SOL-442-16-000001_Malaria_Elimination_Project _4_Dec_15_FINAL.pdf

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SOL-442-16-000001

SOLICITATION, OFFER AND AWARD

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

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

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

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

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

3 111

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

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

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

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

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

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

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

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

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

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

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

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

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

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

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

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

OFFER (Must be fully completed by offeror)

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

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

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

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

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

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

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

AWARD (To be completed by government)

CODE

12/04/2015 X

1400 LT

Honey Sokry hsokry@usaid.gov

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PAGE(S)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

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

1-6 7-9 10-27 28-29 31-44 45-48 49-62

63-71

72-76

77-82

83-105 106-111

Cambodia

USAID/CAMBODIA

Office of Acquisition & Assistance #1 Street 96 Khan Daun Penh Phnom Penh, Cambodia see section L.7

855 23-728-000 8345

Paul Martin

Cambodia Malaria Elimination Project RFP No. SOL-442-15-000001

Table of Contents Page

PART I - THE SCHEDULE 7

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS 7

B.1 PURPOSE 7

B.2 CONTRACT TYPE 7

B.3 ESTIMATED COST, FIXED FEE, AND OBLIGATED AMOUNT 7

B.4 PRICE/COST SCHEDULE 7

B.5 COST REIMBURSABLE 7

B.6 INDIRECT COSTS 8

B.7 ADVANCE UNDERSTANDING ON CEILING ON INDIRECT COST RATES AND

FINAL REIMBURSEMENT FOR INDIRECT COSTS 8

SECTION C - STATEMENT OF WORK 10

SECTION D - PACKAGING AND MARKING 28

D.1 AIDAR 752.7009 MARKING (JAN 1993) 28

D.2 BRANDING POLICY 28

D.3 BRANDING STRATEGY 28

SECTION E - INSPECTION AND ACCEPTANCE 30

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE30

E.2 INSPECTION AND ACCEPTANCE 30

SECTION F - DELIVERIES OR PERFORMANCE 31

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE31

F.2 PERIOD OF PERFORMANCE 31

F.3 PERFORMANCE STANDARDS 31

F.4 LEVEL OF EFFORT/ WORKDAYS ORDERED 31

F.6 PLACE OF PERFORMANCE 40

F.7 AUTHORIZED WORK DAY / WEEK 40

F.8 KEY PERSONNEL 40

F.9 AIDAR 752.242-70 PERIODIC PROGRESS REPORTS (OCT 2007) 43

F.10 AIDAR 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT

EXPERIENCE DOCUMENTS (SEPTEMBER 2013) 43

SECTION G - CONTRACT ADMINISTRATION DATA 45

G.1 AIDAR 752.7003 DOCUMENTATION FOR PAYMENT (NOV 1998) 45

G.2 ADMINISTRATIVE CONTRACTING OFFICE 46

G.3 CONTRACTING OFFICER’S REPRESENTATIVE (COR) 46

G.4 PAYING OFFICE 46

G.5 ACCOUNTING AND APPROPRIATION DATA 46

G.6 TECHNICAL DIRECTIONS/RELATIONSHIP WITH USAID 47

G.7 SPECIAL INSTRUCTIONS 48

SECTION H - SPECIAL CONTRACT REQUIREMENTS 49

H.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE49

H.2 AUTHORIZED GEOGRAPHIC CODE 49

H.3 NONEXPENDABLE PROPERTY PURCHASES AND INFORMATION

TECHNOLOGY RESOURCES 49

H.4 AIDAR 752.7007 PERSONNEL COMPENSATION (JUL 2007) 49

H.5 ADDITIONAL REQUIREMENTS FOR PERSONNEL COMPENSATION 49

H.6 GOVERNMENT PROPERTY 50

H.7 LANGUAGE REQUIREMENTS 50

H.8 LOGISTIC SUPPORT 50

H.9 SUBCONTRACTING PLAN REPORT FOR INDIVIDUAL CONTRACTS AND

SUMMARY CONTRACTING REPORT 51

H.10 SUBCONTRACTING CONSENT 51

H.11 AIDAR 752.7032 INTERNATIONAL TRAVEL APPROVAL AND NOTIFICATION

REQUIREMENTS (APR 2014) 51

H.14 AIDAR 752.225-70 SOURCE AND NATIONALITY REQUIREMENTS (FEB 2012)52

H.15 GRANTS UNDER CONTRACT 52

H.16 REPORTING OF FOREIGN TAXES (JUL 2007) 53

H.17 NONDISCRIMINATION (JUN 2012) 54

H.18 USAID DISABILITY POLICY (DEC 2004) 55

H.19 USAID-FINANCED THIRD-PARTY WEB SITES (AUG 2013) 55

H.20 CONFERENCE PLANNING AND REQUIRED APPROVALS (AUG 2013) 56

H.21 ENVIRONMENTAL COMPLIANCE AND MANAGEMENT 57

H.22 CONFIDENTIALITY AND OWNERSHIP OF INTELLECTUAL PROPERTY 59

H.23 USAID IMPLEMENTING PARTNER NOTICES (IPN) PORTAL FOR ACQUISITION 59

PART II - CONTRACT CLAUSES 63

SECTION I - CONTRACT CLAUSES 63

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE63

PAYMENT BY ELECTRONIC FUNDS TRANSFER SYSTEM FOR AWARD

MANAGEMENT 64

I.2 52.204-1 APPROVAL OF CONTRACT (DEC 1989) 66

I.3 FAR 52.229-8 TAXES—FOREIGN COST-REIMBURSEMENT CONTRACTS

(MAR 1990) 66

I.4 52.247-67 SUBMISSION OF TRANSPORTATION DOCUMENTS FOR AUDIT

(FEB 2006) 66

I.5 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) 67

I.6 AIDAR 752.7013 CONTRACTOR-MISSION RELATIONSHIPS (OCT 1989) 67

I.7 AIDAR 752.7034 ACKNOWLEDGMENT AND DISCLAIMER (DEC 1991) 68

I.8 752.7101 VOLUNTARY POPULATION PLANNING ACTIVITIES (JUN 2008) 68

I.9 DEFENSE BASE ACT (DBA) INSURANCE 69

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS 72

SECTION J - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS 72

PART IV - REPRESENTATIONS AND INSTRUCTIONS 77

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS OF

OFFERORS 77

K.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE 77

K.2 AGREEMENT ON, OR EXCEPTIONS TO, TERMS AND CONDITIONS 77

K.3 52.222-38 COMPLIANCE WITH VETERANS EMPLOYMENT REPORTING

REQUIREMENTS (SEP 2010) 77

K.4 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (DEC 2014)77

K.5 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS

(JUL 2013) 81

K.6 INSURANCE - IMMUNITY FROM TORT LIABILITY 82

K.7 SIGNATURE 82

SECTION L - INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS 83

L.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE83

L.2 FAR 52.216-1 TYPE OF CONTRACT (APR 1984) 83

L.3 52.233-2 SERVICE OF PROTEST (SEP 2006) 83

L.4 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998) 84

L.5 ACQUISITION SCHEDULE 84

L.6 GENERAL INSTRUCTIONS TO OFFERORS 84

L.7 PROPOSAL INSTRUCTIONS 85

L.8 INSTRUCTIONS FOR THE PREPARATION OF THE TECHNICAL PROPOSAL86

L.9 INSTRUCTIONS FOR THE PREPARATION OF THE COST PROPOSAL 91

L.10 BUDGET 95

L.11 INSTRUCTIONS FOR THE PREPARATION OF THE BRANDING

IMPLEMENTATION PLAN (BIP) 95

SECTION M - EVALUATION FACTORS FOR AWARD 106

M.1 GENERAL INFORMATION 106

M.2 DETERMINATION OF THE COMPETITVE RANGE AND CONTRACT AWARD106

M.4 EVALUATION CRITERIA 107

M.5 COST EVALUATION 110

M.6 SOURCE SELECTION 111

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

The purpose of this contract is to secure technical services for the implementation of the program entitled Cambodia Malaria Elimination Project. The contractor will be responsible for providing all services and activities as described throughout this contract document.

B.2 CONTRACT TYPE

This is a Cost-Plus-Fixed-Fee (CPFF) term, level-of-effort contract. For the consideration set forth in the contract, the contractor will provide the deliverables or outputs described in Section C and comply with all contract requirements.

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

(a) The estimated cost for the performance of the work required hereunder, exclusive of fixed fee, if any, is ______________. The fixed fee, if any, is ______________. The estimated cost plus fixed fee, if any, is ______________.

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

(c) Funds obligated hereunder are anticipated to be sufficient through ______________.

B.4 PRICE/COST SCHEDULE

Contract Period (Years 1 – 5)

For Workdays (LOE) Ordered $ ____________ For Other Direct Costs $ ____________ Grants Under Contract $ 1,500,000 Indirect Costs (includes Overhead, G&A $ ____________ and MHO) Fixed Fee $ ____________ Cost Plus Fixed Fee Ceiling Price $ ____________

The contractor will not be paid any sum in excess of the ceiling price.

B.5 COST REIMBURSABLE

The U.S. dollar costs allowable must be limited to reasonable, allocable and necessary costs determined in accordance with FAR 52.216-7, Allowable Cost and Payment, FAR 52.216-8, Fixed Fee, if applicable, and AIDAR 752.7003, Documentation for Payment.

FAR 52.232-20 Limitation of Cost (applies while the contract is fully funded). FAR 52.232-22

Limitation of Funds (applies while the contract is funded in an amount less than the total estimated cost).

B.6 INDIRECT COSTS

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

Description Rate Base Type Period ______________ __________ 1/ 1/ 1/ ______________ __________ 2/ 2/ 2/ ______________ __________ 3/ 3/ 3/

1/Base of Application: ______________ Type of Rate: ______________ Period: ______________ Source: ______________

2/Base of Application: ______________ Type of Rate: ______________ Period: ______________ Source: ______________

3/Base of Application: ______________ Type of Rate: ______________ Period: ______________ Source: ______________

B.7 ADVANCE UNDERSTANDING ON CEILING ON INDIRECT COST RATES AND FINAL

REIMBURSEMENT FOR INDIRECT COSTS

(a) For each of the contractor's accounting periods during the term of this contract, the parties agree as follows:

(1) The distribution base for establishment of final overhead rates is _____________________.

(2) The distribution base for establishment of final G&A rates is ______________________.

(b) The contractor will make no change in its established method of classifying or allocating indirect costs without the prior written approval of the contracting officer.

(c) Reimbursement for indirect costs shall be at final negotiated rates, but not in excess of the following ceiling rates:

Description Rate

(d) The government shall not be obligated to pay any additional amount on account of indirect costs above the ceiling rates established in the contract. This advance understanding shall not change any monetary ceiling, cost limitation, or obligation established in the contract.

B.8 FEE PAYMENT

The contractor will not be paid any sum in excess of the ceiling price. Fee is earned in proportion with level of effort (LOE) delivered under this contract. The contractor may bill fee monthly as a percentage of incurred costs, not to exceed ___%. In the event the contractor does not expend the total level of effort at the expiration of the contract period, the amount of fee will be adjusted accordingly. For example, if the contractor has delivered 85% of the LOE, then the Contractor is entitled to 85% of the fee amount.

Pursuant to FAR 52.216-8, Fixed Fee, after payment of 85 percent of the fixed fee, the Contracting Officer shall withhold further payment of fee until a reserve is set aside in an amount of ____________. The Contracting Officer shall release 75 percent of all fee withholds under this contract after receipt of the certified final indirect cost rate proposal covering the year of physical completion of this contract, provided the contractor has satisfied all other contract terms and conditions, including the submission of the final patent and royalty reports, and is not delinquent in submitting final vouchers on prior years’ settlements.

[END OF SECTION B]

SECTION C - STATEMENT OF WORK

C.1 INTRODUCTION

The President’s Malaria Initiative (PMI) was launched in 2005 with the goal of reducing malaria-related mortality by 50% across 15 high-burden countries in sub-Saharan Africa. With the passage of the Tom Lantos and Henry J. Hyde Global Leadership against HIV/AIDS, Tuberculosis, and Malaria Act in 2008, PMI developed a U.S. Government Malaria Strategy for 2009–2014, which included a long-term vision for worldwide malaria eradication by 2040-2050.

Under this strategy, four new sub-Saharan African countries and one regional program in the Greater Mekong Subregion (GMS) were added in 2011. The contributions of PMI, together with those of other partners, have led to dramatic improvements in the coverage of malaria control interventions in PMI-supported countries, and all 15 original countries have documented substantial declines in all-cause mortality rates among children less than five years of age.

In February 2015, the updated President’s Malaria Initiative Strategy (2015–2020) was launched which continues the vision of a world without malaria. Malaria prevention and control remains a major U.S. foreign assistance objective and this strategy fully aligns with the U.S. Government’s vision of ending preventable child and maternal deaths and ending extreme poverty, and also with the goals articulated in the draft RBM’s second Global Malaria Action Plan and WHO’s draft Global Technical Strategy.

Under this new strategy, PMI will work with NMCPs and partners to accomplish the following objectives by 2020:

1. Reduce malaria mortality by one-third from 2015 levels in PMI-supported countries, achieving a greater than 80% reduction from PMI’s original 2000 baseline levels.

2. Reduce malaria morbidity in PMI-supported countries by 40% from 2015 levels.

3. Assist at least five PMI-supported countries to meet the WHO criteria for national or sub-national pre-elimination.

To achieve these objectives, PMI will take a strategic approach which emphasizes the following five areas: (1) achieving and sustaining scale of proven interventions, (2) adapting to changing epidemiology and incorporating new tools, (3) improving countries’ capacity to collect and use information, (4) mitigating risk against the current malaria control gains, and (5) building capacity and health systems.

Cambodia is one of six countries in the GMS including: Burma, China (Yunnan Province), Lao People’s Democratic Republic, Thailand, and Vietnam. Malaria remains a major contributor to the public health and economic burden in Cambodia due in large part to the development and spread of malaria parasite resistance to artemisinin drugs, the principal component of the combination therapies for malaria that now are the first-line treatment for malaria throughout the GMS. Evidence of Plasmodium falciparum resistance to artemisinin drugs has now been identified in multiple locations in the country; treatment failures to artemisinins have been reported from multiple sites on the Thai-Cambodian border and also in the north and northeast along the Lao-Cambodian and Cambodian-Vietnam borders.

C.2 BACKGROUND

C.2.1 General Overview

The recent results from the 2014 Demographic and Health Survey (DHS) showed that many of Cambodia’s key health indicators have significantly improved as the country’s economy has developed. Between 2000 and 2014, infant mortality rates (IMR) have decreased from 95 per 1000 live births (2000) to 28 per 1000 live births (2014). Similarly, under-five mortality has decreased from 124 per 1000 (2000) to 35 per 1000 (2014), and 73% of children 12-23 months are fully vaccinated. Malaria nevertheless remains a significant burden. Of the country’s estimated 15 million people, 80% of the population lives in areas without malaria transmission, but around 20% (approximately 2.9 million people) either live permanently in the forested endemic areas or are “forest dependent” for additional income. The 2013 Cambodia National Malaria Survey estimated a malaria prevalence of 0.9% in high-risk areas (<2km from the forest).

Both malaria morbidity and mortality rates have declined over the last decade due to increased government commitment together with substantial financial and technical support from the international community. National statistics reported to the World Health Organization (WHO) indicate that between 2002 and 2012 the number of probable and confirmed cases and the number of malaria related deaths reported from public health facilities fell by 76% (from 100,194 to 45,553) and 90% (from 457 to 45), respectively. The Health Information System (HIS) and Village Malaria Worker (VMW) malaria data for 2012 indicate a further reversal of the P.

falciparum: P. vivax ratio (37%: 48% in 2012 compared to 46%: 38% in 2011) confirming the continuation of the long-term decline of malaria burden in the country.

The national case management policy in Cambodia prioritizes access to quality diagnosis and treatment of malaria-confirmed cases with the artemisinin-based combination therapy (ACT), DHA-piperaquine, which has been made available in public health facilities and through trained VMWs. In Cambodia, ACTs are used to treat both uncomplicated P. falciparum and P. vivax malaria infections.

In response to the findings of reduced efficacy of DHA-piperaquine in Pailin, the national treatment guidelines (NTGs) were revised in 2012 authorizing the use of atovaquone/proguanil (Malarone) in that province. Unfortunately, molecular genotyping revealed the presence of atovaquone resistance mutations within six months of introduction, necessitating the discontinuation of Malarone, and reversion back to DHA-piperaquine. With documentation of subsequent therapeutic efficacy studies (TES) demonstrating unacceptably high DHA-piperaquine failure rates in four additional operational districts/provinces, further change in the malaria treatment policy, with artesunate-mefloquine (ASMQ) now again recommended as first-line treatment in those areas. Procurement of ASMQ to implement this policy is currently underway.

C.2.2 Current Epidemiological Situation

The total number of treated malaria cases in the public sector (i.e. all cases treated based on clinical as well as microscopic or rapid diagnostic test (RDT) confirmation in government facilities) was halved from 115,614 in 2001 to 74,608 in 2012 and was further reduced by 40% in 2013 to 44,748 with roughly half of the malaria cases being tested and treated by the extensive network of VMWs (Figure 1). At the end of 2013 the annual malaria parasite incidence was 2.94 per 100,000, and the number of deaths had dropped to 13 compared to 51 in 2012 (a 75% reduction). In some areas the reduction has been even more rapid. However, a significant proportion of the population, though, first seeks care in the private sector. Although efforts are increasing to work with private providers, it remains difficult to know with certainty the numbers of malaria cases seen by both formal and informal private providers.

Figure 1: Trend of Reported Confirmed Malaria Cases in Cambodia, 2009-2014

Until recently P. falciparum was the predominant species among confirmed malaria cases, but in 2012 the proportion shifted and for the first time P. vivax accounted for more than 50% of confirmed case: 55% in 2012 and 58% in 2013. P. malariae is rare and P.

knowlesi has been reported sporadically, although its distribution and the number of human infections are not known.

Malaria in Cambodia is primarily a disease of young males 15-49 years of age who live or work in forested areas or on private farms near the forest. They often travel between endemic and non-endemic areas increasing risk-taking behaviors. Poverty also increases susceptibility to malaria as do changing land use and sometimes-illegal status leading to reductions in care seeking behavior. These factors contribute to the high incidence of malaria among mobile and migrant populations (MMPs) when compared with a resident population of similar socio-economic and demographic profile.

Roughly 15% of malaria cases in 2013 were adult females. These are predominantly residents of villages in or near forests or are cases due to secondary transmission from forest goers that return to towns and cities. Children under 5 years of age constituted only 3% of total malaria cases.

Cambodia's malaria burden continues to be disproportionately borne by ethnic minorities, mobile, migrant, and cross-border populations, representing a huge challenge for prevention and control.

Despite efforts to ensure availability of high quality ACTs and a ban on oral artesunate monotherapies, substandard antimalarials can still be found in the unregulated private sector in Cambodia. Efforts to remove poor quality malaria treatments from the market and replace them with quality-assured ACTs has improved the situation; however, a recent study by the Artemisinin-based Combination Therapy (ACT) Consortium published in the American Journal of Tropical Medicine and Hygiene indicate that up to 30% of antimalarials in Cambodia may be of substandard quality.

C.2.3 Overview of the Health System in Cambodia

The National Centre for Parasitology, Entomology, and Malaria Control (CNM) sits within the

Ministry of Health (MOH) (Figure 2). The leadership of malaria control activities within Cambodia rests at the central level; however, with the MOH’s Decentralization and Deconcentration Strategy, more emphasis is being placed on building the capacity of the Provincial Health Department (PHD) and Operational District (OD) malaria supervisors to plan and implement activities at the local level. Active participation of VMWs, Mobile Malaria Workers (MMWs) and local authorities help to improve the availability and access to malaria services, including early diagnosis and treatment, the provision of long-lasting insecticidal nets (LLINs), and malaria health education. CNM coordinates four main disease programs: malaria, dengue hemorrhagic fever, filariasis and schistosomiasis, and intestinal parasitic infections. It has 155 staff persons with 11 Director and 7 vice Directors.

Figure 2. Organizational structure of CNM, Ministry of Health, Cambodia

C.3.1.National Malaria Control Program Strategy: Moving from control to elimination

Following the Prime Minister’s announcement that Cambodia will seek to eliminate malaria by

2025, Cambodia developed a new malaria strategy. This strategy, the National Strategic Plan for Elimination of Malaria, aims to achieve the following goals:

• Short-Term (by 2015) To move towards pre-elimination of malaria across Cambodia, with special efforts to contain artemisinin resistant P. falciparum malaria.

• Medium-Term (by 2020) To move towards elimination of malaria across Cambodia with an initial focus on P. falciparum malaria and ensure zero deaths from malaria.

• Long-Term (by 2025) To achieve a phased elimination of all forms of malaria in Cambodia.

Figure 3: Phased Approach from Malaria Control to Pre-elimination and Elimination in Cambodia

CNM is currently finalizing an addendum to strategy which outlines specific interventions, activities, and milestones to achieve elimination. This draft document, the Malaria Elimination Action Framework (MEAF) for 2016-2020, includes the following specific objectives:

1. Provide effective program management and coordination at all levels to efficiently deliver combination of targeted interventions for malaria elimination by 2017.

2. Achieve universal coverage of case management services by 2016 to ensure 100% parasitological diagnosis of all suspected cases and effective treatment of all confirmed cases.

3. Protect at least 90% of all populations at risk of malaria with an appropriate vector control intervention by 2017.

4. Enhance the surveillance system to detect, immediately notify, investigate, classify and respond to all cases and foci by 2017 to move toward malaria elimination.

5. Implement comprehensive IEC/BCC approach that facilitates at least 90% of people seeking treatment for fever within 24 hours in appropriate health facility/with care provider and at least 85% of at-risk population utilizing an appropriate protection tool by 2017.

The latest draft of the MEAF is attached in Annex A.

M o n I t o r I n g, E v a l u a t I o n & R e s e a r c h

PRE-ELIMINATI

ON WITH AN

INITIAL

FOCUS ON

P.FALCIPARUM

(2016-2020)

PHASED

ELIMINATION

OF ALL

FORMS OF

MALARIA

(2021-2025)

SCALE UP INTERVENTIONS

TO ACHIEVE UNIVERSAL

COVERAGE, ARREST

ARTEMISININ

RESISTANCE & MOVE

TOWARDS PRE-ELIMINATION

(2011-2015)

1. CONTROL 2. PRE-ELIMINATION 3. ELIMINATION

During the implementation period covered by Cambodia’s National Strategic Plan and the draft MEAF, 2016-2020 the country will transition from control to elimination phase. In concert, PMI will support the development of an evidence-based Model Elimination Package that can be provided to CNM to be scaled up in selected geographies with an initial focus on P. falciparum elimination.

To successfully implement the draft Malaria Elimination Action Framework, CNM recognizes that every malaria control intervention needs to be implemented with the highest degree of coverage and quality. Accordingly, CNM has revised its national treatment guidelines (NTGs) for malaria incorporating updated information presented at national malaria drug policy meetings held in December 2013 and January 2014. The policy focuses on further aggressive reduction of malaria morbidity and mortality as it approaches malaria elimination. In addition, the policy aims to reduce the impact of resistant malaria strains and preserve the current arsenal of malaria treatments by optimizing drug regimens and extending case management to follow up patients in high-risk areas to assure successful cure. The policy also promotes more aggressive diagnostic testing to accurately diagnose and treat a larger proportion of malaria cases. To achieve these objectives, updates in the 2014 treatment guideline include:

● Substitution of artesunate-mefloquine for selected provinces where DHA-piperaquine is currently used and failing to achieve acceptable cure rates;

● Replacing co-blistered artesunate-mefloquine previously used in Cambodia with a fixed dose combination (FDC) once it is available;

● Emphasizing directly observed therapy (DOT) and ensuring clearance as an essential part of case management;

● Enhancing timely surveillance for drug efficacy to inform effective treatment policies;

● Adopting low-dose primaquine to reduce the transmission of P. falciparum malaria in compliance with 2012 WHO guidelines and amending P. vivax radical cure dosing options.

One of the critical components of Cambodia’s elimination strategy is accurate diagnosis and treatment, and rapid reporting and response to every case. This must be coupled with simultaneous efforts to reduce transmission in highly endemic areas that may be a source for re-introduction of malaria cases to districts with low malaria endemicity. Achieving malaria elimination will require the concerted effort and commitment of the government, affected communities, and local and international partners.

While the draft MEAF is being reviewed and finalized, it is anticipated these revised intervention strategies are aligned with the current National Strategic Plan for Malaria Elimination (2011- 2025). The draft MEAF is planned to be implemented jointly by CNM and all implementing partners. Therefore, activities under the Cambodia Malaria Elimination Project, referred to as “the Project”, will be aligned with the MEAF once it is endorsed by the Ministry of Health.

C.3.2 Other Donors and Partners

While PMI is the second largest donor to Cambodia’s malaria program, there are many other donors and partners in the health sector with whom PMI and the contractor will need to coordinate to increase effectiveness of project interventions and reduce duplication of efforts.

PMI’s support for malaria control and elimination in Cambodia leverages support from the Global Fund for AIDS, TB, and Malaria who has been the major external financier of malaria control activities. Two new two-year Global Fund grants are due to start in mid-2015 under the Regional Artemisinin Initiative (RAI) and Single Stream Funding (SSF). Through the “5% Initiative,” the

French Expertise Institute also supports bilateral and regional malaria activities to enhance the effectiveness and impact of the Global Fund grants. Other donors include the Asian Development Bank (ADB) who is funding malaria elimination activities in Preah Vihear and the Clinton Health Access Initiative (CHAI) who provides technical assistance to CNM at national level. Other regional donors supporting malaria activities that impact Cambodia are Australia’s Department of Foreign Affairs and Trade (DFAT) and the Bill & Melinda Gates Foundation who jointly support the WHO Regional Emergency Response for Artemisinin Resistance (ERAR) Hub, as well as key basic and operational research and technical assistance to malaria control and elimination programs throughout the region. The Project is expected to complement and not duplicate the efforts of other donors and partners.

National malaria activities are also complemented by other PMI-funded activities and broader health systems work funded by USAID and other donors. The Cambodia Malaria Elimination Project will complement other PMI-supported activities including therapeutic efficacy studies, drug quality assurance, operational research and capacity building and technical assistance on entomology. Other PMI-funded projects will be responsible for all PMI-funded procurement of malaria commodities, such as LLINs, LLIHNs, RDTs and ACTs, to complement the commodities supplied by the Global Fund while providing technical assistance to CNM and the Central Medical Stores on quantification, distribution, and monitoring of malaria commodity supplies. The Contractor will also need to coordinate with other USG agencies carrying out clinical trials that may help to inform and refine Cambodia’s elimination interventions.

USAID-funded health systems strengthening projects also support the MOH in licensing and regulation of private health care providers, strengthen the HIS and its interoperability with vertical disease program information systems, assist the MOH to deliver social health protection schemes and develop stronger logistics systems. In support of the MOH’s Decentralization and Deconcentration Strategy, USAID and other USG agencies will also provide technical assistance to PHDs and ODs on financial and operational management of health services. The Project is expected to complement and coordinate with these USAID-funded cross-cutting projects.

C.4 STATEMENT OF WORK

The Cambodia Malaria Elimination Project has four primary objectives:

1. Develop a scalable, evidence-based elimination model in Sampov Loun and support its dissemination and replication for malaria elimination in Cambodia;

2. Support scale-up of high quality malaria control and prevention interventions in five to eight

ODs, where gaps in coverage or quality exist;

3. Strengthen national malaria surveillance systems and M&E appropriate for malaria elimination and control activities;

4. Build capacity of Ministry of Health (MOH) to manage, intensify, and sustain malaria control and elimination efforts particularly at the OD level.

This Project is intended to intensify malaria control and elimination activities by providing technical assistance and support to CNM to further develop, refine, and evaluate an evidence-based Model Elimination Package for malaria, which can then be implemented in other appropriate ODs. Initial work on this package has already begun under the existing Greater Mekong Subregion Control and Prevention of Malaria (CAP-Malaria) Project. This regional project has been implemented in Burma, Thailand and Cambodia by University Research Co, LLC (URC) under cooperative agreement number AID-486-A-12-00001.

The Contractor will initially support elimination activities in one pilot OD, Sampov Loun (SPL), in Battambang Province. In SPL OD, only 456 confirmed cases were reported in 2014. This low burden allows for program reorientation toward malaria elimination. The operational district has a network of village malaria workers (VMWs) and a public-private mix (PPM) program, currently managed by the PMI-funded CAP-Malaria Project. However, intense resistance and treatment failures to ACTs have been identified in sentinel sites in proximity to Sampov Loun. This resistance takes the form of both resistance to artemisinin drugs and the two partner drugs most widely deployed as part of ACT regimens—mefloquine and piperaquine. Data from western Cambodia TES studies reflect cure rates to DHA-piperaquine of only 59-69%. Thus, elimination efforts in SPL must not only ensure that case numbers are reduced, but also include measures to mitigate the further selection of resistant P. falciparum strains. Such measures could include:

adoption of low-dose primaquine transmission reduction, if ongoing studies demonstrate its safety, and implementation of directly observed therapy (DOT) and active follow-up of patients to ensure adherence and cure.

Simultaneously, the Contractor will also work in five (5) other target ODs, to be determined in consultation with CNM and PMI. In some of these ODs accelerated control activities will be scaled up with the goal of reducing the Annual Parasite Incidence (API) for Pf to less than 1 per 1,000 population.

The Project is intended to contribute to the overall efforts of CNM and partners to eliminate malaria from Cambodia by 2025. It is recognized that several factors may impede progress towards malaria elimination, including intensifying resistance to ACTs, waning finances for malaria elimination activities, and social and economic factors that are beyond the control of this Project. Nonetheless, the tools, approaches and the strengthened surveillance systems developed through this Project will enable Cambodia to move closer to the goal of elimination and equip CNM and partners to move quickly to address such challenges as they arise.

The Contractor is expected to develop an evidence-based, Model Elimination Package, building upon and refining activities currently being piloted in SPL by PMI’s CAP-Malaria Project, which is scheduled to close in October 2016. Within the first few months of the Project, all CAP-Malaria-supported activities in SPL will be assessed and handed over to the contractor for refinement and continued implementation. During the course of the Project, the Model Elimination Package--with all of its tools, technical guidelines, manuals, standard operating procedures (SOPs), best practices and lessons learned-- will be evaluated and costed before being provided to CNM and other partners for adoption and onward implementation, as appropriate.

At the start of the Project, SPL is expected to already be implementing some parts of the Model Elimination Package and piloting others. All tools, manuals, SOPs and documentation of best practices developed and/or piloted in SPL will be provided to the contractor by the PMI CAP Malaria Project. The contractor will continue to validate, refine, and then scale-up fully this Model Elimination Package within this OD by the end of Project Year 2, in consultation with CNM and PMI. The Contractor will work closely with appropriate staff at CNM and other appropriate partners during the further development and finalization of these tools.

C.4.1 Program Principles

The project activities must be conducted in accordance with the following principles:

i. Support existing Operational Districts Office systems and partners.

To the extent practicable, the Contractor will use the existing health system and strengthen the ability of public and private providers and NGOs to support malaria elimination activities. The Contractor will avoid setting up parallel, project-specific systems. This may also include collaborating with other partners who are strengthening systems that affect the delivery of malaria activities; including logistics, information systems, and other service delivery systems.

ii. Maintain linkages at national and provincial level

While the main focus of activities is at the OD level, the Contractor will also play a critical role in providing technical leadership at the national level. The Contractor must also collaborate closely with the MOH and the CNM in the planning and implementation of activities. In addition, Cambodia has many NGOs, donors and partners. The Contractor’s, in addition to USAID’s, presence at the national level will assist PMI with central level coordination of activities of all PMI-supported partners.

iii. Program reach

Implementation will be done in a phased approach. In Year 1, the Contractor will pilot and implement elimination activities in Sampov Loun OD in Battambang Province and malaria control activities in five (5) other ODs selected in collaboration with CNM and PMI. In consultation with PMI/USAID and CNM, the Contractor may be required to expand to as many as three (3) additional ODs by the third year of the project. The Contractor is expected to establish a presence in each OD although consolidation of management functions in regional offices may be used to decrease management costs and improve efficiency.

iv. Build capacity and sustainability

The Contractor is expected to provide technical leadership and lead implementation while building capacity and skills at the district, health facility, and community level without creating parallel management or reporting structures. The intent is to equip districts to take over ownership and implementation of all malaria control activities and all elimination activities by the end of the Project.

v. Gender considerations

The group that is at highest risk of morbidity and mortality related to malaria consists of male mobile/migrant workers that are in search of employment in the forests and plantations located in the west of the country. The contractor must develop a gender-sensitive communication strategy and targeted messages to reach these workers (and their families) when they arrive in the OD in search of employment and while they are employed. The contractor will also support the targeted ODs to distribute LLINs to mobile/migrant workers and to the resident populations that reside within two kilometers of forested areas to increase LLIN ownership and use as stated in task under Objective 1 in C 5.1.

Gender also plays a critical role in determining access to treatment and care for malaria and use of preventative measures such as LLINs. Populations working in forested areas but residing in households of permanent dwellers may be the source of infection to women and children who reside in the village. Gender norms and behaviors influence access to LLINs within the home if mosquito nets are insufficient to cover every sleeping space. Power dynamics within the household further impact the ability to seek preventative care and treatment. The contractor shall address gender-related barriers to prevention and treatment in all of its interventions.

vi. Coordination with other donors and partners

The Project will coordinate with other implementing partners and Malaria district teams in the target ODs on activities supported by other donors (e.g., Global Fund, Asian Development Bank, and the Bill & Melinda Gates Foundation) to avoid overlapping activities or duplicate funding.

Other malaria partners include, but not limited to: United Nations Development Program, Malaria Consortium, Clinton Health Access Initiative, and the World Health Organization.

C. 5 PROGRAM OBJECTIVES, TASKS AND TARGETS

C.5.1 Objective 1: Develop a scalable, evidence-based elimination model in Sampov Loun (SPL) and support its widespread dissemination and replication in other target ODs in Cambodia.

Should national guidelines for malaria elimination be revised or updated during the lifetime of this project, some of the components of this elimination model may need to be adjusted or changed.

C.5.1.1 Tasks

1. Within 6 months of project award, complete pre-implementation situational analysis of current malaria control and elimination operations in SPL. The purpose of this analysis is to inform project work plans and to identify baseline targets from which future progress will be measured.

The situation analysis will: a) establish the appropriate target populations to be targeted for future elimination operations in SPL; b) assess pre-implementation LLIN coverage and appropriateness of BCC activities of said population; c) assess efficacy of early diagnosis and treatment of all clinical malaria cases; d) assess effectiveness of existing case management, case investigation and response activities in SPL; e) evaluate existing systems to supervise health facility staff and VMWs, improve quality of malaria services, improve stock management, and improve reporting, analysis, and use of data use.

2. Sustain universal coverage with LLINs in targeted populations. The Contractor will support the distribution and supportive BCC activities to promote the use of LLINs through campaigns and routine systems, as appropriate, to ensure access by all targeted high-risk permanent residents and MMPs. The LLINs will be procured and supplied by either the Global Fund, other PMI-supported projects, other donors or the host government. It is not anticipated that the Contractor will procure any LLINs but will require close coordination with relevant partners to support effective distribution and relevant behavior change communication.

3. Ensure early diagnosis, appropriate treatment, and follow-up of all clinical malaria cases.

Support training, supervision, and quality assurance of public health facility clinical and laboratory staff, VMWs, and MMWs to ensure that all suspected malaria cases are correctly assessed, tested with high-quality microscopy and/or RDTs, and provided appropriate treatment in line with the latest recommendations in the National Malaria Treatment Guidelines (NTGs).

Positive cases of P. falciparum and P. vivax will receive appropriate treatment using DOT and case follow-up in accordance to the NTGs.

Cases with recurrent parasitemia up to Day 28 will be referred as specified in the NTGs. Upon favorable results from safety and G6PD feasibility OR studies, CNM may elect to implement both low dose primaquine (PQ) for P. falciparum and radical curative doses of PQ for P. vivax. In this event, the Contractor will develop training materials on PQ administration and safety monitoring and support training of health facility workers, VMWs, and MMWs. Activities may include facilitating short-term resupply of ACTs, RDTs, and other essential commodities to facilities and

VMWs with impending or stock-outs. The Contractor will not be directly involved in routine supplying of commodities to health facilities or VMWs.

4. Implement malaria case reporting, investigation, and response. The Contractor will develop a system to enable rapid reporting of all diagnosed malaria infections, conduct an investigation of every reported case, and carry out response activities, including assessment, testing, and treatment of all household members, if appropriate. If the patient had traveled into the forest, any persons who traveled with him/her will, if feasible, also be followed-up and assessed, tested, and treated for malaria, as appropriate. The target will be to report every case within 24 hours, conduct a case investigation within 3 days, and complete response within 7 days (the so-called “1-3-7” approach). This activity would include adoption and/or development of appropriate information technology to facilitate reporting and follow-up in consultation with CNM and ensure linkages with the national malaria surveillance system.

5. Strengthen case management, reporting, and response to all malaria cases in the private sector. In line with CNM policies and guidelines, support will be provided to ensure that all malaria cases identified by all registered private sector providers and outlets in SPL are rapidly diagnosed and treated; and cases reported, investigated, and response conducted in the same manner as will be done with cases diagnosed in the public sector. This will include supportive supervision of private providers and conducting quality assurance activities to ensure diagnostic testing and treatment are done to the same standard as in the public sector and in accordance with the National Treatment Guidelines. The Contractor will also improve seamless coordination of malaria activities between the public and private sectors to enable regular reporting and response to malaria cases from the private sector to the OD.

6. Build capacity and strengthen systems to manage elimination activities. Support will be provided for the development of a Special Working Group for Elimination at Operational District level to engage key malaria stakeholders, develop and implement action plans, assign roles and responsibilities, and mobilize communities to support elimination goals. Targeted support to build necessary program management capacity at OD and PHD level also will be provided.

Based on the needs of PHDs, ODs, and health facilities in target ODs, the Contractor will strengthen systems to supervise health facility staff and VMWs, improve quality of malaria services, improve stock management, and improve reporting, analysis, and use of data. The Contractor will engage CNM at central level to jointly plan and oversee elimination activities.

7. Strengthen behavior change communication (BCC) for malaria elimination. Support implementation of BCC for malaria elimination through appropriate channels, including through interpersonal communication, community mobilization and dialogues, and other appropriate means. Particular focus will be placed on MMPs and innovative approaches to reach difficult to reach populations will be tested, in consultation with CNM and PMI. Development of improved BCC messaging (including appropriate M&E) to encourage continued use and adherence to malaria prevention and control measures in low transmission settings also will be needed.

8. Support civil society and community-based organizations to complement malaria elimination activities. As appropriate, support will be provided to community-based organizations and groups to conduct behavior change and social mobilization activities to promote and monitor consistent LLIN use and to encourage rapid access to malaria services, particularly among MMPs and ethnic minority communities.

9. Conduct operations research (OR) in the context of malaria elimination. In consultation with CNM and PMI, appropriate OR activities will be carried out to answer key technical questions and address key implementation challenges towards achieving the goal of elimination. The Contracting Officer’s Representative (COR) will provide technical direction regarding research questions and guidelines for operations research. All OR activities will be subject to PMI OR committee and COR review and must be conducted in compliance with Good Clinical Practice (GCP) standards. Findings and data from the program will be routinely evaluated, documented, and shared with PMI, CNM, OD/PHD, and all interested partners. Reporting of results in scientific meetings will be cleared through PMI prior to dissemination.

10. Refine existing malaria elimination tools, SOPs, and guidelines. At the start of the Cambodia Malaria Elimination Project, SPL is expected to already be implementing some parts of the Model Elimination Package. All existing tools, manuals, SOPs and documentation of best practices developed and/or piloted in SPL will be implemented, validated, and refined by the Contractor by the end of Project Year 1.

11. Evaluate programmatic effectiveness, scalability, and cost of SPL project activities. By the end of Year 2, the Contractor will complete an analysis of the Project’s existing malaria elimination operations in SPL. In addition, a detailed costing of the inputs required for the implementation of the Model Elimination Package will be carried out. The analysis will document best practices and identify key components of the elimination package that can be feasibly and effectively replicated in other ODs.

12. Document and disseminate the Model Elimination Package.