NOFO 72061321RFA00008 AGYMRD Final.pdf

Issue Date: March 31, 2021

Deadline for Questions: April 14, 2021 at 17:00 Harare time

Closing Date: May 26, 2021 at 17:00 Harare time

Subject: Notice of Funding Opportunity (NOFO) Number:

72061321RFA00008

Program Title: Adolescent Girls and Young Women Reaching their Dreams

Activity.

Catalog of Federal Domestic Assistance (CFDA) Number: 98.001

Ladies/Gentlemen:

The United States Agency for International Development (USAID) is seeking applications for a cooperative agreement from qualified entities to implement the Adolescent Girls and Young Women Reaching their Dreams program. Eligibility for this award is restricted to local organizations as defined in Section C of this NOFO.

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. 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.f. The registration process may take many weeks to complete. Therefore, applicants are encouraged to begin registration early in the process.

Please send any questions to the point(s) of contact identified in Section D. 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.

http://www.grants.gov/ mailto:support@grants.gov http://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, J. Zeb Simpson 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 CONTACT(S)

SECTION H: OTHER INFORMATION

ANNEX 1 - STANDARD PROVISIONS

ANNEX 2 – DREAMS GUIDANCE

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.

A1. Introduction

Zimbabwe has made exceptional progress towards achieving HIV/AIDS epidemic control.

According to the Zimbabwe Population-based HIV Impact Assessment 2020 results, the country reached 87-97-90 against the 90-90-90 Joint United Nations Programme on HIV/AIDS (UNAIDS) targets, putting epidemic control of HIV within reach for the country. The United States Agency for International Development (USAID) in Zimbabwe, through the United States Government (USG) President’s Emergency Plan for AIDS Relief (PEPFAR), has played a critical role in this progress through multiple program areas, including the support of high-impact HIV prevention programs targeting those most at risk of HIV acquisition. Zimbabwe is well positioned to end AIDS by 2030, provided the country maintains momentum, scales strategic prevention services, and delivers ‘last mile’ HIV prevention, diagnosis, and treatment services.

Developed by PEPFAR, DREAMS is an ambitious approach to programming for adolescent girls and young women (AGYW). The goal for DREAMS programming is to help girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored and Safe women. Since its inception, the DREAMS approach has been implemented as a public private partnership in ten sub-Saharan African countries. In 2015, USAID/Zimbabwe began implementing programming using the DREAMS approach. Since that time, HIV diagnoses among AGYW have reduced by approximately 44 percent in DREAMS districts in Zimbabwe, achieving the highest reduction among all DREAMS countries. The new Adolescent Girls and Young Women Reaching their DREAMS Activity will play a central role in advancing DREAMS programming in Zimbabwe.

Under the coordination and leadership of the Ministry of Health and Child Care (MOHCC) and the National AIDS Council (NAC), the Activity will work through local implementing partners to scale up HIV prevention interventions that empower AGYW aged 10-24 years to reduce their risk of HIV acquisition; strengthen families to provide a safe environment for AGYW; mobilize communities for social and gender norms change; and reduce the risk of sex partners. By improving the coverage, quality, and effectiveness of HIV prevention activities using the DREAMS conceptual framework, AGYW will increase their use of services, feel empowered to practice safer behaviors, and reduce their risk of acquiring HIV, which is critical for Zimbabwe’s pathway to sustained epidemic control. Additionally, parents and communities will increase their advocacy and actions to decrease violence and provide a safe and enabling environment in which AGYW are able to thrive.

This Activity builds upon best practices and lessons learned from five years of USAID experience implementing DREAMS programming in Zimbabwe. The Activity will deliver the DREAMS package, differentiated by age, vulnerability and risk status, in 12 focus districts (Beitbridge, Bulawayo, Bulilima, Chipinge, Gwanda, Gweru, Insiza, Makoni, Mangwe, Matobo, Mazowe, and Mutare), with the potential for additional geographic expansion pending demonstrated need and the availability of funds.

A2. Background

a. Context of HIV/AIDS in Zimbabwe

The country has made tremendous progress towards attaining the UNAIDS 90-90-90 goals.

While prevalence remains relatively high in Zimbabwe, the country was one of the first to experience a sharp decline in new infections and HIV-related deaths. This has been attributed to a comprehensive set of prevention, care, and treatment interventions that have been implemented through a multi-sectoral approach. Adult HIV prevalence has declined from 23.8% in 1999 to 12.9% in 2019 (ZIMPHIA, 2020). Zimbabwe has now met the second and third 90-90-90 targets:

among adults diagnosed with HIV, 97% were on ART and of those on ART, 90% had suppressed viral loads (ZIMPHIA, 2020).

Despite these impressive gains, there are still approximately 31,000 new infections annually.

About 13% of adults living with HIV do not know their status (ZIMPHIA, 2020). Men and women aged 15-34 years are least likely to be aware of HIV status, least likely to be on ART, and least likely to be virally suppressed. There are significant geographic disparities across the country related to border, mining, and farming activities, with the highest prevalence rates observed in the three provinces of Matabeleland South, Matabeleland North, and Bulawayo.

Women in Zimbabwe continue to bear a disproportionate burden of HIV: those aged 15-49 have consistently higher HIV prevalence (14.8%) as compared to men (8.6%) and are nearly three times as likely to acquire HIV than men. Multiple, interrelated factors cause AGYW to be vulnerable to HIV, including low risk perception, poor access to education and economic opportunities, high rates of gender-based violence (GBV), and social and gender norms which limit AGYW’s agency. In addition, the lack of consistent education on HIV, limited youth-friendly health services, and long distances to health and secondary education institutions contribute to low service uptake and attrition in programs.

The country has experienced years of economic decline which has impacted the healthcare delivery system in many ways, including frequent shortages of basic commodities, poorly maintained infrastructure, and chronically underpaid and demoralized health care workers. While commitment within the MOHCC to end AIDS is high, the funding needs far outpace the Government’s annual budget allocation for health. As a result, Zimbabwe's HIV program relies on external resources from multiple donors to fund the HIV response.

Zimbabwe’s HIV epidemic response is coordinated by the NAC, in collaboration with the MOHCC. These two entities provide the policy framework, guidelines, and standard operating procedures to inform implementation of activities at lower levels. The national HIV response is guided by the Zimbabwe Extended National Strategic Plan for HIV/AIDS (ZNASP IV) 2020-25.

b. United States Government contribution to the HIV response in Zimbabwe

Through PEPFAR funding, the United States has been implementing comprehensive HIV programs in Zimbabwe since 2006, through USAID and the Center for Disease Control and Prevention (CDC). The focus of the PEPFAR program is to attain the UNAIDS fast track 90-90- 90 targets, with the goal of achieving epidemic control and ending AIDS by 2030. With funding from PEPFAR through the Office of the Global AIDS Coordinator (OGAC), the U.S.

Government provides approximately $230 million annually to support HIV programming in Zimbabwe. In the current fiscal year (FY 2021), PEPFAR continued to invest in the delivery of a comprehensive package of HIV prevention, care, and treatment activities in the 44 most affected districts that represent 85% of the HIV burden in Zimbabwe. While PEPFAR support strengthens all levels of the health system, there is an emphasis on improving the availability and quality of services at the health facility and/or community level as well as client-centered approaches to address access barriers and encourage service utilization and retention.

USAID/Zimbabwe manages approximately $154 million of the total PEPFAR annual budget, of which approximately $26 million was allocated to implement DREAMS in FY 2021. Assuming the same level of funding as well as consistency in priorities in the coming years, approximately $14 million of the PEPFAR budget will be set aside annually for this Activity. The proposed Activity reflects priorities for HIV prevention activities described in the annual PEPFAR Zimbabwe 2020 Country Operation Plan (COP) and through adaptive management and annual work planning will reflect the priorities of future COPs. The Zimbabwe COP is an annual planning process developed in partnership with the Zimbabwe MOHCC, the Global Fund, non-government organizations, and other HIV/AIDS stakeholders. This Activity builds on experiences and lessons learned from five years of implementing the DREAMS approach in Zimbabwe.

Aside from PEPFAR, USAID/Zimbabwe also manages a diverse health portfolio worth approximately $33 million per year. The USAID/Zimbabwe non-HIV health portfolio includes funding for tuberculosis, malaria, maternal and child health, family planning, and COVID-19.

c. Background to DREAMS in Zimbabwe

After an extensive planning period, USAID/Zimbabwe launched programming through the DREAMS approach in November 2015 focusing on six districts: Bulawayo, Chipinge, Gweru, Makoni, Mazowe, and Mutare. In consultation with stakeholders, these districts were selected after reviewing several factors related to AGYW’s vulnerability to HIV, including HIV prevalence, sexual and reproductive health indicators, school enrolment, GBV, child marriage, and poverty data as well as population size and presence of implementing partners.

USAID engaged existing and new implementing partners to deliver different parts of the DREAMS package according to organizations’ areas of expertise and geographic presence.

Multiple partners brought diversity and new ideas, and this approach necessitated a strong coordination structure at national and district levels, a state-of-the-art database able to track individuals, and a well-functioning referral system.

The initial two-year focus was on achieving population-level coverage of the HIV prevention package among AGYW 15-19 and 20-24 years, with limited social protection services offered to a smaller number of 10-14 year olds identified through the OVC program. DREAMS Zimbabwe programming evolved alongside DREAMS global guidance. Over time, the emphasis shifted to identifying AGYW most vulnerable to HIV, ensuring coverage of adolescent girls (AG) 10-14 years, defining minimum requirements of interventions, monitoring layering and completion of interventions at the individual level, measuring saturation, and adding standardized eligibility criteria, among other technical priorities as described in Sections 3 and 4.

In FY 2021, DREAMS programming in Zimbabwe expanded to an additional ten districts based on estimated HIV incidence among AGYW. USAID assumed responsibility for implementation in six of the ten new districts including Beitbridge, Bulilima, Gwanda, Insiza, Mangwe, and Matobo. CDC began implementation of DREAMS programming in Bubi, Lupane, Nkayi, and Tsholotsho.

To develop this new Activity, USAID consulted with stakeholders providing HIV prevention services, including organizations implementing the DREAMS approach in Zimbabwe, MOHCC, NAC, Ministry of Primary and Secondary Education (MOPSE), and community and faith-based organizations. USAID/Zimbabwe’s Office of Acquisition and Assistance solicited additional feedback through a Request for Information (RFI). USAID conducted a review of DREAMS programming that included consultations with a wide range of stakeholders and participants. Key findings from the program review are in Figure 1 below and recommendations informed the intermediate results, outcomes, and technical priorities in this program description.

Figure 1: Summary of findings from the DREAMS programming review

Strengths & Successes Weaknesses, Shortfalls, Challenges

● Established District Points of Contact to support coordination, communication, & collaboration

● Good working relationships across partners

● Difficulty identifying the most vulnerable AGYW in schools, including young women selling sex

● Over-reliance on teachers to implement the school-based program

● Effective advocacy, engagement and collaboration with Ministries at national and district levels

● Delivery of the primary package curriculum: quality sessions, learning materials and facilitation

● Employed new approaches to implement and monitor layered services

● Established pathway for AGYW to transition to leadership and staff positions

● Developed effective strategies for engaging local authorities and mobilizing communities

● Some AGYW only received the primary package, others only secondary services as a result of coverage, weaknesses in the referral system

● Many implementing partners can lead to inefficiencies and leakages in the referral system

● Challenging macroeconomic environment makes economic strengthening programming very difficult; poverty contributes to increased vulnerability

● Economic strengthening interventions need to employ common benchmarks to assess AGYW’s progress with this DREAMS layer

● Stigma around PrEP is persistent and impacts uptake and continuation

d. Linkage to USAID/Zimbabwe Country Development and Cooperation (CDCS) Strategy

The Activity is designed to be consistent with the USAID/Zimbabwe CDCS’s aspirational goal:

“Inclusive, accountable governance and a healthy, engaged citizenry drive social, political and economic development with equal opportunity for all.” The Activity supports the second DO, which aims to have an “increased number of Zimbabweans live longer and healthier lives.”

HIV/AIDS continues to be the leading cause of death in Zimbabwe, with 20,000 AIDS-related deaths estimated in 2019. The Activity would specifically contribute to longer and healthier lives by reducing new HIV infections and supporting sustainable health outcomes for AGYW and their families.

e. USG and donor coordination

All USG agencies work together closely as one PEPFAR country program, jointly defining strategies and targets on an annual basis through the COP process. The Activity will serve as a pivotal implementation mechanism for USG support to control the HIV/AIDS epidemic in Zimbabwe, in collaboration with other USAID and PEPFAR activities, including related projects implemented by CDC, as well as a range of other stakeholders, to maximize synergies and share program learning and best practices. This Activity will contribute towards the Global LEAD, an Agency-wide initiative that supports the capacity and commitment of emerging young leaders to become partners in building self-reliant communities through civic engagement, education, and leadership development. The Activity will also collaborate with other Mission youth development and empowerment programs including the Local Works Zimbabwe Youth Program.

The Global Fund is a major source of support to the national HIV/AIDS response, providing Zimbabwe approximately $470 million dollars over 3 years (2021-2023) to combat HIV and AIDS. Preventing new HIV infections among AGYW is a major priority for the Global Fund; the new grant includes $20 million to expand programming through a modified DREAMS approach to additional districts.

f. Local ownership and sustainability

This Activity will transfer skills from the implementing partner to smaller community partners as well as host country health providers, teachers and HIV/AIDS coordinators and policy makers.

Capacity building components will strengthen Zimbabwe’s ability to reach and maintain HIV epidemic control long after this Activity ends. This Activity will develop the capacity of multisectoral planners and policy makers, such as the National and District AIDS Coordination units and district health, social welfare and youth offices, to implement evidence-based HIV prevention interventions through a layered approach, apply rigorous monitoring systems, and use data for decision-making. By improving the coverage, quality, and effectiveness of HIV prevention activities using the DREAMS conceptual framework, AGYW will increase their utilization of services, feel empowered to practice safer behaviors, and reduce their risk of acquiring HIV, which is critical for Zimbabwe’s pathway to sustained epidemic control.

Additionally, this Activity will work with parents/caregivers and community leaders to strengthen family relations and support for AGYW and address attitudes and norms which fuel social problems such as violence against women and girls, forced child marriage, and early pregnancy.

In line with Positive Youth Development (PYD) and by improving AGYW’s agency, USAID will ensure that AGYW take leadership in defining priorities and designing interventions and implementation approaches in line with the DREAMS framework. To build and strengthen a network of local actors that can support AGYW and in line with USAID’s Private Sector Engagement policy, the Mission will find ways to consult, strategize, align, collaborate, and implement DREAMS with the private sector for greater scale, sustainability, and effectiveness of development outcomes.

Historically, local partners in Zimbabwe have been instrumental in the progress towards epidemic control. Local partners’ in-depth appreciation of the context makes them best placed to support the country’s health needs. USAID/Zimbabwe is committed to working with local institutions and actors to build self-reliance and sustainability. This award is limited to local partners, furthering USAID/Zimbabwe’s contribution to PEPFAR’s target of at least 70% direct funding to local partners.

A3. Intermediate Results and Outcomes

The goal of this Activity is to reduce the number of new infections among adolescent girls and young women. The Activity is designed to follow the DREAMS theory of change which is elaborated in Figure 2 below.

Figure 2: DREAMS Logic Model/Theory of Change

This Activity has three intermediate results, which map to USAID/Zimbabwe’s DO2:

● Intermediate Result 1: Increased access of AGYW to high-impact HIV prevention services and activities according to the DREAMS package

● Intermediate Result 2: Strengthened capacity of families and communities to provide a safe and supportive environment for AGYW

● Intermediate Result 3: Strengthened systems for planning, coordinating, monitoring, and assuring the quality of programs for AGYW

Result 1: Increased access of AGYW to high-impact HIV prevention services and activities according to the DREAMS package

The Recipient will employ effective approaches to identify AGYW most vulnerable to HIV and assess them for eligibility to the DREAMS package according to a standardized Eligibility Screening tool. The Recipient will administer a standardized HIV Risk and Vulnerability assessment to all AGYW before enrollment and deliver the DREAMS Zimbabwe primary service package, differentiated by age, to eligible AGYW. In addition, the Recipient will provide, or refer AGYW to, secondary services according to information gleaned from the HIV Risk and Vulnerability assessment. As a main enrolling partner, the Recipient will be responsible for entering individual AGYW’s data into the DREAMS Zimbabwe database, monitoring AGYW’s completion of the primary package, following up to ensure completion of secondary services with the AGYW and/or other service providers, re-assessing the AGYW’s HIV risk, and determining if the AGYW has completed DREAMS as a program.

Illustrative activities include, but are not limited to:

● School and community-based delivery of evidence-based HIV and GBV prevention curricula and social asset building (SAB) clubs

● Review and adaptation of curricula to align with USAID and PEPFAR requirements and evolving research

● Condom education and distribution

● Demand creation and support for AGYW to access and continue on PrEP

● Standardization of SAB club mentor selection, training, supervision/support, compensation and pathways for promotion, including opportunities for AGYW who complete the DREAMS program to become Mentors

● Capacity building of guidance and counseling teachers

● Linking AGYW in need of HIV and other sexual reproductive health (SRH) services to other DREAMS and non-DREAMS partners providing these services (HIV Testing Services (HTS), PrEP, family planning, Sexually Transmitted (STI) screening and treatment)

● Linking HIV+ AGYW to Zvandiri Community AIDS Treatment Supporters (CATS)

● Evidence-based economic strengthening interventions for AGYW differentiated according to age and ability, including a pathway to entrepreneurship or employment as part of the comprehensive package

● Provision of non-clinical GBV response services

● Innovative approaches to identifying and retaining AGYW the most vulnerable to HIV in

DREAMS, including approaches which identify AGYW in clinical settings

● Client-centered approaches which integrate learning from COVID-19 pandemic to remove barriers to information, health and education

Result 2: Strengthened capacity of families and communities to provide a safe and supportive environment for AGYW

The Recipient will implement practical, measurable, evidence-informed approaches to mobilize parents/caregivers of adolescent girls and community stakeholders/influencers as active participants in DREAMS. Parents, caregivers and community leaders have important roles to play in addressing gender and social norms and specific contextual factors which impact AGYW’s risk of HIV acquisition and/or inequitable access to health, education and social services. In addition, the Recipient will collaborate with MOHCC and leverage the efforts of other PEPFAR partners to reach the male sexual partners of AGYW with norms change, risk reduction, HTS and linkage to ART activities.

Illustrative activities include, but are not limited to:

● Educational subsidies, part-time continuing education, non-formal education, early warning systems to help AGYW stay in, or return to school after dropping out

● Evidence-based sexual violence prevention activities for parents/caregivers of AGYW

● Approaches to build economic resilience of parents/caregivers

● Developing/adapting and rolling out standards for economic strengthening, factoring in age/life-stage of AGYW and minimum requirements for entry and completion

● Activities to engage male partners of AGYW such as distribution of HIV Self Test kits

● Supporting linkages to voluntary medical male circumcision (VMMC), HTS and

Antiretroviral Therapy (ART) programs for male sexual partners of AGYW

● Evidence-based strategies for addressing and changing harmful gender norms that influence AGYW’s rights, safety and access to health, education and economic opportunities

● Training for parents/caregivers and community members to understand and support PrEP use by AGYW

Result 3: Strengthened systems for planning, coordinating, monitoring, and assuring the quality of programs for AGYW

The success of this Activity relies heavily on strong coordination mechanisms due to the multisectoral nature of the program and the many partners involved in service delivery. Working hand in hand with the NAC structure, the Recipient will play a lead role, on behalf of the DREAMS Zimbabwe network, in coordinating DREAMS at the district level. Key to this will be using Positive Youth Development (PYD) principles to engage and empower DREAMS Ambassadors to meaningfully contribute to DREAMS implementation and leading critical coordination activities with other implementing partners in Zimbabwe using the DREAMS methodology. The Recipient will also strengthen the capacity of Zimbabwean organizations and Government stakeholders to lead, implement and sustain effective HIV prevention programs in order to contribute to broad-based local ownership and sustainability of the HIV response.

Illustrative activities include, but are not limited to:

● Serving as the DREAMS District Point of Contact (POC) partner, supporting the District AIDS Coordinator to effect regular coordination activities for DREAMS partners and stakeholders such as joint work planning, joint program reviews, joint monitoring visits and data quality assessments (DQA)

● Hiring, training and supervising DREAMS Ambassadors to support district-level coordination and support to standardize the DREAMS Ambassador component across the DREAMS partner network

● Developing leadership and skills development pathways for motivated DREAMS participants to advance to the role of Ambassador, mentor, and employment opportunities within and outside of DREAMS

● Supporting development and standardization of the DREAMS Zimbabwe mentorship approach, including training and supportive supervision

● Provision of first line response best practices of “Listen, Inquire, Validate, Enhance Safety, Support” (LIVES) training for all service providers, mentors, and facilitators interacting with AGYW

● Develop supervision and mentoring/quality assurance tools for LIVES

● Innovative approaches for collecting, analyzing, disseminating and learning from

DREAMS Zimbabwe program data to improve the quality of services for AGYW

● Collaborating with other PEPFAR partners to strengthen and scale delivery of non-stigmatizing, adolescent-friendly clinical SRH services

● Developing, implementing and refining an effective completion strategy for DREAMS to facilitate the monitoring of AGYW as they enter DREAMS, receive the primary package and secondary services, and eventually complete DREAMS as a program

● Developing, implementing, and refining an effective strategy to monitor and measure contextual interventions e.g. SASA, CTRF, and parenting programs

● Innovative strategies for harnessing the skills and energy of AGYW who have completed DREAMS as a program to lead health initiatives, strengthen AGYW’s agency and supportive social networks, and contribute to sustainable community development

● Ensuring community feedback mechanisms in place to identify and address community concerns and to improve service delivery

● Developing and implementing a strategy to ensure implementation fidelity and consistency across schools and to further institutionalize the HIV and violence prevention curriculum

A4. Technical Approach

a. Target populations

The primary target population for this Activity is AGYW aged 10- 24 years. Secondary target groups include parents/caregivers of AGYW, community leaders and influencers and male sexual partners of AGYW. Within the DREAMS Zimbabwe program parameters, the Recipient will propose effective strategies differentiated to three age groups of AGYW (10-14, 15-19, 20-24).

The Recipient will propose approaches to identify, screen, and enroll AGYW most vulnerable to HIV who are most likely to benefit from DREAMS following the DREAMS Zimbabwe Eligibility Criteria (see Figure 3) and Enrollment Guidance, 2020.

Figure 3: DREAMS Zimbabwe Eligibility Criteria

The Recipient will propose an appropriate mix and scale of interventions for parents/caregivers and community leaders and influencers which center on strengthening households’ economic resilience, preventing and responding to GBV, and community norms change. Activities targeting male sexual partners of AGYW should build on the DREAMS Zimbabwe implementation platform and be closely coordinated with other programs targeting men including VMMC, HTS, and ART.

b. Geographic coverage

Currently, DREAMS Zimbabwe is being implemented in 12 districts: Beitbridge, Bulawayo, Bulilima, Chipinge, Gwanda, Gweru, Insiza, Makoni, Mangwe, Matobo, Mazowe, and Mutare.

The final list of districts to be covered under this Activity will be determined in consultation with USAID during the initial work planning period. Geographic coverage will be assessed on an annual basis during the COP process. There is potential for additional districts to the DREAMS Zimbabwe program depending on need and the availability of funds.

In the original six focus districts (Bulawayo, Chipinge, Gweru, Makoni, Mazowe, and Mutare), where DREAMS has been operational for five years and a large proportion of AGYW have received at least the primary package of services, USAID will support a maintenance approach.

The maintenance approach will include all services that make up the DREAMS package, but focus on a smaller proportion of AGYW most vulnerable to HIV, AGYW at continued high risk of HIV, and AGYW whose circumstances have changed to make them newly vulnerable to HIV acquisition. In addition, the maintenance approach should include programming that reaches a sufficiently broad segment of AGYW turning ten years old in order to ensure identification and reach in this population. The maintenance approach should also consider the scale of the DREAMS contextual interventions such as community mobilization and norms change and activities targeting male sexual partners of AGYW. Therefore, the Recipient must use program data, and other available sources of data, to identify particular profiles of AGYW and specific hotspots and communities, to strategically target services to the most at risk AGYW.

c. DREAMS Technical Approach

Launched in 2015, the PEPFAR DREAMS approach brings significant financial and technical resources to the global HIV response, addressing the persistently high levels of HIV infection among AGYW in Sub-Saharan Africa. The DREAMS conceptual model moves beyond the provision of health services and uses a multi-sectoral approach to address both the proximate determinants and structural drivers of AGYW’s HIV risk. The DREAMS core package includes interventions along four main domains: those which 1) empower AGYW and reduce risk, 2) strengthen families, 3) mobilize communities for change, and 4) reduce the risk of sex partners.

The DREAMS core package is summarized in Figure 4 below.

Figure 4: DREAMS Core Package

The Zimbabwe DREAMS program has contextualized the core package and defined a primary package of services for all AGYW, disaggregated by age group, and secondary services for AGYW, disaggregated by age group and based on need. Primary and secondary services are reviewed on an annual basis with all DREAMS implementing partners, including DREAMS Ambassadors and mentors, during which time adjustments are made to the minimum requirements for the service to be considered as ‘completed.’ This is especially important for activities which contain several sessions and to ensure AGYW have had sufficient exposure to the intervention. The configuration of the DREAMS Database is regularly updated to capture changes to the DREAMS Zimbabwe Layering Table (see Figure 5) to ensure the system is able to accurately track completion of services and layering.

Figure 5: DREAMS Zimbabwe Layering Table

Age Group

Primary Interventions Secondary Interventions Based on Screening and Identified Needs

AG 10-14 1. Condom Education

2. HIV Prevention Curriculum

3. Gender Norms Curriculum

4. Social Assets Building (HIV/GBV Club in or out-of-school)

5. Sexual Violence Prevention

6. Financial Literacy

7. Combination Socioeconomic Approaches for Caregivers

8. Education Support

9. Contraceptive Method Mix

10. GBV Response

11. Health Services (Other STIs)

12. HTS

13. Parenting for Caregivers

AGYW 15-19 1. Condom Promotion and Provision

2. Gender Norms Curriculum

3. HIV Prevention Curriculum

4. Social Assets Building (HIV/GBV Club in or out-of-school)

5. Sexual Violence Prevention

6. Financial Literacy

7. Economic Strengthening for AGYW

8. Combination Socioeconomic Approaches for Caregivers (of AG 15- 17, maintenance targets)

9. Education Support

10. Contraceptive Method Mix

11. GBV Response

12. Health Services (Other STIs)

13. HTS

14. PrEP

YW 20-24 1. Condom Promotion and Provision

2. Gender Norms Curriculum

3. HIV Prevention Curriculum

4. Social Asset Building

5. Sexual Violence Prevention

6. Financial Literacy

7. Economic Strengthening

8. Education Support (up to age 20 for young mothers, YW finishing school)

9. Contraceptive Method Mix

10. GBV Response

11. Health Services (Other STIs)

12. HTS

13. PrEP

The Recipient will be expected to implement the primary package of services, as well as the following secondary services: economic strengthening, education support (selected districts), GBV response (selected districts), parenting for caregivers (selected districts), and combination socioeconomic approaches for caregivers (selected districts). The Recipients’ role in secondary service provision will depend on the presence of other PEPFAR partners as well as evolving priorities as determined by the annual COP process. The Recipient will be expected to complete referrals for secondary services which they do not implement.

Service delivery approaches must be age-differentiated and reflect differences in life stage, relationships and social networks and risk behaviors among younger adolescents, older adolescents, and young women. For example, lessons learned from DREAMS globally indicate that adolescent girls are motivated by the prospect of gaining knowledge, skills and social networks, while young women are more interested in accessing skills, training and resources or options to improve their livelihoods. Furthermore, sustaining AGYW’s engagement with DREAMS is more likely when there is a strong mentorship relationship, material support and social opportunities. It is also important to plan for changing risk during transitions between life stages, recognizing that AGYW’s experiences of empowerment and autonomy may change as they engage in relationships, marry, and have children. COVID-19 adaptations and innovations should be continued, including virtual approaches, which may be appropriate for certain types of AGYW and facilitate retention in the program. Note, the use of virtual approaches for delivery of evidence-based curricula is currently under review by SGAC.

The key to a successful DREAMS program is a well-functioning referral system that enables the layering of services provided by different implementing partners. The Recipient should draw on lessons learned from the Zimbabwe DREAMS experience to propose strategies to strengthen the DREAMS referral network. Particular emphasis should be placed on improving collaboration and linkages with partners which serve as entry points for AGYW into DREAMS or as providers of secondary services such as the OVC and Key Populations (KP) platforms and health facilities. As Zimbabwe nears epidemic control, the DREAMS program will be an important avenue for reaching sexual partners of AGYW who may be HIV positive and undiagnosed/not on ART, or HIV negative and candidates for other HIV prevention services. The Activity should propose practical approaches for identifying these men and linking them to HIVST or other HTS services, ART for those who are HIV positive, and VMMC or PrEP for those who are negative.

A5. Cross-cutting issues

a. Gender

USAID recognizes the important role that gender norms and gender inequity play in the HIV epidemic, as well as other health and social sector areas. Gender inequities, poverty, and economic vulnerability, including food insecurity, along with cultural factors and low education levels, have put women and girls at heightened risk of HIV acquisition, sexual and physical abuse, discrimination, and even mortality.

HIV incidence among women aged 15-19 years is almost three times higher than men of the same age (0.67 for women, 0.23 for men, ZIMPHIA 2020). The Activity will explicitly ensure that the needs and challenges facing AGYW are addressed in the design and implementation of HIV service delivery models. At the same time, men in Zimbabwe are less likely to know their HIV status and to be virally suppressed than women. The Activity will also strengthen linkages to male-friendly services and approaches to overcome the specific barriers men encounter when seeking HIV services.

Zimbabwe remains a male-dominated society where up to one third of men believe they are justified in beating their wives or partners (ZDHS 2015). According to the Young Adult Survey of Zimbabwe 2017, 27 percent of females experienced physical, sexual and/or emotional violence during childhood, with 9 percent experiencing sexual violence. This Activity will deliver evidence based GBV prevention activities, integrate first line support (LIVES) to individuals who report experiencing violence to them, support local actors to provide GBV response services and facilitate specific referral mechanisms to other medical and support services for GBV survivors.

In addition, this Activity will implement strategies to engage community leaders, parents and caregivers, and other key influencers at the community level to reframe harmful gender and cultural norms which impact AGYW’s behaviors and opportunities such as intimate partner violence, access to education, child marriage, and early childbearing among others.

The Activity will routinely assess progress using sex- and age-disaggregated indicators and propose solutions to reach segments of the population for which coverage of services is lagging.

The Applicant is required to conduct a gender analysis and incorporate activities into the proposal that will reduce any gender gaps in the expected program outcomes. A Gender Action Plan is required as part of the work plan. At a minimum, the gender analysis should address constraints and opportunities related to the following:

● Differences in the status of women and men and their differential access to assets, resources, opportunities which relate to access to HIV prevention, care and treatment services.

● The influence of gender roles and norms (e.g. division of time, decision-making authority, access to financial resources) that influence women’s and men’s uptake and retention in HIV prevention, care and treatment services.

● AGYW’s unique needs and how these can be acknowledged and addressed to reduce observed gaps.

● Other potential differential impacts of the Activity on males and females, including unintended consequences.

b. Country ownership

In line with USAID’s Journey to Self Reliance strategy and PEPFAR’s pathway to sustained epidemic control, the Activity will promote country ownership through the provision of targeted technical assistance to the NAC, MOHCC, MOPSE and other relevant line ministries such as Youth and Women’s Affairs, particularly at the district and service delivery levels. Examples include institutionalizing the delivery of evidence-based curricula through schools, supporting the DACs to increase use of data for decision making in HIV prevention, and collaborating with the MOHCC to establish robust referral systems that identify and link vulnerable AGYW to services.

The Activity will also strengthen the technical, administrative, and financial expertise of local sub-partners, increasing the number of organizations that can implement quality HIV programs in Zimbabwe. The Activity may engage with private sector partners in service delivery, particularly for those services that the public sector is ill-equipped to provide. A diverse set of organizations and entities, which are capable of providing quality services, in collaboration with or on behalf of the Government of Zimbabwe, will be an important component of a sustainable HIV program.

The DREAMS Zimbabwe program is situated within the country’s overarching HIV framework and is led by the MOHCC and NAC at national, provincial and district levels. DREAMS operates within a well-established framework which includes regular national and district DREAMS partner meetings, the MOHCC Prevention Partners Forum, PEPFAR quarterly and COP stakeholder planning meetings, and Global Fund stakeholder meetings, among others. The Recipient will be expected to fully participate in these country-led coordination activities, as well as participate in other Government/donor/stakeholder coordination activities related to HIV prevention, sexual reproductive health, gender, and AGYW. Such coordination will enable an orderly scale up of the most effective strategies, magnifying impact beyond USAID’s investments.

c. Youth

This Activity is rooted in a PYD approach, which is based on the premise that, given development of appropriate skills and assets, guidance and support from caring adults, an enabling environment, and youth are engaged as partners, all youth (ages 10 - 29) can grow up healthy and productive, making positive contributions to their families, schools, and communities. The Activity will include concrete and practical approaches that will not only address the challenges that youth face to accomplish the Activity results but will also involve and support young people in the decision-making, management and leadership of this Activity. Specifically, the Activity will:

● Engage AGYW participants, from various sub populations, in Activity design, implementation, and evaluation.

● Use USAID’s PYD framework to design approaches that build skills, assets, and competencies; foster healthy relationships; support help seeking; and/or transform systems.

● Strengthen pathways for DREAMS participants to develop leadership skills, to serve as DREAMS Ambassadors, and support them to assume leadership roles in their communities.

● Actively support efforts for DREAMS Ambassadors to develop employability skills and link them to employment or educational opportunities.

● Support capacity building and networking opportunities for DREAMS Ambassadors to harness their skills and energy for continued advocacy and community development after completing DREAMS.

● Employ evidence on child and adolescent development and effective youth programming to inform Activity interventions.

● Track indicators and disaggregated service delivery indicators, by age and sex, to monitor Activity participation and impact.

d. Sustainability

For the Activity, USAID is seeking local institutions to implement and manage a high-quality HIV prevention program, building on the experience and expertise of local CBOs and community structures to engage AGYW. USAID expects the Recipient to also strengthen smaller community partners, as well as Zimbabwean health providers and teachers. Thus, the capacity built and lessons learned from the Activity will remain within Zimbabwe and have a positive effect on public health beyond the life of the project. The Activity will also implement a range of community-led behavioral interventions targeting AGYW, their families, communities and male sexual partners which will reinforce agency and lead to sustainable changes in harmful norms and practices that place individuals at risk of HIV acquisition.

e. Adaptive management

Adaptive management is an intentional approach to making decisions and adjustments in response to new information and changes in context. Examples relevant to this Activity include a changing epidemiological context as the country reaches epidemic control, other disease outbreaks, new pandemics, and shifting socio-economic conditions. This is especially important in Zimbabwe where potential for economic instability, and the resulting adverse effects on the health, education and social sectors, is high. The current COVID-19 pandemic has further damaged the economy;

decreased access to essential health services; closed schools and increased dropout rates; and led to increased rates of child marriage and GBV. The effects of COVID-19 will be long-lasting and the number of vulnerable AGYW is likely to be higher than previously estimated, which may affect the need for services, budget requirements, and the pace at which the Activity can achieve high levels of coverage of vulnerable AGYW. The current DREAMS Zimbabwe program adapted its implementation modalities in important ways to ensure continued availability of services including expanding virtual approaches and telehealth, community outreach, remedial education approaches that can be delivered in the community, and network models to reach

AGYW who do not have access to mobile phones. These adaptations are expected to continue post-COVID-19 and would be useful should another pandemic or emergency emerge.

Against this backdrop, the need for adaptive management strategies is very clear. The Activity must therefore:

● Continuously track and analyze indicators that provide sensitive and timely monitoring data on program interventions.

● Develop feedback loops to ensure the incorporation of monitoring data, lessons learned, and emerging best practices into program interventions.

● Build in opportunities to pause and reflect on Activity progress. These may include partner meetings, joint reviews, and work planning sessions, or other participatory and collaborative review efforts. These opportunities may focus on challenges and successes in implementation to date, changes in the operating environment or context that could affect programming, opportunities to better collaborate or influence other actors, and/or other relevant topics.

● Be as nimble as possible to allow for adaptations or redirections in approaches to respond to a changing operational environment.

i. Private sector partnerships

The private sector has a role to play in increasing access to HIV prevention services for vulnerable populations in Zimbabwe. The Recipient will collaborate with the private sector in the implementation of this award when relevant. Such instances include when the service or capacity is not available in the public sector, when the service is more acceptable to the target population through a private sector provider, and/or when the service could be delivered more efficiently when offered through the private sector. In addition, the Activity will leverage the private sector to create economic opportunities for AGYW, which is a core part of the DREAMS package.

Examples of support from the private sector include paid internships, starter packs or other support for small business development, and linking AGYW to market, business networks, and access to credit.

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SECTION B: FEDERAL AWARD INFORMATION

B1. Estimate of Funds Available and Number of Awards Contemplated

USAID intends to award one or more Cooperative Agreement(s) pursuant to this notice of funding opportunity. Subject to funding availability and at the discretion of the Agency, USAID intends to provide up to $70,000,000 in total USAID funding over a five (5) year period.

B2. Start Date and Period of Performance for Federal Awards

The anticipated period of performance is five years. The estimated start date will be October 2021.

B3. Substantial Involvement

USAID/Zimbabwe considers collaboration with the implementing partner crucial for the successful implementation of this activity. In accordance with ADS 303.3.11, the anticipated substantial involvement elements for this award are listed below (this list does not include approvals required by Standard Mandatory Provisions for Non-US NGOs or other applicable law, regulation or provision):

1. The Agency’s approval of the recipient’s implementation plans and monitoring and evaluation plans during performance.