Amendment_01_SOL-615-17-000002.pdf

PAGE NO.

STANDARD FORM 30 (CONTINUATION)

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

CONTINUATION PAGE

Specific amendments are:

1. The following technical, contractual and cost questions received from prospective offerors and the answers are hereby incorporated in this solicitation:

Technical Questions and Answers:

1. Is there any guidance on the ceiling for funding per institution/ organization based on previous funding?

Answer: No, Offerors should determine the appropriate funding level per institution/organization.

2. On Pages 115 to 120 of the RFP each objectives 1-6 outlines "Illustrative Cluster

Interventions". Are the named Illustrative Cluster Interventions the main focus or other interventions areas can be suggested as it relates to specific objective?

Answer: The interventions are illustrative. If offerors believe there are additional, or more appropriate, interventions which should be proposed they should do so.

3. Page 118 and 119, there appears to be overlap in the set of illustrative activities for Objective 4 and Objective 6 with respect to Facility Support including providing in-service training in clinical service delivery, support facilities to use data for decision making and supportive supervision for QA and QI activities. Can USAID please elaborate on the differences in the provision of facility-level support between Objective 4 and Objective 6?

Answer: While there are similarities, Objective 4 focuses on services at the site level while Objective 6 focuses more on the health system overall. The types of in-service training may, or may not, be higher level depending on the Objective.

4. Page 119, Please clarify how the illustrative result for sites reporting their stock status on a timely monthly basis is related to the description and illustrative activities for Objective 5?

Answer: This objective includes laboratory and logistics support.

5. Page 115, Can USAID please provide the classification of counties as scale-up to saturation, aggressive scale-up or sustained and the corresponding definitions and targets? Additionally, what is USAID considering a high burden county and how is that being defined?

Answer: Please see included file on sites by county and their respective classification. Further information on how counties are classified is available on the PEPFAR.gov website in the Kenya Strategic Direction Summary (https://www.pepfar.gov/documents/organization/257644.pdf).

https://www.pepfar.gov/documents/organization/257644.pdf

6. Page 21, Can USAID please provide the complete list of mandatory / core indicators and performance targets to be reported on under HSDSA and the proposed results framework? Can USAID also provide the list of current USAID-supported sites under COP15 and their performance against the site-level targets, as reported in DATIM, for those partners that don't have access to DATIM in Kenya?

Answer: Offerors are encouraged to provide a results framework that represents their proposal. Offerors should review the indicators as highlighted in the original solicitation. See answer to Question 5 for site information. Results data by site is not required for Offerors to respond to this solicitation.

7. Page 19, Can USAD please provide the list of facilities that USAID is currently supported by PEPFAR in each of the counties to help inform the approach to develop the baseline report?

Additionally, how many facilities are being considered high-volume as opposed to low-volume in each county?

Answer: See answer to Question 5 for site information.

8. Page 91, Part c) Can USAID please provide a list of the active USAID HIV/AIDS projects in Kenya?

Answer: The following link provides a list of implementing partners for the PEPFAR program in Kenya (starting on p. 97): https://www.pepfar.gov/documents/organization/267255.pdf

9. With respect to the emphasis on innovation, does USAID envisage conducting operations research and experimenting with small-scale pilots outside of the current policy environment being incorporated within the technical approach?

Answer: Offerors are encouraged to propose innovations and the appropriate mode to operationalize them.

10. Page 117, Can USAID please provide the list of recommended activities that are being referenced as "HIV Service Provision" activities?

Answer: Attachment J.1, Statement of Objectives, lists the activities under HIV Service Provision. See section starting on p.114 of the solicitation.

11. Is this award being fully funded by PEPFAR? Or are there other funding sources from Malaria, Nutrition, TB, WASH, MCH and FP? If so, can you please provide the breakdown of funding from these other sources?

Answer: This award is solely PEPFAR funded.

https://www.pepfar.gov/documents/organization/267255.pdf

12. Section E.3. Quality Assurance Surveillance Plan (p. 17). One of the items listed as a mechanism for monitoring the progress/success of the activity and the contractor’s performance is periodic impact evaluations.

a. Please confirm that any impact evaluations of an HSDSA contract would be conducted by a third party.

b. Please confirm that offerors should not include the cost of an impact evaluation of an HSDSA contract in their budgets.

Answer: Impact evaluations along the lines of a traditional “mid-term” or “final” evaluation are not expected as part of the QASP, however offerors are expected to identify ways to measure and report on the impact achieved.

13. Page 114 of the RFP states that “Contractors are also expected to work across the U.S.

government platform and under the auspices of a ‘lead Agency’ at the county level to ensure that the capacity of the county as a whole to operationalize and oversee clinical HIV services are institutionalized. The lead Agencies may either be Centers for Disease Control and Prevention (CDC), the U.S. Department of Defense (DOD), and the Peace Corps.” Can USAID clarify which one is the lead agency for each county?

Answer: USAID will not provide a lead agency for each county as the eventual lead Agency by county has no impact on an Offerors submission.

14. Could USAID please explain how the targeted end state (FY21) in the table on page 120 was established?

Answer: Please review the PEPFAR 3.0 strategy.

15. Could USAID please confirm that prevention, outreach, and antiretroviral therapy adherence activities for key populations are not expected to be a core set of services provided by HSDSA?

Answer: ART adherence at facility and community level is a key activity under this solicitation.

While Offerors may not have the sole responsibility for all patients entering the supported facilities, it is within their best interest not to lose patients from within the system.

16. We respectfully ask USAID to make publicly available the following information:

a. All recent progress reports of the current AphiaPlus programs. This information is not available through public channels, such as the Development Exchange Clearinghouse.

Answer: USAID is working with partners to get their progress reports posted in the Development Experience Clearinghouse. USAID estimates that the information will be posted by the week of February 6, 2017.

b. Extracted information/reports from DATIM showing performance against targets for all required PEPFAR indicators for all USAID-supported facilities. This information is not available through public channels, such as PEPFAR dashboards.

Answer: Performance against target data is not required for effective responses to this solicitation.

At present, only incumbents have this information. Access to these documents will provide all potential offerors with equal information on current work, accomplishments, and lessons learned. This would enable all offerors to more effectively propose approaches and activities and to set targets as requested in the RFP based on existing baselines that build on the prior work and accomplishments of current USAID programs.

17. The RFP consistently notes that contractors/offerors must work with other implementing agencies and partners regardless of the agency or funding source to ensure HIV services are integrated and complementary. Across clusters, in several counties U.S. government support to facilities is split — most notably, between USAID and the CDC. Can USAID please provide a list of the facilities that are designated to be supported by USAID and those to be supported by the CDC over the life of the HSDSA programs? This information will enable all potential offerors to design and propose approaches and activities, such as those related to referral systems, which effectively consider this aspect of individual county contexts.

Answer: Please see the list of facilities per cluster in Attachment B.

18. Section L.7, page 94, states that the AMELP “will identify core indicators for every result and intermediate result/outcome and provide preliminary five-year performance indicator targets for these core indicators.” The Statement of Objectives (Attachment J.1, page 110) includes only overall objectives and no sub-objectives/intermediate results. Can USAID please confirm that, for the draft AMELP, offerors should include only indicators at the objective level?

Answer: This will be left at the discretion of the offeror. Should the Offeror, propose sub-objectives, indicators at the sub-objective level may be required.

19. The tables on pages 100 and 120 are from 2016 and 2015, respectively, and list different levels of total HIV burden by county. Would USAID please direct offerors as to which numbers should be used as the estimated burden?

Answer: Offerors should use the data from Table 1 which are the most recent UNAIDS and Kenya Country Estimates.

20. Will USAID kindly provide the number of health-care and other staff they are employing, or expect to be employing in each county at the onset of implementation? In this way, all offerors will have access to this information and can propose appropriate approaches for transition between projects and appropriate cost proposals.

Answer: Offerors should propose a staffing plan commensurate with their approach to implementation. Current staff may or may not be required depending on the mode of implementation employed.

21. Our understanding is that the US Government provides direct funds to some county governments for the payment of facility-based healthcare worker salaries. Does USAID allow for these types of arrangements under this contract?

Answer: No.

22. On page 33 of the Kenya COP 2016, there is reference to a specific set of strategies for

PMTCT that are to be implemented “in the highest HIV burden and incidence counties.” Can USAID identify the specific counties so the correct PMTCT strategies are applied in the correct counties?

Answer: These counties are: Nairobi, Homa Bay, Kisumu, Siaya, and Migori – the top five counties contributing to the burden of HIV in Kenya. Note that not all of these counties are included in this solicitation.

23. Can USAID please clearly define and name the counties that fall into the 16 Scale-Up to

Saturation; 11 Aggressive Scale-Up; and 20 Sustained counties?

Answer: See answer to Question no. 5.

24. On page 26, under qualifications of COP, the RFP states that the COP is to possess “At least five years international (outside of Kenya) experience in development, managing, overseeing, and evaluating public health programs of similar size and complexity.” Would USAID consider modifying the 5 years of international experience to a ‘desired’ or ‘preferred’ qualification?

Answer: No.

25. On page 26 USAID uses the title “Deputy Chief of Party and Senior Technical Advisor” to mention this position; however, when referring to the position within the role section of the RFP it states “Deputy Chief of Party/Service Delivery Technical Advisor.” Could USAID please clarify if this position is to be Deputy Chief of Party/Service Delivery Technical Advisor or Deputy Chief of Party/Senior Technical Advisor?

Answer: The correct title is Deputy Chief of Party/Service Delivery Technical Advisor.

26. On page 35 Section H.1 Grants Under Contract, the RFP states that “No awards should be made to partner government entities.” However, on page 125 under Grants Under Contracts, the RFP provides illustrative activities for the grants to “include community level mobilization for advocacy, enrollment and adherence to HIV interventions and services. Support to clinical facilities, sub-counties and counties to ensure capacity building and human resources support.”

Could USAID clarify whether grants can be given to facilities, sub-counties and counties since they are Kenyan government entities?

Answer: Support may be given to facilities, sub-counties and counties through a third party under the GUC.

27. On page 113 of the RFP it states “HSDSA is solely focused on assisting the GOK, and select faith and community based facilities to enhance HIV service delivery.” Could USAID confirm that private for profit facilities will not be supported by HSDSA.

Answer: Private, for profit, facilities are not expected to be supported through this solicitation.

28. On page 114 the RFP references the most recent Gender Analysis conducted by the Mission.

Could USAID share the analysis report?

Answer: https://www.usaid.gov/sites/default/files/documents/1860/5.%20Gender.pdf

29. On page 114 the RFP states “Operating under the auspices of county leadership and direction, this activity will integrate selected services previously operationalized by other implementing partners such as training, hiring of human resources, and facility-based commodity quantification, ordering, stocking, issuing, and resupply/reporting.” Could USAID confirm that the proposed project is to cover these interventions or required to collaborate with other programs providing these services?

Answer: Yes, USAID confirms that the proposed project is to cover these interventions or required to collaborate with other programs providing these services.

30. On page 115 under Objective 1, the RFP discusses VMMC as an illustrative cluster intervention for traditionally non-circumcising areas. Could USAID confirm that VMMC is not to be included as a service in counties and clusters with traditionally circumcising populations?

Answer: VMMC services are expected in the following counties only:

Kisumu, Homa Bay, Migori, Busia, Turkana, West Pokot, and Nakuru

31. On pages 113 and 115 the RFP refers to “individuals at high risk of acquiring HIV” (for PrEP) and “priority populations” for combination prevention services (Objective 1). Does USAID envision any priority populations in addition to AGYW and fisherfolk being reached under Objective 1?

Answer: Offerors should identify, and justify, any additional priority populations outside of AGYW and Fisherfolk.

https://www.usaid.gov/sites/default/files/documents/1860/5.%20Gender.pdf

32. On page 115 the RFP Illustrative Results, it states: >80% of vulnerable AGYW reached with a defined package of services in HIV high burden counties. Could USAID confirm that AGYW activities should only be included in the high burden counties referenced on page 110 (Homa Bay, Kisumu, Migori and Siyaya, etc)?

Answer: The above mentioned counties were the pilot under DREAMS. The new guidelines (released in draft on Dec. 30, 2016) states that “In COP17 countries should consider broadening geographic coverage beyond the original DREAMS SNUs to all prioritized SNUs using DREAMS and OVC funds to maximize AGYW-focused prevention activities.” In line with this guidance Offerors may propose activities outside of the four pilot counties, subject to availability of funding and PEPFAR/Kenya prioritization.

33. On pages 113 and 124 the RFP states “PrEP must be included in this activity in accordance with the NASCOP.” However, PEPFAR support for PrEP has largely focused on DREAMS counties. Does USAID intend for HSDSA to provide PrEP in accordance with NASCOP guidance, which may be outside of DREAMS counties?

Answer: Yes. PrEP will be provided according to national guidelines.

34. In reference to the Table of Current Anti‐Retroviral Therapy (ART) Coverage by County (USAID only) on pages 120 and 121. Could USAID clarify whether the total burden estimates are based on FY 15 or FY 2021 estimates?

Answer: Burden was based on the FY15 estimates. There are, at present, no estimates for HIV burden in 2021.

35. Does USAID/Kenya intend to maintain the earlier designation of counties as scale up and sustained?

Answer: USAID/Kenya does not determine the designation of counties alone. This is part of the annual Country Operational Plan process and subject to S/GAC changes in nomenclature as well as epidemiologic importance of a county in any given year.

36. Under F.4 ,“Quarterly Performance Reports” (pg. 19-20), is it possible that the reporting be limited to results in each of the areas rather than also reporting expenditures by funding stream?

Because budgets are not developed by funding streams (as the funding streams are only known after an obligation is made), reporting by funding stream expenditures complicates the accounting situation for the project.

Answer: PEPFAR requires the annual reporting of expenditures as part of the “Expenditure Analysis”. This requirement includes financial reporting across a range of supported activities which may, or may not, directly align with implementing partner obligations. However, USAID/Kenya has established a process of providing funding by budget code as part of the normal funds obligation process and therefore Implementing Partners do know funding by budget code or funding stream.

37. On Page 26 of the RFP, it is stated that the Chief of Party needs “At least five years international (outside of Kenya) experience in development, managing, overseeing, and evaluating public health programs of similar size and complexity.” What is the rationale for international experience? Would USAID consider a candidate with exceptional experience in Kenya but limited international experience?

Answer: The rationale for international experience is that the experience provides more value in exposure to program and technical management. The requirements do not change. The offeror must propose the require qualifications.

38. Can the offeror support/work with organizations of male/female sex workers given the content of section “H.32 302.3.5.16(a)(4) PROHIBITION ON THE PROMOTION OR ADVOCACY

OF THE LEGALIZATION OR PRACTICE OF PROSTITUTION OR SEX TRAFFICKING

(SEPTEMBER 2014)” on pages 59 and 60? The offeror would consider, for example, anti-discrimination activities against key populations.

Answer: Key Population activities writ large are not expected under this solicitation. However, clinical services, in particular the provision of ART, are expected to be included. In-service training regarding provider attitudes may be included.

39. The figures on HIV burden indicated on page 111 are different from the burden on pages 120 and 121. The figures indicated on page 120 and 121 are different from what is provided by NACC HIV county estimates 2016. Could USAID clarify which figures are correct?

Answer: Both sets of data are correct, they are different because one is historical data.

However, Offerors should use the data from Table 1 which are the most recent UNAIDS and Kenya Country Estimates.

40. On page 118, under Objective four, “Illustrative Cluster Intervention (facility support)”, bullet three, “in-service training” is listed as an illustrative intervention. However, on page 124, bullet six states, “Training and mentoring WILL be integrated into service provision through KMTCs for institutional training/trainers, and in-service training will not be managed by an external partner.” Can USAID clarify its position on training since the two sentences seem contradictory? The latter sentence is repeated on pg 124, “Training and mentoring will be integrated into service provision, through KMTCs for institutional training/trainers, and in-service training and will not be managed by an external partner.” Can USAID elaborate?

Answer: The two statements are not contradictory. In-service training is expected to be part of this solicitation. In-service training should also utilize existing country resources and capacity which includes KMTCs.

41. On page 118, under Objective four, Illustrative cluster intervention (facility support), bullet three, in-service training is listed as an illustrative intervention. However, on page 124, bullet six, “Training and mentoring WIL be integrated into service provision through KMTC for institutional training/trainers, and in-service training will not be managed by an external partner”. Can we get USAID position on training since the two sentences seem contradictory?

Answer: See answer to Question 40.

42. On page 118, the first bullet under “Illustrative Cluster Results” for Objective 4 reads, “95% of support facilities have ‘adequate staff’ (>80% of full-time equivalents are filled) to carry out core HIV service provision.” On page 120, “Illustrative Cluster Results” for Objective 6 reads “Number of health facilities with adequate (above 75%) health workforce for delivery of HIV services.” These two numbers are different but refer to the same indicator, adequacy of staffing of health facilities. Can USAID clarify which is correct?

Answer: Adequate staff should be considered “>80% of full-time equivalents are filled.”

43. RFP Section F.4, page 19, Gender, Youth and Social Inclusion Analysis, states “the contractor will implement approaches for increasing access to quality health services by women, girls and children while also addressing low uptake of health services by men, either for themselves or on behalf of their families and partners. This analysis should map out how best to reach these key sub-populations and integrate findings into work plans and interventions.” Is it USAID’s expectation that in clusters 4 and 5 that this analysis be conducted by both awardees? If so, does USAID have any specifications for what they are seeking for this analysis under Objective 6?

Answer: Awardees for Cluster 4 & 5 will be expected to work closely together and expect close coordination. As such, it will be important that the analysis is carried out in a combined fashion, realizing that the service delivery awardee may have a different focus than the system strengthening awardee. At this time, USAID does not have any specification for this analysis under Objective 6.

44. RFP Section F.7, Key Personnel, clearly lists five key positions. However, given that cluster 5 is health systems strengthening and not service delivery focused, and has a narrower scope than clusters 1-4, would USAID consider alternate staffing for key positions for cluster 5?

Answer: The requirements for key personnel are clearly defined in Section F.7.

45. RFP Section L.8, page 99: The RFP notes that $187,500 should be budgeted for grants under contract for the Cluster 5 award. Can USAID clarify its expectations for the types of services to be sought through GUCs in Cluster 5?

Answer: USAID identified illustrative activities in Section III.6, Grants under Contract of Attachment J.1.

46. Attachment J.1, Section III, Scope of Services and Results, page 118: One of the Illustrative Cluster Interventions under objective 4 is “In-service training/continuous medical education support at site level for clinical and non-clinical staff (e.g. community health workers, mentor mothers, peer educators, lay and adherence counsellors, etc).” One of the Illustrative Cluster Interventions under objective 6 (see page 119) is “Provide in-service training to address identified health worker performance gaps (e.g. in clinical service delivery, leadership and management, commodities management, etc.).” Can USAID clarify the distinction between what is to be done under Objective 4 and 6 in terms of health worker training, particularly as it relates to Clusters 4 and 5?

Answer: See answer to Question No.3.

47. What is the functional and operational relationship that the Government expects between the contractor for objective 1 through 5 and the contractor for objective 6? Shall small business offerors propose options for working in a coordinated manner to achieve the HSDSA objectives and targets?

Answer: Offerors for Cluster 4 and Cluster 5 will be expected to work synergistically. While Cluster 4 will focus on service delivery, Cluster 5 will focus on how to make those services more sustainable. Thus both Offerors will benefit from the work of the other.

48. Is the same team composition to be proposed for Objective 6 as for the other objectives?

Answer: See answer to Question no. 44 .

49. Would the Contract Awardee have access to existing training curriculum, personnel and other resources?

Answer: Yes, all training materials supported by the USG should be in the public domain.

50. Would the Government provide the Contract Awardee access to previously developed Annual Work Plans?

Answer: Yes, the Government may provide annual work plans of previous implementers.

51. Are the Sub-Counties currently using PBB?

Answer: Counties have many different ways of operating. Offerors are encouraged to learn the particular conditions within the various clusters.

52. Would the Government provide the Contract Awardee existing County Health Plans?

Answer: No, the Government will not provide.

53. How quickly would the Government allow Contract Awardee’s access to District Health Information System – II (DHIS2)

Answer: Neither USAID nor the U.S. government would allow the Contract Awardee control access to the DHIS, because this is a Government of Kenya system.

54. Who collects the data on the MOH Form 731 and enters into the DHIS2?

Answer: The health facility completes the Ministry forms and the District (now sub-county) Health Information Officer enters into DHIS2.

55. Does the Government need additional data/information for the EHR?

Answer: No, the Government doesn’t need additional information for the EHR.

56. What form (business rules) are being used to collect health information and data for HIV programming and monitoring by County Staff?

Answer: The Offeror must research the information to find out what business rules are being used.

57. Could USAID please provide annual reports and/or mid-term evaluations from the current

APHIAplus projects?

Answer: See answer to question no. 16(a).

58. On page 115, under Objective 1: Increase availability and use of combination prevention services for priority populations, the Illustrative Cluster Interventions outline a package of services for Adolescent Girls and Young Women (AGYW) which includes (amongst others):

GBV prevention and response, community mobilization and norms change, social protection, parenting and caregiver programs targeting AGYW. These elements of the package of services are traditionally OVC programming and both household economic security interventions and caregiver programs were listed in the Support for Orphans and Vulnerable Children in Kenya Activity (NOFO-615-16-000033). Page 124 of the RFP it states that ‘’Orphan and vulnerable services will be included only where pediatric treatment and longitudinal follow up of HIV exposed infants is required.’’ Please clarify whether the Offeror should include strategies and activities to reduce and respond to GBV, social protection and parenting programs, educational subsidies, social asset building and those which are typically the responsibility of OVC programs.

Answer: The solicitation is clear in this regard, “Orphan and vulnerable children services will be included only where pediatric treatment and longitudinal follow up of HIV exposed infants is required.”

59. On page 115, the first bullet under Illustrative Cluster Results notes: >80% of vulnerable AGYW reached with a defined package of services in HIV high burden counties. Could USAID confirm that the AGYW package of services should not be delivered in non high-burden counties?

Answer: See answer to Question No. 32.

60. On page 118, under Objective 4, the first Illustrative Cluster Result states ‘95% of supported facilities have “adequate staff” (>80% of full-time equivalents are filled) to carry out core HIV service provision’. However, on page 120, under Objective 6, the fourth illustrative cluster result states ‘Number of health facilities with adequate (above 75%) health workforce for delivery of HIV services’. a. Could USAID please clarify if the target for filling staff positions at facility level is expected to be above 75% or > 80%? b. Could USAID please clarify how the scopes of work for QI, data for decision-making and in-service training/continuous medical education support that is noted in the Illustrative Interventions under both HSDSA Cluster 4 (Objectives 1-5) and Cluster 4 (Objective 6) differ and do not overlap?

Answer: See answer to Question no. 42.

61. On page 119, under Objective 6, the first Illustrative Cluster Intervention for Human Resources for Health is, “Determine existing facility level staffing gaps for HIV services, collaborate with the 3 county and the public service commission to recruit needed staff based on resource availability, and develop transition plans for any health workers contracted by the project.” On page 116 under Objective 4: Increased uptake of and adherence to quality HIV treatment services, there is an Illustrative Cluster Result that “95% of supported facilities have ‘adequate staff’ (>80% of fulltime equivalents are filled) to carry out core HIV service provision. Does this result still apply to HSDSA Cluster 4 (Objectives 1-5)? If so, how does it differ from this Objective 6 Illustrative Cluster Result: “Number of health facilities with adequate (above 75%) health workforce for delivery of HIV Services?”

Answer: See answer to Question no. 42.

62. On page 120-121, the RFP has a chart of Current ART Coverage by County. The current ART coverage for Vihiga is 9,157 while the target for FY21 is 9,173 meaning that the gap is only 16 people. However, the same table estimates the gap as 2,630. It is unlikely that the target for FY21 would be 9,173 if this is the estimated gap. Could USAID please explain this discrepancy in data?

Answer: In some counties USAID is not the only implementing Agency. Targets may be split within a county based.

63. Can USAID please provide a results framework for the project?

Answer: Offerors are requested to devise an appropriate results framework.

64. Can USAID please provide a copy of the Mission PMP?

Answer: The RFP has been revised. The subject Mission PMP is no longer necessary.

65. Can USAID please confirm that support for HRH will be covered under objective 4 given its importance in contributing to the achievement of the service delivery objectives?

Answer: Yes , support for HRH at the facility level is under Objective 4, however there may be some support to the County under Objective 6 as well.

66. Can USAID please provide additional information about what cluster (4 vs 5) will cover the following as several activities are listed under Objectives 4 and 6 in the RFP:

i. Support for commodity management

ii. QA/QI at the facility level

iii. Training for health care workers

iv. Capacity building to strengthen monitoring and evaluation at the county and facility level

v. Supportive supervision and joint monitoring at the facility level

Answer: Facility level activities should be supported by Cluster 4. To the degree that supportive supervision or QA/QI are required services for a facility from the County, they should be included in Cluster 5.

67. Can USAID please clarify which activities detailed in the table on page 122/123 of the RFP listed in the service delivery column will be covered under the health systems strengthening vs service delivery objective specifically in relation to cluster 4 and cluster 5?

Answer: See answer to Question no. 66.

68. Can USAID please confirm that the GUC can be used to support county governments including clinical facilities, sub-counties and counties as noted on page 125 of the RFP (including cluster 4)?

Answer: See answer to Question no. 26.

69. Given the integrated nature of the scope of work activities and results appear across multiple objectives. Can USAID please provide guidance on the following:

a) Can USAID please confirm that VMMC should be covered under Objective 1?

Answer: Yes, VMMC should be covered under Objective 1.

b) Objective 4 includes a number of illustrative cluster results focused on HIV+ pregnant women (proportion enrolled in care and treatment, percent of institutional delivery, percent reduction in mother-to-child transmission rates etc.). However, the majority of other care and treatment related activities (including assisted delivery services with a trained provider for HIV+ pregnant women, TB/HIV integration, and various routine treatment services for children and adults) are included under objective 3. Can USAID please confirm which objective services for HIV+ pregnant women should fall under?

Answer: Services for any given population type may fall across multiple objectives and should generally be seen in line with the “90-90-90” goals as both discrete services and part of a cascade. Thus the “initiation” of a service may fall in one objective while the long term follow up for a related service may fall into another objective.

c) “90% of HIV+ clients are retained within the system” is included as an illustrative result under both Objective 3 and Objective 5. Retention is also mentioned in the RFP guidance for Objective 4. Can USAID please confirm that adherence and retention strategies should be detailed under Objective 5 as a key component of achieving viral suppression?

Answer: The illustrative result belongs in both Objectives however the meaning may be somewhat different. Under Objective 3, the focus is on retaining the newly identified HIV+ individual within the system so they may be initiated on ART. Under Objective 5 the focus would be on ensuring the HIV+ patients, on ART, is maintained within the system.

d) Objective 5 is “Long-term follow-up of patients receiving care and treatment services including lab and logistics support”, but lab and logistics support activities seem to fall under Obj. 4 as written in the SOW. Can USAID confirm which objective these activities should fall under?

Answer: See answer to question no. 70b. Services may be supported in different manners across different objectives. The key is the objective statement.

70. Can USAID please provide a list of imperative sites for HSDSA support?

71. Can USAID please share the source of ART coverage data detailed on pages 120-121 of the

RFP?

Answer: There were multiple data sources used in this table, including the prior country estimates of HIV burden and the data from the PEPFAR Annual Performance Report.

72. Can USAID please share a list of the QI model sites in Cluster 4?

Answer: QA/QI are illustrative activities under this objective and not model sites.

73. Can USAID please share the criteria for the classification of high-burden counties or share which counties are considered high-burden across the target counties?

74. Coordination in this project has several dimensions. Are all contractors regardless of cluster bound to coordinate at the National, local (county), and sub-county level for the development and smooth operation of the project?

Answer: Yes, the expectation is that contractors will take direction from the National level and coordinate with the County and site level.

75. What is the role of the contractor? To proactively engage all parties to accelerate the implementation of the project? Is the contractor expected to let the local government take the lead? What role does CASCO play? How does Casco interact with the central government?

To what extent does the potential contractor interface with the centrally retrained contractors to implement the National HIV/AIDS program? We intend to support and build steady capacity and competent decision making at the county level; should we consider the County governments key interlocutor to the development of this project or is there a balance which must be maintained between National and local authorities?

Answer: Attachment J.1 describes the Statement of Objectives that Offerors/Contractors are expected to interpret and respond to.

76. Could USAID please share with us the information on the projects that are currently operating in the three counties and where we can secure information on those projects?

Answer: The Offeror needs to research this information.

77. Page 114 of the RFP refers to the Accelerating Children’s Treatment (ACT) and the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Initiatives. Are ACT and DREAMS being rolled out in Cluster 5? If so, by what IPs?

Answer: USAID supported ACT and DREAMS activities are currently implemented by existing awardees whose activities are being replaced through this solicitation.

78. Page 115 of the RFP indicates that “Contractors are…expected to work across the U.S.

government platform and under the auspices of a “lead Agency” at the country level…” What agency is the lead in Cluster 5 countries?

Answer: See answer to Question no. 13.

79. What existing projects are addressing key populations in Cluster 5?

Answer: The FHI360 LINKAGES activity addresses Key Populations country wide for USAID.

80. Page 120 of the RFP refers to a “lead health financing partner” of USAID’s. Is the USAID lead financial partner currently operating in Cluster 5? If so, for how long will they continue?

Answer: Health Policy Plus is the lead financial partner. USAID does not have the information on how long they will continue.

81. Page 123 mentions a PBB role out to sub-counties with a focus on applications to high volume facilities. Will the PBB roll-out be the responsibility of the USAID health finance lead, and will they play a support role in the 3 counties and if so, for how long?

Answer: See answer to question no. 80.

82. The current health worker strike in Kenya suggests that health care financing is an issue in Kenya. Does USAID anticipate that the implementing partners of the Kenya and East Africa HIV Service Delivery Project will work with the lead USAID finance partner to attempt to address this problem? Is there any possibility that the policy prohibiting incentive payments to health personnel (for example, under a performance-based funding scheme) could be considered?

Answer: USAID does not pay incentives.

83. According to the COP 16 an emphasis will be placed on improving commodity and logistics management to ensure the availability of Rapid Test Kits (RTKs); to this end the COP notes that, “The country will also use the RTK electronic reporting tool to monitor usage and resupply. This will have a positive impact on the roll out of Test and START to achieve the first “90,” and, “The Counties will be empowered to monitor use, ensure reporting, and allocation of the RTK. Health is devolved to the county governments; therefore, the county government is in a better position to ensure rational use of the RTK and reporting.” Has the RTK reporting tool be rolled out in all of the Cluster 5 counties? Does NASCOP currently have an effective commodity distribution system in Cluster 5?

Answer: The RTK reporting tool is being used nationwide.

84. What is implementation status of the Sustainable Financing mechanism cited in the COP?

Answer: See answer to question no. 80.

85. Has an HRIS been introduced at the county level in all of the focus counties to include Cluster

5?

Answer: HRS is a national level, and not at the county level.

86. Under PEPFAR’s Domestic Resource Mobilization initiative, several but not all focus counties have been trained in PBB; can a list of the counties that have been trained and those still requiring training be provided? What IP had the responsibility for this activity in FY16?

Answer: No, we can not provide the list of counties trained. HP Plus is the implementing partner responsible.

87. Is NAAC the MOH entity that will coordinate the on-going rollout of PBB and if so how will

NAAC ensure coordination at the county level with the IP in Cluster 5?

Answer: USAID has no information.

88. Improved VL access will address the programmatic gap related to the third “90”, what percentage of patients now are routinely monitored for VL in Cluster5?

Answer: USAID has no information.

89. Has Test and Start been rolled out by NAAC/ NASCOP in Cluster 5?

Answer: Test and Start is part of the national guidelines.

90. Has KEMSA developed a national supply chain plan that includes ARVs, OI drugs, RTKs, laboratory reagents, tests and supplies, nutrition supplements and HIV prevention commodities?

Answer: Yes.

91. Page 117, Can USAID please confirm that procurement for commodities including ARVs, RTKs, FP, MCH and Malaria should not be budgeted under these awards?

Answer: Yes, procurement for commodities including ARVs, RTKs, FP, MCH and Malaria should not be budgeted under these awards

92. Pages 35, Can USAID confirm that grants can be budgeted collectively, rather than proposing the specific named grantees at this stage?

Answer: Yes, grants can be budgeted collectively, rather than proposing the specific named grantees at this stage.

93. Page 19, 3rd paragraph: Are the Mission Contractors identified?

Answer: The “contractor” noted in this section is the Offeror.

94. Page 19, 4th paragraph: Is the “USAID Gender Equality and Female Empowerment

Policy of March 2012” publicly available?

Answer: See Attachment J.8.

95. Can USAID please expand on its vision for how the contractor for cluster 5 will coordinate with the contractor for cluster 4? Specifically: Can USAID please clarify which activities detailed in the table on page 122/123 of the RFP listed in the service delivery column will be covered under the health systems strengthening vs service delivery objective specifically in relation to cluster 4 and cluster 5?

Answer: Offerors responding for Cluster 5 are not expected to carry out activities at a facility level, outside of potential assistance with supportive supervision carried out by the County/Sub-County.

96. Page 19, 2nd paragraph: This paragraph refers to “Implementing Partners” and “Ministry of Health Technical Working Group” members, when might the offerors anticipate the identification of these activities?

Answer: The Offerors may anticipate the identification of the “Implementing Partners” and “Ministry of Health Technical Working Groups” upon contract award.

97. Is the project expected to second staff to meet the service delivery gaps in the facilities? This is mentioned in a few places with an exit plan expected.

Answer: Offerors should suggest a staffing pattern commensurate with their implementation requirements.

98. Could USAID explain the different approaches expected for sustain vs accelerate counties?

Answer: Implementation is along the 90-90-90 framework.

99. Can we provide the mission's PMP? if yes, can you please provide me the Mission PMP?

Answer: The RFP has been revised. The Mission PMP is no longer necessary. Please see revised RFP.

100. The RFP does not mention the Performance Indicator Reference Sheets (PIRS). Could

USAID please clarify whether or not the PIRS is part of the submission?

Answer: PIRS are not required for proposal submission.

101. Will it be required for the contractor to report through technical area and can USAID clarify how this will be tracked? Will this be broken down by counties?

Answer: PEPFAR requires reporting at a site level. Contractors will be required to report into the USG’s DATIM system.

102. Could USAID provide a breakdown of which technical funds are in the award by ART, PMTCT, HTS, Lab etc.?

Answer: Funding breakdowns will be provided upon award. Offerors should focus on responding to the requirements in the SOO at this time.

103. Will the vehicles from the incumbent projects be given to new contractors? How many?

Answer: Offerors should not assume that there will be vehicles transferred from previous awards.

104. Pages 124-125, Section J.1, VI. Grants under Contract. Can USAID clarify what restrictions are included under grants under contracts? Are we limited to supporting CBOs/NGOs? Can we grant funds directly to the county government for HIV service delivery support? Can the level of these funds be used for spending on behalf of the counties if we are not able to give directly to the county governments?

Answer: Currently GUC’s cannot be provided to Government entities.

105. CD4 is mentioned on page 116 under Objective 3. Will this project support referrals and issues related to CD4 lab support as well as viral load?

Answer: Yes.

106. Does USAID prefer to use COP guidelines and terminology for the offeror’s proposals? For example is USAID using categories such as Sustain, Accelerate, etc. to distinguish the level of effort and type of interventions needed for each individual county?

Answer: As the new guidance has just been issued, Offerors may use either previously existing language or the new language.

107. Ref Objective 1. Page 115, 5th paragraph, 3rd bullet:

Is the mentioned “Health Communications and Marketing activity” a specific approach to be undertaken in the scope of work of this contract? If yes, please can you describe the type of activities and deliverables that you envision? If this activity is not an envisioned part of the scope of work, how is it being provided, under a contract separate from this RFP?

Answer: Health Communications and Marketing activity is led under an on-going award with PS Kenya. The reference in page 115 under Objective 1 is to coordinate with the Health Communications and Marketing activity responsible for social and behavior change communications.

108. Are there any specific IEC (Information, Education, and Communication) deliverables in the foreseen contracts from this RFP, which a bidder needs to address in the Technical Proposal and Cost Proposal?

Answer: All requirements on the technical and cost proposal are detailed in Section L of the

RFP.

Contractual and Cost Questions and Answers:

1. Is there a specific proposal writing format that has been prescribed by USAID specifically for this call?

Answer: There is no Specific proposal writing format that has been prescribed specifically for this call. However, all instructions for proposal submission (technical and cost) detailed in Section L must be followed.

2. Kindly clarify the meaning of the words/clauses below:

Answer:

a. Full and open competition- (FAR 2.101) when used with respect to a contract action, means that all responsible sources are permitted to compete.

b. Contractor – (Glossary of ADS Terms) A non-government organization or individual acting as an agent of USAID and carrying out a scope of work specified by USAID.

(Chapter 102) The seller of the goods and/or services. It includes both organizations and individuals.

c. Subcontractor: (Glossary of ADS Terms) A non-government organization or individual who furnishes services to, or for, a prime contractor.

d. Offeror: (FAR 2.101) means Offeror or bidder.

e. Small / big business: (FAR 2.101) means a concern that does not exceed the size standard for the North American Industry Classification Systems code that the prime contractor determines best describes the product or service being acquired by the subcontract.

“Small disadvantaged business concern” consistent with 13 CFR 124.1002, means a small business concern under the size standard applicable to the acquisition, that:

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by—

(i) One or more socially disadvantaged (as defined at 13 CFR 124.103) and economically disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States; and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at 13 CFR 124.106) by individuals who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

3. If a small business is a Prime Contractor under Cluster #5 "Restricted to Small Business:

Service Delivery (Objective 6)", can such a small business firm be a subcontractor(s) to a large firm(s) on other Clusters 1, 2, 3 and 4 excluding Objective 6)?

Answer: Yes, small business firms can be subcontractor(s) to a large firm on other Clusters 1,2,3 and 4 excluding Objective 6.

4. Can a large business firm that is a Prime Contractor to "Full and Open Competition" under Clusters 1-3, be a Subcontractor to Small Business under Cluster 5?

Answer: Yes, large business firm that is a Prime Contractor under Cluster 1-3 can be a subcontractor to a small business under Cluster 5.

5. Given the size and complexity of this activity, would USAID consider extending the deadline to allow applicants to develop a responsive and comprehensive proposal?

Answer: Yes, the deadline for the submission of proposals has been extended to February 17, 2017. Please see revised RFP in Attachment A of this amendment.

6. Can USAID please provide the anticipated start date for this award?

Answer: The anticipated award date is October 1, 2017.

7. Page 131 provides a template for a work plan but there is no requirement to provide a work plan listed in the ANNEX. Is a Year 1 work plan required?

Answer: There is no Year 1 Work plan required. The RFP is revised to delete the template for a work plan.

8. Page 103, Can USAID please confirm that the branding and marketing plan is not require for the initial submission?

Answer: Section L.9 states that “The cost proposal must include all estimated costs associated with the BIP and the MP. The BIP and MP will not be part of the technical evaluation.

Branding Implementation Plan and Marking plans will be requested of offerors in the competitive range.” Branding and Marking plan is not required for the initial submission.

9. Page 16, Can USAID please elaborate on the difference between the Activity, Monitoring, Evaluation and Learning Plan (AMELP) and the Quality Assurance…