IMPACT_Draft_SOW_-_FedBizOpps_-_Oct20.docx

Improving Prevention and Adherence to Care and Treatment (IMPACT) – Draft SOW

C.1. ACRONYM LIST

C.2. DEFINITIONS

For the purposes of this award;

· SBCC is the coordinated use of a range of communication approaches – including mass media, community-level activities, and interpersonal communication - to change individual behaviors and social norms to assist improved health outcomes. SBCC is related to, but not the same as, health promotion, a broader programmatic category that typically emphasizes universal access to information and community engagement as a component of a robust health system.

· Capacity is the ability of individuals and organizations or organizational units to perform functions effectively, efficiently and sustainably[footnoteRef:1]. [1: http://www.pepfar.gov/documents/organization/197182.pdf ]

· Capacity strengthening is an evidence-driven process of strengthening the abilities of individuals, organizations, and systems to perform core functions sustainably, and to continue to improve and develop over time[footnoteRef:2]. [2: http://www.undp.org/capacity/ourapproach.shtml ]

· SBCC systems refers to structures that facilitates the effective planning, implementation, and measurement of SBCC programming in a synergistic manner at all levels in an effective and quality manner. It includes considerations of operations, human resources, financial management, and procurement, as well as other relevant areas.

· Innovative SBCC is the integration of creative new, proven and/or promising activities into SBCC programming from diverse fields, including; SBCC, marketing, design, advertising, anthropology, social psychology, and behavioral economics.

C.3. INTRODUCTION

As the flagship social behavior change communications (SBCC) project for USAID/Zambia, the Improving Prevention and Adherence to Care and Treatment (IMPACT) project shall design and evaluate well-coordinated, evidence informed, theory-based, and innovative health communication interventions related to HIV/AIDS, malaria, maternal child health, nutrition, and family planning. SBCC interventions will impact relevant knowledge, attitudes, beliefs, norms, and behaviors, leading to improved health outcomes in geographic and programmatic areas where campaigns and other communication activities are implemented. IMPACT activities will increase evidence-based, high-impact preventative, protective and health-seeking behaviors to achieve sustained impact on health outcomes in Zambia. This will include validating and reinforcing currently-practiced positive behaviors, as well as changing harmful behaviors.

The purpose of this Contract is to improve healthy behaviors related to HIV/AIDS, maternal child health, family planning, malaria, and nutrition by Zambian individuals, families, and communities. In furtherance of this purpose, the IMPACT project has the following objectives:

1. Evidence-based and innovative SBCC interventions designed, implemented, and evaluated at scale;

2. Increased research to enhance SBCC implemented.

3. Effective Zambian government coordination and leadership of SBCC programs increased at national and subnational levels;

4. Capacities of the Zambian government and institutions to design, implement, and evaluate coordinated, high-quality SBCC increased;

The period of performance is five years from the award date, subject to the availability of funds.

C.4. BACKGROUND

Zambia is a land-locked country surrounded by eight bordering countries, with a population of over 14 million. In July 2011, the World Bank reclassified Zambia as a lower middle-income country.

Impressive macro-level performance, however, belies the reality facing most Zambians. The country ranks 163 out of 185 countries in the most recent United Nations Human Development Index (HDI). Eighty percent of rural Zambians live in poverty, of which 63 percent live on less than $1.25 per day. Population density is sparse in rural areas, presenting a challenge to delivering accessible health services. Health and education constraints limit the ability of many Zambians to fully participate in economic opportunities. While progress has been made on some key health indicators over the past ten years (under-five mortality, maternal mortality, antenatal care visits, exclusive breastfeeding), Zambia is far from achieving its health- related Millennial Development Goals (MDG).

Behavior Change Programming and Needs in Zambia

HIV/AIDS

According to the 2007 Demographic and Health Survey (ZDHS)[footnoteRef:3], Zambia’s HIV epidemic has stabilized, but prevalence remains one of the highest in the world. Overall HIV prevalence among adults (ages 15-49) is 14.3 percent, with 16.1 percent among women and 12.3 percent among men. Prevalence is 19.7 percent in urban areas and 10.3 percent in rural areas[footnoteRef:4]. Prevalence among women aged 25-29 who recently gave birth in rural areas was as high as 31.5 percent. An estimated 10 percent of HIV transmission is from mother to child, occurring during pregnancy, birth, or breastfeeding. Though the rate of new infections is slowing, the number of people living with HIV/AIDS is growing, as more people live longer due to life-extending anti-retroviral therapy (ART). The intensified USG prevention response to the predicted HIV incidence trends combines biomedical, behavioral, and structural interventions to address the factors at the individual, couple, community, and population levels that mediate sexual transmission. Approaches at the individual and couple levels must delay sexual debut (among youth), promote secondary abstinence and mutual monogamy (among adults and sexually active youth), and increase condom use (especially for dual protection) and male circumcision. [3: The 2007 Zambia Demographic Health Survey represents the period between 2002 and 2007 and is outdated. Preliminary results from the 2007 to 2013 period will be available by late 2014/early 2015 for contract use as baseline information] [4: 2007 ZDHS.** UNICEF’s “The State of the World’s Children 2014” report states Adult HIV prevalence in 2012 is 12.7%]

Malaria Zambia is classified as a malaria high-burden country. Although malaria prevalence by microscopy and anemia has shown a slight downward trend since 2010 -- parasite prevalence declined from 16 to 15 percent and severe anemia declined from 9 to 7 percent between 2010 and 2012[footnoteRef:5] -- reported malaria cases increased from 3,250,128 to 4,892,813, between 2009 and 2013. In-patient malaria deaths for all ages decreased from 3.9 per 10,000 to 2.8 per 10,000 between 2010 and 2012. Among children under age five, malaria parasite prevalence is 14 percent, and the disease accounts for 36 percent of hospitalizations and outpatient attendance nationwide[footnoteRef:6]. Prevention indicators (such as use of insecticide treated nets) show a general upward trend, although considerable room for improvement remains. [5: Zambia National Malaria Indicator Survey (MIS) 2012] [6: Zambia Health Management Information System (HMIS) 2013]

Family Planning/Reproductive Health (FP/RH) A Zambian woman, on average, gives birth to 5.7 children in her lifetime[footnoteRef:7]. The 2007 ZDHS indicates that family planning services reach only a third of sexually active couples. Consequently, the overall unmet need for family planning is high, at 27 percent. While awareness of Family Planning (FP) among Zambians is high, knowledge has not translated into adequate use of FP services.[footnoteRef:8] Modern contraceptive use remains low at 33 percent. The contraceptive method mix has been static for the past eight years, and long-acting methods have had limited acceptance. Zambia’s total fertility rate (TFR) has remained high compared with other South African Development Cooperation countries and is one of the highest in the world.[footnoteRef:9] This is associated with an annual population growth rate of 2.8 percent, resulting in a projected population of 15.5 million by 2015, doubling to 30 million by 2030. [7: “The State of the World’s Children 2014” report, UNICEF] [8: According to the 2007 ZDHS, 97% of all women and 99% of all men had heard of FP.] [9: Republic of Zambia’s Family Planning Services, Integrated Family Planning Scale-up Plan 2013-2020, piii.]

Additionally, Zambia currently has the largest youth population ever in its history, with over 80 percent of the population below the age of 35 years and 50 percent below the age of 15 years.[footnoteRef:10] This cohort’s birth rate in Zambia (young women aged 15-19) is one of the highest in sub-Saharan Africa, as 28 percent of teenage girls have begun childbearing.[footnoteRef:11] Furthermore, Zambia has one of the highest child marriage rates in the world -- 74 percent of girls are married by the time they are 20 years old. Thirty-seven percent of adolescents in the lowest income quintile have begun childbearing. [10: Central Statistical Office (CSO), Ministry of Health, Tropical Diseases Research Centre (TDRC), University of Zambia, and Macro International Inc. 2009. Zambia Demographic and Health Survey (ZDHS) 2007.] [11: Zambia Demographic and Health Survey (ZDHS) 2007.]

Maternal, Newborn and Child Health (MNCH) Maternal and newborn deaths are largely preventable and indicative of inaccessible and poor-quality health care facilities, inadequacies of the health system, and low demand for and utilization of health facilities. For example, while a high number (more than 90 percent) of Zambian women receive some antenatal care, only 48 percent of women deliver in health facilities and 46 percent deliver with the assistance of a skilled health provider. While there has been a decrease in neonatal mortality from 37 to 34 per 1000 live births (2002 to 2007 ZDHS), neonatal deaths constitute approximately half of all infants who die, because of poor perinatal care in the country. The top five causes of child mortality have consistently been malaria, respiratory infection, diarrhea, malnutrition, and anemia.[footnoteRef:12] Although the majority of children receive immunizations and vitamin A supplementation, only about half have access to improved drinking water sources and use oral rehydration fluids for diarrhea. Furthermore, an issue of concern is the 2007 ZDHS finding that the overall vaccination coverage (fully immunized children 12-23 months) decreased from 78 percent in 1996 to 68 percent in 2007. [12: Zambia Demographic and Health Survey (ZDHS) 2007.]

Nutrition Zambia has one of the highest rates of child under-nutrition in the world. While the average rate of stunting of children under five in Africa is 42 percent, the rate of stunting in Zambia is 45 percent and in those children less than two years of age, it is 59 percent. High levels of stunting are present regardless of income quintile.[footnoteRef:13] Interestingly, 48 percent of male children are stunted as compared to 42 percent of female children. Recent data show that Lusaka, Eastern, Copperbelt, and Northern provinces have the most stunted children. These stunting rates have not significantly decreased since the 1992 level of 46 percent.[footnoteRef:14]. [13: Zambia Demographic and Health Survey (ZDHS) 2007.] [14: Zambia Demographic and Health Survey (ZDHS) 1992.]

Behavior Change Structures and Project Interventions Within the Zambian government, health promotion units are located in three primary agencies: the Ministry of Community Development for Mother Child Health (MCDMCH), the National Malaria Control Center (NMCC), and the National AIDS Council (NAC). This represents a recent shift, as the health promotion unit has historically sat in the Ministry of Health (MOH). Of these three agencies, core health promotion functions lie within the MCDMCH, which functions at both national and subnational levels. In addition, there are several technical working groups (TWGs) that oversee health promotion within the government: the National Health Promotion TWG; the HIV/AIDS Information Education Communication/Behavior Change Communication (IEC/BCC) TWG; the Nutritional Communications TWG, and the Malaria IEC/BCC TWG. These are mandated to act as a clearinghouse for health promotion materials, to review IEC/BCC materials, to develop policies and guidelines, to leverage resources to increase coverage and reach of health promotion activities, and to provide guidance and systems to monitor and evaluate IEC/BCC materials and programs, among other functions.

Role of Government and Capacity of Government Several critical gaps currently exist in the Zambian government’s attempts to increase the adoption and maintenance of healthy behaviors. At the national level, the capacity to coordinate and manage SBCC has been quite limited, historically within the MOH and NAC, and currently in the recently formed health promotion units at the MCDMCH, NMCC, and NAC. This has been largely due to limitations in both technical capacity and public sector capacity at the systems level within the Zambian government, including; management, operations, and human resources. For example, the attrition rate at national health promotion units is high, meaning that investments in technical capacity have not been sustained over time. In addition, there are no dedicated health promotion staff at the provincial and district levels. Furthermore, the restructuring of the health promotion unit not only divided the human resource capacity across three bodies, but also led to confusion about the roles of each of these new health promotion units.

Role of USAID U.S. government (USG) entities have invested in SBCC in Zambia for many years. The USAID-funded health communication activities conducted in collaboration with the Zambian government, private sector, and civil society have resulted in many successes, but have also encountered many challenges. For example, the recent Communications Support for Health (CSH) project was mandated contractually to work at the national level. As a result, CSH’s SBCC interventions largely focused on mass media, and capacity-strengthening activities were focused at the national level, with limited community level interpersonal communication activities. The design of the IMPACT project has incorporated lessons learned from the CSH project and mid-term evaluation[footnoteRef:15] including: (1) capacity-building goals and activities must be clearly defined and measurable; (2) capacity building should be centered on systems, not individuals; (3) SBCC activities at the national level should be supported by strong subnational efforts; (4) impact of SBCC activities on behavior change and health outcomes must be measured; (5) support to the GRZ must be well-defined; and (6) continuation and sustainability of successful campaigns across different implementing partners is cost-effective and improves outcomes. [15: Midterm Evaluation for the Communications Support for Health Program]

Coordination of SBCC in Zambia Currently, there is limited coordination of SBCC in Zambia both in respect to intervention channels and between national and subnational levels both by the Zambian government and among USAID partners. For example, GRZ coordination fora provide a great opportunity to engage the plethora of partners and help harmonize approaches, facilitate evidence-based approaches being taken to scale, and reduce duplication among partners. However, communication fora largely sit at the national level, and involve the National Health Promotion TWG, HIV/AIDS IEC/BCC TWG, and Malaria IEC/BCC TWG. These groups have proven effective in reviewing national level materials, but lack sufficient linkages to other national level TWGs, and the provincial and district levels. In addition, there are coordination fora at the provincial or district levels for SBCC, but these are limited and generally not active due to limited funding and human resource capacity. Many Zambian organizations also have difficulty accessing resources or assistance from these groups. Among USAID partners, disparate workplans, timelines, deliverables, geographic focal areas, and indicators have led to challenges in effectively coordinating SBCC interventions across national and community levels. All of these challenges have markedly limited the impact of SBCC interventions in Zambia.

C.5. SCOPE

As a 5-year project, IMPACT shall design and evaluate well-coordinated, evidence-informed, theory-based, and innovative SBCC interventions related to HIV/AIDS, malaria, maternal child health (MCH), nutrition, and family planning (FP) by individuals, families and communities using mass media, community-level activities, and interpersonal communications. IMPACT shall assist the Zambian government in developing national-level behavior change strategies, and operationalizing/adapting those strategies at the sub-national level with a variety of partners, including GRZ, Zambian institutions (private and local non-governmental organizations), and U.S. government (USG) partners. IMPACT will also design and implement high-visibility multi-channel SBCC interventions that will elevate and unify the behavior change initiatives of other USG partners.

Within this, IMPACT will ensure country ownership of SBCC strategies and programs that are consistent with health sector priorities and are embedded in the health system. IMPACT’s assistance to the Zambian government will incorporate significant capacity strengthening to GRZ SBCC systems at both national and subnational levels, including operational, management, technical and financial capacities. In addition, IMPACT will provide capacity strengthening to a core set of Zambian institutions. IMPACT will adapt and utilize, where possible, available capacity building tools and resources that have been developed through other global, regional, and Zambian health communication projects.

Separate USAID government to government (G2G) mechanisms will provide funds directly to the government to further the SBCC objectives outlined in this project and shall commence during the life of the IMPACT contract. In addition, there will be several other USAID awards concurrent to IMPACT that will contain SBCC activities or other activities closely linked to the work undertaken by IMPACT. IMPACT shall develop a productive and complementary working relationship with recipients of G2G funds earmarked for SBCC, with other USAID partners, and with other stakeholders in the health sector. IMPACT is USAID/Zambia’s flagship SBCC project, and will take a leadership role in developing SBCC strategies and materials for HIV/AIDS, MCH, FP, malaria, and nutrition that will be utilized by other USAID implementing partners having relevant health communications components to their project. IMPACT will share the strategies and templates for materials developed by the project with other USAID implementing partners for reproduction and use in their programming. Accordingly, explicit collaboration and coordination with the Zambian government, U.S. government -funded partners, and other stakeholders will be a cornerstone of IMPACT.

By the end of Project Year 5, IMPACT’s capacity- building and SBCC initiatives will have resulted in improved health outcomes through effective SBCC, led and coordinated by the Zambian government, and implemented through Zambian partners.

C.6. OBJECTIVES

The purpose of IMPACT is to improve health-seeking behaviors in HIV/AIDS, malaria, MCH, nutrition, and FP by individuals, families, and communities. The project shall achieve its purpose through the following intermediate results (IRs), realized by the end of the project:

IR1. Evidence-based and innovative SBCC interventions designed, implemented, and evaluated at scale. Expected outcomes include:

· Targeted, multi-channel, and innovative SBCC interventions developed and produced at scale;

· Coordination and bi-directional exchange between mass media, community-level activities, and interpersonal communication improved within programs;

· Health behaviors measurably improved among priority audiences.

IR2. Increased research to enhance health communication implemented. Expected outcomes include:

· Measurement of the contribution of health communication activities to adoption of improved health behaviors and utilization of health services increased;

· Utilization of data to improve program impact increased;

· Quality of research and evaluation improved.

IR3: Effective Zambian government coordination and leadership of SBCC programs increased at national and subnational levels. Expected outcomes include:

· Zambian government investment and capacity in SBCC systems increased at national and subnational levels;

· Linkages between national and subnational levels of GRZ SBCC systems strengthened, with an increased attention to the role of subnational systems on improving health outcomes;

· Zambian government capacity to advocate for, deliver technical leadership in, and coordinate SBCC increased at national and subnational levels;

· Ability of the Zambian government, implementers, and other key stakeholders to access and share information for purposes of program planning, harmonization, and evaluation improved.

IR 4: Capacities of the Zambian government and Zambian institutions to design, implement, and evaluate coordinated, high-quality SBCC increased. Expected outcomes include:

· SBCC technical capacity of the Zambian government and Zambian institutions measurably increased;

· Zambian government capacity to collect and use data in programmatic decision-making for SBCC increased;

· Application of Zambian government-endorsed guidelines, including harmonized messages and quality standards increased;

· Understanding and consistent application of SBCC best practices among implementers increased.

Table 1. Strategic Priorities for SBCC Activities

· Adolescent prevention

· Prevention of onward transmission of HIV by PLHIV

· PMTCT knowledge and use of services

· Uptake of HIV/AIDS counseling and testing

· Condom use

· VMMC uptake

· Adoption of high impact HIV services and protective behaviors among-at-risk populations

· Adolescents aged 15-19 delaying childbearing

· Use of modern family planning method (adolescents and adults)

· Reduction of OVCs reporting first intercourse at less than 15 years of age

· Completion of birth plan

· Facility based delivery

· Post-partum follow up care

· Appropriate treatment for malaria with Artemisinin-based combination therapy

· Ownership and proper use of ITNs

· Acceptance of IRS

· Quality of exclusive breastfeeding

· Amount, quality, and variety of food served to children improved (measured by MAD)

· Hygiene and sanitation practices

· Women’s nutrition during pregnancy and dietary diversity

· Gender integration, participation of males in family health management, and gender related barriers that impact health outcomes

· Integration of key and priority populations health needs into SBCC programming

· Strengthen agriculture and nutrition linkages in SBCC programming

· Consistent and effective use of quantitative and qualitative data for programmatic decision-making

· Development of strong and actionable linkages and impact between national-level programs, community-level activities, and interpersonal communication

· Foster community-led initiatives to deliver a mix of high quality behavioral interventions tailored to each priority population

· Sustainable public and private partnerships to leverage USAID and GRZ investments in SBCC programing beyond project lifecycle

IMPACT must take a multi-sectoral and gender-focused approach where multidimensional barriers can be addressed to confront women’s disempowerment and the complex factors that lead to poor health. Gender roles can be barriers to the uptake of positive health behaviors; therefore, the IMPACT project must integrate gender into all activity components to help reduce gender disparities in health programming and SBCC activities, and collaborate with all USAID/Zambia gender focused activities. The integration of gender into all activities is critical to the success of USAID/Zambia’s investment in SBCC.

In order to help create an enabling environment to support the adaption and maintenance of healthy behaviors, IMPACT SBCC activities need to harness some of the cultural practices in Zambia that influence the adoption and maintenance of existing behaviors and practices, to serve as a positive reinforcement of healthy behaviors, especially among young people. However, some long-standing cultural practices may influence the utilization of health care services, even when services are readily available. In some cases, traditional Zambian societies and communities foster patterns of health-seeking behavior that delay or limit beneficial contacts with the health system, while long-standing gender inequities and poverty levels further complicate desirable behavior. In order to achieve sustainable behavior change, IMPACT activities will build on existing traditions, indigenous sources of health information, and influences in a positive and culturally appropriate manner.[footnoteRef:16] [16: Kaboru B, et.al, Communities’ views on prerequisites for collaboration between modern and traditional health sectors in relation to STI/HIV/AIDS care in Zambia, Health Policy, 2006. ]

C.7. TASKS

CLIN 0001 Social Behavior Change Communication campaigns – All of the work the Contractor will complete under IR1 will be detailed in individually awarded task orders.

IR1. Evidence-based and innovative SBCC interventions designed, implemented, and evaluated at scale. (Approximately 55% - 60% LOE) SBCC initiatives must be innovative, highly targeted, focused, and well-tailored to the Zambian context and cultures. The initiatives must focus on achieving measurable behavior change leading to improved health outcomes in targeted intervention areas, and be closely aligned to USAID and GRZ priority indicators. Campaigns must incorporate crosscutting themes as appropriate. They shall interlink messages and referrals to services across health areas (HIV/AIDS, FP, MCH, malaria, and nutrition) as appropriate, especially at the community level. Activities must ensure appropriate audience segmentation and tailor behavioral interventions to the needs of different target populations. All behavioral interventions must be evidence-informed and theory-based, and reflect established best practices. Interventions must incorporate explicit behavioral objectives and be grounded in formative research to identify individual and social determinants of increased risk. Activities must also emphasize effective use of data for programmatic decision-making, and systematic use of program research and process evaluation to allow for continued quality improvement. In addition, the Contractor must pilot a new and bold key intervention and approach to SBCC programming to achieve maximum public health impact.

The Contractor must partner with the Zambian government to develop a “structure” for SBCC initiatives that engage a broad range of partners in the development and execution of national campaigns and that respond to health priorities identified by the Zambian government. Under the aegis of the Zambian government, the design, execution, and oversight of all SBCC initiatives and programs must be closely coordinated at the national, provincial, district, and community levels. The Contractor must ensure that multi-sectorial stakeholders at the provincial, district, and community levels, and professional/community networks, can participate in the communications process. In addition to including local and contextual formative research, targeting, mapping, and identification of resources, as well as monitoring and oversight during campaign execution. The Contractor must build upon the successes of predecessor USAID and GRZ activities in SBCC, in the design of campaign strategies and materials for project interventions.

The Contractor must employ advocacy, community mobilization, and interpersonal activities via integration into existing SBCC programming through local organizations and existing, strengthened networks. The Contractor must determine the best methods to establish sustainable access to these resources that maintain their quality even after the end of the project.

CLIN 0002 Technical Assistance, Capacity Building, and Monitoring & Evaluation activities – The Contractor’s actual implementation of tasks under IR2, IR3, and IR4 are covered under CLIN 0002, with the exception of the assessments, plans, and strategies integral to executing IR3 and IR4 tasks included in CLIN 0003.

IR2. Increased research to enhance health communication implemented. (Approximately 10% - 15% LOE) The Contractor must develop programmatic strategies and target resources based on relevant quantitative and qualitative data. The application of behavioral theories and models integrated into content and reflected in programmatic approach, research, monitoring, and evaluation should substantially influence each step of the communication process. The Contractor must conduct evaluations of major campaigns and capacity building interventions in close collaboration with the GRZ.

The Contractor must develop and employ a robust learning agenda, i.e., a set of strategic questions for which the program intends to produce evidence, findings, and answers, primarily through research and evaluation. The Learning Agenda must also generate evidence to test the causal pathway between USAID investments in SBCC (IMPACT and G2G) and its higher-level goal of impacting behaviors that result in improved health outcomes in targeted populations.

The learning agenda at a minimum must consider the following key questions:

1. To what extent have health communication interventions undertaken by the program increased comprehensive knowledge of health issues, improved behaviors of interest, and improved health outcomes impact?

2. To what extent has, the project contributed to an enhanced coordination and leadership role by the Zambian government, and to a more coordinated health communication response in Zambia?

3. To what extent has the project enhanced the capacity of the Zambian government and other institutions to deliver high quality, state-of-the-art, evidence-based SBCC interventions?

4. To what extent have project activities led to increased enrollment and retention in care and treatment?

5. To what extent have project activities improved dietary diversity of pregnant woman and children under five, and contributed to the reduction of stunting in targeted districts?

The Contractor must carry out research and evaluation, and must also collaborate with and build capacity of local research institutions. The Contractor must measure and report on how health communication initiatives impact the adoption of key behaviors that lead to improved health outcomes at the population level.

IR3. Effective Zambian government coordination and leadership of SBCC programs increased at national and subnational levels. (Approximately 5% - 10% LOE) The Contractor must assess the GRZ’s SBCC capacity-strengthening needs. This assessment will address the capacity building areas identified in the Objectives section for the MCDMCH, MOH, NMCC, National Food and Nutrition Commission (NFNC), and NAC.

The Contractor must work in partnership with the Zambian government to achieve effective coordination and leadership of SBCC programs, to ensure capacity to coordinate and lead SBCC campaigns at national and subnational levels by the end of the project cycle. Consideration of increased investments from USAID to the Zambian government through G2G funds is essential.

The Contractor must develop a roadmap with clearly identified milestones and measurable outcome-level targets in partnership with the Zambian government to improve the GRZ’s capacity to lead SBCC programming at national and subnational levels. The Contractor must provide appropriate technical assistance and work closely with the Zambian government to achieve the milestones identified in this roadmap.

As part of this capacity strengthening, the Contractor must provide technical assistance to relevant GRZ bodies leading SBCC programming, to support them in the development of a structure that will strengthen linkages between national and sub-national SBCC programming. This must also include increased capacity for procuring and managing grants and contracts at both national and subnational levels. The Contractor must provide capacity strengthening to the Zambian government in the development of strategies and associated budgets for SBCC programming at the national and subnational level. In addition, the Contractor must facilitate and strengthen existing or new technical fora at the national, provincial, and district level. The fora must promote exchange and growth among SBCC professionals and institutions.

In collaboration with the Zambian government, the Contractor must map donor programs, implementing partners, and key stakeholders and identify overlaps and gaps in the area of SBCC intervention. In partnership with the GRZ, the Contractor must develop a plan to collect, generate, and disseminate knowledge to strengthen delivery of health communication initiatives.

The Contractor must advocate for the importance of behavior change programming as an essential component of effective health systems at both national and subnational levels in partnership with health promotion units within the government. As part of this, the Contractor must work with the Zambian government to increase the position of MOH, MCDMCH, NMCC, NFNC, and NAC as leaders of SBCC in Zambia.

The Contractor must implement innovative capacity building strategies with GRZ health institutions that ensure sustainability and successful handover of SBCC leadership to the government by the end of the contract performance period.

IR4. Capacities of the Zambian government and Zambian institutions to design, implement, and evaluate coordinated, high-quality SBCC increased. (Approximately 20% - 25% LOE) The Contractor must assist the Zambian government in the adaptation, development, and application of national and subnational-level SBCC resources, including strategies, messages, campaign concepts, interpersonal communications activities, and standardized tools. These resources must also include the development of Zambian government-endorsed SBCC guidelines that reflect best practices in SBCC, as well as highly innovative and user-friendly materials and activities. The Contractor must provide technical, in-kind, and financial assistance to the Zambian government to ensure that by the end of the performance period sufficient capacity is built within the government that the GRZ can lead quality SBCC programming with minimal to no international technical assistance.

The Contractor must assess and define appropriate roles and responsibilities in design and implementation of SBCC across relevant stakeholders. As part of this, IMPACT must work with the Zambian government at national and subnational levels to strengthen its technical and operational capacity in SBCC design and delivery of interventions, with the specific goal to shift IMPACT campaigns to the Zambian government over the course of the project. Quality assurance in SBCC programming is a key component of IMPACT’s capacity building support to the GRZ and local organizations. Ultimately, these organizations must demonstrate measurable improvements in SBCC design and execution over the life of the project.

Working in partnership with the Zambian government to improve the capacity of its SBCC systems at the national and subnational levels, the Contractor must develop a roadmap with clearly identified milestones including measurable outcome-level targets that reflect enhanced capacity in SBCC. The Contractor must provide appropriate technical assistance and work closely with the Zambian government to achieve the milestones identified in this roadmap.

IMPACT will support the GRZ in the identification of priorities and the development of program designs for G2G activities funded directly through USAID. As part of their role in developing GRZ capacity in SBCC programming, The Contractor will also provide technical and operational assistance to the GRZ during the implementation phase of these G2G activities.

CLIN 0003 Assessments, Plans, and Strategies (7) – The following assessments, plans, and strategies are necessary for the execution of tasks outlined n IR3 and IR4: (1) SBCC Mapping and Gap Analysis Report, (2) SBCC Strengthening Milestone Development Plan, (3) Capacity Strengthening Assessment Report, (4) SBCC Strategic Plan, (5) Grants under Contract Manual, (6) Key Populations Health Needs and Integration report, and (7) Gender Integration Strategy.

C.8. GRANTS UNDER CONTRACTS

The Contractor shall award grants on behalf of USAID to eligible recipients to further the aim of the contract. Sub grants are intended for local entities. The grantees under the sub grants program can include a wide range of governmental and nongovernmental organizations, including but not limited to: local faith-based groups; youth associations; cooperatives; associations; informal groups; non-governmental organizations; local, regional, and national governments; student groups; media; private sector; and coalitions of these entities.

The sub granting mechanism will primarily be used to fund capacity-building and SBCC campaign activities with local organizations and the Zambian government. The Contractor must identify a strategic and manageable group of Zambian institutions that are capable of taking on components of the project’s work in collaboration with the government of Zambia in the early years of the project. The Contractor shall provide focused capacity strengthening, and progressively transition responsibility to these organizations over the life of the project.

Core areas of capacity building for grants under contract agreements include, but are not limited to:

· Development of interpersonal communication or community mobilization interventions;

· Strategic design (communication strategies, marketing plans);

· Organizational, financial and operations management related to SBCC intervention design and implementation;

· Quality assurance.

Institutions that carry out components of SBCC campaigns and receive capacity strengthening from the Contractor must incorporate relevant performance measurements into their sub-agreements.

C.9. MONITORING AND EVALUATION

Monitoring and evaluation of IMPACT’s progress towards achieving objectives and outcomes is critical to successful implementation. This activity shall be results-focused and the Contractor must track indicators related to gender equity and female empowerment. The Contractor shall monitor, track, report on, and evaluate the quality and impact of all activities. The Contractor shall be innovative and creative in their endeavors to capture, document, report the impact of USAID assistance, while strengthening and using relevant national, provincial, and district level reporting systems. The Contractor shall be held accountable for building legitimate technical, institutional, and financial capacity of the Zambian government and sub grantees to improve SBCC implementation locally. Benchmarks for achieving improved institutional and financial capacity will be key high-level performance indicators.

The Contractor’s M&E Plan must include indicators and targets that relate to the achievement of outcomes outlined in the USAID/Zambia’s Country Development Cooperation Strategy (CDCS) and Health Project Appraisal Document (PAD) for 2014 – 2019. The IMPACT project fits into these planning documents under the following Development Objective and Sub-IR’s:

· Development Objective 3 – Human Capital Improved

· Intermediate Result 3.2 - Health Status Improved

· Sub-IR 3.2.3 - Community Health Practices Improved

· Outcome 3.2.3.1 - Increased Awareness, knowledge, and adoption of healthy behaviors;

· Outcome 3.2.3.3 -Improved Household Food Security and Nutrition Outcome

Table 2. Illustrative Indicators from USAID Planning Documents

HIV/AIDS

- HIV prevalence in men and women aged 15-49* -Percent of HIV-positive pregnant women who received antiretroviral to reduce risk of mother-to-child- transmission* -Number of the targeted population reached with individual and/or small group level HIV prevention interventions that are based on evidence and/or meet the minimum standards required (PEPFAR Output - #P8.1D)+ -Number of males medically circumcised*

- Percent of adults and children known to be alive and on treatment 12 months after initiation of antiretroviral therapy*

Family Planning

-Percent of women with one living child who desire another pregnancy “soon” (e.g. within two years)* -Couple Years protection in USG supported programs* -Percent of audience who recall hearing or seeing a specific USG-supported FP/RH message+

Maternal Child Health

-Percent of women attending four or more antenatal visits* -Percent of women who deliver in a health facility* -Percent of women with postnatal check-up within two days of delivery*

Malaria

- Proportion of children under five who slept under an ITN the previous night in households that own at least one ITN&

- Proportion of women who have completed a pregnancy in the last two years who received two or more doses of IPTp during that pregnancy* -Proportion of children under five years old with fever in the last two weeks treated with an antimalarial who received ACTs& -Proportion of houses in targeted communities that are sprayed (IRS)&

Nutrition

-Prevalence of stunted children under five years of age*^ -Prevalence of exclusive breastfeeding for children under six months of age*#^ -Number of children under five reached by USG supported nutrition programs+^ -Prevalence of children 6-23 months receiving a minimum acceptable diet^ -Mean number of good groups consumed by women of reproductive age^

SBCC Capacity Strengthening

-Percent of new GRZ-initiated health campaigns that use evidence-based research* -Number of actively participating organizations involved in the MOH/MCDMCH planning and reporting/monitoring processes*

Source:*USAID Zambia Health PAD 2014 -2019, +Global Health FY 2013 Supplemental Guidance for the Performance Plan and Report, #USAID Zambia DO3 Health Capacity Improved Performance Monitoring Plan, ^USAID/Zambia Feed the Future Targets, &USAID/Zambia MOP PEPFAR Country Operation Plans, and PMI Malaria Operational targets are set annually, and the Contractor is expected to put forth its best effort to attain established targets.

In accordance with the task described in IR2, the Contractor will carry out a robust operations research and evaluation agenda to assess the extent to which heath communication campaigns, messages, and materials resonate with target audiences, and are effective in changing behaviors and promoting service uptake. The Contractor must carefully track, verify, and/or adjust implementation of the project as needed to ensure achievement of results that will impact health outcomes. The M&E plan must clearly outline a plan to demonstrate how behavior change will be attributed to the work of IMPACT. Specific target audiences and key behaviors prioritized in SBCC activities will be further refined through formative research conducted to inform the design of campaign strategies and materials. The Contractor will then evaluate project’s activities, and impact in achieving change in the targeted behaviors and audiences prioritized in the campaign strategies.

The Contractor must report on how project activities are impacting gender equality and empowerment and the M&E plan must include standalone gender indicators. All data collected must be disaggregated by sex where applicable. The Contractor must report on how activities impact persons within target population’s lowest income quintile.

External Evaluations:

The Mission will contract separately for an independent third party to conduct the following evaluations:

· Impact Evaluation of selected project campaigns, inclusive of a baseline, midline and endline assessment to measure higher level impact on health outcomes in target populations;

· Performance evaluation at the midterm (after two years).

The Contractor must collaborate in providing information and documentation necessary for these independent evaluations, which will inform future programming direction, and will determine priority health areas for health communications activities.

C.10. GEOGRAPHIC FOCUS

Where possible IMPACT activities in overlapping districts must be integrative in approach and not exclusive to only health intervention areas outlined below.

Table 3. Proposed Geographic Areas for IMPACT Activities HIV/AIDS (Approximately 55% of funding)

National level, with community-level and interpersonal communication activities in 6 provinces and 16 districts: Lusaka (Lusaka, Kafue); Central (Kabwe, Kapiri Mposhi, Mkushi); Copperbelt (Ndola, Kitwe, Luanshya); Southern (Choma, Kalomo, Pemba, Zimba); Luapula (Mansa, Samfya); Plus 1 TBD province and 2 TBD districts

Family Planning (Approximately 10% of funding)

National level, with community level and interpersonal communication activities in 3 target provinces and up to 8 districts aligned with the SMGL initiatives, and the Family Planning project. FP/HIV integration activities must be implemented in the HIV/AIDS sector provinces and districts in an integrative manner as feasible.

Maternal Child Health (Approximately 20% of funding)

National level, with community level and interpersonal communication activities in 4 provinces and 12 districts: Southern (Kalomo, Choma, Zimba, Pemba); Luapula (Mansa, Samfya, Chembe, Lunga); Central (Kabwe); Eastern (Nyimba, Lundazi, Chipata); with materials and technical support to Petauke, Sinda, Vubwi, and Mambwe districts with SMGL activities led by SIDA

Malaria (Approximately 5% of funding)

National level in alignment with Program for the Advancement of Malaria Outcomes (PAMO) target priorities, subnational technical support to the NMCC and USAID funded PAMO activities, with community level and interpersonal community activities in 1 TBD Province and up to 2 TBD districts. Locations will be selected in collaboration with USAID and GRZ based upon epidemiological need, as well as possible synergies and linkages with other project activities. Community level and interpersonal communications activities led by IMPACT will not overlap with PAMO target provinces and districts.

Nutrition (Approximately 10% of funding)

National level, with community-level and interpersonal communication activities in; Feed the Future five target districts in Eastern Province (Chipata, Nyimba, Petauke, Katete, Lundazi)

SBCC Capacity Strengthening (Funding contributions from PEPFAR, FP, Nutrition, MCH, and Malaria)

National level and subnational level in provinces and districts where project implements activities

C.11. GENDER

USAID is committed to the support of gender equality and female empowerment, and seeks to improve the lives of citizens around the world by advancing equality between women and girls and men and boys, and empowering women and girls to participate fully in and benefit from securing better lives for themselves, their families, and their communities. Outcomes include: (i) reducing gender disparities in access to, control over and benefits from resources, wealth, opportunities, and services – economic, social, political, and cultural; (ii) reducing gender-based violence and mitigating its harmful effects on individuals; and (iii) increasing the capability of women and girls to realize their rights, determine their life outcomes, and influence decision making in households, communities, and societies.

The Contractor shall coordinate closely with relevant USAID/Zambia activities, in particular coordinating design and implementation of gender focused activities to minimize duplication. Illustrative examples of gender sensitive activities include, but are not limited to: (i) working with community and religious leaders on promoting FP and MCH; (ii) promoting gender equality and empowering women through group discussions; and (iii) involving men in behavioral change for HIV/AIDS…