Foa_Content_of_CDC-RFA-JG-24-0135.pdf

Signature Date

Centers for Disease Control and Prevention

Global Health Center

Achieving Global Health Security Through Strengthening Public Health Emergency Preparedness and Management Platforms in Liberia

CDC-RFA-JG-24-0135

06/08/2024

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- 24-0135. 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:

Achieving Global Health Security Through Strengthening Public Health Emergency Preparedness and Management Platforms 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-24-0135

E. Assistance Listings Number:

93.318

F. Dates:

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

06/08/2024

2. Due Date for Applications:

06/08/2024 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) supports CDC Liberia’s efforts to improve national-to-subnational coordination and to detect and manage responses to outbreaks earlier, provide additional expertise to develop and advance Liberia’s Emergency Response Framework (ERF), and develop a national emergency management training program to support county-level response capacity. This NOFO is consistent with the US Centers for Disease Control and Prevention’s (CDC) overall Global Health Security (GHS) goals to strengthen national and sub-national emergency preparedness and response capabilities in Liberia, to direct capacity-building efforts of its external partners towards mentoring Government of Liberia (GOL) counterparts in the Ministry of Health (MOH) and National Public Health Institute of Liberia (NPHIL) and to leverage Global Fund, World Bank, and other United States Government (USG) resources to amplify technical capacity in country.

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:

$5,000,000

d. Average One Year Award Amount:

$1,000,000

e. Total Period of Performance Length:

5 year(s)

f. Estimated Award Date:

September 30, 2024

g. Cost Sharing and / or Matching Requirements:

No 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 CDC Liberia’s mandate is to strengthen Liberia’s capacity to prevent, detect, and respond to public health threats at their source. Prior USG investment, coordinated with GOL and other actors, have strengthened Liberia’s national public health infrastructure and laboratory diagnostic capacities. However, key vulnerabilities persist. A “7-1-7” retrospective exercise revealed that hemorrhagic fever detection takes up to 10 days with an additional 3 days for an effective response mobilization (2021). NPHIL and MOH did not recognize a December 2021 measles outbreak until April 2022, though sub-national level officials provided timely notification.

Furthermore, Liberia’s fragile health system lacks adequate resources to manage acute events without catastrophic impact on other health sectors. In Fiscal Year (FY) 23, 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 such as:

• Inadequate municipal and health care infrastructure, nonexistent road network, and annual rains constrain access to 10 of 15 counties for nearly eight months, impeding timely sample transportation, diagnosis, and deployment of response measures

• Delayed and sometimes absent national-to-subnational technical coordination

Liberia´s donor and implementing partner landscape is complex. Multilateral (e.g. 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 Liberia´s health sector resources (FY23). Donors and their recipients devote significant “hands-on” attention to program implementation because GOL engagement has been found to be insufficient or ineffective. For example, in 2023, Global Fund designated Liberia an “Additional Safety Precautions” recipient based on audit findings documenting US $6.7M in non-compliant expenditures, existing persistent systemic risks, poor MOH management capacities and grant oversight, and low in-country grant funds absorption rate.

Proposed NOFO activities align with GHS priorities of preventing, detecting, and responding to potential threats through surveillance, analysis, diagnostics, workforce, and logistics mobilization. This NOFO supports:1) EOC and Rapid Response Teams (RRT) using a One Health framework; 2) tiered, multi-disciplinary Emergency Management Specialists capacity-building and retention; 3) community and health facility preparedness and mitigation efforts targeted to geographic hotspots identified through multi-disciplinary, multi-hazard risk assessments. This NOFO will build PHEM capabilities (e.g., developing, exercising, and revising All Hazard Response and Incident Action Plans) necessary to address 7-1-7 barriers.

Building upon existing partnerships, the recipient will advance national and sub-national approaches through mentorship, training, and accountability in geographic locales of potential events.

Applicants should delineate approaches to the over-arching strategies described, elaborating on measurable activities, with an accompanying evaluation plan, that will meet intended outcomes.

In addition to Core Global Health Security Priorities (Component 1), this NOFO will support additional activities when funding is made available for a moderate (Component 2) or substantial (Component 3) response to a disease outbreak or other public health emergency. Applicants must apply for all three 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 USG and HHS/CDC strategies and policies:

CDC's strategy for improving 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 CDC Public Health Emergency Management (PHEM) investments. Eight

(8) CDC-trained PHEM Specialists serve as the National EOC Coordinator, NPHIL Director of Environmental Health, NPHIL Logistics Coordinator, and as ad hoc specialists during outbreaks.

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 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

All 15 counties in Liberia have a CDC-supported Emergency Operations Center (EOC). EOCs prepare and issue situational reports, support Rapid Response Teams (RRT) mobilization, & facilitate community activities when outbreak control measures involve risk mitigation, behavior change, or environmental interventions. EOCs lead tabletop & cross-border simulations to reinforce PHEM principles and identify potential response gaps. County Health Teams employ a CDC-trained County Surveillance officer who works closely with the EOC.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

Component 1: Capacity to Prepare, Detect, & Respond

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Strategy 1

Using a multidisciplinary knowledge base, integrate One Health and Water, Sanitation and Hygiene (WASH) principles into public health emergency preparedness and response guidance for EOCs and RRTs

Strategy 2

Conduct capacity-building activities to increase knowledge, capacity, capability and retention of tiered, multi-disciplinary Emergency Management Specialists

RRTs and EOCs routinely operate in accordance with the One Health framework

RRTs and EOCs apply WASH principles to public health emergencies

A skilled and culturally responsive public health workforce is available to support public health emergency response

Improved coordination of multi-disciplinary emergency management workforce

Liberia has access to a skilled and culturally responsive public health workforce to lead public health emergency responses

Improved coordination of One Health, risk communication, and community engagement during public health emergencies

Faster and more effective response logistics, mechanisms, and structures in place, including a well-resourced, well planned emergency management platform centered around EOCs and RRTs

Access to and uptake of public health response

Strengthen the local level to control outbreaks at their source before they spread

Response activations meet global benchmarks

Increase speed of outbreak detection, identification, and response, especially for diseases of epidemic potential

Strategy 3

Community and health facility preparedness and mitigation efforts targeted to geographic hotspots identified through multi-disciplinary, multi-hazard risk assessments

Community and environmental risk factors for disease transmission are characterized and then mitigated in high-risk hotspots measures improves among populations affected by public health events

Risk of secondary disease transmission decreases in high-risk hotspots

Components 2 and 3: Rapid Response to Small-Scale and Large-Scale Public Health Emergencies

Strategies & 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 capacities for epidemiologic and laboratory analysis and program evaluation

Strategy 3

Intensify social mobilization, community and professional

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

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 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 capacities for preparedness and response to highly infectious diseases 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

i. Purpose This NOFO expands national-to-sub-national coordination to detect outbreaks and manage responses earlier and ensures a multi-disciplinary emergency management workforce. It captures the inter-dependent nature of various public health emergency management technical areas, spanning from risk assessments and readiness plans to response activations and community engagement, that will bolster Liberia’s capacity to strengthen its public health emergency preparedness and management systems.

ii. Outcomes The logic model illustrates key strategies and corresponding outcomes at three levels: short-term, immediate, and long-term. The recipient is expected to implement these strategies and demonstrate measurable progress each year of the award toward achieving the outcomes. The recipient will work directly in collaboration with NPHIL and MOH to prepare and respond to public health emergencies and threats, discuss strategies and solutions to address issues and challenges related to public health emergency preparedness and response. Project activities and outcomes should promote the development of the GOL’s long-term capacities to prepare and respond to public health emergencies and preparedness with limited external involvement beyond the project period of performance. The main strategies for this PHEM NOFO are to: (i) using a multidisciplinary knowledge base, integrate One Health and WASH principles, and accountability and evaluation mechanisms into scalable public health emergency management planning and response approaches that apply to national and sub-national EOCs, Incident Management (IMS), and RRT platforms; (ii) conducting capacity-building activities to increase knowledge, capacity, capability and retention of tiered, multi-disciplinary Emergency Management Specialists; and (iii) community and health facility preparedness and mitigation efforts targeted to geographic hotspots identified through multi-disciplinary, multi-hazard risk assessments. Specific activities and outcomes expected of this award’s recipient include the following:

Component 1: Capacity to Prepare, Detect, and Respond

Strategy 1: Using a multidisciplinary knowledge base, integrate One Health and Water, Sanitation and Hygiene (WASH) principles into public health emergency preparedness and response guidance for EOCs and RRTs

Short-term outcomes

• RRTs and EOCs routinely operate in accordance with the One Health framework

• RRTs and EOCs apply WASH principles to public health emergencies

Intermediate outcomes

• Liberia has access to a skilled and culturally responsive public health workforce to lead public health emergency responses

• Faster and more effective response logistics, mechanisms, and structures in place, including a well-resourced, well planned emergency management platform centered around EOCs and RRTs

Long-term outcomes

• Strengthen local level to control outbreaks at their source before they spread

• Response activations meet global benchmarks

• Increase speed of outbreak detection, identification, and response, especially for diseases of epidemic potential

Strategy 2: Conduct capacity-building activities to increase knowledge, capacity, capability and retention of tiered, multi-disciplinary Emergency Management Specialists

Short-term outcomes

• A skilled and culturally responsive public health workforce is available to support public health emergency response

• Improved coordination of multi-disciplinary emergency management workforce

Intermediate outcomes

• Liberia has access to a skilled and culturally responsive public health workforce to lead public health emergency responses

• Faster and more effective response logistics, mechanisms, and structures in place, including a well-resourced, well planned emergency management platform centered around EOCs and RRTs

Long-term outcomes

• Strengthen local level to control outbreaks at their source before they spread

• Response activations meet global benchmarks

Strategy 3: Community and health facility preparedness and mitigation efforts targeted to geographic hotspots identified through multi-disciplinary, multi-hazard risk assessments

Short-term outcomes

• Community and environmental risk factors for disease transmission are characterized and then mitigated in high-risk hotspots

Intermediate outcomes

• Risk of secondary disease transmission decreases in high-risk hotspots

Long-term outcomes

• Strengthen the local level to control outbreaks at their source before they spread

• Response activations meet global benchmarks

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 and emergencies

iii. Strategies and Activities Component 1: Capacity to Prepare, Detect, and Respond

Strategy 1: Using a multidisciplinary knowledge base, integrate One Health and Water, Sanitation and Hygiene (WASH) principles into public health emergency preparedness and response guidance for EOCs and RRTs

• Through multi-sector engagement, update and strengthen routine and emergency All Hazard Response and contingency plans within county and district health team platforms

• Review, revise, and exercise existing national, county, and district policies, procedures, and plans for scaled activation of EOCs, IMS, and RRTs during small, medium, and large-scale emergencies

• Pilot, validate, implement, monitor, and evaluate accountability mechanisms to ensure findings and lessons learned from intra- and after-action reviews, simulation exercises, and other public health activities are consistently adopted at sub-national (county and district) levels during Liberia’s five phases of emergency response (Prevention;

Preparedness; Response; Recovery; Mitigation)

• Develop instruments to conduct or support rapid assessments and development of subsequent operational response plans during small, medium, and large-scale events of public health importance. These may include, but are not limited to, diseases of epidemic potential, vaccine-preventable diseases, WASH, nutrition, maternal and child health, non-communicable diseases, and injuries

• During non-response periods, develop emergency logistics and supply chain management mechanisms (including, but not limited to, procurement and storage arrangements) at national, county, and district levels that can be rapidly activated during a public health emergency

• During response periods, support procurement, mobilization, and tracking of logistic resources at national, county, and district levels

• Establish and integrate multi-sectoral national, county, and district RRTs into the existing EOCs

• Conduct periodic comparative effectiveness or cost-effectiveness evaluations of national, county, and district response approaches (e.g., RRTs, EOCs, etc.)

• Provide technical expertise to propose and incorporate WASH principles, outbreak control techniques, and performance metrics into EOC and County Health Teams’ All Hazard Response and Incident Action Plan

Strategy 2: Conduct capacity-building activities to increase knowledge, capacity, capability and retention of tiered, multi-disciplinary Emergency Management Specialists

• Train national, sub-national and district level public health officials and clinical staff on principles and practices of the five emergency management phases, including best practices and application of multi-sector coordination mechanisms

• Provide technical leadership and subject matter expertise during emergency response operations and EOC activations at national, county, and district levels

• Provide intensive mentorship, supportive supervision, and capacity-building resources for national and sub-national public health emergency staff

• Develop, validate, and implement a robust, multi-disciplinary national and sub-national combined EOC and RRT training curriculum and schedule.

• Establish platform and provide technical support for effective collection, management, analysis, and communication of community, district, county and health facility data

• Incorporate training for health facility, community, and household water quality monitoring into RRT training plans and curriculum

Strategy 3: Community and health facility preparedness and mitigation efforts targeted to geographic hotspots identified through multi-disciplinary, multi-hazard risk assessments

• Conduct multi-disciplinary, multi-hazard risk assessments to target community interventions

• Review and revise county and health facility IPC reporting requirements to align with and reflect best practices for tracking WASH interventions

• Support periodic update of national and county health facility IPC instruments with relevant WASH standards and toolkits

• Provide technical and logistics expertise to sub-national EOCs and environmental specialists to design approaches for locally-sourced WASH interventions for health facilities use during outbreak responses

• Conduct routine and sentinel surveillance, geospatial mapping, diagnostics, and data analysis to identify environmental hotspots where waterborne and enteric disease outbreaks are likely

• In coordination with NPHIL and Liberia Department of Environmental Health, propose and pilot water quality monitoring, reporting, and data visualization approaches for communities or health facilities identified as high-risk for waterborne or diarrheal

• Design or conduct facility- and community-based assessments or surveys on perceptions and behavioral motivations for outbreak response and control measures adherence (including, but not limited to, isolation, hand hygiene, water treatment, etc.)

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 provisions

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 IHR (2005) 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, the recipient will need close activities coordination with other CDC Headquarters offices (such as the Division of Emergency Operations) and CDC-funded programs to realize stated goals and to advance GHS in Liberia.

This coordination includes, but is not limited to, surveillance, workforce development, laboratory diagnostics, and specimen transport – in addition to emergency preparedness and response.

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 donors and bilateral governments. Due to the complexity of the service delivery and the geographic landscape in Liberia, program plans which foster duplication or fragmented implementation are particularly costly and limited in ultimate impact. CDC works closely with other donors, governments, and health working groups to leverage resources from a variety of sources. Recipients will be required to consider diverse stakeholder inputs, One Health approaches, and coordination matrices across the full spectrum of emergency operations and management.

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 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 for whom limited pre-service education, inadequate occupational safety training and vaccine prophylaxis, and on-the-job mentorship is available. Applicants are expected to consider how best to assess current levels of workforce capacity and focus efforts towards in-service, on-the-job mentorship

• Ten (10) of 15 counties in Liberia are geographically inaccessible during eight (8) months of every calendar year. Activities and interventions should be designed accounting for disparities in geographic access, as well as the general resource disparities frequently observed between urban and rural communities

• Liberia, based on recent census figures, has a predominantly adolescent and young adult population. Due to 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. Outbreak preparedness and response planning should consider tailored community engagement and risk mitigation approaches for this group

• Liberians also have diverse religious preferences. Where applicable, this should be considered when identifying populations 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 This NOFO is divided into three (3) 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, 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 2 – 3) follow the same logic model with identical overarching strategies and activities. However, Component 2 should support activities when funding is made available for a moderate response to a disease outbreak or other public health emergency. Component 3 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: Capacity to Prepare, Detect, and Respond

Global Health Security activities are intended to be funded on an annual basis under Component 1. The estimated year one ceiling is $1,000,000. Future years’ funding levels will be dependent on funding availability.

The CDC seeks to advance Public Health Emergency Management (PHEM) in Liberia, building on established platforms within Liberia´s Ministry of Health (MOH), National Public Health Institute of Liberia (NPHIL), and other government ministries. Responding rapidly and effectively to public health emergencies is a key component of the USG’s Global Health Security Agenda (GHSA). Through GHS programs, CDC works with Liberia to address International Health Regulations (IHR) (2005) requirements through implementation of the GHSA. IHR (2005) establishes a legal framework for preparing for and responding to Public Health Emergencies of International Concern (PHEIC). This NOFO advances CDC’s strategic global health goals through its focus on investments and capacity-building at the places where outbreaks or other public health events are most likely to occur.

Recognizing global health threats posed by infectious diseases and other public health threats, the recipient would apply its expertise and funding allocation to prevent, detect, and respond to mitigate the human, environmental, and economic impact of naturally-occurring outbreaks, and intentional or accidental releases of dangerous pathogens.

This NOFO will be funded from CDC GHS appropriations. Occasionally, depending on the strategies and activities described within this NOFO, opportunities may emerge to leverage additional funding streams from other USG agencies. While this NOFO does not specify a ceiling, floor, or range for a particular activity, funding allocation or emphasis should be placed on resources expended directly on program activities with 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.

• Component 2: Rapid Small-Scale Response to Infectious Disease Outbreaks or Other Public Health Emergencies

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 3: Rapid Large-Scale Response to Infectious Disease Outbreaks or Other Public Health Emergencies

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, National Security Council, etc.)

declares a public health emergency as national security priority

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

5. When the U.S. Department of State (DOS) or the 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 one or more of the 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 amount 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. 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 apply to any emergency supplemental funding.

Component Funding: It is required that all GHS-funded cooperative agreements be formulated for component funding. A component is a discrete set of activities with an associated budget.

CDC will use component funding to provide funding for activities proposed in an application that received merit review but were not selected for funding in the initial award (i.e., at the onset of budget period 1) but may be funded at a later point in the budget period as programmatically necessary and as funding becomes available. Please review the following key points about component funding:

• Component funding must be setup at the time of the application. While preparing the application, applicants should review the expectations listed in the NOFO for Year 1 activities and group them under the anticipated components listed above. Only activities planned for Year 1 should be grouped into components; applicants do not need to group activities in the high-level plan for the subsequent years 2-5 of the award into components. Funding amounts and components for years 2-5 will be determined at continuation.

• Each component must be a discrete set of activities with an associated budget.

Distinguishable component budget narratives are required.

• Applicants should submit the anticipated components on an SF-424A form as part of their application which shows all components for the budget period. The amounts should exactly match what is being requested for funding. Each component has its own approved amount and cannot be funded above the established amount. The combined total of all components must total the requested amount.

• If more than 4 components are proposed, multiple SF-424As will be needed. Applicants may include the first 4 components on one SF-424A form and the remaining components on a second SF-424A form. Applicants may download additional SF-424A forms and upload them as PDFs under “Budget Narrative Attachment Form” or “Other Attachments Form.” These should be clearly labeled for easy identification and included in the Table of Contents for the entire submission.

• Any component that is not funded at the time of a new award may be deemed “ABU”.

There is no guarantee that all components will be funded in a budget period as ABU components are subject to the availability of funds and the underlying legal authority for the work.

Components may not be awarded in order. All ABU components are eligible to receive funding once (and if) funds become available.

If funding becomes available, multiple components can be funded through the same funding action (single NOA).

If funding is awarded for an amount less than the ABU component approved amount, it is not possible to fund the difference at a later time. Components can only be funded once.

• If, during the funding confirmation, the Program Office approves a budget that differs from what was submitted at the time of application (reflected in the budget markup), a revised budget may be required in addition to the technical review responses. If required, the revised budget is due within fifteen (15) to thirty (30) days of the start of the budget period. If required, technical review responses will also be due within fifteen (15) to thirty (30) days of the start of the budget period and must be submitted separately from revised budget applications. Future funding for ABU components will not be awarded until a revised budget, if required, is submitted and approved by CDC.

• Once components are awarded, funds cannot be redirected between components.

However, funds may be redirected within a component between object class categories.

It is critical to ensure accountability, transparency, and programmatic performance of all U.S.

taxpayer dollars.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

The applicant should select indicators from the menu that best measure the strategies, activities, and bolded outcomes identified in the logic model. There is no minimum or maximum number of indicators that should be selected. The purpose of collecting and reporting on indicators is to measure progress toward achieving the NOFO activities and outcomes. Results will also be used for program planning, improvement, accountability, and reporting. Results will be shared with recipients and other key parties. 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 select performance measures (indicators) from the menu 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 program implementation indicators (included in the Notice of Award), as well as other CDC or recipient’s standard indicators relevant to the intended outcomes of the project. Recipients will identify which indicators they will report on in their Evaluation and Performance Measurement Plan (EPMP). Recipients will be required to report on program implementation indicators selected from the below list through reporting mechanisms that will be specified by CDC after award (e.g. APR).

While recipients will be responsible for reporting on program implementation indicators relevant to proposed strategies and activities, they are not limited to only program implementation indicators. Applicants can, and are encouraged to, propose additional relevant indicators that, combined with program implementation indicators, will be monitored over the life of the NOFO.

Recipients will also be encouraged to consider additional measures from relevant USG GHSA Interagency Metrics, WHO Joint External Evaluation (JEE), and/or Healthy People 2030 standardized metrics and WHO benchmarks.

Additionally, recipients are only required to report on indicators relevant to their funded scope of work. Recipients should denote identified indicators relevant to their funded activities in their EPMP and should report annually against selected indicators in their APR.

Below is a menu of DGHP M&E Program Implementation Indicators that span eight technical areas: (1) Infection Prevention and Control, (2) Border Health, (3) Community Mitigation, (4) Emergency Operations and Response, (5) Laboratory Diagnostics, (6) Surveillance and Epidemiology, (7) Vaccines, and (8) Field Epidemiology Training Programs. A comprehensive indicator menu inclusive of detailed descriptions of each indicator will be provided at time of award. DGHP program implementation indicators should be incorporated into the recipient’s

EPMP.

DGHP Monitoring and Evaluation – Program Implementation Indicators

1. Infection Prevention and Control (IPC) Indicators

1.1. Cross-cutting IPC

1.1.1. Proportion of facilities that have an IPC focal person in place

1.1.2. Proportion of healthcare facilities providing essential services that implemented guideline-based IPC improvements

1.1.3. Number of healthcare facilities participating in CDC-supported healthcare detection and response networks

2. Border Health Indicators

2.1. POE General Capacity

2.1.1. Proportion of POE with multisectoral SOPs in place for identification (signs and…