oppCDC-RFA-GH18-1848-cfda93.185-cidCDC-RFA-GH18-1848-instructions.pdf

Centers for Disease Control

Center for Global Health

Support for Global Immunization Activities in Complex Settings

CDC-RFA-GH18-1848

Application Due Date: 05/14/2018

Support for Global Immunization Activities in Complex Settings

CDC-RFA-GH18-1848

TABLE OF CONTENTS

Part I. Overview Information A. Federal Agency Name B. Funding Opportunity Title C. Announcement Type D. Agency Funding Opportunity Number E. Catalog of Federal Domestic Assistance (CFDA) Number F. Dates G. Executive Summary

Part II. Full Text A. Funding Opportunity Description B. Award Information C. Eligibility Information D. Application and Submission Information E. Review and Selection Process F. Award Administration Information G. Agency Contacts H. Other Information I. Glossary

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-GH18-1848. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Support for Global Immunization Activities in Complex Settings C. Announcement Type: New - Type 1 This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https ://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.

Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-GH18-1848

E. Catalog of Federal Domestic Assistance (CFDA) Number:

93.185 F. Dates:

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

2. Due Date for Applications: 05/14/2018, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

3. Date for Informational Conference Call:

N/A

G. Executive Summary:

1. Summary Paragraph:

Purpose: Strengthen immunization program capacity development in fragile states and priority countries needed to achieve Global Vaccine Action Plan target. This includes achieving and sustaining polio eradication in Nigeria, Afghanistan and Pakistan and achieving measles/rubella elimination in priority countries of India, Nigeria, Pakistan, Indonesia, Ethiopia, and Democratic Republic of Congo (DRC) between 2018 and 2023. This funding opportunity also supports control of other vaccine preventable diseases (VPDs) and post-eradication sustaining efforts.

Strategies:

Sustain and strengthen essential global immunization program capacity in fragile states (polio) and priority countries (other VPDs);

https://www.grants.gov https://www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.grants.gov

Develop and implement a tactical approach to strengthen national immunization program capacity in fragile states and priority countries.

Outcomes:

Development, dissemination and uptake of immunization-related guidelines, tools, and/or policies for community volunteers;

Improved immunization workforce technical capacity, performance, and development;

Improved access to polio, measles, rubella and tetanus vaccines in inaccessible areas;

Improved community linkage to routine immunization services in urban, hard-to-reach, and disenfranchised communities;

Improved measles/rubella and tetanus supplemental immunization activity (SIA) quality;

Improved event-based and VPD surveillance reporting through community informants for polio, measles/rubella, tetanus, and other priority diseases.

a. Eligible Applicants: Single

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 1

d. Total Period of Performance Funding: $0 There is no project period ceiling; however, the estimated amount is $30,000,000

e. Average One Year Award Amount: $6,000,000

f. Total Period of Performance Length: 5

g. Estimated Award Date: 07/01/2018

h. Cost Sharing and / or Matching Requirements: N

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview The U.S. Congress provides funds to CDC for programmatic support to sustain and strengthen essential global, regional, and national immunization program capacity needed to control, eliminate, and eradicate vaccine-preventable diseases (VPDs). The success of the Global Polio Eradication Initiative has brought the world to the cusp of eradicating polio. Estimated global measles deaths decreased by 79% from 546,000 in 2000 to 90,000 in 2016; along with decreases in pneumonia and diarrhea, the decline in measles deaths is among the three main contributors to the decline in overall child mortality during this time period. Use of new and underutilized vaccines along with continued use of measles vaccine is estimated to save 23.3 million lives from 2011 to 2020 in low-income countries. Measles vaccine now saves over a million lives each year. However, more work is needed to achieve the global immunization agenda highlighted in the Global Vaccine Action Plan (GVAP), 2011-2020 to prevent the 15% to 22% of child deaths globally that are vaccine-preventable. In addition, although polio, measles and rubella have been successfully eliminated from the Western Hemisphere, and other once common infections such as diphtheria, tetanus, pertussis, meningococcus, pneumococcus, Haemophilus influenzae type b and rotavirus rarely occur in the United States, Americans remain at risk for VPDs as long as they persist anywhere in the world. The US Government is compelled to ensure that American children, and children across the globe, are protected from these dangerous yet easily preventable diseases.

The purpose of this cooperative agreement is to support the recipient in collaboration with CDC, to sustain and strengthen immunization program capacity in fragile states and priority countries needed to:

Achieve the globally agreed goals of GVAP (including polio eradication, global and regional elimination targets for measles, rubella, and neonatal tetanus, and national and subnational vaccination coverage targets)

Achieve the 2030 Sustainable Development Goal (SDG) target to end vaccine-preventable disease deaths of children under 5 years of age

Reduce chronic disease and cancer deaths from VPDS Prevent, detect, and respond to VPD outbreaks

To achieve these targets, high quality country-led national immunization program capacity, linked to strong health systems, is needed to provide vaccination services, integrated laboratory and epidemiological disease surveillance, and immunization information systems. In addition, global and regional immunization program capacity to sustain and strengthen high quality country-led immunization programs, and to prevent, detect and respond to VPD outbreaks that cross borders.

A key step to build and strengthen immunization program capacity is to strategically use the strengths of both health system strengthening efforts and disease-specific efforts. Disease-specific efforts depend on strong immunization programs as an integral part of a well-functioning health system. In particular, this cooperative agreement will focus on developing and implementing a strategic approach to achieve and sustain polio eradication in Nigeria, Afghanistan and Pakistan and to reach both the national and subnational vaccination coverage targets. Additionally, this cooperative agreement will focus on, the measles and rubella elimination targets in India, Nigeria, Pakistan, Indonesia, Ethiopia, and DRC, as committed to in the GVAP. These seven countries alone represent 50% of the globe's undervaccinated children.

b. Statutory Authorities Section 307 of the PHS Act (42 U.S.C. 242); section 317(k)(1) and (2) of the PHS Act (42 U.S.C. 247b(k)(1) and (2).

c. Healthy People 2020

This NOFO supports multiple priorities of Healthy People 2020, including:

Immunization and Infectious Diseases Global Health

d. Other National Public Health Priorities and Strategies This NOFO will support the US Government endorsed Global Polio Eradication Initiative (GPEI) and the Global Vaccine Action Plan (GVAP), 2011-2020. In addition, this NOFO will support CDC's Global Health Strategy, which focuses on: 1) improving the health and well-being of people around the world; 2) improving capabilities to prepare for and respond to infectious diseases, other emerging health threats and public health emergencies; and, 3) maximizing the potential of CDC's global programs to achieve public health impact.

e. Relevant Work CDC is supporting the work of IFRC through the secondment of a medical officer to the IFRC office in Geneva. In addition, CDC supports ongoing GPEI activities in the three remaining endemic countries of the world, - Afghanistan, Nigeria, and Pakistan - through the cooperative agreement CDC-RFA-GH16-1721 with the International Federation of the Red Cross and Red Crescent (IFRC); and in Afghanistan through cooperative agreements with the United Nations Children's Fund (UNICEF) under CDC-RFA-GH13-1302 and the World Health Organization (WHO) under CDC-RFA-GH13-1301. This cooperative agreement will build on the efforts of WHO and UNICEF by addressing communities that are not accessed through their efforts. In addition, this cooperative agreement builds on work performed under CDC's cooperative agreement CDC-RFA-GH16-1719 with IFRC.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

Strategies and Activities

Short-term Outcomes Intermediate Outcomes Long-Term Outcomes

Strategy 1: Sustain and strengthen essential global and regional immunization program capacity in fragile states (polio) and priority countries (other VPDs)

1. Support polio eradication

2. Support social mobilization

1. Development, dissemination and uptake of immunization-related guidelines, standards, tools, and/or policies for community volunteers

2. Developed workforce capable of providing technical assistance and operational support for

1. Global interruption of wild poliovirus and vaccine-derived poliovirus

2. Rapid detection and response of VPD outbreaks

3. Improved and sustained vaccination delivery

4. Evidence used by

1. Polio eradicated globally

a. Polio-endemic countries meet progress targets to achieving polio eradication

2. Measles and rubella/CRS eliminated globally

a. Measles mortality https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases https://www.healthypeople.gov/2020/topics-objectives/topic/global-health http://polioeradication.org/ http://polioeradication.org/ http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/ https://www.cdc.gov/globalhealth/security/index.htm activities to improve the quality of routine immunization and measles, rubella, and tetanus supplemental immunization activities

3. Support country ownership and advocacy for immunization

4. Develop strategic partnerships with

WHO, UNICEF,

Civil Society Organizations and other partners at regional and country levels

5. Increase vaccine demand, ensure equitable access to and utilization of vaccines among children Strategy 2: Develop and implement a tactical approach to strengthen national immunization program capacity in fragile states and priority countries

1. Support community-based surveillance with early detection and response to outbreaks of polio, measles, rubella, neonatal tetanus, cholera, meningitis and other priority vaccine preventable immunization program activities

3. Strengthened data management of immunization data systems

4. Improved immunization workforce technical capacity, performance and development

5. Improved access to polio, measles/rubella, and tetanus vaccines in inaccessible areas

6. Improved community linkage to routine immunization services in urban, hard to reach, and disenfranchised communities

7. Improved event-based and VPD surveillance reporting through community informants for priority diseases including polio, measles/rubella, neonatal tetanus, meningitis, cholera, and other priority diseases

8. Improved quality and outcome of measles/rubella, polio, and tetanus SIAs

9. Increase in evidence base needed to address immunization program challenges

10. Increased involvement of MoH, regions and countries to improve immunization policy and practices

5. Increased ownership/leadership from sub-national and local health staff on VPD eradication, surveillance, and routine immunization activities

6. Sustained support for immunization and VPD surveillance institutions’ policies and practices

7. Improved surveillance indicators for measles/rubella and AFP

8. Improved vaccine coverage and equity

9. Improved access to vaccine during humanitarian emergencies

10. Improved demand for routine immunization services as a result of targeted outreach to urban, hard-to-reach, and disenfranchised communities is reduced compared to year 2000

b. Absence of measles outbreaks during humanitarian emergencies.

c. MCV1 and MCV2 district level coverage is maintained at herd immunity standards

d. Improved surveillance indicators for measles/rubella and

AFP

3. Elimination of maternal and neonatal tetanus

4. Global operational capacity for rapid detection and response to outbreaks and humanitarian crisis is integrated into UN cluster system

5. Greater reliance on demand-driven routine immunization and less reliance on campaigns to reach EPI targets in hard to reach urban and/or disenfranchised communities diseases NGOs, and other partners in activity planning and implementation

i. Purpose This Notice of Funding Opportunity (NOFO) will support efforts to sustain and strengthen global, regional, and national immunization program capacity needed to:

Achieve the globally agreed goals of the Global Vaccine Action Plan (including polio eradication, global and regional elimination targets for select VPDs including measles and rubella, and neonatal tetanus;

Achieve the 2030 Sustainable Development Goal (SDG) target to end VPDs of children under 5 years of age;

Reduce chronic disease and cancer deaths from VPDs; and Prevent, detect and respond to VPD outbreaks

ii. Outcomes Short-Term Outcomes

Development, dissemination and uptake of immunization-related guidelines, standards, tools, and/or policies for community volunteers

Improved immunization workforce technical capacity, performance and development Improved access to vaccines in inaccessible areas Improved measles/rubella, and tetanus SIA quality Improved community linkage to routine immunization services in urban, hard to reach, and disenfranchised communities Improved event-based and VPD surveillance reporting through community informants for priority diseases including polio, measles/rubella, CRS, maternal and neonatal tetanus, meningitis, cholera, and other priority diseases

Intermediate Outcomes

Rapid detection and response of VPD outbreaks Improved and sustained vaccination delivery Improved surveillance indicators for measles/rubella and AFP Improved vaccine coverage and equity Improved access to vaccine during humanitarian emergencies Improved demand for vaccines and vaccination services Improved demand for routine immunization services as a result of targeted outreach to urban, hard-to-reach, and disenfranchised communities

Long-term Outcomes

Polio-endemic countries meet progress targets to achieving polio eradication

Measles mortality is reduced compared to year 2000 Improved surveillance indicators for measles/rubella and AFP Global operational capacity for rapid detection and response to outbreaks and humanitarian crisis is integrated into UN cluster system

iii. Strategies and Activities Strategy 1: Sustain and strengthen essential global and regional immunization program capacity in fragile states (polio) and priority countries (other VPDs)

1. Support polio eradication through:

a. Polio campaign and monitoring activities in low-performing districts by recruiting and training country Red Cross Society volunteers who will serve as social mobilizers and work in teams to vaccinate children <5 years of age against polio in high-risk districts of polio-endemic countries and at-risk neighboring countries;

2. Support social mobilization activities to improve the quality of routine immunization and measles, rubella, and tetanus supplemental immunization activities by:

a. Providing logistical and technical support for system strengthening and workforce development projects;

b. Integrate tetanus vaccination with polio and measles SIAs as well as house-to-house and routine immunization activities especially in hard-to-reach areas

3. Support country ownership and advocacy for immunization by;

a. Promoting increased domestic resources for immunization programs, and

b. Advocating for increased awareness of national immunization program resource needs and financing mechanisms among civil society;

4. Develop strategic partnerships with WHO, UNICEF, Civil Society Organizations, ICCs and other partners at regional and country levels by:

a. Conducting monitoring and evaluation of programs/projects in collaborations with partners;

b. Facilitating information sharing between ministries of health and non-governmental organizations;

5. Increase vaccine demand, ensure equitable access to and utilization of vaccines among children by:

a. Identifying and addressing community and health-sector barriers to vaccine access;

b. Minimizing missed vaccination opportunities and facilitating catch-up for vaccinations;

c. Linking planning, delivery, and vaccination monitoring with other health-related interventions Strategy 2: Develop and implement a tactical approach to strengthen national immunization program capacity in fragile states and priority countries

1. Support community-based surveillance with early detection and response to outbreaks of polio, measles, rubella, tetanus, cholera, meningitis and other priority diseases

a. Train community health workers and volunteers in identification and reporting of maternal and neonatal tetanus and fever/rash (measles and rubella), and CRS

1. Collaborations

a. With other CDC programs and CDC-funded organizations:

Recipient is expected to collaborate with the following groups and to explain how each of these collaborations might assist the recipient in achieving the NOFO outcomes:

CDC's Global Immunization Division (GID);

UNICEF country teams;

WHO regional and country teams;

CDC subject matter experts in other Centers and Offices (required when applicable);

CDC staff in affected countries (required when applicable);

CDC Incident Command leadership and staff (required when applicable)

b. With organizations not funded by CDC:

Recipient may collaborate with other organizations external to CDC as deemed necessary to achieve project outcomes. The recipient should explain how each of these collaborations might assist the recipient in achieving the NOFO outcomes. Organizations include: Ministries of Health (and Finance when needed), Bill and Melinda Gates Foundation (BMGF), USAID, GAVI, Lions, Medicines Sans Frontier (MSF), Rotary International, National Red Cross/Crescent Societies; National polio programs including Emergency Operations Centers where applicable and/or other organizations.

2. Target Populations Children under five years of age in the six priority countries for measles activities: India, Nigeria, Pakistan, Indonesia, Ethiopia, and Democratic Republic of Congo and the polio-endemic countries of Nigeria, Afghanistan and Pakistan. May include older age groups that are identified as having immunity gaps to polio due to inaccessibility and insecurity in their geographic areas. For rubella and CRS, pregnant women are the high risk group, so ensuring immunity prior to pregnancy or reduced risk of exposure among this group will be critical.

Approximately 40 countries have not introduced rubella vaccine into their national program.

a. Health Disparities The NOFO requires recipient to collaborate with local Red Cross/Red Crescent Societies who will utilize local volunteers to conduct outreach to underserved communities in low-performing districts: special mobile teams will track and vaccinate (oral polio vaccine only) children under five years of age among migrant and hard-to-reach communities of Nigeria, Pakistan and Afghanistan and countries with populations experiencing wild poliovirus or vaccine derived polio virus outbreaks, as well as the six measles priority countries. The teams will develop and maintain registers of children in these communities to track their vaccination status and ensure they are adequately immunized against polio. The use of volunteers from within the underserved community will assure language does not impede inclusion.

Federal disability rights laws apply to foreign assistance programs. Funded programs consider including people with disabilities in all aspects of the program (e.g., advisory boards, planning committees, project staff, consultants, etc.), and ensure to best of their ability that persons with disabilities are not discriminated against in hiring processes, and that facilities and communications are accessible.

iv. Funding Strategy N/A

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy The purpose of evaluation and performance measurement is to help CDC recipients: (1) Monitor the extent to which activities were successfully completed; (2) Demonstrate progress toward achieving program outcomes (e.g., Were outcomes of interest achieved?); and (3) Inform decisions about future programming that drive continuous program improvement for more efficient and effective program performance (e.g., What and how could things be improved?).

An Evaluation and Performance Measurement Plan (EPMP) is required as part of this NOFO to measure NOFO accomplishments. The primary objective of the EPMP implementation is to determine the progress of activities under this NOFO and indicate how they relate to the desired outcomes. The results will be used for program improvement, accountability and reporting, and for sharing with partners and other stakeholders. The EPMP framework describes the desired activities, outcomes and performance measures and how CDC will work with the recipient to support achievement of these. Proposed performance measures for activities and outcomes described in the logic model are listed in the tables below and should be considered for inclusion into the EPMP.

Table 1: Proposed Performance Measures for Activities

Activity/strategy Performance measure (process) Potential data sources*

Support polio eradication

· Describe type and frequency of assistance provided to countries during the reporting period to achieve Global, Regional and National immunization goals including polio eradication.

· Number of IFRC-supported human resources providing support to member countries globally in the reporting period.

Quarterly reports;

Teleconference minutes; Human resources data

Support social mobilization activities to improve the quality of routine immunization and measles, rubella, and tetanus supplemental

· Describe type, frequency and location of social mobilization support to countries during supplemental immunization activities.

Quarterly reports;

Teleconference minutes immunization activities

Support country ownership and advocacy for immunization

· Describe support and advocacy activities to countries and any plans for sustainability

· Describe most significant change/s in country ownership and advocacy for immunization which have resulted from IFRC support in the reporting period

· Change in number of countries which have a functioning NITAG

Quarterly reports;

minutes

Develop strategic partnerships with WHO, UNICEF, Civil Society Organizations and other partners at regional and country levels

· Describe the nature and type of new partnerships created to facilitate activities under the GPEI, M&RI and control of other VPDs

· Describe most significant change/s which have resulted from newly developed partnerships in the reporting period

Quarterly reports;

minutes

Increase vaccine demand, ensure equitable access to and utilization of vaccines among children

· Describe type and importance of new economic and financial evidence generated during the reporting period.

· Provide examples of use of this evidence.

Quarterly reports;

Teleconference minutes

Support community-based surveillance with early detection and response to outbreaks of polio, measles, rubella, neonatal tetanus cholera, meningitis and other priority diseases

· Describe the nature and type of support provided to improve community-based surveillance activities

· Number of community members trained to identify and report VPD cases

· Change in the number of countries or sub-national areas that have functional community-based surveillance

· Number of VPD cases identified by community-based surveillance

· Number of VPD outbreaks in the reporting period & number/% of these detected within required timeframe/s

Quarterly reports;

community-based surveillance data summary reports;

case investigation reports; outbreak investigation reports

*Sources of data for performance measures may include existing data sources, such as administrative immunization coverage data provided through existing channels like the

WHO/UNICEF Joint Reporting Form, or may include new data sources, such as quarterly update reports to CDC. Relevant data sources from the sub-national, national, regional or global level should be specified, as appropriate, in the Evaluation and Performance Measurement Plan (EPMP). As such, reporting frequency of measures will vary. Recipients should specify reporting frequency as quarterly or annually in the EPMP.

Table 2: Proposed Performance Measures for Outcomes

Performance Measures Outcomes

Process Measures Outcome Measures

Potential Data Sources*

Short Term Outcomes

1. Development, dissemination and uptake of immunization-related guidelines, standards, tools, and/or policies for community volunteers

· Drafts of guidelines, standard, tools or policies for community volunteers

· Approval by in-country leadership of final version of documents

· Community volunteers have access to immunization-related guidelines, standards, tools, and/or policies

· Increased number of staff trained on new immunization-related guidelines, standards, tools, and/or policies

· Tracking document of dissemination of final versions of documents;

· Monthly/quarterly reports

2. Developed workforce capable of providing technical assistance and operational support for immunization program activities

· Analysis of workforce performance outcomes, needs and gaps

· Intervention designed to meet identified needs

· Implementation plan with monitoring and evaluation plan and tools

· Monitoring and evaluation dissemination and use of finding

· Increased number of staff performing adequately based on identified workforce performance priorities by demographics

· Specific performance outcomes and learning objectives met

· Pre- and post-test intervention scores

· Reports, tools, monitoring and evaluation reports and other documents describing processes and outcome measures

3. Strengthened data management of

· Describe factors affecting accuracy of

· Number of fragile countries with

· JRF

immunization data systems numerator data at national and subnational levels, and any changes in these.

availability of quality data for a) VPD surveillance and b) routine immunization coverage data.

· Data quality reviews

4. Improved immunization workforce technical capacity, performance and development

· Workforce performance outcomes and competencies identified

· Identify training needs through performance and needs analysis;

· Develop strategy, intervention or training curricula;

· Conduct new and/or refresher training of staff;

· Supervision plans modified to incorporate capacity, performance, development, and monitoring elements

· Increased number of staff trained in routine immunization and/or supplemental immunization activities incorporating workforce improvement strategies

· Strategy, implementation and evaluation documents;

· Pre- and post-test training scores by staff demographics (i.e.

number of staff trained, local vs. sub-national vs national level staff, etc.);

· Monthly/quarterly reports

5. Improved access to polio, measles/rubella, and tetanus vaccines in inaccessible areas

· Updated microplans that identify inaccessible areas and their needs;

· Implement measures to improve vaccine access (e.g. improved cold chain and mobile outreach strategies and tailoring of immunization services)

· Increased access to vaccines through routine immunization and/or SIAs

· Monthly/quarterly reports;

· Administrative immunization coverage;

· Rapid convenience assessments;

· Post-campaign coverage survey

6. Improved community linkage to routine immunization services in urban, hard-

· Updated microplans that identify urban, hard-to-reach, and disenfranchised

· Increased targeted outreach to urban, hard-to-reach, and disenfranchised

· Monthly/quarterly reports;

· Administrative to-reach, and disenfranchised communities communities with low access to routine services;

· Implement improvement measures communities delivering standardized information and services immunization coverage

7. Improved event-based and VPD surveillance reporting through community informants for priority diseases including polio, measles/rubella, neonatal tetanus, meningitis, cholera, and other priority diseases

· Assess and identify weaknesses in surveillance areas;

· Conduct new and/or refresher event- and case-based VPD surveillance training

· Train community health workers and volunteers in identification and reporting of maternal and neonatal tetanus

· Increased number of VPD cases identified through community informants

· Improved detection and response to priority diseases

· Improved surveillance indicators for polio, measles, rubella, and neonatal tetanus

· Pre- and post-test training scores;

· VPD Surveillance databases (Country-specific, WHO MR database, etc.)

8. Improved quality and outcome of measles/rubella and polio SIAs

· Up-to-date microplans

· High vaccine coverage during SIA at sub-national level and in high-risk areas

· Increased routine immunization coverage

· Rapid convenience monitoring reports;

· SIA technical reports;

· Post-campaign coverage survey

9. Increase in evidence base needed to address immunization program challenges

10. Increased involvement of MoH, NGOs, and other partners in activity planning and implementation

Intermediate Term Outcomes

1. Global interruption of wild poliovirus and vaccine-derived poliovirus

2. Rapid detection and response of VPD outbreaks

· Community informants work with MoH staff to identify VPD cases within recommended disease reporting timeframe

· Increased number of disease cases identified through community informants

· VPD surveillance database (Country-specific, WHO MR database, etc.)

3. Improved and sustained vaccination delivery

· Updated microplans that identify improved vaccine access for hard-to-reach areas (e.g. mobile outreach strategies)

· Improve vaccine delivery infrastructure (i.e. cold chain and vaccine stock in health facilities)

· Increased access to vaccines through routine immunization and/or SIAs

· Monthly/quarterly reports;

· Administrative immunization coverage;

· Cold chain assessments;

· Post-campaign coverage survey

4. Evidence used by regions and countries to improve immunization policy and practices

5. Increased ownership/leadership from sub-national and local health staff on VPD eradication, surveillance, and routine immunization activities

6. Sustained support for immunization and VPD surveillance institutions’ policies and practices

7. Improved surveillance indicators for measles/rubella and

AFP

· Weaknesses in surveillance indicators identified;

· Conduct new and/or refresher case-based VPD surveillance training

· Train community

· Increased number of VPD cases identified through community informants

· Improved detection and response to priority diseases

· Pre- and post-test training scores;

· VPD Surveillance databases (Country-specific, WHO MR database, etc.)

health workers and volunteers in identification and reporting of maternal and neonatal tetanus

8. Improved vaccine coverage and equity

· Updated microplans that identify improved vaccine coverage and equity in urban, hard-to-reach, and disenfranchised communities;

· Implement measures to improve vaccine coverage and equity

· Increased access to vaccines through routine immunization and/or SIAs

· Improved vaccine coverage in urban, hard-to-reach, and disenfranchised communities

· Monthly/quarterly reports;

· Administrative immunization coverage;

· Post-campaign coverage survey

9. Improved access to vaccine during humanitarian emergencies

· Identify strategies used in previous humanitarian emergencies to ensure vaccine access;

· Update strategies as needed to allow for new/innovative improvements;

· Draft vaccine access plans for fragile states and priority countries;

· Approval of vaccine access plans

· Availability of vaccine access plans for fragile states and priority countries;

· Increased number of staff aware of vaccine access plan during humanitarian emergencies

· Tracking document of dissemination of final version of plans;

· Monthly/quarterly reports

10. Improved demand for routine immunization services as a result of targeted outreach to urban, hard-to-reach, and disenfranchised communities

· Identify demand barriers in urban, hard-to-reach, and disenfranchised communities

· Identify strategies for mobilizing key community stakeholders to support routine immunization or campaign efforts

· Demand barrier analyses produced

· Stakeholders engaged

· Increased number of routine immunization services used by affected communities

· Rapid qualitative research

· Administrative coverage data

Long Term Outcomes

1. Polio eradicated globally

a. Polio-endemic countries meet progress targets to achieving polio eradication

· Updated microplans that identify inaccessible areas and their needs;

· Implement measures to improve vaccine access (e.g. improved cold chain and mobile outreach strategies and tailoring of immunization services)

· Increased access to vaccines through routine immunization and/or SIAs;

· Reduced number of polio cases in polio-endemic countries;

· Polio-free status attained in polio-endemic countries;

· Polio-elimination status maintained in polio-free countries

· Monthly/quarterly reports;

· Administrative immunization coverage;

· Rapid convenience assessments;

· Post-campaign coverage survey

2. Measles and rubella/CRS eliminated globally

a. Measles mortality is reduced compared to year 2000

b. Absence of measles outbreaks during humanitarian emergencies.

c. MCV1 national level coverage is maintained at herd immunity standards

d. Improved surveillance indicators for measles/rubella and

AFP

a. Updated microplans that identify inaccessible areas and their needs

· Implement measures to improve vaccine access (e.g. improved cold chain and mobile outreach strategies and tailoring of immunization services d.Weaknesses in surveillance indicators identified;

· Conduct new and/or refresher case-based VPD surveillance training

· Train community health workers and volunteers in identification and reporting of maternal and neonatal tetanus

a. Increased access to vaccines through routine immunization and/or SIAs;

· Reduced number of measles;

· Measles-control status attained in measles-endemic countries d.Increased number of VPD cases identified through community informants

· Improved detection and response to priority diseases

a. Monthly/quarterly reports;

· Administrative immunization coverage;

· Rapid convenience assessments;

· Post-campaign coverage survey

d. Pre- and post-test training scores;

· VPD Surveillance databases (Country-specific, WHO MR database, etc.)

3. Elimination of maternal and neonatal tetanus

· Integration of tetanus SIAs with other polio and/or MR SIAs

· Increase in two doses or more of tetanus toxoid

Vaccination coverage data based on (SIA TT2+ coverage; country especially in hard-to-reach areas

· Integration of tetanus vaccination for women of childbearing age during house-to-house visits and activities for routine vaccination with polio and MR especially in hard-to-reach areas vaccine (TT2+) coverage in SIAs

· Increase in TT2+ coverage in routine immunization estimates of routine TT2+ coverage;

WHO/UNICEF

databases and estimates for TT2+ coverage)

4. Global operational capacity for rapid detection and response to outbreaks and humanitarian crisis is integrated into UN cluster system

· Guidelines or recommendations drafted for rapid detection and response to outbreaks and humanitarian crisis for UN cluster system;

· Identify training needs through needs analysis;

· Develop strategy, intervention or training curricula

· Increased number of staff trained in rapid detection and response to outbreaks and humanitarian crisis

· Strategy, implementation and evaluation documents;

· Pre- and post-test training scores by staff demographics;

· Monthly/quarterly reports

5. Greater reliance on demand-driven routine immunization and less reliance on campaigns to reach EPI targets in hard to reach urban and/or disenfranchised communities

· Communities reached with minimum package of information and services

· Percent having valid health / immunization cards for eligible aged children

· Percent of children reached through routine vs campaign outreach services

· Universal intention to vaccinate for all vaccines offered within the setting

· Coverage surveys

· Administrative coverage data

*Sources of data for performance measures may include existing data sources, such as administrative immunization coverage data provided through existing channels like the WHO/UNICEF Joint Reporting Form, or may include new data sources, such as quarterly update reports to CDC. Relevant data sources from the sub-national, national, regional or global level should be specified, as appropriate, in the Evaluation and Performance Measurement Plan (EPMP). As such, reporting frequency of measures will vary. Recipients should specify reporting frequency as quarterly or annually in the EPMP.

ii. Applicant Evaluation and Performance Measurement Plan

Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

How applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement.

How key program partners will participate in the evaluation and performance measurement planning processes.

Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant)

Plans for updating the Data Management Plan (DMP), if applicable, for accuracy throughout the lifecycle of the project. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data; data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans.

For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additionalrequirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, they should be directed to:

Describe the type of evaluations (i.e., process, outcome, or both).

Describe key evaluation questions to be addressed by these evaluations.

Describe other information (e.g., measures, data sources).

Recipients will be required to submit a more detailed Evaluation and Performance Measurement plan, including a DMP, within the first 6 months of award, as described in the Reporting Section of this NOFO.

c. Organizational Capacity of Recipients to Implement the Approach The eligible applicant must clearly describe their demonstrated experience and collaboration in the following areas:

Collaboration in public health programs with priority country national governments;

Collaboration with multiple polio eradication and measles/rubella elimination partners including BMGF, USAID, WHO, UNICEF, Rotary, Gavi and others;

Collaboration with movement partners ARCS, NRCS, and other country-specific

Red Cross society volunteers who will negotiate for safe access in insecure areas;

Demonstrated accomplishments in designing and implementing public health action and programs in complex settings;

Demonstrated capacity to mobilize sufficient culturally competent personnel to https://www.cdc.gov/grants/additionalrequirements/ar-25.html achieve outcomes;

Ability to manage financial reporting, budget management and administration, personnel, as well as management of grants and contracts.

d. Work Plan Applicants should provide a detailed work plan for the first year of the project period and a high-level work plan for subsequent years.

No specific work plan format is required, as long as it is clear how the components in the work plan crosswalk to the strategies and activities, outcomes and evaluation and performance measures presented in the logic model and the narrative sections of the NOFO.

A sample work plan format is presented below.

Project Period Outcome:

[from Outcomes section and/or logic model]

Outcome Measure:

[from Evaluation and Performance Measurement section]

Strategies and Activities

Process Measure [from Evaluation and Performance Measurement section]

Responsible Position / Party

Completion Date

1.

2.

3.

4.

5.

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and recipients, site visits, and recipient reporting (including work plans, performance, and financial reporting).

Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements:

Tracking recipient progress in achieving the desired outcomes.

Ensuring the adequacy of recipient systems that underlie and generate data reports.

Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities deemed necessary to monitor the award:

Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

Ensuring that recipients are performing at a sufficient level to achieve outcomes within stated timeframes.

Working with recipients on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets.

Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk recipients.

CDC Grant Monitoring Activities Throughout the five-year NOFO period, CDC will engage in the following monitoring activities:

Monthly calls to review program progress, determine needs for technical assistance, and review administrative actions

Annual site visits to review programmatic progress and to plan for the following budget period; site visits will include a review of recipient program and financial reporting systems

Technical review of annual workplans and budgets, with written feedback provided to the recipient

Review of financial and programmatic reports submitted by the recipient

CDC Approaches for Performance Measurement:

Throughout the five-year NOFO period, CDC will work with the recipient to conduct program monitoring and evaluation of activities as needed. This includes:

To conduct process and outcome evaluations of the funded activities.

o Process Evaluation: Process evaluation will assess the extent to which the agreed

NOFO activities have been implemented as planned. Limitations, barriers, and key success factors of the implementation will be explored. It is expected that this evaluation will be conducted during Years 2-3.

o Outcome Evaluation: Outcome evaluation will be conducted to determine whether the funded activities are leading to the expected outcomes. It is expected that this evaluation will be conducted during Years 3-4.

To finalize the evaluation protocols and plan for implementation at the designated timeframe, a system for collecting data over time to answer evaluation questions should be established during program implementation.

To ensure that all evaluations are consistent with established frameworks and program specific requirements. Submission of Non-research Determination (NRD) CDC-ADS for ethical clearance is required. CDC will assist the submission process.

To report the evaluation findings to relevant stakeholders and will make these publically available in order to enhance the utilization of the findings to improve program effectiveness, and continued program improvement upon completion of the award.

CDC will provide technical assistance to the recipient to ensure that the following practices consistent with the established evaluation standards and are integrated with all evaluation activities:

Engage stakeholders Clearly state evaluation questions, purpose, and objectives Use appropriate evaluation design, methods, and analytical techniques Address ethical considerations and assurances Identify resources and articulate budget Construct data collection and management plans Ensure appropriate evaluator qualifications and evaluation independence Monitor the planning and implementation of an evaluation Produce quality evaluation reports Disseminate results Use findings for program improvement and sustainability

f. CDC Program Support to Recipients (THIS SECTION APPLIES ONLY TO

COOPERATIVE AGREEMENTS)

CDC will provide technical assistance to the recipient to ensure that the following practices are consistent with the established evaluation standards and are integrated with all evaluation activities:

• Engage stakeholders

• Clearly state evaluation questions, purpose, and objectives

• Use appropriate evaluation design, methods, and analytical techniques

• Address ethical considerations and assurances

• Identify resources and articulate budget

• Construct data collection and management plans

• Ensure appropriate evaluator qualifications and evaluation independence

• Monitor the planning and implementation of an evaluation

• Produce quality evaluation reports

• Disseminate results

• Use findings for program improvement and sustainability.

B. Award Information

1. Funding Instrument Type: Cooperative Agreement CDC's substantial involvement in this program appears in the CDC Program Support to Recipients Section.

2. Award Mechanism: U2G

3. Fiscal Year: 2018

4. Approximate Total Fiscal Year Funding: $6,000,000

5. Approximate Period of Performance Funding: $0

This amount is subject to the availability of funds.

There is no project period ceiling; however, the estimated amount is $30,000,000

Estimated Total Funding: $30,000,000

6. Approximate Period of Performance Length: 5 year(s)

7. Expected Number of Awards: 1

8. Approximate Average Award: $6,000,000 Per Budget Period

9. Award Ceiling: $0 Per Budget Period

This amount is subject to the availability of funds.

There is no award ceiling; however, the estimated amount is $6,000,000

10. Award Floor: $0 Per Budget Period

11. Estimated Award Date: 07/01/2018

12. Budget Period Length: 12 month(s)

Throughout the project period, CDC will continue the award based on the availability of funds, the evidence of satisfactory progress by the recipient (as documented in required reports), and the determination that continued funding is in the best interest of the federal government. The total number of years for which federal support has been approved (project period) will be shown in the “Notice of Award.” This information does not constitute a commitment by the federal government to fund the entire period. The total period of performance comprises the initial competitive segment and any subsequent non-competitive continuation award(s).

13. Direct Assistance Direct Assistance (DA) is not available through this FOA.

C. Eligibility Information

1. Eligible Applicants Eligibility Category: Others (see text field entitled "Additional

Information on Eligibility" for clarification)

Additional Eligibility Category:

2. Additional Information on Eligibility Single – International Federation of Red Cross/Red Crescent Societies (IFRC) Eligibility is limited to the International Federation of the Red Cross and Red Crescent (IFRC)

3. Justification for Less than Maximum Competition The International Federation of Red Cross and Red Crescent Societies (IFRC) is one of three arms of the International Red Cross and Red Crescent Movement, the world's largest humanitarian network whose mission includes protecting life and health in conflict countries and other emergencies. Each of the three arms performs a critical role. The second arm is the International Committee of the Red Cross (ICRC) which, as the custodian of the Geneva Conventions, ICRC has a permanent mandate under international law to undertake humanitarian activities in conflict settings. The third arm is the National Societies such as American Red Cross Society and Afghan Red Crescent Society; which come together as members of IFRC. The National Societies are a network of community-based volunteers who support the public authorities in their own countries as independent auxiliaries to the government in the humanitarian field.