Pre-solicitation notice_CMEP 2_ 10232020.pdf

Presolicitation Notice Cambodia Malaria Elimination Project 2 (CMEP 2)

Solicitation Number: 72044221R00001 Release Date: October 23, 2020

The purpose of this notice is to comply with the synopses and presolicitation notice requirements of FAR 5.2, Synopses of Proposed Contract Actions. Any solicitation resulting from this notice will be handled in accordance with FAR 5.102(d); therefore, availability of any resulting solicitation package will be limited to this electronic medium. Accordingly, interested vendors, especially small business, are encouraged to register themselves as an interested vendor.

The United States Agency for International Development, Cambodia (USAID/Cambodia) intends to release a solicitation for a project titled “Cambodia Malaria Elimination Project 2” (CMEP 2) that is the is the follow-on to CMEP (ending October 2021). The purpose of this project is to build on previous experience, and strengthen local capacity in malaria prevention, diagnosis, and management, as well as surveillance and reporting, in order to reach elimination targets in Cambodia by 2025. The activity is expected to commence in six provinces: three provinces (Pailin, Batambang, and Pursat) where the U.S. President’s Malaria Initiative (PMI) is currently supporting implementation of malaria elimination activities and three provinces (Kep, Kampot, and Koh Kong) where PMI is providing technical assistance to the Provincial Health Departments (PHD) to conduct these activities on their own.

The anticipated solicitation date is on or about November 6, 2020.

Except for the above information and Attachment 1, no additional information regarding this planned RFP is available at this time. All necessary information will be supplied at the time the RFP is posted at https://beta.sam.gov/. Questions/requests for information will not be responded to until RFP issuance. Interested parties are advised to periodically monitor the above website for updates concerning this procurement. No proposals for funding should be submitted until after the RFP is issued.

This notice does not obligate USAID to release a solicitation or award a contract nor does it commit the Government to pay for costs incurred in the preparation and submission of a proposal. In addition, final award cannot be made until funds have been fully appropriated, allocated, and committed and internal USAID procedures have been completed.

Sincerely, Julie Ota Contracting Officer USAID/Cambodia https://beta.sam.gov/

72044221R00001

ATTACHMENT 1 – DRAFT DESCRIPTION/SPECIFICATIONS/STATEMENT OF

WORK

1. ACTIVITY TITLE

2. PURPOSE

The Cambodia Malaria Elimination Project 2 (CMEP 2) is the follow-on to CMEP (ending October 2021). The purpose of this activity is to build on previous experience, and strengthen local capacity in malaria prevention, diagnosis, and management, as well as surveillance and reporting, in order to reach elimination targets in Cambodia by 2025. The activity is expected to commence in six provinces: three provinces (Pailin, Batambang, and Pursat) where the U.S.

President’s Malaria Initiative (PMI) is currently supporting implementation of malaria elimination activities and three provinces (Kep, Kampot, and Koh Kong) where PMI is providing technical assistance to the Provincial Health Departments (PHD) to conduct these activities on their own.

The activity will support malaria control and elimination priorities as defined by the Cambodian National Center for Parasitology, Entomology and Malaria Control (CNM), especially among high-risk populations (e.g., forest workers and mobile and migrant populations [MMPs]), by implementing evidence-based interventions at the local, district, provincial, and national levels.

Specifically, this activity will implement a proven public health model for malaria diagnosis and treatment; and will add a key component of prevention of reintroduction through real-time surveillance and rapid response to new malaria cases, and applying a tailored approach that responds to the varying epidemiological profiles for malaria transmission in PMI supported areas. Successful implementation of this model will be a major component of PMI’s response to assist CNM to achieve their goal of eliminating Plasmodium falciparum malaria by 2023 and Plasmodium vivax malaria by 2025.

The activity is in line with the US President’s Malaria Initiative Strategy (2015-2020)1, and its objectives of malaria morbidity and mortality reduction, as well as supporting the move towards malaria elimination in Cambodia. The activity reflects PMI’s areas of strategic focus, namely:

achieving and sustaining scale of proven interventions, adapting to changing epidemiology and incorporating new tools, improving countries’ capacity to collect and use information, mitigating risk against the current malaria control gains, and building capacity and health systems. In addition to the clear linkages with USAID and US Government priorities, the activity is a direct response to requests by CNM for PMI to support the Ministry of Health’s Malaria Elimination Action Framework 2021–2025 (MEAF2)2, and its expected results are in alignment with the MEAF2 results and objectives. The activity is also in-line with the World Health Organization’s

1 US President’s Malaria Initiative Strategy (2015-2020) 2 Malaria Elimination Action Framework (MEAF2 – 2021-2025)

(WHO) Global Technical Strategy for Malaria (2016-2030), its three pillars, and its path to malaria elimination.3

3. BACKGROUND

PMI—led by USAID and implemented together with the U.S. Centers for Disease Control and Prevention (CDC)—delivers cost-effective, lifesaving malaria interventions alongside catalytic technical and operational assistance to support Cambodia to end malaria. PMI has been a proud partner of Cambodia since 2011, helping to decrease P. falciparum malaria cases by 73% and deaths to zero by 2018 through investments totaling almost $58 million4.

Malaria is endemic in 21 of the 25 provinces in Cambodia, although transmission rates vary significantly across the country. Provinces surrounding Phnom Penh in southeastern Cambodia are not endemic for malaria while provinces in southwestern and northeastern Cambodia have the highest rates of transmission, especially surrounding forested areas. Many malaria cases occur among MMPs, including forest workers who move from areas of low to high transmission yet lack access to essential malaria services and education, making them vulnerable to malaria infection. Due to occupational exposure while working and traveling through forested areas, malaria predominantly affects males 15–49 years of age with annual parasite incidence (API) in adult males five times higher than adult females. In comparison, only 3.7% of cases occur among children less than five years of age.

Prior to 2010, approximately 100,000 to 150,000 cases of malaria occurred every year. However, due to interventions including the mass distribution of long-lasting insecticide treated bed nets (LLINs); greater access to diagnostic services, including the use of sensitive rapid diagnostic tests (RDTs) through a network of village malaria workers (VMW); wider availability of efficacious treatment; and monitoring optimal first-line treatment options through therapeutic efficacy studies, mortality and morbidity from malaria have showed sustained declines. The activities implemented over the first three years of CMEP led to a 69 percent reduction of the API of all malaria species. Parasite-specific API in Sampov Loun operational district (Battambang province) showed a 99, 100, and 40 percent reduction of Plasmodium falciparum (Pf), Plasmodium vivax (Pv), and mixed cases (Pf+Pv), respectively. The number of severe malaria cases per 100,000 population dropped 100 percent, from 5.54 (baseline) to 0 in year 3 of the project; similarly, the test positivity rate decreased from 4 percent in year 1 to 1 percent in year 3. In 2019 roughly 32,000 malaria cases were diagnosed, without any deaths being reported in Cambodia since 2017.

Given the substantial reductions in malaria transmission, CNM has set ambitious targets of eliminating P. falciparum by 2023 and P. vivax by 2025. To achieve these goals, CNM developed the MEAF25 with support from the WHO, Clinton Health Access Initiative (CHAI) and other technical partners, including PMI. After the Malaria Program Review in July 2019, 3 WHO’s Global Technical Strategy for Malaria (2016-2030) 4 This includes investments until fiscal year 2020.

5 Malaria Elimination Action Framework (MEAF2 – 2021-2025) https://docs.google.com/document/d/1_1_eHYNMBNFluCD8x0ZYNaZTlkh-C-YE/edit#heading=h.gjdgxs

CNM conducted multiple national consultations with provincial and district health staff, donors, and implementing partners from August 2019 to February 2020 to identify key programmatic areas toward malaria control and elimination.

The resulting MEAF2 document, which is based on guidance from the WHO Strategy for Malaria Elimination in the Greater Mekong Subregion (2015–2030) and is aligned with the principles of the WHO Global Technical Strategy for Malaria 2016–2030, details three primary objectives:

● Objective 1: Early detect, and effectively and safely treat 100% of cases, and provide effective personal protection to at least 90% of the high-risk population

● Objective 2: Intensify focal interventions to interrupt transmission in endemic locations with highest risk (including mobile migrant populations/forest goers) to eliminate Plasmodium falciparum by 2023 and Plasmodium vivax by 2025

● Objective 3: Investigate, clear, document and follow up 100% of cases and foci to interrupt transmission and prevent re-establishment

In addition to these objectives, and to ensure sustainability of the MEAF2 outcomes, CNM also detailed the need to develop an enabling environment to strengthen “program leadership to maintain effective program management and coordination at central and provincial levels and harness innovation and research.”

The PMI-supported activities, Control and Prevention of Malaria Project (CAP-Malaria, 2011– 2016) and its follow-on, Cambodia Malaria Elimination Project (2016–2021), supported CNM to reduce the incidence and the spread of drug-resistant P. falciparum malaria. These activities developed an innovative elimination model based on surveillance and response strategies, and implemented it in Battambang and Pailin provinces. Under this model, known as the “1-3-7” model, cases of P. falciparum (including mixed cases) are to be reported within 24 hours of diagnosis (or 1 day); they are investigated by health center staff and classified as indigenous or imported within 3 days; and, within 7 days, remediation response activities are completed, including distribution of LLINs as needed and malaria testing with RDTs for household members and co-travelers with fever. The new activity will continue to respond to the needs of CNM by building on the lessons learned by previous experiences and the scale up of “1-3-7” activities for malaria control as well as assisting CNM in developing and applying best practices for prevention of reintroduction where applicable.

As the burden of P. falciparum has decreased, P. vivax has emerged as the more prevalent species. Partners in Cambodia have begun implementing “radical cure” activities with primaquine added to the artemisinin-based combination therapies (ACT), to ensure killing of malaria parasite hypnozoites. While effective, scaling up a P. vivax radical cure program comes with a number of challenges such as adherence to the 14-day primaquine regimen and identification and management of G6PD6 -deficient individuals.

4. STATEMENT OF WORK (SOW)

4.1 ACTIVITY GOAL

The overarching goal of this activity is to eliminate malaria and prevent its re-introduction in target provinces, thereby contributing towards nationwide elimination in Cambodia.

4.2 ACTIVITY OBJECTIVES

CMEP 2 must specifically address the following Objectives in pursuit of the activity’s overarching goal:

Objective 1: Detect, effectively and safely treat, and follow-up all malaria cases, and provide effective personal protection to at least 90% of the high risk population.

This objective is in line with the first two objectives of the MEAF2 and focuses on the “1” of the 1-3-7 model. It represents core activities that enable malaria elimination in Cambodia. Under this objective, the contractor is expected to implement activities to enable the early (within 24 hours) diagnosis, treatment and reporting of malaria cases in line with the 1-3-7 model that has been successfully implemented in PMI areas. The contractor will also support the protection of at-risk populations, including through continuous and mass distribution of long lasting insecticide-treated nets (LLINs) and other prevention tools within PMI guidance.

Activities will be conducted in areas at risk for malaria transmission including highly endemic forested and hard-to-reach areas. The contractor is expected to support health facilities, VMWs, and Mobile Malaria Workers (MMWs) to conduct prevention, diagnosis, and treatment activities in target districts. This includes training and supervision on malaria diagnosis and treatment (including radical cure for P. vivax) as well as monitoring and reporting of cases, stock management of drugs and RDTs, and support for vector control strategies. In line with PMI guidance, the contractor will complement these activities through social behavior change (SBC) messaging to maximize impact of interventions.

Objective 2: Strengthen national malaria surveillance, monitoring and evaluation (SME) systems appropriate for malaria elimination and control activities as well as prevention of re-introduction.

This objective aligns with the third objective of the MEAF2 and addresses the “3-7” components of the 1-3-7 model. The contractor will assist provincial and district health teams to investigate, 6 Glucose-6-phosphate dehydrogenase. G6PD-deficient individuals may suffer haemolytic anaemia if they take 8-aminoquinolines such as primaquine and tafenoquine; thus, G6PD testing results showing acceptable levels of G6PD activity are required for radical cure.

classify, and report malaria cases’ classification within 3 days of diagnosis7. The contractor should respond swiftly to newly-detected foci including newly-identified malaria outbreaks;

investigations and response being completed within 7 days. The foci register should be updated on an annual basis.

Similar to the above objective, this objective also focuses on the individual case level, but also addresses stratifying geographical regions (within the geographic scope of the activity) and maintenance of malaria-free status through prevention of re-introduction methods. Activities implemented under this objective will center around building the capacity of health facility staff, VMWs and MMWs in surveillance; case investigation; foci investigation and management; as well as strengthening reporting into the MIS. Given prevention of malaria re-introduction is a newly emerging field, the contractor may choose to propose aspects of the programmatic activities to evaluate through operational research (OR); OR proposals are reviewed and approved through a separate PMI process after award.

Objective 3: Build capacity of the Ministry of Health (MOH) to manage, intensify, and sustain malaria control and elimination efforts, particularly at the provincial and operational district (OD) level.

This objective is in line with the “enabling environment” axis of the MEAF2. It includes supporting local capacity to develop and monitor Annual Operational Plans (AOPs) as well as supporting malaria working group meetings and forums. Furthermore, the contractor should expect to provide technical assistance in the development of national guidelines and policies and assist with the process towards certification of malaria elimination. In line with RGC decentralization efforts, the contractor will support provincial health teams to strengthen supervision of ODs, health facilities, VMWs and MMWs8. As Cambodia approaches elimination targets and cases decrease to zero in many areas, a desired outcome would be for sub-national level health teams to retain skills and knowledge for detection and treatment of malaria and assume full technical ownership of activity implementation. For this approach to be effective, and to align with USAID’s journey to self-reliance, ideally, the district teams will gradually assume these duties by the end of the activity. As such, the contractor should develop a transition plan to facilitate the handover of roles and responsibilities to provincial and district health teams.

As this objective is about building local capacity, with the ultimate goal of ensuring sustainability of key activities and reducing the need for external support, the contractor should focus on cost-effective strategies for providing technical assistance tailored to the needs of the province.

7 The reporting here is of the malaria case classification. Diagnosed cases are to be reported within 24 hours, as mentioned under objective one.

8 There are a number of supervision levels. Generally CNM supervises PHDs and ODs; PHDs and ODs check health facilities, and ODs and HFs supervise malaria workers.

4.3 CROSS-CUTTING THEMES AND ACTIVITIES

Collaborating, Learning, and Adapting (CLA)

CLA is a set of practices that help improve development effectiveness9. The contractor will integrate CLA approaches into its implementation to help ensure that the activity interventions are coordinated with others, grounded in a strong evidence base, and iteratively adapted to remain relevant throughout implementation. The CLA will be integrated into workplan development, the activity Monitoring, Evaluation and Learning Plan (MEL) plan, and implementation through consideration of the following questions:

● Collaborating: How will the contractor collaborate with the right partners to promote synergy and facilitate collaborative learning and problem solving internally, with external stakeholders, and other implementing partners?

● Learning: How will learning be used to inform adaptive decision making? How will the learning approach advance local learning to support local ownership of development processes for increased self-reliance?

● Adapting: How will the CLA approach proposed ensure that information gathered through collaboration and learning activities to adapt and make adjustments as necessary?

● Enabling Conditions: How will the contractor foster an organizational environment that supports collaborating, learning, and adapting efforts?

To illustrate, below is some expansion on each of the three principles:

Collaborating

This Activity will complement the efforts of USAID’s implementing partners and other stakeholders at national and subnational levels. The contractor will collaborate with CNM, district and provincial health directorates, local and international NGOs, CSOs, communities, and informal grassroots networks working in malaria control and elimination, to develop key activities to ensure sustained efforts towards malaria elimination. Activities must be in line with CNM and PMI guidelines and policies.

In addition, the contractor will coordinate with other implementing partners and provincial and district health teams in the target provinces on activities supported by other donors (e.g., Global Fund) to avoid overlapping activities or duplicate funding. Other malaria partners include, but not limited to: United Nations Office for Project Services, Malaria Consortium, Clinton Health Access Initiative, the Bill and Melinda Gates Foundation, and the World Health Organization.

To the extent practicable, the contractor will use the existing health system and strengthen the ability of public and private providers and NGOs to support malaria elimination activities. The contractor will avoid setting up parallel, project-specific systems. This may also include

9 For more on CLA, partners can consult this link https://usaidlearninglab.org/node/14633 https://usaidlearninglab.org/node/14633 collaborating with other partners who are strengthening systems that affect the delivery of malaria activities; including logistics, information systems, and other service delivery systems.

Learning

The contractor is expected to build upon lessons learned from these and other experiences throughout Cambodia, in particular from the experience of the Cambodia Malaria Elimination Project (CMEP). The 1-3-7 model has been shown to be effective in Cambodia and elsewhere, and has achieved significant positive results. Experience has shown that easing of interventions often leads to resurgence of cases and loss of gains made. It is important to maintain the capacity to rapidly detect and respond to new cases as well, while introducing and strengthening activities that prevent re-introduction of malaria in areas where incidence is brought down to zero.

In addition, the contractor is expected to document activities, experiences, and lessons learned.

This will inform planning and adapting, and will also contribute to the body of knowledge in the field among the various partners.

Adapting

This contract is designed to allow the contractor the flexibility to conduct needed assessments to inform activities and milestones, in partnership with local MOH officials and other local stakeholders. This will allow local conditions and experiences to be factored into the design and implementation of activities and interventions under this contract.

Given the path to malaria elimination in Cambodia may change over time depending on multiple factors, having a strong adaptive response will be crucial. While it is impossible to know what challenges may drive changes to the national malaria program, the contractor may consider events such as the following:

- Changing epidemiology, CNM goals, and/or donor funding, requiring the partner to reprioritize geographical focus within the province or revise the package of interventions,

- Resurgence of antimalarial drug resistance or discovery of new antimalarial treatment options,

- Changes in CNM or PMI guidance, or priorities on the ground, and

- Emergence of novel infectious diseases (i.e. COVID-19), limiting in-person activities.

While the specific challenges cannot be specifically known at this stage, the contractor should detail in their work plan how adaptation will be decided, with what frequency and at what levels, whose input will be considered and gathered, and how decisions will be documented. The contractor must continually assess the effectiveness of the interventions, evaluate whether those interventions are succeeding, apply lessons learned and adapt work appropriately, in consultation with PMI, and in line with contractual requirements.

Gender

USAID has an explicit commitment to gender equality and female empowerment in all of its development activities. While men are infected with malaria at a higher rate in Cambodia, interventions and approaches must be adapted to ensure equitable access to resources and, in areas where participation is lacking, specific efforts must be developed to help increase participation in a manner that does not create further harm. As an example, it is important to take into consideration the differences in norms and practices between the genders, and to tailor activities accordingly. While activities at the health facility and community level are crucial, it is important to consider times when members of the community are away from their villages and towns, e.g. in the forest. Also, it is important to consider the differences in G6PD deficiency profiles between males and females, and to inform design accordingly. As part of the gender strategic plan, the contractor must also have in place a plan to monitor potential differential impacts of activity implementation on males and females, including unintended or negative consequences. Such any unintended consequences occurred as a result of this activity implementation, proper documentation and action plans must be taken to mitigate them. The contractor will align its activities with the USAID Gender Equality and Female Empowerment Policy10 and Cambodian government’s Gender Mainstream National Policy.

Following this Cambodian government’s Gender Mainstream National Policy, CNM has already integrated human rights and gender equality into different strategies and objectives of the MEAF 2021-2025. Therefore the contractor will conduct gender gap assessment at individual, household, community, health facility level in its target provinces to promote gender equality.

Gender focused activities continue to include case management, vector control, IEC/BCC which are designed to ensure universal access, including for pregnant women, breastfeeding mothers, children, mobile populations, migrants, ethnic minorities and other vulnerable population groups.

Youth

The contractor should systematically consider creating an enabling environment that supports all youth (all youth age groups) to access, participate, and, to the extent relevant, lead in supporting achievement of the activity objectives. The contractor must integrate youth issues into the activity monitoring, evaluation and learning plan and work plan in accordance with USAID Youth in Development Policy in order to:

• Measure Youth Outcomes for key age- and sex-disaggregated data as well as explicit youth indicators as applicable;

• Assess gaps in youth access and engagement in malaria interventions ; and

• Propose and implement approaches to address any challenges youth face in benefiting from, and actively engaging in the activity. The USAID Youth in Development Policy11.

10 https://www.usaid.gov/policy/gender-female-empowerment 11 https://www.usaid.gov/sites/default/files/documents/1870/Youth_in_Development_Policy_0.pdf https://www.usaid.gov/policy/gender-female-empowerment https://www.usaid.gov/sites/default/files/documents/1870/Youth_in_Development_Policy_0.pdf

Indigenous People and Minority Populations

The contractor should consider indigenous people, LGBTI12, and ethnic and religious minorities when planning activities, especially related to access to services and care. When and if indigenous peoples are identified as stakeholders (beneficiaries) in this activity, the contractor must carry out an analysis that considers the potential impact of proposed development activities and that must involve direct engagement with affected Indigenous Peoples. The analysis must be carried out in accordance with the USAID Policy on Promoting the Rights of Indigenous People13 and aligned with MEAF 2021-2025.

A recent analysis carried out by USAID in Cambodia revealed that minority populations, especially poor minorities, are arguably marginalized and left behind when it comes to development and this constrains their access to resources and services. The contractor should work to ensure equitable access to services in activities under this project and should design interventions that take into consideration the barriers to services by minority and indigenous populations.

Sustainability Considerations

As Cambodia moves towards malaria elimination, building local capacity and sustainability become even more important and increasingly challenging as opportunities for malaria-related skills usage diminish as malaria rates drop. The contractor should support building local capacity and systems that ensure the continued learning and practice in malaria control even as indigenous cases are eliminated in districts and provinces. This ensures the availability of capacity to detect new cases, to manage cases properly, and to investigate and report them when or if outbreaks occur. This also ensures the presence of trained human resources, supplies, and systems needed.

Sustainability of the activity’s results will be monitored throughout the entire period of the activity’s implementation and will constitute one of the focal points of its interim and final evaluations.

As the needs for case and foci investigation and response increase, so will the need for human resources to conduct these activities. The contractor will explore modalities of implementation which require less human resources without reducing efficiency or quality.

All activities will be conducted in close cooperation and partnership with local counterparts to ensure their full ownership and transition, future sustainability, and growth of the health sector.

The assistance must—whenever possible—be designed to favor long-term solutions that could be performed by or later taken over by existing Cambodian institutions and organizations. To support Cambodia on its journey to self-reliance, the activity will build the capacity of the MOH, particularly at the OD and provincial levels, to control and eliminate malaria, and prevent its reintroduction. This will cover aspects of planning, budgeting and supervision, as well as diagnosis, treatment, investigation, and monitoring and reporting relevant to malaria. The skills

12 https://www.usaid.gov/sites/default/files/documents/1874/LGBT_Vision.pdf 13 https://www.usaid.gov/indigenous-peoples/usaid-policy-on-indigenous-peoples https://www.usaid.gov/sites/default/files/documents/1874/LGBT_Vision.pdf https://www.usaid.gov/indigenous-peoples/usaid-policy-on-indigenous-peoples gained are expected to strengthen capacity across the health sector, particularly in planning and field epidemiology.

This activity will identify sustainable, cost-effective strategies for prevention of re-introduction, which can be continued by the host government and partners upon completion of this award.

4.4 GEOGRAPHIC FOCUS

The entirety of this activity will take place in Cambodia.The activity is expected to commence in six provinces: three provinces (Pailin, Batambang, and Pursat) where PMI is currently supporting implementation of malaria elimination activities and three provinces (Kep, Kampot, and Koh Kong) where PMI is providing technical assistance to the PHDs to conduct these activities on their own. In addition, there is a possibility of expanding support to two new provinces by the end of year 2. It is expected that throughout this activity’s period of performance, it will be necessary for the contractor’s operations to be flexible and able to respond to the dynamic nature of the program as activities within provinces transition from elimination to prevention of reintroduction. The contractor should remain flexible to adapt to changing geographical priorities as discussed and agreed upon with PMI and CNM. It is also expected that the activities implemented may change with changing context in each province with activities differing, even within villages and districts depending on local epidemiology. USAID/Cambodia expects that most of the activities will be performed at the OD level in those six to eight provinces. However, it is expected that staffing will be based mainly at the provincial level, while also ensuring staff can cover activities at the central level in Phnom Penh.

4.5 GRANTS UNDER CONTRACT

The contractor will be authorized, if necessary, to use Grants Under Contract (GUCs) to issue grants to non-governmental partners to support the activities under the relevant components of the Cambodia Malaria Elimination Project 2 (CMEP 2) activity. Groups not registered with the Government of Cambodia, specifically non-governmental organizations not registered with the MOH, will not be eligible for Grants Under Contract (See ADS 302.3.4.12). USAID will retain, within the contract, the ability to terminate unilaterally any grant activities under extraordinary circumstances.

The total number of grants made to NGOs under this provision will not exceed $650,000 of the total contract cost. Grants made under this contract will be made to carry out activities that are consistent with the activity Objectives.

This activity is designed to build upon progress made in improving malaria health outcomes in Cambodia, by contributing toward malaria elimination, including among vulnerable populations.

Two key principles of eliminating malaria are expanding consistent use of long-lasting insecticide-treated bed nets and ensuring every suspected malaria case is tested, treated and investigated. These efforts must be intensified to reach universal coverage of bed nets while actively seeking out new cases to prevent further spread. This includes reaching difficult-to-reach populations such as forest-goers and other mobile and migrant populations who will continue to drive malaria transmission without these interventions. Community-based organizations (CBOs) and local non-governmental organizations (NGOs) are best positioned to reach such populations given their critical role in conducting grassroots community- level malaria prevention and elimination activities. The contractor will ensure that the activities provided through Grants Under Contract coordinate with the Cambodian health system at all levels. In addition, the contractor will ensure all surveillance and service delivery data obtained through the GUCs will feed into the national malaria surveillance systems to aid program planning, monitoring, and evaluation.

There may be an opportunity to build these organizations’ capacity through other existing USAID mechanisms in organizational, financial and operations management. The contractor may provide organizational capacity building efforts related to the design of malaria control and elimination interventions at the community level that complement the support that these local organizations may receive from other USAID projects.

As Cambodia gets closer to the goal of malaria elimination, there is a need for flexibility and the ability to adapt response activities according to the changes in context. The contractor will be expected to adjust its approach to grant-making accordingly.

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