RFI -72049722RFI00001 - New TB Activity in Indonesia.pdf

REQUEST FOR INFORMATION (RFI)

RFI NUMBER: 72049722RFI00001

ISSUANCE DATE: July 29, 2022

RESPONSE DUE DATE & TIME: August 29, 2022; 15:00 Jakarta Time

RESPONSE EMAIL ADDRESS: proposals-indonesia@usaid.gov

PROJECT TITLE: Accelerating Elimination of Tuberculosis in Indonesia

The United States Agency for International Development Mission in Indonesia (USAID/Indonesia) posts this Request for Information (RFI) to inform interested parties of an upcoming tuberculosis activity designed to help Indonesia accelerate achievement toward 2030 tuberculosis (TB) elimination targets.

This RFI seeks information from capable organizations (i.e., nongovernmental organizations, universities, consortium, for-profit, and local organizations) that are implementing or have implemented TB projects/health programs and may be interested to partner with USAID in achieving the goals of this future TB activity. All capable organizations are encouraged to respond.

If USAID/Indonesia decides to proceed with the solicitation or funding opportunity, then one or more activities with an overall investment estimated up to $80 million for a period of five years are anticipated, subject to the availability of funds.

This is not a Request for Proposals (RFP) or Request For Application (RFA) and is not to be construed as a commitment by the U.S Government to issue any solicitation or ultimately make one or multiple awards on the basis of this RFI, or to pay for any cost incurred in the preparation and submission of comments on this RFI. If USAID/Indonesia issues a solicitation or funding opportunity, it will be posted on www.sam.gov or at www.grants.gov.

It is the potential offeror’s responsibility to monitor these sites. Responding to this RFI will not provide any advantage to or preclude any firm or organization if USAID issues a subsequent RFP or RFA.

Information received in response to this RFI will become the property of USAID. All proprietary information should be marked as such. Please note that respondents that provide submissions in response to this RFI will not be notified of the results of the review.

USAID/Indonesia will not provide individualized feedback in response to any submitted

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

U.S. Embassy Jakarta Jl. Medan Merdeka Selatan 3-5 Jakarta 10110, Indonesia USAID.gov mailto:proposals-indonesia@usaid.gov http://www.sam.gov http://www.grants.gov information. No basis for claims against the U.S. Government shall arise as a result of a response to this RFI or from the Government’s use of such information.

All responses must be submitted via email to proposals-indonesia@usaid.gov, with copies to ychristanti@usaid.gov with a subject line: "Response to 72049722RFI00001," no later than the date and time shown above.

We appreciate your contribution and look forward to receiving your comments.

Sincerely, Ross Barnard Contracting and Agreement Officer

USAID/Indonesia

Attachments:

Attachment I. Questions for Response

Attachment II. Activity Description mailto:proposals-indonesia@usaid.gov mailto:ychristanti@usaid.gov

ATTACHMENT I: QUESTIONS FOR RESPONSE

SECTION I: RESPONSE REQUIREMENTS

USAID/Indonesia seeks to collect feedback on the following questions in relation to the Activity Description (Attachment II). When preparing your response to the following questions, please ensure comments are concise and specific to the question asked. Please do not submit requests for funding or proposals/applications in response to this request.

A. Response format:

1. Cover page: not to exceed one (1) page, that includes

a. Organization name and address, including point of contact name and contact information;

b. Organization type (e.g., non-governmental organization, social enterprise, civil society organization, U.S. small business, local organization );1

c. Please state whether you are a local Indonesian organization or international organization;

d. Legal registration status in Indonesia;

e. Unique Entity Identifier (if applicable);

f. Please briefly describe your technical expertise in working in health or specifically tuberculosis programs.

2. Questions and comments on the Draft Activity Description

Comments and responses to the following questions on the draft Activity Description (Attachment II), not to exceed five (5) pages. Please keep in mind that the activity will focus on accelerating achievement toward 2030 TB elimination targets.2

1. How would you prioritize the three proposed activity objectives? Please assign a weight for each objective ranging from 0-100% and describe your reasoning for assigning these weights. In addition, please indicate which of these areas are already receiving sufficient or considerable support and describe the level (whether national or subnational) at which you would prioritize the objectives.

2. What is missing in the activity description that needs to be addressed to accelerate progress towards TB elimination?

3. What innovative solutions might address the gaps you identified in the activity description that are missing in Indonesia’s TB control program? Please provide evidence to show the potential impact of this innovation.

4. What stakeholders should a USAID program work with at the national and subnational levels and how should USAID collaborate with those stakeholders?

2 “The End TB Strategy.” World Health Organization, World Health Organization, 2015, https://apps.who.int/iris/handle/10665/331326.

1 USAID defines a “local entity” as an individual, corporation, a nonprofit organization, or another body of persons that: (1). Is legally organized under the laws of; and (2). Has as its principal place of business or operations in; and (3) Is majority owned by individuals who are citizens or lawful permanent residents of; and

(4) Is managed by a governing body of the majority of who are citizens or lawful permanent residents of the country receiving assistance.

5. Please share any other comments or inputs you may have on the program/activity description.

B. Submission Instructions:

Please send responses to this RFI via email to the addresses listed on the cover page by the closing date listed. Please keep your responses to no more than six (6) pages in length, 12 pt, Times New Roman font.

USAID values concise, issue-specific comments. Any pages beyond the six requested may not be reviewed. Responses must be submitted in English or Bahasa Indonesia.

Please number each page consecutively and please relate your responses to each question included in Section I of this RFI.

Please be reminded that you will only receive an electronic confirmation acknowledging receipt of your response. No feedback or debrief will be provided on comments received. Phone calls or hard copy responses will not be accepted.

SECTION II: ELIGIBILITY

We are reaching out to all stakeholders and interested parties, including but not limited to public and private health service providers, industry associations, faith-based organizations, private corporations, academia, non-governmental organizations (both international and local), and community and civil society groups to obtain their comments/suggestions.

ATTACHMENT II: ACTIVITY DESCRIPTION

I. Background and Context

While Indonesia has made progress over the past decade toward reducing TB incidence and increasing treatment success rates, significant challenges to eliminating TB remain and have been worsened by the COVID-19 pandemic. During the pandemic, Indonesia reprioritized TB budgets, personnel, hospitals, and equipment to rapidly respond to COVID-19. As a result, progress on key TB indicators declined and Indonesia continues to grapple with the third highest burden of TB and the fifth highest burden of multidrug-resistant TB (MDR-TB). In 2020, an estimated 824,000 people fell ill with TB in Indonesia and more3 than 250 people died every day from the disease. Additionally, case notifications (the4 number of cases identified and reported) declined by 40% in 2020 compared to the prior year with only about half of TB cases notified. Consequently, many TB patients remained either5 undiagnosed or diagnosed but not notified to the National Tuberculosis Program (NTP) making it harder to find and treat TB cases. Of the new cases diagnosed and started on care, 83 percent were successfully treated. However, in 2020, an estimated 24,000 patients still6 developed drug resistant TB (DR-TB)/MDR-TB, but only roughly one-third (7,921) of cases were diagnosed and only 66 percent of those cases were initiated on treatment. Meaning that7 drug resistant TB strains which require longer treatment regimens and are more expensive to treat are still spreading in Indonesia.

However, even prior to COVID-19, progress towards decreasing Indonesia’s TB burden remained stagnant despite strong political commitment at the national level to address the TB epidemic. In the first UN high-level meeting on TB held in 2018, Indonesia reaffirmed the sustainable development goal (SDG) target to reduce the death rate from tuberculosis by 90% and reduce the incidence rate of tuberculosis by up to 80% by 2030. Additionally, Indonesia pledged support for global targets to treat 40 million people for TB and administer TB preventive treatment (TPT) to 30 million people by 2022. With political will, came increases in domestic funding for TB, which more than doubled from 53 million in 2017 to 109 million in 2019. Furthermore, the National Tuberculosis Program (NTP) housed within the Ministry8 of Health (MOH), made coordinated efforts to increase distribution of GeneXpert machines to improve TB diagnosis, developed a TB Information System to improve TB recording and reporting, and standardized procedures and policies for TB programs at the national level.

However, despite these efforts, even prior to the pandemic, Indonesia was not on track to achieve 2022 or 2030 TB targets and the disruptions in TB care caused by COVID-19 only worsened the TB situation.

8 “The Republic of Indonesia Joint External Monitoring Mission for Tuberculosis (JEMM), January

20-31,2020” (WHO, 2020), 4.

7 World Health Organization: Diagnosis, notification, and treatment of Rifampicin-Resistant TB (MDR-TB/RR-TB).

https://app.powerbi.com/view?r=eyJrIjoiZDhjNDM0YmMtOGExOS00ODIxLWEzMjktZDk0NmI4YTAwODgwIiwidCI6ImY2MTBjMGI3 LWJkMjQtNGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9

6 Ibid.

5 World Health Organization, Tuberculosis Profile: Indonesia , 2020.

https://worldhealthorg.shinyapps.io/tb_profiles/?_inputs_&entity_type=%22country%22&lan=%22EN%22&iso2=%22ID%22

4 World Health Organization, Tuberculosis Profile: Indonesia , 2020.

https://worldhealthorg.shinyapps.io/tb_profiles/?_inputs_&entity_type=%22country%22&lan=%22EN%22&iso2=%22ID%22

3 World Health Organization Global lists of high burden countries for Tuberculosis (TB), TB/HIV, and Multidrug/Rifampicin Resistant TB

(MDR-TB/RR-TB), 2021-2025,

2021.https://cdn.who.int/media/docs/default-source/hq-tuberculosis/who_globalhbcliststb_2021-2025_backgrounddocument.pdf?sfvrsn= f6b854c2_9

To regain lost ground on TB, President Jokowi issued a decree to establish a multi-sectoral response to accelerate achievement of the 2030 TB elimination targets as current efforts are insufficient to achieve TB elimination.9

II. Problem Statement

More than 800,000 people continue to fall ill with TB in Indonesia every year and with the COVID-19 pandemic TB notifications, treatment outcomes, and TPT uptake have declined.

Without concerted and collaborative efforts to accelerate the detection, treatment, and prevention of TB cases, Indonesia may not achieve its TB elimination targets by 2030.

Building off the momentum from World TB Day and G-20 TB side event where Indonesia re-emphasized commitment to eliminating TB, USAID seeks innovative and comprehensive solutions and strategies to collaboratively reverse declines in TB control caused by COVID-19 and accelerate progress towards 2030 TB elimination targets in Indonesia.

III. Development Hypothesis (Theory of Change):

IF access to quality, integrated and patient-centered care is increased; promotion, prevention, and delivery of TPT is optimized; and service delivery platforms are strengthened THEN the overall quality of TB detection, prevention, and treatment in Indonesia will improve, resulting in reduced TB incidence and deaths .

IV. Goal and Objectives:

USAID intends to assist Indonesia in accelerating achievement toward its 2030 TB elimination targets by improving the quality of TB prevention, care, and treatment for all TB patients. To achieve this goal, USAID will pursue three main objectives in line with the U.S.

Government Global TB strategy 2015-2019 and the National Tuberculosis Strategy for Tuberculosis Care and Prevention in Indonesia 2020-2024:10

Objective 1. Increased access to quality, integrated and patient-centered TB care

Objective 2. Optimized TB Preventive Therapy (TPT) and prevention of disease progression

Objective 3. Strengthened TB service delivery platforms

V. Relationship to Mission CDCS and ICS

This Activity is aligned with USAID/Indonesia’s Country Development Cooperation Strategy (CDCS) 2020 - 2025 . The Activity falls under Development Objective (DO) 4 and also11 aligns with the Government of Indonesia (GOI) priorities in tackling the TB epidemic in Indonesia and moving forward achieving the End TB goal in 2030. DO4 prioritizes increasing adoption of recognized best practices to improve treatment coverage and quality of care for Indonesia’s priority health areas, including TB, HIV/AIDS, and high rates of maternal and newborn mortality. USAID’s partnership with the GOI in controlling infectious

11USAID/Indonesia 2020-2025 CDCS: https://www.usaid.gov/indonesia/cdcs 10 United States Government Global Tuberculosis Strategy, 2015-2019.

9 To Realize The Elimination Of Tuberculosis 2030, Jokowi Issues Presidential Regulation On TB Control.

https://voi.id/en/news/77813/to-realize-the-elimination-of-tuberculosis-2030-jokowi-issues-presidential-regulati on-on-tb-control diseases reflects Indonesia’s commitment to improving and protecting the health of Indonesians, the region and the world. This Activity intends to strengthen Indonesia’s capacity to prevent a larger TB epidemic and build the country’s aspiration to be self-reliant in the fight against TB. It also focuses on engaging and expanding Indonesia’s commitment and adherence to international standards of care and disease control, and strengthening its capacity for prevention, surveillance, and treatment of infectious diseases.

VI. Activity Description

Objective 1. Increased access to quality, integrated, and patient-centered TB care

I.R 1.1 Prompt TB detection and treatment

Universal access to early TB detection and care is essential to slow down the spread of TB, reduce deaths from TB, and prevent adverse consequences from the disease. The Activity will assist the NTP in addressing long delays in TB diagnosis and improve appropriate treatment of people with limited access to TB services, including those who are suffering from TB without the typical symptoms. This activity should ensure health facilities have access to novel TB diagnostic technology, new TB drugs or regimens, or other effective diagnostic platforms while also strengthening the capacity of public and private health care providers to accurately diagnose and treat TB cases under the national strategy. The Activity will build upon lessons learned from past and ongoing USAID investments in the TB program in Indonesia, such as bidirectional screening of TB and COVID-19 in healthcare settings and integration of patient-care support in TB care management, optimization of TB diagnostics and specimens transportation, private sector engagement, and TB-HIV collaboration. Most importantly, the activity will: build upon national TB program priorities;

support the NTP in addressing systemic challenges with detecting TB among children (especially child contacts of adult TB patients); and promote mechanisms that improve adherence to treatment.

IR 1.2 TB diagnostic network strengthened

Rapid and accurate diagnosis of TB requires ensuring diagnostic networks have reliable access to highly sensitive diagnostic tools, such as the GeneXpert test or other nucleic acid amplification tests (NAATs). However, the conventional method for TB detection using the microscopy test remains extensively used in Indonesia despite it being less effective in accurately diagnosing the disease. This is due to the low cost of performing microscopy tests and their greater availability which contributes to suboptimal use of GeneXpert machines.

The Activity will assist in closing the gaps of finding undetected/undiagnosed TB cases by promoting proper TB diagnosis algorithms using rapid molecular tests/GeneXperts to increase TB notifications. The activity should primarily improve access to GeneXperts in Indonesia’s TB laboratories and diagnostics networks and promote the introduction of new diagnostic platforms that are easily available and affordable for TB patients. The Activity should also establish or improve specimen transport for GeneXpert testing, ensure there are laboratory quality assurance systems at all levels, and link diagnosis and treatment by expanding real-time monitoring of GeneXpert systems.

IR 1.3 Patient-centered care and treatment improved

As there are multiple factors influencing the TB epidemic, there is an increased need to apply a patient-centered model to achieve universal access to quality TB care for all. This Activity will support incorporation of social support for TB patients into health facility-based TB care.

This would include integrating patient support mechanisms into TB care management to support treatment completion, management of adverse drug reactions, and prevent treatment interruption which leads to development of drug resistant TB. The Activity will adopt and leverage learnings derived from USAID investments in integrating community-based DR-TB support into clinical-centered care, and explore opportunities to expand the model to public health systems and other non-governmental health care settings. Additionally, to ensure continuity of care for TB patients with comorbidities, the activity will assist in pursuing joint collaboration between TB and other diseases/health issues, e.g., HIV and MNH, to build an integrated model of care.

The End TB strategy highlights the fundamental need to ensure early diagnosis and treatment of patients with effective and uninterrupted anti-TB drugs. However, due to the pandemic, finding cases, enrolling them in treatment, and successfully curing their TB declined by nearly 50%. This is clear evidence that TB screening and diagnosis alone are insufficient to stop the spread of the disease without also linking patients to high quality treatment and support. Therefore, in addition to interventions under IR 1, this Activity will also ensure prompt and appropriate treatment for all persons with any form of TB, especially persons with DR-TB and MDR-TB. The Activity will assist the NTP to increase public and private health providers’ capacity to manage resistant TB through continued training and education, alignment of TB care practices with international standards, expansion of shorter DR-TB regimens, enhancement of clinical management of adverse drug reactions during treatment, and promotion of standard tools to monitor the quality of DR-TB case management.

IR.1.4 Enabling environment to allow a holistic approach for TB control created

Implementing TB control activities to meet the needs of diverse communities at risk requires execution of strategic interventions that take into account major barriers to rapid adoption of the global and national TB strategies, development and implementation of evidence-informed policy, bolder multi-sectoral commitment in TB prevention and care, service uptake by the community’s at greater risk of TB, and social inclusion in TB case management. The Activity should ensure such barriers will not be left unaddressed to improve effectiveness and efficiency, accessibility, quality and equal coverage of TB care and treatment. The activity should also support prioritization of TB and domestic resource mobilization, adoption of more effective payment mechanisms for TB services, and contributions to ongoing efforts to overcome the lack of human resources to implement the TB control program in Indonesia.

In alignment with Presidential decree no 67/2021, this Activity will support the GOI’s efforts in strengthening the inter ministerial and non-government actors’s commitment and participation in TB elimination, including (but not limited to) ensuring the establishment and functioning of multi-stakeholders partnership forum at the national and subnational levels for better coordination, collaboration and evaluation of TB control program.

Objective 2. Optimized TB Preventive Therapy (TPT) and prevention of disease progression

IR. 2.1 TPT coverage expanded

The Activity will expand uptake of the new TPT shorter regimen which has stronger evidence of effectiveness and improved completion rates. The Activity will effectively scale-up TPT in robust collaboration with another USAID activity, LON TPT, to increase demand for TPT through a behavior change communication intervention.

IR 2.2 Management of Latent TB Infection strengthened

As a licensed and highly efficacious vaccine to protect people from TB infection is not yet available, this activity will primarily support the NTP in improving early diagnosis of TB and reducing the risk of latent TB infection from progressing to active TB. Effective management of Latent TB Infection (LBTI) should be the cornerstone of this strategy along with contact investigation, targeted screening of people who are at high risk for developing TB in the community, and other settings such as workplaces, prisons, and religious boarding schools to address the underlying clinical and risk factors for TB progression.

IR 2.3 Infection control at health facilities strengthened

The Activity will help the national TB program ensure appropriate infection prevention and control policies are enforced in health care facilities and other settings where the risk of transmission is high. This would include enforcement of the standardized infection control policy in managerial, administrative, environmental and personal measures, and facility construction related to TB management.

Objective 3. Strengthened TB service delivery platforms

IR. 3.1 Improved surveillance, monitoring and evaluation

This Activity will improve systems to track TB disease burden and strengthen TB notification and vital registration systems. This includes strengthening of real-time surveillance by improving the quality of data entry, validation, quality assurance, and utilization of information to inform policy and develop strategies for action on TB. The Activity should support transitioning of SITB into the national health information system under the digital transformation agenda. At the national level, the activity needs to collaborate with DTO/Pusdatin. At the sub-national level, the District Health Office (DHO) TB staff should be empowered to effectively use surveillance data to inform action and policy for management of TB at the district level

IR 3.2 Improved drug and commodity management

Successful TB management requires strengthening of the entire health system to ensure uninterrupted supply of quality assured TB drugs and commodities to TB patients whenever they are needed. For this, the availability of a strong system in forecasting, procurement, supply chains of TB drugs and commodities is pivotal. This Activity will contribute to the

NTP's continued effort in improving the TB supply and chain management system that allows reliable forecasting methods, drug quality assurance, timely distribution of drugs and commodities, and prevention of overstocking and drug stock outs.

IR. 3.3 Improved human resources

The Activity will provide technical support to the NTP and district and provincial levels to improve the capacity of TB human resources and propose innovative solutions to address the lack of dedicated human resources at all levels for the TB program. As current training models may not cope with training needs, the Activity should provide options for feasible training programs for TB staff.

IR 3.4 Accelerated programmatic innovations and research

The Activity will promote stronger collaboration between the national TB research network, namely JETSET TB, and national TB stakeholders in translating the evidence generated by their members into policies that align with TB program priorities.

VII. Geographic focus

The proposed geographic locations for this activity are based on the highest TB burden provinces and prioritized within the eight priority provinces under USAID’s Country Development Cooperation Strategy (CDCS) 2020-2025. The Activity will work in at least 50% of the districts in North Sumatra, Banten, DKI Jakarta, West Java, Central Java, East Java, and South Sulawesi provinces. The Activity will finalize the geographic locations based on available and upcoming data on TB burden, and in consultations with USAID, MOH and subnational governments (including PHOs and DHOs).