PROPEL APS (Amended 12-17-2021).pdf

Federal Agency Name: United States Agency for International Development

(USAID)

Funding Opportunity Title: Promoting Results and Outcomes through Policy and Economic Levers (PROPEL)

Announcement Type: Annual Program Statement (APS)

Funding Opportunity Number: 7200AA22APS00002

Catalog of Federal Domestic Assistance (CFDA) Number: 98.001

Issuance Date: December 7, 2021

Closing Date: November 30, 2027

Questions Deadline for this Revised APS Document: January 07, 2022 at 12:00 pm EST

For questions on this APS document, please submit all questions to Mrs. LaVietra Shannon via email at propelaps@usaid.gov by the deadline specified above.

Please see individual Round documents for each Round’s deadlines and submission instructions for concept papers.

For a USAID/Washington Office wishing to issue a Round under this APS, the program description must fit within Section I of this document. Please contact LaVietra Shannon (propelaps@usaid.gov) for review of the Round document - it must be reviewed before being posted publicly under this APS. All new Rounds must be posted as a PROPEL APS Round on the USAID Business Forecast.

To Interested Applicants:

This Annual Program Statement (APS) publicizes the intention of the United States Government (USG), as represented by the United States Agency for International Development (USAID), Bureau for Global Health (GH), to fund one or multiple awards to address the overarching APS program purpose. The purpose is to improve the enabling environment for equitable and sustainable health services, supplies and delivery systems through: policy development and implementation; adequate, predictable, and sustainable financing; enhanced government stewardship, transparency, and accountability; and an engaged and informed civil society prepared to advocate for improved systems and outcomes.

This main APS document outlines the goal, purpose, expected results, and priorities of Promoting Results and Outcomes through Policy and Economic Levers (PROPEL), and may result in multiple awards issued under subsequent APS Rounds. Note: When referencing PROPEL in this document, it is referring to the full portfolio of possible awards under this overall purpose. This specific document is an umbrella APS and will not be accepting concept papers or applications. Prospective applicants will be provided a fair opportunity to develop and submit competitive concept papers to USAID for potential funding via discrete Rounds under this APS. For the purposes of the PROPEL APS, a “Round” is defined as a specific program description that falls under the larger PROPEL APS goal, purpose, and expected results but is tailored to a certain focus. Under each Round, applicants will first submit a short concept paper that will be reviewed for responsiveness to the overall PROPEL purpose, selected results, and Round’s focus and then scored according to the evaluation criteria provided in the Round document. If an applicant is successful in the concept paper stage, applicant representatives may be invited to join a co-creation process. Following the co-creation process, selected applicants (individual organizations and/or consortia developed at concept paper stage or during co-creation) will be requested to submit a Full Application, the content and format of which will be provided in greater detail by the Agreement Officer. Publishing this APS does not commit USAID to make any awards. USAID also reserves the right to not conduct a co-creation process and request Full Applications from successful applicants at concept paper stage.

As Rounds occur, notifications will be posted on Grants.gov.

Sincerely, /s/ Alisa J. Dunn Supervisory Agreement Officer Office of Acquisition & Assistance

Table of Contents

ACRONYM TABLE

SECTION I: FUNDING OPPORTUNITY DESCRIPTION

A. Background

B. Technical Considerations

C. Statement of APS Goal, Purpose, and Expected Results

SECTION II: AWARD INFORMATION

A. Funding:

B. Period of Performance:

C. Expected Number of Awards:

D. Expected Implementation Mechanism:

E. USAID’s Substantial Involvement:

F. Intellectual Property

G. Environmental Impact

H. Authorized Geographic Code

I. Benefiting Geographic Areas

SECTION III: ELIGIBILITY INFORMATION

A. Eligibility Criteria

B. Cost Share

SECTION IV. CONCEPT PAPER SUBMISSION INFORMATION

SECTION V. EVALUATION CRITERIA

ACRONYM TABLE

ADS Automated Directives System AO Agreement Officer AOR Agreement Officer’s Representative APS Annual Program Statement CA Cooperative Agreement CLA Collaborating Learning and Adapting COVID Coronavirus Disease CFR Code of Federal Regulations DEI Diversity Equity and Inclusion DUNS Data Universal Numbering System EA Environmental Assessment FP Family Planning FP/RH Family Planning and Reproductive Health GFF Global Financing Facility GH Global Health Bureau HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome HP+ Health Policy Plus HPP Health Policy Project IEE Initial Environmental Evaluation IR Intermediate Result KM Knowledge Management MCH Maternal and Child Health MCHN Office of Maternal Child Health and Nutrition MDGs Millennium Development Goals MEL Monitoring, Evaluation, and Learning MNCH Maternal, Newborn, and Child Health MNH Maternal and Newborn Health MRC Merit Review Committee NGOs Non-Governmental Organizations NPI New Partnerships Initiatives OFDA Office of Foreign Disaster Assistance PAFG Policy Advocacy Financing and Governance PEPFAR President’s Emergency Plan for AIDS Relief PHE Population Health and the Environment PRH Office of Population and Reproductive Health PROPEL Promoting Results and Outcomes through Policy and Economic Levers RCE Request for Categorical Exclusion RH Reproductive Health RHSC Reproductive Health Supplies Coalition SBC Social and Behavior Change

SAM System for Award Management, Registration, Renewal, & Migration SDGs Sustainable Development Goals UNFPA United Nations Population Fund USAID United States Agency for International Development USG United States Government WASH Water, Sanitation, and Hygiene WHO World Health Organization

Promoting Results and Outcomes through Policy and Economic Levers

(PROPEL)

SECTION I: FUNDING OPPORTUNITY DESCRIPTION

The U.S. Agency for International Development (the Agency), Office of Population and Reproductive Health (PRH) is pleased to announce the Promoting Results and Outcomes through Policy and Economic Levers (PROPEL) Annual Program Statement (APS). This APS contributes to the Agency’s health development priorities, which correspond to the goals of:

preventing maternal and child deaths, controlling the HIV/AIDS epidemic, and combating infectious disease. The purpose of this APS is to improve the enabling environment for equitable and sustainable health services, supplies and delivery systems through: policy development and implementation; adequate, predictable, and sustainable financing; enhanced government stewardship, transparency, and accountability; and an engaged and informed civil society prepared to advocate for improved systems and outcomes. This APS has a specific emphasis on voluntary, rights-based family planning and reproductive health (FP/RH), and FP/RH integration with maternal and child health (MCH), and HIV/AIDS. It will encourage work across health elements, systems, and development sectors, with specific efforts in increasing FP/RH demand, facilitating FP uptake, and advancing other FP/RH-related outcomes.

USAID has a significant history of investment in policy, advocacy, financing, and governance (focused on stewardship, accountability, and transparency) to improve health outcomes.

Continued investment in health and population policies and programs is essential to spurring country-level progress to meet the sustainable development goals (SDGs1, see here) and to help improve individual lives, build communities, and advance democracy. Overall, USAID focuses on advancing U.S. national security and economic prosperity; demonstrates American generosity; and promoting a path to recipient countries’ self-reliance and resilience.

Countries continue to face significant challenges in obtaining and sustaining both political and financial commitments to improve health outcomes, particularly in meeting the demand for family planning (FP), ending preventable child and maternal deaths, and achieving an AIDS-free generation. While some countries exhibit positive and notable gains in outcomes and systems strengthening, in-country commitment - both political and financial - generally remains difficult;

health systems are strained and often unsupported; and civil society is still frequently excluded from important policy decisions, and from access to holding policy makers accountable. A supportive and strengthened environment has economic, political, administrative, and socio-cultural attributes that positively impact the ability of governments and stakeholders to engage effectively and in a sustained manner; it is critical that transparent and inclusive policy processes are in place to ensure that services, supplies, and delivery systems are grounded in sustainable policy and regulation and implemented equitably, and that needed resources are secured.

Rapidly changing global and country contexts continue to impact economic growth and the ability of local leaders to support a robust health system, and commitments to FP/RH in https://sdgs.un.org/goals particular. There is opportunity to increase country commitment to FP/RH through policies and regulations that expand the resource envelope for voluntary FP/RH services, supplies, and delivery systems, and the integration of FP/RH with HIV/AIDS and MCH, and to support a vital and resilient environment.

This APS builds on the work of USAID’s flagship policy projects, including the Health Policy Plus (HP+) project and the Promoting Advocacy and Communication Enhanced (PACE) project, supporting key stakeholders and governments to ensure that global, national, and decentralized policies and resources prioritize and support foundational health structures, including critical services such as FP/RH. As part of a comprehensive view of health systems strengthening noted in USAID’s Vision for Health System Strengthening 2030 2, substantive changes in and implementation of policy may be required to support rapid and substantial increases in financial and human resources for sustainable, country-led development and FP/RH programming and its integration with HIV/AIDS and MCH in particular. Adequate, predictable, and sustainable financing, along with an emphasis on efficiency and effective allocation and use of resources, are required to assure broad and critical health policy implementation and effective quality service and delivery systems for required supplies. New approaches are needed as countries seek to improve the environment for FP/RH and its integration, and the related health outcomes and, finally, to promote entirely new approaches for funding of health services and determining required policy and regulatory changes. As decision-making and allocative responsibilities continue to devolve to the subnational level, it is essential to have improved accountability and transparency, with inclusion of those impacted by the policies in processes for health planning, and approaches that build capacity across a range of analytic, advocacy, and negotiation skills.

This APS has been designed with significant input from country partners, industry partners, and across USAID and its global partners. In addition to the focus areas outlined above, priority areas have been illuminated through a data collection process that included key informant interviews, a survey to the field and USAID missions, a review of USAID Operational Plans, and a request for information seeking industry input. Areas of new and renewed focus include vulnerable populations such as youth and adolescents; fragile contexts including public health emergencies like the COVID-19 pandemic; a specific focus on gender equity and equality; digital health; and innovative policy, advocacy, financing, and governance approaches that reflect the need for integration of strategic work in population, health, and the environment (Click here for more information on PHE 3).

A. Background

USAID has a long history of advancing and supporting voluntary, rights-based family planning and reproductive health programs, with current programming in nearly 40 countries across the globe. As the world's largest bilateral donor in FP/RH, USAID is committed to helping countries meet the FP/RH needs of their people. USAID's FP/RH program covers the key components of successful family planning programs, and related reproductive health activities, including post-abortion care, other FP/MCH integration, FP/HIV integration, ending child marriage 4, female genital mutilation/cutting 5, reproductive empowerment, and gender-based violence 6. USAID’s programming is aligned with the Family Planning 2030 (FP2030) 7 vision of “a future where https://www.usaid.gov/global-health/health-systems-innovation/health-systems/Vision-HSS-2030-download https://pdf.usaid.gov/pdf_docs/PA00T59H.pdf https://www.usaid.gov/what-we-do/gender-equality-and-womens-empowerment/child-marriage https://www.usaid.gov/news-information/fact-sheets/female-genital-mutilation-cutting-usg-response https://www.usaid.gov/news-information/fact-sheets/female-genital-mutilation-cutting-usg-response https://www.usaid.gov/gbv https://familyplanning2020.org/Building2030 https://familyplanning2020.org/Building2030 https://familyplanning2020.org/Building2030 women and girls everywhere have the freedom and ability to lead healthy lives, make their own informed decisions about using contraception and having children, and participate as equals in society and its development” and related guiding principles and focus areas. USAID recognizes that sustainable, country-led advancements in FP/RH and FP/RH integration will require strong and resilient health systems. Programming under PROPEL will align with the USAID’s Vision for Health System Strengthening 2030 8, noting a focus on efforts towards:

a. Equity. All people should have a fair opportunity to achieve their health potential.

b. Quality. Care that is safe, effective, efficient, timely, people-centered, integrated and equitable.

c. Resource Optimization. Promoting resource optimization by identifying and strengthening constituent processes within local health systems, assisting stakeholders in determining the most appropriate allocation and use of resources within the system, and promoting availability of health system resources adequate to deliver high-quality, accountable and responsive care that emphasizes the needs of underserved and socially excluded populations. Health system resources include, but are not limited to, human and financial resources, health care infrastructure, information resources, and medicines, and other health technologies.

A strategic approach across health elements and sectors, and with other global partners, that supports greater system strengthening is required to enhance the environment for FP/RH and FP/RH integration with HIV/AIDS and MCH.

Stakeholders were critical in the process undertaken to identify the thematic approaches under this APS, including sustainability through policy development and implementation, prioritization of increasing the envelope and environment for FP/RH financing, and the execution of evidence-based country plans. Increased transparency and accountability in government, as well as participation in evidence-based decision-making, are imperative to improving the enabling environment. Given the size of the youth and adolescent cohorts in USAID-assisted countries, improving the policy environment for health outcomes for these groups will advance the development of nations and their ability to effectively provide necessary services to their citizenry.

1. The Global Context

The need to engage and collaborate with global partners and donors is critical to the efforts and results of this APS. Leadership in global knowledge, technical work and evidence, and advocacy will be demonstrated and advanced through activities of this APS, in coordination with the entities below and other global actors, as appropriate.

a. FP2030 9. (here) Over the last eight years, thanks to global commitments made as part of FP2020, significant progress has been made in creating an enabling environment for millions of girls and women to access modern contraception. FP2030 is the next iteration of this global commitment to family planning.

b. The Global Financing Facility (GFF) 10. (here) https://www.usaid.gov/global-health/health-systems-innovation/health-systems/Vision-HSS-2030 https://www.usaid.gov/global-health/health-systems-innovation/health-systems/Vision-HSS-2030 https://www.usaid.gov/global-health/health-systems-innovation/health-systems/Vision-HSS-2030 https://www.usaid.gov/global-health/health-systems-innovation/health-systems/Vision-HSS-2030 https://familyplanning2020.org/news/introducing-fp2030 https://www.globalfinancingfacility.org/

Launched in 2015 and housed at the World Bank, the Global Financing Facility is a global partnership of governments, civil society organizations, private sector, and multilateral organizations aimed at filling the funding gap for reproductive, maternal, newborn, child, and adolescent health and nutrition.

c. Reproductive Health Supplies Coalition (RHSC) 11. (here) Launched in 2004, the Coalition is made up of thought leaders from the global reproductive health community and is primarily focused on ensuring access to contraceptives and maternal health supplies.

d. UNFPA 12. (here) The United Nations Population Fund (UNFPA) is a multilateral agency that aims to improve reproductive and maternal health outcomes.

e. Foreign, Commonwealth and Development Office (FCDO) 13. (here) Established in June 2020, the Foreign, Commonwealth and Development Office (FCDO) is the result of a merger of the U.K’s previous development agency, the Department for International Development (DfID), and the UK’s previous Foreign Commonwealth Office.

f. Bill and Melinda Gates Foundation 14. (here) The Bill and Melinda Gates Foundation (BMGF) is a U.S. based foundation that works in 135 countries providing grants to address multiple areas, including FP/RH.

g. Clinton Foundation 15. (here) Established by former President, Bill Clinton, the foundation’s work includes the Clinton Global Initiative, which addresses a range of development issues, including FP/RH.

h. The Global Fund to Fight AIDS, Malaria and TB 16. (here) The Global Fund is a partnership designed to accelerate the end of AIDS, Tuberculosis and Malaria as epidemics.

i. The World Bank 17. (here) The World Bank provides financing, policy advice, and technical assistance to governments of developing countries.

j. The World Health Organization (WHO) 18. (here) WHO works through its 150 country offices to improve health globally, produce international reference materials, and set global standards in health.

k. Other International and Local Organizations that work with USAID Partnerships with a range of organizations throughout the world have significantly impacted demand, uptake, and service or product availability for FP/RH and its integration with other health elements. These organizations range from non-governmental organizations to universities, faith-based organizations, corporations and small businesses. Partners are based in the U.S. and elsewhere. For more information about and examples of USAID partnerships, click here 19.

https://www.rhsupplies.org/ https://www.unfpa.org/ https://www.gov.uk/government/organisations/foreign-commonwealth-development-office https://www.gatesfoundation.org/ https://www.clintonfoundation.org/ https://www.theglobalfund.org/en/ https://www.worldbank.org/en/home https://www.who.int/ https://www.usaid.gov/work-usaid/organizations

2. Operating Context: USAID Initiatives and Projects

Previous USAID Policy Projects

USAID has invested in tools, models and approaches to improve policy, advocacy, financing, and governance in health for decades. Capitalizing on these investments, successes, and lessons learned will be critical to the success of PROPEL. Achievements to date include raising awareness of the impact of population growth on development, increasing budget allocation and execution for health and inclusion of FP/RH in UHC, substantive policy implementation, leadership development (particularly women leaders), and improved engagement of civil society to hold governments accountable for policies and programs.

Starting in the 1980s, PRH launched policy projects such as RAPID (Resources for Awareness of Population Impact on Development) and OPTIONS, followed by POLICY I and II, and the Health Policy Project (HPP). The current policy project (ending September 2021) for the Bureau for Global Health - the Health Policy Plus (HP+) project - works with in-country partners to sustain commitment to and ownership of policy responses, including health and relevant gender policies that support improvements in FP/RH, maternal health, and HIV/AIDS. The Policy and Advocacy Communication Enabled (PACE) APS suite of projects, focuses on engaging a diverse group of stakeholders with a multi-sectoral approach to population issues, advocacy, and communication.

Current USAID Initiatives and Projects

PROPEL will complement and build upon current and past policy projects, including HP+ and other mechanisms within USAID, and will complement other existing awards that also have policy, advocacy, financing, and governance (PAFG) components. Awards under the PROPEL APS will be unique within the Bureau for Global Health’s portfolio for the focus on engaging in PAFG of FP/RH and FP/RH integration. PROPEL is expected to collaborate with related awards to ensure complementarity and avoid duplication of efforts. Current USAID awards that have a PAFG component with which PROPEL may coordinate include, but are not limited to:

a. Integrated Health Systems IDIQ and Task Order 1 “Local Health System Sustainability” (LHSS) (GH/OHS) (2019-2024) 20: This mechanism supports partner countries and USAID operating units to plan and implement health system strengthening (HSS) solutions with the overall goal of improving health and transitioning capacity to local partners. The mechanism focuses on overall country HSS including a mix of public and private interventions. Complementary to this focus, PROPEL will focus on supporting policy, advocacy, financing, and governance for voluntary, rights-based FP/RH and FP/RH integration with HIV/AIDS and MCH.

b. Health Systems Strengthening Accelerator (HSSA) (GH/OHS) (2019-2023) 21: The Health Systems Strengthening Accelerator (HSSA) is a five-year global initiative that supports countries to address health systems challenges that impede progress toward self-sustaining health systems. This project addresses persistent health systems problems at the local and global levels by identifying and analyzing root causes; translating relevant and the latest evidence; encouraging innovation and applying iterative adaptation https://www.usaid.gov/kyrgyz-republic/fact-sheets/local-health-system-sustainability-project-lhss https://www.usaid.gov/kyrgyz-republic/fact-sheets/local-health-system-sustainability-project-lhss https://www.usaid.gov/kyrgyz-republic/fact-sheets/local-health-system-sustainability-project-lhss https://www.acceleratehss.org/ approaches; understanding political dynamics, motivation, and incentives; and focusing on institutionalization and sustainability. PROPEL will complement these efforts while providing a technical focus on FP/RH and FP/RH integration with other health areas.

c. MOMENTUM Suite of Projects (GH/MCHN/PRH) (2020-2025) 22: The MOMENTUM

Suite of Projects focuses on accelerating reductions in maternal, newborn, and child mortality and morbidity in high-burden, USAID-supported countries by increasing the capacity of host country institutions and local organizations to introduce, deliver, scale up, and sustain the use of evidence-based, quality maternal, newborn, and child health (MNCH) services, voluntary family planning (FP), and reproductive health (RH) care.

PROPEL addresses policy, advocacy, financing, and governance, with a focus on government stakeholders and civil society and their role in creating an enabling environment for better private sector engagement. PROPEL’s work will help advance access to high quality services through effective policy and resource development.

d. Policy Advocacy Communications Enhanced (PACE) Suite of Projects (GH/PRH) (2015- 2022) 23 : The PACE Suite of Projects works closely with global actors, national and local governments, USAID missions, and civil society to build champions, bridge sectors, and distill evidence through data-driven, innovative products. PACE strengthens capacities in advocacy, policy communication, and negotiation, and increases commitments to multisectoral approaches. The newly awarded PACE-Building Capacity for Integrated Family Planning & Reproductive Health and Population, Environment and Development (PED) Action (BUILD) works to increase commitment and build individual and institutional capacity for cross-sectoral approaches that integrate population and FP with other development sectors. PROPEL will complement and build upon PACE’s work by recognizing the changing landscape in FP/RH and FP/RH integration and pivot towards successes using new, innovative and cross-sectoral strategies.

e. African Collaborative for Health Financing Solutions (ACS) (Africa Bureau/Health)

(2017-2022) 24 : ACS assists countries to address health financing challenges and advance universal health coverage (UHC) by using a highly participatory model that builds on national and regional capacity rather than traditional externally-sourced technical assistance. This involves working with both African regional and country-level experts and facilitators. PROPEL will complement these efforts by ensuring adequate FP/RH financing through capacity building.

f. USAID CATALYZE (Bureau for Development, Democracy and Innovation (DDI; PSE Hub) (2019-2027) 26: USAID's CATALYZE project engages with domestic and international finance providers to mobilize private financing across sectors, geographies, and transaction types and sizes. This market development approach enables enterprises to obtain the necessary investment and working capital to sustain and grow their businesses and advance development priorities. CATALYZE is one of multiple USAID Private Sector Engagement projects aimed at strengthening partnerships with new or underutilized private sector firms. PROPEL will use financing techniques and employ local, regional, and country-level actors to create sustainable FP/RH infrastructure.

https://www.usaid.gov/global-health/momentum-project https://www.usaid.gov/PACE https://acs.r4d.org/ https://acs.r4d.org/ https://www.usaid.gov/catalyze

g. Frontier Health Markets (FHM) (GH/PRH) (2021-2027) 27: FHM seeks to improve the functioning of local health markets and support the effective engagement and systemic inclusion of the private sector to advance voluntary family planning, maternal, newborn and child health (MNCH), malaria, TB, and HIV/AIDS outcomes. PROPEL seeks to use an integrated model to link FP/RH with HIV/AIDS and MCH to expand the resource envelope for health to support a vital and resilient health system. PROPEL will also strengthen the ability of host governments to steward mixed health systems and foster an enabling environment for private sector engagement in health related to FP/RH.

h. Market Access and Innovative Finance (MAIF) (GH/CII) (2020-2023) 28: The MAIF award is designed to provide support services and technical assistance on designated requirements for a range of diverse market access activities, including strategic planning, market shaping, innovative financing, private sector engagement, and human-centered design. PROPEL will complement MAIF by providing a lasting foundation in financing efforts for FP/RH and integrated sectors.

i. Country Health Information Systems and Data Use (CHISU) (GH/OHS) (2020-2025) 29:

The CHISU project builds capacity for local leadership and engagement by strengthening health information systems (HIS) to improve interoperable information architecture and data use. This program addresses gaps and builds up and complements prior and current USAID investments in HIS and data driven decision making. PROPEL will advance HIS and promote greater data use for FP/RH and integrated sectors.

j. Digital Square (GH/CII) (2016-2026) 30:

Digital Square empowers and enables countries in their efforts to develop digital systems and structures. It ensures that these systems are enduring and built to scale so governments and decision makers can access the information they need, when they need it, to ensure better health outcomes for all. PROPEL will coordinate and collaborate with Digital Square where digital systems and structures support the outcomes articulated in this APS.

3. Local Partners

Contributing to sustainable and equitable health systems that are transparent and accountable to civil society, including women, girls, and other vulnerable populations, requires ongoing engagement with local communities and partners. It also demands an understanding of local health needs and socio-cultural contexts that affect the availability of specific health services.

Focusing on the effectiveness of stakeholder interactions, social accountability, and engagement is particularly critical in health policy. The policy process and political economy of health systems investment are dynamic and constantly evolving in response to changing circumstances and emerging challenges. Government, civil society, and other stakeholders need to possess the skills necessary to actively engage in all aspects of the policy process to support the development and implementation of sound health policies. Activities under PROPEL will work to increase capacity of individuals, communities, and institutions, and the effectiveness of their interactions;

and to design, implement, and monitor policies and improve financing for a sustainable enabling https://www.usaid.gov/business-forecast/search/award/01352ea94b?search=&location=All&ouid=All&page=22 https://www.usaid.gov/cii https://www.usaid.gov/global-health/health-areas/hiv-and-aids/technical-areas/using-health-information https://digitalsquare.org/ environment. Identifying and maximizing opportunities to enhance local partnerships to leverage greater total resources at country-level and support strategic solutions will be critical.

PROPEL will build on and diversify USAID’s partner base through concentrated efforts to engage the private sector, including NGOs and CSOs, and other local actors (including youth and women’s groups) at the country level for local intelligence and expertise. PROPEL aims to work with a variety of partners, including new partners by reaching, engaging, and increasing the capacity of such organizations using co-creation strategies. PROPEL’s aims include furthering collaboration with local partners, enabling them to better access USAID support either via a sub-partner relationship with the prime implementing partner or via direct USAID support. PROPEL also aims to work with local partners to strengthen host country government health systems and reduce the reliance on foreign aid. PROPEL awards may issue performance-based, capacity-building, and/or innovation sub-awards and sub-grants to local organizations.

Alignment with the New Partnerships Initiative (NPI): (USAID’s New Partnerships Initiative) calls for greater engagement with new and underutilized partners to leverage significant private and non-U.S. government funding to support and finance partner countries’ own development.

PROPEL will build on USAID’s long history of working with local partners and will incorporate the aims of NPI to expand access to USAID support to new local partners, building their capacity to better address FP/RH outcomes within the larger health system. Where applicable, PROPEL will coordinate with NPI.

See Round-specific guidance for more information on local partner requirements.

a. Coordination with Ongoing and Existing Mechanisms In-Country.

PROPEL will complement, coordinate, support, and learn from existing awards implemented at country level. USAID’s country level awards are often the most responsive to their environments and PROPEL will produce greater health outcomes through strong coordination with these mechanisms.

b. Enhancing Participation and Collaboration with Local Partners.

PROPEL’s aims include furthering collaboration with local partners, enabling them to better access USAID support either via a sub-partner relationship with the prime implementing partner or via direct USAID support. PROPEL also aims to work with local partners to strengthen host country government health systems and reduce the reliance on foreign aid.

B. Technical Considerations

The principles below are critical to achieving the results of this APS and will be addressed throughout the implementation, monitoring, and evaluation of the awards made as a result of this

APS.

The following principles and considerations may rise to the level of a thematic Round and/or may remain a cross-cutting consideration across Rounds. Please see Round-specific documents for further information.

https://www.usaid.gov/npi

Specific Integration Considerations

This APS has a specific emphasis on voluntary, rights-based FP/RH, and FP/RH integration with MCH and HIV/AIDS. However, the APS will strongly encourage work across health elements, systems and development sectors, with specific efforts to achieve results in FP/RH demand, uptake, and overall improvements in related health outcomes. Strategic, cross-sectoral, integrated planning and programming can effectively support the achievement of FP/RH outcomes and objectives, while contributing to the accomplishment of multiple other development goals and outcomes. In addition to the focal areas for integration noted above, this APS also seeks to advance and elevate the role of population and FP/RH across multiple development sectors and promote cross-sectoral approaches (such as Population Health and the Environment approach, here) 31, and the further development of in-country digital health technology (see USAID Vision for Action in Digital Health) 32. Primary integration activities will highlight:

a. HIV/AIDS

Women of reproductive age are disproportionately affected by HIV/AIDS, especially in sub-Saharan Africa where women account for nearly 60% of people living with HIV.

Adolescent girls and young women ages 15-24 are particularly vulnerable to HIV; they are approximately 14 times more likely to be infected than their male counterparts and have lower rates of retention in HIV care.1 FP/RH and HIV/AIDS programs and policies have remained vastly separate, despite established connections between the fields.

Women and adolescent girls with HIV/AIDS still have unintended pregnancies and should be free to make reproductive decisions without coercion through voluntarism and informed choice. Alarmingly, rates of unintended pregnancies remain high in women with HIV, and family planning interventions have been chronically underutilized in HIV prevention, care, and treatment programs, though both FP/RH work and HIV/AIDS work address similar populations.2

In 2003, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) was created, which marked a moment of significant attention and funding to control the HIV/AIDS epidemic. In 2014, PEPFAR launched the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) public private partnership, which promotes FP/HIV integration as part of a comprehensive package of HIV prevention services for adolescent girls and young women in 15 countries. PEPFAR implements a public health approach to achieve and maintain epidemic control through data-driven, accountable service delivery leading to greater impact. Many PEPFAR-supported countries are increasing their responsibility of sustaining their HIV/AIDS response; with this comes the integration of HIV services and resources into the public sector. Furthermore, USAID has a long history of FP/HIV service integration, but more effort is needed at the policy, finance, and governance level to integrate HIV/AIDS services into FP and primary care

Wilcher, R., Cates, W., Jr, & Gregson, S. (2009). Family planning and HIV: strange bedfellows no longer. AIDS (London, England), 23 Suppl 1(Suppl 1), S1–S6.

https://doi.org/10.1097/01.aids.0000363772.45635.35

Wilcher, R., Cates, W., Jr, & Gregson, S. (2009). Family planning and HIV: strange bedfellows no longer. AIDS (London, England), 23 Suppl 1(Suppl 1), S1–S6.

https://doi.org/10.1097/01.aids.0000363772.45635.35 https://pdf.usaid.gov/pdf_docs/PA00T59H.pdf https://www.usaid.gov/sites/default/files/documents/USAID-A-Digital-Health-Vision-for-Action-v10.28_FINAL_508.pdf https://www.usaid.gov/sites/default/files/documents/USAID-A-Digital-Health-Vision-for-Action-v10.28_FINAL_508.pdf systems. To support integration with HIV/AIDS, PROPEL may support PAFG activities that address one or more of the following:

● Legal and regulatory requirements for integration.

● Ability of governments to fund quality FP/RH services and integration with

HIV/AIDS, through increased efficiency gains and resource optimization.

● Effectively targeting resources for greater impact on FP/RH, integration with

HIV/AIDS, and related health outcomes.

● Equity and resource optimization to ensure that vulnerable populations -economically or socially - have access to quality FP/RH and integration services, supplies and information, are not faced with stigma or discrimination and are not faced with impoverishment from catastrophic spending to access services.

● Role of the private sector to contribute resources and provide greater access to healthcare services in FP/RH and integration activities within the HIV/AIDS space.

b. Maternal and Child Health (MCH)

Globally, the number of women and girls who died each year from complications of pregnancy and childbirth declined from 451,000 in 2000 to 295,000 in 2017. These improvements are remarkable in light of population growth in many countries where maternal deaths are the highest. However, this statistic still represents more than 800 preventable deaths per day. 3 USAID works to ensure that all women and children have the same chance of a healthy life, regardless of income, race, or creed. USAID has active projects in 25+ priority countries with the goal of integrating MCH with other related development sectors, such as immunization, nutrition, and water, sanitation, and hygiene (WASH). In addition, an integrated MOMENTUM suite of projects (here)33 prioritizes integration with FP/RH in key areas such as private sector healthcare, improving service delivery, and generating evidence to support future programming. Although strides have been made to integrate maternal health with FP/RH, more work is needed as it relates to PAFG in this sector. A key priority is identifying and supporting concrete ways to integrate maternal and child health services, data, and policies with related health concerns, such as FP/RH. To support integration with MCH, PROPEL may support PAFG activities that address one or more of the following:

● Legal, regulatory, and policy requirements for improving integration between MCH, FP/RH, and related services.

● Improving the ability of governments to adequately plan, allocate, and fund quality

FP/RH services and integration with MCH, through increased efficiency gains and resource optimization, finding synergies across the health portfolio.

● Effectively targeting resources for greater impact on FP/RH and integration with MCH and related health outcomes.

● Including civil society, especially women and vulnerable populations, in policy-making that directly impacts them, and fostering the accountability mechanisms to ensure ongoing impact.

WHO, UNICEF, UNFPA and The World Bank, Trends in Maternal Mortality: 2000 to 2017 WHO, Geneva, 2019 https://www.usaid.gov/global-health/momentum-project

● Equity and resource optimization to ensure that vulnerable populations -economically or socially - have access to quality FP/RH and integration services, supplies and information, are not faced with stigma or discrimination, and are not faced with impoverishment or catastrophic spending to access these healthcare services.

● Role of the private sector to contribute resources, provide greater access to healthcare services, and assist health authorities with the ability to scale successful integrated FP/RH and MCH interventions.

Gender Equity and Equality

USAID recognizes gender equality and female empowerment as core development objectives, fundamental to the realization of human rights and key to achieving positive health and development outcomes. Gender norms and expectations are established early in life and are reinforced by formal policy structures, families, and communities -fundamentally affecting health at the individual, local, and societal levels. The differential status of women, men, boys, girls, and people of other gender identities frequently impacts health outcomes and is viewed as a cross-sectoral issue that often intersects with FP/RH, MCH, HIV/AIDS, and integrated programming.

Investing in gender equality and women’s empowerment can unlock human potential on a transformational scale. For societies to thrive, women and girls, and men and boys, and gender and sexual minorities must have equal access to education, healthcare, and technology. PROPEL seeks to advance the momentum towards gender equity and equality by reducing gender disparities in access to, control over, and benefit from resources, wealth, opportunities, and services - all while reducing gender-based violence and mitigating its harmful effects on individuals and communities. PROPEL seeks to increase the capacity of women and girls to realize their rights, determine their own life outcomes, make their voices heard and influence decision making in households, communities, and societies, as well as improve sensitive male involvement. This can be better accomplished through including women and girls in the development and implementation of gender-sensitive policies, increased financing for gender transformative activities, and awareness of gender positive approaches within civil society and leadership. In consultation with USAID, PROPEL will work to assure that sufficient effort is invested in monitoring and evaluating these activities, including collecting and analyzing gender-sensitive indicators and sex-disaggregated data, where feasible and relevant. This work will significantly improve PROPEL’s progress towards the results outlined for policy, advocacy, financing, and governance, and the health outcomes sought. See USAID Gender Policy34 .

Vulnerable Populations, Including Youth and Adolescents

Young people make up an especially large share of the population in developing countries, often requiring additional support and programming to meet their needs, as they are typically spending more time in school, entering the workforce later, and delaying having families longer than previous generations. As a suite of projects, PROPEL will emphasize the meaningful engagement and inclusion of youth and adolescents in policy development, implementation, and accountability processes as well as implement youth and adolescent-centered programming, https://www.usaid.gov/GenderEqualityandWomensEmpowermentPolicy especially as it pertains to assisting adolescents and youth to take control of decision-making regarding voluntary and rights-based FP/RH, and FP/RH integration with MCH and HIV.

PROPEL awards will employ a multi-sectoral approach, as described in the Positive Youth Development (PYD) framework 35, to address the protective factors that support youth resiliency, including positive health outcomes. See USAID Youth in Development Policy 36.

Other vulnerable populations such as people living in extreme poverty, indigenous peoples, sexual minorities, and those living in rural communities are also considered part of the focus of PROPEL. A core function of this APS is to improve the enabling environment for equitable and sustainable health services for all populations.

Fragile Contexts: Epidemics, Pandemics, Humanitarian Response

As a leader in global health programming for decades, USAID supports and invests in helping communities develop the infrastructure needed to combat infectious diseases, such as Ebola, HIV/AIDS, Tuberculosis, Malaria, and now COVID-19. In the wake of the COVID-19 pandemic in particular, voluntary family planning initiatives have been negatively affected by the reallocation of funds, stay at home orders, closure of services, supply chain disruptions, limited provision of FP/RH in-person care, and increases in gender-based violence.

Fragile contexts, whether due to COVID-19 or issues like political crisis, violent extremism, climate conditions, or natural disaster, will continue to impede progress towards achieving good health outcomes and rights-based, voluntary family planning options for all. PROPEL seeks to identify and address policy, advocacy, financing, and governance challenges in these fragile settings, and the resulting barriers to care. See USAID’s Resilience Policy37.

Digital Health Technology

Digital transformation can advance FP/RH health outcomes when paired with sufficient investment in the analog components of digital transformation. In 2020, USAID launched a Digital Health Vision to address issues around fragmentation and lack of sustainability and interoperability in the digital health technologies implemented in USAID partner countries. The Vision has four priorities: 1. Building country digital health capacity, 2. Advancing national digital health strategies, 3. Strengthening national digital health architectures, and 4. Leveraging global goods.

In the context of health services, countries have leveraged digital health technologies to increase and maintain access to FP/RH services. This has included the use of digital financing tools to increase access to health insurance or streamline reimbursement and payment systems, use of dashboards to hold governments and others accountable, and use of digital tools to collect real time data. PROPEL seeks to identify digital health technologies and approaches to address issues relevant to this APS and efforts to achieve FP/RH and integration outcomes. This could include (but is not limited to) building the digital health capacity of stakeholders such as government counterparts, civil society advocates, and others; supporting implementation of national digital health strategies and architectures that leverage existing investments and host country systems;

and supporting the scale-up of global goods to reduce duplication and promote sustainability.

https://youth.gov/youth-topics/positive-youth-development https://youth.gov/youth-topics/positive-youth-development https://www.usaid.gov/policy/youth https://www.usaid.gov/policy/resilience

Capacity Development

PROPEL awards will utilize capacity development approaches to ensure individuals, communities, and local organizations possess the knowledge and expertise required to promote and sustain policies that are beneficial and responsive to the communities they serve. These critical stakeholders in the health system build capacity by sustaining positive policy change and supporting sustainable financing, and by effectively utilizing and promoting evidence for decision making. Overall, the PROPEL APS looks to apply capacity development approaches throughout the health system in order to support local capacity thereby ensuring the sustainability of results and continued action towards country health and larger development goals.

Prioritizing and focusing on the effectiveness of stakeholder linkages and platforms is particularly critical in health policy, where the process is dynamic and evolving in response to changing circumstances. Government, civil society, and other stakeholders will need to possess the means necessary to actively engage in all aspects of the policy process to support the development, implementation, and evaluation of sound health policies. PROPEL’s capacity development activities will support countries and communities in their ability to effectively design, implement, and monitor policy, advocacy, finance, and governance efforts, with an emphasis on those efforts that impact FP/RH outcomes, and the integration of FP/RH with HIV/AIDS and Maternal Health.

Sustainability

USAID has made a commitment to support sustainable development through high-impact partnerships and local solutions. Partnerships between governments and stakeholders, including citizens, NGOs, CSOs, and the private sector, have been created and utilized to bring to scale innovative solutions to development challenges. To date, USAID has demonstrated this achievement through improved outcomes and critical health indicators, such as modern contraceptive prevalence rates, increased demand for FP, and reduced maternal mortality.

In the context of improving the enabling environment for FP/RH and FP/RH integration with HIV/AIDS and MCH, the PROPEL awards will support the implementation of resilient health policies and financing strategies, as well as evidence-based advocacy and decision making, that fuel countries’ self-sustaining improvement of critical health indicators and achievement of country goals for health and development. Overall, PROPEL supports alignment with host-country government strategies, policies, and investments.