Solicitation 72065622RFA00004 MCAPS.pdf

Issue Date: January 13, 2022

Deadline for Questions: January 20, 9 a.m. Mozambique time

Closing Date and Time to submit Applications: February 14, 9 a.m. Mozambique time

Subject: Notice of Funding Opportunity Number: 72065622RFA00004

Program Title: USAID Malaria Capacity Strengthening (MCAPS) in Mozambique

Federal Assistance Listing Number: 98.001

Ladies/Gentlemen:

The United States Agency for International Development (USAID) is seeking applications for a

Cooperative Agreement from qualified entities to implement the USAID Malaria Capacity

Strengthening (MCAPS) program. Eligibility for this award is not restricted.

USAID intends to make an award to the applicant(s) who best meets the objectives of this funding opportunity based on the merit review criteria described in this NOFO, subject to a risk assessment. Eligible parties interested in submitting an application are encouraged to read this

NOFO thoroughly to understand the type of program sought, application submission requirements and selection process.

To be eligible for award, the applicant must provide all information as required in this NOFO and meet eligibility standards in Section C of this NOFO. This funding opportunity is posted on www.grants.gov, and may be amended. It is the responsibility of the applicant to regularly check the website to ensure they have the latest information pertaining to this notice of funding opportunity and to ensure that the NOFO has been received from the internet in its entirety.

USAID bears no responsibility for data errors resulting from transmission or conversion process.

If you have difficulty registering on www.grants.gov or accessing the NOFO, please contact the

Grants.gov Helpdesk at 1-800-518-4726 or via email at support@grants.gov for technical assistance.

USAID may not award to an applicant unless the applicant has complied with all applicable unique entity identifier and System for Award Management (SAM) requirements detailed in

Section D.6 f) The registration process may take many weeks to complete. Therefore, applicants are encouraged to begin registration early in the process.

Please send any questions to the points of contact identified in Section D. The deadline for questions is shown above. Responses to questions received prior to the deadline will be furnished to all potential applicants through an amendment to this notice posted to www.grants.gov.

USAID MCAPS RFA – 72065622RFA00004

Issuance of this notice of funding opportunity does not constitute an award commitment on the part of the Government nor does it commit the Government to pay for any costs incurred in preparation or submission of comments/suggestions or an application. Applications are submitted at the risk of the applicant. All preparation and submission costs are at the applicant’s expense.

Thank you for your interest in USAID programs.

Sincerely, Patrice Lopez

Agreement Officer

Digitally signed by Patrice Lopez Date: 2022.01.13 20:38:13 +02'00'

TABLE OF CONTENTS

SECTION A: PROGRAM DESCRIPTION

A.1 Introduction

A.2 Background and Problem Analysis

A.3 Geographic Focus and Operations

A.4 Alignment with USAID/USG Strategies

A.5 Summary of Relevant USG and Donor Activities

A.6 Lessons Learned

A.7 Development Hypothesis and Results Framework

A.8 Strategic Considerations

A.9 Collaborating, Learning and Adapting (CLA)

A.10 Monitoring, Evaluation, And Learning

SECTION B: FEDERAL AWARD INFORMATION

B.1 Estimate of Funds Available and Number of Awards Contemplated

B.2 Start Date and Period of Performance for Federal Awards

B.3 Substantial Involvement

B.4 Authorized Geographic Code

B.5 Nature of the Relationship between USAID and the Recipient

SECTION C: ELIGIBILITY INFORMATION

C.1 Eligible Applicants

C.2 Cost Sharing or Matching

SECTION D: APPLICATION AND SUBMISSION INFORMATION

D.1 Agency Points of Contact

D.2 Questions and Answers

D.3 General Content and Form of Application

D.4 Application Submission Procedures

D.5 Technical Application Format and Content

D.6 Business (Cost) Application Format

D.7 Branding Strategy & Marking Plan

SECTION E: APPLICATION REVIEW INFORMATION

E.1 Merit Review

E.2 Merit Review Criteria

SECTION F: FEDERAL AWARD ADMINISTRATION INFORMATION

F.1 Federal Award Notices

F.2 Administrative & National Policy Requirements

F.3 Reporting Requirements

SECTION G: FEDERAL AWARDING AGENCY CONTACT(S)

G.1 NOFO Points of Contact

G.2 Acquisition and Assistance Ombudsman

SECTION H: OTHER INFORMATION

ANNEX 1 - STANDARD PROVISIONS

ANNEX 2 - INITIAL ENVIRONMENTAL EXAMINATION

SECTION A: PROGRAM DESCRIPTION

This funding opportunity is authorized under the Foreign Assistance Act (FAA) of 1961, as amended. The resulting award will be subject to 2 CFR 200 – Uniform Administrative

Requirements, Cost Principles, and Audit Requirements for Federal Awards, and USAID’s supplement, 2 CFR 700, as well as the additional requirements found in Section F.

A.1 Introduction

USAID/Mozambique intends to award a $29.9 million USD, five-year Cooperative Agreement

(hereafter referred to as “the activity”) to improve provision of quality malaria services in target provinces of Mozambique. The award, to run from 2022-2027, will contribute to the National

Malaria Control Program (NMCP) objective of “testing 100% of suspected malaria cases and treating 100% of confirmed malaria cases, at health facility and community level”. The award will also contribute to improvements in malaria in pregnancy (MiP) activities and surveillance, monitoring and evaluation (SME). The award will contribute to these NMCP objectives by supporting the following interventions, in targeted geographic locations:

● Ensure all case management commodities are available at all service delivery points;

● Improve quality assurance and quality control of malaria diagnosis;

● Improve the uptake of intermittent preventive treatment in pregnancy (IPTp) to reach all eligible pregnant women attending antenatal care (ANC) services; and

● Strengthen the review and use of data to strengthen programming.

The activity will also contribute to the USAID Country Development Cooperation Strategy

(CDCS) for Mozambique. Specifically, the award will contribute to “DO 1: Healthier and Better

Educated Mozambicans, Especially the Young and Vulnerable.” By improving health outcomes for Mozambicans and strengthening health systems, USAID will contribute to Mozambique’s capacity and commitment to create a more prosperous and healthier environment in which all

Mozambicans, even the young and vulnerable, can flourish.

The award will contribute to the GRM priorities and the USAID CDCS in two distinct areas:

● Quality of health services improved; and

● Resilient health systems strengthening.

Activities in these areas will be implemented at the national, provincial and district levels. All work below the national level will be focused in three provinces: Nampula, Zambézia, and

Manica. USAID’s contributions in each province will be coordinated with other USAID-funded initiatives. Nampula and Zambézia continue as key provinces for USAID’s goal of reducing malaria in high transmission areas. The province of Manica is a new priority province for

USAID due to its high malaria prevalence and incidence.

A.2 Background and Problem Analysis

Malaria is endemic in Mozambique, and the entire population of over 29 million is at risk of contracting the disease1. Pregnant women and children under the age of five have the greatest risk of developing severe malaria. In 2020, malaria accounted for approximately 26% of all outpatient consultations with over 11.3 million cases diagnosed in public health facilities and communities. Since 2015, the number of reported malaria cases nationwide has increased each year, but there are important differences throughout the country with decreases noted in Gaza, Maputo City, and Maputo Province, but large increases noted in Zambézia and Nampula.

Malaria incidence increased by 67% from 2015 to 2020 with 226 cases per 1,000 population in

2015 and 377 cases per 1,000 population in 2020. The number of reported hospital malaria deaths decreased from 2,337 deaths in 2015 to 563 deaths in 2020. Malaria prevalence among children aged 6-59 months remained stable at around 40% since 2011, but the prevalence of low hemoglobin in the same ages increased from 9% in 2011 to 14% in 2018. Data from the 2018 malaria indicator survey (MIS) showed that malaria prevalence varies across the country.

Prevalence is higher in the Northern and Central regions (ranging from 29% in Sofala to 57% in

Cabo Delgado) and lower in the Southern region (ranging from 1% in Maputo city to 35% in

Inhambane).

The spread of COVID-19 has affected malaria activities in several ways. National data from 18 months after the onset of the pandemic show a 12 percent reduction of external consultations, when compared with a similar period before COVID-19. Disruptions in the global supply chain affected implementation of the national insecticide-treated net (ITN) campaign, which had to be postponed, and other malaria commodities such as rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACTs) were also affected. The need to ensure social distancing and procure personal protective equipment led to increased costs for the ITN and indoor residual spraying campaigns and affected the implementation of social and behavior change (SBC) activities, training, and integrated supervision. While activities have resumed, the increase in

COVID-19 cases in 2021 continues to influence malaria care-seeking, care provision, and the implementation of malaria activities.

The goals of the Mozambique NMCP, as described in the 2017-2022 National Malaria Strategic

Plan, are by 2022, to reduce malaria morbidity and mortality at national level by at least 40%, compared to levels observed in 2015. The NMCP just started the process of devising the 2023-

2027 NMSP and information related to the new goals is not yet available.

The objective of this cooperative agreement is to improve the provision of quality malaria services by improving adherence to malaria service delivery protocols in targeted areas, strengthening the generation and use of malaria data, and increasing the capacity of the MOH and local stakeholders to plan and manage evidence-based malaria interventions at all levels of the health system.

To maintain and accelerate the gains made in malaria prevention and control requires interventions that impact multiple levels and technical areas, including the following: the development and revision of relevant national malaria policies/guidelines and training materials, the integrated supervision of malaria services, the increased utilization of digital platforms, fostering a culture of timely, data-informed decision making, and the improvement of

Ministry of Health, 2019 coordination of and planning for malaria activities.

A.3 Geographic Focus and Operations

Geographic Focus

In line with USAID/Mozambique’s geographic focus, in accordance with MOH recommendations, and in order to achieve meaningful and sustainable impact, this activity will be implemented in the provinces of Nampula, Zambézia, and Manica, and may be expanded depending on MOH and USAID priorities.

The activity is expected to operate at the provincial and district levels in the targeted provinces, in addition to providing support at the central level. The recipient will be expected to specify the location and expected staffing levels of their headquarters and provincial offices, including those embedded at national, provincial, and district levels.

These focal provinces were selected based on the malaria prevalence, incidence and malaria burden and are aligned with forthcoming malaria social and behavior change activities. The presence of other USAID/donor activities and of USAID-funded provincial advisors was also used as criteria for determining the geographic focus of this activity. A landscape analysis of the malaria donor ecosystem identified three major donors currently funding malaria activities across

Mozambique. Major donors include the U.S. President’s Malaria Initiative (PMI), which USAID implements, and which will fund this Cooperative Agreement; the Global Fund; and the Bill and

Melinda Gates Foundation. According to the analysis, USAID and Global Fund are presently the only two donors supporting malaria activities across Nampula and Zambézia; Global Fund and

Bill and Melinda Gates Foundation are the two donors supporting activities in Manica.

Therefore, the applicant will need to ensure close coordination of malaria activities to prevent any duplication of efforts. The activity will also be expected to effectively coordinate and communicate with other USAID and non-USAID funded health activities, as appropriate.

Operational Model

The activity must strengthen local systems so that local actors continue to sustain key results after the activity ends. Efforts must also align with and support the priorities of local actors, leverage local resources, and increase local implementation over time to sustain positive changes. To achieve this approach, the recipient must work with a minimum of two local organizations as sub-partners and commit to strengthening the organizational and technical capacity of the selected local organizations, with the goal of transitioning key activities to the local organizations in a phased approach over the life of the activity. The prime implementing partner will need to have a clear capacity development strategy with appropriate indicators and benchmarks in place, to ensure that the local sub-partners are prepared to sustain key results after the activity ends. This will include assessing the baseline organizational and technical capacity, developing tailored capacity action plans, and implementing capacity-building interventions.

Additionally, it is critical that clear capacity indicators and benchmarks are established, allowing

USAID/Mozambique to monitor and assess the local organizations’ progress in real time. Prior to transitioning activities, USAID/Mozambique will require an external midterm evaluation of the project, with a significant focus on the local partners’ performance to determine if they are on track to transition.

A.4 Alignment with USAID/USG Strategies

The U.S. Government’s development approach in Mozambique is focused on improving the quality of life for all Mozambicans, targeting specifically the young and vulnerable. To reach this goal, the USG closely collaborates with the GRM, the private sector, and other donors, leveraging emerging opportunities to achieve inclusive socio-economic development.

In addition to alignment with USAID/Mozambique’s CDCS as mentioned above, this activity follows several relevant USAID statutory and policy requirements, including:

Global Health Legislative and Policy Requirements

USAID Journey to Self-Reliance

Mozambique’s Country Road Map

USAID Local Systems: A Framework for Supporting Sustained Development (2014)

USAID Gender Equality and Female Empowerment Policy (2012)

USAID’s global priority of Preventing Child and Maternal Deaths

A.5 Summary of Relevant USG and Donor Activities

It is essential that the activity collaborates closely with USAID/Mozambique’s other malaria, maternal child health (MCH), SBC, President’s Emergency Plan for AIDS Relief (PEPFAR), and supply chain activities described below, as well as other relevant future USAID programming. Additionally, the project is expected to coordinate with partners and activities of other major malaria donors working in the same districts and/or provinces. The activity should also seek opportunities for better coordination among GRM ministries and other major donors.

Strong USAID/GRM/donor coordination may include joint annual work plan development with partners in the target geographic areas; establishment of joint mechanisms for coordination and dialogue with relevant GRM institutions, civil society and citizen stakeholders; and joint monitoring and evaluation, planning, and implementation.

This activity will leverage resources and build upon successes of the following USAID and other donor activities:

Global Health Supply Chain Program-Procurement & Supply Management (GHSC-PSM), 2015-2023, Chemonics: The GHSC-PSM project provides direct support to CMAM, the

Provincial Public Health Directorates (DPS), and the Central Department of Laboratory (DCL) to strengthen and improve health commodity procurement, logistics, quality assurance, and data visibility, to increase Mozambicans’ access to high-quality and low-cost medicines and health commodities. The activity also aims to sustain the long-term availability of health commodities by providing training to staff at the central and provincial level. The malaria activity will work closely with GHSC-PSM to ensure adequate commodities are forecasted and available.

Last Mile Supply Chain (LMSC), 2018-2023, VillageReach: LMSC supports the development of a more streamlined and effective distribution system to address chronic logistics and transport challenges at the local level. VillageReach is working in partnership with the MOH and technical partners to improve the transport and logistics systems to primary health facilities and is also supporting MOH in supply chain integration to combine the distribution of medicines and vaccines into a single supply chain under the management of Central Medicine Stores (CMAM).

LMSC also serves as a third part monitorer of the newly awarded activity Commodities for

Health: Ensuring Guaranteed Access and Reliability (CHEGAR).

Commodities for Health: Ensuring Guaranteed Access and Reliability (CHEGAR), 2021-

2024, Balloré Transport & Logistics Moçambique, Lda: CHEGAR supports the distribution of health commodities to the last mile by transporting medicines from the warehouse at the provincial level with monthly deliveries in all districts across the country, including in Zambézia, Nampula and Manica provinces, CHEGAR works closely with CMAM and the National Malaria

Control Program, to ensure the availability of malaria commodities at the health facility level, while LMSC serves in an oversight role. The program allows for malaria commodities that are essential for malaria services to be available at health facilities.

Alcançar, 2019-2024, FHI 360: The project aims to improve health services for women and children in Nampula province by providing support to the Nampula provincial health directorate, district health directorates, and frontline healthcare providers in building individual and organizational capacity to make improvements in service quality and efficiency.

Integrated Social Behavior Change Communication (SBCC), 2019-2024, PIRCOM:

PIRCOM aims to increase the reach, recall, and quality of priority health messages by developing an integrated health SBCC package, in which messages will be disseminated by faith leaders and community radios. Considering PIRCOM implements activities in Nampula, Sofala, and Zambézia, the applicant will need to coordinate with PIRCOM and utilize relevant IEC and

BCC materials developed by the SBCC project in all service delivery points at both facilities and at the community level.

Finally, it is also expected that this activity will work in close collaboration and coordination with a new USAID/Mozambique malaria social behavior change activity that the Mission plans to award. It is expected that these two activities will leverage funding and will complement their approaches.

A.6 Lessons Learned

A review of USAID’s Integrated Malaria Program (IMaP) generated important findings and lessons that should inform this activity. The overall goal of IMaP is to contribute to the reduction of malaria-associated mortality, morbidity, and parasitemia in four high malaria burden provinces (Zambézia, Nampula, Cabo Delgado, and Tete).

According to IMaP’s data, the proportion of inpatient deaths due to malaria in targeted health facilities of the four focus provinces reduced from 6% to 2%, in the first three years of the project. These findings are consistent with NMCP data, which shows that the number of reported in-hospital malaria deaths reduced from 734, in calendar year 2019, to 563, in calendar year

2020. These results may be related to improvements in malaria case management practices. In fact, the NMCP carried out a nationwide training on malaria case management and started the roll out of a new integrated supervision package. IMaP provided technical support for the design of the integrated supervision package. In addition, IMaP provided support for the roll-out of the case management training in Nampula province and for the implementation of the integrated supervision package in the four target provinces. Despite these improvements, there are still many challenges. Findings from the integrated supervision visits show that there are still gaps in malaria case management practices. Moreover, a mortality analysis conducted by NMCP and partners in health facilities from the center and northern Mozambique found under-reporting of malaria deaths. As such, there is a need to continue to invest in this area, and to better target the support to address specific problems.

In relation to malaria in pregnancy activities, the proportion of pregnant women who received two or more doses of IPTp for malaria, in targeted health facilities, increased from 52% to 75% in the first three years of the project. Similarly, the proportion of pregnant women who received four or more doses of IPTp for malaria, in targeted health facilities, increased from 28% to 50%, in the same period. More work is needed to support the continued increase in IPTp uptake to achieve the set target of 85%. These improvements in IPTp uptake were associated with better availability of sulfadoxine-pyrimethamine at health facility level, improved supervision, and better collaboration between the NMCP and the maternal health program.

IMaP also included the implementation of an SBC package aimed at promoting key malaria behaviors. The package included a combination of health facilities and community interventions.

However, the implementation of the SBC activities was delayed, especially those at community level. To make the implementation process more efficient, PMI Mozambique decided that the case management partner should only focus on the SBC activities implemented at health facility level. A different partner should focus on implementing SBC activities at community level. This will require a high level of coordination and collaboration between the two partners. This can be achieved by strengthening the existing coordination platforms at central, provincial and district level.

A.7 Development Hypothesis and Results Framework

The high-level intended impact of this activity is to deliver cost-effective, lifesaving malaria interventions alongside catalytic technical and operational assistance to support Mozambique to end malaria. The objective of the project is to improve the provision of quality malaria services

(by improving adherence to protocols, strengthening data generation and use, and increasing the capacity of the MOH and local stakeholders to plan and manage interventions at all health system levels), resulting in decreased morbidity and mortality due to malaria.

In order to contribute to this impact and objective, the activity is driven by the following development hypothesis:

If Mozambique’s malaria program is strengthened by implementing evidence-based practices that improve the quality of malaria service provision, strengthen data generation and use for informed decision-making, and increase the management capacity at the community, national, provincial, district levels and service delivery points

Then utilization of quality key malaria prevention and control interventions can be improved

Leading to a decreased impact of malaria morbidity and mortality in Mozambique

Contributing to healthier Mozambicans.

The activity results framework outlined in Figure #1 below provides a more detailed overview of the intended results. Each intermediate result is supported with a list of illustrative approaches and indicators provided below.

Figure #1: Project Results Framework

Objective: Improved provision of quality malaria services

IR 1: Improved adherence to malaria service delivery protocols in targeted areas

IR 2: Strengthened generation and use of malaria data

IR 3: Increased capacity of

MOH and local stakeholders to plan and manage evidence-based malaria interventions at all levels of the health system

Intermediate Result (IR) 1: Improved adherence of malaria service delivery protocols in targeted areas.

Context: Quality service delivery is an essential component of this malaria program as it enables evidence-based prevention and control interventions to be executed in order to decrease malaria morbidity and mortality. Malaria service delivery requires a well-trained and supervised health workforce at facility and community levels to ensure adherence to protocols, the capacity and resources to facilitate quality diagnosis at the point of care and the laboratory, administration of appropriate therapeutics, and distribution of targeted malaria messages and materials. In order to achieve this intermediate result, this activity will be expected to work across various levels of the health system, engage various partners, and coordinate with existing efforts to improve healthcare service delivery.

Illustrative approaches:

● Support the design/update of relevant national malaria policies, strategies, guidelines and training materials.

● Support for integrated supervision of clinical health staff, in public health facilities and at the community level, to promote appropriate case management of malaria cases.

● Support provision of quality malaria diagnosis services, including implementation of laboratory QA/QC activities, training, and supervision.

● Support integrated supervision of health staff to increase delivery of the full course of intermittent preventive treatment to pregnant women (IPTp).

● Support integrated supervision of health staff to improve malaria case management among pregnant women.

● Support implementation of social and behavior change (SBC) activities at health facility level, including provision of malaria talks, interpersonal communication by health facility providers, and printing and distribution of SBC materials for use at health facilities.

Mandatory Indicators:

● Percent of trained health care workers who are observed following identified critical case management protocols.

● Number of health workers in targeted provinces trained in malaria laboratory diagnostics

(RDTs or microscopy) with USG funds.

● Percentage of children under five years of age who were tested positive for malaria that received treatment.

● Percentage of pregnant women who were tested positive for malaria that received treatment.

● Number of health workers in targeted districts trained in case management with artemisinin-based combination therapy (ACTs) with USG funds.

● Number of health workers in targeted districts trained in intermittent preventive treatment in pregnancy (IPTp) with USG funds.

● Percent of pregnant women who received IPTp2/4 for malaria in targeted health facilities.

Intermediate Result (IR) 2: Strengthened generation and use of malaria data.

Context: Malaria data in Mozambique consists of information generated during the provision of service delivery, maintenance of the supply chain and commodity distribution, the integrated supervision of the health workforce, and many other sources. In order to achieve this intermediate result, this activity will be expected to support teams (national, provincial, district, and community-based) to generate and use quality data, encourage the use of digital data platforms across the health system, and implement approaches that help to foster a culture that utilizes and applies the information generated for the improvement of malaria services and efforts.

Illustrative approaches:

● Support improvement of quality of routine malaria case management, prevention and commodity data collection and analysis through activities such as integrated supervision, data quality checks, data meetings, among others.

● Support the increased utilization of digital platforms at provincial, district and health facility and community level.

● Support the Ministry of Health to foster a culture of data-informed decision-making.

● Implement evidence-generation activities to inform the national and provincial malaria control programs, including conducting operations research.

● Percent of health facilities in the targeted provinces that report complete and on time

HMIS data through DHIS2.

● Percent of health facilities receiving quarterly supervision visits that perform analysis of key malaria indicators and identify recommendations for improvements.

● Number of health providers trained in Surveillance Monitoring and Evaluation (SM&E) topics.

● Percent of health facilities in the targeted provinces with data accuracy greater than 80 percent.

Intermediate Result (IR) 3: Increased capacity of MOH and local stakeholders to plan and manage evidence-based malaria interventions at all levels of the health system.

Context: Despite the GRM commitments and progress made to ensure a successful malaria program, challenges persist within the health system in general and more specifically related to the malaria program, in terms of quality, coverage, and sustainability. These challenges are exacerbated by the limited capacity of malaria program management at the national, provincial, district, and facility levels; inadequate cross-sectoral coordination and institutionalization across relevant GRM ministries; lack of capacity for collection, collation, and use of quality data for decision making at all levels; and absence of local implementing partner organizations with the capacity to lead, manage and implement comprehensive malaria programs at the national level.

In addition, stagnant domestic resource mobilization, insufficient infrastructure and commodities, supply chain bottlenecks, a critical shortage of human resources, limited private sector participation, humanitarian emergencies such as COVID-19 and multiple cyclones, and high dependence on donor funding affect the sustainability of malaria and other public health programs. This activity will support efforts to improve the management capacity, technical capacity, and coordination of actors at various levels of the health system to ensure the successful implementation of malaria activities.

Illustrative approaches:

● Assess malaria-related health system constraints and appropriate solutions.

● Apply blended technical assistance approaches that include coaching and mentoring in addition to enhancing technical skills to strengthen and sustain capacity of program managers and implementers at all levels to mobilize, plan and execute resources for malaria.

● Strengthen the management and technical capacity of non-government local actors (civil society organizations, local NGOs, and the private sector) to manage and implement malaria programs.

● Develop and implement innovative approaches that support the coordination of community engagement and coordinate with health management committees at all levels to strengthen accountability, ownership, quality, demand and use of services.

● Support the National Reference Laboratory to conduct WHO external competency assessment for malaria microscopy.

● Improve capacity for detection of malaria parasites by supporting certification of the

National Reference Laboratory.

● Number of provinces/districts receiving well defined blended technical assistance packages.

● Percentage of district health management teams or other administrative units that have developed a monitoring plan, including annual work objectives and performance measures.

● Number of microscopists certified through the World Health Organization External

Competency Assessment for Malaria Microscopists process.

● Number of non-government local actors that received management and technical support to manage and implement malaria programs.

A.8 Strategic Considerations

A.8.1 Gender

Women and girls face important structural, cultural and normative barriers to early and appropriate access to antenatal care (ANC) services and, in turn, the associated malaria prevention in pregnancy interventions. Promoting gender equality, empowering women, and advancing the status of women and girls is vital to achieving USAID’s development objectives.

The recipient is expected to address gender by ensuring that the activity builds upon

Mozambique’s existent legal framework, which promotes gender equality, is responsive to existent gender cultural norms and beliefs and roles, access to resources, and patterns of power and decision-making. Attention to the implications this has on malaria prevention and treatment among youth, communities, and health providers is essential.

According to USAID/Mozambique’s 2019 gender analysis, conducted to inform CDCS development, gender roles and power dynamics between men and women significantly influence health-related decisions and access to and utilization of health services. Cultural norms also create barriers to access and utilization of health services by women, men, boys, and girls -particularly from their parents and other relevant community influencers, including health providers. In most cases, men manage the household economic resources and serve as the household decision-makers, controlling women’s decisions and timely access to health services.

The recipient must implement approaches to reducing gender gaps, fostering girls’ and women’s empowerment, and developing constructive engagement of boys and men in the Mozambique context to support health care seeking and adopt healthy behaviors in their families.

Per USAID Policy ADS 205, gender must be mainstreamed and integrated into all USAID interventions. All proposed interventions must be designed using a gender lens and demonstrate gender-responsive and gender-sensitive approaches at the individual, community, structural, social and political levels. The recipient will be required to conduct a gender analysis within 60 days of receiving the award. The recipient will also be required to conduct a gender analysis and develop gender-specific indicators in its Monitoring, Evaluation, and Learning (MEL) plan and, where applicable, to report on standard U.S. Foreign Assistance gender indicators, including tools and processes for monitoring and data collection.

A.8.2 Self-Reliance and Sustainability

As a long-term strategy to promote sustainability and assist Mozambique on its journey to self-reliance, the activity will identify opportunities to strengthen public institutions and systems and build local partners and private sector capacity. The implementation methodology must be adapted to the local situation; particularly where existing systems are weak, the strengthening of systems must be balanced with the delivery of benefits. For more information on this approach, see Local Systems: A Framework for Supporting Sustained Development.

The activity must strengthen local systems so that local actors continue to sustain key results after the activity ends. In order to achieve this, efforts must align with and support the priorities of local actors, leverage local resources, and increase local implementation over time to sustain positive changes. The activity must focus on sustainably strengthening the capacity of the GRM to manage FP programs and strategic information systems that would enable use of data for decision making at the national, provincial, district, and facility levels. Therefore, the recipient will adopt an approach which works extensively through local government systems - ensuring close partnership and accountability between the activity and local institutions. The operational model described in Section A.3 directly contributes to this strategic consideration.

A.8.3 Host Government, Donor, and Other Counterpart Collaboration

The recipient will maintain transparent, collaborative partnerships with Mozambican government entities, other USG funded programs, and non-USG donors and partners in implementing activities under this program. Note that throughout the life of the Activity, the engaged host government counterparts, donors and partners are likely to change, and the recipient is expected to stay abreast of these changes and continue collaborating with relevant key partners and government representatives.

The recipient must ensure strong engagement with the GRM on policy issues, alignment with national priorities, joint planning, and dissemination of performance reports and data to develop a shared vision for successful implementation of the activity. The recipient must also collaborate with other USG-funded program activities to develop synergies to maximize expected outcomes.

Such activities include, but are not limited to, other USAID-funded programs and programs funded by other USG Agencies such as the Centers for Disease Control and Prevention (CDC), as well as with other donors such as the World Bank, Health Partners’ Group (HPG) members, United Nations Agencies and other non-governmental organizations (NGOs) as appropriate. This collaboration is expected to take place via participation in key meetings such as the FP Technical

Working Group (TWG), Commodities Technical group, and other relevant TWGs.

A.8.4 Climate Change Integration

Climate change is a cross-cutting issue that can have significant impacts on regional, national, and local development efforts in all sectors. In recognition of the Executive Order (EO) 13677, which requires all US agencies to factor climate change into their foreign assistance planning and manage the associated climate risks, the recipient will consider expected climate change impacts over the life of the activity and work toward reducing those risks in order to ensure sustainability of the activities objective by working with the AOR on a Climate Risk Management (CRM) plan before implementation of the Activity.

A.8.5 Science Technology Innovation and Partnerships (STIP)

Where feasible, the recipient must integrate science, technology, innovation and establish strategic partnerships to improve program performance, cost-effectiveness and to advance the achievement of USAID’s malaria activity objectives. The recipient is encouraged to propose innovative approaches to achieve activity objectives during implementation. For additional information consult the U.S. Global Development Lab website.

A.8.6 Transparency and Accountability

Fostering transparency and accountability is an important focus for the U.S. Mission in

Mozambique. All data (as appropriate) generated from the activity will be made broadly available to the public, government and civil society stakeholders. This data should be easily accessible, reusable, complete, and timely, in accordance with USAID Policy ADS 579.

A.8.7 Environmental Compliance Considerations

The recipient is required to be in compliance with regulation 22 CFR 216. The Foreign

Assistance Act of 1961, as amended, Section 117 requires that the impact of USAID’s activities on the environment be considered, and that USAID include environmental sustainability as a central consideration in designing and carrying out its development programs. This mandate is codified in Federal Regulations (22 CFR 216) and in USAID’s Automated Directives System

(ADS) Parts 201.5.10g and 204 (http://www.usaid.gov/policy/ads/200/), which, in part, require that the potential environmental impacts of USAID-financed activities are identified prior to a final decision to proceed and that appropriate environmental safeguards are adopted for all activities. The recipient must adhere to the conditions set forth in the Mission Initial

Environmental Examination (IEE) and any other environmental documents developed and approved by USAID prior to the initiation of the Activity. In addition, the recipient must comply with host country environmental regulations unless otherwise directed in writing by USAID.

A.8.8 Rapid Response Funds

As part of the activity, a Rapid Response Fund (RRF) will be established to enable the recipient to respond efficiently and effectively to rapid-onset natural and/or man-made disasters in the activity’s target geographic districts. The purpose of the RRF is to quickly respond to, or mitigate, natural emergencies or crisis originated emergencies, which can lead to the outbreak of disease and acute shortage of critical malaria commodities.

Given the potential for known and unknown risks to project implementation, the RRF will be a dedicated line item of $1,000,000 in the activity budget which, with an estimated $200,000 annually. Rapid Response Funds will only be allocated if the need arises. Project use of RRF will be agreed to in principle by USAID through a detailed concept note, and written approval by the

Agreement Officer will be required prior to use of funds for activities not foreseen in the annual work plan. All activities funded by RRF will be reported on a quarterly basis and should be included in annual performance reports.

A.9 Collaborating, Learning and Adapting (CLA)

This activity is expected to contribute to USAID/Mozambique’s commitment to a multi-faceted

Collaborating, Learning and Adapting (CLA) approach to development. The CLA approach is based on the understanding that development efforts yield more effective results if they are coordinated and collaborative, test promising, new approaches in a continuous yet also rapid, targeted search for generating improvements and efficiencies, and build on what works and eliminate what doesn’t. CLA creates the conditions for fostering broader development success by:

● Collaborating: Facilitating collaboration internally and with external stakeholders to promote increasingly local-led development (e.g., enhancing existing stakeholder engagement into learning platforms and substantially coordinating with other USG or other complementary activities to ensure complementarity and reduce overlap, while also facilitating learning among activities to reduce the collective cost while enhancing shared results faster). The recipient is expected to collaborate with other USAID implementing partners, with the GRM, and with USAID staff as directed by their AOR. Also, the recipient must participate in partners’ meetings organized by USAID, and report to

USAID as requested on the ways in which they are coordinating with other IPs and with the GRM.

● Learning: Generating and feeding new learning, innovations, and performance information back into the system to inform program management, design, USG-GRM policy dialogue opportunities and funding allocations; (e.g., creating pauses for reflection within the activity implementation scheme, engaging stakeholders for shared ‘learning moments’, conducting analytical review of existing and/or new evidence that may support or contradict common understanding);

● Adapting: Translating learning (from within the implementation experience or external sources) and considering changing conditions, along the lines of the risks, assumptions and game changers, into strategic and programmatic adjustments (e.g., adjusting workplans to account for contextual shifts or tacit learning from a team’s experience, from previous implementation’ experience, while clearly and explicitly capturing and sharing the rationale for adjustments along the way).

A.10 Monitoring, Evaluation, And Learning

Monitoring and evaluating the activity’s results-focused progress towards achieving its objectives is critical to successful implementation. The recipient must develop a monitoring, evaluation, and learning (MEL) plan and conduct performance monitoring of the activity, as further described in Section F.

A.10.1 Monitoring

Performance monitoring is the ongoing and systematic collection of performance indicator data and other quantitative or qualitative information to reveal whether implementation is on track and whether expected results are being achieved. Performance monitoring includes monitoring the quantity, quality, and timeliness of activity outputs within the control of the implementer, as well as monitoring the outcomes expected to result from the combination of these outputs and other factors. The implementer must analyze performance monitoring data in order to inform judgments about the outputs and outcomes of the activity as a basis to improve effectiveness and/or inform decisions about current and future programming. The recipient must track all indicators, as well as indicators related to gender equity and female empowerment and youth.

Indicators will be finalized at time of award and during work plan development. The recipient must capture, document and report on the impact of USAID assistance, while strengthening and using relevant national, provincial, and district-level reporting systems.

The recipient will be held accountable for building the technical and organizational capacity of select Mozambican CSO partners (and other local entities, as discussed and agreed upon). This will include assessing the baseline organizational and technical capacity, developing tailored capacity action plans, and implementing capacity-building interventions. Additionally, clear indicators and benchmarks will be established, allowing USAID to monitor and assess the local organizations’ progress in real-time and via quarterly reviews on capacity action plan progress.

The recipient will conduct a baseline survey to establish the pre-intervention conditions to inform the development of tailored interventions and provide a basis for monitoring activity results and impacts. All supported facilities must have individual baseline assessments against which measurable improvements in the provision and quality of service delivery, management, and other aspects of the activity can be measured. The assessments should provide gender-disaggregated statistics and also investigate specific gaps that exist between males and females with respect to the problem that is being addressed and explain or indicate potential causes of those gaps and indicate what opportunities there are to promote women’s leadership and empowerment related to project outcomes.

A.10.2 Use of Geographic Information Systems (GIS)

The recipient should incorporate GIS for analysis, interpretation and reporting of activity results and ensure the use of geo-enabled performance management data to track progress, identify trends, and resolve challenges across interventions that are implemented at the health facility and community levels.

A.10.3 Evaluation

USAID will plan for and commission an external evaluation to take place at mid-term of the activity. The evaluation will assess progress toward the objectives and achievement of targets and project objectives and will consider a significant focus on the local sub-partners performance to determine if they are on track to lead the management and implementation of key activities.

Based on the findings and recommendations provided by the mid-term evaluation, USAID along with the prime will determine if local sub-partners are prepared to take the lead on specific technical areas. USAID will contract and fund the external evaluation separately from this award.

Illustrative evaluation questions include:

● In targeted areas, to what extent have the interventions contributed to: a) Improve quality of malaria case management practices, both at health facilities as well as at community level and b) Improving leadership and commitment to support the malaria program at all levels of the health system.

● How has the organizational and technical capacity of local sub-partners members been impacted as a result of the targeted capacity building interventions?

● What were the most significant challenges encountered during program implementation and what are the best strategies to address these?

A.10.4 Environmental Monitoring and Mitigation Plan (EMMP):

The EMMP will be developed by the applicant and approved by USAID prior to the launch of each activity having a potential adverse impact on the physical and natural environment.

A.10.5 Key Personnel

Key personnel are considered essential to the work being performed under this grant. Please be advised that these are full time positions and must not be shared with other activities. USAID seeks to emphasize its support for capacity building and professional development of

Mozambican staff.

USAID stipulates the following qualifications for the five key personnel positions:

Chief of Party: The Chief of Party (COP) will provide overall strategic leadership and oversight to the activity. The COP must demonstrate the following:

● A Masters’ degree or higher in public health or in a related field

● Minimum of 12 years of managerial and operational experience, preferably in managing large donor projects involving coordination with multiple implementing partners or institutions in Mozambique or the Sub-Saharan region;

● Demonstrated experience in managing programs with a technical scope similar to the activity;

● Experience in developing activity work-plans, budgets, managing implementation, and staff and short-term technical assistance;

● Experience working with USG supported projects and knowledge of financial rules and regulations at a senior level;

● Excellent representational and communication skills, and written and oral proficiency in

English and Portuguese;

● Demonstrated experience building capacity and health systems strengthening;

● Excellent past performance references.

Deputy Chief of Party: The Deputy Chief of Party (DCOP) supports the COP in the provision of leadership and oversight. The DCOP must demonstrate the following:

● A Masters’ degree or higher in public health or in a related field;

● Minimum of 7 years of managerial and operational experience, preferably in managing large donor projects involving coordination with multiple implementing partners or institutions in Mozambique or Sub-Saharan region;

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