USAID Urban TB LON II Addenum 8 - Ethiopia.pdf

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

ANNOUNCEMENT

CALL FOR CONCEPT PAPERS

ADDENDUM No. 08

USAID Urban TB Local Organization Network II (USAID Urban TB LON II) Activity in

Ethiopia

Under Existing

TB LOCAL ORGANIZATIONS NETWORK (LON)

ANNUAL PROGRAM STATEMENT APS No.: 7200AA19APS00001

CATALOG OF FEDERAL DOMESTIC ASSISTANCE (CFDA) NUMBER: 9801

ISSUANCE DATE: March 20, 2023

CLOSING DATE OF QUESTIONS: April 10, 2023 (5:00 PM Ethiopia time)

CLOSING DATE OF CONCEPT PAPERS: May 1st. 2023 (5:00 PM Ethiopia time)

PLEASE NOTE: This is an Addendum to an existing Annual Program Statement (APS)

7200AA19APS00001. All interested organizations should carefully review both this

Addendum AND the full APS announcement, Amendment No. 5, which can be found here.

Important information contained in the full worldwide announcement is not repeated in this specific Addendum.

This program is authorized in accordance with Foreign Assistance Act of 1961, as amended.

Through this Addendum No. 08 to the Local Organization Network Project (LON) Annual Program Statement (APS) No. 7200AA19APS00001, the United States Government, as represented by the U.S. Agency for International Development Mission in Ethiopia (USAID/Ethiopia) is providing additional specifications for the submission of Concept Papers from eligible local entities proposing activities in Ethiopia.

Concept Paper submission for Ethiopia should aim to support the National TB Priorities in alignment with Government, Tuberculosis (TB)-Leprosy National Strategic Plan (TBL NSP

2021-2026) of Ethiopia and government Global commitments by implementing focused https://www.grants.gov/web/grants/search-grants.html?keywords=7200AA19APS00001

TB/Drug Resistant (DR) TB interventions to strengthen high impact TB case finding activities, improve access to TB/DR-TB diagnostics, treatment, prevention, psycho social and economic support services, empower the key affected communities and their representative organizations’ role in the social accountability exercise at the local urban community health platforms, enhance local urban TB programing capacity including accountability and ownership, and optimize community based TB care activities within the Primary Health Care Unit (PHCU) of the health system. The Activity will be targeting Addis Ababa City administration, Dire Dawa City administration, Sheger City administration in Oromia regional state, and Harari National Regional State with predominantly urban population. The interventions of the Activity should address the needs of key affected and underserved population groups for TB with adaptive management and social accountability approach.

USAID anticipates awarding one cooperative agreement with a ceiling not to exceed $7,500,000.00 for a period of five years. USAID reserves the right to fund any or none of the applications received. Actual funding amounts are subject to availability of funds.

Publishing this Addendum does not commit USAID to make any awards. USAID also reserves the right not to follow a co-design process and request full application from the applicants successful at concept paper stage.

I. Purpose

USAID is seeking Concept Papers from eligible local organizations in Ethiopia to address the specific objectives of USAID Urban TB LON II Activity in Ethiopia that are provided in Section II of this Addendum. Unless otherwise stated herein, all terms and conditions of the LON APS Amendment-5, apply. Information provided in the Concept Paper should address the objectives and Activity description presented in the following sections.

II. Activity Description

1. Background

The USAID Urban TB LON II in Ethiopia will focus on locally generated solutions to provide TB prevention, screening, diagnosis, treatment, and care in the capital city and other secondary cities of the country with features of urbanization with a particular emphasis on:

● High impact TB/DR-TB case finding interventions/strategies, uptake of newer rapid TB diagnostic technologies, and engagement of private care providers in differentiated TB service delivery models.

● Creating demand for Tuberculosis preventive treatment and improving up take of TPT through decentralizing TPT provision at community level

● People centered TB/DR-TB treatment and care with differentiated TB treatment service delivery and addressing psycho- social and economic need of people with TB/DR-TB

● Building the organizational capacity of local partners and engaging Local Organizations and TB affected communities in social accountability and community participation platforms to identify and overcome TB service quality and equity.

● Improving TB program management with integration of community TB care program into the Urban Health Extension Program with engagement of local organizations.

● Improve TB program management and TB information system using sub city/district lead

TB programing.

2. Overview

USAID released a new Global TB strategy 2023-2030, and aligns its goal, strategic objectives, and principles to contribute to partners’ collaborative efforts to meet upcoming UNHLM TB targets, end TB by 2035, and eliminate TB by 2050. The new strategy commits to continue its focus on key elements of the Accelerator by building on past successes and optimizing future opportunities to reduce TB incidence and mortality by 35% and 52 % respectively by 20301.

The strategy emphasizes the need to respond to additional needs of addressing health -related risk factors, socioeconomic determinants, and other underlying drivers of the TB epidemic, while building sustainable systems, to accelerate efforts to diagnose, prevent, and cure TB among all affected people and communities.

The Tuberculosis Local Organizations Network (TB LON) is a key component of the USAID

Global Accelerator to End Tuberculosis. It creates partnerships and opportunities to address the challenges of TB, make sustainable improvements in TB service delivery by accelerating the transition to local accountability and ownership, and assist countries as they progress on their journey to self-reliance.

TB LON is designed to increase investments from the public, private sectors, communities including faith-based partners to improve access to TB diagnostic, treatment and prevention and accelerate the fight for ending TB while building a sustainable urban health system in Ethiopia.

TB LON promotes the use of locally generated solutions by directly partnering with local organizations to meet the needs of people with TB/DR-TB disease and affected communities through addressing TB stigma and discrimination.

USAID Urban TB LON Activity has been supporting community TB care activities in urban areas of the country, including the state capital Addis Ababa and two secondary cities; Dire Dawa and Harari through locally tailored interventions and demonstrated an Urban TB care model within the Primary Health Care Unit (PHCU) of the health system. The Activity has also been building the organizational capacity of local partners in urban TB programming. USAID Urban TB LON II Activity aims to capitalize on the current (USAID Urban TB LON Activity) investment and expand its technical scope, introduce social accountability to empower the community, and collaborate with multi-stakeholders to accelerate the efforts to end TB. The Activity is expected to ensure equitable access to essential TB services to all segments of the urban communities, including the disadvantaged and underserved population through meaningful engagement of local organizations and communities.

1 United States Government Global Tuberculosis Strategy | 2023-2030.

USAID’s investments are most successful when they are coupled and aligned with strong commitments from local governments and partners. To accelerate the progress to end TB epidemic, USAID Urban TB LON II should leverage additional domestic resources from the

Government of Ethiopia (GOE), private sector partners, and other local organizations and implement cost efficient high-impact and evidence-proven Urban TB interventions that addresses the major challenges of TB in the rapidly urbanizing settings.

3. Problem Statement

Despite the remarkable achievements in the national TB prevention and care effort, Ethiopia still misses more than one fourth (27%) of people with drug susceptible TB (DS TB), and more than two-third (71%) of people with drug resistance TB (DR-TB) annually2.

The burden and determinants of Tuberculosis significantly varies by country’s ecological and living contexts- urban, Agrarian, and pastoral communities. The burden of TB in Urban settings of the country is not very well understood due to paucity of evidence at sub-national levels, and the complex population dynamics in rapidly growing big cities. However, the routine report collected through the national Health Management Information System shows a high TB case notification rate compared to the national level estimates.

In Ethiopia, the key determinants of TB, risk drivers and service barriers to early detection and treatment of TB significantly varies by the geographic, population dynamics, and administrative boundaries of the country as it is reflected in national TB program data for the past several years and it requires to design tailored packages of TB interventions and TB programing to the context and population need.

Factors contributing to and compounding TB in Urban areas.

Health related risk factors: Ethiopia has been facing a significant problem of malnutrition due to environmental, social, political, economic and culture related problems. Inadequate productivity, drought, postharvest loss, poor food safety and quality, poor caring practices and hygiene and health problems are some of the major drivers of food and nutrition insecurity.

Undernutrition has been a consistent problem of urban populations of Ethiopia. According to the 2019 Ethiopia Mini-Demographic and Health survey, in urban areas 26% of children are stunted and 15% are underweight. In Ethiopia, undernutrition is the main driver of the tuberculosis epidemic2.

The prevalence of HIV is seven times higher in urban than rural settings (2.9% Vs 0.4%)3.

Similarly, the prevalence of Diabetes Mellitus (DM) is 2-4 times higher compared with rural dwellers.

Behavioral risk factors: In urban areas behavioral risk factors for TB such as commercial tobacco smoking, excessive alcohol and drug use are more prevalent compared to rural areas.

2 WHO Global TB Report 2022, Geneva, Switzerland 3 Central Statistical Agency (CSA) [Ethiopia] and ICF. 2018. Ethiopia Demographic and Health Survey 2016:

HIV Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF; 2018

These risk factors did not only increase the risk of acquiring infection and progression of TB disease but also result poor treatment outcomes due to suboptimal adherence.

Socio economic determinants: Urban dwellers are disproportionately affected by TB, due to a higher proportion of key affected populations living in urban centers. Poor living conditions especially in Urban slums; defined by overcrowding, lack of water and sanitation, lack of secure tenure and poor quality of housing, and high inequalities in access to quality health services due to social exclusion and financial constraints worsen the TB situation in urban centers. Besides, most congregate settings (universities, shelters, correction centers and industry hubs) reside in the cities.

Growing numbers of Ethiopians migrate in the capital province or other urban areas to look for job opportunities, often in the informal economy, and as a result of the volatile security situation in the most parts of the country, people are displaced to cities which will have forced them to live with a compromised living conditions including poor hygiene and overcrowding that increase the risk of TB infection and disease development.

Psychosocial and economic issues: People with TB disease usually face psychological, social, and economic problems that complicate treatment and care which leads to decreased adherence to prescribed treatment regimens and poorer clinical outcomes, including higher loss-to-follow-up, relapse and mortality rates. Lack of comprehensive psychosocial and economic support for people with TB disease living in urban slums, streets and congregate settings has been a persistent challenge of the National TB program.

Unaddressed human rights issues and inequalities in accessing TB service: TB and Health inequalities are hugely influenced by the population dynamics, socio -economic status, housing and living conditions, capacity of functioning TB programming and health system capacities and commitment of the governments. The designing and implementation of any TB programming in urban settings requires meticulous consideration of health-related risk factors, socio economic determinants and other underlying drivers of the TB epidemic. In Ethiopia, the growth of urban areas does not go hand in hand with growth of health facility infrastructure which stretches the existing urban health services to match the needs and compromise the quality service delivery.

Achieving END TB ambitious targets requires narrowing inequalities and increasing access to preventive, diagnostic and treatment services for those at the highest risk of TB. In resource-limited and high-TB burden countries like Ethiopia, identifying hotspot and underserved areas for targeted interventions is particularly important to optimize use of available resources and to increase efficiencies in the delivery of TB services.

Funding gap: The economic benefits of ending TB far outweigh the costs. The High-Level Panel for the UN’s SDGs has estimated that an investment of US$ 1 in TB care yields a return of US$

30. Other studies have put the return as high as US$ 115 for each dollar invested 4. Likewise, fully implementing the Global Plan to END TB (2023-2030) will yield a return on investment of US$ 40 per dollar invested5. However, the National TB program has a significant funding gap (58%)

4 Tuberculosis domestic resource mobilization and sustainability roadmap for Ethiopia, January 2022

5 STOP TB partnership Global plan to End TB (2023-2030); July 2022 compared to the estimated budget and this has been a challenge for the implementation of priority intervention that are indicated in the TBL-NSP and Global plan to END TB.

TB has always been a disease of poverty and has affected those who are most marginalized.

According to the study done by Lelisa Fikadu etal, 48 percent of TB affected households faced catastrophic expenditure6.

USAID Urban TB LON II Activity is expected to capitalize on the gains of the current USAID Urban TB LON Activity and previous USAID and other donors’ investment and support the regional effort to achieve the targets set on, the TBL NSP (2021-2026), USAID Global TB strategy and Global plan to END TB (2023-2030) through supporting the implementation of locally generated solutions and addressing inequalities in accessing TB service.

Country Context: Ethiopia is the second most populous country in Africa after Nigeria, with an estimated population of more than 120 million in 20227. The country is predominantly rural, with almost 80% of its population residing in rural areas. It has a surface area of approximately

1.1 million km² and a population density of 215 people/km2. The country is characterized by rapid population growth (2.6%), young age structure, and a high dependency ratio.

Political and Administrative structures: The country’s political and administrative structures have seen major reforms in the past with the current federal structure that mandates decentralization of power and decision-making authorities primarily to the regional state governments and then to woreda/city administrations. At present, the country's political and administrative structure is composed of a federal central government and eleven regional estate governments and two city administrations. It is further divided into 99 zones, 1159 woreda and more than 16,000 kebele administrations.

Economic and social development context: Ethiopia is a low-income country with a gross domestic product (GDP) per capita of $944 in 2022 only a 0.8% increase from 20208. The economy is predominantly dependent on agriculture. According to the UNDP Human Development report the country is in the low human development category; positioned at 173 out of 189 countries and territories. The ongoing conflict and the COVID- 19 pandemic increased the number of people requiring humanitarian support to close to 15.8 million in 2021 from about 8 million in 2020 (African Economic Outlook 2022).The government’s vision is to reach middle-income status with an estimated gross national income per capita of US$1,560 by 2025.

Urban population growth and urbanization: Ethiopia is one of the nations with fast urbanization rate (more than 4.8% per year)9. However, the country is the least urbanized in the world with only 20 percent of the population living in urban areas, significantly below the sub-

Saharan average of 40.4%.

6 Assebe LF, Negussie EK, Jbaily A, et al. Financial burden of HIV and TB among patients in Ethiopia: a cross sectional survey. BMJ Open 2020;10:e036892. doi:10.1136/ bmjopen-2020-036892

7 https://www.worldometers.info/world-population/ethiopia-population/ 8 https://www.macrotrends.net/countries/ETH/ethiopia/gdp-per-capita 9 https://www.macrotrends.net/countries/ETH/ethiopia/urban-population https://www.afdb.org/en/documents/african-economic-outlook-2022 https://www.worldometers.info/world-population/ethiopia-population/ https://www.macrotrends.net/countries/ETH/ethiopia/gdp-per-capita https://www.macrotrends.net/countries/ETH/ethiopia/urban-population

The state of Urban Cities: In Ethiopia young population are migrating to cities seeking for better education, job opportunities and better life qualities. As a result, the capital and other secondary cities are experiencing the deleterious impact of rapid urbanization as the cities are failing to meet the demands of growing numbers of urban residents in three critical areas: access to jobs, infrastructure and services, and housing.

- Access to Jobs: According to the 2020 urban employment unemployment survey conducted by Ethiopia Central Statistics Agency urban unemployment rate was 18.7% (male 12.2% and female 26.1%). According to the same study, in urban areas there were 163 non-employed persons per one hundred employed persons. In other words, for every

100 employed persons, there are almost 163 dependents to be supported in terms of food, clothing, health, education and so on.

- Access to adequate infrastructure and services. While access to services, such as water, sanitation, solid waste, and electricity, is significantly better in urban areas than rural areas, it nonetheless remains low. Ninety percent urban households in Ethiopia have access to basic water services (i.e., water from an improved source, with collection time not more than 30 minutes round trip), 93% have access to electricity. However only 16% use improved sanitation (e.g., flush/ pour-flush to piped sewer/septic/latrine and a significant number of households in urban areas has no basic hygiene facilities10. The challenge of providing infrastructure and services is not just to meet current levels of demand, but also that of the rapidly expanding urban populations.

- Housing condition: Housing quality in Ethiopia, in terms of materials used for construction, is considered poor compared to other countries. It is estimated that 70-80% of the urban population in Ethiopia live in settings that are believed to be slums (according to the international standards) and 65% of urban households use a single room for sleeping, yet the average urban household size is 3.5 persons. The main drivers of urban slums in

Ethiopia are population growth, rural to urban migration, poverty, and poor governance.

Tuberculosis context and National responses priorities in Ethiopia: Ethiopia has reduced the TB incidence rate by 31.3% and the TB mortality by more than 34.6% between 2015 and 2020 achieving the 2020 WHO End TB strategy milestone. With the concerted effort, the burden of MDR/RR-TB has also significantly reduced which enabled the country to transition out from the list of 30 high MDR/RR-TB countries. Despite the remarkable progress so far achieved, in Ethiopia TB is still a major public health problem. According to the 2022 Global TB report an estimated 143,000 incident TB cases, and 19,000 estimated TB related deaths occurred in 2021.

During the same period, Ethiopia has notified 104,606 drug susceptible TB cases leaving behind more than 38,000 people with TB which is a favorable and fertile ground for an ongoing community level transmission and increasing the risk of delayed diagnosis if not death from the illness. The National TB program has also detected 518 DR-TB cases and linked to second line treatment.

National Strategic plan and priorities to End TB 2021-2026: Ethiopia has adopted the global

End TB targets and strategies, and the latest strategic plan document is in line with UNHLM targets

10 T. Matsumoto, J. Crook; sustainable and inclusive housing in Ethiopia: A POLICY ASSESSMENT and to the broader global commitment to end TB by 2035 by reducing TB incidence by 90%, TB associated mortality by 95% and avoid financial hardship to household of TB patients11.

National strategic plan (2021-2026) priority interventions include but not limited to; establishing equitable access to quality assured comprehensive TBL diagnostic and therapeutic services to all population groups, prevent infection and active TB disease among people who are at increased risk, mitigate TB related stigma in the community and healthcare settings, promote the human right, gender, social and financial protection of TB affected and under-served population and support resilient and functioning systems for TB including adaptation of TB programming approaches to the population dynamics, and proactively manage and mitigate potential impacts of COVID-19 on basic TBL services12.

National initiative on Finding the missing people with TB from key affected populations.

NTP/MoH has developed National operational guidance on TB programming for key affected populations to address TB among these key populations13. With the support from Global Fund and USAID implementation mechanisms the National TB program along with regional health bureaus has mapped and conducted a prioritization exercise of key affected population groups. Besides, tailored TB case finding activities among Key affected population groups has been started in all regions. The NTP has also included the recording and reporting of TB among selected key affected populations in the revised Unit TB register and DHIS2 reporting formats. Hence, lessons learned from the intervention should be used to further refine and map the Key populations groups in the different geo settings to reach the underserved populations and guide the TB program to enhance its effort to end TB in the country.

4. Activity Description

USAID Urban TB LON II Activity aims to provide comprehensive TB program support: TB/DR- TB detection, treatment, and prevention through improving access to high-quality, and patient-centered TB services in Addis Ababa, Dire Dawa, Harari and other secondary cities. This activity will focus on empowering the local community for their meaningful engagement to improve TB service delivery through introducing social accountability, reduce TB stigma and promote health seeking behaviors of the community, with particular attention to underserved, marginalized and the most at-risk key population segments who are likely to suffer from the dire consequences of TB. The activity will introduce a social accountability program and involve TB affected communities and their representatives in the local urban community health platforms to provide quality TB service. The Activity will also build the organizational capacity of local partners to enhance the local policy and environment and support multi-sectoral TB response to sustain and scale up urban TB programming.

11 WHO. 2015. Implementing the end TB strategy: the essentials 12 FMOH. 2020. Tuberculosis and Leprosy National strategic plan document 2021-2026 13 FMOH. 2018. Finding Missed TB cases in Ethiopia: Operational guide and National plan for 2018-2020

Goal

The overall Activity’s goal is to reduce TB incidence and mortality through citizen responsive, locally led, and accountable urban community health systems to achieve end TB strategy targets set for 2030.

Major End of Activity Objectives:

● 90 percent of individuals with TB notified, including 50% from key affected population.

● 70 percent of eligible individuals provided with TB preventive treatment.

● 90 percent of individuals with drug-sensitive and drug-resistant TB successfully treated.

● 70 percent of the local organizations enrolled in the TB LON platform achieved improved performances using the NUPAS/OCA performance matric score.

● 70% of supported urban PHCU implement citizen responsive TB programming.

Activity Description and Expected Results:

The applicant is expected to clearly describe the proposed intervention approaches that will lead to the achievement of planned indicators performance target (output, outcome, and impact) for each sub-IR.

IR 1: Reach all people with TB and DR-TB

This IR intends on finding missing people with TB/DR-TB through maximized implementation of high impact TB/DR-TB case finding interventions and uptake up of WHO approved rapid molecular TB diagnostic with a greater emphasis on optimizing community -based TB service delivery to address the underserved urban communities.

Expected results:

● Improved implementation and coverage of contact investigation

● Improved Community TB contribution

● Improved TB /DR-TB treatment coverage

● Improved access to TB/DR-TB services for key affected and vulnerable populations in urban settings.

● Improved engagement of private and other non -governmental organizations in TB service delivery

● Improved Universal DST coverage for TB/DRTB cases.

IR 2 Ensured People centered TB/ DR-TB treatment and prevention services.

This IR intends to successfully treat people with TB/DR-TB, improve TB preventive therapy among nationally prioritized population groups and address psycho-social and economic needs of people with TB/DR-TB

Optimal degree of adherence remains the mainstay of treatment to achieve favorable outcomes.

This Activity will promote and support the implementation of people-centered differentiated care strategies that are tailored and sensitive to every individual with TB to early initiate and ensure optimal degree of treatment adherence. The Activity should come up with cost effective and feasible TB and other comorbidities (HIV, Mental health etc.) management. This Activity is expected to employ innovative approaches and collaborate with other stakeholders to address the psycho-social and economic needs of people with TB/DR-TB.

Expected results:

● Improved TB/DR-TB/Preventive treatment success rate

● Implementation of differentiated TB service delivery model

● Improved access to Psycho-social and economic support services

IR3: Responsive, locally led Urban TB programing built to accelerate progress and support pandemic preparedness.

This IR intends to build the organizational capacity of local partners and leverage the experience and connections of local government, civil society partners, community-based organizations, and academic institutions to strengthen the health systems for TB service delivery and sustainability.

The Activity will emphasize on Sub-city/woreda led TB programing and will build the capacity of

Urban TB programing in the Primary Health Care units to provide comprehensive TB service. The Activity will work towards establishing a system that is responsive to the local community needs.

It also supports and empowers the local community and local organizations' engagement for resilient TB programming and introduces a social accountability framework in the urban health systems to uphold the PHCU and Woreda administration accountable to respond to the needs of underserved communities, including stigma, discrimination, and other rights-violations.

Expected result:

● The organizational capacity of local partners with improved organizational performance matric as per Agency’s Localization implementation framework

● Improved capacity of PHCU and sub-city for local-led TB programing

● Increased number of PHCU implementing social accountability framework for TB

5. Guiding Principles

The full, detailed development of USAID Urban TB LON II Activity design, implementation approach and work plan will be carried out through mission-led co-design process with the engagement of key stakeholders including representatives from TB key affected communities, TB survivor associations, National TB program, and Regional Health Bureaus to facilitate implementation, and address key challenges.

USAID suggests considerations of the following seven overarching principles as guide in developing TB Activity approaches. Applicants may recommend modifying and/or further expanding these principles to tailored to the existing local situation of this activity:

1. Diversity, Inclusion, Equity and Accessibility (DIEA): USAID’s TB program will work to promote, enhance, and sustain diversity and inclusion in all activities. To meet the goal of equity, USAID TB LON will prioritize working with underserved communities, and those who are in the greatest need.

2. Local Ownership and Leadership: USAID will continue to partner with local governments and organizations and support their direct implementation of TB activities.

USAID will actively engage with countries’ leadership to promote program ownership, through both active program monitoring and increased local investments. USAID will continue to support high-level advocacy to actively engage local leaders and communities in eliminating TB at the national level.

3. Person-Centered Approach: USAID will continue to put the individuals and communities affected by TB in the center of all interventions. USAID will support countries in building a holistic, individualized, respectful, and empowering health service delivery system for TB that includes TB-affected individuals in decision-making regarding the development, implementation, and evaluation of care and treatment services. USAID will support national/regional/local TB programs in adopting flexible and tailored approaches that minimize health system barriers and personal costs and meet the needs and preferences of people affected by TB to improve individuals’ health outcomes.

4. Effective and Efficient Programming: USAID will strive for the effective and efficient use of funds to achieve value for money. USAID will remain flexible and responsive to adapt to the new challenges and situations of the TB epidemic in partner countries.

5. Strategic Partnership and collaboration: USAID will continue to work with partners including WHO, CDC, the Stop TB Partnership, the Global Fund, and others to achieve global goals. As the lead agency for the USG international TB efforts, USAID will continue to coordinate other USG TB efforts, and leverage investments to achieve more.

6. Evidence Driven Programming: USAID will support the availability of high-quality, updated, and rigorous systems for TB care across partner countries. USAID will also evaluate systems to generate evidence that will help to improve strategic planning, project design, and resource decisions.

7. Multisectoral Approach: USAID will support the implementation of a multi-sectoral approach to achieve effective accountability, through the use of social accountability approaches, of local governments and all stakeholders–at global, regional, and country levels–in order to accelerate progress to end the tuberculosis epidemic.

III. Eligibility information

Local non-governmental entities are eligible to submit a concept paper. USAID welcomes and encourages concept papers/applications that include organizations as sub-partners for technical assistance and organizational capacity building. Only local entities are eligible for award as a prime. Definition of “local entity” as an organization, a corporation, or another body for persons that:

1. Is legally organized under the local Ethiopian law.

2. Has its principal place of business or operations in Ethiopia; and

3. Is majority owned by individuals who are citizens or lawful permanent residents in Ethiopia, and

4. Is managed by a governing body, the majority of whom are citizens or lawful permanent residents of Ethiopia.

The majority owned and managed by Ethiopians and /or permanent residents of, include without limitation, beneficiary interests and the power, either directly or indirectly, whether exercised or exercisable to control the election, appointment, or tenure of the organization’s managers or a majority of the organization's governing body by any means.

The recipient must be a responsible entity and have the necessary organizational experience, accounting system, operational controls, and technical skills/knowledge/ability to obtain them to achieve the expected objectives of the addendum and comply with the terms and conditions and standards of the award and USAID.

It is the responsibility of applicant organizations to be compliant with the local Government’s regulations for receiving US government funds through a federal assistance program.

Concept papers from organizations that do not meet the above eligibility criteria will not be reviewed and evaluated. Individuals are not eligible to apply for this addendum/APS.

USAID Ethiopia strongly encourages concept papers from potential partners to the US government who meet the above eligibility criteria. Such organizations are strongly advised that they will be required to undergo a pre-award responsibility determination, a process to determine fiscal responsibility (whether the prospective recipients have the necessary organization, experience, accounting and operational controls, and technical skills-or ability to achieve the objectives of the project and comply with the terms and conditions of the award.

While for profit organizations may participate, pursuant to 2CFR 200.400(g) it is USAID policy not to award profit to prime recipients and subrecipients under the assistance instruments. However, while profit is not allowed for sub-awards, the prohibition does not apply when the recipient acquires goods and services in accordance with 2 CFR 200.317 -326, “Procurement Standards.” This is discussed more in detail in ADS 303 sai “Profit Under USAID Assistance Instrument'' which can be found at this link:

https://www.usaid.gov/sites/default/files/documents/1868/303sai.pdf

IV. Additional Considerations

Prior to submitting a Concept Paper, applicants should ensure that submissions are in line with the US Government Global TB Strategy and Ethiopia’s National TB leprosy strategic Plan (TBL NSP 2021-2025) . Successful Concept Papers will also align closely with the broader priorities of USAID/Ethiopia.

USAID/Ethiopia is greatly interested in concept notes from organizations that have experience working in urban areas to deliver the expected results.

There is no cost share requirement for this Activity.

https://www.usaid.gov/sites/default/files/documents/1868/303sai.pdf https://drive.google.com/drive/folders/1xcH-aGWTWEVwbLU-lDLK5jU0c9ZS6Q8Q https://drive.google.com/drive/folders/1xcH-aGWTWEVwbLU-lDLK5jU0c9ZS6Q8Q

The resulting award from this Addendum to the TB LON APS will be administered in accordance with ADS 303mab, Standard Provisions for Non-U.S. Nongovernmental organizations (http://www.usaid.gov/ads/policy/300/303mab).

V. Concept Paper Template and Submission

USAID/Ethiopia is responsible for the review process and management of any awards issued under this Addendum.

Concept Papers, Full Applications, and management of any awards issued under this Addendum will be managed in accordance with the process described in the umbrella LON APS announcement.

a. Concept Paper Content and Template

● The Concept Paper must be specific, complete, presented concisely and written in English.

The Concept Paper must demonstrate the Applicant’s capabilities and expertise with respect to achieving the objectives.

● Based on the activities proposed by the Applicant, the proposed award size and duration must be specified in the Concept Paper. Proposed award duration can be less than or up to five years.

● The concept Paper must follow the template provided below. Excluding the cover page, the Concept Paper must not exceed ten (10) pages, using Times New Roman 12-point font, on standard A4 paper size, and single spaced with no less than one-inch margins and pages numbered consecutively. 10-point font can be used for graphs and charts. Any pages submitted beyond the ten-page limit will not be evaluated.

● Additional documentation, such as annexes, charts and graphs that exceed the ten pages will not be reviewed. USAID will not review any information provided in links in the Concept Paper.

● The Concept Paper must be submitted in PDF format.

USAID URBAN TB LON II ACTIVITY CONCEPT PAPER TEMPLATE

A. Cover Page – to the extent possible or applicable, please complete the following questions below: [Note that #1-9 shall be submitted as a cover page, not included in the ten-page limit for the Concept Paper.]

1. Proposed Activity Name/Title: _________________________________________

2. Proposed Period of Performance (i.e., start date and end date): ________________

3. Overall Estimate of Funding Requested (in USDs, not to exceed $7.5 million):

4. Applicant Organization Name: _________________________________________

5. Applicant Contact Person (name, title, phone, email): ________________________

6. Full Address for Applicant Organization: ________________________________

7. Type of Organization (e.g., non-US, multilateral, private, for-profit, non-profit, date of incorporation, and place of incorporation, etc.):

8. Name(s) of Partner(s) (Applicants that are Implementing Partners will name Resource Partner(s) (if any) here): ___________________________________________________

9. Unique Entity Identifier from System for Award Management (SAM):___________ Note: USAID may not award to an applicant unless the applicant has complied with all applicable requirements in www.sam.gov to get the Unique Entity Identifier from System for Award Management (SAM). The applicant is required to:

1. Provide a Unique Entity ID for the applicant.

2. Be active in www.sam.gov before the award.

The registration process may take many weeks to complete. If your organization does not have a Unique Entity ID or is not registered in SAM when submitting a concept paper, the applicants are encouraged to begin the process early. If an applicant has not fully complied with the requirements above by the time USAID is ready to make an award, USAID may determine that the applicant is not qualified to receive an award and use that determination as a basis for making an award to another applicant.

B. Concept Introduction and problem analysis: (1 page) Identify the TB problem you will address, linking it to the problem statement described above and briefly describe your intervention for tackling this problem. present summary analysis of regional socio -economic and health determinants relevant to urban TB. Describe why there is a strategic need for your concept, how it differs from alternatives and any relevant gender-specific considerations for the problem or solution.

C. Beneficiaries: (½ page) Describe the types of benefits the intervention will produce and the types and range of people who will benefit from this intervention. Does this concept meaningfully engage urban underserved communities in all proposed stages of the concept to enhance their ability to determine their own priorities? Has it or can it be adapted to reach both women and men? How can the concept be scaled up to reach more people?

D. Geographic Location: (½ page) In what location(s) (e.g., regions, district/woreda, city) are you proposing to operate under this proposed partnership, and reaching approximately what total population? Describe key elements of and actors in the value chain or intervention in the geographic location(s) in which you propose to work. What are the biggest challenges and opportunities?

E. Intervention approach: (3½ pages) Building on the introduction, propose a Theory of Change for how this intervention will produce the desired impact in the focus area(s) identified. Briefly describe critical barrier(s) or problem(s), related to your focus area(s) that your concept addresses. Be sure to include information describing why the approach is creative or innovative, how it is potentially scalable, and evidence to support it as a tested solution or as an intervention likely to have a significant development impact, and how it will be sustained. The analysis should consider population demographics, disease burden, geography, and present a reasonable theory of change. The concept paper should demonstrate current knowledge of the primary challenges http://www.sam.gov/ http://www.sam.gov/ related to TB implementation among Urban population, and a strong understanding of the opportunities for and barriers to achieving the project purpose.

F. Intervention results: (2 page) As specifically as possible, describe the Result framework and monitoring plan for the anticipated outputs, outcomes, results and/or impact of the proposed intervention. What is the key, quantifiable metrics related to your project’s performance or expected performance? What is the scale needed to achieve results sufficient to add ress the problem? What are the baselines that you will measure before the project begins? Propose the adaptive management approach to be implemented in the project.

G. Partner roles: (1 page) If applicable, describe and define the role of any other entities in the partnership. This must include a description of how roles will be divided and managed efficiently.

This should also discuss partnership with the private sector and health service providers other than the formal public system including multi-sectoral response.

H. Applicant capacity: (1 ½ page) Describe organizational capacity – technical, managerial, financial, etc. – to carry out the proposed intervention. Describe the business model for your innovation. Describe the experience of your organization in the past five years and its relevance to the USAID Urban TB LON II Activity description.

b. Concept Paper Submission

● All Concept Papers must be submitted by the closing date listed on page 1 of this

Addendum. Submissions received after the specified closing date will not be eligible for review.

● The subject line of concept paper email submissions must indicate:"[APS number], Addendum Title ‘USAID Urban TB Local Organizations Network (LON) II Activity in Ethiopia’, and applicant’s name in the subject line [Organization Name]"

● Concept Papers must be submitted by email to LON@usaid.gov and caddis@usaid.gov.

VI. Merit Review Process for Concept Papers

All concept papers received by the deadline stated on the Addendum cover page and as revised via amendment of and annex to the APS Addendum will be reviewed for eligibility and compliance with the instructions for submission prior to evaluation against the merit review criteria listed in this section. The Agreement Officer will forward to the Selection Committee (SC) those concept papers that are complete and comply with the instructions for submission. The SC will then conduct a merit review of the concept papers.

The final selection of successful concept papers will be determined by the AO. A concept paper is determined to be successful if it receives a “Pass” based on the merit criteria specified in the relevant Addendum.

USAID will not provide feedback on concept papers that do not pass. USAID does not anticipate providing feedback to those applicants that pass as they will be invited for co-design; however, it mailto:LON@usaid.gov mailto:caddis@usaid.gov reserves the right to provide written feedback. Should such feedback be provided, it will be provided to all applicants that pass.

VII. Merit Review Criteria

The Merit Review criteria to be considered when reviewing concept papers by the selection committee are listed below, in descending order of value and will be scored using adjectival scoring:

I. Overall technical merit of the concept: the extent to which the concept paper result framework is in line with Agencies' CDCS (Attachment 2), proposes technically sound and programmatically feasible implementation strategy and methodology to measure intended results/outcomes. The level to which the concepts identify key partners and relevant initiatives, demonstrates the potential risks and opportunities, and intends to incorporate key cross-cutting issues in the project design and implementation.

II. Local context analysis and understanding of TB situation and key determinants in rapidly urbanizing big cities of Ethiopia: understanding of the socio-cultural determinants, TB risk drivers, and local urban community health systems’ capacity affecting the quality of TB programming including identification of key priority TB underserved population in the targeted areas.

III. Application of globally recommended high impact TB strategies and interventions with proposed innovative implementation approaches: The extent to which the proposed interventions and activities to achieve intermediate results are aligned to the USAID Global TB strategy, National TBL strategic plan, END TB strategy to accelerate progress and sustainably build local systems capacity. The extent to which proposed local solutions and innovative approaches are practical, impactful, scalable. The deliberation for local CSOs engagement in such a way that they can be real representatives and the voice of key affected and vulnerable communities and the urban community in general.

IV. Organizational capacity: Local organization(s) which demonstrates institutional capacity to manage grants of equivalent complexity on technical, financial and project management capacity, prior successful experience of the applicants in supporting Urban TB programming in the context of urban community health programming of the host country.

Proven experience working with international organizations, or USG.

Phase 2: Co-design Process

The Agency will invite only concept note(s) from the apparently successful applicant(s) to proceed the co-design process of the Urban LON II activity.

The co-design is a collaborative process to identify and develop the activities that will help achieve the results desired under this APS and relevant Addendum; identify and incorporate additional partners; and determine respective roles and responsibilities related to the implementation of those activities.

The co-design process, led by the USAID co-creation team, builds on a Concept Paper that has strength and potential; it is not intended to supplant Applicants initiative or build new concepts from the ground up. USAID envisages a product of the co-design process as a strong draft project description for the award development phase, as well as quantitative and/or qualitative indicators or performance milestones. The USAID co-design team will recommend to the Agreement Officer the Apparently successful Applicant that has successfully completed the co-design process to advance to the final award development. Applicants that successfully complete this process will advance to Phase 3.

As noted above, successful completion of co-design will be determined by the co-design team when the applicant has developed a strong draft of the project description for the award development phase, as well as sufficient quantitative and/or qualitative indicators or performance milestones. USAID does not expect that all applicants will successfully complete co-creation, but only those whose proposed approach and capacity are directly aligned with USAID intervention priorities.

If an Applicant fails at the co-creation phase, the process ends for that applicant.

Phase 3: Award Development

In Phase 3 applicants are advanced to the Agreement Officer, based on the recommendation of the co-design team, for further review and to inform award instrument negotiation and finalization.

During this process, the applicant can further refine the technical approach, general resource requirements, and management control of the project under the guidance of the Agreement Officer.

During Phase 3, the applicant will develop the budget during this stage in the format specified by the Agreement Officer. The applicant may also be asked to provide more information about its technical approach, capacity, management and organization, past performance, and budget, as well as certifications and representations, or other information, as needed.

The Agreement Officer, in conjunction with the USAID co-design team, will engage in the final review process, negotiation, and apply Cooperative agreement as an award instrument and determine the level of engagement.

As per the ADS 303.3.11 guidance on Substantial involvement, the following level of engagements are proposed for successful implementation of this award:

● The Agency’s approval of the recipient’s implementation and arrangement plans during performance,

● The AO’s prior approval for the recipient to transfer the role and responsibili ties of the prime partner to its TB LON partners to minimize programmatic and financial/grant management risks and vulnerabilities to the activity,

● The AO shall be engaged in the decision processes for any changes in the geographic and implementation arrangements during implementation to ensure alignments to the Agency’s interest while achieving the end results, and

● The AO’s active engagement is required in the planning, provision of technical guidance and monitoring of local implementers…