PAMO_SOW_June_2014_-Cleared_09.30.2014.docx

LIST OF ACRONYMS

SECTION C: STATEMENT OF WORK

C.1 INTRODUCTION

The President’s Malaria Initiative (PMI) Zambia supports the National Malaria Control Program (NMCP) to implement key high impact proven malaria interventions. This support is directed through several implementing partners. A procurement and supply chain management partner provides support for procurement and distribution of malaria commodities including insecticide-treated nets (ITNs), anti-malarials, rapid diagnostic tests (RDTs) and other malaria diagnosis commodities. Indoor residual spraying (IRS) and entomological monitoring support is through an IRS implementing partner. Additional support includes design and production of malaria social behavior change communication (SBCC) materials through a national level SBCC partner and malaria case management and laboratory diagnosis strengthening through a national level case management partner . Technical support is provided at central, provincial, and district levels. PMI Zambia and partners are active participants in all the NMCP initiatives and technical working groups: SBCC, case management, ITN, IRS, insecticide resistance management, and monitoring and evaluation. Partners are also active at provincial and district coordination meetings.

The Program for the Advancement of Malaria Outcomes (PAMO) will be the flagship malaria activity for PMI in Zambia. The purpose of the PAMO is to contribute to reducing malaria mortality by two-thirds, malaria incidence by three-fourths, and malaria parasitemia in children under age five by one-half in targeted provinces in alignment with the Project Appraisal Document (Improving the Health Status of Zambians FY 2014-2019). This will be achieved by increasing access to and uptake of quality malaria control interventions. The activity will align strategically with the National Malaria Strategic Plan (NMSP) 2011-2016 to support the national vision of “a malaria-free Zambia by 2030.” PAMO will be a key partner in PMI’s endeavor to support malaria control in Zambia. PAMO will strengthen the Ministry of Health (MOH) and Ministry of Community Development Mother and Child Health’s (MCDMCH) capacity to implement the NMSP at provincial, district, and community levels. The project will build strong effective partnerships with communities, civil society, health facilities, District Community Medical Offices (DCMO), Provincial Medical Offices (PMO), the private sector, and cooperating partners to scale-up and maintain internationally accepted strategies to fight malaria.

C.2 BACKGROUND

C.2.1 General Overview

Zambia has a population of over 14 million (2.8 percent annual growth rate), ten provinces and currently 102 districts. Zambia’s key health indicators are generally positive: under-five mortality has fallen from 191 per 1,000 live births in 1992, to 168 per 1,000 in 2002, and to 119 per 1,000 in 2007 (2007 Demographic Health Survey- DHS). Eighty-five percent of children complete primary school and overall poverty has been declining. Despite these positive trends, Zambia continues to face major challenges in its efforts towards achieving health related Millennium Development Goals. For example, although the under-five mortality rate has declined, it is nearly double the under-five mortality goal of 63 per 1000 live births by 2015. In addition, sixty-eight percent of the population still lives below the national poverty line. Zambia also continues to be burdened by high levels of infectious disease, notably HIV, tuberculosis and malaria, which continue to have an impact on overall health status.

C.2.2 Overview of the Health System in Zambia

The Ministry of Health (MOH) is responsible for planning, setting health policy, allocating funds, and sourcing of key health inputs including drugs and equipment for service delivery. In addition, the MOH provides technical oversight for the implementation of health activities. The National Malaria Control Center (NMCC) is a department under the Directorate of Disease Surveillance, Control and Research of the MOH, and provides technical and management oversight to malaria activities in public health facilities to the provincial level, as well as supporting and coordinating a wide range of partners, including research and training institutions. The Ministry of Community Development, Mother and Child Health (MCDMCH) is responsible for the delivery of primary health care services and disease control activities from the district level to the local level.

C.2.3 Malaria situation in Zambia

Significant progress in malaria control has been achieved in Zambia since 2006, but malaria remains a major cause of morbidity and mortality, directly contributing to poverty, low productivity, and reduced school attendance. Zambia is classified as a malaria high-burden country. Although malaria prevalence has shown a general downward trend since 2010, 4.9 million new cases and 3,242 deaths were reported in 2013through the Health Management Information System (HMIS). Among children under the age of five, prevalence is 15 percent, and the disease accounts for 36 percent of hospitalizations and outpatient attendance nationwide.

Zambia implements a comprehensive package of high impact malaria prevention and case management interventions that include integrated vector control (insecticide treated nets and indoor residual spraying), prevention of malaria in pregnancy (intermittent preventive treatment with sulphadoxine-pyrimethamine), accurate diagnosis (microscopy or rapid diagnostic test), and appropriate treatment (artemisinin-based combination therapy).

Zambia continues to make progress in its fight against malaria. Data from the MOH’s HMIS revealed a 52% reduction in hospitalization due to malaria and a 64% reduction in malaria deaths in children under the age of five years from 2001 to 2013. Additionally, results from the 2012 HMIS show progress in several areas of malaria control. However, some indicators seem to have leveled off and progress is not homogeneous throughout the country with some provinces lagging behind or falling back to 2006 levels on some key malaria indicators. Additionally, between 2009 and 2013 HMIS data showed an increase in the number of malaria cases. Table 1 shows a comparison of key national level indicators between 2006 and 2012.

Table 1: Recent Estimates of Malaria Indicators:

Indicator results of nationwide population-based malaria indicator surveys, 2006-2012

C.2.4 The President’s Malaria Initiative

In June 2005, the United States Government (USG) announced the PMI, a new five-year, $1.2 billion initiative to rapidly scale-up malaria prevention and treatment interventions in high-burden countries in sub-Saharan Africa. In 2008, the Lantos/Hyde Act authorized up to $5 billion in USG funding for malaria prevention and control. This act provides for continued support to the 15 PMI focus countries and an expansion to other endemic countries. It also called for the development of a comprehensive multi-year USG malaria strategy, which was released on April 25, 2010. The new USG Malaria Strategy revised the original PMI goal upwards from 50% to 70% reduction in malaria morbidity and mortality by 2015. The new strategy continues PMI’s focus on four highly effective interventions: 1) insecticide-treated mosquito nets; 2) indoor residual spraying; 3) intermittent preventive treatment for malaria during pregnancy; and 4) correct diagnosis and appropriate treatment with artemisinin-based combination therapy (ACT).

In December 2006, Zambia was selected as a PMI country. Since then, Zambia has received approximately $127 million in PMI funding. PMI/Zambia currently provides support for Insecticide treated nets (ITNs), IRS, MIP, case management and M&E.

C.3 SCOPE

The PAMO is expected to strengthen malaria prevention and case management activities at health facilities and community level, build management capacity of the district and provincial level to provide oversight/supervision of malaria interventions, improve data reporting, analysis, and use for decision-making by strengthening the HMIS and empower communities to take ownership of the malaria problem and work with governmental and non-governmental entities to control malaria in their communities. PAMO will not be expected to implement indoor residual spraying nor procure malaria commodities.

The PAMO will target four higher malaria burden provinces of Eastern, Luapula, Muchinga, and Northern beginning with all districts in one province and eventually covering all districts in the four targeted provinces. The number of communities reached in each district will depend on negotiations between the contractor and USAID/PMI.

C.4 PROGRAM OBJECTIVES, TASKS AND TARGETS

C.4.1 Objective 1: To support proven malaria interventions in alignment with the National Malaria Strategic Plan (Level of effort 60 %)

C.4.1.1 Tasks

1. Strengthen ITN distribution in targeted provinces

It is anticipated that all project districts will achieve near universal ITN coverage following the 2013/2014 Zambia mass campaign. The main challenge in Zambia has been maintaining high coverage levels following mass campaigns. At national level, assessment and recommendations for routine and continuous ITN distribution will be available and must be implemented in the project districts. The targeted provinces differ in their ITN coverage and will require alternative strategies and levels of effort.

The contractor must provide technical and material assistance to DCMOs, health facilities, and communities to implement ITN distributions through mass campaigns and routine continuous channels such as EPI, ANC, schools, and communities to attain and maintain universal coverage of ITNs.

2. Improve access to and quality of malaria case management at public health facilities and community level to ensure prompt accurate diagnosis and appropriate treatment of malaria Although the primary focus is on malaria, an integrated approach is necessary (e.g. IMCI, iCCM).

The contractor must provide technical assistance and material support to strengthen public health systems at targeted provincial, district, and community levels so that clinical, laboratory personnel and community health workers trained in iCCM maintain malaria diagnostic and treatment skills, and supervisory systems function in order to ensure quality malaria case management.

3. Increase delivery of intermittent preventive treatment to pregnant women (IPTp) using sulphadoxine-pyrimethamine as part of an integrated package of antenatal services.

The contractor must provide technical and material assistance to DCMOs, health facilities, and communities to implement malaria in pregnancy (MIP) activities to increase ANC attendance and the consistent delivery of IPTp as part of an integrated package of antenatal services.

4. Strengthen social and behavioral change communication (SBCC) implementation for malaria at health facility and community levels through community mobilization and community dialogues. This will lead to increased acceptance of IRS, increased ANC attendance with higher IPTp uptake, and improved health care seeking behavior and increased demand for and acceptance of malaria diagnostics. The Improving Prevention and Adherence to Care and Treatment (IMPACT) project will lead PMI’s support to the GRZ for malaria focused SBCC strategies and materials in collaboration with PAMO and other partners. The targeted provinces differ in their ITN use and will require alternative strategies and levels of effort to increase ownership, use, care, and maintenance of ITNs.

The contractor must provide technical and material assistance to the DCMOs and health facilities to strengthen community structures in the targeted provinces. The contractor must also implement evidence based SBCC activities to increase individual and community ownership of malaria interventions.

5. Strengthen malaria policies and guidelines

At the national level, the contractor must provide technical assistance to the MOH/NMCC and MCDMCH to develop, review, and update policies, strategies and guidelines to scale-up proven malaria interventions indicated under tasks C.4.1.1. The contractor must participate in all national level malaria Technical Working Groups and meetings.

6. Support civil society and community-based organizations to implement malaria control activities

The contractor must also provide to a lesser extent technical and material assistance to district level civil society organizations and community-based organizations in the target provinces to implement malaria control activities.

7. Conduct operations research

The contractor must contribute to national level learning about effective approaches to malaria control. This includes providing evidence through program experience and operations research. PMI Zambia will provide technical direction regarding research questions and guidelines for operations research. Findings and data from the program are to be freely shared.

C.4.1.2 Targets

1. 80% of households with an ITN-to-sleeping space ratio of at least one to one

2. 75% of children under 5-years old with fever in the last 2 weeks will have a finger or heel stick (malaria test)

3. 85% of children under five will have slept under an ITN the previous night in households that own at least one ITN

4. 85% of pregnant women will have slept under an ITN the previous night in households that own at least one ITN

5. 85% of women who have completed a pregnancy in the last two years will have received two or more doses of IPTp during that pregnancy

6. Over 90% of children under five years old with fever in the last two weeks treated with an antimalarial will receive ACTs

7. 50% of children under five years old with fever in the last two weeks sought treatment from a facility/provider on same day or next day

8. 60% of zonal community level health organization/groups in each target health facility catchment area meeting quarterly

C.4.2. Objective 2: Strengthen management capacity of the Provincial and District Ministry of Health/ MCDMCH personnel to provide oversight/supervision of malaria interventions. (Level of effort 20 %)

C.4.2.1 Tasks

1. The contractor must identify health system deficiencies at the provincial and district levels that constrain delivery of high impact malaria interventions in close collaboration with the MOH/NMCP, MCDMCH, and other malaria actors.

2. The contractor must develop and implement a plan to strengthen management capacity as measured by set targets within each targeted province and district. This includes the ability to plan, budget and implement all areas of the malaria program, including resource allocation, financial management, personnel management, training, supervision, commodities, logistics, communications and monitoring/evaluation.

C.4.2.2 Targets

1. 100% of targeted districts will develop management capacity development plans for malaria programming

2. Over 60% of planned case management supervisory visits conducted at health facilities in all districts in the target provinces

C.4.3. Objective 3: Strengthen the Health Management Information System at the provincial and district levels to improve data reporting, analysis, and use for decision making. (Level of effort 20 %)

C.4.3.1 Tasks The contractor must provide technical and material assistance to DCMOs, health facilities, and communities to:

1. Improve the timeliness and accuracy of HMIS reporting

2. Assist with training for the roll out of DHIS2 in the targeted provinces and districts

3. Strengthen malaria data analysis and use for planning and decision making.

C.4.3.2 Targets

1. Over 90% of health facilities in all districts in target provinces reporting timely HMIS data

2. Over 60% of planned district-level planning meetings held to discuss HMIS data

C.5 DELIVERABLES

Monitoring and Evaluation plan

Within 90 calendar days of award

Within 90 days of award

· Background section outlining the problem statement and circumstances surrounding facing Zambia at the beginning of the award period

· Summary of the support provided directly to the GRZ entities and to ultimate beneficiaries, including linkages/coordination/relationships with other USAID (and/or other cooperating partner) projects/activities.

· Impact/Outcome of the support provided

· Challenges encountered during implementation and actions taken to overcome those challenges

· Lessons Learned and best practices, including what worked well and what didn’t and why

· Additional analyses (gender, sustainability, cost-benefit)

· Recommendations for next steps and why – what entities to engage, problem areas to focus on, activities to stop, investments to make 45 days prior to the end of the period of performance

Quarterly progress reports, annual reports, portfolio reviews, PMI country results review narratives and annual report narratives must include the specific gender equality and female empowerment results achieved, both as a direct and an indirect result of the project/activities. Indicators used and reported against should be gender sensitive. All findings should, to the extent possible, be disaggregated by age and sex. Additional disaggregation (eg, urban/rural, educational level, etc) may also be necessary, based on the type of activity

C. 6 GRANTS UNDER CONTRACT

The contractor shall award grants to qualified recipients on behalf of USAID to help realize the objectives of the activity. These awards will fund the Zambian government and local organizations to conduct district and community level malaria control activities. The contractor will identify a strategic and manageable group of Zambian organizations capable of undertaking this work. The local organizations will work in collaboration with district and community level structures of the MCDMCH and the local traditional leadership with the contractor providing oversight of implementation of activities. The contractor will then provide capacity strengthening for implementation of malaria control activities at the district and community level. Furthermore, the contractor will provide capacity building for organizational financial and operations management related to the design of malaria control interventions at the community level.

C.7 PROGRAM PRINCIPLES

The contractor must act in accordance with the following principles:

C.7.1 USG Collaboration

Collaboration with other PMI supported projects will be critical to the success of the program. The contractor must plan, develop and implement work plans in consultation with other PMI partners involved in Indoor Residual Spraying (IRS), Procurement and Supply Chain Management (PSM), Case Management, and Social Behavioral Change Communication (SBCC) in order to ensure coordination of all PMI-supported efforts and avoid duplication of activities.

The Improving Prevention and Adherence to Care and Treatment (IMPACT) is USAID/Zambia’s flagship SBCC project, and will take a leadership role in developing SBCC strategies and materials for malaria that must be utilized by PAMO. IMPACT will share the strategies and templates for materials developed by the project with PAMO for reproduction and use in programming and implementation of activities.

Also, integration with other USAID supported activities presents an additional opportunity for collaboration and leveraging of resources. Other USAID funded projects are active at the district, health facility, and community level in the targeted districts. Collaboration will also be required where there is geographic overlap with other USAID funded projects.

The purpose of this collaboration is to coordinate implementation, avoid duplication, harmonize monitoring and evaluation, learn through joint site monitoring, and, critically, to streamline technical assistance to the Government of Zambia. USAID may require the Contractor to work in close partnership with another USG implementing contractor on select activities.

At a minimum, this collaboration must include regular (at least quarterly) meetings at the national level and at the provincial level, based on the various contractors' geographic scopes.

At the national and provincial level, USAID's health systems strengthening activity will play a convening role among partners unless otherwise directed by USAID. Collaboration must also include active participation in an annual work plan presentation and discussion meeting called by USAID/Zambia annually. As feasible, USAID/Zambia recommends activity or Zambian government co-location, joint site visits and joint meetings with the Government of Zambia.

C.7.2 Support existing Provincial and District Community Medical Office systems and partners

The contractor is expected to build capacity and skills at the provincial, district, health facility, and community level without creating parallel structures. National policy and strategies are to be implemented in the targeted districts. The intent is to equip districts to take over ownership and implementation of all malaria control activities. District malaria task forces, non-governmental organizations (NGOs), and community groups are also important for sustainability. The contractor must work closely with government staff, facilitating activities, but must not take on government responsibilities.

C.7.3 Maintain linkages at national level

While the main focus of activities is local, the contractor must play a critical role at the national level. The contractor must collaborate closely with the MOH/NMCC and MCDMCH in the planning and implementation of activities. In addition, Zambia has many malaria donors and actors. The contractor’s presence at the national level will assist PMI with central level coordination of activities of all PMI-supported partners. The other key malaria partners include: the United Kingdom’s Department for International Development, Malaria Control and Evaluation Partnership in Africa (MACEPA), Global Fund for AIDS, Tuberculosis and Malaria, United Nations Development Program, United Nations Children’s Fund, and the World Health Organization.

C.7.4 Program Reach

The program will be implemented in four high malaria burden provinces: Eastern, Luapula, Muchinga, and Northern. A presence in each province must be established by the end of the first year of the project. Activity implementation must begin in the first year in all target provinces. However, activities at the district level will require a phased approach. By the end of the second year of implementation, the program should reach every district in the four-targeted provinces.

C.7.5 Build Capacity & Sustainability

The contractor must, to the extent possible, promote the takeover of project functions by provincial and local counterparts as soon as capacity is developed. Local NGOs and community groups may be able to play a key role, once their capacity is built. The contractor must take as much a background role as is compatible with maintaining high rates of coverage of key interventions.

C.7.6 Gender Considerations Biologically, infants, young children, and pregnant women are at highest risk of morbidity and mortality related to malaria. The contractor must work to increase two-dose IPTp coverage through improving early attendance of ANC. The contractor will also support the districts in targeted provinces to distribute ITNs to pregnant women through ANC in order to increase ITN ownership and use among pregnant women as stated in task 1 under Objective 1 in C4.

Gender also plays a critical role in determining access to treatment and care for malaria and use of preventative measures such as ITN and ANC. Gender norms and behaviors influence access to ITNs within the home if nets are insufficient to cover every sleeping space. Power dynamics within the household further impact the ability to seek preventative care, such as ANC, and treatment. The contractor shall consider gender-related barriers to prevention and treatment in all of its interventions.

C.7.7 Reporting USAID/Zambia requires all activities to align their work planning process with that of the Government of Zambia. Annual work plans are due on December 15th of each year. For awards beginning off-cycle, the first work plan will be truncated to bring the activity in line with this requirement. Reporting on results will still be required according to the United States Government fiscal year.

C.8 KEY PERSONNEL

Three (3) positions in PAMO; Chief of Party, Technical Director and Director of Finance and Operations are considered essential for implementation of the project. Key personnel must possess in-depth knowledge, and relevant experience and skills for their planned portfolios. Management personnel must have experience leading large malaria or related health programs in developing countries. They must also have demonstrated ability to effectively interact with national, district and community authorities, the USG and other implementing partners. Persons proposed for key technical positions must be technical experts in the subject areas for which they are proposed.

Two out of the three key personnel positions must be from Zambia. USAID/Zambia has a strong preference for a local hire Chief of Party.

Chief of Party (COP) –100% Chief of Party will be responsible for the strategic direction, overall coordination and management of the project. The Chief of Party position will require experience in management and technical fields, with a proven track record of programmatic accomplishment, professional achievement, management competence, and interpersonal skills.

Minimum qualification requirements:

· A Master’s degree in public health or equivalent

· At least ten years of experience in managing multimillion dollar health programs in developing countries, including experience and technical knowledge in malaria

· At least five years of experience (out of 10 years) should be as a COP or senior field management experience such as Project Director, Deputy COP or Country Director roles

· Experience working in Zambia or sub-Saharan Africa will be an added advantage

· Ability to interact with and lead a broad range of governmental and non-governmental actors and institutions across sectors.

· A proven record of excellent management, leadership, decision-making, and interpersonal skills.

Technical Director (TD) - Level of Effort 100% The Technical Director will be responsible for supporting the Chief of Party (COP) with technical leadership of the project, and for direct operational oversight.

Minimum qualification requirements:

· Medical degree and postgraduate qualification in public health, epidemiology, international health or related discipline

· A minimum of eight years of experience implementing public health programs, with at least four years of experience in malaria control in Zambia or other parts of sub-Saharan Africa

· Experience and understanding of the Zambian health systems context

· A minimum of four years of experience in managing the operational functions of a large, multi-year project Finance and Operations Director (FM) – Level of Effort 100% The Finance Manager (FM) will provide financial, contractual, and administrative oversight and project reporting in compliance with USAID procedures.

Minimum qualification requirements:

· Master’s Degree in Business Administration, Finance, Accounting, or other relevant field, or a Bachelor’s or certified accounting degree with 12 years’ experience

· Minimum eight years’ experience in administrative and financial management of large-scale, complex, international development assistance programs

· Demonstrated supervisory experience

· Demonstrated experience and skills in developing and managing large budgets

· Extensive experience in developing and managing a donor funded grants program.