RFI_Namibia_VMMC-signed.pdf

Subject: Request for Information for USAID/Namibia Scaling up Access For Expanded Voluntary Medical Male Circumcision (VMMC) Services

(SAFE) (RFI-673-18-00002)

Issuance Date: May 7, 2018

Closing Date: May 23, 2018

Closing Time: 16:00 South Africa time

USAID/Southern Africa and USAID/Namibia have developed a Request for Information (RFI) for the purpose of providing industry and stakeholders an opportunity to review, comment and provide suggestions for improvement or clarification. The RFI may lead to a formal solicitation or notice of funding opportunity for potential offerors.

BACKGROUND

USAID/Namibia’s voluntary medical male circumcision activity (VMMC), working in close partnership with the Namibian Ministry of Health and Social Services, is anticipated to transition during U.S. fiscal year 2019 to a mechanism identified through competitive procedures. As a result USAID/Namibia seeks stakeholder input on activity design with the goal of aggressively scaling-up to saturation voluntary medical male circumcision in Khomas and Oshikoto regions of Namibia to 80 percent among males aged 10 - 29 years of age by the end of 2021. Achievement of Fast Track targets will result in averted HIV infections. VMMC, delivered in combination with other HIV prevention interventions and linked to HIV treatment will contribute to HIV epidemic control. A draft results framework and activity components description is provided for review and clarification prior to issuance of a solicitation or notice of funding opportunity. At this time USAID has not selected a type of obligating instrument for the anticipated activity.

USAID is currently considering restricted eligibility to local Namibian organizations as prime recipients/contractors with substantial involvement of U.S.-based subrecipients/subcontractors to a threshold of 20 percent of the value of the award to provide specialized technical support in the areas of quality management and U.S. Government administration and compliance. Feedback provided to this RFI will be utilized in the finalization of the activity design.

FAR 52.215-3 REQUEST FOR INFORMATION OR SOLICITATION FOR PLANNING

PURPOSES (OCT 1997)

(a) The Government does not intend to award a contract on the basis of this solicitation or to otherwise pay for the information solicited except as an allowable cost under other

RFI-673-18-00002

contracts as provided in subsection 31.205-18, Bid and proposal costs, of the Federal Acquisition Regulation.

(b) Although “proposal” and “offeror” are used in this Request for Information, your response will be treated as information only. It shall not be used as a proposal.

(c) This solicitation is issued for the purpose of obtaining information from interested parties regarding the design process of an anticipated upcoming activity to expand access to high quality lifelong biomedical intervention that will avert new HIV infections among young boys and men. (see details below).

(End of provision)

DISCLAIMER

This is a Request for Information (RFI) only. It is not a Request for Proposal, a Request for Quotation, an Invitation for Bids, a Solicitation, nor is it an indication that USAID/Southern Africa or USAID/Namibia will contract for the items contained in this Notice. This RFI is an opportunity for USAID/Southern Africa and USAID/Namibia to obtain information from interested parties regarding the anticipated activities. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the U.S. Government to form a binding contract. Responses to this RFI are strictly voluntary and USAID will not pay respondents for information provided in response to this RFI. Responses to this RFI will not be returned and respondents will not be notified of the result of the review. If a Solicitation or Notice of Funding Opportunity is issued, it will be announced on the Federal Business Opportunities website http://www.fbo.gov or https://www.grants.gov, as applicable, at a later date, and all interested parties must respond to that Solicitation or Notice of Funding Opportunity announcement separately from any response to this announcement. This RFI does not restrict the Government’s acquisition approach on a future Solicitation or Notice of Funding Opportunity.

INSTRUCTIONS

Responses (comments, suggestions, and enhancements) to this RFI are due to the procurement office identified below by 16:00hrs (South Africa time); May 23, 2018. USAID seeks responses relating to the following:

• DRAFT Results Framework and Activity Components Description for USAID/Namibia Scaling up Access For Expanded Voluntary Medical Male Circumcision (VMMC) Services (SAFE);

• Other feedback on design of the activity; and

• Brief capability statements (not to exceed two pages) from interested organizations.

Responders shall provide one (1) electronic copy of their response; electronic submissions, in Microsoft Word or Adobe Acrobat formats are acceptable. Please e-mail responses to Nathan Piper at npiper@usaid.gov. Please reference the e-mail with the subject title “Response to RFI- 673-18-00002”.

Thank you for your interest in USAID’s activities.

Sincerely, Elizabeth Colarik Regional Contracting/Agreement Officer

Attachment 1: DRAFT Results Framework and Activity Components Description for USAID/Namibia Scaling up Access For Expanded Voluntary Medical Male Circumcision (VMMC) Services (SAFE)

ATTACHMENT 1: DRAFT RESULTS FRAMEWORK AND ACTIVITY COMPONENTS

DESCRIPTION

Acronyms ART Antiretroviral Therapy ARV Antiretroviral services CHW Community health worker CDC US Centers for Disease Control and Prevention CQI Continuous quality improvement DHIS District Health Information System DMMPT Decision Makers’ Program Planning Tool Version EIMC Early infant medical circumcision EQA External quality assurance GRN Government of the Republic of Namibia HCW Health care worker HIV Human immunodeficiency virus HRH Human resources for health HTS HIV testing services LIP Local implementation partner LTC Linkage to Care and Treatment MOHSS Ministry of Health and Social Services MGECW Ministry of Gender Equality and Child Welfare NSF National Strategic Framework for HIV and AIDS PEPFAR President’s Emergency Plan for AIDS Relief PLHIV Persons Living with HIV PIR Performance Indicator Reference PITC Provider-initiated HIV counseling and testing OTH Online training hub OVC Orphans and vulnerable children SAFE Scaling up access for expanded voluntary medical male circumcision SC/SU Site capacity - Site utilization STI Sexually transmitted infections TGF The Global Fund for AIDS, Tuberculosis and Malaria VMMC Voluntary medical male circumcision USAID US Agency for International Development WHO World Health Organization

I. INTRODUCTION

The purpose of the USAID – Scaling up Access For Expanded Voluntary Medical Male circumcision VMMC Services (SAFE) activity is to expand access to high quality lifelong biomedical intervention that will avert new HIV infections among young boys and men. Through this activity USAID intends to support the Ministry of Health and Social Services and the private health sector deliver high quality safe medical male circumcisions.

SAFE will provide technical support towards site-level and above-site interventions including technical leadership, service delivery, in-service training, quality management, policy and guidelines revision, domestic resource mobilization, communications and social mobilization, monitoring and evaluation for accelerated scale up of voluntary medical male circumcision delivered in combination with other HIV prevention interventions. It is envisioned that communities will be engaged and empowered through routine advocacy, demand creation and social mobilization for male circumcision.

II. ACTIVITY BACKGROUND

A. Country Context Namibia is a sparsely populated desert country of 2.46 million people (World Bank, 2015) with an area of 823,290 sq km. Most people are settled in small urban areas scattered throughout the country.

Namibia is classified as an upper-middle income country with a gross national income (GNI) per capita of USD (US Dollars) 5,190 (World Bank, 2015). Namibia’s Gini coefficient is 0.5971, the seventh-highest in the world (CIA Factbook 2010). According to a 2012 assessment of poverty dynamics in Namibia, approximately 29% of people in Namibia are poor (living on less than NAD (Namibian Dollars) 30/day) and more than 15% are severely poor (living on less than NAD 22/day). Unemployment was estimated at 28.1% in 2014 (CIA Fact Book 2014).

Namibia has a generalized HIV epidemic, with 13.3% of the 15-49 year old population living with HIV (2016 Spectrum Model). It is estimated that HIV will remain the leading cause of death among adults and sixth-leading cause among children under 5 years of age (MOHSS Child Survival Strategy, 2014).

Among adults (>25 years of age), women bear a disproportionate burden of the HIV epidemic, with a prevalence of 19.8% compared to 14.9% for men. Although limited data is available on sex specific positivity rates among children, an estimated 1.2% of children under 15 years of age are HIV positive (HIV+). According to the 2016 Spectrum Model, the highest proportion of estimated new infections is among women ages 15-24, who are estimated to account for 21% of new infections. Men 15-24 years old are estimated to account for 12% of the new infections (2016 Spectrum Model).

Namibia implements the Treat All approach for all PLHIV. Since ART was introduced in 2003, the number of PLHIV on ART has increased annually, rising from 75,681 in 2010 to 184,465 in 2017. The majority of Namibians receive ART from the public sector. However, according to the Ministry of Health and Social Services (MOHSS), a small number of PLHIV (18500 in 2017) receive ART from a network of well-developed private, for-profit sector. With an increasing coverage of ART among PLHIV it is expected Namibia will be moving rapidly towards universal access to all and epidemic control.

B. Namibia VMMC Program

The Government of the Republic of Namibia (GRN) has made remarkable progress towards scaling up VMMC services as a prevention intervention among healthy HIV negative men. VMMC is included in the five year National Strategic Framework for HIV and AIDS (2017-2022) and the Combination HIV Prevention Guidelines 2017 as an important component of the overall Prevention strategy. A national policy has also been developed to guide implementation of VMMC programs in the Country. Namibia’s national policy for VMMC provides guidance on national scale up plan using a nurse led approach. This is in recognition of the human resource challenges that exist.

Despite this progress, VMMC coverage remains low in Namibia. Based on the recent data, the population based self-reported circumcision rate is 25.5% among all ages (NDHS, 2013). This is significantly less than the recommended 80% target required to achieve public health impact on epidemic control. By the end of 2017 VMMC coverage among men aged 15-29 was only about 35%. The highest coverages for VMMC are recorded in Zambezi (50%), Kunene (49%), Oshana (47%), Khomas (45%) and Erongo (44%) regions. Kunene and Omaheke reports the practice of traditional circumcision. The MOHSS utilized the DMMPT2.0 model to project circumcision coverage among priority populations disaggregated by region as an input to VMMC planning. The table below provides information per region on expected circumcision coverage by the end of 2018 and 2019 if current MOHSS and PEPFAR assistance achieves VMMC targets.

VMMC coverage end of 2018 Estimated VMMC coverage end of 2019)

SNU EIMC 15-29 10-29 EIMC 15-29 10-29

National 0% 35% 33% 0% 47% 41%

Erongo 0% 44% 39% 0% 65% 54%

Hardap 0% 14% 12% 0% 14% 12%

Karas 0% 21% 19% 0% 33% 28%

Kavango 0% 39% 35% 0% 39% 35%

Khomas 0% 45% 44% 0% 77% 66%

Kunene 0% 49% 44% 0% 49% 44%

Ohangwena 0% 20% 18% 0% 34% 28%

Omaheke 0% 46% 42% 0% 46% 42%

Omusati 0% 22% 22% 0% 23% 22%

Oshana 0% 47% 46% 0% 69% 60%

Oshikoto 0% 19% 17% 0% 19% 17%

Otjozondjupa 0% 39% 35% 0% 39% 35%

Zambezi 0% 50% 50% 0% 75% 66% Source: DMPPT.2 2018 Modeling

Namibia’s VMMC program is a mixed model of public and private sector led approaches. In Windhoek, where there is a well-developed network of private sector health facilities, the VMMC program is supported through private clinics which work closely with the MOHSS. Program scales up in the regions are support through existing health facilities. Overall it is estimated that the country has circumcised about 126,503 young men aged 15-29 years. To expand VMMC services to Namibians the MOHSS collaborates with the key development partners; TGF and PEPFAR for support. Funding from TGF has been reduced significantly in 2017 resulting in an overall low number of circumcisions being provided to the clients.

Under the current USAID VMMC activity, a consortium of US-based implementing partners including JSI and Abt Associates provided targeted assistance to private for-profit health providers and the public sector in Khomas to increase access to and affordability of VMMC. Through this mechanism private providers are identified, trained and equipped to provide MC services to insured clients. CDC provides assistances through ITECH and Jhpiego who work through public facilities to offer high quality circumcision.

Program quality is addressed through strict adherence to WHO/PEPFAR and Namibia standards. Namibia prohibits the use of dorsal slit technique of circumcision in boys under the age of 15 and those with immature penile anatomy. In 2017 the USAID activity experienced severe adverse events that were not reported and resulted in a temporary suspension. The MOHSS, USAID, and JSI conducted oversight and quality control interventions at private-sector clinics participating in the program. In addition, the MOHSS, in collaboration with all partners, conducted two external quality assurance interventions to encompass the private sector and the public sector. The findings from these activities form the basis of continuous quality improvement activities and informed program implementation of future scale up plan and well as quality assurance.

B. PEPFAR and USAID VMMC Assistance To reach men with HIV prevention services, PEPFAR Namibia supports the MOHSS to increase coverage and uptake of VMMC services in priority districts. As a result of PEPFAR support to the MOHSS, national VMMC coverage among young men aged 15-29 years old increased 20% between 2016 and 2017 (29%-35%). By the end of FY18, the national VMMC coverage among males 15-29 years old (the priority age group) is expected to be 47%. The greatest increase in coverage is expected to be achieved in MOHSS priority districts where PEPFAR assistance is focused. Health districts include Windhoek (Khomas region 77%), Katima Mulilo (Zambezi Region 75%), Oshakati (Oshana region 69%), Swakopmund and Walvis Bay (Erongo region 65%) (DMPPT Version 2.0, 2018).

To improve national VMMC coverage, PEPFAR Namibia will support the MOHSS to expand VMMC services to districts that were previously supported by TGF. These include districts in Oshakati, Engela, Omuthiya, Onandjokwe, and Tsumeb. PEPFAR Namibia will support nurses, clinical officers and data clerks to expand VMMC programs in these districts. PEPFAR assistance is targeted to achieve 17,414 circumcisions by the end of FY19 in these districts. PEPFAR Namibia’s expansion of VMMC services in the highlighted districts will fill the gaps as a result of TGF grant expiry. The expansion of VMMC into districts in Oshikoto complement DREAMS activities (HIV prevention) planned for these districts.

Through PEPFAR, USAID assisted the MOHSS scale up VMMC through a public private mix model.

Through this approach, USAID harnessed and standardized surgical and safety procedures conducted by private doctors to offer VMMC services through a direct subsidy in addition to the above-site assistance to mobilize private medical insurers. As a result a medical circumcision for HIV prevention is covered under private insurance benefits including for civil servants and soldiers in the military. This model has greatly been successful in scaling up VMMC services in Windhoek where there is an existing network of private providers of health services. Current USG subsidy to clinic, which pays for a minimum package of circumcision services under local anesthetic is NAD1500 ($125) whereas the national medical tariff paid by insurers is NAD2500 ($208) however there is room for further technical efficiencies to the direct subsidy costs and to utilization of the public sector to address demand. USAID has donated disposable surgical kits valued at $12-14 per procedure to clinics to further standardize training procedures, practices and quality control interventions. The activity resulted in 21,250 males receiving circumcision over a three year period in Khomas to December 2017. Furthermore, the partnership between the private sector medical personnel in Khomas and the MOHSS alleviated an HRH shortages and congested sites as a result of HIV testing and treatment expansion.

USAID recently expanded support to a public private mix model in Oshikoto region however there is a lower density of private sector medical personnel. The provision of technical assistance in Onandjokwe, Omuthiya and Tsumeb is at its nascent stages but the VMMC demand at sites reflects a need to rapidly scale-up VMMC services in that region using a public private mix.

III. ACTIVITY OBJECTIVE

The primary goal of the USAID SAFE activity is to increase access to quality VMMC services for youth and adult men in the Khomas region (Windhoek health district) and Oshikoto region (Onandjokwe, Omuthiya and Tsumeb) with the aim of achieving 80% coverage of VMMC services. Specifically the program will rapidly scale up VMMC services to saturation targeting males aged 10-29 years in line with the national strategy.

Accelerating scale-up entails expanding the number of static and outreach service delivery points in the public and private sector and closely generating and tracking demand for VMMC services. Although SAFE will focus demand creation among young boys aged 15-29 to increase uptake of services, no medically eligible adolescents aged 10-14 will be denied services per national policy. Service delivery should be available for all volunteer medically eligible adolescents and men consistent with national policy and standards.

USAID SAFE will build on the current VMMC platform being supported through the private sector and adopt key lessons learned of the national program to improve access and quality of services. As the national program determines expansion to future areas will be jointly discussed with the MOHSS, USAID, and other stakeholders.

Results Framework

Expected result: Achieve 80% coverage of circumcision among males aged 10 - 29 years in selected health districts and achieve <0.5% adverse events as a result of the activity.

Intermediate Result 1: Increased VMMC service access in Khomas and Oshikoto regions

Intermediate Result 2: Increased utilization of VMMC services by young boys and adult men

Intermediate Result 3: Quality assurance and quality management of VMMC service delivery

Intermediate Result 4: Improved enabling environment and sustainability of VMMC services

USAID envisions the following activity components will be required to achieve the expected result:

Component 1: VMMC service delivery and linkage to other prevention, care, and treatment services

Component 2: Quality assurance and Quality Management of VMMC service delivery

Component 3: Enabling environment for national VMMC service delivery

Component 4: Monitoring and Evaluation

A. ACTIVITY COMPONENTS

Component 1: VMMC service delivery and linkage to other prevention, care, and treatment services

Namibia’s National Strategic Framework on HIV and AIDS recognizes VMMC as a highly effective HIV prevention intervention that has the potential to reduce the risk of female to male transmission by at least 60%. Male circumcision also reduces the probability of sexually transmitted infections (STIs), particularly ulcerative STIs, including herpes and syphilis; and of penile cancer. The NSF also sets out an ambitious 5 year target of 300,000 to be achieved by 2022. Under this activity, USAID envisions assistance to both support the provision of, and strengthen the enabling environment for high quality VMMC service delivery.

Activities in support of VMMC service delivery are envisioned to be implemented in schools, public and private sector health facilities and communities. Activities will build and support existing health infrastructure and structures for community mobilization to create demand for VMMC. Specifically community mobilization will target context specific messaging that aims to break societal barriers and remove misconceptions about VMMC.

Illustrative Activities

a. Assist the Ministry of Health and private health providers deliver VMMC services from fixed and outreach sites using public sector and private sector health care workers in Khomas and Oshikoto regions in collaboration with GRN and regional government.

b. Implement multi-level, multi-channel segmented communications to increase demand for VMMC and address misconception.

c. Utilization of pre-fabricated structures and other space creation techniques to optimize client services including capture, retention and flow through VMMC services.

d. Provision of VMMC services in accordance to national and PEPFAR/WHO standards using a combination of complementary service delivery models to achieve the coverage required in the region. Service delivery models will include:

• High volume efficiency sites– employing the WHO-recommended surgical techniques to maximize volume and efficiency (fixed MOHSS public health facilities);

• Outreach teams– Outreach and mobile service delivery is critical component of rapid scale-up;

• Low intensity static site – comprised of already established facilities under MOHSS, and other private providers, used during campaign periods.

Expected Results

1. Increased uptake of VMMC services to among priority target groups in the two regions.

2. Improved access to quality VMMC services through establishment of committed vibrant private sector network and public sector VMMC teams in the Khomas and Oshikoto region in collaboration with MOHSS.

3. Increased demand for VMMC in the Khomas and Oshikoto regions with a focus on 10-29 year old males and demonstrate effectiveness of such activity through site utilization rate at each site.

a. Strengthen each site (fixed or outreach) to have dedicated well-trained and well-equipped community mobilisers.

b. Strengthen the in-service communication at each site (fixed or mobile/outreach) to have dedicated and well-trained counsellors or through training of lone providers.

c. Improve client flow and maintain overall measurable high client satisfaction.

Component 2: Quality assurance and Quality Management of VMMC service delivery

VMMC is a safe and easy to perform surgical intervention that has a significant public health impact on HIV prevention. However, because of its surgical nature, adverse events are inherent to the procedure being conducted at scale. Complex factors from the provider and client create quality issues in VMMC that must be managed across the continuum of VMMC services, including demand creation, counseling and client communications, supply logistics, staff competency, infection prevention, waste management, referral and linkages to care and treatment, client follow-up, emergency response, and rapid evidence-based response to adverse events. Since the inception of VMMC in Namibia, program scale up has placed significant emphasis on safety of the client, the staff and the environment. Routinely, the national program conducts continuous quality improvements exercises to identify vulnerabilities and use the findings to improve program quality and plan trainings. In 2017 two External quality assurances (EQA) were conducted jointly by the MOHSS, CDC and USAID. Findings from these EQAs are critical for sustained program quality support. USAID envisions that SAFE will support standards that encompass all elements of service delivery that affect the quality and outcomes of VMMC for HIV prevention.

In liaison with national and regional MOHSS structures and focal persons, SAFE will conduct routine and periodic quality assurance assessment in all supported VMMC sites using the developed national VMMC quality standards to ensure operations are in compliance with the VMMC quality assurance standards (National Standard Operating Procedures for VMMC, 2010 and WHO standards).

Illustrative Activities

a. Provision of support to the national and regional health authority to conduct regular external Quality assurance.

b. Institute continuous quality improvement activities at all supported sites.

c. Conduct audits of all VMMC adverse events occurrence and outcomes.

d. Promote learning and information sharing platform across clinics and providers of VMMC services.

e. Routinely mentor service providers, and institutionalize quality assurance and improvement (including that required for the expected surge in numbers of male circumcisions during high seasons).

1. Developed a comprehensive quality assurance and continuous quality management strategy with all the required human resource components.

2. Strengthened Regional Level VMMC Quality Assurance System using the Continuous Quality

Improvement (CQI) Model.

Component 3: Enabling environment for national VMMC service delivery

In line with the Fast track strategy of UNAIDS, scaling up VMMC could contribute significantly to ending the AIDS epidemic by 2030 in the context of concerted efforts to close the treatment gap. 80% coverage across all regions among priority population is required to achieve this impact. For a sustainable result VMMC program needs to go beyond saturation among target population but also address the aging of you boys in the population. USAID envisions that through SAFE, support will be provided to for enabling environment for the implementation of early infant male circumcision. (EIMC).

The cost (both financial and human) required for this scale up is daunting in most settings. Already governments have placed significant resources for ARVs, personnel and infrastructure to identify PLHIV and keep them on treatment. USAID envisions that this activity will strengthen health systems and infrastructure including building the health workforce and tapping into the private sector network for rapid scale up of VMMC in Namibia. The private sector, both the for-profit and the not-for-profit, have valuable roles to play in the provision of effective and efficient ways to deliver high quality VMMC services. The awardee will be expected to explore and facilitate partnerships with private sector entities such as universities, and private sector clinics.

Illustrative Activities:

a. Provide material and technical assistance to develop skills and competency among private sector for VMMC service delivery.

b. Convene workshops, meetings and other forums to identify and overcome barriers to public and private sector involvement in VMMC service delivery.

c. Include private sector partners in planning, training and exercises.

d. Provide support such as grants to private and public sector clinics to fund relevant activities that would strengthen and enhance partnerships.

e. Partnership with the private sector insurance bodies to jointly supply public health goals related to

VMMC and other HIV prevention interventions.

f. Develop and harness regional and national leadership and oversight function for sustainable

VMMC program.

g. Developing capacity of health facilities to routinely provide high quality VMMC services to clients in line with national and PEPFAR standards of care.

h. Training: In collaboration with MOHSS and other VMMC partners in Namibia, identify and train a pool of health care workers in VMMC service delivery.

i. Targeted assistance to the MOHSS to integrate and deliver early infant medical circumcision into a routine neonatal bundle of evidence-based services at high volume hospitals.

1. Effectively coordinate regional level coordination of VMMC services to provide leadership in

VMMC services.

2. Capacity of GRN and VMMC TWG to monitor and evaluate the VMMC program is strengthened though use of the following tools:

• VMMC DMPPT 2 online

The Decision Makers Program Planning Tool (DMPPT) is an online software that uses published and program data on the national VMMC program to estimate age specific coverage, update of services and calculate future year targets required for optimal saturation. This tool facilitates strategic planning and resource mobilization by the national program and stakeholders.

• VMMC GIS Mapping The Site Capacity tool supports implementation at sub-national level of output results from the DMPPT. This tool aids the achievement of the line mile planning.

• VMMC Site capacity-Site utilization (SC/SU) Tool The VMMC Site capacity/Site Utilisation tool facilitates site level planning, quality management and optimum use of resources.

3. Active regional and national VMMC forum developed.

4. Routine provision of men friendly VMMC services at all health facilities supported by the project.

5. Increased funding for VMMC through insurance as compared to PEPFAR funding.

6. Policies and systems developed to support EIMC.

Component 4: Monitoring and Evaluation Throughout the program as required, the applicant will input programmatic information into USAID monitoring and evaluation systems such DATIM. Monitoring of results is a key element of USAID programs to improve performance and effectiveness as well as to inform planning and management decisions.

The monitoring, evaluation, and learning activities of this activity will be oriented towards providing information on progress to achieving intermediate result areas and ultimately the goal of this activity. The applicant is expected to have a strong and comprehensive monitoring evaluation, and Learning (MEL) Plan to track implementation progress towards its objectives and verifiably measure results. The MEL Plan should include a description of a methodologically appropriate means of monitoring the activity’s relevance, effectiveness, efficiency, and impact. USAID/Namibia will perform quarterly reviews of reported data and to discuss needed strategic shifts to improve performance and progress toward targets and other benchmarks on a regular basis.

It is expected that the applicant will develop an activity MEL Plan together with the proposed staffing structure required and summit to USAID/Namibia together as part of its application. This MEL will include plans to strengthen monitoring of VMMC program, evaluations and reporting systems, including client records reviews and routine reporting. The monitoring and evaluation system should monitor key aspects of the program in accordance to PEPFAR VMMC MER 2.0 and additional quality indicators, namely:

• Number of males circumcised as part of the VMMC for HIV prevention program within the reporting period – MER 2.0 Indicator

• Number of males who received HIV testing and counseling services (HTS) for HIV and received their test results (to be captured under facility based testing even if in outreach setting) – MER 2.0 Indicator

• Number of males circumcised who experienced one or more moderate or severe adverse event(s) within the reporting period (disaggregate by severity: moderate, severe) – not MER 2.0 removed from MER1.0

• Number of health care workers who successfully completed a VMMC in-service training program for both dorsal slit and forceps guided methods and any devices.- Not MER 2.0 Indicator

• Number of locations (public or private fixed sites, mobile sites and outreach sites; and which outreach & mobile sites are link to which fixed sites) providing MC surgery as part of the minimum package of MC for HIV prevention services within the reporting period. Not MER 2.0 Indicator

• Number of males circumcised within the reporting period who return at least once for post-operative follow-up care (routine or emergent) within 14 days of surgery and the day 2 follow up visit) – MER 2.0 disaggregation for VMMC_CIRC

In addition to the MEL Plan, the successful applicant will be required to provide quarterly reporting on MER indicators, annual expenditure analysis, and participate in the Site Improvement Monitoring System (SIMS) for quality improvement.

B. SUPPLEMENTAL GUIDANCE

The Minimum Package of VMMC

In line with Global norms and standards Namibia adheres strictly to standards that have been advanced by the WHO. It is expected that the applicant will demonstrated competency and adherence to implement the minimum package of services for comprehensive VMMC program. These standards have been adopted by PEPFAR for safe, cost effective and efficient program implementation and quality assurance.

Additional guidance can be found at: https://www.malecircumcision.org/resource/chapter-six-providing-vmmc-minimum-package-services-pepfar%E2%80%99s-best-practices-voluntary

At a minimum these package includes;

• Provision of non-mandatory HIV testing and counseling on site following National policies and international (WHO/UNAIDS) guidelines

• Age-appropriate pre- and post-operative sexual risk reduction counseling

• Active exclusion of symptomatic STIs and syndromic treatment when indicated

• Provision and promotion of correct and consistent use of condoms

• Client eligibility screening to identify contraindications to surgery

• counseling on risk reduction and safer sex

• Linkage and referral to appropriate services including HIV care and treatment

• Circumcision surgery in accordance with national standards and international guidance; including following WHO/PEPFAR guidelines for clients 10-14 years, or clients >14 years with immature penile anatomy, in whom only the dorsal slit and/or sleeve resection must be used as the method of circumcision

• Counseling on the need for abstinence from sexual activity during wound healing including wound care instructions

• Tetanus risk mitigation activities recommended by WHO and PEPFAR: including, at a minimum, the Clean Care Approach for all clients (reference to September 2016

WHO guidelines and November 2016 PEPFAR Directive to PEPFAR implementers to follow these WHO guidelines)

• Post-operative clinical assessments and care at 2 and 7 days

• Prevention, management and tracking of adverse events (including appropriate reporting)

C. TARGETS

Throughout the life of this activity, USAID will support the provision of accelerated service delivery for VMMC. This is to rapidly achieve the ambitious national goal of reaching 80% coverage. The successful applicant is expected to achieve the following performance target in year one. Out year targets will be established during annual implementation planning based on resources available.

Indicator Year one Target

Life of Award Comment

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

29,000 TBD* Based on outputs of the DMMPT2.0

Required: Disaggregate by age Required: HIV status and linkage to care Required: Postoperative follow-up

D. GEOGRAPHIC PRIORITIZATION

Through this activity USAID envisions to provide assistance to beneficiaries in sites located in Khomas and Oshikoto regions.

This activity will provide above site national support to the MOHSS in the field of combination HIV prevention and integrated services.

E. INTENDED POPULATION

Primary: Males aged 10 – 29 years old Secondary: Males aged >30 years and 0-60 days of age

PEPFAR Expenditures Reporting

For better reporting in the annual PEPFAR Expenditure Analysis (EA) exercise, key program activity elements monitored by the M&E plan should be linked to cost tracking information in USAID SAFE implementation efforts. The applicant is expected to apply the principles of the new PEPFAR guidance on accountability, transparency and impact in programs. The performance indicators selected will measure progress and achievement of the activity goal, purpose, outcomes and outputs. Activity-level performance indicators will, at a minimum, include all required and applicable standard indicators as defined by the PEPFAR Monitoring, Evaluation and Reporting (MER 2.0) Guidance. Each indicator reported by the activity will be supported by a Performance Indicator Reference (PIR) sheet, which will include a summary of the following key information: indicator definition and unit of analysis; data disaggregation; data sources and collection methods; data analysis methods; and frequency, schedule and reporting responsibilities.

[END OF RFI]

Acronyms