SAFE_RFP__01072016.pdf

United States Agency for International Development Office of Acquisition and Assistance (OAA) Subdivision 694/Stand 100 P O Box 32481 Lusaka 10101 Zambia

Telephone +260.211 350000

Fax +260.211 357041/2 URL http://www.usaid.gov/zm

Date Issued: January 7, 2016 Closing Date: February 8, 2016 6:00 a.m. local Zambia time Questions due date: January 14, 2016 6:00 a.m. local Zambia time Past Performance Information Data Reference Sheet: January 25, 2016 12:00 pm local Zambian time

SUBJECT: Request For Proposals (RFP) No.: SOL-611-16-000001

REF: USAID/PEPFAR Supporting an AIDS Free Era (SAFE)

The U.S. Agency for International Development (USAID)/ Zambia is seeking proposals from qualified organizations interested in providing the services described in the attached solicitation.

The U.S. Government represented by U.S. Agency for International Development (USAID) anticipates a single Cost Plus Fixed Fee Completion contract. Under FAR Part 15, this is a full and open competition, under which any type of organization is eligible to compete. The authorized geographic code for procurement of goods and services under this award is 935. The period of performance for this contract will be five years from the effective date of the award. The NAICS code for this procurement is 541611. All requirements are subject to availability of funds.

This solicitation in no way obligates USAID to award a contract, nor does it commit USAID to pay any costs incurred in the preparation and submission of a proposal.

Furthermore, the Government reserves the right to reject any and all offers, if such action is considered to be in the best interest of the Government.

Offerors are encouraged to read the entire solicitation, which includes all pertinent technical sections and the terms, conditions and instructions required for submitting a proposal. Any empty fill-in spaces in Sections B through J will be completed by the Contracting Officer before award.

By email only, please submit all questions about this RFP no later than the deadline indicated above to oaa-solicit-lusaka@usaid.gov . Oral instructions, answers or guidance from any USAID source prior to the award of the contract shall not be binding. The Agency points of contact for this solicitation are Ayana Angulo at aangulo@usaid.gov and Joshua Holmes, at jholmes@usaid.gov .

Best Regards, /s/

Ayana Angulo Contracting Officer USAID/Zambia http://www.usaid.gov/zm mailto:oaa-solicit-lusaka@usaid.gov mailto:aangulo@usaid.gov mailto:jholmes@usaid.gov

SOL-611-16-000001

SOLICITATION, OFFER AND AWARD

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

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

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

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

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 146

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

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

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

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

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

I

J

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L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

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

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

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ADDRESS

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

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

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

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

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

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

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

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

OFFER (Must be fully completed by offeror)

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

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

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

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

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

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

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

AWARD (To be completed by government)

CODE

REQ-611-15-00003001/07/2016

X

ZAMBIA

USAID Zambia Ms. Ayana Angulo Supervisory Contracting Officer USAID/Zambia oaa-solicit-lusaka@usaid.gov

0600 LT 02/08/2016

Joshua Holmes 202 jholmes@usaid.gov

595-0793

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Ayana Angulo

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

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

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 146

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

SOL-611-16-000001

(A) (B) (C) (D) (E) (F)

Supporting an AIDS-Free Era (SAFE) activity in

Zambia

0001 The USAID/Zambia public sector support for

HIV/AIDS services through the Supporting an

AIDS-Free Era project operationalizes

USAID/Zambia’s vision of equal access to quality, gender-sensitive, and sustainable HIV/AIDS and family planning services by the Zambian people, as close to the family as possible. The purpose of SAFE is to reduce mortality, morbidity and transmission of HIV/AIDS, while improving nutrition outcomes and family planning integration in the six USAID-supported provinces in Zambia.

NAICS Code - 541611

OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

NSN 7540-01-152-8067

SECTION B – SERVICES/PRICES

B.1 PURPOSE

The purpose of Supporting an AIDS-Free Era (SAFE) is to reduce HIV mortality, morbidity and transmission, while improving nutrition outcomes and family planning integration in the six USAID-supported provinces as detailed in Section C.

B.2 CONTRACT TYPE

The U.S. Government represented by the United States Agency for International Development Mission in Zambia intends to award a Cost-Plus-Fixed-Fee Completion type contract.

B.3 ESTIMATED COST AND FIXED FEE

(a) The total estimated cost plus fixed fee for the performance of this award is between $125,000,000 and $150,000,000. The final negotiated amounts will be entered in the table below at the time of award:

Total Estimated Cost: $ Fixed Fee: $ Total Estimated Cost Plus Fixed Fee: $

(b) The total estimated cost for the performance of the work required hereunder, exclusive of fixed fee, is $[to be inserted by CO at time of award].

(c) Within the estimated cost plus fixed fee specified in paragraph (a) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the Contractor for performance hereunder is $[to be inserted by CO at time of award].

(d) Funds obligated are anticipated to be sufficient through [date to be inserted by CO at time of award].

B.4 LINE ITEMS

The following budget table captures the final negotiated cost elements for the performance of the work required hereunder.

CLIN 001 Services required for Objectives 1 through 5

Cost Element Amount Salaries and Wages $ Fringe Benefits $ Allowances $ Travel, Transportation, and Per Diem $ Equipment Supplies Other Direct Costs (ODC) $ Sub-contracts $ Grants Under Contracts (GUCs) $9,600,000

Indirect Costs $ Total Estimated Costs $ Fixed Fee $ Total Estimated Cost Plus Fixed Fee $

CLIN 002 Optional Services –Manage Routine Supervision and Mentoring Programs

Fringe Benefits $ Allowances $ Travel, Transportation, and Per Diem $ Equipment Supplies Other Direct Costs (ODC) $ Sub-contracts $ Grants Under Contracts (GUCs) $ Indirect Costs $ Total Estimated Costs $

CLIN 003 Optional Services – Roll out new clinical policies and guidelines Manage Routine Supervision and Mentoring Programs

Fringe Benefits $ Allowances $ Travel, Transportation, and Per Diem $ Equipment Supplies Other Direct Costs (ODC) $ Sub-contracts $ Grants Under Contracts (GUCs) $ Indirect Costs $ Total Estimated Costs $

CLIN 004 Optional Services – Implement QA/QI practices at provincial, district and facility levels

Fringe Benefits $ Allowances $ Travel, Transportation, and Per Diem $

Equipment Supplies Other Direct Costs (ODC) $ Sub-contracts $ Grants Under Contracts (GUCs) $ Indirect Costs $ Total Estimated Costs $

CLIN 005 Optional Services – Procure and maintain medical equipment

Salaries and Wages $ Fringe Benefits $ Allowances $ Travel, Transportation, and Per Diem $ Equipment Supplies Other Direct Costs (ODC) $ Sub-contracts $ Grants Under Contracts (GUCs) $ Indirect Costs $ Total Estimated Costs $

CLIN 006 Optional Services – NACS services

Salaries and Wages $ Fringe Benefits $ Allowances $ Travel, Transportation, and Per Diem $ Equipment Supplies Other Direct Costs (ODC) $ Sub-contracts $ Grants Under Contracts (GUCs) $ Indirect Costs $ Total Estimated Costs $

CLIN 007 Optional Services – Fully manage facility level pharmacy and laboratory services including stock levels

Fringe Benefits $ Allowances $ Travel, Transportation, and Per Diem $ Equipment Supplies Other Direct Costs (ODC) $ Sub-contracts $ Grants Under Contracts (GUCs) $ Indirect Costs $ Total Estimated Costs $

CLIN 008 Optional Services – Manage facility level data information systems for routine monitoring and evaluation

Fringe Benefits $ Allowances $ Travel, Transportation, and Per Diem $ Equipment Supplies Other Direct Costs (ODC) $ Sub-contracts $ Grants Under Contracts (GUCs) $ Indirect Costs $ Total Estimated Costs $

B.5 INDIRECT COSTS

Prime:

Description Rate Base Type Period

TBD TBD 1/ 1/ 1/

TBD TBD 2/ 2/ 2/

1/ Base of Application: TBD Type of Rate: TBD Period: TBD

2/ Base of Application: TBD Type of Rate: TBD Period: TBD

The Contractor is allowed to recover applicable indirect costs (i.e. overhead, G&A, etc.) on other direct costs (ODCs), if it is part of the Contractor’s usual accounting procedures, consistent with FAR Part 31, and the Negotiated Indirect Cost Rate Agreement (NICRA).

B.6 CEILING ON INDIRECT COSTS

Reimbursements for allowable indirect costs shall be at final negotiated rates but not in excess of the following ceiling rates:

Contractor Overhead Rate % Overhead Ceiling Rate %

G&A Rate % G&A Ceiling Rate %

PRIME

MAJOR

SUBCONTRACTOR(S)

NOTE 1: Insert additional indirect rates as needed for prime and major subcontractors in the above table.

(1) The Government will not be obligated to pay any additional amount should the final indirect cost exceed the negotiated ceiling rates. If the final indirect cost rates are less than the negotiated ceiling rates, the negotiated rates will be reduced to reflect the lower rates.

(2) This understanding shall not change any monetary ceiling, obligation, or specific cost allowance or disallowance. Any changes in classifying or allocating indirect costs require the prior written approval of the Contracting Officer.

B.7 COST REIMBURSEMENT

Allowable costs shall be limited to reasonable, allocable and necessary costs determined in accordance with FAR clause 52.216-7, Allowable Cost and Payment, FAR clause 52.216-8, Fixed Fee, and AIDAR clause 752.7003, Documentation for Payment.

B.8 PAYMENT OF FIXED FEE

Pursuant to FAR 52.216-8, Fixed Fee, payment of fixed fee shall be allocated based upon the execution of tasks outlined in Section C, the approval of required deliverables listed in Section F, and the proportion of allowable and allocable costs incurred to accomplish the tasks and deliverables.

B.9 MULTI-YEAR CONTRACT

CLIN 001 is considered non-severable and the Government only has funding for two years and is therefore a multi-year contract as defined in FAR 17.103. Therefore, this contract is subject to the requirements of FAR 17.106.

Cancellation Dates:

Contract Year 3: June 1, 2019 Contract Year 4: June 1, 2020

Contract Year 5: June 1, 2020

Cancellation Ceiling:

This is a CPFF type contract where the contractor is authorized to be reimbursed for all costs which are allowable in accordance with FAR 52.216-7, “Allowable Costs and Payment”. Therefore, the contractor will not incur any costs which would have been amortized over the life of the contract should the contract be cancelled in accordance with FAR 52.217-2. Therefore, the cancellation ceiling for each cancellation date is [negotiated amount].

[END OF SECTION B]

SECTION C – DESCRIPTION/SPECIFICATIONS

Acronym List

ACT Accelerating Children's HIV/AIDS Treatment Initiative ADFHS Adolescent Friendly Health Services AIDS Acquired Immunodeficiency Syndrome APR Annual Performance Report ART Antiretroviral Therapy ARV Antiretroviral AU African Union BCC Behavior Change Communication BMI Body Mass Index CDC Centers for Disease Control and Prevention CDCS Country Development Cooperation Strategy CD4 Cluster of Differentiation 4 CHW Community Health Workers COP Country Operational Plan CSW Commercial Sex Workers DMO District Medical Office EID Early Infant Diagnosis EMTCT Elimination of Mother-to-Child Transmission EPCMD Ending Preventable Child and Maternal Deaths FANTA Food and Nutrition Technical Assistance Project FP Family Planning G2G Government to Government GRZ Government of the Republic of Zambia GUC Grants under Contracts HCT HIV care and treatment HEPS High-Energy Protein Supplement HIV Human Immunodeficiency Virus HIV+ HIV positive HTC HIV testing and counseling ICE Information, Communication, Education IMAM Integrate Management of Acute Malnutrition IR Intermediate Result IPTp Intermittent Preventive Therapy in pregnancy ITN Insecticide-Treated Net IYCN Infant and Young Child Nutrition M&E Monitoring and Evaluation MCH Maternal and Child Health MDG Millennium Development Goals MER Monitoring, Evaluation and Research MNCH Maternal, Newborn and Child Health MOA Ministry of Agriculture MOF Ministry of Finance MOH Ministry of Health MUAC Mid-Upper Arm Circumference MSM Men who have Sex with Men

MSL Medical Stores Limited MTB/RIF Mycobacterium Tuberculosis/Rifampicin MTCT Mother-to-Child Transmission NAC National AIDS Council NACS Nutrition, Assessment, Counseling and Support NASF National AIDS Strategic Framework NFNC National Food and Nutrition Commission NGO Non-governmental organization NHSP National Health Strategic Plan NMCC National Malaria Control Center NSP National Strategy for the Prevention of HIV/AIDS in Zambia OVC Orphans and vulnerable children PAD Project Appraisal Document PEPFAR President’s Emergency Plan for AIDS Relief PHC Primary Health Care PLHIV People Living with HIV PLWHA People Living with HIV and AIDS PMI President’s Malaria Initiative PMO Provincial Medical Office PMTCT Prevention of Mother-to-Child Transmission RH Reproductive Health R-SNDP Revised Sixth National Development Plan RTK Rapid Test Kits RUTF Ready-to-use therapeutic food SAFE USAID/PEPFAR SAFE: Supporting an AIDS-Free Era SAPR Semi-Annual Performance Report SIMS Site Improvement Monitoring System sdNVP Single dose of Nevirapine SOW Statement of work TB Tuberculosis TWG Technical Working Group UNAIDS Joint United Nations Program on HIV/AIDS USAID United States Agency for International Development USAID/Z United States Agency for International Development/Zambia VMMC Voluntary Medical Male Circumcision WHO World Health Organization ZDHS Zambia Demographic and Health Survey ZPCT II Zambia Prevention, Care and Treatment partnership II ZPCT IIB Zambia Prevention, Care and Treatment partnership II Bridge

C.1 INTRODUCTION

The purpose of Supporting an AIDS-Free Era (SAFE) is to reduce HIV mortality, morbidity and transmission, while improving nutrition outcomes and family planning integration in the six USAID-supported provinces.

C.2 BACKGROUND

Country Context Zambia’s population is estimated at 15 million people. At 741,000 square kilometers (286,000 square miles) Zambia is slightly larger than the U.S. state of Texas and is geopolitically divided into ten provinces and over 100 districts. Approximately 60 percent of the population lives in sparsely populated rural areas.

Zambia has made significant progress in managing its generalized HIV epidemic over the past decade, with UNAIDS estimating at least a 50 percent reduction in new infections between 2000 and 2012, and a halving in the number of HIV-related deaths according to the 2013 -2014 Zambia Demographic and Health Survey (ZDHS). While prevalence has decreased one percentage point since 2007, Zambia still suffers from one of the world’s most devastating HIV/AIDS epidemics, with a current prevalence of

13.3 percent.

Prevalence among women in Zambia, compared to their counterparts in the region, continues to be higher than among men. UNAIDS estimates the differential as 16.1 vs. 12.3 percent, while the ZDHS measured 15.1 vs. 11.3 percent. The difference in HIV sero-prevalence is particularly striking among the age group of 20 - 24 years, where young women are six times more likely (12 percent versus 2 percent) to be HIV infected than young men (Population Council, 2013); the measurement from the 2013/14 ZDHS is 11.2 for young women vs 7.3 for young men.

HIV prevalence is twice as high in urban areas (18.2 percent) compared to rural areas (9.1 percent), and the epidemic is geographically diverse, with provincial prevalence ranging from 6.4 percent to 18.2 percent. The Muchinga and Northwestern provinces, both predominantly rural with low population densities, have the lowest prevalence, at 6.4 percent and 7.2 percent respectively. In six of Zambia’s ten provinces, much of prevalence is concentrated in “hotspots” in the provincial capitals and some districts.

In contrast, Lusaka and Copperbelt Provinces have densely populated urban areas with a prevalence of 16 percent or higher.

Food and nutrition support is a critical component of HIV/AIDS treatment and care. HIV and malnutrition interact in a vicious cycle; leading to severe morbidity and mortality. For many people living with HIV (PLHIV), the infection causes or aggravates malnutrition through reduced food intake, increased energy needs, impaired nutrient absorption and nutrient losses associated with frequent and persistent diarrhea. Malnutrition can hasten the progression of HIV to AIDS, further weakening the immune system and increasing susceptibility to and complicating treatment of opportunistic infections (OI) as well as reducing the effectiveness of antiretroviral therapy (ART). Food insecurity and malnutrition remain highly prevalent in most sub-Saharan African countries, including Zambia. Thus, Nutrition Assessment Counselling and Support (NACS) is a critical component of management of patients with HIV and AIDS. According to the ZDHS, nationally, 40 percent of children under age 5 are stunted, and 17 percent are severely stunted. Analysis by age groups shows that stunting is highest (54 percent) in children age 18-23 months and lowest (14 percent) in children less than 6 months of age.

Severe stunting shows a similar pattern, with the highest proportion among children age 18-23 months (25 percent). Stunting is higher in male than in female children (42 percent versus 38 percent). Stunting decreases as the length of the preceding birth interval increases; it is highest among children born less than 24 months following a previous birth (46 percent) and lowest among children born 48 or more months after a preceding birth (34 percent). More than half of children whose size at birth was very small (62 percent) or small (52 percent) are stunted. Mothers’ nutritional status, as measured by their body mass index, also has an impact on the level of stunting in their children. Stunting is most likely (50 percent) among children whose mothers are thin (BMI of less than 18.5) and least likely (32 percent) among children whose mothers are overweight or obese (BMI of 25 or above).

While modern contraceptive prevalence is relatively high compared to other countries in the region at 44.8%, family planning services are poorly integrated into HIV services and only 4% of women report using male condoms, one of the most cost-effective HIV prevention interventions. Further, 11.3% of all couples in Zambia are HIV discordant, with rates of discordance higher among couples with significant age differences (13% - 15%, depending on the age category), and urban couples (15.8%). Primary health care facilities make up the largest source of family planning methods, with 69 percent of users obtaining their method from government health centers and posts.

The HIV response in Zambia is coordinated by the National HIV/TB/STI Council (NAC) and the Ministry of Health (MOH) with the MOH taking the primary lead on HIV/AIDS and nutrition activities.

Stakeholders implementing HIV activities include the Zambian government, international bilateral and multilateral cooperating partners, local and international non-governmental organizations, civil society organizations and Zambian communities. The country’s long-term vision calls for a “nation free from the threat of HIV and AIDS by 2030.”

The main goals of the HIV treatment program in Zambia are to increase HIV treatment coverage for all PLHIV to 80 percent; reduce AIDS-related mortality by 50 percent and enhance HIV prevention. Only 50 percent of persons living with HIV/AIDS (PLWHA), however, are actually receiving HIV treatment.

These data underscore the continued need for improved access to and utilization of comprehensive HIV/AIDS services, including testing and counseling, prevention of mother-to-child transmission of HIV (PMTCT), voluntary medical male circumcision (VMMC), ART, and clinical care and support.

National Policy Context

Zambia’s Revised Sixth National Development Plan (SNDP) envisions equitable access to quality healthcare for all its citizens by 2030 and recognizes that a healthy population is critical to improved production and productivity. The SNDP specifically identifies the goal of a well- nourished and healthy population by 2030, and highlights the importance of maternal and child nutrition programs in achieving this goal, Additionally, the National Health Strategic Plan (NHSP) promotes access, as close to the community as possible, to high quality and cost-effective health services. The key principles of the NHSP include availability of primary health care services, equity of access, affordability, cost-effectiveness, accountability, partnership, decentralization, leadership and a clean, caring and competent health care environment. The NHSP outlines health system strengthening priorities based on the six World Health Organization (WHO) building blocks. The plan also identifies maternal, neonatal and child health, HIV/AIDS and sexually transmitted infections, tuberculosis and malaria as public health priorities. The Government of the Republic of Zambia (GRZ) has committed to providing essential health care to all Zambians through the implementation of a Basic Health Care Package that includes services based on an epidemiological analysis of the diseases and conditions that cause the highest burden of disease and death.

Family planning is part of the government’s integrated reproductive health services and is further outlined in the Eight-Year Integrated Family Planning Scale-Up Plan (2013-2020). At a national level, the goal is to increase contraceptive prevalence rate of modern methods from 33 to 58 percent by 2020, in line with the commitments made by the Zambian government at the London Summit in July 2012.

Another national plan guiding USAID’s work in Zambia is the Revised National HIV/AIDS Strategic Framework (R-NASF) 2014-2016. The framework is a roadmap to achieve Zambia’s vision of “a nation free from the threat of HIV and AIDS” and to reach the goal of reducing new infections by 50 percent, while scaling up treatment, care and support. It lays out the objectives of the national response:

1. Reduce new HIV infections by 50%;

2. Reduce AIDS related mortality by 50%;

3. Reduce HIV related stigma and discrimination by 50%; and

4. Increase domestic financing of the HIV response to 20%.

Zambia committed to reduce mother-to-child transmission of HIV/AIDS by 95 percent by 2015. The R- NASF also places emphasis on the prevention of infections in the populations most at risk, such as sex workers and mobile populations. USAID continues to have a major role in this response through PEPFAR-financed activities.

The draft Zambian HIV/AIDS commodity security strategy (2009-2010) discusses the availability of nutrient supplements for nutrition care and treatment programming. The document targets the availability and standardization of information on the use of supplemental and therapeutic nutrient products for ART, PMTCT, and Tuberculosis (TB) clients. It suggests that strategies should include the identification and treatment of malnutrition, improvement of nutrition-related counseling and support, supply chain management for nutrient commodities, and building capacity in the health system by the deployment and retention of trained nutritionists.

PEPFAR/USAID’s HIV/AIDS Response in Zambia

In early 2003, U.S. President George W. Bush announced PEPFAR, a five-year, $15-billion program aimed at fighting HIV/AIDS around the world. The program prioritized assistance for 15 of the world’s most severely affected nations, including Zambia. Now in its third phase, PEPFAR has evolved into a program focused on helping countries build a long-term, sustainable response to fight HIV/AIDS. In its third authorization, PEPFAR expands existing commitments around service delivery and strengthens emphasis on sustainability and country ownership.

At the onset of the PEPFAR program in Zambia in 2004, because the HIV/AIDS problem was a generalized epidemic, urgent concerted steps were required to reverse the epidemic’s tide. This led to splitting the country into two service delivery regions, with the Centers for Disease Control and Prevention (CDC) working in the four southern provinces and USAID in the five northern provinces. A new province was subsequently created in 2012, bringing the total number of USAID supported provinces to six. The six northern provinces contain both provinces with a high disease burden and provinces with low HIV prevalence, although the latter contain well-defined high-prevalence HIV areas (“hotspots”). With the exception of Copperbelt Province, which is urbanized, the other provinces are predominantly rural, with poor road networks and health infrastructure. The geographic scope of the six “USAID” provinces comprises 57 districts and approximately 1,017 health facilities.

With PEPFAR support, USAID scaled up its activities and initiated a number of interventions, which have significantly contributed to rolling back the HIV/AIDS epidemic in Zambia. Support has strengthened a national and community-based response; improved service delivery systems and institutions; and implemented a broad portfolio of proven interventions and innovative activities. Within the health and integrated approach to service delivery, USAID has supported a number of partners to scale up the HIV/AIDS response, including: supporting facility-based service delivery; expanding and improving service delivery through bilateral programs; and leveraging the private sector. Additionally, concerted steps strengthened health infrastructure at all levels, with a focus on decentralization and support to local government and local organizations.

In partnership with the GRZ, these activities had a number of positive results:

• Enrolled over 600,000 HIV-infected patients in ART at more than 530 clinics nationwide, representing a 50 percent treatment coverage of PLHIV;

• Revised the Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infections to expand treatment eligibility to include all HIV-infected children and adolescents under age 15, infected adolescents aged 15 and older, and adults with a CD4 count under 500 cells/mm3;

• Implemented Option B+ for HIV+ pregnant women; and

• Scaled-up TB/HIV activities in Zambia: Approximately 90 percent of TB patients know their

HIV status, 93 percent of HIV-positive TB patients are on cotrimoxazole, and ART coverage for TB/HIV patients has risen.

PEPFAR and USAID/Zambia Projects in Zambia

On August 6, 2014, the Accelerating Children’s HIV/AIDS Treatment Initiative (ACT) was announced, in conjunction with the U.S.-Africa Leaders’ Summit, PEPFAR and the Children’s Investment Fund Foundation (CIFF). The objective of ACT is to double the total number of children receiving life-saving ART across at least 10 sub-Saharan African countries over 2014-2016. Zambia has been identified as an ACT eligible country, and USAID-supported activities will align to support the ACT goal.

The USAID Health Care Improvement (HCI) and follow-on Applying Science to Strengthen and Improve Systems (ASSIST) projects, with FANTA-3 and Thrive, have implemented NACS in numerous countries with significant results identifying and improving the nutritional status of PLHIV and other key populations. The project seeks to improve prevention and management of malnutrition in PLHIV by: integrating NACS into facility-based ART, PMTCT and MNCH services; strengthening community-facility linkages; and strengthening the capacities of district health managers and care providers to apply improvement skills. To date, these projects have focused primarily on case identification and categorization, as well as retention of malnourished clients. There is now a need to focus more on the effectiveness of treatment on the nutritional status of PLHIV and the contribution of NACS services to larger goals of HIV/AIDS support.

USAID Systems for Better Health is a 5-year project working with the GRZ to develop and implement national strategies and plans that address key system challenges faced by the health sector. The project will provide technical assistance to the MOH to build the capacity of health managers and professionals at the national, provincial, district, and facility levels to plan, implement, monitor, and evaluate health, including HIV, programs. Systems for Better Health will be implemented in a maximum of 28 districts spread across seven provinces, including Copperbelt, Central, Eastern, Lusaka, Luapula and Southern provinces.

Attachment J.2 contains a comprehensive list of ongoing and completed projects in Zambia relevant to

SAFE.

C.3 PROJECT, PURPOSE AND OBJECTIVES

The purpose of SAFE is to reduce HIV mortality, morbidity and transmission, while improving nutrition outcomes and family planning integration in the six USAID-supported provinces. The SAFE contractor will primarily utilize a technical assistance approach to strengthen services at the district and facility level, and a direct service delivery model at the community level. SAFE activities are informed by analyses including gender, policy, and cost-effectiveness analyses, and consultation with the Zambian government, U.S. Government agencies, civil society, private sector, research institutions, donors and other stakeholders.

In general, after five years of implementation, SAFE will have achieved its intended purpose by having:

• Reached 80 percent of eligible HIV-positive adults and children with antiretroviral treatment across SAFE districts;

• Reduced HIV-related deaths by 50 percent;

• Improved the quality of life for HIV-infected people by maintaining viral suppression for 90 percent of beneficiaries on HIV treatment;

• Lowered the incidence of new HIV infections by 50 percent;

• Reached 90 percent of the HIV positive adults and children with NACS; and

• Reduced wasting by 50 percent among HIV positive adults and children.

As a result of this project, a sustainable HIV/AIDS response, with a focus on epidemic control, will be achieved through the following objectives:

Objective 1: Increase access to and utilization of quality HIV/AIDS services.

Expected outcomes are:

• Improved range of comprehensive HIV/AIDS services;

• Improved quality of comprehensive HIV/AIDS services;

• Increased coverage of comprehensive HIV/AIDS services; and

• Community involvement and participation in providing HIV services.

Objective 2: Improve the capacity of MOH and MCD at the provincial and district levels to provide comprehensive, high-impact HIV/AIDS services.

Expected outcomes are:

• Strengthened ability to provide decentralized services;

• Increased professional and institutional capacity for management of HIV/AIDS services; and

• Successful transition of select SAFE program components to the GRZ.

Objective 3: Integrate family planning services into all HIV/AIDS service programs in the six supported provinces.

Expected outcomes are:

• Increased access to family planning services at facilities that provide HIV/AIDS services.

Objective 4: Improve the health and well-being of PLHIV through improving NACS services.

Expected outcomes are:

• NACS services implemented in SAFE facilities and communities; and

• Improved linkages between clinical and community economic strengthening, livelihoods and food security services.

Objective 5: Strengthen the GRZ’s capacity to manage Government-to-Government (G2G) activities

SAFE is part of a larger effort to achieve sustainable epidemic control, and the SAFE contractor must work with other stakeholders to achieve this objective. A key component of this effort is USAID’s G2G initiative with the GRZ. USAID anticipates providing funding directly to the MOH to increase the resources available to the GRZ in its efforts to control the HIV epidemic. The purpose of G2G funding is to utilize host country government systems to address the HIV epidemic while strengthening local systems and increasing country ownership. Under this arrangement, the GRZ will be the primary provider of direct services, while the SAFE contractor will implement specific activities defined in this SOW to increase access to and utilization of HIV prevention and treatment services and provide technical assistance to strengthen the services provided by the GRZ. Additionally, the SAFE contractor will build the financial management capacity of the GRZ. USAID anticipates G2G funding levels to increase over the life of the SAFE contract, with select activities originally implemented by the SAFE contractor eventually becoming the responsibility of the GRZ as the contract progresses. As defined in Task 2.2, the SAFE contractor will also work with the GRZ to ensure the smooth transition of specific activities from the SAFE Contractor to the GRZ.

Expected outcomes are:

• Improved budgetary systems of the Ministry of Finance (MOF) and MOH; and

• Improved procurement operations, including but not limited to, procurement planning, contract administration, and supplier management, of the MOF and MOH.

C.4 SCOPE

4.1 Geographic Scope and Focus

The SAFE contractor must work in the following provinces: Central, Copperbelt, Luapula, Muchinga, Northern, and North-Western. The level of effort for each district within these provinces will be determined by their priority classification, a ranking determined by USAID/Zambia, in coordination with OGAC and CDC, through epidemiologic data and potential to curb the HIV epidemic. Priority classification definitions (scale-up, sustained, and centrally supported), and district assignments are provided in Table 1 below.

Facilities within each district will also be assigned a priority classification (scale up, sustained, centrally supported). Throughout the life of the activity, USAID may direct the SAFE contractor to adjust and shift targeted districts and facilities within the six SAFE provinces based on changing epidemiological factors.

4.2 Technical Focus

The SAFE contractor must provide assistance to establish and roll out service delivery systems where they may be lacking, strengthen existing service delivery platforms, and strengthen the ability of the GRZ to manage USAID G2G activities. Support to direct service delivery systems must focus on the following HIV/AIDS program areas: PMTCT; HTC; ART; VMMC; Nutrition, basic care and support;

TB/HIV; laboratory support; post-exposure prophylaxis for both pediatrics and adults; FP/ MNCH integration at ART facilities; strategic information for HIV-related services; and facility management system support, including for laboratory services, patient flow enhancement, pharmacy, records, reports and waste management.

Districts and facilities that are classified as scale-up will require a comprehensive package of core services that includes infrastructure upgrades, improved district and facility management, improved patient management, active case identification, and other interventions that maximize the capacity of facilities and increase the number of patients seeking services. Sustained districts and facilities include much of the same activities as scale-up districts, but do not include an active case finding approach.

Centrally supported districts and facilities will have no facility level activity, but will be supported by activities at the provincial level that strengthen planning and implementation of the overall, province-wide HIV response.

Table 1. District Priority Classification and Associated Core Service Packages

Priority Classification

Districts (Province) Core Service Package

Classification

Districts (Province) Core Service Package

Scale-Up

Chisamba (Central) Kabwe (Central) Mumbwa Central Serenje (Central) Chililabombwe (Copperbelt) Chibombo (Central) KapiriMposhi (Central) Mkushi (Central) Chingol (Copperbelt) Kalulushi (Copperbelt) Kitwe (Copperbelt) Mufulira (Copperbelt) Ndola (Copperbelt) Solwezi (North-Western) Kalumbila (North-Western) Mushindamo (North-Western)

Laboratory, pharmacy and infrastructure upgrades;

Diagnostic (equipment and reagents) Laboratory monitoring platforms (viral load, CD4，etc.)

Pharmacy logistics/upgrades

Clinical management Increasing access to HIV treatment to reach 80% of PLHIV Increasing utilization of HIV services Strengthening monitoring of patients

(clinical and surrogate) Adherence support Retention on HIV treatment Pre-ART services (care and support services) Alternative service delivery models

(private sector and community systems)

Strengthening data management systems including electronic health register

Active case identification

Demand generation Community-based mobilization Intensified provider initiated testing and counseling (PITC)

VMMC

Clinical procedures

QA/QI

HIV/FP Integration Nutrition, Assessment, Counseling and Support

Sustained

Luanshya (Copperbelt) Mpongwe (Copperbelt) Kawambwa (Luapula) Mansa (Luapula) Nchelenge (Luapula) Samfya (Luapula) Chinsali (Muchinga) Isoka (Muchinga) Mpika (Muchinga) Nakonde (Muchinga) Kaputa (Northern) Kasama (Northern) Luwingu (Northern)

Laboratory, pharmacy and infrastructure upgrades;

Diagnostic (equipment and reagents) Laboratory monitoring platforms (viral load, CD4，etc.)

Pharmacy logistics/upgrades

Clinical management Increasing access to HIV treatment to reach 80% of PLHIV Increasing utilization of HIV services Strengthening monitoring of patients

(clinical and surrogate) Adherence support Retention on HIV treatment

Classification

Districts (Province) Core Service Package

Mbala (Northern) Mporokoso (Northern) Mpulungu (Northern) Itezhi Tezhi (Central)

Pre-ART services (care and support services)

Alternative service delivery models (private sector and community systems)

Strengthening data management systems including electronic health register

Passive case identification

No demand creation activities Provision of PITC for clinical symptomology

VMMC

Clinical procedures

QA/QI

HIV/FP Integration Nutrition, Assessment, Counseling and Support

Centrally Supported

Luano (Central) Ngabwe (Central) Lufwanyama (Copperbelt) Masaiti (Copperbelt) Chiengi (Luapula) Chipili (Luapula) Chembe (Luapula) Lunga (Luapula) Milenge (Luapula) Mwansabombwe (Luapula) Mwense (Luapula) Chama (Muchinga) Mafinga (Muchinga) Shiwa'Ngandu (Muchinga) Chilubi (Northern) Mungwi (Northern) Nsama (Northern) Chavuma (North-Western) Ikelenge (North-Western) Kabompo (North-Western) Kasempa (North-Western) Manyinga (North-Western) Mufumbwe (North-Western) Mwinilunga (North-Western) Zambezi (North-Western)

• Technical assistance to PMO

As of FY 2014, there were 360,348 PLHIV in the 16 scale-up districts (saturation and aggressive). Of these, 207,365 are currently on ART, leaving an unmet need of 152,983 within the scale-up districts.

Through current implementing mechanisms and the SAFE contract, it is expected that 80 percent of this unmet need will be reached by the end of FY 2017. As scale-up districts reach saturation, sustained districts will be evaluated and potentially converted to scale-up districts so that, by 2020, 80 percent of eligible PLHIV across all SAFE districts are receiving ART.

4.3 CLIN001 Tasks

The contractor must implement the following tasks to achieve the objectives and outcomes of SAFE:

Objective 1: Increase access to and utilization of quality HIV/AIDS services.

By 2019, it is expected that Zambia’s ART program will deliver services to approximately one million people. Currently there are over 600,000 people on ART at over 530 sites across the country. Although significant numbers of providers have been trained and the number of nurse prescribers is increasing, alternative models of delivery are necessary. As the growing number of HIV-infected clients continues to outstrip space in secondary and tertiary health facilities, the GRZ is considering moving away from treating HIV/AIDS through acute care services only. The GRZ is also contemplating the introduction of a chronic care model to provide HIV/AIDS services to stable clients. There is a need to improve quality and integrate HIV/AIDS service delivery at the primary health care (PHC) facility level. Measures of improved patient outcomes include, but are not limited to: immunologic recovery; viral suppression, increased TB treatment success rate among PLWHA with active TB; improved patient retention rates, and reduced vertical transmission of HIV and HIV-related mortality and morbidity. The contractor, in coordination with the GRZ, must routinely monitor patient outcome data to ensure that remediation measures for service delivery issues are effectively implemented. The contractor must track remediation measures to resolution.

Outcome 1.1 Improved range of comprehensive HIV/AIDS services in scale-up and sustained districts.

The contractor must provide technical and material assistance to GRZ facilities to enable them to offer an expanded range of high quality, comprehensive HIV/AIDS services. At a minimum, the Contractor must:

Task 1.1.1 Provide specialized provider training and supportive mentorship on the provision of PMTCT, HTC, adult ART, Pediatric ART, pediatric care and support, adult care and support, TB/HIV, and VMMC;

Task 1.1.2 In collaboration with the GRZ, develop and implement continuum of care systems for HIV-infected clients;

Task 1.1.3 Expand the capacities of laboratory platforms to offer a wider range of laboratory tests to include TB, HIV, and chemistry through technical and material assistance;

Task 1.1.4 Provide technical and material assistance to the GRZ in maintaining high-tech laboratory equipment and apparatus in a functional state; and Task 1.1.5 Provide technical and material assistance to the GRZ in maintaining adequate laboratory and pharmacy commodities and supplies to reduce the incidence of stock-outs at the facility level.

Outcome 1.2 Increased quality of HIV services in scale-up and sustained districts.

The contractor must provide technical and material assistance to provincial and district medical offices to improve the quality of decentralized services. At a minimum, the contractor must:

Task 1.2.1 Develop and/or standardize criteria for addressing and improving quality of care for all HIV/AIDS clinical services;

Task 1.2.2 Identify and implement evidence-based practices to shorten laboratory turnaround time;

Task 1.2.3 Provide technical, material, and/or financial assistance to PMOs to ensure facilities attain at least an acceptable level rating for all services, from diagnosis to viral suppression to adherence, in accordance with PEPFAR’s SIMS guidance and Zambian standards for clinical HIV-related interventions.

Outcome 1.3 Increased coverage of comprehensive HIV/AIDS services

The contractor must assist the GRZ through technical and material assistance to scale up and sustain high-quality, comprehensive HIV/AIDS clinical care and treatment services at the primary care level, and sustain services at the secondary care level. At a minimum, the contractor must:

Task 1.3.1 Provide material and technical assistance to the GRZ to identify and implement alternative ART implementing models including but not limited to community-based platforms, down-referral of stable patients so that they may receive care and treatment services at the community level, three month supply of ARVs, and private sector linkages.

Task 1.3.2 Develop, improve and expand two-way referral systems for quality clinical care, treatment and follow-up within hospitals and between clinics and hospitals and vice versa

Task 1.3.3 Identify community-based programs in each of the facility catchment areas and assist in the establishment of linkages to care and treatment at facilities;

Task 1.3.4 Develop early diagnosis and treatment initiation systems for district-based hospitals and PHC facilities and support the GRZ to roll-out and implement these systems;

Task 1.3.5 Develop and implement a strategy to profile and rank patients by CD4 count in order to prioritize and transition patients into care and lessen chances of losing pre- ART patients;

Task 1.3.6 Develop and implement novel approaches to increase the numbers of individuals tested for HIV, and increase the HTC yield, including PITC, mobile HTC, outreach facilities and other platforms offering biomedical services. This must be done through the implementation of evidence-based strategies that target most-at-risk populations and populations with high HIV prevalence; and

Task 1.3.7 Mobilize and strengthen community involvement in the provision of HIV prevention and treatment services to support scale-up sites.

Task 1.3.8 Establish public-private partnerships (PPPs) to increase the engagement of the private sector in the provision of HIV services.

Performance Standards for Outcomes 1.1 through 1.3:

Performance Standard Acceptable Quality

Level Quality Assurance Plan

Incentives

Mother-to-child transmission of HIV is reduced to less than five percent in sustained and scale-up districts

100% of standard

80 percent of HIV+ pregnant women enrolled in PMTCT are retained on HIV treatment 24 months after commencement of

ART

100% of standard

80 percent of adults aged 15-49 attending in-patient and out-patient services in the scale-up districts get tested for HIV and receive their results

100% of standard

80 percent of HIV-positive clients in scale-up districts receive ART services by 2017

100% of standard

80 percent of HIV-positive clients in all SAFE districts receive ART services by 2017

100% of standard

80 percent of HIV-positive clients in all SAFE districts receive ART services by 2020

100% of standard

80 percent of identified HIV-infected children receive HIV treatment

100% of standard

80 percent retention on ART 12 months after commencement of HIV treatment in all supported sites (static and mobile)

100% of standard

80 percent of PLHIV in scale-up districts access HIV/AIDS care services

100% of standard

80 percent of all PLHIV in care in scale up districts are screened for

TB

100% of standard

90 percent of PLHIV with active TB complete TB treatment

100% of standard

50 percent increase in the number of public health laboratories capable of conducting HIV/AIDS diagnosis and disease monitoring across supported districts

100% of standard

90 percent of supported facilities report through the GRZ structures

100% of standard

90 percent of supported sites implement continuous quality improvement plans

100% of standard

100 percent of supported sites are meeting national waste management standards

100% of standard

100 percent of supported sites are utilizing national infection control standards

100% of standard

100 percent of supported sites for VMMC are meeting national VMMC standards

90% of standard

50 percent increase in the number of HIV negative men provided with VMMC services

100% of standard

100 percent of supported sites have procedures that track remediation from identification of issues to resolution, as per Zambian government standards

100% of standard

90 percent of sites report results to national, provincial and district levels on a monthly, quarterly, semi-annual and annual basis

100% of standard

Laboratory support and monitoring systems established and…