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Issuance Date: March12, 2008

Closing Date: May 8, 2008

Closing Time: 11:00 AM EST

Subject: Request for Applications (RFA) Number: M/OAA/GH/POP-08-712

> Responding to the Need for Family Planning through Expanded
> Contraceptive Choices and Program Services (RESPOND)

The United States Agency for International Development (USAID) is
seeking applications for a Leader with Associates Cooperative Agreement
from eligible U.S. for-profit, non-profit, or private voluntary
organization for a program titled, "Responding to the Need for Family
Planning through Expanded Contraceptive Choices and Program Services."
The authority for the RFA is found in the Foreign Assistance Act of
1961, as amended. USAID strongly encourages applicants to develop
consortiums with other responsible organizations (U.S. or Non-U.S.
Organizations).

**Any questions concerning this RFA must be submitted in writing to Ms.
Alisa Dunn, Agreement Specialist, via email at <adunn@usaid.gov> by
April 24, 2008 at 2:00PM EST.**

With this RFA, USAID's objective is to **increase the use of
reproductive health and family planning services, with a focus on the
informed and voluntary use of long-acting and permanent methods of
contraception (LAPMs)**. Specifically, USAID is seeking assistance to:

-   Strengthen global learning and application of state of the art
    approaches for LAPMs.

-   Gain knowledge generated, organized and disseminated to strengthen
    commitment, support and programming for LAPMs.

-   Establish holistic and evidence based approaches used to strengthen
    supply, demand and the enabling environment for RH/FP services with
    a focus on LAPMs.

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 application of the 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 application.

Subject to the availability of funds, USAID seeks to competitively award
the Responding to the Need for Family Planning through Expanded
Contraceptive Choices and Program Services (RESPOND) Leader with
Associates (LWA) Cooperative Agreement. USAID reserves the right to fund
any or none of the applications submitted.

This RFA provides an estimate of the dollar amount for the Leader of
\$240 million over five years. Each Associate Award has its own ceiling
that is not included in the Leader ceiling. The Associate award shall
specify the Total Estimated Award (TEA) amount for the Cooperative
Agreement.

For the purposes of this program, this RFA is being issued and consists
of this cover letter and the following:

> 1\. Section I Cooperative Agreement Application Format
>
> 2\. Section II Evaluation Criteria
>
> 3\. Section III Program Description
>
> 4\. Section IV Certifications, Assurances, and Other Statements of
> Applicant
>
> 5\. Section V Annexes

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\".

If you decide to submit an application, it must be received by the
closing date and time indicated at the top of this cover letter at the
place designated in the Technical Application Format for receipt of
applications. Applications and modifications thereof shall be submitted
in envelopes with the name and address of the applicant and RFA No.
M/OAA/GH/POP-08-712

Applicants are requested to submit both technical and cost portions of
their applications in separate volumes. Award will be made to that
responsible applicant(s) whose application(s) offers the greatest value.

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 application(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; if 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 internet at [www.grants.gov](http://www.grants.gov/). This RFA and
any future amendments can be downloaded from
[http://www.grants.gov](http://www.grants.gov/). Click on "Search for
Grant Opportunity," then click on \"Browse by Agency\" and choose U.S.
Agency for International Development, then click on the Opportunity
titled, "Responding to the Need for Family Planning through Expanded
Contraceptive Choices and Program Services (RESPOND)". If you have
difficulty accessing the RFA, please contact the Grants.gov Helpdesk at
1-800-518-4726 or via e-mail at <support@grants.gov> 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 grant 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 II Evaluation Criteria

\(b\) Section I Application Format

\(c\) Section III Program Description

\(d\) This Cover Letter

Sincerely,

Eduardo Elia

> Agreement Officer
>
> M/OAA/GH/POP

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# Table of Contents

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[ACRONYMS 5](#__RefHeading___Toc193014810)

[SECTION I -- AGREEMENT APPLICATION FORMAT
6](#__RefHeading___Toc193014811)

[*General Instructions* 6](#__RefHeading___Toc193014812)

[*Content of the Technical Application -- Instructions*
8](#__RefHeading___Toc193014813)

[**Cost/Business Application** 12](#__RefHeading___Toc193014814)

[SECTION II --SELECTION CRITERIA 21](#section-ii-evaluation-criteria)

[Section 1II - Program Description 27](#__RefHeading___Toc193014816)

#  

**SECTION IV -- CERTIFICATIONS AND ASSURANCE
.....................\...........52**

Affirmation of Certification:
<http://www.usaid.gov/policy/ads/300/303sad.dpf>

**SECTION V -- ANNEXES
......................................................................53**

Standard Form 424: <http://www.usaid.gov/forms/sf424.dpf>

Mandatory Standard Provisions for U.S. Nongovernmental Recipients:

<http://www.usaid.gov/policy/ads/303/303mab.pdf>

**ACRONYMS**[]{#__RefHeading___Toc193014810 .anchor}

ART Antiretroviral Treatment for AIDS

AIDS Acquired Immune Deficiency Syndrome

ACQUIRE Access for Quality and use in Reproductive Health

BCC Behavior Change Communications

CA Cooperating Agency

CAPACITY Human Development Capacity Project

CPR Contraceptive Prevalence Rate

CYP Couple Year Protection

DMPA Depo-Provera

FP Family Planning

FP/RH Family Planning/Reproductive Health

GH Global Health Bureau

INFO Information and Knowledge for Optimal Health Project

IUD Intrauterine Device

HIV Human Immunodeficiency Virus

HTSP Healthy Timing and Spacing of Pregnancy

IBP Implementing Best Practices

LAPM Long Term Permanent Methods

LMS Leadership, Management and Sustainability Project

LWA Leader with Associates

MAQ MAXIMIZING Access to Quality

MCH Maternal Child Health

MNCH Maternal Newborn Child Health

NGO Non-governmental Organization

OR Operational Research

PAC Postabortion Care

PEPFAR President's Emergency Plan for AIDS Response

PMI Presidential Malaria Initiative

PRH Office of Population and Reproductive Health

SDI Services Delivery Improvement Division

TFR Total Fertility Rate

USAID United States Agency for International Development

VCT Voluntary HIV Counseling and Testing

**SECTION I -- APPLICATION FORMAT**

[]{#__RefHeading___Toc193014811 .anchor}

**A. General Instructions**[]{#__RefHeading___Toc193014812 .anchor}

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.

The successful Applicant for this RFA will be awarded a Leader with
Associate (LWA) agreement with USAID. Applications in response to this
RFA should respond directly to the terms, conditions, specifications and
provisions of this RFA. Applications not conforming to this RFA may be
categorized as non-responsive, thereby eliminating them from further
consideration.

Applicants should submit one original plus four (4) copies of a
technical application and one original plus two (2) copies of the
cost/business application, in English.  Applications should reference
the total proposed funding level and the estimated cost share on the
cover page.  In addition to hard copies, technical and cost/business
applications should be submitted on one (1) CD ROMS each in Microsoft
Word 2003 and Excel 2003.

All copies of the technical and cost/business applications must be
separately placed in sealed envelopes clearly marked on the outside with
the following words

\"RFA No. M/OAA/GH/POP-08-712 with the contents indicated:  e.g.
Technical, and/ or Cost/Business (as appropriate) Application\".

Any application with data not to be disclosed should be marked 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 cooperative agreement 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 cooperative agreement. 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 \[insert numbers or other identification of sheets\]\"

Mark each sheet of data you wish 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.\"

**[Eligibility Criteria]{.underline}**

To be eligible to receive this Cooperative Agreement, an organization
must:

-   Be a US based-non-profit, or private voluntary organization or an
    Institution of Higher Education (as defined in 22 CFR part 145);

-   Have managerial, technical and institutional capacities to achieve
    the results outlined in this program description;

-   Propose at least one new partner with the technical expertise to
    plan and implement project activities worldwide or within a specific
    region (Africa or South Asia); and

-   Propose to contribute from their own, private or local sources no
    less than 20 percent of the amount of funds obligated by USAID for
    the implementation of this program over the course of the agreement.

    **B. Preparation Guidelines for the Technical Application**

All applications received by the deadline will be reviewed for
responsiveness to the specifications outlined in these guidelines and
the application format. Section II, "Evaluation Criteria*,*" addresses
the technical evaluation procedures for the applications. Applications
that are submitted late or are incomplete will not be considered for
award.

Applications shall be submitted in two separate parts: (a) technical and
(b) cost or business application, following the instructions listed in
the first part of this section.

The application will be prepared according to the structural format set
forth below. Applications must be submitted to the location indicated in
the cover letter accompanying this RFA by the date and time specified.

Technical applications should be specific, complete and concise. The
Application should demonstrate the Applicant\'s capabilities and
expertise with respect to achieving the goals of this program. The
technical application should fully respond to the technical evaluation
criteria found in Section II.

Applicants should retain for their records one copy of the application
and all enclosures that 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.

USAID requests that applications be kept as concise as possible. 
Detailed information should be presented only when required by specific
RFA instructions.  Technical

Applications are limited to 30 pages (12 point single-spaced type, 1
inch margins), not including the cover page, executive summary,
appendices, figures and tables.  Shorter applications are encouraged.
USAID requests that applications provide all information required by
following the general format described below.

The technical evaluation criteria, with the possible points allocated to
each, are described in Section II. The maximum number of points
available is 100. A USAID Technical Evaluation Panel will evaluate the
technical applications in accordance with the evaluation criteria in
Section II.  The format of the technical application should follow the
outline and order of the technical scoring criteria according to the
guidelines provided below.

The suggested format for the technical application is:

**B1.** **Cover Page**

Include project title, RFA number, name of organization(s) submitting
application, contact person, telephone and fax numbers, e-mail, and
address.

**B2.**   **Executive Summary** **(1-3 pages)**

Briefly describe how the Applicant(s) proposes to meet the requirements,
carry out the activity functions, and achieve the anticipated results. 
Briefly describe the technical and managerial resources of the
Applicant's organization and describe how the overall program will be
managed.

**B3. Technical Application Format (maximum 30 pages)**

This section represents the technical portion of the RFA.  Applications
should be kept as concise and specific as possible. The technical
portion of the application shall be no more than 30 pages, excluding
attachments. The technical application should be organized in the order
of the evaluation criteria found in Section VI.

*[Content of the Technical Application --
Instructions]{.underline}*[]{#__RefHeading___Toc193014813 .anchor}

A. Technical Approach

*1. Overall quality of proposed strategies, approaches, and
interventions*

Applicants should describe how they propose to achieve the purpose of
this activity---to increase the use of family planning and reproductive
health (RH/FP) services, with a focus on the informed and voluntary use
of long-acting and permanent methods. Applicant should describe how this
will contribute to higher level outcomes.

For each of the three Results described in the RFA, Applicants should
present an overview of how they will accomplish each result, with
specific illustrative activities they would use to accomplish specific
sub-results and each of the anticipated outcomes under the Leader Award.
Applicants are encouraged to propose additional or modified anticipated
outcomes, with corresponding proposed activities to accomplish these
outcomes.

For the purpose of this application, Applicants should assume they will
receive principally population core funds and population field support
funds, with possible funding from other sources, particularly to promote
integration of family planning and HIV/AIDS and/or maternal and child
health activities.

In this section, Applicants should describe strategies for building on
and strengthening local partners, networks and institutions and
collaborating with other USAID Cooperating Agencies (CAs). Specifically,
Applicants should describe how they will involve local partners in
program implementation, and how they will work with other USAID CAs and
other groups to increase the use of family planning, especially LAPMs,
with the aim of achieving measurable increases in contraceptive
prevalence rate, delay of first birth, longer birth intervals, increased
in use of LAPMs, and decreases in total fertility rates.

Applicants should also describe how they will be responsive to USAID
missions that provide field support funding or issue Associate Awards.
Specifically, Applicants should include a brief description of how they
would address each of the challenges listed in the RFA.

*2. Case Studies:*

Applicants' response to the case study questions should be no more than
three pages each (6 pages total) as part of the thirty page limit.

[Case Study 1:]{.underline}

#1: Choose a country in Africa and present the relevant health and
family planning data for that country. Identify two underutilized LAPMs
and design a communications strategy specifically for those LAPMs for
each target audience that you are attempting to reach. Please elaborate
on your strategy and activities, including frequency and duration of
campaigns, and how it links to services. Show how you will do monitoring
and evaluation to determine effectiveness.

[Case Study 2]{.underline}:

#2: Choose a country that is receiving a high level of PEPFAR and/or PMI
funding, and that has a severe human resources problem in the health
sector. Present the relevant health and family planning data for that
country. Illustrate a

comprehensive program approach for the sustainable scale-up of the use
of LAPMs throughout the country. Please include time frame and
monitoring indicators.

B. Staffing, including Key Personnel

Applicants should propose a staffing plan that demonstrates an
appropriate balance of skills and accountability. They should present a
plan that enables achievement of the RESPOND results.

Applicants should provide the following information which may be
included in an annex:

-   A complete staffing plan including key personnel and core technical
    staff, with underlying rationale, including an organizational chart
    demonstrating lines of authority and staff responsibility
    accompanied by position descriptions. Staffing plans are expected to
    include non-program staff, core technical staff and an explanation
    of how additional technical expertise will be obtained with
    attention to cost-containment and avoiding unnecessary staffing;

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

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-   An annex including letters of commitment and resumes (three pages
    maximum) including a half page summary of qualifications for all
    candidates for key positions.

> Summary biographical statements (no more than one page each) of
> personnel other than those designated for key positions that are
> considered important to implementation of the project. It is not
> necessary to include resumes of part-time staff, support staff, or
> potential consultants.

-   Documentation that demonstrates organizational capabilities
    including past performance.

Applicants shall provide the names of the key individuals responsible
for preparing the technical application, the specific sections of the
proposal to which each contributed, and the approximate percentage of
the final document that each individual contributed.

C. Management and Institutional Capacity

Applicants should provide a management plan for project implementation
showing how responsibility and lines of authority will be managed within
the project and across any proposed partnerships. The management plan
should describe how the project will relate to and respond to USAID
Washington and to missions in the field. The Applicant should describe
plans for rapid start-up of

the project, including plans for rapidly accessing and deploying key
personnel and essential technical staff to support the implementation of
the technical program and meet Washington and mission needs on the
ground while avoiding excess staffing.

The Applicant should describe their proposed management and
administrative structure, policies and practices for overall
implementation of the program including personnel, financial and
logistical support; and coordination.

The plan should also explain how the Applicant will address mission
priorities. Applicants should specifically describe how they will be
responsive in a timely manner to missions requesting support from
RESPOND across a range of technical areas, including those outlined in
the program description.

USAID strongly recommends that the headquarters of the project be
located in the Washington D.C. metropolitan area. Further, USAID expects
that all key personnel and core technical staff be located at the
project headquarters.

In an annex to the technical proposal, Applicants should demonstrate
that their past performance meets or exceeds the Eligibility Criteria
provided in the RFA.

D. Performance Monitoring and Evaluation

Applicants should propose a preliminary performance monitoring plan
(PMP) to track progress in achievement of the RESPOND objective and each
of the three Results under the Leader Award. The PMP will include
proposed performance indicators with specific targets and benchmarks for
the overall objective and each of the three results. Applicants should
also propose a process to adapt the PMP for specific activities that may
be the subject of Associate Awards, or other country-specific
activities, to include monitoring and information necessary to track
progress of country-specific activities.

Applicants should describe how the PMP indicators will be regularly
collected and reported to facilitate results reporting to USAID
Washington and USAID Missions.

Applicants should describe how overall impact of RESPOND activities will
be assessed, including how baselines will be established and how changes
in status will be measured and attributable to RESPOND activities.
Applicants should also describe how the data provided by the PMP, and
any proposed operations research or other specific studies to monitor
particular aspects of RESPOND activities, would be used to make mid-term
corrections or other changes.

E. Cost Share

Applicants will be evaluated on their ability to maximize their cost
share. At a minimum the cost share requirement for the Leader Award is
20%. Applicants shall be evaluated on the effectiveness, cost efficiency
and matching resources that the leader award and its partners bring to
the implementation of the Leader Award.

**Applications that do not meet at least the minimum cost-share
requirement are not eligible for award consideration.**

**C. Cost/Business Application**[]{#__RefHeading___Toc193014814
.anchor}**  **

The following sections describe the documentation that applicants for an
assistance award must submit to USAID prior to award in order for an
Agreement Officer (AO) to make a determination of responsibility. 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.

Applicants must include a detailed five-year budget with accompanying
budget narratives for the **[Leader Award only]{.underline}**, which
provides in detail the total costs for implementation of the program
your organization is proposing. For the purposes of developing an
illustrative budget, it should be assumed that the award will be funded
at an estimated \$5 million in core funds and an estimated \$15 million
in field support for the first year. The information from the detailed
budget must be then included on the Standard Form 424, which can be
downloaded from the following links
<http://www.usaid.gov/forms/sf424.pdf> (Standard Form 424). The
Applicant should submit the cost/business application on a CD ROM,
formatted in Word 2003 and Excel 2003.

If the Applicant has established a consortium or another legal
relationship among its partners, the Cost/Business application must
include a copy of the legal relationship between the parties.  The
agreement should include a full discussion of the relationship between
the Applicants including: identification of the Applicant with which
USAID will treat for purposes of Agreement administration; identity of
the Applicant that will have accounting responsibility; how Agreement
effort will be allocated; and the express agreement of the principals
thereto to be held jointly and severally liable for the acts or
omissions of the other. 

Over the course of the Agreement, in addition to USAID funds, Applicants
are expected to contribute from their other sources, no less than 20
percent of the amount obligated by USAID for the implementation of this
program, over the life of the project. Contributions can be either cash
or in-kind and can include contributions from the U.S. NGO, local
counterpart organizations, project clients, and other donors (not other
USG funding sources). Information regarding the proposed cost-share
should be included in the SF 424

and the Cost Matrix as indicated on those documents. The cost-share
should be discussed in the budget narratives to the extent necessary to
realistically access these sources and funds and the feasibility of the
cost-sharing plan. Applications that do not meet the

minimum cost-share requirement are not eligible for award consideration.
It should be noted that there is no separate/additional evaluation
criteria category for cost share because cost-share is included within
cost-effectiveness.

[]{.mark}

Additionally, if an Applicant proposes a higher than minimum cost share,
this may be considered with the "cost effectiveness" evaluation. If the
cost share is less than 20 percent, then the proposal shall not be
reviewed and will be deemed non-responsive.

To support the proposed costs, [please provide detailed budget
notes/narrative for all costs that explain how the costs were
derived]{.underline}.  The following provides guidance on what is
needed.

a\. The breakdown of all costs associated with the program according to
the costs of, if applicable, headquarters, regional, and/or country
offices; project management and administrative costs will be shared
equitably across all funding sources.

b\. The breakdown of all costs according to each partner organization
involved in the program.

c\. The costs associated with external, expatriate technical assistance
and those associated with local in-country technical assistance.

d\. The breakdown of any financial and in-kind contributions of all
organizations involved in implementing this Cooperative Agreement.

e\. Potential contributions of non-USAID or private commercial donors to
this Cooperative Agreement.

f\. Procurement plan for commodities (if applicable).

The cost application should contain the following budget categories:

-   [Salary and Wages]{.underline}:  Direct salaries and wages should be
    proposed in accordance with the Applicant\'s personnel policies;

-   [Fringe Benefits]{.underline}:   If the Applicant has a fringe
    benefit rate that has been approved by an agency of the U.S.
    Government, such rate should be used and evidence of its approval
    should be provided.  If a fringe benefit rate has not been so
    approved, the application should propose a rate and explain how the
    rate was determined. If the latter is used, the narrative should
    include a detailed breakdown comprised of all items of fringe
    benefits (e.g., unemployment insurance, workers compensation, health
    and life insurance, retirement, FICA, etc.) and the costs of each,
    expressed in dollars and as a percentage of salaries;   

-   [Travel and Transportation]{.underline}:  The application should
    indicate the number of trips, domestic and international, and the
    estimated costs.  Specify the origin and destination for each
    proposed trip, duration of travel, and number of individuals
    traveling.  Per Diem should be based on the Applicant\'s normal
    travel policies;

-   [Equipment]{.underline}: Estimated types of equipment (i.e., model
    #, cost per unit, quantity);

-   [Supplies:]{.underline} Office supplies and other related supply
    items related to this activity;

-   [Contractual:]{.underline} Any goods and services being procured
    through a contract mechanism;

-   [Other Direct Costs:]{.underline}  This includes communications,
    report preparation costs, passports, visas, medical exams and
    inoculations, insurance (other than insurance included in the
    Applicant\'s fringe benefits), equipment, office rent abroad, etc.
    The narrative should provide a breakdown and support for all other
    direct costs;

-   [Indirect Costs]{.underline}:  The Applicant should include a
    current negotiated indirect cost rate (NICRA) from a cognizant
    government audit agency. Applicants who do not currently have a
    NICRA from any agency of the United States government (USG) shall
    also submit the following information:

    -   Copies of the applicant's financial reports for the past three
        years, which has been audited by a certified public accountant
        or other auditor satisfactory to USAID;

    -   Projected budget, cash flow and organizational chart;

    -   A copy of the organizations accounting manual.

**ADDITIONAL DOCUMENTATION**

Please include information on the organization\'s financial status and
management, including:

a\. Copies of the Applicant\'s financial reports for the previous 3-year
period, which have been audited by a reputable certified public
accounting firm;

b\. A current Negotiated Indirect Cost Rate Agreement;

c\. Organizational chart;

d\. If the Applicant has made a certification to USAID that its
personnel, procurement and travel policies are compliant with applicable
OMB circular and other

applicable USAID and Federal regulations, a copy of the certification
should be included with the application.  If the certification has not
been made to USAID/Washington, the

Applicant should submit a copy of its personnel (especially regarding
salary and wage scales, merit increases, promotions, leave,
differentials, etc.), travel and procurement policies, and indicate
whether personnel and travel policies and procedures have been reviewed
and approved by any agency of the Federal Government. If so, provide the
name, address, and phone number of the cognizant reviewing official.

e\. 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.

Applicants must submit any additional evidence of responsibility deemed
necessary for the Agreement Officer to make a determination of
responsibility. The information submitted must substantiate that the
Applicant:

-   Has adequate financial resources or the ability to obtain such
    resources as required during the performance of the cooperative
    agreement;

-   Has the ability to comply with the cooperative agreement conditions,
    taking into account all existing and currently prospective
    commitments of the Applicant, nongovernmental and governmental;

-   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;

-   Has a satisfactory record of integrity and business ethics;

-   Is otherwise qualified and eligible to receive a cooperative
    agreement under applicable laws and regulations (e.g., Equal
    Employment Opportunity laws); and

-   Completed copy of certifications and representations

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

    1\. 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 artwork, expensive
paper and bindings, and expensive visual and other presentation aids are
neither necessary nor wanted.

2\. Acknowledgement of Amendment to the RFA

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

3\. 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.

4\. Submission of Applications

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.

5\. Preparation of Applications

-   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.

-   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 application. 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.

-   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, must:

    -   Mark the title page with the following legend:

    -   "This application includes data that shall not be disclosed
        outside of the U.S. Government and shall not be duplicated,
        used, or disclosed -- in whole or part -- for any purpose other
        than to evaluate this application. If, however, a cooperative
        agreement 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 agreement. 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

    -   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."

        6\. Explanation to Prospective Applicants

        Any prospective applicant desiring an explanation or
        interpretation of this RFA must request it in writing. Oral
        explanations or instructions given before award of a cooperative
        agreement 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 applicant.

        7\. Cooperative Agreement Award

The Government may, without discussions or negotiations, award an
agreement resulting from this RFA to the responsible Applicant, whose
application conforming to this RFA offers the best proposal, including a
calculation of costs that are reasonable and clearly explained. 
Therefore, the initial application should contain the Applicant\'s best
effort from a technical standpoint, with reasonable allocation of
costs.  The Government may reject any or all applications, accept other
than the lowest cost application, and waive informalities and minor
irregularities in applications received.

Although technical evaluation factors are significantly more important
than cost factors, the closer the technical evaluations of the various
applications are to one another, the more important cost considerations
become. The Agreement Officer may determine what a highly ranked
application based on the technical evaluation factors would mean in

terms of performance and what it would cost the Government to take
advantage of it in determining the best overall value to the Government.

8\. Authority to Obligate the Government

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

9\. The Applicant 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 agreement.

10\. Foreign Government Delegations to International Conferences - Funds
in this agreement 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 Agreement Officer.

11\. LWA Cooperative Agreement

It is USAID's intent to award a five year leader with associate (LWA)
cooperative agreement to build upon its extensive work in expanding
contraceptive choices and family planning (FP) and reproductive health
(RH) programs. This Request for Applications (RFA) is issued for a
cooperative agreement covering a specified worldwide activity (Leader
Award) as described in the Program Description, Section III of this RFA
under which missions or other offices are authorized to fund associate
assistance activities under separate non-competitive assistance awards
that are subject to the provisions of the leader agreement. A worldwide
activity is an activity or a series of linked activities identified at
the business/development sector's strategic objective level that is
intended to provide results in multiple regions and countries. An
associate award is a separate assistance agreement funded by a mission
or other office and awarded to the leader recipient to support a
distinct local or regional activity that fits within the scope of the
broad worldwide program description in the leader agreement. The
associate award can be a grant or cooperative agreement notwithstanding
the type of assistance instrument issued as the Leader Agreement.

Each associate award shall contain a separate activity description that
fits within the broader program requirements, but will otherwise be
considered to be covered by the terms and conditions of the leader
agreement.

The benefits of this mechanism include: (1) no further competition
required for Missions or other USAID offices awards under the
Leader/Associate cooperative agreement, (2) simplified Missions or other
USAID offices award documents, (3) simplified certification by the
recipient of the leader award and (4) reporting directly to the Missions
or other USAID Offices on the use of Missions or other USAID Offices
funds.

12\. Competition

Once a recipient is selected for the Leader Award pursuant to this RFA,
no further competition or waiver of competition is required for any
associate cooperative agreements/grants awarded within the terms of the
LWA. The competition under this RFA covers the initial Leader award,
which will provide leadership for regional

and/or worldwide activities and for subsequent associate awards
providing support to Missions and other USAID Offices. In this manner,
Missions or other USAID offices may fund specific activities of the
Leader recipient that fit within the RFA/Leader program description
through field support or associate awards without further competition.

13\. Issuance of Associate Awards

Prior to issuance of an Associate agreement, the requesting office or
Strategic Objective Team in the Mission or other USAID Office shall
consult with the Cognizant Technical Officer (CTO) at USAID/WASHINGTON.
This will help ensure the technical leadership role of global program
and the appropriate use of the mechanism. After receiving the CTO's
concurrence, the appropriate Mission or other USAID office personnel
shall request the recipient of the Leader award provide an application
(specific Program Description and budget - SF-424 is not required) to
the Mission or other USAID Office. The application shall be reviewed by
the appropriate technical personnel, and the Agreement Officer shall be
responsible for cost analysis and negotiation of the final agreement.

The Mission or other USAID Office has the discretion to decide whether
or not to award the associate agreement. When the Mission or other USAID
Office and recipient of the Leader award are in agreement on the program
description, budget and substantial involvement anticipated, the
Agreement Officer for the Mission or other USAID Office may award the
Associate agreement. The Mission or other USAID Office activity manager
is the Cognizant Technical Officer for the Associate agreement.

14\. Certifications

The required certifications, including validation of the umbrella
organization as a single entity with a single accounting system, shall
be obtained from the applicant prior to award of the Leader Cooperative
Agreement. Prior to award of an Associate grant/cooperative agreement,
the recipient of the Leader must affirm that certifications remain
valid, or provide new certifications. (See attachment) After the Leader
is awarded, a copy of the award will be sent to all Missions or other
USAID Offices along with any necessary guidance or instructions
regarding issuance of Associate awards.

15\. Grant vs. Cooperative Agreement

Regardless of whether the Leader instrument is a grant or cooperative
agreement, Missions and other USAID Offices may issue an Associate
instrument of either type; i.e., an Associate cooperative agreement may
be issued under a Leader grant and vice versa.

16\. Period of Performance

The Leader award will be issued for a performance period of five (5)
years. Associate awards may be issued until the Leader award expires and
can be for a period of performance up to 5 years past the expiration
date of the Leader award.

17\. Estimated Dollar Value

This RFA provides an estimate of the dollar amount for the Leader of
\$240 million over five years. Each Associate Award has its own ceiling
that is not included in the Leader ceiling. The Associate award shall
specify the Total Estimated Award (TEA) amount for the Cooperative
Agreement.

#  

# SECTION II --EVALUATION CRITERIA 

**A. Overview**

Each technical application submitted in response to this RFA will be
evaluated in relation to the evaluation factors set forth in this
solicitation and which have been tailored to the requirements of this
RFA to allow USAID to choose the highest quality application.

The Government intends to evaluate applications and award an agreement
without discussions with Applicants.  However, the Government reserves
the right to conduct discussions if later determined by the Agreement
Officer as necessary.  Therefore, each initial offer should contain the
Applicant's best terms from a cost or price and technical standpoint.

**B. Acceptability of Proposed Non-Price Terms and Conditions**

An offer is acceptable when it manifests the Applicant\'s assent,
without exception, to the terms and conditions of the RFA, including
attachments and provides a complete and responsive proposal without
taking exception of the terms and conditions of the RFA.  If an
Applicant takes exception to any of the terms and conditions of the RFA,
then USAID will consider its offer to be unacceptable.  Applicants who
wish to take exception to the terms and conditions stated within this
RFA are strongly encouraged to contact the Agreement Officer before
doing so.  The USAID reserves the right to change the terms and
conditions of the RFA by amendment at any time prior to the Applicant
selection decision. 

The criteria presented below have been tailored to the requirements of
this RFA. Applicants should note that these criteria serve to: (a)
identify the significant areas that Applicants should address in their
applications and (b) serve as 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. An award will be made to responsible
Applicants whose applications offer the greatest value, cost
reasonableness and other factors considered.

Award will be made based on the ranking of proposals according to the
technical selection criteria identified below.

**C. Evaluation Criteria**

USAID will award to the one Applicant whose proposal best meets the
program description and represents the best value to the U.S.
Government, all factors considered. Technical proposals for RESPOND will
be evaluated and scored based on the following percentages.

**C1. Technical Approach (35/100)**

The application reflects excellent understanding of the overall program
description and its objective, and the ability to synthesize and apply
the lessons learned from past and current USAID agreements and other
critical sources. The technical approach will be evaluated on the
overall merit (creativity, clarity, analytical depth, state-of-the-art
technical knowledge, and responsiveness) and feasibility of the program
approach and strategies proposed to achieve the program\'s objective,
results and sub-results. Responsiveness to each of the bullets provided
below will be taken into consideration by the technical review committee
in determining the overall score, but will not be individually scored.

1.  **Overall quality of proposed strategies, approaches, and
    interventions** **(25/35)**

-   An understanding of, and a proposed approach for addressing the key
    issues and challenges, application of best practices, and
    achievement of specific results for meeting the requirements of the
    program description. Illustrative activities are relevant and likely
    to achieve the anticipated outcomes for each result. The proposal
    reflects thorough understanding of current issues in service
    delivery and integration, provision of LAPMs, innovation in
    communications, performance improvement, policy issues around family
    planning, gender considerations, research and monitoring and
    evaluation.

-   An understanding of, and a proposed approach for actively engaging a
    variety of local stakeholders, including government,
    non-governmental organizations, private and commercial interests and
    communities in the planning, provision, management and
    sustainability of RH/FP services and commodities for increasing the
    use of family planning with an emphasis on LAPMs. The proposal
    should specifically address activities that will strengthen
    stakeholder organizations and improve quality of services.

-   Technical leadership, creativity, innovation and soundness in
    advancing evidence-based best practices and state-of-the-art
    approaches for RH/FP services and programming, including
    identification and sharing of successful practices and approaches
    for promoting the use of family planning and particularly LAPMs

-   The proposed approaches are feasible, efficient, sustainable, and
    have potential to be scaled-up; identify
    strategies/mechanisms/activities for coordination/collaboration with
    USAID partners and a wide range of other organizations.

    **2. Case Studies (10/35; 5 for each study)**

The responses to the case study questions will be evaluated according to
the following criteria. Responsiveness to each of the bullets below will
be taken into account by the technical review committee in determining
the score for each case study, but will not be individually scored.

-   Case study responses reflect a careful review and understanding and
    analysis of the background information presented for each case study

-   Proposed approaches to improving service delivery and communications
    are state-of-the-art and evidence-based.

-   Proposed activities are appropriate to the specific setting and
    efficient in use of technical and financial resources.

-   Proposed activities reflect understanding of the diverse nature of
    relationships and partnerships that need to be fostered and the
    importance of gender considerations.

-   Adequate emphasis is placed on scaling-up and achieving broad-based
    impact.

-   Appropriate work-plan and/or monitoring and evaluation strategies
    are proposed.

    **C2. Staffing including Key Personnel** **(45/100)**

Responsiveness to each of the criteria below will be taken into account
by the technical review committee in determining the score for each
category, but will not be individually scored.

**Qualifications for the proposed Project Director**: **(15 points)**

The proposed Project Director must have a Master's Degree or higher in
public health or social sciences, management or a related advanced
degree relevant to the field of RH/FP. He/she must have at least 10
years senior level experience designing, implementing and managing
large, complex RH/FP projects in/for developing countries. He/she must
demonstrate a strategic vision, leadership qualities, depth and breadth
of technical and management expertise and experience. Have a positive
professional reputation, and strong interpersonal, writing, and oral
presentation skills. He/she must have demonstrated experience
interacting with government agencies, host country governments and
counterparts, and international donor agencies. Two years experience
living and working in a developing country and fluency/proficiency in a
second language are desirable.

**Qualifications for the proposed Deputy Director: (5 points)**

The proposed Deputy Director must have a Master's Degree in public
health, a clinical discipline, social sciences or a related advanced
degree relevant to the field of RH/FP.

He/she must have at least eight years of mid to senior level experience
in designing, implementing or managing large, complex, RH/FP projects
in/for developing countries.

He/she must have demonstrated leadership qualities, depth and breadth of
technical and management expertise and experience, strong interpersonal,
writing, and oral presentation skills. Two years experience living and
working in a developing country and fluency/proficiency in a second
language are desirable.

**Qualifications for the proposed Financial Management and
Administration Specialist: (5 points)**

The proposed financial management and administration specialist must
have a Master's Degree or higher in Business Administration, Finance or
other relevant field. He/she must have at least eight years experience
in administrative and financial management of large international
projects including experience in the management of USAID Projects.

He/she must have familiarity with compliance and the Federal Acquisition
Regulations as well as experience and skills in developing and managing
large budgets. He/she should be proficiency in relevant computer
applications and databases. He/she must possess excellent
organizational, analytical, oral and written communications skills;
demonstrated supervisory skills; and ability to work well on teams.

**Qualifications for the proposed Monitoring and Evaluation (M&E)
Specialist (5 points)**

The proposed Monitoring and Evaluation Specialist must have an advanced
degree in Public Health, social science or other related discipline.
He/she must have at least eight years of applied skills in designing,
implementing, monitoring and evaluating activities and special studies
for RH/FP or related programs. He/she must have a firm command of M&E
issues with respect to the special populations of interest. He/she must
also have experience supervising monitoring and evaluation efforts for
multi-country, multi-faceted programs. He/she must have demonstrated
analytical skills and experiences to identify and evaluate best
practices and state-of-the-art approaches to be utilized by the project.

In addition, he/she must possess strong writing and organizational
skills for reporting on program and study results.

**The complement of other technical staff and organizational structure
(15/45)**

The staffing pattern and the number and type of positions proposed are
responsive to the technical requirements and Applicants approach, with
an optimal configuration for efficiency and cost containment. The
proposed technical specialists have demonstrated technical and
operational experience in the subject areas for which they are proposed.

The proposed technical specialists cover the technical areas needed to
achieve the main results of this Project. Regarding the organizational
arrangements (e.g., consortium,

recipient/subrecipients), the staffing pattern and the number and type
of positions proposed reflect the specific expertise of each
organization, are not duplicative and represent an efficient use of
resources.

**C3. Management and Institutional Capacity (10/100)**

The management and institutional capacity will be evaluated according to
the following criteria. Responsiveness to each of the bullets will be
taken into consideration by the technical review committee, but will not
be individually scored.

-   Management and administrative structure, policies and practices for
    overall implementation of the program including personnel, financial
    and logistical support; the role and level of effort for staff
    supporting these functions; and a realistic plan for monitoring the
    technical and financial activities and the reporting on results.

-   Plans for rapid start up of the project, including the first year
    plan of activities and timeline; and plans for rapid response to
    requests from USAID/Washington and/or USAID Missions, including how
    the program will manage a complex set of activities in multiple
    countries and regions of the world, and balance the competing
    demands from AID/W and USAID Missions, including the reporting
    requirements;

-   How applicants will divide responsibilities and funding among
    partners to manage and implement activities; how the applicant will
    work with local partners, other USAID programs, and other
    implementing organizations to achieve results; and how management is
    structured in a way that is mutually reinforcing, optimally
    efficient and effective in its use of technical and financial
    resources, and not duplicative.

-   The proposal demonstrates the Applicant's institutional capacity,
    organizational systems and competence to creatively plan, implement,
    monitor and report on the range of activities outlined in this RFA
    in both global and country-specific contexts.

    **C4**. **Monitoring, Evaluation and Research (10/100)**

The Monitoring and Evaluation Plan will be evaluated according to the
following criteria. Responsiveness to each of the bullets provided below
will be taken into account by the technical review committee in
determining the overall score for this category, but will not be
individually scored.

-   The application presents a comprehensive Performance Management Plan
    that clearly outlines its approach to monitoring and evaluation, and
    research. The plan delineates ambitious but achievable performance
    targets and benchmarks for achieving the results outlined in the
    program description. Special attention should be paid to a rational
    plan for tracking client use of RH/FP and LAPMs services.

-   The plan should demonstrate what will be achieved by year three and
    by the end of the project. There should be at least a minimal set of
    indicators for targets, and benchmarks should show how they lead to
    the achievement of results.

-   The plan should describe the methodology to be used for data
    collection that is cost effective and timely.

-   The monitoring and evaluation plan includes a detailed plan for
    oversight of compliance with USAID family planning legal and policy
    requirements.

-   The application should also give a preliminary idea of proposed
    research activities that will yield key information to assist in
    achieving results. It should demonstrate how research will be put to
    practice and inform programs and direction of the project.

> **Summary:**
>
> Technical Approach 35 points
>
> Staffing/Key Personnel 45 points
>
> Management/Institutional Capacity 10 points
>
> Monitoring, Evaluation and Research 10 points
>
> **TOTAL 100 points**

**Section III: Program Description**[]{#__RefHeading___Toc193014816
.anchor}

**A. Introduction**

The U.S. Agency for International Development (USAID) Bureau for Global
Health (GH) is issuing this Request for Applications (RFA) for a
five-year, \$240 million, Leader with Associates (LWA) Cooperative
Agreement to build upon its extensive work in expanding contraceptive
choices and family planning (FP) and reproductive health (RH) programs.
The name **RESPOND** stands for Responding to the Need for Family
Planning through Expanded Contraceptive Choices and Program Services,
and is used throughout this document to refer to this activity.

The concept for the RESPOND activity was developed in the Office of
Population and Reproductive Health (PRH) Service Delivery Improvement
(SDI) Division by a design team that included representatives from other
divisions as well as SDI, and several experts that work Bureau wide. The
design also benefited from the findings of a participatory evaluation of
the ACQUIRE Cooperative Agreement, an analysis of use of long acting and
permanent methods of contraception (LAPMs), trends and needs, and a
survey of priorities from Missions, other PRH Divisions, GH Offices and
USAID regional Bureaus.

**B. Purpose**

The purpose of this agreement is to increase the use of reproductive
health and family planning (RH/FP) [^1] services, with a focus on the
informed and voluntary use of long-acting and permanent methods
(LAPMs)[^2] of contraception.

This Activity Objective will be accomplished through the achievement of
the three results listed below. The Detailed Program Description with
results framework, sub-results and expected outcomes is provided in
Section G. []{.mark}

[]{.mark}

**Result 1: Strengthened global learning and application of state of the
art approaches for LAPMs**

> This result calls for technical leadership to advance global learning
> and to support the identification and application of evidence-based
> and state-of-the-art approaches. Knowledge sharing and collaboration
> with other stakeholders will
>
> advance the use of evidence based tools, approaches and models for
> providing quality family planning with a focus on LAPMs.

**Result 2: Knowledge generated, organized and disseminated to
strengthen commitment, support and programming for LAPMs**

> This result supports identification of key topics for global
> analytical studies and the development of essential programmatic
> analyses that are needed to support the use of services. Achievements
> under this result will strengthen monitoring and evaluation of
> approaches, tools and services, and dissemination of findings, lessons
> learned and best practices.

**Result 3**: **Holistic and evidence based approaches used to
strengthen supply, demand and the enabling environment for RH/FP
services with a focus on LAPMs**

> This result focuses on increasing information about and demand for
> family planning in general, and LAPMs in particular; strengthening
> essential systems to ensure quality provision of these services; and
> supporting an enabling environment to reduce barriers to access
> including advocating for inclusion of FP and in national and
> subnational health and development strategies, annual plans and
> budgets.

This project will fill a unique niche by focusing on increasing the use
of LAPMs. It will have a core agenda, focused primarily on the first two
results, and a field agenda, focused primarily on the third result.
Field programs will use a holistic approach to supply, demand, and
fostering an enabling environment. They should be flexible enough to
respond to needs in countries for integrating FP/LAPMs with other
programs, such as HIV/AIDS and MNCH, and should target groups such as
men, youth, postpartum women, and postabortion clients RESPOND will work
collaboratively with other GH projects in service delivery, research,
communications, commodity logistics, and policy to draw on their
specialized expertise, bring new learning to RESPOND, provide input into
activities in their specialization, and share lessons to advance LAPM
use. Select Global Leadership Priority initiatives may also be
implemented by RESPOND to enable strategies, methodologies, approaches
and tools to be tested, adapted and taken to scale.

**C. Relationship of RESPOND to PRH and Foreign Assistance Frameworks**

The results framework for RESPOND is aligned with the PRH results
framework, with its three results focusing on global leadership,
knowledge generated, and support to the field. In the Foreign Assistance
framework, this agreement falls under Investing in People (IIP). The
relationship of RESPOND to both the PRH and Foreign Assistance
frameworks is illustrated in the box below.

**Alignment of Foreign Assistance, PRH and RESPOND Frameworks**

**RH/FP** Expand access to high-quality family planning services and

**Element** information and reproductive health care in order to reduce

**(3.7)** unintended pregnancy and promote healthy reproductive
behaviors.

**GH/PRH** Advance and support voluntary family planning and
reproductive

**Objective** health programs worldwide

**GH/PRH** Global leadership Knowledge generated Support
**Intermediate** exercised in RH/FP organized, and communi- the field to
**Results** policy, advocacy, cated in response to implement

and services program needs effective RH/FP

programs

**RESPOND** Strengthened global Knowledge generated, Holistic and
**Intermediate** learning and application organized, and evidence based

**Results** of state of the art disseminated to approaches

approaches for support programming used to LAPMs for LAPMs strengthen

supply, demand

& the enabling

environment

for RH/FP

services with a

focus on LAPM

D.  **Programmatic Background**

For more than 35 years, USAID service delivery programs have helped
countries and institutions create accessible, high-quality, voluntary
RH/FP services. USAID programs around the world have increased the
availability and quality of RH/FP products and services in partnership
with a broad array of public, nonprofit, and commercial institutions.

Many USAID-funded organizations developed and refined the provision of
voluntary long-acting and permanent methods of contraception. This
resulted in new contraceptive methods such as hormonal implants, and
improved techniques such as non-scalpel vasectomy. Service delivery
models, tools and approaches have been tested and have advanced the
provision and quality of family planning programs offering LAPMs.

ACQUIRE, the immediate predecessor to RESPOND, also advanced the state
of the art in communications strategies for behavior change. These
strategies provided more accurate information about FP methods (and
where they could be obtained); created a more positive and accurate
image of contraceptives as well as users; and provided information on
benefits and disadvantages. ACQUIRE also developed a tool (Reality
Check) to improve advocacy and programming for FP and LAPMs.

In June 2007 the Office of Population and Reproductive Health (PRH)
conducted a visioning exercise to guide programming for the next five to
ten years. Along with a new vision, PRH identified a set of technical
priorities that include: LAPMs; community-based FP services; FP/HIV
integration; FP/MNCH integration; contraceptive security; and healthy
timing and spacing of pregnancy (HTSP). While LAPM are the central focus
of RESPOND, all the technical priorities should be included in its
overall implementation as needed.

In addition, PRH identified 13 countries as priorities for global family
planning efforts. Although USAID's work is not limited to these
countries, a concerted effort will be made with missions in these
priority countries to advance family planning programs, particularly
LAPMs, over the coming years.[^3]

**E. Programmatic Emphases**

At current population growth rates, the world will have added over 1½
billion people between the years 2000 and 2020. The greatest percentage
of growth will be in sub-Saharan Africa, South-Central Asia, and Latin
America which will see increases in their populations by 63, 34 and 27
percent respectively. Family planning programs helped countries around
the world achieve impressive results in reducing their total fertility
rates (TFR) and slowing population growth. These declines, in turn,
enabled countries to improve the health of mothers and children, better
educate their citizens, and achieve sustainable economic growth.

However, much remains to be done to increase access to and use of family
planning, particularly in sub-Saharan Africa and South Asia. In many
countries contraceptive prevalence rates (CPR) have stagnated over the
past decade. Meeting both the current and future needs for family
planning remains a large and growing challenge. Among contraceptive
methods, LAPMs are the most effective, and have the lowest
discontinuation rates. They have the greatest potential to positively
influence CPR and TFR, and yet, they are the most underutilized methods
in most family planning programs.

**Long-acting methods** include the intrauterine device (IUD) and
hormonal implants. Both of these methods are appropriate for women who
wish to delay their first pregnancy, space subsequent pregnancies, or
who have reached their desired family size.

Both methods are easy to remove, and fertility returns quickly once
removed. IUDs are also cost-effective: the Copper-T 380A intrauterine
device (CuT-380A IUD, or IUCD). has an efficacy period of 12 years, and
yields 3.5 couple-years of protection (CYP). It is the most
cost-effective method, averaging \$0.16 per year of protection. Implants
vary in numbers of rods, duration of efficacy and cost per CYP.
Norplant, Jadelle and Implanon yield three CYP.

Permanent methods (male and female sterilization) are non-reversible and
are appropriate for couples who have completed their child-bearing.
Sterilization yields ten CYP in Asia and Latin America and eight CYP in
Africa and the Near East.

+---------------------------------------------+-----------+-----------+
| > **Method**                                | **Average | **Cost    |
|                                             | number of | per       |
|                                             | CYPs**    | year**    |
+---------------------------------------------+-----------+-----------+
| IUD                                         | 3.5       | \$0.16    |
+---------------------------------------------+-----------+-----------+
| Implants:                                   |           |           |
+---------------------------------------------+-----------+-----------+
| > Norplant                                  | 3.5       | \$6.80    |
+---------------------------------------------+-----------+-----------+
| > Jadelle                                   | 3.5       | \$6.00    |
+---------------------------------------------+-----------+-----------+
| > Implanon                                  | 2.0       | \$9.80    |
+---------------------------------------------+-----------+-----------+
| Female Sterilization---Asia & Latin America | 10        | \$1.01    |
+---------------------------------------------+-----------+-----------+
| Female Sterilization---Africa & Near East   | 8         | \$1.01    |
+---------------------------------------------+-----------+-----------+
| Male Sterilization---Asia & Africa          | 10        | \$0.55    |
+---------------------------------------------+-----------+-----------+
| Male Sterilization---Africa & Near East     | 8         | \$0.55    |
+---------------------------------------------+-----------+-----------+
| Injectable (4 doses)                        | 1         | \$3.86    |
+---------------------------------------------+-----------+-----------+

An analysis of the demand for spacing and limiting among PRH's priority
countries showed a significant unmet need for contraception (see USAID
Strategic Appraisal of the ACQUIRE Project, page 83 at
http://www.ghtechproject.com/resources**)**. Offering long acting and
permanent methods of contraception provides more informed choices for
women and should be available as an option for women who want to space
or limit their child bearing.

Addressing the needs of different population groups

-   **Postpartum women:** The unmet need for both spacing and limiting
    is high among women in the first year postpartum. This, however,
    varies by region -- in Asia it is roughly equal, while in Africa
    about three-quarters of the unmet need is for spacing, and in Latin
    America about three-fifths is for limiting. In the absence of
    breastfeeding, fertility can return as quickly as 30-45 days
    postpartum.

-   **Postabortion:** Pregnancies following an induced abortion are more
    likely to end in a repeat abortion, as are very closely spaced
    pregnancies following a live birth. Abortion rates decline as use of
    modern contraception increases. By definition, postabortion care
    (PAC) includes family planning; however, FP remains a weak or

nonexistent component of PAC services. Fertility can return as quickly
as eleven days

following an abortion or miscarriage.

-   **People living with HIV/AIDS or at risk of infection**: Preventing
    unintended pregnancies among at-risk and HIV-positive women will
    reduce HIV infection among infants and is a critical intervention in
    meeting the President's Emergency Plan for AIDS Relief (PEPFAR)
    goals. Among HIV positive women, about 80 percent say they do not
    want another child, while 20 percent indicate that they would like
    to have another child. Family planning helps both groups prevent or
    space pregnancy according to their desires and health needs.

-   **Youth**: More youth than ever will enter their reproductive years
    in the next decade, nearly all of whom will have a need for family
    planning at different points in their lives. High unmet need exists
    among both married and unmarried sexually active adolescents between
    the ages of 15 and 19. In most countries, the unmet need for
    contraception among unmarried teens is nearly double that of their
    married counterparts. Approximately 23% of women in Africa have
    given birth by age 18 and only 9% of women ages 15-19 are using any
    form of contraception.

-   **Men:** There is a growing demand among men for condoms and
    vasectomy to prevent pregnancy, and for circumcision to prevent HIV
    transmission/acquisition. Involving men in RH/FP programs and
    addressing male gender norms around contraception, family size,
    childbirth, and intimate partner violence, has broad benefits for
    their partners' and children's' health and well being.

-   **Urban and rural** **poor**: Worldwide, those in the poorest
    quintiles have substantially greater unmet need than other
    populations. Overall, they are 4.4 times less likely than those in
    the wealthiest quintile to use modern contraceptives.

    **F. Issues and Challenges**

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-   **Building/re-building commitment for FP and LAPM**

While there are ever-growing numbers of women, men and youth wanting and
using family planning, the health and development goals of many
countries have shifted away from family planning toward other
priorities. Because of the very low and/or plateauing CPR in many
sub-Saharan African countries, USAID developed an initiative to
Reposition Family Planning, through concerted efforts in advocacy to
generate greater commitment from governments, and to be proactive in
supporting RH/FP services. RESPOND's challenge will be to continue
encouraging country governments to build sustained commitment for FP
programs, encourage normative shifts towards smaller, healthier
families, and offer an expanded contraceptive method mix that includes
LAPMs.

-   **Expanding the use of LAPMs for all stages of reproductive life**

LAPMs are safe and effective, appropriate at all stages of reproductive
life, including delaying first pregnancy, spacing subsequent
pregnancies, and limiting childbearing. Many hold the perception that
LAPMs are only appropriate for later in life, for older women who have
had several children. The challenge for RESPOND will be to inform and
educate different audiences about LAPMs and their appropriateness for
various stages of reproductive life. This approach applies to government
officials, program managers, supervisors and health care providers, as
well as to individuals and communities.

-   **Dispelling myths and misconceptions about LAPMs**

Some LAPMs, especially the IUD and vasectomy, are surrounded by myths
and misconceptions about their safety and efficacy. These myths keep
potential users from requesting the methods and many providers from
offering the methods. RESPOND's challenge is to dispel these myths and
misconceptions and create positive images for LAPMs and their users,
regardless of their stage of reproductive life.

-   **Ensuring competent providers for FP and LAPMs**

Expanding family planning and LAPMs services is hampered by shortages of
qualified healthcare personnel and policies that limit services to
specified cadres of healthcare workers. Programs for FP and LAPMs are
further challenged by limited inclusion in pre-service education and
weak in-service training programs. Education/training programs need to
include not only technical skills for method provision, but also
state-of-the-art information to combat myths and misconceptions and
counseling skills to ensure correct information and informed choice.
Ongoing opportunities to maintain competency must also be provided.

Training systems require skilled and competent trainers, appropriate
sites, and an adequate caseload for trainees to build their skills.
Well-functioning in-service training sites can serve as clinical sites
for students in pre-service education, as well as to update and train
supervisors who oversee their performance. In-service training and
pre-service education need to be linked to each other as well as to the
country context.

Performance improvement approaches other than training, such as
supportive supervision or other measures that enhance the transfer of
training to the worksite, are needed to improve the quality of services
for FP and LAPMs. These activities are labor intensive and require
significant resource investment. RESPOND will also be challenged to work
with governments to expand the cadre of healthcare providers who can
safely provide various FP methods including LAPMs. Where appropriate,
RESPOND should collaborate with other USAID projects such as Capacity
and LMS.

-   **Stimulating Interest and Demand for FP and LAPMs**

Increasing the use of FP and LAPMs requires knowledge, perceived need
and behavior change. While interest in FP has grown over the years, much
remains to be done to shift social-cultural norms toward smaller
families, longer birth intervals, and older age of marriage (at minimum
18 years old) and first pregnancy. Communications approaches that work
best to increase the use of LAPMs are still not well understood. ACQUIRE
implemented campaigns for individual methods such as vasectomy and IUD,
and although they found the commonalities between countries about myths,
misperceptions and biases, more needs to be learned about how to program
effective behavior change communication (BCC) for LAPMs. RESPOND's
challenge is to address both the normative behaviors around FP use in
general, and stimulate sustained interest in specific LAPMs among
clients, providers, managers and government officials. In addition,
RESPOND will need to build the body of evidence around the programming
and effectiveness of communications approaches to advocate for the
inclusion of behavior change communications within country programs.
They should work toward building in-country capacity to plan, implement
and evaluate BCC programming. RESPOND is encouraged to collaborate with
the new Partnership for Health and Development Communication (PHDC).

-   **Linking facilities and communities**

In contrast to LAPMs, other FP methods do not necessarily need to be
facility based. To make maximum use of skilled providers, LAPMs may be
provided through periodic outreach visits to lower level facilities, or
through mobile services. When services are not regularly available at a
facility, community health workers provide a critical link to identify,
refer and follow-up clients seeking FP and LAPMs services. By the same
token, community health workers receive support from facility staff and
supervisors to conduct community mobilization activities. They get
re-supply for FP methods that they distribute, such as pills, condoms
and injectables from facilities. RESPOND is designed to meet the
challenge of building and strengthening the link between facilities,
communities, supervisors, staff, and volunteers.

-   **Gender**

For the most part, gender-related work has either focused on women's
empowerment (e.g., improving women's education, decision-making, public
participation, access to resources, access to and utilization of RH/FP
services) or on men's participation.  The objective of Male Involvement
(MI) was originally to improve men's access to RH/FP services as clients
(e.g., increased condom use and vasectomies).  MI gradually evolved into
a more comprehensive approach, seeking to expand men's support for their
female partners and to critically examine gender norms and
socialization, in order to expand men's roles as clients, supportive
partners, decision makers and their role as agents of change within
communities.  

 

The dichotomized approach to gender integration in RH/FP, described
above, needs to be re-examined. RESPOND's challenge will be to explore
and define a more integrated and comprehensive approach to gender, one
that addresses *both* women's empowerment and constructive engagement of
men. This 'gender alignment' should focus on women's specific gendered
vulnerabilities and on men's gendered role in creating and sustaining
these vulnerabilities. It should address the gender power dynamics and
interactions between *women and men*, and their norms and prescribed
roles in the context of improving supply and demand of RH/FP.

 

-   **Ensuring availability of adequate sites, commodities, supplies and
    equipment**

Clinical and surgical methods of family planning require adequate sites
that are clean, have enough space and privacy, and that are accessible
to clients. Underlying the entire FP program and LAPM services in
particular, is the assured availability of contraceptives, equipment and
supplies necessary to provide each of the methods. LAPMs require
clinical/surgical equipment as well as consumable supplies that are
often procured through a different channel than contraceptives. Ensuring
the availability of both contraceptives and other commodities for LAPMs
at the same place, in the right quantities, often requires close
coordination and collaboration with different parts of the ministries of
health, and with the logistics projects supporting them. RESPOND's
challenge is to collaborate with other stakeholders to ensure that the
supplies needed for FP and LAPMs reach the "last mile" and that the
"end-users", providers and clients, use the commodities correctly.

-   **Closing the knowledge gap**

One of the biggest challenges for RESPOND will be to manage knowledge
about all aspects of programming related to LAPMs. This includes
identifying information needs at the global level as well as the country
level, generating knowledge to fill those gaps, and manage the
dissemination and application of this knowledge to advance the use of
LAPMs. RESPOND's challenge will be ensuring that those who need the
information to design, implement and evaluate program activities have
what they need, in a way that enables them to use it most efficiently
and effectively to advance programs' goals. They should collaborate with
other USAID projects that provide information and materials.

-   **Measurement of results**

A central challenge of all service delivery projects is determining
whether FP and LAPM interventions are effective, whether FP and LAPM use
is increasing, and how much of the success is attributable to the
project. RESPOND will be responsible for identifying and using
established and effective tools for monitoring and evaluating the
effectiveness and impact of its interventions.

**G. Detailed Program Description**

As a global mechanism, the purpose of this award is to increase the use
of reproductive health and family planning (RH/FP) services, with a
focus on the informed and voluntary use of long-acting and permanent
methods (LAPMs) of contraception. This award has expectations for both
core and field results, aligned with the Office of Population and
Reproductive Health's results framework. The core results focus on
strengthening global learning and application of state of the art
approaches to expand commitment, support and programming for LAPMs. The
field results focus on applying global learning to generate and sustain
interest and commitment within a country for RH/FP services with a
holistic focus on LAPMs through increasing demand, strengthening service
delivery systems, integrating RH/FP with other programs, and building a
supportive environment to increase the use of LAPMs and other RH/FP
services. Ultimately, results will be to increase the number of users of
LAPMs in selected countries.

The table below presents the results framework that this award will work
toward achieving. RESPOND is expected to make major progress toward the
Activity Objective, through substantial, tangible achievements in each
of the three result areas. While a strategic focus of this award is to
introduce and expand informed choice and voluntary use of LAPMs, this
award should also be used to stimulate and respond to the existing and
growing demand for FP among women, men, couples and youth at all stages
of their reproductive lives.

+---------------------+-----------------------+------------------------+
| **Activity          |                       |                        |
| Objective:          |                       |                        |
| Increased Use of    |                       |                        |
| Reproductive Health |                       |                        |
| and Family Planning |                       |                        |
| Services, With a    |                       |                        |
| Focus on Informed   |                       |                        |
| and Voluntary use   |                       |                        |
| of Long-Acting and  |                       |                        |
| Permanent Methods   |                       |                        |
| of Contraception**  |                       |                        |
+---------------------+-----------------------+------------------------+
| **[Result           | **[Result             | **[Result              |
| 1]{.underline}:     | 2]{.underline}:       | 3]{.underline}:        |
| Leadership, global  | Knowledge generated,  | Holistic and evidence  |
| learning, and       | organized and         | based approaches used  |
| application of      | disseminated to       | to strengthen supply,  |
| state of the art    | strengthen            | demand and the         |
| approaches for      | commitment, support   | enabling environment   |
| LAPMs               | and programming for   | for RH/FP services     |
| strengthened**      | LAPMs**               | with a focus on**      |
|                     |                       |                        |
| 1.1 Promising       | 2.1 Key topics        | **LAPMs**              |
| practices to        | related to LAPMs      |                        |
| support the         | identified and global | 3.1 Behavior change,   |
| expanded use of     | data compiled,        | communications, and    |
| LAPMs identified    | analyzed and widely   | community strategies   |
| and applied         | disseminated.         | increase the demand    |
|                     |                       | for and use of RH/FP   |
| []{.mark}           | 2.2 Effective         | services, especially   |
|                     | monitoring and        | LAPM.                  |
| 1.2 Knowledge       | evaluation conducted  |                        |
| sharing,            | to validate           | 3.2 Key service        |
| collaboration, and  | strategies,           | delivery systems       |
| use of              | approaches and tools  | strengthened to        |
| evidence-based      | for enhancing use.    | enhance the provision  |
| tools, approaches   |                       | and use of RH/FP       |
| and models          | 2.3 Relevant          | services, especially   |
| supporting LAPMs    | programmatic research | LAPMs.                 |
| services advanced   | conducted to inform   |                        |
|                     | LAPM programming and  | 3.3 Effective models   |
|                     | services.             | demonstrated and       |
|                     |                       | scaled up to increase  |
|                     |                       | demand for and use of  |
|                     |                       | RH/FP services,        |
|                     |                       | especially LAPMs.      |
|                     |                       |                        |
|                     |                       | 3.4 Supportive         |
|                     |                       | enabling environment   |
|                     |                       | advances the use of    |
|                     |                       | LAPMs and other RH/FP  |
|                     |                       | services.              |
+---------------------+-----------------------+------------------------+

**[Result 1]{.underline}: Leadership, global learning, and application
of state of the art approaches for LAPMs strengthened**

A principal focus of RESPOND's core agenda is to provide technical
leadership to advance global learning and the application of
state-of-the-art approaches for LAPM programming and services. RESPOND
will share findings from global and country-specific analyses to advance
understanding, commitment and programming for LAPM.  RESPOND will
collaborate with others to apply best practices and state of the art
approaches for building commitment, generating demand, strengthening
service delivery systems, monitoring and evaluating program
interventions and results, and reaching underserved populations with
LAPM services. Two sub-results outline the broad areas of intervention
to strengthen global learning and application of best practices and
state of the art approaches to enhance LAPM use:

**1.1 Promising practices to support the expanded use of LAPMs
identified and applied**.

Much can be learned from global projects, Mission bilateral programs,
NGO/PVO programs, and other programs in the field which, in turn, could
inform the programming and provision of LAPMs interventions globally.
Global Health resources may be used to identify promising practices and
approaches from these programs, analyze processes used for adapting and
scaling them up, and to provide technical coordination for dissemination
and knowledge management.

 

Anticipated outcomes:

-   Successful LAPM practices and approaches identified from
    centrally-managed and bilateral projects, NGO/PVO projects, MAQ and
    IBP activities, OR studies, and projects integrating FP with other
    programs.

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-   Lessons learned from the experiences of mainstreaming and scaling up
    best practices and state-of-the-art approaches contributed to the
    global body of evidence, and guidance provided, as appropriate, on
    the process of implementing best practices.

    **1.2 Knowledge sharing, collaboration, and use of evidence-based
    tools, approaches and models supporting LAPM services advanced.**

Sharing project results and lessons learned is critical to the success
of expanding services worldwide. RESPOND will develop strategies,
processes and materials for sharing critical lessons learned about
tools, approaches and models, so that these lessons can be used in
future LAPM programs.  The core agenda will support leadership in MAQ
and IBP activities, and strengthen the development of South-to-South
technical assistance for the transfer and application of successful LAPM
interventions to other countries.  RESPOND will work on dissemination
with other projects as appropriate, and will define prospective
audiences, formats, content, and media for sharing information about
LAPMs, with an emphasis on efficiency and cost-containment.

Anticipated outcomes:

-   Comprehensive strategy articulated in collaboration with MAQ, IBP,
    INFO and other central mechanisms to disseminate lessons learned and
    evidence-based practices to enhance supply, demand and use of LAPMs.

-   South-to-South capacity from successful projects developed and
    strengthened to provide technical assistance to other countries
    wishing to replicate LAPM interventions.

-   Essential information about LAPMs identified, prepared and presented
    for PRH dialogue with international donors and field missions.

    **[Result 2]{.underline}: Knowledge generated, organized and
    disseminated to strengthen commitment, support and programming for
    LAPMs**

Another key area for RESPOND'S core support is to generate, organize and
disseminate essential information related to strengthening commitment,
support and programming for LAPMs. RESPOND will identify key topics for
global analysis, determine essential programmatic research needed, and
strengthen monitoring and evaluation for LAPM activities included in
Result 3. Findings from programmatic research, biomedical research,
monitoring and evaluation, and analyses of global survey data, will be
organized, disseminated, and as appropriate, published in peer reviewed
journals.

**2.1 Key topics related to LAPMs identified and global data compiled,
analyzed and widely disseminated.**

As USAID's lead centrally-managed project to enhance the use of LAPMs,
RESPOND will identify and undertake global analyses that address use,
trends and need for LAPMs across all age and parity groups and different
geographic areas. These analyses will provide essential information
about LAPMs for PRH to use in its global program to build sustainable
interest with field missions and international donors.  

RESPOND will play a key role in facilitating a working group with PRH
and a select group of centrally-managed projects to identify and
prioritize topics for this type of analysis, and ensure appropriate
support through coordinated annual workplans. Collaboration among a
broad group of cooperating agencies within the Global Health Bureau and
utilizing the capacity of non-SDI CAs (such as the INFO project), to
share best practices and lessons learned, and to transfer knowledge to
wider global programs and audiences, will be essential.

To complement analyses on the health outcomes of age at first pregnancy,
birth intervals, and interventions to achieve healthy timing and spacing
of pregnancy (HTSP), RESPOND will compile and/or facilitate analyses on
the health outcomes of age, high parity, and other trends, as they
relate to limiting family size and maternal/newborn health. RESPOND is
expected to publish selected analyses in peer reviewed journals.

[Anticipated Outcomes]{.underline}

-   Key topics for global analyses identified, implemented and published
    to enhance the understanding of the use, trends, and need for of FP
    and LAPMs by women of all ages and parity.

-   Collaboration among GH projects as well as the broader RH/FP
    community results in sharing of best practices, lessons learned, and
    formation of communities of practice to utilize state of the art
    knowledge.

-   A strategic plan for sharing RESPOND practices and transferring
    knowledge to others is developed and implemented throughout the life
    of the project.

    **2.2 Effective monitoring and evaluation conducted to validate
    strategies, approaches and tools for enhancing LAPM use.**

The ability of RESPOND to determine the progress of programs depends on
reliable data reported from service delivery points. Accurate, reliable,
and timely data facilitates all facets of planning and budgeting
including forecasting and procurement of commodities, numbers and types
of providers in place and required, training and supervision needed, and
demand and use by clients. In support of the health information system
strengthening activities in Result 3.2, RESPOND is expected to draw on
existing monitoring and evaluation methodology and tools, adapt them as
needed for country programs, strengthen local capacity to collect and
analyze data, and support the analysis, reporting and dissemination of
findings. The predecessor project, ACQUIRE, adapted tools from Measure
Evaluation to conduct baseline and endline surveys in large country
programs. RESPOND is encouraged to consult with ACQUIRE and Measure
Evaluation if conducting these types of surveys to advance global
learning about the use and replication of this methodology.

[Anticipated Outcomes]{.underline}

-   Effective monitoring tools and approaches are used by providers and
    managers at all levels of a health system to gather, analyze, report
    and solve problems related to FP and LAPM services.

-   A Performance Management Plan (PMP) that identifies key indicators
    and research activities is developed, reviewed and updated annually.

    **2.3 Relevant programmatic research conducted to inform LAPM
    programming and services.**

Although LAPMs have long been included in family planning programs, much
remains to be learned about effective approaches to LAPM programming.
These include:

-   Designing and implementing communications strategies

-   Facilitating the provision of LAPMs within busy clinics in the face
    of human resource shortages

-   Reducing/eliminating provider biases

-   Understanding the effects of shifts in method mix on program costs
    and LAPM use

-   Reducing discontinuation of long acting methods

-   Counseling approaches to advance understanding of the role of
    long-acting methods in achieving women's delay and spacing
    preferences

-   Systems strengthening and logistics issues.

RESPOND will facilitate the development of a programmatic research
agenda, including biomedical research as necessary, for discussion and
coordination with PRH and other centrally-managed projects. Research
topics should address key questions for strengthening the design,
implementation, and scale-up of LAPM services. Findings related to key
themes will be synthesized and published.

[Anticipated Outcomes]{.underline}

-   Key topics for programmatic research identified, implemented and
    published to enhance the understanding and use of FP and LAPMs.

-   Results of programmatic research applied to country programs to
    strengthen RH/FP and LAPMs, and their results documented, shared and
    transferred to other programs, as applicable.

    **[Result 3]{.underline}: Holistic and evidence based approaches
    used to strengthen supply, demand and the enabling environment for
    RH/FP services with a focus on LAPMs**

This result aims to achieve a balance between demand, supply and the
enabling environment using a holistic approach. Reliable operating
processes and systems are necessary to achieve positive program
outcomes, including functioning communications systems,
facility-community outreach and referrals, and effective training,
supervision, logistics, and management information systems. These are
supported by an enabling

environment that is committed to and encourages use of RH/FP and LAPM
services. All aspects of the holistic demand-supply-environment model
should be informed by and apply results from data and programmatic
analyses and proven state of the art approaches.

The greatest portion of RESPOND's work will be to strengthen country
programs' capacity to support and sustain RH/FP services, especially the
informed and voluntary use of LAPMs. To accomplish this, country
organizations need at least minimal infrastructure, equipment and
supplies to offer services; adequate and qualified human resources to
provide services; behavior change communications to inform and motivate
clients to use RH/FP services; community mobilization and outreach
services; links between facilities and communities to identify, refer
and follow up clients; and to resupply, support and report on
community-based distribution activities; an information system to help
manage the program and respond to client and program needs; and a
supportive environment in which to plan, budget and sustain services.

To reach clients in need of RH/FP services, RESPOND will collaborate
with field missions and host country programs to identify and respond to
opportunities to integrate RH/FP with other programs, such as HIV/AIDS,
MNCH, male and youth friendly services, and programs reaching out to
those in the poorest quintiles. RESPOND should be prepared to develop,
replicate and adapt innovative approaches and models that go beyond
stand alone FP programs.

RESPOND will be responsible for achieving marked results in key demand,
supply and service integration, and creating an enabling environment
through the sub-results listed below. The proposal should establish
ambitious yet achievable targets for increasing the number of family
planning and particularly users.

**3.1 Behavior change, communications, and community strategies increase
the demand for RH/FP services, especially LAPMs.**

Behavior change communication is an effective means of building interest
in, informing and educating about, and generating action for the use of
FP, especially LAPMs. It helps dispel myths and rumors, overcome biases,
and create a positive image for LAPMs among providers and potential
clients. Key among the information to be conveyed is the appropriateness
of long-acting methods for all stages of reproductive life including
delaying, spacing and limiting births.

Government leaders and program managers, health care providers and
supervisors, civil society organizations, religious leaders, couples and
individuals benefit from BCC, and are also important channels for
implementing BCC. Developing and supporting champions at all levels
builds a critical mass to inform, educate and encourage greater use of
FP, especially LAPMs. RESPOND is expected to build country commitment
and local capacity for implementing BCC interventions, provide technical
assistance in the

design, testing, and modification of interventions, and evaluate the
effectiveness of BCC interventions to contribute to global learning
about BCC, especially for LAPMs.

[Anticipated Outcomes]{.underline}

-   Communication strategies promote social norms for delaying, spacing
    and limiting using appropriate social and cultural context, and
    create positive images of FP and LAPMs.

-   Increased numbers of community leaders, families and clients have
    accurate knowledge of RH/FP, especially LAPM services and where to
    obtain them.

-   Providers appropriately counsel women, men, and youth in response to
    their fertility desires and provide accurate information about
    contraceptive options.

-   Increased demand for and use of RH/FP services, especially LAPMs.

-   Local organizations gain experience and capacity for planning,
    implementing and evaluating BCC for FP and LAPMs.

    **3.2 Key service delivery systems strengthened to enhance the
    provision and use of RH/FP services, especially LAPMs.**

Smooth functioning systems are the backbone of health care provision.
Crucial to the provision of all RH/FP services are institutions,
trainers and teaching methodologies that produce qualified and competent
providers. This is especially important for LAPMs and other clinical
services that require clinical judgment and specialized skills.
Supportive supervision and other performance improvement interventions
that facilitate the transfer of learning at the worksite, enhance both
the performance of providers and the effectiveness of support systems,
by identifying and remedying problems.

All FP programs require that contraceptives reach facilities so that
they can be provided to clients. LAPMs have additional commodity and
equipment requirements that are not always procured or distributed
through the same system as contraceptives, creating an additional
challenge for system strengthening.

Community outreach and involvement facilitate links between health
facilities and clients at the local level. Communities should be able to
identify priority health needs; provide support for community health
workers; and facilitate the identification, referral and follow-up of
clients for FP and LAPM services.

Well functioning information systems provide health care workers,
supervisors and district managers with critical information about the
program's performance and needs, including management of commodities and
supplies, and numbers of clients served.

RESPOND will provide technical assistance to build local capacity to
strengthen, manage and sustain service delivery support systems in
countries where they are weak. RESPOND is also expected to collaborate
with organizations and projects specialized in logistics management to
reinforce community and facility performance, and to ensure that
RESPOND's program needs are communicated and planned for in advance of
activity implementation.

[Anticipated Outcomes]{.underline}

-   Training, support and performance improvement mechanisms
    strengthened.

-   Providers, trainers and supervisors performing to established
    standards.

-   Commodities, supplies and equipment reach the end user

-   Contraceptives are used appropriately and correctly by both
    providers and clients.

-   Health information systems capture and report FP method use in a
    timely manner, and are routinely used to identify and solve
    problems.

-   Community-facility links increase client identification and
    referrals, and increase use of RH/FP services provided in the
    facility and in the community through outreach services.

    **3.3 Effective models demonstrated and scaled up to increase demand
    for and use of RH/FP services, especially LAPMs.**

Nearly all women and men of reproductive age need family planning
services at some point in their lives. These clients include those that
are HIV-positive, those receiving antiretroviral treatment (ART) for
AIDS, women who are postpartum or have had a miscarriage or abortion,
married and unmarried adolescents, men of all ages, and underserved
populations such as those in the poorest economic quintiles.

Identifying appropriate models to integrate FP with MNCH and HIV/AIDS
programs will help maximize the use of resources across programs and
reach individuals and couples that are often missed in conventional FP
service delivery. RESPOND may be called upon to support and scale up
male-friendly services that offer vasectomy and male circumcision and
promote healthy male normative behaviors; youth-friendly services
offering FP and related HIV/STI prevention for married and unmarried
adolescents and young adults; and to link with programs that reach those
in the poorest quintiles or rural areas, e.g. by supporting
community-based distribution of DMPA by trained community health
workers.

To increase the use of RH/FP services, including LAPMs, RESPOND is
expected to identify opportunities for integrating FP with MNCH
programs, [^4] and HIV/AIDS[^5] programs as well as community-based,
male, and youth services; adapt and replicate proven models and test new
models as needed; and document the process and outcome of the integrated
programming.

[Anticipated Outcomes]{.underline}

-   Program needs identified, and models developed and tested to
    integrate RH/FP and LAPM services with other related health
    services.

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-   Process of integration documented, results monitored and findings
    widely disseminated.

-   

-   Proven integration interventions and evidence-based practices are
    scaled-up and integrated into ongoing services.

-   Use of LAPMs increases substantially in selected countries.

    **3.4 Supportive enabling environment advances the use of LAPMs and
    other RH/FP services.**

An enabling environment is essential for ensuring that LAPMs are
incorporated into the country's strategic plan and budgets, establishing
appropriate policies and guidelines to ensure full access to RH/FP
services, especially LAPMs, and updating and disseminating curricular
and performance support materials to those who need them.

National five and ten year strategic plans often project unattainable
increases in CPR, and seldom have realistic plans for enhancing their
method mix with long-acting and/or permanent methods. Under this
sub-result, RESPOND is expected to use evidence and

available advocacy and programming tools[^6] to attract and retain the
interest of local leaders at all levels and across sectors. RESPOND will
act to build commitment for RH/FP services, especially LAPMs, and to
assist decision makers to plan and budget activities, appropriate for
their level, into short (annual), medium (three to seven years) and long
(five to fifteen years) range plans, including mortality reduction
strategies and Millennium Development Goals. In addition, RESPOND will
assist host countries to establish and/or strengthen a mechanism for
ensuring accountability for implementing the plans, reviewing results,
and making adjustments to plans as needed to reach desired goals.

One of the functions of national health ministries is to mobilize
commitment for FP and LAPM throughout the country. By providing guidance
to regions, districts and facilities, the national level defines and
updates standards for provider performance, develops and updates
curricula to ensure knowledge and skill competencies, removes
unnecessary barriers to access or eligibility, and promotes informed
choice and high quality FP services and care, especially for LAPMs.
RESPOND will assist host country ministries to update policies,
standards and guidelines, curricula, and job-aide materials, and ensure
that they are fully disseminated and put into practice by providers in
health facilities, faculty in pre-service education and trainers and
supervisors conducting in-service training and performance improvement.

[Anticipated Outcomes]{.underline}

-   Analytical findings are appropriately tailored and addressed to
    government, religious, community, civil society, and health
    professional leaders, at all levels, raising awareness and educating
    them about the health, quality of life and other benefits of FP and
    LAPM.

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-   Host country governments' national mid-range and long-range
    strategic plans include FP and LAPMs, have realistic CPR and TFR
    goals, and a demonstrated commitment for funding.

-   Host country governments understand and appreciate the role of FP in
    helping them achieve the Millennium and other development goals.

-   Sub-national levels have strategies and goals for RH/FP and LAPM
    services, and annual plans and budgets to support the attainment of
    the goals.

-   National standards, guidelines, curricula, and policies incorporate
    analytical findings, are fully disseminated, and are implemented by
    personnel at teaching institutions and service delivery points.

    **H. Performance Monitoring and 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 RESPOND to adapt to changing conditions and make
mid-course corrections as necessary. Data also must be available to
demonstrate program impact. Specific indicators and targets for
achievement of the activity objective and each of the three intermediary
results will be developed by the implementing agency for RESPOND and
submitted as part of the overall performance management plan (PMP) for
this activity. The PMP submitted by the implementing agency will be
subject to approval of the USAID Cognizant Technical Officer (CTO).

Indicators and targets for each result should illustrate how RESPOND
will contribute to improved service delivery of FP with a focus on LAPMs
and /or other clinical RH/FP services. Measurement of achievements under
the Leader award should directly relate to the technical leadership and
support provided under this project, including the identification,
development and application of best practices. They should also
demonstrate how RESPOND will leverage results not only through
partnering under this agreement but also by spreading practices through
other cooperating agencies and bilateral agreements. Indicators should
have widely shared definitions and allow aggregation of results across
countries, regions and/or the entire program.

An important aspect of monitoring, particularly for service delivery
projects, is the monitoring of compliance with USAID family planning
legal and policy requirements. These legislative and policy requirements
deal with voluntarism and informed choice, a target free approach,
quality counseling with comprehensible information, and non involvement
with abortion related activities. This will be further addressed in the
evaluation criteria.

For each Associate agreement, a key early activity of the recipient will
be to reach agreement with the Mission CTO on a Performance Monitoring
Plan, including indicators and performance targets. The Recipient will
be expected to describe the expected outcomes under each result in
annual workplans, and to report on progress according to agreed
indicators on a semi-annual basis.

**I. Substantial Involvement**

USAID shall be substantially involved during the implementation of this
Leader with Associate Agreement in the following ways:

1)  Approval of annual work plans, and all modifications, which describe
    the specific activities to be carried out under the Agreement;

2)  Review of annual or semi-annual technical progress reports and
    financial\` reports;

3)  Approval of key personnel and any changes;

4)  Approval of monitoring and evaluation plans. USAID will be involved
    in monitoring progress toward achievement of the Objective and
    Expected Results during the course of the Agreement and in
    monitoring financial expenditures; and

5)  Review and approval of all Associate award program descriptions by
    the GH CTO to ensure that they fall within the LWA program
    description.

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

> The Leader award for RESPOND will be managed by the Service Delivery
> Improvement Division, Office of Population and Reproductive Health
> within the USAID Bureau for Global health (GH/PRH/SDI).

**J. Reporting Requirements**

> The recipient will adhere to all reporting requirements listed below.
> All reports as required under Substantial Involvement shall be
> submitted by the due date for approval of the USAID Cognizant
> Technical Officer (CTO) designated by the Office of Assistance and
> Acquisition. Additional reports requiring review and clearances, when
> necessary, are listed under each requirement. Recipient will consult
> with the CTO on the format and expected content of reports prior to
> submission.

1.  **Financial** **Reporting**

> Financial reporting requirements will be in accordance with 22 CFR
> 226.

2.  **Performance Monitoring and Reporting**

> The recipient will submit reports to the USAID CTO as described below.
> The exact format for preparation of and timing for, submission of all
> reports will be determined in collaboration with the CTO.
>
> a\) Annual Work Plan (2 copies)
>
> RESPOND will prepare annual work plans for the Leader award on a
> schedule and according to a format established by USAID, to be
> submitted to the GH/PRH/SDI CTO for approval. The work plans for the
> Associate Awards will be submitted to the Mission CTOs. For the Leader
> award, the Recipient will follow the work plan year as defined by the
> CTO and the Office of Population and Reproductive Health. 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 on the start date of the
> agreement.
>
> b\) Performance Monitoring Report (2 copies)
>
> The recipient shall submit an updated report on progress toward agreed
> performance targets every three (3) months for the first year and
> every six (6) months thereafter, based on the Performance Monitoring
> Plan to be developed by the recipient in collaboration with USAID.
> This will include information on activities in all countries and
> regions. The reports must also include the following: 1) explanation
> of quantifiable output of the programs or projects, if appropriate and
> applicable; 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 must 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 must include a statement
> of the action taken or contemplated and any assistance needed to
> resolve the situation.

c\) Final Report (2 Copies)

> As USAID requires, 90 days after the completion date of this
> 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 country or region, as appropriate during the
> life of the Cooperative Agreement; an assessment of the progress made
> toward accomplishing the objective and expected results, 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.  **Distribution of Reports**

> The recipient shall submit an original and one copy of the final
> report to the Technical Advisor and the CTO and one copy to the USAID
> Development Experience Clearinghouse: E-mail (the preferred means of
> submission ) is : <docsubmit@dec.cdie.org>. The mailing address via US
> Postal Service is:
>
> Development Experience Clearing House
>
> 8403 Colesville Road
>
> Suite 210
>
> Silver Spring , MD 20910

**K. USAID Management**

> The Leader Award will have one Cognizant Technical Officer (CTO) and a
> GH/PRH/SDI Technical Advisor (TA). The CTO and TA will work in
> collaboration with CTOs for other projects that overlap or feed into
> service delivery, other centrally managed projects and Mission
> bilaterals to provide technical assistance to the field. The USAID
> /Washington management team will handle day-to-day oversight of the
> Leader Agreement. The Leader CTO will retain substantial involvement
> for activities conducted directly under the Leader Award and under
> field support funds. S/he will regularly meet with Project senior
> leadership and staff to track program and activity design,
> implementation, progress, and evaluation; and conduct semi-annual
> management reviews and budgetary analyses. Management of funds and
> technical content related to GH global leadership priorities or
> directly related to MNCH or HIV/AIDS will include technical input from
> those offices as appropriate.
>
> If Missions opt to use the Leader mechanism, they will access it
> through the field support system. Mission funds will be obligated
> directly into the Leader Award as incremental funding. If a Mission or
> Bureau operating unit opts to develop its own Associate Award, the
> Mission or Bureau will designate a CTO.

**L. Management Reviews and Evaluations**

> The Annual Work Plan will form the basis for a joint management review
> by USAID and program staff to review program directions, achievement
> of the prior year work plan objectives, and major management and
> implementation issues, and to make recommendations for any changes as
> appropriate. A semi-annual management review will also be held to
> review progress.
>
> At any time during program implementation, USAID may conduct one or
> more evaluation(s) to review overall progress, assess the continuing
> appropriateness of the project design, and identify any factors
> impeding effective implementation. USAID will utilize the results of
> the evaluations to recommend any mid-course changes in
>
> strategy if needed and to help determine appropriate future
> directions. Site visits may occur anytime after the initial six month
> period.

III. **IMPLEMENTATION ARRANGEMENTS**

     **A. Anticipated Award Schedule**

The RESPOND Project is expected to be awarded on or about June 30, 2008.

B.  **Eligibility Criteria**

> To be eligible to receive this Cooperative Agreement, an organization
> must:

-   Be a US based-non-profit, or private voluntary organization or an
    Institution of Higher Education registered with USAID (as defined in
    22 CFR part 228);

-   Have managerial, technical and institutional capacities to achieve
    the results outlined in this program description;

-   Propose at least one new partner with the technical expertise to
    plan and implement project activities worldwide or within a specific
    region (Africa or South Asia); and

-   Propose to contribute from their own, private or local sources no
    less than 20 percent of the amount of funds obligated by USAID for
    the implementation of this program over the course of the agreement.

C.  **Implementation Mechanisms**

> The RESPOND Project is a Leader with Associates (LWA) cooperative
> agreement with a five-year term. The Service Delivery Improvement
> Division, of the Office of Population and Reproductive Health within
> the Global Health Bureau will manage the Leader Award. The Leader
> Award covers all core-funded activities under this Agreement, but may
> receive both USAID core and field support funds, from a variety of
> accounts and earmarks. Applicants are encouraged to propose creative
> collaborative partnerships with other U.S. and/or international
> organizations, NGOs, private voluntary organizations, and firms to
> implement activities under this program. Inclusion of South-to-South
> partners and faith based organizations (FBOs) is highly desirable.
> Successful responses to this RFA are expected to propose at least one
> new partner. "New partners" are defined as organizations that have
> never received Global Health Bureau funding as either a direct or
> sub-recipient. Under this definition, organizations that have been
> directly funded by a USAID Mission bilateral project or have received
> USAID Regional Bureau funding will be considered a new partner.
> Partnerships should be of manageable size with relationships and
> responsibilities clearly defined.
>
> USAID anticipates allocating up to \$240 million in total funding for
> this activity over the five year performance period. Indirect costs,
> if any, are to be included in these totals. It is the intent of the
> U.S. government to make one award for this five year period. The
> Government, however, reserves the right to fund more than one
> application, depending on the relative technical merit, relative cost
> of proposals received, and availability of funds, etc., or to make no
> award. The Agreement Officer is the ONLY USAID official or
> representative of the Government authorized to change any terms and
> conditions of the Cooperative Agreement.

D.  **Staffing**

> The Recipient is expected to develop and fill a comprehensive staffing
> plan that enables achievement of all results under RESPOND and
> demonstrates an appropriate balance of skills and accountability. The
> professional staff proposed should possess complementary experience
> that reflects a combination of strong management as well as specific
> technical expertise. The staffing level and pattern may be increased
> or modified over time if needed to provide effective support to field
> programs as they come on stream, rather than from the onset of the
> award.

**Key personnel:** The following are designated KEY positions under
RESPOND: Project Director; Deputy Project Director; and Financial and
Administrative Management Specialist; and Monitoring and Evaluation
Specialist. All proposed Key Personnel must have the demonstrated
ability to address the conceptual framework of the Project and advance
the state-of-the art delivery of LAPMs and RH/FP services.

> **Project Director**:
>
> The proposed Project Director must have a Master's Degree or higher in
> public health or social sciences, management or a related advanced
> degree relevant to the field of RH/FP. He/she must have at least 10
> years senior level experience designing, implementing and managing
> large, complex RH/FP projects in/for developing countries. He/she must
> demonstrate a strategic vision, leadership qualities, depth and
> breadth of technical and management expertise and experience have a
> positive professional reputation, and strong interpersonal, writing,
> and oral presentation skills. He/she must have demonstrated experience
> interacting with government agencies, host country governments and
> counterparts, and international donor agencies. Two years experience
> living and working in a developing country and fluency/proficiency in
> a second language are desirable.
>
> **Deputy Director:**
>
> The proposed Deputy Director must have a Master's Degree in public
> health, a clinical discipline, social sciences or a related advanced
> degree relevant to the field of RH/FP. He/she must have at least eight
> years of mid to senior level experience in designing, implementing or
> managing large, complex, RH/FP projects in/for
>
> developing countries. He/she must have demonstrated leadership
> qualities, depth and breadth of technical and management expertise and
> experience, strong interpersonal, writing, and oral presentation
> skills. Two years experience living and working in a developing
> country and fluency/proficiency in a second language are desirable.
>
> **Financial Management and Administration Specialist:**
>
> The proposed financial management and administration specialist must
> have a Master's Degree or higher in Business Administration, Finance
> or other relevant field. He/she must have at least eight years
> experience in administrative and financial management of large
> international projects including experience in the management of USAID
> Projects. He/she must have familiarity with compliance and the Federal
> Acquisition Regulations as well as experience and skills in developing
> and managing large budgets. He/she should be proficiency in relevant
> computer applications and databases. He/she must possess excellent
> organizational, analytical, oral and written communications skills;
> demonstrated supervisory skills; and ability to work well on teams.
>
> **Monitoring and Evaluation (M&E) Specialist:**
>
> The proposed Monitoring and Evaluation Specialist must have an
> advanced degree in Public Health, social science or other related
> discipline. He/she must have at least eight years of applied skills in
> designing, implementing, monitoring and evaluating activities and
> special studies for RH/FP or related programs. He/she must have a firm
> command of M&E issues with respect to the special populations of
> interest. He/she must also have experience supervising monitoring and
> evaluation efforts for multi-country, multi-faceted programs. He/she
> must have demonstrated analytical skills and experiences to identify
> and evaluate best practices and state-of-the-art approaches to be
> utilized by the project. In addition, he/she must possess strong
> writing and organizational skills for reporting on program and study
> results.

**FINANCIAL PLAN**

USAID funding for the RESPOND cooperative agreement will have a
\$240,000,000 ceiling over the five-year implementation period. An
estimated twenty percent (20%) of the project will be funded through
core funds, with eighty percent (80%) of funding provided through field
support. The project can accept funds from any earmark or account,
though it will be funded mainly from the USAID Child Survival and Health
(CSH) Account. Activities under this Agreement will conform to relevant
guidance on use of these funds, including USAID guidance on the use of
CSH and other funds.

There is a 20 percent cost sharing requirement for the Leader Award.
Such funds may be mobilized from the prime recipient; other
multilateral, bilateral and foundation donors;

host governments; and local organizations, communities and private
businesses that contribute financially, and in-kind to implementation of
activities at the county level.

**SECTION IV -- CERTIFICATIONS, ASSURANCES, AND OTHER STATEMENTS OF
APPLICANT**

Affirmation of Certifications:
<http://www.usaid.gov/policy/ads/300/303sad.pdf>

**SECTION V -- ANNEXES**

Standard Form 424: <http://www.usaid.gov/forms/sf424.pdf>

Mandatory Standard Provisions for U.S. Nongovernmental Recipients

<http://www.usaid.gov/policy/ads/300/303mab.pdf>

[^1]: All references to reproductive health, reproductive health care
    and reproductive health services in this RFA refer to voluntary
    family planning and any combination of: HIV/AIDS-related prevention,
    treatment and care services; maternal/newborn services; treatment of
    sexually transmitted infections; post-abortion care and elimination
    of female genital cutting; and specifically exclude provision or
    promotion of induced abortion services.

[^2]: LAPM: Long-acting and permanent methods of contraception include
    intra-uterine contraceptive devices (IUDs), and implants (e.g.,
    Norplant, Jadelle, and Implanon). Permanent methods of contraception
    include female sterilization (tubectomy or bilateral tubal
    ligation/BTL) and male sterilization (vasectomy or non-scalpel
    vasectomy/NSV).

[^3]: The 13 countries are: Democratic Republic of Congo, Ethiopia,
    Kenya, Madagascar, Malawi, Angola, Rwanda, Tanzania, Uganda, Zambia,
    India, Pakistan and Haiti. Note that many of these are also PEPFAR
    focus countries.

[^4]: MNCH programs include antenatal, birth, postpartum, postabortion,
    newborn, and child health care including breastfeeding, nutrition,
    and immunization services.

[^5]: HIV/AIDS programs include prevention, care and treatment services,
    including VCT and ART.

[^6]: The predecessor ACQUIRE project developed Reality Check Users
    Guide, a family planning advocacy and programming resource package
    that focuses on LAPM. The tool is available on --
    [www.acquireproject.org](http://www.acquireproject.org/).