Foa_Content_of_CDC-RFA-GH21-2169.pdf

Centers for Disease Control and Prevention

Center for Global Health

Strengthening detection, prevention and response to infectious disease threats in Uzbekistan

CDC-RFA-GH21-2169

07/10/2021

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- GH21-2169. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Strengthening detection, prevention and response to infectious disease threats in Uzbekistan C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52- 2.pdf. Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr- 46/index.html (See section 45 CFR 46.102(d)).

New Type - 1

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-GH21-2169

E. Assistance Listings Number:

93.318 F. Dates:

1. Due Date for Letter of Intent (LOI):

N/A https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html

2. Due Date for Applications:

07/10/2021 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

N/A

G. Executive Summary:

1. Summary Paragraph This Notice of Funding Opportunity (NOFO) seeks to build upon previous activities funded by CDC to support the Ministry of Health (MOH) of the Republic of Uzbekistan reach its Global Health Security Agenda (GHSA) targets.

CDC has worked with the MOH over many years and supported programs and activities that focus on protecting and improving health globally through successful partnerships with Ministry of Health of Uzbekistan and local public health institutions.

https://www.cdc.gov/globalhealth/security/

This NOFO solicits a proposal for non-research activities to strengthen the MOH’s capacity to detect, respond to, and prevent emerging and current infectious disease threats. It aims to improve the quality of data collected by strengthening laboratory services, surveillance, data analysis, integration of sectors for greater coordination, and improvement of emergency operational capacity within the country.

The expected outcomes of the NOFO include:

• Improve ability to rapidly detect threats early, including detecting, characterizing, and reporting emerging biological threats, and

• Respond rapidly and effectively to public health threats of international concern.

This NOFO has a required component funding structure. Please refer to Funding Strategy section.

a. Eligible Applicants:

Single

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards

d. Total Period of Performance Funding:

$ 207,000,000

e. Average One Year Award Amount:

$ 1,400,000

f. Total Period of Performance Length:

g. Estimated Award Date:

https://www.grants.gov/

September 30, 2021

h. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Although there is no statutory match requirement for this NOFO, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview The U.S. Government’s (USG) Global Health Security Agenda (GHSA) envisions a world safe and secure from global health threats posed by infectious diseases, where it is possible to prevent or mitigate the impact of naturally occurring outbreaks and intentional or accidental releases of dangerous pathogens, rapidly detect and transparently report outbreaks when they occur, and employ an interconnected global network that can respond effectively to limit the spread of infectious disease outbreaks in humans and animals, mitigate human suffering and the loss of human life, and reduce economic impact. https://www.cdc.gov/globalhealth/security/

In partnership with the Ministry of Health of the Republic of Uzbekistan (MOH) and other public and private stakeholders, the CDC seeks to accelerate progress toward a world safe and secure from infectious disease threats and to promote global health security as an international security priority. To properly address these threats, strong capacity from local public health institutions and agencies is essential [1].Ministries of Health must focus on strengthening surveillance, laboratory diagnostics, and management based on classic and modern technologies, data analysis and communication, operational management, and coordination of different sectors to mitigate disease spread.

There is little knowledge of the circulation of genetic determinants in Uzbekistan due to the lack of modern and rapid techniques like genetic whole genomic sequencing, MALDI-TOF detection of bacterial pathogens, and detection of AMR (Antimicrobial resistance)-related genes. Public health authorities require action plans based on objective, evidence-based data collected by proper surveillance, including the genetic diversity of pathogens, genetic determinants, like resistance genes for AMR, and a comprehensive collection of epidemiological data.

Since 2015, the MOH has implemented an AMR surveillance project to look more closely at the scope and magnitude of the AMR problem in Uzbekistan. The MOH found that AMR is a significant problem in Tashkent City [2]. It is necessary to expand AMR surveillance to other regions and cities of Uzbekistan to formulate and manage the AMR National Action Plan based on this evidence. It is also very important to implement rapid, modern, and reliable diagnostic pathogen detection methods and AMR-related target genes. There is also a need to have the capability within the MOH to address other emerging and re-emerging infectious public health problems like the current COVID-19 pandemic.

Additionally, a country must have a public health emergency operational center to collect all relevant information and establish and implement action plans, allowing the country to improve https://www.cdc.gov/globalhealth/security/ its capability to detect and respond to emerging and current public health threats and provide essential and evidence-based information to the public health authorities.

The purpose of this NOFO is to provide assistance to Uzbekistan by supporting the local public health institutions to improve laboratory and surveillance components in the most important areas of public health, create operational capacity, and coordinate sectors in addressing infectious disease threats in Uzbekistan.

In addition to Core Global Health Security Priorities "(Component 1), this NOFO will support additional activities when a disease outbreak or other public health emergency reaches a scale that requires a moderate (Component 2, Rapid Response to Small Scale Infectious Disease Outbreaks or Other Public Health Emergencies) or substantial response (Component 3, Rapid Response to Large-Scale Infectious Disease Outbreaks or other Public Health Emergencies)". Finally, this NOFO supports activities to combat COVID-19 and other emerging infectious disease threats (Component 4, Emerging Infectious Disease Threats [EIDT]).

Applicants must apply for all four components.

[1] https://www.who.int/vietnam/news/feature-stories/detail/ten-threats-to-global-health-in-2019 [2] Personnel communication. The data are in preparation for publication.

b. Statutory Authorities Section 307 of the Public Health Service Act [42 USC 242l] and Section 301(a) [42 USC 241(a)] of the Public Health Service Act.

c. Healthy People 2030 This project supports the following Healthy People 2030 topic areas:

Global Health Public Health Infrastructure Health Care Access and Quality Infectious Disease Emergency Preparedness

d. Other National Public Health Priorities and Strategies Activities funded through this cooperative agreement must align with the following United States Government (USG) and HHS/CDC strategies and policies:

CDC’s strategy for improving global health security (GHS), based on three concepts embedded in the agency’s mission to protect public health worldwide: 1) Prevent 2) Detect 3) Respond https://www.cdc.gov/globalhealth/security/index.htm The Department of Health and Human Services’ (HHS) Global Health Strategy https://www.hhs.gov/about/agencies/oga/about-oga/why-hhs-works-globally/hhs-global-strategy/index.html International Health Regulations, IHR (2005) and supporting policies and frameworks https://www.who.int/topics/international_health_regulations/en/

e. Relevant Work Past work under GH15-1653: Conducting Public Health Research Activities in Uzbekistan resulted in 1) An AMR Center; 2) Evaluation of the scope and magnitude of AMR in https://health.gov/healthypeople/objectives-and-data/browse-objectives/global-health https://health.gov/healthypeople/objectives-and-data/browse-objectives/public-health-infrastructure https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality https://health.gov/healthypeople/objectives-and-data/browse-objectives/infectious-disease https://health.gov/healthypeople/objectives-and-data/browse-objectives/emergency-preparedness

Uzbekistan; 3) A training center for AMR technical and national curriculum, including monitoring and evaluation, and 4) A national AMR Action Plan.

During the last five years, the MOH demonstrated the capacity to organize and manage pilot anti-microbial surveillance and provide AMR-related data through the ISO15189-based quality management system. This NOFO builds on the expertise gained through past collaborative work and focuses on strengthening laboratory, surveillance, and emergency management priorities.

2. CDC Project Description

a. Approach Bold indicates period of performance outcome.

Component 1: Core Global Health Security Priorities

Strategies and Activities

Short-term Outcomes

Intermediate Outcomes

Long-term Outcomes

Strategy 1:

Strengthen surveillance capacity

Strengthen capabilities in collecting evidence based on surveillance of the emerging and other important pathogens

Establish country capacity for detection of public health threats through surveillance

Increased capabilities for surveillance for priority pathogens and other targets important for public health

Increased data analysis and evidence-based recommendati ons

Improved data quality and timeliness of surveillance data Strengthened technical capacity for surveillance, Increased analysis and usage of surveillance data for program planning and response purposes data sharing between different sectors (e.g., animal/hum an).

Improved capacity for early detection and real-time reporting of public health threats.

Developme nt of evidence-based public programs.

investigation, and data management.

Strategy 2:

Strengthen workforce

Provide training and mentorship to surveillance, laboratory and emergency management staff within the MOH

Build capacity to respond to and mitigate emerging public health threats

Increased sustainability of training programs for staff workforce capacity to respond to health threats multidisciplina ry-trained workers sustainability of country owned workforce development training programs

Expanded and strengthene d public health workforce capacity demand for service delivery programs in community-settings.

communicat ion on safety and effectivenes s of public health programs

Enhanced sustainabl e national funding for workforce developme nt.

Strategy 3:

Strengthen laboratory capacity

Create capacity for collecting and sharing quality laboratory data in response to emerging

Improved multi-sectoral collaboration among host government departments and stakeholders

Enhanced network operations, Improved diagnostic capacity, sample referral, and biosafety and biosecurity.

Establishe d capabilitie s to improve public health preparedn ess ability to threats

Ensure quality data by using rapid and reliable methods and sharing data with the global community.

molecular characterizati on, and laboratory training ability for public health labs to test each of their priority pathogens using core tests support for lab identification of causative pathogens rapidly detect by using modern technologi es and characteri ze infectious disease threats.

Strategy 4:

Strengthen management of emergencies

Establish and improve national and sub-national public health emergency operations, centers, emergency management and preparedness plans, and incident management systems

Improved functionality of a public health emergency operations center at the national and subnational levels

Sustained improvements by host government in response time and quality of response for outbreaks and other emergencies

Decreased time to detect and respond to public health emergencie s.

preparedne ss for global health emergencie s coordination during and after global

Improved national capacity to rapidly and effectively respond to public threats.

Functional emergency operationa l center to rapidly detect, respond, and prevent infectious

Train a multidisciplin ary response team for public health emergencies diseases threats

Components 2, 3, and 4: Rapid Response to Small-Scale and Large-Scale Infectious Disease Outbreaks or other Public Health Emergencies and Emerging Infectious Disease Threats

(EIDT)

Strategies Short-term

Intermediate Outcomes

Long-term Outcomes

Strategy 1:

Intensify active surveillance, case finding, contact tracing, monitoring and other outbreak response measures at local levels

Strategy 2:

Strengthen capabilities for epidemiologic and laboratory analysis and program evaluation

Strategy 3: Intensify social mobilization, community and professional education and engagement.

Strategy 4:

Improve outbreak case management and infection control

Improved time to deploy healthcare workers to respond and control the spread of infectious diseases

Strengthened coordination and robust emergency preparedness and response capacities

Improved disease outbreak case management and infection control

Shortened time to detect highly infectious disease outbreaks through active surveillance and case finding

Reduced transmission of highly infectious

Reduced time to reinvigorated public health activities that have been interrupted or slowed due to outbreak response

Improved access to health services by individuals in outbreak affected areas

Increased capacity of countries for early warning, risk reduction and management of national and global health risks

Sustained improvements in timeliness of achieving outbreak/epidemic/ pandemic control

Reduced morbidity and mortality attributed to disease outbreaks or other public health threats

Reduced spread of infectious outbreaks into other countries

Improved preparedness for potential future outbreaks and other highly infectious diseases

Strategies Short-term Outcomes

Intermediate

Long-term Outcomes

Strategy 5:

Strengthen non-outbreak related public health activities that are impacted by the outbreak

Strategy 6: Increase security and logistics for local responders

Strategy 7:

Strengthen capabilities for preparedness and response to highly infectious diseases diseases in clinical and community settings

Increased awareness, knowledge, and support for local disease outbreak response and prevention efforts at the community level

Rapid identification of and containment of highly infectious disease outbreaks

i. Purpose Current public health problems in Uzbekistan like AMR, COVID-19, and other emerging and re-emerging threats require a strategic approach to solve. This NOFO addresses public health problems in Uzbekistan by improving capacity of the MOH to quickly and reliably identify infectious disease threats, collect and analyze data, improve the operational capacity of the MOH to effectively mobilize specialists, establish sustainable capacity development, and provide an evidence-based approach to respond to and mitigate health threats in the country and region.

ii. Outcomes Component 1: Core Global Health Security Priorities

Short-term Outcomes:

Increased capabilities for surveillance for priority pathogens and other targets important for public health

Increased data analysis and evidence-based recommendations Improved data quality and timeliness of surveillance data Strengthened technical capacity for surveillance, investigation, and data management.

Increased sustainability of training programs for staff Improved public health workforce capacity to respond to health threats Enhanced network operations, molecular characterization, and laboratory training

Intermediate Outcomes:

Increased analysis and usage of surveillance data for program planning and response purposes

Expanded and strengthened public health workforce capacity Improved diagnostic capacity, sample referral, and biosafety and biosecurity.

Decreased time to detect and respond to public health emergencies. Increased preparedness for global health emergencies

Long-Term Outcomes:

Improved capacity for early detection and real-time reporting of public health threats.

Development of evidence-based public health programs.

Enhanced sustainable national funding for workforce development.

Established capabilities to improve public health preparedness Improved ability to rapidly detect by using modern technologies and characterize infectious disease threats.

Improved national capacity to rapidly and effectively respond to public health threats.

Functional emergency operational center to rapidly detect, respond, and prevent infectious diseases threats

(EIDT)

Short-Term Outcomes:

Improved time to deploy healthcare workers to respond and control the spread of infectious diseases

Strengthened coordination and robust emergency preparedness and response capacities Improved disease outbreak case management and infection control Shortened time to detect highly infectious disease outbreaks through active surveillance and case finding Reduced transmission of highly infectious diseases in clinical and community settings Increased awareness, knowledge, and support for local disease outbreak response and prevention efforts at the community level Rapid identification of and containment of highly infectious disease outbreaks

Intermediate Outcomes:

Reduced time to reinvigorated public health activities that have been interrupted or slowed due to outbreak response

Increased capacity of countries for early warning, risk reduction and management of national and global health risks

Long-Term Outcomes:

Reduced spread of the outbreak into other countries with improved coordination and collaboration between relevant stakeholders

Improved preparedness for potential future outbreaks and other highly infectious diseases Improve timeliness of achieving outbreak/epidemic/pandemic control Reduced morbidity and mortality from disease outbreak or public health threat &

iii. Strategies and Activities Component 1: Core Global Health Security Priorities

Strategy 1: Strengthen surveillance capacity

Strengthen capabilities in collecting evidence based on surveillance of the emerging and other important pathogens

Establish country capacity for detection of public health threats through surveillance Establish a system for systematic collection, analysis and dissemination of health data related to emerging and current public health threats Develop an improved system for collecting epidemiolocal, laboratory, and other relevant data for proper analysis and dissemination Improve the quality of data collected Demonstrate a critical review of current and proposed activities and how they will improve surveillance

Strategy 2: Strengthen public health workforce

Provide training and mentorship to surveillance, laboratory and emergency management staff within the MOH

Build capacity to respond to and mitigate emerging public health threats Develop a strategy to improve the public health workforce and how it will improve the response by the MOH to emerging threats

Strategy 3: Strengthen laboratory capacity

Create capacity for collecting and sharing quality laboratory data in response to emerging public health threats

Ensure quality data by using rapid and reliable methods and sharing data with the global community.

Develop a strategy to improve current laboratory systems, including classic and modern methods (bacteriology, microbiology, genetic, protein detection, etc.) of rapid and reliable detection, to mitigate public health threats

Ensure high quality laboratory data and communication of the data to the proper response authorities

Strategy 4: Strengthen management of public health emergencies

Establish and improve national and sub-national public health emergency operations, centers, emergency management and preparedness plans, and incident management systems

Train a multidisciplinary response team for public health emergencies Build a training module to sustain training

(EIDT)

This component is designed to support the applicant with small-scale infectious disease outbreaks and public health emergencies if these arise during the period of performance. The applicant will indicate in the application what activities would be supported during a small-scale outbreak or emergency. Activities may include but are not limited to the following.

Strategy 1: Intensify active surveillance, case finding, contact tracing, monitoring, and other critical response efforts at local levels

Conduct and improve ongoing active surveillance, with laboratory confirmation to ensure rapid identification of missed, new or newly imported outbreak cases

Strengthen capacity for general surveillance including support for personnel required for surveillance and epidemiology activities.

Strengthen surveillance at entry points (border posts, airports and maritime ports) from countries with ongoing transmission

Strategy 2: Strengthen capabilities for epidemiologic and laboratory analysis and program evaluation

Improve operational and technical analysis, coordination and monitoring of interventions.

Assess the impact of the epidemic on health care seeking and health care provision.

Strategy 3: Intensify social mobilization, community and professional education and engagement, and psychosocial care for infected persons and their families, where applicable

Conduct intensified social mobilization and community engagement to enhance awareness and gather community support, acceptance and participation in implementation of containment measures

Provide psychosocial first aid training for community agents and their supervisors so they can provide direct psychosocial support to contact cases and their families.

Develop and conduct communications to contain the outbreaks and enforce the theme of "Staying at Zero Cases."

Develop and disseminate key health risk communication messages.

Strategy 4: Improve outbreak case management and infection control

Develop plans for patient management as community and clinical settings.

Improve infection control practices, particularly in facilities that might receive outbreak cases for example, on a border with a country with ongoing transmission

Strategy 5: Strengthen non-outbreak related public health activities that are impacted by the outbreak

Restore priority aspects of the health/public health system such as surveillance and assessment of vaccination coverage for epidemic-prone disease (e.g., measles), that are negatively impacted or stalled due to the outbreak.

Strategy 6: Increase security and logistics for local responders

Strengthen field security to ensure operational security, and protect national and international staff involved in the response

Strategy 7: Strengthen capabilities for preparedness and response to highly infectious diseases

Develop/implement partnership mechanisms for a more robust and responsive global health emergency workforce.

Train frontline responders on emerging infectious diseases.

Strengthen critical International Health Regulations (IHR) and health systems capacities in affected region and elsewhere.

1. Collaborations

a. With other CDC programs and CDC-funded organizations:

Recipient(s) are required to work with other CDC implementing partners, including non-governmental organizations, universities, Ministry of Health and other host governmental bodies and multi-lateral organizations that receive CDC funds. Recipient(s) should ensure their proposed activities are not duplicating activities already implemented by other CDC-funded organizations.

b. With organizations not funded by CDC:

The recipient(s) will work primarily and directly with partner governments specifically with the Ministries of Health and other government entities who are working towards the objectives of this NOFO. In addition, the recipient(s) will be expected to work with other in-country and global stakeholders, including but not limited to government entities, non-governmental organizations, universities, civil society, the private sector, and other USG agencies.

2. Target Populations

The target population for this NOFO include those populations that fall under the following jurisdiction(s): Uzbekistan.

The target populations for this NOFO include, but are not limited to, those individuals infected and affected by infectious diseases, or at risk for becoming infected by an infectious disease. The target population for this NOFO may also include at-risk population for non-communicable diseases and/or other public health emergencies.

The work under this NOFO may also target increased capacity at the national and sub-national level to implement activities in alignment with the objectives of this NOFO.

a. Health Disparities Recipients are expected to use epidemiologic, social determinants, and linked laboratory, epidemiological, and surveillance data to identify communities disproportionately affected by infectious diseases or non-communicable diseases in the target areas to ensure that program activities appropriately cover these populations. Recipients should ensure that supported services are accessible and available to all patients regardless of age, sex, race/ethnicity, sexual orientation, gender identity, or socio-economic status in order to achieve the outcomes of this

NOFO.

iv. Funding Strategy This NOFO is divided into four components. Applicants are required to apply for all components and include a separate budget and work plan for each component. The applicant’s application package should be inclusive of all component work plans and budgets; multiple applications will not be reviewed. Applicants are encouraged to submit component budgets toward the year one award ceiling for each component. However, budget proposals for year one may not exceed the year one award ceiling. Please note these amounts are subject to approval and the availability of funds. The emergency components (Components 2 – 4) follow the same logic model with identical overarching strategies and activities, however, Component 2 should support activities when a disease outbreak or other public health emergency reaches a scale that requires a moderate response, Component 3 should support activities when a disease outbreak or other public health emergency reaches a scale that requires a moderate response and Component 4 should support activities to combat COVID-19 and other emerging infectious disease threats.

Component 1: Core Global Health Security Priorities These GHS activities are intended to be funded on an annual basis. The estimated year one ceiling is $1,400,000. Future years funding level will be dependent on funding availability.

Component 2: Rapid Response to Small Scale Infectious Disease Outbreaks or other Public Health Emergencies This is intended to be approved but unfunded (ABU) as a baseline practice. It would be funded to support additional activities needed within a budget period when a disease outbreak or other public health emergency reaches a scale that requires a moderate response. Estimated year one ceiling is $10,000,000.

Component 3: Rapid Response to Large Scale Infectious Disease Outbreaks or other Public Health Emergencies This is intended to be approved but unfunded (ABU) as a baseline practice. It would be funded to support additional activities needed within a budget period when a disease outbreak or other public health emergency reaches a scale that requires a substantial response. Estimated year one ceiling is $15,000,000.

Component 4: Emerging Infectious Disease Threats (EIDT) This is intended to be an approved but unfunded (ABU) component that will support activities to combat COVID-19 and other emerging infectious disease threats globally, including efforts related to global health security, global disease detection and response, global health protection, global immunization, and global coordination on public health. Expected Year 1 funding amount is $15,000,000.

Emergency Management and Response The ability to respond rapidly and effectively to public health emergencies is a key component of global health security. International public health emergencies including humanitarian crises are by nature unpredictable, requiring fulfilment of changing and often unpredictable needs that vary widely according to context. Consequently, funding for public health emergencies is also unpredictable and based on external factors. In recent years, there has been a sharp rise in the number of people living in regions of the world affected by public health emergencies, including humanitarian emergencies, which has often led to additional funding resources from the USG to respond to these threats. Given this unpredictability and the resulting need for rapid, flexible, and efficient process to award funding under an emergency situation, recipients that are selected for funding under this NOFO will be eligible to receive additional expedited supplemental funding when a public health emergency occurs to scale up activities included within the scope of work of this NOFO.

Definition of public health emergency:

In order to qualify for supplemental emergency funding, one of the following situations must apply:

1. When UN or WHO classifies the emergency as a Level 3 (L3)

2. When the US Congress appropriates funding for an international response related to humanitarian or public health crisis with the words containing “emergency” in the program title.

The appropriated funding could be for CDC directly or is transferred to CDC through an Interagency Agreement (IAA) by HHS or another USG

3. When the US government (Congress, White House, National Security Council, etc.) declares a public health emergency as national security priority

4. When the CDC Director activates Emergency Operation Center (EOC) in response to an international public health threat

5. When Department of State or U.S. Agency for International Development (USAID) transfer funds to CDC to respond to an international disaster or humanitarian assistance under 2 FAM 060 (International Disaster and Humanitarian Assistance) If a public health emergency situation meets any one criteria listed above, then selected recipients under this NOFO will be eligible to receive supplemental emergency funding to scale up public health activities included in the scope of work of this NOFO on a single-source basis, i.e., without additional competition, within a 12-month budget period and throughout the 60-month period of performance. There is no limit on the number of emergency supplemental funding that a recipient may receive within a 12-month budget period or the 60-month period of performance under a public health emergency situation. Recipients receiving funds under a public health emergency will be eligible to receive emergency funding without constraint to the period of performance funding ceiling, annual budget period ceiling, or lack of component funding. In addition, applications for funding under a public health emergency will not need a merit review and will only require approval from the CDC Project Officer and Grants Management Officer (GMO) in order to be funded.

All reporting requirements listed under this NOFO still applies to any emergency supplemental funding.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy The applicant should describe how they plan to measure and collect data on the funded activities and bolded outcomes identified in the logic model. The purpose of collecting and reporting these data is to determine the progress toward achieving the NOFO activities and outcomes. The results will also be used for program planning, development and improvement, accountability and reporting, and for sharing with partners and other stakeholders. CDC will work with the recipient throughout the life of this award to ensure that all activities and expected outcomes are in alignment with current USG and the recipient’s strategies and goals. The recipient should dedicate funds made available under this NOFO for evaluation and performance monitoring within each project. The final funding amount will be agreed upon by both CDC and the recipient; however, it should be expected that approximately 3% (of a given project’s funding) will be dedicated to monitoring, reporting, and evaluation activities. CDC and the recipient will agree upon the specific funding amounts within review of each project’s work plan and budget.

Monitoring CDC expects that the work conducted under this NOFO will be structured as a series of discrete projects oriented at achieving elements of the NOFO’s strategic objectives. CDC and the recipient will jointly develop formal performance measures shortly after award based on activities within each project. For each project, these performance measures must include CDC’s Division of Global Health Protection’s Division-wide Indicators (DWIs), as well as other CDC or recipient’s standard indicators relevant to the intended outcomes of the project. The DWIs include indicators that are required reporting for CDC, such as for OMB, HHS, USG, Global Health Security Agenda (GHSA) interagency, and Healthy People. At a minimum, applicants should describe proposed process measures for the strategies and activities in the logic model, and proposed outcome measures for the period of performance outcomes in the logic model.

While recipients will be responsible for reporting on DWIs relevant to proposed strategies and activities, they are not limited to only DWIs listed below. Applicants can, and are encouraged to, propose additional relevant indicators that, combined with relevant DWIs, will be monitored over the life of the NOFO. Recipients will also be encouraged to identify relevant USG GHSA Interagency Metrics, WHO Joint External Evaluation (JEE), and/or Healthy People 2030 standardized metrics and WHO benchmarks.

Technical Area Division of Global Health Protection (DGHP) Division-wide Indicators (DWIs) as of April 2019* WD#1: Number of individuals trained by CDC to prevent, detect and respond to public health threats

WD#2: Number of Field Epidemiology Training Program (FETP) residents trained by CDC that have participated in outbreak investigations and responses WD#3: Number and proportion of subnational jurisdictions per country that have had at least one staff member trained by FETP- Frontline

Workforce Development (WD)

WD#4: Number of CDC staff ready to provide emergency management and response assistance EMR#1: Number of public health events of international importance monitored and reported

EMR#2: Number of public health events and other global health emergency responses supported by CDC EMR#3: Number of outbreaks investigated and responded to by the country

Emergency Management and Response (EMR)

EMR#4: Number and proportion of countries with an established Public Health Emergency Operations Center (PHEOC) that have used their PHEOC for a real-world response or simulation SS/LS#1: Number and proportion of country-prioritized diseases and pathogens with laboratory testing capacity, surveillance system, and routine reporting to public health authorities

SS#2: Number and proportion of countries with a centralized national database that includes linked suspect case reports and laboratory data from subnational jurisdictions for the country’s priority notifiable diseases/syndromes LS#2: Number and proportion of designated laboratories that have bio-risk management policies, physical security controls and inventories for potential high consequence pathogens and toxins LS#3: Number of new diagnostic tests established in national or regional laboratories with CDC support

Surveillance Systems (SS) and Laboratory Systems (LS)

LS#4: Number of new strains or pathogens detected or discovered with CDC support

LS#5: Number and proportion of countries that have developed a national laboratory specimen referral system and transport networks LS#6: Number and proportion of laboratory facilities, designated in the national action plan for antimicrobial resistance (AMR) or as part of a national surveillance system, that conduct antimicrobial susceptibility testing (AST) and have reported susceptibility data to a designated national body LS #7: Number and proportion of countries that have adopted and implemented a national program of quality management systems

(QMS)

ID#1: Number of countries with a National Public Health Institute (NPHI) that was strengthened with CDC support

Institutional Development (ID)

ID#2: Number of countries whose core public health functions (laboratory, surveillance, workforce development and emergency management and response) are coordinated by the NPHI

* These indicators are subject to change; the latest iteration of the DGHP DWIs should be incorporated into the recipient’s EPMP.

Performance reports will be based on which NOFO activities and outcomes are identified in the logic model. Performance reports will be submitted to CDC in accordance with the requirements listed under this NOFO and overall performance will be reviewed on regular technical calls as well as through joint strategic review meetings.

Evaluation The potential evaluation questions and/or topics below are examples of what the applicant may be expected to answer through evaluation(s). Applicants should include at least 1, but no more than 3 potential evaluation questions, or evaluation topics if specific questions are unknown. It is acceptable to provide only evaluation questions, only evaluation topics, or a combination of both evaluation questions and topic, as needed. Applicants should consider but are not limited to the following areas when developing evaluation questions and/or topics.

Sample Evaluation Topics:

Program evaluations to measure the differences in outbreak responses, or other public health responses, in a country, before and after public health investments (in terms of days of outbreak start, days to outbreak detection, laboratory confirmation of outbreak, days to control outbreak, etc.).

Extent to which enhancements in public health surveillance in a country improved outbreak response (in terms of outbreak(s) controlled, cases averted, and time lags from specimen detection to collection).

Extent to which enhancements of the public laboratory systems, such as addition of a specific laboratory capacity in a country, improved outbreak response (in terms of outbreaks detected controlled, cases averted, and time lags from specimen collection to detection).

Program evaluations to measure if the coverage and capacity of the specimen referral network increased

Final evaluation questions and data sources will be determined together with CDC within six months after the award and will be included in the submission of the evaluation and performance measurement plan (EPMP). Evaluations are expected to align with national, USG, and agency priorities and programmatic gaps, and maybe be reviewed by global action committees. As such, the evaluation topics listed in this announcement may be amended.

Dissemination of Evaluation and Performance Measures: By the end of the period of performance, evaluation and performance measures will yield findings to demonstrate the value of the NOFO. The findings should be disseminated through the Annual Performance Report (APR) and the recipient is expected to pursue additional dissemination in public domains, including in public health journals, including global health journals, conferences and through informal channels (e.g., website, newsletters) where applicable.

ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

How the applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement.

How key program partners will participate in the evaluation and performance measurement planning processes.

Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant)

Plans for updating the Data Management Plan (DMP) as new pertinent information becomes available. If applicable, throughout the lifecycle of the project. Updates to DMP should be provided in annual progress reports. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data;

data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans. For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additionalrequirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, the applicant should be directed to:

Describe the type of evaluations (i.e., process, outcome, or both).

Describe key evaluation questions to be addressed by these evaluations.

Describe other information (e.g., measures, data sources).

https://www.cdc.gov/grants/additionalrequirements/ar-25.html

Recipients will be required to submit a more detailed Evaluation and Performance Measurement plan, including a DMP, if applicable, within the first 6 months of award, as described in the Reporting Section of this NOFO.

c. Organizational Capacity of Recipients to Implement the Approach The applicant should succinctly describe their capacity (skills, expertise, experience) to implement the activities proposed under this NOFO. For components 2, 3 and 4, the applicant should detail their ability to carry out emergency operations/coordination. Applicants are encouraged to describe their experience working with the target population, ability to implement project strategies/activities, and their physical infrastructure as it applies to the NOFO.

The applicant should provide as part of their appendix the following documents:

1. Curricula vitae (CVs)/Resumes for positions related to Principal Investigator, Project Director, Business Official, and other key staff related to program planning and implementation, finance, and monitoring and evaluation.

2. Job descriptions (maximum 1 page per job description) for key positions including:

Principal Investigator, Project Director, Business Official, and other key staff related to program planning and implementation, finance, and monitoring and evaluation.

3. Organizational chart (maximum 1 page)

4. Financial management statement that demonstrates experience in managing USG or CDC funds that are similar in size and scope of this NOFO (maximum 1 page).

The above referenced documents to be submitted in the appendix should demonstrate the organization's capacity to address the requirements of the NOFO.

Applicants must title these documents in their appendix as follows: "CVs/Resumes," "Job Descriptions," "Organizational Chart," "Capacity," "Financial Statement" and upload as a pdf at www.grants.gov.

d. Work Plan The applicant’s application package should be inclusive of all component work plans and budgets; multiple applications will not be reviewed. Each component must have a separate work plan and budget.

Applicant must include a work plan that demonstrates how the outcomes, strategies, activities, timelines, and staffing will take place over the course of the award.

Applicants must submit a detailed work plan for the first year of the project, and a high-level work plan for subsequent years. An example work plan is shown below. Applicants are not required to use this format, as long as the information above is demonstrated.

Period of Performance Outcome:

[from Outcomes section and/or logic model]

Outcome Measure:

[from Evaluation and Performance Measurement section]

Strategies and Activities Process Measure [from Evaluation and Performance Measurement section]

Responsible Position / Party

Completion Date

1.

2.

3.

4.

5.

6.

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and recipients, site visits, and recipient reporting (including work plans, performance, and financial reporting).

Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements:

Tracking recipient progress in achieving the desired outcomes.

Ensuring the adequacy of recipient systems that underlie and generate data reports.

Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities deemed necessary to monitor the award:

Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

Ensuring that recipients are performing at a sufficient level to achieve outcomes within stated timeframes.

Working with recipients on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets.

Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk recipients.

The recipient will be required to collaborate with CDC in-country offices for technical oversight of project activities to be implemented under this NOFO. In addition to the CDC Project Officer, the recipient will collaborate with in-country or HQ contacts, Subject Matter Experts (SMEs), and technical leads. The Project Officer for this award will provide relevant contacts of CDC staff and coordinate discussions with the award recipients.

f. CDC Program Support to Recipients

1. Organize an orientation meeting with the recipient for a briefing on applicable U.S.

Government and HHS/CDC expectations, regulations and key management requirements, as well as report formats and contents. The orientation could include meetings with staff from HHS agencies and/or other parts of the USG.

2. Review and make recommendations as necessary to the process used by the recipient to select key personnel and/or post-award subcontractors and/or sub recipients to be involved in the activities performed under this agreement.

3. Provide technical assistance, as mutually agreed upon, and revise annually during validation of the first and subsequent annual work plans. This could include expert technical assistance and targeted training activities in specialized areas, such as surveillance, use of data for program planning purposes, lab programs etc.

4. Provide technical assistance, where applicable, to help the recipient meet U.S.

Government financial and reporting requirements approved by the Office of Management and Budget (OMB).

5. Collaborate with the recipient on designing and implementing the activities listed above, including, but not limited to: the provision of technical assistance to develop program activities, data management and analysis, quality assurance, surveillance program, the presentation and possibly publication of program results and findings, and the management and tracking of finances.

6. CDC offices in-country, where applicable, may assist the recipient in identifying and connecting with other partners working towards the objective of this NOFO and the recipient shall ensure work is not duplicative but complementary and supportive to existing efforts funded by CDC and the rest of the USG.

7. CDC, via project officer, will provide contact for in-country staff, Subject Matter Experts (SMEs) and technical leads from CDC where applicable for the recipient to coordinate activities at the country level.

8. Provide technical assistance or advice on any data collections on 10 or more people that are planned or conducted by the recipient. All such data collections-- where CDC staff will be or are approving, directing, conducting, managing, or owning data-- must undergo OMB project determinations by CDC and may require OMB PRA clearance prior to the start of the project.

9. Provide consultation and scientific and…