RFI_Final_9.21.18.pdf

Request for Information (RFI)

Date of Issue: September 21, 2018 Closing Date: October 5, 2018 Closing Time: 17:00 Lusaka time

Subject: Draft Performance Based Work Statement (PBWS) for the Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAH&N) Continuum of Care Technical Assistance Activity (CoC TA) in Zambia

To all Interested Respondents/Parties:

The U.S. Agency for International Development’s Mission to Zambia (USAID/Zambia) seeks to collect input from interested Respondents who may provide comments, opinions, and recommendations in response to the proposed approach and questions outlined in the subject draft Performance Based Work Statement (PBWS) under this RFI. USAID anticipates that the PBWS will serve as the basis for an up-to five-year cost-plus-fixed-fee contract under a subsequent Request for Proposals. The information provided will be used to help guide future planning decisions. The requested information will not be shared publically.

As potential offerors, we invite you to provide your feedback to help ensure clarity and purpose.

While we welcome all comments, we especially request that you provide responses to the following questions:

1. Community engagement is essential to improving health outcomes, particularly to address demand for services and care-seeking behaviors. How can USAID support and engage community health volunteers and community health structures within this activity? Is the proposed solution financially and developmentally sustainable, if so, how?

2. How can we better address health needs of underserved groups within the target populations, such as adolescents and family planning, or serving people living with HIV, or under five children who are, or at risk of becoming, malnourished within the RMNCAH&N framework?

3. What national and policy level activities would you recommend to complement the district-level focus and activities, for example providing expert support to a technical working group?

4. What should be included in a sustainability plan for this activity? How do you measure this and its success? What are the respective roles of the GRZ, particularly given a tightening budget, and the donor community?

5. What is your definition of technical assistance? How does this differ from a direct service delivery model?

USAID may choose to respond to questions submitted with the RFI responses but is not obligated to do so. If USAID responds to questions, those responses will be posted as an addendum to this

RFI.

Submission Instructions

Interested parties are strongly encouraged to submit a response to this inquiry. All submissions must be via email, and should be in the following format:

Email Subject Line: USAID/Zambia CoC TA RFI - Organization Name File Attachment: USAID/Zambia CoC TA RFI - Organization Name

All responses to this RFI must be emailed to Jessica R. Faber, Contracting Officer, at jfaber@usaid.gov, with a copy to Ms. Shachibonde Kasanda, Acquisition and Assistance Specialist, at skasanda@usaid.gov, by no later than October 4, 2018 – 17:00 Lusaka, Zambia local time.

Submitted documents and correspondence must be in the English language. Although not required, if you choose to provide any price lists, they must be in USD. Phone calls or hard copy delivery of information will not be accepted.

Submissions will receive an electronic confirmation acknowledging receipt. USAID will only provide responses to questions submitted to this RFI at our discretion, and no proposals or resumes will be accepted or considered.

Thank you for your interest in the subject request for information.

Jessica R. Faber Deputy Director Office of Acquisition and Assistance USAID/Zambia

Disclaimer Notice

This RFI is issued solely for market research and planning purposes. This is not a solicitation or call for proposals. Any proposals submitted in response to this request will not be considered. USAID will not pay for information submitted nor will it reimburse for costs incurred by an organization that elects to respond to this request. All costs associated with responding to this request will be solely at the respondent's expense. USAID is in no way obligated to utilize submitted information or issue a solicitation as a result of this request. USAID is not obligated to procure any of the services described herein, nor should the release of this request be construed as such a commitment on the part of USAID. Any information submitted in response to this notice is voluntary. Not responding to this request does not preclude participation of any legal entities in future solicitation, if any, following this RFI.

DRAFT

SECTION C – DESCRIPTION/PERFORMANCE BASED WORK STATEMENT

C.1 Activity Title

The activity title is USAID Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH&N) Continuum of Care Technical Assistance Activity (hereafter referred to as “CoC TA”).

C.2 Overview

USAID Zambia supports the Government of the Republic of Zambia (GRZ) and their Ministry of Health (MOH) to improve the health of mothers and children through strengthened capacity to engage with communities for health, to deliver quality services, and strengthening systems at national and subnational levels. This activity will provide technical assistance to the government‐led RMNCAH&N Continuum of Care (CoC) Program (hereafter referred to as “CoC Program”). It is a program that aims to provide quality health services as close to the community as possible through implementation of high impact interventions that save lives.

USAID will support the MOH CoC Program in four provinces of Zambia (Luapula, Muchinga, Southern and Eastern) through this CoC TA Activity and the Swedish International Development Cooperation Agency (Sida) Grant (hereafter referred to as the “Sida Grant”) that provides funding to the MOH CoC Program.

Figure 1: Support to the MOH CoC Program in four provinces of Zambia

Success

Successful implementation will result in a strengthened public health system in Zambia that is better able to deliver quality reproductive, maternal, newborn, child, adolescent health and nutrition services in four provinces. This support will also result in improved capacity of the government to engage with communities on health.

C.3 Key Stakeholders

Implementation of the CoC Program and the CoC TA activity requires close coordination and collaboration with key stakeholders. The following list provides key stakeholders and their respective roles and responsibilities within and in support of the CoC Program:

Stakeholder Role

Ministry of Health The Ministry of Health is the custodian of the CoC Program and will be responsible for execution of the Sida grant, planning, implementation, and monitoring and evaluation of activities at national (central), provincial and district levels, as well as provision of technical and supervisory assistance across all levels.

Swedish Development Cooperation Agency (Sida)

Sida is the donor overseeing the Sida Grant to the GRZ in support of the CoC Program in Luapula, Muchinga, Eastern, and Southern provinces. Sida manages the disbursement of funds to the Ministry based on milestones achieved at all levels of the CoC program. The Results Based Financing (RBF) component of the grant is implemented through CHAI. USAID also provides financial support through this mechanism.

CHAI CHAI implements the RBF component of the CoC Program. Their role is to ensure the verification of results and provide feedback and recommendations on indicator performance for the districts.

RMNCAH&N CoC Steering Committee/Interagency Coordinating Committee

The RMNCAH&N CoC Steering Committee coordinates activities across the CoC Program that the various partners implement, including the Sida grant.

Cooperating partners (USAID, UKAID, Swedish

SIDA, UNFPA)

These include donors providing funding to support the MoH CoC Program through pooled funds and technical assistance activities.

Key stakeholders and partners in implementation of the CoC Program, Sida Grant and CoC TA include government structures and community organizations and members. The following graphic delineates structures at different levels of the health system and community, and the level of effort anticipated at both the national/provincial levels and the district/community levels.

Figure 2: Government and community partners at different levels of health services, with percent of level of effort and funding allocation expected

C.4 Background

The GRZ Vision for the health sector for Zambia is to ensure equity of access to assured quality, cost‐effective and affordable health services as close to the family as possible and the overall goal is to improve health service delivery in order to significantly contribute to the attainment of the Sustainable Development Goals and national health priorities. The Seventh National Development Plan guides the implementation of all the priority activities under the following principles; equity of access, affordability, cost‐effectiveness, partnerships, accountability, decentralization and leadership. The RMNCAH&N CoC is one of the priority areas under the Seventh National Development Plan. This a Zambian Government owned and led program that targets the whole reproductive life cycle of a woman ‐ from adolescence, pre‐pregnancy, pregnancy, labor and delivery, and postnatal periods, including nutrition ‐ with high‐impact, evidence‐based interventions and aims to improve health outcomes to adolescents, women, newborns, and children. It is a program that aims to provide quality health services as close to the community as possible through implementation of high impact interventions that save lives. USAID will continue to support the CoC Program in four provinces of Zambia through this CoC TA Activity and the Swedish International Development Cooperation Agency (Sida) Grant that provides funding to the CoC Program.

The CoC program is currently active in six provinces: Luapula, Muchinga, Eastern, and Southern supported by Swedish International Development Cooperation Agency (Sida) and USAID.

Western and Central provinces are being supported by UKAID. USAID intends to continue to

Level

National

Provincial

District

Community

Structure MoH

Hospitals

Posts

Funding

20%

80% support this program through the Sida grant until 2022 when this mechanism closes. However it is envisioned that the program will continue to be funded through the USAID government to government mechanism for the next two years until 2024.

While significant progress has been made in improving health indicators and health outcomes over the past ten years, Zambia is one of the countries among others that did not reach its maternal and child health related Millennium Development Goals (MDGs). In addition Zambia is also far from achieving the current Sustainable Development Goal (SDG) 3 of working towards achieving a goal of less than 70 per 100,000 live births by 2030. The maternal mortality ratio (398/100,000 live births)1 and newborn mortality rate (24/1,000 live birth) remain among the highest in the world, and reflect challenges in the overall health sector. Nationally, only 67 percent of women deliver in health facilities and 64 percent deliver with the assistance of a skilled health provider. While awareness of family planning among Zambians is high at over 94 percent, fertility rates are high and family planning services reach less than half of sexually active couples, posing challenges for achieving desired timing and spacing of pregnancies. The adolescent pregnancy rate stands at 28 percent. Forty percent of children under five are chronically malnourished. Particularly concerning is the finding from further analysis of the 2014 ZDHS that approximately 30 percent of Zambian families are not having any meaningful contact with the health system, preventive or curative: they are delivering at home, not taking their children to the clinic for complete immunizations, and not seeking care for signs of acute respiratory infection, malaria, or diarrhea.1

For the past six years, USAID worked to improve its maternal health activities on the Saving Mothers, Giving Life (SMGL) initiative. This was a global initiative aimed at reducing maternal and newborn mortality, and complementary investments in family planning and reproductive health. Through this journey and with the extensive data collected, USAID identified multiple high‐impact practices that could be sustained through host‐country systems. To ensure sustainability and scale of these lessons learned from the SMGL initiative, USAID entered into a partnership with Sida and GRZ to support the program through provision of a grant for implementation of high impact RMNCAH & N activities. This program builds on the SMGL initiative by extending its focus to pre‐ and post‐pregnancy periods as well as adding child health and nutrition. In addition it better aligns USAID’s support to the Ministry of Health system, enables more integrated service delivery, and promotes sustainability. The CoC Grant, managed by Sida, consists primarily of direct funding to the Ministry of Health with the majority (80%) targeted at the district level and the remainder (20%) for the provinces and national levels. To complement the CoC program, USAID procured technical assistance through the Maternal and Child Survival Program (MCSP) and Systems for Better Health (SBH). These mechanisms and other recent USAID investments in RMNCAH&N are described in more detail below:

Current CoC Program, SIDA Grant and CoC TA

1 All data in this paragraph is from the 2013/4 Zambia Demographic and Health Survey.

To support the CoC Program, the MOH receives a grant from the Swedish Embassy, USAID and DfID to implement the nationally agreed package of evidence‐based interventions, based on national strategies already in place and aligned with the current and upcoming National Health Strategic Plan. The overall goal of this support is to improve maternal, neonatal, child and adolescent health and nutrition in Zambia. The specific objectives include: increase the availability and readiness of quality health and nutrition services for mothers, newborns, children and adolescents in six target provinces in Zambia; increase the demand and uptake of physically, culturally, and financially accessible services for mothers, newborns, children and adolescents in six target provinces in Zambia; and strengthen health systems at the national and sub‐national levels enabling effective RMNCAH&N service delivery.

Within the grant, 80 percent of the funding supports district‐level plans that have been approved by the cooperating partners and the central Ministry of Health. The remaining funding is split between the national and provincial levels and similarly approved by the cooperating partners and the Ministry of Health. A set of commonly agreed indicators measure the program’s success. Beginning in 2017, Sida hired a third party to independently verify program results to introduce the Results‐Based Financing (RBF) component of the award covering USAID as well as Sida support.

The current RBF service delivery indicators are measured include the following:

1. Percent of pregnant women attending antenatal care (ANC) before 14 weeks

2. Percent of births attended by a skilled health care provider

3. Percent of postpartum women attending a postnatal care (PNC) visit within 6 days

4. Percent of children 12 ‐ 24 months of age that are fully immunized

5. Number of new family planning acceptors.

To complement this program, USAID procured technical assistance from the Maternal Child Survival Project, a field support mechanism. This technical assistance primarily goes to districts to improve implementation of activities in the Continuum of Care. MCSP works in collaboration with other partners in the provision of TA to the CoC Program. USAID Systems for Better Health (SBH) provides technical assistance, in the area of health systems strengthening to ensure robust planning procedures, strengthen financial management and improve the use of data for decision‐making. The table below illustrates the role played by each of the TA partners currently supporting the COC program.

Maternal and Child Survival Program (MCSP) – 2017 ‐2018

MCSP is one of the TA partners providing support to the Sida Grant which USAID is co‐funding.

The goal of MCSP is to provide demand driven technical assistance to enable high‐impact interventions for RMNCAH&N implementation across four provinces: Southern, Eastern, Muchinga, and Luapula. The objectives of the project include: 1. Providing demand‐driven technical assistance for sustainable scale‐up of RMNCAH&N interventions across the four focus provinces of Zambia. 2. Developing institutional collaboration aimed at increasing local capacity in RMNCAH&N. 3. Developing e‐learning training courses for newly recruited nurses and midwives to improve provider knowledge and for skills acquisition and retention.

USAID Systems for Better Health (SBH) ‐2015 ‐2020

SBH is the Mission’s flagship health systems strengthening activity that has the goal to improve health outcomes for Zambians by strengthening the systems that underpin the delivery of high quality health services. The activity is implemented at national level and in the six CoC provinces where SBH provides technical assistance to strengthen systems to assure activities are effectively implemented and desired results are achieved. Specifically, SBH staff mentor and build capacity of PHO and DHO counterparts to improve performance management, public financial management, and data use for decision‐making. Additionally, SBH supports PHO and DHO staff to conduct periodic self‐assessments on how they are implementing MOH systems and regulations, as well as to develop corrective action plans to address identified gaps

Saving Mothers, Giving Life (SMGL) ‐ 2012‐2018

SMGL was launched in 2012 with the ambitious goal of reducing maternal and newborn mortality by 50 percent and 35 percent respectively in select districts in Zambia. It was implemented by four US government agencies and more than a dozen implementing partners.

The initiative addressed the three delays affecting maternal mortality (delays to seek care, reach care and receive care) through implementation of a comprehensive systems approach targeting the critical 72 hour period around labor and delivery. Evaluation of the SMGL final results indicates reductions in maternal mortality and newborn mortality of 41 percent each and an increase in institutional delivery to above 80 percent in the supported districts.

Safe Motherhood 360+ project (SM360+) – 2015‐2020

SM360+ is the flagship program for implementation of the SMGL initiative in 16 selected districts: Luangwa, Kabwe, Livingstone, Zimba, Choma, Kalomo, Pemba, Nyimba, Petauke, Mambwe, Chipata, Lundazi, Chembe, Lunga, Samfya and Mansa. SM360+ is focused on ensuring that all women, newborns, and children most in need have equitable access to quality health care services that save lives through strengthening community and facility based interventions. The goal of the project is to reduce the maternal mortality ratio (MMR) and newborn mortality ratio (NMR) by 35% each. The objectives of the project include increasing institutional delivery, improving the quality of health care services, and strengthening service integration.

Sexual and Reproductive health for all Initiative (SARAI) ‐2015 ‐2020

SARAI is the USAID’s bilateral family planning project whose aim is to reduce unmet need for family planning in three targeted provinces: Muchinga, Luapula, and Copperbelt. The project goal is to increase the modern Contraceptive Prevalence Rate (mCPR) by 2% annually through increased access to and improved quality of family planning and reproductive health (FP/RH) services. The objectives include: improving FP service delivery, strengthening FP service delivery systems and accountability, and increasing healthy FP/RH practices among women of reproductive age and their partners.

The Thrive Project: 2013 ‐ 2017

The Thrive project was an activity designed to deliver Nutrition Assessments Counselling and Support to HIV positive individuals and orphans and Vulnerable Children (OVC). It provided consolidated nutrition services to improve the nutrition status of people living with HIV. The activity was implemented in four (4) provinces (Eastern, Copperbelt, Central and Southern) and provided nutrition counselling and support to 70,000 beneficiaries. In addition, Thrive supported the production of High Energy Protein Supplements and Ready To Use Therapeutic feeds to manage malnutrition.

MAWA: 2013‐2017

MAWA aimed to address nutritional challenges for the most vulnerable sectors of the population. The MAWA project worked directly with some of the most food insecure and vulnerable populations two districts in Eastern Province, Lundazi and Chipata. MAWA helped households, which included adolescents, women and children, to find a balance between harnessing agriculture for consumption and for income through engagement with markets.

Under this project, agriculture, nutrition, health and incomes are addressed to create more resilient families and communities.

National Food and Nutrition Commission (NFNC) G2G Behavior Change: 2017‐2018

The purpose of the Project is to improve Zambian health outcomes by promoting nutritional behavior change in Petauke and Lundazi districts of Eastern Province. Activities include printing and distribution of community nutrition promotional materials and social and behavior change materials, development, production and broadcasting of nutrition‐related radio programs on community radio stations, formation and training of Radio Listening to promote better nutrition; and conducting public nutrition forums.

Scaling UP Nutrition Technical Assistance (SUN TA): 2018 ‐2025

The goal of Scaling Up Nutrition Technical Assistance (SUN TA) is to reduce stunting in 30 selected districts over a period of seven years through technical assistance provided to the GRZ.

SUN TA is an integrated nutrition program which includes the following components:

agriculture, water and sanitation, health, FP, early childhood development and governance. It will be implemented within the broader umbrella of the SUN 2.0 program. The SUN 2.0 program is a cross –ministry and multi –donor program that is implemented through the GRZ’s 1000 Most Critical Days Program (MCDP).

C.6. Goal and Objectives

Goal: The overall goal of the CoC TA activity is to improve the capacity of the public health system to sustainably deliver quality reproductive, maternal, newborn, child, and adolescent health and nutrition services (RMNCAH&N) across four provinces of Zambia.

Objectives:

1. To improve the capacity for GRZ to deliver quality services

2. To strengthen health systems at national and sub‐national levels to provide an enabling environment for effective RMNCAH&N service delivery

3. To improve the capacity of the GRZ to engage with communities for health

C.7. Results Framework

The following Results Framework provides an overall description of the goal and objectives:

The Contractor will achieve the objectives through the sub‐Intermittent Results (IRs) described below. The contractor will draw upon these illustrative indicators and propose a comprehensive set of indicators, benchmarks, and targets to accomplish CoC TA objectives:

Objective 1: Improved capacity of GRZ to deliver quality services

IR1.1 Health Care Provider (HCP) skills improved

● % of districts with functional mentorship teams

● % of facilities who had received a supportive supervision/mentorship in the last quarter from the district

● % of women receiving antenatal care from a skilled health professional

● % of deliveries assisted by a skilled health care provider

● % of facilities with at least one IMNCI trained staff

● % of facilities with RMNCAH & N job aides

IR1.2 High impact, quality interventions implemented

Reproductive health

● % of facilities that provide LARCs services

● % of postpartum women who access Postpartum FP services

● Number of new users of family planning in past 12 months (stratified by age)

● % of FP clients who also access HTS services

Objective 1: Improved capacity of Government of Zambia to deliver quality services.

IR.1.1 Health Care Provider skills improved

IR.1.2 High impact, quality interventions implemented

IR.1.3 Community health delivery strengthened

Objective 2:

Strengthened health systems at national and sub‐national levels

IR. 2.1 Governance and performance management strengthened

IR.2.2 Health care financing strengthened

IR.2.3 Health management systems improved

Objective 3: Improved capacity to engage with communities for health.

IR.3.1 Social and behavior change capacity improved

IR.3.2 Community structures and leadership for health strengthened

● % of health facilities with providing YF SRH services Maternal health

● % women delivering in a health facility who are provided with prophylactic postpartum oxytocin/uterotonics/AMTSL

● % of facilities with functional basic Emergency Obstetric and Newborn Care services

● % of facilities with functional* Comprehensive Emergency Obstetric and Newborn Care service

● % of districts conducting MPDSR quarterly

● % of women delivering in health facilities

Newborn health

● % of newborns asphyxiated at birth that were successfully resuscitated

● % of districts conducting Perinatal death audits quarterly

● % of preterm babies who are managed with KMC

Child health

● % of districts with MR1‐MR2 dropout rates less than 10%

● % of suspected pneumonia cases provided with antibiotics

● % of children with diarrhea receiving both ORS and Zinc

Nutrition

● # of health facilities with functional anthropometric equipment (child length/height boards, weighing scales, and MUAC tapes)

● % of mothers who practiced early initiation of breastfeeding within one hour of birth

● % of children 0‐5 months who are exclusively breastfed

● # of children under 5 who receive vitamin A supplementation

IR. 1.3 Community health service delivery strengthened

● % of health facilities conducting at least one outreach event or mobile service per month

● % of health facilities with active community based volunteers, specify by type: (SMAGs, CBDs, YPEs, ICCM, Nutrition volunteers)

● % of health facilities who have conducted any supervision of community based volunteers (CBVs) in the past quarter

Objective 2: Strengthened health systems at national and sub‐national levels to provide an enabling environment for effective RMNCAH&N service delivery.

IR2.1 Governance and performance management strengthened

● % of districts that have a QA/QI work plan (check SQA tool)

● % of facilities with improved SQA scores

● # DHO staff trained/mentored/oriented in performance management skills

● % of PHOs that conducted PA and TSS in districts in the last six months

● % of DHOs that conducted PA and TSS in facilities in the last six months

● % of Districts that have incorporated RMNCAH & N CoC Plan and Budget in Annual

District Action Plan

● % of District that used RMNCAH scorecard to review implementation of annual work plan in the last quarter

IR2.2. Health care financing strengthened

● % DHOs that have staff trained and/or oriented in public financial management

● # of staff trained and/or oriented in public financial management

● % of DHOs with annual budget execution rate greater than 80%

● % of transactions conducted in NAV

IR 2.3 Health management information systems improved

● % of health facilities holding monthly data review meetings

● % of districts holding quarterly data review meetings

● % of districts submitting timely data reports

● % of districts submitting complete data reports

● % DHO with staff oriented on DHIS2

● % of health facilities submitting community HMIS (cHMIS) reports on time

● % of health facilities submitting complete cHMIS reports on time

● % of districts fully integrated cHMIS reports into their monthly reporting

● % of DHOs generating and reviewing RMNCAH&N scorecards from HMIS/DHIS2 quarterly.

Objective 3: Improved capacity of the GOZ to engage with communities

IR.3.1 Social and behavior change capacity strengthened

● # of provincial, district, and health facility staff oriented on social and behavior change

● # of provincial and district health promotion officers who have conducted any supervision of health facilities or community health structures in the past month

● % of districts who include SBC activities (radio, billboard, drama groups, SBCC materials, etc.) in their annual budgets and work plans

● % of districts who have supported mid‐ or mass‐media SBC activities (radio, billboards, drama groups, etc.) in the past quarter

● % of health facilities with posters (e.g. safe motherhood, child health, nutrition, and family planning) posted in public waiting areas

● % of schools reached with school health outreach activities in the past quarter

IR3.2 Community structures and leadership for health strengthened

● % of districts who include community engagement activities (meetings, etc.) in their annual budgets and work plans

● # of provincial, district, and health facility staff oriented on community engagement

● % of health facilities with functional community based committees by type: (NHCs, HCCs)

● % of health facilities maintaining community dashboards (reference community health strategy & PA tool)

● % of districts who have conducted events to formally engage traditional and faith leadership in the past quarter

C.8 Link to CDCS

USAID/Zambia’s Country Development Cooperation Strategy (CDCS) seeks to better understand the Zambian context and what USAID, the GRZ, and the donor community need to do differently to turn Zambia’s development around. Over the last 34 years, USAID has supported and implemented programs that target economic growth, health, education, democracy and governance, and humanitarian assistance. The CoC TA activity will contribute to the Development Objective 3, Health Status of Zambians improved, Sub‐Intermediate Result (IR)

3.2.1 Health service delivery improved, Sub‐IR 3.2.2 Health systems improved, and Sub‐IR 3.2.3 “Community Health Practices Improved.” The CDCS is available from: https:

//www.usaid.gov/zambia/cdcs. USAID envisions that improving health outcomes for mothers and children will continue to be a high‐level priority in the future CDCS.

C.9 Link to other Programs

This activity is expected to build upon successes and key interventions implemented by other reproductive, maternal and child health and nutrition programs that have been supported by USAID, including the Saving Mothers Giving Life Initiative, the Maternal and Child Survival Program, the Safe Motherhood 360+ program, the Sexual and Reproductive Health for All Initiative, the SUN TA program, Breakthrough and Population Media Centre. In addition, this activity should promote linkages to and complement other non‐U.S. Government programs implemented by other donors and stakeholders, including but not limited to Sida, UKAID, and the EU.

C.10 Assumptions

USAID/Zambia believes that through this activity the results will be achieved by the end of the five years given the following assumptions:

● GRZ will continue to invest in health, increasing its contributions to the health sector over the next five years

● GRZ is committed to improving the COC Program

● Donors continue to support the COC Program

● GRZ is effective in implementation of health services

● Availability of human resources for health

● The political situation in the country remains stable

The assumptions listed above will be revisited on an annual basis during the Performance Management Plan review to help determine why results are (or are not being achieved.

C.11 Guiding Principles

To improve delivery of RMNCAH&N services it is critical to coordinate across the full spectrum of stakeholders. This contract will follow these five guiding principles to position it for success:

1. Support a set of strategic priorities that align with the objectives and priorities of the

Seventh National Development Plan, the National Health Strategic Plan and relevant MOH and GRZ policies on health.

2. Support the institutionalization of performance‐based management and reporting through the utilization of HMIS data for performance monitoring at all levels.

3. Place strong emphasis on coordination of efforts and activities across the MOH, Cooperating Partners, and health implementers for greater efficiency and continuity of investments.

4. Include national‐level strategic support and implementation support at the provincial, district, facility, and community level to capitalize on existing opportunities and ongoing activities of other partners. (80 percent of effort and funding of this contract should be focused at the district and community level, with the remaining 20 perfect focused at the national and provincial level.)

5. Proactively draw on the best practices and successes identified through prior USAID projects in Zambia, and from other countries as a regular practice through the life of the award.

C.12 Scope

This activity is expected to provide high‐impact, demand‐driven technical assistance, coupled with targeted direct implementation, of reproductive maternal, newborn, child health and nutrition services. This activity will work through a whole district approach across four provinces in Zambia (Muchinga, Luapula, Southern and Eastern) with the potential to increase geographic scope in future years. The Contractor will utilize adaptive management approaches to respond to assessments, reports and implementation findings throughout the course of the award. While this feedback‐ loop and adaptive implementation will take place throughout the implementation process, there are critical points of learning and reflection which should be utilized to improve overall program performance.

C.12.1 Inception Phase

The activity will begin with a rapid ‘inception phase’ which will last no longer than six months, encompassing:

1. Staffing Plan Finalized and Personnel Operational

2. Approved Annual Work Plan (3 months)

3. Approved Strategic Framework and Sustainability Plan

4. Approved Performance Monitoring and Evaluation Plan

TASK 1: Staffing Plan Finalized and Personnel Operational The contractor must provide the Chief of Party (COP) and Deputy Chief of Party (DCOP) within the country no later than one month after award. The contractor is responsible for all logistics and ensuring that Key Personnel have resources to enter the implementation phase (see C.12.2). All full time staff must be in place no later than three months after award. The staffing plan must reflect the expertise and level of effort necessary to provide ongoing technical assistance, as well as mechanisms to respond to needs as they arise. To promote collaboration between the CoC TA provider and MOH, USAID envisions that as much as possible staff will be co‐located with relevant government bodies, ideally at the provincial and district levels.

TASK 2: Year One Work Plan

The Year One work plan must describe the timeline and major activities necessary to successfully complete the inception phase and begin the implementation phase. It must be realistic and reflect a prioritized plan to move through inception to implementation. The work plan must reflect time for consultations and approvals among key stakeholders within the CoC Program. While the details of all interventions per district must be determined under the implementation phase and may not be available at the time of submission, the work plan must demonstrate the process that will lead to and build from those plans.

The work plan must align with the Results Framework and describe how this activity will reach the overall goal of improving RMNCAH&N services in the districts. In the Year 1 work plan, the Contractor must propose an approach that will ensure geographic coverage across all districts using a district‐wide approach, that will ultimately reach 80% of target beneficiaries in the district. The work plan must reflect government input at all levels (central, provincial, district, facility and community) and collaboration across relevant ministries and stakeholders.

Below is a table summarizing some examples of the types of activities that should/should not be included in the CoC TA.

CoC TA Should Provide CoC TA Should NOT Provide

Mentorship/Supervision support

Support to MOH staff salaries

Coordination Procure medicines, consumables and equipment

Training, mentorship and coordination of training (where CoC grant is limited)

Do MOH staff’s job; Implement supportive mentorship without the MOH

Support optimal data collection, analysis and use for decision making, including timeliness and completeness of reports sent to higher levels of the health system

Fill in gaps without consulting central, provincial and/or district plans

Ensuring compliance with legislative and policy requirements that govern the use of U.S. family planning assistance

Make plans without MOH

TA to design and conduct pilots and studies to improve models of service delivery. Relevant implementation science

Routine data collection outside of MOH/GRZ tools and systems

Community volunteer incentives/stipends

Gap filling on IEC materials, job aides, and data collection tools

TASK 3: Approved CoC TA Strategic Framework and Sustainability Plan

Maternal, newborn, and child morbidity and mortality still remain a huge challenge and therefore require a multi‐sectoral approach to effectively intervene. To maintain focus on evidence‐based, cost‐effective interventions and to streamline the process of central, provincial, and district‐level priority setting and planning, the framework must be developed in collaboration with the overall CoC Program, and will guide the CoC TA work plan development.

The framework will show progression in key milestones of the CoC TA in coordination with the Sida Grant and CoC Program, as districts increase their own capacity in planning and utilizing grant resources, and be coupled with a sustainability plan. The milestones in the framework will include the key evidence‐based interventions in RMNCAH&N and linkages to cross‐cutting areas of: performance management, public finance and data use, community engagement and social and behavior communication change.

Below is an illustration of division of labor between the COC grant and the COC TA to guide the development of the framework.

CoC Grant CoC TA

Start Mid‐point End Start Mid‐point End

Focus: Build or expand a platform for Program implementatio n

Focus: Facility‐ level service improvement

Focus:

institutionaliz ation and sustainability

Focus: Build or expand a platform for Program implementatio n

Focus: Facility‐ level service improvement

Focus:

institutionaliz ation and sustainability

Procurement of Equipment

Training of facility staff on equipment

Maintenance of equipment and plans for replacement parts

Assist with assessment of most essential equipment to procure with

Monitoring support on appropriate use of equipment

Districts have equipment procurement, maintenance, and limited resources ‐ tied to health outcome goals replacement plans in place

Vehicle procurement

Vehicle maintenance

Vehicle maintenance and reviews of efficient use for outreach and referral

Assistance to determine most efficient use of vehicle procurement

Working with district to monitor vehicle use against health goals and related HMIS indicators (increasing institutional deliveries, increased number of outreaches)

Innovations in efficient and successful use of transport is shared across districts at provincial level

Hiring staffing gaps

Transitioning staff to regular government payroll

Staff absorbed by government payroll

TA supports assessment of most needed staff across district within limited resources

TA to district in their annual HRH planning

TA focused on different cadres of health workers once basic needs are addressed.

Districts have a plan for how to use multiple data inputs into their annual grant planning.

Planning and budgeting for the data reviews within grants.

Inclusion of special studies to understand problem indicators.

Reviews down to the facility level are included in grant.

Mentoring for improved data use across districts included as part of regular grant plans.

Working with provinces, districts, and facilities on data use and analysis. If not already occurring, facilitate the convening of data reviews as mandated by MOH standards

TA focuses on increasing analytical skills at all levels to interpret data and problem‐ solve on action needed. Can deploy or develop tools that would assist in analysis and use.

TA is focused on trouble spots or low‐ performing districts as data review are routinized within the CoC grant.

Districts have work plans on what priority interventions will be

Performance monitoring on the implemen‐ tation of planned

Reviews and lessons learned

Assist with TA for prioritization of interventions

TA on performance management of activities;

utilization of

Districts have prioritized activities in the work plan based on implemented activities;

Service Quality Assessments (SQA) and self‐ assessments according to identified gaps in the work plans the SQA and self‐ assessment tools evidence generated

Districts have necessary SBCC materials and job aids required for service provision

Monitoring on availability of the various materials

SBCC materials and job aids available in the facilities

Assist with the dissemination of /printing of SBCC materials and job aids (where necessary)

TA on utilization of the job aids

Districts have necessary SBCC materials to raise awareness and staff oriented to job aids utilization.

The framework will be submitted to USAID and subsequently accepted by the MOH. It will provide the province, district and implementing partners a list of key milestone activities to choose from, based on their local context, to guide their programming and planning. Each district must choose the appropriate evidence‐based interventions based on their local context.

These interventions must be primarily implemented by the MOH with technical assistance from the Contractor. Sustainability measures in ensuring ownership and effective transition of program to the MOH must be incorporated into the plan.

TASK 4: Monitoring, Coordination and Communication Plan

The Monitoring, Coordination and Communication Plan will guide the overall strategy on how this activity will collaborate with the government and other RMNCAH&N partners.

This plan must provide the methods of monitoring across the districts to achieve the results and possible remedies where districts are not achieving results. The contractor must establish data‐ driven selection and monitoring systems and tools, without establishing parallel systems, to ensure appropriate targeting, supervision and reporting of activities being implemented.

Monitoring systems must capture data about the input, output, outcomes and impact utilizing a theory of change framework to establish where the program is and where it needs to go in the next five years. The next Zambia Demographic and Health Survey (ZDHS) should be available by 2019 and can serve as a baseline.

C.12.2 Implementation Phase

Following the successful completion of the ‘inception phase,’ the contractor will initiate the ‘implementation phase,’ encompassing:

1. Annual Work Plan

2. Finalize Annual Work Plans for each Province, District

3. Provide Technical Assistance (TA)

4. Capacity Building

5. Direct Implementation

6. Adaptive Management

7. Monitoring

TASK 1: Annual Work Plan The annual work plan must describe the timeline and major activities necessary to successfully complete the implementation phase and is the strategic document that lays out the strategy, challenges, and expected outcomes for the year ahead. The work plan must demonstrate a consensus and ‘buy‐in’ from key stakeholders, and include documentation of this process. This will serve as a road map for activities in the coming year.

TASK 2: Finalize Annual District and Provincial Work Plans for each of the provinces and districts

One of the priority interventions for the CoC TA is to work with the district and provincial and health offices to review their draft annual provincial and district work plans to ensure that they have developed a prioritized package of interventions based on gaps identified. The Strategic Framework (in C.12.1 Task 3) and available funding envelop from the Sida Grant will help inform decision‐making to develop this costed work plan. The technical assistance to be provided must be reviewed and approved by the MOH, USAID, Sida and other relevant stakeholders.

TASK 3: Provide Technical Assistance (TA)

The Contractor will work in partnership with the MOH at multiple levels to ensure the best possible planning and execution of Sida Grants in support of the CoC Program. The Contractor must provide technical assistance to the national, provincial, district and facility levels in the development of CoC Program work plans, to identify priorities and best practices and address emerging challenges. Pending DHS 2018 results, the CoC TA should focus on select health outcomes, while working to strengthen the whole continuum.

1. Maternal health: While significant progress has been made in the reduction in maternal morbidity and mortality in last five years, the trends remain suboptimal. The SMGL initiative results of 41% reduction in both maternal and newborn deaths respectively, highlight how high impact interventions around the 48 hours of labor and delivery can contribute to improvements in health outcomes of women and newborns. The focus of the TA should be on improving the quality of service provision through supporting high‐impact practices identified through the SMGL initiative (SMGL initiative appendix), tracking of the indicators in section C.6 and lessons learned from global evidence. TA should build on and expand existing gains made and focus on gaps that remain, e.g. Lifesaving skills, Maternal and Perinatal Death Surveillance Response scale up, and respectful maternity care.

2. Newborn Mortality: Newborn mortality still remains a significant challenge country‐wide, with fresh stillbirths and macerated stillbirths continuing to show alarming increasing trends. Newborn mortality accounts for approximately 30% of all infant deaths. 1 This is an indication of gaps in service delivery, during ANC, during labor and delivery periods and of delays in accessing care. The TA should focus on capacity strengthening to ensure staff is equipped with experience and expertise in essential newborn care in both facility and community interventions, e.g. Essential Newborn Care (ENC), Helping Babies Breathe (HBB).

The TA must provide support to the different levels of government in prioritization of activities based on the identification of the causes and persistent gaps, e.g. birth asphyxia, prematurity and sepsis in service delivery, in tracking the relevant indicators in section C.6, and, based on this information, contribute to the strengthening of the required interventions.

3. Child Health: Pneumonia and diarrheal disease still remain the highest causes of child morbidity and mortality. The TA should have a comprehensive childhood focus looking at interventions for helping children thrive through prevention and treatment of child illnesses, e.g. Early Childhood Development (ECD), Integrated Management of Newborn and Childhood Illnesses (IMNCI) and the Expanded Program for Immunization (EPI). The focus of the TA should be on improving the quality of service provision through supporting best practices for the management of diarrhea and pneumonia at the lowest levels possible, including at the community. The TA should provide support to the GRZs rollout and implementation of updated Reaching Every Child (REC) guidelines and ensure districts support health facilities to develop, implement and monitor relevant micro plans. In districts where there is overlap with the implementation of Gavi Vaccine Alliance Health Systems Strengthening (HSS) grants, there should be clear linkages to effectively leverage, collaborate and complement services.

4. Reproductive Health and Family Planning (RH/FP): Achievements in FP so far include an increase in the mCPR from 34% to 45%, and a reduction in the unmet need for family planning from 27% to 21%. The national aim is to increase the mCPR to 58% and reduce unmet need to 14% by 2020. Distinct focus should be maintained on the family planning program. The Contractor should include technical staff with the expertise to support further expansion of the method mix at district level. In addition, TA should be provided to the central level MOH for interpretation of new research results to make evidence‐based policy decisions. The TA should focus on improving quality service delivery through ongoing training and mentorship for health care providers to offer both short term and long term methods. In addition, TA will support Community Based Distribution (CBD) of contraceptives, as appropriate. The TA should also include a strong component of FP commodity security strengthening to ensure availability of an expanded contraceptive method mix.

5. Adolescent health: Access to Adolescent Sexual and Reproductive Health remains a huge challenge, with adolescent pregnancy (age 15‐19) currently at 28%. 15‐19 year olds have the highest unmet need for FP of any age group in Zambia. They are also the age group least likely to be reached with messages on family planning through radio, TV, print, or interaction with a healthcare worker, despite having the highest overall media exposure.