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# 

**Issuance Date: March 05, 2009**

**Deadline for receipt of Questions: March 26, 2009**

**Closing Date for Submission of Applications: April 20, 2009**

> **Closing Time for submission of Applications: 14:00 (Nigeria Time)**

**Subject: USAID/Nigeria Request for Applications (RFA) Number
USAID-Nigeria-HPN-09-012-RFA: Targeted States High Impact Project
(TSHIP)**

Dear Sir/Madam:

The United States Agency for International Development (USAID), Nigeria
mission is seeking applications from organizations to fund a program
entitled "Targeted States High Impact Project (TSHIP)." The authority
for the RFA is found in the Foreign Assistance Act of 1961, as amended.

The Recipient will be responsible for ensuring achievement of the
program objectives. Please refer to the Program Description for a
complete statement of goals and expected results.

Pursuant to 22 CFR 226.81, it is USAID policy not to award profit under
assistance instruments. However, all reasonable, allocable, and
allowable expenses, both direct and indirect, which are related to the
grant program and are in accordance with applicable cost standards (22
CFR 226, OMB Circular A-122 for non-profit organization, OMB Circular
A-21 for universities, and the Federal Acquisition Regulation (FAR) Part
31 for-profit organizations, and the Mandatory Standard Provision
"Allowable Costs (DEC 2003) for public international organizations), may
be paid under the grant.

Subject to the availability of funds, USAID intends to provide
approximately \$93,200,000 in total USAID funding to be allocated over a
five (5) year period. USAID reserves the right to fund any or none of
the applications submitted.

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

1\. Section A -- Cooperative Agreement Application Format;

2\. Section B -- Selection Criteria;

3\. Section C -- Program Description;

4\. Section D - Certifications, Assurances, and Other Statements

of Applicant/Grantee;

5\. Section E -- 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\".

The preferred method of distribution of USAID assistance solicitation
information is internet at [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 "Targeted States High Impact Project (TSHIP)."
If you have difficulty registering or accessing the Request for
Applications (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 persons noted below. It is the
responsibility of the recipient of the solicitation document to ensure
that it has been received from Grants.gov in its entirety. USAID bears
no responsibility for data errors resulting from transmission or
conversion processes.

**Any questions concerning this RFA should be submitted in writing to
Ugo Oguejiofor, Acquisition & Assistance Specialist via e-mail to
<uoguejiofor@usaid.gov> and to <abujasolicitations@usaid.gov> with copy
to Michael Glees at <mglees@usaid.gov>** . The deadline for submission
of questions on this RFA is March 26, 2009 as specified on the first
page of this letter. 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 below for receipt of applications.
Facsimile (fax) submissions are not authorized.

Applicants are requested to submit their applications by e-mail
attachment, followed by the hard copies. See Section A: **Preparation
and Submission Guidelines** and **Submission of Applications by E-Mail**
for full submission instructions. Applications and modifications thereof
shall be submitted in envelopes with the name and address of the
applicant and RFA Number -- "USAID-Nigeria-HPN-09-012-RFA". It is
recommended that applicants use courier service instead of international
mail for submission of the hard copies. Following is the submission
address:

[By Courier or Hand Delivery]{.underline}

Ugo Oguejiofor

Acquisition and Assistance Specialist

USAID/Nigeria

7 -- 9 Mambilla Street (Off Aso Drive)

Maitama, Abuja

Nigeria

Tel (234)9-461-9300 (Ext. 9308)

<uoguejiofor@usaid.gov>

Applicants are requested to submit both technical and cost portions of
their application in separate volumes. To be eligible for award, the
applicant must provide all required information in its application,
including the requirements found in any attachments to the solicitation
in Grants.gov. Applicants should retain for their records one copy of
all enclosures which accompany their applications. Award will be made to
the responsible applicant(s) whose application(s) offers the greatest
value.

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**REQUEST FOR APPLICATIONS**

USAID-Nigeria-HPN-09-012-RFA

**USAID/NIGERIA**

**TARGETED STATES HIGH IMPACT PROJECT (TSHIP)**

**March 05, 2009**

**TABLE OF CONTENTS**

**Page**

**SECTION A -- COOPERATIVE AGREEMENT APPLICATION FORMAT ............1**

1.  Preparation and Submission
    Guidelines..............................................1

2.  Technical Application Format
    ......................................................\...3

##  3. Cost/Business Application Format ...................................................9

4\. Cooperative Agreement Award
.......................................................11

5\. Authority to Obligate the
Government.............................................\...12

6\. Environmental Compliance
Guidance................................................12

**SECTION B -- SELECTION CRITERIA
.........................................................14**

**SECTION C -- PROGRAM DESCRIPTION
...................................................17**

Part A - Acronyms
..................................................................\...17

Part B - Introduction
..................................................................18

> Part C - Background
> ..................................................................21
>
> Part D - Technical Approach and Program Interventions
> ........................35
>
> Part E - Performance Monitoring and
> Indicators...................................45
>
> Part F - Monitoring and Evaluation
> .................................................50
>
> Part G - Reporting Requirements
> ....................................................50
>
> Part H - Management Review and Evaluations
> ....................................51
>
> Part I - Supporting Information
> ...................................................\...52
>
> Part J - Substantial Involvement
> .....................................................52
>
> Part K - Designation of Key Positions and Personnel
> ....................................53

**SECTION D -- CERTIFICATIONS, ASSURANCES AND OTHER STATEMENTS OF**

> **RECIPIENT
> .......................................................................\...54**

PART I -- Certifications and Assurances
....................................................54

> Certifications, Assurances, & Other Statements of Recipient:
>
> <http://www.usaid.gov/policy/ads/300/303sad.pdf>

PART II -- Forms
...............................................................................54

# [**http://www.grants.gov/agencies/approved_standard_forms.jsp**](http://www.grants.gov/agencies/approved_standard_forms.jsp) 

# Standard Form 424: [**www.grants.gov/techlib/SF424-V2.0.pdf**](http://www.grants.gov/techlib/SF424-V2.0.pdf) ;

> Standard Form 424A:http://www.grants.gov/techlib/SF424A-V1.0.pdf
>
> Standard Form 424B:
> <http://www.grants.gov/techlib/SF424B->[V1.0.pd]{.underline}
>
> OMB Circular A-133 or Similar Audits

**SECTION E -- ANNEXES
...........................................................................55**

> Annex 1 -- List of Reference Documents
> ...................................................56
>
> Annex 2 - Initial Environmental Examination
> .......................................\......57
>
> Annex 3 -- Branding Strategy and Marking Plan
> ..........................................64
>
> Annex 4 -- Other
> Provisions...................................................................74

SECTION A -- COOPERATIVE AGREEMENT APPLICATION FORMAT

##  1. PREPARATION AND SUBMISSION GUIDELINES

All applications received by the deadline will be reviewed for
responsiveness and programmatic merit in accordance with the
specifications outlined in these guidelines and the application format.
Section B addresses the selection criteria and procedures for the
applications.

Applications are to be submitted electronically via e-mail attachments,
in accordance with the instructions below **"Procedures for Submission
of Applications by E-mail,"** to be followed by hard copies.

Applications shall be submitted in two separate volumes: (1) technical
and (2) cost/business application. **In addition to the e-mail
submission, applicants shall submit an original and four (4) hard copies
of the technical application and an original and one (1) hard copy of
the cost/business application to the address specified on the cover
letter**. Faxed applications will [not]{.underline} be considered.

The hard copies of applications and modifications thereof shall be
submitted in sealed envelopes or packages addressed to the office
specified in the cover letter of this RFA, with the RFA number, the name
and address of the applicant, and whether the contents contain technical
and/or cost applications noted on the outside of the envelopes/packages.
**Provided that the e-mail submissions have been successfully received
by the due date, the hard copy submissions need not arrive by the due
date. However, they must be received no later than two weeks after
receipt of the e-mail submission**. It is recommended that applicants
use courier service instead of international mail for submission of the
hard copies. The submission address is specified in the RFA cover
letter.

The application should be prepared according to the structural format
set forth below in **(2) Technical Application Format** and **(3)
Cost/Business Application Format.** Applications must be submitted no
later than the date and time indicated on the cover page of this RFA, to
the location indicated on the cover letter accompanying this RFA.
Applications which are received late or incomplete run the risk of not
being considered in the review process. Late applications will be
considered for award [only if]{.underline} the Agreement Officer
determines it is in the Government's interest.

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

Any prospective applicant desiring an explanation or interpretation of
this RFA must request it in writing by the **Deadline for Receipt of
Questions** indicated on the cover letter of this RFA, to the e-mail
address set forth in the RFA cover letter to allow a reply to reach all
prospective applicants before the submission of their applications. Oral
explanations or instructions given before award of a Cooperative
Agreement will not be binding. Any information given to a prospective
recipient concerning this RFA will also be furnished to all other
prospective recipients as an amendment to this RFA, if that information
is necessary in submitting applications or if the lack of it would be
prejudicial to any other prospective recipients.

**Procedures for Submission of Applications by E-Mail**

1.  Before sending your documents to USAID as e-mail attachments,
    convert them into Microsoft Word (for narrative text), Excel (for
    tables). Documents requiring signature may be sent as scanned
    documents.

2.  Once sent, check your own e-mails to confirm that your attachments
    were indeed sent. If you discover an error in your transmission,
    re-send the material again and **note in the subject line of the
    e-mail that it is a "corrected" submission**. Do not send the same
    e-mail more than one time unless there has been a change, and if so,
    note that it is a corrected e-mail. Do not wait for USAID to advise
    you that certain documents intended to be sent were not sent, or
    that certain documents contained errors in formatting, missing
    sections, etc. Each applicant is responsible for its submissions.

3.  To avoid confusion, duplication, and congestion problems with our
    e-mail system, only one authorized person from your organization
    should send in the e-mail submissions.

4.  If you send your application by multiple e-mails, indicate in the
    subject line of the e-mail whether the e-mail relates to the
    technical or cost proposal, and the desired sequence of multiple
    e-mails (if more than one is sent) and sequence of attachments (e.g.
    Organization X, Cost Proposal, Part 1 of 4, etc.). However, you are
    requested to consolidate, as much as possible, the various parts of
    your technical application into one technical application document
    and the various parts of your cost application into one cost
    application document.

5.  The attachments should be formatted in Microsoft Word and/or Excel
    (version 2000) or PDF format, with a 3MB limit per e-mail. Because
    of our system restrictions, if you send zipped files, do
    [not]{.underline} use a "zip" extension as part of the file name.
    Also, specify in the body of the e-mail that the attachment contains
    zipped files. Applications and modifications thereof shall be
    submitted with the name and address of the applicant and the RFA
    number (referenced above) inscribed thereon, via e-mail, to
    <abujasolicitations@usaid.gov> . Due to phone system limitations,
    faxed applications will not be considered. Applicants must confirm
    with Ms. Ugo Oguejiofor at <uoguejiofor@usaid.gov>, copy Mr. Michael
    Glees at <mglees@usaid.gov> that their e-mail submissions were
    successfully received by the required due date.

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

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

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

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

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

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

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

Applicants shall confirm receipt of the RFA by written e-mail
notification to the contact person specified in the RFA cover letter.
Applicants shall also acknowledge receipt of any amendment to this RFA
by signing and returning the amendment. The Government must receive the
acknowledgement by the time specified for receipt of applications

**2. TECHNICAL APPLICATION FORMAT**

The technical application will be the most important item of
consideration in selection for award of the proposed activity. It should
demonstrate the applicant\'s capabilities and expertise with respect to
achieving the goals of this program.

To facilitate the competitive review of the applications, USAID [will
consider only applications conforming to the format prescribed
below:]{.underline}

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 45 pages (Times
New Roman 12 point single-spaced type, 1 inch margins) not including the
cover page, executive summary, appendices, figures and tables. While
there is no page limit for the annexes, brevity is encouraged. Shorter
applications are encouraged. USAID requests that applications provide
all of the information required by following the general format
described below.

The technical evaluation criteria, with the possible points allocated to
each are described in SECTION B -- "Selection Criteria" below. The
maximum number of points available is 100. The format of the technical
application should follow the outline and order of the technical scoring
criteria according to the guidelines provided below.

A suggested format for the Technical Application contains the following
sections:

-   Cover Page

-   Table of Contents

-   Executive Summary

-   Technical Application

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-   Technical Approach

-   Management

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-   Illustrative Implementation Plan and First Year Annual Work Plan

-   Monitoring and Evaluation Plan

-   Annexes (Staffing Plan, CVs/Resumes, Past Performance references,
    and Letters of Commitment from implementing partners, if any)

[Cover page]{.underline}: A single page that includes project title, RFA
number, the name of the organization(s) submitting application, contact
person, telephone and fax numbers, e-mail, and address. Any proposed
subgrantees (or implementing partners) should be listed separately. If
applicable, the TIN (Tax Identification Number) and DUNS (Data Universal
Numbering System) should also be listed on the cover page.

[Table of Content]{.underline}: Listing of all parts of the technical
application, with page numbers and attachments.

[Executive Summary (not to exceed three pages]{.underline}): Applicants
should briefly describe the technical approach, activities, goals,
purposes, and anticipated results. The Executive Summary should also
briefly describe the technical and managerial resources of the
applicant's organization and describe how the overall program will be
managed.

**[Technical Application]{.underline} (**maximum 45 pages**)**

[Content of Technical Application -- Instructions]{.underline}

**A. Technical Approach**

*1. Proposed strategies, approaches, and interventions*

-   Applicants should describe how they propose to achieve each of the
    sub-objectives and intended results of this activity and thus
    accomplish the overarching objective of increased use of high impact
    MCH/FP/RH interventions in the **two potential target states (Bauchi
    and Zamfara), which is subject to change.**

-   Applicants should demonstrate their familiarity with national
    systems, funding mechanisms, programs, policies and guidelines, and
    show how their program fits within these.

-   Applicants should describe how they will coordinate with other USAID
    cooperating agencies and USG programs, the FMOH, State MOH
    initiatives, other donor-funded programs, and state and local
    authorities, as well as indigenous and local partners, in
    implementing activities.

-   Applicants should describe how they will control costs and improve
    the cost-effectiveness of the program.

*2. Case study: Comparison of health situation, systems, and program
considerations in Bauchi and Zamfara*

-   The applicant should provide a brief (not more than six pages) case
    study that compares the MCH/FP/RH situations, health systems, and
    key factors that will affect the determination of approaches to
    achieving the program's sub-objectives and objective in each of the
    two target states. This analysis might consider similarities and
    differences in organization and capabilities of the public health
    system, approaches to the planning and management of local health
    services, key challenges to effective service delivery, experiences
    in community mobilization, and the overall donor and government
    resource and health program environment.

> 3\. *Illustrative Implementation Plan and First Year Annual Work Plan*
>
> Applicants are encouraged to design innovative implementation
> approaches to reach the desired results. The illustrative
> implementation plan should include information on critical activities
> towards achieving the results, a timeline, partners and resources
> (including human resources) required for carrying out the activity.
> The proposed implementation plan should cover the life of project and
> include a more detailed first-year annual work plan.

**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 TSHIP results. The staffing should
reflect a diverse staff including personnel who know the language and
culture of the selected target states (potentially Bauchi and Zamfara
states). As much as possible staff should be Nigerians that speak the
language and understand the culture of the two selected target states
(potentially Bauchi and Zamfara). **Applicants are invited to propose
and justify any alternative staffing structure, including a different
configuration of key staff positions, if they feel that a different
structure is more conducive to achieving the desired project results.**

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

\(1\) A complete staffing plan for each state 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 core technical staff, non-program staff and an
explanation of how additional technical expertise will be obtained with
attention to cost-containment and in order to avoid unnecessary
staffing. ***USAID envisions all project support infrastructure to be
located in the selected target states, potentially Bauchi and
Zamfara.  Given the intent to focus efforts at the state level, we do
not envision any management of the project to be based in Abuja.***

**[Key Personnel]{.underline}**:

The applicant shall propose a maximum of five (5) key personnel by name
and position for Chief of Party (COP), Deputy Chief of Party, Senior
Financial/Administrative Specialist, Senior Policy Advisor, and Senior
Monitoring and Evaluation (M&E) Specialist. The following descriptions
highlight ideal attributes for candidates for the positions:

\- **Chief of Party (COP)** (to be stationed in one state as team leader
for that state will be the overall manager of the project.) The
desirable attributes of the Chief of Party are: a Master's Degree or
higher in public health or social sciences, management or a related
advanced degree relevant to the broad areas of MCH and FP/RH. S/he must
have at least 10 years senior level experience designing, implementing
and managing large, complex MCH and FP/RH programs or projects in Africa
or in developing countries elsewhere. S/he 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. S/he must have demonstrated experience interacting with
government agencies, host country governments and counterparts, and
international donor agencies. S/he must have prior experience as a
supervisor, and as director of a project or program. At least eight
years experience living and working in a developing country is
desirable.

\- **Deputy Chief of Party (DCOP)** (to be stationed in one state
(separate from the COP) will be team leader for one of the states.)
While the COP will be the overall manager of the project, it is expected
that the state where the DCOP is located will be able to act
independently in setting program directions, approaches and
relationships with state and local governments and other partners. The
desirable attributes of the Deputy Chief of Party are: a Master's Degree
in public health, a clinical discipline, social sciences or a related
advance degree relevant to the field of FP/RH or MCH. S/he must have at
least eight years of mid to senior level experience in designing,
implementing or managing large, complex FP/RH or MCH project in/for
developing countries. S/he must have demonstrated leadership qualities,
depth and breadth of technical and management expertise and experience,
strong interpersonal, writing, oral presentation skills. Five years
experience living and working in a developing country is desirable.

\- **Senior Financial/Administrative Specialist** will be stationed in
the same state as the COP and will have responsibility for the overall
project finances. S/he is expected to develop the project financial
plan, to include monitoring and reporting systems that meet USG
requirements, and manage contracting activities. The desirable
attributes of the Senior Financial/Administrative Specialist are: a
Master's Degree or higher in Business Administration, Finance or other
relevant fields. S/he must have at least eight years experience in
administrative and financial management of large international projects
including experience in the management of USAID projects. S/he must have
familiarity with USAID financial regulations and management systems as
well as experience and skills in developing and managing large budgets.
S/he should be proficient in relevant computer applications and
databases. S/he must possess excellent organizational, analytical, oral
and written communications skills, demonstrated supervisory skills, and
ability to work well on teams.

\- **Senior Policy Advisor** is expected to assist the FMOH, the
National Planning Commission (NPC), the two states and other relevant
policy-making bodies in linking the states up to the federal level
regarding proposed policy changes and assist the two states in the
implementation of federal policies where appropriate. The senior policy
advisor will work with the program team in his/her designated state to
identify key constraints and issues that can be addressed through policy
and strategy, and to bring the experience, results, and perspective of
state and local programming to those policy and strategy discussions.
(Nigerian or relevant African experience is highly desirable). The
desired attributes of the Senior Policy Advisor are: a Master's Degree
or higher in fields relevant to health policy in developing countries.
S/he must have at least eight years senior level experience designing,
implementing and managing complex policy programs in Africa or in
developing countries elsewhere. S/he should have depth of experience in
FP/RH and/or MCH program implementation in developing countries and
expertise in strategy and policy development. S/he should also have
recognized stature in health development, demonstrated ability to work
effectively in policy and political environments, the ability to
establish effective relationships with senior leaders, and good
understanding of evidence-based approaches to program and the use of
operational research. S/he must have demonstrated strong interpersonal,
writing and oral presentation skills.

[]{.mark}

\- **Senior Monitoring and Evaluation (M&E) Specialist** will be
stationed in the same state as the DCOP and will have responsibility for
the overall project monitoring and evaluation. The desirable attributes
of the Senior M&E Specialist are: a Master's degree or higher in fields
relevant to monitoring and evaluation. S/he must have at least five
years senior level experience in monitoring and evaluating complex
systems improvement programs in Africa or developing countries
elsewhere. S/he must have demonstrated a depth and breadth of technical
and management expertise, strong interpersonal, writing and oral
presentation skills.

\(2\) Brief descriptions of each of the five proposed key staff should
be included in the body of the application, showing how they meet the
requirements above. Each key personnel position requires USAID approval,
as noted in substantial involvement provisions (Section C, part J).

**[Other Proposed Core Technical Personnel]{.underline}**:

It is desired that the following core technical positions be included in
the applicant's personnel workforce for each of the two states:

-   Additional Senior Policy Advisor (for state 2)

-   Senior Health Systems Advisor;

-   Senior Maternal and Child Health (MCH) Advisor;

-   Senior Family Planning/Reproductive Health (FP/RH) Advisor;

-   Assistant Financial Specialist.

A list of other core technical staff (and other personnel deemed
critical to the project) including one-page summary biographic
statements should be included in the staffing plan. These persons should
have the specific technical knowledge and skills to manage and support
activities under the award. The applicant must propose specific
expertise in operations and evaluation research, with evidence of
proposed staff having generated effective research that resulted in
improved programming or policy. Depending on the program proposed by the
applicant, other areas of expertise could include, but are not limited
to: MCH and FP/RH technical and program skills, training and performance
improvement, health care management and organization, quality assurance,
supply and logistics, health management information, human resource
management, knowledge management, community mobilization and development
and monitoring and evaluation. (Nigeria or relevant West African
experience and local language skills are highly desirable). It is not
necessary to include résumés of part-time staff, support staff, or
consultants.

> **C. Management and Institutional Capacity**
>
> Applicants should demonstrate that they have managerial, technical and
> institutional capacities to achieve the results outlined in this
> program description. Applicants are encouraged to propose creative
> collaborative partnerships with NGOs, private voluntary organizations,
> South-to-South partners, faith-based organizations, and indigenous
> Nigerian organizations and firms to implement activities.
>
> The Applicant should describe its proposed management and
> administrative structure; policies and practices for overall
> implementation of the program including personnel, financial, and
> logistical support; and coordination.

**D. Monitoring and Evaluation Plan (M&E)**

*It is anticipated that the final M&E Plan and the Performance
Management Plan (PMP) for the first year will be completed by the
awardee and approved by USAID approximately six months after the project
is awarded. This will allow the awardee to conduct base line and
systems' assessments and hold discussions at the state and Local
Government Authority (LGA) levels during the start up phase of the
project. These final plans will have process and outcome/impact
indicators with plans on how to generate the data needed to measure the
impact of the program.*

Applicants should propose an illustrative monitoring and evaluation
approach that will track progress in achievement of the TSHIP objective
and each of the four sub-objectives under the Award.

Noting this, applicants should describe how they anticipate the data
will be regularly collected and reported to facilitate results reporting
from USAID/Nigeria to USAID/Washington. Applicants should describe how
overall impact of TSHIP activities will be assessed, including how
baselines will be established and how changes in status will be measured
and attributable to TSHIP activities. Applicants should also describe
how the data collected would be used to make mid-term corrections or
other changes.

> **[ANNEXES]{.underline}:**
>
> The technical application shall contain the following four annexes:
> staffing plans for each state including key personnel, curriculum
> vitae/ résumés, past performance references, and letters of commitment
> from implementing partners, if any.
>
> *Staffing Plan*: A staffing plan for each state including proposed
> core technical staff. See proposed core staff above.
>
> *Curriculum vitae/résumés* should be provided for each key and core
> technical and home office personnel. They should be limited to a
> maximum of three pages per person.

*Past performance references*: Applicant should describe all contracts,
grants and cooperative agreements that the primary applicant (as well as
any partners substantially involved in implementation) has implemented
involving similar or related programs over the past three years. Include
the following for each award listed: name and address of the
organization for which the work was performed; current telephone number
and e-mail address of responsible representative of the organization for
which the work was performed; contract/grant name and number (if any);
annual amount received for each of the last three years; term of award,
i.e., beginning and ending dates; and a brief description of the
program.

*Letters of commitment* should be provided from all proposed
implementing partners. Such letters do not have to be exclusive to one
Applicant.

## 3 COST/BUSINESS APPLICATION FORMAT

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

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

A. Include a [budget with an accompanying budget narrative]{.underline}
which provides in detail the total costs for implementation of the
program your organization is proposing. The budget should be structured
according to Section C - PROGRAM DESCRIPTION, Part I.2: Proposed Funding
Sources and Funding Levels and have a breakdown by objective, program
elements and sub-activity. The **budget narrative** must provide
detailed budget notes and supporting justification of all proposed
budget line items. It must clearly identify the basis of all costs, such
as market surveys, price quotations, current salaries, historical
experience, etc. A summary of the budget must be submitted using
Standard Form 424, 424A and 424B, which can be downloaded from
<http://www.grants.gov/agencies/approved_standard_forms.jsp> The full
budget must include:

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

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

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

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

-   potential contributions of non-USAID or private commercial donors to
    the expected Cooperative Agreement;

> \- the name, annual salary, and expected level of effort of each
> person charged to the activity. Provide resumes showing work
> experience and annual salary history for at least the three most
> recent years for major personnel.

-   if not included in an indirect cost rate agreement negotiated with
    the U.S. Government, the applicable fringe benefit rates for each
    category of employees, and an explanation of the benefits included
    in the rate.

-   the same individual information for consultants must be provided as
    for regular personnel.

-   a breakdown of allowances by specific type and by person, and they
    must be in accordance with the applicant\'s policies.

-   travel, per diem and other transportation expenses detailed to
    include number of international trips, expected itineraries, number
    of per diem days and per diem rates.

-   financial plans for all proposed sub-grants and subcontracts, with
    the same format and level of detail as those of the applicant.

-   separate cost line items for other direct costs such as supplies,
    communication costs, photocopying, visas, passports and other
    general costs.

B. A current [Negotiated Indirect Cost Rate Agreement
(NICRA)]{.underline};

C. Required [Certifications and Representations]{.underline}, included
in Section D Certifications, Assurances and Other Statements;

D. Details regarding the level of [cost share]{.underline} your
organization is proposing for this activity. USAID encourages applicants
to contribute cost sharing. Cost sharing may be proposed from any
available and interested local and international funding sources,
including but not limited to, government and public institutions,
individuals, corporations, NGOs, and foundations. While there is no
stated minimum required cost share amount, applicants are encouraged to
give serious consideration to the amount they propose as a signal of the
applicant\'s commitment to the activity. See also Section B Selection
Criteria, under costs.

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

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

-   projected budget, cash flow and organizational chart;

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

F. Applicants should submit any [additional evidence of
responsibility]{.underline} deemed necessary for the Agreement Officer
to make a determination of responsibility. The information submitted
should substantiate that the Applicant:

1.  Have adequate financial, management and personnel resources and
    systems, or the ability to obtain such resources as required during
    the performance of the award.

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

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

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

5.  Is otherwise qualified and eligible to receive an award under
    applicable laws and regulations (e.g., EEO).

An award shall be made only when the Agreement Officer makes a positive
determination that the applicant possesses, or has the ability to
obtain, the necessary management competence in planning and carrying out
assistance programs and that it will practice mutually agreed upon
methods of accountability for funds and other assets provided by USAID.
For the organizations that are new to USAID, or organizations with
outstanding audit findings, it may be necessary to perform a pre-award
survey.

G. 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]{.underline}. If a copy has already been
submitted to the U.S. Government, the applicant should advise which
Federal Office has a copy.

H. Certificate of Compliance: Submit a copy of your Certificate of
Compliance if your organization\'s systems have been certified by the
USAID/Washington\'s Office of Acquisition and Assistance (M/OAA).

**4. COOPERATIVE AGREEMENT AWARD**

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

The Government will award the cooperative agreement on the basis of
initial applications received, and may not conduct discussions or
negotiations. Therefore, each initial application should contain the
applicant\'s best terms from a cost and technical standpoint. As part of
its evaluation process, however, USAID may elect to discuss technical,
cost or other pre-award issues with one or more applicants.
Alternatively, USAID may proceed with award selection based on its
evaluation of initial applications received and/or commence negotiations
solely with one applicant.

A written award mailed or otherwise furnished to the successful
applicant within the time for acceptance specified either in the
application or in this RFA (whichever is later) shall result in a
binding cooperative agreement without further action by either party.
Before the application\'s specified expiration time, if any, the
Government may accept an application, whether or not there are
negotiations after its receipt, unless a written notice of withdrawal is
received before award. Negotiations or discussions conducted after
receipt of an application do not constitute a rejection or counteroffer
by the Government.

Neither financial data submitted with an application nor representations
concerning facilities or financing, will form a part of the resulting
cooperative agreement unless explicitly stated otherwise in the
agreement.

To be eligible for award of a cooperative agreement, in addition to
other conditions of this RFA, organizations must have a politically
neutral humanitarian mandate, a commitment to non-discrimination with
respect to beneficiaries and adherence to equal opportunity employment
practices. Non-discrimination includes equal treatment without regard to
race, religion, ethnicity, gender, and political affiliation.

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

Foreign Government Delegations to International Conferences: Funds in
the cooperative 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.

**5. AUTHORITY TO OBLIGATE THE GOVERNMENT**

The USAID 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 Agreement or a specific written authorization
from the Agreement Officer.

**6. ENVIRONMENTAL COMPLIANCE GUIDANCE**

1a) The Foreign Assistance Act of 1961, as amended, Section 117 requires
that the impact of USAID's activities on the environment be considered
and that USAID include environmental sustainability as a central
consideration in designing and carrying out its development programs.
This mandate is codified in Federal Regulations (22 CFR 216) and in
USAID's Automated Directives System (ADS) Parts 201.5.10g and 204
(<http://www.usaid.gov/policy/ADS/200/>), which, in part, require that
the potential environmental impacts of USAID-financed activities are
identified prior to a final decision to proceed and that appropriate
environmental safeguards are adopted for all activities. Recipient's
environmental compliance obligations under these regulations and
procedures are specified in the following paragraphs of this RFA.

1b) In addition, the contractor/recipient must comply with host country
environmental regulations unless otherwise directed in writing by USAID.
In case of conflict between host country and USAID regulations, the
latter shall govern.

1c) No activity funded under this CA will be implemented unless an
environmental threshold determination, as defined by 22 CFR 216, has
been reached for that activity, as documented in a Request for
Categorical Exclusion (RCE), Initial Environmental Examination (IEE), or
Environmental Assessment (EA) duly signed by the Bureau Environmental
Officer (BEO). (Hereinafter, such documents are described as "approved
Regulation 216 environmental documentation.")

2\) An Initial Environmental Examination (IEE)

IEE 34Nigeriax_SO13_Soc Sector and IEE 33Nigeria3_NetMark_PERSUAP have
been approved for Increased Use of Social Sector Services funding this
RFA. The IEE covers activities expected to be implemented under this
Cooperative Agreement. USAID has determined that a Negative
Determination with conditions applies to one or more of the proposed
activities. This indicates that if these activities are implemented
subject to the specified conditions, they are expected to have no
significant adverse effect on the environment. The applicant shall be
responsible for implementing all IEE conditions pertaining to activities
to be funded under this solicitation. This will include proactive
monitoring of the use and effectiveness of ITN pesticides, including
household use, exposure and disposal of the product, watching for
potential adverse impacts on humans or on local aquatic ecosystems.

3a) As part of its initial Work Plan, and all Annual Work Plans
thereafter, the recipient, in collaboration with the USAID Agreement
Officer's Technical Representative (AOTR) and Mission Environmental
Officer or Bureau Environmental Officer, as appropriate, shall review
all ongoing and planned activities under this CA to determine if they
are within the scope of the approved Regulation 216 environmental
documentation.

3b) If the recipient plans any new activities outside the scope of the
approved Regulation 216 environmental documentation, it shall prepare an
amendment to the documentation for USAID review and approval. No such
new activities shall be undertaken prior to receiving written USAID
approval of environmental documentation amendments.

3c) Any ongoing activities found to be outside the scope of the approved
Regulation 216 environmental documentation shall be halted until an
amendment to the documentation is submitted and written approval is
received from USAID.

**\[END OF SECTION A\]**

**SECTION B - SELECTION CRITERIA**

**1. OVERVIEW**

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

The technical applications will be evaluated in accordance with the
Technical Evaluation Criteria set forth below. The cost/business
applications of all applicants submitting a technically acceptable
application will be evaluated by the Agreement Officer in accordance
with the criteria specified below in COST EVALUATION CRITERIA. To the
extent that they are necessary (if award is made based on initial
applications), negotiations will then be conducted with all applicants
whose applications, after technical review and evaluation, have a
reasonable chance of being selected for award. Award will be made to the
responsible applicant whose application offer the greatest value, cost
and other factors considered. Applicants are specifically advised that
until a grant document is received and duly signed by a Grant or
Agreement Officer, no program expenditures will be paid by
USAID/Nigeria.

To the extent necessary, if award is not made on the initial
applications, USAID may request clarification and supplemental materials
from applicants whose applications have a reasonable chance of being
selected for award. The entry into discussion is to be viewed as part of
the evaluation process and shall not be deemed by USAID or the
applicants as indicative of a decision or commitment upon the part of
USAID to make an award to the applicants with whom discussions are being
held.

**2. TECHNICAL EVALUATION CRITERIA (100 POINTS)**

Technical evaluation of applications will be based on the extent and
appropriateness of proposed approaches and feasibility of achieving the
strategic objectives, in accordance with the following criteria.

> **2.1. [Technical Approach]{.underline} 40/100**
>
> \(1\) The scoring of the technical approach is based on the overall
> quality of proposed strategies, approaches, and capabilities, as
> follows:

-   Technical and programmatic quality of proposed approaches to achieve
    each of the sub-objectives and intended results of this activity and
    thus accomplish the overarching objective of increased use of high
    impact MCH/FP/RH interventions in the two target states. (15 points)

-   Familiarity with national systems, funding mechanisms, programs,
    policies, strategies, and guidelines, and how the proposed program
    fits within these. (5 points)

-   Proposed coordination with other USAID cooperating agencies and USG
    programs, the FMOH, State MOH initiatives, other donor-funded
    programs, and state and local authorities, as well as indigenous and
    local partners, in implementing activities. (5 points)

-   Mechanisms and approaches to control costs and improve the
    cost-effectiveness of the program. (5 points)

\(2\) Case study (5 points)

\(3\) Illustrative Implementation Plan and First Year Annual Work Plan.
Plan for rapid start up of the project, including the first year plan of
activities and timeline (5 points)

**2.2. [Staffing/Key Personnel]{.underline} (30/100)**

**a. Key Personnel** (15 points)

-   The five proposed key personnel have requisite experience and
    expertise and meet or exceed requirements specified in Section A.
    They have breadth and dept in technical expertise and experience in
    management, design and implementation of complex programs.

-   The proposed key personnel, individually and collectively, show
    evidence of the ability to build collaborative relationships with
    the Government of Nigeria and other donors currently working in the
    target states.

**b. Other Proposed Core Technical Personnel (**15 points**)**

-   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 demonstrate a mix of practical
    technical skills necessary for achieving the main results of this
    Project.

-   Qualified Nigerians are proposed for leadership, technical and
    managerial positions.

**2.3. [Management and Institutional Capacity]{.underline} (15/100)**

The management and institutional capacity will be evaluated according to
the following criteria.

-   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.

-   How 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.

-   Demonstration of 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.

-   Demonstration of the Applicant's past performance and how it meets
    or exceeds the Eligibility Criteria provide in the RFA.
    Documentation should demonstrate organizational capabilities
    including past performance of each partner receiving at least 15
    percent of project funds.

**2.4. [Monitoring and Evaluation (M&E)]{.underline} (15/100)**

The M&E Plan will be evaluated according to the following criteria.

-   The application presents a comprehensive M&E approach to monitoring
    and evaluation, with the understanding that it may be modified
    during the start-up phase of the project. . The approach should
    include illustrative indicators for outputs, intermediate outcomes
    (both system and intervention-related), and impact, describing how
    these levels of indicator will be used in a linked manner to monitor
    progress toward MCH/FP/RH outcome and impact performance targets.
    The description of the M&E approach should also illustrate how data
    on these indicators will be collected or generated, and how the
    program will work to shift from parallel, program-specific data
    collection to use of local and state level data where possible.
    Examples of illustrative targets and benchmarks should be provided
    that relate to achieving the results outlined in the program
    description.

-   The plan should describe the methodology to be use 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.

**SUMMARY:**

**Technical Approach 40 points**

**Staffing/Key Personnel 30 points**

**Management and Institutional Capacity 15 points**

**Monitoring and Evaluation [15 points]{.underline}**

**TOTAL 100 points**

**\[END OF SECTION B\]**

> **SECTION C: PROGRAM DESCRIPTION**

**PART A.** **ACRONYMS**

ADB African Development Bank

AIDS Acquired Immune Deficiency Syndrome

AIF Access to Finance

AMTSL Active Management of the Third Stage of Labor

ANC Antenatal Care

AOTR Agreement Officer's Technical Representative

ART Anti-Retroviral Therapy

BASICS BASIC Support for Institutionalizing Child Survival

BCC Behavior Change Communication

CA Cooperative Agreement

CC Community Coalition

CDIA Canadian International Development Agency

CHEW Community Health Extension Workers

COMPASS Community Participation for Action in the Social Sector

COP/DCOP Chief of Party/Deputy Chief of Party

CPR Contraceptive Prevalence Rate

CPS Country Partnership Strategy

CS Child Survival

DfID Department for International Development (UK)

EC European Commission

EmONC Emergency Obstetric and Newborn Care

ENHANSE Enabling HIV/AIDS and TB and the Social Sector Environment

FP Family Planning

FP/RH Family Planning and Reproductive Health

FMOH Federal Ministry of Health

GAVI Global Alliance for Vaccines and Immunization

GHAIN Global HIV/AIDS Initiative Nigeria

GON Government of Nigeria

HEW Health Extension Worker

HIV/AIDS Human Immuno-deficiency Virus

HMO Health Maintenance Organization

IEC Information, Education, and Communication

IMNCH Integrated Maternal, Newborn, and Child Health Strategy

IPD Immunization-Plus Day

IPT Intermittent Prevention Treatment

IR Intermediate Results

IUD Intrauterine Device

ITN Insecticide Treated Nets

JICA Japan International Cooperation Agency

LAM Lactational Amenorrhea Method

LAPMS Long Acting and Permanent Methods

LGA Local Government Authority

LLN Long Lasting Nets

LOP Life of Project

MCFW Managed Care Family Wellness

MCH Maternal and Child Health

MDG Millennium Development Goal

M&E Monitoring and Evaluation

NDHS Nigerian Demographic and Health Survey (2003)

NEEDS National Economic Empowerment and Development Strategy

NGO Non-Governmental Organization

NPC National Planning Commission

NPHCDA National Primary Health Care Development Agency

ORT Oral Rehydration Therapy

OVC Orphans and Vulnerable Children

PEPFAR President's Emergency Plan for AIDS Response

PHC Primary Health Care

PMI Presidential Malaria Initiative

PMP Performance Management Plan

PMTCT Preventing Mother to Child Transmission

PPT Prepackage Treatment

PRIME Partnership to Reinforce Immunization Efficiency

PRRINN Partnership for Reviving Routine Immunization in Northern Nigeria

PSP-One Private Sector Partnerships One

RBM Roll Back Malaria

RFA Request for Applications

SDM Standard Days Method

SEEDS State Economic Empowerment and Development Strategy

SFH Society for Family Health

SMOH State Ministry of Health

SPHCDA State Primary Health Care Development Agency

TFR Total Fertility Rate

TSHIP Targeted States High Impact Project

TT Tetanus Toxoid

UNICEF United Nations Children's Fund

USAID United States Agency for International Development

USG United States Government

VOA Voice of America

WHO World Health Organization

**PART B. INTRODUCTION**

**[Overview of Planned Activity]{.underline}**

USAID/Nigeria plans to implement a 5-year family planning, reproductive
health, and maternal and child health (MCH/FP/RH) program through a
Cooperative Agreement whose overall primary objective is to increase the
use of selected high impact interventions in the two selected target
Nigerian states, potentially Bauchi and Zamfara, through public sector
health services. A strongly associated sub-objective (section C, below)
is to draw on the program investments in these two states to develop
evidence and experience that will inform and improve policies, programs,
and resource allocation in other states and in Nigeria as a whole.

The program to be implemented under this proposed Cooperative Agreement
has been developed under USAID/Nigeria's new strategy for its MCH/FP/RH
activities (see "Referenced Documents" and associated links, below).
Under this strategy, the program to be supported under this RFA is part
of a larger, multi-agreement program that will be implemented by
USAID/Nigeria. It is anticipated that this broader program will include
five complementary mechanisms (see Figures 1 and 2 below)

Figure 1

+-----------------------------------------------------------------------+
| Mechanism 1: Public sector support in two states, (potentially Bauchi |
| and Zamfara) (this agreement)                                         |
|                                                                       |
| Mechanism 2: National policy level support                            |
|                                                                       |
| Mechanism 3: Social marketing of MCH/FP/RH commodities and services   |
| (national)                                                            |
|                                                                       |
| Mechanism 4: Non-social marketing private sector partnerships         |
| (multiple states)                                                     |
|                                                                       |
| Mechanism 5: Buy-ins to USAID/Washington projects for specialized     |
| technical expertise                                                   |
+-----------------------------------------------------------------------+

![](media/image3.wmf){width="5.333464566929134in"
height="4.05984251968504in"}

**PART C. BACKGROUND**

*1. [Nigeria's Health Situation]{.underline}*

Nigeria is the largest country in Africa, with a population of
approximately 140 million people. It has been ranked 158 out of 177
countries in the United Nations Development Program, a combined index
for overall quality of life (2007-2008 UNDP Human Development Report).

The health system has been neglected for the past two decades, resulting
in devastating statistics. In the recent 2008 Report on the State of the
World's Mothers[^1], Nigeria ranked 70 out of 71 less developed
countries as one of the worst places in the world to be a mother. The
total fertility rate is 5.7 children per woman and the prevalence of
modern contraceptive methods is only 8.9 percent (Nigerian Demographic
Health Survey (DHS)). Maternal mortality hovers at 800 per 100,000 lives
births, with the rate being at least three times that in the northern
States. The 2003 NDHS indicates that consumers are choosing to forego
treatment or to pay for treatment with unskilled providers. Sixty-six
percent of deliveries take place in the home, with only 35 percent
attended by a skilled provider.

About one million Nigerian children die each year before their fifth
birthday. This figure represents about ten percent of the global total,
although Nigeria's population is just two percent of the world's
population. The infant mortality rate is 100 per 1,000 live births and
the under five mortality rate is 200 per 1,000 live births (NDHS).
Communicable diseases, particularly malaria, pneumonia, and diarrhea,
often in association with malnutrition are the major causes of mortality
and morbidity, especially among children. Malaria remains largely
unchecked and kills more people, especially children, than any other
disease. These statistics suggest that the national healthcare system is
in a crisis state and is struggling to meet even the bare minimum of any
national health sector standard.

In general, development, health, and fertility indicators in Nigeria are
worst in the states of the northern region. For example, the 2003 NDHS
found the under-five mortality rate across the North Western states to
be 269/1,000 and in the North Eastern states to be 260/1,000, while the
rate in next highest region ("South South," including the delta region)
was 176/1,000 and in the South Eastern states was 103/1,000. In the
North Western states, complete immunization was only 3.7 percent (12.9
per cent nationally) and women's literacy was 20.9 percent (48.2 per
cent nationally). Many health indicators in Nigeria (infant and child
mortality, immunization, oral rehydration therapy use, and others) have
actually declined since the NDHS survey in 1990.

*2. [Nigeria's Health System]{.underline}*

Nigeria operates through a three-tier health system.

The Federal Ministry of Health (FMOH) generally provides policy and
technical guidance for the health sector and supports and manages
tertiary level care, research, and academic "centers of excellence." The
FMOH also contributes to human resource capacity development through the
training of medical doctors, nurses, midwives, and community health
officers at all levels. Along with other sectors, international donor
aid to the health sector is overseen by the National Planning
Commission.

The Federal Ministry of Finance (FMOF) provides funds to the FMOH, the
states and the Local Government Authorities (LGAs) based on the National
Revenue Allocation Formula.

State Ministries of Health (SMOH) also have important policy setting and
technical direction roles within their states. In addition, they fund
and manage state hospitals, maternities, and teaching colleges. SMOHs
also are responsible for the development of health manpower for
secondary and primary health care, from midwives and nurses to Community
Health Extension Workers (CHEWS). The FMOF channels funds to the LGAs
through the states. State governments allocate funding to Local
Government Areas (LGAs), generally in the form of non-earmarked grants
that are meant to include funding for health services.

Local government is presently tasked with planning, managing, staffing,
supporting, and implementing primary health care services. About 71
percent of Nigerians have access to a primary health care (PHC) facility
that is within a five km radius of their homes; however, many of these
centers are not functional due to lack of equipment, essential supplies
and qualified staff. Up to 64 percent of the PHC facilities have not
received any drugs from the government in the past two years. LGAs are
made up of approximately five to ten wards. Each ward contains a
collection of settlements or communities. Originally established for
election purposes, wards do not have an official government function.
Wards usually have traditional leaders who settle disputes, advocate for
the ward and mobilize the community around issues, such as polio and
other interventions.

The LGA level especially remains a critical "missing link" in making
Nigeria's health system function. The fragmentation of responsibility at
this level (personnel are managed by the Ministry of Local Government
and the resources for payment of the personnel are from the LGA) and
especially the lack of capacity and a defined structured approach to
priority setting, resource allocation, and health services management at
this level, make the LGA level perhaps the weakest link in effective
health service delivery.

In actual terms, the blurring of the roles of each of these tiers
sometimes contributes to overlapping and unclear (or contested)
responsibilities or fragmented support of service delivery. The picture
is further complicated by the roles of other government institutions.
Most important among these is the National Primary Health Care
Development Agency (NPHCDA). In the years prior to Nigeria's latest
military dictatorship, the NPHCDA was established as a strong federal
institution that was directly involved in establishing primary health
care services nationwide. However, the NPHCDA waned in importance under
the Sani Abacha lead government from 1993 until 1998. The lead role for
the NPHCDA was never substantially re-established despite the return of
non-military government in the late 1990s and the fact that it remains a
legal entity.

To strengthen primary health care delivery services, some states are
setting up their own "State Primary Health Care Development Agencies;"
and other states are putting in place different mechanisms aimed at
controlling resources and/or management of primary health care. Some
states have taken no substantive action to deal with the shortcomings of
funding, planning, management, staffing, and support of PHC. Given the
critical importance of PHC in achievement of the objectives of USAID's
program under this agreement, this evolving institutional issue will be
an important contextual factor in the program's implementation.

3\. *[Ongoing USAID MCH/FP/RH Activities]{.underline}*

USAID/Nigeria is currently implementing a portfolio of projects and
activities upon which the new proposed program described under this RFA
and the other components of its portfolio will strategically build and
expand. The present portfolio includes:

[NetMark (2004-2009)]{.underline}: NetMark supports reduction of malaria
associated morbidity and mortality by increasing the use of insecticide
treated nets (ITNs), particularly by pregnant women and children
under-five. Key activities include: Support to local net manufacturers
to increase quality, quantity, sale, and distribution of a variety of
local ITN; and mass awareness, demand creation and adoption of long
lasting net (LLNs) technology.

[Improving Reproductive Health in Nigeria (IRHIN]{.underline})
(2005-2010): The Society for Family Health (SFH), a Nigerian NGO, in a
consortium with other partners, manages this contraceptive social
marketing project to improve the distribution of contraceptive
commodities nationwide, train providers, provide technical support, and
supervision and monitor activities in three states.

[Community Participation for Action in the Social Sector (COMPASS)
Project (FP/RH,]{.underline} [MCH/Child Survival, Malaria and Polio
(5/04-5/09]{.underline}): COMPASS/FP/RH works in 51 local government
areas in five states to provide an integrated FP/RH and MCH package in
557 public and 143 private health facilities to increase community
participation in the provision of social services. COMPASS/MCH/Child
Survival provides support to health facilities for the reduction of
morbidity and mortality caused by preventable childhood disease. The
project works with health workers and community coalitions to provide
improved routine immunization, improved prevention and treatment of
diarrhea, improved maternal and young child nutrition and treatment of
childhood illnesses. COMPASS/Polio supports the implementation of
Immunization Plus Days in eight northern states. COMPASS/Malaria
increases access to and use of proven malaria interventions ITNs and
Intermittent Preventive Treatment (IPT) through antenatal clinics,
immunization activities and community coalitions using an integrated
approach towards reducing malaria in pregnant women and child under
five.

[Global HIV/AIDS Initiative Nigeria (GHAIN]{.underline}) (2004-2009):
This project integrates family planning services into HIV prevention,
care and treatment services.

[Prepackaged Treatment (PPT) (11/04-11/09)]{.underline}: This project
through a social marketing mechanism provides access to prepackaged anti
malarial treatment. Children less than five years are the target.

[DELIVER (10/06-9/11)]{.underline}: This project improves the
availability of contraceptive supplies in the public sector by
strengthening Nigeria's supply systems.

[ACCESS]{.underline} (1/06-6/09): This project supports the utilization
of quality Emergency Obstetric and Newborn Care services (EmONC)
including birth spacing/reproductive health and family planning) by
pregnant women, mothers and their newborns in three states . The ACCESS
project works in two LGAs in Zamfara. Because the ACCESS project may be
extended for another year, it is anticipated that the new project will
need to coordinate closely with ACCESS in Zamfara to ensure a smooth
transition of EmONC services in Zamfara from ACCESS to the new project.

[Immunization Basics]{.underline}(10/06-5/09): This project supports the
development of the human and organizational capacity needed to
strengthen delivery of quality routine immunization services.

[Private Sector Partnerships One (PSP-One]{.underline}) (10/06-9/09):
This project supports the delivery of FP/RH and other health products
and services through the private sector. Working through Health
Management Organizations (HMOs), PSP-One conducts Managed Care and
Family Wellness (MCFW) and Access to Finance (ATF) trainings for private
providers. PSP-One also works with the Nigerian NGO, Society for Family
Health (SFH) in the distribution of social marketed contraceptives.

[Enabling HIV/AIDS and Social Sector Environment (ENHANSE]{.underline})
(6/04-6/09): The ENHANSE project strengthens the policy environment for
FP/RH by addressing the key constraints to access and utilization of
FP/RH services through policy reform.

[Voice of America (VOA) Hausa Services]{.underline} (10/06-9/08): This
activity supports the production of Hausa language radio programming,
which reaches listeners in northern Nigeria and neighboring countries.
The messages include information and education on child spacing, child
health, and malaria.

[ACQUIRE -- Fistula Care]{.underline}(10/06-10/11): This project
supports comprehensive fistula prevention, repair, community-based
integration, and family planning activities.

*4. [Summarized Key Findings (and Recommendations) from Recent
Evaluations and Assessments of these Activities]{.underline}*

-   While the COMPASS activity sought to build on potential synergies
    between two social sector program areas (health and education), the
    lack of congruence in delivery approaches and target groups reduced
    the effectiveness of programming in each area.

    -   *It was recommended that future activities in each of these
        areas should be implemented separately, although synergies among
        them should still be sought where the potential exists.*

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    -   For a number of reasons, both political and historical, USAID's
        MCH/FP/RH activities have been implemented in six states and a
        large number of LGAs. Sometimes one element of a program (e.g.,
        maternal health care improvement) might be implemented in some
        states or areas, while other elements (e.g., immunization) are
        being carried out in others. In other cases, multiple program
        elements might be carried out in shared or overlapping areas,
        but by different Implementing Partners (IPs) with somewhat
        different approaches to similar service delivery problems. This
        geographic and programmatic fragmentation of USAID's MCH/FP/RH
        program investments has resulted in the influence of those
        investments often being less than the sum of its parts.

> A lack of sufficient influence is especially true at the state and
> national levels, where the sub-division of USAID activities among
> multiple implementing mechanisms and projects has resulted in USAID's
> investments sometimes being seen as relatively small in comparison
> with those of other donors and with limited leverage. (In reality, not
> considering PEPFAR resources, USAID is probably the third largest
> health sector donor in Nigeria \[at \$49 million in FY 2008\], behind
> DfID and the World Bank -- with PEPFAR resources, USAID is the largest
> health donor.)

-   *It was recommended that USAID should achieve greater effectiveness,
    impact, and influence from its program investments by concentrating
    those investments [geographically]{.underline} and by bringing the
    separate components of its MCH/FP/RH program into [a smaller number
    of integrated activities with larger scope and scale]{.underline}
    (ideally, working at the level of whole states).*

-   *It was also recommended that USAID should plan and carry out its
    MCH/FP/RH assistance and support within an overarching framework to
    further increase the coherence and effectiveness of its programming
    and to assure coherence among implementing partners and activities
    in different program areas and at different levels of the health
    system.*

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-   The USAID health strategy and immunization teams agreed that the
    "Immunization Plus Days," which are intended both to strengthen
    polio eradication activities and also to effectively deliver other
    interventions, appear to be falling short in both and in realizing
    potential synergies.

    -   *It was recommended that USAID have separate investments to
        support the extraordinary efforts of polio eradication and
        accelerated measles control campaigns, while its core MCH/FP/RH
        programming should focus on strengthening routine immunization,
        building on the work already done in this area in Bauchi and
        Sokoto (as well as the work of the DfID PRRINN and EU PRIME
        projects). A limited amount of polio resources should be
        incorporated into USAID's state-level program support
        mechanisms, to allow these state level activities to develop
        "win-win" relationships with polio eradication and accelerated
        measles activities. However, in general, USAID support for these
        campaign activities should be carried out through a separate
        mechanism, with a state level focus on routine immunization.*

-   The primary focus of much of USAID's public sector support in
    MCH/FP/RH has been on improving the service delivery level. This
    work has given USAID important first-hand experience on the sorts of
    service delivery improvements that are required and that are
    feasible. However, the impact and endurance of such project-achieved
    service delivery improvements is limited in the absence of
    improvement in the functioning and capability of key components of
    the public health system.

    -   *It was recommended that, specifically for its work in the
        public sector, USAID should expand its focus from mainly direct
        engagement in improving delivery at the point of service to
        achieving such service delivery improvement through support for
        improvement in the capabilities and functioning of critical
        components of the health system at state, local, primary care,
        and community levels. The outcome of these improved capabilities
        must continue to be measured in terms of improved health
        services and outcomes at the population level. It was recognized
        that this process will be at best medium term, with outcome
        level improvement likely to require several years of investment.
        It was also realized that such improvement is only likely to be
        achieved at scale in states that are clearly committed to reform
        and to resolving the important constraints on health care
        delivery effectiveness that exist.*

-   USAID's support for delivery of family planning commodities and
    services through social marketing has demonstrated substantial
    success at scale in increasing contraceptive prevalence. More
    recently, there has also been significant success in social
    marketing of insecticide-treated bed nets and malaria treatment. A
    recent USAID-supported assessment of additional opportunities to
    work with Nigeria's dynamic private sector, along with the
    government's recently adopted Public-Private Partnership strategy,
    have opened the door for potentially important additional non-social
    marketing (NSM) interactions with the private sector in health.

    -   *It was therefore recommended that USAID should continue to
        mobilize the power of the private sector by expanding the scope
        of its social marketing program to additional MCH/RH commodities
        and services, and also pursue NSM activities that have the
        potential of delivering high impact goods, services, and/or
        information in sustainable and scalable ways. \[USAID/Nigeria
        plans to act on this recommendation through mechanisms other
        than the proposed agreement under this RFA.\]*

-   Virtually all project-specific evaluations (as well as evaluations
    of USAID's earlier MCH/FP/RH activities in Nigeria) recognized the
    important success and effective approaches that these projects and
    activities have achieved through mobilization and engagement of
    communities.

    -   *It was recommended that in its planned future work with the
        public sector, including the proposed work under this RFA, USAID
        should incorporate and build on these experiences in successful
        community mobilization and engagement, as an essential element
        of a functional health systems approach in Nigeria.*

-   Evaluation of USAID's work in health policy indicated that, while
    some important policy steps had been achieved, in many ways the
    policy work at the federal level was divorced from the program
    experience of USAID's other MCH/FP/RH activities. At the same time,
    many central policies were not being translated into effective
    policy, program, and investment at the state and local level.

    -   *It was recommended that USAID should maintain a role in central
        policy dialogue (especially in areas where it had direct program
        engagement or comparative advantage, such as health care
        financing), but that USAID's work in health policy support needs
        to be much more tightly connected to the experience and needs of
        state, local, and community-level health care programming.*

*5. [Related Activities of Other Donors ]{.underline}*

[The World Health Organization in Nigeria (WHO)]{.underline}: WHO has
numerous national projects that address various public health problems.
These include: Communicable Disease Prevention and Control: HIV/AIDS,
Malaria and Tuberculosis Control; Non Communicable Disease Control;
Child, Adolescent Health and Reproductive Health; Emergency Preparedness
and Response; Health Promotion; Sustainable Development; Health and
Environment; Nutrition and Food Safety; Health Systems Strengthening;
and Essential Medicines.

[UK Department for International Development (DfID]{.underline}): DfID
projects include the Partnership for Transforming Health Systems
(PATHS); Health Commodities and Equipment Procurement (HCP); Partnership
for Reviving Routine Immunization in Northern Nigeria (PRRINN); Support
to Health Reform Foundation of Nigeria (HERFON); Bridging the Gap (pilot
in Niger State to show that basic health services can be provided in a
sustainable way at the LGA level); and the National Malaria Project,
PATHS2 (has not begun implementation). DfID also has several projects
that focus exclusively on various aspects of the HIV/AIDS problem.

[Canadian International Development Agency (CIDA)]{.underline}: CIDA
projects include the School College of Health Technology and PHC
Project, the Nigeria Evidence-based Health Systems Initiative, support
to WHO Polio Eradication Phase IV, and purchase of Contraceptive and
Safe Motherhood Kits

[World Bank]{.underline}: The World Bank projects include the Health
Systems Development Project II, which ends in 2008; the HIV/AIDS Program
Development Project; the Malaria Booster Project which ends in 2012, and
the Avian Influenza Control and Human Pandemic Preparedness and Response
Project. A new health sector project is being prepared.

[European Commission (EC) Delegation]{.underline}: EC projects include
the European Union Partnership to Reinforce Immunization Efficiency
(PRIME), support to routine immunization in Kano, integrated sexual and
reproductive health service delivery in Northern Nigeria, and support to
control of Avian Influenza.

[UNICEF]{.underline}: The projects supported by UNICEF under the
Accelerated Child Survival and Development strategy include malaria and
under-five mortality reduction, immunization services, nutrition,
including micronutrients, and HIV/AIDS prevention and care.

[African Development Bank (ADB):]{.underline} The ADB supports the
Health System Development Project, ending December 2008.

[Government of Japan/Japan International Cooperation Agency
(JICA]{.underline}): JICA projects include the infectious diseases
prevention for children, through UNICEF; the attachment of an expert to
the Directorate of Public Health, Lagos State (ends August 2008); the
Asia-Africa Knowledge Co-Creation Project, which ends October 2008; the
Project on Improvement of Maternal and Child Health in Lagos State
(planned); support to the HIV/AIDS National Response through provision
of equipment and country-focused training; and training and dialogue
programs that train health professionals in the public sector.

[Bill & Melinda Gates Foundation]{.underline}: The foundation is
initiating support for an urban reproductive health initiative that will
be implemented in five cities.

*6. [Partnership Environment and New Opportunities]{.underline}*

The program of work being solicited under this RFA is being started at a
time when there are important new opportunities for USAID's MCH/FP/RH
support to be linked with other actions and investments, in ways that go
beyond "coordination and communication" to actually achieve strategic
complementarity, leverage, and greater impact. This new environment
includes important overarching strategies and agreements on donors'
cooperation with each other and with the Nigerian government. It also
includes new initiatives and funding sources that can be leveraged
strategically.

One key reality to which these strategies and agreements respond is that
-- despite the significant level of resources being provided by USAID
and other donors -- *these* *external resources are small in relation to
Nigeria's own public sector resources for health, and also in relation
to the resources spent by Nigerian citizens on their own families'
health*. **As a result, USAID expects work proposed and carried out
under this RFA to proactively and effectively identify opportunities for
complementarity of resources and approaches with those of other donors
and partners, and to strategically influence partners' investments and
the investments of the Nigerian health system itself (at all levels) to
achieve improved health outcomes and impact at the greatest scale
possible.**

The major partnership and leveraging opportunities at present include:

-   [The "Country Partnership Strategy" (CPS)]{.underline}: The CPS was
    developed by the World Bank Group and the U.K.'s DfID in 2005 as a
    positive response in support of both the "National Economic
    Empowerment and Development Strategy (NEEDS)" and the "State
    Economic Empowerment and Development Strategies (SEEDS)" drafted by
    a number of states. The NEEDS and SEEDs provide overarching
    strategic approaches to development [across]{.underline} sectors,
    including the health sector, and the CPS in turn places increased
    external investment into the context of these strategies, links that
    support to Nigeria's efforts in reform of governance across sectors,
    and provides a framework for donor coordination. Among the important
    principles of the CPS is to support national initiatives for human
    development, specifically strengthening of the health system. New
    investment activities by the World Bank and DfID are being framed
    within the CPS. USAID/Nigeria has committed itself to the CPS as an
    overarching development assistance framework (consistent with the
    U.S. Government's commitment to the principles of the Paris
    Declaration on Aid Effectiveness) and intends to become a signatory
    to the updated version of the CPS presently under development.

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-   [National "Integrated Maternal, Newborn, and Child Health Strategy
    (IMNCH)"]{.underline}: The national IMNCH Strategy was developed in
    2006 through collaboration among the FMOH, donor partners, and
    leading NGOs and health care professional organizations. It has been
    officially adopted as policy at the federal level, and roll-out of
    implementation is being planned and initiated in selected states
    through cooperative action by the FMOH, state officials, and
    partners. The IMNCH Strategy represents a useful programmatic and
    technical framework as well as a coherent focus for advocacy
    regarding the need to strengthen delivery of basic MCH services. As
    such, in states that are attempting to use the IMNCH Strategy as an
    organizing framework for improving and expanding those services,
    USAID expects to support this strategy *\[recognizing that the
    comprehensive package of MNCH interventions and services identified
    in the IMNCH Strategy is broader than the more limited, but more
    generally feasible, set of interventions identified for USAID
    support in this RFA -- the more basic package in this RFA is seen as
    a foundation for the later addition of additional interventions in a
    phased, state-specific process\]*.

-   ["Millennium Development Goal (MDG)funds"]{.underline}: The federal
    government holds a substantial amount (billions of dollars) of "Debt
    Forgiveness" funds from international donors and lenders that are
    intended to be used to achieve social development and poverty
    reduction in support of achieving the "Millennium Development Goals"
    in Nigeria. These funds are held and disbursed by a special office
    attached to the Office of the President. They are generally being
    allocated in response to proposals by federal ministries and state
    governments. The MDG Fund administrator has stated that funds will
    only be allocated in support of credible proposals that *both*
    support achievement of MDG targets *and* reflect commitment by the
    proposing entity to fundamental governance reform, transparency, and
    the strengthening of essential oversight and management
    capabilities. *\[One activity that might be supported in one or both
    of the target states under this proposal would be to work with state
    government and partners to develop, and then implement, successful
    proposals for support from the "MDG Fund."\]*

-   [Global Alliance for Vaccines and Immunization (GAVI) Health Systems
    Strengthening funding]{.underline}: Nigeria has been awarded
    approximately \$45 million by GAVI to support health system
    strengthening activities that will increase the availability and use
    of both immunization and other MCH services in wards with the worst
    health indicators. These funds might be available to support
    selected aspects of systems strengthening in the states targeted
    under this RFA.

-   [Malaria Booster Project:]{.underline} Nigeria is a priority country
    for the World Bank's "Malaria Booster" program, which is operating
    in seven states.

-   Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria: Nigeria won
    Round 2 and Round 4 malaria grants totaling \$95 million, of which
    about \$30 million have yet to be spent. Nigeria submitted a Round 8
    grant request for more than \$850 million. Thus, there are likely to
    be substantial resources available for malaria activities with which
    the work under this RFA can interact and to some extent integrate.

These broad opportunities for partnership and leveraging are in addition
to the opportunities to cooperate and synergize with the state-specific
activities being supported by several donor and international
organization partners (including those listed above). Key partners in
the target states have expressed their willingness and enthusiasm for
strategic cooperation with USAID's MCH/FP/RH program support. The
development of the CPS, a new government climate that permits and
promotes improved partner coordination, and the development or proposed
development of state-level strategic plans for the health sector in a
number of states offer substantive opportunities for influence,
leverage, and impact. USAID intends to take advantage of these
opportunities as a key feature of work under this RFA.

*7. [Potential for Synergy with Other USAID/Nigeria Assistance
Activities]{.underline}*

There are a number of other areas of USAID assistance where MCH/FP/RH
investment can complement, and be complemented by other health and
non-health investments in ways that deliver "win-win" outcomes. Most
prominent among these are:

a\. PEPFAR

*[FP/MCH/HIV Integration]{.underline}*:

There is an opportunity to strengthen the linkages between FP/MNCH and
HIV/PEPFAR programming within USAID and in collaboration with other
donors and the Government. This includes strengthening the communication
and collaboration between PEPFAR/USAID-supported projects and the
MCH/FP/RH program where these programs are currently being implemented.
This collaboration is likely to be enhanced by PEPFAR's ongoing
development of global guidance for integrating MCH and FP activities
with HIV programming, including:

-   linking prevention of mother to child transmission (PMTCT) (for
    example, linked to antenatal care plus \[ANC+\]);

-   using primary and community services (as they develop) to support
    follow-up and treatment of HIV-exposed and infected children and
    HIV+ mothers;

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-   delivering integrated messages through a range of communication
    channels; and

-   capitalizing on antenatal and primary care visits to address
    relevant HIV, RH and MCH issues.

PEPFAR's investments in immunization safety can be linked to USAID's
investments in strengthening immunization services in primary health
care (PHC). At the referral level, PEPFAR can strengthen PMTCT
platforms, which can then improve the quality of other FP, PPFP, and MCH
services, especially ANC, delivery, and post-partum/newborn services.

Reportedly, PEPFAR-supported prevention, care, and treatment activities
are beginning to move from the hospital level to the local, PHC, and
community levels in some states. Since there is presently limited
capacity at these levels - and therefore much opportunity for
strengthening capacity, service delivery, and communication - it is
likely that there may be significant opportunities for "win-win"
wrap-around and integrated MCH/FP/RH and HIV/AIDS investments. These
should be proactively defined and pursued.

In addition, PEPFAR has developed an effective logistics system that is
parallel to other logistics systems. The potential for leveraging that
system may also be explored.

*PEPFAR OVC*

Since FY2004, USAID/Nigeria has provided leadership under the PEPFAR
program for activities focused on orphans and vulnerable children (OVC).
This PEPFAR component is supported by a 10% earmarked providing
approximately \$10 million in FY08. The OVC component of the program
works in collaboration with Ministry of Women\'s Affairs and Social
Services and provides services through community-based organizations
(NGOs and faith-based organizations). These implementing partners offer
a comprehensive array of programs for eligible children and their
families. There are more than 32 implementing partners with programs in
9 focus states. Services include assistance with education, health
services, protection (legal and social), food and shelter, psychosocial
support and assistance with livelihoods and job training. Health
services are generally obtained through LGA primary or secondary health
facilities. Occasionally, services are obtained from private church
based health care providers. This is a logical area for collaboration as
community partners have well developed support programs with primary and
secondary healthcare facilities. Wherever possible, these are co-located
with ARV treatment facilities. It is clear that there are opportunities
for leveraging resources and collaborative planning to strengthen
provider capacity and build services. This could support efforts to
bring existing services into compliance with existing OVC standards of
care and simultaneously strengthen capacity of facilities that serve the
general population.

An important feature of the OVC program is its focus on community
outreach. Implementing partners work at the community and household
level with community leaders to identify the most vulnerable children
and defined their needs and the needs of their extended families. This
provides a logical opportunity for enhanced outreach and strengthening
of community-based monitoring and follow-up of women who may have
registered for PMTCT/FP/MCH services but who have been lost to
follow-up. Recruitment and referral of new patients requiring
PMTCT/FP/MCH services, but who have not registered could be integrated
into existing community outreach. The OVC program is already in dialogue
with the ARV treatment component of PEPFAR and Tuberculosis (TB)
services to explore these options. Building on this existing platform
could significantly strengthen and accelerate outreach FP and MCH
services.

*b. Water and Sanitation:*

In FY 2009, USAID/Nigeria is planning to allocate two million dollars in
water and sanitation funds to local governance activities, municipal
water systems, and actual hardware investments (e.g., bore holes) in
communities. To the greatest extent possible, USAID will work to
co-locate these and future activities in the health focus states, and to
seek maximum benefit to community health through joint planning of these
activities. For example, water installation might be focused on Primary
Health Care facilities as part of efforts to increase functionality of
those facilities. Community organizations assisted by either MCH/FP/RH
or governance activities might be given the capability to support
maintenance and repair ("software components") of water facilities,
complementing installations by either USAID or DoD. In addition, through
PEPFAR the Mission already supports point-of-use water treatment,
focused on HIV-affected families and communities, and these activities
might be expanded to other households through MCH/FP/RH social marketing
of water purification products. Again, congruence with health focus
states may create opportunities for joint planning and mutually
supportive implementation.

*c. Governance*:

In addition to focusing its health inputs under its new program,
USAID/Nigeria sees additional potential impact through the application
of USAID's governance expertise alongside its health investments. In
many respects, USAID's MCH/FP/RH programming already includes strong
governance elements, especially through community organization and
"empowerment" (development of self-responsibility for health outcomes)
and through communities' representation of their own interests and
demands with local government. However, substantial value could be added
to USAID's direct health activities by bringing governance expertise to
some of the key challenges faced in improving health services. Two areas
where this could be especially beneficial are:

-   strengthening the now ill-defined functionality and accountability
    of Local Government Authorities in supporting, managing, and
    financing primary health care services (as well as education), and

-   implementing public-private partnerships.

While many of USAID/Nigeria's current health activities effectively
involve a governance dimension, the program being proposed under this
RFA can potentially do more to create partnerships between state
governments, LGAs and civil society for the betterment of health
systems. At the same time, the new governance program being developed by
USAID/Nigeria may find important opportunities to systematically
strengthen key governance functions by focusing on such important and
concrete outcomes as those in health and education.

*8. [Reference Documents ]{.underline}*

A full compendium of USAID relevant documents is available in annexes
posted at <http://www.usaid.gov/ng> brief summary of the major annexes
is found below:

> a\. Maternal, Child, Reproductive Health and Family Planning Strategic
> Approach; USAID/Nigeria, September 2008.
> [http://www.usaid.gov/ng/downloads/hpndraftstrategy%20(pdf,%20111kb).pdf](http://www.usaid.gov/ng/downloads/hpndraftstrategy (pdf, 111kb).pdf)
>
> b\. Immunizations Today and Way Forward - Promising Support by
> USAID/Nigeria; M. Harvey, C. Lee, E. Ogden. (May 12-24, 2008)

[http://www.usaid.gov/ng/downloads/immunizationstoday%20(pdf,%20341kb).pdf](http://www.usaid.gov/ng/downloads/immunizationstoday (pdf, 341kb).pdf)

c\. An Evaluation of the USAID/Nigeria Social Sector Projects: ENHANSE
and COMPASS; J. Holfeld, et al. June 2008.

[http://www.usaid.gov/ng/downloads/compassenhansevaluation%20(pdf,%20387%20kb).pdf](http://www.usaid.gov/ng/downloads/compassenhansevaluation (pdf, 387 kb).pdf)

> d\. The Ground is Softening for the USAID/Nigeria Health Portfolio,
> Considerations for the Present and Future; J. Holfeld, P. MacDonald,
> January 2007 (Is that date correct)
> [http://www.usaid.gov/ng/downloads/thegroundisoftening%20(pdf,%20166kb).pdf](http://www.usaid.gov/ng/downloads/thegroundisoftening (pdf, 166kb).pdf)

Additional relevant materials include and are posted at:

> e\. Broken Promises, Human Rights, Accountability, and Maternal Death
> in Nigeria; Center for Reproductive Rights. 2008.
> [www.reproductiverights.org/pdf/pub_nigeria2.pdf](http://www.reproductiverights.org/pdf/pub_nigeria2.pdf)
>
> f\. National Integrated Maternal, Newborn, Child Health Strategy;
> Government of Nigeria

<http://www.who.int/pmnch/countries/sampleplans/en/index.html>

9\. [*Rationale for design of the public sector MCH/FP/RH support
program*]{.underline}

The program for which proposals are being solicited under this RFA has
been designed in response to USAID/Nigeria's new Maternal, Child,
Reproductive Health and Family Planning Strategic Approach, the findings
of evaluations and assessments of its present and past health portfolio,
and the opportunities for greatest scale and sustainability of impact
through its support for MCH/FP/RH services in the public sector. In this
context, key aspects of the program design include:

-   [Focusing on two states (potentially Bauchi and
    Zamfara)]{.underline}: This key aspect responds to the
    recommendation to focus USAID's program geographically, and to do so
    in states that offer the greatest opportunity for USAID's investment
    to support the achievement of impact at scale and influence on
    programming in other states and nationally.

> The criteria for selection of the two potential focus states were:

-   levels of need (health indicators)

-   commitment of the state to health issues and good governance

-   ratio of USAID MCH/FP/RH resources to population

-   planned or ongoing presence of other USAID programs with which
    MCH/FP/RH can interact in a win-win investment approach

-   other donor presence and potential for coordination (and openness of
    the state to donor collaboration)

-   requests by the states for USAID partnership

-   private sector opportunities

-   previous USAID experience and investment that can be built on and
    leveraged for expanded impact (*and the results of that previous
    investment*), and

-   potential zonal and regional influence of the state.

+---------------+----------------------------+------------------------+
| **Indicator** | **Bauchi**                 | **Zamfara**            |
+---------------+----------------------------+------------------------+
| Population    | 4,676,465                  | 3,259,846              |
+---------------+----------------------------+------------------------+
| No. of LGAs   | 20                         | 14                     |
+---------------+----------------------------+------------------------+
| No. of PHCs   | 1,140                      | 585                    |
+---------------+----------------------------+------------------------+
| No. of        | 16                         | 18                     |
| Hospitals     |                            |                        |
+---------------+----------------------------+------------------------+
| Tertiary      | 2                          | 1                      |
| Hospital      |                            |                        |
+---------------+----------------------------+------------------------+
| \<5 Mortality | 260/1000                   | 269/1000               |
+---------------+----------------------------+------------------------+
| Maternal      | 1,549/100,000              | 1,500/100,000          |
| Mortality     |                            |                        |
+---------------+----------------------------+------------------------+
| CPR           | 2%                         | 1-3%                   |
+---------------+----------------------------+------------------------+
| State         | \--ANC, delivery and \<5   | \--Free MCH services   |
| Commitment    | services are free in all   |                        |
|               | government hospitals,      | \--Construction and    |
|               |                            | renovation of health   |
|               | \--All general hospitals   | facilities through MDG |
|               | are under going            | funds                  |
|               | renovation,                |                        |
|               |                            | \--Employment of       |
|               | \--New doctors, nurses and | health personnel       |
|               | midwifes have recently     | across the state       |
|               | been employed and deployed |                        |
|               | to all health facilities,  | \-\--2008 budgetary    |
|               |                            | allocation for health  |
|               | \--Purchase and            | 7.6% (approximately    |
|               | distribution of hospital   | 6.7 billion Naira)     |
|               | equipment to all general   |                        |
|               | hospitals.                 | \--Supplies of         |
|               |                            | hospital consumables   |
|               | \-- 2008 budgetary         | and the construction   |
|               | allocation for health      | of Millennium Hospital |
|               | \>10% (approximately 8     |                        |
|               | billion Naira) of the      |                        |
|               | total budget               |                        |
|               |                            |                        |
|               | \--120 million naira       |                        |
|               | counterpart funds          |                        |
+---------------+----------------------------+------------------------+
| Other Donors  | WHO, UNICEF, UNFPA,        | WHO, UNICEF, DfID,     |
|               |                            | PRRINN, and EU PRIME   |
|               | EU-PRIME Action Aid,       |                        |
|               | WaterAid and CIDA          |                        |
+---------------+----------------------------+------------------------+
| USAID         | Previous: Vision,          | Current: ACCESS,       |
| Projects      |                            | ACQUIRE/Fistula Care,  |
|               | Current: PSP-One, IRHIN,   | and COMPASS/Polio      |
|               | GHAIN, COMPASS,            |                        |
|               | COMPASS/Polio,             |                        |
|               | ImmunizationBasics,        |                        |
|               | ACQUIRE/Fistula Care,      |                        |
|               | DELIVER, and CEDPA         |                        |
+---------------+----------------------------+------------------------+

Sources: National census, 2005; Needs Assessment of Safe Motherhood
-Bauchi; Federal Ministry of Health Situation Analysis of Newborn Care,
2008; Zamfara State Budget, 2008

> In focusing the program in these two potential states, with the
> intention of achieving state-level impact, USAID/Nigeria recognizes
> and emphasizes that ***full ownership by the state of all activities,
> approaches, and investments under this program is absolutely
> essential*** and will be a criterion for evaluation of the
> implementing organization's performance*.*

-   [Reducing fragmentation of USAID's MCH/FP/RH program]{.underline}:
    The program under this RFA brings together what were formerly
    separate components of MCH and FP/RHsupport and adds to them,
    providing for delivery and use of a core package of MCH/FP/RH
    interventions.

-   [Moving from a principal focus on service delivery to an expanded
    focus that includes system and capacity strengthening]{.underline}:
    The program under this RFA continues an overall focus on the
    achievement of increased use of high impact interventions, but
    emphasizes strengthening the systems, service delivery, community,
    and behavioral capacities and approaches required to increase and
    sustain their use in the Nigerian context.

-   [At same time, building on USAID's deep experience in primary health
    care and community engagement for health in Nigeria]{.underline}:
    The proposed program does not abandon work on improved service
    delivery at the point of service, nor on the engagement of
    communities in support of those services and in the promotion of
    their own health. Instead, it is intended to encompass its work in a
    broader system strengthening context, recognizing that in many cases
    the constraints on effective delivery and promotion of health
    services are the result of failures in the system, management, and
    resource allocation and utilization. .

-   [Maximizing complementarity of USAID resources with other (partner
    and Nigerian) resources]{.underline}: The proposed program
    recognizes that USAID resources, although significant, are small in
    relation to both the unmet need for MCH/FP/RH interventions and the
    resources being provided (with inadequate impact) by the federal,
    state, and local governments of Nigeria and by Nigerians themselves.
    This fact means that to achieve effect, outcome change, and impact
    at scale this program must identify and operationalize opportunities
    to strategically leverage its resources and comparative advantages
    against those of other USAID programs, other donors and
    international organizations, and government.

-   [Mobilizing the resources and capabilities of the private
    sector]{.underline}: Once again, the program to be implemented under
    this RFA is NOT the intended mechanism for USAID's social marketing
    activities nor for the exploration of major new ventures with the
    private sector. However, the organization implementing the program
    under this RFA can and should support the development of
    public-private partnerships where a state identifies value-added of
    such partnerships. Examples could include contracting out of support
    services (from transport to laundry to financial management support)
    or of clinical services (for example, contracting private midwives
    to attend deliveries at primary or community level) or including
    private practitioners (M.D.s, nurses, midwives, pharmacists, patent
    medicine vendors) in relevant training activities. Another "private
    sector" dimension could be applying private sector principles to the
    public health system, such as the use of innovative human resource
    incentive or management approaches, or the use of performance-based
    financing at various levels of the system.

-   [Assuring the connection between program and policy]{.underline}:
    This connection between program and policy needs to exist in two
    dimensions, both of which have been weak. One is the adaptation and
    application of national policy and strategy (e.g., the IMNCH
    Strategy) at state and local levels. However, probably more
    important -- especially in relation to USAID's comparative advantage
    of "having a seat at the table and its feet on the ground" -- is the
    need to systematically "uplink" the needs, experience and evidence
    of programming at the state, local, and community levels to the
    development of national and state health policy. The program under
    this RFA is intended to do this in part by placing senior policy
    advisors at the national level who will be responsible for bringing
    forward and representing the program's actual experience (and the
    evidence generated from that experience) in policy dialogue. The
    program will also carry out this policy-informing function by
    applying solid operations and evaluation research capabilities to
    key areas of the system and service delivery to generate credible
    evidence from programming; by identifying, applying, and
    disseminating successful approaches (whether USAID-supported or not)
    to resolving key constraints and improving health care
    effectiveness; and (with government and partners) by supporting
    experience sharing activities focused on key areas of system and
    service delivery function.

**PART D. TECHNICAL APPROACH AND PROGRAM INTERVENTIONS**

*1. [Program Framework]{.underline}*

[Objective]{.underline}: The objective of the program being solicited
under this RFA is "**Increased Use of High Impact Interventions in
selected target states" (potentially Bauchi & Zamfara**)

This objective has important implications for the approach to be
proposed:

-   The program aims for measurable improvement of health outcomes [at
    the state level]{.underline} in these two targeted states

-   The results of all program investments and activities -- whether in
    policy, system strengthening, service delivery improvement,
    community mobilization, behavior change, or other areas -- will be
    evaluated in terms of their contribution to measurable improvement
    in health outcomes during the project and at its conclusion. This
    means that determination of priority for program activities needs to
    focus on the pay-off of those activities in terms of improving those
    outcomes. The connection of program activities and investment with
    outcome change needs to be explicit in the year-by-year planning and
    implementation process, in consultation with USAID.

-   Because USAID MCH/FP/RH resources by themselves are not sufficient
    to achieve state-level impact, the implementing organization, with
    USAID, will need to identify and operationalize appropriate
    opportunities for partnering and for leveraging partner and Nigerian
    resources.

*2. ["Packages" of selected high impact FP/RH/MNCH interventions for the
program]{.underline}*

The Nigerian health system is weak and its needs are great. Indicators
of maternal and child health are exceptionally poor, particularly in the
northern states, including Bauchi and Zamfara. The challenge is to
identify a very selective set of interventions that, taken as a package:

-   reduce some of the major causes of maternal and child morbidity and
    mortality

-   require reasonable and replicable inputs for delivery, and

-   contribute to key elements of a functioning health system (both
    public and private sector), so that other interventions can later be
    introduced on the "platform" established by this program.

*While the final determination will need to be made with focus state and
local governments and with partners, the interventions considered as
most appropriate for this program are:*

a\. [Family planning]{.underline}: With total fertility rate (TFR) over
seven in the north, and averaging around 5.5 nationally, early and
closely-spaced births contribute to poor maternal, infant and child
health indicators, as well as strained family resources and other health
problems. Assessments and evaluations have highlighted recent increases
in the acceptability of FP and the success of a number of
community-based approaches. This program's family planning interventions
should include an adequate range of methods to assure that women can
choose an appropriate method for their situation, although weaker
systems like Nigeria's may not be able to provide every method. The
minimum choice of methods that should be made available in the Nigerian
context at the current stage of health system development includes
pills, condoms, injectables, lactational amenorrhea method (LAM),
Standard Days Method (SDM) and Intrauterine Devices (IUDs). Experience
in Nigeria and elsewhere in Africa suggests that there will potentially
be especially high demand for injectable contraceptives. All of these
methods, with the possible exception of IUDs, can be made available by
trained primary health care workers (either at a facility, or by
outreach into the community) and community level workers. In addition to
method provision, there is a need for behavior change communication
(BCC), including both mass media and interpersonal approaches, to
promote "healthy timing and spacing" messages and to make the link
between family planning and the health of mothers and children.

b\. "[Antenatal care+]{.underline}": In a population where demand for
preventive services is relatively weak, it is significant that a
majority of women make at least one antenatal care visit, and that a
significant number of women make two or more visits. These visits
provide a window of opportunity for provision of a package of
high-impact interventions: TT, IPT and ITNs for malaria prevention, iron
supplementation and nutritional counseling, counseling on exclusive
breast feeding, LAM, and transition to other FP methods. These antenatal
visits also should be used to counsel mothers and provide reminder
materials on danger signs of pregnancy, delivery, and the post-partum
and newborn period, on planning for use of referral facilities in case
of these complications, and on basic newborn care. They should also be
used to identify other MCH needs, such as routine immunizations or
counseling on the use of ORT for diarrhea. The use of a systematic
screening tool such as that developed by the Population Council at the
antenatal visit could assist in identification of unmet needs for
maternal, infant and child health interventions, and filling these gaps.
Of course, a *sine qua non* for the applicability of this tool is the
availability of the necessary services at site (or less desirably, by
referral) to fill the identified needs.

**\
**c. [Recognition of Complicated Pregnancy and EmOC]{.underline}: During
the next five years, USAID's efforts through this program need to help
develop and support a transitional approach with four basic components:

-   increasing availability of skilled attendance for birth at home,
    PHC, [and]{.underline} referral level facilities

-   increasing utilization of these skilled birth attendants and
    facilities for delivery

-   assuring recognition of danger signs and complications of pregnancy
    and delivery, and removing barriers to timely movement of women
    experiencing these complications to appropriate referral facilities,
    and

-   strengthening the capacity of these referral facilities to resolve
    life-threatening pregnancy, delivery, and post-partum/post-abortion
    complications.

Presently, most PHC facilities in USAID-assisted states, including
Bauchi and Zamfara, do [not]{.underline} have skilled birth attendants.
While future efforts will include developing and supporting assistance
for routine delivery at the PHC level, at present the appropriate
approach to increasing institutional delivery for even routine
deliveries is to channel demand to referral level facilities and
strengthen their capability. Immediate and sustained efforts also need
to focus on getting complicated pregnancies and births to these
secondary facilities, including recognition by families and community
workers of the danger signs and complications of pregnancy and child
birth that [require]{.underline} facility-based care, planning how that
care will be accessed, and establishing a system to transport women to
the appropriate facility. This approach could have a major impact on
maternal mortality in the near term.

At the same time, analysis of numbers of births and the capacity of
hospital facilities in an area where USAID is working in the North
indicates that those facilities, when operating at capacity, could
handle only about 20 percent of all births in their catchment areas.
Therefore, in the long term, it is probably not feasible or advisable to
promote births by [all]{.underline} women in these referral facilities.
Thus, beginning immediately, there should be a concurrent focus on
building alternative sources of adequate care for routine deliveries,
either through strengthened and staffed PHC facilities, increased
training of lower level community health workers (e.g., female junior
community health extension workers) who can attend uncomplicated births
and detect complications, or contracting out of midwifery services to
trained midwives.

Finally, there are specific technologies whose introduction at
appropriate levels could produce significant impact in reducing maternal
mortality: the two most important are the use of either oxytocin
(potentially in UniJect) or misoprostol to prevent and control
post-partum hemorrhage, and the use of magnesium sulfate to treat
eclampsia.

d\. [Routine Immunization]{.underline}: As noted above, USAID has
concluded that its investments to support the extraordinary efforts of
polio eradication and accelerated measles control campaigns, as well as
other campaign approaches, including the "Immunization Plus Days,"
should be separated from its support for improving routine immunization
as part of basic heath services. Therefore, in the program under this
RFA, the focus will be on strengthening routine immunization, building
on the highly regarded work already done in this area in Bauchi and
Sokoto. A limited amount of polio resources will be incorporated into
this program to allow the program to develop "win-win" relationships
with polio eradication and accelerated measles activities. However, in
general, USAID support for these campaign activities will be carried out
through a separate mechanism potentially WHO, with the focus of this
program being on routine immunization.

Immunization is an essential function of a working primary health care
system, including the upstream management, logistics, and monitoring
required to implement it. USAID has had some success in strengthening
the ability to plan, implement, and monitor routine immunization at
state, local, PHC facility and community levels. This program will
should work to synthesize this experience, and collaborate with DfID and
the EU in combining this experience with that of the PRRINN and PRIME
projects, to develop a coherent approach and program materials that can
be used to support states and local governments in strengthening routine
immunization.

In line with the findings of USAID's immunization assessment team, the
key foci of work in supporting routine immunization as part of PHC
should include strengthening facilities and building structural and
human capacity to:

-   ensure vaccine and vaccination supplies at service delivery points;

-   increase the number of service delivery points reliably providing
    immunizations;

-   increase and sustain high levels of attendance during immunization
    sessions;

-   establish monitoring at LGA and health facility levels; and

-   strengthen efficient data management and quality of services using
    the Reach Every Ward approach at LGAs, health facilities and
    community levels. .

The importance of child immunization should also be a component of BCC
messages through a range of channels including outreach and mass media.
Community health committees should raise awareness on the importance of
immunization, and antenatal visits should be used as an opportunity to
identify children in need and to counsel mothers on the importance of
fully immunizing their next child. Community organization can be also
used to organize the population for routine outreach (which is a key
component of routine immunization in settings with low facility
coverage) and also for extraordinary campaigns, as are implemented for
polio and measles.

Overall, to achieve these results, this program will support:

-   decentralized ownership of routine immunization at the state and LGA
    levels;

-   increased and sustained immunization coverage through community
    planning;

-   strengthened health worker, facility, and government capacity; and,

-   through these inputs, development of a functional and affordable
    approach to improving routine immunization services as a core
    component of primary health care.

e\. [Vitamin A]{.underline}: Program efforts will focus on maximizing
coverage of vitamin A through multiple channels, with emphasis on
increasingly doing this through primary services and community
mobilization. Routine outreach (as opposed to polio and measles
campaigns and IPDs) is a core function of PHC facilities and should be
used to the maximum to achieve high levels of vitamin A coverage.
Delivery at PHC facilities and other facilities will also be
strengthened -- this will require knowing children's vitamin A capsule
administration status (as well as their immunization status), making the
use of immunization and child health cards retained by mothers an
important element. Community identification of children needing vitamin
A and immunization can contribute to increased coverage, as can focused
community-organized "child health days." With vitamin A supplies and
delivery strategies being driven by other partners, it will be necessary
for USAID-supported health systems strengthening activities to help
maximize the effect of these investments through improved planning and
organization; however, the emphasis should be on increasingly delivering
vitamin A through less intensive and disruptive approaches than IPDs.

f\. [Treatment of child illness ("Malaria-plus")]{.underline}: About 110
million cases of malaria are diagnosed each year in Nigeria, accounting
for more than 60% of outpatient visits and 30% of hospitalizations.
Malaria is the leading cause of mortality in children under five,
killing an estimated 300,000 children a year. USAID and other partners
(World Bank "Malaria Booster" program, Global Fund) are making
substantial investments in improving the availability and use of
effective treatment (Artemesinin-based Combination Therapy) through the
public sector and private channels. These investments can act as the
leading edge of a package of appropriate care-seeking and treatment of
malaria, diarrhea (with ORT), and pneumonia -- thus addressing the other
two leading causes of post-neonatal infant and child death - again in
both public and private services.

For malaria, the package will also include provision and promotion of
use of insecticide-treated bed nets (ITNs). This program will focus on
ITN distribution and promotion through effective public sector channels.
At the community level, there are important opportunities for BCC and
organization around obtaining ITNs and their use by pregnant women and
children under five.

**The framework for the proposed program has four Sub-Objectives:**

![](media/image4.wmf){width="4.997916666666667in"
height="3.5229166666666667in"}

**Sub-Objective 1** - Strengthen state and local government capacity to
deliver and promote use of high impact MCH/FP/RH interventions
(*estimated 35% of Level of Effort {LOE}*)[^2]

[Expected Results]{.underline}

-   Major systems deficiencies, constraints, and opportunities for
    improved delivery of high impact MCH/FP/RH interventions identified
    (in each state)

-   Technical capacity of key state, local and ward health system
    managers strengthened

-   Critical elements of resource allocation, planning, management,
    organization, and financial management improved at state and local
    government levels

-   Availability, quality, and use of information for decision-making
    increased

-   Availability of essential commodities, drugs, vaccines and equipment
    at PHC facilities and essential referral levels assured

-   Required staff at PHC facilities and essential referral levels
    present, supported, and effectively managed

-   Capacity to plan and implement effective behavior
    change/communication activities strengthened

[Statement of Intent]{.underline}

In the selected targets states (potentially Bauchi and Zamfara), this
program will work with the state and local governments and with
development partners to identify and help overcome key system obstacles
that reduce the effective delivery and use of the program's identified
packages of "core" MCH/FP/RH interventions. Both states, and the
Nigerian health system as a whole, have been the subjects of multiple
health system assessments; it is anticipated that the implementing
organization for this program will be cognizant of these assessments,
carrying out additional assessment activities only as needed to fill key
information gaps. The program should focus on both the *need* and
*opportunity* to make the greatest improvements in key system functions
in applying USAID resources and comparative advantages. If strategic or
investment plans for strengthening the health system exist or are
developed in the state, these plans will serve as the starting framework
for program activity; additional areas of work can be proposed to and
agreed upon by the government. In all assessment and planning
activities, the implementing organization will work directly with state
and relevant local government representatives to assure agreement and
ownership of planned activities.

It is expected that the implementing organization will provide strong
staff capability in key aspects of health systems strengthening, with
access to additional expertise that may be required through the
resources of its own organization and any sub-grantees.

In its annual plan submission to USAID, the implementing organization
will demonstrate how the proposed investments and activities in systems
strengthening are strategically and operationally related to increasing
use of the core package of MCH/FP/RH interventions.

As noted in Section B.9. above, USAID recognizes that it does not have
adequate resources to carry out all the improvements required by the
health systems in these two states. Therefore, it intends that the
implementing organization will work with USAID, state and local
governments, and development partners to identify and use opportunities
for complementarity and leverage of USAID resources. USAID also expects
that this program will identify and utilize opportunities for
complementarity with other USG programs, such as logistics, training,
and behavior change/communication investments made by PEPFAR and USAID
malaria activities and any investments in strengthening key functions of
state or local government by USAID's governance program.

As indicated in "Expected Results" above, USAID anticipates that many of
the program's activities under this Sub-Objective will focus on
strengthening "classic" components of public sector health systems.
However, USAID also understands the potential utility of partnerships
and linkages with the private sector that may be useful in strengthening
or carrying out key health system functions: examples might include
developing and applying government capacity to contract out either
support functions or clinical services, or increasing the capacity of
private health care providers where this capacity increases the
effectiveness of delivering high impact MCH/FP/RH interventions.

[Illustrative Approaches]{.underline}

-   Promote the collection and use of data for decision making

-   Assist in supporting "decentralization" both to ensure community
    participation and to increase the ability of LGAs to manage health
    facilities in a participatory, accountable and transparent manner.

-   Support coordinated and consistent sector management (planning,
    budgeting, program implementation and performance management) and
    the development of systems to carry out those management functions,
    particularly at the LGA level

-   Work with the DELIVER project to strengthen the logistics systems
    within the states

-   Increase the number and effectiveness of health providers at the PHC
    facility level

-   Improve the technical quality and skills development aspects of
    training institutions in the development of critical health care
    cadres

-   Improve personnel management to increase the effective use, support,
    and retention of primary and essential referral level health care
    staff.

**Sub-Objective 2** -- Strengthen the delivery and promotion of high
impact FP/RH/MNCH interventions at PHC facilities and essential referral
levels (*estimated 30% of LOE*)

[Expected Results]{.underline}

-   Technical capacity and skills of PHC facility and essential referral
    level staff increased

-   Delivery of standards-based care at primary and referral facilities
    expanded

-   Provision of health services through appropriate outreach and
    facility-community linkages maximized

-   HW performance improved through strengthened supervisory systems and
    community oversight

-   Communication by health workers at the health facility and community
    levels improved and expanded

-   Appropriate and timely referral and counter-referral between
    referral facilities and PHC clinics increased.

[Statement of Intent]{.underline}

Given the low coverage of essential health services in Nigeria and the
nature of the burden of disease, increasing the coverage and
effectiveness of primary health care services is a critical requirement
for improving the health and population status of Nigeria's families. In
the selected target states (potentially Bauchi and Zamfara), this
program will apply, and wherever possible build upon, the extensive
experience and investments of predecessor USAID-supported activities in
improving the effectiveness and quality of PHC services and of referral
level services where they are essential to delivery of key MCH/FP/RH
interventions (for example, in the provision of emergency obstetric
care).

In selected areas, these predecessor activities and the work of other
development partners and the federal and state governments have:

-   developed improved training and skill-building approaches for PHC
    staff;

-   technically updated diagnosis and treatment approaches (including
    updated "standing orders");

-   developed and applied quality improvement approaches for PHC and
    essential referral level services;

-   identified the support required for effective participation of PHC
    workers in outreach, community mobilization, and campaign
    activities;

-   developed materials and training to support improved communication
    between PHC health workers and their clients; and

-   helped PHC workers and their supervisors establish improved links
    with the communities they serve.

USAID intends that this work and other essential efforts to improve
coverage, quality, and utilization will be continued and extended under
this program. Again, recognizing that USAID's MCH/FP/RH resources are
limited, expansion of improved PHC at the state level will require a
greater degree of stepping back from actual points of service delivery
to take more systemic, scalable, and leveraged approaches to PHC.

[Illustrative Approaches]{.underline}

-   Increase the number and functionality of PHC workers

-   Support the development and/or application of effective,
    level-appropriate skills-based training for PHC and essential
    referral level personnel

-   Ensure use of standards-based management for facility and
    community-based services.

-   Identify feasible approaches to supervision and other approaches to
    maintain and ensure quality (including community supervision and
    incentive-based approaches)

-   Identify additional mechanisms to encourage health service
    accountability to the community

-   Identify approaches to maximize community outreach by and
    effectiveness of CHEWs and "Junior CHEWs"

-   Facilitate improved coordination and collaboration between community
    and facility-based services.

**Sub-Objective 3** -- Strengthen the roles of households and
communities in promotion, practice, and delivery of high impact
MCH/FP/RH interventions (*estimated 25% of LOE*)

[Expected Results]{.underline}

-   Family planning, child spacing and healthy mother and child
    behaviors established as cultural and community norms

-   Knowledge and awareness of the benefits of appropriate health
    practices increased

-   Recognition of illness, malnutrition and other health complications
    increased

-   Appropriate health care seeking behaviors increased

-   Delivery of basic health services and provision of essential health
    information through appropriate community channels maximized

-   Community organization and participation in outreach and other
    health activities increased

-   Community participation in advocacy and oversight of local health
    services increased

-   Communication and service delivery links between community and
    facility enhanced

[Statement of Intent]{.underline}

USAID's experience in support of MCH/FP/RH programming in Nigeria has
generated a substantial and successful body of experience in mobilizing
communities to participate in and advocate for healthcare activities.
USAID's programs have also demonstrated successful approaches to
reaching households and improving preventive, promotive, and
care-seeking practices. As with Sub-Objective Two, the program's work
under this Sub-Objective will continue and extend this experience, with
the final target of strengthening community engagement and
household-level practices across the two states.

[Illustrative Approaches]{.underline}

-   Identify and address, as feasible, key obstacles to appropriate
    practices and care seeking behavior

-   Increase IEC/BCC and social mobilization in communities

-   Increase use of demonstrated family and community-based information
    tools (e.g. immunization card) and communication materials

-   Support organization, capacity building, and engagement of community
    groups such as health committees, women's groups, youth groups,
    market women's groups, and others as relevant in appropriate health
    activities

-   Establish roles for community representatives in oversight of local
    health services and representation of community needs with local
    government

-   With government, identify and help operationalize appropriate,
    expanded roles for community health workers and volunteers in
    detection and management of child illness and complicated
    pregnancies and deliveries.

**Sub-Objective 4** - Improve policies, programming, and resource
allocation at state and federal levels (*estimated 10% of LOE*)

[Expected Results]{.underline}

-   Critical policy, resource, and program constraints on improving
    MCH/FP/RH outcomes are clearly identified and effectively addressed
    at the national and state levels

-   Credible evidence is developed from USAID-supported program
    experience through operations and evaluation research

-   Evidence, experience and issues identified from program experience
    in selected target states (potentially Bauchi and Zamfara) are
    represented in strategy and policy dialogue with federal and state
    decision-makers

-   Important policy and strategy decisions at national level are
    effectively adapted and applied in the selected target states
    (potentially Bauchi and Zamfara)

-   USAID and other development partners speak with "one voice" in
    dialogue with government

-   Selected target states (potentially Bauchi and Zamfara) develop
    successful proposals for MCH/FP/RH funding under Nigeria's "MDG
    Fund," GAVI Health Systems Strengthening support, and other new
    funding sources

[Statement of Intent]{.underline}

As noted in section B.4. [Summarized key findings (and recommendations)
from recent evaluations and assessments of these activities]{.underline}
above, USAID/Nigeria has supported policy dialogue at the federal level
through a dedicated mechanism (ENHANSE). While this activity has had
some influence, USAID believes that policy and strategy dialogue at the
federal level, and in the two states that are the focus of this program,
needs to be more tightly linked to the realities of program experience
at the state, local, and community levels. Under this program, USAID's
engagement in policy dialogue will be strengthened by the presence of
two highly experienced and effective senior policy advisors in Abuja.
The senior advisors will not be in charge of field operations of the
program, but will rather be responsible for working with USAID, the team
leaders of program operations in the two states, state and local
officials in the two states, and development partners to link program
experience to policy dialogue in Abuja and with state and local
government. The policy advisors, and program leaders in the two states,
will also be positioned to help states adapt and apply key MCH/FP/RH
strategies and policies coming from the federal level (for example, the
IMNCH Strategy).

A second critical dimension of introducing program experience into
policy and strategy deliberations is the need to produce systematic
documentation and credible (whenever possible, quantitative) evidence.
To do this, USAID intends this program to include and apply a strong
capacity in operations and evaluation research. USAID notes that many
programs focus first on implementation and hope to carry out
"documentation" and "lessons learned analyses" retrospectively; however,
in USAID's experience, these approaches seldom produce influential and
credible evidence. Thus, USAID intends that the operations and
evaluation research of the program will be applied prospectively and
strategically to document the results of approaches aimed at improving
effectiveness in critical aspects of systems strengthening, primary care
service delivery, or community/household engagement. It is expected that
the senior policy advisor, state team leaders, state officials, relevant
partners, and USAID/Nigeria will consult periodically to identify the
most relevant areas for this operations and evaluation research.

Finally, USAID expects that the program will participate in the planning
and implementation of experience-sharing activities (consultations,
exchange visits, etc.) that will allow the selected target states
(potentially Bauchi and Zamfara) to benefit from successful program
solutions in other states, and that will allow other states and federal
officials to benefit from program successes in the selected target
states.

[Illustrative Approaches]{.underline}

-   Participate in/conduct analyses of policy, resource, and program
    constraints on improving MCH/FP/RH outcomes

-   Apply operations and evaluation research to key areas of health
    system function, PHC and essential referral service delivery, or
    household/community health activities

-   Engage in strategy and policy development processes at state and
    federal levels

-   Participate in regular and *ad hoc* coordination activities with
    development partners at the state and federal level

-   Provide technical and analytic support to development of proposals
    for MCH/FP/RH funding from the "MDG Fund," GAVI Health Systems
    Strengthening funding, and other sources

**PART E. PERFORMANCE MONITORING AND INDICATORS**

The program will be characterized by robust monitoring and evaluation,
using strategic information for decision making, analysis, and
programming. The program should continuously gather and analyze data and
information to refine and improve its activities and should be
results-oriented, producing measurable positive outcomes and impact.
Applications should include detailed plans to monitor and evaluate
program performance. Upon award, the selected recipient will work with
USAID/Nigeria's Agreement Officer's Technical Representative (AOTR) to
ensure that indicators are aligned with the U.S. Foreign Assistance
Standard Indicators and also measure results and impacts of the program.

Performance monitoring under this program shall include two components,
which may for some indicators overlap.

1\. [OP Indicators]{.underline}

-   From the beginning of the program, the awardee shall be required to
    report annually the data on USAID-specific "Operational Plan" ("OP")
    indicators relevant to the USAID program. The current indicators are
    listed below, but are subject to future modification. The specific
    OP indicators to be reported on shall be determined in consultation
    with USAID/Nigeria as relevant to the actual program being
    implemented.

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-   Number of improvements to laws, policies, regulations, or guidelines
    related to improved access to and use of health services drafted
    with USG Support

-   Number of institutions (States/LGAs/PHC Centers ) with improved MIS
    as a result of USG Assistance

-   Number of people trained in child health and nutrition through
    USG-supported health area program

-   Number of people trained in maternal/newborn health through
    USG-supported programs

-   Number of medical and para-medical practitioners trained in
    evidence-based clinical guidelines

-   Number of antenatal care (ANC) visits by skilled provider

-   Number of deliveries with a skilled birth attendant (SBA) in
    USG-assisted programs

-   Number of cases of child diarrhea treated in USAID-assisted programs

-   Number of cases of child pneumonia treated with antibiotics by
    trained facility or community health workers in USG-supported
    programs

-   Number of children less than 12 months of age who received DPT3 form
    USG-supported program

-   Number of children under five years of age who received Vitamin A
    from USG-supported program

-   Couple years of protection (CYP) in UGS-supported program

-   Number of people trained in FP/RH with USG funds

-   Number of USG-assisted service delivery points providing FP
    counseling or services

-   Number of USG-assisted service delivery point experiencing
    stock-outs of specific tracer drugs

2.  Performance Indicators

    -   In addition, USAID shall require monitoring and annual reporting
        of program-specific performance indicators relevant to
        achievement of the program's objectives and each of the
        sub-objectives. Targets for at least a sub-set of these
        indicators for each state, and for the program overall, shall be
        agreed upon among USAID, the awardee, and state-level
        counterparts; these targets shall be established for the end of
        Year 2 (of the 5 year program), and a new set of end-of program
        targets shall be developed at the beginning of Year 3.

> USAID acknowledges that it is inappropriate to specify these objective
> and sub-objective level indicators and targets at this point, prior to
> assessments and negotiations with each state. A number of
> "illustrative indicators," at these levels are identified here.
> However, USAID intends that, before the end of Year 1, the awardee, in
> consultation with USAID and state authorities, will have identified
> the principal foci of systems, PHC, community, and policy activities
> for the first years of the program and shall then propose a
> Performance Management Plan (PMP) for USAID approval that includes
> both process and outcome/impact indicators and targets relevant to the
> planned work under the program. The PMP shall also include plans on
> how to generate the data needed to measure the impact of the program.
>
> [Illustrative Performance Indicators]{.underline}:
>
> *Objective Level --*

-   Modern contraceptive prevalence rate

-   The proportion of birth intervals that are 36 months or longer

-   Percent of births to mothers under age 18

-   Percentage of women seen at ANC at least one (and at least four)
    times during their last pregnancy

-   Percent of pregnant women receiving intermittent preventive therapy
    with an appropriate antimalarial

-   Percent of deliveries attended by skilled attendants

-   Vitamin A supplementation coverage among children 6-59 months

-   Percent of infants exclusively breastfed through age six months

-   Percent of pregnant women/children under age five sleeping under
    ITNs

-   Percent of children under five with fever receiving an appropriate
    antimalarial

-   Percent of children who received DPT3/measles immunizations by age
    12 months

-   Percent cases of child pneumonia treated with appropriate antibiotic

-   Percent of children with diarrhea receiving oral rehydration
    therapy/zinc treatment for diarrhea

*Sub-Objective 1 -*

-   Number/percent of LGAs with:

    -   Managers for health programming identified and trained

    -   Adequate health plans in place

    -   Functioning information systems providing specified key
        information

    -   Etc.

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-   Number/percent of PHC facilities with essential staff

-   Number of state, local and ward health systems managers trained (in
    specific areas)

-   Number/percent of PHC facilities with less than one week of
    stock-out of tracer drugs/commodities in preceding six months

-   State MoH has adequate:

    -   Planning and budget process

    -   Information system

    -   Position descriptions for key technical, communication, and
        management staff

    -   Staff with appropriate technical and program experience (in
        relation to position descriptions)

    -   Etc.

*Sub-Objective 2 -*

-   Number of visits to public health providers in target LGAs for
    (specific) MCH/FP/RH services (increase based on baseline data.)
    *(alternate: percent of expected cases of \[condition\] using PHC
    services for care)*

-   Percent of PHC providers demonstrating adequate levels of competence
    (in specified key services) in relation to evidence-based standards

-   Percent of PHC workers receiving at least one adequate supervisory
    session during past six months

-   Percent of PHC facilities that offer routine immunization

-   Number of community visits by CHEWs and Junior CHEWs

*Sub-Objective 3 -*

-   Change in percent of women/men who desire to limit or space number
    of children

-   Percent of households with knowledge of key symptoms/danger
    signs/appropriate care-seeking for specified MNCH conditions

-   Percent of households practicing selected preventive behaviors

-   Number of community-level health volunteers engaged in LGA-approved
    community health activities

-   Number of communities that have engaged with LGA officials on health
    care delivery

-   Number of beneficiaries of specified community-level health
    services.

*Sub-Objective 4 -*

-   Number of improvements to laws, policies, regulations or guideline
    related to improved access to and use of health services drafted
    with USG support

-   Number of program-based operations/evaluation research activities
    conducted

-   Number of meetings held with other development partners to discuss
    appropriate position in discussions with the GON and States

[Note]{.underline}: USAID intends that, to the greatest extent possible,
data collection for monitoring and reporting purposes be collected
through state and local information systems themselves, in ways that
contribute to the strengthening of those systems. However, USAID also
recognizes that -- especially for OP indicators and during the early
stages of program assistance when local information systems may be
especially weak, program-specific data collection and reporting systems
may need to be used to complement or stand in place of, state and local
systems.

*"[Overarching Considerations]{.underline}"*

-   [A "holistic" approach to achieving the program
    Objective]{.underline} - Although the program framework for
    achievement of the program objective identifies four Sub-Objectives,
    USAID's intent is that the program will be viewed and implemented as
    a coherent whole, so that key actions at the policy/resource,
    system, primary care, and community household levels are
    strategically connected to address the major opportunities for and
    constraints to achieving the Objective:

![](media/image5.wmf){width="4.997916666666667in" height="3.75625in"}

-   [State ownership]{.underline} -- This program is intended to be
    primarily a partnership among USAID and the two selected states.
    While USAID foresees that the experiences and approaches developed
    in these states will be systematically drawn upon to inform broader
    policy and program, the central focus is at the state level. For
    this reason, the Chief of Party and Deputy Chief of Party will each
    be located in one of the states and will function as team leader for
    their state component of the program. In addition to this
    decentralized approach, USAID intends that activities under the
    program be understood and perceived by each state to be intrinsic
    support to their programming, not a semi-autonomous or parallel
    USAID-supported activity. Establishing that ownership and engagement
    by state and local authorities will be essential for at-scale
    success and ultimate sustaining of program contributions, and will
    therefore be a primary criteria for evaluation the performance of
    the COP/DCOP and the state teams.

-   "[Parity" between the two states]{.underline} -- Although the nature
    of USAID agreements requires one COP, who will be in one state, a
    corollary to state "ownership" of the program is that the programs
    of each state are to be seen as independent and equal. There will be
    opportunities for shared technical resources, experiences, tools,
    materials, and other exchanges that will be of mutual benefit, and
    the program is expected to take advantage of these. However, one
    state program is not viewed as subsidiary to the other.

-   [Gender]{.underline} -- The situation and autonomy of women is a
    major factor in accessing essential health services. It is also a
    key factor in achieving control of their fertility and in
    maintaining and improving their own health and that of their
    families. This situation will vary between and within states, but
    must be taken into consideration. Appropriate opportunities to
    support the empowerment of women and improving their access to
    resources and information should be proactively identified and taken
    into consideration in service delivery, community mobilization,
    communication, and other programming activities. At the same time,
    the important role of men as gatekeepers and as self-perceived
    responsible parties for family welfare also needs to be understood
    and taken into consideration in the program's activities.

-   [Community as part of the "system]{.underline}" -- USAID's
    experience both in Nigeria and throughout the world confirms that
    communities can play effective and critical roles in public health
    through mobilization of resources, active engagement in assuring
    availability and quality of services, actual delivery of services,
    transmission of information and support for behavior change, and
    other actions. For this reason, USAID envisions the community as an
    essential part of the health system, not as a separate entity that
    exists outside a health system that ends at the last facility. (In
    fact, in some of its most important experiences, such as Nepal, the
    health system works from the community up, not down from the
    center.) USAID intends that this program will embody this vision of
    community as a core component of the health system, and will
    operationalize it in the program implementation[.]{.underline}

-   [Governance]{.underline} -- USAID also holds a vision of government
    that responds to the needs of people and engages people affected by
    government practices. As noted, many of USAID's health activities in
    Nigeria have actively applied this vision to the planning, funding,
    oversight, and implementation of health services and health
    communication. At the same time, USAID's governance programming
    works to strengthen these key characteristics of good government.
    Thus, USAID intends that this program will work with health systems
    and health care delivery to embody this vision, and to interact with
    broader governance programming where such opportunities exist.

-   [Strategic complementarity of investment and activities with other
    USG and partner investments]{.underline} -- For many reasons, USAID
    intends that strategic complementarity of investment and programming
    will be a fundamental characteristic of this program, for many
    reasons. On one level, USAID and the U.S. Government subscribe to
    the principles of the Paris Declaration on Aid Effectiveness, which
    calls for harmonization of donor actions and alignment of those
    actions with country-led plans and programs. At the national level
    USAID/Nigeria is committed to the CPS and recognizes the important
    new opportunity that exists for donors to help catalyze needed
    change by working together, sharing experiences, and speaking with
    one voice. In terms of resources, the relatively limited USAID
    resources for MCH/FP/RH clearly will benefit by being applied
    wherever appropriate with malaria, HIV/AIDS, and other USG programs,
    as well as with the investments of other donors in these areas,
    immunization, and other programming.

**PART F. MONITORING AND EVALUATION**

Monitoring of results is a key element of USAID programs. USAID/Nigeria
seeks data and information to improve performance and effectiveness as
well as to inform planning and management decisions. Accurate and timely
monitoring will enable TSHIP to adapt to changing conditions and make
mid-course correction 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 four
sub-objectives will be developed by the implementing agency and
submitted as part of the overall monitoring and evaluation plan (M&E
plan) for this activity. The M&E plan submitted by the implementing
partner will be subject to approval of the Agreement Officer's Technical
Representative (AOTR).

Indicators and targets for each sub-objective should illustrate how
TSHIP will contribute to improved delivery of MCH/FP/RH services.
Measurement of achievement under the award should directly relate to the
technical assistance and other support provided under this project.

**PART G. REPORTING REQUIREMENTS**

The recipient shall submit reports to the USAID AOTR as described below.

1\. [Annual Work Plan]{.underline}: The recipient shall prepare detailed
Annual Work Plans, with detailed cost information to the AOTR for
approval. The format shall be established by USAID. The first Annual
Work Plan will be due within 45 days of the award and will cover the
period from effective date of award through September 30, 2009. The
subsequent Annual Work Plans will cover the period October-September
(The USAID fiscal year) and are due by August 31.

2\. [Performance Management Plan (PMP):]{.underline} The Recipient shall
submit one original and two copies of a performance management plan to
the AOTR The performance reports shall be submitted quarterly and shall
contain the following information on activities: 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 (recipient must immediately notify USAID of development that
have a significant impact on award-support 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.

The PMPs are due 30 days after the end of the quarter. The quarters are
based on the USAID fiscal year, i.e., October-December, January-March,
April-June, and July-September. The first Performance Management Plan
shall be completed by the awardee and approved by USAID approximately
six months after the project is awarded. Thereafter the reports shall be
prepared and submitted quarterly. The first PMP shall be a plan of
action that shall identify indicators, establish base line data, and how
data will be generated.

The fourth quarter PMP shall report on the quarter and also include an
annual report of the project.

3\. [Final Performance Report:]{.underline} The recipient shall submit
the original and one copy to the AOTR and one copy to USAID Development
Experience Clearinghouse, ATTN: Document Acquisitions, 1611 N. Kent
Street, Suite 200 Arlington, VA 22209-2111 (or email:
<docsubmit@dec.cdie.org>).

The final performance report, to be submitted 90 days after project
completion, shall include 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 by results by country or region, as
appropriate during the life of the CA; 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.

> 4\. [Financial Reporting]{.underline}: Financial Reports shall be in
> keeping with 22 CFR 226.52. In accordance with 22 CFR 226.52 the SF
> 269 "Financial Status Report" will be required on a quarterly basis,
> to coincide with USAID's fiscal year calendar. **The first quarterly
> report will cover the period of TBD (award date through September 30,
> 2008). Subsequent reports will cover the three month periods ending in
> December, March, and June, September.**

a\. The recipient shall submit a signed and electronic copy of the SF
269A "Financial Status Report (Short Form)" to the Cognizant Technical
Officer with one copy to the Agreement Officer. In block 12. "Remarks"
of the SF 269 "Financial Status Report" (or as an attachment to the SF
269 Report), the recipient shall provide, in tabular format, block 10
"Transactions" information (blocks 10.c through 10.i.) [by Fund Source
for each of the Results]{.underline}. Quarterly financial SF 269 reports
are due 30 calendar days, after the reporting period.

b\. In accordance with 22 CFR 226.70-72, the Recipient shall submit the
original of the final financial report to Financial Management Office,
one copy to the Agreement Officer, one copy to the Cognizant Technical
Officer.

**PART H. MANAGEMENT REVIEW AND EVALUATIONS**

The Annual Work Plan shall 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 changes as
appropriate. A semi-annual management review shall also be held to
review progress.

At any time during program implementation, USAID may conduct one or more
evaluations 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
valuations to recommend any mid-course changes in strategy if needed and
to help determine appropriate future directions. Site visits may be
scheduled at a time convenient to both the Recipient and USAID.

**PART I. SUPPORTING INFORMATION**

**1. Period of Performance**

The period of performance of this agreement is five (5) years from the
date of award.

**2. Proposed Funding Sources and Funding Levels**

The Mission estimates that the funding for the TSHIP project will total
approximately \$93,200,000.00 to be allocated over the program period.
The Cooperative Agreement will be incrementally funded subject to the
availability of funds.

**3. Authorized Geographic Code**

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

**4. USAID Management**

The award will have one Agreement Officer's Technical Representative
(AOTR) from the Health, Population and Nutrition (HPN) Team (Investing
in People Office). The AOTR will work in collaboration with AOTRs from
other projects that overlap or feed into service delivery, centrally
managed USAID/Washington projects that may be working in Nigeria, and
other Mission activities that may be able to provide support. The AOTR
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.

**PART J. SUBSTANTIAL INVOLVEMENT**

USAID/Nigeria shall be substantively involved during the implementation
of the Cooperative Agreement in the following ways:

> 1\. Review and comments on the Recipient's Annual Work Plan will be
> made by the AOTR. Significant changes to the work plan will also
> require review and comments by the AOTR.

2\. Designation of key positions and approval of key personnel by the
AOTR.

> 3\. Approval by the AOTR of the Performance Management Plan and any
> subsequent changes to the PMP.
>
> 4\. Approval by the AOTR of the Recipient's Monitoring and Evaluation
> plan.

**PART K. DESIGNATION OF KEY POSITIONS AND PERSONNEL**

Certain skilled experienced professional and/or technical personnel are
essential for accomplishing the work to be performed. These individuals
are defined as 'Key Personnel'. The Technical Application must propose
Key Personnel and show how their skills and experience support the
program. Proposed Key Personnel positions are, Chief of Party (COP),
Deputy Chief of Party, Senior Policy Advisor, Senior
Financial/Administrative Specialist, and Senior M&E Specialist. It is
the Applicants' responsibility to propose a staffing structure and
designate senior technical advisors as appropriate.

Contact information for Key Personnel references must also be included,
along with a statement of what consideration will be offered if proposed
key personnel are no longer available at the time of award. Curriculum
Vitae for proposed key personnel must be included in the annexes.
Applicant may also include short biographical information on non-key
personnel.

For purposes of building capacity, cost efficiency and project
sustainability, USAID strongly encourages applicants to minimize the use
of expatriate staff. Staff must include some professionals with
extensive knowledge of Nigeria.

**\[END OF SECTION C\]**

**SECTION D - CERTIFICATIONS, ASSURANCES, AND OTHER STATEMENTS OF
RECIPIENT**

# 

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

# The certifications and forms included on the links below are to be completed and submitted as part of the Cost/Business Application. Refer to instructions in Section A of the RFA. 

PART I - CERTIFICATIONS AND ASSURANCES

Certifications, Assurances, & Other Statements of Recipient:
<http://www.usaid.gov/policy/ads/300/303sad.pdf>

# 

# PART II -- FORMS

# [**http://www.grants.gov/agencies/approved_standard_forms.jsp**](http://www.grants.gov/agencies/approved_standard_forms.jsp) 

# Standard Form 424: [**www.grants.gov/techlib/SF424-V2.0.pdf**](http://www.grants.gov/techlib/SF424-V2.0.pdf) ;

Standard Form 424A:http://www.grants.gov/techlib/SF424A-V1.0.pdf

Standard Form 424B:
<http://www.grants.gov/techlib/SF424B->[V1.0.pdf]{.underline}

## 

**OMB CIRCULAR A-133 OR SIMILAR AUDITS**

If applicable, please provide the date of your most recent A-133 or
similar audit, including findings and results of such audits.

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

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

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

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

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

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

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

**\[END OF SECTION D\]**

# SECTION E - ANNEXES

**LIST OF ANNEXES**

ANNEX 1. LIST OF REFERENCE DOCUMENTS

ANNEX 2. INITIAL ENVIRONMENTAL EXAMINATION

ANNEX 3. BRANDING STRATEY AND MARKING PLAN

ANNEX 4. OTHER PROVISIONS

**SECTION E -- ANNEXES**

**ANNEX 1 -- LIST OF REFERENCE DOCUMENTS**

1\. Maternal, Child, Reproductive Health and Family Planning Strategic
Approach; USAID/Nigeria, September 2008.

[http://www.usaid.gov/ng/downloads/hpndraftstrategy%20(pdf,%20111kb).pdf](http://www.usaid.gov/ng/downloads/hpndraftstrategy (pdf, 111kb).pdf)

2\. Immunizations Today and Way Forward - Promising Support by
USAID/Nigeria; M. Harvey, C. Lee, E. Ogden. (May 12-24, 2008)

[http://www.usaid.gov/ng/downloads/immunizationstoday%20(pdf,%20341kb).pdf](http://www.usaid.gov/ng/downloads/immunizationstoday (pdf, 341kb).pdf)

3\. An Evaluation of the USAID/Nigeria Social Sector Projects: ENHANSE
and COMPASS; J. Holfeld, et al. June 2008.

[http://www.usaid.gov/ng/downloads/compassenhansevaluation%20(pdf,%20387%20kb).pdf](http://www.usaid.gov/ng/downloads/compassenhansevaluation (pdf, 387 kb).pdf)

4\. The Ground is Softening for the USAID/Nigeria Health Portfolio,
Considerations for the Present and Future; J. Holfeld, P. MacDonald,
January 2007 (Is that date correct)

[http://www.usaid.gov/ng/downloads/thegroundisoftening%20(pdf,%20166kb).pdf](http://www.usaid.gov/ng/downloads/thegroundisoftening (pdf, 166kb).pdf)

5\. Broken Promises, Human Rights, Accountability, and Maternal Death in
Nigeria; Center for Reproductive Rights. 2008.
[www.reproductiverights.org/pdf/pub_nigeria2.pdf](http://www.reproductiverights.org/pdf/pub_nigeria2.pdf)

6\. National Integrated Maternal, Newborn, Child Health Strategy;
Government of Nigeria

<http://www.who.int/pmnch/countries/sampleplans/en/index.html>

**SECTION E -- ANNEXES**

**ANNEX 2 -- INITIAL ENVIRONMENTAL EXAMINATION**

**PROGRAM/ACTIVITY DATA**:

**Program/Activity No.:** Strategic Objective No. 13 (620-006)

**Country/Region:** Nigeria

**Program/Activity Title:** Increased Use of Social Sector Services

1.  **BACKGROUND AND PROJECT DESCRIPTION**

    1.  **Purpose and Scope of IEE**

This document provides an environmental examination of all activities of
the USAID/Nigeria Strategic Objective (SO) 13, "Increased Use of Social
Sector Services," to be implemented under the Country Strategic Plan
2004 -- 2009. This program of activities was previously covered by IEEs
30Nigeria2SO3BasicEducation.doc and 31Nigeria1 FP HIV AIDS Cs.doc\].
This IEE replaces all previous IEEs, with the exception of the Pesticide
Evaluation Report and Safer Use Action Plan (PERSUAP) IEE for the
NetMark program
[33Nigeria3_NetMark_PERSUAP.doc](http://www.afr-sd.org/documents/iee/docs/33Nigeria3_NetMark_PERSUAP.doc),
which is incorporated herein by reference.

2.  **Background**

The health and basic education sectors in Nigeria have been particularly
hard hit by the twin impacts of rapid population growth and poor
economic performance under the military regimes of the 1980s and 1990s.
The results are high child and maternal morbidity and mortality, low
levels of adult literacy and poor academic performance, and high
fertility that translates into rapid and unsustainable population
growth. Availability and use of affordable child survival and maternal
health measures are low. At least 15 percent of Nigerian children will
die before their fifth birthday, while a Nigerian woman dies every three
minutes from causes related to pregnancy and childbirth. Adult literacy
declined during the decade of the 1990s, and fewer than 60 percent of
children are in school. Health and education indicators are much worse
in northern Nigeria than in the rest of the country, demonstrating
regional imbalance and inequity. The poor quality of education, coupled
with lack of access, is trapping successive generations of the poor
deeper into poverty.

Key constraints to the use of social sector services in Nigeria include
their poor quality and lack of accessibility. There is also a need to
strengthen the policy environment, given the extremely low resource
levels allocated to health and education in the Federal budget.

The powerful linkages between health and education indicators argue for
the strategic integration of programs in reproductive health and family
planning, child survival and basic education where feasible and
practical. Strategic approaches and interventions developed under SO13
will reinforce and help to sustain the conditions for increased use of
health and education services by addressing key constraints and
challenges. USAID experience to date suggests that the greatest return
on individual investments will occur through targeted activities in
health and education at the community level, such that gains in health
status reinforce gains in educational achievement and vice versa.

3.  **Description of Activities**

To maximize the impact of limited USG resources, activities under this
SOAG will focus on strengthening social sector services in four states
(Kano, Lagos, Bauchi, and Nasarawa) and the Federal Capital Territory
(FCT).

Some activities, such as social marketing, policy reform and advocacy,
and the Polio Eradication Initiative will be conducted on a national
scale. National level activities do not imply working with the Nigerian
federal government on an exclusive nor a priority basis. Rather,
activities that support policy and regulatory changes, advocacy and
communication will be implemented through a wide range of stakeholders,
including the Nigerian federal government, to ensure ownership and
sustainable action.

In consultation with Government of Nigeria Health and Education
Ministries and agencies, donors, USAID implementing partners, civil
society groups, private sector, and other stakeholders, USAID developed
a five-year Country Strategic Plan 2004-2009, which responds to the
sustainable development needs of Nigeria. The Strategic Objective 13 (SO
13) Team will collaborate with USAID's contracting and legal offices to
determine the most appropriate type of instruments to implement
activities under this Agreement. In accordance with USAID's policies on
competitive bidding, USAID will encourage competition in the award of
contracts, grants and cooperative agreements in order to identify and
fund organizations to achieve the Objective.

The following is a list of specific activities to be undertaken to
achieve the Objective, together with illustrative activities that may be
undertaken to achieve the Objective. The list is neither exhaustive nor
definitive and USAID and the Grantee may consider new opportunities
based on their potential for advancing the Objective and its related
Intermediate Results.

# IR 13.1 [Improved quality of social sector services]{.underline}

This component aims to improve the quality of health (family planning
and child survival) and basic education through technical assistance and
training.

Illustrative Activities:

-   Train health care workers and teachers to enhance their skills in
    the delivery of quality health and education services;

-   Support the development/revision of critical Standards of Practice
    (SOP) that can be used uniformly by both public and private
    providers to ensure that all clients receive quality services;

-   Support the development and implementation of pre-service and
    in-service training curriculum that are based on the standards of
    practice;

-   Support the development and implementation of institutional
    management systems that are based on performance improvement
    approaches;

-   Promote the use of data for decision-making;

-   Share best practices in quality assurance methods, approaches and
    tools.

##### 

##### 

##### IR 13.2 [Strengthened enabling environment]{.underline}

This component of the SO is to assist the GON to increase its capacity
to implement its policy framework. Two essential elements of this
component include capacity building at the federal, state, local
government and community levels and modest sector program assistance to
support extension and improvement of Education and Health Management
Information System (E/HMIS).

**Illustrative activities are as follows:**

-   Support the development of community partnerships and participatory
    planning;

-   Support the development of improved policies and action plans;

-   Advocate for greater national, state and LGA resources and use for
    health and education;

-   Develop donor and private sector partnerships to leverage new
    resources;

-   Improve information systems for management, decision-making and
    advocacy;

-   Develop national, state and local capabilities in planning,
    implementation and evaluation of programs.

**IR 13.3 [Expanded demand for improved Social Sector
Services]{.underline}**

This component aims to improve the quality of health and basic education
through technical assistance and training.

**Illustrative activities:**

-   Develop and integrate behavior change communication (BCC)for child
    survival, reproductive health and basic education;

-   Undertake operations research to improve understanding of the
    factors affecting behavior change and expanded demand;

-   Expand and strengthen social marketing for selected products and
    services;

-   Scale up successful models of community mobilization for demand
    expansion.

**IR 13.4 [Increased access to services, commodities and
materials]{.underline}**

**Specific Activities:**

This component aims to increase access to health and basic education
services, commodities and materials through technical assistance and
training. Activities, however, may include construction/rehabilitation
of clinics and schools, provision of wells and sanitation projects.

**Illustrative activities:**

-   Develop initiatives directed to special groups such as girls,
    adolescents, Islamic schools, orphans and vulnerable children,
    faith-based organizations, uniformed services, and hard-to-reach
    populations;

-   Strengthen commodity logistics systems;

-   Develop cost-recovery systems, including innovative community
    financing;

-   Improve vaccine security.

**2.0 COUNTRY AND ENVIRONMENTAL INFORMATION (BASELINE INFORMATION)**

**(from "Nigeria Environmental Analysis: Final Report," April 2002, ARD,
Inc.)**

Nigeria's natural environmental resources and the quality of its air,
water, and soils are severely threatened. Increasing poverty, high
population growth and migration, especially into urban areas, and
political/institutional constraints are the underlying causes for
environmental degradation in the country.

Nigeria is Africa's most populous nation; one out of every five people
living in sub-Saharan Africa lives here. Its population growth rate is
above three percent and rural to urban migration is making the country's
cities some of the largest in the world. Although Nigeria receives
considerable revenue from its large multinational oil industry sector,
this money rarely trickles down to the populace who are generally poor
and growing poorer. This combination of expanding population and
increasing poverty puts increasingly severe demands upon the natural
environment, the institutional structures and the resources available to
manage them. The technical capacity to deal with the enormity of the
problem is generally weak and the lack of enforcement of (and compliance
with) existing regulations make for huge institutional obstacles when
trying to effectively tackle environmental issues.

These causes lead to the major threats of unsustainable use of renewable
natural resources, unplanned urban development and oil industry
operations that confound sound community practices to manage natural
resources for their mutual benefit.

Nigeria presently contains considerable biodiversity as well as some
very important tracts of fairly undisturbed tropical forests. Its
diversity of natural ecosystems ranges from semi-arid savanna to montane
forests, rich seasonal floodplain environments, rainforests, vast
freshwater swamp forests and diverse coastal vegetation. Nigeria, in the
Niger Delta region, contains the largest remaining tract of mangroves in
Africa---the third largest in the world. But all of this is threatened.

Most of the land in Nigeria has been converted to agricultural or
pastoral uses and agricultural encroachment threatens the natural areas
that remain. Desertification, the loss of soil fertility, insufficient
quantities and quality of water and enormous erosion problems have
followed in the wake of overuse and mismanagement of the country's
resources. Environmental problems that stem from large unplanned urban
centers with inadequate solid and municipal waste disposal practices and
the impacts of the oil, mining and manufacturing industries are taking
their toil on water and air quality in many areas. Add to this the
escalating practices of over-fishing, uncontrolled logging, and many
other unsustainable uses of the natural resources that remain, and
threats to the survival of significant components of Nigeria's
biodiversity is very real. There is, however, still some hope.

Since the return to democracy in 1999, there has been a renewed interest
in environmental management and protection. The newly created Federal
Ministry of the Environment (FMoE) is pushing an agenda that makes
priority issues of gas flaring, marine and coastal resources
degradation, desertification, and industrial and urban pollution. The
recently formed Niger Delta Development Commission has a transparent
mandate and dynamic leadership to help that unique and resource-rich
region seek and develop community-based solutions to the social and
environmental problems that have been growing for decades. In many
states across the country, there are encouraging signs that public
leaders, NGOs and community-based organizations (CBOs) are focusing
actively on threats to the environment and donors are moving to help
implement environmental activities that result in improved livelihoods
for the people of Nigeria.

**3.0 EVALUATION OF PROJECT/PROGRAM ISSUES WITH RESPECT TO ENVIRONMENTAL
IMPACT POTENTIAL**

All the activities under IR 13.1, 13.2 and 13.3 and some activities
under IR 13.4 involve technical support, capacity building, meetings and
workshops and document and information transfer. None of these
activities are expected to have direct effects on the environment.

Some activities under IR 13.4 may involve the development of resource
centers and building of modest add-on structures to schools and clinics
through grants. The size of the structures to be renovated or built will
be modest and widely dispersed among the targeted schools and
communities. However, the anticipated construction and renovation can be
expected to result in limited impacts on the immediate environment of
the schools and the communities. For example, the school grounds can be
contaminated by construction debris, borrow pits might be created in
some areas to make bricks, creating rain-filled holes that become
mosquito breeding sites, and the renovation of painted structures has
the potential to create toxic dust, if the structure happens to have
been painted with lead-containing paint. These and other potential
environmental impacts of small construction activities are described in
the [Small Scale Construction
chapter](http://www.encapafrica.org/EGSSAAsectionsMarch2003/Env Guidelines BW Chapter 4 Construction.pdf)
of the Environmental Guidelines for Small Scale Activities in Africa
(EGSSAA), which can be downloaded at
[www.encapafrica.org](http://www.encapafrica.org/).

# 

In addition, it is expected that wells and sanitation projects may be a
part of activities under IR 13.4. These interventions are likely to
affect the environment directly. The potential environmental impacts of
water supply and sanitation projects are identified in the [Water Supply
and Sanitation
chapter](http://www.encapafrica.org/EGSSAAsectionsMarch2003/Env Guidelines BW Chapter 16 Water.pdf)
of the EGSSAA. For example, these potential impacts include the
potential for wells to deliver water containing arsenic or other
contaminants and for sanitation projects to become sources of
groundwater contamination, if poorly sited.

# 

**4.0 RECOMMENDED MITIGATION ACTIONS (INCLUDING MONITORING AND
EVALUATION)**

# 

All the activities under IR 13.1, 13.2 and 13.3 and some activities
under IR 13.4 relating to provision of support, capacity building in
education and health, planning, managing and other essential skills,
involve strictly technical assistance, training and capacity building. A
**Categorical Exclusion** is recommended for this set of activities,
pursuant to 22 CFR 216.2 (c)(2)(i) \[technical assistance and
training\].

For any of the activities under IR 13.4 that will involve minor
constructions or add-on buildings in schools, as well as the
construction of wells and sanitation projects, a **Negative
Determination with Conditions** is recommended for this set of
activities, pursuant to (CFR 216.2(c)(2)(i)). The condition being that
program managers will take measures to ensure that these activities are
conducted in an environmentally sound manner, as described below.

***Small Scale Construction***

The conditions for the small scale construction activities are the
following:

-   All construction activities will be conducted following principles
    for environmentally sound construction, as provided in [*Chapter 3:
    Small Scale
    Construction*](http://www.encapafrica.org/EGSSAA/Construction.pdf)
    of the USAID Environmental Guidelines for Small-scale Activities in
    Africa, which can be found at
    [www.encapafrica.org](http://www.encapafrica.org/).

-   For the rehabilitation of existing facilities, and for construction
    of facilities in which the total surface area disturbed is less than
    10,000 square feet, the condition is that these activities will be
    conducted following principles for environmentally sound
    construction, as provided in the Small Scale Construction chapter of
    the USAID Environmental Guidelines for Small-scale Activities in
    Africa, which can be found at:
    [www.encapafrica.org](http://www.encapafrica.org/).

-   For the construction of any facilities in which the total surface
    area disturbed exceeds 10,000 square feet (1,000 square meters), the
    program will conduct a supplemental environmental review according
    to guidance in Annex G of the Africa Bureau Environmental Procedures
    Training Manual (EPTM). Construction may not begin until such a
    review is completed and approved by the Mission Environmental
    Officer.

***Potable Water Supply and Sanitation***

Both water supply and sanitation activities should be conducted in a
manner consistent with the good design and implementation practices
described in *EGSSAA [Chapter 16: Water Supply and
Sanitation](http://www.encapafrica.org/egssaa/watsan.pdf)*. The SO Team
and implementing partners should closely examine this chapter, as it
provides a thorough discussion of program design and implementation
issues that can help avoid numerous preventable problems. Another useful
reference to consult for good water and sanitation design and
implementation principles is the document, "Guidelines for the
Development of Small Scale Rural Water Supply and Sanitation Projects in
Ethiopia," by Catholic Relief Services and USAID, July 31, 2003.

Water quality testing is essential for determining that the water from a
constructed water source is safe to drink and to determine a baseline so
that any future degradation can be detected. Among the water quality
tests which must be performed are tests for the presence of arsenic. Any
USAID-supported activity engaged in the provision of potable water must
adhere to Guidance Cable State 98 108651, which requires arsenic
testing. That 1998 cable also anticipates "practical guidelines on
sampling and testing for arsenic" that were then under development. The
EGAT Bureau completed these guidelines, and the Africa Bureau has
packaged them in a document titled, "[Guidelines for Determining the
Arsenic Content of Ground Water in USAID-Sponsored Well Programs in
Sub-Saharan
Africa](http://www.encapafrica.org/docs/Watsan/Arsenic testing guidelines AFR.doc)."
The SO team must assure that the standards and testing procedures
described in this guideline document are followed for potable water
supply activities under this program.

# 

As required by ADS 204.5.4, the SO team must actively monitor ongoing
activities for compliance with approved IEE recommendations, and modify
or end activities that are not in compliance. If additional activities
not described in this document are added to this program, then amended
or new environmental documentation must be prepared. The SO team will
also ensure that provisions of the IEE concerning mitigative measures
and the conditions specified herein along with the requirement to
monitor be incorporated in all contracts, cooperative agreements, grants
and sub-grants.

**SECTION E -- ANNEXES**

**ANNEX 3 -- BRANDING STRATEGY AND MARKING PLAN**

**1. BRANDING STRATEGY -- ASSISTANCE (December 2005)**

\(a\) **Definitions**

***Branding Strategy*** means a strategy that is submitted at the
specific request of a USAID Agreement Officer by an Apparently
Successful Applicant after evaluation of an application for USAID
funding, describing how the program, project, or activity is named and
positioned, and how it is promoted and communicated to beneficiaries and
host country citizens. It identifies all donors and explains how they
will be acknowledged.

***Apparently Successful Applicant(s)*** means the applicant(s) for
USAID funding recommended for an award after evaluation, but who has not
yet been awarded a grant, cooperative agreement or other assistance
award by the Agreement Officer. The Agreement Officer will request that
the Apparently Successful Applicants submit a Branding Strategy and
Marking Plan. Apparently Successful Applicant status confers no right
and constitutes no USAID commitment to an award.

***USAID Identity (Identity)*** means the official marking for the
Agency, comprised of the USAID logo and new brandmark, which clearly
communicates that our assistance is from the American people. The USAID
Identity is available on the USAID website and is provided without
royalty, license, or other fee to recipients of USAID-funded grants or
cooperative agreements or other assistance awards or subawards.

\(b\) **Submission.** The Apparently Successful Applicant, upon request
of the Agreement Officer, will submit and negotiate a Branding Strategy.
The Branding Strategy will be included in and made a part of the
resulting grant or cooperative agreement. The Branding Strategy will be
negotiated within the time that the Agreement Officer specifies. Failure
to submit and negotiate a Branding Strategy will make the applicant
ineligible for award of a grant or cooperative agreement. The Apparently
Successful Applicant must include all estimated costs associated with
branding and marking USAID programs, such as plaques, stickers, banners,
press events and materials, and the like.

\(c\) **Submission Requirements**

At a minimum, the Apparently Successful Applicant's Branding Strategy
will address

the following:

**(1) Positioning**

*What is the intended name of this program, project, or activity?*

Guidelines: USAID prefers to have the USAID Identity included as part of
the program or project name, such as a \"title sponsor,\" if possible
and appropriate. It is acceptable to \"co-brand\" the title with USAID's
and the Apparently Successful Applicant's identities. For example: \"The
USAID and \[Apparently Successful Applicant\] Health Center.\"

If it would be inappropriate or is not possible to \"brand\" the project
this way, such as when rehabilitating a structure that already exists or
if there are multiple donors, please explain and indicate how you intend
to showcase USAID\'s involvement in publicizing the program or project*.
For example: School #123,*

*rehabilitated by USAID and \[Apparently Successful Applicant\]/ \[other
donors\].*

Note: the Agency prefers \"made possible by (or with) the generous
support of the American People\" next to the USAID Identity in
acknowledging our contribution, instead of the phrase \"funded by.\"
USAID prefers local language translations.

*Will a program logo be developed and used consistently to identify this
program? If yes, please attach a copy of the proposed program logo.*

Note: USAID prefers to fund projects that do NOT have a separate logo or
identity that competes with the USAID Identity.

**(2) Program Communications and Publicity**

*Who are the primary and secondary audiences for this project or
program?*

Guidelines: Please include direct beneficiaries and any special target
segments or influencers. *For Example: Primary audience: schoolgirls age
8-12, Secondary audience: teachers and parents -- specifically mothers.*

*What communications or program materials will be used to explain or
market the*

*program to beneficiaries?*

Guidelines: These include training materials, posters, pamphlets, Public
Service Announcements, billboards, websites, and so forth.

*What is the main program message(s)?*

Guidelines: *For example: \"Be tested for HIV-AIDS\" or \"Have your
child inoculated.\"*

Please indicate if you also plan to incorporate USAID's primary message
-- this aid is \"from the American people\" -- into the narrative of
program materials. This is optional; however, marking with the USAID
Identity is required.

*Will the recipient announce and promote publicly this program or
project to host country citizens? If yes, what press and promotional
activities are planned?*

Guidelines: These may include media releases, press conferences, public
events, and so forth.

Note: incorporating the message, "USAID from the American People", and
the USAID Identity is required.

*Please provide any additional ideas about how to increase awareness
that the American people support this project or program.*

Guidelines: One of our goals is to ensure that both beneficiaries and
host-country citizens know that the aid the Agency is providing is
\"from the American people.\" Please provide any initial ideas on how to
further this goal.

**(3) Acknowledgements**

*Will there be any direct involvement from a host-country government
ministry? If yes, please indicate which one or ones. Will the recipient
acknowledge the ministry as an additional co-sponsor*?

Note: it is perfectly acceptable and often encouraged for USAID to
\"co-brand\" programs with government ministries.

*Please indicate if there are any other groups whose logo or identity
the recipient will use on program materials and related communications.*

Guidelines: Please indicate if they are also a donor or why they will be
visibly acknowledged, and if they will receive the same prominence as
USAID.

\(d\) **Award Criteria**. The Agreement Officer will review the Branding
Strategy for adequacy, ensuring that it contains the required
information on naming and positioning the USAID-funded program, project,
or activity, and promoting and communicating it to cooperating country
beneficiaries and citizens. The Agreement Officer also will evaluate
this information to ensure that it is consistent with the stated
objectives of the award; with the Apparently Successful Applicant's cost
data submissions; with the Apparently Successful Applicant's project,
activity, or program performance plan; and with the regulatory
requirements set out in 22 CFR 226.91. The Agreement Officer may obtain
advice and recommendations from technical experts while performing the
evaluation.

**2. MARKING PLAN -- ASSISTANCE (December 2005)**

\(a\) **Definitions**

***Marking Plan*** means a plan that the Apparently Successful Applicant
submits at the specific request of a USAID Agreement Officer after
evaluation of an application for USAID funding, detailing the public
communications, commodities, and program materials and other items that
will visibly bear the USAID Identity. Recipients may request approval of
Presumptive Exceptions to marking requirements in the

Marking Plan.

***Apparently Successful Applicant(s)*** means the applicant(s) for
USAID funding recommended for an award after evaluation, but who has not
yet been awarded a grant, cooperative agreement or other assistance
award by the Agreement Officer. The Agreement Officer will request that
Apparently Successful Applicants submit a Branding Strategy and Marking
Plan. Apparently Successful Applicant status confers no right and
constitutes no USAID commitment to an award, which the Agreement Officer
must still obligate.

***USAID Identity (Identity)*** means the official marking for the
Agency, comprised of the USAID logo and new brandmark, which clearly
communicates that our assistance is from the American people. The USAID
Identity is available on the USAID website and USAID provides it without
royalty, license, or other fee to recipients of USAID funded grants,
cooperative agreements, or other assistance awards or sub-awards.

A ***Presumptive Exception*** exempts the applicant from the general
marking requirements for a *particular* USAID-funded public
communication, commodity, program material or other deliverable, or a
*category* of USAID-funded public communications, commodities, program
materials or other deliverables that would otherwise be required to
visibly bear the USAID Identity. The Presumptive Exceptions are:

Presumptive Exception (i). USAID marking requirements may not apply if
they would compromise the intrinsic independence or neutrality of a
program or materials where independence or neutrality is an inherent
aspect of the program and materials, such as election monitoring or
ballots, and voter information literature; political party support or
public policy advocacy or reform; independent media, such as television
and radio broadcasts, newspaper articles and editorials; and public
service announcements or public opinion polls and surveys (22 C.F.R.
226.91(h)(1)).

Presumptive Exception (ii). USAID marking requirements may not apply if
they would diminish the credibility of audits, reports, analyses,
studies, or policy recommendations whose data or findings must be seen
as independent (22 C.F.R. 226.91(h)(2)).

Presumptive Exception (iii). USAID marking requirements may not apply if
they would undercut host-country government "ownership" of
constitutions, laws, regulations, policies, studies, assessments,
reports, publications, surveys or audits, public service announcements,
or other communications better positioned as "by" or "from" a
cooperating country ministry or government official (22 C.F.R.
226.91(h)(3)).

Presumptive Exception (iv). USAID marking requirements may not apply if
they would impair the functionality of an item, such as sterilized
equipment or spare parts (22 C.F.R. 226.91(h)(4)).

Presumptive Exception (v). USAID marking requirements may not apply if
they would incur substantial costs or be impractical, such as items too
small or otherwise unsuited for individual marking, such as food in bulk
(22 C.F.R. 226.91(h)(5)).

Presumptive Exception (vi). USAID marking requirements may not apply if
they would offend local cultural or social norms, or be considered
inappropriate on such items as condoms, toilets, bed pans, or similar
commodities (22 C.F.R. 226.91(h)(6)).

Presumptive Exception (vii). USAID marking requirements may not apply if
they would conflict with international law (22 C.F.R. 226.91(h)(7)).

\(b\) **Submission.** The Apparently Successful Applicant, upon the
request of the Agreement Officer, will submit and negotiate a Marking
Plan that addresses the details of the public communications,
commodities, program materials that will visibly bear the USAID
Identity. The marking plan will be customized for the particular
program, project, or activity under the resultant grant or cooperative
agreement. The plan will be included in and made a part of the resulting
grant or cooperative agreement. USAID and the Apparently Successful
Applicant will negotiate the Marking Plan within the time specified by
the Agreement Officer. Failure to submit and negotiate a Marking Plan
will make the applicant ineligible for award of a grant or cooperative
agreement. The applicant must include an estimate of all costs
associated with branding and marking USAID programs, such as plaques,
labels, banners, press events, promotional materials, and so forth in
the budget portion of its application. These costs are subject to
revision and negotiation with the Agreement Officer upon submission of
the Marking Plan and will be incorporated into the Total Estimated
Amount of the grant, cooperative agreement or other assistance
instrument.

\(c\) **Submission Requirements**. The Marking Plan will include the
following:

\(1\) A description of the public communications, commodities, and
program materials that the recipient will be produced as a part of the
grant or cooperative agreement and which will visibly bear the USAID
Identity. These include:

\(i\) program, project, or activity sites funded by USAID, including
visible infrastructure projects or other programs, projects, or
activities that are physical in nature;

\(ii\) technical assistance, studies, reports, papers, publications,
audio-visual productions, public service announcements, Web
sites/Internet activities and other promotional, informational, media,
or communications products funded by USAID;

\(iii\) events financed by USAID, such as training courses, conferences,
seminars, exhibitions, fairs, workshops, press conferences, and other
public activities; and

\(iv\) all commodities financed by USAID, including commodities or
equipment provided under humanitarian assistance or disaster relief
programs, and all other equipment, supplies and other materials funded
by USAID, and their export packaging.

\(2\) A table specifying:

\(i\) the program deliverables that the recipient will mark with the
USAID Identity,

\(ii\) the type of marking and what materials the applicant will be used
to mark the program deliverables with the USAID Identity, and

\(iii\) when in the performance period the applicant will mark the
program deliverables, and where the applicant will place the marking.

\(3\) A table specifying:

\(i\) what program deliverables will not be marked with the USAID
Identity, and

\(ii\) the rationale for not marking these program deliverables.

\(d\) **Presumptive Exceptions.**

\(1\) The Apparently Successful Applicant may request a Presumptive
Exception as part of the overall Marking Plan submission. To request a
Presumptive Exception, the Apparently Successful Applicant must identify
which Presumptive Exception applies, and state why, in light of the
Apparently Successful Applicant's technical proposal and in the context
of the program description or program statement in the USAID Request For
Application or Annual Program Statement, marking requirements should not
be required.

\(2\) Specific guidelines for addressing each Presumptive Exception are:

\(i\) For Presumptive Exception (i), identify the USAID Strategic
Objective, Interim Result, or program goal furthered by an appearance of
neutrality, or state why the program, project, activity, commodity, or
communication is 'intrinsically neutral.' Identify, by category or
deliverable item, examples of program materials funded under the award
for which you are seeking exception 1.

\(ii\) For Presumptive Exception (ii), state what data, studies, or
other deliverables will be produced under the USAID funded award, and
explain why the data, studies, or deliverables must be seen as credible.

\(iii\) For Presumptive Exception (iii), identify the item or media
product produced under the USAID funded award, and explain why each item
or product, or category of item and product, is better positioned as an
item or product produced by the cooperating country government.

\(iv\) For Presumptive Exception (iv), identify the item or commodity to
be marked, or categories of items or commodities, and explain how
marking would impair the item's or commodity's functionality.

\(v\) For Presumptive Exception (v), explain why marking would not be
cost-beneficial or practical.

\(vi\) For Presumptive Exception (vi), identify the relevant cultural or
social norm, and explain why marking would violate that norm or
otherwise be inappropriate.

\(vii\) For Presumptive Exception (vii), identify the applicable
international law violated by marking.

\(3\) The Agreement Officer will review the request for adequacy and
reasonableness. In consultation with the Cognizant Technical Officer and
other agency personnel as necessary, the Agreement Officer will approve
or disapprove the requested Presumptive Exception. Approved exceptions
will be made part of the approved Marking Plan, and will apply for the
term of the award, unless provided otherwise.

\(e\) **Award Criteria**: The Agreement Officer will review the Marking
Plan for adequacy and reasonableness, ensuring that it contains
sufficient detail and information concerning public communications,
commodities, and program materials that will visibly bear the USAID
Identity. The Agreement Officer will evaluate the plan to ensure that it
is consistent with the stated objectives of the award; with the
applicant's cost data submissions; with the applicant's actual project,
activity, or program performance plan; and with the regulatory
requirements of 22 C.F.R.226.91. The Agreement Officer will approve or
disapprove any requested Presumptive Exceptions (see paragraph (d)) on
the basis of adequacy and reasonableness. The Agreement Officer may
obtain advice and recommendations from technical experts while
performing the evaluation.

**3. MARKING UNDER USAID-FUNDED ASSISTANCE INSTRUMENTS (December 2005)**

**(a) Definitions**

***Commodities*** mean any material, article, supply, goods or
equipment, excluding recipient offices, vehicles, and non-deliverable
items for recipient's internal use, in administration of the USAID
funded grant, cooperative agreement, or other agreement or subagreement.

***Principal Officer*** means the most senior officer in a USAID
Operating Unit in the field, e.g., USAID Mission Director or USAID
Representative. For global programs managed from Washington but executed
across many countries, such as disaster relief and assistance to
internally displaced persons, humanitarian emergencies or immediate post
conflict and political crisis response, the cognizant Principal Officer
may be an Office Director, for example, the Directors of USAID/W/Office
of Foreign Disaster Assistance and Office of Transition Initiatives. For
non-presence countries, the cognizant Principal Officer is the Senior
USAID officer in a regional USAID Operating Unit responsible for the
non-presence country, or in the

absence of such a responsible operating unit, the Principal U.S
Diplomatic Officer in the non-presence country exercising delegated
authority from USAID.

***Programs*** mean an organized set of activities and allocation of
resources directed toward a common purpose, objective, or goal
undertaken or proposed by an organization to carry out the
responsibilities assigned to it.

***Projects*** include all the marginal costs of inputs (including the
proposed investment) technically required to produce a discrete
marketable output or a desired result (for example, services from a
fully functional water/sewage treatment facility).

***Public communications*** are documents and messages intended for
distribution to audiences external to the recipient's organization. They
include, but are not limited to, correspondence, publications, studies,
reports, audio visual productions, and other informational products;
applications, forms, press and

promotional materials used in connection with USAID funded programs,
projects or activities, including signage and plaques; Web
sites/Internet activities; and events such as training courses,
conferences, seminars, press conferences and so forth.

***Sub-recipient*** means any person or government (including
cooperating country government) department, agency, establishment, or
for profit or nonprofit organization that receives a USAID sub-award, as
defined in 22 C.F.R. 226.2.

***Technical Assistance*** means the provision of funds, goods,
services, or other foreign assistance, such as loan guarantees or food
for work, to developing countries and other USAID recipients, and
through such recipients to sub-recipients, in direct support of a
development objective -- as opposed to the internal management of the
foreign assistance program.

***USAID Identity (Identity)*** means the official marking for the
United States Agency for International Development (USAID), comprised of
the USAID logo or seal and new brandmark, with the tagline that clearly
communicates that our assistance is "from the American people." The
USAID Identity is available on the USAID website at
www.usaid.gov/branding and USAID provides it without royalty, license,
or other fee to recipients of USAID-funded grants, or cooperative
agreements, or other assistance awards.

**(b) Marking of Program Deliverables**

\(1\) All recipients must mark appropriately all overseas programs,
projects, activities, public communications, and commodities partially
or fully funded by a USAID grant or cooperative agreement or other
assistance award or subaward with the USAID Identity, of a size and
prominence equivalent to or greater than the recipient's, other donor's,
or any other third party's identity or logo.

\(2\) The Recipient will mark all program, project, or activity sites
funded by USAID, including visible infrastructure projects (for example,
roads, bridges, buildings) or other programs, projects, or activities
that are physical in nature (for example, agriculture, forestry, water
management) with the USAID Identity. The Recipient should erect
temporary signs or plaques early in the construction or implementation
phase. When construction or implementation is complete, the Recipient
must install a permanent, durable sign, plaque or other marking.

\(3\) The Recipient will mark technical assistance, studies, reports,
papers, publications, audio-visual productions, public service
announcements, Web sites/Internet activities and other promotional,
informational, media, or communications products funded by USAID with
the USAID Identity.

\(4\) The Recipient will appropriately mark events financed by USAID,
such as training courses, conferences, seminars, exhibitions, fairs,
workshops, press conferences and other public activities, with the USAID
Identity. Unless directly prohibited and as appropriate to the
surroundings, recipients should display additional materials, such as
signs and banners, with the USAID Identity. In circumstances in which
the USAID Identity cannot be displayed visually, the recipient is
encouraged otherwise to acknowledge USAID and the American people's
support.

\(5\) The Recipient will mark all commodities financed by USAID,
including commodities or equipment provided under humanitarian
assistance or disaster relief programs, and all other equipment,
supplies, and other materials funded by USAID, and their export
packaging with the USAID Identity.

\(6\) The Agreement Officer may require the USAID Identity to be larger
and more prominent if it is the majority donor, or to require that a
cooperating country government's identity be larger and more prominent
if circumstances warrant, and as appropriate depending on the audience,
program goals, and materials produced.

\(7\) The Agreement Officer may require marking with the USAID Identity
in the event that the recipient does not choose to mark with its own
identity or logo.

\(8\) The Agreement Officer may require a pre-production review of
USAID-funded public communications and program materials for compliance
with the approved Marking Plan.

\(9\) Sub-recipients. To ensure that the marking requirements "flow
down\'\' to sub-recipients of sub-awards, recipients of USAID funded
grants and cooperative agreements or other assistance awards will
include the USAID-approved marking provision in any USAID funded
sub-award, as follows:

*"As a condition of receipt of this sub-award, marking with the USAID
Identity of size and prominence equivalent to or greater than the
recipient's, sub-recipient's, other donor's or third party's is
required. In the event the recipient chooses not to require marking with
its own identity or logo by the sub-recipient, USAID may, at its
discretion, require marking by the sub-recipient with the USAID
Identity."*

\(10\) Any 'public communications', as defined in 22 C.F.R. 226.2,
funded by USAID, in which the content has not been approved by USAID,
must contain the following disclaimer:

*"This study/report/audio/visual/other information/media product
(specify) is made possible by the generous support of the American
people through the United States Agency for International Development
(USAID). The contents are the responsibility of \[insert recipient
name\] and do not necessarily reflect the views of USAID or the United
States Government."*

\(11\) The recipient will provide the Cognizant Technical Officer (CTO)
or other USAID personnel designated in the grant or cooperative
agreement with two copies of all program and communications materials
produced under the award. In addition, the recipient will submit one
electronic or one hard copy of all final documents to USAID's
Development Experience Clearinghouse.

**(c) Implementation of marking requirements.**

\(1\) When the grant or cooperative agreement contains an approved
Marking Plan, the recipient will implement the requirements of this
provision following the approved Marking Plan.

\(2\) When the grant or cooperative agreement does not contain an
approved Marking Plan, the recipient will propose and submit a plan for
implementing the requirements of this provision within \[***Agreement
Officer fill-in***\] days after the effective date of this provision.
The plan will include:

\(i\) A description of the program deliverables specified in paragraph
(b) of this provision that the recipient will produce as a part of the
grant or cooperative agreement and which will visibly bear the USAID
Identity.

\(ii\) the type of marking and what materials the applicant uses to mark
the program deliverables with the USAID Identity,

\(iii\) when in the performance period the applicant will mark the
program deliverables, and where the applicant will place the marking,

\(3\) The recipient may request program deliverables not be marked with
the USAID Identity by identifying the program deliverables and providing
a rationale for not marking these program deliverables. Program
deliverables may be exempted from USAID marking requirements when:

\(i\) USAID marking requirements would compromise the intrinsic
independence or neutrality of a program or materials where independence
or neutrality is an inherent aspect of the program and materials;

\(ii\) USAID marking requirements would diminish the credibility of
audits, reports, analyses, studies, or policy recommendations whose data
or findings must be seen as independent;

\(iii\) USAID marking requirements would undercut host-country
government "ownership" of constitutions, laws, regulations, policies,
studies, assessments, reports, publications, surveys or audits, public
service announcements, or other communications better positioned as "by"
or "from" a cooperating country ministry or government official;

\(iv\) USAID marking requirements would impair the functionality of an
item;

\(v\) USAID marking requirements would incur substantial costs or be
impractical;

\(vi\) USAID marking requirements would offend local cultural or social
norms, or be considered inappropriate;

\(vii\) USAID marking requirements would conflict with international
law.

\(4\) The proposed plan for implementing the requirements of this
provision, including any proposed exemptions, will be negotiated within
the time specified by the Agreement Officer after receipt of the
proposed plan. Failure to negotiate an approved plan with the time
specified by the Agreement Officer may be considered as noncompliance
with the requirements is provision.

**(d) Waivers.**

\(1\) The recipient may request a waiver of the Marking Plan or of the
marking requirements of this provision, in whole or in part, for each
program, project, activity, public communication or commodity, or, in
exceptional circumstances, for a region or country, when USAID required
marking would pose compelling political, safety, or security concerns,
or when marking would have an adverse impact in the cooperating country.
The recipient will submit the request through the Cognizant Technical
Officer. The Principal Officer is responsible for approvals or
disapprovals of waiver requests.

\(2\) The request will describe the compelling political, safety,
security concerns, or adverse impact that require a waiver, detail the
circumstances and rationale for the waiver, detail the specific
requirements to be waived, the specific portion of the Marking Plan to
be waived, or specific marking to be waived, and include a description
of how program materials will be marked (if at all) if the USAID
Identity is removed. The request should also provide a rationale for any
use of recipient's own identity/logo or that of a third party on
materials that will be subject to the waiver.

\(3\) Approved waivers are not limited in duration but are subject to
Principal Officer Review at any time, due to changed circumstances.

\(4\) Approved waivers "flow down" to recipients of sub-awards unless
specified otherwise. The waiver may also include the removal of USAID
markings already affixed, if circumstances warrant.

\(5\) Determinations regarding waiver requests are subject to appeal to
the Principal Officer's cognizant Assistant Administrator. The recipient
may appeal by submitting a written request to reconsider the Principal
Officer's waiver determination to the cognizant Assistant Administrator.

**(e) Non-retroactivity.** The requirements of this provision do apply
to any materials, events, or commodities produced prior to January 2,
2006. The requirements of this provision do not apply to program,
project, or activity sites funded by USAID, including visible
infrastructure projects (for example, roads, bridges, buildings) or
other programs, projects, or activities that are physical in nature (for
example, agriculture, forestry, water management) where the construction
and implementation of these are complete prior to January 2, 2006 and
the period of the grant does not extend past January 2, 2006.

**SECTION E -- ANNEXES**

**ANNEX 4 -- OTHER PROVISIONS**

**1. APPLICABILITY OF 22 CFR PART 226 (May 2005)**

\(a\) All provisions of 22 CFR Part 226 and all Standard Provisions
attached to this agreement are applicable to the recipient and to
subrecipients which meet the definition of \"Recipient\" in Part 226,
unless a section specifically excludes a subrecipient from coverage. The
recipient shall assure that subrecipients have copies of all the
attached standard provisions.

\(b\) For any subawards made with Non-US subrecipients the Recipient
shall include the applicable \"Standard Provisions for Non-US
Nongovernmental Grantees.\" Recipients are required to ensure compliance
with subrecipient monitoring procedures in accordance with OMB Circular
A-133.

**2. "USAID DISABILITY POLICY - ASSISTANCE (December 2004)**

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

\(b\) USAID therefore requires that the recipient not discriminate
against people with disabilities in the implementation of USAID funded
programs and that it make every effort to comply with the objectives of
the USAID Disability Policy in performing the program under this grant
or cooperative agreement. To that end and to the extent it can
accomplish this goal within the scope of the program objectives, the
recipient should demonstrate a comprehensive and consistent approach for
including men, women and children with disabilities."

**3. "PROHIBITION ON THE USE OF FEDERAL FUNDS TO PROMOTE, SUPPORT, OR
ADVOCATE FOR THE LEGALIZATION OR PRACTICE OF PROSTITUTION - ASSISTANCE
(JULY 2004)**

\(a\) The U.S. Government is opposed to prostitution and related
activities, which are inherently harmful and dehumanizing, and
contribute to the phenomenon of trafficking in persons. None of the
funds made available under this agreement may be used to promote,
support, or advocate the legalization or practice of prostitution.
Nothing in the preceding sentence shall be construed to preclude
assistance designed to ameliorate the suffering of, or health risks to,
victims while they are being trafficked or after they are out of the
situation that resulted from such victims being trafficked.

\(b\) \[This subsection (b) only applies to foreign non-governmental
organizations and PIOs receiving U.S. Government funds to carry out
programs that target victims of severe forms of trafficking as either
prime awardees or subawardees.\]

\(1\) For programs that target victims of severe forms of trafficking,
as a condition of entering into this agreement or subagreement, the
recipient/subrecipient agrees that in its activities outside of the
United States and its possessions it does not promote, support, or
advocate the legalization or practice of prostitution. The preceding
sentence shall not apply to organizations that provide services to
individuals solely after they are no longer engaged in activities that
resulted from such victims being trafficked.

\(2\) The following definitions apply for purposes of this clause:

FOREIGN NON-GOVERNMENTAL ORGANIZATION -- The term "foreign
non-governmental organization" means an entity that is not organized
under the laws of any State of the United States, the District of
Columbia or the Commonwealth of Puerto Rico.

SEVERE FORMS OF TRAFFICKING IN PERSONS. \-- The term ''severe forms of
trafficking in persons'' means---

\(A\) sex trafficking in which a commercial sex act is induced by force,
fraud, or coercion, or in which the person induced to perform such act
has not attained 18 years of age; or

\(B\) the recruitment, harboring, transportation, provision, or
obtaining of a person for labor or services, through the use of force,
fraud, or coercion for the purpose of subjection to involuntary
servitude, peonage, debt

bondage, or slavery.

\(c\) The recipient shall insert this provision in all sub-agreements
under this award.

\(d\) This provision includes express terms and conditions of the
agreement and any violation of it shall be grounds for unilateral
termination, in whole or in part, of the agreement by USAID prior to the
end of its term."

**4. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (JANUARY
2004)**

\(1\) The recipient agrees to notify the Agreement Officer immediately
upon learning that it or any of its principals:

\(a\) Are presently excluded or disqualified from covered transactions
by any Federal department or agency;

\(b\) Have been convicted within the preceding three-years period
preceding this proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public
(Federal, State**,** or local) transaction or contract under a public
transaction; violation of Federal or State antitrust statutes or
commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, tax evasion, receiving
stolen property, making false claims, or obstruction of justice;
commission of any other offense indicating a lack of business integrity
or business honesty that seriously and directly affects your present
responsibility;

\(c\) Are presently indicted for or otherwise criminally or civilly
charged by a governmental entity (Federal, State**,** or local) with
commission of any of the offenses enumerated in paragraph (1)(b); and

\(d\) Have had one or more public transactions (Federal, State**,** or
local) terminated for cause or default within the preceding three years.

\(2\) The recipient agrees that, unless authorized by the Agreement
Officer, it will not knowingly enter into any subagreements or contracts
under this grant with a person or entity that is included on the
Excluded Parties List System (http://epls.arnet.gov). The recipient
further agrees to include the following provision in any subagreements
or contracts entered into under this award:

> DEBARMENT, SUSPENSION, INELIGIBILITY, AND VOLUNTARY EXCLUSION

(DECEMBER 2003)

> The recipient/contractor certifies that neither it nor its principals
> is presently excluded or disqualified from participation in this
> transaction by any Federal department or agency.

\(3\) The policies and procedures applicable to debarment, suspension,
and ineligibility under USAID-financed transactions are set forth in 22
CFR Part 208.

**5. DRUG-FREE WORKPLACE (JANUARY 2004)**

\(1\) The recipient agrees that it will publish a drug-free workplace
statement and provide a copy to each employee who will be engaged in the
performance of any Federal award. The statement must

\(a\) Tell the employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited
in its workplace;

\(b\) Specify the actions the recipient will take against employees for
violating that prohibition; and

\(c\) Let each employee know that, as a condition of employment under
any award, he or she

\(1\) Must abide by the terms of the statement, and

\(2\) Must notify you in writing if he or she is convicted for a
violation of a criminal drug statute occurring in the workplace, and
must do so no more than five calendar days after the conviction.

\(2\) The recipient agrees that it will establish an ongoing drug-free
awareness program to inform employees about

\(a\) The dangers of drug abuse in the workplace;

\(b\) Your policy of maintaining a drug-free workplace;

\(c\) Any available drug counseling, rehabilitation and employee
assistance programs; and

\(d\) The penalties that you may impose upon them for drug abuse
violations occurring in the workplace.

\(3\) Without the Agreement Officer's expressed written approval, the
policy statement and program must be in place as soon as possible, no
later than the 30 days after the effective date of this award, or the
completion date of this award, whichever occurs first.

\(4\) The recipient agrees to immediately notify the Agreement Officer
if an employee is convicted of a drug violation in the workplace. The
notification must be in writing, identify the employee's position title,
the number of each award on which the employee worked. The notification
must be sent to the Agreement Officer within ten calendar days after the
recipient learns of the conviction.

\(5\) Within 30 calendar days of learning about an employee's
conviction, the recipient must either

> \(a\) Take appropriate personnel action against the employee, up to
> and including termination, consistent with the requirements of the
> Rehabilitation Act of 1973 (29 USC 794), as amended, or
>
> \(b\) Require the employee to participate satisfactorily in a drug
> abuse assistance or rehabilitation program approved for these purposes
> by a Federal, State or local health, law enforcement, or other
> appropriate agency.

\(6\) The policies and procedures applicable to violations of these
requirements are set forth in 22 CFR Part 210.

**6. EXECUTIVE ORDER ON TERRORISM FINANCING (FEB 2002)**

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

**7. VOLUNTARY POPULATION PLANNING ACTIVITIES - SUPPLEMENTAL**

**REQUIREMENTS (JANUARY 2009)**

a\. Voluntary Participation and Family Planning Methods:

> \(1\) The recipient agrees to take any steps necessary to ensure that
> funds made available under this award will not be used to coerce any
> individual to practice methods of family planning inconsistent with
> such individual\'s moral, philosophical, or religious beliefs.
> Further, the recipient agrees to conduct its activities in a manner
> which safeguards the rights, health and welfare of all individuals who
> take part in the program.
>
> \(2\) Activities which provide family planning services or information
> to individuals, financed in whole or in part under this agreement,
> shall provide a broad range of family planning methods and services
> available in the country in which the activity is conducted or shall
> provide information to such individuals regarding where such methods
> and services may be obtained.

b\. Requirements for Voluntary Family Planning Projects

\(1\) A Family planning project must comply with the requirements of
this

> paragraph.
>
> \(2\) A project is a discrete activity through which a governmental or
> nongovernmental organization or public international organization
> provides family planning services to people and for which funds
> obligated under this award, or goods or services financed with such
> funds, are provided under this award, except funds solely for the
> participation of personnel in short-term, widely attended training
> conferences or programs.
>
> \(3\) Service providers and referral agents in the project shall not
> implement or be subject to quotas or other numerical targets of total
> number of births, number of family planning acceptors, or acceptors of
> a particular method of family planning. Quantitative estimates or
> indicators of the number of births, acceptors, and acceptors of a
> particular method that are used for the purpose of budgeting,
> planning, or reporting with respect to the project are not quotas or
> targets under this paragraph, unless service providers or referral
> agents in the project are required to achieve the estimates or
> indicators.
>
> \(4\) The project shall not include the payment of incentives, bribes,
> gratuities or financial rewards to (i) any individual in exchange for
> becoming a family planning acceptor or (ii) any personnel performing
> functions under the project for achieving a numerical quota or target
> of total number of births, number of family planning acceptors, or
> acceptors of a particular method of contraception. This restriction
> applies to salaries or payments paid or made to personnel performing
> functions under the project if the amount of the salary or payment
> increases or decreases based on a predetermined number of births,
> number of family planning acceptors, or number of acceptors of a
> particular method of contraception that the personnel affect or
> achieve.
>
> \(5\) No person shall be denied any right or benefit, including the
> right of access to participate in any program of general welfare or
> health care, based on the person\'s decision not to accept family
> planning services offered by the project.
>
> \(6\) The project shall provide family planning acceptors
> comprehensible information about the health benefits and risks of the
> method chosen, including those conditions that might render the use of
> the method inadvisable and those adverse side effects known to be
> consequent to the use of the method. This requirement may be satisfied
> by providing information in accordance with the medical practices and
> standards and health conditions in the country where the project is
> conducted through counseling, brochures, posters, or package inserts.
>
> \(7\) The project shall ensure that experimental contraceptive drugs
> and devices and medical procedures are provided only in the context of
> a scientific study in which participants are advised of potential
> risks and benefits.
>
> \(8\) With respect to projects for which USAID provides, or finances
> the contribution of, contraceptive commodities or technical services
> and for which there is no subaward or contract under this award, the
> organization implementing a project for which such assistance is
> provided shall agree that the project will comply with the
> requirements of this paragraph while using such commodities or
> receiving such services.

\(9\)

> i\) The recipient shall notify USAID when it learns about an alleged
> violation in a project of the requirements of subparagraphs (3), (4),
> (5) or (7) of this paragraph;
>
> ii\) the recipient shall investigate and take appropriate corrective
> action, if necessary, when it learns about an alleged violation in a
> project of subparagraph (6) of this paragraph and shall notify USAID
> about violations in a project affecting a number of people over a
> period of time that indicate there is a systemic problem in the
> project.
>
> iii\) The recipient shall provide USAID such additional information
> about violations as USAID may request.

c\. Additional Requirements for Voluntary Sterilization Programs

> \(1\) None of the funds made available under this award shall be used
> to pay for the performance of involuntary sterilization as a method of
> family planning or to coerce or provide any financial incentive to any
> individual to practice sterilization.
>
> \(2\) The recipient shall ensure that any surgical sterilization
> procedures supported in whole or in part by funds from this award are
> performed only after the individual has voluntarily appeared at the
> treatment facility and has given informed consent to the sterilization
> procedure. Informed consent means the voluntary, knowing assent from
> the individual after being advised of the surgical procedures to be
> followed, the attendant discomforts and risks, the benefits to be
> expected, the availability of alternative methods of family planning,
> the purpose of the operation and its irreversibility, and the option
> to withdraw consent anytime prior to the operation. An individual\'s
> consent is considered voluntary if it is based upon the exercise of
> free choice and is not obtained by any special inducement or any
> element of force, fraud, deceit, duress, or other forms of coercion or
> misrepresentation.
>
> \(3\) Further, the recipient shall document the patient\'s informed
> consent by (i) a written consent document in a language the patient
> understands and speaks, which explains the basic elements of informed
> consent, as set out above, and which is signed by the individual and
> by the attending physician or by the authorized assistant of the
> attending physician; or (ii) when a patient is unable to read
> adequately a written certification by the attending physician or by
> the authorized assistant of the attending physician that the basic
> elements of informed consent above were orally presented to the
> patient, and that the patient thereafter consented to the performance
> of the operation. The receipt of this oral explanation shall be
> acknowledged by the patient\'s mark on the certification and by the
> signature or mark of a witness who shall speak the same language as
> the patient.
>
> \(4\) The recipient must retain copies of informed consent forms and
> certification documents for each voluntary sterilization procedure for
> a period of three years after performance of the sterilization
> procedure.

d\. Prohibition on Abortion-Related Activities:

> \(1\) No funds made available under this award will be used to
> finance, support,
>
> or be attributed to the following activities: (i) procurement or
> distribution of equipment intended to be used for the purpose of
> inducing abortions as a method of family planning; (ii) special fees
> or incentives to any person to coerce or motivate them to have
> abortions; (iii) payments to persons to perform abortions or to
> solicit persons to undergo abortions; (iv) information, education,
> training, or communication programs that seek to promote abortion as a
> method of family planning; and (v) lobbying for or against abortion.
> The term \"motivate\", as it relates to family planning assistance,
> shall not be construed to prohibit the provision, consistent with
> local law, of information or counseling about all pregnancy options.
>
> \(2\) No funds made available under this award will be used to pay for
> any biomedical research which relates, in whole or in part, to methods
> of, or the performance of, abortions or involuntary sterilizations as
> a means of family planning. Epidemiologic or descriptive research to
> assess the incidence, extent or consequences of abortions is not
> precluded.

e\. The recipient shall insert this provision in all subsequent
subagreements and contracts involving family planning or population
activities that will be supported in whole or in part from funds under
this award. The term subagreement means subgrants and subcooperative
agreements.

**8. FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL CONFERENCES (JAN
2002)**

Funds in this agreement may not be used to finance the travel, per diem,
hotel expenses, meals, conferences fees or other conference cots for any
member of a government's delegation to an international conference
sponsored by a public international organizations, except as provided in
the ADS Mandatory Reference "Guidance on Funding Foreign Government
Delegations to International Conferences" or as approved by the
Agreement Officer.

**9. REGULATIONS GOVERNING EMPLOYEES (AUGUST 1992)**

(The following applies to the recipient\'s employees working in the
cooperating country under the agreement who are not citizens of the
cooperating country.)

a\. The recipient\'s employees shall maintain private status and may not
rely on local U.S. Government offices or facilities for support while
under this grant.

b\. The sale of personal property or automobiles by recipient employees
and their dependents in the foreign country to which they are assigned
shall be subject to the same limitations and prohibitions which apply to
direct-hire USAID personnel employed by the Mission, including the rules
contained in 22 CFR Part 136, except as this may conflict with host
government regulations.

c\. Other than work to be performed under this award for which an
employee is assigned by the recipient, no employee of the recipient
shall engage directly or indirectly, either in the individual\'s own
name or in the name or through an agency of another person, in any
business, profession, or occupation in the foreign countries to which
the individual is assigned, nor shall the individual make loans or
investments to or in any business, profession or occupation in the
foreign countries to which the individual is assigned.

\*An asterisk indicates that the adjacent information is new or
substantively revised.

d\. The recipient\'s employees, while in a foreign country, are expected
to show respect for its conventions, customs, and institutions, to abide
by its applicable laws and regulations, and not to interfere in its
internal political affairs.

e\. In the event the conduct of any recipient employee is not in
accordance with the preceding paragraphs, the recipient\'s chief of
party shall consult with the USAID Mission Director and the employee
involved and shall recommend to the recipient a course of action with
regard to such employee.

f\. The parties recognize the rights of the U.S. Ambassador to direct
the removal from a country of any U.S. citizen or the discharge from
this grant award of any third country national when, in the discretion
of the Ambassador, the interests of the United States so require.

g\. If it is determined, either under (e) or (f) above, that the
services of such employee should be terminated, the recipient shall use
its best efforts to cause the return of such employee to the United
States, or point of origin, as appropriate.

**10. PROHIBITION OF ASSISTANCE TO DRUG TRAFFICKERS (JUNE 1999)**

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

b\. (1) For any loan over \$1000 made under this agreement, the
recipient shall insert a clause in the loan agreement stating that the
loan is subject to immediate cancellation, acceleration, recall or
refund by the recipient if the borrower or a key individual of a
borrower is found to have been convicted of a narcotics offense or to
have been engaged in drug trafficking as defined in 22 CFR Part 140.

\(2\) Upon notice by USAID of a determination under section (1) and at
USAID\'s option, the recipient agrees to immediately cancel, accelerate
or recall the loan, including refund in full of the outstanding balance.
USAID reserves the right to have the loan refund returned to USAID.

c\. (1) The recipient agrees not to disburse, or sign documents
committing the recipient to disburse, funds to a subrecipient designated
by USAID (\"Designated Subrecipient\") until advised by USAID that: (i)
any United States Government review of the Designated Subrecipient and
its key individuals has been completed; (ii) any related certifications
have been obtained; and (iii) the assistance to the Designated
Subrecipient has been approved. Designation means that the subrecipient
has been unilaterally selected by USAID as the subrecipient. USAID
approval of a subrecipient, selected by another party, or joint
selection by USAID and another party is not designation.

\(2\) The recipient shall insert the following clause, or its substance,
in its agreement with the Designated Subrecipient:

"The recipient reserves the right to terminate this
\[Agreement/Contract\] or take other appropriate measures if the
\[Subrecipient\] or a key individual of the \[Subrecipient\] is found to
have been convicted of a narcotic offense or to have been engaged in
drug trafficking as defined in 22 CFR Part 140."

**\[END OF SECTION E\]**

[^1]: 2008 State of the World's Mothers, Save the Children, 2008

[^2]: A percentage of the total level of effort for the project is shown
    for each Sub-objective. This is to reinforce earlier discussions
    that USAID/Nigeria considers the relative level of importance and
    level of effort needed to achieve results under each sub-objective.