Revised_TB_SOW_August_15_awa_cleared.docx

Acronyms CSO - Civil society organizations DOTS - Directly Observed Therapy Short-course GRZ - Government of the Republic of Zambia M&E - monitoring and evaluation plan MDG - Millennium Development Goals MDR - TB- Multi Drug Resistant TB NTP - National TB and Leprosy Control Program NAAT-Nucleic Acid Amplification Technics OR - Operational Research PLWHA/PLHIV- People Living With HIV/AIDS PPP - Public Private Partnerships TB - Tuberculosis USAID - United States Agency for International Development WHO - World Health Organization ZDHS - Zambia Demographic and Health Survey (2007)

A. BACKGROUND

Zambia is a sub-Saharan African country with a land mass of 752,610 square kilometers, and a population of 13 million people. Zambia is classified as a low-middle income country with a Gross Domestic Product per capita of $1, 540 in 2013 (World Bank).

Tuberculosis (TB) is a major cause of morbidity and mortality in Zambia. Zambia notified 45,277 cases of TB in 2011(WHO, 2012). The high notification of TB is primarily attributed to the high prevalence of HIV, which is estimated to be 14.3 percent (ZDHS, 2007) in the adult population (age 15-49). The prevalence of HIV among TB patients is 61 percent (WHO, 2013).

The Government of the Republic of Zambia (GRZ) recognizes TB as a major public health problem and is committed to its control (National Health Strategic Plan 2011-16). TB control is implemented by the National TB and Leprosy Control Program (NTP).

The main interventions for TB control in Zambia are based on the Daily Observed Treatment, Short-course (DOTS) and the Stop TB Strategies. Through these efforts, Zambia has made tremendous gains in TB control. For example, treatment success has increased from 77 percent in 2002 to 88 percent in the 2011 cohort (WHO Global TB Report 2013).

However, more work needs to be done to improve case detection, which stands at 68 percent for all forms of TB in 2012 (WHO Global TB Report 2013). The other critical gaps in TB control in Zambia are in the areas of multi-drug resistant TB (MDR-TB), TB/HIV co-infection, and awareness of rights and responsibilities of people and communities affected by TB. In addition, there is need for additional research to generate new evidence in TB programming.

USAID/Zambia has been providing support to TB control efforts in Zambia since 2005. This support has been channeled through the NTP at the national level and in six northern provinces, Luapula, Northern, North-western, Copperbelt, Muchinga, and Central provinces. At the national level, USAID/Zambia provides financial and technical support to strengthen supervision, develop guidelines, strengthen laboratories, strengthen the national surveillance system for incidence and prevalence level data, and strengthen national coordination with the HIV/AIDS program in TB/HIV collaborative activities. At the provincial level, USAID/Zambia supports laboratory strengthening, training of health care workers, infection control, procuring of supplies, infrastructure renovations, transportation of specimens, supervision of health care workers, and joint strategic planning.

B. SCOPE

Over the next five years, USAID will invest in supporting the GRZ’s vision of a “Nation of Healthy and Productive People” with the specific goal of reducing TB-related mortality by 50 percent in the intervention provinces by 2019.

The Contractor for this TB activity (the Activity) will work in partnership with the GRZ, NTP, private sector and others at the national, provincial and community levels to strengthen implementation of key components of the GRZ’s response to control TB in Zambia. At the national level, the Contractor will work with the NTP on outstanding policy-related activities such as strategies, guidelines, and protocols. At a minimum, the Contractor will implement its TB control activities in six provinces, building on USAID’s previous investments in TB. These provinces are: Northern, Luapula, Muchinga, Copperbelt, Central, and North-Western provinces. More specific geographic scope will be determined by USAID and the Contractor. The Activity’s target communities have a high burden of TB, including underserved communities, people in congregate settings such as prisons, children, and People Living with HIV (PLHIV). In addition to the Objectives listed below, infection control and intensified case finding will be priority interventions across activities.

E. OBJECTIVES

1. To increase the number of individuals screened for TB in the target provinces by 50 percent (Baseline: number of individuals screened for TB in the target provinces in 2013); thereby increasing the number of people diagnosed with TB; and

2. To increase TB treatment success rate to 85 percent and beyond in the target provinces.

F. TASKS

The Tasks of the Activity will support the National TB Strategic Plan (2011-2016). The Activity has four main tasks which are aligned with the Global Stop TB Strategy[footnoteRef:2]: [2: WHO’s Stop TB Strategy is available at the following link: http://www.who.int/tb/strategy/en/.]

1. Pursue high-quality DOTS expansion and enhancement

2. Address TB-HIV, MDR-TB and the needs of poor and vulnerable populations in six target provinces

3. Engage all categories of care providers

4. Enable and promote research

Below are the required sub-tasks, expected results and mandatory indicators for each Activity task. The contractor must collect the following indicators at a minimum but should suggest additional indicators as appropriate in the Activity Monitoring & Evaluation Plan.

Task 1: Pursue high-quality DOTS expansion and enhancement

Sub-task 1.1: Increase political commitment:

Political commitment in TB control involves engagement of a broad range of leaders at national, provincial, district, and community levels to raise awareness about the need to control TB and increase involvement in TB control at each level. Good political commitment not only results in promulgation of enabling legislature and policies but also stimulates allocation of resources to TB control efforts.

The Contractor must plan and implement activities to engage and organize stakeholders, including civil society organizations (CSO), traditional and religious opinion leaders, private sector, and international organizations implementing programs in-country to ensure a harmonized, evidence-based response to TB in Zambia. The Contractor must prioritize the following among TB stakeholders: promoting sufficient and appropriately directed funding for TB control activities; addressing human resources constraints in the NTP; strengthening the governance and accountability of NTP; and promoting awareness around the importance of controlling TB in a harmonized manner.

· The Contractor must provide technical assistance to NTP to increase financing for TB control efforts. This includes technical assistance for the preparation of proposals for funding from the GRZ, the private sector, and international funders, including the Global Fund, CIDA, and others.

· The Contractor must conduct an assessment of NTP’s governance structure to identify key human resource gaps at national and provincial levels and develop plans to fill them based on priorities and available resources. This must be done in close consultation with the host Government and other stakeholders/funders.

· The Contractor must plan and implement capacity building activities for organizations and community groups at the national and sub-national levels to advocate for TB control activities and to raise awareness among Zambians on TB detection and treatment (including the world TB day commemorations).

1.1 Expected Results

· Current and former TB patients and civil society organizations represented in national and subnational TB and HIV meetings increased

· Partnerships between the Activity and corporate entities aimed at increasing funding for TB control activities in Zambia formed

· In collaboration with the GRZ, human resources gaps at national and provincial levels of the NTP identified and filled based on priorities

· National/subnational activities aimed at raising awareness for TB implemented

· CSOs, current and former TB patients and other members of the community involved in organizing TB and TB/HIV awareness raising activities in communities where they are domiciled or active increased

· TB and TB/HIV promotional/awareness raising and stigma reduction activities and services organized by district, village, or neighborhood committees in collaboration with the local health service providers increased

1.1 Indicators

· Number of corporate entities funding TB control activities through partnerships with the program

· Percentage of staff positions at provincial and national levels filled

· Percentage of planned provincial TB and TB/HIV supervision visits conducted by the GRZ to the districts

· Percentage of planned national TB supervisory visits conducted by the GRZ to the provincial level

· Percentage of national and sub-national TB meetings in which CSOs and community groups are involved

· Percentage of community-level planned activities to raise awareness for TB implemented

Sub-task 1.2: Increase TB case detection through quality-assured microscopy and other diagnostic methods (including the Gene Xpert mycobacterium tuberculosis/rifampicin (MTB/RIF) technology) in the six targeted provinces

While increasing TB case detection is a priority of the NTP, in 2010, Zambia detected only 73 percent (45,000) of the estimated incidence of TB (62,023).

· The Contractor must technically assist the NTP to systematically scale up quality assured TB diagnostic services, including the gene Xpert technology (See Deliverable II).

· The Contractor must identify and renovate selected laboratories/diagnostic centers in each target province in accordance with the unique needs of the center/s (See Deliverable I).

· The Contractor must provide technical assistance to the NTP in the area of TB laboratory commodity forecasting and quantification

· The Contractor must provide technical assistance to the targeted provinces in the area of TB diagnosis quality assurance focused on province-to-district and district- to-health facilities activities.

· The Contractor must develop and implement an innovative mentoring program for laboratory staff in all the TB diagnostic centers located in the target provinces.

· The Contractor must provide material and technical assistance to the GRZ to strengthen the laboratory specimen courier system developed by the current USAID-supported TB control Program.

· The Contractor must procure lab equipment and supplies based on identified need by the host Government.

1.2 Expected Results

1. TB case detection increased

1. Commodity security for TB diagnostic supplies improved

1. Equitable access by all the target provinces to quality assured TB diagnostic services including X-pert technology achieved

1. TB diagnosis quality assurance in the target provinces improved

1.2 Indicators

· Percentage of the planned/targeted laboratories/diagnostic centers for renovation that are actually renovated and appropriately equipped

· Percentage of provinces reporting stock-out of key laboratory reagents (these key lab reagents will be determined by the Activity in collaboration with USAID and the GRZ)

· Percentage of PEPFAR-supported TB diagnostic centers reporting 95 percent correct results (this will be determined during routine quarterly external quality assurance visits to centers supported by the program using panel testing and blinded rechecking methods)

· Number of staff mentored in TB diagnosis

· Number of individuals screened for TB

· Number of individuals diagnosed with TB

· Percentage increase in TB case notification from the previous year/s

· Percentage of districts using the national courier system for transportation of TB specimens

Sub-task 1.3: Standardize TB treatment, support, and care

A standard treatment regimen with adequate treatment support systems at institutional and community levels is critical for Zambia’s TB control program. Patient-centered TB treatment support systems will ensure that TB patients take TB treatment correctly and consistently. Treatment adherence support, which may include direct observation of therapy (DOT) and psycho-social support, helps patients take their drugs regularly and complete treatment, thus achieving cure and preventing the development of drug resistance.

· The Contractor must provide technical assistance to the GRZ through the NTP to update TB treatment guidelines based on current national and international evidence in the area of TB and combined TB/HIV treatment.

· The Contractor must print and disseminate TB treatment guidelines to front line health care workers and community health workers responsible for the care of TB and co-infected TB/HIV patients.

· The contractor must train “community volunteers” to support patients receiving TB treatment in their communities.

· The Contractor must devise and implement a capacity building plan to equip health care workers with clinical and laboratory knowledge, skills, and abilities necessary to improve TB patient outcomes.

· The Contractor must create partnerships with the corporate world to support community volunteers as part of corporate social giving.

· The Contractor must support the national TB surveillance system by ensuring the GRZ has sufficient TB and TB/HIV reporting and recording tools printed and distributed, and the NTP provides ongoing mentoring on recording and reporting requirements.

1.3 Expected Results

· TB treatment success rates increased

· Health facilities reporting stock-outs of anti-TB medicines reduced

· NTP implementation of up-to-date TB treatment guidelines increased

· Community volunteers providing adherence counseling and TB drugs to TB patients at community level across target provinces increased

· Treatment outcomes (treatment success rate, mortality, and morbidity) and quality of care for patients suffering from TB (TB case management) and TB/HIV co-infection in all target districts improved

1.3 Indicators

· Percentage of targeted districts with active community TB treatment support groups, including CSOs

· Percentage of health facilities reporting stock-out of anti-TB medicines

· TB treatment success rates in the target provinces

· Percentage of targeted health care workers trained in patient-centered TB DOTS and TB/HIV care as well as direct observational therapy

· Percentage of targeted district health offices trained in patient-centered TB and TB/HIV care

Sub-task 1.4: Support the existing NTP monitoring and evaluation (M&E) system

The NTP already has a Monitoring & Evaluation (M&E) system for monitoring TB control activities. The current USAID-supported TB program supports this M&E system emphasizing development of data collection and reporting tools and support for data review meetings. However, the NTP faces the following challenges: 1) MDR-TB data is not systematically collected and reported; 2) TB data is not consistently used at the points of generation; 3) NTP does not have adequate numbers of sufficiently trained staff in M&E; and 4) the provinces/districts do not have a systematic way of reporting data to the next/higher level.

1. The Contractor must provide technical assistance to the GRZ to build the capacity of NTP staff in Monitoring & Evaluation.

1. The Contractor must technically assist the GRZ to incorporate MDR-TB data in the M&E system.

1. The Contractor must provide technical and administrative assistance to the GRZ to establish a standard system/format for reporting TB data by provinces

1. The Contractor must technically and logistically assist the GRZ and other stakeholders to pilot an electronic TB register.

1.4 Expected Results

1. A critical mass (to be defined by the NTP, Contractor, and USAID) of NTP M&E staff trained

1. MDR-TB data routinely and systematically reported by NTP

1. Provinces report TB data following a standard format

1. New TB data collection and collating tools adapted and implemented

1. TB data integrity in target provinces improved

1. Use of TB data for decision making at the point of its generation in the target provinces improved

1.4 Indicators

· Number of NTP staff trained in M&E

· Percentage of planned provincial and district data review meetings that convened

· Number of provinces and districts submitting semi-annual and annual reports within the agreed reporting period

· Number of district quarterly reports that have been peer reviewed /audited during quarterly review meetings

Task 2: Address TB-HIV, MDR-TB and the needs of poor and vulnerable populations in target provinces

Sub-task 2.1: Reduce the burden of TB/HIV co-morbidity

Fifty-four percent of all TB patients in Zambia are also co-infected with HIV. The NTP needs to reduce the burden of the TB/HIV co-morbidity by screening all registered TB patients for HIV and screening all HIV-infected patients in HIV care for TB to reduce missed opportunities. The current USAID-supported TB program continues to support the NTP in implementing intensified TB case finding, TB infection control, and provider- initiated counseling and testing for HIV. Challenges in TB/HIV include: only 30% of HIV-infected patients are screened for TB, only 66% of TB/HIV infected patients are started on HIV treatment, and delayed implementation of the isoniazid preventive therapy (IPT) program.

· The Contractor must provide technical and administrative assistance to the NTP to coordinate integrated TB/HIV activities at the national, provincial, and district health offices.

· The Contractor must plan and implement activities aimed at increasing TB detection among HIV-infected individuals by targeting any combination of the following factors: increased use of effective technology, training, and/or location of TB and HIV service provision. The Contractor is not limited to addressing the list of factors outlined above.

· The Contactor must provide technical and financial assistance to the NTP to define a context-specific infection control package (a minimum number of infection control activities necessary to assure infection control at community and health facility levels) to be implemented in the target provinces.

· The Contractor must provide technical and financial assistance to the NTP to ensure continued screening of TB patients for HIV and provision of HIV-infected TB patients with HIV treatment.

2.1 Expected Results

· Joint planning for TB and HIV services/activities at provincial and district levels implemented

· Proportion of HIV-infected individuals screened for TB increased

· Proportion of patients with TB/HIV commenced on HIV treatment increased

· Infection control activities at TB/HIV sites and community levels strengthened

· Proportion of TB-infected patients tested for HIV increased

2.1 Indicators

· Percentage of TB/HIV patients initiated on HIV treatment

· Percentage of registered TB patients tested for HIV

· Number of districts implementing TB infection control plans

· Number of provinces with a joint annual TB/HIV implementation plan and which held at least three coordinating meetings in the past year

Sub-task 2.2: Strengthen systems to halt MDR-TB expansion

The incidence of new MDR-TB cases is still low in Zambia (between 500 and 800 cases per year), but there is a critical need to strengthen systems to ensure MDR-TB is controlled since other sub-Saharan African countries such as South Africa are experiencing increased rates of MDR-TB. Zambia continues to record new MDR-TB cases and the NTP is yet to operationalize the programmatic management of MDR-TB. For example, the MDR-TB treatment guidelines have not yet been finalized and the country does not have a sufficient pool of health care workers trained to manage MDR-TB or special admission facilities for MDR-TB patients needing hospitalization.

1. The Contractor must provide technical assistance to the NTP to finalize and implement the MDR-TB treatment guidelines.

1. The Contractor must provide technical, financial, and logistical assistance to NTP to train health care workers in the diagnosis and management of MDR-TB.

1. The Contractor must develop and implement a plan aimed at increasing TB and MDR-TB case detection among vulnerable groups, such as prisoners, children, and people living with HIV by involving key stakeholders like CSOs and community leaders and prison authorities.

1. The Contractor must renovate two centers to serve all targeted provinces to manage MDR-TB patients.

1. The Contractor must provide technical assistance and funding to the National TB reference laboratory to strengthen its capacity to process specimens from subordinate laboratories and to provide rapid turn-around time and complete reports to subordinate laboratories.

1. The Contractor must materially and technically support the systematic scale-up of new diagnostic technology including the X-pert technology to enhance TB and MDR-TB case finding.

2.2 Expected Results

· Treatment success and cure rate among registered MDR-TB patients increased

· Intensified and active TB/MDR-TB case finding among high risk populations: prisoners, children, PLWHA, pregnant women increased

· A pool of health care workers trained in managing MDR-TB patients developed

· Clinical and laboratory outcomes for MDR-TB patients/clients improved

· MDR-TB patients treated/managed in designated MDR-TB treatment facilities increased

· National TB reference laboratory’s capacity to process specimens referred from provinces and support an efficient feedback mechanism improved

· Equitable access to modern and quick TB testing equipment/technology such as the X-pert technology achieved

2.2 Indicators

· Number of health care workers trained to manage MDR-TB patients

· Average turn-around time of results for specimens referred to the national TB reference laboratory

· Number of patients diagnosed with drug resistant TB and MDR-TB

· Treatment success and cure rate among registered MDR-TB patients

Sub--task 2.3: TB detected and treated among children and other vulnerable populations

Diagnosing and treating children and other vulnerable populations is a particular unmet challenge in Zambia. In those cases in which children are identified by their families or communities as at-risk for TB, it is challenging to diagnose them because children are usually unable to produce the sputum specimen for examination. Compounding this difficulty is the fact that children with TB typically come from families that are poor, lack knowledge about the disease, and live in communities with limited access to health services.

· The Contractor must mentor health care workers in childhood TB.

· The Contractor must provide technical assistance to the NTP to integrate training on childhood TB into existing training for health workers on TB

· Integrate childhood TB into the mentorship activities listed in sub-tasks 1.2 and 1.3

· The Contractor must integrate specific information on childhood TB into community-level activities as mentioned in sub-task 1.1.

2.3 Results

· Number of children screened for and diagnosed with TB increased

· A pool of clinicians to manage childhood TB created

· Training and mentoring on childhood TB integrated into TB training

2.3 Indicators

· Number of health care workers trained to manage childhood TB

· Percentage of targeted districts with clinicians trained in the diagnosis of TB in children

· Number of children screened for TB

· Number of children diagnosed with TB

· Percentage of children successfully treated for TB of those cases identified

Sub--task 2.4: TB detected and treated among prisoners

TB prevalence in prisons is estimated to be significantly higher than prevalence in the general population in Zambia as in other countries given the often compact living conditions. While prisoners are frequently mobile, entering prisons with TB or leaving with it and infecting others in the general population, prisons are a static and high impact site for TB testing and treatment.

· The Contractor must provide technical assistance to ensure all new prisoners are screened for TB in selected prisons and that routine TB testing is done on an annual basis.

· The Contractor must provide technical and material assistance to ensure provider-initiated HIV counseling and testing is provided to prisoners with TB.

· The Contractor must provide technical and material assistance to ensure all prisoners exiting selected prisons are screened for TB and that those found positive are provided provider-initiated HIV counseling and testing.

2.4 Expected Results

· Proportion of prisoners screened and successfully treated for TB increased

· Proportion of children living in select prisons screened and successfully treated for TB increased

2.4 Indicators

· Percentage of prisoners screened for TB at the point of entry

· Percentage of prisoners screened for TB annually

· Percentage of targeted prisons that screen all new inmates entering prisons

· Proportion of children in prisons screened for TB

Task 3: Engage all categories of care providers (clinicians in public and private sectors, pharmacists, and community volunteers)

To accelerate achievement of TB control goals, Zambia must engage and coordinate all care providers in TB control in the public and private sectors (private medical practitioners and pharmacists) and communities, including traditional leaders.

· The Contractor must develop and implement a strategy to increase organized involvement of private sector medical practitioners, pharmacists, and communities, including traditional healers in TB control activities.

3.1 Expected Results

· Private pharmacists collecting and referring sputum from TB suspects who visit their pharmacies increased

· Pharmacists providing TB drugs to confirmed TB patients increased

· Private medical practitioners diagnosing and treating TB patients increased

· Private-Public Partnerships in TB control created to increase financing for TB developed

· Community ‘volunteers’ collecting and referring sputum for examination increased

· Community ‘volunteers’ providing TB drugs and adherence counseling to TB patients increased

3.1 Indicators

· Number of private medical practitioners trained in TB

· Number of ‘community volunteers’ trained in TB

· Proportion of TB patients notified (diagnosed) by the private sector

· Number of traditional medical practitioners/healers trained with USAID support

· Number of referred presumptive TB patients and percentage of TB patients identified and diagnosed by the private sector (disaggregated by private clinic, and pharmacy)

· Number of referred presumptive TB patients and percentage of TB patients identified and diagnosed through referrals by ‘community volunteers’

· Number of ‘community volunteer’ groups receiving financial and material support from the private sector as a result of partnerships created with the program

· Number of ‘community volunteer’ groups implementing income generating activities with initial support from the corporate world Task 4: Enable and promote operational research Operational Research (OR) in TB has lagged behind the other components of the Stop TB Strategy in TB programming in Zambia. The main barriers limiting OR in TB programing in Zambia are: The NTP does not have sufficient staff adequately trained in TB OR; funding for TB OR has been limited; and Zambia has not defined key areas for TB OR.

Program-based OR will be a core component of this TB Activity. To achieve TB OR objectives, the Contractor must:

· Strengthen the capacity of the NTP staff to conduct OR TB through training, mentorship, and strategic partnerships with research institutions and the academia

· Identify and prioritize areas requiring OR in order that resources are directed at TB OR areas with greatest potential of improving outcomes in TB control such as: childhood TB, new innovations in TB control, and community involvement in TB control.

· Create strategic partnerships with the corporate world to increase funding for TB OR

4.1 Results

1. Collaborative partnerships between the NTP, local research institutions, private sector partners and others in TB research developed

1. NTP capacity to identify TB program operational problems and to develop, test, and scale-up context specific solutions together with contracted local and international research institutes strengthened

1. NTP leveraging private sector funding for TB OR.

4.1 Indicators

1. Percentage of health care workers targeted for training in research that are actually trained

1. Number of organizations (public and private) supporting TB operational research

1. Amount of funding allocated by NTP per year for operational research

1. Number of targeted research activities conducted

F. DELIVERABLES

I. Renovation Plan (180 days): The Contractor must work with key stakeholders in Zambia to reach consensus on critical renovations to strengthen the TB control program and then must carry out those renovations in a timely and cost efficient manner. The Contractor must deliver to USAID/Zambia a renovation plan detailing the number and names of facilities to be renovated in each of the five years of project implementation within 180 days of award. The renovation plan must include two centers for treating in-patient MDR-TB patients (the two centers will serve all the target provinces) and must also identify critical gaps in lab equipment and supplies. At a minimum, the renovation plan must include a brief description of the process for reaching consensus about renovations, agreed-to criteria for identifying renovations. All construction activities must be limited to renovation.

II. New technology (120 days): The Contractor must deliver to USAID/Zambia a scale-up plan for the X-pert technology within 120 days of being awarded this contract.

III. TB Engagement Strategy (180 days): Within 180 days of award, the Contractor must submit for COR approval, a strategy to engage and strengthen the NTP, private sector financiers and private sector providers. The strategy must identify opportunities for engagement, a brief summary of short-term and long-term activities and benchmarks by which “success” will be measured for each of the following: NTP, private sector and private sector providers.

NTP TA plan (60 days): Within 60 days of the award, the Contractor must submit to USAID its strategy for providing technical assistance to the NTP to ensure the assistance builds the capacity of the NTP over the life of the activity. As an attachment to this Strategy, the Contractor must provide a detailed technical assistance plan for year one to NTP including those areas identified in the Tasks. This plan must be updated annually and sent to USAID/Zambia for approval.

Private sector investment: Within 120 days of this award, the Contractor must submit to USAID its approach to increasing private sector involvement and financial support for TB control activities. This may include but should not be limited to private sector support for operations research or private sector support for “community volunteers.” Under no circumstance should funding from the Activity be used to subsidize private sector workplace programs. These are important efforts that should be advocated for by the Contractor but they are the responsibility of the profit-earning company to provide.

Private sector providers and pharmacists: Within 100 days, the Contractor must submit to USAID its strategy to increase organized involvement of private sector medical practitioners and pharmacists in TB control activities. This must include the following: an initial assessment of the involvement of the private sector in TB control and detailed plans on how private sector providers and pharmacists can best support Zambia’s TB control activities. This must include traditional practitioners/healers.

VI. Operational research (240 days): The Contractor must deliver to USAID/Zambia an operational research plan within 240 days of being awarded this contract. The plan must include activities to be implemented and timelines for implementing these activities. The Plan must include how the Contractor will develop collaborative relationships with local research institutions; training for NTP and other health staff at national, provincial, and district levels to identify innovative context-specific operations research; and plans and timelines for implementing identified operational research.

VIII. Monthly updates: The Contractor must provide the COR monthly status reports summarizing major activities, accomplishments, identified challenges and plan for remediation, and outcomes of previously identified challenges.

IX. Monitoring and Evaluation and coordination plan (90 days): The plan must have five major elements : 1) a comprehensive framework of how the Contractor will monitor its own performance, 2) a comprehensive plan of how the new TB program will strengthen the NTP M&E system focusing effort on building the NTP staff capacity in M&E, incorporating MDR-TB data elements into the M&E system, and standardizing the reporting format by provinces (including the use of an electronic register), 3) identifying and incorporating indicators which will contribute to USAID/Zambia’s Performance Monitoring Plan, 4) reaffirming the program’s commitment to reporting on all data required by the MOH/MCDMCH through the Health Management Information System (HMIS) and National HIV/AIDS/STI/TB M&E System, 5) and a plan on how the Activity will coordinate with other partners at district level.

The plan must provide an account of activities to be implemented and the timelines to implement the activities. On data, the plan must include a data collection plan (specifying the data sources and data collection methodology to be used to gather data) and plans to analyze the collected data (including resource requirements).

The plan must indicate specific early exercises to establish baseline proxy indicators at and/or below the level of intermediate results and to undertake rapid field assessments as well as other exercises or studies to establish baseline indicators for activities, especially in the first year of the program.

X. Strategy for Gender Integration (90 days): Gender, a social construct of differences between men and women, should be streamlined into this Activity to achieve equitable access by males and females to quality-assured TB services based on their unique needs. The Contractor shall deliver a Gender strategy within 90 days of this award articulating the potential gender issues associated with this TB program and how these would be mitigated.

XI. Other plans and reports

The program shall provide the following documents and reports, per schedule and format to be developed in collaboration with USAID/Zambia after award:

1. Country Operational Plan (COP) Semi-Annual and Annual Progress Reports, including success stories

2. COP Quarterly Financial Reports

3. COP Narratives and Targets

4. Quarterly Performance Reports (will include benchmarks and milestones)

5. Narrative Annual Report

6. Success stories not linked to the COP reports

7. Operational Research Reports

8. Final/Completion Report.

Key Personnel

Key Personnel Minimum Qualifications

a. The Country Director or Chief of Party will head the project team and make regular reports to the USAID Contracting Officer’s Representative (COR). The Country Director will be responsible for the overall management and implementation of the Activity. S/he will supervise project implementation and ensure that the Activity meets its planned results. The Country Director will represent and coordinate with all cooperating organizations and be the point of contact for all purposes of this project.

The Country Director or Chief of Party must have an advanced degree (Masters) in Public Health or a relevant field from a reputable university. S/he must have at least 5 years of project management experience of public health projects. S/he should have demonstrated capacity to build and maintain productive working relationships with a wide network of partners and stakeholders; broad technical understanding of public health, particularly TB programing. S/he will have proven leadership and management skills to effectively achieve the Activity results described in the Request for Proposals (RFP). The Country Director must be Zambian, fluent in English and must possess excellent oral and written communication skills.

b. The Deputy Director is responsible for providing technical oversight to Activity operations. This includes providing overall technical guidance for planning, implementation and monitoring of the activities. This position will require a dynamic individual capable of translating public health data and evidence into practice and effective implementation of TB control activities.

The Deputy Director will preferably have a bachelor’s degree in health science or business or their equivalent and masters training in public health, management or their equivalent. The ideal candidate must have at least 5 years working in a senior technical position for a public health and/or international development project.

c. The Finance Director is a long term position responsible for overseeing the finance and administration functions of the project and ensuring compliance with project and USAID procedures. S/he will work closely with the Country Director and the Deputy Director and other staffs to ensure project resources are effectively and efficiently budgeted and managed.

The Financial Director should have a Bachelor’s Degree in business or accounting along; ACCA or ZICA professional membership is preferred. A Master’s Degree in a related field is also preferred. S/he should have at least 5 years professional experience managing financial and contractual aspects of development projects.

d. The Strategic Information (SI) Advisor is responsible for overseeing monitoring and evaluation activities for the Activity. In addition, the SI Advisor will provide strategic and technical direction to improving data collection and the overall evidence-base for TB programing.

The SI Advisor should have a Bachelor’s Degree, and preferably a Master’s Degree in Public Health or a related field. S/he should have at least 5 years of professional experience in monitoring and evaluation.