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> **Issuance Date: May 22, 2006**
>
> **Closing Date: June 29, 2006**
>
> **Closing Time: 3:00 pm Nairobi local time**

[Subject:]{.underline} RFA 623-A-06-21

> AIDS, Population, and Health Integrated Assistance Program (APHIA II)

Dear Prospective Applicant:

The United States Government, represented by the U.S. Agency for
International Development, (USAID) intends to enter into a cooperative
agreement for the implementation of the APHIA II program, as more
specifically described in Section I, entitled Program Description. To
this end, USAID is seeking applications from qualified U.S. and non-U.S.
organizations and institutions, in the form of partnerships or consortia
that include Kenyan organizations, interested in providing the services
described in this solicitation. This is full and open competition, under
which any type of organizations, large or small commercial (for profit)
firms, faith-based, and non-profit organizations in partnerships or
consortia, from geographic code 935, are eligible to compete. In
accordance with the Federal Grants and Cooperative Agreement Act, USAID
encourages competition in order to identify and fund the best possible
applications to achieve program objectives.

USAID plans to award one, five-year (3 base years plus 2 option years)
cooperative agreement. Subject to the availability of funds, the costs
of the agreement is estimated to range between:

Western Province \$32-35 million

Of the total funding provided for this award, for Western Province up to
90% is expected to be HIV/AIDS funds and approximately 10% is expected
to be population funds. Child Survival funds may also be added.

Since the award will be a cooperative agreement based on the successful
application, this RFA does not specify a level-of-effort (LOE). The
applicant is to propose the LOE and staffing according to the
applicant's strategy for achieving the objectives specified in the RFA.
The applicant is also to propose key personnel positions and candidates.
The key positions are described in Section IV, however applicants may
propose alternative positions as key positions other than the ones
specified, with adequate justification.

Pursuant to 22 CFR 226.81, it is USAID policy not to award profit under
assistance instruments. However, all reasonable, allocable, and
allowable expenses, both direct and indirect, which are related to the
grant program and are in accordance with applicable cost standards (22
CFR 226, OMB Circular A-122 for non-profit organization, OMB Circular
A-21 for universities, and the Federal Acquisition Regulation (FAR) Part
31 for-profit organizations), may be paid under the grant.

For the purposes of this RFA, the term \"Grant\" is synonymous with
\"Cooperative Agreement\"; \"Grantee\" is synonymous with \"Recipient\";
and \"Grant Officer\" is synonymous with \"Agreement Officer\".

This solicitation includes a requirement for a 10% cost share. This cost
share is required to help ensure cost-effective programming on the part
of the consortia, to help ensure sustainability of local partners, and
help ensure that the consortia, including the local partner, have
additional capacity to mobilize resources. The cost share was set at the
low level of 10% so as not to discourage Kenyan or smaller international
organizations from joining a consortia bid.

When awarding a cooperative agreement under this RFA, USAID must make a
determination that the recipient complied with all applicable federal
and USAID regulations and policies. In particular, there are several
requirements applicable to specific aspects of the program to be funded
under this award. The partner that will be engaged in HIV/AIDS
activities will be required to sign cooperative agreements that include
Standard Provisions that implement requirements of the United States
Leadership Against HIV/AIDS, Tuberculosis and Malaria Act Of 2003. In
addition, a partner that will be engaged in HIV/AIDS activities will be
required to certify, before award of funds for HIV/AIDS activities, that
they are in compliance with these Standard Provisions. A full
description of these requirements and the Standard Provisions is set
forth in USAID's Acquisition and Assistance Policy Directive 05-04. The
partner that will be receiving assistance for family planning activities
will be required to sign cooperative agreements that include the
Standard Provisions entitled "Voluntary Population Planning." This
Standard Provision includes the clauses that implement the Mexico City
Policy. A full description of this Standard Provision (excluding the
Mexico City Policy requirements) is set forth in Contract Information
Bulletin 99-6, and a full description of the Mexico City Policy
requirements is set forth in Contract Information Bulletin 01-08. A
partner receiving funds for both HIV/AIDS activities and family planning
activities will be required to comply with the requirements applicable
to each activity. Any partner receiving funds for only HIV/AIDS
activities or only family planning activities will only be required to
comply with the requirements applicable to the activities for which such
partner receives funds.

If you decide to submit an application to be considered for award, it
must be received by the closing date and time indicated at the top of
this cover letter at the place designated below for receipt of
applications. Applications and modifications thereof shall be submitted
in envelopes with the name and address of the applicant and RFA \#
(referenced above) inscribed thereon, to:

(By U.S. Mail) (By All Other Means of Delivery)

Mr. Gary Juste, Regional Ms. Milly Warobi

Agreement Officer USAID/ECA/RAAO USAID/REDSO/ESA/RAAO

Unit 64102 ICIPE Complex, Kasarani Road

APO AE 09831-4102 Opposite Kasarani Police Station Nairobi, Kenya

Nairobi, Kenya

The technical and cost applications should be submitted in separate
volumes, in an original plus **five (5) copies technical and (2) copies
cost** clearly marked and indicate which geographic region they are
applying for under the RFA. Applications received after the deadline
cannot be considered.

[Note:]{.underline} Delivery to the post office or air courier
representative does not constitute meeting the statutory requirement
that proposals are received timely at the designated office. For
purposes of recording the official receipt of applications, the
date/time stamp of the procurement office at USAID/Kenya will govern.
Applicants should retain for their records copies of any and all
enclosures which accompany their applications.

Any questions about this RFA must be made in writing to Gary Juste,
preferably via email at <gjuste@usaid.gov> or Charis Nastoff at,
ntdy-r-guest02@usaid.gov or via facsimile (254)-20-862-2674 and must
reference the subject RFA number. For all inquiries, please provide a
contact person's name, phone number and email address. To allow adequate
response time, questions must be received by May 29, 2006. Questions
received after that date will be answered as quickly as possible, but
responses may not be issued until after the RFA closes. If USAID
determines that the answer to any question(s) is of sufficient
importance to warrant notification to all prospective recipients, the
RFA will be amended to provide such questions and answer(s). If USAID
determines that any question(s) does not warrant an amendment to the
RFA, USAID will respond by email to the inquirer.

Issuance of this RFA does not constitute an award commitment on the part
of the Government, nor does it commit the Government to pay for costs
incurred in the preparation and submission of an application. In
addition, final award of any resultant grant(s) cannot be made until
funds have been fully appropriated, allocated, and committed through
internal USAID procedures. While it is anticipated that these procedures
will be successfully completed, potential applicants are hereby notified
of these requirements and conditions for award. Applications are
submitted at the risk of the applicant; should circumstances prevent
award of a cooperative agreement, all preparation and submission costs
are at the applicant\'s expense.

The preferred method of distribution of USAID procurement information is
via Grants.gov on the World Wide Web (www). The address is
http://www.grants.gov. Select \"Find Grant Opportunities\", then click
on \"Browse by Agency", then select "US Agency for International
Development\", and search for the RFA. If you have difficulty with
accessing the RFA, please contact Ms. Sebrina Robinson at 202-712-0595
for technical assistance. Receipt of this RFA through grants.gov must be
confirmed by written notification to the contact person noted below. It
is the responsibility of the recipient of the application document to
ensure that it has been received from grants.gov in its entirety and
USAID bears no responsibility for data errors resulting from
transmission or conversion processes.

In the event of an inconsistency between the documents comprising this
RFA, it shall be resolved by the following descending order of
precedence:

\(a\) Section V - Selection Criteria;

\(b\) Section IV -- Agreement Application Instructions;

\(c\) This Cover Letter;

\(d\) The Program Description.

If there are problems in downloading the RFA off the Internet, please
contact the USAID Internet Coordinator at (202) 712-4442.

Sincerely,

Gary Juste

Agreement Officer

USAID/REDSO

**TABLE OF CONTENTS**

**AIDS, Population, and Health Integrated Assistance Program**

**(APHIA II)**

**Section Number Page**

**I. Program Description** 7

A. Introduction 7

B. Purpose 9

C. Background 10

D. Context of the RFA 21

E. Programmatic Emphasis of this RFA 24

F. Detailed Program Description 30

**II. Monitoring and Evaluation** 45

A. Performance Monitoring and Evaluation 45

B. Substantial Involvement 45

C. Deliverables and Reports 46

D. Performance-Based Evaluation 48

**III. Implementation Arrangements** 49

A. Anticipated Award Schedule 49

B. Funding 49

C. Work Week 49

D. Authorized Geographic Code 49

E. Eligibility Criteria 49

**IV. Agreement Application Instructions** 50

A. Preparation Guidelines 50

B. Technical Application Preparation 50

C. Cost Application Format 56

**V. Selection Criteria** 62

A. Overview 62

B. Technical Evaluation 62

C. Cost Evaluation 65

**VI. Certification, Assurances and Other Statements of Applicant** 66

Part I - Certifications and Assurances 66

Part II - Other Statements of Recipient 74

Part III - Special Provisions: 82

**APPENDIX** A Western Imperative Sites for APHIA II

> B PEPFAR & GOK Targets for ART and PMTCT by Province
>
> C PEPFAR Semi-Annual Report

D PEPFAR Semi-Annual Program Narrative

E Final Evaluation of the AMKENI Project

F FHI Impact/Kenya Mid-Term Evaluation

G Questions & Answers from Previous RFA

H Kenya Five Year Strategy Final October 2004s

**LIST OF ATTACHMENTS** Attachment 1 --Mandatory Standard Provisions

Website

Attachment 2 -- SF 424 Application for Federal

Assistance Website

Attachment 3 -- List of Acronyms

**SECTION I -- PROGRAM DESCRIPTION**

A.  **Introduction**

The U.S. Agency for International Development Mission to Kenya
(USAID/Kenya) is issuing this RFA for one Cooperative Agreement to
provide HIV/AIDS and Tuberculosis (TB) prevention, treatment, care and
support, and to a lesser extent, reproductive health[^1]/family planning
(RH/FP), malaria, and maternal and child health (MCH) services. The
geographic region that has been identified for support:

1.  Western Province

Specific sites for startup of implementation within these regions are
identified in Appendix A. This RFA describes a comprehensive health
service delivery program that applicants are expected to use while
developing a realistic application based on funding capacity. Applicants
are expected to develop as comprehensive a program as possible to reach
all of the results. Strategic linkages to other programs, both regional
and national, should be used wherever feasible to help leverage
programmatic results. It is anticipated that awards for the remaining
five geographic provinces will be made under the APHIA II RFA that was
released in December 2005.

The activities funded under this RFA are expected to improve and expand
facility and community-based HIV/AIDS, reproductive health/family
planning (RH/FP) and selected maternal and child health services.
HIV/AIDS services and activities are the most important component of
this procurement but integrating these services with TB, RH/FP, and MCH
services is required, to the maximum extent feasible. Also funded under
this RFA are selected training and operations research activities that
contribute to improved service delivery and which will be gradually
introduced and increased over the course of the project. USAID/Kenya
expects to award this Cooperative Agreement by September 30, 2006
pending availability of funds. They will be awarded for an initial
period of approximately three years. There will be a two-year renewal
option for this Cooperative Agreement, pending the results of a
performance-based evaluation by the end of the 24^th^ month. Consortia,
with local non-governmental organizations (NGOs), faith-based
organizations (FBOs) and new partners are requested to bid for these
Cooperative Agreements.

Applicants are restricted only by the Emergency Plan (PEPFAR) regulation
that no one organization may receive more than 10% of total PEPFAR (USG
President's Emergency Plan for AIDS Relief, or "Emergency Plan") funding
to Kenya in any given year. All applicants are required to be a
consortium in order to cover the broad range of services which are to be
integrated into the geographic area. Primes are strongly encouraged to
include the services of smaller, technically specialized organizations
wherever possible. USAID strongly discourages local NGOs from exclusive
relationships with partners in the application process, i.e. small NGOs
may pair with one or more prime partners if they wish, and appear in
several applications. Organizations may not form "exclusive"
relationships with GOK, private sector or mission service delivery
sites.

This RFA represents a transition in the way USAID/Kenya does service
delivery programs -- to an integrated geographic focus. In the first
year of this award, the emphasis is on continuity of service, to ensure
that no client on anti-retroviral treatment or related treatment is
dropped. Accordingly, budgets for the first year are expected to be
smaller than each consecutive year. A list of "imperative sites" in
Appendix A should be used as a guide to ensuring that all current
clients continue to receive services. Applicants are expected to
research existing programs to be able to identify clients and their
needs and ensure a smooth transition and continuity of service. In later
years of the award, emphasis will be placed on expansion and
improvement, as reflected in the results framework in this RFA.

The award is expected to receive multiple sources of funding, including
GHAI (Global HIV/AIDS Initiative funds, for Emergency Plan activities),
population funds (FP/RH), and child survival (CS) funds (child survival,
malaria, and other infectious diseases). While integrating services,
recipients must maintain the ability to report separately on the use of
each stream of funding, abiding by restrictions in the Foreign
Appropriations Act (FAA), and guidance issued by the Office of the
Global AIDS Coordinator for all HIV/AIDS components of the program. In
the first year, CS funds are extremely limited , but applicants are
expected to plan to leverage all existing funds, use creative
partnerships, and plan for increased integration of services if child
survival funds increase in later years. Of the total funding provided
for this award, for Western, up to 90% is expected to be HIV/AIDS funds
and approximately 10% is expected to be population funds. Child survival
funds may also be added, but are not expected to exceed 5% of the total
budget for these awards.

This award is considered key to the accomplishment of the US Government
(USG) Five-Year Strategy for the President's Emergency Plan for AIDS
Relief in Kenya, and USAID/Kenya's AIDS, Population and Health
Integrated Assistance Program (APHIA), which has been the framework for
USAID/Kenya's assistance to the health sector since 1999. Since this RFA
represents a new phase of assistance, the framework is referred to as
"APHIA II" and the agreement awarded will be named "APHIA II Western".

This award jointly comprise USAID/Kenya's program to deliver integrated
HIV/AIDS, TB, RH/FP, malaria and MCH services at the hospital, clinic
and community levels[^2] in their specific geographic region. Activities
within the region will link to national level systems[^3] to help
achieve their goals. Most of these national programs will be implemented
through other mechanisms. Applicants may suggest mechanisms to link with
or support these areas within their geographic area.

The APHIA II activity was developed in the USAID/Kenya Office of
Population and Health (OPH) by a design team that included
representatives of OPH, other offices within USAID/Kenya, other USG
agency partners including the Centers for Disease Control and Prevention
(CDC), the Government of Kenya (GOK), other donors, and the
USAID/Washington Global Health Bureau[^4]. The design also benefited
from the findings of the final evaluation of the AMKENI project (March
2005), a 2002 mid-term evaluation of the IMPACT project, and service
statistics from the Kenya PEPFAR Semi-Annual Report. These documents are
attached to this RFA.

USAID's HIV/AIDS program in Kenya is done as part of the combined US
government response to HIV/AIDS under The Emergency Plan. This RFA
describes USAID-funded activities within the country, which make up part
of the entire USG response. CDC, DOD, and Peace Corps have ongoing
programs in Kenya. The successful applicant of this RFA is required to
collaborate with and complement these projects. The Emergency Plan in
Kenya strives to provide health services to as many Kenyans nationwide
as possible without duplication of services or geographic areas.
Applicants should recognize that technical assistance may come from
these USG partners, in particular to ensure best practices.

B.  **Purpose**

    The APHIA II framework is designed to contribute substantively to
    USG and GOK goals in HIV/AIDS, TB, and to a more limited extent,
    RH/FP, malaria and maternal and child health. The Activity Objective
    of APHIA II is "Healthier behaviors and increased use of high
    quality HIV/AIDS, RH/FP and MCH services[^5]." The Activity
    Objective is based on three Results described below:

**Result 1: Improved and expanded facility-based HIV/AIDS, TB, RH/FP,
malaria and MCH services**

This result will increase availability of services at Comprehensive Care
Centers (CCCs), hospitals, health centers and dispensaries for HIV/AIDS
prevention, care and treatment; prevention, detection and treatment of
TB, opportunistic infections (OI) and sexually transmitted infections
(STI); and to a lesser extent, the availability of RH/FP; and selected
malaria and MCH services. Although not all services will be available at
all facilities (e.g., ART or long term and permanent methods of
contraception such as implants, IUCDs, tubal ligation, and vasectomy
will not be available at every dispensary), strong networks and referral
systems will incorporate greater numbers of public and private sector
health facilities that can provide a wider range of services, interact
well with community programs, and refer clients when needed to more
appropriate levels of health care.

**Result 2: Improved and expanded civil society activities to increase
healthy behaviors**

This result will help strengthen community and workplace-based behavior
change interventions, counseling, appropriate types of health
interventions at this level, and referral for those needing more complex
medical care. A wide range of civil society activities, implemented in
most cases by community-based organizations (CBOs) and faith-based
organizations (FBOs) but also including private employers, educational
institutions, private doctors, midwives and nurses, and other health
care providers such as community health workers, are expected to promote
positive behavior change in communities, workplaces, and with
most-at-risk populations. They are also expected to help strengthen
networks to the formal health care system to ensure a continuum of care
for HIV+ people, increase appropriate use of health services, and
generally improve relations between communities and health services.

**Result 3: Improved and expanded care and support for people and
families affected by HIV/AIDS**

This result will address the health, psychosocial and economic needs of
people living with HIV/AIDS (PLWA), their families, and orphans and
vulnerable children (OVC). Home and community care and support and
stigma reduction are essential for people suffering from the effects of
HIV and AIDS. PLWA, their family members, and especially OVCs, often
require such things as money for school fees, psychological support,
nutritional supplementation, clothing, shelter, basic health care,
access to credit, and legal services.

**C. Background**

**1. History of USAID support for HIV/AIDS and RH/FP programs**

*National level activities*

For many years, and particularly since 1995, USAID/Kenya has supported
Kenya's health sector at the national level and also in selected
districts. Support at the national level contributed to health sector
reform, family planning, HIV/AIDS prevention and care activities, and
child survival. Support was provided for policy development and
advocacy, development of national standards and guidelines for provision
of key services such as voluntary counseling and testing (VCT) and
family planning (FP); national monitoring and evaluation such as
Demographic and Health Surveys (DHS); cost sharing and health sector
reform; and national public health laboratory systems. Program research,
conducted in collaboration with national professional bodies and medical
schools resulted in progressive new policies and standards aimed to make
modern contraception, post-abortion care (PAC) and other interventions
more widely and safely available. USAID technical assistance also helped
improve systems that make service delivery possible, through assistance
to Kenya Medical Supply Agency (KEMSA) and the Ministry of Health (MOH)
to upgrade commodity logistics and management; support to the MOH to
expand trainers and personnel; and other support to national working
groups. USAID and its cooperating agencies are considered leaders in
providing "state of the art" assistance to Kenya's MOH, the Ministry of
Planning and Development's National Coordinating Agency for Population
and Development (NCAPD), the Office of the President, and other bodies.

USAID has also supported private sector efforts to improve the health
status of Kenyans by utilizing social marketing to increase access to
and demand for needed health products and services. The program has
marketed products including "Trust" condoms, oral and injectable
contraceptives, and "Supanet" insecticide treated nets (ITNs), as well
as positive behavior change messages. These messages have been
nationally broadcast on radio and TV, and have addressed issues such as
stigma and avoidance of practices which enhance HIV transmission (e.g.
"sugar daddies," and "trusted partners"), the benefits of abstinence or
delay of sex, and the benefits of child spacing. Most social marketing
strategies are national in scope, with some focus on urban and
peri-urban areas for condoms, oral contraceptives (OCs) and injectable
contraceptives, and on malaria endemic areas for ITNs. It should be
noted that social marketing is a collaborative program with the United
Kingdom's Department for International Development (DfID) which provides
approximately 60% of the financial and commodity resources for the
program overall.

*Provincial and district-level activities*

In the past 10 years, USAID/Kenya's health service delivery activities
have generally focused on selected geographic areas, according to a
variety of demographic and epidemiological factors. A decentralized
approach, focusing first on Coast and Western provinces, but then
expanding to parts of Rift Valley and Nairobi, has characterized the
Mission's efforts to improve services at the local level. Because many
of the health issues were overlapping in geographic areas or localities
(e.g., high HIV prevalence, low contraceptive prevalence rate (CPR)),
contractors and grantees were charged with strengthening many of the
same health facilities, district authorities and NGOs. In some cases,
comprehensive approaches in particular districts were identified as
models for activities that could be replicated elsewhere. In all cases,
USAID's district based approach has included:

-   Expansion of VCT and introduction of ARV treatment, linking these to
    other services;

-   Synergy and integration of selected HIV/AIDS, RH/FP and maternal and
    child health (MCH) interventions;

-   Joint work planning with district level authorities to ensure that
    USAID support was integrated into overall district plans;

-   Public-private partnerships, including significant support to and
    capacity building of local non-governmental organizations (NGOs) and
    faith-based organizations (FBOs);

-   Clinic upgrading, training of personnel and improved quality of
    care, and expansion of services; and

-   Strong community-clinic links, with development of innovative models
    for behavior change and communication (BCC) activities and community
    participation.

Selected operations research and program research have helped identify
positive models that can be scaled up, such as the development of
positive and accurate [A]{.underline}bstinence, [B]{.underline}e
Faithful, and correct and consistent [C]{.underline}ondom use (ABC)
messages for selected age groups; better understanding of the specific
food and nutrition needs of clients on anti-retroviral therapy; what
support service providers need to be able to integrate nutritional care
into the treatment of clients on anti-retroviral therapy (ART); and how
to revitalize and scale up the use of intra-uterine contraceptive
devices (IUCDs).

Partners in these efforts have included municipal, district and
provincial authorities, private physicians and nurse-midwife clinics,
FBO and NGO hospitals, clinics and groups, community-based
organizations, professional organizations, universities, medical schools
and networking organizations.

Specific program elements at the district level have included:

> a\) HIV/AIDS prevention, care and treatment. USAID's programs have
> supported contractors and grantees in 22 districts to help local
> governments, NGOs, FBOs and communities develop and expand
> HIV/AIDS-related prevention, care and treatment activities. Support
> was provided to establish or upgrade VCT, Prevention of Mother to
> Child Transmission (PMTCT), Tuberculosis (TB), Sexually Transmitted
> Infections (STI), and ART services. BCC interventions have included
> peer education in communities and workplaces, focused on high risk
> groups (commercial sex workers, police, security guards and transport
> workers), low income communities, and in- and out-of-school youth.
> Interventions ranged from plays, poetry and songs to comic books
> linked to interactive radio programs. Within the last several years,
> PMTCT services have expanded rapidly, and comprehensive care centers
> were established that link ART to home-based care and other
> interventions in several hospital sites.
>
> Community-based efforts to mitigate the impact of AIDS on families
> have included home-based care, psycho-social support,
> microfinance/credit activities, and support for orphans and vulnerable
> children (including special programs for under-5s) through networks of
> people living with AIDS, faith-based organizations, and social welfare
> and community-based organizations. Home-based care has been linked to
> VCT and STI services, and more recently, to integration with PMTCT
> services and voluntary FP services. Other critical interventions, such
> as nutritional support and prevention of malaria and other diseases
> have been incorporated into the home-based care approach. While these
> approaches are promising, they have been generally modest in scale and
> need to be greatly expanded.
>
> b\) RH/FP services USAID-supported contractors and grantees work in
> sixteen districts to improve the quality and quantity of RH/FP/MCH
> services. These activities are closely coordinated with district
> authorities, and have strengthened a variety of private, NGO and FBO
> providers as well as the public sector. Activities included training,
> integration of FP with other services (ante-natal care, VCT);
> expansion of services such as permanent and long-term contraception,
> emergency obstetric care, post-abortion care, and better infection
> prevention and client counseling. BCC interventions were designed to
> increase demand for and use of quality FP services, to increase the
> participation and awareness of women regarding RH, to promote healthy
> behaviors among men and adolescents at the community level, and to
> link communities with health care providers. Training and supervision
> teams were reconstituted in focus districts in conjunction with
> interventions at the national level to establish sustainable RH
> training and supervision systems.

**2. Progress to date**

*HIV/AIDS*

While still at an extremely high level, the HIV prevalence rate is
declining and better means of estimating prevalence have allowed the GOK
to refine initial projections. Prevalence among adults 15-49 years old
is estimated at 7% in 2003, well below the estimate of 10.2% in 2002 and
the peak of 11.5% in 2000. There are still an estimated 1.4 million
HIV-positive Kenyans, however, and almost 1.7 million orphans[^6],
650,000 of whom have lost parents to AIDS[^7]. The 2003 KDHS survey,
however, also shows that after decades of improvement, child mortality
rates increased by 28% from the late 1980s to 2003. Of 1,000 births in
Kenya, 114 children died before age five in 1998-2002, up from 89 deaths
per 1,000 births in 1984-88. 

 

There are also some encouraging trends.  There are signs that attitudes
toward sexual and reproductive issues and behavior are changing. A
comparison of data from the 2003 KDHS with similar data from the 1998
KDHS indicates there has been an increase in the age at first sexual
experience. The median age at first sex among women age 20 -- 49 has
increased from 16.7 to 17.8. The 2003 KDHS data show that only 2 % of
women and 12 % of men report having had more than one sexual partner in
the 12 months prior to the survey. In terms of awareness of AIDS, almost
all (99%) of Kenyan women and men have heard of AIDS. More than 4 in 5
respondents (81 % of women and 89% of men) indicate that the chances of
getting the AIDS virus can be reduced by limiting sex to one faithful
partner.

In terms of treatment, at the end of March, 2005, over 36,000 Kenyans
were receiving antiretroviral therapy.  Direct support contributed to a
greater number of patients receiving treatment than was originally
anticipated. Approximately 27,000 Kenyans receiving ART did so through
USG support. 20,000 received treatment at one of the 78 sites directly
supported by USG agencies or USG implementing partners, and 7,000
patients received treatment at one of the additional 20 sites whose
indirect support results from Emergency Plan funding to the Ministry of
Health National AIDS and STD Control Program. The remaining 9,000 were
supported through other donors, private sector, and the GOK.

The USG in Kenya, working in partnership with 337 local and
international partners and sites, has exceeded targets for counseling
and testing; between October 2003 and March 2005, over 360,000 people
have attended VCT sites to know their status.

In March 2003, the Government of Kenya publicly committed to a \"Total
War on AIDS.\" The Ministry of Health is committed to providing
leadership, coordination, supervision, and monitoring but this has not
yet translated into a clear coordinated effort on the ground.
USAID/Kenya and its USG partners are rapidly scaling up HIV/AIDS
activities under the President\'s Emergency Plan for AIDS Relief. Public
sector health facilities, faith-based mission hospitals, and NGO and
private sector facilities are working hard to contribute to this goal
but need strengthening. Community-based activities can be expanded
nationally.  The increasing number of donors involved in health programs
in Kenya offers great opportunities, but it also means that the
activities of this growing number of agencies need to be carefully
coordinated. During this year the Kenya National HIV/AIDS Strategy Plan
(2005-2010) was also developed and will be the main driving strategic
framework for all AIDS prevention, care and treatment activities.

 

*Family Planning*

Between 1983 and 1998, the modern contraceptive prevalence rate (CPR)
among married women more than tripled from 10 to 32 percent, one of the
most rapid increases in the world. Among African countries, only South
Africa and Zimbabwe have higher CPR. Due principally to this increase in
use of contraception, the total fertility rate (TFR) fell dramatically
over the past 20 years, from an estimated 8.1 to 4.7 children per woman
between 1976 and 1998. This 40 percent decline in fertility helped to
ease the pressures of population growth on Kenya's society, economy and
environment. However, the 2003 DHS showed that fertility increased over
the past 5 years, reversing a decade of outstanding progress in family
planning. The total fertility rate, or TFR, in 2000-02 was 4.9 children
per woman, up from 4.7 in 1995-97.

*Health Care Financing*

USAID has provided support in this area for over a decade, beginning
with policy reforms that saw the introduction of cost sharing in the
country then working to introduce training on cost-sharing at the Kenya
Medical Training College (KMTC) and also working nationally to
strengthen the then Health Care Financing Secretariat that became the
Division of Health Care Financing. In addition, USAID has worked at 14
peripheral hospitals to introduce cash registers and point of sale
systems that help the facilities better track the amounts of cost
sharing revenues collected.

All these activities resulted in a marked increase in revenues
generated, growing from under \$1 million in 1990 to \$4 million in 1993
to over \$10 million in 1999. This initiative has been critical to
increasing the sustainability and improving the quality of public health
services. It has also been a cornerstone of national health reform as it
has helped to devolve authority and accountability in public health to
the district level. This initiative also lent support to the
privatization of two major hospitals and the sustainability of health
NGOs through "shared risk" insurance.

The GOK is continuing to examine how it can expand cost-effective health
care within the overall budgetary framework.

**3. Issues and challenges related to HIV/AIDS, RH/FP and MCH services**

Kenya's population faces many challenges in accessing quality,
affordable health services. HIV prevalence remains high. The population
of people of reproductive age in Kenya continues to grow and child
morbidity is increasing. These challenges assure that the demands on the
health care system in Kenya will grow rapidly in the years ahead.
Further, the negative impact of HIV/AIDS on health care expenditures is
a widely recognized problem in Kenya, with as much as 70 percent of
in-patient admissions estimated to be HIV positive.

a\) Kenya's population is young. Fifty percent of Kenyans are under 18.
Growing numbers of people each year enter reproductive age and are
exposed to the risk of infection. The overwhelming majority is not
infected but many young people remain at risk, with girls and young
women at greatest risk. This is a difficult group to reach, since there
remains a resistance to providing information and counseling on healthy
behavior, including abstinence and fidelity to young people, and even
more resistance to providing condoms to those who need them. Many have
insufficient access to confidential, low-cost reproductive health
services including information about and strategies to prevent HIV/AIDS
and unwanted pregnancy. Making information and services accessible to
youth is a high priority, whether through facility-based approaches or
separate activities aimed at young audiences. Youth need information
about the risks of HIV/AIDS, and the advantages of abstinence and
fidelity. Those who are already sexually active, including married
adolescents, need confidential access to VCT, condoms, and a full range
of STI services. In Western Province, the median age at first marriage
is 19.8, and in North Eastern it is 15.8, meaning youth need access to
information at a very early age. In Western, 63% of youth knew that
condoms can prevent HIV infection, while only 5% in North Eastern had
this same information. Importantly, most youth do not know their status.
Only 4% had received their results in Western, and less than 1% in North
Eastern (2003 KDHS). The realities of the HIV epidemic present an
unprecedented opportunity to frame the public debate on adolescent
reproductive health. Improvements in both policies and program
interventions could provide Kenyan youth---both in-school and
out-of-school---with the information and motivation they need to make
responsible decisions about sexual behavior and how to protect
themselves from HIV infection.

b\) There are widespread deficiencies in quality of care at health
facilities. A wide range of program deficiencies discourage clients from
accessing or continuing to use HIV/AIDS, FP and other important
preventive services.  Preliminary results from the recently conducted
facility-based Kenya Service Provision Assessment Survey (KSPA 2004)
indicate that only two out of three hospitals and health centers offer
all basic health services. The same survey revealed that there are huge
disparities in the distribution of skilled health providers with doctors
and clinical officers largely found in hospitals while only enrolled
nurses and midwives are found in the dispensaries. For basic infection
control facilities had a wide range of deficiencies. At the time of the
survey, only 65% had water, 60% had functioning sterilization equipment,
and 29% had disinfectant, needles, syringes, and latex gloves. Overall,
only 50% of the facilities were able to offer the full package of basic
services due to the nature of their specialized services (e.g.
maternities) or lack of complexity of their systems (e.g. clinics or
dispensaries). The survey also revealed gaps in the provision of
specialized services for HIV/AIDS, family planning, child and maternal
health, and youth friendly services. For instance at the time of the
survey, only 35% provided VCT at least one day a week, 24% provided
PMTCT, 7% provide ART, and 13% of the facilities provide post-exposure
prophylaxis (PEP). For safe motherhood, only 40% of the clients said
that the providers discussed birth preparedness prior to delivery.
Clinical guidelines for IMCI were only found in 21% of the facilities
and only 12% of the facilities provide youth friendly services.

c\) Barriers to access are still very high for some populations. In many
cases, significant population groups lack access to services. Men,
adolescents, and marginalized communities (i.e., refugees, pastoralists,
and disabled people) face particular problems in accessing HIV/AIDS and
FP services. Men are often the decision-makers concerning the access of
family members to health services, so leaving them uninformed and
uninvolved can have direct consequences on women's access to care as
well as their own health. People in isolated rural communities also lack
access to services, despite years of effort by public and
non-governmental organizations to develop effective outreach programs.
Youth face dual vulnerability to HIV infection and to unwanted
pregnancy, but do not feel welcome in most reproductive health care
settings, and do not know where they can find information or services.
People with disabilities may be physically unable to access hospital or
clinic buildings and facilities, may not receive the same quality of
services, and/or may be unable to ask for what they need.

Other barriers include distance from services, culturally inappropriate
practices, and both official and unofficial payments by clients to
access services. Further, for some at-risk and underserved groups, no
accessible HIV/AIDS or FP service delivery points exist; for others,
service delivery points are physically accessible but other barriers
such as cost, stigma, gender, age or disability discrimination, limited
hours of operation, lack of information for clients and providers, or
other socio-cultural factors inhibit access to and use of services. Even
if service delivery points exist and are fully accessible, drugs to
treat common OIs, contraceptive methods and appropriate equipment may
not be available. To meet client desires to achieve longer birth
intervals or limit family size, long-term or permanent methods of
contraception should be made more accessible. Ensuring consistent supply
of appropriate drugs and a range of contraceptive methods represents one
of the important challenges of this program.

d\) Prevention, treatment, and care and support services for HIV/AIDS
need to be scaled up. While there are ongoing HIV/AIDS activities
throughout Kenya, programs need to be scaled up in order to meet the
current need:

-   Focus on the individual client by ensuring a *continuum of care*
    which includes early identification of status, treatment of TB and
    OIs, PMTCT, health maintenance with appropriate support, ART when
    medically indicated, supportive communities and policies, including
    social and economic support for PLWA and care of orphans and
    vulnerable children;

-   *ABC promotion* ([A]{.underline}bstinence, [B]{.underline}e
    Faithful, correct and consistent use of [C]{.underline}ondoms);

-   improved outreach to men, including increased emphasis on "B";

-   more people aware of their HIV status and taking appropriate steps
    to protect their health;

-   better linkages of community and home care to clinical care;

-   scale up of PMTCT services;

-   increased attention to people and groups that are vulnerable or who
    practice high-risk behavior, including promotion of correct and
    consistent condom use among them;

-   rapid and sustained scale up of ART with particular attention to
    quality of care to reach all eligible clients;

-   improved nutrition, especially for undernourished or malnourished
    HIV+ individuals;

-   greatly increased and better coordinated efforts to help OVCs[^8].

Pharmaceutical commodity procurement, lab infrastructure procurement,
and national policy work are not included in this RFA, but will be done
at the national level.

e\) Knowledge about AIDS must be increased and translated into
behavioral change and positive health seeking behavior. Over 99 percent
of all Kenyan men and women have heard of AIDS. However, this knowledge
is often superficial and may not reflect an understanding of personal
risk of disease. Consumption of substances that reduce inhibitions and
promote risky behavior is very widespread and is especially common among
high risk populations. For example, female commercial sex workers
consume alcohol regularly. More than three‑quarters consumed alcohol in
the last four weeks with 23% reporting daily consumption and 44%
reporting consumption once a week. About 38% chew *miraa* (a leaf used
as a stimulant) and 19% smoke marijuana regularly. Male adult
respondents commonly use alcohol and marijuana. Nearly two‑thirds of
policemen and one‑half of mini-van taxi (*matatu*) drivers consume
alcohol regularly. Drug use, particularly chewing *miraa*, is common
among *matatu* drivers (41%) and policemen (28%). *Matatu* drivers (25%)
and bicycle taxi drivers (13%) also smoke marijuana regularly.

Many out‑of‑school youth are sexually active (64.6%) and engage in early
and risky sex (Mean age at first sex = 15.7years), which makes them
vulnerable to HIV infection, particularly given the high prevalence
rates in the general population (6.7%[^9]). Their knowledge of HIV
prevention methods (47.5%) and awareness of someone (especially a friend
or relative) infected with HIV or who has died of AIDS, is also
relatively much lower than those of the adult population groups surveyed
in the KDHS. Since many of them start engaging in sex at an early age,
their chances of infection are increased. This risk is especially high
among young females who have sex with older men.

Men who have multiple sex partners often will refuse to use a condom
with their wives, making their wives vulnerable to infections contracted
from other partners. Cultural practices such as wife inheritance or
sexual "cleansing" (sex with a virgin - believed to cure certain
sexually transmitted illnesses, including HIV) are still practiced in
some areas, even though many people understand that HIV is transmitted
through unprotected sex. Better BCC approaches, both within and outside
of clinic settings, are required. In addition to mass media,
interpersonal communication and community-based messages are necessary
to create informed demand for health services, especially among youth
and men.

Only 72% of men and 61% of women know that condom use is a way to
prevent AIDS (KDHS 2003). Even for those who know this, this knowledge
does not assure an understanding of one's personal risk of becoming
infected. For example, commercial sex workers report that with regular
or "trusted" partners they don't use a condom.

f\) The burden of care for those affected by HIV/AIDS is increasingly
devastating for individuals and families. The continued number of new
HIV infections, increasing number of AIDS cases, vulnerable children,
and orphans is overwhelming the immediate and extended family, the
health care infrastructure, and social support services. There are an
estimated1.7 million orphans, and 100,000 children living with AIDS in
Kenya. At the family level, there is increased burden and stress on
extended families, many of whom are either headed by children or
grandparents. At the community and national level, there is an increased
burden on society to provide services for children and families affected
by AIDS, including psychosocial support, health care and school fees.
Community groups, particularly in rural areas, traditionally have served
as safety nets in times of trouble. The key to community-based
prevention, care and support for people affected by HIV/AIDS is
information, coordination, shared resources, and expertise. Communities
need help to mobilize and may need basic technical assistance to deal
with the crisis. Communities also need to establish critical linkages to
the government and private sector programs that may be able to provide
what the community cannot.

g\) The nature of the HIV/AIDS epidemic is changing. Program strategies
and implementation must respond to changing needs as the epidemic
matures in Kenya. Two factors of the epidemic now are that tuberculosis
has become the most common opportunistic infection among HIV positive
people, and the number of orphans is growing. By 2005, there will be an
additional 120,000 cases of TB per year due to HIV/AIDS. TB is
infectious through casual contact and can be costly when treated in
vertical programs. It is currently addressed through a vertical program
in an MOH department unrelated to HIV/AIDS. TB is frequently the first
manifestation of HIV/AIDS disease and the reason why many people first
present themselves for medical care. It may therefore be more
cost-effective to integrate TB and HIV services, especially in
counseling and testing, and treatment follow-up. The government needs
the capacity to address this problem even as financial and human costs
are increasing. Similarly, they need the capacity to meet the needs of
the country's growing orphan population.

h\) The national economy is affected by HIV/AIDS. Infection rates are
highest among productive adult members of society, including the
formally employed. Companies are already spending increasing amounts of
money to pay health and funeral costs. Productive work days in the
public and private sector are lost when employees take time off from
work because of opportunistic infections AIDS-related problems, when
they must care for family members or attend funerals. Studies from Kenya
indicate that the agricultural sector is already suffering from the
effects of AIDS; in some large agro-estates the HIV prevalence rates
among the workforce are as high as 30 percent. The health and education
sectors also have high mortality rates, which may be related to
HIV/AIDS.

i\) There are huge challenges in reproductive health and family
planning. Both HIV negative and HIV positive persons need improved
access to good reproductive health services and practices including
prompt treatment of STIs, child spacing and/or limiting, and pre- and
post-natal care. Kenya's reproductive age population is growing rapidly
because of very high fertility in Kenya 20 years ago. This means that
the number of contraceptive users will need to grow by 3 percent each
year just to maintain current contraceptive prevalence. There are still
large numbers of women who wish to limit or space their next birth (24%)
but are not using contraception. Young women are in particular need of
assistance; almost half of all births to women under age 20 were wanted
either later or not at all. In North Eastern, the percentage of
currently married women using a modern method of contraception is only
0.2% in Northeastern[^10]. Integrating HIV and family planning services
and promoting FP/HIV/AIDS integration programs such as "dual use[^11]",
may increase the number of women who seek and receive both HIV and
family planning services.

j\) Child mortality has increased. Since the mid-eighties and through
the nineties child survival statistics have worsened in Kenya as more
children succumb to preventable diseases such as malaria, diarrhea,
pneumonia, malnutrition and measles. Malaria alone claims the lives of
26,000 under-five children annually. Although infant and child mortality
rates stagnated between 1998 and 2003 they still remain high with a
child mortality rate of 115 per 1,000 live births. Regional differences
exist with North Eastern having one of the highest under-five mortality
rates in the country (along with Nyanza and Rift Valley). Full
immunization coverage has also fallen from 79 percent to 74 percent.
Exclusive breastfeeding in Kenya is the lowest in Eastern Africa, with
only 15.5% of mothers exclusively breastfeeding in the first 4 months
and less than a quarter breastfeeding for two years, as recommended by
WHO.[^12] The HIV/AIDS epidemic has also had an impact on child health
in spite of growing efforts on preventing mother-to-child transmission.

Shrinking national financial resources and inconsistent donor support
have created a void in vision, energy and program efforts for child
survival. The MOH introduced the Integrated Management of Childhood
Illnesses (IMCI) strategy in 2000 but this has not translated into
improvements in child health. Evidence based interventions for child
survival still need to be taken to scale, through a network of care
between the home and health facilities. Priorities for child health
include:

-   Improved coordination between relevant MOH programs to enhance
    efficiency in planning and resource allocation. These programs
    include malaria control, PMTCT, an expanded program for immunization
    (EPI), safe motherhood and child health

-   Promotion of healthier behaviors and prompt treatment for children
    in communities through integrated BCC efforts

-   Provision of a continuum of care from pre-pregnancy, to pregnancy,
    child birth and the early days of life through quality antenatal
    care, PMTCT, and appropriate breastfeeding counseling.

-   Promotion of insecticide treated nets (ITNs), intermittent
    presumptive treatment (IPT) of malaria, and treatment of malaria in
    pregnancy

k\) Maternal and neonatal mortality are very high. Even before reaching
delivery, the health of women and their babies is compromised by
nutritional deficiencies and/or poor birth spacing. Access to and use of
effective maternity services is still inadequate in Kenya, leading to
high rates of maternal death and poor neonatal survival. In addition to
improved pre-natal care, more work is needed to improve delivery care
and, especially, protect the lives of women and neonates in the early
post partum period. Funds for MCH are severely limited, so creative,
cost-effective approaches are required to ensure a continuum of care,
through delivery, and into the neonatal/postpartum stage.

l\) Sustainability of public health programs remains a challenge for
Kenya. The burden of providing HIV/AIDS and RH/FP services (including
ARV drugs, OI and TB drugs and contraceptive supplies) is great.
Involvement of the private sector, including small-scale private
enterprises that function at the community level, and workplace employee
and family health care programs can help reduce that burden. Communities
themselves can play a role in sustaining HIV/AIDS and FP/RH programs by
designing programs that reinforce the use of these services as a norm
for informed populations.

**D. Context of this RFA**

The US President's Emergency Plan for AIDS Response (PEPFAR or "The
Emergency Plan") is in its third year of implementation in Kenya. This
Emergency Plan has brought together the assistance of multiple US
government agencies, including USAID, CDC, DOD, and the Peace Corps.
Working together, they have collaborated with the government of Kenya to
rapidly scale up all programmatic areas of HIV/AIDS response. For many
years, USAID has worked alongside, and in collaboration with other
donors in the health sector on maternal and child survival
interventions, reproductive health and family planning, and infectious
disease control. The HIV epidemic in Kenya has had an impact on many
sectors of society, including health, education, food security, economic
growth, and even legal and policy areas. The scale of both the epidemic
and the need for an integrated response within the health sector
necessitates collaboration at every level and across sectors for the
most effective response.

This RFA relates to the following strategic plans:

**1. Relationship to the Millennium Development Goals (MDGs)**

APHIA II will help achieve the Millennium Development Goals in health by
reducing child mortality, reducing maternal mortality, halting and
reversing the spread of HIV/AIDS, halting and reversing the spread of
malaria and other diseases such as TB, and helping provide access to
affordable essential drugs in Kenya.

**2. Relationship to USAID/Department of State Goals and Strategic
Objectives**

APHIA II directly supports the USAID goal, World Population Stabilized
and Human Health Protected, and contributes to several of the Agency's
health-related strategic objectives under this goal. USAID/Kenya's
Strategic Objective 3: "Reduce Fertility and the Risk of HIV/AIDS
transmission through sustainable, integrated family planning and health
services" is directly linked to the Agency's strategic and performance
goals.[^13] Because of Kenya's high HIV/AIDS prevalence and high
fertility, the Mission's focus is on reduction of the risk of HIV/AIDS
transmission[^14] and fertility reduction. This focus reflects USAID's
global leadership in HIV/AIDS, population and health, and its technical
and programmatic comparative advantage in HIV/AIDS and population
programs. All HIV/AIDS-related activities under this RFA and under
USAID's health strategy also directly support Emergency Plan goals, and
are included in the annual Country Operational Plan submitted to the
office of the Global AIDS Coordinator.

**3. Relationship to goals of the President's Emergency Plan for AIDS
Relief (The Emergency Plan or "PEPFAR")**

The Five Year Strategy for the President's Emergency Plan for AIDS
Relief of the United States Mission in Kenya is titled, *Strong Networks
for a Sustained Response*. Prepared by the interagency USG team in
October 2004, it lays out the vision and main strategies that will guide
all interventions in Kenya funded under The Emergency Plan through 2008.
As stated in the title, the USG team has committed to work across
sectors and program areas to build systems that promote sustainability.
In the public sector, the USG is making strategic investments in the
GOK's capacity to plan, secure resources, and implement the treatment,
care and support, and prevention interventions that Kenya's citizens
require. In the private sector, the USG response will capitalize on the
already robust networks of mission health care facilities, support the
formation of networks of employment-based health delivery, and invest in
nascent networks of health maintenance organizations serving urban
areas.

Another strong emphasis of the Five Year Strategy is to put youth first,
to protect them from infection and prolong their productive lives if
they are already infected. Since 50% of all Kenyans are under 18,
focusing on young people will be essential to the long-term success of
the networks referenced above. This approach must be done in a
participative, interactive and non-stigmatizing way if youth are to
truly benefit from Emergency Plan interventions.

Personal knowledge of HIV status is a third main theme identified in the
Five Year Strategy. As the GOK and its partners work to increase access
to ART, one of the major barriers is that so many HIV+ people do not
know their status, or only learn about it when they are ill.

Targets of the Five Year Strategy for Kenya reflect the overall goals of
the President's Emergency Plan for AIDS Relief, known as 2-7-10: Two
million HIV+ people receiving ART; seven million HIV infections averted,
and 10 million people affected by AIDS, including orphans and vulnerable
children, receiving appropriate care and support. In Kenya, the target
is to have 250,000 Kenyans on ART by September 30, 2008: 100,000 of whom
will receive USG-purchased ARV drugs, an additional 85,000 of whom will
receive other types of USG support for their ART, and the remainder
being supported by other donor or GOK programs. The target for
infections averted in the same timeframe, both through PMTCT programs
and other prevention efforts, is 425,000. By September 2008, 450,000
orphans and vulnerable children and 250,000 PLWA will be receiving
palliative care. Appendix B has more information on PEPFAR targets.

The award resulting from this RFA is expected to contribute
substantively to these goals and to support overall accomplishment of
the Five Year Strategy, as USAID's principal HIV/AIDS service delivery
intervention for the period 2006-2008.

**4. Relationship to the USAID Strategic Plan for Africa**

USAID released in June, 2005, a draft Strategic Plan for Africa for the
next 5 years, in line with US State Department foreign policy objectives
for Africa. The program in this RFA supports the transformational
development goal to foster a healthier, better educated, and more
productive population, and each of the four specific objectives under
this goal: reduce transmission and impact of HIV/AIDS and TB, reduce
child mortality (including malaria), reduce maternal and newborn
mortality, and improve reproductive health.

**5. Relationship to goals of the Government of Kenya (GOK)**

Overall coordination of Kenyan responses to HIV/AIDS is the
responsibility of the National AIDS Control Council (NACC) in the
Ministry of Special Projects in the Office of the President. This
council, which deals with HIV/AIDS issues in a multi-sectoral context,
is the working group responsible for all matters related to HIV/AIDS.
Its meetings are convened by the Director of the NACC, and the members
include government departments, NGOs, FBOs, the private sector, and
development partners.

The Kenya National AIDS Strategic Plan (KNASP) 2005-2010 provides a
framework and context within which sectoral HIV/AIDS strategies, plans,
and budgets should be formulated, monitored, and coordinated. The KNASP
guides the implementation of all HIV/AIDS interventions to avoid
duplication of efforts and misappropriation of resources. To support the
previous KNASP (2000-2005), various strategies, policies and guidelines
have been developed that guide the implementation of the priority areas
identified in the national strategy:

-   Prevention of new infections.

-   Improvement of quality of life of those infected and affected.

-   Mitigation of socio-economic impact.

The KNASP is one of the agreed "Three Ones[^15]" principles providing
basic elements for coordination across partnerships and funding
mechanisms, and for the effective functioning of a national AIDS
coordinating authority. Other related strategies and interventions
include the national VCT strategy, national condom strategy, PMTCT
strategy, national blood transfusion policy, national ART strategy,
communication strategy, home-based care (HBC) strategy, OVC guidelines,
national food security policy, and the National OVC Action Plan.

The Government of Kenya is also committed to reproductive health and to
increasing voluntary family planning. USAID assisted in development of
the National Reproductive Health Strategic Plan 1997-2010, the National
Implementation Plan/Kenya Family Planning Program 1995-2000, the
National Reproductive Health Training Plan 2000-2004, the Revised Family
Planning Guidelines 2003 and the Revised National Reproductive Health
Curriculum 2003. USAID and its implementing partners have also provided
significant support to the GOK's initiatives to better integrate FP into
HIV/AIDS-related services, such as VCT. National policies and guidelines
already exist, and supervision and training in this area is being
strengthened. Currently, USAID is supporting the development of a
National Reproductive Health Policy.

Over the life of this project, the GOK and donors in the health sector
intend to develop a sector-wide approach (SWAp) to health programming.
Key aspects of a SWAp are that: all significant government and donor
funding for the sector supports a single sector policy and expenditure
program; Government leads the process and its implementation; common
approaches are adopted across the sector by all funding parties
(government and donors); and there is progress towards relying on
government procedures to disburse and account for donor funds. In this
event, USAID management will direct APHIA II recipients how to adjust
their programs.

**6. Relationship to the Kenya Health Sector Strategic Plan (KHSSP) II**

The Kenya Health Sector Strategic Plan II (KHSSP II) was formulated to
re-invigorate the 1994 Kenyan Health Policy Framework (KHPF).  This
strategy is committed to achieve the internationally agreed upon
Millennium Development Goals, the targets set in the Kenya Economic
Recovery Strategy, and the vision of providing accessible, affordable
and quality care for all Kenyans, specifically with a focus on the
community level and delivery of essential health care.  APHIA II will
contribute substantively to GOK goals in health service delivery,
particularly at the community and district level, in HIV/AIDS, TB, and
to a more limited extent, RH/FP, malaria and maternal and child health
(MCH).

> **E. Programmatic Emphasis of this RFA**

**1. Guiding principles**

a\) APHIA II supports a strong facility/community approach. Consolidated
services at the facility level should link to community care, support
and AIDS prevention as well as TB, FP, and child survival BCC and
services. Home and community care are both incorporated into this
comprehensive facility/community approach, including income generation
and OVC support.

b\) Gender concerns are an integral part of quality health service
delivery. Male involvement and attitudes are important to the health
seeking behavior and decisions of women regarding their health choices.
Women are disproportionately affected by HIV/AIDS, with higher
prevalence, higher burden of caretaking for both the sick and the
orphans, and greater vulnerability to poverty and lack of legal
representation. Integrated programs at the clinic and the community
level should be gender equitable, addressing the issues of women, and
also involving men.

c\) APHIA II supports integrated HIV/AIDS, TB, RH/FP, and MCH services.
Building on substantial work already accomplished, USAID/Kenya is
committed to continuing support of Kenya's integrated health service
delivery system. HIV/AIDS, TB, FP/RH and other services are inherently
mutually supportive and synergistic. The close links between positive
reproductive health behaviors, prevention of HIV and STIs, and child
spacing, for example, should not be underestimated. The link between TB
and HIV is extremely strong, as TB is frequently the first manifestation
of HIV/AIDS disease and the reason why many people first present
themselves for medical care. Since both TB and HIV/AIDS treatment
require longitudinal care and follow-up, successful TB programs provide
excellent platforms upon which to build capacity for HIV/AIDS diagnosis
and treatment. Kenya is a global leader in USAID/Washington's special
initiative areas such as FP/HIV integration, and is ready to scale-up
best practices and lessons learned in this area.

d\) Within the province and even within districts, activities should be
tailor-made to local conditions. For example, if a province or district
has a high number of transit workers and sex workers, the recipient
would need to prioritize prevention activities among high-risk groups
and their partners while promoting an ABC approach for youth and stable
couples. If another province or district has a generalized epidemic and
a large number of PLWAs and OVCs, the emphasis should be on
population-based counseling and testing, provision of basic preventive
products and services for HIV+ clients, strengthening and expanding ART,
and community support networks linked to clinical care.

e\) Strong networks are imperative for a sustained response. The USG's
Five Year Strategy for the President's Emergency Plan for AIDS Relief
emphasizes the need to focus on coordination at every level, ensure
appropriate linkages among different levels of care, reinforce already
existing networks among private and faith-based groups, and strengthen
links between community support groups and health facilities. This may
also include educational institutions where applicable.

f\) The prevention-to-care continuum for HIV/AIDS must be scaled up.
This includes prevention messages, voluntary counseling and testing,
clinician-initiated counseling and testing, prevention of mother to
child HIV transmission, preventive, supportive and clinical care for
people living with HIV and AIDS, and antiretroviral treatment programs
when medically appropriate.

g\) Capacity building is a key strategy. Many Kenyan NGOs, FBOs and
government authorities have already benefited from technical assistance
and other support from previous projects. APHIA II recipients are
expected to partner with local organizations and transfer managerial and
technical responsibilities to them as their capacities are strengthened.
This includes developing their capacity in strategic planning, financial
and administrative management, human resource management, and
supervision and quality control. Recipients should strengthen the
performance of provincial and district-level managers in planning and
supervising clinical care; develop approaches that sustain performance
among front line health workers; reinforce and increase the
sustainability of community NGOs, FBOS, and CBOs, provide incentives for
private sector linkages, and assist help develop referral networks that
link clinical services with community support services.

h\) APHIA II is designed as a decentralized approach. Recipients will be
expected to place most of their technical and management resources in
the province(s) or districts in which they are working (not Nairobi).
This supports the GOK's goal of decentralization of health service
delivery. These staff will coordinate with other regional recipients as
necessary, and provide technical assistance to the GOK as needed, in a
way that minimizes management costs. The configuration of offices and
staff that are based in the province will be proposed by each applicant,
and should be based on provincial/district and programmatic needs.

i\) APHIA II requires appropriate networking, complementary linkages and
respect for other existing programs. Recipients are expected to work
closely with and communicate with other Emergency Plan or other
donor-funded organizations in each province. The USG team in Kenya is
composed of USAID, The Centers for Disease Control and Prevention (CDC),
Department of Defense (DOD), Peace Corps, and the Department of State.
Within HIV/AIDS programs, it is critical that recipients be responsive
to the entire Emergency Plan team approach, including acknowledging,
respecting and coordinating with other implementing partners to avoid
geographic or programmatic duplication of efforts.

**2. Principal customers of services under this RFA**

A wide variety of customers are expected to benefit from USAID support
under this program. Women and men of reproductive age (15-49) are the
main recipients of HIV/AIDS prevention, care and treatment, TB detection
and treatment, and reproductive health services, including family
planning services, treatment of sexually transmitted infections and
pre-and post-partum care. Children under five are clients for improved
child survival interventions including improved post partum care and
reduction of malaria episodes. Orphans and vulnerable children of all
ages will benefit from OVC programs. Families and communities affected
by HIV will also benefit from a myriad of community and home-based
services.

-   *Youth:* The USG's Five Year Strategy for the President's Emergency
    Plan for AIDS Relief emphasizes that 50% of Kenyans are under 18 and
    that prevention, and as necessary, care, support and treatment, must
    focus on their needs. Improving access in clinical facilities to
    make them more youth-friendly may be helpful, but adolescents are
    not frequent visitors to clinics, so efforts to reach them in other
    ways are equally important. There must be continued efforts to work
    with parents, church leaders, and adults in general to give
    consistent, informed ABC messages and confront the realities of
    adolescent sexual behavior. High unmet need exists among both
    married and unmarried sexually active adolescents between the ages
    of 15 and 19. At the community level, youth are underserved with
    respect to reproductive health and family planning education and
    services. In greatest need of services are sexually active female
    adolescents (whether voluntarily or otherwise) who are at elevated
    risk of both HIV infection and the dangers associated with
    adolescent pregnancy. School-based programs, special events for in
    and out-of-school youth, peer-to-peer approaches, and innovative
    venues (e.g. sports matches, concerts, and Community Theater) are
    ways to reach youth with positive behavior change messages.

-   *Men:* In general, men resist the need to change behavior and seek
    health care more strongly than women do. While men are
    well-represented at testing sites in Kenya, preventive health
    services have focused so strongly on women and children that men may
    feel excluded or out of place. Gender norms often mean that men make
    decisions around use of health services and act as gatekeepers,
    preventing their partners or their children from obtaining services.
    Gender-based violence increases the risk of HIV infection and
    unintended pregnancy and partner intimidation deters women from
    seeking health care services. Men frequently lack knowledge about FP
    and the benefits of birth spacing for the mother and baby. Involving
    men as partners has been shown to increase use of reproductive
    health services, including contraception, maternal and child health
    care, and STI treatment for men and their partners. However, social
    and medical norms often keep men from becoming involved in their
    partner's health needs or prevent men from seeking RH services.
    Identifying and applying effective means of reaching men will be
    critical for encouraging healthy behaviors, including prevention of
    HIV transmission, seeking testing and counseling, partner reduction,
    treatment of STIs, faithfulness and/or condom use, and reducing
    gender based violence.

-   *Those most-at-risk for infection*: Many population groups are
    especially vulnerable or prone to high-risk behaviors for HIV/AIDS.
    These include commercial sex workers, discordant couples,
    transport/migrant workers, people with disabilities, health care
    personnel, injecting drug users, binge drinkers, and men who have
    sex with men. Programs targeted toward vulnerable and/or high-risk
    populations should, among other things, encourage use of VCT,
    promote the correct and consistent use of condoms in every sexual
    encounter, promote development, expansion, and better access to STI
    programs, address stigma issues, and ensure better continuity of
    care for those who are HIV+ through improved outreach and networking
    appropriate to the target group.

-   *People living with HIV/AIDS***:**  The estimated HIV/AIDS
    prevalence in adults 15 to 49 years in Kenya in 2003 was about 7%,
    meaning that there are currently about 1.1 million adults infected
    with HIV. As a first step, personal knowledge of HIV status is
    essential for Kenyans to access care and treatment, and for them to
    prevent further HIV transmission.  Studies in 2003 found that only
    about 15% of Kenya's adult population had been tested for HIV
    status, and only 90% of them actually learned their results.
    Currently, only an estimated 20% of Kenyans know their status. One
    of the main groups that could benefit from increased knowledge of
    their status is discordant couples. In the 2003 KDHS, 7.4% of all
    couples were discordant and 3.7% were concordant positive. The fact
    that there are twice as many couples that are discordant for HIV as
    couples that are both infected represents an unmet HIV prevention
    need for the country, since the vast majority of these couples do
    not mutually know their HIV status.  For all PLWA, once their HIV+
    status is known, interventions are needed, primarily within
    communities and households, to prevent further transmission, to
    protect the health and well-being of PLWA, and to extend the period
    before which they need ART.  Care and support must be holistic,
    provided in a stigma-free environment, and linked to appropriate
    medical interventions when needed.  Once on treatment, PLWA also
    need close medical and community follow-up to ensure treatment
    compliance, monitor health and provide necessary ancillary care
    including help with planning their future and that of their
    families.

-   *Children affected by HIV/AIDS*: In 2001, 12.3% of all children in
    sub-Saharan Africa were orphans, where the estimate in Kenya is
    10.9% of all children.  This has resulted in a myriad of health,
    psychological and economic problems for children of all ages. OVC
    infants and under-fives are susceptible to preventable diseases,
    malnutrition, stunting and impaired cognitive functions more than
    children with both parents. Those who are HIV-positive, need access
    to pediatric OI and ARV treatment and services. Older children who
    lose one or both parents are often forced to become care-givers of
    younger siblings or ill parents, drop out of school, and become
    victims of exploitative labor. As adolescents mature, certain
    program areas become increasingly significant, including prevention
    of sexual abuse and exploitation, the attainment of life skills
    (including those for HIV prevention) and the achievement of overall
    healthy and productive development.[^16]

-   *Postpartum women and newborns*: Home and community-based postpartum
    services are the weakest aspect of maternal health care. Post-partum
    hemorrhage and infections are a leading cause of maternal death and
    infection, and fetal distress is among the leading causes of
    neonatal death. The postpartum interval is also a critical time to
    provide access to contraception to increase birth spacing. Generally
    in sub-Saharan Africa ninety-eight percent of postpartum women want
    to postpone their next birth two years or longer, yet only 40
    percent use family planning. For each month that the birth interval
    is shortened from 37 months, the risk increase for neonatal
    mortality is 3.7%. Extremely short birth intervals of less than 15
    months are associated with a 150 percent increase in risk of
    maternal death, as well as related maternal health complications.
    Particularly for women who do not deliver in a health facility, home
    or community-based postpartum services (including traditional
    midwives) are important as part of a strong referral network to
    trained health providers in the event of postpartum complications,
    and as providers of family planning information and services.

-   *Mothers and Children*: The focus of health resources on the
    HIV/AIDS pandemic has made it difficult to launch and sustain
    effective services for mothers and children. Cost effective
    interventions to prevent maternal deaths due to pregnancy and child
    mortality related to preventable diseases are known. Unfortunately
    for many women, the pathway to safe motherhood has several obstacles
    that lead to delays in accessing appropriate care. Malnutrition, low
    immunization coverage, and preventable and treatable diseases
    continue to affect a majority of Kenyan children in both urban and
    rural settings. The socioeconomic consequences of maternal, newborn
    and child morbidity and mortality are significant[^17].

> Improving the health of mothers and children requires effective
> coordination of child survival programs with programs that address
> maternal health and HIV/AIDS. Promoting care for mothers and children
> from pregnancy, to delivery, and through the post partum period and
> childhood can be achieved by strengthening and expanding integrated
> programs. Building strategic partnerships between communities and
> health facilities will promote the communities' capacity to recognize
> and care for sick children and ensure access to skilled attendants at
> birth for mothers.

**F. Detailed Program Description**

**Activity Objective**

Healthier behaviors and increased use of high quality

HIV/AIDS, TB, RH/FP, and MCH services

+---------------------+-------------------------+---------------------+
| **Result 1**        | **Result 2**            | **Result 3**        |
+---------------------+-------------------------+---------------------+
| Improved and        | Improved and expanded   | Improved and        |
| expanded            |                         | expanded            |
|                     | civil society           |                     |
| facility-based      | activities              | care and support    |
| HIV/AIDS,           |                         | for people          |
|                     | to increase             |                     |
| TB, RH/FP, malaria  |                         | and families        |
|                     | healthy behaviors       | affected by         |
| and MCH services    |                         |                     |
|                     |                         | HIV/AIDS            |
+---------------------+-------------------------+---------------------+
| **Sub-Results**     |                         |                     |
+---------------------+-------------------------+---------------------+
| **1.1** Expanded    | **2.1** Expanded        | **3.1** Expanded    |
| availability of     | community and workplace | home and            |
| HIV/AIDS            | prevention programs     |                     |
| prevention, care    |                         | community support   |
| and treatment       |                         | programs            |
| services            |                         |                     |
+---------------------+-------------------------+---------------------+
| **1.2** Expanded    | **2.2** Expanded        | **3.2** Expanded    |
| availability of FP  | prevention programs     | support for OVCs    |
| and MCH services    | targeting most-at-risk  |                     |
|                     | populations             |                     |
+---------------------+-------------------------+---------------------+
| **1.3** Reinforced  | **2.3** Reinforced      | **3.3** Reduced     |
| networking between  | networking              | stigma and          |
| levels of care and  |                         | establishment of    |
| between clinical    | between communities and | safety nets for     |
| services and        | clinical services       | PLWA and their      |
| communities         |                         | families            |
+---------------------+-------------------------+---------------------+

Under this RFA, hospital, clinic, and community-based HIV/AIDS, TB,
FP/RH and child survival services will be strengthened at the district
level. Interventions will include:

-   Integrated planning for health services at the provincial and
    district level with reference to the Kenya Health Sector Strategic
    Plan (KHSSP);

-   Support for an expanded comprehensive approach to HIV/AIDS
    prevention, care and treatment with reference to the KHSSP, and
    including psychosocial support where needed;

-   Improved quality and integration of FP/RH with related HIV/AIDS, TB
    and MCH services;

-   Quality assurance of health services across public, NGO and private
    sectors;

-   Technical and managerial assistance to local entities (NGOs, FBOs,
    CBOs, educational institutions, and local government);

-   Scale up and wider geographic coverage for these priority health
    services, based on a decentralized, district-based approach;

-   Improved M&E and strategic information for decision-making, analysis
    and programming;

-   Efficient management with a focus on the field as opposed to the
    central level;

-   Linkages between district and provincial offices and central
    ministries and offices;

-   Linkages and referrals between Comprehensive Care Centers (CCCs),
    other levels of the health system, and community or home-based
    support services;

-   Linkages and referrals between clinic and community-based services;

-   Community empowerment for OVCs, people living with AIDS (PLWAs) and
    groups that provide advocacy;

-   Health, nutrition, and social services for OVCs and PLWAs;

-   Attention to the needs of vulnerable, high-risk, and underserved
    groups such as youth, discordant couples, commercial sex workers,
    transport/migrant workers, refugees, and people with disabilities;

-   Partnerships between public and private sector health providers;

-   Appropriate linkages to national level service-delivery and policy
    programs, which may include exchanges of technical assistance;

-   Training of trainers or health service providers and/or links to
    national training programs;

-   Focused/limited operations research to strengthen service delivery
    approaches;

-   Limited/focused activities that strengthen or bolster the existing
    national and decentralized supply chain system for pharmaceuticals
    to help prevent stock-outs;

-   Ensuring sustainability by building of local consortia partners'
    technical and management capacity (including administrative,
    strategic planning, financial, and quality assurance capabilities),
    and transferring increasing responsibility to them;

-   Linkages to the "3 ones" (one strategy, one monitoring and
    evaluation framework, and one coordinating body).

**Result 1: Improved and expanded facility-based HIV/AIDS, TB, RH/FP,
malaria and MCH services**

USAID's assistance in HIV/AIDS, TB, FP/RH, malaria, and MCH services,
building on past efforts, is intended to result in widespread
availability of a complete package of services at the clinic level,
characterized by strong referral systems, links to community level BCC
and mobilization, and capacity building. Because of the importance of
the facility as the locus for HIV/AIDS, FP/RH and MCH services, this
result will strengthen the variety of HIV/AIDS services offered
(including VCT, PMTCT, ART, care and treatment, and TB services); expand
the family planning method mix (including "natural[^18]," permanent and
long-term methods); and selected MCH services (e.g. insecticide treated
nets, focused antenatal care, and emergency obstetric care.)

In order to improve the quality and quantity of facility-based services,
the recipient of award under this RFA is expected to work closely with,
and in most cases build the capacity of, district and provincial health
authorities to improve the functioning of networks between local
partners (public health facilities, NGOs, FBOs, workplaces and private
sector). For sustainability, technical assistance should focus on
enabling district and provincial health management teams (DHMTs and
PHMTs) to design, implement and evaluate their own programs. In
addition, recipients must build the capacity of local NGOs, FBOs, CBOS,
private sector, and other partners within their consortium or that are
sub-awardees, to plan, manage, and implement donor-funded programs.

As facility-based programs are expanded and integrated, attention to
quality, supervision, and standardization are important.

**Sub-Result 1.1: Expanded availability of HIV/AIDS prevention, care and
treatment services**

Under this sub-result, the recipients are expected to contribute
significantly to the expansion of comprehensive, quality HIV/AIDS
services in their respective region. The USG Five Year Strategy for the
President's Emergency Plan in Kenya calls for strengthening and
expanding HIV treatment at established sites, and for adding sites,
particularly at district hospital and health center levels, with an
emphasis on "working down" through the network model to assure that both
urban and rural populations are reached.

The range of services and activities to be introduced or reinforced
include but are not limited to preventive interventions in line with ABC
guidelines and expanded efforts in medical and injection safety at
facility level, increased use of provider-initiated diagnostic
counseling and testing, post exposure prophylaxis of HIV infection,
nutritional support for HIV+ clients who are malnourished to ensure
better compliance and outcomes with ART, and prevention of
mother-to-child transmission of HIV in antenatal care and maternity
settings with increased post partum follow up of both mother and exposed
infants. This follow-up should include access to long term
antiretroviral therapy and OI prophylaxis for mothers and children
identified as HIV+ through PMTCT services.

Recipients are expected to introduce and improve care for all
HIV-infected individuals including early detection and treatment of
opportunistic infections including TB, STI, and nutritional support for
vulnerable individuals. Care for HIV infected persons must include
increased access to cotrimoxazole prophylaxis as a minimum standard of
care, and where indicated and infrastructure permits, fluconazole and
isoniazid prophylaxis.

TB/HIV integration is an essential component of this activity.
Recipients will ensure increased provider-initiated counseling and
testing of TB suspects and patients for HIV on an opt-out basis,
increased screening of HIV infected persons for TB, and increased
referrals of HIV positive TB patients for HIV care and treatment.

Antiretroviral therapy targeting both adults and children will be a
major component of comprehensive treatment and care services already
started in many sites. These are critical services offered in
Comprehensive Care Centers (CCCs) that must be sustained and scaled up
significantly in the respective regions. Recipients should take steps to
integrate TB/HIV/FP/PMTCT services and improve referral systems as
described in sub-result 1.3 below. ARVs, OI drugs and other
pharmaceutical commodities will be procured separately at a centralized
level. Some food support will be provided through national-level
program, targeted toward HIV+ patients and OVCs only. Recipients may do
additional food and nutrition programs to complement or scale-up this
activity.

To ensure better HIV prevention and treatment outcomes, recipients are
expected to provide IEC materials for both providers and clients
covering HIV prevention, care and treatment. Recipients are also
expected to conduct regular training and updates to health providers to
ensure best practices in HIV prevention, care and treatment, or to link
them to national-level training programs that do the same. Training is
expected to follow current national guidelines.

**Expected Outcomes:**

-   Health care workers provide comprehensive HIV care and treatment
    services as per national guidelines

-   HIV prevention, care and treatment activities scaled up in health
    facilities to achieve PEPFAR targets by province (see Appendix B)

-   HIV testing significantly expanded with better targeting and
    implementation of diagnostic counseling and testing in health
    facilities where appropriate.

-   Expansion and strengthening of prevention program within testing
    services, especially for those who are HIV negative or in discordant
    relationships.

-   Integrated health services are increasingly accessible to youth

-   Increased TB/HIV integration at health facilities, with more
    effective referrals between TB and HIV services.

-   Care for HIV positive mothers and infants supported and expanded
    with better linkages to other services.

-   Care for HIV infected and affected expanded to routinely address
    nutritional needs of the malnourished.

-   Health care providers provide better quality of care, through
    increased training (or links to national training programs), better
    supervision and quality assurance programs

-   Limited and focused operations research to improve service delivery
    (later years of project)

**Sub-Result 1.2: Expanded availability of Family Planning, Reproductive
Health and Maternal and Child Health services with HIV/AIDS services**

The funding and programming importance of HIV/AIDS interventions creates
a challenge to keeping FP/RH and MCH services as a central component of
health services. This sub result emphasizes the integration of FP/RH/MCH
and HIV/AIDS services and builds on lessons learned from successful
FP/RH programs that simultaneously address both supply and demand.

Recipients are expected to expand the availability of FP/RH and MCH
services to help clients meet their desired fertility goals for spacing
and limiting, prevent unintended pregnancies and improve health outcomes
for pregnant women and newborns. Family Planning services in Kenya
predominantly rely on short-term methods. Given the high unmet demand
for FP especially in rural areas, lack of adequate trained personnel,
inadequate commodity supply and equipment, recipients are expected to
expand availability of contraceptive methods -particularly long-term and
permanent methods. Emphasis will be placed on improved quality of care
through strengthened support systems for service provider training and
supervision (including linking them to national-level training), and
utilization of up-to-date FP/RH guidelines. A decentralized system for
training and supervision of RH services has been introduced and
recipients are expected to assist in scale up to facility level. They
should also work with private facilities, and networks between public
and private facilities and community midwives to reach women. To prevent
stock-outs and to ensure an adequate supply of contraceptives,
recipients should help facilities improve their logistic management of
commodities and supplies, but are not expected to provide commodities.

Post-abortion Care (PAC) services are also in high demand, and have been
successfully introduced into both public and private sector (private
nurse-midwife) clinics. Recipients should scale up these services with
appropriate attention to informed choice and quality of care. In MCH,
priority will be placed on increasing skilled attendance for pregnancy,
childbirth, emergency obstetric care (EOC), and post natal care at all
levels. Recipients should support focused antenatal care to ensure that
the essential package of services: FP, tetanus immunization, nutrition
counseling, breastfeeding counseling, malaria prevention, early disease
detection, counseling and testing for HIV, and PMTCT as needed. Early
detection and timely referral for pregnancy complications, care for the
mother and newborn, including early initiation of breastfeeding and
exclusive breastfeeding in the postnatal period, will be emphasized.
This will require that recipients help establish an effective, efficient
referral network with appropriate feedback mechanisms.

For women, decision-making concerning FP/RH is influenced by their
communication with partners and families. Therefore recipients will need
to identify effective means for involving men as partners, creating
appropriate linkages between facilities and communities in order to
raise demand and increase the use of family planning, reproductive
health, maternal and child health services. An important challenge will
be to ensure increased access and availability of services for youth to
encourage healthier behaviors.

**Expected Outcomes:**

-   Quality FP/RH and MCH services available at public and private
    health centers and hospitals and appropriately integrated with
    HIV/AIDS services

-   Increased uptake of FP at lower level facilities and at private
    facilities

-   Increased Contraceptive Prevalence Rate

-   Increased number of mothers who deliver in a facility or with a
    trained health provider, and are linked to postpartum services

-   Improved linkages between private and public health services for FP
    and MCH services

-   Expanded range and improved supply of contraceptive methods
    particularly long term methods

-   Improved birth planning and referral between the community and the
    facility, as well as access to Emergency Obstetric Care when needed

-   Increased numbers of women who are successfully referred to and
    treated by Emergency Obstetric Care personnel.

-   Health care providers provide better quality of care, through
    increased training (or links to national training programs), better
    supervision and quality assurance programs

-   Limited and focused operations research to improve service delivery
    (later years of award)

**Sub-Result 1.3: Reinforced networking between levels of care and
between clinical services and communities**

The Emergency Plan Five-Year Strategy emphasizes using the network model
to provide appropriate care and treatment at different levels within the
health care system. The USG\'s Five Year Emergency Plan Strategy for
Kenya is entitled \"Strong Networks for a Sustained Response,\"
identifying networking as its priority structure. In Kenya the formal
health care network is made up of national referral hospitals,
provincial and district hospitals, and local health centers,
dispensaries, and clinics. In the private sector there are robust
networks of mission health care facilities and employment-based health
services. Recipients are expected to help reinforce linkages within and
across these networks, and between the health care system and the
burgeoning CBO and FBO networks of care providers, associations of
PLWAs, and other community-based care and support groups.

To have a well functioning, well-managed health care network, recipients
should work with the Provincial and District Health Management Teams to
ensure that referral endpoints within their regions are capable of
providing more complex treatment and services, whether in ART or
permanent family planning methods (whether at secondary or tertiary
facilities). There must be a flow down the network as well. Patients who
start ART at higher-level facilities, which have more advanced
diagnostic equipment, need to be referred to facilities in their
communities for continuing treatment. Technical support and products
need to flow from the center to facilities at the periphery.

While clinical services are essential for proper care, they are not
sufficient to provide the full range of support that clients need in
these areas, particularly HIV/AIDS. Recipients of this award will need
to define areas in which clinics and communities can work more
synergistically together, and what approaches to take to reinforce the
networking concept. At the community level, non-ART HIV care is being
established in rural health centers and dispensaries, and
community-based ART is expected. Recipients will need to work with local
facilities to ensure that communities are encouraged and assisted to
more actively access clinic-based HIV/AIDS, FP/RH and other services;
increase participation of women's agencies in health advocacy and
decision making for clinic operations; develop linkages with private
facilities, and develop appropriate care-seeking behavior at the
individual, family and community levels. Awareness of the need for FP
within a VCT or PMTCT context (and vice versa), or information about the
need to promptly treat STIs or determine one's HIV status, are expected
to be strongly reinforced by recipients by supporting these efforts
through local clinics and at the community level.

**Expected Outcomes:**

-   Clearly defined networks of Comprehensive Care Centers (CCCs) at the
    tertiary care level, linked to health centers, dispensaries, and
    private facilities serving a defined catchment area

-   Reduction of stable ART & WHO stage II patients being seen in CCC,
    and corresponding increase in the these clients who receive care at
    clinics and dispensaries while stable

-   Increased number of ANC visits at health centers and dispensaries

-   Increased number of mothers who deliver in a facility or with a
    trained health provider, and are linked to community or home-based
    postpartum services

-   Increased reliability of tracking and follow-up of patients.

**Result 2: Improved and expanded civil society activities to increase
healthy behaviors**

The Emergency Plan Five Year Strategy makes a strong case for working
across sectors and program areas to build systems that promote
sustainability. Of course, public sector networks, including health
facilities and local government authorities will play a major role in
achieving the results of this activity. However, networks of mission
health care facilities, employment-based health delivery and other
community-based networks are essential for adequate coverage of health
needs. Recipients are expected to ensure that NGOs and FBOs expand their
commitment and capacity to carry out prevention, care and treatment, and
support services for PLWA. Other community-based services such as
malaria prevention, point-of-use water purification or promotion of use
of skilled attendants at delivery might be appropriate and complementary
interventions to introduce or scale-up with these same organizations.

While the clinic is the focal point for the services described above,
many Kenyans access health services and information from other
providers, including traditional healers, traditional birth attendants,
workplace clinics, pharmacies, community health workers and peer
educators. Communities, including village health committees, *barazas*,
community groups, CBOs and other innovative structures are important
channels for behavior change communication, information dissemination,
and extension of services to the grass-roots level. This result is
particularly vital with an increasing emphasis on programming focusing
on the promotion of fidelity in men, care and support for discordant
couples and reduction of consumption of alcohol and other products that
decrease inhibition. All are issues that are more effectively addressed
by civil society than by the public sector.

In order to achieve this result, recipients will need to help local
partners undertake a broad range of activities to strengthen outreach to
people at risk or who may be at risk; increase community participation
in decision-making and support for rural health facilities; develop
linkages with formal and informal workplaces; and create stronger
linkages with the private sector. Participatory approaches, use of
existing structures (e.g., village health committees, traditional
healers), and training of local inhabitants as community animators or
facilitators, can contribute to locally developed action plans for
activities that address a variety of health and non-health issues.
Another aspect of this result is to establish/strengthen integrated
HIV/AIDS, FP and MCH services among private sector providers. These
would include, for example, private midwives who can provide PMTCT, EOC
and PAC services, and private physicians who can be encouraged to treat
OIs, refer patients to CCCs when appropriate, and provide long-term and
permanent contraceptive methods at a reasonable price.

All of the activities described above will support the closing of the
'gap' between communities and their local health dispensaries, ensuring
that health care is addressed at the sub-district facilities, thus
freeing up the district and provincial hospitals to focus on more
complex clinical services.

**Sub-Result 2.1:** **Expanded and strengthened community and workplace
prevention programs**

Recipients are expected to foster a comprehensive, innovative approach
to HIV/AIDS prevention that includes increased engagement and capacity
building of CBOs, FBOs and worksites. Programs should include ABC
messages, which include promotion of fidelity, condom promotion when
appropriate, and associated messages about the benefits of knowing one's
status, preventing or treating STIs, accessing PMTCT services, and where
to go for ART. Recipients will be expected to support outreach efforts
by local partners to reduce high-risk behaviors and encourage
care-seeking behavior through a variety of means and media. Worksites
should include health care facilities themselves, encouraging injection
safety, information about post-exposure prophylaxis, and to encourage
health confidential access to VCT and other HIV/AIDS services. Increased
engagement of NGOs, FBOs and worksites will result in 1) improved
capacity to implement and monitor HIV/AIDS programs 2) development and
utilization of networks of NGOs, FBOs and worksites, and 3) development
and implementation of comprehensive policies and strategies on HIV/AIDS
prevention.

**Expected Outcomes:**

-   Increased provision of consistent and appropriate messages, care and
    support within NGOs, FBOs, and worksite programs

-   Existence of expanded and collaboratively supported workplace
    HIV/AIDS prevention programs, with appropriate referral for and
    access to clinical services

-   Improved policies and practices in participating workplace programs

-   Improved messages, practices, and policies at health facilities
    targeted toward health care providers

-   Rapid response grants to NGO/FBO/CBOs to implement quality programs.

-   Strengthened NGO/FBO/CBO capacity to provide a range of HIV/AIDS,
    FP, MCH, malaria and other health information services

-   Decreased stigma and increased knowledge at worksites, and within
    NGOs and FBOs

**Sub-Result 2.2: Expanded prevention programs targeting most-at-risk
populations**

The HIV/AIDS epidemic in Kenya is evolving, and new, innovative programs
need to be developed that address the emerging risk groups and issues.
For example, the role of high-risk sex is declining in high prevalence
epidemics, resulting in the need to address risk within the general
population. In Kenya, there are the following factors:

-   Many new infections are occurring in the general population among
    discordant couples -- many of whom do not know their status

-   Men and women may not be monogamous in their relationships
    (promotion of fidelity should focus on men and boys as well as
    women)

-   Alcohol plays an important role in increasing sexual risk-taking

-   There are major transport corridors along which are many commercial
    sex workers and transport workers

-   There are vulnerable groups that include school-age girls, people
    with disabilities, and refugees.

Expanded prevention programs should develop integrated HIV/family
planning/ reproductive health activities leading to increased
utilization of services and respond to the emerging issue of family
planning in the context of improved health status of those who are HIV+.
Programs should be targeted to reach the specific population in
acceptable ways with appropriate information about risk and prevention,
including AB and C methodologies appropriate to the population.
Vulnerable populations may need to be assisted through creative outreach
programs and advocacy groups.

**Expected Outcomes:**

-   Increased provision of consistent and appropriate messages about
    prevention, care and support appropriately targeted to most-at-risk
    populations

-   Innovative community programs to target high-risk populations with
    appropriate preventive messages, and to link them to health
    facilities.

-   Improved scale-up and delivery of community outreach activities such
    as community-based BCC, peer education, *barazas*, songs and
    puppeteering by NGOs, FBO and health workers

-   Rapid response grants to NGO/FBO/CBOs to implement quality programs
    that target high-risk groups

-   Quality programs that address stigma and discrimination at the
    community and facility level.

**Sub-Result 2.3: Reinforced networking between communities and clinical
services**

Under this sub-result, recipients are expected to create or reinforce
communications, referrals, and decision-making between communities and
clinical services (ref. Sub-result 1.3.). Community mobilization and
participation efforts will usually include existing community
structures, village health committees, traditional healers and other
groups. Gender considerations are important, as women often play a
subordinate or non-existent role in these structures. Village health
committees can play a key role as a bridge between the community and the
local dispensary or health center. Working mainly with local partners to
achieve this sub-result, recipients are expected to help communities
learn to diagnose their own health needs and recognize the benefits of
family planning and the prevention of STIs, HIV and malaria so that they
can become active participants in prevention of HIV/AIDS, unplanned
pregnancies or other adverse health conditions. This sub-result will
increase healthy behaviors, including care-seeking behavior of entire
communities, as well as their demand for better services.

The prevention-to-care continuum is an essential approach under the
President's Emergency Plan. Community groups, women's groups, village
health committees and others may provide care and support services,
including palliative care, and are also important in promoting
information about CCCs or other sites that may be able to provide a
package of treatment for AIDS or related illnesses. For HIV/AIDS
affected individuals and their families, recipients are expected to
strengthen linkages between communities and local groups that provide
home-based care and other support for people and families affected by
HIV and AIDS.

**Expected Outcomes:**

-   Increased provision of consistent and appropriate messages, care and
    support by community health workers and CBOs, and that include
    appropriate referral messages

-   Use of CBOs such as women's groups and youth groups to develop and
    deliver culturally appropriate messages that address stigma and
    discrimination and encourage knowledge of status and use of health
    services

-   Existence of a healthy and functional community/health facility
    relationship and referral system for prompt referral of clients
    needing clinical care

-   Developed links between community-based programs, health facilities
    and social marketing efforts (stigma reduction, ABC, FP products and
    messages)

**Result 3**: **Improved and expanded care and support for people and
families affected by HIV/AIDS**

Kenya has approximately 1.4 million HIV+ persons (1.1 million aged
15-49), and over 2 million orphans and vulnerable children. This result
is crucial to helping families and children affected by AIDS cope with
the health, economic and psychosocial effects of HIV/AIDS. All care and
support services will be linked to other HIV prevention and treatment
programs, such as VCT and PMTCT programs, ART provision, and services
for OVCs. While clinics will need strengthening in order to provide
counseling and testing for HIV, PMTCT services, FP/RH for child
spacing/limiting and diagnosis and management of opportunistic
infections, it is essential that communities too are strengthened to
cope with the increasingly large burden that falls on them.

Local organizations (FBOs, CBOs, NGOs, village health committees, etc.),
through advocacy and social mobilization, are expected to create a
supportive environment for families and OVCs. These organizations need
assistance to manage and implement these services. Recipients are
expected to work with NGOs and CBOS to strengthen the abilities and
resources of families to protect and care for OVCs, by prolonging the
lives of parents and providing economic, psychosocial, educational and
other support. Villages and communities must be mobilized and supported
to provide assistance to vulnerable households, including home-based
care and other social support. OVCs must be able to access essential
services, including education, nutrition and health care. Links and
support to local government organizations (often non-health agencies,
associated with social services or education) for positive policy
change, must be created as well. Recipients are expected to help local
NGOs and CBOs interface effectively with District Development Committees
(DDCs) and Constituency AIDS Control Committees, for example, and
reinforce their relationship with joint activities at the grass-roots
level. Recipients are also expected to strengthen PLWA groups and
networks to enable them to provide support to each other in dealing with
stigma and treatment and the general population in prevention and ART
services.

Attention to quality, sustainability and standardization of services is
important among organizations serving OVCs, PLWA, and affected
communities.

**Sub-Result 3.1: Expanded home and community support programs**

Recipients are expected to significantly scale up such efforts and
wherever possible to link provision of simple palliative care,
psychological support and food supplements to prevention, FP/RH, orphans
support and income generation activities. Referrals of clients and
family members for counseling and testing services, and ART (as well as
non-ART health services) are other important aspects of home-based
support services. Therefore recipients are expected to link home-based
care to CCCs or other health services. Home-based care should include
counseling and support for HIV testing, as well as disclosure, and
adherence to clinical care including consistent use of medications.[^19]
For PLWA who are able to work and carry out their normal activities,
counseling and services for family planning and child spacing should be
provided. Condom promotion, use of effective FP methods, and treatment
of STIs is essential for PLWA and their partners. As treatment is scaled
up, home-based care will need to take on the additional responsibility
of supporting adherence to ARV regimens as an essential task.

PLWA communities need help to develop durable and effective prevention,
home-based care and other social services for community members affected
by HIV/AIDS. Local organizations (FBOs, CBOs, NGOs, village health
committees, women's groups, self-help groups, etc.) often have close
ties to the community and may be best placed to identify and sustain
target groups such as under-fives affected by HIV/AIDS. However, they
often require assistance to manage and implement these services. Links
and support to local government organizations (often non-health agencies
associated with social services or education) must be created as well.
District Development Committees (DDCs) and Constituency AIDS Control
Committees, for example, are key agencies which support advocacy and
other activities at the grass-roots level. CBOs and grass-roots NGOs
often lack information, business skills, or organizational skills to
carry out programs at the village level. To promote a "bottom-up
approach, communities must be able to diagnose their needs (in relation
to people and families affected by HIV/AIDS), and identify interventions
and local implementing agencies. Recipients are expected to provide
technical and management support, and other support where needed to help
NGOs and CBOs become stronger, more sustainable implementation partners.
This may include building their management, administrative, financial,
and quality control abilities. It is expected that these recipients will
become increasingly independent in their implementation and management.

PLWA often live marginal lives, and even when not suffering clinical
manifestations of AIDS, they frequently have nutritional gaps or lack
essential foods. Because of their positive HIV status, PLWA may have
even greater nutritional needs than others. HIV disease can be
exacerbated by anemia, diarrhea, infections or other problems that
weaken the body, while inadequate nutrition can provoke or contribute to
these problems. Adequate quantity, type and nutritional value of food
are essential to ensure that PLWA (and their families, especially
under-fives) stay healthy. For example, one study in Kenya reported that
75% of HIV+ home-based care clients had gone without food for one to
four days since becoming ill.[^20] Ensuring proper diet, with adequate
macro and micro-nutrient intake, is a major challenge in care and
support of PLWA. At a broader level, caregivers of PLWA and OVCs have
reported that provision of food rations to households free up household
income for other expenses, such as school supplies and fuel.[^21] Under
The Emergency Plan, food assistance must be targeted toward HIV+
individuals and orphans, in order to maximize its impact. Recipients
should develop and implement innovative approaches that respect The
Emergency Plan guidance and address the nutritional needs of clinically
identified HIV+ patients and organizations that assist orphans. They are
also expected to take into consideration the food security situation of
the population in general in which they are working and to approach this
with sensitivity and creativity.

PLWA, even those on ART, can be subject to acute episodes of illness
requiring not only medical interventions but rehabilitative care to
recover from such episodes. Recipients will need to develop and support
approaches and programs to deliver appropriate palliative care,
nutritional supplements for those with diagnosed need, and psychosocial
support to PLWA and their families through acute stages of illness.

**Expected Outcomes:**

-   Improved home and community-based health care services that serve as
    a strong link in the referral network to clinical services.

-   Increased access to basic and preventive health services for
    HIV-affected families.

-   Increased access to RH/FP for HIV-affected families

-   Better follow-up of HIV+ clients to improve compliance with ART, TB
    and other drug regimens

-   Improved referral of PLWA and OVC to social support services, funded
    with other than GHAI funds, as needed (including links to other
    sectors -- agriculture, education/job skills, legal services)

-   Increased access to nutritional and food support for HIV+
    individuals and their families.

**Sub-Result 3.2: Support for OVCs**

Orphans and vulnerable children have many special needs. Depending on
the age of the orphan, each age group has its own unique requirements.
For example, under-fives are very vulnerable to disease and malnutrition
while older children are at higher risk of gender-based violence (GBV),
rape, abandonment, dropping out of school, and other problems. Girl
children are especially vulnerable to sexual and economic exploitation.
Some may need special legal protection to ensure their property rights
and to help protect them from abuse. Existing programs in Kenya which
offer these services should be used within a referral network. OVCs
require shelter and clothing, access to health facilities and preventive
health care (including immunization for younger children); psycho-social
support (especially for those who must care for parents or siblings);
school fees, so that they can continue their education; nutritional
supplementation, and job or skills training. These first six elements
are considered essential parts of a comprehensive care package for OVC.
Programs that address OVC needs must do so comprehensively. Where
necessary, services should be provided through referral to existing
services, such as immunizations and some legal services. Caregivers and
counselors experience considerable emotional stress and burnout and
there are growing numbers of children who are caregivers themselves.
Other caregivers are elderly and need assistance in meeting the daily
needs of their household. An important role of the recipient of this
award is to interface with the CBOs, FBOs and other groups providing OVC
and caregiver support, to strengthen their ability to sustain these
services. Recipients are expected to provide technical and management
support, small grants and other support where needed to help NGOs and
CBOs to become stronger, more sustainable resources for OVCs and their
caregivers.

**Expected Outcomes:**

-   OVC have increased access to a range of health services

-   Increasing numbers of OVC are provided with shelter, clothing,
    school fees, nutritional support, and psychosocial support to meet
    their needs

-   Increased numbers of caregivers and community organizations with the
    capacity to offer sustained support to OVC in their household or
    community.

-   OVCs have better access to primary and secondary education, and
    job-training

-   Links and referrals to programs in other sectors not funded with
    GHAI funds, (e.g. agriculture, education, small business
    development) are forged as appropriate to better serve OVC and
    caregiver needs.

-   OVC have increased access to legal services through effective
    referral, when needed.

-   Community, home and/or school-based programs decrease stigma and
    discrimination against OVC

**Sub-Result 3.3:** **Reduced stigma and establishment of safety nets
for PLWA and their families**

Most communities need additional advocacy for and awareness of PLWA, and
of their needs for encouragement and support. In some communities, PLWA
are shunned by neighbors and family members; they may lose rights to
their children, land, or possessions. Women may be at increased risk of
gender-based violence when they disclose their status, and widows are at
greater risk of having their family assets seized, and often have
minimal legal recourse. Recipients are expected to support grass-roots
campaigns that explain how AIDS is transmitted (or not transmitted),
encourage understanding and support of PLWA, and bring to bear legal
information to protect them. Puppetry, peer education, songs and drama
are ways in which anti-stigma messages can be conveyed. In addition to
communications efforts, however, in some cases temporary shelter or
other forms of protection may be needed for PLWA or their survivors
faced with violent reactions.

"Safety nets" in this case refers to financial (micro-credit) and legal
services which are needed by PLWA and OVC. Community-based paralegals,
for example, can help facilitate legal aid activities, assist in raising
community awareness of legal protection services and link clients with
legal aid organizations. In some cases village elders or religious
leaders can be trained to provide these services. PLWA often are unable
to work on a regular basis or, if terminally ill, risk losing their
house, land or other possessions. Micro-credit facilities, small loans,
"merry-go-round" arrangements (which involve mutual aid society members
taking turns at lending each other money out of a revolving fund) can
assist PLWA to start or strengthen a small business that their children
or other family members can carry on, or expand small-scale production.
Improved business skills and increased savings and household income can
be critical to improve food security, reduce dependency and stigma, and
encourage expansion of similar groups. Where appropriate, recipients are
encouraged to link effectively with other groups providing these
services to ensure that PLWA are reached by them. Attention should be
paid to the particular situation of PLWAs and their families, so that
involvement in such programs do not increase their economic
vulnerability or place the family in debt in the event of the PLWA's
death.

**Expected Outcomes:**

-   PLWA have increased access to a range of health services, and are
    systematically referred by community care providers for OI/STI
    treatment, ARVs and FP/RH services as needed.

-   PLWA have increased access to psychosocial support services

-   PLWA and OVCs have increased access to legal protection, credit and
    other forms of livelihood security by referral, and not with GHAI
    funds

-   Local organizations serving PLWA and OVC are strengthened (better
    strategic planning, financial management, human resource
    utilization, and quality assurance) to become more sustainable

-   Community -based programs decrease stigma and discrimination against
    PLWA.

-   Links to programs in other sectors (e.g. agriculture, education,
    small business development) are forged as appropriate to better
    serve PLWA needs.

**SECTION II - MONITORING AND EVALUATION**

**A. Performance Monitoring & Evaluation**

Monitoring of results is a key element of USAID programs. USAID seeks
data and information to improve performance and effectiveness, as well
as to inform planning and management decisions. Accurate and timely
monitoring will enable APHIA II to adapt to changing conditions and make
mid-course corrections as necessary. Data also must be available to
demonstrate program impact. As part of the Performance Monitoring Plan
(PMP), special emphasis will be on standardized Emergency Plan
indicators. The applicant will be given guidance from the CTO on these
and specified formats. Additional indicators and targets for achievement
of the activity objective and each of the three results will be
developed by the implementing agencies for APHIA II and submitted as
part of the overall PMP for this activity. The PMP submitted by both
implementing agencies will be subject to approval of the USAID Cognizant
Technical Officer (CTO), based on pertinence, feasibility and funding
availability.  Indicators and targets for each result under each of the
Cooperative Agreements should illustrate how the Award will contribute
to improved utilization of services among target groups. Targets should
also reflect progress towards the Development Goals.

The Recipient under APHIA II is expected to fully engage local partners,
particularly GOK partners and NGOs in their intervention areas, in
planning and monitoring of program efforts. Given the decentralized
nature of the planned award, the complexity of tasks that are to be
undertaken, and the multitude of other interested parties, including the
GOK, other USG partners and other donors, special efforts will be
required to keep all parties informed and engaged in the planning,
implementation, and reporting of activities. Therefore all recipients
will be expected to participate in, and in some cases take
responsibility for organizing, regular meetings among the different
recipients, their counterparts at the district, provincial and/or
central levels, USAID, USG agency partners, and other donors. One of the
outcomes of these coordination/organizing responsibilities is to ensure
that targets for specific program areas are met in a geographic area
without duplication of effort or reporting by the various players in the
same program area.

**B. Substantial Involvement Understanding**

The Cognizant Technical Officer (CTO) is responsible for the following
elements or USAID's involvement during the implementation of the
program:

1\) Approval of annual work plans and performance monitoring plan (PMP).

2\) Approval of specified key personnel.

3\) Involvement in monitoring progress toward achievement of the
objective and anticipated results during the course of the agreement.

4\) Supporting an independent evaluation of the project after 24 months.

5\) As appropriate, other monitoring as described in 22 CFR 226.

**C**. **Deliverables & Reports**

# 

All reports as required under Substantial Involvement shall be submitted
by the due date for approval of the USAID CTO (Cognizant Technical
Officer). Additional reports requiring review and clearances, when
necessary, are listed under each requirement. Recipients will consult
the CTO on the format and expected content of reports prior to
submission. Each report shall be submitted (electronic copies to the CTO
and alternate + 2 hard copies).

**1. Financial Reports**

> Monthly baseline and pipeline reports will be submitted to the CTO
> during first and last six months of the award, and quarterly for all
> other periods of the Award. Quarterly 269 financial reporting will be
> submitted in accordance with 22 CFR 226.

**2. Performance Monitoring and Reporting**

a.  [Annual Work Plan.]{.underline} Each Recipient will prepare annual
    work plans on a schedule and according to a format provided by
    USAID, to be submitted to the CTO for USAID approval. The first work
    plan to be submitted will not necessarily be for a full year or may
    be for more than a full year, depending upon the start date of the
    agreement. Work plans are expected to reflect extensive discussions
    and joint planning exercises at the local and national levels as
    discussed above.

b.  [Performance Monitoring Report]{.underline}. For the first and last
    years of each Cooperative Agreement, based on the PMP to be
    developed by the recipient in collaboration with USAID, the
    recipient shall submit an updated report on progress towards agreed
    performance targets every three (3) months. This will include
    information on activities in all intervention districts. The reports
    must include the following: 1) explanation of qualitative and
    quantifiable output of the programs; 2) reasons why established
    goals were not met, if appropriate; and, 3) analysis and explanation
    of cost overruns or high unit costs (recipients must immediately
    notify USAID of developments that have a significant impact on
    award-supported activities). Further, notification should be given
    in the case of problems, delays, or adverse conditions which
    materially impair the ability to meet the objectives of the award.
    These notifications are expected to include a statement of the
    action taken or contemplated, and any assistance needed to resolve
    the situation. These reports and any additional reports, including
    information for Emergency Plan semi-annual reports need to meet
    reporting requirements under the President's Emergency Plan for AIDS
    Relief are expected to be produced promptly and completely.

c.  [Final Report]{.underline}. Each Recipient shall submit an original
    and five copies of the final report to the CTO and one copy to the
    USAID Development Experience Clearinghouse. Not later than 60 days
    after the completion date of each Cooperative Agreement, the
    recipient shall submit a final report which includes an executive
    summary of the Recipient's accomplishments in achieving results and
    conclusions about areas in need of future assistance; an overall
    description of the Recipient's activities and attainment of results
    by region, as appropriate, during the life of the Cooperative
    Agreement; an assessment of progress made toward accomplishing the
    Objective, Results and Expected Outcomes; significance of these
    activities; important research findings; comments and
    recommendations; and a fiscal report that describes how the
    Recipient's funds were used. See 22 CFR 226.51.

    **3. Management Reviews and External Evaluations**

The annual work plans will form the basis for joint annual management
reviews by USAID and program staff to review program directions,
achievement of the prior year work plan objectives, any major management
and implementation issues, and to make recommendations for any changes
as appropriate. These management reviews as well as work plan meetings
may be broadened to include dialogue across the different cooperating
agencies, and among MOH and USG partners.

At any time during program implementation, USAID may conduct one or more
external mid-term assessment/process evaluation(s) to review overall
progress, assess the continuing appropriateness of the program design,
and identify any factors impeding effective implementation. USAID will
utilize the results of the assessment to recommend any mid-course
changes in strategy if needed and to help determine appropriate future
directions. Site visits may occur anytime after startup.

**4.** **Management Plan**

Coordination and communication with a wide range of partners, including
GOK, USG agencies, local public/private sector partners, other
cooperating agencies, awardees in other geographic regions, other
donors, and communities are vital to achieving results. Applications
should reflect a willingness to partner with non-traditional and
creative partners and utilize diverse human resources effectively. It
must be demonstrated that local partners have a significant role in
management and implementation.

A management plan for the APHIA II Award will need to specify clear
lines of supervision, accountability, decision-making and responsibility
among staff. In the case of proposed prime/sub relationships, especially
in cases of geographic separation of collaborative institutions, clear
lines of communication should be established. Special attention will
need to be paid to ensuring efficiencies in operational and financial
management. Applicants should address how they intend to manage the
operational partnerships in order to maximize the input and utility of
all partner organizations, collaboratively and effectively. Applicants
should address how their regional implementation plan supports the "The
Three Ones" -- in particular, national action plans, and national
monitoring and evaluation frameworks.

USAID will host a startup and annual meeting for all APHIA II
recipients[^22], USG PEPFAR partners, GOK, and other stakeholders to
ensure sustained collaboration, and to support the "Three ones."
Awardees in each geographic area may be asked to have a standardized PMP
and/or to standardize other elements of their program as necessary. It
is the responsibility of staff based in Nairobi to coordinate ongoing
communication between regional implementing partners, to help link their
regional program with national programs, and to represent their program
at CTO-approved national meetings related to service-delivery, policy,
or coordination.

**D.** **Performance-Based Evaluation**

This cooperative agreement is awarded for an initial three years with an
option to extend for an additional two years, based on performance
during the initial period. Therefore, to assess performance of each
recipient, an external performance evaluation is planned to occur
approximately 24 months after award. Pending availability of funds and
program strategy at that time, including The Emergency Plan strategies
and guidelines, the performance evaluation and data from other reporting
and observations over the life of the initial award will be used to
determine whether the option to extend each individual cooperative
agreement will be exercised.

**SECTION III -- IMPLEMENTATION ARRANGEMENT**

**A.** **ANTICIPATED AWARD SCHEDULE**

The APHIA II award is anticipated to be awarded by September 30, 2006.

**B. FUNDING**

The Cooperative Agreements will be incrementally funded.

**C. WORKWEEK**

A five-day work week is authorized under this cooperative agreement.

**D. AUTHORIZED GEOGRAPHIC CODE**

The authorized geographic code for procurement of goods and services
under the cooperative agreement is 935.

**E. ELIGIBLE APPLICANTS**

To be eligible to receive this Cooperative Agreement, a consortium or
organization must be an institution of higher education, research
institution, for-profit, non-profit, or private voluntary organization.
U.S. Private Voluntary Organizations (PVOs) must be registered with
USAID, as defined in 22 CFR part 228 and Kenyan NGOs must be registered
in Kenya. Government of Kenya entities and parastatals are precluded
from applying for this Cooperative Agreement.

**SECTION IV -- AGREEMENT APPLICATION INSTRUCTIONS**

## A. PREPARATION GUIDELINES

Applications must be submitted no later than the date and time indicated
on the cover page of this RFA, to the location indicated on page 2 of
the cover letter accompanying this RFA. All applications received by the
deadline will be reviewed for responsiveness to the specifications
outlined in these guidelines and the selection criteria presented in
Section V. Section V addresses the technical evaluation procedures for
the applications. Applications which are submitted late or are
incomplete run the risk of not being considered in the review process.

Applications shall be submitted in two separate parts: (a) technical and
(b) cost or business application. Technical portions of applications
shall be submitted in an original and five (5) copies, cost portions of
applications in an original and five (5) copies.

The application should be organized according to the selection criteria
presented in Section V.

Technical applications should be specific, complete and presented
concisely. The application should demonstrate the applicant\'s
capabilities and expertise with respect to achieving the goals of this
program. The applications should take into account the technical
evaluation criteria found in Section V.

Applicants should retain for their records one copy of the application
and all enclosures which accompany their application. Erasures or other
changes must be initialed by the person signing the application. To
facilitate the competitive review of the applications, USAID will
consider only applications conforming to the format prescribed below.

## **B. TECHNICAL APPLICATION PREPARATION** {#b.-technical-application-preparation .unnumbered}

USAID requests that the application be kept as concise as possible. 
Detailed information should be presented only when required by specific
RFA instructions.  Technical applications are limited to 35 pages (12
point single-spaced Times New Roman font, and a minimum of 1 inch
margins all around) not including the cover page, executive summary,
appendices, and certain graphics as specified.  Pages should be
paginated at the bottom. Graphics and charts specifically requested in
this technical application will not count against the page limit for the
application, and may be included either in the application or in
attachments. Shorter applications are encouraged. USAID requests that
applications provide all information required by following the general
format described below.

Applicants may use appendices for such required supplemental information
as key personnel resumes, resumes of other personnel, and a list of
previous contracts, grants, and cooperative agreements and past
performance reports. Applicants are requested to limit appendices to a
total of 25 pages. Applicants shall provide the names of the individuals
responsible for the preparation of the application.

A Technical Evaluation Panel will evaluate the technical applications in
accordance with the evaluation criteria in Section V.   The suggested
format for the technical application is:

**1.** **Cover Page**

Include proposed Project title, RFA Number, "APHIA II Western" name of
organization(s) submitting application, contact person, telephone and
fax numbers, e-mail, and address.

**2.**   **Executive Summary** **(1-3 pages)**

Although this section will not be scored, it should allow technical
reviewers to quickly understand the critical elements of the application
including the most salient features of the applicants' technical vision
and approach, the key personnel and management plan proposed, and the
capabilities of the partners to accomplish the desired results.

**3. Technical Application (maximum 35 pages)**

**a.  Technical Approach   **

The applicant should describe how the partners will implement the full
scope of the HIV/AIDS prevention, treatment, care and support activity
including TB, FP/RH, and selected MCH services in the selected
province(s) through accomplishment of the three results. The technical
approach should include:

-   How applicants propose to build upon existing capacities and address
    the gaps in integrated services, including 11 of the 14 PEPFAR
    areas[^23] (excluding blood safety, ARV drug procurement, laboratory
    infrastructure), FP/RH and Maternal and Child Health. Applicants
    should demonstrate that they have researched other USG, GOK and
    donor activities in the region on which they are bidding, and
    suggest solutions to ensure continuity of service and meet known
    gaps in the "imperative sites" list in Appendix A;

-   How applicants plan to promote and leverage family planning and
    child survival activities within their integrated program to
    maximize the impact of these programs relative to their limited
    funding;

-   How applicants will incorporate the "guiding principles" of this RFA
    into their program

-   How applicants will coordinate with other donors and implementing
    partners through the Provincial and District Ministry of Health.
    Before an agreement is signed, successful applicants will be asked
    to show a letter of collaborative support from the Provincial
    Medical Officer (PMO) of the province(s) in which they will work.
    Only one letter, from the prime bidder will be required. Applicants
    should state in their application their intent to work with the PMO
    for donor coordination within a province, but should not include a
    letter of support at this time;

-   How applicants will link or work alongside implementing partners
    already in the province(s), including "Track 1" partners and other
    USG partners and how this will help achieve proposed targets;

-   How applicants will control costs, including special attention to
    publications and events, and improve the cost-effectiveness of the
    program; and

-   Applicants' demonstration of familiarity with national systems,
    programs, policies and guidelines, and show how their program fits
    within these.

**b. Key Personnel and staffing plan: **

Applicant should propose a staffing plan for the achievement of the
APHIA II results that demonstrates an appropriate balance of skills and
accountability. The use of qualified Kenyans in leadership, technical
and managerial positions is strongly encouraged. Applicants may propose
the same people on more than one application for positions that are
based in Nairobi or that are part-time. The application shall include
the names, position title and roles of the key personnel it proposes to
use.

Applicant should provide:

-   A complete staffing plan including key personnel and technical
    staff, with underlying rationale, including an organizational chart
    demonstrating lines of authority and staff responsibility
    accompanied by position descriptions. Applicants may propose and
    justify the configuration of key staff positions in addition to or
    in substitution of those described herein. Staffing patterns are
    expected to include core non-program staff, minimal key technical
    staff and an explanation of how additional technical expertise will
    be obtained with attention to cost-containment and avoiding
    unnecessary staffing;

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-   A matrix of relevant programmatic and technical skills and
    experience necessary to implement the applicant's plan, that shows
    how all proposed staff in the staffing pattern meet these
    requirements (matrix will not count against page limit);

-   Description and/or graphic of the field location and anticipated
    travel of each of their staff relative to the technical and
    programmatic needs in the province(s). Key core and technical staff
    should be based in the province(s) in which the applicant is
    working. Only the Project Director and Financial Management
    Specialist should be based in Nairobi (graphic will not count
    against page limit); and

-   Resumes and letters of commitment for two years from all key
    personnel and at least one year from senior technical staff should
    be included in the appendices, and, for each key person proposed,
    three references with telephone and email contact information, with
    one of these being a host country counterpart.

**Key personnel** positions and qualifications:

The four (4) key positions envisioned for each Cooperative Agreement
include: Project Director; Deputy Director; Monitoring and Evaluation
Specialist; and Financial Management Specialist. Applicants may propose
alternative positions as key positions other than the ones specified,
with adequate justification.

[Project Director:]{.underline} The Project Director must have at least
a master's degree in a relevant discipline and demonstrated experience
in the field of HIV/AIDS The Project Director is expected to have the
strategic vision, leadership qualities, depth and breadth of technical
expertise and experience, professional reputation, management
experience, interpersonal skills and written and oral presentation
skills to fulfill the diverse technical and managerial requirements of
the program description. S/he will also have at least 10 years of
experience in developing countries (preferably in Africa), at least 5 of
which involve experience interacting with other donor government
agencies, host country governments and international donor agencies.
S/he must have prior experience as a supervisor, and as director of a
project or program. This position should be based in Nairobi.

[Deputy Director:]{.underline} The Deputy Director must also have at
least a master's degree in health or social sciences or a related
advanced degree relevant to the field of HIV/AIDS and one other health
field from among the following: FP/RH, Maternal & Child Health, or
Infectious Diseases (ideally in complement to the proposed Director's
expertise). S/he is expected to have strong leadership qualities, good
depth and breadth of technical expertise and experience, strong
management experience and excellent written and oral communication and
interpersonal skills. S/he must have at least 7 years experience in
developing countries, and have experience working with donor agencies.
S/he must have prior experience as a supervisor, and in managing a large
project or program. This position should be based in the geographic
region of the application.

The Project Director and Deputy should have complementary skills and
knowledge and have at least 17 years of combined relevant work
experience in less developed countries, preferably with broad
geographical coverage. The Project Director and/or the Deputy must have
substantial experience in designing, implementing and managing large,
complex community-level integrated HIV/AIDS/FP/RH projects in Africa.

[Monitoring and Evaluation Specialist:]{.underline} The Monitoring and
Evaluation (M&E) Specialist must have an advanced degree in a relevant
discipline, and applied skills in designing and implementing monitoring
and evaluating activities and formative or operations research for
integrated HIV/AIDS or related programs in developing countries. S/he
must have a firm command of M&E issues related to populations of special
interest (e.g. orphans, PLWA, high-risk groups, mothers and children).
The M&E Specialist must have demonstrable analytical skills and
experiences to identify and evaluate best practices and state-of-the-art
approaches to be utilized by APHIA II. Additionally, s/he must have
strong writing and organizational skills for reporting on program and
study results. This position should be based in the geographic region of
the application.

[Financial Management Specialist:]{.underline} The Financial Management
Specialist must have an advanced degree in accounting, finance or
business administration and applied skills in developing and managing
large budgets. S/he must have at least 8 years of experience in
professional accounting or auditing, including at least 4 years
experience working with international donor reporting, preferably USG
reporting requirements. S/he must be proficient in relevant computer
applications and databases, and must be organized, responsible, and
concise to meet reporting requirements and deadlines. The Financial
Management Specialist should have demonstrable analytical,
organizational, and written communication skills in English. This
position should be based in Nairobi.

**Technical staff** positions and qualifications:

The applicant is requested to identify 2-3 key technical staff,
consistent with the overall staffing plan, who are considered essential
to achieving the results of the core agenda. The combination of these
staff should demonstrate a mix of practical technical skills necessary
for extending and strengthening clinic and community-based integrated
HIV/AIDS/FP/RH services and systems, and an ability to manage the design
and implementation of key components of this program description. If
they are in team leader positions, they should have a demonstrated
capacity to liaise and negotiate with key stakeholders in other
organizations, as well as to support and supervise staff.

**c. Monitoring and Evaluation Plan:**

Applicants should:

-   Describe how they would develop a cost-effective, results-oriented
    monitoring system that will provide USAID/Kenya and the program
    itself with information to track progress toward achieving each of
    the three results, improve performance and effectiveness, and inform
    planning and management decisions.

-   Describe how they will track progress toward achieving results in
    HIV/AIDS. Applicants will be required to measure progress against
    PEPFAR indicators and targets, so should identify against which
    indicators they will report, and may also include illustrative
    sub-indicators relevant to their approach; and

-   Articulate realistic goals and targets that they expect to achieve
    by the end of The Emergency Plan -- September 2008, at 3 years and
    at 5 years from project start in each of the 14 PEPFAR areas (as
    appropriate to the province -- not all provinces require applicants
    to work in each program area), as well as in family planning and
    reproductive health, and child survival. Goals and targets should
    also demonstrate contribution to the Millennium Development Goals.

**d. Management:**

Applicants should describe how the partnership will be organized and
managed to use the complementary capabilities of partners most
effectively and to minimize non-productive costs to the government such
as multiple overheads. For example, applicants should describe how each
partner will be utilized and present a management plan that addresses
key management challenges such as internal and external coordination of
partners and staff, establishing lines of authority, financial
management and decision-making and management skills to ensure success
in achieving results.

This section of the application should include:

-   Management and administrative arrangements for overall
    implementation of the program including organizational structure,
    logistical support, personnel management, procurement arrangements
    for goods and services, and lines of authority between organizations
    and staff.

-   One or two organizational charts to illustrate the management plan,
    including coordination with consortia partners, collaboration with
    the PMO and other relevant GOK officials, linkages with existing
    programs/partners in the province(s), linkages with other Awardees,
    monitoring and evaluation and reporting (charts will not count
    against page limit).

-   How each partner agency, including local partners, will contribute
    to the overall strategy, implementation and results; and the
    proposed level of effort of all partners.

-   How the Applicant will coordinate with and manage sub-grantees and
    will encourage local, non-traditional and innovative partnerships,
    build capacity within these, and have a plan to transfer
    responsibility to local organizations as their capacity develops
    over the first 3 years and subsequent two years.

-   Realistic strategies or approaches for knowledge management,
    cost-containment and for coordinating with non-USAID supported
    organizations.

e.  **Technical Capabilities and Past Performance:**

The applicant should describe the expertise that each organization in
its consortium brings to strengthen the activities and achieve the
results described within this RFA. Applicant(s) should demonstrate their
technical capabilities and relevant past performance to undertake the
program described in this RFA.  The Applicant is asked to:

-   Describe the blend of technical and geographic expertise that will
    be needed to achieve the goal and results described in this RFA in
    the selected province, and how their application meets these needs.

-   Provide specific examples of how the Applicant and partners have
    successfully implemented worldwide and/or national projects in
    HIV/AIDS, FP/RH, MCH, or related services, at a level of size and
    complexity similar to the requirements of this RFA.

-   Describe how they have used creative and/or non-traditional partners
    and approaches to strengthen the overall capacity of the primary
    organization and project outcomes.

-   Describe how they have developed capacity of local partners and
    devolved responsibility to these local partners over time as
    capacity was developed.

-   Note: Past performance information is required for the prime and
    major sub-recipients. A major sub-recipient is an organization that
    anticipates receiving 15% of the award from the prime. Past
    performance references are not required for resource organizations
    or sub-recipients that are not considered major.

> For verification of past performance, applicants must submit three (3)
> different contracts/awards that the organizations were awarded within
> the past three (3) years that demonstrate ability to perform the work
> identified in the statement of work. Each organization must be
> separately identified and include the following reference information:
> Organization's name, at least two (2) current points of contacts who
> are capable of providing information with respect to performance of
> the organization, current telephone numbers for each points of
> contact, a brief description of the work performed, and an explanation
> of any negative past performance. The principal applicant must provide
> organizational past performance information for themselves and any
> proposed sub-recipients and subcontractors. It is extremely important
> that applicants disclose instances in which their past performance may
> be considered by previous customers or their representatives to have
> been less than fully satisfactory, and that they tell their side of
> the story and/or describe corrective action that they have taken.

-   USAID reserves the right to obtain past performance information from
    other sources including those not named in this application.

## C. COST APPLICATION FORMAT

The Cost or Business Application is to be submitted under separate cover
from the technical application. Certain documents are required to be
submitted by an applicant in order for a Grant Officer to make a
determination of responsibility. However, it is USAID policy not to
burden applicants with undue reporting requirements if that information
is readily available through other sources.

The following sections describe the documentation that applicants for
Assistance awards must submit to USAID in response to this solicitation.
While there is no page limit for this portion, applicants are encouraged
to be as concise as possible, but still provide the necessary detail to
address the following:

A. Provide a copy of the applicant's business/cost application, on a
compact disk, formatted in Word2000.

Present the summary budget for proposed activity including uses of USAID
funds and any other needed funds. Clearly indicate the partnerships' own
commitment to match funds separate from other donor support. **The RFA
does include a requirement for cost-sharing**. The portion of this
matching fund which will qualify as cost-share under 22 CFR 226 should
be clearly identified

B. Include a detailed budget, in US dollars, with an accompanying budget
narrative which provides in detail the total costs for implementation of
the program your organization is proposing. The budget must be submitted
using Standard Form 424 and 424A which can be downloaded from the USAID
web site,

http://www.usaid.gov/procurement_bus_opp/procurement/forms/sf424/;

Please note that the SF424 is submitted by the prime. It is a
consolidation of the primes and subs budgets.

A detailed budget must be submitted for the prime and major
sub-recipients. A major sub-recipient is an organization that
anticipates receiving 15% of the award from the prime

\- the breakdown of all costs associated with the program according to
costs of, if applicable, headquarters, regional and/or country offices;

\- the breakdown of all costs according to each partner organization
involved in the program;

\- the costs associated with external, expatriate technical assistance
and those associated with local in-country technical assistance;

\- the breakdown of the financial and in-kind contributions of all
organizations involved in implementing this Cooperative Agreement;

\- potential contributions of non-USAID or private commercial donors to
this Cooperative Agreement;

\- your procurement plan for commodities (note that contraceptives and
other health commodities will not be provided under this Cooperative
Agreement).

C. A current Negotiated Indirect Cost Rate Agreement is required for the
prime and major sub-recipients. A major sub-recipient is an organization
that anticipates receiving 15% of the award from the prime;

D. Required certifications and representations (as attached) are
required for the prime and major sub-recipients. A major sub-recipient
is an organization that anticipates receiving 15% of the award from the
prime;

E. Cost share has been recommended to be **10%** of the total estimated
amount. If the applicant proposes a cost share of less than 10%, it will
be deemed as not responsive, and will be removed from further
consideration. A proposed cost share greater than 10% will be considered
highly responsive.

F. Applicants who do not currently have a Negotiated Indirect Cost Rate
Agreement (NICRA) from their cognizant agency shall also submit the
following information:

1\. The applicant\'s financial reports for the previous 3-year period,
which have been audited by a certified public accountant or other
auditor satisfactory to USAID;

2\. Budget, cash flow and organizational chart;

3\. A copy of the organization\'s accounting manual.

G. Applicants should submit any additional evidence of responsibility
deemed necessary for the Grant Officer to make a determination of
responsibility. This information is required for the prime and major
sub-recipients. A major sub-recipient is an organization that
anticipates receiving 15% of the award from the prime

The information submitted should substantiate that the Applicant:

1\. Has adequate financial resources or the ability to obtain such
resources as required during the performance of the award.

2\. Has the ability to comply with the award conditions, taking into
account all existing and currently prospective commitments of the
applicant, nongovernmental and governmental.

3\. Has a satisfactory record of performance. Past relevant
unsatisfactory performance is ordinarily sufficient to justify a finding
of non-responsibility, unless there is clear evidence of subsequent
satisfactory performance.

4\. Has a satisfactory record of integrity and business ethics; and

5\. Is otherwise qualified and eligible to receive a grant under
applicable laws and regulations (e.g., EEO).

H. Applicants that have never received a grant, cooperative agreement or
contract from the U.S. Government are required to submit a copy of their
accounting manual. If a copy has already been submitted to the U.S.
Government, the applicant should advise which Federal Office has a copy.

In addition to the aforementioned guidelines, the applicant is requested
to take note of the following:

I. Unnecessarily Elaborate Applications - Unnecessarily elaborate
brochures or other presentations beyond those sufficient to present a
complete and effective application in response to this RFA are not
desired and may be construed as an indication of the applicant\'s lack
of cost consciousness. Elaborate art work, expensive paper and bindings,
and expensive visual and other presentation aids are neither necessary
nor wanted.

J. Acknowledgement of Amendments to the RFA - Applicants shall
acknowledge receipt of any amendment to this RFA by signing and
returning the amendment. The Government must receive the acknowledgement
by the time specified for receipt of applications.

K. Receipt of Applications - Applications must be received at the place
designated and by the date and time specified in the cover letter of
this RFA.

L. Submission of Applications:

1\. Applications and modifications thereof shall be submitted in sealed
envelopes or packages (1) addressed to the office specified in the Cover
Letter of this RFA, and (2) showing the time specified for receipt, the
RFA number, and the name and address of the applicant. A copy of the
full technical application should be provided in an electronic format
(CD) formatted in Word 2000 or XP. A copy of the cost or business
application should be provided on a separate CD in Excel version 2002 or
earlier format.

2\. Faxed applications will not be considered; however, applications may
be modified by written or faxed notice, if that notice is received by
the time specified for receipt of applications.

M. Preparation of Applications:

1\. Applicants are expected to review, understand, and comply with all
aspects of this RFA. Failure to do so will be at the applicant\'s risk.

2\. Each applicant shall furnish the information required by this RFA.
The applicant shall sign the application and print or type its name on
the Cover Page of the technical and cost applications. Erasures or other
changes must be initialed by the person signing the application.
Applications signed by an agent shall be accompanied by evidence of that
agent\'s authority, unless that evidence has been previously furnished
to the issuing office.

3\. Applicants who include data that they do not want disclosed to the
public for any purpose or used by the U.S. Government except for
evaluation purposes, should:

\(a\) Mark the title page with the following legend:

\"This application includes data that shall not be disclosed outside the
U.S. Government and shall not be duplicated, used, or disclosed - in
whole or in part - for any purpose other than to evaluate this
application. If, however, a grant is awarded to this applicant as a
result of - or in connection with - the submission of this data, the
U.S. Government shall have the right to duplicate, use, or disclose the
data to the extent provided in the resulting grant. This restriction
does not limit the U.S. Government\'s right to use information contained
in this data if it is obtained from another source without restriction.
The data subject to this restriction are contained in sheets; and

\(b\) Mark each sheet of data it wishes to restrict with the following
legend:

\"Use or disclosure of data contained on this sheet is subject to the
restriction on the title page of this application.\"

N. Explanation to Prospective Applicants -- Any prospective applicant
desiring an explanation or interpretation of this RFA must request it in
writing by May 29, 2006 to allow a reply to reach all prospective
applicants before the submission of their applications. Oral
explanations or instructions given before award of a Grant will not be
binding. Any information given to a prospective applicant concerning
this RFA will be furnished promptly to all other prospective applicants
as an amendment of this RFA, if that information is necessary in
submitting applications or if the lack of it would be prejudicial to any
other prospective applicants.

O. Grant Award:

1\. The Government may award one Grant resulting from this RFA to the
responsible applicant whose application conforming to this RFA offers
the greatest value. The Government may (a) reject any or all
applications, (b) accept other than the lowest cost application, (c)
accept alternate applications, and (d) waive informalities and minor
irregularities in applications received.

2\. The Government may award one Grant on the basis of initial
applications received, without discussions. Therefore, each initial
application should contain the applicant\'s best terms from a cost and
technical standpoint.

3\. Neither financial data submitted with an application nor
representations concerning facilities or financing, will form a part of
the resulting Grant.

P. Authority to Obligate the Government - The Grant Officer is the only
individual who may legally commit the Government to the expenditure of
public funds. No costs chargeable to the proposed Grant may be incurred
before receipt of either a fully executed Grant or a specific, written
authorization from the Grant Officer.

Q. The Recipient is reminded that U.S. Executive Orders and U.S. law
prohibits transactions with, and the provision of resources and support
to, individuals and organizations associated with terrorism. It is the
legal responsibility of the recipient to ensure compliance with these
Executive Orders and laws. This provision must be included in all
subcontracts/sub-awards issued under this Agreement.

R. Foreign Government Delegations to International Conferences - Funds
in this \[contract, agreement, amendment\] may not be used to finance
the travel, per diem, hotel expenses, meals, conference fees or other
conference costs for any member of a foreign government\'s delegation to
an international conference sponsored by a public international
organization, except as provided in ADS Mandatory Reference \"Guidance
on Funding Foreign Government Delegations to International Conferences

\[http://www.info.usaid.gov/pubs/ads/300/refindx3.htm\] or as approved
by the \[CO/AO/CTO\].

**SECTION V -- SELECTION CRITERIA**

**A. OVERVIEW**

The criteria presented below have been tailored to the requirements of
this particular RFA. Applicants should note that these criteria serve
to: (a) identify the significant matters which applicants should address
in their applications and (b) set the standard against which all
applications will be evaluated. To facilitate the review of
applications, applicants should organize the narrative sections of their
applications in the same order as the selection criteria.

The technical applications will be evaluated in accordance with the
Technical Evaluation Criteria set forth below. Thereafter, the cost
application of all applicants submitting a technically acceptable
application will be opened and costs will be evaluated for general
reasonableness, allowability, and allocability. To the extent that they
are necessary (if award is made based on initial applications),
negotiations will then be conducted with all applicants whose
application, after discussion and negotiation, has a reasonable chance
of being selected for award. The award will be made to the responsible
applicant whose application offer the greatest value, cost and other
factors considered.

The award will be made based on the ranking of proposals according to
the technical selection criteria identified below. To make an objective
evaluation possible, applications must clearly demonstrate how the
organization and the application meet these criteria. A Cooperative
Agreement may be awarded to the applicant or applicants representing the
overall best value to the government.

**B. TECHNICAL EVALUATION CRITERIA**

**1. Technical Approach 30 points**

-   Application reflects excellent understanding of the USG program in
    Kenya, including USAID/Kenya, Emergency Plan programs of other USG
    partners, and USAID regional border programs. Applicant has a
    comprehensive understanding of GOK national health policies and
    programs, and other donors' HIV and other relevant health programs
    in Kenya. There is excellent understanding of the overall program
    description and its objectives and the blend of technical and
    geographic expertise that are needed to achieve the objectives of
    this program in the selected province. The applicant synthesizes and
    applies the lessons learned from past and current USAID agreements
    and other critical sources. **(6 points)**

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-   Application demonstrates technical leadership, creativity,
    innovation and soundness in advancing evidence-based best practices
    for HIV/AIDS, FP/RH services, health sector reform, MCH, and
    programming and highly relevant approaches for addressing the key
    issues and challenges listed in the RFA, in particular the
    continuity of services at "imperative sites" (Appendix A.) This
    includes:

    -   Effective approaches to achieve specific results in increasing
        knowledge and health seeking behaviors for HIV/AIDS and the
        other key health services (RH/FP and selected MCH services);

    -   Effective ways to increase availability of non-clinic and
        clinic-based HIV/AIDS services and products;

    -   Effective approaches to strengthen support systems to extend
        these services at the community, sub-district, and district
        levels for the population groups and at the imperative sites in
        this RFA;

    -   Practical approaches to address gender and the other "guiding
        principles" of this RFA.

> (**16 points**)

-   Application presents a viable approach for actively engaging a
    variety of partners, including government, non-governmental
    organizations, private and commercial interests and communities in
    the planning, provision, management and sustainability of HIV/AIDS
    and related health services and commodities for the underserved
    population groups in this RFA; addressing the organizational
    strengthening needs of local consortia [partners]{.underline} and
    sub-partners; and how realistic and sustainable the plan is to
    transfer responsibility to these partners as they gain capacity.
    **(8 points)**

**2. Key Staff and Staffing Plan 25 points**

The application demonstrates that key staff and core technical staff, in
particular the Project Director, have the requisite.

-   Breadth and depth of technical expertise and experience in
    management, design and implementation of complex facility- and
    community-level delivery programs for AIDS and related health
    services *and* community-level service delivery programs or
    components of those programs. (**8 points**)

# [Evidence of strong leadership skills and ability to build collaborative]{.smallcaps} [relationships among staff, partners, other cooperating agencies, key stakeholders, and donors. (**7 points**)]{.smallcaps}

Overall staffing pattern

# [The staffing pattern reflects the minimum number of highly experienced technical staff sufficient to manage the range of activities needed and the optimal mix of technical personnel considered necessary to achieve all results in the specified geographical area and contribute to national policies and guidelines]{.smallcaps}**. (3 points)**

-   Qualified Kenyans are proposed for leadership, technical and
    managerial positions (**4 points**)

-   Proposed technical staff (other than key personnel) demonstrate a
    mix of practical technical skills necessary for extending and
    strengthening clinic and community-based integrated HIV/AIDS/FP/RH
    and related health services and systems, and an ability to manage
    the design and implementation of key components of this program
    description. **(3 points)**

#  

**3. Monitoring and Evaluation Plan 12 points**

The application presents ambitious but achievable performance targets
and benchmarks for HIV/AIDS and FP/RH services that will be achieved by
the end of three and of five years; a minimal set of indicators for
these targets; the main benchmarks on the way to achieving these
results; how progress will be monitored and measured; a description of
the methodology to be used for data collection within target groups that
is cost-effective and timely; and how the Performance Monitoring Plan
(PMP) will take into account other players in achieving targets. The M&E
plan demonstrates a thorough understanding of PEPFAR indicators and
reporting requirements.

**4. Management Plan 15 points**

The application demonstrates:

-   Appropriate plans for rapid start up of the project to ensure
    continuity of service, including plans for rapidly accessing and
    deploying key personnel and essential technical staff to support the
    implementation of the technical program and meet Mission needs on
    the ground while avoiding excess staffing (**7 points**)

-   Appropriate management and administrative structure, policies and
    practices for overall implementation of the program including
    personnel, financial and logistical support; coordination across all
    partners in the consortium; reporting requirements; realistic
    approaches for cost-containment and achieving the cost-share
    requirements of the RFA[;]{.underline} the role and level of effort
    for staff supporting these functions; and a realistic plan for
    monitoring the technical and financial activities and reporting of
    sub-recipients and grantees. (**8 points**)

**5. Technical Capabilities and Past Performance 18 points**

The application demonstrates:

-   Organizational and technical capacity among the Prime and its major
    partners to achieve the results described in this RFA, including
    evidence of having successfully managed an award of comparable
    complexity and duration. The combined, complementary expertise and
    experience of the partners includes having managed a program of at
    least \$3 million per year, preferably in East Africa; with a proven
    track record for accomplishing program outcomes, using best
    practices or state-of-the-art approaches; and shows the
    institutional capacity to accurately track and report program
    expenditures, based on complete documentation as described in
    Section A.3. (**8 points**)

-   The proposed consortium or partnership includes at least one Kenyan
    organization; includes partnerships that add value and strengthen
    the management experience of local organizations by bringing their
    expertise and in-depth understanding of the local context to bear in
    the areas described under Results 1, 2 and 3. (**5 points**)

-   Favorable past performance checks from prior donors on achievement
    of the contract/agreement objectives within the timeline, timeliness
    of reporting, responsiveness to donor needs, cost containment,
    management of personnel, and overall satisfaction. (**5 points**)

# 

**C. Cost Evaluation**

Cost will not be part of the technical review, but costs will be
reviewed by the Grant Officer for reasonableness. Proposals that have
more efficient operational systems that reduce operation costs will be
more favorably considered. Organizations that respond to this RFA are
required to include a cost share of up to 10% or more of the value of
the expected USAID resources, in cash or in kind and describe how these
resources will contribute to the sustainability of the project over
time. Examples of in-kind contributions include: use of facilities,
vehicles and staff, as well as utilities or other non-cash
contributions, provided the grantee can reliably track the actual
contributions of these goods or services over time and can provide a
credible cost basis for these contributions.

#  

-   How effective is the application in the use of grant funds?

-   Does the applicant show reasonableness of grant administration
    costs?

> \- Does the applicant provide a cost share of 10 percent or more (It
> should be noted that there is no separate additional evaluation
> criteria for cost share, because cost share is included within
> cost-effectiveness.)

# 

# 

# 

**SECTION VI -- CERTIFICATION, ASSURANCE AND OTHER STATEMENTS OF
APPLICANTS**

## PART I - CERTIFICATIONS AND ASSURANCES

1\. ASSURANCE OF COMPLIANCE WITH LAWS AND REGULATIONS GOVERNING
NON-DISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS

\(a\) The recipient hereby assures that no person in the United States
shall, on the bases set forth below, be excluded from participation in,
be denied the benefits of, or be otherwise subjected to discrimination
under, any program or activity receiving financial assistance from
USAID, and that with respect to the grant for which application is being
made, it will comply with the requirements of:

\(1\) Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352, 42
U.S.C. 2000-d), which prohibits discrimination on the basis of race,
color or national origin, in programs and activities receiving Federal
financial assistance;

\(2\) Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794),
which prohibits discrimination on the basis of handicap in programs and
activities receiving Federal financial assistance;

\(3\) The Age Discrimination Act of 1975, as amended (Pub. L. 95-478),
which prohibits discrimination based on age in the delivery of services
and benefits supported with Federal funds;

\(4\) Title IX of the Education Amendments of 1972 (20 U.S.C. 1681, et
seq.), which prohibits discrimination on the basis of sex in education
programs and activities receiving Federal financial assistance (whether
or not the programs or activities are offered or sponsored by an
educational institution); and

\(5\) USAID regulations implementing the above nondiscrimination, set
forth in Chapter II of Title 22 of the Code of Federal Regulations.

\(b\) If the recipient is an institution of higher education, the
Assurances given herein extend to admission practices and to all other
practices relating to the treatment of students or clients of the
institution, or relating to the opportunity to participate in the
provision of services or other benefits to such individuals, and shall
be applicable to the entire institution unless the recipient establishes
to the satisfaction of the USAID Administrator that the institution\'s
practices in designated parts or programs of the institution will in no
way affect its practices in the program of the institution for which
financial assistance is sought, or the beneficiaries of, or participants
in, such programs.

\(c\) This assurance is given in consideration of and for the purpose of
obtaining any and all Federal grants, loans, contracts, property,
discounts, or other Federal financial assistance extended after the date
hereof to the recipient by the Agency, including installment payments
after such date on account of applications for Federal financial
assistance which were approved before such date. The recipient
recognizes and agrees that such Federal financial assistance will be
extended in reliance on the representations and agreements made in this
Assurance, and that the United States shall have the right to seek
judicial enforcement of this Assurance. This Assurance is binding on the
recipient, its successors, transferees, and assignees, and the person or
persons whose signatures appear below are authorized to sign this
Assurance on behalf of the recipient.

2\. CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS

\(a\) Instructions for Certification

\(1\) By signing and/or submitting this application or grant, the
recipient is providing the certification set out below.

\(2\) The certification set out below is a material representation of
fact upon which reliance was placed when the agency determined to award
the grant. If it is later determined that the recipient knowingly
rendered a false certification, or otherwise violates the requirements
of the Drug-Free Workplace Act, the agency, in addition to any other
remedies available to the Federal Government, may take action authorized
under the Drug-Free Workplace Act.

\(3\) For recipients other than individuals, Alternate I applies.

\(4\) For recipients who are individuals, Alternate II applies.

\(b\) Certification Regarding Drug-Free Workplace Requirements

Alternate I

\(1\) The recipient certifies that it will provide a drug-free workplace
by:

\(A\) Publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession or use of a controlled
substance is prohibited in the applicant\'s/grantee\'s workplace and
specifying the actions that will be taken against employees for
violation of such prohibition;

\(B\) Establishing a drug-free awareness program to inform employees
about\--

1\. The dangers of drug abuse in the workplace;

2\. The recipient\'s policy of maintaining a drug-free workplace;

3\. Any available drug counseling, rehabilitation, and employee
assistance programs; and

4\. The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace;

\(C\) Making it a requirement that each employee to be engaged in the
performance of the grant be given a copy of the statement required by
paragraph (b)(1)(A);

\(D\) Notifying the employee in the statement required by paragraph
(b)(1)(A) that, as a condition of employment under the grant, the
employee will\--

1\. Abide by the terms of the statement; and

2\. Notify the employer of any criminal drug statute conviction for a
violation occurring in the workplace no later than five days after such
conviction;

\(E\) Notifying the agency within ten days after receiving notice under
subparagraph (b)(1)(D)1, from an employee or otherwise receiving actual
notice of such conviction;

\(F\) Taking one of the following actions, within 30 days of receiving
notice under subparagraph (b)(1)(D)2., with respect to any employee who
is so convicted\--

1\. Taking appropriate personnel action against such an employee, up to
and including termination; or

2\. Requiring such employee to participate satisfactorily in a drug
abuse assistance or rehabilitation program approved for such purposes by
a Federal, State, or local health, law enforcement, or other appropriate
agency;

\(G\) Making a good faith effort to continue to maintain a drug- free
workplace through implementation of paragraphs (b)(1)(A), (b)(1)(B),
(b)(1)(C), (b)(1)(D), (b)(1)(E) and (b)(1)(F).

\(2\) The recipient shall insert in the space provided below the site(s)
for the performance of work done in connection with the specific grant:

Place of Performance (Street address, city, county, state, zip code)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Alternate II

The recipient certifies that, as a condition of the grant, he or she
will not engage in the unlawful manufacture, distribution, dispensing,
possession or use of a controlled substance in conducting any activity
with the grant.

3\. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS \-- PRIMARY COVERED TRANSACTIONS \[3\]

\(a\) Instructions for Certification

1\. By signing and submitting this proposal, the prospective primary
participant is providing the certification set out below.

2\. The inability of a person to provide the certification required
below will not necessarily result in denial of participation in this
covered transaction. The prospective participant shall submit an
explanation of why it cannot provide the certification set out below.
The certification or explanation will be considered in connection with
the department or agency\'s determination whether to enter into this
transaction. However, failure of the prospective primary participant to
furnish a certification or an explanation shall disqualify such person
from participation in this transaction.

3\. The certification in this clause is a material representation of
fact upon which reliance was placed when the department or agency
determined to enter into this transaction. If it is later determined
that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for
cause or default.

4\. The prospective primary participant shall provide immediate written
notice to the department or agency to whom this proposal is submitted if
at any time the prospective primary participant learns that its
certification was erroneous when submitted or has become erroneous by
reason of changed circumstances.

5\. The terms \"covered transaction,\" \"debarred,\" \"suspended,\"
\"ineligible,\" lower tier covered transaction,\" \"participant,\"
\"person,\" \"primary covered transaction,\" \"principal,\"
\"proposal,\" and \"voluntarily excluded,\" as used in this clause, have
the meaning set out in the Definitions and Coverage sections of the
rules implementing Executive Order 12549. \[4\] You may contact the
department or agency to which this proposal is being submitted for
assistance in obtaining a copy of those regulations.

6\. The prospective primary participant agrees by submitting this
proposal that, should the proposed covered transaction be entered into,
it shall not knowingly enter into any lower tier covered transaction
with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction,
unless authorized by the department or agency entering into this
transaction.

7\. The prospective primary participant further agrees by submitting
this proposal that it will include the clause titled \"Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion\--Lower Tier Covered Transaction,\" \[5\] provided by the
department or agency entering into this covered transaction, without
modification, in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.

8\. A participant in a covered transaction may rely upon a certification
of a prospective participant in a lower tier covered transaction that it
is not debarred, suspended, ineligible, or voluntarily excluded from the
covered transaction, unless it knows that the certification is
erroneous. A participant may decide the methods and frequency by which
it determines the eligibility of its principals. Each participant may,
but is not required to, check the Non-procurement List.

9\. Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render in good faith
the certification required by this clause. The knowledge and information
of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business
dealing.

10\. Except for transactions authorized under paragraph 6 of these
instructions, if a participant in a covered transaction knowingly enters
into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal
Government, the department or agency may terminate this transaction for
cause or default.

\(b\) Certification Regarding Debarment, Suspension, and Other
Responsibility Matters\--Primary Covered Transactions

\(1\) The prospective primary participant certifies to the best of its
knowledge and belief, the it and its principals:

\(A\) Are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions
by any Federal department or agency;

\(B\) Have not within a three-year period preceding this proposal been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State or local)
transaction or contract under a public transaction; violation of Federal
or State antitrust statutes or commission of embezzlement, theft,
forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;

\(C\) Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity (Federal, State or local) with
commission of any of the offenses enumerated in paragraph (1)(B) of this
certification;

\(D\) Have not within a three-year period proceeding this
application/proposal had one or more public transactions (Federal, State
or local) terminated for cause or default.

\(2\) Where the prospective primary participant is unable to certify to
any of the statements in this certification, such prospective
participant shall attach an explanation to this proposal.

4\. CERTIFICATION REGARDING LOBBYING

The undersigned certifies, to the best of his or her knowledge and
belief, that:

\(1\) No Federal appropriated funds have been paid or will be paid, by
or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee of any agency, a Member
of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment or modification of any Federal
contract, grant, loan, or cooperative agreement.

\(2\) If any funds other than Federal appropriated funds have been paid
or will be paid to any person for influencing or attempting to influence
an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL,
\"Disclosure of Lobbying Activities,\" in accordance with its
instructions.

\(3\) The undersigned shall require that the language of this
certification be included in the award documents for all sub-awards at
all tiers (including subcontracts, sub-grants, and contracts under
grants, loans, and cooperative agreements) and that all sub-recipients
shall certify and disclose accordingly.

This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, United
States Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than \$10,000 and not
more than \$100,000 for each such failure.

Statement for Loan Guarantees and Loan Insurance

The undersigned states, to the best of his or her knowledge and belief,
that: If any funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this commitment
providing for the United States to insure or guarantee a loan, the
undersigned shall complete and submit Standard Form-LLL, \"Disclosure
Form to Report Lobbying,\" in accordance with its instructions.
Submission of this statement is a prerequisite for making or entering
into this transaction imposed by section 1352, title 31, U.S. Code. Any
person who fails to file the required statement shall be subject to a
civil penalty of not less than \$10,000 and not more than \$100,000 for
each such failure.

5\. PROHIBITION ON ASSISTANCE TO DRUG TRAFFICKERS FOR COVERED COUNTRIES
AND INDIVIDUALS (ADS 206)

USAID reserves the right to terminate this \[Agreement/Contract\], to
demand a refund or take other appropriate measures if the \[Grantee/
Contractor\] is found to have been convicted of a narcotics offense or
to have been engaged in drug trafficking as defined in 22 CFR Part 140.
The undersigned shall review USAID ADS 206 to determine if any
certifications are required for Key Individuals or Covered Participants.

If there are COVERED PARTICIPANTS: USAID reserves the right to terminate
assistance to, or take other appropriate measures with respect to, any
participant approved by USAID who is found to have been convicted of a
narcotics offense or to have been engaged in drug trafficking as defined
in 22 CFR Part 140.

The recipient has reviewed and is familiar with the proposed grant
format and the applicable regulations, and takes exception to the
following (use a continuation page as necessary):

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Solicitation No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Application/Proposal No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Application/Proposal
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Recipient
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Typed Name and Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\[1\] FORMATS\\GRNTCERT: Rev. 06/16/97 (ADS 303.6, E303.5.6a) \[2\] When
these Certifications, Assurances, and Other Statements of Recipient are
used for cooperative agreements, the term \"Grant\" means \"Cooperative
Agreement\". \[3\] The recipient must obtain from each identified
sub-grantee and (sub)contractor, and submit with its
application/proposal, the Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion \-- Lower Tier Transactions, set
forth in Attachment A hereto. The recipient should reproduce additional
copies as necessary. \[4\] See ADS Chapter E303.5.6a, 22 CFR 208,
Annex1, App A. \[5\] For USAID, this clause is entitled \"Debarment,
Suspension, Ineligibility, and Voluntary Exclusion (March 1989)\" and is
set forth in the grant standard provision entitled \"Debarment,
Suspension, and Related Matters\" if the recipient is a U.S.
nongovernmental organization, or in the grant standard provision
entitled \"Debarment, Suspension, and Other Responsibility Matters\" if
the recipient is a non-U.S. non-Governmental Organization.

##  PART II - OTHER STATEMENTS OF RECIPIENT

1\. AUTHORIZED INDIVIDUALS

The recipient represents that the following persons are authorized to
negotiate on its behalf with the Government and to bind the recipient in
connection with this application or grant:

Name Title Telephone No. Facsimile No.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. TAXPAYER IDENTIFICATION NUMBER (TIN)

If the recipient is a U.S. organization, or a foreign organization which
has income effectively connected with the conduct of activities in the
U.S. or has an office or a place of business or a fiscal paying agent in
the U.S., please indicate the recipient\'s TIN:

TIN: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\. CONTRACTOR IDENTIFICATION NUMBER - DATA UNIVERSAL NUMBERING SYSTEM
(DUNS) NUMBER

\(a\) In the space provided at the end of this provision, the recipient
should supply the Data Universal Numbering System (DUNS) number
applicable to that name and address. Recipients should take care to
report the number that identifies the recipient\'s name and address
exactly as stated in the proposal.

\(b\) The DUNS is a 9-digit number assigned by Dun and Bradstreet
Information Services. If the recipient does not have a DUNS number, the
recipient should call Dun and Bradstreet directly at 1-800-333-0505. A
DUNS number will be provided immediately by telephone at no charge to
the recipient. The recipient should be prepared to provide the following
information:

\(1\) Recipient\'s name.

\(2\) Recipient\'s address.

\(3\) Recipient\'s telephone number.

\(4\) Line of business.

\(5\) Chief executive officer/key manager.

\(6\) Date the organization was started.

\(7\) Number of people employed by the recipient.

\(8\) Company affiliation.

\(c\) Recipients located outside the United States may obtain the
location and phone number of the local Dun and Bradstreet Information
Services office from the Internet Home Page at
http://www.dbisna.com/dbis/customer/custlist.htm. If an applicant is
unable to locate a local service center, it may send an e-mail to Dun
and Bradstreet at globalinfo@dbisma.com.

The DUNS system is distinct from the Federal Taxpayer Identification
Number (TIN) system.

DUNS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4\. LETTER OF CREDIT (LOC) NUMBER

If the recipient has an existing Letter of Credit (LOC) with USAID,
please indicate the LOC number:

LOC:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5\. PROCUREMENT INFORMATION

\(a\) Applicability. This applies to the procurement of goods and
services planned by the recipient (i.e., contracts, purchase orders,
etc.) from a supplier of goods or services for the direct use or benefit
of the recipient in conducting the program supported by the grant, and
not to assistance provided by the recipient (i.e., a sub-grant or
sub-agreement) to a sub-grantee or sub-recipient in support of the
sub-grantee\'s or sub-recipient\'s program. Provision by the recipient
of the requested information does not, in and of itself, constitute
USAID approval.

\(b\) Amount of Procurement. Please indicate the total estimated dollar
amount of goods and services which the recipient plans to purchase under
the grant:

\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\(c\) Nonexpendable Property. If the recipient plans to purchase
nonexpendable equipment which would require the approval of the
Agreement Officer, please indicate below (using a continuation page, as
necessary) the types, quantities of each, and estimated unit costs.
Nonexpendable equipment for which the Agreement Officer\'s approval to
purchase is required is any article of nonexpendable tangible personal
property charged directly to the grant, having a useful life of more
than one year and an acquisition cost of \$5,000 or more per unit.

TYPE/DESCRIPTION QUANTITY ESTIMATED UNIT COST

(Generic)

\(d\) Source, Origin, and Componentry of Goods. If the recipient plans
to purchase any goods/commodities which are not of U.S. source and/or
U.S. origin, please indicate below (using a continuation page, as
necessary) the types and quantities of each, estimated unit costs of
each, and probable source and/or origin. \"Source\" means the country
from which a commodity is shipped to the cooperating country or the
cooperating country itself if the commodity is located therein at the
time of purchase. However, where a commodity is shipped from a free port
or bonded warehouse in the form in which received therein, \"source\"
means the country from which the commodity was shipped to the free port
or bonded warehouse. Any commodity whose source is a non-Free World
country is ineligible for USAID financing. The \"origin\" of a commodity
is the country or area in which a commodity is mined, grown, or
produced. A commodity is produced when, through manufacturing,
processing, or substantial and major assembling of components, a
commercially recognized new commodity results, which is substantially
different in basic characteristics or in purpose or utility from its
components. Merely packaging various items together for a particular
procurement or re-labeling items does not constitute production of a
commodity. Any commodity whose origin is a non-Free World country is
ineligible for USAID financing. \"Components\" are the goods which go
directly into the production of a produced commodity. Any component from
a non-Free World country makes the commodity ineligible for USAID
financing.

TYPE/QUANTITY EST. GOODS PROBABLE GOODS PROBABLE DESCRIPTION UNIT
COMPONENTS SOURCE COMPONENTS ORIGIN

(Generic) COST

\(e\) Restricted Goods. If the recipient plans to purchase any
restricted goods, please indicate below (using a continuation page, as
necessary) the types and quantities of each, estimated unit costs of
each, intended use, and probable source and/or origin. Restricted goods
are Agricultural Commodities, Motor Vehicles, Pharmaceuticals,
Pesticides, Rubber Compounding Chemicals and Plasticizers, Used
Equipment, U.S. Government-Owned Excess Property, and Fertilizer.

TYPE/QUANTITY ESTIMATED PROBABLE PROBABLE INTENDED

DESCRIPTION UNIT COST SOURCE ORIGIN USE

(Generic)

\(f\) Supplier Nationality. If the recipient plans to purchase any goods
or services from suppliers of goods and services whose nationality is
not in the U.S., please indicate below (using a continuation page, as
necessary) the types and quantities of each good or service, estimated
costs of each, probable nationality of each non-U.S. supplier of each
good or service, and the rationale for purchasing from a non-U.S.
supplier. Any supplier whose nationality is a non-Free World country is
ineligible for USAID financing.

TYPE/ QUANTITY ESTIMATED PROBABLE NATIONALITY RATIONALE

DESCRIPTION UNIT COST SUPPLIER for (Generic) (Non-US Only) NON-US

\(g\) Proposed Disposition. If the recipient plans to purchase any
nonexpendable equipment with a unit acquisition cost of \$5,000 or more,
please indicate below (using a continuation page, as necessary) the
proposed disposition of each such item. Generally, the recipient may
either retain the property for other uses and make compensation to USAID
(computed by applying the percentage of federal participation in the
cost of the original program to the current fair market value of the
property), or sell the property and reimburse USAID an amount computed
by applying to the sales proceeds the percentage of federal
participation in the cost of the original program (except that the
recipient may deduct from the federal share \$500 or 10% of the
proceeds, whichever is greater, for selling and handling expenses), or
donate the property to a host country institution, or otherwise dispose
of the property as instructed by USAID.

TYPE/DESCRIPTION - QUANTITY - ESTIMATED - PROPOSED DISPOSITION

(Generic) UNIT COST

6\. PAST PERFORMANCE REFERENCES

Please refer to Section IV, B.(e).

7\. TYPE OF ORGANIZATION

The recipient, by checking the applicable box, represents that -

\(a\) If the recipient is a U.S. entity, it operates as \[ \] a
corporation incorporated under the laws of the State of, \[ \] an
individual, \[ \] a partnership, \[ \] a nongovernmental nonprofit
organization, \[ \] a state or loc al governmental organization, \[ \] a
private college or university, \[ \] a public college or university, \[
\] an international organization, or \[ \] a joint venture; or

\(b\) If the recipient is a non-U.S. entity, it operates as \[ \] a
corporation organized under the laws of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (country), \[
\] an individual, \[ \] a partnership, \[ \] a nongovernmental nonprofit
organization, \[ \] a nongovernmental educational institution, \[ \] a
governmental organization, \[ \] an international organization, or \[ \]
a joint venture.

8\. ESTIMATED COSTS OF COMMUNICATIONS PRODUCTS

The following are the estimate(s) of the cost of each separate
communications product (i.e., any printed material \[other than non-
color photocopy material\], photographic services, or video production
services) which is anticipated under the grant. Each estimate must
include all the costs associated with preparation and execution of the
product. Use a continuation page as necessary.

**CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS**

\(a\) Instructions for Certification

1\. By signing and submitting this proposal, the prospective lower tier
participant is providing the certification set out below.

2\. The certification in this clause is a material representation of
fact upon which reliance was placed when this transaction was entered
into. If it is later determined that the prospective lower tier
participant knowingly rendered an erroneous certification, in addition
to other remedies available to the Federal Government, the department or
agency with which this transaction originated may pursue available
remedies, including suspension and/or debarment.

3\. The prospective lower tier participant shall provide immediate
written notice to the person to whom this proposal is submitted if at
any time the prospective lower tier participant learns that its
certification was erroneous when submitted or has become erroneous by
reason of changed circumstances.

4\. The terms \"covered transaction,\" \"debarred,\" \"suspended,\"
ineligible, \"lower tier covered transaction,\" \"participant,\"
\"person,\" \"primary covered transaction,\" \"principal,\"
\"proposal,\" and \"voluntarily excluded,\" as used in this clause, has
the meanings set out in the Definitions and Coverage sections of rules
implementing Executive Order 12549. 1/ You may contact the person to
which this proposal is submitted for assistance in obtaining a copy of
those regulations.

5\. The prospective lower tier participant agrees by submitting this
proposal that, should the proposed covered transaction be entered into,
it shall not knowingly enter into any lower tier covered transaction
with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction,
unless authorized by the department or agency with which this
transaction originated.

6\. The prospective lower tier participant further agrees by submitting
this proposal that it will include this clause titled \"Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion\--Lower Tier covered Transaction,\" 2/ without modification,
in all lower tier covered transactions and in all solicitations for
lower tier covered transactions.

7\. A participant in a covered transaction may rely upon a certification
of a prospective participant in a lower tier covered transaction that it
is not debarred, suspended, ineligible, or voluntarily excluded from the
covered transaction, unless it knows that the certification is
erroneous. A participant may decide the method and frequency by which it
determines the eligibility of its principals. Each participant may, but
is not required to, check the Non procurement List.

8\. Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render in good faith
the certification required by this clause. The knowledge and information
of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business
dealings.

9\. Except for transactions authorized under paragraph 5 of these
instructions, if a participant in a covered transaction knowingly enters
into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal
Government, the department or agency with which this transaction
originated may pursue available remedies, including suspension and/or
debarment.

\(b\) Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion\--Lower Tier Covered Transactions

\(1\) The prospective lower tier participant certifies, by submission of
this proposal, that neither it nor its principals is presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from participation in this transaction by any Federal
department or agency.

\(2\) Where the prospective lower tier participant is unable to certify
to any of the statements in this certification, such prospective
participant shall attach an explanation to this proposal.

Solicitation No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Application/Proposal No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Application/Proposal
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Applicant/Sub-grantee
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Typed Name and Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1/ See ADS Chapter 303, 22 CFR 208.

2/ For USAID, this clause is entitled \"Debarment, Suspension,
Ineligibility, and Voluntary Exclusion (March 1989)\" and is set forth
in the USAID grant standard provision for U.S. nongovernmental
organizations entitled \"Debarment, Suspension, and Related Matters\"
(see ADS Chapter 303), or in the USAID grant standard provision for
non-U.S. nongovernmental organizations entitled \"Debarment, Suspension,
and Other Responsibility Matters\" (see ADS Chapter 303).

**KEY INDIVIDUAL CERTIFICATION NARCOTICS OFFENSES**

**AND DRUG TRAFFICKING**

I hereby certify that within the last ten years:

1\. I have not been convicted of a violation of, or a conspiracy to
violate, any law or regulation of the United States or any other country
concerning narcotic or psychotropic drugs or other controlled
substances.

2\. I am not and have not been an illicit trafficker in any such drug or
controlled substance.

3\. I am not and have not been a knowing assistor, abettor, conspirator,
or colluder with others in the illicit trafficking in any such drug or
substance.

Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title/Position:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Organization:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Birth:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NOTICE:

1\. You are required to sign this Certification under the provisions of
22 CFR Part 140, Prohibition on Assistance to Drug Traffickers. These
regulations were issued by the Department of State and require that
certain key individuals of organizations must sign this Certification.

2\. If you make a false Certification you are subject to U.S. criminal
prosecution under 18 U.S.C. 1001.

**PARTICIPANT CERTIFICATION NARCOTICS OFFENSES AND DRUG TRAFFICKING**

1\. I hereby certify that within the last ten years:

a\. I have not been convicted of a violation of, or a conspiracy to
violate, any law or regulation of the United States or any other country
concerning narcotic or psychotropic drugs or other controlled
substances.

b\. I am not and have not been an illicit trafficker in any such drug or
controlled substance.

c\. I am not or have not been a knowing assistor, abettor, conspirator,
or colluder with others in the illicit trafficking in any such drug or
substance.

2\. I understand that USAID may terminate my training if it is
determined that I engaged in the above conduct during the last ten years
or during my USAID training.

Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Birth:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NOTICE:

1\. You are required to sign this Certification under the provisions of
22 CFR Part 140, Prohibition on Assistance to Drug Traffickers. These
regulations were issued by the Department of State and require that
certain participants must sign this Certification.

2\. If you make a false Certification you are subject to U.S. criminal
prosecution under 18 U.S.C. 1001.

FORMATS\\GRNTCERT: Rev. 06/16/97 (ADS 303.6, E303.5.6a) When these
Certifications, Assurances, and Other Statements of Recipient are used
for cooperative agreements, the term \"Grant\" means \"Cooperative
Agreement\". The recipient must obtain from each identified sub-grantee
and (sub)contractor, and submit with its application/proposal, the
Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion \-- Lower Tier Transactions, set forth in Attachment
A hereto. The recipient should reproduce additional copies as necessary.
See ADS Chapter E303.5.6a, 22 CFR 208, Annex1, App A. For USAID, this
clause is entitled \"Debarment, Suspension, Ineligibility, and Voluntary
Exclusion (March 1989)\" and is set forth in the grant standard
provision entitled \"Debarment, Suspension, and Related Matters\" if the
recipient is a U.S. nongovernmental organization, or in the grant
standard provision entitled \"Debarment, Suspension, and Other
Responsibility Matters\" if the recipient is a non-U.S. nongovernmental
organization.

**CERTIFICATION REGARDING MATERIAL SUPPORT AND RESOURCES**

As a condition of entering into the referenced agreement,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ hereby certifies that it has
not provided and will not provide material support or resources to any
individual or entity that it knows, or has reason to know, is an
individual or entity that advocates, plans, sponsors, engages in, or has
engaged in terrorist activity, including but not limited to the
individuals and entities listed in the Annex to Executive Order 13224
and other such individuals and entities that may be later designated by
the United States under any of the following authorities: § 219 of the
Immigration and Nationality Act, as amended (8 U.S.C. § 1189), the
International Emergency Economic Powers Act (50 U.S.C. § 1701 et seq.),
the National Emergencies Act (50 U.S.C. § 1601 et seq.), or §
212(a)(3)(B) of the Immigration and Nationality Act, as amended by the
USA Patriot Act of 2001, Pub. L. 107-56 (October 26, 2001)(8 U.S.C.
§1182). \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ further certifies
that it will not provide material support or resources to any individual
or entity that it knows, or has reason to know, is acting as an agent
for any individual or entity that advocates, plans, sponsors, engages
in, or has engaged in, terrorist activity, or that has been so
designated, or will immediately cease such support if an entity is so
designated after the date of the referenced agreement.

For purposes of this certification, \"material support and resources\"
includes currency or other financial securities, financial services,
lodging, training, safe houses, false documentation or identification,
communications equipment, facilities, weapons, lethal substances,
explosives, personnel, transportation, and other physical assets, except
medicine or religious materials.

For purposes of this certification, \"engage in terrorist activity\"
shall have the same meaning as in section 212(a)(3)(B)(iv) of the
Immigration and Nationality Act, as amended (8 U.S.C. § 1182(a)(3)(B)
(iv)).

For purposes of this certification, \"entity\" means a partnership,
association, corporation, or other organization, group, or subgroup.
This certification is an express term and condition of the agreement and
any violation of it shall be grounds for unilateral termination of the
agreement by USAID prior to the end of its term.

Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NOTICE: If you make a false Certification you are subject to U.S.
criminal prosecution under 18 U.S.C. 1001.

**PART III -** **SPECIAL PROVISIONS**

**(A) SUPPORTING USAID'S DISABILITY POLICY IN CONTRACTS, GRANTS, AND
COOPERATIVE AGREEMENTS**

[USAID Disability Policy -- Assistance (December 2004)]{.underline}

(a) The objectives of the USAID Disability Policy are (1) to enhance the
    attainment of United States foreign assistance program goals by
    promoting the participation and equalization of opportunities of
    individuals with disabilities in USAID policy, country and sector
    strategies, activity designs and implementation; (2) to increase
    awareness of issues of people with disabilities both within USAID
    programs and in host countries; (3) to engage other U.S. Government
    agencies, host country counterparts, governments, implementing
    organizations and other donors in fostering a climate of
    non-discrimination against people with disabilities; and (4) to
    support international advocacy for people with disabilities. The
    full text of the policy paper can be found at the following website:
    <http://www.usaid.gov/about/disability/DISABPOL.FIN.html>

(b) USAID therefore requires that the recipient not discriminate against
    people with disabilities in the implementation of USAID-funded
    programs and that it make every effort to comply with the objectives
    of the USAID Disability Policy in performing the program under this
    grant or cooperative agreement. To that end and to the extent it can
    accomplish this goal with the scope of the program objectives, the
    recipient should demonstrate a comprehensive and consistent approach
    for including men, women and children with disabilities. Questions
    about USAID's Disability Policy can be directed to Lynne Schaberg,
    PPC/P at 202-712-1891 or Lloyd Feinberg, DCHA/DG, 202-712-5725.

(c) USAID encourages Recipients to follow this policy to the maximum
    extent possible. By signing below, the Recipient acknowledges that
    it is aware of this policy and will apply it to the maximum extent
    practicable.

> Signature:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Name:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**(B) DEPARTMENT OF STATE GUIDANCE ENTITLED -- SECTION 579**

**IMPLEMENTATION -- TAXATION OF US FOREIGN ASSISTANCE**

**"Reporting of Foreign Taxes**

\(a\) Final and Interim Reports. The contractor must annually submit two
reports:

\(i\) an interim report by November 17; and

\(ii\) a final report by April 16 of the next year.

\(b\) Contents of Report. The reports must contain:

\(i\) Contractor name.

\(ii\) Contact name with phone, fax and email.

\(iii\) Contract number and task order number(s).

> \(iv\) Amount of foreign taxes assessed by a foreign government \[each
> foreign government must be listed separately\] on commodity purchase
> transactions valued at \$500 or more financed with U.S. foreign
> assistance funds under this agreement during the prior U.S. fiscal
> year. NOTE: For fiscal year 2003 only, the reporting period is
> February 20, 2003 through September 30, 2003.
>
> \(v\) Only foreign taxes assessed by the foreign government in the
> country receiving U.S. assistance is to be reported. Foreign taxes by
> a third party foreign government are not to be reported. For example,
> if an assistance program for Lesotho involves the purchase of
> commodities in South Africa using foreign assistance funds, any taxes
> imposed by South Africa would not be reported in the report for
> Lesotho (or South Africa).

\(vi\) Any reimbursements received by the Contractor during the period
in (iv) regardless of when the foreign tax was assessed plus, for the
interim report, any reimbursements on the taxes reported in (iv)
received by the recipient through October 31 and for the final report,
any reimbursements on the taxes reported in (iv) received through March
31.

\(vii\) The final report is an updated cumulative report of the interim
report.

\(viii\) Reports are required even if the contractor did not pay any
taxes during the report period.

\(ix\) Cumulative reports may be provided if the contractor is
implementing more than one program in a foreign country.

\(c\) Definitions. For purposes of this clause:

\(i\) "Agreement" includes USAID direct and country contracts, grants,
cooperative agreements and interagency agreements.

\(ii\) "Commodity" means any material, article, supply, goods, or
equipment.

\(iii\) "Foreign government" includes any foreign governmental entity.

\(iv\) "Foreign taxes" means value-added taxes and custom duties
assessed by a foreign government on a commodity. It does not include
foreign sales taxes.

\(d\) Where. Submit the reports to: Controller's Office

USAID/KENYA

Unit 64102

APO, AE 09831-4102

\(e\) Sub-agreements. The contractor must include this reporting
requirement in all applicable subcontracts, sub-grants and other
sub-agreements.

> \(f\) For further information see
> [**http://www.state.gov/m/rm/c10443.htm**
> ."](http://www.usaid.gov/cgi-bin/goodbye?http://www.state.gov/m/rm/c10443.htm)

**(C) IMPLEMENTATION OF E.O. 13224 \-- CERTIFICATION REGARDING TERRORIST
FINANCING**

Before making the award of a grant or cooperative agreement to a
non-governmental organization, the Agreement Officer must obtain a
certification from both U.S. and non-U.S. organizations, substantially
as follows:

> "As a condition of entering into the referenced agreement, \[name of
> organization\] hereby certifies that it has not provided and will not
> provide material support or resources to any individual or entity that
> it knows, or has reason to know, is an individual or entity that
> advocates, plans, sponsors, engages in, or has engaged in terrorist
> activity, including but not limited to the individuals and entities
> listed in the Annex to Executive Order 13224 and other such
> individuals and entities that may be later designated by the United
> States under any of the following authorities: § 219 of the
> Immigration and Nationality Act, as amended (8 U.S.C. § 1189), the
> International Emergency Economic Powers Act (50 U.S.C. § 1701 et
> seq.), the National Emergencies Act (50 U.S.C. § 1601 et seq.), or §
> 212(a)(3)(B) of the Immigration and Nationality Act, as amended by the
> USA Patriot Act of 2001, Pub. L. 107-56 (October 26, 2001)(8 U.S.C.
> §1182). \[Name of organization\] further certifies that it will not
> provide material support or resources to any individual or entity that
> it knows, or has reason to know, is acting as an agent for any
> individual or entity that advocates, plans, sponsors, engages in, or
> has engaged in, terrorist activity, or that has been so designated, or
> will immediately cease such support if an entity is so designated
> after the date of the referenced agreement.
>
> For purposes of this certification, \"material support and resources\"
> includes currency or other financial securities, financial services,
> lodging, training, safe houses, false documentation or identification,
> communications equipment, facilities, weapons, lethal substances,
> explosives, personnel, transportation, and other physical assets,
> except medicine or religious materials.
>
> For purposes of this certification, \"engage in terrorist activity\"
> shall have the same meaning as in section 212(a)(3)(B)(iv) of the
> Immigration and Nationality Act, as amended (8 U.S.C. §
> 1182(a)(3)(B)(iv)).
>
> For purposes of this certification, "entity" means a partnership,
> association, corporation, or other organization, group, or subgroup.
>
> This certification is an express term and condition of the agreement
> and any violation of it shall be grounds for unilateral termination of
> the agreement by USAID prior to the end of its term."

Solicitation No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Application/Proposal No.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Application/Proposal
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Applicant/Sub-grantee
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Typed Name and Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Please indicate concurrence to standard provisions that can be viewed at
USAID website [www.usaid.gov/pubs/ads/300/303.pdf]{.underline}

Also, as per AAPD 02-04, dated March 20, 2002, it is mandatory to
incorporate the following Standard Provisions in all solicitations and
awards:

"PROHIBITIONS ON TRANSACTIONS WITH INDIVIDUALS OR ORGANIZATIONS
ASSOCIATED WITH TERRORISM:

The Contractor/Recipient is reminded that U.S. Executive Orders and U.S.
law prohibits transactions with, and the provision of resources and
support to, individuals and organizations associated with terrorism. It
is the legal responsibility of the contractor/recipient to ensure
compliance with these Executive Orders and laws. This provision must be
included in all subcontracts/sub awards issued under this
contract/agreement.\"

**ATTACHMENTS**

1\. Mandatory Standard Provisions for U.S. Nongovernmental recipients
can be accessed through USAID's website
<http://www.usaid.gov/policy/ads/300/refindx3.htm>

Mandatory Standard Provisions for Non-U.S., Nongovernmental recipients
can be accessed through USAID's website
<http://www.usaid.gov/policy/ads/300/refindx3.htm>

**Marking Under Assistance Instruments (AAPD 05-11) can be accessed
through USAID's website**

http://www.usaid.gov/business/business_opportunities/cib/pdf/aapd05_11.pdf

**2. SF 424 Application For Federal Assistance Website: This form can be
downloaded on USAID website at**:
[**http://www.usaid.gov/procurement_bus_opp/procurement/forms**](http://www.usaid.gov/procurement_bus_opp/procurement/forms).

**ATTACHMENT 3 - LIST OF ACRONYMS**

<table>
<colgroup>
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 4%" />
<col style="width: 75%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 4%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2">AAPD</td>
<td colspan="9"><blockquote>
<p>Acquisition and Assistance Policy Directive</p>
</blockquote></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">APHIA II</td>
<td colspan="9">AIDS Population and Health Integrated Assistance</td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">ART</td>
<td colspan="2">Anti-retroviral therapy</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">ARV</td>
<td colspan="2">Anti-retroviral drugs</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">BCC</td>
<td colspan="4">Behavior Change and Communication</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">BCC/IEC</td>
<td colspan="4">Behavior Change and Communication/Information,
Education, Communication</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">CBO</td>
<td colspan="4">Community-Based Organization</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">CCC</td>
<td colspan="7">Comprehensive Care Center (includes ART)</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">CDC</td>
<td colspan="7">Centers for Disease Control and Prevention</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">CFR</td>
<td colspan="4">Combined Federal Regulations</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">CPR</td>
<td colspan="4">Contraceptive Prevalence Rate</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">CS</td>
<td colspan="2">Child Survival (funds)</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">CT</td>
<td colspan="4">Counseling and Testing (either voluntary or
diagnostic)</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">DDCs</td>
<td colspan="4">District Development Committees</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">DfID</td>
<td colspan="9">Department for International Development (British
Aid)</td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">DHMT</td>
<td colspan="4">District Health Management Team</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">DHS</td>
<td colspan="4">Demographic and Health Survey</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">DOD</td>
<td colspan="2">Department of Defense (US)</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">EPI</td>
<td colspan="4">Expanded Program of Immunization</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">FAA</td>
<td colspan="7">Foreign Assistance Act (from US Congress)</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">FBO</td>
<td colspan="2">Faith-Based Organization</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">FP</td>
<td>Family Planning</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">GBV</td>
<td colspan="2">Gender-Based Violence</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">GHAI</td>
<td colspan="4">Global HIV/AIDS Initiative (funds)</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">GOK</td>
<td colspan="2">Government of Kenya</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">HBC</td>
<td>Home-Based Care</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">HIV+</td>
<td>HIV-positive</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">IPT</td>
<td colspan="7">Intermittent Presumptive Treatment (of malaria)</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">ITN</td>
<td colspan="2">Insecticide Treated Net</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">IUCD</td>
<td colspan="4">Intra-Uterine Contraceptive Device</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">KDHS</td>
<td colspan="7">Kenya Demographic and Health Survey</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">KEMSA</td>
<td colspan="4">Kenya Medical Supply Agency</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">KHPF</td>
<td colspan="4">Kenya Health Policy Framework</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">KHSSP II</td>
<td colspan="4">Kenya Health Sector Strategic Plan</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">KMTC</td>
<td colspan="4">Kenya Medical Training College</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">KNASP</td>
<td colspan="4">Kenya National AIDS Strategic Plan</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">KSPA</td>
<td colspan="7">Kenya Service Provision Assessment Survey</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">M&amp;E</td>
<td colspan="2">Monitoring and Evaluation</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">MCH</td>
<td colspan="2">Maternal and Child Health</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">MDGs</td>
<td colspan="4">Millennium Development Goals</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">MOH</td>
<td>Ministry of Health</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">NACC</td>
<td colspan="4">National AIDS Control Council</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">NCAPD</td>
<td colspan="10">National Coordinating Agency for Population and
Development</td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">NGO</td>
<td colspan="4">Non-Governmental Organization</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">NICRA</td>
<td colspan="7">Negotiated Indirect Cost Rate Agreement</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">OC</td>
<td colspan="2">Oral Contraceptives</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">OI</td>
<td colspan="2">Opportunistic Infection</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">OPH</td>
<td colspan="7">Office of Population and Health (USAID/Kenya)</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">OVC</td>
<td colspan="4">Orphans and Vulnerable Children</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">PAC</td>
<td colspan="2">Post-Abortion Care</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">PEP</td>
<td colspan="4">Presumptive Intermittent Treatment</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">PEPFAR</td>
<td colspan="9">President's Emergency Plan for AIDS Response (US)</td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">PHMT</td>
<td colspan="4">Provincial Health Management Team</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">PLWA</td>
<td colspan="2">People living with HIV/AIDS</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">PMO</td>
<td colspan="2">Provincial Medical Office</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">PMTCT</td>
<td colspan="9">Prevention of Mother-to-Child Transmission (of HIV)</td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">RFA</td>
<td colspan="2">Request for Applications</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">RH</td>
<td colspan="2">Reproductive Health</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">RH/FP</td>
<td colspan="4">Reproductive Health and Family Planning</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">STI</td>
<td colspan="2">Sexually Transmitted Infection</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">SWAp</td>
<td colspan="2">Sector-Wide Approach</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">TB</td>
<td>Tuberculosis</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">TFR</td>
<td>Total Fertility Rate</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">UNAIDS</td>
<td colspan="4">United Nations AIDS Foundation</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">UNICEF</td>
<td colspan="4">United Nations International Children's Fund</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">USAID</td>
<td colspan="4">United States Agency for International Development</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">USG</td>
<td colspan="2">United States Government</td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">USP</td>
<td colspan="4">Uniformed Services Program</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">VCT</td>
<td colspan="4">Voluntary Counseling and Testing</td>
<td colspan="6"></td>
</tr>
</tbody>
</table>

[^1]: Reproductive health, reproductive health care and reproductive
    health services for the purposes of this RFA refer to voluntary
    family planning and any combination of the following:
    HIV/AIDS-related counseling, services and care; maternal/newborn
    services; postabortion care; counseling and treatment for sexually
    transmitted infections; prevention of gender-based violence; and
    specifically exclude provision or promotion of induced abortion
    services.

[^2]: "Community-level", for purposes of this award, is defined as
    including district, sub-district and community levels.

[^3]: Including, but not limited to: policy and advocacy, medical
    commodities and logistics, laboratory technology, training,
    workforce planning, national-level BCC/IEC programs, limited food
    commodities, national level strategic information, and health care
    financing.

[^4]: Office of Population and Reproductive Health, Strategic Planning,
    Budgeting and Operations Office, and Office of HIV/AIDS.

[^5]: Only modest resources for MCH and other CS interventions are
    available at present.

[^6]: An orphan is a child under 18 years of age who has lost one or
    both parents.

[^7]: [Children on the Brink 2004]{.underline}, July 2004, UNAIDS,
    UNICEF, USAID

[^8]: [United States Mission to Kenya Five Year Strategy for the
    President's Emergency Plan for AIDS Relief: Strong Networks for a
    Sustained Response]{.underline}, December 2004.

[^9]: KDHS 2003

[^10]: KDHS 2003

[^11]: "Dual use" primarily refers to condoms, but may eventually be
    used for microbicides when they are widely available. It means that
    one contraceptive device offers "dual" protection against pregnancy
    and HIV.

[^12]: UNICEF website, MICS, 2000.

[^13]: The Agency's performance goals under its health strategic goal
    is: Improved global health, including child, maternal, and
    reproductive health, and the reduction of abortion and disease,
    especially HIV/AIDS, malaria, and tuberculosis.

[^14]: Kenya's fertility rate was 4.7 children per woman for the three
    years preceding the 1998 Kenya Demographic and Health Survey. 13.9%
    of adults 15-49 years of age were estimated to be HIV positive in
    1998.

[^15]: The Three Ones is a principle of Coordination of National
    Responses to HIV/AIDS from UNAIDS and are: **One** agreed HIV/AIDS
    Action Framework that provides the basis for coordinating the work
    of all partners; **One** national AIDS coordinating authority with a
    broad based, multi-sector mandate; and **One** agreed country-level
    Monitoring and Evaluation System.

[^16]: [Children on the Brink 2004]{.underline}, July 2004, UNAIDS,
    UNICEF, USAID.

[^17]: The Lancet, Neonatal Survival March 2005

[^18]: This may include well-researched and effective methods such as
    the Lactational Ammenorhea Method (LAM), which also promotes
    exclusive breastfeeding, and the Standard Days Method (SDM), which
    may be considered a "long-term method"

[^19]: The USG's [Five Year Strategy for the President's Emergency Plan
    for AIDS Relief]{.underline} states that, "...Where appropriate,
    programs will offer medical services including recognition and
    referral for evaluation of tuberculosis, treatment with
    multivitamins, malaria prevention, provision of food as appropriate,
    and cotrimoxazole preventive therapy...management of symptoms...and
    assistance with activities of daily living...\[and\] Emotional and
    spiritual support." (p. 23).

[^20]: [Reproductive Health Needs of Home-Based Care (HBC) Clients:
    Preliminary Findings and Intervention Activities]{.underline},
    Family Health International, March 2005.

[^21]: [USAID Project Profiles: Children Affected by
    HIV/AIDS]{.underline}, January 2005, p. 37.

[^22]: This includes APHIA II awardees for the five other geographic
    provinces of Kenya, for a total of seven APHIA II partners. All
    APHIA II coordination will be among all seven partners.

[^23]: The 14 PEPFAR Program areas are: PMTCT, Abstinence and Be
    Faithful (AB), Blood Safety, Injection Safety, Other Prevention,
    Palliative Care: Basic Health Care and Support, Palliative Care:
    TB/HIV, OVCs, Counseling and Testing, HIV Treatment: ARV Drugs, HIV
    Treatment: ARV Services, Laboratory Infrastructure, Strategic
    Information, Other/Policy Analysis and System Strengthening.