Family Planning Flagship.pdf

SOLICITATION TYPE: REQUEST FOR INFORMATION (RFI)

RFI NUMBER: RFI-720656-Catalyzing Access to Family Planning

PROGRAM NAME: USAID Catalyzing Access to Family Planning

ISSUANCE DATE: December 27, 2024

CLOSING DATE FOR

SUBMISSION OF RESPONSES: February 15, 2025

Dear Potential Applicant/ Offeror, USAID/Mozambique intends to design a new Activity – USAID Catalyzing Access to Family

Planning - that will aim to support Mozambicans to achieve their fertility intentions thereby improving the health outcomes of Mozambican women, men, and youth by increasing use of quality, person-centered FP services. With a clear focus on voluntarism and informed choice, the FP Flagship Activity will address persistent barriers experienced by Mozambican individuals and communities related to FP/RH service delivery and expand their access to equitable, affordable, and sustainable FP/RH information, products, and services. This is anticipated to be a five (5) year award 2025-2030, with a total value of up to $35 million.

The purpose of this communication is to obtain industry information on the above-mentioned activity. More specifically, the RFI intends to:

● Assess the interest of potential organizations in submitting applications/ proposals for the new USAID Catalyzing Access to Family Planning

● Gain technical and organization insights in the capacity of potential organizations

● Gain technical inputs and suggestions for adjusting, adding, or reducing elements of the

Results Framework for the greatest possible health outcomes

Attachment B presents the set of questions to which organizations should respond. Note that this is a RFI and not a Request for Applications (RFA) or a Request for Proposal (RFP). This RFI is not to be construed as a commitment by the U.S. Government to issue any solicitation or ultimately an award on the basis of this RFI, or to pay for any information submitted as a result of this request. Please do not submit a full application or statements in response to this RFI. It should be noted that responding to this RFI will not give any advantage to any organization in the subsequent procurement.

USAID/Mozambique may use feedback and comments from this RFI to develop future programs. If a solicitation is issued for this activity, it is the organization’s responsibility to monitor the sites https://www.grants.gov or www.sam.gov and local newspapers for the release of any further information.

Please submit responses to this RFI to Nelly Mahanjane at mission-maputo-oaa@usaid.gov no later than the date provided at the top of this RFI. Late submissions will not be accepted. The subject line of the e-mail must read “RFI – USAID Catalyzing Access to Family Planning.''

Responses can be submitted in English or Portuguese, they must include the organization's name, address, point of contact, phone number and email address. You will receive an electronic confirmation acknowledging receipt of your response. Hard copy responses will not be accepted and are discouraged.

Sincerely, Alice Gillispie

Supervisory Contracting/Agreement Officer

Attachments:

• Attachment A – Brief Activity Concept Overview

• Attachment B – Response Requirements

• Attachment C- RFI translated in Portuguese

Attachment A: Brief Activity Concept Overview for USAID Catalyzing Access to Family

Planning in Mozambique

Contextual Analysis

Family planning and reproductive health (FP/RH) positively impact women’s and girls’ health, well-being, empowerment, and agency by improving their socio-economic status, allowing girls to remain in school and attain higher levels of education, enabling their full participation in the workforce, and supporting their civic engagement1. Increasing access to FP information and services can help reduce the number of unintended pregnancies as well as maternal and newborn deaths, leading to healthier families and communities. USAID’s efforts in FP/RH have significantly contributed to increased voluntary use of contraceptives and more informed decision-making regarding FP/RH for women, men, youth, and couples globally2.

The proposed new flagship FP Activity builds upon the previous FP flagship project, Improved

Family Planning Initiative (IFPI). Findings from the IFPI mid-term evaluation demonstrated a higher rate of engagement in FP activities in women aged 20 to 49 as compared to adolescent girls, indicating a wider acceptance and involvement. In addition, cultural beliefs and practices, including child/early/forced marriage, hinder decision-making, access, and use of modern contraception. Persistent challenges included sociocultural norms around reproductive health decision-making centered on male partners and family member preferences, stockouts of preferred methods, and confidentiality concerns, particularly affecting adolescent girls. In general, Mozambican health providers offer a welcoming environment in the majority of the consultations, but continued skill-building in comprehensive counseling is still needed and the retention of technically trained staff poses a challenge.

Learning from past experiences and following the recommendations from the mid-term evaluation, this new FP activity seeks to expand its FP initiatives, especially in rural areas, by utilizing evidence-based social behavior change and communications approaches and increasing positive male engagement. Engaging community leaders, parents and young men about the benefits of delayed marriage and childbirth, highlighting the positive impacts on health, economic opportunities, and overall well-being is a good practice to be maintained. It will also be important for the new activity to focus on continuous professional development and training for providers, such that they are equipped to deliver comprehensive information, counseling

1 Investing in Family Planning: Key to Achieving the Sustainable Development Goals. Ellen Starbird, Maureen Norton, Rachel Marcus. Global

Health: Science and Practice Jun 2016, 4 (2) 191-210; DOI: 10.9745/GHSP-D-15-00374

Pathways to Progress for Sexual and Reproductive Health. Technical Approach of USAID’s Family Planning and Reproductive Health

Program. 2024-2030. USAID.

https://dec.usaid.gov/dec/content/Detail_Presto.aspx?ctID=ODVhZjk4NWQtM2YyMi00YjRmLTkxNjktZTcxMjM2NDBmY2Uy&rID=NjMxODE0&qrs=RmFsc2U%3d&q=RG9jdW1lbnRzLkZpbGU6KFVTQUlEIE1vemFtYmlxdWUgSUZQSSBNaWR0ZXJtIEFzc2Vzc21lbnQp&ph=VHJ1ZQ%3d%3d&bckToL=VHJ1ZQ%3d%3d&rrtc=VHJ1ZQ%3d%3d https://www.ghspjournal.org/content/4/2/191 https://www.usaid.gov/sites/default/files/2024-07/PRH_USAID_2024_Global_Health_PRH_Pathways_Report-FINAL_508__1.pdf and support when accessing health services. Finally, close coordination with supply chain and logistics efforts will be critical to ensure FP commodity management to facilitate FP activities.

Context and Challenges

Mozambique faces significant challenges in meeting the reproductive intentions and FP/RH needs of their populations; access to and use of FP/RH remains limited due to multiple intersecting factors. First, considering an approximate 2.8% population growth, the

Mozambican population is projected to double by 2050. This translates to a growing number of women of reproductive age who could benefit from modern contraception. The modern contraceptive prevalence rate has doubled in Mozambique, increasing from 12 to 25 percent

(DHS 2011 to DHS 2023), yet stagnated when compared with IMASIDA 2015 (25 percent). The unmet need for FP increased from 2015 to 2023, from 23% to 27%, reflecting a total demand for FP at 53% in the DHS 2023. Mozambique’s mCPR still ranks lowest when compared with neighboring countries. The total fertility rate has reduced slightly from 5.9 to 4.9 (DHS 2011 to

DHS 2023).3 This national average, however, masks striking differences between urban and rural populations: the urban TFR is 3.6 and rural TFR is 5.8. Total demand for FP in urban areas is 64%, compared to 48% in rural areas; and use of FP in urban areas is 40% as compared to

18% in rural areas. Deeply rooted social and gender norms and cultural and religious beliefs often prevent Mozambicans from seeking, accessing, and using FP/RH information and services.

Frequent stockouts of contraceptives, a reduced government budget for the national health system including health commodities and other access challenges, particularly in the northern and more populous provinces of Zambézia and Nampula, have contributed to this mCPR stagnation. There is an ongoing shortage of critical FP commodities. In 2024, there was an approximate gap of $3M needed to sufficiently provide FP methods to the entire population.

This gap is projected to grow significantly in 2025, to approximately $8M. Injectables, the most common contraceptive method used, are stocked-out at an average of 14 percent. Moreover, there are challenges in maintaining a functioning and efficient commodity distribution system along the full supply chain. While this FP Activity will not procure commodities; it will work in concert with complementary commodity procurement investments by USAID/Mozambique to ensure commodity procurement, arrival, warehousing, distribution, and last mile delivery.

As noted above, it will be important that this Activity addresses the unique FP/RH needs of adolescent girls and young women (AGYW). AGYW face discrimination, gender-based violence

(GBV), and poverty. According to a 2024 Human Rights Watch report, the country has the fifth

3 Mozambique DHS 2022-2023.

https://dhsprogram.com/publications/publication-FR389-DHS-Final-Reports.cfm highest rate of child marriage in the world, and its adolescent pregnancy rate is the highest in

East and Southern Africa: 180 out of 1,000 AGYW aged 15-19 gave birth in 2023, in contrast with the regional average of 94 births per 1,000 girls4. The median age at first sex and first marriage are 16.8 and 18.2 respectively, and an alarming 36 percent of adolescent girls aged

15-19 have begun childbearing, reaching between 40-55% in populated northern provinces. Per the 2022-23 DHS, only 14 percent of girls aged 15-19 and 24 percent of those aged 20-24 use modern contraception5. This creates a precarious situation, as evidence suggests that early motherhood is associated with a diverse range of adverse health outcomes for both the mother and child6. Furthermore, adolescent mothers face physical, emotional, and social stigma and often experience mental health challenges7 8, and, as a result, they are less likely to continue their education or fully engage in other opportunities9. FP/RH interventions for AGYW and their male counterparts must be age- and stage-appropriate and designed to accommodate the needs of youth10, including demystifying inaccurate perceptions about modern contraception and promoting body literacy.

The meaningful engagement of men and boys is an essential part of creating gender equality and equity and transforming social and gender norms, but this remains a challenge11. While male involvement is critical to achieving household prosperity, and men fulfill important roles and societal expectations that impact a couple's fertility intentions and use of contraception12, male involvement in the Mozambique family planning context is often limited. Meaningful male engagement can increase uptake and continuation of FP/RH care by improving couples’ communication and ability to achieve their reproductive intentions, and it can decrease male opposition13. Encouraging men to use contraception (e.g., condoms and vasectomy) and to be advocates for gender equality in their communities is vital to preventing maternal and child

Girls Shouldn’t Give Up On Their Studies: Pregnant Girls’ and Adolescent Mothers’ Struggles to Stay in School in Mozambique. February 13, 2024. Human Rights Watch.

5 Mozambique DHS 2022-2023.

Ahmad K, Kabir E, Keramat SA, Khanam R. Maternal health and health-related behaviours and their associations with child health: Evidence from an Australian birth cohort. PLoS One. 2021 Sep 13; 16(9):e0257188. PMID: 34516561; PMCID: PMC8437270.

7 Zoe Aitken, Belinda Hewitt, Louise Keogh, Anthony D. LaMontagne, Rebecca Bentley, Anne M. Kavanagh. Young maternal age at first birth and mental health later in life: Does the association vary by birth cohort? Social Science & Medicine, Volume 157, 2016, Pages 9-17, ISSN 0277-

9536, https://doi.org/10.1016/j.socscimed.2016.03.037.

8 Mangeli M, Rayyani M, Cheraghi MA, Tirgari B. Exploring the Challenges of Adolescent Mothers From Their Life Experiences in the

Transition to Motherhood: A Qualitative Study. J Family Reprod Health. 2017 Sep;11(3):165-173. PMID: 30018654; PMCID: PMC6045691.

9 The Social and Educational Consequences of Adolescent Childbearing. February 25, 2022. World Bank

Adolescent-Responsive Contraceptive Services: Institutionalizing adolescent-responsive elements to expand access and choice. FP HIP.

Gender Equity & Male Engagement (report). 2018. ICRW.

Engaging Men and Boys in Family Planning: A Strategic Planning Guide. FP HIP.

Kabagenyi, A., Jennings, L., Reid, A. et al. Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda. Reprod Health 11, 21 (2014). https://doi.org/10.1186/1742-

4755-11-21 https://www.hrw.org/report/2024/02/13/girls-shouldnt-give-their-studies/pregnant-girls-and-adolescent-mothers-struggles https://dhsprogram.com/publications/publication-FR389-DHS-Final-Reports.cfm https://pmc.ncbi.nlm.nih.gov/articles/PMC8437270/ https://www.sciencedirect.com/science/article/pii/S027795361630137X#:~:text=In%20models%20adjusted%20for%20early,25%20years%20and%20older%20(Late https://www.sciencedirect.com/science/article/pii/S027795361630137X#:~:text=In%20models%20adjusted%20for%20early,25%20years%20and%20older%20(Late https://pmc.ncbi.nlm.nih.gov/articles/PMC6045691/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6045691/ https://genderdata.worldbank.org/en/data-stories/adolescent-fertility https://www.fphighimpactpractices.org/briefs/adolescent-responsive-contraceptive-services/ https://www.icrw.org/publications/gender-equity-male-engagement-report/ https://www.fphighimpactpractices.org/guides/engaging-men-and-boys-in-family-planning/ https://reproductive-health-journal.biomedcentral.com/articles/10.1186/1742-4755-11-21#citeas deaths, improving women’s and girls’ opportunities for education, employment, and full participation in society, and promoting family and community prosperity.

Leverage Points / Opportunities

This new FP Flagship Activity will build on a number of FP/RH initiatives in Mozambique. The

GRM committed to the global FP2030 Partnership and has pledged to expand the number of trained FP/RH providers, increase the contraceptive commodity availability, and improve the integration of FP with other health services. At this time, FP integration with other services is gaining traction. In 2024, Mozambique finalized its National FP Strategy and Costed

Implementation Plan (2023-2030) and aligned with its FP2030 commitments. To improve FP data collection, analysis, and use, Mozambique updated its health facility register tools with disaggregation that allows for better analysis and developed corresponding dashboards in use for all provinces. Although there are contraceptive availability challenges, Mozambique also recognizes the importance of increased FP access and is implementing initiatives that promote and increase its voluntary use; for example, the Ministry of Health (MoH) seeks to expand FP provision at the community level by community health cadres and offering the option of FP self-injection (DMPA-SC) to clients. To complement these activities, the MoH and different FP partners, have Collaborating, Learning and Adapting (CLA) sessions where there are opportunities to share experiences, learn and monitor progress across the country.

To promote voluntary FP among adolescents and youth, Mozambique is implementing FP/RH activities at the school level, supported with counseling and an established referral system.

Mozambique is also implementing the PEPFAR DREAMS Initiative, reaching AGYW, their partners, families, and communities. Under DREAMS NextGen, adolescent boys and young men

(ABYM) can participate. This brings implications for FP uptake, as DREAMS will strengthen holistic FP/RH services to both AGYW and ABYM in health facilities and the community. As data show, the couple years protection (CYP) in youth is growing, and teenage pregnancies among

AGYW aged 15-19 have reduced from 46 percent in 2015 to 36 percent in 2022-2314. The new

FP Activity will align with the GRM’s youth strategy and existing activities to ensure a focus on reaching youth with age-appropriate FP information and services.

Additionally, the new FP Flagship Activity will complement current and upcoming projects that will improve the health outcomes in Sofala, Zambezia, and Nampula provinces. The Activity will coordinate with the maternal, newborn, child health, immunization, and nutrition projects, PEPFAR projects, supply chain and procurement activities, and Government-to-Government mechanisms. Finally, the new FP Flagship Activity will build on best practices, such as health

Mozambique DHS 2022-2023.

provider mentorship, task sharing, FP integration across all facility entry points, male engagement and gender transformative programming, and engagement of community and religious leaders and other key influencers.

Outcome and Results

The Mozambique FP Flagship Activity will advance excellence, innovation, and best practices in

FP/RH service delivery through strategic technical assistance at the central level and across three provinces in the country: Nampula, Sofala, and Zambezia. The Activity may also support technical assistance (TA) and target interventions in Cabo Delgado, should USAID receive additional resources. A draft results framework has been developed for the activity.

The overarching goal of the Activity is to support Mozambicans to realize their fertility intentions, and the purpose is to improve the health outcomes of Mozambican women, men, and youth by increasing use of quality, person-centered FP services. The goal and purpose will be reached through the achievement of four Intermediate Results (IRs):

➔ IR 1: Healthy individual and community FP behaviors and norms adopted

➔ IR 2: Access to and availability of FP services at facility and community levels expanded

➔ IR 3: Quality FP services offered by empowered facility and community providers

➔ IR 4: Enabling environment for improved FP strengthened

A strategy for this new Activity will be to instill FP as a national movement, catalyzing increased attention, resources, and leadership commitment from the central level to the local level.

Improved leadership, management, multisectoral coordination, and overall advocacy for FP will strengthen the enabling environment and lay the foundation for the individual, community, and facility-level social and behavior change and service delivery interventions necessary to ensure the realization of fertility goals.

Interventions under the FP Flagship Activity will be designed to produce measurable, clearly defined results. The Activity will focus on locally-led development and inclusion, and it will engage women, men, and youth in implementing, monitoring, and evaluating its efforts.

Emphasis will be placed on adapting and scaling high impact practices in FP, expanding use of existing tools and resources, and building on prior USAID health investments. The Activity will consolidate efforts in current IFPI districts within Nampula, Sofala, and Zambezia provinces, and will potentially expand to new districts in Zambezia.

Interventions and Approaches

With a clear focus on voluntarism and informed choice, the FP Flagship Activity will address persistent barriers experienced by Mozambican individuals and communities related to FP/RH service delivery and expand their access to equitable, affordable, and sustainable FP/RH information, products, and services. Where appropriate, the Activity will include FP/RH integration with related health services, such as HIV, MNCH, immunization, nutrition, and with other sectors. Fundamental to the Activity is the recognition that provinces, districts, communities, and individuals to be served may have different demographic and epidemiologic profiles and unique challenges that require tailored support to address the needs of populations. To that end, the goal and purpose of the Activity will be reached through the achievement of four IRs and sub-IRs. Intervention areas, drawn from globally-accepted, evidence-based High Impact Practices in FP (HIPs), will be described in detail in the Program

Description.

IR 1: Healthy individual and community FP behaviors and norms adopted

● Sub-IR 1.1: Harmful social and gender norms and attitudes that inhibit positive FP behaviors reduced

● Sub-IR 1.2: Accurate and comprehensive information among individuals and communities increased

● Sub-IR 1.3: Gender transformative approaches for and with men/boys and women/girls adopted in communities

● Sub-IR 1.4: Youth and other vulnerable groups meaningfully engaged in the delivery of

FP information and services

Illustrative Intervention Areas:

- Community group engagement

- Localized mass media, including community radio

- Digital health for clients

- Targeted demand generation and service promotion efforts

- First-time parents’ activities

- Body literacy activities for very young adolescents

- Individual and small group interpersonal communication

- Gender norms work, such as healthy couples’ communication and male engagement

- Linkages and referrals to other development programming

- Meaningful engagement of individuals and communities, including youth and other vulnerable groups, such as persons with disabilities, internally displaced persons, racial and ethnic minorities, and persons living in extreme poverty

IR 2: Access to and availability of FP services at facility and community levels expanded https://www.fphighimpactpractices.org/

● Sub-IR 2.1: FP linkages between health facilities and communities strengthened

(referrals, community health committees)

● Sub-IR 2.2: Facility and community FP service provision expanded

● Sub-IR 2.3: Integration of FP with other health services and cross-sectoral program leveraging increased

Illustrative Interventions Areas:

- Formalized communication channels and processes between health facilities and community health workers, community health committees, and other referral providers

- Differentiated service delivery models, e.g., static facilities, mobile brigades, mobile clinics, school corners, Serviços Amigos dos Adolescentes e Jovens (SAAJ) (youth-friendly services)

- Postpartum and postabortion FP service provision

- Mother-to-mother and other relevant support groups

IR 3: Quality FP services offered by empowered facility and community providers

● Sub-IR 3.1: Clinical and technical capacity of FP providers strengthened

● Sub-IR 3.2: Behavioral competencies of FP providers improved

● Sub-IR 3.3: Management and leadership support for quality of care strengthened

Illustrative Intervention Areas:

- Pre-service and in-service training

- Supportive supervision and mentoring

- Job aids

- Digital health for providers

- Provider behavior change activities

- Task sharing

- Values clarification and attitude transformation exercises

- Private sector engagement (e.g., pharmacies)

- FP counseling provision during antenatal appointments

IR 4: Enabling environment for improved FP strengthened

● Sub-IR 4.1: FP accountability, program management, and leadership at all levels of the health system improved

● Sub-IR 4.2: Advocacy for and commitment to catalytic FP national efforts increased

● Sub-IR 4.3: Cross-sectoral and multi-sectoral coordination at all levels strengthened and institutionalized at the national, provincial and district levels

● Sub-IR 4.4: Data quality and use for decision-making and advocacy improved

● Sub-IR 4.5: Capacity of local partner organizations and G2Gs to manage and implement voluntary FP programs strengthened

Interventions Areas:

- Leadership and management for domestic resource mobilization

- Commodity management at provincial, district, and facility levels

- Strengthened systems for data collection, management and analysis

- Training on data quality assurance and visualization

- Social accountability mechanisms

- Capacity strengthening action planning and transition roadmaps

- Private sector engagement

- Co-management committees and feedback and complaint mechanisms

Draft Results Framework Visual of Logic Model

The results framework for the Mozambique FP Flagship Activity is included below.

Attachment B: Response Requirements

USAID/Mozambique seeks to collect feedback on the questions listed below in relation to this

Request for Information (RFI).

A. Response Format (5 Page Limit Total)

● Cover Page: not to exceed one (1) page, that includes

○ Organization name and address, including point of contact name and contact information

○ Organization type (e.g. non-governmental, social enterprise, civil society organization, U.S. small business, local organization, local established organization, international organization)

● Answers: when preparing your responses, please ensure comments are concise and specific to the question asked.

B. Submission Instructions

● All organizations are invited to respond to this RFI.

● Please send responses to this RFI via email to the address listed on the cover page by the closing date listed. Please ensure that you are using 12 pt and Calibri font.

● USAID values concise and issue-specific comments. Responding to each question is not required. USAID values concise, specific and useful responses. For market research purposes, USAID/Mozambique is also interested in your organization’s capabilities, geographic coverage, and experience.

● Responses can be submitted in Portuguese. Please number each page consecutively and please relate your responses to each question included in this RFI.

● Please be reminded that you will only receive an electronic confirmation acknowledging receipt of your response. No feedback or debrief will be provided on comments received. Phone calls or hard copy responses will not be accepted.

● As noted above, please do not submit requests for funding, proposals, or statements of qualifications in response to this request as they will not receive a response.

C. RFI Questions

Please give consideration and respond to the following questions in 300 words or less per response:

1. What is your organization’s contact information (telephone, email, physical address)?

Who is the point of contact for donor coordination?

2. What is the size of your organization in terms of staff, budget and/or annual revenue?

Does your organization have the capacity and the resources to effectively operate in central and northern Mozambique? If not, what challenges or limitations would need to be addressed?

3. How many beneficiaries/clients did you reach in the last year?

4. Has your organization received funding from a national or international source and, if so, can you provide a general amount and source(s) of funding?

5. What is the technical expertise of your organization?

6. Has your organization ever provided Family Planning services? If so, please provide a short description of the program and challenges proved to be barriers or limitations during performance and how they were mitigated?

7. Does the Concept Paper provide enough information to enable drafting a comprehensive technical response? If not, what additional details or clarifications would be helpful?

8. What type of partnerships and/or alliances do you foresee as necessary to effectively and efficiently carry out the tasks noted in the Concept Paper?

9. Looking at the results framework, which other components, if any, do you believe should be adapted, removed or included in order to reach more beneficiaries?

A. Does the draft concept note provide adequate flexibility to allow for innovation and bold, new approaches to achieve the proposed results? If not, what specific changes or improvements would enhance its adaptability

B. In your estimation, what level of effort would you propose for each IR? Recognizing limited resources, what level of emphasis should be placed at the community, health facility, and health systems levels?

10. Based on the definitions provided below, under which category does your organization best fit?

A. United States Organization (U.S. Organization) B. Local Entity As defined in Section 7077 of Public Law 112-74, the Consolidated Appropriations Act, 2012 (P.L. 112-74), as amended by Section 7028 of the Consolidated Appropriations Act, 2014 (P.L. 113-76), and included by reference in subsequent appropriations acts, local entity means an individual, a corporation, a nonprofit organization, or another body of persons that—

(1) is legally organized under the laws of the Republic of Mozambique;

(2) has as its principal place of business or operations in the Republic of Mozambique; and

(3) is

(A) majority owned by individuals who are citizens or lawful permanent residents of the Republic of Mozambique; and

(B) managed by a governing body the majority of who are citizens or lawful permanent residents of the Republic of Mozambique.

For purposes of this definition, “majority-owned’ and “-managed by” include, without limitation, beneficiary interests and the power, either directly or indirectly, whether exercised or exercisable, to control the election, appointment, or tenure of the organization's managers or a majority of the organization's governing body by any means.”

C. Locally Established Partner (LEP) A U.S. or international organization that works through locally led operations and programming models. LEPs:

● Have maintained continuous operations in-country for at least five years and materially demonstrate a long-term presence in a country through adherence or alignment to the following: - Local staff should comprise at least 50 percent of office personnel, -

Maintenance of a dedicated local office, - Registration with the appropriate local authorities, - A local bank account, and - A portfolio of locally implemented programs.

● Have demonstrated links to the local community, including: - If the organization has a governing body or board of directors, then it must include a majority of local citizens; - A letter of support from a local organization to attest to its work; and - Other criteria that an organization proposes to demonstrate its local roots.

11. Do you have any other feedback or recommendations that you would like to share with

USAID regarding any anticipated solicitation for this requirement?

(Attachment C)

TIPO DE PEDIDO: Pedido de Informações(RFI) NÚMERO DA RFI: RFI-720656-Catalyzing Access to Family Planning NOME DO PROGRAMA: USAID Catalyzing Access to Family Planning DATA DE EMISSÃO: 27 de Dezembro de 2025

DATA-LIMITE PARA APRESENTAÇÃO

DE RESPOSTAS: 15 de Fevereiro de 2025

Caro Potencial Proponente, A USAID/Moçambique pretende desenhar uma nova Actividade – USAID Catalyzing Access to Family Planning - que terá como objectivo apoiar os moçambicanos a atingir as suas intenções de fertilidade, melhorando assim os resultados de saúde das mulheres, homens e jovens moçambicanos através do aumento do uso de serviços de Planeamento Familiar (PF), de qualidade e centrados no indivíduo. Com um enfoque claro no voluntarismo e na escolha informada, a atividade emblemática de PF, irá abordar as barreiras persistentes sentidas pelos indivíduos e comunidades moçambicanas relacionadas com a prestação de serviços de PF/SR e expandir o seu acesso à informação, produtos e serviços de PF/SR equitativos, acessíveis e sustentáveis. Prevê-se que este seja um prémio de cinco (5) anos, 2025-2030, com um valor total de até 35 milhões de dólares.

O objetivo da presente comunicação é obter informações do sector sobre a atividade acima referida. Mais especificamente, o RFI tem como objetivo

Avaliar o interesse de potenciais organizações em submeter candidaturas/propostas para o novo USAID Catalyzing Access to Family Planning

Obter conhecimentos técnicos e organizacionais sobre a capacidade das potenciais organizações

Obter contributos técnicos e sugestões para ajustar, acrescentar ou reduzir elementos do Quadro de Resultados para obter os melhores resultados possíveis no domínio da saúde

O Anexo B apresenta o conjunto de perguntas às quais as organizações devem responder.

Notese que se trata de uma pedido de informação (RFI) e não de um pedido de candidaturas (RFA) ou de um pedido de propostas (RFP). Esta RFI não deve ser interpretada como um compromisso do Governo dos EUA para emitir qualquer solicitação de propostas ou, em última análise, uma adjudicação com base nesta RFI, ou para pagar por qualquer informação apresentada como resultado deste pedido. Por favor, não apresente uma candidatura completa ou declarações em resposta a este RFI. É de notar que a resposta a este RFI não dará qualquer vantagem a qualquer organização na aquisição subsequente.

A USAID/Moçambique pode usar o feedback e os comentários deste RFI para desenvolver programas futuros. Se uma solicitação for emitida para esta actividade, é da responsabilidade da organização monitorar os sites https://www.grants.gov ou www.sam.gov e os jornais locais para a divulgação de qualquer informação adicional.

As respostas ao presente RFI devem ser enviadas para Nelly Mahanjane, através do endereço eletrónico mission-maputo-oaa@usaid.gov, o mais tardar até à data indicada na parte superior do presente documento. Não serão aceites envios tardios. O assunto do e-mail deve ser "RFI - USAID/Moçambique Catalyzing Access to Family Planning". As respostas podem ser enviadas em inglês ou português e devem incluir o nome da organização, endereço, ponto de contacto, número de telefone e endereço de e-mail. Receberá uma confirmação electrónica a confirmar a receção da sua resposta. As respostas em papel não serão aceites e são desaconselhadas.

Com os melhores cumprimentos, Alice Gillispie

Responsável pelos contractos/acordos

Anexos:

• Anexo A – Breve descrição do conceito da atividade

• Anexo B – Requisitos de resposta

Anexo A: Breve descrição da nota conceptual da actividade

Análise contextual O planeamento familiar e a saúde reprodutiva (PF/SR) têm um impacto positivo na saúde, no bem-estar, no empoderamento e na capacidade de acção das mulheres e das raparigas, melhorando o seu estatuto socioeconómico, permitindo que as raparigas permaneçam na escola e atinjam níveis de educação mais elevados, possibilitando a sua plena participação na força de trabalho e apoiando o seu envolvimento cívico15 . O aumento do acesso à informação e aos serviços de PF pode ajudar a reduzir o número de gravidezes indesejadas, bem como as mortes maternas e de recém-nascidos, conduzindo a famílias e comunidades mais saudáveis.

Os esforços da USAID em matéria de PF/SR contribuíram significativamente para o aumento da utilização voluntária de contraceptivos e para a tomada de decisões mais informadas em matéria de PF/SR por parte de mulheres, homens, jovens e casais a nível global16 .

A nova Actividade emblemática de PF proposta, baseia-se no anterior projecto emblemático de PF, a Iniciativa para um Melhor Planeamento Familiar (IFPI). Os resultados da avaliação intercalar( de meio termo) da IFPI demonstraram uma taxa mais elevada de participação em actividades de PF nas mulheres com idades compreendidas entre os 20 e os 49 anos, em comparação com as raparigas adolescentes, o que indica uma maior aceitação e envolvimento.

Além disso, as crenças e práticas culturais, incluindo o casamento infantil/precoce/forçado, dificultam a tomada de decisões, o acesso e a utilização de contracepção moderna. Os desafios persistentes incluem normas socioculturais em torno da tomada de decisões sobre saúde reprodutiva, centradas nas preferências dos parceiros masculinos e dos membros da família, falta de stock dos métodos preferidos e preocupações com a confidencialidade, que afectam particularmente as raparigas adolescentes. Em geral, os provedores de saúde moçambicanos oferecem um ambiente acolhedor na maioria das consultas, mas ainda é necessário o desenvolvimento contínuo de competências em aconselhamento abrangente, bem como a retenção de pessoal tecnicamente formado, que constitui um desafio.

Aprendendo com as experiências passadas e seguindo as recomendações da avaliação intercalar, esta nova Actividade de PF procura expandir as suas iniciativas de PF, especialmente nas zonas rurais, utilizando abordagens de comunicação e mudança de comportamento social baseadas em provas e aumentando o envolvimento positivo dos homens. Envolver os líderes comunitários, os pais e os jovens sobre os benefícios de adiar o casamento e o parto, destacando os impactos positivos na saúde, nas oportunidades económicas e no bem-estar geral, é uma boa prática a manter. Também será importante que a nova Actividade se centre no desenvolvimento profissional contínuo e na formação dos prestadores de serviços, de modo a que estes estejam equipados para fornecer informações abrangentes, aconselhamento e

15 Investing in Family Planning: Key to Achieving the Sustainable Development Goals. Ellen Starbird, Maureen

Norton, Rachel Marcus. Global Health: Science and Practice Jun 2016, 4 (2) 191-210; DOI: 10.9745/GHSP-D-15- 00374 16 Pathways to Progress for Sexual and Reproductive Health. Technical Approach of USAID’s Family Planning and

Reproductive Health Program. 2024-2030. USAID.

https://dec.usaid.gov/dec/content/Detail_Presto.aspx?ctID=ODVhZjk4NWQtM2YyMi00YjRmLTkxNjktZTcxMjM2NDBmY2Uy&rID=NjMxODE0&qrs=RmFsc2U%3d&q=RG9jdW1lbnRzLkZpbGU6KFVTQUlEIE1vemFtYmlxdWUgSUZQSSBNaWR0ZXJtIEFzc2Vzc21lbnQp&ph=VHJ1ZQ%3d%3d&bckToL=VHJ1ZQ%3d%3d&rrtc=VHJ1ZQ%3d%3d https://dec.usaid.gov/dec/content/Detail_Presto.aspx?ctID=ODVhZjk4NWQtM2YyMi00YjRmLTkxNjktZTcxMjM2NDBmY2Uy&rID=NjMxODE0&qrs=RmFsc2U%3d&q=RG9jdW1lbnRzLkZpbGU6KFVTQUlEIE1vemFtYmlxdWUgSUZQSSBNaWR0ZXJtIEFzc2Vzc21lbnQp&ph=VHJ1ZQ%3d%3d&bckToL=VHJ1ZQ%3d%3d&rrtc=VHJ1ZQ%3d%3d https://www.ghspjournal.org/content/4/2/191 apoio no acesso aos serviços de saúde. Por último, a estreita coordenação com a cadeia de abastecimento e os esforços logísticos será fundamental para garantir a gestão dos produtos de PF, a fim de facilitar as actividades de PF.

Contexto e Desafios

Moçambique enfrenta desafios significativos para satisfazer as intenções reprodutivas e as necessidades de PF/SR das suas populações; o acesso e a utilização de PF/SR continuam limitados devido a múltiplos factores que se cruzam. Primeiro, considerando um crescimento populacional de aproximadamente 2,8%, prevê-se que a população moçambicana duplique até 2050. Isto traduz-se num número crescente de mulheres em idade reprodutiva que poderiam beneficiar da contracepção moderna. A taxa de prevalência de contraceptivos modernos duplicou em Moçambique, aumentando de 12 para 25 por cento (DHS 2011 para DHS 2023), mas estagnou quando comparada com a IMASIDA 2015 (25 por cento). A necessidade não satisfeita de PF aumentou de 2015 a 2023, de 23% para 27%, reflectindo uma procura total de PF de 53% no DHS 2023. A taxa de prevalência contraceptiva de métodos modernos (mCPR) de Moçambique ainda é a mais baixa quando comparada com os países vizinhos. A taxa de fertilidade total reduziu ligeiramente de 5,9 para 4,9 (DHS 2011 para DHS 2023)17. Esta média nacional, no entanto, esconde diferenças marcantes entre as populações urbanas e rurais: a TFR urbana é de 3,6 e a TFR rural é de 5,8. A procura total de PF nas zonas urbanas é de 64%, em comparação com 48% nas zonas rurais; e a utilização de PF nas zonas urbanas é de 40%, em comparação com 18% nas zonas rurais. Normas sociais e de género profundamente enraizadas e crenças culturais e religiosas impedem frequentemente os moçambicanos de procurar, aceder e utilizar informação e serviços de PF/SR.

As frequentes rupturas de stock de contraceptivos, um orçamento governamental reduzido para o Sistema Nacional de Saúde, incluindo os produtos de saúde, e outros desafios de acesso, particularmente nas províncias mais populosas do norte, Zambézia e Nampula, contribuíram para esta estagnação da mCPR. Existe uma escassez actual de produtos essenciais para o PF. Em 2024, havia um défice aproximado de $3M necessários para fornecer, de forma suficiente, métodos de PF a toda a população. Prevê-se que este défice aumente significativamente em 2025, para cerca de 8 milhões de dólares. Os injectáveis, o método contraceptivo mais utilizado, estão em ruptura de stock numa média de 14%. Além disso, existem desafios na manutenção de um sistema de distribuição de produtos funcional e eficiente ao longo de toda a cadeia de abastecimento. Embora esta Actividade de PF não adquira produtos, ela trabalhará em conjunto com investimentos complementares de aquisição de produtos da USAID/Moçambique para garantir a aquisição, chegada, armazenamento, distribuição e entrega dos produtos.

Como já foi referido, é importante que esta Actividade aborde as necessidades específicas de PF/SR das raparigas adolescentes e das mulheres jovens (AGYW). As AGYW enfrentam discriminação, violência baseada no género (VBG) e pobreza. De acordo com um relatório da

17 Mozambique DHS 2022-2023.

Human Rights Watch de 2024, o país tem a quinta taxa mais elevada de casamentos infantis do mundo e a sua taxa de gravidez na adolescência é a mais elevada da África Oriental e Austral:

180 em cada 1.000 (AGYW) com idades entre os 15 e os 19 anos deram à luz em 2023, em contraste com a média regional de 94 nascimentos por 1.000 raparigas18. A idade média da primeira relação sexual e do primeiro casamento é de 16,8 e 18,2 anos, respectivamente, e um número alarmante de 36% das raparigas adolescentes com idades entre os 15 e os 19 anos já começaram a ter filhos, atingindo entre 40-55% nas províncias populosas do norte. De acordo com o DHS de 2022-23, apenas 14% das raparigas com idades entre os 15 e os 19 anos e 24% das raparigas com idades entre os 20 e os 24 anos utilizam métodos contraceptivos modernos19. Isto cria uma situação precária, uma vez que as provas sugerem que a maternidade precoce está associada a uma gama diversificada de resultados adversos em termos de saúde, tanto para a mãe como para a criança20. Além disso, as mães adolescentes enfrentam estigmas físicos, emocionais e sociais e têm frequentemente problemas de saúde mental21 22, pelo que têm menos probabilidades de continuar a estudar ou de se envolver plenamente noutras oportunidades23. As intervenções de PF/SR para as raparigas e para os seus pares masculinos devem ser adequadas à idade e à fase em que se encontram e concebidas para acomodar as necessidades dos jovens24, incluindo a desmistificação de percepções incorrectas sobre a contracepção moderna e a promoção da literacia corporal.

O envolvimento significativo de homens e rapazes é uma parte essencial da criação de igualdade e equidade de género e da transformação das normas sociais e de género, mas isto continua a ser um desafio25. Embora o envolvimento masculino seja fundamental para alcançar a prosperidade do agregado familiar, e os homens desempenhem papéis importantes e expectativas sociais que afectam as intenções de fertilidade de um casal e o uso de contracepção26, o envolvimento masculino no contexto do planeamento familiar em Moçambique é muitas vezes limitado. O envolvimento significativo dos homens pode aumentar a adopção e a continuação dos cuidados de PF/SR, melhorando a comunicação dos casais e a

18 Girls Shouldn’t Give Up On Their Studies: Pregnant Girls’ and Adolescent Mothers’ Struggles to Stay in School in Mozambique. February

13, 2024. Human Rights Watch 19 Mozambique DHS 2022-2023.

20 Ahmad K, Kabir E, Keramat SA, Khanam R. Maternal health and health-related behaviors and their associations with child health: Evidence from an Australian birth cohort. PLoS One. 2021 Sep 13; 16(9):e0257188. PMID: 34516561; PMCID: PMC8437270.

21 Zoe Aitken, Belinda Hewitt, Louise Keogh, Anthony D. LaMontagne, Rebecca Bentley, Anne M. Kavanagh. Young maternal age at first birth and mental health later in life: Does the association vary by birth cohort? Social Science & Medicine, Volume 157, 2016, Pages 9-17, ISSN 0277-

9536, https://doi.org/10.1016/j.socscimed.2016.03.037.

22 Mangeli M, Rayyani M, Cheraghi MA, Tirgari B. Exploring the Challenges of Adolescent Mothers From Their Life Experiences in the

Transition to Motherhood: A Qualitative Study. J Family Reprod Health. 2017 Sep;11(3):165-173. PMID: 30018654; PMCID: PMC6045691 23 The Social and Educational Consequences of Adolescent Childbearing. February 25, 2022. World Bank

24 Adolescent-Responsive Contraceptive Services: Institutionalizing adolescent-responsive elements to expand access and choice. FP HIP.

25 Gender Equity & Male Engagement (report). 2018. ICRW.

26 Engaging Men and Boys in Family Planning: A Strategic Planning Guide. FP HIP.

https://www.hrw.org/report/2024/02/13/girls-shouldnt-give-their-studies/pregnant-girls-and-adolescent-mothers-struggles https://dhsprogram.com/publications/publication-FR389-DHS-Final-Reports.cfm https://pmc.ncbi.nlm.nih.gov/articles/PMC8437270/ https://www.sciencedirect.com/science/article/pii/S027795361630137X#:~:text=In%20models%20adjusted%20for%20early,25%20years%20and%20older%20(Late https://www.sciencedirect.com/science/article/pii/S027795361630137X#:~:text=In%20models%20adjusted%20for%20early,25%20years%20and%20older%20(Late https://pmc.ncbi.nlm.nih.gov/articles/PMC6045691/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6045691/ https://genderdata.worldbank.org/en/data-stories/adolescent-fertility https://www.fphighimpactpractices.org/briefs/adolescent-responsive-contraceptive-services/ https://www.icrw.org/publications/gender-equity-male-engagement-report/ https://www.fphighimpactpractices.org/guides/engaging-men-and-boys-in-family-planning/ capacidade de alcançar as suas intenções reprodutivas, e pode diminuir a oposição masculina27.

Encorajar os homens a usar contracepção (por exemplo, preservativos e vasectomia) e a serem defensores da igualdade de género nas suas comunidades é vital para prevenir mortes maternas e infantis, melhorar as oportunidades das mulheres e raparigas para a educação, emprego e participação plena na sociedade, e promover a prosperidade da família e da comunidade.

Pontos de alavancagem / Oportunidades

Esta nova Actividade emblemática de PF basear-se-á numa série de iniciativas de PF/SR em Moçambique. O GRM comprometeu-se com a Parceria FP2030 global e comprometeu-se a expandir o número de provedores de PF/SR formados, aumentar a disponibilidade de produtos contraceptivos e melhorar a integração das PF com outros serviços de saúde. Neste momento, a integração do PF com outros serviços está a ganhar espaço. Em 2024, Moçambique finalizou a sua Estratégia Nacional de PF e o seu Plano de Implementação Custeado (2023-2030) e alinhou-se com os seus compromissos do FP2030. Para melhorar a recolha, análise e utilização de dados de PF, Moçambique actualizou as suas ferramentas de registo de unidades sanitárias com desagregação que permite uma melhor análise e desenvolveu painéis de controlo correspondentes em uso para todas as províncias. Embora existam desafios em termos de disponibilidade de contraceptivos, Moçambique também reconhece a importância de aumentar o acesso às PF e está a implementar iniciativas que promovem e aumentam o seu uso voluntário; por exemplo, o Ministério da Saúde (MISAU) procura expandir a provisão de PF a nível comunitário através de quadros de saúde comunitários e oferecendo a opção de auto-injecção de PF (DMPA-SC) aos utentes. Para complementar estas actividades, o Ministério da Saúde e os diferentes parceiros das PF realizam sessões de Colaboração, Aprendizagem e Adaptação (Collaboration, Learning and Adapting - CLA), em que há oportunidades para partilhar experiências, aprender e monitorizar os progressos em todo o país.

Para promover o PF voluntário entre adolescentes e jovens, Moçambique está a implementar actividades de PF/SR a nível escolar, apoiadas por aconselhamento e um sistema de referência estabelecido. Moçambique também está a implementar a Iniciativa DREAMS do PEPFAR, alcançando as AMJ, os seus parceiros, famílias e comunidades. No âmbito do DREAMS NextGen, podem participar rapazes e homens jovens adolescentes (AGYW). Isto tem implicações para a adopção do PF, uma vez que o DREAMS reforçará os serviços holísticos de PF/SR tanto para as AMJ como para os AMJ nas unidades de saúde e na comunidade. Como mostram os dados, a protecção dos jovens durante os dois anos (CYP/CAP) está a aumentar e a gravidez na adolescência entre as AMJ com idades entre os 15 e os 19 anos diminuiu de 46% em 2015 para 36% em 2022-2328. A nova Actividade de PF será alinhada com a estratégia para a juventude do

27 Kabagenyi, A., Jennings, L., Reid, A. et al. Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda. Reprod Health 11, 21 (2014). https://doi.org/10.1186/1742-

4755-11-21

28 Mozambique DHS 2022-2023.

https://reproductive-health-journal.biomedcentral.com/articles/10.1186/1742-4755-11-21#citeas

GRM e com as actividades existentes para garantir que os jovens recebam informações e serviços de PF adequados à sua idade.

Além disso, a nova Actividade emblemática de PF irá complementar os projectos actuais e futuros que irão melhorar os resultados de saúde nas províncias de Sofala, Zambézia e Nampula. A Actividade será coordenada com os projectos de saúde materna, neonatal, infantil, imunização e nutrição, projectos PEPFAR, actividades da cadeia de abastecimento e aprovisionamento, e mecanismos de Governo para Governo.