UHCP APS Addendum 3 TB VisMin app hw.pdf

ADDENDUM #3 – Tuberculosis Visayas and Mindanao Activity (TB VisMin) (Local Philippines Organization Set Aside)

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

This is Addendum 3 to an existing USAID/Philippines APS. 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: Nov. 15, 2023

QUESTIONS SUBMISSION CLOSING DATE: Nov. 30, 2023, 3:00 PM Philippine Time

ADDENDUM SUBMISSION DEADLINE: Jan. 17, 2024, 3:00 PM Philippine Time

Estimated Funding (pending funding availability): $30 million to $35 million Period of Performance: 2024 – 2029

Addendum 3 - Tuberculosis (TB) VisMin Activity - The USAID/Philippines Mission is requesting the submission of concept papers from local Philippine organizations only. Concept papers must demonstrate how the applicant will support the Government of the Philippines by working with national government agencies at the regional level, local government units, stakeholders, and partners in Visayas and Mindanao to reach every Filipino with TB, provide appropriate treatment, and prevent both the spread of new infections and progression from infection to active TB disease or multidrug resistant TB. Applicants shall propose creative solutions to meet the objectives in the APS supported by robust analyses, development hypotheses, and a theory of change. This Activity will contribute UHCP’s purpose of, “Improved health for underserved and vulnerable Filipinos,” through activities that are aligned with the UHCP’s results framework’s three key pillars: positive social norms and behaviors adopted; high quality and responsive services delivered; and health system performance and resilience improved.

Sincerely, Agreement Officer Regional Office of Acquisition and Assistance, USAID/Philippines

Addendum 3 to USAID/Philippines APS No.72049223APS00001 TB VisMin Activity

SECTION A: PROGRAM DESCRIPTION

I. Introduction

The TB VisMin activity is a key component of the USAID Universal Health Care Project (UHCP) to improve health outcomes of underserved Filipinos. To accelerate action towards TB elimination, the TB VisMin activity will leverage resources from national and local governments, Global Fund and other donors, private sector partners, and relevant local organizations in the Philippines to contribute to the country’s target of treating almost 2.9 million people with TB by 2028. The TB VisMin activity will work with the Department of Health (DOH) - Centers for Health Development (CHDs) and regional offices of other national agencies and Local Government Units (LGUs) in the Visayas and Mindanao (with the exception of BARMM, which will be covered by the BARMM Resilience Activity), and partner with communities to deliver results towards achieving reduced TB incidence and mortality in the Philippines. The activity will adopt global best practices and international standards of TB care and implement locally generated solutions that tailor USAID’s TB response to more effectively address the diagnosis, treatment and prevention needs of clients and communities, while also addressing stigma and discrimination. The TB VisMin activity will assist in improving access to quality services, contributing to the achievement of the 90-90-90+ global TB prevention targets by 20301:

● 90 percent of individuals with TB diagnosed and initiated on treatment;

● 90 percent of individuals with Drug-Resistant TB (DR-TB) diagnosed and initiated on treatment;

● 90 percent treatment success rate for Drug-Sensitive TB and DR-TB;

● 30 million eligible populations provided TB Preventive Treatment (TPT).

II. Background

Problem statement The Philippines is among eight countries who account for more than two-thirds of global TB cases. With a population of 114 million, the World Health Organization (WHO) estimated 741,000 new and relapsed TB cases in the country in 2022. In 2020, the COVID-19 pandemic disrupted TB service provision nationwide, leading to an increase in estimated TB incidence and mortality and a 40 percent reduction in TB case notification.2

In 2022, the Philippines made critical progress in reversing the negative impacts of the pandemic on the TB program. The total number of TB cases notified in 2022 reached almost 450,000, which is 40 percent higher than the prior year performance of 321,564 cases notified.

Private healthcare provider notification increased as well, constituting at least 30 percent of the total TB case notifications.3 While these case finding accomplishments surpassed pre-COVID-19 performance (2019), they fell short in meeting the 2022 national target. The treatment success

1 USAID’s Global Tuberculosis Strategy 2023-2030 2 World Health Organization Global TB Report 2022 3 Race to end TB dashboard: racetb.doh.gov.ph rate (TSR) for all forms of TB remained below target at 79 percent due to the persistent underreporting of outcomes by private healthcare providers. Disaggregating further, among drug-resistant TB (DR-TB) patients from the 2020 cohort, TSR reached 79 percent – the highest accomplished since the institutionalization of programmatic management of DR-TB (PMDT) in almost two decades. The adoption of an all-oral short treatment regimen was a key contributor to this improved outcome in 2022.4

The Visayas and Mindanao are estimated to have a high number of missing TB cases. Despite diagnosing and treating 112,366 TB cases in 2021, an estimated 141,624 new TB cases were not reached in this geographic area.5 TB VisMin aims to address the key challenges to reaching and successfully treating underserved Filipinos with TB.

Social determinants are considered major drivers of TB endemicity in the country. Susceptibility to infection and poorer treatment outcomes are more evident in vulnerable populations, particularly the urban poor, people living with HIV (PLHIV), and people deprived of liberty. In addition, while the majority of TB services are provided free under the national TB Control Program (NTP), 42 percent of TB-affected households faced catastrophic costs.6 As such, interventions must be directed to those populations most impacted by the disease.

Coordinated and robust efforts to address the social determinants of TB will be critical to ending one of the biggest health issues in the country.7

All of the regions in Visayas and Mindanao have poverty incidence numbers that are higher than the national figure of 21.6 percent. Of the provinces, Cebu (Region 7) has the highest number of individuals living below the poverty threshold at 986,557.8 This is followed by Negros Occidental (Region 6) at 867,141; Bukidnon (Region 10) at 732,027; and Negros Oriental (Region 6) at 694,293.9 In addition, issues of undernutrition, unemployment and poor health conditions complicate TB control efforts in many of these provinces. Due to poverty, residents from poorer regions migrate to Metro Manila and other major cities looking for employment opportunities, fueling overcrowding, homelessness, and increased risk for TB transmission in urban areas.

USAID TB Portfolio Over the last 23 years, USAID has been a global leader in combating TB. Throughout the world, USAID TB programs support 24 high-priority countries and five regions through a variety of

4 Race to end TB dashboard: racetb.doh.gov.ph 5 Data from Integrated TB Information System 6 Florentino JL, Arao RML, Garfin AMC, Gaviola DMG, Tan CR, Yadav RP, et al. (2022) Expansion of social protection is necessary towards zero catastrophic costs due to TB: The first national TB patient cost survey in the Philippines.

PLoS ONE 17(2): e0264689. https://doi.org/10.1371/journal.pone.0264689 7 Flores G, Alberto I, Eala M, Canal J. (2022) “The social determinant of tuberculosis in the Philippines” The Lancet Global Health 10(1), E38, https://doi.org/10.1016/S2214-109X(21)00516-7 8 Magnitude of the poor refers to the number of families or the population whose annual per capita income falls below the poverty threshold 9 https://pcij.org/article/1409/stats-on-the-state-of-the-regions-hubs-of-wealth-ponds-of-poverty centrally managed and bilateral cooperative agreements, grants, and contracts. In the Philippines, USAID has provided nearly $130 million over the past 10 years to support the Department of Health (DOH)’s NTP. Currently, USAID works hand-in-hand with implementing partners, key stakeholders, civil society organizations (CSOs), the private sector, and communities to support critical TB prevention, detection and treatment interventions. (Refer to Annex A).

III. Activity Description

The TB VisMin activity is designed to strengthen TB programs at the regional, provincial, municipal and city levels through social and behavior change communication, and improved screening, diagnosis, prevention, care, and treatment of TB. The activity will support the implementation of TB strategies, policies and guidelines that are culturally appropriate, and patient centered. It will build the capacity of the regional offices of DOH, other regional-based government agencies and local health offices to oversee and implement effective and responsive TB programs. The activity will support the introduction of new approaches and tools for TB prevention, detection, diagnosis, and treatment from the regional and provincial levels down to the barangays. Efforts to bolster local health systems will improve the quality of TB care at the province, city, municipal, and community levels.

The TB VisMin activity will support the implementation of the Philippine Acceleration Action Plan for Tuberculosis (PAAP-TB) 2023-2035 through institutionalization of Regional and Provincial Coordinating Committees (RCC/PCCs).10 The PAAP-TB focuses on addressing the social determinants of health, ensuring equitable access to care, and actively detecting TB cases through a multi-sectoral approach. It promotes health-risk reduction behaviors and increases demand for TB protection and care in order to improve the health and well-being of all Filipinos. The PAAP-TB’s approach is consistent with the USAID Global Accelerator to End TB11 and the USAID Global TB Strategy 2023-2030. The TB VisMin activity will partner with local stakeholders to adopt global best practices and implement locally generated solutions to improve TB service delivery. The activity will identify opportunities to leverage additional resources in priority convergence and focus sites12 in Visayas and Mindanao (excluding the BARMM region). It will build on the capacity and available resources of the DOH, CHDs, regional TB reference laboratories (RTRL), private health providers, and local government units (LGUs) to strengthen TB program implementation. The TB VisMin activity will work with the TB Luzon activity in scaling up proven innovations and new tools as applicable to the local context in Visayas and Mindanao. It seeks to make sustainable improvements in TB service delivery through fostering increased programmatic and financial accountability and ownership among local stakeholders. While the TB VisMin activity will focus primarily on providing technical assistance to increase access to and improve the quality of TB service delivery, it will coordinate

10 National Coordinating Committee for TB (NCC), The Philippine Acceleration Plan for TB (PAAP-TB) 11 USAID Global Accelerator to End TB 12 Refer to the UHCP APS closely with other TB activities and the USAID Health Systems Strengthening (HSS) activity13 to build resilient and sustainable systems at the regional and local levels.

IV. Technical, Strategic, and Geographic Areas of Emphasis

Globally, TB is the second leading cause of death from infectious disease after COVID-19. In 2021, an estimated 10.6 million people fell ill with TB and 1.6 million people died from TB worldwide.14

Burden: The Visayas and Mindanao are home to almost half of the total estimated Filipinos living with TB. Central Visayas, BARMM, and Northern Mindanao are the three regions with the greatest gap in case-detection and notification, followed by Davao, Eastern and Western Visayas, SOCCSKSARGEN, Zamboanga, and CARAGA. The TB VisMin activity, in addition to the TB Luzon, BARMM Resilience, and HSS activities, will target regions with the highest TB burden and focus interventions to ensure coverage of 70 percent of the country’s total disease burden.

The activity will introduce and scale up proven, high impact, and innovative detection and treatment approaches to reach as much of the population as possible in targeted regions. The TB VisMin activity will ensure that TB interventions are culturally appropriate and gender transformative and will not only reach and benefit, but also empower men, women, girls, boys and gender diverse individuals to take control of their health.

TB case detection: A number of provinces and cities are underperforming in terms of TB case-detection. Even with the progress made in reversing the negative programmatic impacts caused by the pandemic, the country fell short in reaching the 2022 national target for TB case detection. The 2016 National TB Prevalence Survey (NTPS) shows that the burden of the disease is much higher than previously estimated. The prevalence of TB is higher among men, and a high proportion of TB cases are being treated in private and non-public settings.15 The activity will focus strategically on closing gaps in TB case-detection and linkage to treatment and develop differentiated approaches to reach underserved communities. Understanding gender related barriers to TB diagnosis can inform the development of targeted strategies, policies, and programs to improve case detection and treatment outcomes.

DR-TB burden: DR-TB is an increasing problem in the country. The emergence and spread of extensively drug-resistant and multi-drug resistant TB (X/MDR-TB) pose a significant threat to health, economic development, and national security, and undermines the significant progress made nationally to achieve a country free of TB. Between 2018 and 2022, almost 35,000 DR-TB patients were enrolled in treatment, but this performance falls far from meeting the Philippines’ United Nations High Level Meeting (UNHLM) commitment to treat 60,670 people with DR-TB.16 Scale up of effective DR-TB interventions is essential.

13 Refer to the HSS Addendum 14 World Health Organization Global TB report 2022 15 Department of Health 2016 National TB Prevalence Survey, Philippines 16 UNHLM 2018-2023 TB Key Targets and commitments

Treatment success rate (TSR): Great strides have been made over the years in improving the TSR. However, TSR among private sector-managed cases and those reported through the national notification platform remain low. Provinces and cities in Visayas and Mindanao have yet to achieve at least an 85 percent TSR for new and relapsed DS-TB cases. For DR-TB, TSR is improving with the introduction of shorter, all-oral regimens. Improving TSR requires strengthening service delivery and institutionalizing continuous quality improvement and people-centered care. The consequences of poor TB treatment adherence are disastrous – increasing the risk of patient morbidity and mortality, disease relapse, drug-resistance, and transmission of the disease. Effective and gender transformative monitoring strategies and tools for treatment adherence should be adopted and scaled up.

Economic/Income groups: Approximately 20 million Filipinos live in poverty, constituting 18 percent of the total population.17 UN Habitat has estimated that 37 percent of urban dwellers in the country are living in slums.18 In the 2016 NTPS, indicators of poverty were found to be significantly associated with having TB.19 As an airborne disease, TB is fueled by overcrowding, poor ventilation, inadequate sanitation, and undernutrition. An increased focus on poverty alleviation and social protection are critical pieces of a whole-of-government, multisectoral effort. In the 2022 National Demographic and Health Survey (NDHS), the lowest wealth quintile had the highest proportion experiencing any sign or symptom related to TB, but also the lowest turnout for consultation or treatment sought, when compared to other income quintiles.20 To improve health seeking behavior, socio-economic determinants must be addressed. In addition, interventions to alleviate the significant out-of-pocket costs for patients and their families should be considered. Combined with loss of income and other economic strains associated with having TB, addressing catastrophic cost is critical. Poverty differentially impacts women, girls, youth, and men; thus, it is crucial that gender transformative approaches are put into place. For example, social and cultural norms influence behaviors that increase exposure to TB, access to health care, and adherence to treatment.21 Gender integration helps identify and address the unique needs, barriers, and opportunities of both men and women to design more effective and inclusive TB programming strategies. This should aim to reduce disparities, enhance access to services, and improve health outcomes for all individuals affected by TB.

V. Sustainability and Local Partnerships

USAID’s Local Capacity Strengthening Policy states that sustainable development depends on local actors leading efforts to improve their communities and working inclusively and

17 2021 Full Year Official Poverty Statistics of the Philippines (Preliminary 2021 Report)) 18 United Nations Human Settlement (UN-Habitat) Population living in slums (percent of urban population), Philippines 19 Department of Health National Prevalence Survey 2016 Philippines 20 2022 Philippine National Demographic and Health Survey (NDHS), Philippine Statistics Authority 21 Danarastri S., Perry K., Hastomo Y, Kurniiawati, Priyonugroho K.. (2022) Gender differences in health-seeking behaviour, diagnosis and treatment for TB, The International Journal of Tuberculosis and Lung Disease 26(6):568-

570. https://doi.org/10.5588%2Fijtld.21.0735 collectively to see those efforts through.22 The foundational assumption of the TB VisMin activity is that empowerment of local stakeholders, by supporting locally-led and inclusive interventions within a framework of accountability, will result in sustainable achievements that will outlast the period and level of USAID investment. Under the TB VisMin activity, USAID will partner with an array of new and local partners, e.g., civil society, faith-based organizations, private sector service delivery providers, and non-traditional partners, to implement locally generated, context-specific solutions through a matching grant. The activity will focus on the scale up of new technologies with proven results to improve case detection and treatment outcomes, building of pandemic resiliency, and the utilization of new approaches to empower stakeholders through local capacity strengthening. The TB VisMin activity will use innovative, co-creation design structures to leverage increasingly iterative, agile, and accountable approaches to address TB challenges. As part of this initiative, market research demonstrated that there are adequate local organizations to perform the work, therefore this Addendum #3 has been set-aside for local organizations.

VI. Strategic Objectives and Intermediate Results

The TB VisMin activity aims to fulfill the shared vision of a TB-free Philippines and the goals of the Global Plan to End TB23 by focusing on three objectives:

Objective 1: Demand and access to high impact and quality TB services scaled up (Reach and Cure);

Objective 2: Spread of new TB infections and progression to active TB disease prevented (Prevent);

Objective 3: TB service delivery platforms to plan, finance, and manage TB and health systems in both public and private sectors strengthened (Sustain).

Through TB VisMin, USAID will maximize the detection and treatment of all forms of TB in individuals across the life stage and is committed to rapidly developing approaches and introducing and scale-up of new tools and technologies to reach all those in need of TB screening, testing, and treatment. The key challenges and intermediate results that this Addendum seeks to address may include, but are not limited to, those listed below:

Objective 1: Demand and access to high impact and quality TB services scaled up (Reach and Cure)

22 USAID’s Local Capacity Strengthening Policy 23 Global Plan to End TB, 2023-2030

IR 1.1 Missing people with TB detected and diagnosed promptly.

Availability of timely and accurate screening and testing services for TB will require expanded use of existing and new tools, to bring high-quality screening and diagnostic technologies closer to the patient. The TB VisMin activity aims to scale-up artificial intelligence for computer-aided diagnosis, molecular testing, use of alternative specimen types (such as stool and urine), and other technologies. Ensuring effective implementation of these tools will require strengthening diagnostic data management systems and specimen referral networks, where needed. In order to identify those with TB missing from diagnosis, care and treatment, the activity will implement effective approaches tailored to the local setting; support systematic screening models; and eliminate barriers to health service delivery and uptake, particularly those related to gender, stigma, and discrimination.

IR 1.2 TB screening and testing integrated into other health services.

Integration of TB screening and testing into other health services promotes a holistic approach to providing comprehensive, person-centered care by acknowledging and leveraging the interconnected relationship between TB and non-communicable diseases (NCDs), HIV, diabetes, nutrition, substance abuse, tobacco cessation, and mental health. Through an integrated model, health outcomes improve in individuals with co-morbidities and the health sector’s capacity to address a wide range of health conditions also improves.

IR 1.3 Tools and technology to deliver people-centered care adopted and scaled up.

Adherence to TB treatment is critical for curing patients, controlling the spread of infection, and minimizing the development of drug resistance. In order to achieve improved adherence, the activity will engage patient support groups and civil society organizations to empower TB clients in their treatment journey. The TB VisMin activity will develop or scale up existing interventions to improve DS and DR-TB clients’ adherence to treatment. The establishment of programmatic guidance for psychosocial support and mental health for people affected with TB and their caretakers may also be supported to promote and improve adherence. The activity will work with the DOH-CHDs and LGUs to ensure pharmacovigilance reporting and strengthen their capacity to manage adverse drug reactions. Digital health tools to improve patient care and follow up will be implemented. Institutionalizing people-centered care will close gaps along the TB cascade from initial care seeking to successful treatment and appropriate care for post-treatment.

IR 1.4 Safe and effective TB treatment options made universally accessible.

Universal access to high quality, safe, and effective TB treatment is a key strategy for eliminating TB. The TB VisMin activity will support the DOH-CHDs and build their capacity in ensuring the routine performance of drug susceptibility testing for medicines used in the clinical management of all patients. Institutionalizing surveillance systems is critical for determining the local prevalence of DR-TB strains and for guiding decision makers in programmatic planning. The activity will work with the DOH-CHDs and other partners to facilitate the adoption and scale up of the WHO recommended new TB regimens, both for DS and DR-TB. The activity will provide critical technical assistance in policy development at the local level and in the roll out of implementation at the facility level.

IR 1.5 Services for the prevention, detection, and treatment of DR-TB enhanced.

One of the main challenges in the management of DR-TB in Visayas and Mindanao is poor access to rapid diagnostics and universal drug susceptibility testing. For geographically isolated and disadvantaged areas (GIDA), near point of care (POC) testing made available to clients may be more appropriate than reliance on specimen referral systems through a hub-and-spoke model. Commodity insecurity and shortages of human resources for health further contribute to delays in DR-TB detection. In addition to the expansion of WHO-recommended rapid diagnostic tests for first and second-line drug susceptibility testing, it is a priority to ensure that all diagnosed patients are promptly notified and enrolled in recommended DR-TB treatment regimens. The scale up of new, shorter regimens and rapid decentralization to primary care facilities, e.g., iDOTS phase 2, will support a more effective public health response.

IR 1.6 Public communications strategies to raise TB awareness and promote early health seeking developed and implemented (social and behavior change communication or SBCC).

The 2016 NTPS found that 41 percent of Filipinos with TB symptoms take no action and 40 percent self-medicate, while only 19 percent seek medical consultation. Primary reasons undermining health-seeking behavior include the perceived nature of symptoms and costs associated with a lost workday, travel and drugs. The 2022 NDHS indicated higher figures, with 56 percent not consulting a provider and 77.5 percent self-medicating. Innovative behavioral interventions and enablers to improve health-seeking behavior should be adopted and scaled

up. Raising TB awareness and motivating people to seek early care is crucial in detecting, treating, and preventing further transmission of TB. This approach should have quantifiable targets to measure the impact of the SBCC interventions, including the number of presumptive TB cases screened, tested and treated.

Objective 2: Spread of new TB infections and progression to active TB disease prevented (Prevent)

IR 2.1 TB risk factors and social determinants addressed.

The activity will implement the PAAP-TB by working with various government agencies including regional offices of DOH, Department of Social Welfare and Development (DSWD), Department of Education (DepEd), Department of Labor and Employment (DOLE) and other stakeholders to address stigma, discrimination, social determinants and improve access to screening and testing among high risk and vulnerable populations. In order to operationalize this, TB VisMin will work with various agencies to ensure that the sector's activities are supported with adequate resources to facilitate achievement of the sector specific action plans.

Additionally, the participation of non-health stakeholders is critical to co-design and implement regional multi sectoral accountability frameworks that are responsible to carry out interventions in addressing social determinants of health. The TB VisMin activity will collaborate with the TB Luzon and HSS activity and other health programs, development initiatives, and national agencies to address the social determinants undermining TB prevention.

IR 2.2 Contact investigation scaled up and TB disease monitoring capabilities strengthened.

Contact investigation (CI), when implemented properly, is effective in identifying undetected TB patients in families and communities. To support this, the TB VisMin activity will work with the DOH-CHDs to ensure that CI national policies are disseminated and implemented. The activity will also support LGUs to ensure implementation of TB screening and testing algorithms. Access to new tools and approaches to detect TB infection should be made available at the facility level. In order to build capabilities for TB disease monitoring and CI, it will be essential to invest in high quality data systems and to deploy digital tools to aid health workers in the community to conduct contact tracing.

IR 2.3 Access to TB preventive treatment (TPT) scaled up.

The use of TPT constitutes one of the principal interventions in reducing TB incidence. TPT reduces the risk of developing active TB disease, hence preventing further TB transmission.

Expanding access to TPT will require ensuring TPT availability to all who test positive for TB infection. Expanding programmatic implementation of TB contact investigation is a key entry point for accelerated implementation and scale up of TPT for at-risk populations (people living with HIV, household contacts, including children <5 years old, and other people at risk). The activity will need to work with the DOH-CHDs and LGUs in collaboration with other partners to ensure that access to TPT will be made available.

IR 2.4 Infection Prevention and Control (IPC) measures in health care settings and congregate settings strictly implemented.

Implementation of IPC measures is critical to preventing TB transmission. The activity will identify gaps in the implementation of policies and procedures for infection prevention and control measures and evaluate their effectiveness to minimize the risk for TB transmission in all healthcare and congregate settings. In collaboration with the HSS activity there is a need to work closely with various government agencies as this will require investments for the health system and strong coordination to be fully implemented. Emphasizing the importance of building a localized, integrated, well coordinated, multisectoral approach towards TB infection control across all levels of care, as well as in non-health care settings with a high risk of TB transmission, is crucial to establishing and sustaining IPC implementation.

IR 2.5 Preparations for the successful roll out of new effective vaccines undertaken.

(Note: applicable once it is officially recommended and available) New effective vaccines, alongside the implementation of other high impact innovative approaches, are needed to effectively eliminate TB. In preparation, the TB VisMin activity in collaboration with the TB Luzon activity will support introduction and roll out of vaccines once available. Other critical activities will include advocacy and community mobilization to generate demand for and acceptance of vaccines and ensuring investment of adequate resources for vaccine roll-out and scale up.

Objective 3: TB service delivery platforms to plan, finance, and manage TB and health systems in both public and private sectors strengthened.

TB services are delivered at all levels of the health system, from primary to tertiary care. The national health system is the platform through which TB prevention, diagnosis, and treatment activities are introduced, expanded, and strengthened. Accordingly, the quality of the system has a direct impact on the provision of TB services. Although the TB VisMin activity is not intended to address the health system as a whole, it will work closely with activities implemented under the UHCP APS, in convergence sites to strengthen key TB service delivery platforms through the implementation of UHC reforms. For non-convergence sites, TB VisMin will lead the implementation of local health systems strengthening aligned with the HSS activity in focus sites in Visayas and Mindanao, with the exception of BARMM.

IR 3.1 TB service delivery systems strengthened.

The TB VisMin activity will identify populations at high risk of TB and support improvements in the health settings in which they seek care. This will require a multi-sectoral approach and engagement with a range of partners, including non-traditional government agencies, affected communities and community organizations, and the private sector – for-profit and nonprofit. The activity will support TB Commitment Grants (TCG) to selected LGUs to increase local ownership and accountability and to accelerate progress towards TB elimination at the local level. Details of the TCG fund, such as the number of grants, amounts, and subrecipients, will be decided during co-creation.The TB VisMin activity will work in collaboration with the HSS activity in selected provinces and cities to strengthen essential core systems to support the overall TB program, including, but not limited to: health leadership and governance; budgeting and public finance management; procurement and supply chain to ensure the consistent availability of high quality drugs and other commodities with no stock-outs; health information systems to support improved data quality and decision making; and human resources planning to ensure adequate staffing; and institutionalized training and capacity-building for health care and lay workers. Strong platforms are needed to introduce and scale up new diagnostics, drugs, and vaccines as they become available.

IR 3.2 Private health sector engaged in UHC and TB care.

WHO has indicated that achieving UHC through public sector service delivery alone will not be possible. Cooperation, collaboration, and partnership between public and the private sector actors, including individual private providers and large corporations, will be necessary.

Introduction and scale up of new tools and models for private sector engagement will improve quality treatment outcomes for both TB and DR-TB. Capacity to outsource contracts should be strengthened both at the regional and LGU levels to expand access to TB services. Governance, management and financing of the TB private sector and non-NTP partners should be developed and improved. Models for partnerships and consortiums should be expanded that embrace market-based approaches as a more-sustainable way to support communities in achieving better health outcomes. This is based on the premise that private enterprise is one of the most powerful forces for lifting lives, strengthening communities, and accelerating sustainability.

IR 3.3 Data use and communications bolstered.

Improved data collection, management, and analysis for decision-making is critical to ensure effective and efficient program implementation. TB VisMin shall adopt and scale up the geoportal hotspot mapping platform, which was introduced in the country by WHO Philippines, and uses Artificial Intelligence to predict TB risk within communities, generates estimates for TB burden in localities, and informs programmatic efforts. In addition, data should be analyzed to identify programmatic gaps and guide advocacy efforts for more political support and resources to address the epidemic.

IR 3.4 Multi-sectoral Accountability Framework (MAF) institutionalized.

The TB VisMin activity will establish and strengthen the capacity of the Regional and Provincial Coordinating Committees (RCC/PCCs) to oversee the implementation of the commitments of various sectors consistent with Republic Act 10767 (TB Law), as well as the Political Declaration of the UN General Assembly High-Level Meeting (UNHLM) on the fight against TB. The RCCs and PCCs will support the National Coordinating Committee's goals and the MAF-TB platform through formalizing commitments from various regional government agency offices, the private sector, and civil society to collectively address TB as articulated in the PAAP-TB. The RCCs/PCCs will advocate for budget allocations to support the achievement of targets. The TB VisMin activity will work with the RCCs to develop regional results-based frameworks to oversee progress towards achieving the regions’ PAAP-TB commitments. This will include the achievement of key milestones, such as the adoption and roll-out of new WHO guidelines, addressing issues raised by CSOs and key populations through community-led-monitoring mechanisms, and institutionalization of each of the accountability framework components.

VII. Project Monitoring, Evaluation, and Learning

The TB VisMin activity will be guided by the USAID’s Evaluation Policy and the Performance Based Monitoring and Evaluation Framework (PBMEF) in its approach to monitoring, evaluation, and learning.24 The activity will emphasize consistent and effective utilization of data for purposes of design, adaptation, quality assurance, and context-appropriate scaling, with particular attention to improving transparency, access to data, and application of evidence-based practices among practitioners and decision makers at the country, regional, and global level. USAID will organize a participatory monitoring and evaluation system from the local to national level and institutionalize a continuous quality improvement process among service delivery sites. TB outcomes will be tracked under the PBMEF indicators (core, core plus, project-level) and the Country Development Cooperation Strategy (CDCS) and reported through the USAID Development Information System (DIS) and the TB Data, Impact Assessment, and Communications Hub (TB DIAH). The TB VisMin activity will collaborate with all UHCP activities and the USAID/Philippines Collaborating, Learning and Adapting (CLA) mechanism, as well as other partners and stakeholders, working both in convergence sites and non-convergence sites.

24 USAID TB Performance Based Monitoring and Evaluation Framework

[End of Section A]

SECTION B: FEDERAL AWARD INFORMATION

B.1 Funding Subject to funding availability, USAID intends to provide approximately $30 million to $35 million in total funding over a five-year period to support the activity described 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 February 2024 and April 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 Please refer to the APS.

[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 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 Please refer to the APS.

C.3 Limitations on Submissions Please refer to the APS.

C.4 Teaming Agreements Please refer to the APS.

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. Applicants must be fully SAM registered before award. UEIs and SAM registration may be obtained at https://sam.gov/content/home

[End of Section C]

SECTION D: CONCEPT PAPER SUBMISSION INFORMATION

Refer to Sections D.1 and D.2 of the APS for

● Agency Point of Contact

● Concept Paper Submission Instructions

● Concept Paper Format, Content, and Instructions

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

Technical Approach – Applicants should follow the instructions for the Technical Approach provided in Section D.2 of the APS.

Management and Staffing Plan - Applicants should follow the instructions for this section provided in Section D.2 of the APS. Additionally, it is critical that the TB VisMin activity utilizes a staffing structure that can meet the stated technical objectives, while remaining adaptive and flexible to address needs that may arise at both central and local levels. Rapid start-up will be critical to ensure continuity of services, and the activity must provide timely responses to requests from USAID/Washington, USAID/Philippines, and partner agencies. Applicants should demonstrate expertise in, or access to, specialists in the range of technical areas needed to effectively implement the work as outlined above. The staffing pattern should reflect a minimum number of highly experienced technical staff sufficient to conduct activities anticipated under the award.

Institutional Capability- Applicants should follow the instructions for Institutional Capability provided in Section D.2 of the APS for this section.

NOTE: Applicants should review the merit review criteria in Section E of the APS before drafting concept papers to understand how concept papers will be evaluated. Concept papers should demonstrate the technical and managerial capability to implement an award with respect to the merit review criteria. Previous USAID experience is not required for an award.

Clarity and specificity are critical. Applicants should become familiar with the USAID/Philippines development portfolio found on https://www.usaid.gov/philippines.

USAID/Philippines will confirm receipt of a concept paper. As detailed in the APS, after a concept paper is reviewed, USAID/Philippines will inform applicants whether further discussions are warranted, and, after those discussions, whether a full application or co-creation will be requested or not.

D.3 Evaluation Process Please refer to the APS.

D.4 Evidence of Local Entity Status Applicants must include copies of the following documents with their submission or risk having their application rejected without review.

a) Organization registration with relevant Philippine government agency, office or department

b) Name, citizenship (or legal resident status) and title of all members of the board of directors or other governing body of the organization

c) Name, citizenship (or legal resident status) and percent ownership of all owners of the organization

[End of Section D]

SECTION E: APPLICATION REVIEW INFORMATION

Concept Paper Merit Review Criteria See Section E, Concept Paper Merit Review Criteria of the APS for an explanation of the merit review criteria.

Full Application Merit Review Criteria Merit review criteria will be provided to applicants who are requested to submit a full application.

Cost Application Instructions Applicants are not requested to provide cost applications at this time.

[End of Section E]

SECTION F: FEDERAL AWARD ADMINISTRATION INFORMATION

See Section F of the APS for federal award administration information.

NOTE: In addition to reporting requirements on the APS, geospatial reporting for all award activities will be required.

SECTION G: FEDERAL AWARDING AGENCY CONTACTS

See Section G of the APS for federal awarding Agency Contacts.

SECTION H: OTHER INFORMATION

See Section H of the APS for other information.

ATTACHMENTS 1 through 4 Refer to the APS.

ANNEX A

Health TB Project 2018-2023 Implementation Activities USAID/Philippines through its bilateral agreement with the DOH currently manages a comprehensive portfolio to strengthen health systems and address the TB epidemic in the country through the following activities:

TB Innovations and Health Systems Strengthening- funding to strengthen national and regional level implementation of the Philippine Strategic TB Elimination Plan by supporting the DOH in the development and scale up of high impact interventions designed to prevent, detect, and treat TB. This activity contributes to U.S. foreign policy priorities through preventing the spread of deadly infectious diseases and is aligned with USAID’s Global Accelerator to End TB.

TB Platforms for Case Detection and Treatment- funding to strengthen and sustain supportive and crosscutting interventions to increase case detection of TB and drug-resistant TB (DR-TB) and improve treatment success rates. This activity supports the U.S. government’s Global TB Strategy and USAID’s Global Accelerator to End TB.

TB Local Organizations Network for civil society organization strengthening - funding to strengthen community engagement in the TB response through organizing, capacitating, and mobilizing TB civil society organizations to form a unified network that will advocate for a rights-based, gender transformative, and people-centered TB response in the Philippines.

ProtectHealth - funding to strengthen foundational cross-cutting health system components to support TB, FP, HIV, and GHS program implementation to achieve better health outcomes and realize equity, quality, and resource optimization in health care. Building on the health systems reforms through the UHC law, the new HSS activity will serve as the primary mechanism to manage policy, coordination, and knowledge sharing that will strengthen key systems building blocks at local and national levels.

In addition to the bilateral investment, the USAID Bureau for Global Health, Office of Infectious Disease Tuberculosis Division (GH/ID/TB) partners with different stakeholders to provide technical assistance to the TB portfolio in the Philippines. These partners and activities include:

1. Medicines, Technologies, and Pharmaceutical Services: supports the DOH in implementing a unified and effective supply chain and pharmacovigilance management systems for tuberculosis (TB), family planning (FP), HIV/AIDS and other health programs to ensure access to and appropriate use of quality medicines and supplies at the service delivery level.

2. World Health Organization (WHO) Global TB Program: Grant (2009-2020) funding to support global TB policy development and guidance including: TB monitoring and surveillance and impact measurement; surveillance and management of multi drug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB); innovations for intensifying early and complete TB case detection and effective service delivery;

technical capacity building for policy adaptation, implementation, and service delivery;

and the Global Laboratory Initiative.

3. Stop TB Partnership: Grant (2015-2022) funding to support the Global TB Drug Facility and technical activities of the Partnership Secretariat including: global communications;

advocacy, communication, and social mobilization; building national partnerships; and the Challenge Facility for Civil Society.

4. Infectious Disease Detection and Surveillance: A contract (2018-2024) to support the strengthening of disease detection networks and identification of antimicrobial resistance (AMR) in priority infectious diseases, and to improve the quality of real-time surveillance systems for pathogens of greatest public health concern, including AMR and zoonotic diseases.

5. Sustaining Technical and Analytic Resources (STAR): A bureau-wide cooperative agreement (2018-2023) to second technical advisors to key positions within National TB Programs and other strategic positions to address bottlenecks, build capacity within government health systems, and maximize the impact of interventions to improve TB services.

6. TB Data, Impact Assessment, and Communications Hub (TB DIAH): A cooperative agreement (2018-2023) focused on developing a TB data hub that ensures optimal consolidation and analysis of TB data and the appropriate use of such information to measure and evaluate performance and inform national TB programs and USAID portfolio interventions and policies.

7. TB Implementation Framework Agreement (TIFA): A cooperative agreement (2021- 2024) focused on direct engagement with local governments and partners, TIFA co-designs TB commitment grants that accelerate countries' progress toward national and global TB targets.

8. SMART4TB: A newly awarded initiative (2023) which will build the research capacity in high TB burden countries by supporting studies that evaluate novel approaches, interventions, and tools to combat TB.

9. TB LON Mental Health (2023)- Asia: Core funded, regional approach activity that seeks to address programmatic challenges for integration of early identification, accurate diagnosis, and effective management of mental health and substance use conditions into TB care.

(End of Addendum 3)