Request for Proposals (RFP) No 72061120R00005_MECH - 03062020.pdf

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

Embassy of the United States of America

Subdivision 694/Stand 100 Ibex Hill Road

P.O. Box 320373, Lusaka, Zambia

March 6, 2020

Subject: Request for Proposals (RFP) No: 72061120R00005

USAID Maintained Epidemic Control of HIV (MECH) Activity

Dear Prospective Offerors:

The United States Agency for International Development (USAID) Mission to Zambia is seeking proposals to provide technical services described in the attached Request for Proposals (RFP).

This procurement will be conducted under limited competition to “Local Partners” for USAID

Maintained Epidemic Control of HIV (MECH) Activity valued between $85 and $95 million.

Definition of a Local Partner: Under the PEPFAR definition, to be considered a local partner, the offeror must meet the following criteria:

(1) An entity (e.g., a corporation or partnership):

a) Must be incorporated or legally organized under the laws of, and have its principal place of business in, the country served by the PEPFAR program with which the entity is or may become involved;

b) Must be at least 75% beneficially owned by individuals who are citizens or lawfully admitted permanent residents of that same country, per sub-paragraph

(2)(a);

c) At least 75% of the entity’s staff (senior, mid-level, support) must be citizens or lawfully admitted permanent residents of that same country, per subparagraph (2)(a), and at least 75% of the entity’s senior staff (i.e., managerial and professional personnel) must be citizens or lawfully admitted permanent residents of such country; and

d) Where an entity has a Board of Directors, at least 51% of the members of the Board must also be citizens or lawfully admitted permanent residents of such country.

This RFP directly responds to the PEPFAR goal of transitioning to local organizations and the

USAID’s vision of a Journey to Self-Reliance by creating sustainable local capacity.

USAID anticipates the award of a Cost-Plus-Award-Fee Type Contract for a maximum five (5) year period of performance as a result of this RFP. USAID anticipates that the total estimated cost will be between $85 and $95 million. The North American Industry Classification System

(NAICS) code for this solicitation is 541990. The authorized geographic code for the prime contractor of this procurement is 935.

The Government intends to conduct the evaluation as an Advisory Phased Procurement with two (2) phases. Participation in Phase I is a mandatory part of this acquisition. Interested offerors that do not participate in Phase 1 will not be considered for phase II. Proposals will be evaluated based on evaluation factor (s) for each Phase. At the conclusion of Phase I evaluation, advisory notification will be sent to all Offerors informing them of the evaluation results.

Offerors not deemed as viable competitors as a result of evaluation may still elect to participate in Phase II or may voluntarily withdraw their proposal from further consideration. Please refer to Section L for detailed information regarding offeror’s submission of proposals in Phase I and

Phase II based on the Government Advisory Notice

Action Date Time Submission/Location:

Questions Due March 19, 2020 14:00 Lusaka Time oaa-solicit-lusaka@usaid.gov

Phase I: Proposals Due April 8, 2020

[See Section L.5 (Phase I)]

14:00 Lusaka Time

Advisory Notice o/a April 21, 2020 14:00 Lusaka Time

Phase II: Proposals Due [Will be communicated via the advisory notice.]

[See Section L.5 (Phase II) and

L.6]

14:00 Lusaka Time

Failure to comply with the submission date and time may result in a submission being non-responsive, such that it will not be reviewed or evaluated. Faxed proposals are not acceptable, nor will they be reviewed or evaluated. Section M states the criteria for both Phase I and II by which proposals will be evaluated. This RFP in no way obligates USAID to award a Contract.

Nor does it commit USAID to pay any cost incurred in the preparation and submission of a proposal. Award of a Contract under this RFP is subject to availability of funds and other internal USAID approvals.

This RFP and any future amendments can be viewed and downloaded from www.beta.SAM.gov.

USAID bears no responsibility for data errors resulting from transmission or conversion processes. Further, be aware that amendments to solicitations are occasionally issued and will be posted on the same internet site from which you downloaded the solicitation. You are therefore advised to regularly check the above internet site for amendments.

Sincerely, Mohib Ahmed

Supervisory Contracting Officer

Director, Office of Acquisition and Assistance mailto:oaa-solicit-lusaka@usaid.gov http://www.beta.sam.gov/

72061120R00005

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 127

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

(Date)(Hour) local timeuntildepository located in copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

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L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

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SEC. DESCRIPTION PAGE(S) (X) DESCRIPTION SEC. (X)

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

CALENDAR DAYS (%)30 CALENDAR DAYS (%)20 CALENDAR DAYS (%)10 CALENDAR DAYS (%)

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

41 U.S.C. 253 (c) ( 10 U.S.C. 2304 (c) (

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

REQ-611-20-00001403/06/2020

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720611

USAID/Zambia Embassy of the United States of America Subdivision 694/Stand 100 Ibex Hill Road P.O. Box 320373, Lusaka, Zambia

1400 B 04/08/2020

Charles Nyanoka oaa-solicit-lusaka@usaid.gov

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Mohib Ahmed

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

1-4 5-8

9-27 28-32 34-41 42-46 47-82

83-93

95-119

120-125 126-127

12. In compliance with the above, the undersigned agrees, if this offer is accepted within _____0_________ calendar days (60 calendar days unless a different period is inserted

03/06/2020

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

72061120R00005

(A) (B) (C) (D) (E) (F)

0001 The primary purpose of USAID MECH is to reduce

HIV mortality, morbidity and transmission by achieving the UNAIDS and PEPFAR goal of 95/95/95

HIV treatment coverage and providing comprehensive HIV prevention and care and treatment maintenance services in Luapula, Muchinga and Northern provinces. Additionally, USAID MECH will strengthen public financial management systems in provinces where USAID has government to government agreements. In order to achieve these objectives, USAID MECH will strengthen systems and provide direct service delivery at the province, district, facility and community levels.

OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

NSN 7540-01-152-8067

Request for Proposals (RFP) No: 72061120R00005 USAID Maintained Epidemic Control of HIV (MECH) Activity

ACRONYM LIST

7NDP Seventh National Development Plan

ACT Accelerating Children's HIV/AIDS Treatment Initiative

ADFHS Adolescent Friendly Health Services

AIDS Acquired Immunodeficiency Syndrome

APR Annual Performance Report

ART Antiretroviral Therapy

ARV Antiretrovirals

AU African Union

BCC Behavior Change Communication

BMI Body Mass Index

CACX Cervical Cancer

CDC Centers for Disease Control and Prevention CDCS Country Development Cooperation Strategy

CD4 Cluster of Differentiation 4

CHW Community Health Workers

COP Country Operational Plan

DMO District Medical Office

EID Early Infant Diagnosis eLMIS Electronic Logistics Management Information System eSCMIS electronic Supply Chain Management Information Systems

EMTCT Elimination of Mother-to-Child Transmission

FP Family Planning

FSW Female Sex Workers

G2G Government to Government

GRZ Government of the Republic of Zambia

HCT HIV care and treatment

HEPS High-Energy Protein Supplement

HIV Human Immunodeficiency Virus

HIV+ HIV positive

HMIS Health Management Information Systems

HTC HIV testing and counseling

ICE Information, Communication, Education

IMAM Integrate Management of Acute Malnutrition

IR Intermediate Result

IPTp Intermittent Preventive Therapy in pregnancy

ITN Insecticide-Treated Net

IYCN Infant and Young Child Nutrition

M&E Monitoring and Evaluation

MCDSS Ministry of Community Development and Social Services

MCH Maternal and Child Health

MDG Millennium Development Goals

MER Monitoring, Evaluation and Research

MNCH Maternal, Newborn and Child Health

MOA Ministry of Agriculture

MOH Ministry of Health

MUAC Mid-Upper Arm Circumference

MSM Men who have Sex with Men

MSL Medical Stores Limited

MTB/RIF Mycobacterium Tuberculosis/Rifampicin

MTCT Mother-to-Child Transmission

NAC National AIDS Council

NACS Nutrition, Assessment, Counseling and Support

NASF National AIDS Strategic Framework

NGO Non-governmental organization

NHSP National Health Strategic Plan

NMCC National Malaria Control Center

NSP National Strategy for the Prevention of HIV/AIDS in Zambia

OVC Orphans and vulnerable children

PAD Project Appraisal Document

PEPFAR President’s Emergency Plan for AIDS Relief

PHC Primary Health Care

PLHIV People Living with HIV

PLWHA People Living with HIV and AIDS

PMI President’s Malaria Initiative

PMO Provincial Medical Office

PMTCT Prevention of Mother-to-Child Transmission

RH Reproductive Health eMTCT Elimination of Mother-to-Child Transmission

RTK Rapid Test Kits

RUTF Ready-to-use therapeutic food

SAFE USAID SAFE: Supporting an AIDS-Free Era

SAPR Semi-Annual Performance Report

SIMS Site Improvement Monitoring System sdNVP Single dose of Nevirapine

SNU Sub National Unit

SOW Statement of work

TB Tuberculosis

TWG Technical Working Group

UNAIDS Joint United Nations Program on HIV/AIDS

USAID United States Agency for International Development

USAID/Z United States Agency for International Development/Zambia

VMMC Voluntary Medical Male Circumcision

WHO World Health Organization

ZDHS Zambia Demographic and Health Survey

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1. PURPOSE

The purpose of this contract is to implement USAID Maintained Epidemic Control of HIV

(MECH) in accordance with Section C.

B.2. CONTRACT TYPE

This is a Cost-Plus-Award-Fee (CPAF) type contract. The contractor shall provide results and outputs as described under Section C and other requirements of Section F and H in accordance with the performance standards specified herein.

B.3. ESTIMATED COST, AWARD FEE, AND OBLIGATED AMOUNT

In accordance with FAR Part 52.232-22 - Limitation of Funds:

(a) The estimated cost for the performance of the work required hereunder, exclusive of award fee, if any, is $TBD. The maximum award fee, if any, is $TBD. The estimated cost plus award fee, if any, is $TBD.

(b) Within the estimated CPAF specified in paragraph (a) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the Contractor (and payment of fee, if any) for performance hereunder is $TBD. The contractor must not exceed the aforesaid obligated amount.

(c) Budget

NOTE: The contractor will be required to notify the USAID COR of Budget Line Item variation of 10% and request concurrence.

Contract Budget

Line Item

Description

PERIOD

Yr. 1 Yr. 2

Yr. 3

Yr. 4

Yr. 5

Total All Years

Salaries and Wages

Fringe Benefits

Travel, Transportation and Per Diem

Equipment and Supplies

Subcontracts

Consultants

Other Direct Costs

Indirect Costs

Total Estimated Cost

Award Fee

Total Estimated Cost

Plus Award Fee

Contract Line Item (CLIN)

ITEM NO SUPPLIES/SERVICES (DESCRIPTION) QTY UNIT UNIT PRICE

TOTAL

AMOUNT

CLIN

Service Delivery (Direct & Indirect Costs)

Estimated Cost

Award fee

Base Fee

Total Cost Plus Award Fee

(d) In accordance with FAR 52.232-19, Availability of Funds, funds obligated hereunder are anticipated to be sufficient through o/a TBD. Funding for this contract will be on an incremental basis, subject to the availability of funds.

B.4 PAYMENT OF AWARD FEE

The Contractor may earn and be paid all or a portion of an award fee for performance under this contract. The Government's purpose in granting an award fee is to encourage and reward superior contract performance.

The maximum award fee must be made available to the Contractor in five (5) increments, with the first evaluation occurring approximately one year after the award date and after final annual performance review (APR) data is submitted, reviewed and accepted into the PEPFAR DATIM system. The remaining four evaluations occurring annually following APR DATIM data submission, review and acceptance in December of a given year as specified below:

Contract Year Period*

(Start/End date)

Amount of Award Fee

Available

Contract Year 1 TBD at Award TBD

Contract Year 2 TBD at Award TBD

Contract Year 3 TBD at Award TBD

Contract Year 4 TBD at Award TBD

Contract Year 5 TBD at Award TBD

Maximum Award Fee

Available

TBD

* Period will be completed upon contract award.

The determination of the award fee, if any, earned by the Contractor must be in accordance with the Award Fee Evaluation Plan [Attachment J.1]. Unearned award fee cannot rollover from one award fee increment to the next award fee increment. The amount of award fee to be earned is a unilateral and subjective Government evaluation decision.

Payment of any award fee earned by the Contractor must not be subject to the withholding provisions of the clause of this contract entitled "Allowable Cost and Payment" (FAR 52.216-7).

B.5 INDIRECT COSTS

The Contractor is authorized to recover applicable indirect costs, if it is part of the contractor's usual accounting procedures, consistent with FAR Part 31, and Negotiated Indirect

Cost Rate Agreement (NICRA).

Pending establishment of revised provisional or final indirect cost rates, allowable indirect costs will be reimbursed on the basis of the following negotiated provisional or predetermined rates and the appropriate bases as below:

[To be inserted at the time of Award]

Contractor Fringe

Rate %

Overhead

Rate %

G&A

Rate %

PRIME (insert)

Type of Rate (insert)

Base of Application (insert)

Source: (insert)

Period: (insert)

MAJOR SUBCONTRACTOR(S)

(insert)

Type of Rate

Base of Application (insert)

Source: (insert)

Period: (insert)

NOTE: Insert additional indirect rates as needed for all primes and subcontractors in the above table.

NOTE: The un-shaded columns in the indirect cost table are the current approved indirect cost rates for the prime and subcontractor(s).

NOTE: Contractors are allowed to recoup indirect costs (OH, G&A, etc.) as other direct costs if it is part of the contractor’s usual accounting procedures, consistent with FAR 31 and the contactor’s NICRA.

NOTE: Major subcontractors are those subcontractors whose proposed costs exceed 20% of the Offeror’s proposed total cost or perform a key element of the RFP.

NOTE: The Contractor will make no change in its established method of classifying or allocating indirect costs without the prior written approval of the Contracting Officer.

Reimbursement for indirect costs shall be at final negotiated rates.

B.6 COST REIMBURSABLE

The U.S. dollar costs allowable will be limited to reasonable, allocable and necessary costs determined in accordance with FAR 31 (Contract Cost Principles), 2 CFR Part 200 (Cost

Principles), FAR 52.216- 7 (Allowable Cost and Payment), AIDAR 752.216-70 (Award Fee) if applicable, FAR 52.232-20 (Limitation of Cost), FAR 52.232-22, (Limitation of Funds), and

AIDAR 752.7003 (Documentation for Payment), may be reimbursable under this contract.

[END OF SECTION B]

SECTION C - DESCRIPTION/SPECIFICATIONS/PERFORMANCE BASED WORK

STATEMENT

C.1 ACTIVITY TITLE

The activity title is USAID Maintained Epidemic Control of HIV (MECH).

C.2 OVERVIEW

The primary purpose of USAID MECH is to reduce HIV mortality, morbidity and transmission by achieving the UNAIDS and PEPFAR goal of 95/95/95 HIV treatment coverage and providing comprehensive HIV prevention and care and treatment maintenance services in Luapula, Muchinga and Northern provinces. Additionally, USAID MECH will strengthen public financial management systems in provinces where USAID has government to government agreements. In order to achieve these objectives, USAID MECH will strengthen systems and provide direct service delivery at the province, district, facility and community levels.

C.3 SUCCESS

Success will be measured by performance towards agreed upon targets described here and further expanded on in the performance monitoring plan. Achievement of these targets will result in HIV epidemic control during year one of the project and maintained epidemic control over the life of the project. In addition to ensuring that 95 percent of PLHIV know their status, 95 percent of those people are on treatment, and 95 percent of those on treatment are virally suppressed, this activity will be determined as successful if the services provided through the public health sector are of high quality. High quality means that services are provided to patients in environments that are respectful to patient needs, convenient and accessible, and meet minimum international quality standards.

C.4. BACKGROUND

Country Context

Zambia’s population is estimated at 18 million people. At 741,000 square kilometers Zambia is geopolitically divided into ten provinces and over 100 districts. Approximately 60 percent of the population lives in sparsely populated rural areas.

Zambia has made significant progress in managing its generalized HIV epidemic over the past decade, with notable achievements made in the past two years. By the end of the calendar year

2019, 1,065,657 of the approximately 1.2 million HIV positive individuals were on HIV treatment in health facilities supported by PEPFAR, with additional individuals on treatment in health facilities supported only by the Ministry of Health. Viral load suppression of those on treatment is estimated at 92%. Despite these significant achievements, gaps in services, particularly among pediatrics, young girls and men remain. If these populations do not achieve the targeted 90% treatment coverage, Zambia will not achieve HIV epidemic control as the virus will continue to infect new individuals.

In order to reach these priority populations the PEPFAR program has emphasized targeted index testing, primary prevention among young children, risk reduction among adolescents and young adults, and improved access to testing and treatment services in locations where patients prefer them. By aggressively pursuing these approaches, USAID anticipates that at least 81% of

PLHIV will be on treatment in early FY2020 in USAID supported provinces. In preparation of this major milestone, USAID programs will need to shift focus from aggressive case identification to maintaining high quality HIV treatment services for hundreds of thousands of patients, while ensuring that all patients adhere to their treatment and are retained in services.

Additionally, prevention efforts will need to continue to ensure that no children are born HIV positive, young girls stay HIV negative and discordant couples remain that way.

National Policy Context

Zambia’s Revised Seventh National Development Plan (SNDP) envisions equitable access to quality healthcare for all its citizens by 2030 and recognizes that a healthy population is critical to improved production and productivity. Additionally, the National Health Strategic Plan

(NHSP) promotes access, as close to the community as possible, to high quality and cost-effective health services. The key principles of the NHSP include availability of primary health care services, equity of access, affordability, cost-effectiveness, accountability, partnership, decentralization, leadership and a clean, caring and competent health care environment. The plan also identifies maternal, neonatal and child health, HIV/AIDS and sexually transmitted infections, tuberculosis and malaria as public health priorities. The Ministry of Health has multiple HIV specific policies that are particularly forward leaning and make Zambia a regional leader in creating a positive policy environment for achieving HIV epidemic control. These policies include rapid initiation of all HIV positive individuals on treatment, 6 month dispensing of ARVs and an aggressive transition to the tenofovir lamivudine dolutegravir combination

(TLD).

PEPFAR/USAID’s HIV/AIDS Response in Zambia

PEPFAR has categorized Zambia as a ‘Bucket 2’ country, meaning that HIV epidemic control is near, but significant effort is still needed to achieve it. This means that not only do hundreds of thousands of PLHIV need to be identified and initiated on treatment, but also that systems need to be put in place to ensure minimal loss to follow up and retention on treatment of over 95%.

As Zambia crosses the threshold for achieving HIV epidemic control, the program must transition from an emergency response to one that treats HIV as a chronic disease. This will mean making high quality services available in patient-friendly environments that are accessible.

PEPFAR and USAID/Zambia Projects in 2019/20

The overall PEPFAR/Zambia program is budgeted at approximately $435 million in COP19. The

PEPFAR program is comprehensive in that it provides services across the entire HIV continuum of care, and targeted in that it is concentrated in the geographic area that have the highest HIV burden. USAID and CDC administer HIV treatment projects that serve geographically distinct areas. Other USAID funded projects that will operate in the USAID MECH supported provinces to provide various HIV related services include the following:

1. The electronic Supply Chain Management Information System (eSCMIS) project supports the MOH endorse electronic Logistics Management Information System

(eLMIS) through training of MOH staff on the use of the system as well as deployment and development of the system. The eLMIS system is a foundational component of the country’s supply chain management system and allows health facility level stock visibility.

2. The Breakthrough Action project is a social and behavior change project working to increase the adoption and maintenance of health behaviors. This contributes to the broader goal of improved health and development outcomes, with a focus on behaviors related to HIV, MCH, FP, malaria and nutrition.

3. The USAID Community Health Assistant Support project trains, deploys and strengthens the management systems for community health assistants. Once deployed, these community health assistants work to improve access to quality health services by bringing services closer to beneficiaries.

4. The USAID DISCOVER-HEALTH project provides a variety of health services through newly constructed health posts and existing MOH facilities. These services include HIV counseling, testing and treatment, PreP, and VMMC in addition to MCH and FP services.

Newly constructed facilities are placed in areas with the greatest unmet need for services and target traditionally underserved populations.

5. The USAID Eradicate TB project supports the National TB Control Program to control

TB in Zambia by working at the community, national and provincial levels to strengthen

TB case finding, laboratory strengthening, and managing drug resistant TB.

6. The USAID Global Health Supply Chain – Procurement and Supply Management

(GHSC-PSM) project supports Zambia’s commodity distribution systems by providing technical assistance to improve inventory management, procures commodities for HIV, TB, MCH, FP and Malaria programs, and provides distribution and warehousing support.

This support is focused on the national and provincial levels.

7. USAID Supporting an AIDS Free Era (SAFE) provides comprehensive HIV treatment and prevention services in Copperbelt, Central and Northwestern provinces. MECH will provide the same services as SAFE in Luapula, Northern and Muchinga.

C.5 OBJECTIVES

USAID has identified nine objectives that must be met for the Activity to achieve the success mentioned above.

1. Ensure access to comprehensive HIV prevention interventions

2. Initiate 95 percent of those who tested positive on ART

3. Ensure that 95 percent of those on ART are virally suppressed

4. Reach 90 percent of eligible HIV positive adults and children with NACS

5. Provide cervical cancer screening services for WLHIV at HIV service delivery locations

6. Provide tuberculosis preventive treatment

7. Strengthen M&E capacity at the facility, district and provincial levels for improved program management

8. Strengthen facility level commodity management to mitigate the risk of stock outs

9. Strengthen the public financial management systems of the Ministry of Health and

Ministry of Finance to enable the efficient use of direct G2G funds from USAID

C.6 GEOGRAPHIC SCOPE

Throughout the life of the activity, USAID may direct the MECH contractor to adjust targeted districts and facilities within the following three provinces: Luapula, Muchinga and Northern.

The level of effort for each district within these provinces will be determined by their priority classification. Priority classification ranking is determined by USAID/Zambia in coordination with the Office of the Global AIDS Coordinator (OGAC) based on epidemiologic data and the potential to curb the HIV epidemic. District classification definitions (scale-up, sustained, centrally supported, and attained), and district assignments are provided in Table 1 below.

Throughout the life of the activity, USAID may direct the MECH contractor to adjust its level of effort in targeted districts in other provinces other than the 3 mentioned depending on changing epidemiological factors.

C.7 TECHNICAL FOCUS/GENERAL REQUIREMENTS

Contractor must respond to the specific technical areas listed below and must be consistent with the technical approaches and best practices identified in the most recent PEPFAR COP guidance.

C.7.1 Ensure access to comprehensive HIV prevention interventions

C.7.1.1 Ensure that 95 percent of HIV positive individuals know their HIV status;

C.7.1.2 Provide voluntary medical male circumcision (VMMC);

C.7.1.3 Provide pre-exposure prophylaxis to priority populations to avert new infections;

C.7.1.4 Eliminate mother-to-child transmission of HIV.

C.7.2 Initiate 95 percent of those who tested positive on ART

C.7.3 Ensure that 95 percent of those on ART are virally suppressed

C.7.4 Integrate voluntary family planning services into 95 percent of HIV service delivery locations

C.7.5 Provide cervical cancer screening services for WLHIV at HIV service delivery locations

C.7.6 Provide tuberculosis preventive treatment

C.7.7 Strengthen M&E capacity at the facility, district and provincial levels for improved program management to achieve the overall objective of 95-95-95

A sound monitoring and evaluation system is integral to the successful implantation of the tasks outlined. MECH’s monitoring and evaluation system will generate data that meets USAID’s data quality standards: validity, reliability, integrity, precision and timeliness. Data for indicators used for performance monitoring should be available at useful frequency, be current and be timely enough to influence management decision-making.

Ensuring that patient files are up-to-date and easily accessible is critical for both patient management and reporting results. MECH must ensure that supported facilities have adequate staff, training and infrastructure to routinely use both SmartCare, the eLMIS system and general

HMIS.

The ability to continuously generate data that details progress towards objectives is critical as it identifies areas that may need remedial action. MECH must:

● Conduct tailored assessments in order to understand the needs of partner communities and districts. This informs the development of appropriate implementation strategies

● Collect and submit monitoring, evaluation and reporting (MER) PEPFAR indicators for quarterly and annual performance reports using the prescribed systems (e.g. DATIM)

● Ensure that all MOH reports (HMIS and program) — are completed and sent on time

● Conduct customized data analysis in response to specific needs and requests

● Ensuring ALL (100%) of ART clients have active Smartcare files that are utilized for clinical care, date reporting and patient movement tracking

● Routinely monitor indicator trends and patterns through systematic analysis of data and implement adaptive management

C.7.8 Strengthen facility level commodity management to mitigate the risk of stock outs

Finding, initiating and retaining PLHIV on ART requires consistent access to ARVs and other commodities critical for providing comprehensive HIV services. MECH must ensure that at the facility level there are systems in place to efficiently and effectively manage HIV commodities and that staff are appropriately trained on these systems. MECH will not be responsible for supporting an electronic logistics management system as they will be the responsibility of a separate contractor.

C.7.9 Strengthen the public financial management systems of the Ministry of

Health and Ministry of Finance to enable the efficient use of direct G2G funds from

USAID

As part of USAID’s commitment to Zambia’s journey to self-reliance, USAID anticipates increasing funding directly from USAID to the Government of Zambia through the Ministry of

Health, using the direct G2G mechanisms. The purpose of G2G funding is to utilize host country government systems to address the HIV epidemic while strengthening local systems and increasing country ownership.

MECH will support this transition by building the public financial management capacity of SNUs where MECH operates. MECH must work with USAID to identify capacity building needs through review of existing Public Financial Management Risk Assessment Frameworks, Risk

Mitigation Plans, and routine update assessments.

Under this arrangement, the MECH contractor will support the MoH to gradually take up more direct services provision, and they (contractor) will implement specific activities defined in this

SOW to increase access to and utilization of HIV prevention and treatment services and provide technical assistance to strengthen the services provided by the GRZ.

Expected outcomes are:

● Improved budgetary systems (including the use of electronic financial systems) of the

Ministry of Finance (MOF) and MOH; and

● Improved procurement operations, including but not limited to, procurement planning, contract administration, and supplier management, of the MOF and MOH.

C.8 Indicators

Required indicators for each objective are listed below. Where required indicators are not currently available, illustrative indicators are listed. Full definitions for all PEPFAR indicators can be found in the most recent Monitoring, Evaluation and Reporting (MER) guidance from

OGAC. Annual targets will be established during the PEPFAR Country Operational Plan development process and shared with the contractor on/about June 1st prior to the implementation period for a given fiscal year beginning on October 1. Targets for the geographic regions for MECH for the current Fiscal Year (FY 2020) have been included to provide context. MECH will not be expected to achieve FY2020 targets.

C.8.1 Objective 1: Ensure access to comprehensive HIV prevention interventions

Indicator Code

PEPFAR Indicator Code

Indicator Name FY20 Year

LOP Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

1.1 HTS_TST Number of individuals who received

HIV Testing Services (HTS) and received their test results, disaggregated by HIV result

201,928 TBD TBD See MER guidance for additional information.

HTS register, integrated/ or eMTCT register, SmartCare

Daily/Weekly/ Monthly

Weekly/Monthly Quarterly

1.2 HTS_INDEX Number of individuals who were

identified and tested using Index testing services and received their results

18,408 TBD TBD See MER guidance for additional information.

HTS Register Daily/Weekly/

Monthly

Weekly/Monthly Quarterly

1.3 HTS_TST_POS Number of individuals who received

HTS, received their results and tested positive

8,346 TBD TBD See MER guidance for additional information.

HTS Register Daily/Weekly/ Monthly

Weekly/Monthly Quarterly

1.4 HTS_RECENT Percentage of persons aged ≥15

years newly diagnosed with HIV-1 infection who have a test for recent infection result of ‘recent infection’ during the reporting period

7,344 TBD TBD See MER guidance for additional information.

HTS

Register

Daily/Weekly/ Monthly

Weekly/Monthly Quarterly

1.5 HTS_SELF Number of individual HIV self-test

kits distributed

40,200 TBD TBD See MER guidance for additional information.

HTS

Register

Daily/Weekly/ Monthly

Weekly/Monthly Quarterly

1.6 VMMC_CIRC Number of males circumcised as

part of the voluntary medical male circumcision (VMMC) for HIV prevention program within the reporting period

55,919 TBD TBD See MER guidance for age disaggregation, circumcision technique and additional information.

Facility registers, patient files

Daily/Weekly/

Monthly

Weekly/Monthly Quarterly

Code

PEPFAR Indicator Code

Indicator Name FY20 Year

LOP Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

1.7 PREP_NEW Number of individuals who were

newly enrolled on oral antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period

699 TBD TBD See MER guidance for additional information.

Facility registers, patient files

Daily/Weekly/

Monthly

Weekly/Monthly Quarterly

1.8 PMTCT_STAT Percentage of pregnant women with

known HIV status at antenatal care (includes those who already knew their HIV status prior to ANC), disaggregated by HIV result

58,343 TBD 95% Numerator:

Number of pregnant women with known HIV status at antenatal care

(includes those who already knew their HIV status prior to

ANC).

eMTCT register, SmartCare

Daily/Weekly/

Monthly

Weekly/Monthly Quarterly

1.9 PMTCT_EID Number of infants born to HIV-

positive women who had a virologic

HIV test done within 12 months of birth

5,884 TBD 95% of infants born to

HIV-

positive women with a virologic HIV test done within 12 months of birth

Numerator:

Number of infants who had a virologic HIV test within 12 months of birth during the reporting period.

Facility registers, patient files

Daily/Weekly/

C.8.2 - Objective 2: Initiate 95 percent of those who tested positive on ART

PEPFAR Indicator Code

Indicator Name FY20 Year 1 LOP Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

2.1 TX_NEW Number of adults and children

newly enrolled on antiretroviral therapy (ART)

8,346

TBD Number of adults and children newly enrolled on antiretroviral therapy

(ART).

See MER guidance for additional information.

Facility ART registers, patient files or other databases

Daily/Weekly/ Monthly

Weekly/Monthly Quarterly

2.2 TX_CURR Number of adults and children

currently receiving antiretroviral therapy (ART)

112,383

TBD 95% of

PLHIV

in geograp hic focus region

Number of adults and children currently receiving antiretroviral therapy

(ART).

See MER guidance for additional information.

Daily/Weekly/

C.8.3 - Objective 3: Ensure that 95 percent of those on ART are virally suppressed

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information

Data source

Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

3.1 TX_PVLS Percentage of ART patients with a viral load

result documented in the medical record and/or laboratory information systems (LIS) within the past 12 months with a suppressed viral load

D:

116,472

N:

TBD

D:

TBD

95% Numerator: Number of ART patients with suppressed VL results (<1,000 copies/ml) documented in the medical or laboratory records/LIS within the past 12 months

Denominator: Number of

ART patients with a VL result documented in the medical or laboratory records/LIS within the past 12 months

See MER guidance for additional information.

Patient files, facility registe rs

Monthly Monthly Quarterly

C.8.4 Integrate voluntary family planning services into 95 percent of HIV service delivery locations

PEPFAR

Indicator

Code

Indicator Name FY20 Year 1 End of

Contract

Additional

Indicator

Information

Data source

Data

Collection

Frequency

USAID

Reporting

Frequency

DATIM

Reporting

Frequency

4.1 FPINT_SITE Number of HIV service delivery points

(SDP) at a site supported by PEPFAR that are providing integrated voluntary family planning (FP) services.

95% 95% 100% Number of facilities providing integrated FP services.

Program records

Quarterly Annually Annually

4.2 CUSTOM Number of new family planning users

identified at HIV service delivery points (ART clinics, ART corners, etc.) within sites supported by PEPFAR

N/A TBD TBD Disaggregation by: age-bands, method type and whether facility or outreach delivery mode required

Facility registers

Quarterly Annually N/A

C8.5 Provide cervical cancer screening services for WLHIV at HIV service delivery locations

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

5.1 CXCA_S

CRN

Percentage of HIV-positive women on ART screened for cervical cancer

10,523 TBD TBD Patient files, facility registers

Monthly Monthly Quarterly

5.2 CXCA_T

X

Percentage of cervical cancer screen-positive women who are

HIV-positive and on ART eligible for cryotherapy, thermocoagulation or LEEP who received cryotherapy, thermocoagulation or LEEP

All screened positive

All screened positive

All screened positive

C.8.6 Provide tuberculosis preventive treatment

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of

Contract

Additional Indicator

Information

Data source Data

Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

6.1 TB_STAT Percentage of new and

relapse TB cases with documented HIV status, disaggregated by HIV result

95% 100% 100% Numerator: Number of new and relapse TB cases with documented HIV status, during the reporting period.

Denominator: Total number of new and relapsed TB cases, during the reporting period.

See MER guidance for additional information.

Patient files and facility registers

Monthly Semi Annual Semi Annual

Code

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

6.2 TB_PREV The number of ART

patients who completed a standard course of TB preventive therapy within the semiannual reporting period

37,778 TBD TBD See MER guidance Facility registers, patient files

Monthly Semi Annual Semi Annual

6.3 TX_TB Proportion of ART

patients screened for TB in the semiannual reporting period who start TB treatment.

TBD TBD Numerator Number of ART patients who were started on TB treatment during the semiannual reporting period.

Denominator Number of ART patients who were screened for TB at least once during the semiannual reporting period.

Facility registers, patient files

Monthly Semi Annual Semi Annual

C.8.7 Strengthen M&E capacity at the facility, district and provincial levels for improved program management to achieve the overall objective of 95,95,95

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of

Contract

Additional Indicator

Information

Data source Data

Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

7.1 CUSTOM Percent of

TX_CURR patients reported in SmartCare

95% 98% TBD See MER guidance for age dissagregations, circumcision technique and additional information.

Facility registers, patient files

Monthly Quarterly Quarterly

7.2 CUSTOM Percent of USAID

supported facilities that hold quarterly data review meetings

90% 100% 100% Numerator: Number of USAID supported facilities conducting data review meetings

Denominator: Total number of MECH supported facilities

Minutes, program report

Quarterly Quarterly N/A

7.3 CUSTOM Percent of facility

staff trained in data management

100% 100% 100% Program records

Quarterly Quarterly N/A

C.8.8 Strengthen facility level commodity management to mitigate the risk of stock outs

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

8.1 CUSTOM Percent of facility level

staff trained in stock management

70% 100% 100% Program records Monthly Monthly N/A

8.2 CUSTOM Percent of facilities

reporting stock outs of key HIV commodities

70% >5% 0% eLMIS Monthly Monthly N/A

8.3 CUSTOM Percent of eligible

TX_CURR on 6 month MMD

70% 85% 100% Facility registers, patient files, pharmacy registers

Weekly Monthly N/A

8.4 CUSTOM Percent of TX_CURR

on TLD

39% 75% 85% If another ARV regimen replaces TLD as the preferred first line option the indicator will be updated to reflect the change.

Facility registers, patient files, pharmacy registers

Weekly Monthly N/A

C.8.9 Strengthen the public financial management systems of the Ministry of Health and Ministry of Finance to enable the efficient use of direct G2G funds from USAID.

PEPFAR

Indicator Code

Indicator Name FY20 Year 1 End of Contract

Additional Indicator Information

Data source Data Collection Frequency

USAID

Reporting Frequency

DATIM

Reporting Frequency

9.1 CUSTOM Percentage of

Provincial Risk Mitigation Plan Action Items that USAID is responsible for, are addressed within the plan year

N/A 100% TBD Numerator: Number of action items addressed Denominator: Total number of action items identified

Program reports

Monthly Annually N/A

9.2 CUSTOM Percentage of bank

reconciliations with employee signatures indicating bank statements reviewed

N/A 100% 100% Numerator: number of bank statements with employee signatures Denominator: Number of bank statements

Program reports

Monthly Quarterly N/A

9.3 CUSTOM Percentage of

procurements included in the annual procurement work plan

N/A 100% 100% Numerator: Total procured according to the planned procurement

Denominator: Total planned procurements

(The work plan is specific to G2G funds)

Program reports

Monthly Quarterly N/A

9.4 CUSTOM Percentage of MoH

employees receiving the correct DSA amount for trainings and meetings paid for through G2G funds (USAID program specific)

N/A 100% 100% Numerator: Number of

MoH staff

Denominator: receiving correct amount of DSA Number of MoH staff receiving DSA

Program reports

Monthly Quarterly N/A

9.5 CUSTOM Percentage of

equipment purchased using

G2G funds, tagged and tracked using MECH system and included in the correct MoH in asset register

N/A 100% 100% Numerator: Number of equipment bought with

G2G funds tagged, tracked using MECH system and asset register Denominator: Number of all equipment bought with

G2G funds

Program reports

Monthly Quarterly N/A

C.9 ADDITIONAL REQUIREMENTS

C.9.1 Coordination with Other Initiatives and Implementing Partners

Contractor must seek opportunities to partner with others working in geographical areas of operation and in the range of services and products supported by the Project. All Project activities support MOH to achieve its health objectives and are closely coordinated through

MOH.

Coordination with the Ministry of Health will happen at the National, Provincial, District and

Site levels. National level coordination will focus on updating technical guidelines and addressing specific bottlenecks in the regulatory and policy environments to allow optimal HIV service delivery at the site level, Provincial level coordination will include regular data meetings to assess progress and identify target areas of focus, District level coordination will also include regular data meetings to assess progress and identify target areas for focus and site level coordination will be the primary level for providing service delivery and technical assistance support.

Contractor must further coordinate with the USAID regional level staff in implementation of programs. MECH is further expected to clearly outline its partnerships with other implementing partners working in Zambia particularly in the regions of interest

C.9.2 Monitoring and Evaluation

As indicated in section C.7.5, MECH’s monitoring and evaluation system must generate data that meets USAID’s data quality standards: validity, reliability, integrity, precision and timeliness.

Data for indicators used for performance monitoring should be available at useful frequency, be current and be timely enough to influence management decision-making. Monitoring and

Evaluation is critical to measuring progress of this contract and all data generated must support program objectives as well as being sharable among key stakeholders in an aggregate form not containing personally identifiable information. All efforts will support building capacity in the health facilities of operation and will connect to other host government efforts and hence promote sustainability.

C.9.3 Gender

Gender refers to the socially constructed roles, behaviors, activities and attributes that a given society considers appropriate for men and women. USAID is committed to promoting gender equality and female empowerment, and seeks to improve the lives of citizens around the world by advancing equality between women and girls and men and boys and empowering women and girls to participate fully in and benefit from securing better lives for themselves, their families and their communities. Desired outcomes are: (i) reduction of gender disparities in access to, control over and benefits from resources, wealth, opportunities, and services – economic, social, political, and cultural; (ii) reduction of gender-based violence and mitigation of its harmful effects on individuals; and (iii) increased capability of women and girls to realize their rights, determine their life outcomes, and influence decision-making in households, communities, and societies.

The incidence and prevalence of HIV is higher among females than males in most settings. From biological, socio-cultural, violence against women, legislature, education, knowledge and skills, economic inclusion, and stigma and discrimination considerations, women and young girls are more predisposed and/or more susceptible to acquisition of HIV than males (UNAIDS, 2002). According to the 2016 Zambia Population-based HIV Impact Assessment, although the number of new infections has decreased significantly, HIV prevalence remains higher among women aged 15-49 (14.3%) than their male counterparts (8.3%). Higher prevalence is particularly striking among the age group of 20 - 24 years; who are four times more likely to be

HIV infected than young men (8.3 percent versus 2 percent) (ZAMPHIA, 2016).

Although young women are more likely to be infected with HIV, a higher proportion of HIV-positive women aged 15-59 know their HIV status (72.6%) compared to their male counterparts (69.2%) (ZAMPHIA, 2016). Women are more likely to interact with public health facilities and have more opportunities to access HIV testing services. A closer look at data indicates a significantly higher unmet need among men aged 25-39. Despite increased opportunities to test for HIV and a higher likelihood to accept HIV testing among women, linkage to treatment, according to routinely collected data across the PEPFAR program in

Zambia in 2019, remains suboptimal among both males and females aged 15-29.

Once initiated on ART, a higher proportion of women aged 20-29 are more likely to not be retained after 12 months on treatment. Retention is especially poor among adolescent girls and young women, with only 69% of AGYW aged 15-19 retained on treatment after 12 months.

Short term retention is equally poor among this target population, with younger patients being less likely to return for their second pharmacy pick-up within 30 days (PEPFAR Zambia data

2018).

Although significant progress has been made in improving coverage of viral load testing in

Zambia, viral suppression is highest among older adults, with 73.0% of females and 73.3% of…