VMMC RFI USAID Malawi.pdf

REQUEST FOR INFORMATION (RFI)

RFI Number: RFI-265-0922 Issuance Date: September 30, 2022 Closing Date/Time: October 28, 2022 - 4:00 PM Lilongwe Local Time Subject: Request for Information for USAID/Malawi VMMC Service

Delivery Provision Activity.

Greetings Stakeholders:

The United States Agency for International Development (USAID) Mission in Malawi seeks feedback from all interested organizations regarding the currently planned USAID/Malawi VMMC Service Delivery Provision Activity.

The purposes of the Request for Information (RFI) are as follows:

1) To allow industry and interested organizations to review comments and make scope-related suggestions.

2) To receive responses to the RFI questions below; and

3) To increase USAID's knowledge of potential offerors' capabilities and solicit information that will allow the agency to better prepare a solicitation that meets the agency's needs for this potential new activity.

USAID/Malawi intends to consult with the broad community of HIV prevention sector actors, particularly in Malawi. Your feedback is requested to assist in refining the potential scope to ensure clarity, maximum development impact, sound coordination with existing activities, and alignment with the Government of Malawi top priorities.

THIS IS ONLY A REQUEST FOR INFORMATION (RFI), issued solely for planning and informational purposes. It is not a Request for Proposal/Application/Quotation, an Invitation for Bids, or a Solicitation, and any proposals/applications submitted in response will not be considered. The information provided in response to the RFI is subject to change and does not bind the government. This request for information does not obligate the United States Government to issue a solicitation. In addition, USAID/Malawi is not currently soliciting applications and will not accept unsolicited submissions. All costs associated with responding to this RFI are solely the responsibility of the interested party.

The United States Government will not pay for any information or administrative costs incurred in response to this RFI, and the release of this RFI should not be construed as a commitment to do so or as authorization to incur costs for which reimbursement would be required or sought.

Responses to this RFI are strictly voluntary, will not be returned, nor will respondents be notified of the review's outcome.

If a solicitation is issued, it will be announced at a later date on https://grants-gov or https://sam.gov/ and all interested parties must respond separately to that solicitation announcement.

It is the responsibility of interested parties to monitor these websites, and it is the responsibility of interested parties to check these websites for additional information and updates. Respondents are advised that USAID is under no obligation to acknowledge receipt of the information, respond to questions, or provide feedback regarding any information submitted.

Notably, responding to this RFI will not provide any advantage to any organization, and failure to respond does not preclude participation in any future solicitation, if one is issued.

RESPONSES:

All interested parties may respond to this RFI with any supporting documentation. Respondents may submit responses in Microsoft Word or Adobe Acrobat formats via email to OAA- MALAWI-SOLICIT@usaid.gov by no later than October 28, 2022, at 4:00 p.m. Lilongwe Time.

Responses to the RFI must be written in English, in formats compatible with Microsoft Word, with a 12-point font size, and are limited to one per organization. Please number each page consecutively and use the subject line RFI-265-0922 - USAID/Malawi VMMC Service Delivery Provision Activity. Please note that there will be no opportunity for questions during this RFI. To facilitate USAID review, please limit responses to five (5) pages or less including any attachments.

If any proprietary information exists, it must be clearly marked. To assist the Government, please clearly label any proprietary information as such. The information obtained through this RFI will be kept confidential. Responses will be used to inform USAID's strategy and activity design and may be incorporated into future requests for proposals. Please note that feedback will not be provided individually. All submissions become the property of the government and will not be returned.

Thank you for your interest in USAID/Malawi projects and thank you for responding to this RFI.

Viktoria Stott Hollosy Agreement Officer https://grants-gov/ https://sam.gov/ mailto:OAA-MALAWI-SOLICIT@usaid.gov mailto:OAA-MALAWI-SOLICIT@usaid.gov

ACTIVITY SCOPE:

USAID/Malawi is planning the next phase of activities to support the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the Government of Malawi national HIV response. USAID/Malawi seeks to incorporate feedback from stakeholders into the design of upcoming activity that aim to increase uptake of proven, high-impact HIV prevention interventions among men aged 10-49 years.

Malawi has one of the highest HIV prevalence rates in Southern Africa. The HIV prevalence among adults aged 15-49 years was estimated to be 8.8 percent in the 2015-16 Malawi Demographic and Health Survey (DHS). However, according to the most recent SPECTRUM estimates, the prevalence has fallen slightly over the last five years to 8.5 percent, with women continuing to have a higher prevalence of 10.4 percent (10.8 percent in the DHS) than men, whose prevalence is estimated to be 6.3 percent (6.4 percent in the DHS). This represents a further decrease from the 2010 Malawi DHS results, which estimated the national adult (15-49 years) prevalence at 11%.

According to the 2015-16 DHS, HIV prevalence was twice as high in urban areas as it was in rural areas (14.6 percent versus 7.4 percent). HIV prevalence was more than twice as high in the Southern region (12.8 percent) as it was in the Northern (5.1 percent) and Central (5.6 percent) regions. This appears to be the case in the most recent SPECTRUM estimates. Most new infections are occurring in the country's south. Six districts (Lilongwe, Blantyre, Mangochi, Thyolo, Mulanje, and Zomba) accounted for 53% of all new infections in 2021, while 17 districts had fewer than 500 new infections. The fact that women have a much higher number of new cases than men is notable in these estimates. 15 percent of the 20,000 new infections in 2021 were children (0-14 years old; from mother-to-child transmission), 31 percent were men, and 54 percent were women. AGYW accounted for 25percent of all new infections, while men aged 20 to 39 years accounted for 24 percent.

Following the adoption of the VMMC Policy in 2012, the Malawi Voluntary Medical Male Circumcision (VMMC) program was launched. Scaling up the program and meeting national targets has been slow. There is regional variation in prevalence and uptake, with the Southern region having the highest coverage, followed by the Central and finally the Northern regions, owing to cultural differences. Several guidance and policy documents, including the Revised National Policy on VMMC, Standard Operating Procedures for Service Providers, and a National VMMC Communication Strategy 2020-2025, have been finalized in the last two years.

The National AIDS Commission (NAC), in collaboration with partners, has created a new HIV Prevention Strategy for the years 2022 to 2026. One of the aims and objectives of the Strategy is to increase VMMC coverage among males aged 15 to 49. The strategy will guide national HIV prevention efforts for the next five years, in accordance with the recently developed 2020-2025

National HIV and AIDS Strategic Plan and with the goal of achieving the most recent prevention targets for 2025 as outlined in the new Global AIDS Strategy.

The NSP targets for VMMC for 2015-2020 were developed based on the incidence and prevalence of HIV, as well as the assumption that adequate financial resources would be available to cover all 28 districts in the country. From 2015 to June 2018, all 28 districts were supported by PEPFAR and the World Bank, and uptake was high. However, the end of the World Bank grant in June 2018, which had essentially provided most of the support to VMMC, changed the equation, resulting in a gradual decline in performance. Only 11 districts received partner support in the following fiscal year 2019-2020: PEPFAR in eight districts and the Global Fund in three districts.

The 2020-2025 HIV NSP targets were developed based on the potential impact and cost effectiveness of VMMC scale up at the district level, which is determined by (i) the size of the overall male population, (ii) the incidence of HIV among men, and (iii) the baseline proportion of circumcised men in the population. Based on cost effectiveness and the most recent district risk profile, the VMMC program intends to perform 940,000 circumcisions in 12 priority districts: Machinga, Mangochi, Zomba, Blantyre, Chiradzulu, Balaka, Mulanje, Phalombe, Thyolo Nsanje, Chikwawa, and Lilongwe, to achieve 80 percent coverage. The 2020-2025 HIV NSP focuses on middle-aged men (25-39) for maximum public health benefits.

Many medical practitioners have been trained to perform MCs in recent years. Traditional circumcisers are being used as community influencers to mobilize men for VMMC, with trained medical personnel performing the actual surgery. The use of devices such as the Shang Ring makes VMMC more acceptable while decreasing the number of adverse events (AE). Because of the task-shifting to lower cadres, the Medical Council has approved the training of medical assistants to perform the procedure.

As part of the consultation process, USAID/Malawi invites feedback from stakeholders on innovative approaches to reach the intended populations with VMMC to address any implementation gaps. The following information will be of great assistance in interested parties’ statements:

• Whether the registration status of the interested organization is local Malawian1, US-based, or non-US regional.

• Programmatic expertise and accomplishments in reaching targeted populations with HIV services in the VMMC program area.

• Total and HIV-specific budget of the organization over the past five years.

• Experience of the organization working with local structures at the national and district levels, including the Government of Malawi.

1 Please refer to ADS 303.6 for USAID’s definition of a local entity and the COP/ROP 2022 Guidance for PEPFAR definition of a local entity (Pages 104-105).

https://www.usaid.gov/sites/default/files/documents/303.pdf https://www.state.gov/2022-country-operational-plan-guidance/

RFI QUESTIONS:

Question 1: Level of VMMC Service Delivery Provision Activity Interest

a) How interested are you in this development opportunity using the below scale?

● 1 = Zero Interest

● 2 = Limited Interest (20% probability we will submit an offer/application)

● 3 = Moderate Interest (50% probability we will submit an offer/application)

● 4 = High Interest (75% probability we will submit an offer/application)

● 5 = No Doubt (100% probability we will submit an offer/application)

b) Are you interested in implementing as a prime or subcontractor/subawardee? In that case, what specific capabilities does your organization bring to achieving the Activity's goals?

Question 2: Interested organizations are encouraged to explain why their mission, programs, or activities merit federal support in relation to the activity overview. Specifically, please discuss your organization’s experience in implementing a donor funded VMMC program and how funds would aid the interested organization in implementing the VMMC program in relation to third parties (e.g., GOM departments and institutions, local organizations, target beneficiaries, etc.).

Question 3: How have you previously implemented or currently implementing VMMC program activities with USAID (i.e., contract or cooperative agreement or other mechanism)? Was/Is this, in your experience, the most effective method for achieving program objectives? Please do not provide a mechanism-type recommendation for this activity.

Question 4: Please indicate whether USAID should consider technological advancements that, if incorporated into this activity, could result in exponential development gains.

Question 5: What are the most significant opportunities or challenges in achieving these results in relation to the global pandemic of COVID-19, climate-related weather events, and other challenges?

Question 5: Lessons Learned: If not addressed in previous questions, please provide some lessons learned that USAID should consider as it refines this requirement based on the interested organization's implementation of similar programs and activities, particularly in terms of technical solutions that worked (and why), solutions that did not work (and why), risks associated with similar operational environments, and other opportunities/constraints that would impact success in this instance.

Question 6: Target populations - Is it feasible and as inclusive as possible to target males aged 15 years and older?

Question 7: How would you ensure effective learning and adapting in the VMMC service delivery activity?

Question 8: As Malawi has reached epidemic control, please tell us how your organization can make VMMC more sustainable including ideas to engage the private sector.

Question 9: If you have any specific concerns or considerations to bring to the attention of USAID, please succinctly note it here.

[END of RFI-265-0922]