure; the use of stand-up clinics and field hospitals; strategies to reduce stigmatization related to COVID-19; support for contact tracing; promotion of appropriate care seeking behavior; local manufacture of PPE; disinfectants, hand cleansing materials, and effective, innovative WASH; referrals (for COVID-19 related and second order outcomes, such as violence and abuse) and guidelines, enforcement of directives, and identification of and support to vulnerable families in line with national policies and guidance.

● Social and behavior change: engage public, voluntary and private sector health professionals on the frontlines, CHWs, civil society organizations, communities, faith-based institutions, families to combat misinformation, fear, and mistrust in the public health system; address COVID-19 stigmatization including potential for increased violence against those with COVID-19 infection; promote the use of media (radio, television, local theater and arts) to share culturally appropriate accessible information to reduce viral transmission and promote positive behaviors such as handwashing, respiratory hygiene, physical distancing and other alternatives to physical distancing and ensure psychosocial support and motivation for community members, but more importantly, frontline health workers, and promote collective action for COVID-19 preparedness and response. Address limited access to healthcare (e.g., self-care), where appropriate, signs and symptoms that should prompt a visit to a health professional, and potential for stigmatization related to COVID-19.

Result 3. Effective linkages are established between communities and health systems

● Referral: Support implementation of mechanisms for COVID-19 care, including improving COVID-19 screening, diagnosis, treatment and care, transition of services to home-based delivery and supporting community members on when and where to seek care for specific symptoms, including the management of comorbidities such as TB, Malaria or HIV/AIDS.

Support could also include transition from clinical to community based care during recovery.

● Supportive Supervision: Adapt supportive supervision for COVID-19 response and continuity of health care, as necessary. Promote systems and networks that enhance recruitment, training, quality and accountability for both financial management and clinical care to improve patient access and resilience of health interventions.

● Surveillance & Data: Build on and expand existing community-based surveillance to incorporate COVID-19 response and monitor progress and community-based service delivery with communities through visualization of data (community dashboards); build capacity of health facilities, CHWs, community groups, and local civil society in surveillance and data collection to improve active case finding and contact tracing as well as community progress; promote downward flows of sex, age, and disability disaggregated data to engage citizens and promote transparency and accountability.

● Availability of Essential Commodities: Support identification of needs for essential commodities within communities and facilities serving those communities. This would include home healthcare commodities, PPE, disinfectants, hand cleaning agents (alcohol, soap, sanitizer), diagnostics, oxygen equipment for noninvasive and invasive respiratory support, essential medicines and critical care equipment and supplies for both COVID-19 response and ongoing health care. To help ensure these items are available, distribution of available commodities as needed, including through supply chain and logistics.

● Promote community involvement in solving public health challenges: Using community input and ideas, address issues such as WASH in health facilities, markets, schools and homes, and community management of waste materials, plastics or other refuse.

Result 4. Innovative approaches and partnerships across local health system providers (public, private, civil society and faith-based groups) and between health system levels to enhance community COVID-19 preparedness and response, including clinical care

● Technology: Implement effective alternative communication and service delivery modalities

(telemedicine, decision support applications, etc.), drawing on existing systems and improved connections between facilities, health workers including CHWs, and communities; facilitate data flows and data integration (including of sex and age disaggregated data) from various sources to improve local and national decision making, especially as required to support roles of health workers, including CHWs for the COVID-19 response and integrated into delivery of ongoing health care, including clinical care in health facilities.

● Trusted communication: Identify, inform and empower trusted community leaders, institutions and groups to support personal and community behavior changes that reduce the risk of COVID-19. Local governmental officials, teachers and educational leaders, local religious and faith-based organizations, civil society, tribal, and networks of women, youth, and persons with disabilities can be identified through broader networks as well as local resources.

● Capacity building of local, civil-society, faith-based and community groups to increase organizational capacity to identify and address needs, and strengthen the voice of communities in planning and prioritization for response activities as part of a whole-of-society approach.

● Partner with public and private radio to inform and engage with communities about

COVID-19, including through the use of human-centered design techniques to ensure culture appropriate messaging. Draw on existing social networks (including female and male influencers) to expand/amplify messaging in mass and other media.

● Targeting Resources and Support to Vulnerable Families and Communities: develop opportunities to support livelihoods and direct (or target) resources to the most vulnerable families, including female- and child-headed families and families with orphans and vulnerable children, with both community and government support/assets.

● Products: support or implement new ways to distribute commodities to the front lines through alternate supply chain delivery channels or ordering mechanisms. This could include, when appropriate, in-country or local manufacture and procurement of items such as disinfectant, hand cleaning agents, and PPE. Also included support to ensure facilities serving the community have appropriate supplies including as necessary to provide clinical care.

C. Cross-Cutting Concepts

This COVID-19 Round addresses the first overarching result of the NPI GH APS: to expand the number of new and underutilized implementing partners contributing to the development of resilient, sustainable households, communities, public health responses, and healthcare systems.

In addressing this overarching NPI GH APS result area, COVID-19 Round will seek to engage communities in COVID-19 preparedness and response and enable continuity of essential care, with a focus on functionality, roles and performance of community and other local organizations, and strengthening critical linkages between communities, CHWs, healthcare facilities (public, private including faith-based health institutions) and sub-national government; and with a particular focus on supporting continuity of services critical to USAID’s health programs in Maternal and Child Health, Voluntary Family Planning/Reproductive Health, Infectious Diseases, Tuberculosis, Malaria, HIV/AIDS and Neglected Tropical Diseases.

USAID recognizes that the COVID-19 situation is evolving rapidly and varies by country.

Evidence also suggests that it is possible that there will be multiple waves of COVID-19.

Applicants should identify response efforts that fit their anticipated community needs over the next year and should prioritize activities that go beyond emergency response needs and which are likely to have a lasting effect on overall community resilience to this and other crises.

i. Strategic Partnerships and Alignment for Systems Response and Continuity of Services

Strategic partnerships with the government and local partners are critical to USAID’s investment through this Addendum and require effective integration and alignment of bottom-up, local approaches with national and global investments, policies, and implementation plans for COVID-19 response and continuity of essential services. Applicants must align and integrate the community response for COVID-19 with the national policy and strategy in place for COVID-19 in order to ensure that communities and local organizations are effectively engaged and empowered to lead the implementation of a local systems response in partnership with local government and their key partners.

Applicants are encouraged to use the forthcoming guidance developed by UNICEF, WHO, and IFRC (Community-based Health Care, including Outreach and Campaigns, in the Context of the COVID-19 Pandemic) aimed at decision makers and managers at national and sub-national levels. This guidance complements a range of other existing guidance and the use of this https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance guidance should be informed by emerging evidence, national guidelines, and policies, within the health systems context.

Applicants are also encouraged where possible to coordinate with other organizations engaged in health systems strengthening and social and behavior change, including but not limited to USAID/U.S. Government initiatives and partners, and multinational organizations but also health associations, private and faith-based health networks, and civil society organizations. Applicants are strongly encouraged to build on existing assessments articulation of national priorities and gaps to improve investments in and impact of primary health care at the community level such as the Community Health Roadmap (https://www.communityhealthroadmap.org/) as well as regional and national COVID-19 coordination structures.

Collaboration that fosters investments with existing or emerging funders for COVID-19 response and health systems strengthening, or developing effective connections between health and other relevant sectors will be valued as leverage against USAID investment. This would include child 5 protection, democracy and governance, education, agriculture, economic development, food security to promote the health and well-being of the most vulnerable communities.

ii. Contributing to the Journey to Self-Reliance

NGOs, including community and faith-based organizations, are recognized essential components of a vibrant and sustainable health system. The partnerships supported in COVID-19 Round are expected to build on existing community structures, networks, private, faith-based, and public healthcare infrastructure which will endure beyond the scope of the resultant award(s). In doing so, this Round will expand and amplify the Agency’s efforts to support countries in their own Journey to Self-Reliance by enhancing the capacity and resilience of these enduring community-based structures through innovative or blended financing, increased domestic resource mobilization, or as appropriate the Applicant may propose the use of leveraged funding as demonstrated in Partnership 3.

iii. Collaborating, Learning and Adapting (CLA)

As in all USAID programming, incorporation of CLA principles into the activity design is a priority and can include the adaptation of existing tools, methodologies or approaches to support and better inform program implementation and analysis. Thus at the conclusion of these awards, 6 it is expected that information learned during program implementation will be available for dissemination and knowledge management of other related community health and resilience projects. Applicants are encouraged to consider a range of approaches to generate this learning.

5 For USAID, leverage is defined as significant resources mobilized from non-U.S. Government sources. USAID seeks the mobilization of resources of other actors on a 1:2 or greater basis (i.e., 50 percent of the proposed value of the award). Leveraged resources may include grants/awards from non-U.S. Government organizations and other donor governments.

6 For USAID, a learning agenda includes (1) a set of questions addressing critical knowledge gaps (2) a set of associated activities to answer them and (3) products aimed at disseminating findings and designed with usage and application in mind. https://usaidlearninglab.org/qrg/learning-agenda https://www.communityhealthroadmap.org/ https://www.communityhealthroadmap.org/

iv. Gender

USAID programs advance equality between women and men, boys and girls, and enhance women and girls’ capacity to participate fully in and benefit from development activities, through the integration of their concerns in the entire project cycle. Goals include: 1) reducing disparities between women and men in access to, control over and benefit from resources, wealth, opportunities, and services; 2) reducing mitigating harmful effects of gender-based violence; and 3) increasing the capability of women and girls to contribute to overall success of their households, communities, and societies. The activities under this Addendum will contribute to these goals while addressing prevention and mitigation of COVID-19 and maintaining access to and use of health care. Principles and activities to achieve project outcomes, include performing analyses to inform approaches which will empower women, girls and vulnerable and marginalized populations, as well as the groups and organizations in the community that represent them. Community engagement efforts will promote balanced participation of men, women and marginalized populations in leadership and decision-making; and activities will address negative social norms. Approaches will address the potential for increased violence as a result of physical distancing. The project will take a ‘do no harm’ approach, so as to reduce potential exploitation of women and girls, while avoiding disadvantaging men and boys, and not creating factual or perceived unequal treatment.

D. Communities Leading COVID-19 Response and Oxygen Ecosystem

i. Expected Results

The overall goal for COVID-19 Round is to support community level COVID-19 country response efforts, including supporting the continuity of health care, while building overall community and health systems resilience. Given the relatively short-term nature of the award, consideration will be given to concepts that meet one of the following result areas by building on existing local assets to fill an identified gap critical to the COVID-19 response. Preference is for proven approaches over pilots. As relevant, results can be included as specific milestones at the award stage.

The COVID-19 Round award(s) will contribute to either Result 1 or the three other overarching results below (Results 2 - 4). Concept Paper(s) will be considered acceptable so long as they discuss Result 1 OR Results 2 - 4. Applicant(s) may submit two Concept Paper(s)provided that one addresses Result 1 and one addresses Results 2-4. Sub-results are not expected to be covered by all Concept Papers, but Applicants should identify the sub-results that are most relevant to their proposed intervention(s):

Result 1: Health workers have the resources and training needed to safely and appropriately use oxygen.

● PPE is made more widely available to health workers and community members.

● Health professionals receive training in the safe and appropriate use of oxygen.

● Health professionals demonstrate improved knowledge, skills and proficiency in the safe and effective use of oxygen.

Result 2: Community empowerment and ownership are increased, and communities are effectively engaged and supported to lead select COVID-19 responses.

● Rapid assessments are conducted with community input to integrate communities in national, subnational and local COVID-19 response.

● Implementation priorities are developed and costs estimated with relevant local stakeholders, including vulnerable groups.

● Community groups/structures (including those that represent vulnerable groups) report enhanced capacity, participation in decision-making and trust in the local public health system, local authorities and frontline healthcare professionals.

● Community-level data, including epidemiologic data, are collected, analyzed and disseminated, including sex, age, and disability disaggregated data, and integrated into decision making, prioritization, continuous learning and adaptation.

● Implementation of physical-distancing or alternative community health interventions to reduce COVID-19 transmission are increased and expanded.

● Joint plans or coordination agreements between relevant community-based stakeholders, including those that represent vulnerable populations, are developed and implemented.

● There is evidence of increased adherence to possible pharmaceutical and non-pharmaceutical interventions (hand-washing, use of disinfectants, physical distancing, appropriate treatment seeking) by community members.

● There is evidence of active and positive communication between health professionals in the health system and community members.

● Scale up community approaches to slow the spread of COVID-19, focusing on risk communication and community engagement.

● Find, investigate, and respond to COVID-19 cases through expanded disease surveillance and detection, focusing on community-based surveillance, contact tracing, and care linkages, while avoiding stigmatization.

Result 3: Effective linkages are established between communities and health systems.

● Community-based workforce/CHWs and community groups/networks/local civil society, faith-based organizations, and organizations of persons with disabilities mobilized, trained and supported to address COVID-19, use of primary health care and prioritized second order impacts (e.g., domestic violence, social support).

● Clinical care, including for COVID-19 patients, is strengthened.

● USAID priority health care and support services currently active in the community continue to address patient needs.

● Plan for continuity of essential community-based services including psycho-social and support services (including for survivors of domestic violence) is developed and implemented jointly between communities and health facilities.

● Alternative delivery modalities for ongoing healthcare and support services - including psychosocial support and personal assistance services, is instituted (e.g. switch to home visits, home delivery of medications, multi-month prescribing with caregiver support).

● Community support for health professionals and facilities is increased.

● Health literacy is promoted.

● Households increase healthy behaviors (including good nutrition, breastfeeding, household water, sanitation and hygiene, hand cleansing, and use of disinfectants).

● Households continue to seek essential care in appropriate ways (relevant to COVID-19 situation).

● Address critical needs of health care facilities, health care workers, and patients, focusing on accessible WASH-infection prevention and control and increasing access to the oxygen ecosystem.

● Employ strategies to address second order impacts (e.g. economic, social, governance, security, and stabilization), focusing on using health data to inform other sectors’ responses.

● Ready plans for deployment of therapeutics and vaccines, focusing on suitable products for Low and Middle Income Countries (LMIC) that are prioritized, tested in populations of interest to USAID, and rapidly introduced.

Result 4: Innovative approaches and partnerships across local health system providers (public, private, civil-society and faith-based groups) and between health system levels to enhance community COVID-19 preparedness and response, including clinical care.

● Communication modalities and community mobilization approaches, including alternative or innovatives ones, are implemented or expanded.

● Supply chain and commodity delivery modalities, including alternative or innovative ones, are implemented or expanded.

● Service delivery modalities, including alternative or innovative ones, are implemented or expanded.

● Existing data collection and digital job aids are expanded to include COVID-19 response protocols.

● Clinical care and responsiveness including in-hospital and critical care, are improved

● Local-level decision making related to COVID-19 improved through coordination, collaboration and/or integration of diverse data sources.

● Multisectoral partnerships established to support community members dealing with

COVID-19 and its impacts.

● Resource sharing partnerships and agreements are established or facilitated between local health systems providers across public, private, and civil society sectors.

● Availability of community-based clinical care (overnight and short-stay units, for example) is improved.

● Access to and availability of locally manufactured and produced PPE, hand cleansing agents, disinfectants and commodities increased.

SECTION II: AWARD INFORMATION

A. Funding

Subject to the availability of funds, USAID anticipates making multiple awards, which will not exceed a cumulative ceiling of $100,000,000.00. Awards in smaller value(s) are preferred, but not required. The ceiling provides the total estimated amount(s) for the award(s) funding and is not guaranteed. Furthermore, the information will be included in the Request for Full Applications (RFA) for selected Applicants who received notification that their Concept Paper was successful. USAID reserves the right not to issue any awards.

B. Geographic Focus

Award(s) will have a geographic focus in one or more USAID COVID-19 presence country(ies).

Target countries include: Ghana, Kenya, Malawi, Mozambique, Nigeria, Haiti, Afghanistan, Tajikistan, Bolivia, Ecuador, El Salvador, Guatemala, Honduras, Peru, South Africa, and Bangladesh. As much as possible, applicants must align their approaches with relevant USAID Mission COVID-19 response programming, country response plans, ongoing efforts of other international organizations and/or other national/sub-national stakeholders to maximize synergies with existing or planned U.S. Government/USAID in-country investments aimed at supporting national priorities and implementation plans. Applicants with a cross-country approach are also expected to connect and coordinate with each USAID country Mission to ensure alignment with U.S. Government/USAID strategic initiatives and priorities.

C. Period of Performance

For COVID-19 Round, the anticipated start date for the first cycle of the award(s) as soon as possible, with an expected award duration of at least one year. The Agency may renew these awards provided funds are available, the results achieved warrant further support, and the recipient meets any other renewal conditions specified in the award and USAID Automated Directive Systems (ADS) 303. Renewal awards are also known as “continuation grants.” A renewal award allows for the continuation of an award beyond its initial period, but not to exceed the total period of performance specified in the original award. Renewal awards may also allow for the continuation of an award beyond initial activities or initial milestones.

D. Expected Implementation Mechanisms

Awards resulting from this Addendum may take the form of a Grant, a Fixed Amount Award (FAA) or a Cooperative Agreement. Please refer to the explanation below.

Grant: Recipients have adequate financial and management capacity to operate on a cost reimbursement basis with the USG and USAID will not be “substantially involved” in selected programmatic elements. A grant is a legal instrument used when the principal purpose is to transfer anything of value (i.e. money, property, or services) to a recipient in order to accomplish a public purpose of support or stimulation authorized by Federal statute. Grants are appropriate when substantial involvement by USAID is not anticipated. 7

Fixed Amount Award: This is a form of grant in which milestones can be defined; adequate pricing information is available; recipient has limited financial and management capacity.

Milestones with fixed amounts assigned to each. It focuses on outputs and results, limiting risk for both parties.