NOFO 72048225RFA00001_ RTBR_Final.pdf

1. Issue Date: October 18, 2024

2. Pre-Concept Note Information Session RSVP: October 30, 2024

3. Pre-Concept Note Information Session: November 6, 2024

4. Deadline for Questions: November 14, 2024

5. Closing Date: December 17, 2024

Subject: Notice of Funding Opportunity (NOFO) Number: 72048225RFA00001 Title: BURMA: Resilient Tuberculosis Response in Myanmar (RTBR) Activity

Federal Assistance Listing Number: 98.001

Ladies/Gentlemen:

The United States Agency for International Development (USAID/Burma) is seeking applications for a cooperative agreement from qualified entities to implement in BURMA: Resilient Tuberculosis Response in Myanmar (RTBR) Activity. Eligibility for this award is restricted to local organizations (Please see the SECTION B below). Applicants may include international (including US-based organizations) as a subrecipient.

USAID intends to make an award to the applicant(s) who best meets the objectives of this funding opportunity based on the merit review criteria described in this NOFO, subject to a risk assessment and responsibility determination. Eligible parties interested in submitting an application are encouraged to read this NOFO thoroughly to understand the type of program sought, application submission requirements and selection process.

To be eligible for award, the applicant must provide all information as required in this NOFO and meet eligibility standards in Section B of this NOFO. This funding opportunity is posted on www.grants.gov and may be amended. It is the responsibility of the applicant to regularly check the website to ensure they have the latest information pertaining to this notice of funding opportunity and to ensure that the NOFO has been received from the internet in its entirety.

USAID bears no responsibility for data errors resulting from transmission or conversion process.

If you have difficulty registering on www.grants.gov or accessing the NOFO, please contact the Grants.gov Helpdesk at 1-800-518-4726 or via email at support@grants.gov for technical assistance.

USAID may not award to an applicant unless the applicant has complied with all applicable unique entity identifiers and System for Award Management (SAM) requirements detailed in http://www.grants.gov/ http://www.grants.gov/ mailto:support@grants.gov

NOFO 72048225RFA00001

BURMA: Resilient Tuberculosis Response in Myanmar (RTBR) Activity

Section D.6.g. The registration process may take many weeks to complete. Therefore, applicants are encouraged to begin registration early in the process.

USAID will conduct a virtual Pre-Concept Note Information Session in local Burmese language for applicants and interested organizations on November 6, 2024. Applicants are encouraged to attend this information session so that they may fully understand the requirements of this NOFO. Applicants are requested to register their attendance by RSVP to Mr Aung Min Thaw at athaw@usaid.gov with copy to BurmaOAA@usaid.gov no later than October 30, 2024. While the eligibility for the award is restricted to local organizations, additional organizations may attend the virtual information session. The google link of the virtual information session will be shared with those registered by November 4, 2024.

Please send any questions to the point(s) of contact identified in Section A. The deadline for questions is shown above. Responses to questions received prior to the deadline will be furnished to all potential applicants through an amendment to this notice posted to www.grants.gov.

Issuance of this notice of funding opportunity does not constitute an award commitment on the part of the Government nor does it commit the Government to pay for any costs incurred in preparation or submission of comments/suggestions or an application. Applications are submitted at the risk of the applicant. All preparation and submission costs are at the applicant’s expense.

Thank you for your interest in USAID programs.

Sincerely, Bruce Gelband Agreement Officer mailto:athaw@usaid.gov mailto:BurmaOAA@usaid.gov

This Burmese translation of the cover letter is provided as a courtesy. The English version of this NOFO will take precedence in case of any inconsistency in the

Burmese translation and any disputes will be resolved by USAID.

အေမရိကနြ်ပညေ်ထာငစု် �ိငုင်တံကာဖွံ� �ဖိုးေရးေအဂျငစီ် (USAID/Burma) သည ်ြမနမ်ာ�ိငုင်တံငွ ်

အေကာငအ်ထညေ်ဖာ်မည့ ်Resilient Tuberculosis Response in Myanmar – RTBR

စီမံကိနး်အတွက ်သင့ေ်လျာ်ေသာအဖွဲ�အစညး်များမှ Cooperative Agreement

လက်တွဲေဆာငရွ်က်မ� ေလျှာက်ထားချက်များကို �ှာေဖွလျှက�်ှိပါသည။် ဤရနပုံ်ေငအွစီအစဥ်အား

ြပညတ်ွငး်အဖွဲ�အစညး်များသာ ေလျှာက်ထားရန ်ကန ့သ်တ်ထားပါသည။် သိုေ့သာ်

ေလျှာက်ထားသမူျားသည ်အြပညြ်ပညဆ်ိုငရ်ာအဖွဲ�အစညး်များ (အေမရိကနအ်ေြခစုိက်

အဖွဲ�အစညး်များအပါအဝင)် အား လက်တွဲလုပ်ေဆာငမ်ည့ ်မိတ်ဖက်အဖွဲ�အစညး်များအြဖစ်

ထည့သ်ငွး်ေလျှာက်ထား�ိငုပ်ါသည ်(ေကျးဇူးြပု၍ ေအာက်တွငေ်ဖာ်ြပထားေသာ SECTION B ကို

�ကည့ပ်ါ)။

USAID/Burma သည ်ဤရံပုံေင ွအခွင့အ်လမ်း၏ ရညမှ်နး်ချက်များ�ငှ့ ်အည ီအကဲြဖတ်သံးုသပ်မ�

စံ��နး်များအရ အသင့ေ်တာ်ဆံုး ေလျှာက်ထားသ(ူများ)အား ရနပုံ်ေငေွပးအပ်ရန ်ရညရွ်ယ်ပါသည၊် Risk

Assessment and Responsibility Determination ြပုလုပ်မညြ်ဖစ်�ပီး ေလျှာက်လွှာ တငသ်ငွး်ရန ်

စိတ်ပါဝငစ်ားပါက အေသးစိတ်အချက်အလက်များကို နားလညသ်ေဘာေပါက်ရန ်

ဤရနပုံ်ေငအွခငွ့အ်လမ်း (NOFO) ကို ေသချာစွာ ဖတ်��ရန ်အ�ကံြပုပါသည။်

ရံပုံေင ွေလျှာက်ထားသသူည ်ဤ NOFO တွင ်ေဖာ်ြပထားေသာ အချက်အလက်များအားလံုးကို

ြဖည့စွ်က်ေလျှာက်ထားရမညြ်ဖစ်�ပီး၊ ဤ NOFO ၏ Section B တွင ်ေဖာ်ြပထားေသာ

လိုအပ်ချက်စံ��နး်များ�ငှ့ ်ကိုက်ညရီမည။်

ဤ NOFO ကို www.grants.gov တွင ်၀ငေ်ရာကဖ်တ်���ိငု�်ပီး၊ အခါအားေလျှာ်စွာ

ြပငဆ်ငြ်ဖည့စွ်က်မ��ှိ�ိငုသ်ညက်ို သတိြပုေစလိုပါသည။် ထိုေ့�ကာင့ေ်လျှာကထ်ားသမူျားအေနြဖင့ ်ဤ

NOFO �ငှ့ ်စပ်လျဉ်းသည့ ်ေနာက်ဆံုးသတငး်အချကအ်လက်များကို ရ�ှိ�ိငုရ်န ်

အဆိုပါဝဘဆ်ိုဒစ်ာမျက်�ာှကိ ု စစ်ေဆးရန ်လိုအပ်�ပီး NOFO အြပည့အ်စုံကို

ယငး်ဝဘဆ်ိုဒစ်ာမျက်�ာှမှ ရယူထားသင့ပ်ါသည။် USAID/Burma သည ်ေလျှာက်လွှာတငသ်ငွး်ြခငး်

လုပ်ငနး်စဥ်ေ�ကာင့ ်ြဖစ်ေပါ်လာေသာ အချက်အလက်အမှားအယွငး်များအတကွ် တာဝနမ်ယူပါ။ www.grants.gov တွင ်မှတ်ပုံတငရ်န ်သိုမ့ဟုတ် NOFO ကို ဖတ�်�ရန ်အခက်အခဲ �ှိပါက

နညး်ပညာဆိငုရ်ာ အကူအညရီယူလိုပါက Grants.gov Helpdesk (1-800-518-4726) သို ့

ဆက်သယွ်ရန ်သိုမ့ဟုတ် support@grants.gov သို ့ အးီေမးလ်ပုိရ့န ်တိုက်တွနး်အ�ကံြပုလိုပါသည။်

ရံပုံေငေွလျှာက်ထားသသူည ်အပုိငး် E.3 တွင ်ေဖာ်ြပထားသည့ ်Unique Entity Identifiers and

System for Award Management (SAM) လိအုပ်ချက်များအားလံုး ြပည့စုံ်မှသာ

USAID/Burma မှ ရနပုံ်ေငေွလျှာက်ထားမ�ကို ထည့သ်ငွး်စဥ်းစားမညြ်ဖစ်သည။် SAM တွင ်

မှတ်ပုံတငြ်ခငး်မှာ အချိနက်ာလတခုအထ ိ�ကာြမင့�်ိငုသ်ည့အ်တွက် မှတ်ပုံတငြ်ခငး်အား ေစာလျှငစွ်ာ

စတငရ်န ်အ�ကံြပုပါသည။်

ရနပုံ်ေငေွလျှာက်ထားရန ်စိတ်ပါဝငစ်ားေသာအဖွဲအစညး်များအတကွ် လိုအပ်ချက်များအား

ကနဦးေဆွးေ�းွမ� အစီအစဉ် ကို ၂၀၂၄၊ �ိဝုငဘ်ာလ ၆ ရက် တွင ်ြမနမ်ာဘာသာြဖင့ ်Google Meet

မှတဆင့ြ်ပုလုပ်မညြ်ဖစ်ပါသည။် NOFO အေသးစိတ်အချက်အလက်များကို

ေသချာစွာသ�ိှိနားလညေ်စရန ်ေဆွးေ�းွမညြ်ဖစ်ေသာေ�ကာင့ ်စိတ်ဝငစ်ားသမူျားအေနြဖင့ ်

တက်ေရာကရ်န ်တိုက်တနွး်လိုပါသည။် တက်ေရာကရ်နစိ်တ်ဝငစ်ားသမူျားအေနြဖင့ ်ဦးေအာငမ်ငး်ေသာ်

၏ အးီေမးလ်လိပ်စာ athaw@usaid.gov သိုလ့ိပ်မူ၍ မိတ� ူကိ ုBurmaOAA@usaid.gov သို ့

၂၀၂၄၊ ေအာက်တိုဘာ ၃၀ ရက် ေနာက်ဆံုးထား နာမညစ်ာရငး် ေပးသငွး်ရမညြ်ဖစ်ပါသည။် http://www.grants.gov/ mailto:BurmaOAA@usaid.gov

USAID/Burma မှ ၂၀၂၄၊ �ိဝုငဘ်ာ ၄ ရက် တွင ်Google Meet meeting link

အားေပးပုိသ့ာွးမညြ်ဖစ်သည။်

NOFO အတွက်ေမးခနွမ်ျား�ှိပါက Section A တွငေ်ဖာ်ြပထားေသာ ဆက်သယွ်ရမည့သ်ထူသံို ့

ေမးြမနး်�ိငုပ်ါသည။် ေမခွနး်များေပးပုိရ့နေ်နာက်ဆံုးရက်အား အထက်တငွေ်ဖာြ်ပထား�ပီး

အဆိုပါရက်မတိုငမီ် ရ�ှိခဲသ့ည့ ်ေမးခွနး်များ၏ ေြဖ�ကားမ�များကို NOFO ြပငဆ်ငခ်ျက်ြဖင့ ်ြဖည့စွ်က်

ေြဖ�ကားေပးသာွးပါမည။်

ဤ NOFO ထတု်ြပနြ်ခငး်သည ်အေမရိကနအ်စုိးရဘက်မှ ကတိကဝတ်ြပုြခငး် မဟုတ်ပါ။

ေလျှာက်လွှာတငသ်ငွး်ြခငး် သိုမ့ဟုတ် ေလျှာက်ထားမ� ကုနက်ျစရိတ်များအတကွ ်အေမရိကနအ်စုိးရမှ

ေပးေဆာငရ်န ်ကတိြပုြခငး်လညး် မဟုတ်ပါ။ ေလျှာက်လွှာြပငဆ်င ်တငသ်ငွး်ြခငး်အတွက်

ကုန�်ကစာရတိ်များသည ်ေလျှာက်ထားသ၏ူတာဝနသ်ာြဖစ်သည။်

USAID/Burma ၏စီမံကနိး်များအား စိတ်ပါဝငစ်ားမ�အတွက ်ေကျးဇူးတင�်ှိပါသည။်

ေလးစားစွာြဖင့ ်

Bruce Gelband

Agreement Officer

NOFO TABLE OF CONTENTS

NOFO TABLE OF CONTENTS 6

SECTION A: BASIC INFORMATION 7

SECTION B: ELIGIBILITY 9

SECTION C: PROGRAM DESCRIPTION 11

SECTION D: APPLICATION CONTENT AND FORMAT 21

SECTION E: SUBMISSION REQUIREMENTS AND DEADLINES 28

SECTION F: APPLICATION REVIEW INFORMATION 30

SECTION G: AWARD NOTICES 33

SECTION H: POST-AWARD REQUIREMENTS AND ADMINISTRATION 34

ANNEX 1 - STANDARD PROVISIONS 42

SECTION A: BASIC INFORMATION

1. Executive Summary

This activity will strengthen the ability of non-National TB Program (NTP)/ Public providers, such as GPs, private hospitals and clinics, and NGO-managed clinics to screen, test, and treat TB and DR-TB patients and provide TB preventive therapy to close contacts of TB patients.

This activity also seeks to improve the providers’ knowledge of TB and DR-TB, enhance their abilities to provide TB-related services to their clients and to expand the number of partners and organizations involved in TB care delivery. The Activity will engage large private hospitals in the TB testing and treatment consortium, facilitate the introduction of novel strategic health purchasing schemes, and train health providers to apply internationally-accepted TB testing and treatment algorithms and protocols. In addition, the activity will have significant emphasis on improving TB diagnosis in Myanmar, with the introduction of new technologies, electronic laboratory management systems, and quality control. To support the Monitoring and Evaluation (M&E), the activity will strengthen TB data recording and reporting among engaged healthcare providers, including private GPs and hospitals, assist utilization of M&E frameworks, databases, data analysis and reporting. This activity will expand the network of TB service providers, improve people's access to TB diagnosis and treatment, and improve data surveillance.

2. Estimate of Funds Available and Number of Awards Contemplated

USAID intends to award a one Cooperative Agreement pursuant to this notice of funding opportunity. Subject to funding availability and at the discretion of the Agency, USAID intends to provide an amount not to exceed $13,500,000 in total USAID funding over a five-year period.

3. Start Date and Period of Performance for Federal Awards

The anticipated period of performance is five-year as of the effective date of the award. The estimated start date will be the third quarter of the USG Fiscal Year (FY) 2025.

4. Agency Point of Contact

Name: Aung Min Thaw Title: Acquisition and Assistance Specialist Email: athaw@usaid.gov

5. Acquisition and Assistance Ombudsman

The A&A Ombudsman helps ensure equitable treatment of all parties who participate in USAID’s acquisition and assistance process. The A&A Ombudsman serves as a resource for all organizations who are doing or wish to do business with USAID. Please visit this page for additional information: https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman.

The A&A Ombudsman may be contacted via: Ombudsman@usaid.gov

6. Authorized Geographic Code

The geographic code for the procurement of commodities and services under this program is 937, which is defined as the United States, the recipient country, and developing countries other than advanced developing countries, but excluding any country that is a prohibited source.

[END OF SECTION A]

https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman

SECTION B: ELIGIBILITY

1. Eligible Applicants

The eligibility requirement is restricted to local organizations.

Organizations eligible to submit a Concept Paper in response to this NOFO are local organizations.

Only local organizations as defined below are eligible for the award. USAID defines a “local entity” as an individual, a corporation, a nonprofit organization, or another body of persons that:

(1) Is legally organized under the laws of;

(2) Has as its principal place of business or operations in; and

(3) Is majority owned by individuals who are citizens or lawful permanent residents of; and

(4) Is managed by a governing body the majority of who are citizens or lawful permanent residents of the country receiving assistance.

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

Recipients must be responsible entities and must have the necessary organizational experience, accounting, operational controls and technical skills, or ability to obtain them in order to achieve the objectives of the activity and comply with the terms and conditions of the Award. Concept papers from organizations that do not meet the above eligibility criteria will not be reviewed and evaluated.

USAID strongly encourages concept papers from potential new partners to the US government who meet the above eligibility requirements. Such organizations are advised that they will be required to undergo a Pre-Award Responsibility Determination - a pre-award survey to determine fiscal responsibility (i.e. whether the prospective recipient has the necessary organization, experience, accounting and operational controls, and technical skills – or ability to obtain them – in order to achieve the objectives of the project and comply with the terms and conditions of the award).

While for-profit firms may participate, pursuant to 2 CFR 200.400(g) it is USAID policy not to award profit to recipients and subrecipients under assistance instruments. However, while profit is not allowed for sub-awards, the prohibition does not apply when the recipient acquires goods and services in accordance with 2 CFR 200.317 -326, “Procurement

Standards.” This is discussed more specifically in ADS 303sai “Profit Under USAID Assistance Instruments” which can be found at this link:

2. Cost Sharing

Cost Sharing is not required for this activity.

[END OF SECTION B]

https://www.usaid.gov/about-us/agency-policy/series-300/references-chapter/303sai

SECTION C: PROGRAM DESCRIPTION

This funding opportunity is authorized under the Foreign Assistance Act (FAA) of 1961, as amended. The resulting award will be subject to 2 CFR 200 – Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, and USAID’s supplement, 2 CFR 700, as well as the additional requirements found in Section H.

I. PROBLEM STATEMENT

Myanmar’s high burden of TB, TB-HIV, and MDR-TB is a significant public health challenge that the country has been grappling with for decades. Despite some progress made in reducing TB incidence over the last decade, the number of total TB cases notified decreased by 50 percent in 2021 compared to 2019, after the COVID pandemic in 2020 and political upheaval in 2021.

Further deterioration of the public healthcare system in the country resulted in significant decline in TB parameters in 2023 and estimated to be further declined in 2024.

Limited capacity and ability by the players outside of the National Tuberculosis Program (NTP), such as private general practitioners (GPs), private hospitals, pharmacies, and clinics managed by NGOs to sustain and scale up TB interventions, such as TB screening, testing, treatment delivery and implementation of TB preventive measures. While non-NTP players contribute up to 30% of annually detected TB cases, it is estimated that it could be as much as 50-60%, based on the data published by the Word Bank.

II. PURPOSE

The purpose of this activity is to strengthen the ability of non-NTP providers, such as GPs, private hospitals and clinics and NGO-managed clinics to screen, test, treat TB and DR-TB patients and provide TB preventive therapy to close contact of TB patients.

A. Background

Tuberculosis (TB) is one of the world’s leading infectious disease killers. Despite being preventable, treatable, and curable, this ancient disease continues to kill more people each year than HIV and malaria combined. In cooperation with local partners, USAID provides bilateral assistance to 24 countries globally with high burden of TB, including Myanmar, which has one of the highest levels of tuberculosis in the world. Myanmar is among countries with triple TB epidemic: drug-sensitive tuberculosis (DS-TB), multidrug-resistant TB (MDR-TB), and coinfection of TB and Human Immunodeficiency Virus (TB/HIV). According to the Institute for Health Metrics and Evaluation data, TB remains among Myanmar’s top ten causes of morbidity and mortality.

The WHO’s 2022 TB incidence estimation for Myanmar is 475 per 100,000, a 30 percent increase compared to 2021, due to significant drop in TB case detection by the National TB Program (NTP) in 2020-2021. WHO estimates that 257,000 new TB cases emerged in the country in 2022, a 32 percent increase from the 2021 estimate of 194,000. The estimated incidence of lab-confirmed pulmonary TB in Yangon is 506/100,000, significantly higher than the national average. Based on preliminary data from 2023, 128,000 drug-sensitive TB (DS-TB) cases were detected in Myanmar among 257,000 estimated, demonstrating a significant gap of 50%. Also, 2,664 Drug Resistant (DR-TB) cases were detected, among 13,000 estimated. USAID/Burma implementing the Global TB Accelerator program and aiming to achieve national TB targets set during the 2023 UN High-Level meeting for TB.

USAID has provided bilateral support to address TB in Myanmar since 2013 and invested over $90 million. USAID/Burma provides training, technical assistance and capacity building to local and international organizations to address TB detection, treatment and prevention among vulnerable and high-risk groups. Through Resilient Tuberculosis Response in Myanmar (RTBR) Activity, USAID intends to expand the technical assistance and support to private, non-governmental players in the country in order to expand access to and delivery of TB services.

B. Private Sector Engagement In Myanmar, private sector providers, ranging from general practitioners to large and small private hospitals and pharmacies play an important role in delivering healthcare to the population. Publications show that private providers are the destination for 75% (67%–84%) of initial care-seeking, and private expenditure represents 61%–74% of total expenditure on health in Asia countries, including Myanmar. Approximately 30% of all TB notifications are reported by the non-governmental sector, such as private GPs, hospitals, clinics as well as healthcare facilities managed by the non-governmental organizations (NGOs).

National TB Prevalence Survey (2018) proved that health seeking behaviors of TB suspects started with private health care providers including general practitioners and pharmacies, without formal quality assurance of care and reporting systems with NTP. No TB cases reported from private pharmacies at the national level and not affiliated with NTP, although some NGOs have been working with private pharmacies for active case finding, and there is no data on disbursing the TB medications in the pharmacies.

While WHO’s Joint Monitoring Mission (2019) recommended the scale up of collaborative and cooperative efforts between public and private sectors of TB care, among 253 private hospitals and 6,590 GP clinics, a very limited number of private care providers (11% of hospitals and 45% of GPs) had been working for TB through some NGOs. NTP committed to “strengthen PPM activities first, by engaging drug sellers and pharmacies to encourage patients with a long-standing cough to visit TB facilities…a system can be set up whereby drug sellers and pharmacies will refer”.

C. USAID/Burma TB program USAID/Burma’s health programming is closely aligned with the goals of the National Strategic Plan (NSP) 2021-2025 for Tuberculosis in Myanmar, the TB Action Plan as well as the global End TB Strategy. The National Strategic Plan 2021-2025 for Tuberculosis aims to reduce TB incidence by 50% by 2025, and end the TB epidemic in Burma by 2035. USAID/Burma aims to institutionalize improvements in policy development, data use, financial risk protection, supply chain management, and human resource development of health providers to improve delivery of TB detection, prevention, and treatment services. USAID support to local NGOs which have on-site clinics demonstrated the value of support and positive outcomes in the number of clients served. Partnering with a network of private GPs demonstrated significant output in the number of people screened for TB disease and enrolled on first-line treatment for DS-TB.

USAID RTBR activity will assist non-NTP clinics to be able to routinely screen and test patients for TB symptoms, utilize novel diagnostic equipment for disease confirmation and provide high-quality TB care services for both sensitive and drug-resistant TB. Activity will assist with engaging large private hospitals in the TB testing and treatment consortium, facilitate the introduction of novel strategic health purchasing schemes and train health providers to apply internationally-accepted TB testing and treatment algorithms and protocols

USAID/Burma's TB program covers the States and Regions of Yangon (catchment area including Bago and Ayeyarwaddy), Mandalay, Sagaing (Magway), Kachin state, Shan state, and Tanintharyi. with national level support for Procurement and Supply Chain Management and technical assistance to the National Tuberculosis Program (NTP). See Table 2 found in the link below for a full breakdown of USAID's TB programming in Myanmar

Also find the report from USAID funded Local Action Towards TB Free Myanmar Activity

D. USAID/Burma’s key TB priorities USAID/Burma will build upon recent program adjustments (including engaging more with the non-governmental sector) to maximize TB prevention, diagnostic, and treatment services amidst staffing shortages and other crises that are expected to continue in the current political situation. The program will prioritize finding missing cases to catch up to the case notification targets set forth by the UN General Assembly (UNGA) and in the Burma National Strategic Plan for TB, and will work to ensure that all notified cases receive treatment services. USAID/Burma will work to link community-based case finding activities with contact investigation and https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/news-and-updates/global-accelerator-end-tb/tb-roadmaps/burma-fy-2024 https://docs.google.com/document/d/1L30AYfL0OY82paZTyoRwBMVdh_y05yOQ/edit?usp=sharing&ouid=101589619311733830653&rtpof=true&sd=true promotion of tuberculosis preventive treatment (TPT), and will tailor interventions to the needs and preferences of clients, with a special focus on understanding how to make services more male-friendly, as there are a higher number of males affected by TB in Burma. The Mission will bolster TB services in high-burden areas, by involving the private sector and strengthening NGO-supported service delivery. USAID RTBR activity will play an important role in helping to achieve 2024 TB Roadmap priorities as well as the USAID TB Strategy for 2023-2027.

E. Donor Support and Other Partners USAID is working closely with the WHO, and the Global Fund principal recipients (PRs) and the Access to Health Fund to advance the TB and HIV response. Global Fund and Access to Health also work with local organizations such as the Myanmar Medical Association and the Myanmar Anti Tuberculosis Association to implement community-based TB care (CBTBC) activities led by trained community volunteers.

F. Coordination with other Health Activities and Development Partners USAID RTBR will work with all relevant USAID health projects and other development partners implementing TB activities in Burma. USAID RTBR will assist with engaging large private hospitals in the TB testing and treatment consortium, facilitate the introduction of novel strategic health purchasing schemes and train health providers to apply internationally-accepted TB testing and treatment algorithms and protocols. Activity will closely cooperate and coordinate with other USAID-funded partners, such as HIV TB Agency, Information and Services Activity and Local Engagement and Development for TB activity. USAID RTBR will have significant emphasis on improving TB diagnosis in Myanmar, with the introduction of new technologies, electronic laboratory management systems and quality assurances and partner with the Access to Health as well as the WHO Burma office.

G. Expected Geographic coverage in Burma RTBR is expected to cover the following geographic regions: Yangon, Ayeyarwady, Bago, Mandalay, Sagaing (Magway), Kachin state, Shan state and Tanintharyi.

III. OBJECTIVES

Through this NOFO, USAID seeks Concept Papers (CPs) to achieve the following objectives:

Objective 1. Strengthen the network of private general practitioners for TB detection and care Nongovernmental health service delivery has a long history of implementation in Myanmar.

Since 2004, through the support of PSI, the social franchise network of Sun Quality Health Clinics

(SQH Network) has been formed among private general practitioners who independently operate small and mid-size clinics for neighboring communities. The initial focus of the network was on family planning, but then expanded to other health services including tuberculosis.

Approximately 1,500 general practitioners belong to the SunHealth network, with approximately 800 engaged in TB screening, referral and treatment for DS-TB. Through the support of Population Service International (PSI), network providers receive training and educational sessions on specific health topics, mentoring, basic supplies of commodities and guidance on reporting and recording. GPs engaged in TB work, participate in three “schemes” of services:

from initial scheme 1, when providers only screen people for TB and refer them for testing and treatment to the governmental clinics, to scheme 3, when GPs provide full testing and treatment care.

Through the implementation of Objective 1, USAID is seeking to support an implementing partner (IP) to expand the size of the current TB network of Sun clinics, add more general practitioners to the network. Assist current network members in scheme 1 to increase their capacity and expand service provision to reach scheme 2 and respectively providers in scheme 2 to engage in TB treatment delivery under scheme 3. The implementing partner will improve access to digital chest X-ray and molecular diagnostic TB tests for Sun Health clients through the expansion of diagnostic sites, facilities and through procurement of equipment and commodities. Lastly, the implementing partner will assist GPs in scheme 3 to expand service delivery for patients with drug-resistant tuberculosis, through short, all-oral regimens. The IP will also train the clinic assistants to support the GP doctors for timely and consistent recording and reporting, and provide training on how to manage patients while on treatment. Also, digital adherence tools would be introduced and scaled up through implementation of this Objective.

Objective 2. Establish network of private and nongovernmental hospitals for TB service delivery Myanmar healthcare system has a large network of private hospitals, providing services to people from basic health conditions to specialized care, including surgery and rehabilitation.

There are nearly 300 private hospitals in the whole country and more than 200 hospitals are members of Myanmar Private Hospital Association (MPHA). It is estimated that major private hospitals receive as much as 50,000 outpatient department (OPD) visits per day, and with a TB rate as high as 475 per 100,000, as many as 230 TB patients could be diagnosed per day.

However, the Myanmar NTP does not have enough capacity to engage and work closely with the private hospitals and support from USAID implementing partners is required. The proper assessment is needed to understand the screening, diagnostic and treatment practices at the large private hospitals for TB. While chest X-ray is likely available at the facilities, access to novel molecular diagnostic tools is probably lacking. Also, the level of bacteriological testing among clients accessing private hospitals is low. Treatment regimens might not be in line with international standards and care for patients with DR-TB might be absent.

Through implementation of Objective 2, USAID is seeking to support the establishment of a practical screening and testing network of private and non-governmental hospitals in order to improve screening for TB among OPD visitors, achieve universal access to chest X-ray and significantly improve access to bacteriological testing through novel molecular tools. An implementing partner will provide training and capacity building to healthcare staff to improve their knowledge on both TB detection and treatment. Staff will be trained on provision of standard TB treatment protocols for adults and children, with both DS- and DR-TB, improve quality of care delivery, introduce digital adherence practices and provide psychological counseling and support. Moreover, the IP will also advocate and coordinate between the National TB Program and the private hospital network and support the private hospitals to mandatorily notify their TB cases to the NTP surveillance system. Lastly, the implementing partner will introduce a system of strategic health purchasing in order to establish a sustained service delivery platform and reduce catastrophic cost to patients and their families.

Objective 3. Strengthen the network of pharmacies for TB detection In many Asian countries, including Myanmar, pharmacies play a crucial role in providing initial healthcare services to the public. The process of seeking initial healthcare through pharmacies in these countries often involves several key elements like accessibility, availability of the over-the-counter medicines, consultation with pharmacists, etc. Pharmacies are often widely distributed and easily accessible in urban and rural areas. They are commonly found in neighborhoods, markets, shopping centers, and even nearby and within hospitals. People seeking initial healthcare often visit pharmacies to purchase over-the-counter medications for common ailments such as headaches, cough, colds, fever, and digestive issues. Pharmacists may offer advice on suitable medication and products based on the symptoms described by the customer.

In many Asian countries, including Myanmar, a limited number of pharmacists are trained to provide basic healthcare consultations while most of the small-scale drug shopkeepers are not properly trained. However, when people with cough or other TB-related symptoms seek medical attention in pharmacies, usually no information is provided about how people can be tested or screened for TB and where to get TB treatment, resulting in a missed opportunity. While in the past, donor-funded activities introduced a self-screening application via the phones, which helps to run the TB-related questionnaire, such activities are implemented at a limited scale.

Through this Objective, USAID is seeking to support the expansion of the existing network of pharmacies in Yangon region and create a similar type of network in other states and regions, where the activity will be operational (see Geographical focus area Section). The IP will also recruit the workforce like coordinators and support the clients referred from the pharmacies to reach to the diagnostic facilities and have a right diagnosis and treatment from the clinics and hospitals and completely finish the treatment. They will also train and make sure the pharmacies record and report the data by monitoring and supervision. The implementing partner will provide training and educational sessions to pharmacists and pharmacy operators/managers, establish a digital online system for patients to self-screen for symptoms and pilot an innovative method of non-sputum testing via PCR technology. In particular, the partner will establish a hub-and-spoke model for pharmacies to be connected to the molecular diagnostic center, where portable PCR instruments will be located. Patients would be able to self-swab and deposit the stick at the pharmacy designated location. Later it will be sent to the PCR testing center for processing and both the patients and healthcare provider would be notified of the test results.

Objective 4. Strengthen TB data recording and reporting Collecting and reporting essential programmatic data is a necessary element of public health operations. However, in the private sector, especially in the GP network and private hospitals, recording and reporting of TB data has not been well established. In most cases, patient’s records are recorded in the internal M&E system, and only limited data parameters are collected, which are needed to manage the TB condition. However, a significant number of parameters, which are usually recorded in the NTP database and then submitted to the WHO global TB database is not routinely collected by the private providers. Incomplete data collection and absence of reporting to the state/regional and national TB database makes it difficult for local and international partners and donors to fully assess the TB epidemiology in the country and make data driven decisions.

Under this Objective, the implementing partner will assist activity clients, such as network of general practitioners, private and non-governmental hospitals and pharmacies to develop modern, digital and user-friendly TB data collection tools and systems, which could be operational on mobile devices as well as stationed computers. Implementing partner will roll out the new data collection tools, establish linkages with the state and provincial NTP M&E systems and facilitate reporting of internationally-accepted parameters. In addition, the partner will introduce data quality assurance mechanisms and data validation processes. As a result, all activity clients would be able to record and report TB data parameters, in accordance with the WHO, Global Fund and USAID requirements, and meet the NTP standards.

The state and regional TB program utilizes the District Health Information System 2 (DHIS2) as the principal tool for eHealth architecture for aggregate reporting. After the military coup, the public sector strike and widespread internet connection outages are negatively impacting the quality of reporting. Due to limited human resources in the public sector, NTP has limited ability to collect, process and record essential TB data coming from both public and non-governmental facilities, including the private sector. It is expected that the implementing partner will be able to assist governmental M&E offices at selected states and regions to improve the monitoring system, assist with data entry and validation and support the quarterly data collection, analysis and reporting.

Objective 5. Support local entities for sustainable and resilient operations In the last few years USAID made significant attention to direct partnership with local organizations and shifting decision-making power to the people, organizations, and institutions that are driving change in their own countries and communities. Experience shows that local leadership over development and humanitarian goals and programming is important for equity, effectiveness, and sustainability. Through the localization approach, USAID strives to advance locally led development and public health response, in which local actors set their own agendas, develop solutions, and mobilize the capacity, leadership, and resources to make those solutions a reality.

However, time and efforts are required to build, support and sustain local partners for public health response in Myanmar. Through this Objective, USAID is aiming to provide direct support to local partners, implementing this activity, to improve capacity for operations and management, gain new skills and information and improve quality of day-to-day operations. It is expected that local private entities like private hospitals, GP clinics, laboratories and pharmacies from participating states and regions would be able to join the implementation of this activity and will receive capacities and skill sets in organizational development, financial management and accountable recording and reporting to implement TB activities and contribute to the goals and objectives of this activity. Capacity building will be provided to continue, sustain and expand operations in selected geography.

IV. GUIDING PRINCIPLES

The applicant should consider the following when developing the interventions:

1. Diversity, Equity, and Inclusion (DEI): USAID’s TB program will work to promote, enhance, and sustain diversity and inclusion in all activities. To meet our goal of equity, USAID will prioritize working with underserved communities and those who are in the greatest need.

2. Local Ownership and Leadership: USAID will partner with local governments and organizations and support their implementation of TB activities. USAID will actively engage with country leadership to promote program ownership through increased local investments and program monitoring. USAID will continue to support high-level advocacy to actively engage local leaders and communities in eliminating TB at the national level.

3. Person-Centered Approach: USAID will continue to place individuals and communities affected by TB at the core of each activity. USAID will support countries in building a holistic, individualized, respectful and empowering health service delivery system for TB that includes TB-affected individuals in decision making regarding the development, implementation, and evaluation of care and treatment services. USAID will support national TB programs in adopting flexible and tailored approaches that minimize health system barriers and costs to individuals, and to meet the needs and preferences of people affected by TB to improve each person’s health outcomes.

4. Effective and Efficient Programming: USAID will strive to use funds effectively and efficiently to achieve value for money. The Agency will remain flexible and responsive to adapt to existing and new TB-related challenges and situations in partner countries.

5. Strategic Partnership: USAID will continue to work with key international and domestic partners, including the Global Fund to achieve global goals.

6. Evidence Driven Programming: USAID will support the availability of high-quality, updated, and rigorous systems for TB care across partner countries. USAID will also evaluate systems to generate evidence that will help to improve strategic planning, project design, and resource decisions.

V. ANTICIPATED RESULTS

The activity will contribute to national efforts to end the TB epidemic in Myanmar. Applicants are expected to propose activities that are appropriate and relevant to the situation and needs of people affected by tuberculosis.

Specifically, at the end of the activity, RTBR activity will have contributed to the following:

• Increased TB case finding and notifications among non-NTP players nationwide;

• Improved service delivery for engaged private providers;

• Scaled up and expansion of novel diagnostic tools, such as digital chest X-ray and molecular testing;

• Established and sustained of network of nongovernmental hospitals;

• Established, sustained and expanded network of pharmacies in targeted cities, states and regions;

• Strengthened and improved quality of TB referrals and case finding among pharmacy network members;

• Improved capacity of private providers and nongovernmental organizations to record and report TB data;

• Established and sustained quality assurance mechanism for data processing, recording and reporting;

• Increased number of local organizations engaged in TB response in targeted selected states and regions; and

• Improved capacity of local organizations for continued and resilient operations.

VI. EXPECTED PERFORMANCE INDICATORS, TARGETS, BASELINE DATA AND DATA

COLLECTION

The AMEL plan will specify indicators and should incorporate "core" and "core plus" TB indicators based on USAID's TB Performance-Based Monitoring and Evaluation Framework (PBMEF) for TB Programs (Guide for Indicators) as appropriate for this activity. The PBMEF indicators are aligned with the leading global strategic documents, including the U.S.

Government's USAID Global TB Strategy 2023-2030, the WHO End TB Strategy, and UNGA HLM Political Declaration on TB. The AMEL plan should be aligned and reflect the elements of the USAID Global TB Strategy M&E logical framework. Other national, sub-national, and extended PBMEF indicators from the comprehensive list presented in the USAID PBMEF guide may also be https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/news-and-updates/global-accelerator-end-tb/pbmef considered to help track progress toward achieving set targets. The monitoring section should also envision a clear and concise Data Quality Assurance (DQA) plan to verify the quality and reliability of data collected for every indicator. When proposing interventions, the following indicators should be considered:

• Number of people screened for TB

• Number of people with presumptive TB identified

• Number of people with presumptive TB who were tested with a rapid diagnostic test

• Number of people notified with new and relapse TB

• Percent Bacteriologically Confirmed

• Rapid diagnostic testing at the time of initial diagnosis (percentage)

• Number of DS-TB treatment initiations

• Number of DS-TB people who were successfully cured or treatment completed

• Percent of people with new and relapse TB with drug susceptibility testing (DST)

• Number of people with RR/MDR-TB notified

• Number of pre-XDR/XDR notified

• Number of people with DR-TB initiated treatment

• Number of people with DR-TB disease who successfully treated

• Percent of people with notified TB with a contact investigation initiated

• Percent of Contacts Screened for TB disease

• TPT Initiations (core), including TPT initiations among contacts

• TPT Completions rate/number

VII. SUBSTANTIAL INVOLVEMENT

A successful applicant under this funding opportunity should anticipate a cooperative agreement award involving substantial involvement. In accordance with ADS 303.3.11, USAID/Burma will be substantially involved during the implementation of this Cooperative Agreement, through the Agreement Officer's Representative (AOR)’s approval of the following:

• Approval of recipient’s Annual Implementation Plans.

• Approval of the specified Key Personnel.

• Agency and Recipient Collaboration or Joint Participation: Collaborative involvement in selection of advisory committee members, if the program will establish an advisory committee that provides advice to the recipient. USAID may participate as a member of this committee as well. Advisory committees must only deal with programmatic or technical issues and not routine administrative matters.

• Concurrence on the substantive provisions of sub-awards.

• Approval of Activity Monitoring, Evaluation and Learning (MEL) Plans.

• Agency monitoring to permit specific kinds of direction or redirection because of the inter-relationships with other projects.

• Approval of Gender Action Plan.

[END OF SECTION C]

SECTION D: APPLICATION CONTENT AND FORMAT

1. General Content and Form of Application

USAID/Burma will utilize the following application selection process.

Phase 1: Concept Application

Each applicant must furnish the information required by this NOFO. The Concept Application should be submitted per the below instructions and describe technical aspects of the applicant’s proposed program.

Each applicant must also submit a summary budget with the Concept Application indicating the requested USAID funding amount. See Section D.E below.

Phase 2: Co-Creation and Full technical and cost application submission

USAID will inform the Apparently Successful Applicant(s) that they have been selected to proceed to the next stage of the process, co-creation.

The co-creation phase is a collaborative approach whereby USAID and the selected Applicant(s) will jointly develop the Program Description of the Activity. Instructions will be provided on how the co-development process will be conducted, either in person in Yangon, Myanmar or virtually.

The applicant’s proposed Chief of Party from the concept application phase should participate in and support the co-creation phase, if available.

After completion of the co-creation phase, a Request for a Full Application (RFA) will be issued to the Apparently Successful Applicant(s). The Apparently Successful Applicant(s) will then be required to submit the full technical application using the co-created Program Description and a full cost application (solely developed by the Apparently Successful Applicant) along with any other required documents to be submitted as instructed. During co-creation/ co-development or after receipt of the full application, USAID reserves the right to select another applicant from the pool of applicants in the event a final agreement is not reached with the initially selected Apparently Successful Applicant(s).

The following requirements apply to documents submitted for Phase 1:

• Letter size paper.

• Written in English.

• 12-point Calibri font with one inch margins.

• Graphics/charts/tables may use 10-point Calibri font, so long as it is legible without magnification. Graphs, charts, and tables should be for illustrative purposes only and should not comprise the majority of the application text.

• Submitted via Microsoft Word or PDF compatible formats.

• All pages after the cover page must be consecutively numbered.

The applicant should retain a copy of the application and all enclosure for their records.

2. Phase I- Concept Application

Timeline:

1. Pre-Concept Note Information Session: All interested organizations are requested to acknowledge their attendance by RSVP no later than the date and time indicated on the cover page. The link of the virtual information session will be shared prior to the session with those who RSVP. The email subject line should be “BURMA: Resilient Tuberculosis Response in Myanmar (RTBR) Information Session”.

2. Questions: Any question related to the NOFO must be submitted by the date and time indicated on the cover page. The email subject should be “BURMA: Resilient Tuberculosis Response in Myanmar (RTBR) NOFO Questions”.

3. Concept Note Submission: The concept note in response to the NOFO must be submitted by the date indicated on the cover page. The email subject line should be “BURMA: Resilient Tuberculosis Response in Myanmar (RTBR) Concept Note Submission”

The Applicant must submit a concept application not to exceed ten pages (including the cover page, the Summary Budget Information). The Concept Application should be written from a strategic viewpoint that reflects an understanding of the opportunities and challenges that exist and reflect a convincing approach to achieve the Activity outcomes and results set forth above. Concept submissions must be in standard 8 ½” x 11”, single sided, single-spaced, 12-point Calibri font, 1” margins, left justification and headers and/or footers on each page reflecting consecutive page numbers, date of submission, and Applicant’s name.

Submissions must be via Microsoft Word or PDF formats, except budget files which must be submitted in Microsoft Excel with formulas and cells unlocked.

Any pages submitted beyond the limit will not be evaluated. Additional documentation, such as annexes, charts and graphs that exceed the ten pages will not be reviewed. USAID will not review any information provided in links in the Concept Application. The Concept Application may be in English language. The applicant must also submit a Summary Budget (not counted towards page limit) as a separate document in the format described below and must be submitted in English language only.

Order Required Item Page Limit Instructions

Concept Application: Technical Part

1 Cover Page 1 See Section D.A

2 Proposed Technical Approach 5 See Section D.B

Institutional Experience and Past Success

See Section D.C

4 Management Plan (excluding COP annex)

See Section D.D

Additional Information:

1 Summary Budget Information 1 See Section D.E

The concept application should be specific, complete, and presented concisely. The application must demonstrate the applicant's capabilities and expertise with respect to achieving the goals of this activity. The application should take into account the requirements of the program description.

The concept application must be structured as follow:

A. Cover Page

The cover page must be include the following:

• Name of the organization

• Organization submitting the application;

• Signature of authorized representative of the applicant;

• Identification of the primary contact person (by name, title, organization, mailing address, telephone number and email address) and the identification of the alternate contact person (by name, title, organization, mailing address, telephone number and email address);

• Activity/Program title;

• UEI number for primary applicant if available;

• Notice of Funding Opportunity number; and

• Name of any proposed subrecipients or partnerships (identify if any of the organizations are local organizations, per USAID’s definition of ‘local entity’ under ADS 303.3.6.5(c)(1).

B. Proposed Technical Approach

The proposed technical approach should: (1) demonstrate a thorough understanding of and appreciation for the implementation challenges of the current country context and policy environment in Myanmar in the selected geographic areas and clearly describe how the proposed approaches/interventions will achieve the objectives and results of this funding opportunity within the timeframe anticipated; (2) describe how the approach prioritizes the Guiding Principles, including gender considerations1.

C. Institutional Experience and Past Success

The Applicant must demonstrate the institutional capacity to successfully implement this activity successfully. Applicants must describe their relevant previous experiences from the past five years, working on health sector interventions…