Foa_Content_of_CDC-RFA-JG-24-0134.pdf

Signature Date

Centers for Disease Control and Prevention

Global Health Center

Advancing Diagnostic Network Optimization, Stepwise Laboratory Accreditation, and Integrated One Health Specimen Transport in Liberia

CDC-RFA-JG-24-0134

05/28/2024

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-JG- 24-0134. 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:

Advancing Diagnostic Network Optimization, Stepwise Laboratory Accreditation, and Integrated One Health Specimen Transport in Liberia

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 purposes of this NOFO, research is defined as set forth in 45 CFR 75.2 and, for further clarity, as set forth in 42 CFR 52.2 (see eCFR :: 45 CFR 75.2 -- Definitions and https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR- 2007-title42-vol1-sec52-2.pdf. In addition, for purposes of research involving human subjects and available exceptions for public health activities, please see 45 CFR 46.102(l) (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section- 46.102#p-46.102(l)).

New Type 1 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.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l)

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-JG-24-0134

E. Assistance Listings Number:

93.318

F. Dates:

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

2. Due Date for Applications:

05/28/2024 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

CDC will host an informational webinar for interested applicants. The intent of the webinar is for potential applicants to learn key NOFO information and timelines. Questions and answers from the session will be compiled and amended in the NOFO. Due to limited space, applicants will need to register for the webinar.

• When: April 4, 2024 09:00am US Eastern Daylight Time (-4 hours GMT).

• Topic: CDC Notice of Funding Opportunity Webinar, CDC-RFA-JG-24-0134:

Advancing Diagnostic Network Optimization, Stepwise Laboratory Accreditation, and Integrated One Health Specimen Transport in Liberia

• Register in advance for this webinar:

https://cdc.zoomgov.com/webinar/register/WN_krl9JNVpTD2Krqi1bP9SXA

G. Executive Summary:

1. Summary Paragraph This Notice of Funding Opportunity (NOFO) aims to innovate, implement, and evaluate approaches to One Health laboratory diagnostic network optimization and specimen transport in Liberia. This multi-component NOFO’s design will support development of a comprehensive, resource-mapped, accredited national and sub-national laboratory network; facilitate the physical transportation architecture required to transfer network commodities (namely human, animal, and environmental specimens) point-to-point; and optimize digital communication, information, and supply chain systems necessary to sustain the network itself. Recipients will implement the activities at national and sub-national levels throughout Liberia’s 15 counties. Additionally, recipients will provide technical assistance, capacity-building, direct services, and/or logistics and procurement support depending on the specified component. Activities and expected outcomes will focus on strengthening Liberia’s national and sub-national reference laboratory diagnostic capacity; facilitating Government of Liberia's (GOL), ownership of laboratory networks and its eventual capacity to coordinate a robust specimen transport network beyond the https://www.grants.gov/ https://cdc.zoomgov.com/webinar/register/WN_krl9JNVpTD2Krqi1bP9SXA project period of performance; improving health system capacities to rapidly detect and respond to public health threats.

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

a. Funding Instrument Type:

CA (Cooperative Agreement)

b. Approximate Number of Awards

c. Total Period of Performance Funding:

$8,500,000

d. Average One Year Award Amount:

$1,700,000

e. Total Period of Performance Length:

5 year(s)

f. Estimated Award Date:

September 30, 2024

g. Cost Sharing and / or Matching Requirements:

No N/A

Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview Since 2015, CDC´s support of the Global Health Security Agenda (GHSA), has bolstered Liberia’s capacity to prevent, detect, and respond to public health threats. CDC, in coordination with GOL and other partners, supports rapid detection and response to neutralize public health threats at their source. Prior USG investment in Liberia’s public health infrastructure has introduced laboratory capacities for Ebola, COVID-19, yellow fever, Lassa fever, cholera and meningitis. However, key vulnerabilities persist. A 2021 retrospective exercise revealed that detection of a hemorrhagic fever takes up to 10 days (World Health Organization [WHO] benchmark is 7 days), with an additional three days needed to mobilize effective response (WHO benchmark is 7 days). Also, neither the National Public Health Institute of Liberia (NPHIL) nor Ministry of Health (MOH) recognized a December 2021 measles outbreak until April 2022, even though the sub-national level officials provided timely notification.

Further, Liberia’s fragile health system lacks resources to manage acute events without catastrophic impact on other health sectors. In Fiscal Year (FY) 2023, the health sector accounted for only 9.5% of GOL´s national budget. Additional health system challenges have persisted since the 2014–2016 Ebola outbreak:

• Inadequate municipal service provision, poor quality health care infrastructure, nonexistent roads, and annual rains constrain access to 10 of 15 counties for nearly eight months, impeding timely sample transportation, diagnosis, and response

• Delayed and sometimes absent national-to-subnational coordination

Liberia´s donor and implementing partner landscape is complex. Multi-lateral (Global Fund;

Global Financing Facility; World Bank; WHO) and bilateral entities (CDC; USAID US National Institutes of Health; US Department of Defense; Japanese International Cooperation Agency;

GIZ; Agency for French Development) invest and manage over 50% of GOL's health sector resources (FY23). Donors and their recipients typically devote significant “hands-on” attention to program implementation because GOL engagement is insufficient or ineffective. For example, in 2023, Global Fund designated Liberia as an “Additional Safety Precautions” country due to audit findings detailing US $6.7M in non-compliant expenditures, existing, persistent systemic risks, insufficient MOH management capacities and grant oversight, and low in-country grant funds absorption rate.

Proposed NOFO activities align with GHS pillars, supporting real-time bio-surveillance and diagnostics. It supports diagnostic technology and workforce laboratory investments, cost-effective diagnostic network optimization and integration, and rapid, reliable, and geographically-balanced direct point-to-point specimen transport. Building upon existing partnerships with MOH, NPHIL [which houses the National Public Health Reference Laboratory (NPHRL)], other USG health agencies, and other NGO partners, successful applicants will advance national and sub-national strategies, by offering mentorship, training, and accountability.

Applicants should delineate approaches to the over-arching strategies described and elaborate on measurable activities (with accompanying evaluation plan) to reach intended outcomes.

In addition to Core Global Health Security Priorities (Components 1-3), this NOFO will support additional activities when funding is made available for a moderate (Component 4) or substantial (Component 5) response to a disease outbreak or other public health emergency. Applicants must apply for all five components.

b. Statutory Authorities This program is authorized under 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:

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

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

CDC and the Global Health Security Agenda | Global Health | CDC

The Department of Health and Human Services' (HHS) Global Health Strategy

HHS Global Strategy | HHS.gov

International Health Regulations (2005)(IHR) and supporting policies and frameworks

International health regulations (who.int)

e. Relevant Work This NOFO builds on previous funding awards (CDC-RFA-GH19-1962; CDC-RFA-GH19- 1961). NOFO activities will optimize capacity and integrate evidence-based cost efficiencies through One Health coordination; tailoring of modalities, resources, and specimen transport to epidemiologic and geographic realities; laboratory accreditation; logistics and supply chain management; digital information systems; and preparation for an anticipated transition to Liberia´s new laboratory site.

The NOFO acknowledges existing investments from Global Fund, World Bank, and other USG entities. The NOFO recipient will join donors and partners who are committed to harmonized, fiscally-responsible, and impactful programs.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

Component 1: Investments in Laboratory Diagnostic Technology, Quality, & Workforce

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Strategy 1

Apply qualified and sustained technical expertise to improvement of laboratory and quality management systems at national and sub-national level to achieve and maintain international

Strengths and gaps in national and sub-national laboratory quality management systems are characterized

Technical capacity to achieve accreditation is introduced among laboratory workers

Timeliness, quality, and credibility of pathogen detection and reporting of disease of public health importance improves

National laboratory services consistently adhere to external quality assurance and control measures

Reliable detection of pathogens of public health importance leads to improved understanding of Liberia’s https://www.cdc.gov/globalhealth/security/index.htm https://www.hhs.gov/about/agencies/oga/about-oga/why-hhs-works-globally/hhs-global-strategy/index.html https://www.who.int/health-topics/international-health-regulations#tab=tab_1 laboratory accreditation epidemiologic risk profile

Strategy 2

Establish and support cadres of mid-level and senior One Health Laboratory Managers for effective governance and operations of national and sub-national laboratory network

Accountable resource utilization at national and sub-national laboratory levels

Improved national and sub-national coordination and fidelity to laboratory processes and procedures

Increased number of laboratories function efficiently due to less staffing or operational disruptions

A skilled public health technical cadre is professionally codified into Liberia’s civil service

Workforce pipeline is established and preserves institutional best practices necessary to achieve and maintain international accreditation

Strategy 3

Successful preparation and launch of a new integrated One Health central reference laboratory

Potentially dangerous pathogens are safely and securely managed during physical relocation

Enhanced state-of-the-art laboratory diagnostic capacities are available in Liberia and in West Africa sub-region

Reduced fragmentation between clinical, public health, animal, food and water, and environmental labs

Efficiency and speed in identifying causative agent(s) contributing to Liberia’s global health security risks improves

Component 2: Investments in Laboratory Diagnostic and Specimen Transport Network Optimization, Integration & Cost-Effectiveness

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Strategy 1

Design and optimize an integrated One Health diagnostic

Improved coordination between animal, Increased availability and reliability of diagnostic tests that are appropriately

Health care services are minimally disrupted during and specimen transport network to establish the business and operational environment conducive to a future public-private partnership approach to specimen transport in Liberia environmental, and human sectors

Increased access to definitive diagnosis at point-of-care and through reference laboratory services

Consensus is established among One Health stakeholders on what constitutes an ideal specimen referral pathway in Liberia applied for known and emerging pathogens of public health importance

Improved quality, reliability, and safety of transfer of One Health samples from point-of-collection to definitive diagnostic location outbreaks and public health events

Expedited processes and procedures, and administrative and regulatory systems support specimen transfer to regional or global laboratories

Strategy 2

Improve logistic and management capacity at national and sub-national Public Health Reference Laboratories to maintain routine operations and prepare surge capacity for outbreak surge capacity

Consistent procurement and stock-on-hand balances of reagents, media, point-of-care, and reference kits at NPHRL and sub-national laboratories are maintained and tracked

Reduced capital and operational expenses

Cost-savings are reinvested to sustain diagnostic platforms and laboratory workforce

Strategy 3

Establish, consolidate, or interoperate digital laboratory information systems used to track tests, results, specimens, and supplies to improve availability and dissemination of diagnostic information

Persistent, recurrent bottlenecks from point-of-sample collection to results return are identified, quantified, and corrected

Characterization of the relationships between and the impact of workforce, technology, and supply chain on timely and reliable

Direct service clinical providers improve therapeutic algorithms and decision-making

National policy and decision makers, laboratory leaders, county and district health officers are informed about outbreaks, supply chain gaps, etc. at

Human and animal beneficiaries receive appropriate and timely clinical care or management necessary for public health response diagnostics reduces or eliminates fragmented and redundant information platforms, policies, and procedures earliest possible stage

Component 3: Investments in Rapid, Reliable and Geographically-Balanced Specimen Transport

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Strategy 1

Transport of One Health specimens from point-of-sample collection to intended destination for definitive diagnosis

Time required to rule-out priority diseases of public health importance is reduced

Appropriate clinical management is consistently delivered

Faster specimen transport time

All laboratories with public health relevance participate in detection and response to public health threats

Decreased transmission of diseases between humans and animals

Components 4 and 5: Rapid Response to Small-Scale and Large-Scale Public Health Emergencies

Strategies and Activities

Short-Term Outcomes

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

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

Strengthened coordination and robust emergency

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

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 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

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 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 outbreak affected areas

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

i. Purpose This NOFO presents a Results Framework that represents the ideal for an inter-dependent lab and specimen referral system in Liberia expanded from the current platform: one central lab performs Integrated Disease Surveillance & Response (IDSR); five regional hospitals have varying capacity for reference testing. Because these labs are not well-supported by GOL or donors, a CDC-funded cost-intensive hub and spoke specimen network was created in 2015 during the Ebola response.

ii. Outcomes The logic model illustrates key strategies by component and its outcomes at three levels – short-term, immediate, and long-term. The recipient is expected to implement these strategies and demonstrate measurable progress toward achieving the outcomes each year of the award. The recipient will directly work and collaborate with the MOH and NPHIL to: 1) support continuous quality improvement in provision of reference and clinical laboratory services; 2) develop innovative approaches to optimize resource investment and expenditures through the network; 3) physically transport public health, clinical, animal, or environmental specimens to designated laboratories; and 4) to collaboratively propose strategies and solutions. Project activities and outcomes should promote the development of the GOL’s long-term capacity to operate and sustain clinical and reference diagnostic laboratories and efficiently coordinate a robust specimen transport network beyond the project period of performance. Specific strategies, activities and outcomes expected of the recipient include the following:

Component 1: Investments in Laboratory Diagnostic Technology, Quality, & Workforce

The principal strategies for this component are: 1) The achievement of international accreditation of the national and sub-national reference laboratories in Liberia; 2) the establishment of mid-level and senior-level One Health laboratory managers; and 3) successful preparation and launch of a new integrated central reference laboratory. Below are expected outcomes by level:

Short-term outcomes

• Strengths and gaps in national and sub-national laboratory quality management systems are characterized

• Technical capacity to achieve accreditation is introduced among laboratory workers

• Accountable resource utilization at national and sub-national laboratory levels

• Potentially dangerous pathogens are safely and securely managed during physical relocation

Intermediate outcomes

• Timeliness, quality, and credibility of pathogen detection and reporting of disease of public health importance improves

• Improved national and sub-national coordination and fidelity to laboratory processes and procedures

• Increased number of laboratories function efficiently due to less staffing or operational disruptions

• Enhanced state-of-the-art laboratory diagnostic capacities are available in Liberia and in West Africa sub-region

• Reduced fragmentation between clinical, public health, animal, food and water, and environmental labs

Long-term outcomes

• National laboratory services consistently adhere to external quality assurance and control measures

• Reliable detection of pathogens of public health importance leads to improved understanding of Liberia’s epidemiologic risk profile

• Workforce pipeline is established and preserves institutional best practices necessary to achieve and maintain international accreditation

• Efficiency and speed in identifying causative agent(s) that contribute to Liberia’s global health security risks improves

Optimization, Integration & Cost-Effectiveness

The following are key strategies for Component 2 to build disease detection capacity with a special focus on cost-effective network optimization & integration investments: 1) Design One Health diagnostic and specimen transport network; 2) Improve logistic and management capacity at national and sub-national public health reference laboratories; and 3) Establish digital laboratory information system. Below are expected outcomes for this component:

Short-term outcomes

• Improved coordination between animal, environmental, and human sectors

• Increased access to definitive diagnosis at point-of-care and through reference laboratory services

• Consensus is established among One Health stakeholders on what constitutes an ideal specimen referral pathway in Liberia

• Consistent procurement and stock-on-hand balances of reagents, media, point-of-care, and reference kits at NPHRL and sub-national laboratories are maintained and tracked

• Persistent, recurrent bottlenecks from point-of-sample collection to results return are identified, quantified, and corrected

• Characterization of the relationships between and the impact of workforce, technology, and supply chain on timely and reliable diagnostics reduces or eliminates fragmented and redundant information platforms, policies, and procedures

Intermediate outcomes

• Increased availability and reliability of diagnostic tests that are appropriately applied for known and emerging pathogens of public health importance

• Improved quality, reliability, and safety of transfer of One Health samples from point-of-collection to definitive diagnostic location

• Reduced capital and operational expenses

• Direct service clinical providers improve therapeutic algorithms and decision-making

• National policy and decision makers, laboratory leaders, county and district health officers are informed about outbreaks, supply chain gaps, etc. at earliest possible stage

Long-term outcomes

• Health care services are minimally disrupted during outbreaks and public health events

Component 3: Investments in Rapid, Reliable, and Geographically-Balanced Specimen

Component 3 focuses on strengthening the capacity to detect and respond to disease outbreaks rapidly through reliable and geographically focused specimen transport. The key strategy is to transport One Health specimens from point-of-sample collection to intended destination for definitive diagnosis. Expected outcomes by level for this component include:

Short-term outcomes

• Time required to rule-out priority diseases of public health importance is reduced

• Appropriate clinical management is consistently delivered

• Faster specimen transport times

Intermediate outcomes

• All laboratories with public health relevance participate in detection and response to public health threats

Long-term outcomes

• Decreased disease transmission between humans and animals

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 reinvigorate 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:

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

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

• Improved preparedness for potential future outbreaks and other highly infectious diseases

iii. Strategies and Activities Component 1: Investments in Laboratory Diagnostic Technology, Quality, and Workforce

• Strategy 1: Apply qualified and sustained technical expertise to improvement of laboratory and quality management systems at national and sub-national level to achieve and maintain international laboratory accreditation

• Activities:

o Provide technical oversight on management, maintenance, and biosafety certification of national and sub-national diagnostic equipment o Promote biosafety and bio-security best practices of sample collection, packaging, specimen transport and diagnostic testing through supportive supervision and monitoring o Consistent with the benchmarks and metrics established for ISO accreditation, support development of quality management Standard Operating Procedures (SOPs), and when necessary, establish international agreements with regional or global laboratories to perform diagnostic and confirmatory testing when local capacity is unavailable o Design external quality assessment approaches that achieve national goals for stepwise reference laboratory accreditation o Apply continuous quality improvement methodology to document, review, and systematically address diagnostic network successes and challenges, data quality gaps, and staff performance o Conduct regular supportive supervision of and provide technical assistance to public health diagnostic officers across all geographic regions within Liberia’s fifteen counties o Provide relocation and initialization technical assistance for the anticipated USG-constructed NPHRL, including its specimen bio-repository, equipment, and materials

• Strategy 2: Establish and support cadres of mid-level and senior One Health Laboratory Managers for effective governance and operations of national and sub-national laboratory network

• Activities:

o Review career progression and competency retention of Liberia laboratory managers who previously participated in laboratory leadership programs o Design and pilot an in-service laboratory mentorship program for newly-graduated public health laboratories employed in public health or reference laboratory contexts o Develop a mid-term and long-term laboratory workforce staffing plan for the anticipated new NPHRL site

• Strategy 3: Successful preparation and launch of a new integrated One Health central reference laboratory

• Activities:

o Provide pathogen specific, subject matter expert (SME) input on biosafety related topics in the form of curriculum development, trainings, and competency monitoring o Provide technical assistance and logistics support for transfer of designated, non-obsolete NPHRL equipment from Charlesville to new reference laboratory location o Installation, validation, and re-certification of transferred equipment o Provide technical expertise to procedures for archiving public health (i.e., IDSR-related) specimens prior to physical transfer o Provide technical assistance and logistics support for physical transfer of IDSR-related NPHRL specimens from previous central laboratory to newly-constructed

NPHRL

o Provide technical assistance and guidance on international and USG endorsed standards for specimen transport and storage

Optimization, Integration and Cost-Effectiveness

• Strategy 1: Design and optimize an integrated One Health diagnostic and specimen transport network to establish the business and operational environment conducive to a future public-private partnership approach to specimen transport in Liberia

• Activities:

o Develop a roadmap and costed implementation plan for clinical, public, animal, and environmental laboratory diagnostic network optimization at national and sub-national levels o Lead or support retrospective cost-effectiveness evaluation of existing diagnostic and specimen transport platform o Use modeling methodology to propose and simulate scenarios for diagnostic and specimen network optimization o Based upon modeling scenarios, design, pilot, evaluate, validate, and launch cost-effective and sustainable business model(s) for integrated One Health specimen transport network through existing One Health and Laboratory Working Groups, increase technical coordination between and within host government, partners, and donors (including but not limited to: National Diagnostic Division, NPHRL, and other human, animal, and environmental actors) o Support comprehensive resource mapping that leverages bilateral, multi-lateral, and private sector resources as part of development of an optimized roadmap for future host government network management o In coordination with other relevant specimen transport stakeholders, apply industrial flow mapping and analysis techniques to reestablish optimal specimen collection modalities and pick-up sites based upon an optimized and resourced One Health roadmap o As part of network optimization activities, provide technical assistance to assessments, reviews, and field validations of point-of-care and rapid diagnostic tests for priority diseases of public health importance o As part of network optimization activities, examine historical outbreak trends and known seasonal geographical access constraints to inform quantification, procurement, and pre-positioning of diagnostic sample collection and specimen transportation kits

• Strategy 2: Improve logistic and management capacity at national and sub-national public health reference laboratories to maintain routine operations and develop surge capacity for outbreaks

• Activities:

o Design, pilot, evaluate, validate, and launch open-source, digital, and bi-directional transfer of diagnostic results and supply chain information between points-of-sample collection, transfer, processing, and definitive testing o Support local and/or international market research to identify and establish competitive service agreements for diagnostic kit, reagent, and equipment maintenance, procurement, and distribution

• Strategy 3: Establish, consolidate, or interoperate digital laboratory information systems used to track tests, results, specimens, and supplies to improve availability and dissemination of diagnostic information necessary for public health response

• Activities:

o Provide technical leadership to establish consensus requirements and best practices for digital public health platforms in Liberia o Provide guidance and technical assistance to characterize, track, and report commonly observed challenges in specimen transfer and results return o Design, pilot, evaluate, validate, and launch open-source, digital, and bi-directional transfer of diagnostic results and supply chain information between points-of-sample collection, transfer, processing, and definitive testing o Support electronic linkage and routine reconciliation of sub-national and national epidemiologic and laboratory case data

Component 3: Investments in Rapid, Reliable and Geographically-Balanced Specimen

• Strategy 1: Transport of One Health specimens from point-of-sample collection to intended destination for definitive diagnosis

• Activities o Identify, recruit, train, supervise, and retain qualified specimen transport workforce o Establish a workforce and operational fleet necessary to reach diverse terrains and hard-to-access geographies during all climates and seasons o Establish necessary policies, procedures, and oversight to ensure safe specimen handling and transport o Maintain quick and reliable communication and coordination mechanisms between health care facilities, district and county diagnostic officers, and district and county surveillance officers; mechanisms should convey location of specimens awaiting transport and courier availability to collect and move the specimens o Provide continuous maintenance, refurbishment, or replacement of vehicles, supplies, and equipment allocated for specimens of public health importance transport o Maintain operational fleet, resources, contracts, and mechanisms to increase or surge specimen collection and transfer capacity during public health events or other identified emergencies o Participate as key stakeholder in Laboratory and One Health Technical Working Groups o In coordination with relevant Technical Working Groups, develop and adopt policies and procedures to minimize turnaround time, reduce specimen rejection rates, and ensure regular and reliable customer service

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 (e.g., 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 projects 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.

Due to CDC Liberia´s long and trusted partnership with key GOL health entities (MOH and NPHIL), CDC benefits from strong, successful implementing partners who provide technical expertise and direct service delivery in several GHS pillars. As such, funded components will need close activity coordination to realize stated goals and advance GHS in Liberia. This support includes but is not limited to surveillance, workforce development, emergency preparedness & response, laboratory diagnostics, and specimen transport.

• Components 1, 2, and 3: To reach the desired outcomes and impact, recipient(s) will be required to exhibit flexibility and innovative approaches to engage and coordinate with existing CDC partners and other non-governmental actors who have an established track record in a given technical pillar

• Components 2 and 3: Recipient(s) who lead network optimization strategies and activities will closely coordinate with the entity(ies) that provide direct services

• Component 3: Relationships and experiences with national government entities, such as MOH or NPHIL, should be documented in the application

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.

Liberia has significant health system investments from other multilateral and bilateral government donors. Due to Liberia’s service delivery and geographic landscape complexity, program proposals which foster duplication or fragmented implementation are particularly costly and ultimately have limited impact. CDC works closely with other donors, governments, and health working groups to leverage resources from a variety of sources, particularly in the specimen transport domain. Recipients will be required to consider stakeholder inputs, One Health approaches, and new or existing health sector mapping analyses. These should indicate how both USG and non-USG actors can best address Liberia’s GHS diagnostic and specimen transport gaps.

2. Population(s) of Focus The target populations for this NOFO include but are not limited to those individuals infected or at risk for becoming infected by an infectious disease. The target population for this NOFO may also include at-risk populations for non-communicable diseases, humanitarian crises, and/or other public health emergencies.

The work under this NOFO will also target increased capacity at the national and sub-national level to implement and achieve outbreak/epidemic/pandemic control in line with USG and CDC strategy.

The public and clinical health workforce in Liberia should be uniquely considered as a target population. Currently, they have limited pre-service education, inadequate occupational safety training and vaccine prophylaxis, and on-the-job mentorship is limited or unavailable. Recipients should consider how best to assess current workforce capacity levels and focus efforts towards in-service, on-the-job mentorship.

In addition to the above variables:

• Liberia, based on recent census figures, has a predominantly adolescent and young adult population. Because of limited educational and employment opportunities, particularly in urban communities, these individuals are predisposed to marginal or no housing environments, incarceration in crowded, poorly-resourced prisons, and high-risk migratory patterns.

• Liberians also have diverse religious preferences. Where applicable, applicants should consider identifying religious communities disproportionally affected by infectious diseases or non-communicable diseases and how to appropriately work with each identified population.

This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of race, color, national origin, disability, age, sex (including gender identity, sexual orientation, and pregnancy) or other constitutionally protected statuses.

a. Health Disparities The goal of health equity is for everyone to have a fair and just opportunity to attain their highest level of health. Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.

Broadly defined, social determinants of health are non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces (e.g., racism, climate) and systems include economic policies and systems, development agendas, social norms, social policies, and political systems. See content below and in other sections (e.g., Approach, Collaborations, Populations of Focus) for information on how this specific NOFO affects social determinants of health.

A health disparity is a preventable difference in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been socially, economically, geographically, and environmentally disadvantaged. Health disparities are inextricably linked to a complex blend of social determinants that influence which populations are most disproportionately affected by these diseases and conditions.

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 populations 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 The core funding for this NOFO will be obtained from Centers for Disease Control and Prevention (CDC) Global Health Security (GHS) funding allocations. Occasionally, depending on the strategy and activities, opportunities may emerge to leverage additional funding streams from other United States Government (USG) agencies. Funding allocation or emphasis should be placed on resources expended directly on program activities that have high likelihood of GHS impact within Liberia´s borders (preferably at the sub-national level where outbreaks or public health events can be controlled at the source).

This NOFO is divided into five components, three core components and two emergency components. The applicant is required to apply to at least one of three core components. For Components 1–3, applicants are encouraged to apply for the component(s) that best match their areas of expertise. Applicants are not required to apply to all three core components – however, if an applicant has expertise in all three core components, they are welcome to apply to all three core components.

In addition, applicants are required to apply for components 4 and 5 and include a separate budget and work plan for each component applied. 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, detailed below. However, budget proposals for year one may not exceed the year one award ceiling. Please note, these amounts are subject to the approval and availability of funds.

The emergency components (Components 4 – 5) follow the same logic model with identical overarching strategies and activities. However, Component 4 should support activities when funding is made available for a moderate response to a disease outbreak or other public health emergency. Component 5 should support activities when funding is made available for a substantial response to a disease outbreak or other public health emergency. Applicants are encouraged to consider the following in the development of their budgets and budget narratives:

• Component 1 – Investments in Laboratory Diagnostic Technology, Quality, & Workforce o The estimated year one ceiling is $500,000. Future years’ funding levels will be dependent on funding availability.

• Component 2 – Investments in Laboratory Diagnostic and Specimen Transport Network Optimization, Integration, & Cost-Effectiveness o The estimated year one ceiling is $600,000. Future years’ funding levels will be dependent on funding availability.

• Component 3 – Investments in Rapid, Reliable and Geographically-Balanced Specimen Transport o The estimated year one ceiling is $600,000. Future years’ funding levels will be dependent on funding availability.

• Component 4: Rapid small-scale response to infectious disease outbreaks or other public health emergencies o This component is intended to be approved but unfunded (ABU) as a baseline practice. This component would be funded to support additional activities needed within a budget period when funding is made available for a moderate response to a disease outbreak or other public health emergency. Estimated year one ceiling is $10,000,000.

• Component 5: Rapid large-scale response to infectious disease outbreaks or other public health emergencies o This component is intended to be ABU as a baseline practice. This component would be funded to support additional activities needed within a budget period when funding is made available for a substantial response to a disease outbreak or other public health emergency. Estimated year one ceiling is $15,000,000.

Applicants must specify a descriptive title for each corresponding column shown on the SF- 424A, followed by the total (cumulative) in the column to the far right of the SF-424A.

Additional Information

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 fulfillment 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 a 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 the UN or the WHO classifies the emergency as a Level 3 (L3)

2. When the U.S. 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 entity.

3. When the U.S. government (Congress, White House,…