NOFO #72052123RFA00006_SBC.docx.pdf

Issue Date: June 30, 2023 Deadline for Question: July 24, 2023 Closing Date: August 18, 2023 Closing Time: 4:00 pm EST

Subject: Notice of Funding Opportunity Number: 72052123RFA00006

Program Title: Health Service Delivery – Integrated Social Behavior and Change Activity

Federal Assistance Listing Number: 98.001

Ladies/Gentlemen:

The United States Agency for International Development (USAID) is seeking applications for a cooperative agreement from local qualified entities to implement the Integrated Social Behavior and Change Activity program. Eligibility for this award is restricted to local organizations.

USAID intends to make an award to the applicant who best meets the objectives of this funding opportunity based on the merit review criteria described in this NOFO subject to a risk assessment. 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 C 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 identifier and System for Award Management (SAM) requirements detailed in Section D.6.g. The registration process is complex and lengthy, and may take many weeks to complete. Therefore, applicants are encouraged to begin registration early in the process.

http://www.grants.gov mailto:support@grants.gov

Please send any questions to the point(s) of contact identified in Section G. 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, Edel Perez-Campos Agreement Officer

TABLE OF CONTENTS

Section A – Program Description

Section B – Federal Award Information

Section C – Eligibility Information

Section D – Application and Submission Information

Section E – Application Review Information

Section F – Federal Award Administration Information

Section G – Federal Awarding Agency Contacts

Section H – Other Information

SECTION A: 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 F.

Health Service Delivery – Integrated Social and Behavior Change

I. ACTIVITY GOAL

The overall goal of the Activity is to increase the adoption of targeted positive health behaviors at the individual, household, and community level, in multiple, intersecting areas of public health. This includes sectors such as family planning and reproductive health; HIV; maternal, child health, and nutrition; water, sanitation, and hygiene. In addition, this includes other epidemic and emerging public health threats such as COVID-19, cholera, tuberculosis, and other primary care, including consideration of gender-based violence in health programs.

II. BACKGROUND AND DEVELOPMENT CHALLENGES

Haiti’s prolonged economic, political, and security crises and limited access to basic primary healthcare weaken its public health system and outcomes. In 2020-2021, the humanitarian situation in Haiti significantly worsened due to increased political turmoil, deteriorating socioeconomic conditions, mounting insecurity and gang violence in the Port-au-Prince metropolitan area, recurring fuel shortages, the earthquake and tropical storm that hit the southern region, further impacting the livelihood of vulnerable communities and households, and hindering progress towards the 2030 Agenda for Sustainable Development. Recent health data reveals a number of weaknesses in the system. Although the last 2017 Demographic and

Health Survey (DHS), known in Haiti as the 2016-2017 Enquête Mortalité, Morbidité et Utilisation des Services or EMMUS-VI, suggests that trends in mortality and morbidity improved, poor health outcomes and low utilization of available services persist due to a number of factors.

Rampant violence and instability have prevented the systematic gathering of new demographic survey data, complicating our current understanding of national health indicators; however, significant barriers to service access and rampant malnutrition point towards a worsening health climate in Haiti. Analysis of the current context, as well as experience from other regions, indicates that individual behavior is often the “last mile” in successful public health programming. Even as the supply and quality of services is expanded, there remain barriers which limit the uptake and demand for these services, including social norms and low levels of knowledge and awareness among beneficiaries, as well as behaviors and attitudes among service providers themselves.

Health Sector Challenges

Haiti has the highest HIV burden in the Caribbean region, and the country also has the highest incidence of tuberculosis in the region, further compounding the HIV epidemic. HIV incidence has seen a small decline of new annual cases in the past 10 years, but individual behaviors and practices, as well as stigma within the community and health service providers, hamper further progress on achievement of global UNAIDS targets. Inequitable social norms and conditions of women and youth are considered key enablers of HIV transmission, and women are disproportionately affected by HIV, accounting for greater than half of adult infections.

Emerging infectious diseases and public health emergencies, including COVID-19 in 2020 and the declaration of a cholera epidemic in late 2022 have strained public health systems, and have been exacerbated by low uptake of vaccines and recommended hygiene practices in vulnerable communities.

Access to, and utilization of, modern family planning services remains lower than anticipated, in particular among adolescents and young adults, due to prevailing social norms. Infant and maternal mortality remain at high levels, with a lack of progress in reducing infant and neonatal mortality. This has been partially attributed to the fact that over 60 percent of births in Haiti still occur outside of health facilities without a skilled provider, driven in part by social norms and beliefs. Pregnant women also do not regularly seek out or consistently attend available routine care, and some service providers’ behaviors and attitudes mean that they do not always provide respectful maternity care.

In 2022, according to the latest Integrated Food Security Phase Classification (IPC) analysis1, 4.3 million people (44% of the Haitian population) will be exposed to high levels of acute food insecurity (IPC phase 3 and 4)2. According to the 2022 Haiti Needs Overview (HNO), at least 224,800 children under five are expected to suffer from acute malnutrition in 2022. Out of them, around 87,500 will suffer from severe acute malnutrition and will risk death without immediate assistance. In 2020, an estimated 6 percent amongst under -five children were already suffering from global acute malnutrition (GAM), an increase by around 2 percent as compared to the SMART survey carried out in 20123. Consecutive seasons of below-average production, high

3The prevalence of the severe acute malnutrition (SAM) was 2.1 percent. The Metropolitan area of Port Au Prince had both a higher GAM and SAM rate respectively 6.5% and 2.5% followed by the remaining West department with a GAM rate of 6%. The prevalence of chronic malnutrition was 22.7%; this rate remained stagnant as statistically similar to the 2012 SMART survey result (23.4%). The South -Est had a higher rate (25.7%).

2 This figure is projected to increase to 4.6 million people will likely experience high levels of acute food insecurity (IPC Phase 3 and 4) including 1.3 million people in emergency (IPC 4).

1 Conducted in August-September 2021 prices, fuel shortages, and gang violence continue to constrain households' ability to generate adequate income to purchase food. For example, Cite Soleil will likely continue to face Emergency (IPC Phase 4) outcomes, and an increase in households in Emergency (IPC Phase 4) is likely in Nord-Ouest and Grand'Anse4. Alongside rising staple food prices that have exacerbated already significant food insecurity, poor infant and young child feeding practices by parents and caregivers have contributed to malnutrition.

Children are also more vulnerable to disease due to a decline in the proportion of children who received all eight essential vaccines. While there had been a positive trend from 1994 to 2012, the numbers began to decline again in 2017, which may be attributed to multiple factors that include social norms and behavior, as well as the logistical capacity of the Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population - MSPP) and certified Community Health Workers (Agents de Santé Communautaire Polyvalents - ASCP) to serve the most remote facilities and reach children living in the last mile.

Integrated Social and Behavior Change Programming Challenges

USAID, in partnership with the MSPP, is currently implementing a number of activities to enhance health service delivery and address Haiti’s many health challenges. Some of these interventions include complementary social and behavior change (SBC) interventions to promote the uptake of certain practices and ensure that beneficiaries are aware of and accessing services being provided.

here are a number of challenges that impact the long term sustainability of and effectiveness of SBC programming that include:

● focus on singular health issues instead of using an integrated SBC approach that considers how different aspects of health may intersect (e.g., maternal health and HIV, or routine immunization and childhood nutrition).

● Rumor and misinformation on social media platforms that affects perceptions or misperception of the population against some diseases like Covid-19 and even against some strategies put in place by the Haitian Government and our USAID Implementing partners that promote Covid-19 vaccination.

● do not always ensure coordination and a balance between using SBC approaches to build demand for certain services that service providers are not yet able to adequately supply in the regions where the demand is being built. For example, if campaigns to encourage births in healthcare facilities are not targeted to areas where such facilities have capacity to meet increased demand, experience of care may be negative.

● do not always adequately conduct/incorporate research on the specific local context, barriers and determinants of social and behavior change for the targeted health issues

4 FEWS NET Food Assistance Outlook Brief February 2023 among specific populations, and key entry points in each community, including harmful gender norms.5

● focus more on influencing individual behavior, without adequate support for changing related social norms.

● rely heavily on communication/information campaigns that use awareness as the primary tool to influence behavior, but do not make use of other types of evidence-based behavioral science approaches that have been effective, such as choice architecture, nudges, etc.

● do not adequately focus on identifying and changing key behaviors of medical and non-medical health sector staff that will improve the quality and experience of services and maximize service delivery.6

● do not adequately build capacity within local government and other stakeholders on sustainable and coordinated SBC7

● do not equip facility and non-facility based actors (such as ASCP) with SBC knowledge and tools that they can apply to increasing patient and community uptake of desired behaviors, or consider how SBC approaches for enhancing the enabling environment at the health facility level that can improve the patient experience.

These challenges, among others, impact the extent to which individuals and communities adopt targeted positive health behaviors that are being promoted and provided through the health system. Local organizations and the MSPP’s specialized communications department responsible for SBC programming have been contributing to efforts to make progress in this area, but additional efforts are needed.

III. OBJECTIVES AND EXPECTED RESULTS

To address these challenges, this Activity will work hand-in-hand with MSPP and USAID’s service-delivery implementing partners to apply SBC across the service continuum—before, during, and after services to maximize the impact of their health programming.8 It will use SBC to motivate clients to access services (before services), to improve the client-provider interaction and the environment in which services are delivered (during services), and to boost adherence and maintenance (after services).

USAID’s theory of change for this Activity is that:

if the barriers to the consistent practice of healthy behaviors are reduced; and

8 See Breakthrough Action: From Vision to Action: Guidance for Implementing the Circle of Care Model, 2021 7 See TCI Nigeria Institutionalizing State-Led Social and Behavior Change (SBC) Capacity Strengthening, 2021 6 See HC3 in Action Enhancing Family Planning Service Delivery through SBC, October 2017

5 For example, see MOMENTUM Routine Immunization Transformation and Equity, Gender and Immunization: Recognizing and Reducing Barriers, Jan 2023 https://breakthroughactionandresearch.org/wp-content/uploads/2021/01/From-Vision-to-Action.pdf https://tciurbanhealth.org/wp-content/uploads/2021/06/Institutionalizing-State-led-SBC-in-Nigeria-optimized.pdf https://healthcommcapacity.org/wp-content/uploads/2017/10/HC3-in-Action_FPSD.pdf https://mailchi.mp/prb/immunization-in-focus-5904205?e=21ed3d8b85 https://mailchi.mp/prb/immunization-in-focus-5904205?e=21ed3d8b85 if the capacity of local actors to collect and utilize evidence, and implement integrated SBC approaches is improved;

then there will be an increase in the adoption of targeted positive health behaviors at the individual, household, and community level, in multiple, intersecting areas of public health.

USAID is therefore seeking to fund an Activity that will achieve tangible and measurable changes in behavior, including through the results and illustrative intermediate results (IRs) listed below and any other results and intermediate results that will contribute to the Activity goal.

Goal: Increased adoption of targeted positive health behaviors at the individual, household, and community level.

Result 1: Barriers to the consistent practice of healthy behaviors reduced

Result 2: Capacity of local actors to collect and utilize evidence and implement integrated SBC approaches improved

IR 1.1: Targeted health behaviors and barriers are identified through research and in collaboration with stakeholders

IR 2.1 MSPP staff are supported in the development, implementation and institutionalization of a harmonized SBC approach

IR 1.2: SBC interventions for individuals, households, and communities are designed, implemented and monitored

IR 2.2 Key health service actors and other stakeholders trained and monitored on utilizing effective SBC methodology/tools in their work with patients/clients and communities

IR 1.3: SBC interventions to address provider behavior and service delivery environment are implemented and monitored

IR 2.3: Local organizations engage in SBC research, data analysis and utilization, and design/implementation of interventions

Because of the interrelated nature of Haiti’s health challenges, an integrated SBC approach that identifies and addresses barriers to key priority behaviors and practices across a number of related aspects of health will be essential for the success of this Activity. USAID considers

“integrated SBC” to mean programming which aims to understand and address factors such as knowledge, attitudes, and norms pertaining to multiple health areas or development sectors in a coordinated and intentional way that influences multiple health outcomes.9 The Activity will therefore operate across multiple health sectors to plan and implement integrated, comprehensive and logically packaged interventions that unite different health or other development areas, where appropriate, or standalone SBC interventions when more narrow

9 See Advancing Integrated and Social Behavior Change Programming, Breakthrough Action and Research, Aug 2019 3 https://breakthroughactionandresearch.org/wp-content/uploads/2019/02/RLA-Integrated-SBC.pdf intervention is needed. Integration of SBC efforts can help ensure efficient and effective use of resources. Specific priorities for SBC interventions will be determined collaboratively by the GoH, USAID, and other stakeholders, and may also depend on available USAID funding streams -including special funding for accelerating access to COVID-19 vaccination, nutrition, maternal and child health, and HIV, among other things.

The Activity will also draw on the significant body of knowledge on the use of SBC in health and utilize a broad toolkit of evidence-based approaches that are integrated and tailored to different communities and demographics. This includes, among other things, communication campaigns, behavioral economics (including choice architecture/nudges), psychology, sociology, and social marketing.

By taking into account underlying social norms, individual attitudes, and other factors at the household, community, provider, and institutional levels that influence priority behaviors, the

Activity will complement and enhance the impact of other health service delivery activities implemented by USAID, the Government of Haiti (GoH), and development partners. Beneficiaries will include populations who have been historically underserved, including women and girls, adolescents, and other key populations under USAID’s service-delivery activities, as well as service providers and Government of Haiti stakeholders, in a way that ensures a focus on equity.

Goal: Increased adoption of targeted positive health practices at the individual, household, and community level

By the end of the Activity, it is anticipated that there will be:

1) an increase in overall demand for and acceptance of modern family planning services, and in the rate of individuals reporting the practice of recommended family planning methods and Healthy Timing and Spacing Pregnancies (HTSP);

2) an increase in demand for and use of essential pre- and post-natal care for mothers and newborns and infants, including attitudes towards delivery in healthcare facilities, and increased uptake of routine childhood vaccinations, including in zero dose children, and HIV testing at ante-natal appointments;

3) improved awareness of the 1000 first days of a child and the Essential Nutrition Actions (ENA) and reported use of practices at the household and community levels that can reduce chronic and acute malnutrition;

4) improved HIV patient Treatment literacy and continuity of HIV treatment;

5) improved knowledge, attitude, and awareness of the community against COVID-19 , the importance of COVID-19 vaccination, and accelerated access to vaccinations.

6) increased community responsiveness to public health threats (eg. COVID-19, cholera, TB), including adoption of water, sanitation and hygiene practices, vaccination (eg. COVID-19, cholera); and

7) improved communication between service providers and patients/clients.

In order to effectively implement interventions in the health sector and measure progress towards the achievement of the goal, strong collaboration between this Activity and the implementing partners of USAID’s service delivery activities that provide services and track usage will be essential.

Result 1: Barriers to the consistent practice of healthy behaviors reduced

Result 1 is centered on reducing barriers to the adoption of targeted behaviors by delivering a variety of high quality, integrated SBC interventions that address key health areas of focus. This includes youth and beneficiary-informed interventions in coordination with other US government-funded activities and the Ministry of Public Health and Population (MSPP) relating to: sexual, reproductive, maternal, newborn, child and adolescent health, nutrition, family planning, emerging infectious diseases and public health threats, HIV health care, and water, sanitation and hygiene practices, among other things. USAID envisions that by the end of this

Activity, targeted beneficiaries (including individuals, communities, as well as health sector workers and service delivery providers) will be exposed to tailored interventions that approach audiences holistically in a way that reflects their reality rather than a division by health topic. The interventions will be geared towards improving relevant knowledge, attitudes, practices (KAP), beliefs and norms, and quality of service delivery in geographic and programmatic areas where interventions are implemented - before, during, and after service delivery.

Approaches that may contribute to successfully achieving Result 1 include those that:

● engage with communities, in particular youth, to identify priority health behaviors that should be targeted by the Activity and underlying factors that influence them (including gender and climate change), as well as key entry/leverage points for meaningful change.

● draw on existing evidence and continue to advance knowledge on the interdependence of certain positive health behaviors and practices.

● harmonize high quality health communication messages and interventions that are responsive to needs at the local level, including shifting away from traditional disease-based messaging to targeted audience-specific programming.

● scale up existing successful approaches that have been implemented in Haiti by USAID, MSPP, and other actors, and that can rapidly pilot and assess new approaches

● improve on the SBC approaches and materials being used by implementing partners in other USG-funded and other donor activities

● prioritize localized learning, such as participatory research including case studies, feedback studies, listening surveys, special surveys, and exit interviews, and social media monitoring to feed directly into SBC design and adaptation.

● providing recommendations to implementing partners of other USAID service-delivery activities, MSPP, and medical and non-medical staff at healthcare facilities, and health system managers, etc. on using choice architecture and nudges, and adaptations/adjustments that could enhance the service delivery environment.

● support healthcare workers by focusing on provider behavior change and addressing biases and other barriers to quality care, for example efforts centered on improving respectful maternity care.

Some illustrative interventions and resources that may help guide implementation under this

Result include:

- Tulonge Afya integrated SBC activity in Tanzania (2017-2022) which used community-based platforms segmented by life stage, mass media and linkage to service delivery partners

- Empathways tool foster empathy and trust between young clients and service providers

- I CAN SBC initiative in Malawi and Zimbabwe aimed as reframing HIV treatment

- High-Impact Practices in Family Planning (HIPs) Digital Health for Social and Behavior

Change: New technologies, new ways to reach people

- Knowledge, Beliefs, Attitudes, and Self-efficacy: strengthening an individual’s ability to achieve their reproductive intentions

- SBC Family Planning Evidence Database Brief: Circle of Care: Social and Behavior Change

During Services

- Key Principles of Designing SBCC for Health Services

Result 2: Capacity of local actors to collect and utilize evidence and implement integrated SBC approaches improved

USAID values local actors' knowledge, respects their expertise, and recognizes their commitment and integrity. Local actors are critical in bringing changes in their communities.10 Consequently, the focus under Result 2 is ensuring a system-wide incorporation of behavioral science approaches in the health sector by improving research and data collection, analysis, and utilization of SBC evidence by local actors. This includes an enhanced capacity of organizations and government entities - such as health sector workers, local civil society, faith based, and private sector organizations, education sector actors, the Ministry of Public Health and Population/Direction de Promotion de la Santé et de Protection de l’Environnement (MSPP/DPSPE) and Comité d'appui au développement de Matériels éducatifs (MSPP/CADME) - to

10 USAID Localization Strategy:

https://www.usaid.gov/sites/default/files/2022-12/USAIDs_Localization_Vision-508.pdf https://www.comminit.com/global/content/usaid-tulonge-afya https://breakthroughactionandresearch.org/empathways-dealing-a-winning-hand-to-youth-centered-health-services/ https://icanlivepositively.com/plhiv http://www.fphighimpactpractices.org/briefs/digital-health-sbc/ http://www.fphighimpactpractices.org/briefs/digital-health-sbc/ https://www.fphighimpactpractices.org/briefs/knowledge-attitudes-and-beliefs/ https://www.fphighimpactpractices.org/briefs/knowledge-attitudes-and-beliefs/ https://breakthroughactionandresearch.org/wp-content/uploads/2020/07/Circle-of-Care-During.pdf https://breakthroughactionandresearch.org/wp-content/uploads/2020/07/Circle-of-Care-During.pdf https://sbccimplementationkits.org/service-communication/lessons/addressing-providers-as-a-behavior-change-audience/ https://www.usaid.gov/sites/default/files/2022-12/USAIDs_Localization_Vision-508.pdf conduct research, design, and manage integrated SBC interventions. Increasing the ability of MSPP and other actors to develop and monitor high quality, tailored SBC programming will maximize their impact on changing behavior. This requires alignment of this Activity with GoH strategic and policy frameworks, and development of technical, management, and leadership competencies within the GoH and local organizations. By the end of this Activity, USAID envisions that the Government of Haiti and local organizations will be better able to lead, coordinate, scale-up, and evaluate high quality SBC interventions, and that SBC will be more effectively mainstreamed as an integral element of addressing various public health issues. In addition, USAID envisions that health sector workers and managers will more effectively use SBC approaches to ensure their delivery of services accounts for local contexts and targeted priority behaviors.

Approaches that may contribute to successfully achieving Result 2 include those that:

● identify and address key SBC leadership challenges and enhance SBC technical capacity for the MSPP, local health implementing partners and stakeholders to design integrated SBC interventions, including through internships, fellowships, and on-the-job training.11

● improve coordination of health SBC interventions, including reaching consensus on adoption of a national integrated SBC approach.

● engage at the policy level to ensure systems reform, including on issues of gender and equity within the health sector and patients/clients in the community.

● consider current shortfalls and gaps in understanding and utilization of SBC by service providers to adapt service delivery to account for local contexts and priority behaviors.

● leverage local actors’ skills and abilities to develop qualitative research tools and interpret results, that can better inform GoH, USAID, and implementing partner priorities and interventions.

● foster vibrant communities of practice at the national, regional and community levels that support improved evidence-based programming and continued innovation.

Some illustrative interventions and resources that may help guide implementation under this

Result include:

- Using after-action reviews to learn and improve SBC programs - lessons from Guyana

- E-course Introduction au Changement Social et de Comportement

- Real-Time Tracking of COVID-19 Rumors Using Community Based Methods in Côte d’Ivoire

11 See Johns Hopkins University, A Model for Building the Capacity of the Next Generation of SBC Professionals, 2023, and Social and Behavior Change Communication for Frontline Health Workers https://breakthroughactionandresearch.org/how-to-use-after-action-reviews-to-learn-and-improve-lessons-from-the-breakthrough-action-guyana-team/ https://thecompassforsbc.org/sbcc-tools/cours-en-ligne-introduction-au-changement-social-et-de-comportement https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324191/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324191/ https://ccp.jhu.edu/2023/03/29/interns-tanzania-sbc-breakthrough-action/ https://thecompassforsbc.org/project-examples/social-and-behavior-change-communication-frontline-health-workers

- Using social listening and social media monitoring in Francophone West Africa to inform SBC programs

- How to Conduct a Rapid Community Assessment

- Behavioural and social drivers of vaccination: tools and practical guidance for achieving high uptake

- Social & Behavior Change Strategy to Enhance Resilience: Taking Proactive Steps to

Improve Demand for and Use of Quality Health Services in Fragile Settings

IV. RELATIONSHIP TO USAID PRIORITIES

The Activity will contribute to USAID/Haiti’s goal that “Haitians are more engaged in creating and sustaining a more resilient, prosperous, and democratic future”; Development Objective (DO) 1:

Haiti is more resilient to shocks and stresses and DO 3: Governance that is more responsive to citizens’ needs; and Intermediate Result (IR) 1.3: Increased capacity of systems to support Haitians when shocks and stress occur and IR 3.1: Provision of public services improved of USAID/Haiti’s Strategic Framework 2022-2024 approved on December 23, 2020.12 USAID engages with local actors and regards them as partners rather than as agents and beneficiaries.

Through this Activity, USAID envisions expanding the share of its programs that are locally led, in which a diverse group of local actors define priorities.

V. GUIDING PRINCIPLES

USAID considers the following to be characteristics of a successful Activity:

➔ Equitable, strategic partnerships and local resources: Promoting equitable and collaborative relationships among implementing partners, including prime awardees and their sub-partners, as well as including local, regional and/or international non-governmental and private sector organizations as both beneficiaries and implementing partners, to draw on their local knowledge, expertise, and relationships, and institutionalize change responsive to local needs. This includes engagement with cultural gatekeepers and other sources of local knowledge to deepen understanding of social norms, contexts, and risk factors in different regions of the country. Many health sector partners are successfully engaging local communities and private sector actors in health communication activities.

➔ Collaboration with Other Activities: Coordinating with other USAID implementing partners working in relevant sectors, in particular USAID/Haiti health implementing partners, and/or implementing partners of other donors, in order to implement SBC interventions in collaboration with them within health service facilities and with stakeholders that they support. This will complement and avoid duplicating other efforts, as well as build their capacity to implement integrated SBC health interventions and adapt them as needed for specific priority populations.

12 USAID/Haiti Strategic Framework 2020-2024 https://breakthroughactionandresearch.org/informing-sbc-programs-social-listening-monitoring/ https://breakthroughactionandresearch.org/informing-sbc-programs-social-listening-monitoring/ https://www.cdc.gov/vaccines/covid-19/vaccinate-with-confidence/rca-guide/index.html https://apps.who.int/iris/handle/10665/354459 https://apps.who.int/iris/handle/10665/354459 https://usaidmomentum.org/resource/momentum-integrated-health-resilience-social-and-behavior-change-strategy-to-enhance-resilience/ https://usaidmomentum.org/resource/momentum-integrated-health-resilience-social-and-behavior-change-strategy-to-enhance-resilience/ https://www.usaid.gov/haiti/strategic-framework

➔ Country ownership: Ensuring GoH leadership in the coordination of all health sector activities to ensure sustainability and institutionalize capacity building support, in particular to ensure that initiatives and that interventions reflect health sector priorities and are embedded in the health system.

➔ Inclusion and gender equity: Consideration of how gender norms, decision-making practices, and gender-based violence (GBV) play a role in service delivery, access to messages and services, resources, treatment and subsequent health outcomes, and how programming will affect/be affected by gender dynamics. In addition, consideration of how current service delivery attitudes and practices may reinforce stereotypes and marginalization of individuals based on disability status, health status, geography, socio-economic limitations, and ensuring that all interventions are inclusive of all beneficiaries. Additional information and guidance on inclusion and gender equity are outlined in Section IX below.

➔ Youth and adolescent engagement and empowerment: Prioritizing the engagement of youth and adolescents, including emancipated minors, in the design and implementation of interventions, in particular in reproductive health and HIV programming. Additional information and guidance on youth and adolescent engagement are outlined in Section IX below.

➔ Effective Technology Use: Relying on evidence-based and cost-effective use of technology and innovations in digital communication, as well as utilizing no-tech and low-tech approaches where appropriate.

➔ Adaptation, Flexibility and Learning: Planning for piloting/testing then refining/scaling up interventions, and continually assessing whether the timing, selected approach, participants, location, etc. are still appropriate, effective, and achieving the anticipated results. This includes seeking new opportunities and shifting methodologies if a particular approach is not yielding results or is no longer optimal due to external shocks and change of circumstances (eg. shifts in GoH needs and priorities, and security, political and environmental challenges), and pivoting levels of support for different interventions depending on need, new opportunities, and comparative advantage.

➔ Sustainability: Ensuring the sustainability of interventions and partnerships beyond the life of the activity, including through financially sustainable commitments, and prioritizing the integration of materials and resources within the health system to ensure institutionalization and standardization, particularly in light of continually evolving GoH priorities, emerging public health threats, and other external shocks, including the security situation. Effective sustainability is achieved through systemic changes in Haitian institutions that will continue to improve beyond the life of the award, even as individual interventions are phased out.

VI. GEOGRAPHIC SCOPE

Under their bilateral agreement with the Government of Haiti, the U.S. Government has committed to support improved health service delivery to a significant portion of the population in Haiti within a certain number of primary health care facilities and in hard-to-reach geographic regions. For over three decades, USAID-supported service delivery projects have been implementing activities in all ten departments targeting the most vulnerable within their communities.

The Activity is designed to have national coverage and will support multi-channel efforts

(electronic and non-electronic), including mass media initiatives that are national in reach.

However, in some instances, the Activity may work with selected partners to target and tailor interventions to specific Haitian contexts and cultures. Interventions, whether national or targeted, will ensure appropriate coverage and reach to achieve impact on priority health outcomes. The Activity will support implementation by other partners by developing and adapting evidence-based SBC approaches and materials.

VII. MONITORING, EVALUATION AND REPORTING

The Activity will implement rigorous performance management and learning to guide decision-making within the program and contribute to the global community of practice. In particular, the Activity will support a robust learning agenda to strengthen project implementation, document impact, and contribute to the knowledge base relating to health communication. It will also ensure the dissemination results to the MSPP, the Mission, USAID partners, and stakeholders.

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SECTION B: FEDERAL AWARD INFORMATION

1. Estimate of Funds Available and Number of Awards Contemplated

USAID intends to award one (1) Cooperative Agreement pursuant to this notice of funding opportunity. Subject to funding availability and at the discretion of the Agency, USAID intends to provide $10,000,000 in total USAID funding over a five (5) year period.

2. Expected Performance Indicators, Targets, Baseline Data, and Data Collection

Please see SECTION F; 3. Reporting Requirements

3. Start Date and Period of Performance for Federal Awards

The anticipated period of performance is five (5) years. The estimated start date will be upon the signature of the award, on or about.

4. Substantial Involvement

USAID/Haiti will approve the recipient's implementation plans (e.g., annual work plan, monitoring and evaluation plan, branding strategy and marking plan, etc.) during performance.

● Agency approval of applicant key personnel, sub-awards and service agreements, and plans (e.g., implementation, procurement, AMELP, capacity development, closeout) prior to and throughout the award;

● The Agency’s ability to immediately halt an activity if the recipient does not meet detailed performance specifications;

● Agency and recipient collaboration or joint participation, such as when the recipient’s successful accomplishment of program objectives would benefit from USAID’s technical knowledge.

● Agency monitoring to permit specific kinds of direction or redirection of the work because of the interrelationships with other projects or activities.

5. Authorized Geographic Code

The geographic code for the procurement of commodities and services under this program is 937.

6. Nature of the Relationship between USAID and the Recipient

The principal purpose of the relationship with the Recipient and under the subject program is to transfer funds to accomplish a public purpose of support or stimulation of the Health Service Delivery - Integrated Social Behavior and Change Activity which is authorized by Federal statute.

The successful Recipient will be responsible for ensuring the achievement of the program objectives and the efficient and effective administration of the award through the application of sound management practices. The Recipient will assume responsibility for administering Federal funds in a manner consistent with underlying agreements, program objectives, and the terms and conditions of the Federal award.

[END OF SECTION B]

SECTION C: ELIGIBILITY INFORMATION

1. Eligible Applicants

Eligibility is restricted to local entities. Prime local entities may have US or non-US organizations as sub-awardees.

Locally led development has been identified for the Health Service Delivery – Integrated Social and Behavior Change Activity because changing social norms and behaviors requires in-depth knowledge and connections within the targeted communities. Restricting eligibility to local entities for this activity supports USAID’s Localization Vision and Approach, which seeks to expand the share of USAID programming that is locally led, and that engages with local actors as partners rather than as agents and beneficiaries.

Only local entities as defined below are eligible for award. USAID defines a “local entity” in ADS 303.6(b) as an individual, a corporation, a nonprofit organization, or another body of persons that:

(1) Is legally organized under the laws of; and

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

(3) Is

a) majority owned by individuals who are citizens or lawful permanent residents of; and

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

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

USAID welcomes applications from organizations that have not previously received financial assistance from USAID.

Faith-based organizations who meet the criteria of being local entities are eligible to apply for federal financial assistance on the same basis as any other organization and are subject to the protections and requirements of Federal law.

2. Cost Sharing or Matching

USAID has established a mandatory minimum recipient cost share of three percent (3%) of projected award amount. Such funds may be provided directly by the recipient; other multilateral, bilateral, and foundation donors; host governments; and local organizations, communities and private businesses that contribute financially and in-kind to implementation of activities at the country level. This may include contribution of staff level of effort, office space or other facilities or equipment which may be used for the program, provided by the recipient.

For guidance on cost sharing in grants and cooperative agreements see 2 CFR 200.306, the Standard Provisions and ADS 303.3.10.3.

3. Other

Covered Telecommunication and Video Surveillance Equipment or Services

In accordance with the cost principles in 2 CFR § 200.471, obligating or expending costs for covered telecommunications and video surveillance services or equipment or services as described in 2 CFR § 200.216 are unallowable. Recipients and subrecipients are prohibited from using award funds, including direct and indirect costs, cost share and program income, for such covered telecommunications and video surveillance services or equipment, except as otherwise authorized in the award.

Please see the Standard Provision entitled “Prohibition on Certain Telecommunication and Video Surveillance Services or Equipment (July 2022).

[END OF SECTION C]

SECTION D: APPLICATION AND SUBMISSION INFORMATION

1. Agency Point of Contact

Edel Perez-Campos Sandra Ricot Agreement Officer A&A Specialist USAID/Haiti USAID/Haiti Port-au-Prince, Haiti Port-au-Prince, Haiti Email: eperez@usaid.gov Email: sricot@usaid.gov

2. Questions and Answers

Questions regarding this NOFO should be submitted to the following email addresses:

sricot@usaid.gov, eperez@usaid.gov; and usaidhaitioaa@usaid.gov no later than the date and time indicated on the cover letter, as amended. Any information given to a prospective applicant concerning this NOFO will be furnished promptly to all other prospective applicants as an amendment to this NOFO, if that information is necessary in submitting applications or if the lack of it would be prejudicial to any other prospective applicant.

3. General Content and Form of Application

Preparation of Applications:

Each applicant must furnish the information required by this NOFO.

Overview of Application Process

The award process under this NOFO will use a phased approach that will capitalize on local expertise. The purpose of this process is to identify the application with the best technical approach that will have the greatest chance of achieving the objectives of the Activity.

The selection process will go through the three (3) following phases:

Phase 1: Technical Application and Summary Budget - The applicant submits its Technical Application and Summary Budget per the Application Instructions outlined below. All applications received will be evaluated by a Selection Committee for responsiveness to the merit review/evaluation criteria outlined in Section E.

Phase 2: Co-Creation - The highest rated applicant (the “Apparently Successful Applicant)” will be invited by USAID for a virtual and/or in-person co-creation and collaboration process to identify and develop the activities that will help achieve the results desired under this NOFO. This process will ensure that local perspectives and priorities are at the center of the Activity.

Proposed sub-awardees may also attend the co-creation sessions.

mailto:sricot@usaid.gov mailto:eperez@usaid.gov mailto:usaidhaitioaa@usaid.gov

Phase 3: Final Package - Following the co-creation phase, if successful, the Apparently Successful Applicant will be invited by USAID to submit a Final Package that includes the finalized Technical Application that incorporates the discussions, ideas, feedback, and agreed upon changes from the co-creation; a Business (Cost) Application; a Branding Strategy and Marking plan; and other documents required per the Application Instructions below. Upon request, only the Apparently Successful Applicant should submit these additional documents to USAID.

Notes: USAID may cancel the negotiation(s) and award process at no cost to the Government.

USAID’s communication during the co-creation process provided by this NOFO should not be interpreted as a commitment to making an award of USAID funding. Further, USAID’s request for a Final Package does not constitute an award commitment on the part of the Government.

Applicants are advised that participation in any phase of the NOFO process is entirely at their own risk; the Government is not responsible for any costs incurred by the applicant prior to an award. A commitment to an award of USAID funding is only made when an award agreement is signed.

Applications must be submitted in two separate parts: the Technical Application and the Summary Budget in Phase 1. This subsection addresses general content requirements applying to the overall application process. Please see subsections 5 and 6, below, for information on the content specific to the Technical Application, Summary Budget for Phase 1, and to the Final Package including Business (Cost) application for Phase 3.

The Technical application must address technical aspects only while the Summary Budget and subsequently the Business (Cost) Application must present the costs, and address risk and other related issues.

Both the Technical and Business (Cost) Applications must include a cover page containing the following information:

● Name of the organization(s) submitting the application;

● Identification and signature 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);

● Program name

● Notice of Funding Opportunity number

● Name of any proposed sub-recipients or partnerships (identify if any of the organizations are local organizations, per USAID’s definition of ‘local entity’ under

ADS 303.

Any erasures or other changes to the application must be initialed by the person signing the application. Applications signed by an agent on behalf of the applicant must be accompanied by evidence of that agent’s authority, unless that evidence has been previously furnished to the issuing office.

Applicants may choose to submit a cover letter in addition to the cover pages, but it will serve only as a transmittal letter to the Agreement Officer. The cover letter will not be reviewed as part of the merit review criteria.

Applications must comply with the following:

● USAID will not review any pages in excess of the page limits noted in the subsequent sections. Please ensure that applications comply with the page limitations.

● Written in English.

● Use standard 8 ½” x 11”, single sided, single-spaced, 12-point Times New Roman font, 1” margins, left justification and headers and/or footers on each page including consecutive page numbers, date of submission, and applicant’s name.

● 10-point font can be used for graphs and charts. Tables, however, must comply with the 12-point Times New Roman requirement.

● Submitted via Microsoft Word or PDF formats, except budget files which must be submitted in Microsoft Excel.

● The estimated start date identified in Section B of this NOFO must be used in the cost application.

● The technical application must be a searchable and editable Word or PDF format as appropriate.

● The Cost Schedule must include an Excel spreadsheet with all cells unlocked and no hidden formulas or sheets.