Eswatini CDC-RFA-JG-25-0072 Final NOFO for Publication.pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due March 5, 2025

Strengthening the organizational capacity of the Ministry of Health to deliver a sustainable and resilient response to HIV/TB and related public health threats in the Kingdom of Eswatini under PEPFAR Opportunity number: CDC-RFA-JG-25-0072

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 10

Step 2: Get Ready to Apply 30

Get registered 31

Questions 32

Step 3: Prepare Your Application 33

Application contents and format 34

Step 4: Learn About Review and Award 44

Application review 45

Award notices 51

Step 5: Submit Your Application 52

Application submission and deadlines 53

Application checklist 55

Step 6: Learn What Happens After Award 57

Post-award requirements and administration 58

Contacts and Support 65

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date Applications are due by 11:59 p.m. Eastern Time on March 5, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 8

Program description 10

Basic information U.S. Centers for Disease Control and Prevention (CDC)

Global Health Center

Division of Global HIV and Tuberculosis

Reducing HIV and TB incidence and mortality in global settings through data-driven programs and strengthened public health systems.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Strengthening the organizational capacity of the Ministry of Health to deliver a sustainable and resilient response to HIV/ TB and related public health threats in the Kingdom of Eswatini under PEPFAR

Opportunity number:

CDC-RFA-JG-25-0072

Announcement type:

New

Assistance listing: 93.067 Global AIDS Program

Key dates

Application deadline:

March 5, 2025

Expected award and start date:

September 30, 2025

We will inform you of your application status by the end of August 2025.

See other submissions for other time frames that may apply to this

NOFO.

Summary We expect you to provide technical assistance to the Eswatini Ministry of Health (MOH) to help them plan, coordinate, and manage a sustainable and resilient HIV/TB response. You should focus on building organizational capacity in three areas:

1. Leadership and governance.

2. Resource mobilization and financial management.

3. Workforce planning and performance management.

Specifically, we expect you to use evidence-based approaches to help:

• Strengthen the MOH’s governance structures, oversight functions, and operational processes to effectively lead and coordinate the strategic objectives of the HIV response.

• Facilitate resource mobilization and use for the HIV response through improving financing, stewardship mechanisms, visibility, and stakeholder engagement.

• Foster a responsive health sector workforce that is well-coordinated, trained, and equipped through data-driven planning and enhanced performance management.

Robust capacity in these organizational domains will position the MOH to nimbly adapt to emerging issues in the HIV/TB response and address related public health threats.

Step 1: Review the Opportunity 5

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $2,000,000 This is the expected total Year 1 funding for all awards made under this

NOFO.

Expected number of awards: 1 to 2 The number of awards is subject to available funds and program priorities.

Exact amounts for each award under this NOFO will be determined upon award.

We plan to award projects for five 12-month budget periods for a five-year period of performance.

Funding strategy

Funding amounts We encourage you to apply for the expected total NOFO funding for Year 1.

You may not request more than this amount.

Funding amounts for years two through five will be set at continuation. We will continue funding based on:

• Availability of funds.

• Evidence of satisfactory progress, as documented in your required reports.

• The determination that continued funding is in the best interest of the federal government.

Component funding

Overview

We fund all President’s Emergency Plan for AIDS Relief (PEPFAR) cooperative agreements using component funding.

Component funding allows us to provide funding as it becomes available. To do so, we fund sets of activities by quarter and project.

CDC may fund one or more of your components to start the budget period, and then consider other components based on available funding later.

Step 1: Review the Opportunity 6

Setting up components

You must set up your components in your application. While preparing your application:

• Review the expectations for year one activities in the strategies and activities section.

• Group your activities under the following anticipated components. Only include the activities planned for year one.

◦ Component 1: COP Q1 Targets and Activities.

◦ Component 2: COP Q2 Targets and Activities.

◦ Component 3: COP Q3 Targets and Activities.

◦ Component 4: COP Q4 Targets and Activities.

◦ Component 5: COP Additional Targets and Activities.

◦ Component 6: Central Initiative Funds (buffer component if needed).

For information on how to incorporate component funding into your application, see the following sections:

• Budget narrative

• Component funding instructions for SF-424A

PEPFAR local partner funding preference This NOFO includes a funding preference for local partners. Your organization will receive 15 extra points during the selection process if you provide sufficient documentation demonstrating you meet the PEPFAR local partner definition.

Step 1: Review the Opportunity 7

Eligibility Statutory authority This program is authorized under:

• The United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, Public Law 108-25 (22 U.S.C. 7601, et seq.).

• The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, Public Law 110-293.

• The PEPFAR Stewardship and Oversight Act of 2013, Public Law 113-56.

• Public Health Service Act (42 U.S.C. 242I).

Eligible applicants This is a fully competitive NOFO, and eligibility is unrestricted. Any and all types of organizations are eligible and encouraged to apply, including but not limited to those listed below.

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and state-controlled institutions of higher education.

• Native American tribal governments (federally recognized).

• Public housing authorities and Indian housing authorities.

• Native American tribal organizations, other than federally recognized tribal governments.

• Nonprofits having a 501(c)(3) status, other than institutions of higher education.

• Nonprofits without 501(c)(3) status, other than institutions of higher education.

• Private institutions of higher education.

• For-profit organizations other than small businesses.

• Small businesses.

• Foreign or non-U.S. based entities.

Step 1: Review the Opportunity 8

Other required qualifying factors

Delivery location While any type of organization may apply, you must conduct the project in Eswatini.

Responsiveness criteria We will review your application to make sure it meets these requirements.

These are the basic requirements you must meet to move forward in the competition. We won’t consider an application that:

• Is from an organization that doesn’t meet eligibility criteria. See requirements in eligibility.

• Is submitted after the deadline.

• Proposes research activities. See 45 CFR 75.2 for the definition of research.

• Requests more funding than the expected total NOFO funding for Year 1.

• Exceeds the 20-page limit for the project narrative (see the project narrative section for what counts toward the page limit).

• Is not in English.

• Includes a budget or budget narrative that uses a currency other than U.S. dollars.

• Does not respond to and is outside the scope of this NOFO.

See the application checklist to understand your application requirements.

Application limits We do not limit the number of applications an organization may submit.

Cost sharing and matching funds This program has no cost-sharing or matching funds requirement. We will not consider cost-sharing fund contributions during your application review.

However, if you submit voluntary cost-sharing funds and we fund your project, we will require you to report on these funds.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://www.ecfr.gov/current/title-45/part-75#p-75.2(Research)

Program description Background overview and related work With a population of 1.2 million, the Kingdom of Eswatini is one of the countries most heavily impacted by the HIV epidemic. Nearly a one in four adults aged 15 years and older are living with HIV. The latest national population-based HIV impact assessment, SHIMS3 2021, demonstrated significant progress towards the ambitious UNAIDS 95-95-95 targets ahead of the global 2025 benchmark. Of people aged 15 years and older living with

HIV:

• 94% are aware of their HIV status.

• 97% of those aware of their HIV status are on antiretroviral therapy (ART).

• 96% of those on ART are virally suppressed.

At a population level, viral suppression has surpassed the UNAIDS target of 86% for both men and women. Furthermore, mother-to-child transmission of HIV has dropped from 6.3% in 2017 to 1.2% in 2022.

Great progress has been made. But to avoid significant consequences in the future, these gains must be sustained and remaining gaps for all populations must be closed. Significant gaps in HIV case-finding persist among:

• Young women ages 15 to 24 years.

• Men ages 25 to 34 years.

• Children under 15.

• The military.

• Key populations.

Many men ages 25 to 34, are not consistently linked to or continually receiving ART. Children on ART are yet to reach 95% viral suppression (except those aged 5 to 9).

Women are disproportionately affected. Among people ages 25 to 29, HIV prevalence is more than five times higher than among men. More than half of women aged 35 to 49 are living with HIV.

Though the rate of new HIV infections has dropped by nearly half between 2016 and 2021, approximately 4,000 individuals aged 15 and above are newly infected with HIV annually. incidence remains higher among women at 1.11%, a rate nearly seven times that of 0.17% for men. Young women aged 15 to 29 are particularly vulnerable. As demonstrated by the 2022 Eswatini Violence

Step 1: Review the Opportunity 10

Against Children Survey, gender-based violence persists as a risk factor for new infections. One in 12 females aged 13 to 24 reporting having experienced sexual violence at least once in their lifetime.

HIV-related deaths have also been on the decline from about 10,000 in 2005 to 3,100 in 2022. However, with an aging population of people living with HIV, co-infections and co-morbidities such as TB, cervical cancer, and non-communicable diseases, must be addressed to further reduce morbidity and mortality.

Donor funding has flatlined in recent years with indications that it will remain constrained in the short to medium term and possibly decrease in the long term. To avoid a regression in the HIV response, MOH will have to increase its leadership, financial oversight, and human resource management responsibilities. We must ensure the MOH has the required skills, expertise, and domestic and external financial resources to effectively lead and manage.

The Government of the Kingdom of Eswatini (GoKE) is developing a sustainability roadmap with input from key stakeholders to define and clearly articulate an implementation approach that can be sustained largely through domestic resources in the medium to long term. This will ultimately inform how the government structures and equips itself to nimbly adapt to emerging issues in the HIV/TB response and address related public health threats. MOH will have a pivotal role to play in implementing the sustainability roadmap.

Using evidence-based approaches, you will help strengthen the MOH’s ability to lead the HIV/TB response by increasing the efficiency and effectiveness of governance structures, streamlining operational processes, building leadership competencies, and improving coordination with internal and external stakeholders. This includes the central line ministries at national and regional levels. You will build on previous investments that standardized operational guidance for the Regional Health Management Teams (RHMTs) and develop a leadership curriculum for upskilling nurse managers.

Improved financial management will be critical to effective resource mobilization and use by the MOH. You are expected to provide technical assistance to strengthen stewardship mechanisms, visibility, and stakeholder engagement in financing and spending for HIV/TB and related public health programs.

The recently launched WHO-led human resources for health (HRH) labor market analysis policy brief highlights gaps in HRH planning, financing, and management. MOH also recently completed a mapping and classification of PEPFAR-funded positions to determine whether they remain critical in the current epidemiological context. Using these and other assessments, you will

Step 1: Review the Opportunity 11 assist the MOH in strengthening the health sector workforce through data-driven planning and enhanced performance management.

MOH’s ability to lead, govern, coordinate, manage finances, and effectively develop and use its human capital will determine whether it can sustain the gains made toward ending HIV as a public health threat.

Purpose The purpose of this NOFO is to enhance the Eswatini MOH’s role and capacity to strengthen internal systems, structures, and processes toward a sustainable and resilient HIV/TB response. It focuses on improving leadership and governance, financial resource mobilization and management, and workforce planning and performance.

Approach Program logic model The following logic model includes the expected strategies under this NOFO.

The logic model also includes the program’s expected outcomes. Outcomes are the results that you intend to achieve and usually show the intended direction of change, such as increase or decrease.

The asterisked ( * ) outcomes are those we expect you to achieve or substantially contribute to during the five-year period of performance. You must report on these outcomes.

Not all outcomes apply to all strategies. You will use these outcomes as a guide for developing performance measures.

Step 1: Review the Opportunity 12

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1:

Strengthen MOH leadership and governance to lead the response to HIV/ TB and related public health threats focused on national and regional levels.

Strategy 2: Enhance MOH capacity to mobilize and effectively manage financial resources for sustaining the HIV/TB response.

Strategy 3: Optimize MOH HRH planning and performance management for HIV/ TB and related service delivery.

Improved coordination and communication between the Senior Management Team, Directorate, National Program Leads, RHMTs, and Nurse Managers.*

Increased capacity to prepare the national health budget, develop funding proposals for external aid, and manage and report on donor funding.*

Increased government and external stakeholder visibility of HIV/TB program funding, budgets, and spending.*

Improved quality and reliability of HRH data.

Improved alignment of employment titles and job descriptions across MOH and donor-supported

HRH.*

Increased leadership and performance management skills of supervisors and managers at national and regional levels.*

Improved performance along organizational capacity building maturation indices.*

Improved mobilization and use of donor and government resources for HIV/TB and related programs.*

Reduced rate of leadership vacancies at national, regional, and facility levels.

Improved alignment of donor-supported HRH compensation with government compensation plan.*

Increased analysis and use of HRH data for decision-making.*

Increased MOH staff adherence to human resource policies, procedures, management practices, and supervisory processes.*

Strengthened MOH leadership, management, and coordination.*

Improved performance of national HIV/TB and related programs.

Improved accountability, efficiency, transparency, and stakeholder engagement in financing and spending for HIV/TB and related public health programs.*

Improved coverage and availability of healthcare workers at national, regional, and site levels for sustaining epidemic control and related public health threats.

Sustained availability of reliable and accurate HRH data for policy and evidence-based decision-making.*

Improved management of the HRH lifecycle.*

Step 1: Review the Opportunity 13

Strategies and activities This section elaborates on the strategies described in the logic model by providing expected activities and details about how you expect to implement your program.

The following are strategies and the required and optional activities under this NOFO. You may also propose additional related strategies and activities to achieve the expected outcomes.

Strategy 1: Strengthen MOH leadership and governance to lead the response to HIV/TB and related public health threats focused on national and regional levels.

Required activities

• Support the development and implementation of leadership development strategies, initiatives, and/or continuous learning programs in collaboration with local institutions to upskill current MOH leaders and groom internal MOH talent for advancement. Topics may include:

◦ Strategic planning.

◦ Effective communication.

◦ Conflict resolution.

◦ Change management.

◦ Financial oversight.

◦ Risk management.

• Support the Principal Secretary’s office, and other offices/departments, as guided by the MOH Senior Management Team, in strengthening and institutionalizing process mapping and process management to improve organizational performance and efficiency.

• Use an organizational capacity-building model to track the maturation of organizational processes over time.

• Support the development and/or operationalization of health statutes, regulations, and policies, including the Health Act 2023.

• Develop and support processes that improve internal and external communication, coordination, and collaboration.

• Design mechanisms that will improve ownership and accountability of program performance at national and regional levels.

• Develop processes and frameworks for periodic institutional review of the organizational structure of MOH programs.

Step 1: Review the Opportunity 14

Strategy 2: Enhance MOH capacity to mobilize and effectively manage financial resources for sustaining the HIV/TB response.

Required activities

• Support MOH to develop a framework for ensuring visibility of donor funding for health services to government and stakeholders.

• Assist MOH in implementing robust internal controls in line with relevant public finance rules and regulations.

• Build MOH capacity to identify and apply for external and domestic funding opportunities, including innovative health financing mechanisms.

• Support the MOH to develop accurate and timely management accounts and financial reports for sharing with internal and external stakeholders.

• Support MOH to collaborate with central ministries to strengthen accountability and oversight of donor-supported activities.

• Assist in conceptualizing, establishing, and operationalizing a health external aid management structure.

• Support MOH to use financial data for improved budgeting, programmatic planning, and policy decision making.

Optional activities:

• Assist the MOH in understanding the financial implications of absorbing donor-supported HIV/TB activities.

Strategy 3: Optimize MOH HRH planning and performance management for HIV/TB and related service delivery.

Required activities

• Support MOH to develop a costed health workforce strategy and staffing plan for advocacy with Central Ministries to sustainably support HIV/TB and related service delivery. This may include:

◦ Reviewing and revising job descriptions and schemes of service based on core, emerging, and obsolete functions.

◦ Identifying donor-supported positions that need to be transitioned/ absorbed into MOH functions.

◦ Identifying critical vacancies, positions that can be repurposed, and new positions that may be needed within the MOH structure.

Step 1: Review the Opportunity 15

◦ Identifying HIV/TB response core functions that other partners, including faith-based organizations and community-based organizations, are better positioned to support.

◦ Proposing organograms that better align with service delivery and program needs.

• Support MOH to improve processes and coordination with the Ministry of Public Service for timely recruitment of vacancies.

• Develop an onboarding and handover policy and training framework for new and newly promoted staff.

• Review and strengthen national HRH data sources and systems to ensure availability and facilitate use of quality and reliable HRH data.

• Support MOH to implement the government’s human resource performance management system.

• Support retention and performance through providing technical support for continuous improvement of the health workforce wellness program.

• Support MOH to develop policies to ensure alignment of donor-supported HRH compensation with the government compensation plan.

To support the purpose of this NOFO, you are expected to provide copies of and/or access to all data, software, tools, training materials, guidelines, and systems developed under this NOFO to Ministry of Health and other relevant stakeholders, including HHS/CDC, for appropriate use consistent with underlying authorities.

Epidemic control activities In coordination with the Global Health Security and Diplomacy (GHSD) Bureau at the U.S. Department of State, and as part of PEPFAR, CDC works with host country governments and other partners. Together, we assess the needs of each country and design a plan for assistance that fits within the host nation’s strategic plan.

We consider a national HIV epidemic to be under control when:

• The number of HIV-related deaths is declining, and

• The number of new infections is less than the number of deaths.

Controlling the epidemic does not mean that HIV will be eliminated. Instead, it means that the number of people with HIV in the population is decreasing. If new infections or death rates increase, this means the epidemic is no longer under control.

Step 1: Review the Opportunity 16

Our work doesn’t end when we reach epidemic control; we must sustain the gains. During your award we may ask you to conduct additional activities to reach and maintain epidemic control, consistent with the scope of this NOFO and the related policies below. This may include:

• Improving prevention, testing, and treatment efforts for HIV/AIDS, TB, sexually transmitted infections (STI), and related opportunistic infections, especially among vulnerable, key, and priority populations as defined in PEPFAR’s annual Country/Regional Operational Plan (COP/ROP) Guidance.

• Promoting sustainable, country-led approaches to managing HIV/AIDS and TB and empowering national and local partners to take the lead in designing and conducting high-quality and cost-effective programs. This could involve forming new partnerships with private, public, local, and multisector entities that can complement and expand the reach of existing programs.

• Improving and expanding laboratory, surveillance, and information systems and using the PEPFAR platform for broader disease surveillance and public health programs in ways that align with PEPFAR goals and initiatives.

• Enhancing efforts to prevent, detect, respond to, and treat other diseases affecting people living with or at risk of HIV.

Related policies If awarded, any activities you conduct must follow the directions in:

• Reimagining PEPFAR’s Strategic Direction: Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030.

• PEPFAR’s annual COP/ROP Guidance and approved COPs/ROPs.

• Similar forthcoming strategy, guidance, or planning documents that are consistent with relevant laws.

Geographic focus The geographic focus of this program may change during the period of performance, based on the burden of disease and changing program and PEPFAR priorities.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 17 https://www.state.gov/reports-pepfar/ https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf https://www.state.gov/reports-pepfar/

Outcomes We expect you to achieve or substantially contribute to the outcomes asterisked ( * ) in the logic model by the end of the five-year period of performance. You will be expected to report on these outcomes.

Focus populations The focus populations for this NOFO include:

• MOH Executive Leadership.

• MOH Senior Management Team.

• MOH Program Managers and Technical Leads.

• RHMTs.

• Central ministries’ personnel seconded to MOH.

Equal opportunities This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of:

• Race.

• Color.

• National origin.

• Disability.

• Age.

• Sex (including gender identity, sexual orientation, and pregnancy).

• Other constitutionally protected statuses.

Health disparities The goal of health equity is for everyone to have a fair and just opportunity to be as healthy as possible. Health disparities are often caused by social determinants of health. Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age.

These determinants affect a wide range of health, functioning, and quality-of-life outcomes and risks. They also influence which populations are most affected by health conditions.

A health disparity is a difference in health burdens between groups of people with differing social determinants of health.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 18 https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html

We expect all proposed activities to affirm and advance health equity and an equitable, diverse, and inclusive workforce as core principles. In addition to the strategies and activities listed above, during your award, we may ask you to conduct activities consistent with local laws to:

• Address health disparities in access to and use of HIV and TB services.

• Reduce HIV and TB stigma and discrimination.

• Promote civil and human rights to improve health outcomes of people living with or at risk of HIV and TB.

• Make the workforce more inclusive.

Organizational capacity You must include a heading in your Project Narrative titled Organizational Capacity, under which you should include a brief description of your organizational capacity to carry out these strategies and activities.

You must also provide supporting documentation in your attachments. See the attachments section for full instructions.

Collaborations If funded, we will expect you to collaborate with:

• MOH.

• Other Kingdom of Eswatini line ministries and parastatals, including:

◦ Prime Minister’s Office.

◦ Ministry of Economic, Planning, and Development.

◦ Ministry of Finance.

◦ Ministry of Public Service.

◦ Ministry of Commerce.

◦ National Emergency Response Council for HIV and AIDS (NERCHA).

• Training and academic institutions.

• Multilateral institutions, including:

◦ World Bank.

◦ WHO.

◦ UNDP.

◦ UNAIDS.

◦ UNICEF.

◦ Global Fund.

Step 1: Review the Opportunity 19

◦ European Union.

◦ Africa CDC.

• U.S. government agencies, CDC, and other PEPFAR-supported implementing partners.

• Other implementing partners, as identified based on the evolving landscape and priorities.

Through the PEPFAR program, CDC works with partners to help prevent HIV infection, provide life-saving treatment to people living with HIV, and reduce HIV-related deaths. We encourage our partners to collaborate with local organizations, U.S.-based organizations, and international partners. The goal of this collaboration is to complement efforts to lower costs, make programs more effective, sustain the gains, and accelerate progress towards the three UNAIDS 95-95-95 targets:

• At least 95% of people living with HIV know their HIV status.

• At least 95% of people who know their HIV status are on treatment.

• At least 95% of people on treatment have a suppressed viral load.

If you work with key populations as defined in PEPFAR’s annual COP/ROP Guidance, we will expect you to collaborate with them when designing, delivering, and monitoring HIV services.

Data, monitoring, and evaluation CDC expectations CDC expects you to review, clean, and use routine performance data for program management. As a result, you should hold regular review meetings to discuss performance and use data to inform program quality improvement activities.

In your application budget, you should allocate at least 10% of funds for monitoring activities and 5% for evaluation activities. We will discuss these percentages and finalize them at or after award. These are estimates for the total funding over the 5-year project.

Required performance measures

Overview This program includes two types of indicators. These include:

• PEPFAR’s Monitoring, Evaluation, and Reporting (MER) indicators common to all awards. You can find additional information regarding

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 20

MER reporting in the MER Guidance and resource materials, available at DATIM’s MER Indicator Reference Guides.

• Custom indicators that either we or you create. These monitor achievement of outcomes not directly measured by MER indicators.

These include process and outcome measures that directly correlate with the logic model.

The indicators shown below may change before award or in future years. For example, any gaps or unmet needs not fulfilled in the first year may affect the targets in later years.

MER indicators There are currently no MER indicators applicable for this NOFO, but that may change in future project years.

Custom indicators Below we show some anticipated custom indicators, targets, and reporting frequencies for the first year. You may also propose custom indicators.

• Percentage of partner-supported government units that have increased at least one step along an organization capacity maturity index. [Target:

90%; Reporting Frequency: Semi-Annual]

• Percentage of financial management and internal control gaps assessed that are addressed. [Target: 100%; Reporting Frequency: Annual]

• Percentage of funding applications that are successful. [Target: 75%;

Reporting Frequency: Annual]

• Percentage of government and donor funding available in the reporting period that was used. [Target: 90%; Reporting Frequency: Quarterly]

• Percentage of vacant leadership positions at the beginning of the reporting period that are successfully filled within the reporting period.

[Target: 75%; Reporting Frequency: Quarterly]

• Percentage of staff performance reviews completed within a reporting period. [Target: 90%; Reporting Frequency: Annual]

• Percent concordance of Human Resources Information System (HRIS) data and physical staff count. [Target 90%; Reporting Frequency: Annual]

Data sources for MER and custom indicators Data sources may include HRIS, performance management system reports, financial and audit reports, staff audit reports, quarterly progress reports, and other program monitoring tools.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 21 https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

Evaluation Below, we include examples of evaluation topics that we may expect you to answer through process, outcome, or economic evaluation. In your application, include at least one, but no more than three potential evaluation questions. We will expect you to conduct a mid-term evaluation.

• The extent to which interventions improved or established systems and/ or structures for continuous leadership and coordination skill-building as staff are promoted or onboarded: outcome evaluation.

• The extent to which interventions improved the MOH ability to effectively mobilize, use, and share financial information: outcome evaluation.

• Barriers and facilitators of optimal HRH staffing and performance:

process evaluation.

Evaluation data sources Data sources may include, recipient progress reports, focus groups and other program monitoring tools.

Dissemination of evaluation results Dissemination channels could include:

• Local and international conferences and forum abstract presentations.

• Conference poster displays.

• Manuscripts.

• Bulletins.

• Reports.

• Presentations to technical working groups and stakeholder meetings.

• Other approved products in print and electronic media.

The primary intended users of evaluation results and findings will be the wider program stakeholders.

CDC and stakeholders will use overall evaluation findings during the 5-year project period to share and implement key recommendations to strengthen program implementation and effectiveness, sustainability, and continued program improvement after the award ends.

All evaluation reports will be publicly available on PEPFAR resource sites.

Step 1: Review the Opportunity 22

Evaluation and performance measurement plan You must submit an initial draft of your evaluation and performance measurement plan with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

As you develop your evaluation and performance measurement plan, align it with national, PEPFAR, and agency priorities as detailed in the NOFO. If awarded, we will work with you to finalize the plan and ensure it takes into account agreements made during COP/ROP planning.

Include the following elements in your evaluation and performance measurement plan.

Methods Describe how you will:

• Collect the performance measures.

• Respond to the evaluation topics.

• Use evaluation findings for continuous program quality improvement.

• Incorporate evaluation and performance measurement into planning, implementing, and reporting of project activities.

Additionally, explain:

• How findings will contribute to reducing or eliminating health disparities, as relevant.

• How key program partners will participate in the evaluation and performance measurement process.

• How feasible it will be to collect appropriate evaluation and performance data.

• How you will share evaluation findings with communities and populations of interest in a way that meets their needs.

• Other relevant information, such as performance measures you propose.

Evaluation activities You must carry out specific evaluation activities.

At least one evaluation must be carried out for each cooperative agreement during the course of funding. The evaluation can be:

• Process evaluation: Measures how the intervention was delivered, what worked and did not, the differences between the intended population and the population served, and access to the intervention.

Step 1: Review the Opportunity 23

• Outcome evaluation: Determines the effects of the intervention in the focus population, such as change in knowledge, attitudes, behavior, or capacity.

• Economic evaluation: Determines cost, cost drivers, cost effectiveness, efficiency, factors influencing economic behavior and choices, or the economic impact of interventions or activities to justify the investment.

Describe:

• The type of evaluations you will complete (process, outcome, and/or economic).

• Key evaluation questions these evaluations will address.

• Other information, such as measures and data sources.

Data management plan (DMP) For all public health data you plan to collect, a DMP is required. For a definition of “public health data” and other key information, see AR 25: Data Management and Access on our website.

You must submit an initial draft of your DMP with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

Submit your initial DMP with your application and include:

• The data you will collect or generate and their sources.

• Any reasons why you cannot share this data with CDC. These could include legal, regulatory, policy, or technical reasons.

• Who can access the data and how you will protect and secure it.

• Data standards that explain what documentation released data will have.

That documentation should describe collection methods, what the data represent, and data limitations.

• Archival and long-term data preservation plans.

• How you will update the DMP as new information becomes available during the project. You will provide updates to the DMP in annual reports. For more information about CDC’s policy on the DMP, see Data Management and Access Requirement at CDC’s website.

In addition to the other requirements listed, also include:

• Cybersecurity plans.

• How you will protect personally identifiable information (PII) when you collect, store, transfer, and use this data.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 24 https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html

• How you will remove information from the data that could reveal participants’ identities (de-identify the data) in intermediate and final data sets.

CDC and PEPFAR will inform you of data you need to share with us and how and when it should be shared.

Work plan You must provide a work plan for your project. The work plan connects your performance outcomes, strategies and activities, and measures. It provides more detail on how you will measure outcomes and processes. A sample work plan is provided below.

You should provide a detailed work plan for the first year and a high-level work plan for later years.

Table: Sample format

Activities you will implement

Progress or process measures

From the data, monitoring, and evaluation section.

Relevant period of performance outcomes

From the logic model.

Responsible position or party

Funding component / completion date

Strategy 1:

1.

2.

3.

Strategy 2:

1.

2.

3.

Step 1: Review the Opportunity 25

Paperwork Reduction Act Any activities involving information collection from 10 or more individuals or organizations may require Paperwork Reduction Act (PRA) approval. The PRA requires review and approval of the information collection by the White House Office of Management and Budget. For further information to determine if a proposed activity requires PRA approval, contact your project officer. Collections include items like surveys and questionnaires. If you have collections requiring PRA approval, CDC is responsible for working with OMB to gain the approval.

For more information about CDC’s requirements under PRA see CDC Paperwork Reduction Act Compliance.

Funding policies and limitations General policies

• Your budget is arranged in eight categories: salaries and wages, fringe benefits, consultant costs, equipment, supplies, travel, other, and contractual.

• You may use funds only for reasonable program purposes consistent with the award, its terms and conditions, and federal laws and regulations that apply to the award. If you have questions about this determination, ask the grants management officer.

• Generally, you may not use funds to purchase furniture or equipment.

Clearly identify and justify any such proposed spending in the budget.

• All requests for funds contained in the budget should be stated in U.S.

dollars.

• Cost increases due to changes in exchange rates are allowed if enough funding is available. If an increase in the exchange rate would reduce the scope of the project or cause you to need more federal funding, you must get prior approval for exchange rate fluctuations.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting your project’s objectives.

◦ A decision that continued funding is in the government’s best interest.

• If we receive more funding for this program, we will consider:

◦ Funding more applicants.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 26 https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=13f24ea1f961f5f0d14b87ec1b39b25f&term_occur=999&term_src=Title:45:Chapter:A:Subchapter:A:Part:75:Subpart:E:Subjgrp:39:75.440

◦ Extending the period of performance.

◦ Awarding supplemental funding.

See also program-specific limitations.

Unallowable costs You may not use funds for:

• Research.

• Clinical care, except as allowed by law.

• Pre-award costs, unless we give you prior written approval.

• Other than for normal and recognized executive-legislative relationships:

◦ Publicity or propaganda purposes, including preparing, distributing, or using any material designed to support or defeat the enactment of legislation before any legislative body.

◦ The salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body.

◦ See Anti-Lobbying Restrictions for CDC Recipients.

• Needle exchange programs.

For guidance on some types of costs that we restrict or do not allow, see 45 CFR part 75, General Provisions for Selected Items of Cost.

Indirect costs Indirect costs have a common or joint purpose across more than one project and cannot be easily separated by project. Learn more at CDC Budget Preparation Guidelines.

To charge indirect costs you can select one of two methods:

Method 1 — Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency.

Provide a summary of the rate. Enclose a copy of the current approved rate agreement in your attachments.

Method 2 — De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 27 http://www.cdc.gov/grants/documents/Anti-Lobbying_Restrictions_for_CDC_Grantees_July_2012.pdf https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.ecfr.gov/current/title-2/section-200.414 rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

Foreign organizations and foreign public entities Indirect costs on awards to foreign organizations and foreign public entities performed fully outside of the U.S. and its territories may be paid to support the costs of complying with federal requirements. This rate is fixed at eight percent of MTDC exclusive of tuition and related fees, direct expenditures for equipment, and subawards in excess of $25,000. Negotiated indirect costs may be paid to the American University, Beirut, and the World Health Organization.

Other indirect cost policies

• As described in 45 CFR 75.403(d), you must consistently charge items as either indirect or direct costs and may not double charge.

• Indirect costs may include the cost of collecting, managing, sharing, and preserving data.

Salary rate limitation As of January 2024, the HHS/CDC salary rate limitation is $221,900. This salary rate limitation does not apply to PEPFAR funds, which are part of an appropriation from the U.S. Department of State; but to the extent that HHS/ CDC funds are added to an award, this limitation applies. We will update this limitation in future years.

Program income Program income is money earned as a result of your award-supported project activities. You must use program income for the purposes and under the conditions of the award. Find more about program income at 45 CFR 75.307.

Program-specific limitations

CDC PEPFAR terms and conditions You can find a list of PEPFAR-specific terms and conditions on our website.

They apply to all PEPFAR awards, so we strongly encourage you to read them and ask questions if you need more information. These terms and conditions will apply if you are selected for an award so you should confirm that you are able to comply with them prior to applying.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 28 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-45/part-75#p-75.403(d) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307 https://www.cdc.gov/grants/documents/PEPFAR-Terms-and-Conditions.pdf

Host country laws and regulations If funded, you are expected to follow applicable host country laws and regulations related to the strategies under this NOFO; if there are conflicts with this award, contact the Grants Management Officer.

Step 1: Review the Opportunity 29

Step 2:

Get Ready to Apply

In this step

Get registered 31

Questions 32

Get registered You must be registered in both SAM.gov and Grants.gov to apply. You can review the requirements and get started on developing your application before your registrations are complete.

SAM.gov You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI). SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist for the information you will need to register.

When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations. You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

Grants.gov You must also have an active account with Grants.gov. You can see step-by-step instructions at the Grants.gov Quick Start Guide for Applicants.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number

CDC-RFA-JG-25-0072.

If you can’t use Grants.gov to download application materials or have other technical difficulties, including issues with application submission, contact Grants.gov for assistance. The Grants.gov Contact Center is available 24 hours a day, 7 days a week, except U.S. federal holidays. The Contact Center is available by phone at 1-800-518-4726 (U.S.) and 1-606-545-5035 (international) or by email at support@grants.gov.

We will post any changes, updates, or amendments on Grants.gov. To get updates on changes to this NOFO, select Subscribe from the View Grant Opportunity page for this NOFO on Grants.gov.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 31 https://sam.gov/content/entity-registration https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://grants.gov/search-grants https://www.grants.gov/support https://www.grants.gov/support mailto:support@grants.gov

Need help? See Contacts and Support.

Help applying For help related to the application process and tips for preparing your application, see How to Apply on our website. For other questions, see Contacts and Support.

Questions If you have questions, you must submit them by email to pepfarfoas@cdc.gov no later than 20 calendar days after the NOFO is published to Grants.gov. We will not respond to questions received later. We will post answers to questions in a Q&A document in the Grants.gov application package.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 32 https://www.cdc.gov/grants/applying/index.html mailto:pepfarfoas@cdc.gov

Step 3:

Prepare Your Application

In this step

Application contents and format 34

Application contents and format…