Revised_SOL-617-14-000010_USAID_Uganda_Malaria_Action_Program.pdf

USAID/Uganda RFP-617-09-009

NUDEIL

Original RFP Issuance Date: October 22, 2014

Closing Date for submission of questions November 7, 2014 Closing Time for submission of questions 4:00 p.m. (EST) Washington, D.C.

Issuance of Amendment 1: Revised RFP and Q&A November 25, 2014

Closing Date for submission of proposals: December 19, 2014 Closing Time for submission of proposals: 4:00 p.m. (EST) Washington, D.C.

Place of Performance: Uganda

Subject: USAID/Uganda Malaria Action Program for Districts

Dear Sir/Madam:

The U.S. Agency for International Development (USAID), Uganda, is seeking proposals from qualified organizations interested in providing Malaria prevention and control services. The Malaria Action Program for Districts will also support implementation of the National Malaria Control Program (NMCP)’s vision which states that by 2016, malaria will no longer be the major cause of illness and death in Uganda and families will have universal access to malaria prevention and treatment measures.

This procurement shall be conducted under full and open competition, under which any type of organization (U.S. and non-U.S. commercial for profit firms, educational institutions, non-profit organizations) is eligible to compete. The procedures set forth in Federal Acquisition Regulation (FAR) (48 CFR Chapter 1) Part 15 shall apply.

USAID anticipates awarding one Cost Plus Award Fee (CPAF) contract with a total estimated range of $40,000,000 to $45,000,000 for the entire program, to be implemented over a period of five years, subject to the availability of funds. The purpose of providing an estimated range for the contract is to help Offerors develop their proposals for the RFP period of 45 calendar days.

Offerors should provide the lowest possible cost corresponding with their technical approach.

USAID encourages the participation to the maximum extent possible of small business concerns, small disadvantaged business concerns, veteran owned small business, service-disabled veteran small business, HUB Zone small business and women-owned small business concerns in this activity as the prime Contractor or as subcontractors in accordance with Part 19 of the FAR.

The RFP and any amendments to this solicitation will be issued and posted on the FBO website at https://www.fbo.gov. It is the Offeror’s responsibility to check the website periodically for official updates and amendments to the solicitation. It is the responsibility of the recipient of this solicitation document to ensure that it has been received from the internet in its entirety and USAID bears no responsibility for data errors resulting from transmission or conversion processes. If substantive questions are received which affect the response to the solicitation, or if changes are made to the closing date and time, as well as other aspects of the RFP, this solicitation will be amended.

OFFICE OF ACQUISITION AND ASSISTANCE

USAID /UGANDA

2190 KAMPALA PLACE

WASHINGTON DC 20521-2190

1. THIS CONTRACT IS A RATED ORDER RATING PAGE OF

PAGES

UNDER DPAS (15 CFR 700)

2. CONTRACT NUMBER 3. SOLICITATION NUMBER 4. TYPE OF SOLICITATION 5. DATE ISSUED

SEE COVER PAGE

6. REQUISITION/PURCHASE NUMBER

SEALED BID (IFB)

NEGOTIATED (RFP)

7. ISSUED BY CODE 8. ADDRESS OFFER TO

OFFICE OF ACQUISITION AND ASSISTANCE

USAID/UGANDA

PLOT 1577 GGABA ROAD

KAMPALA, UGANDA

Email: KampalaUSAIDSolicita@USAID.gov

(If other than Item 7)

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

9. Sealed offers in original and _Electronic only___ 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 depository located in n/a until (see Cover Letter and section L.7 for date and time) local (Kampala) time .

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.

A. NAME B. TELEPHONE (NO COLLECT CALLS) C. E-MAIL ADDRESS

AREA CODE

256-414

NUMBER

306-001

EXT.

6629 KampalaUSAIDSolicita@USAID.gov

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

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 3 X I CONTRACT CLAUSES 63

X B SUPPLIES OR SERVICES AND PRICES/COSTS 7 PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

X C DESCRIPTION/SPECS./WORK STATEMENT 10 X J LIST OF ATTACHMENTS 69

X D PACKAGING AND MARKING 30 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 32

X F DELIVERIES OR PERFORMANCE 34

X G CONTRACT ADMINISTRATION DATA 42 X L INSTR., CONDS., AND NOTICES TO OFFERORS 80

X H SPECIAL CONTRACT REQUIREMENTS 47 X M EVALUATION FACTORS FOR AWARD 98

X K

REPRESENTATIONS, CERTIFICATIONS AND OTHER

STATEMENTS OF OFFERORS 70

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

12. In compliance with the above, the undersigned agrees, if this offer is accepted within __150______ calendar days (60 calendar days unless a different period is inserted 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 designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT 10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS (%)

(See Section I, Clause No. 52-232-8)

14. ACKNOWLEDGEMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated:

CODE FACILITY

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

ADDRESS

OF OFFEROR

(Type or print)

15B. TELEPHONE NUMBER 17. SIGNATURE 18. OFFER DATE

AREA CODE NUMBER EXT.

15C. CHECK IF REMITTANCE ADDRESS IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS IN SCHEDULE

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION: 23. SUBMIT INVOICES TO ADDRESS SHOWN IN ITEM (4 copies unless otherwise specified)

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

24. ADMINISTERED BY (If other than Item 7) 25. PAYMENT WILL BE MADE BYCODE

USAID/Uganda Financial Management Office US Mission Compound, Plot 1577,Ggaba Road, Kampala, Uganda

CODE

26. NAME OF CONTRACTING OFFICER (Type or print)

TRACY J. MILLER

27. UNITED STATES OF AMERICA 28. AWARD DATE

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

(Signature of Contracting Officer)

(REV. 9-97)

10. FOR INFORMATION CALL:

Godfrey Kyagaba

11. TABLE OF CONTENTS

STANDARD FORM 33

SOLICITATION, OFFER AND AWARD

SOLICITATION

OFFER (Must be fully completed by offeror)

AWARD (To be completed by Government)

N/A

SOL-617-14-000010

X

See Attached Table of Contents

USAID/Uganda Malaria Action Program for Districts

CONTENTS

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

B.2 CONTRACT TYPE

B.3 ESTIMATED COSTAND OBLIGATED AMOUNT

B.4 BUDGET

B.5 INDIRECT COSTS

B.6 COST REIMBURSABLE

B.7 MULTI-YEAR CONTRACT

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 INTRODUCTION

C.2 STATEMENT OF WORK

C.3 COLLABORATING, LEARNING AND ADAPTING (CLA)

C.4 IMPLEMENTATION APROACH

SECTION D - PACKAGING AND MARKING

D.1 AIDAR 752.7009 MARKING (JAN 1993)

D.2 BRANDING AND MARKING POLICY

D.3 BRANDING STRATEGY

D.4 DELIVERABLES IN PAPER FORM

SECTION E - INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

E.2 INSPECTION AND ACCEPTANCE

E.3 MONITORING AND EVALUATION

SECTION F - DELIVERIES OR PERFORMANCE

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

F.2 PERIOD OF PERFORMANCE

F.3 PLACE OF PERFORMANCE

F.4 REPORTS AND DELIVERABLES OR OUTPUTS

F.5 SYNOPSIS OF CONTRACT REPORTS/PLANS

F.6 KEY PERSONNEL

F.7 TECHNICAL APPROVAL REQUIREMENTS

F.8 AIDAR 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT EXPERIENCE

DOCUMENTS (SEPTEMBER 2013)

SECTION G - CONTRACT ADMINISTRATION DATA

G.1 AIDAR 752.7003 DOCUMENTATION FOR PAYMENT (NOV 1998)

G.2 ADMINISTRATIVE CONTRACTING OFFICE

G.3 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

G.4 TECHNICAL DIRECTIONS/RELATIONSHIP WITH USAID

G.5 PAYING OFFICE

G.6 ACCOUNTING AND APPROPRIATION DATA

G.7 AWARD FEE EVALUATION

G.8 AIDAR 752.216-70 AWARD FEE (MAY 1997)

G.9 CONTRACTOR’S PRIMARY POINT OF CONTACT

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

H.2 AIDAR 752.7004 EMERGENCY LOCATOR INFORMATION (JULY 1997)

H.3 FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL CONFERENCES (JAN

2002) 48

H.4 INSURANCE AND SERVICES

H.5 AIDAR 752.228-70 MEDICAL EVACUATION (MEDEVAC) SERVICES (JUL 2007)

H.6 AUTHORIZED GEOGRAPHIC CODE

H.7 LOGISTIC SUPPORT

H.8 CONSENT TO SUBCONTRACT

H.9 ADS 302.3.5.14(B) STANDARDS FOR ACCESSIBILITY FOR THE DISABLED IN USAID

CONSTRUCTION CONTRACTS (JULY 2007)

H.10 ADS 302.3.5.5 REPORTING OF FOREIGN TAXES (JULY 2007)

H.11 ADS 302.3.5.14(A) USAID DISABILITY POLICY - ACQUISITION (DEC 2004)

H.12 AIDAR 752.225-70 SOURCE AND NATIONALITY REQUIREMENTS (FEB 2012)

H.13 AIDAR 752.245-71 TITLE TO AND CARE OF PROPERTY (APR 1984)

H.14 AIDAR 752.7007 PERSONNEL COMPENSATION (JULY 2007)

H.15 INFORMATION TECHNOLOGY REQUIREMENT

H.16 MANAGEMENT OF INFORMATION TECHNOLOGY RESOURCES

H.17 VALUE ADDED TAX AND CUSTOMS DUTIES

H.18 AIDAR 752.7032 INTERNATIONAL TRAVEL APPROVAL AND NOTIFICATION

REQUIREMENTS (APR 2014)

H.19 NONEXPENDABLE PROPERTY AND INFORMATION TECHNOLOGY RESOURCES

H.20 LANGUAGE REQUIREMENTS

H.21 EMPLOYMENT COSTS OF THIRD COUNTRY NATIONALS AND COOPERATING COUNTRY

NATIONALS

H.22 ENVIRONMENTAL COMPLIANCE AND MANAGEMENT

H.23 ADS 302.3.5.9 NONDISCRIMINATION (JUNE 2012)

H.24 DISCLOSURE OF INFORMATION

H.25 ELECTRONIC PAYMENTS SYSTEM

H.26 SUPPORT TO THE GOVERNMENT OF UGANDA

H.27 SUPPORT TO THE MINISTRY OF HEALTH

H.28 NON-DISCRIMINATION IN IMPLEMENTATION OF USAID-FUNDED PROGRAMS

H.29 BUSINESS CLASS TRAVEL

H.30 USAID IMPLEMENTING PARTNER NOTICES (IPN) PORTAL FOR ACQUISITION (JULY 2014) 61

H.31 USAID-FINANCED THIRD-PARTY WEB SITES (AUGUST 2013)

H.32 CONFERENCE PLANNING AND REQUIRED APPROVALS (AUGUST 2013)

PART II - CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

I.2 52.216-24 LIMITATION OF GOVERNMENT LIABILITY (APR 1984)

I.3 52.216-25 CONTRACT DEFINITIZATION (OCT 2010)

I.4 52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS

SUBCONTRACTORS (DEC 2013)

I.5 AIDAR 752.219-70 USAID MENTOR-PROTÉGÉ PROGRAM (JULY 2007)

I.6 AIDAR 752.242-70 PERIODIC PROGRESS REPORTS (OCT 2007)

I.7 FAR 52.217-8 OPTION TO EXTEND SERVICES

I.8 REPRESENTATION BY CORPORATION REGARDING A DELINQUENT TAX LIABILITY OR A

FELONY CRIMINAL CONVICTION (DEVIATION OAA-DEV-14-02C) (AUGUST 2014)

I.9 COMPLIANCE WITH SECTION 508 OF THE REHABILITATION ACT OF 1973, AS

AMENDED

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J - LIST OF ATTACHMENTS INCLUDED AND REFERENCED BY LINK

PART IV - REPRESENTATIONS AND INSTRUCTIONS

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS OF OFFERORS

K.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

K.2 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (MAY 2014)

K.3 INSURANCE - IMMUNITY FROM TORT LIABILITY

K.4 52.204-3 TAXPAYER IDENTIFICATION (OCT 1998)

K.5 FAR 52.209-5 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, PROPOSED

DEBARMENT, AND OTHER RESPONSIBILITY MATTERS (APRIL 2010)

K.6 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

K.7 52.230-1 COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION (MAY 2012) . 77

K.8 52.230-7 PROPOSAL DISCLOSURE--COST ACCOUNTING PRACTICE CHANGES (APR

2005) 79

K.9 COMPLIANCE WITH VETERANS EMPLOYMENT REPORTING REQUIREMENTS

K.10 SIGNATURE

SECTION L - INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

L.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

L.2 FAR 52.215-1 INSTRUCTIONS TO OFFERORS—COMPETITIVE ACQUISITION (JAN 2004) 81

L.3 FAR 52.216-1 TYPE OF CONTRACT (APR 1984)

L.4 FAR 52.233-2 SERVICE OF PROTEST (SEPT 2006)

L.5 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

L.6 GENERAL INSTRUCTIONS TO OFFERORS

L.7 SUBMISSION/DELIVERY INSTRUCTIONS

L.8 INSTRUCTIONS FOR THE PREPARATION OF THE TECHNICAL PROPOSAL

L.9 INSTRUCTIONS FOR THE PREPARATION OF BRANDING AND MARKING PLANS

L.10 DIGITIZING PAYMENTS IN UGANDA

L.11 COST PROPOSAL INSTRUCTIONS

SECTION M - EVALUATION FACTORS FOR AWARD

M.1 GENERAL INFORMATION

M.2 EVALUATION CRITERIA

M.3 COST PROPOSAL EVALUATION

M.4 DETERMINATION OF THE COMPETITIVE RANGE AND CONTRACT AWARD

M.5 SOURCE SELECTION

M.6 CONTRACTING WITH SMALL BUSINESS CONCERNS AND DISADVANTAGED

ENTERPRISES

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

The purpose of USAID’s Malaria Action Program for Districts contract is to control and prevent malaria morbidity and mortality, and thereby minimize the social effects and economic losses and contribute to the reduction of under-five all-cause mortality rate, as a result of reduced malaria mortality. By pursuing this, malaria will no longer be the major cause of illness and death in Uganda and families will have universal access to malaria prevention and treatment measures.

To establish the foundation for the Government of Uganda (GOU) to control and prevent malaria morbidity and mortality, the program must:

Provide universal coverage and encourage utilization of preventive measures with Insecticide Treated Nets(ITNs) and Indoor Residual Spraying (IRS) to all populations at risk of malaria;

Provide effective preventive treatment for pregnant women with at least two doses of Sulfadoxine/pyrimethamine (SP) for intermittent prevention of malaria in pregnancy (IPTp);

Provide definitive diagnosis to at least 85 percent of suspected malaria cases treated in the public sector;

Provide effective treatment in the public or private sector using artemisinin-based combination therapies to at least 85 percent of people with uncomplicated malaria within 24 hours of onset of symptoms; and

Provide an enabling environment for implementation of key malaria interventions. Such an environment includes ensuring comprehensive behavioral change towards malaria prevention, appropriate treatment- seeking, obtaining adequate financing for malaria control interventions, ensuring appropriate and adequate human resources, conducting relevant operational research, Monitoring & Evaluation (M&E), and overall health systems strengthening.

B.2 CONTRACT TYPE

For the consideration set forth below, the Contractor must provide the results, deliverables or outputs described in Section C and F, in accordance with the performance standards specified in Section E for this cost-plus-award-fee (CPAF) completion type contract.

B.3 ESTIMATED COSTAND OBLIGATED AMOUNT

(a) The estimated cost for the performance of the work required hereunder, exclusive of fee(s), if any, is $TBD. The base fee, if any, is $TBD and the possible award fee, if any, is $TBD. The estimated cost plus maximum fee, if any, is $TBD.

(b) Within the estimated cost plus award fee (if any) specified in paragraph (a) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the

Contractor (and payment of fee, if any) for performance hereunder is $TBD. The Contractor must not exceed the aforesaid obligated amount.

(c) Funds obligated hereunder are anticipated to be sufficient through [ TBD ].

B.4 BUDGET

Item CLIN Years 1, 2, 3, 4 and 5

Total Estimated Direct Costs (Not including subcontracts, grants and construction)

001 TBD

Subcontracts* 002 $4,000,000 Grants* 003 $4,000,000 Construction 004 $1,000,000 Total Estimated Indirect Costs 005 TBD Total Estimated Cost TBD Base Fee 006 TBD Award Fee 007 TBD Total Estimated Cost Plus Fee TBD

* The amounts proposed are exclusively for subcontracts and grants and not include management or administrative expenses incurred by the Contractor.

B.5 INDIRECT COSTS

Pending establishment of revised provisional or final indirect cost rates, allowable indirect costs shall be reimbursed on the basis of the following negotiated provisional or predetermined rates and the appropriate bases:

Description Rate Base Type Period

TBD 1/ 1/ 1/ 1/

Base of Application: TBD Type of Rate: TBD Period: TBD Source: TBD

(1) The Government shall not be obligated to pay any additional amount shall the final indirect cost rates exceed the negotiated ceiling rates. If the final indirect cost rates are less than the negotiated ceiling rates, the negotiated rates must be reduced to conform to 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.6 COST REIMBURSABLE

Allowable costs shall be limited to reasonable, allocable and necessary costs determined in accordance with FAR clause 52.216-7, Allowable Cost and Payment, AIDAR clause 752.216- 70, and AIDAR clause 752.7003, Documentation for Payment.

B.7 MULTI-YEAR CONTRACT

All contract CLINs under this award are considered non-severable and constitutes a multi-year contract as defined in FAR 17.103. Therefore, this contract is subject to the requirements of FAR 17.106. In the event that the Government cancels requirements for services in subsequent program years under this contract, the following conditions will apply: [Amount and dates to be filled in at time of award]

Cancellation Dates:

Contract Year 2: DATE TBD, 2016 Amount: $___TBD___ Contract Year 3: DATE TBD, 2017 Amount: $___TBD___ Contract Year 4: DATE TBD, 2018 Amount: $___TBD___ Contract Year 5: DATE TBD, 2019 Amount: $___TBD___

Cancellation Ceiling:

This is a CPAF 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/STATEMENT OF WORK

C.1 INTRODUCTION

Malaria prevention and control are major foreign assistance objectives of the U.S. Government (USG) (see Attachment J.8 for a list of acronyms) and this activity is intended to be the flagship activity of the United States President’s Malaria Initiative (PMI) in Uganda (see Attachment J.9 for a description of PMI in Uganda). Since 2008, PMI has been funding the Stop Malaria Project (SMP), which implemented most of the key malaria interventions mentioned in this statement of work. SMP ends in March 2015, and this activity is intended to take to scale the SMP activity, and address certain gaps identified in the SMP activity design and implementation. (See Section J.10 for the SMP Evaluation Report). This activity will be implemented in 43 districts in the Central (excluding Wakiso and Kampala), Mid-Western and West Nile regions.

Since 2010, the Government of Uganda (GOU) has been taking the lead on public health reforms in the country, and these policies and plans (Uganda's Second National Health Policy 2011-2020 (NHP II) and the Health Sector Strategic and Investment Plan, 2010-2015 (HSSIP) prioritize health system strengthening and health service delivery as the means for reducing morbidity and mortality – both of which are inherent in the outcomes in the Malaria Action Program for the Districts results framework. Additionally, the GOU's public commitment to malaria is evident from its significant commitment of its own resources to the ongoing universal net coverage campaign. This activity will also support implementation of the National Malaria Control Program (NMCP)’s vision. The NMCP states that by 2016, malaria will no longer be the major cause of illness and death in Uganda and families will have universal access to malaria prevention and treatment measures.

This activity falls under Development Objective (DO3) of USAID/Uganda’s Country Development Cooperation Strategy (CDCS): Improved health and nutrition status in focus areas and population groups, a comprehensive effort to improve outcomes in health, HIV/AIDS and education in Uganda. Reflecting the GOU’s vision for national development, USAID/Uganda’s 2011-2015 CDCS (see Attachment J.2) includes supporting key elements to accelerate Uganda's transition to a modern and prosperous country. DO3 implements the U.S. Global Health Initiative (GHI), which is aligned with the GOU national development priorities as stated in national and sector development plans. This activity supports the Project Appraisal Document (PAD) of DO3 objectives: (i) building on already experienced, existing service delivery platforms to integrate the delivery of health care services; and ii) organizing project implementation through a combination of regionally based health service delivery programs, supportively supervised by integrated, regional teams and high-level, centrally supported, cross-cutting programs to strengthen health systems.

USAID/Uganda aims for all of its DO3 supported intervention activities in malaria, HIV/AIDS, child survival, maternal and child health, family planning and health system strengthening to be implemented in as integrated a manner as possible, and to strengthen health systems at the national and district-levels.

C.2 STATEMENT OF WORK

1. Background

Approximately 90 percent of Uganda’s 34.5 million people live in areas with high malaria transmission (>1 case per 1,000 population), and the World Health Organization (WHO) estimates there are about 17,000 malaria-related deaths annually. Uganda is one of the ten highest malaria burden countries in Africa that account for over 70 percent of regional and 56 percent of global malaria burden. Nearly half of hospital in-patient deaths among children under five are attributed to malaria and there are even more unreported malaria-related deaths that occur at home (WHO, World Malaria Report 2012).

Malaria transmission is persistently high in some areas of northern Uganda. For example, before the implementation of PMI’s indoor residual spraying (IRS) in 10 districts, Apac District reported an entomological inoculation rate of 1,6001. That is more than four infected mosquito bites every night and is among the world’s highest recorded. In most of Uganda, favorable temperature and rainfall allow intense vector propagation and perennial malaria transmission.

According to the GOU’s Statistical Abstract (UBOS 2012), malaria is the highest ranked cause of morbidity during the previous five years in Uganda. As the leading cause of morbidity and mortality, malaria accounts for 25–40 percent of outpatient visits at health facilities and 20 percent of all hospital admissions. According to the WHO World Malaria Report 2012, Uganda reported 11.8 million cases of presumed and confirmed malaria in 2010. Hospital- based mortality data indicates that malaria is the leading cause of all deaths.

The Uganda Malaria Indicator Survey (UMIS), conducted in 2009, reported a high prevalence of malaria parasites in children less than five years of age with a national average of 42 percent.

Survey data indicated that anemia is also a significant public health problem in Uganda. Six out of ten Ugandan children under five years of age are anemic (hemoglobin concentration below 11 g/dL).

The 2009 UMIS showed that Plasmodium falciparum, the most deadly form of malaria, is responsible for 99 percent of malaria cases in Uganda. Vector surveillance activities have revealed that Anopheles gambiae s.l. and Anopheles funestus are the most common malaria vectors. Anopheles gambiae s.l. and Anopheles funestus feed and rest indoors, making insecticide treated nets (ITNs) and IRS viable vector control strategies.

The Uganda Demographic Health Survey (UDHS), conducted in 2011, reported that the ownership of ITNs in Uganda increased from 16 percent in 2006 to 59 percent in 2011. There was significant variance in ownership by region with the highest ownership of ITNs in West Nile at 82 percent and the lowest ownership in East Central at 38 percent. The proportion of under-fives and pregnant women who slept under an ITN on the night previous to the survey increased from 10 percent in 2006 to 43 percent and 47 percent respectively in 2011. The proportion of under-fives who received malaria treatment within 24 hours of fever increased from 29 percent to 43 percent, and the number of pregnant women who took two doses of

1 Okello PE, Van Bortel W, Byaruhanga AM, Correwyn A, Roelants P, Talisuna A, D'Alessandro U, Coosemans M.

2006. Variation in malaria transmission intensity in seven sites throughout Uganda.Am J Trop Med Hyg.

Aug;75(2):219-25 sulfadoxine/pyrimethamine (SP) for prevention of malaria during the last pregnancy increased from 18 percent to 27 percent.

The status of the major malaria indicators, as estimated by the 2006 UDHS (baseline), 2009 UMIS, and 2011 UDHS, is shown below:

Indicator UDHS

(2006)

UMIS

(2009)

UDHS

(2011)

Percentage of households that own at least one ITN 16% 47% 60% Proportion of children under five years of age sleeping under an ITN the previous night

10% 33% 43%

Proportion of pregnant women sleeping under an ITN the previous night 10% 44% 47%

Proportion of pregnant women who received at least two doses of Intermittent prevention treatment in pregnancy( IPTp) during antenatal care (ANC)

16% 32% 25%

Prevalence of parasitemia (by microscopy) in children 0–59 months N/A 42% N/A

Prevalence of anemia in children 0–59 months (Hg <11 g/dl) N/A 62% 50%

Prevalence of severe anemia in children 0–59 months (Hg <8 g/dl) N/A 10% 3%

Alignment with GOU Malaria Control Policies Uganda already has several policy and strategy documents that provide policy guidance for the treatment and prevention of malaria including: The Policy and Strategy for Control of Malaria in Pregnancy (MIP – 2000); the use of artemisinin-based combination therapies at the community level; and management of uncomplicated malaria (2005); home-based management of fever (2005); Policy and Strategy for Insecticide Treated Nets (2006); and the IRS strategy (2006).

PMI fully supports the NMCP guidance on implementation of malaria control activities through a broad Roll Back Malaria (RBM) partnership, which includes all stakeholders and which is based on the three ones: one strategic plan under which all partners work and contribute, one coordination mechanism to ensure maximum synergy and avoidance of duplications, and one monitoring and evaluation (M&E) plan to measure progress and assess the impact. The Ministry of Health (MOH), through the NMCP, has the leading role in the coordination of efforts with Interagency Coordination Committee and its Technical Working Groups as the major tools.

Alignment with National Malaria Control Strategic Plan According to the National Malaria Control Strategic Plan 2010/11–2014/15, the vision of the NMCP is that by 2016, malaria will no longer be the major cause of illness and death in Uganda and families will have universal access to malaria prevention and treatment measures. The MOH/NMCP’s goal is to control and prevent malaria morbidity and mortality so as to minimize related social ill effects and economic losses attributable to malaria (see MOH/NMCP website http://www.health.go.ug/mcp/index2.html).

The overall goals of the National Malaria Control Strategy 2010/11–2014/15 are:

I. To control and prevent malaria morbidity and mortality, and thereby minimize the social effects and economic losses.

II. To contribute to the reduction of under-five all-cause mortality rate, as a result of reduced malaria mortality.

The specific objectives are:

1. To provide universal coverage and encourage utilization of preventive measures with ITNs, and IRS to all populations at risk of malaria;

2. To provide effective preventive treatment for pregnant women with at least two doses of SP for IPTp);

3. To provide definitive diagnosis to at least 85 percent of suspected malaria cases treated in the public sector;

4. To provide effective treatment in the public or private sector using artemisinin-based combination therapies to at least 85 percent of people with uncomplicated malaria within 24 hours of onset of symptoms; and

5. To provide an enabling environment for implementation of key malaria interventions.

Such an environment includes ensuring comprehensive behavioral change towards malaria prevention, appropriate treatment- seeking, obtaining adequate financing for malaria control interventions, ensuring appropriate and adequate human resources, conducting relevant operational research, M&E, and overall health systems strengthening.

The core interventions include:

1. Malaria prevention through ITNs, with special emphasis on distributing long-lasting insecticide treated nets (LLINs)2 in highly-endemic areas;

2. IRS with a focus both on low and epidemic-prone areas (to prevent malaria epidemics) and high transmission endemic areas, accompanied by environmental management where feasible and effective (IRS is currently implemented via USAID’s Indoor Residual Spraying Indefinite Quantity Contract and is not included in this contract);

3. Improved diagnosis and treatment of uncomplicated and severe malaria;

4. Emphasis on treatment and prevention of malaria in pregnancy, particularly IPTp;

5. Intensive information, education and communication (IEC) efforts and social mobilization at all levels;

6. Integration of malaria control into a balanced health system with emphasis on human resource development; and

7. Strong monitoring, evaluation, and operational research to monitor progress, evaluate impact, and continuously improve interventions.

The evaluation of the SMP showed that these key interventions were largely effective in SMP districts. However the evaluation highlighted to the need to implement these interventions as part of building the capacity of the NMCP and districts to sustainably manage malaria programs.

Based on the findings of the SMP evaluation, the MAPD will have the following new/enhanced elements:

1) District focused capacity building for implementation of national malaria polices and guidelines;

2) Integration of activities into district planning, budgeting and monitoring system;

3) Increased focus on community level intervention; and

4) Innovative approaches for increasing IPTp uptake.

Development Objective:

The development objective for this activity is as follows:

The objective of this activity is to build the capacity of the NMCP and District Health Management Team’s (DHMT) to implement a package of key malaria interventions, resulting in a reduction in mortality and morbidity due to malaria, thereby significantly decreasing in the target districts with a population of 9.5 million.

2 LLINs are a type of ITNs. ITNs can be either treated with a short-lasting insecticide or a long-lasting insecticide.

ITNs refer to both of these types while LLIN refers to only those with a long-lasting insecticide.

2. Activity Description

This section discusses the current status of implementation of the key malaria interventions that this activity will undertake, and how they support the USAID and GOU priorities highlighted in the previous section. It also describes Contractor requirements.

IPTp The 2011 Uganda Malaria Program Review (MPR) reported the need for full integration of the IPTp program within the reproductive health division (RHD) of MOH. NMCP is responsible for providing technical assistance to the RHD to ensure quality IPTp implementation, including training of health workers on IPTp, ensuring that provision of IPTp services at health facilities follows directly observed therapy, supportive supervision, M&E, operational research, and IEC campaigns at the community level for IPTp. The RHD is now the focal point for IPTp implementation and activities are integrated within the focus antenatal clinic policy and procedures.

Antenatal attendance by pregnant women in Uganda remains high; with 2011 UDHS results showing that over 95 percent of pregnant women attended at least one ANC visit. However, only 25 percent attended at least two visits and received two doses of SP. Various efforts have been scaled up by PMI and other partners to ensure improved availability and uptake of SP at health facilities, such as provision of safe water and cups at the ANC for directly observed treatment of SP and training of both women and male health workers. However, surveys continue to demonstrate low IPTp uptake.

In 2015, the Contractor will continue to support the NMCP and DHMTs to include male involvement in the malaria in pregnancy (MIP) strategy to improve the IPTp uptake. The Contractor will also support the revitalization of the MIP working groups at national and district levels and the adoption of WHO’s new IPTp guidelines for implementation. The involvement of men in the development of mother-to-mother support groups’ strategy in collaboration with other similar USAID activities to increase the uptake of IPTp will be encouraged.

LLINs LLINs remain one of the NMCP’s key intervention strategies. The national household coverage (households owning one or more ITN) is only 60 percent and ownership varies by geographic region. There is a need to increase coverage of ITNs, especially LLINs, to achieve strategic goals. Currently the NMCP supports a four-pronged strategy for ITN distribution:

Free distribution through antenatal and expanded program on immunization (EPI) clinics;

Free household distribution through mass campaigns and community-based organizations;

Subsidization of LLINs for sale in the private sector; and Development of the private sector sale of full-priced LLINs.

Since 2006, PMI has procured and distributed six million LLINs and supported the distribution of 10 million free LLINs to children under five, pregnant women, and people living with HIV/AIDS.

These LLINs were distributed through antenatal and expanded program of immunization (EPI) clinics, community-based organizations, and as part of a mass campaign in partnership with other donors. To complement the increase in net ownership, radio talk show programs were aired and materials developed and disseminated to raise awareness about the proper usage of ITNs.

Uganda is expected to achieve universal coverage of LLINs, defined as one net per two persons, by July 2014. By the end of 2014, at least 90 percent of the general population in Uganda will be protected by nets. By the end of 2015, Uganda aims to have significantly reduced the malaria burden in the country by attaining the RBM target of universal access to preventive interventions, including the consistent and correct use of ITNs. The inequality between women and men in intra-household use of nets must be addressed through advocacy at all levels both during the campaign and afterwards. As of May 2014, a total of 11.9 million LLINs have been distributed in 4.6 million households providing protection to 21.3 million people.

USAID/Uganda has procured another one million LLINs for free distribution using different channels (ANC/EPI, schools and social marketing) to maintain the results achieved through universal net campaign. Because there is still improper and inconsistent usage of nets, mass media and community mobilization strategies to increase awareness of the need to use ITNs correctly and consistently is an important part of the MAPD activity.

Treatment of Uncomplicated and Severe Malaria Facility Level Ugandan malaria treatment policy calls for the use of the ACT artemether-lumefantrine (AL) or artesenate-amodiaquine (AQ) as the first-line treatment for uncomplicated malaria, and artesunate as first-line treatment for severe malaria (with parenteral quinine for first trimester pregnant women as alternate).

While still problematic, the supply of ACTs at health facilities has improved over time with the increase in commodity availability and changes in the national system of supplying the facilities.

A survey done in four districts two years into the new policy implementation revealed that there are often stock-outs of the recommended drugs (13% of the facilities reported complete lack of AL in the prior two weeks); however, this has drastically improved due to increased availability of ACTs from the Affordable Medicines Facility – malaria (AMFm) and purchases with the GOU’s own resources from Quality Chemical Industries Limited, a local manufacturer that recently obtained WHO approval for ACTs. In addition, some facilities are still benefitting from the “push-kit” system of drug supplies whereby National Medical Store (NMS) provides a specified quantity of drugs to level II and III health centers (Health Center II and Health Center III) every two months. The push-kit, however, does not take into account the actual needs of individual health facilities. Thus, some facilities do end up with stock-outs, while others have an oversupply. Efforts have been made by the district MOH and USG partners to redistribute supplies in these cases as well as document the under- and over-supply to assist NMS in revising the contents of the kits. The improved supply of ACTs in public facilities has been evidenced by 44 percent of children with fever reporting use of ACTs in the results of the 2011 DHS, a substantial increase from the 14 percent of children reported by the 2009 MIS.

Although intravenous (IV) artesunate is now recommended for treatment of severe malaria, the MOH is still trying to develop a plan for a sustained supply of artesunate, which is likely to be phased in over the next several years. IV quinine continues to be used for treatment of severe malaria during this transition; unfortunately, improper administration of quinine frequently occurs due to inadequate supplies of IV dextrose solutions, and may lead to overdosing patients.

Since GF has huge procurement of ACTs and RDTs, there is no need for major procurement of ACTs. PMI has focused on supporting the MOH’s treatment policy on the procurement of necessary severe malaria drugs, improving diagnostics, providing technical assistance for supply chain management, and training and supervising health personnel in the treatment of both uncomplicated and severe malaria. With PMI support, NMCP staff conducted supportive supervision, health workers received on-the-job training, and job aids were developed and distributed. However, there is still additional need for supportive supervision and training of the newly recruited health workers to ensure the appropriate use of all malaria drugs, knowledge of how to manage severe malaria, and an understanding of the use of pre-referral drugs at lower level heath facilities.

The Contractor will address these lingering issues by providing continued training and supportive supervision of health care workers. Also, the Contractor will address issues in the treatment of severe malaria by procuring drugs and training health workers in their use. This activity will continue to support NMCP and DHMTs to strengthen clinical audits and supportive supervisions.

The Contractor will address these lingering issues by providing continued training and supportive supervision of health care workers. Also, the Contractor will address issues in the treatment of severe malaria. When there are challenges in supply chain hence failure to provide lifesaving drugs for severe malaria, the Contractor may be required to procure, with prior approval of USAID, small amount for immediate and urgent use. This activity will continue to support NMCP and DHMTs to strengthen clinical audits and supportive supervisions.

Community level - Home-Based Management of Fever and Integrated Community Case Management In line with the malaria treatment policy, in 2006, the MOH introduced use of ACTs for home-based management of fever (HBMF) in 40 out of the 80 districts. There has been piecemeal implementation of HBMF with ACTs, and scale-up has never been countrywide due to an inadequate supply of ACTs.

With funding from the Global Fund, training on implementation of HBMF using ACTs was rolled out to 39 more districts in 2010. In July 2010, building on the success of the HBMF strategy, and in order to facilitate access to and reduce the treatment gap for malaria, pneumonia and diarrhea, the MOH, together with development partners, adopted a strategy for integrated community case management (iCCM) for these diseases. The iCCM program includes using ACT to treat malaria, oral trimethoprim-sulfamethoxazole or amoxicillin to treat pneumonia and oral rehydration solution and zinc for diarrhea at the community level. However, repeated shortages of ACT, challenges with motivating community volunteers, and poor referral systems from community to health facilities have hampered implementation. Another challenge has been the different funding streams supporting HBMF and iCCM resulting in differences in implementation of these programs. The HBMF strategy was funded through Global Fund, and iCCM through the Canadian International Development Agency (CIDA) and the Gates Foundation. While the Global Fund Round 10 grant does merge HBMF with iCCM, its support is for 31 districts only, and there is no guaranteed continued support for the districts that have rolled iCCM out already. In December 2012, the pilot phase preliminary results were positive, and include a drastic increase in the number of children receiving prompt ACT treatment (from 8 to 45%). Based on these results and the identified gap in increasing access to prompt treatment, PMI will reinstitute support for iCCM in one Central district in FY 2014 in this activity.

PMI is committed to helping the NMCP appropriately transition to iCCM with ACTs in highly endemic areas. To support this transition, this activity will fund training, logistics support, and supportive supervision for VHTs and/or community drug distributors implementing iCCM.

Diagnosis The current diagnostic policy has been rolled out in all public health facilities in the country.

However, adherence to the policy is still weak with most malaria diagnosis still based on clinical symptoms. PMI observed during site visits, meetings, and facility record reviews that there is limited awareness and/or willingness on both the clinician and patient sides to request and adhere to testing prior to treatment. Clinicians also need to be retrained on the differential diagnosis of fever when the malaria laboratory test is negative. In addition, many facilities lack adequate laboratory diagnostic capacity, especially laboratory technicians. The 2009 MIS found that only 17 percent of children with a fever were tested for malaria before receiving treatment, and the average laboratory confirmation reported in the 2009 National Health Management and Information System (HMIS) was 24 percent (amongst all age groups). The 2011 DHS shows an increase to nearly 25 percent for children with fever who were tested for malaria before receiving treatment. As malaria prevention activities are scaled up (in particular the universal ITN distribution finished in August 2014, the burden of malaria is expected to decrease;

therefore appropriate diagnosis and treatment of non-malarial febrile illnesses will become even more critical. Future efforts will require sustained education of clinicians and other cadre of health staff to base treatment on the test results and to educate communities to demand a malaria test before receiving antimalarial treatment.

Currently, PMI supports improving malaria case management, focusing first on improving and maintaining high quality microscopic or RDTs in the six outpatient and six inpatient sentinel sites while also improving treatment practices. This novel approach integrates training in fever management, parasitological diagnosis (including RDT), microscopy training, surveillance, malaria treatment and data collection and management among clinicians, laboratory technicians and data managers. Following the initial training, mobile support teams provide on-site visits to the newly trained technicians to ensure the implementation of improved skills and practices. PMI supported the NMCP to update the country’s guidelines for diagnosis with microscopy and RDTs. Importantly; these guidelines (to be finalized by 2014) specifically recognize the necessity of supporting both the public and private sector in order to increase the proportion of suspected malaria cases receiving testing prior to treatment.

With support from PMI, NMCP is developing a quality assurance manual that outlines the plan for implementing a pilot district level malaria microscopy quality assurance program in Uganda.

It encompasses retraining, validation and the development of competency standards designed to ensure the quality of diagnosis necessary for a successful malaria program, while remaining within the expected financial and personnel resource constraints.

This activity will support quality assurance and quality control (QA/QC) and provide supportive supervision to health workers to improve parasite-based diagnosis at all levels of the health system and in both public and private facilities. The Contractor and NMCP will work closely with WHO to support the development of an appropriate QA/QC system. This activity’s support will complement Global Fund and PEFPAR funding for general laboratory and microscopy strengthening, and will work with PEPFAR to improve coordination of USG efforts to improve the laboratory system in Uganda. PMI will support diagnostics supplies procurement, QA/QC and supportive supervision for diagnostics at health centers, and improved diagnostics in the public and for-profit private sectors.

This activity will support NMCP and DHMTs to understand the gender-related dynamics of malaria treatment-seeking behavior, financial authority within households, and the inequality between women and men in accessing malaria diagnosis and treatment services. This activity will address this inequality through advocacy at all levels and during the actual behavior change communication intervention.

Monitoring & Evaluation (M&E) According to the Uganda NMCP Monitoring and Evaluation Plan 2007–2012, the goal of the national M&E system for malaria control is to provide reliable information on progress in controlling malaria.

Improvements have been made in Uganda in the monitoring, evaluation and surveillance of malaria over the past several years. Measureable achievements include: (1) finalization of the National Monitoring & Evaluation Plan for 2012-2015; (2) revision of the HMIS with increased malaria representation and a more cohesive and coordinated support for the national roll-out;

(3) completion of the 2009 MIS and the 2011 DHS; (4) development of the NMCP’s first performance monitoring plan; and (5) development and publication of a quarterly malaria bulletin. However, challenges remain within the NMCP’s M&E unit, including a non-functional database, inconsistent data receipt from partners and lack of dissemination of data to stakeholders for programming use.

The malaria sentinel surveillance sites continue to provide high-quality longitudinal data from twelve health facilities – six outpatients and six inpatients facilities – located in different malaria transmission zones across Uganda. NMCP, PMI, and other partners use the data to understand the burden of malaria in the catchment areas served by these facilities. This activity will strengthen national malaria surveillance by: 1) improving data quality at health facilities, 2) improve timeliness and completeness of reported data, and 3) use data for decision making at health facilities, district, regional performance monitoring team and at national level.

When the HMIS was updated in 2010, USG support to the system was also reorganized to ensure that comprehensive and uniform support is provided for the entire country. The USG implementing partners provide support for printing tools, follow-up support supervision, training, data transmission (weekly surveillance and routine monthly data), and data dissemination to the Ministry of Health Resource Center (responsible for the HMIS) and for select districts. PMI continues to support basic equipment at the district level to improve data collection and reporting (e.g. internet connection and internet technology maintenance); and has introduced data quality assessments in select districts. Through PMI support, timely submission of HMIS reports from districts to national level increased from 45 percent in 2010 to 74 percent in 2012, and the completeness of HMIS reports from districts to national level increased from an average of 65 percent in 2010 to 97 percent in 2012. However significant challenges remain. For example, HMIS data routinely shows that up to 10 times as many ACT’s are prescribed than malaria cases suspected. Currently PFP facilities largely do not report into the HMIS system making it hard to gauge the private sector’s contribution to program results.

This activity will seek opportunities to advance promising science and technology applications for augmenting monitoring and evaluation. Following the roll-out of mTRAC, the MOH's mobile phone based tool to collect surveillance and malaria stock data at the health facility level, PMI implementing partners have begun to support DHMTs to improve reporting rates, and to validate the data being reported, especially around reported stock-outs of ACTs.

The Global Fund Round 10 Health Systems Strengthening Grant has started to support 12 Regional Performance Monitoring and reporting Teams (RPMTs). The goal of the RPMTs is to contribute to the establishment of a comprehensive, fully integrated, harmonized and well-coordinated Monitoring and Evaluation system of the Health Sector Strategic and Investment

Plan (HSSIP). They will work synergistically with existing health services coordination structures like those of TB, RH, Malaria, Quality…