UHCP APS Addendum 1 Health Systems Strengthening app hw.pdf

Addendum #1 – Health Systems Strengthening

Call for Concept Papers Under USAID/Philippines Mission Annual Program Statement (APS) No.72049223APS00001

This is Addendum 1 to an existing USAID/Philippines APS. All interested applicants should carefully review both this addendum and the full Universal Health Care Project Annual Program Statement (UHCP APS) No.72049223APS00001, which can be found at www.grants.gov. There is important information in the APS that is not repeated in this addendum.

Where information in the APS differs from information in this addendum, information in this addendum takes precedence.

ADDENDUM ISSUANCE DATE: August 14, 2023

QUESTIONS SUBMISSION CLOSING DATE: August 31, 2023, 3:00 PM Philippine Time

ADDENDUM SUBMISSION CLOSING DATE: October 13, 2023, 3:00 PM Philippine Time

Estimated Funding (pending funding availability): $30 million to $36 million Expected Period of Performance: 2024 – 2029

Addendum 1 – Health Systems Strengthening (HSS) – The USAID/Philippines Mission is requesting the submission of concept papers from local Philippine organizations only. Concept papers must demonstrate how strengthening foundational health systems components can be carried out effectively in support of the Philippine Government’s effort to achieve Universal Health Care (UHC) through implementation of Republic Act 11223, and build strong and resilient health systems.

Sincerely, Howard Weston Agreement Officer Regional Office of Acquisition and Assistance USAID/Philippines http://www.grants.gov/ http://www.grants.gov/

Addendum 1 to USAID/Philippines APS No.72049223APS00001 Health Systems Strengthening (HSS)

SECTION A: PROGRAM DESCRIPTION

{Applicants are advised to read Section A of the UHCP APS before proceeding}

Introduction

The recent COVID-19 pandemic has highlighted practical lessons and insights that will enhance the potential of fully operationalizing Republic Act 11223 or the Universal Health Care (UHC) law through a calibrated approach to health systems strengthening reforms. Over the years, USAID/Philippines has been at the forefront of many reforms in the health sector that are now embodied in the UHC law. Specifically, in the past five years, USAID/Philippines has supported the development of policies to operationalize the UHC law, including the issuance of its Implementing Rules and Regulations and various issuance providing guidance on integrating province-wide and city-wide health systems. This work has demonstrated how integration is effectively implemented in selected sites through working with various DOH Regional Offices or Centers for Health Development (CHD) and local government units (LGUs) in localizing these policies. These initiatives include the formulation and testing of various models of primary care and integrated service delivery, using tuberculosis (TB), family planning (FP), adolescent reproductive health, and global health security (GHS) program goals to track progress. Through its UHC Project (UHCP), USAID/Philippines is committed to support the Philippine Government’s drive to address institutional bottlenecks, which have hampered the delivery of quality preventive, promotive, curative, and rehabilitative care to underserved Filipinos, to bring about improvements in health, not only for TB and FP, but also for HIV/AIDS, global health security, and mental health.

The Health Systems Strengthening Addendum will prioritize identifying operational bottlenecks in fully implementing policies that connect the individual building blocks of health systems including health workforce; information; medical products, vaccines, and technologies; rational financing; and leadership and governance (stewardship).1 Improved and more effective integration of key health system components will bolster the delivery of quality health services and advance sustained health outcomes in measurable terms. Additionally, strengthening intersectoral linkages to address non-health factors impacting quality will equally be important in achieving this goal. USAID prioritizes health systems strengthening (HSS) initiatives that aim to expand access to quality, essential services for underserved populations through a full optimization of available resources. USAID’s Vision for HSS2 strongly emphasizes systems thinking and systems practice; the role of communities, civil-society, and the private-sector in those processes; and the need for partnership with the public sector, including health workers, policymakers, leaders, clients, researchers, and other non-traditional partners. Also, as gender inequality remains a pervasive element in the country’s health systems that hinders the attainment of positive health outcomes for all individuals, the HSS Addendum seeks to

1 “Everybody’s Business. Strengthening Health Systems to Improve Health Outcomes. WHO’s Framework for Action.” World Health Organization. 2007.

2 “USAID Vision for Health System Strengthening 2030.” USAID. March 29, 2021.

https://apps.who.int/iris/bitstream/handle/10665/43918/9789241596077_eng.pdf?sequence=1&isAllowed=y https://apps.who.int/iris/bitstream/handle/10665/43918/9789241596077_eng.pdf?sequence=1&isAllowed=y https://www.usaid.gov/global-health/health-systems-innovation/health-systems/Vision-HSS-2030-download integrate gender equality and women’s empowerment in new and existing Philippine health policies to promote equity and inclusivity. Recognizing the role of local partners in sustainable health systems, USAID/Philippines is aligned with the USAID Administrator’s vision of increasing local participation in and implementation of programming, as well as strengthening the institutional capacity of local entities.

Purpose and Theory of Change

The UHC law provides a framework for achieving successful health systems strengthening reforms crucially needed to enhance the delivery of TB, FP, HIV, and other health security measures that will improve health outcomes, particularly for the vulnerable sectors of our society. The purpose of this Addendum is to continue to support the Government’s efforts to realize the goals of UHC with specific emphasis on strengthening the performance, sustainability, resilience, and responsiveness of the local and national health systems.

Integrating these systems in a way that will ensure routine delivery and equitable access to high-quality, affordable, gender-sensitive and transformative health services in a timely manner will sustainably improve health outcomes for all Filipinos. While USAID/Philippines recognizes that appropriate health services should be delivered when and where needed, the priority health outcomes that this Addendum will focus on, working together with other UHCP Addenda, are essential, primary care and public health services related to TB, HIV, FP, and global health security (GHS). This focus will ensure better alignment with the Philippine Government’s Health Sector Strategy and the DOH’s 8-point Action Agenda within the given duration of this Activity.

Theory of Change: IF health governance capacity is strengthened; evidence-based decision-making and accountability are enhanced; financial and human resources are optimized; quality and delivery of priority services and medical products are improved; and equitable access to high-quality, affordable, healthcare is enhanced, THEN underserved and vulnerable Filipinos will have improved health outcomes and enhanced quality of life.

Objectives and Technical Areas of Focus

This Addendum has six objectives, each with corresponding intermediate results (IRs), that align with specific health system Technical Areas of Focus (TAF). A description of these objectives and IRs are provided below to highlight the priority challenges that USAID/Philippines is looking to address. USAID/Philippines will to partner with local health system actors. These actors include communities, civil-society, private sector, and public sector, including all health workers, policymakers, leaders, clients, researchers, and others.

Box 1: Summary of Objectives and Intermediate Results

Objective 1: Governance capacity and evidence-based decision-making improved

● Transparent and accountable policy process enhanced

● Whole-of-society and cooperative governance approaches institutionalized

● Organizational development and institutional capacity increased

● Leadership and management skills of the next generation of leaders at all levels improved

Objective 2 Sustainable and efficient financing enhanced

● Financial risk protection improved

● Domestic resources mobilized and pooled strategically

● Resource allocation and strategic planning improved

Objective 3: Access to quality, safe, and effective medical products expanded

● Procurement and supply chain to ensure uninterrupted supply of quality-assured products strengthened

● Medical regulatory capacity bolstered

● Institutional capacity to manage systems/services improved

Objective 4: Human resources for health (HRH) organization, quality, and performance improved

● HRH leadership, management, and organization enhanced

● Production, hiring, retention, and succession of quality HRH strengthened

Objective 5: Utilization of quality health information for decision-making enhanced

● Governance for health information systems enhanced

● Uptake of tools and information systems improved

Objective 6: Integrated delivery of quality services bolstered

Objective 1: Governance capacity and evidence-based decision-making improved

The UHC law provides mandates for integrated health systems to improve efficiencies in the delivery of services with the goal of consolidating fragmentation in the health sector, particularly of local health systems. This evolving health system design is a work in progress; a critical piece in realizing this vision is the presence of sufficient leadership and management skills at all levels of government to handle this transition and to effectively manage the system overall. USAID recognizes the critical role of health governance and has supported efforts to institutionalize and strengthen health leadership and governance programs. Additionally, USAID continues to support local health systems integration in selected UHC Integration Sites.

The intermediate results and key challenges that this Addendum seeks to address may include, but are not limited to, those listed below.

Transparent and accountable policy process enhanced Evidence-based policy formulation and implementation remains a critical pillar of ongoing health reforms under the UHC law. While significant progress has been made in institutionalizing the policy process in the DOH as defined by Department Orders 2009-0292 and 2021-0584, and in engaging a broader range of stakeholders in policy development, monitoring and evaluation (M&E) remains a challenge. Capacity constraints in M&E, access to administrative and health data, and the untapped potential in the private sector are some of the challenges. At the local level, there is a need to strengthen capacity for evidence-based policy development and in engaging a broad range of local actors.

Whole-of-society and cooperative/unified governance approaches institutionalized Given the importance of addressing social determinants of health in attaining better health outcomes, a whole of society and whole of government approach is critical in realizing the vision of UHC. Aside from bolstering engagement with stakeholders in non-health sectors, decision-makers in the health sector need to foster a participatory space that encourages open engagement across the whole of society. In addition, fostering cooperative governance and managerial integration by strengthening and integrating province-wide and city-wide local health boards are critical pieces of UHC reforms that have the potential to address longstanding challenges in the delivery of health services.

Organizational development and institutional capacity increased To successfully implement and carry out current policy reforms, sufficient organizational development and institutional capacity is needed across the health sector. Organizational capacity improvements at national, regional, and local levels can optimize the performance of different operating bureaus and units across the sector. Understanding existing capacity along with clear roles and responsibilities can help establish consensus on how to integrate the health system. A clear delineation of functions is necessary to streamline policy implementation, reduce duplication, and prevent critical aspects from being overlooked. This is especially important as implementation of the UHC law continues under new DOH and PhilHealth units, new leadership and possibly with new entities, like the proposed Center for Disease Control and Prevention at the national level, in addition to local health boards and management support units (MSU) at the local level. It is also vital that these units develop core competencies and are able to plan strategically, share knowledge, foster teamwork and maintain a focus on the goal of universal health coverage for all Filipinos.

Leadership and management skills of the next generation of leaders at all levels improved Successful implementation of the UHC law requires that strong leadership and management skills exist at all levels of the health system. Health system leaders must become better consumers and users of health data, understand the value of new technologies, and be able to implement and adjust to new innovations. Leadership and management should be developed as a skill, cultivating and recognizing its critical significance in improving health outcomes. Local leaders are taking on new roles and responsibilities and are expected to work collaboratively to effectively manage the health system, while weighing health needs against competing social needs. Additionally, any targeted LGU support must also involve parallel leadership support to CHDs. This will ensure that local leaders develop the necessary skills and enable improved alignment across system counterparts.

Objective 2: Sustainable and efficient financing enhanced

The UHC law introduces key reforms and innovations on health financing to support the ambitious vision of universal coverage and financial risk protection for Filipinos. Aside from operationalizing these innovations, the Philippines requires sustainable financial resources and sufficient funding for systems at all levels to upgrade and implement evolving service delivery models. As the country grapples with limited funds, competing priorities, and the implications of the Mandanas-Garcia ruling, strategic use of existing resources for interventions becomes imperative. Meanwhile, preventing catastrophic health spending remains an elusive challenge that needs to be addressed. USAID has supported DOH and PhilHealth in the development of health financing policies to optimize the use of resources and to operationalize key reforms in the UHC law, like the special health fund and the roll-out of Konsultasyong Sulit at Tama (KonSulTa), as part of the mandate to transition to comprehensive out-patient benefit packages. The intermediate results and key challenges that this Addendum seeks to address may include, but are not limited to, those listed below.

Financial risk protection improved Ensuring Filipinos are protected from impoverishment in accessing health services remains an important challenge. Out-of-pocket spending remains a significant proportion of current health expenditure (CHE), and the share of CHE covered by social health insurance has remained stagnant for the last 5 years. High cost of care has been one of the significant barriers to accessing health services, including for primary care services. Ongoing innovations to support financial risk protection include the roll-out of the KonSulTa, the shift to the Comprehensive Outpatient Benefit Package (COBP), and the transition to prospective payment and global budgets; ensuring that these reforms are implemented effectively will be critical in realizing the vision of the UHC law. Even as these new innovations continue to be introduced and as the financing of population-based and individual-based services are considered, there is also a need to revisit existing packages for priority health programs, including TB, FP, maternal, neonatal, and child health, nutrition, COVID-19, and HIV/AIDS, in their ability to support attainment of outcomes and their complementation with the COBP. Furthermore, despite mandates of the UHC law for immediate eligibility, challenges remain in ensuring that Filipinos, especially the poor and underserved are registered, informed of, and able to fully utilize their benefits.

Mechanisms to facilitate collections and targeting of the indigent and informal sector need to be reviewed. Finally, challenges in PhilHealth’s claims and reimbursements processes have severely impacted the sustainability of health facilities, particularly private primary care facilities. Improving these systems to promote transparency and efficiency will be critical to achieving and sustaining UHC.

Domestic resources mobilized and pooled strategically Despite a steady increase in the health budget in the past 15 years, a massive funding gap remains to realize the UHC law’s vision of comprehensive out-patient and emergency care.

Substantial investments are necessary given the significant expected impact of expanding benefits, including out-patient and emergency services, and a corresponding increase in service utilization. The health sector has been a beneficiary of government efforts to raise revenue through tobacco, alcohol, and sweetened sugar taxes, and initial proposals to institute more health-related taxes could provide additional financing opportunities. As the transition to full devolution and local health system integration continues, mobilizing resources increasingly falls to the local government units. Local taxes for health, public-private partnerships, accessing grants, and optimizing PhilHealth reimbursements need to be further explored. The Special Health Fund (SHF), a mechanism introduced by the law designed to pool financial resources at the province-wide/city-wide health system level, is a platform for mobilizing and sharing resources; however, challenges in its implementation need to be addressed.

Resource allocation and strategic planning improved Even as new resources for health are mobilized, increasing demand for health services necessitates both efficient allocation and use of resources to achieve intended outcomes. At national and local levels, capacity for public financial management needs to be strengthened, particularly critical considering current reforms introduced by UHC. Processes and mechanisms for medium-term and annual planning as part of the government cycle (including the development of costed implementation and strategic plans for TB, FP, HIV, and GHS), at both the DOH and PhilHealth, need to be further strengthened through building capacity for evidence-based planning and fostering multi-sectoral participation. At the local level, investment and operational planning for health through the Local Investment Plan for Health and its yearly translation into the Annual Operation Plan (AOP) need to be strengthened as a genuine platform for integrated planning of province and city-wide health systems that is aligned with the local government budget cycle. This is especially important to enable resource pooling through the SHF. As limited funding for health is a perennial issue in the sector, the disbursement and utilization, monitoring, transparency, and accountability of these health funds is even more crucial. Targeted reforms aimed at eliminating waste and fraud will improve the overall quality and accessibility of services and make the system more accountable overall.

Objective 3: Access to quality, safe, effective medical products expanded

The UHC law recognizes that improving access to quality-assured, effective, and affordable health commodities at the point of care is foundational to the improvement of health outcomes. Strengthening procurement and supply chain management at different levels of the sector and enhancing quality assurance for health commodities are key components included in the UHC law. USAID supported the DOH in setting up the electronic logistics management systems (eLMIS) and in exploring innovative procurement modalities in light of the UHC law and transition to full devolution. USAID assisted the Food and Drug Administration in streamlining quality assurance processes for health commodities and in strengthening capacity in pharmacovigilance. The intermediate results and key challenges that this Addendum seeks to address may include, but are not limited to, those listed below.

Procurement and supply chain to ensure uninterrupted supply of quality-assured products strengthened Supply chain issues like bidding failures, storage and distribution challenges, lack of data visibility and timely feedback loops persist, contributing to stock-outs, over-stocks, and waste and expiration. While the national government pursues the full devolution of health services and transitions the procurement of selected commodities to LGUs, there is an increasing need to enhance the supply chain management capacity at all levels to ensure availability of essential commodities at the service delivery points. The DOH central office is expected to continue the procurement and management of commodities for population-based health services3 while it slowly devolves to the LGUs the responsibility to procure commodities for individual-based health services.4 The DOH central office, through the recently established Supply Chain Management Office, has invested in a unified electronic logistics management information system (eLMIS)5 to enable real-time data visibility to inform programmatic and procurement decisions at all levels. The DOH has also started collaborating with the Government Procurement Policy Board (GPPB) to test innovative procurement modalities to overcome systemic challenges in procurement. It is currently establishing a governance mechanism that will be responsible for the oversight and management of the supply chain at all levels, including the setting of standards, testing new approaches, and issuing necessary policies to implement, institutionalize and sustain a functioning and resilient supply chain in the context of integrated health systems. All these efforts are ongoing and need to be strengthened, along with the exploration of innovative mechanisms like central price negotiation and fourth party logistics, among others. Furthermore, the DOH regional offices are expected to support both the DOH central office and the LGUs in maintaining a functional supply chain across the country. LGUs have expressed the need for capacity building on procurement and supply chain management in the context of local health systems integration, and on forecasting and other supply chain functions including implementation of eLMIS, supply chain standards, and data utilization.

Medical regulatory capacity bolstered Ensuring the safety and effectiveness of medicines and medical devices in the market is a critical component of universal health care. The Food and Drug Administration (FDA) is seeking to advance to a higher level of maturity for the national regulatory system, but challenges persist including lengthy registration processes, weak regulatory enforcement and pharmacovigilance systems, and inappropriate use of antibiotics and other medicines that leads to greater prevalence of antimicrobial resistance. The FDA seeks to understand the harmonized regulatory regimes for pharmaceuticals and medical devices of countries exporting to the Philippines to innovate and shorten the product registration lead-time. Assistance is required to monitor, analyze, and report the safety profile of new health commodities in the public health program; to develop a strategy to support the country’s antimicrobial resistance efforts, including collaboration with interagency partners and domestic stakeholders; to create platforms for regular communication with the pharmaceutical industry to expand availability of innovative products; and adopt best practices to strengthen regulatory enforcement in the country.

Institutional capacity to manage systems, services, and products improved

3 Population-based health services refer to interventions such as health promotion, disease surveillance, and vector control, which have population groups as recipients (Republic Act 11223).

4 Individual-based health services refer to services which can be accessed within a health facility or remotely that can be definitively traced back to one (1) recipient, has limited effect at a population level and does not alter the underlying cause of illness such as ambulatory and inpatient care, medicines, laboratory tests and procedures, among others (Republic Act 11223).

5 eLMIS has been deployed in 32 DOH regional and 2 LGU warehouses as of June 2023 and the rollout continues.

The DOH, FDA, PhilHealth, Department of Science and Technology (DOST), and the Sexually Transmitted Diseases Acquired Immunodeficiency Syndrome (STD/AIDS) Cooperative Central Laboratory (SACCL) are the primary government agencies governing the availability and introduction of essential medicines and devices. Efforts to clarify their functions and responsibilities and to strengthen their capacity and collaboration are critical for ensuring a unified effort towards expanding access to essential supplies. Additionally, efforts should also focus on engaging the private sector further and leveraging their participation and expertise.

These agencies also play a critical role in building local manufacturing capacity, which is a top priority under the current Administration.

Objective 4: Human resources for health organization, quality, and performance improved

Reforms in the structure and organization of the healthcare system that are slowly being introduced under the UHC law require corresponding support in human resources management across the health sector. Apart from building the capacity of the various cadres of the health workforce involved in service delivery, capacity building efforts should also target health institutions implicated in the oversight, management, operations, and planning of the health workforce. Equally important is the need to build the capacity for the management surrounding production, recruitment, distribution, tracking, retention, and succession of various cadres of health workers across the sector. Gender imbalances in the health workforce persist, limiting the ability of the health system to offer gender sensitive and/or transformative services. Finally, supporting the health workforce’s rights and welfare is a critical factor in human resources for health (HRH) development and is a pillar in the new administration’s 8-point Action Agenda. USAID supported the DOH in the development of the National HRH Master plan and in setting up the DOH Academy. The intermediate results and key challenges that this Addendum seeks to address may include, but are not limited to, those listed below.

HRH Leadership, Management, and Organization enhanced A key piece in addressing the challenges in the health sector is the enhancement of the macro-level planning and human resources for health. Strengthening the organization and capacity of the DOH Health Human Resources Development Bureau (HHRDB), which is tasked with leading sectoral efforts for HRH development, will be crucial. The HRH Network, established to strengthen interagency collaboration and to harmonize HRH policies across multiple agencies, needs to be further enhanced. The National HRH Master Plan provided key recommendations for the short, medium, and long-term implementation of critical strategies to address persistent HRH challenges and to achieve the overall goal of the Master Plan. In collaboration with CHDs, there is a need to provide guidance on localizing the National HRH Master Plan and on health workforce planning in the context of integrated province-wide and city-wide health systems. At the LGUs, there have been issues with the need to increase task-shifting, task-sharing, and re-evaluate team compositions, which therefore requires an update to HRH functions, which should be based on evolving needs and demands of the population. LGUs also need to build the capacity of local health staff in local policy development, budget advocacy, and program management.

Production, recruitment, retention, and succession of quality HRH strengthened (Transformative education, skills mix, competencies, satisfaction) As clinical competencies of HRH are an essential factor in the delivery of quality healthcare, efforts to build up, not only the technical capacities, but also the soft skills of different health cadres are critical, especially considering the transitions brought about by the UHC law.

However, challenges in both pre-service and in-service training need to be addressed to increase the quality of the country’s HRH. The link between the pre-service, academic institutions (e.g., medical, nursing, midwifery schools) and even the leadership and management programs to health service delivery and health systems management need to be improved, particularly as the production of HRH is not strategically set up to meet the needs of the population. Also, as mandated by the UHC law, the curriculum of medical and allied medical professionals needs to be redesigned and appropriately oriented to produce primary care providers and a fit for purpose, competitive future health workforce. Further, as global health security threats and health emergencies arise, the broader health workforce needs to be well-equipped to deal with these threats, while the capacities of dedicated workforce like field epidemiologists and One Health Workforce (OHW) will need to be enhanced. In addition, there is potential to professionalize, formalize, and integrate barangay health workers (BHWs), other community workers, and OHW, who are trained in public health functions for GHS, TB, HIV, FP, and mental health, as USAID and DOH pursue primary healthcare strengthening. BHW formalization and standardization, and CHW empowerment would increase case-finding and facilitate task-shifting, task-sharing, and reduce the burden on the LGU’s functions and the formal system.

Objective 5: Utilization of quality health information for decision-making enhanced Whether in aid of individual care at the clinic, in support of rapid interventions to prevent the spread of diseases, or to aid decisions on resource allocation, rapid access to quality health information is crucial for decision-making at all levels. The UHC law recognizes the role that digital technologies play in improving health system performance and enhancing the quality of care and articulates interventions to strengthen health information systems across service providers. A key reform being pursued is the streamlining and interoperability of health information systems, which would facilitate reporting and access to timely health information.

Enhancing data use and evidence-based decision-making underscores the need for sustaining health information systems interventions. USAID’s initial work to support platforms for health information exchanges and integrated Electronic Medical Records (EMRs) for primary care need to be further enhanced. The intermediate results and key challenges that this Addendum seeks to address may include, but are not limited to, those listed below.

Governance for e-Health strengthened While there is an increasing use of digital tools and platforms to process and analyze data, the culture of data-driven decision-making needs to be further institutionalized and strengthened, both at the national and local level. Gaps in policy and legal frameworks remain, while integration among systems and interoperability between existing systems pose significant challenges. Private sector expertise in e-Health remains untapped. The country is advancing digital health through an e-Health strategic framework, which seeks to harness information and communication technology to improve the delivery of healthcare, enhance administration and management, foster transparency and accountability, and communicate health information to all Filipinos. Realizing this vision and addressing these gaps require stronger collaboration among various government agencies including the DOH (Knowledge Management Information and Technology Services [KMITS], Epidemiology Bureau [EB], and the Disease Prevention and Control Bureau [DPCB]), PhilHealth, Department of Information Communications Technology (ICT), which have key mandates in moving the e-Health agenda forward. There is also a need to utilize mechanisms, expertise, coordination and partnerships to develop, adopt and enforce e- Health components (e.g., standards) to facilitate integration and interoperability.

Uptake of tools and information systems improved Despite the availability of tools and information systems, these platforms have not been fully optimized. Several parallel information systems hosted a variety of health information platforms exist, but the majority of these are not linked with one other. In addition, many of these information systems are centralized at the DOH level, but the data is collected and consolidated at the subnational level. As such, limitations in the centralized system, including volume of data, analytical capabilities, access, system crashes, etc., also impact the uptake of the systems at the lower levels. At the local level, challenges persist in utilizing ICT tools as health workers continue to use paper charts and parallel systems requiring multiple encoding of individual clients. Streamlining health information systems in the context of province and city-wide health systems and building capacity on the management, analysis and use of facility level and local data, have the potential to promote utilization of these tools. A streamlined information system would: support evidence-based decision-making by clinicians; improve the timely and accurate payments made by payers/ Philippine Health Insurance Corporation (PHIC);

streamline the submission of DOH-mandated reports; and support accessible electronic records for patients in the province-wide system. Furthermore, integrating gender considerations into data collection, analysis and utilization will support the identification of specific health challenges faced by women and girls, men and boys, and gender-diverse individuals and facilitate the development of gender transformative policies and programs.

Objective 6: Integrated delivery of quality services bolstered The devolution of the health system has posed a significant challenge in the delivery of services across the healthcare continuum to underserved Filipinos. Delivery of primary care services by municipal and city governments is often not linked to secondary and tertiary care provided by provincial governments and the DOH-retained hospitals. Uncoordinated referrals are still the norm, posing a significant challenge for patients to navigate and access care. In addition, the private sector remains relatively untapped to support and complement the delivery of vital services for primary and even higher levels of care. The UHC law envisions the delivery of promotive, preventive, curative, and rehabilitative care as a continuum and introduced key reforms to consolidate and integrate service delivery through primary care provider networks (PCPNs) and health care provider networks (HCPNs). Meaningful and sustainable engagements with private providers remains a challenge. Testing and assessment of various network models will help inform the private and/or mixed HCPNs. Furthermore, mechanisms to ensure continuous quality improvement (CQI) across networks need to be enhanced. Initial work supported by USAID in establishing referral networks, PCPNs and CQI integration needs to be further strengthened, particularly as the DOH advances reforms in UHC implementation. This HSS Addendum, working with other UHCP Addenda (technically focused addenda), will continue to support the organization of these service delivery models and build the capacity of DOH and PhilHealth, to support the sustainability of these models. The other UHCP Addenda focused on TB, FP, HIV, and GHS will target key service delivery aspects, including but not limited to, quality improvement, stakeholder engagement, service coverage expansion, and capacity building targeting service providers.

Additional Considerations

Support for Local Health Systems Strengthening in Selected Sites The HSS Addendum will support local health systems strengthening in selected convergence sites.6 Using the framework of the UHC law on integrating province-wide and city-wide health systems, the HSS Addendum will strengthen critical health system components (i.e.

governance, financing, supply chain, HRH, health information systems, service delivery networks, etc.) in selected sites in order to demonstrate how strengthening the interrelationship among these components can lead to better health outcomes. Priority will be given to provinces and cities that are UHC Integration Sites (UIS) and are in the process of achieving the Local Health System Maturity Level (LHS-ML)7. In addition, UIS that have been identified as sites for more intensive focus for the enhancement of primary care services will also be considered. Given the unique development challenges in the Bangsamoro Autonomous Region for Muslim Mindanao (BARMM), UIS in the BARMM may be considered as potential sites. The identification of sites will be discussed during the co-creation process. Refer to Section B.4: Geographic and Target Population of the APS for additional information.

Support for National Government Agencies (NGAs) and Regional Offices While focused on local health system strengthening, the HSS Addendum maintains the need to support critical units of the DOH, PhilHealth, Commission on Population and Development (POPCOM), FDA, and other NGAs as necessary, to support the development of macro policies, plans, and programs; strengthen individual and organizational capacity; and support other activities that are critical factors to realizing the intended results of this addendum. Given its critical role in supporting UHC and other key health programs, special emphasis is provided under this addendum for strengthening the capacity of CHDs, PhilHealth regional offices, and other national agencies’ regional offices to achieve its objectives.

Collaborating, Learning, and Adapting As the HSS Addendum is just one component of the UHCP, this addendum will work with other UHCP Addenda to achieve the objectives of the UHCP. While the other Addenda will focus on

6 Please see the UHCP APS DOH Department Circular 2023-0049 and 2023-0133 - FY 2022 LHS MLl Year End Monitoring Reports provides more information on the progress 71 UIS improving access to quality health services to achieve improved health outcomes in TB, FP, HIV, and GHS, the HSS Addendum will focus on the cross-cutting health systems components that support service delivery enhancements, including governance, financing, policy/regulations, HRH, and health information systems. All UHCP activities working in convergence sites will represent themselves as “One USAID,” with the HSS Addendum taking the lead in coordinating activities of other UHCP Addenda, including engagement with local partners, the conduct of joint planning, organization of site visits, and support of monitoring and reporting on critical indicators in coordination with the Health Component of the Mission’s Collaborating, Learning, and Adapting (CLA) Activity (PIMMELA). As needed, the HSS Addendum will convene Technical Working Groups to facilitate multi-mechanism coordination to harmonize initiatives under the UHCP. The HSS Addendum will substantially coordinate with other United States Government and other complementary activities working in relevant sectors, including education, environment, economic development and democratic governance, where interests coincide. It will collaborate with and directly engage with the private sector, civil society, professional organizations, academic institutions, international experts, communities, schools, youth groups, women’s organizations, faith-based organizations, and other donors and international organizations. Representation and inclusive development are key for promoting equity when strengthening the health system.

The monitoring and evaluation for this addendum will be expected to measure health systems performance and track health outcomes, in coordination with other UHCP Addenda. The newly released Health Systems Performance Assessment (HSPA)8 Framework is related to the concept of health system resilience and utilized in the WHO resilience toolkit. The HSPA is valuable as a MEL framework for this addendum for multiple reasons: it highlights how the health system functions and how that functionality is linked to health system performance; it centers governance as the most enabling function; and reflects quality of care as an intermediate objective. In addition to the HPSA assessment areas, the HSS compendium of indicators and the USAID HSS Learning Agenda9 should be integrated into the MEL framework for the HSS Addendum. M&E for health outcomes should be aligned with the national health sector goals and USAID/Philippines’ priority health outcome measures. The MEL team and staffing for this addendum will be expected to coordinate closely with the USAID/Philippines CLA mechanism and the MEL teams from the other UHCP projects.

[End of Section A]

8 “Health Systems Strengthening – A Compendium of Indicators”. Measure Evaluation. 2017 9 “Health Systems Learning Agenda.” USAID. 2022 https://www.measureevaluation.org/resources/publications/tr-17-167b/at_download/document https://www.usaid.gov/sites/default/files/2022-05/Final_HSS_Learning_Agenda_.pdf

SECTION B: FEDERAL AWARD INFORMATION

B.1 Funding

Subject to funding availability, USAID intends to provide approximately USD 32,000,000 to USD 36,000,000 in total funding over a five-year period to support the program description in Section A. USAID intends to issue one award under this addendum but reserves the right to issue one, more than one, or no awards under this addendum.

B.2 Period of Performance

For this addendum, the anticipated start date of an award is between December 2023 to March 2024. The period of performance is five years from the award start date. Applicants should tailor their concept paper to the proposed period of performance.

B.3 Contents and Organization of Concept Papers

Applicants must propose an approach(s) and specific activities that will achieve all goals, objectives, and intermediate results stated in the program description in Section A of this addendum. Submission instructions are presented later in this addendum.

B.4 Geographic Code

Please refer to the APS.

B.5 Type of Award and Substantial Involvement

USAID/Philippines anticipates issuing a cooperative agreement(s) in response to this addendum, in which case USAID/Philippines will be substantially involved. USAID/Philippines, however, reserves the right to issue a grant or fixed amount award. Please see the Section B.5 of the APS for more information on substantial involvement.

B.6 Emergency Response Provision

[End of Section B]

SECTION C: ELIGIBILITY INFORMATION

C.1 Eligible Entities

Please see Section C.1 Eligibility Information of the UHCP APS for general eligibility information regarding organizations.

Given that the attainment of the results envisioned under the this Addendum requires a thorough understanding of the local context and an expert ability to liaise and coordinate across many levels of government and various national entities, eligibility is restricted to local Philippine organizations only as defined in ADS 303.6.

Local entity means an individual, a corporation, a nonprofit organization, or another body of persons that—

(1) is legally organized under the laws of;

(2) has as its principal place of business or operations in; and

(3) is (A) majority owned by individuals who are citizens or lawful permanent residents of; and

(B) managed by a governing body the majority of who are citizens or lawful permanent residents of a country receiving assistance.

Applicants are advised to refer to ADS 303.6 for additional information defining a local entity.

Applicants will be asked to provide evidence of their local status in Section D.4 of this addendum. Submissions without evidence as prescribed in D.4 will not be accepted.

Applicants may engage non-local entities as subrecipients.

C.2 Cost Sharing

C.3 Limitations on Submissions

C.4 Teaming Agreements

C.5 Unique Entity Identification Applicants must have a Unique Entity Identifier (UEI) or show evidence of a submitted application for a UEI when submitting a concept paper under this addendum. UEIs may be obtained at https://sam.gov/content/home

[End of Section C] https://sam.gov/content/home

SECTION D: CONCEPT PAPER SUBMISSION INFORMATION

D. 1 Agency Point of Contact

• Questions regarding the APS should be emailed to manila-roaa-rfa@usaid.gov by the date and time stated on the cover page of this APS.

• In the subject field of the email write, “Questions for UHCP APS - Organization Name”

• Please return to grants.gov after the closing date to review the answers.

Concept papers must be submitted via email,

● To manila-roaa-rfa@usaid.gov by the date and time stated in addenda.

● As a single, searchable, and editable PDF file.

● Do not send multiple files. Do not send organization literature, promotion material, articles, or any other information not explicitly asked for.

● In the subject field of the email write – “Submission for UHCP Addendum # -

Organization Name”

D.2 Concept Paper Format, Content and Instructions Applicants must write and submit concept papers in accordance with this APS. Failure to do so may result in disqualification of a concept paper. Addenda may contain additional or different format or submission information from this APS. NOTE: Instructions in the addenda take precedence over instructions in the APS.

Applicants may submit only one concept paper per addendum but may submit a concept paper to more than one addendum. There is no limit to being included as a potential subrecipient on other applicants’ submissions.

Concept Papers Must Comply with the Following or Risk Being Rejected Without Evaluation

● Written in English

● Use standard 8 ½” x 11” page format, single sided, single-spaced, 12-point Calibri or other similar non-serif font, 1” margins all around, left justification and headers on each page other than the first page that include date of submission, organization name and addendum number. Footers shall contain consecutive page numbers after the first page.

● 10-point Calibri or other non-serif font can be used for graphs and charts but must remain legible without magnification. Tables, however, must comply with the 12-point Calibri or other non-serif font.

● Submitted as a searchable and editable PDF file. USAID may later request a word version.

● Files must not be in ZIP format or encrypted.

Concept Paper Organization and Content: (Yellow highlighted sections indicate changes from the APS)

● The first page The first page of the concept paper must be the completed Standard Cover Page (Attachment 1) of the APS.

mailto:manila-roaa-rfa@usaid.gov mailto:manila-roaa-rfa@usaid.gov

● Technical Approach (not to exceed 8 pages). Sections in yellow highlight are substantive changes from the APS.

In this section, state your understanding of the key needs, challenges, and opportunities to achieve the desired outcomes outlined in the goals, objectives and intermediate results of the addendum. Applicants must provide a preliminary theory of change that is responsive to the needs, challenges, and opportunities identified and that leads to the intermediate results outlined in the goals and objectives of this addendum. A preliminary implementation plan with specific activities must be included to demonstrate how proposed interventions will be carried out. The technical approach must also address how proposed interventions and results will be sustained. The concept paper should describe the expected benefits interventions will produce and how the approach will reduce gender gaps or address the unique needs and interests of women, men, and gender-diverse individuals. A strong concept paper will also include a partnerships strategy or plan that incorporates local partners and alliances. If applicants propose a partnership strategy in the Technical Approach, they should indicate the organizations they are planning to partner with and submit letters of support from these potential partners. Further, with coordination and collaboration essential components of the HSS activity, applicants are encouraged to describe their technical approach to leading engagements with CSOs and government and non-government partners and other USAID activities.

Applicants must not describe the geographic locations and site selection criteria or identify the regions, provinces, or cities they are proposing to target under their proposed interventions. Site selection will be addressed during the co-creation process.

Applicants must also consider environment and describe climate risk mitigation in their technical approach.

Please Note: Construction is not anticipated under this APS but could become necessary to facilitate an emergency response to a natural or human made disaster after an award is made. Applicants must not include any construction in their concept papers.

● Management and staffing plan (not to exceed 3 pages)

State specifically and justify the composition and organizational structure of the entire country-based activity…