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Issuance Date: July 26, 2013 RFA Clarification Questions Due date: August 09, 2013 Closing Date: September 09, 2013 Closing Time: 3:00 P.M. Cotonou, Benin local time Subject: Request for Applications (RFA) USAID-Benin-680-13-000001-RFA Advancing Newborn, Child and Reproductive Health (ANCRE) Ladies and Gentlemen: The United States Government, as represented by the United States Agency for International Development (USAID) Mission to Benin, is seeking applications (for assistance funding) from qualified U.S. private voluntary organizations (USPVOs) and/or U.S., other non-U.S. non-governmental organizations (NGOs) or private, non-profit organizations (or for-profit companies willing to forego profits) to implement a four year (4) program to improve Child and Reproductive Health in Benin. Subject to the availability of funds as described in the following Request for Applications (RFA), this application will support USAID/Benin’s Advancing Newborn, Child and Reproductive Health (ANCRE). The Recipient will be responsible for ensuring achievement of the program objectives. Please refer to the Program Description (Section I), for a complete statement of goals, objectives 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 organizations, OMB Circular A-21 for universities, and the Federal Acquisition Regulation (FAR) Part 31 for-profit organizations), may be paid under the agreement when awarded. Subject to the availability of funds, USAID intends to provide approximately $10,000,000.00 in total USAID funding to be allocated over the 4 year period. USAID reserves the right to fund any or none of the applications submitted. This RFA is being issued and consists of this cover letter and the following: 1. Section I, Funding Opportunity Description; 2; Section II, Award Information 3. Section III, Eligibility Information; 4. Section IV, Application and Submission Information 5. Section V, Application Review Information 6. Section VI, Award and Administration Information 7. Section VII, Agency Contacts 8. Section VIII, Other Information

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”. Any questions concerning this RFA must be submitted in writing to Francine E. Agblo, Acquisition & Assistance Specialist, via internet at [email protected]; [email protected] and [email protected] . If it is determined that the answer to any question(s) is of sufficient importance to warrant notification to all prospective recipients, a Questions and Answer document, and/or if needed, an amendment to the RFA, will be issued. Therefore, questions should be submitted no later than 3:00 p.m. Cotonou, Benin local time on August 09, 2013, 2013. Applicants are requested to submit both technical and cost portions of their applications in separate volumes (one (1) original and two (2) hard copies of the Technical Application) and (one (1) original and one (1) hard copy of the Cost Application). Award will be made to that responsible applicant(s) whose application(s) offers the greatest value to the U.S. Government. Issuance of this RFA does not constitute an award commitment on the part of the Government, nor does it commit the Government to pay for costs incurred in the preparation and submission of an application. Further, the Government reserves the right to reject any or all applications received. In addition, final award of any resultant grant(s) cannot be made until funds have been fully appropriated, allocated, and committed through internal USAID procedures. While it is anticipated that these procedures will be successfully completed, potential applicants are hereby notified of these requirements and conditions for award. Applications are submitted at the risk of the applicant; should circumstances prevent award of a cooperative agreement, all preparation and submission costs are at the applicant's expense. Beginning November 1, 2005, the preferred method of distribution of USAID RFAs is via electronically Grants.gov, which provides a single source for Federal government-wide competitive grant opportunities. This RFA and any future amendments can be downloaded from that Web Site. The address is http://www.grants.gov. In order to use this method, an applicant must first register on-line with Grants.gov. If you have difficulty registering or accessing the RFA, please contact the Grants.gov Helpdesk at 1-800-518-472 or via e-mail at [email protected] for technical assistance. If you decide to submit an application, it should be received by the closing date and time indicated at the top of this cover letter at the place designated below for receipt of applications. Applications and modifications thereof shall be submitted in envelopes with the name and address of the applicant and USAID-Benin-680-13-000001-RFA inscribed thereon, and should be sent via courier to: U.S. Agency for International Development (USAID)/Benin Attention: Francine E. Agblo Acquisition & Assistance Specialist Rue Caporal Bernard Anani 01 BP 2012 Cotonou, Benin

USAID-Benin-680-13-000001-RFA Advancing Newborn, Child and Reproductive Health (ANCRE)

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Table of Contents Page

SECTION I - FUNDING OPPORTUNITY DESCRIPTION/PROGRAM DESCRIPTION ............ 2

SECTION II - AWARD INFORMATION.........................................................................................................…...28

SECTION III – ELIGIBILITY INFORMATION ............................................................................... 25

SECTION IV – APPLICATION AND SUBMISSION INFORMATION ......................................... 26

SECTION V - APPLICATION REVIEW INFORMATION…………………………………………………... 48

SECTION VI – AWARD AND ADMINISTRATION INFORMATION .......................................... 46

SECTION VII – AGENCY CONTACTS ............................................................................................. 49

SECTION VIII – OTHER INFORMATION ....................................................................................... 49

ATTACHMENTS AND ANNEXES ....................................................................................................... 59


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SECTION I - FUNDING OPPORTUNITY DESCRIPTION/PROGRAM DESCRIPTION A. INTRODUCTION AND BACKGROUND A.1 INTRODUCTION The overall goal of USAID/Benin’s Global Health Initiative (GHI) Country Strategy is the “improved health status of Beninese families”. USAID’s four-year project under the GHI Country Strategy, Advancing Newborn, Child and Reproductive Health (ANCRE) ANCRE, supports the Ministry of Health (MOH) and specifically the Direction de la Santé de la Mère et de l’Enfant (DSME) to effectively scale up a subset of evidence-based, high-impact interventions listed under the Paquet des Interventions de Haut Impact (PIHI). These interventions will be delivered in an integrated fashion to significantly contribute to accelerate and sustain improvements in maternal, newborn, and child health (MNCH), leading to progress towards the achievement of Millennium Development Goals (MDGs) 4 and 5 in Benin. ANCRE also supports the introduction, scale-up, and further development of PIHI for the private health sector, to ensure program approaches are in sync with the public sector, resulting in synergistic delivery of these interventions to expand achievement of measurable reductions in under-five and maternal mortality and morbidity. Achieving equitable and sustained coverage of proven, high-impact interventions is critical to reducing mortality and morbidity among women of reproductive age, newborns and children under-five in low resource settings. In Benin, the challenge rests in introducing, scaling up, and evaluating the results from implementation solutions that address key gaps in policies and programs to improve the delivery and use of these proven, high impact interventions in communities most in need. In order to accelerate progress towards achieving the MDGs, it is important to identify, understand, and address gaps in coverage and quality of care along the continuum of care for MNCH; improve the quality of delivery and use of essential interventions and packages to achieve sustainable impact at scale; and work to eliminate coverage disparities related to gender, residence, and socio-economic classification. The overall expected outcome is the achievement of a national scale-up of PIHI at the community and health facility levels, including both public and private health providers. ANCRE will achieve this by accomplishing the following Intermediate Results (IR) within USAID/Benin’s GHI Country Strategy (see page 11): IR 1. Improved public health sector performance in delivering integrated family health services

ANCRE will focus on working with the MOH, particularly the Directorate for Mother and Child Health (DSME) to introduce, scale up and evaluate the potential of new and/or promising implementation solutions that address key gaps in policies and programs to improve the delivery and use of PIHI. In short, ANCRE will strengthen operational strategies to increase equitable access to PIHI across Benin in both urban and rural environments; improve the coverage and quality of PIHI provided by health care workers at all levels including the professionalization of community health workers (CHWs); strengthen the management and support systems for PIHI delivery at the community and health facility levels in up to ten designated Health Zones; and support the inclusion of high impact services under PIHI into the developing, national list services covered by the universal health care (RAMU) package.


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IR 2. Improved private health sector performance in delivering integrated family health services

Under this IR, ANCRE will provide support and technical assistance to expand PIHI services to highly frequented private sector care providers, particularly in urban areas. PIHI will be assessed and modified, if necessary, for the private sector, focusing on quality improvement, AMTSL, essential obstetric and newborn care, and post-partum family planning counseling, among others. Furthermore, ANCRE will help DSME establish a PIHI accreditation system for private health services and improve coordination with the District Health Teams

IR 3. Improved prevention and care-seeking behavior of an empowered population

USAID/Benin recognizes the central role women play in maintaining family health in both the home and in the community and the influence by the social support of their male partners and persons of authority. Under this IR, ANCRE will conduct an analysis in order to better understand gender and cultural constraints to health care and assist the MOH to tailor interventions accordingly. ANCRE will work with the DSME and partners in the field to monitor the delivery of an integrated communication strategy for PIHI and document and position for scale-up successful approaches.

The recipient of the ANCRE award will work hand in hand with the MOH/DSME, USAID/Benin’s Family Health Team (FHT), as well as Mayors’ offices, District Health Teams, health providers, and pre-identified local NGO partners in the 10 designated health zones. The recipient will be a key partner within a wider community of USAID-supported projects and activities as its role is primarily technical assistance. Ensuring government ownership and accountability at all levels of the health system —from development to implementation—is critical to this project in order to influence government planning and resource allocation process. Successful collaboration among different departments of the MOH and various partners in Benin will increase the impact of ANCRE and other project investments.


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A.2 BACKGROUND Brief Introduction to Benin Benin has enjoyed political stability and democracy for 20 years and has recently embarked on a major effort to accelerate its economic growth. However, key economic and social challenges remain. The Republic of Benin is one of the poorest countries in the world, ranking 167th among 187 countries on the United Nations Development Program's 2011 Human Development Index. Despite a gross national income (GNI) per capita of US$1,5101, roughly 37 percent of the population lives on less than $1.50 per day2. In 2012, Benin’s population was estimated to be 9.4 million3, of which approximately, 44% are under the age of 154. Rapid population growth is evidenced by the population having tripled since independence in 1960. Although currently predominantly rural with 53 percent of the population residing in the rural areas5, the population of Benin is projected to become a majority urban country by 2017. The situation of generalized poverty, coupled with incomplete access to an improved water source (71%, DHS, 2006) and overcrowding under unsanitary conditions takes a heavy toll on the health of the people living in those areas. A critical challenge to Benin's development prospects will be the ability of the Government of Benin (GOB) to support current programs designed to improve the health status of the population. The health of women and the above average growth of the urban population compound the struggle to increase access to high quality, effective health care. Statistics on the status of health and education, although improving over the past decade, still reflect a low level of human development. Latest estimate of life expectancy is 54 years for men and 60 years for women6. Education levels are low – six in ten women and three in ten men have had no schooling7, resulting in a literacy rate of 28% for women and 55% for men. In 2011, the infant mortality rate was 68 per 1,000 live births and the under-five mortality rate was 106 per 1,000 live births8. In 2006, the maternal mortality ratio was 397 per 100,000 live births (2011 DHS data will be available in March 2013)9. The total fertility rate (TFR) for Beninese women remains high at 4.9 births per woman, and modern contraceptive prevalence for women increased only slightly from 6.1 percent in 2006 to 7.9 percent in 20115. Less than half of children under the age of two years are fully vaccinated5. Malaria remains the number one killer of children under-five and is a common condition afflicting many mothers and pregnancies each year. It constitutes more than 40 percent of all out-patient consultations in health facilities, and 22 percent of all hospital admissions. The HIV/AIDS epidemic in Benin has been stable at 1.2 percent adult prevalence over the last five years. A.2.1 Overview of Benin’s Health Sector Politically, Benin is divided into 12 departments (average of 650,000 inhabitants per department), 77 communes and three urban areas (Cotonou, Porto Novo and Parakou), 546 arrondissements, and 3,747 villages. The Ministry of Health divides the country into 34 health zones, each covering an average of 262,000 people (range from 84,000 to 492,000). Each health zone serves one to four communes (average of two per health zone).

1 Based on Purchasing Power Parity methodology, World Bank, July 1, 2011 2 INSAE, 2010 3 World Bank estimate 4 2011 PRB World Population Data Sheet 5 2011 Preliminary DHS 6 2009 World Health Statistics 7 2011 Preliminary DHS 8 2012 UN Levels and Trends in Child Mortality Report 9 2006 DHS


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The GOB has made an effort to improve the health of its population. National policies favor the poor: the PIHI, an indigent fund, free caesarians, and free malaria treatment of children under-five and pregnant women have been instituted to make services affordable to them. Additionally, in April 2012, the president launched the RAMU to finance the costs of health care of all Beninese. The structure of the health system ensures access to health services in all arrrondissements of the country. With the current emphasis on decentralization and performance-based management, communities and health zones have the chance to shape, manage and monitor health services that they need. Benin’s public health system has a pyramidal structure with three levels: Central: Ministry of Health and its central Directorates; one National Referral Hospital (Centre

National Hospitalier et Universitaire)

Intermediate: Departmental Directorates for Health, Departmental referral hospitals (Centres Hospitaliers Départementaux); there are only six functioning referral hospitals nationwide

Peripheral: Health zones which include the following health facilities: Zonal hospital (Hôpital de Zone; HZ), District Health Centers (Centre de Santé de la Commune; CSC), Community Health Centers (Centre de Santé d’Arrondissement; CSA), private health facilities, and village health units. In practice, not all health zones have a functioning zonal hospital

A.2.2 Community Health Workers: According to the National Directives, there should be one CHW for every 30-50 households, depending on the physical access of the community to a health facility. According to the MOH, there are over 8,000 documented CHWs offering a range of services including case management of malaria, diarrhea, and pneumonia, and maternal and newborn care, family planning, TB and HIV/AIDS care. Many of them were established in the past five years under UNICEF, USAID, and Global Fund malaria programs. The system is fragmented with various approaches and degrees of quality for supervision, community participation, reporting, motivation and supply chain management in place. In recognition of this fragmentation, national revision of the Community Health Directives is underway. A.2.3 Private Health providers: Since 1997, Benin has experienced an explosion of growth in private health sector practice. According to the 2012 Benin HS 20/20 health systems assessment, there are over 18,000 health providers working in the private sector. The majority of private clinics are not registered due to restrictive regulatory and licensing processes and limited incentives for registration among private providers. There are a few networks of licensed private providers including AMCES, ProFam and a Professional Association of Private Providers. National medical professions’ associations license pharmacists, doctors, nurses and midwives working in Benin.. The MOH is authorized by law to work with licensed facilities and practitioners, but not unlicensed ones. This is a potential obstacle, as the unauthorized private sector is an important source of care for the poor. During the 24-month period between 2008 and 2010, health services were unavailable to the public due to MOH strikes and demonstrations for an estimated total of three months. When such events occur, the private sector is the only recourse for basic health services to be delivered to the Beninese population, including mothers and young children.


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A.2.4 Health Sector Challenges Benin has made some commendable progress in health care services, as demonstrated by positive gains in health indicators such as the use of Active Management of Third Stage Labor (AMTSL), utilization of long lasting insecticide-treated bed nets (LLINs) among pregnant women and children under-five, and gains in presumptive treatment for malaria among pregnant women. However, many indicators have been stagnant or decreasing over the past decade, notably vaccinations, family planning, nutrition and sick child care-seeking as demonstrated by the DHS surveys from 2001 to 2011. Benin shares with most developing countries these key challenges: 1) an acute health worker crisis – both in terms of absolute numbers and professional qualifications; 2) limited leadership and management skills of Health Zone and departmental supervisors; 3) weak supply chain management, especially at the health zone level where product stock-outs and leakages are common; 4) an ineffective health management information system, especially in routine monitoring and data quality; and 5) incomplete implementation of national policies and treatment protocols. Capacity constraints of the public health sector remain one of the major obstacles to development. Although Benin has a good distribution of health infrastructure across the country (77 percent of the population lives at less than 5 km from a health establishment), insufficient planning and management capacity, poor infrastructure, shortages of medicines and supplies, and a lack of emergency transport limit utilization to only 44 percent of the population. There is an acute shortage and mal-distribution of health care workers, to the detriment of those in the most remote communes. Irregular leadership, management and governance at every level; limited accountability of health workers and health facilities; lack of adequate mechanisms for ensuring affordability; and underfunded health facilities and high-impact interventions due to low levels of health financing and inefficiencies in resource allocation continue to plague the system. Overcoming these challenges will require an enabling policy environment that allows for a decentralized management of sustainable family health services and the coordination of donors and private sector providers. Improvements in access, quality, and demand for services will lead to the increased use of services. This expanded use of a package of family health services will result in a healthier population and a strengthened human resource base, thereby contributing to reduced morbidity and mortality. Services must be delivered in a manner that is respectful of the client, while promoting confidence in the safety and effectiveness of services. Affordable services and products must be available; and the customer must be aware of their location and know the benefits of services and products prior to adopting and purchasing them. A.2.5 Government of Benin’s Health Policies and Maternal and Child Health Strategy The Government of Benin's health sector strategy is described in the ten-year National Health Development Plan (Plan National de Développement Sanitaire, PNDS), a policy document to guide health efforts during 2009-2018. USAID/Benin’s investments in integrated family health respond directly to this plan, which states that:

“By 2025, Benin will have a performing health system based on public-private, individual and collective partnerships offering continuous, quality health services that are accessible and equitable to all segments of the population, rooted in the values of solidarity and risk sharing to meet the health needs of the Beninese people.”


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The plan specifically spells out the GOB's health priorities: to achieve universal access to and improve quality and coverage of services leading to significant and lasting reductions in infant, child and maternal mortality. The documents that govern the organization, functions, programs, and financing of the MOH and the practice of medicine are embodied in laws, health plans, and policies. These have been updated from time to time in Benin’s history to ensure that the health system respond to the emerging needs of the country. In addition to the National Health Plans, programs such as malaria, maternal and child health, the expanded program of immunizations, family planning and reproductive health, and HIV/AIDS have their own specific plans covering specific periods of time. Benin's three-year operational plan for 2010-12, the Plan Triennal de Développement Sanitaire, focuses on the delivery of the package of low-cost, high-impact interventions (PIHI). In 2010, the GOB issued the Cadre de Dépenses à Moyen-Terme, 2010-2012, an attempt to assign costs needed to achieve different scenarios to the achievement of the MDGs. This was followed in early 2011 by a five-year plan (Plan Opérationnel de la Mise à l'Echelle Nationale des Interventions à Haut Impact sur la Mortalité Maternelle, Néonatale et Infanto-juvenile, 2011-2015) to bring to scale a package of high-impact (PIHI) interventions to accelerate reductions in maternal, neonatal, and child mortality in time for the deadline on the MDGs. Preceding the PIHI were several GOB policy initiatives that were designed to increase access to health services to all Beninese. These include: 1) free or heavily subsidized caesarean sections, 2) a waiver of user fees for children under-five who consult public sector facilities, 3) reinforcement of health financing schemes, 4) creation of an Indigent Fund to provide free health services to the extremely poor, and 5) revitalizing primary health care (PHC) by increasing the number of community health workers (CHWs) and improving their capacity to promote PHC and treat common diseases at household and community levels. The role of CHWs is being enhanced by piloting contract arrangements between local government and CHWs in the delivery of health services and by expanding the range of services and family planning commodities they offer. A.2.6 USAID’s Health Program in Benin For the next five years, USAID/Benin’s Integrated Family Health Program (IFHP) will focus on improving the health status of Beninese families by strengthening public sector, private sector and community-level responses for a more effective and efficient approach to sustainable health outcomes that will ultimately save lives. The program serves as the implementation plan for the GHI Country Strategy 2011-2016 for Benin, which aims to achieve specific and measurable health goals. The GHI and the IFHP build on the achievements of USAID’s past and existing health programs, which have successfully improved health systems and services throughout Benin. These past efforts emphasized institutional capacity building; delivery of integrated family health services; quality improvement, social marketing; community case management of childhood illness; and behavior change communications. These projects worked across a range of malaria, family planning, maternal and child health, infectious diseases, and HIV/AIDS and were evaluated in January 2011. Lessons learned from the evaluation are incorporated into future USAID/Benin implementation plans. GHI/Benin concentrates health investments in three program areas: malaria prevention and control, maternal, newborn and child health (MNCH) and reproductive health/ family planning (RH/FP), with efforts focused on mortality reduction and energizing the achievement of the MDGs. Under the GHI Country Strategy, USAID/Benin will continue to work closely with the MOH to improve basic health


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services nationwide, but will also invest in engaging the private sector as a significant and growing sub-sector that can help accelerate achievement of health improvement targets. Health activities focus on 1) improving public health sector performance in delivering integrated family health services; 2) improving private health sector performance in delivering integrated family health services; and 3) improving preventive and care-seeking behaviors of an empowered population. Supporting the above are two cross-cutting GHI principles: building sustainability through health systems strengthening (HSS); and focusing on women, girls and gender equality (WGGE). ANCRE will be a principal mechanism under USAID/Benin Integrated Family Health Program to bring technical assistance for health systems strengthening as it relates to PIHI with an emphasis on MNCH and FP/RH and will ensure the implementation of the following intermediate results and sub-results across the overall GHI/Benin Results Framework:

IR 1. Improved public health sector performance in delivering integrated family health services ‐ Sub-result 1.1. Improved planning and management of health systems and services

especially at decentralized level ‐ Sub-result 1.2. Improved quality service delivery, especially for women and

young children, at public health facilities ‐ Sub-result 1.3. Essential commodities more available at service and product

delivery points IR 2. Improved private health sector performance in delivering integrated family health services

‐ Sub-result 2.1. Improved public sector policies, oversight, and supervision of private sector service delivery

‐ Sub-result 2.2. Improved quality service delivery, especially for women and young children, at private health facilities

IR 3. Improved prevention and care-seeking behavior of an empowered population

‐ Sub-result 3.1. Increased appropriate health-promoting behaviors made by households and especially women

‐ Sub-result 3.2. Informed families make appropriate choices on accessing public and private health services and commodities

‐ Sub-result 3.3. Strengthen community-level contribution to health sector decisions and financing10

A.2.7 High Impact Interventions Package/Paquet d’Interventions à Haut Impact (PIHI) in Benin PIHI, a package of scientifically-proven, high-impact and low-cost interventions proven to save the lives of mothers, newborns and children, focuses on a continuum of care from the mother to the newborn and child. The package includes interventions in maternal and child health, nutrition, HIV, water, and hygiene and sanitation to be implemented at the each level of the health pyramid (household/community, intermediate, and central). Each of the three health system levels has a role to play in the implementation and scale-up of PIHI. The national (central) level is charged with developing policies and strategies by setting national priorities, defining norms and standards, mobilizing resources and coordinating the implementation of activities. At the departmental level, facilitation and technical assistance is provided for: planning, supervision and

10 No specific activities are planned under ASSIST towards this sub-intermediate result of USAID/Benin’s Integrated Family Health Program.


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coordination of activities as well as support to training, monitoring and evaluation of health interventions. The health zone is the operational level where activities are realized. Under the National Operational Plan to Scale-up High Impact Interventions (Plan Opérationnel de la Mise à l’Echelle Nationale des Interventions à Haut Impact sur la Mortalité Maternelle, Néonatale et Infanto-juvenile, 2011-2015), the objectives for PIHI are: 1. To reach 90% of mothers and newborns by 2015 with the entire package of high-impact interventions

to reduce maternal and neonatal mortality taking into account the following factors: Focus on the interventions identified as weaknesses according the continuum of care steps

The integration of interventions for newborns, especially in in the delivery and post-partum periods

An emphasis on the community level during implementation 2. Ensure 100% of obstetrical complications presenting in health centers are managed through

Essential/Emergency Obstetric and Neonatal Care. Current Status of PIHI Implementation: In 2011, the Ministry of Health held a workshop to review the progress of the national strategy. The review concluded that although the vision is clearly expressed and harmonized with the GOB’s health needs, efforts made to date are still insufficient to face the challenges ahead and an environment conducive to the health of mothers and newborns has not been sufficiently created. To date, the private sector has not been included in the strategy or roll out of PIHI. Annex A presents the results of a 2011 rapid review of Benin’s National Strategy to Reduce Maternal and Neonatal Mortality (“Revue Rapide de la Stratégie Nationale pour la Réduction de la Mortalité Maternelle et Néonatale au Bénin, November 2011). Challenges of Implementing PIH: Challenges on the GOB side stem from an inadequate capacity for coordination and a weak health system. MOH staffs are often not motivated and are not held accountable for their performance. Recurrent health worker strikes in the recent past have paralyzed health facilities and/or the MOH itself. In addition to human resource issues, the health information system is not efficient; data are delayed, incomplete, and often not reliable. The management of the health commodities supply chain is also weak, resulting in pilfering, stock-outs, and expiration of drugs. To deal with these inefficiencies, partners have developed multiple parallel systems for commodities, services, and information management. Other important health system challenges are related to a poor communication system, lack of real decentralization, weak absorptive capacity of the health budget, and the low quality and insufficient availability of services. Bringing PIHI to a national scale requires that a number of conditions be met, including:

o Reducing the gaps in human and material resources throughout the health system (inadequate and poor distribution of qualified personnel and problems with logistics)

o Improving the governance of the health system at all levels (problems with management not linked to results, insufficient leadership and ownership at all levels)

o Full respect of the operational mechanisms o Development of the technical newborn care component o Ensuring that monitoring, evaluation and coordination tools are in place at all levels o Mobilization and transparent management of additional financial resources o Ensuring equity (coverage/extension activities)


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A.2.8 USAID/Benin and PIHI The following activities and interventions within the PIHI were strategically selected as priority intervention areas for ANCRE. These interventions were chosen to target the most severe health problems, taking into account their cost, institutional feasibility and potential high impact on mortality, morbidity and quality of life.

Integrated case management of sick children (IMCI), including malaria, diarrhea and ARI/pneumonia at the community level and peripheral health units

Assisted deliveries with AMTSL Case management of low birth weight newborns Nutrition promotion in mothers and young children under two Essential and emergency obstetric and newborn care (EONC and EmONC; SONU in French –

Soins Obstétricaux et Néonatals d’Urgence) Contraceptive security Increased men’s participation in family planning Access to long-term methods of family planning Post-partum family planning

Focused prenatal care (with IPT2, VAT2 and PMTCT where available) Prevention of mother-to-child transmission of HIV (PMTCT), including testing, counseling,

Nevirapine administration, and newborn feeding counseling Complete vaccination of children (Diphtheria/Tetanus/Pertussis [DTaP] 1-3 ; Hep B; Polio 0-3;

measles) and newly introduced vaccinations such as the meningitis A vaccination campaign in November 2012

(Annex C provides a snapshot of the overlaps between the National Health Plan PIHI interventions and GHI Country Strategy)


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B. PROGRAM GOAL, OBJECTIVES AND PROPOSED RESULTS The goal of ANCRE is to support the MOH’s Direction de la Santé de la Mère et de l’Enfant (DSME) to effectively scale up PIHI. While ANCRE will influence all levels of the healthcare system, it is essential that the project maintain very strong relationships with the DSME and close collaboration and coordination with other MOH units including the DNSP, NACP and the NMCP. ANCRE will help the MOH implement PIHI in a viable, harmonized manner, and such success depends not only on understanding the entire health “eco-system” (public and private, rural and urban), but also on understanding the objectives of the GOB in adopting PIHI. Moreover, ANCRE should reinforce existing systems without inventing parallel ones to improve overall quality of services, adoption of respectful care and achieving efficiencies. The recipient of the ANCRE award will also work hand in hand with USAID/Benin’s Family Health Team (FHT), as well as Mayors’ offices, the District Health Teams, health providers in the 10 designated health zones. The recipient must be a key partner within a wider community of USAID-supported projects and activities described in section D. Ensuring government ownership and accountability at all levels of the health system —from development to implementation—is critical in order to influence government planning and resource allocation processes. B.1 Program Objectives and Proposed Results To achieve the overall expected outcome of national scale-up of PIHI at the community and health facility levels, including both public and private health providers, the following results must be accomplished:

1. Strengthened operational strategies to increase equitable access to PIHI across Benin 2. Improved coverage and quality of PIHI provided by health care workers at all levels of the public

health system and within the private health system 3. Strengthened supporting management systems for the delivery of PIHI at the community and

health facility levels in designated Health Zones 4. Increased support for the inclusion of high impact services under PIHI into the developing,

national list services covered by the universal health care (RAMU) package 5. Expanded PIHI services to the highly frequented private sector, particularly in urban and peri-

urban areas 6. Timely and appropriate technical assistance given to the DSME to establish a PIHI accreditation

system for private health services 7. Obstacles analyzed to better understand gender and cultural constraints to health care and to tailor

interventions accordingly 8. Coordinated partnership between the DSME and field implementers to ensure the delivery of an

integrated communication strategy These results are further described below and presented within USAID/Benin’s GHI strategic framework. B.1.1. IR 1: Improved public health sector performance in delivering integrated family health services Strengthening the public health system is at the core of this IR. It directly targets health system strengthening, focusing on improving basic health services nationwide and investing in engaging private health providers as a significant and growing sub-sector that can help accelerate achievement of health. ANCRE’s work under IR 1 will focus on working with the MOH/DSME to introduce, scale up and evaluate new and/or promising implementation solutions that address key gaps in policies and programs to improve the delivery and use of PIHI. In short, ANCRE will strengthen operational strategies to increase equitable access to PIHI across Benin; improve the coverage and quality of PIHI provided by health care workers at all levels of the public health system and within the private health system;


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strengthen the supporting management systems for the delivery of PIHI at the community and health facility levels in designated Health Zones; and support the inclusion of high impact services under PIHI into the developing, national list services covered by the national health insurance (RAMU) package. Initially, the team leading ANCRE will conduct a needs-assessment on PIHI in both urban and rural Health Zones. By meeting with key stakeholders and understanding the entire PIHI “context,” the team will be able to assess where the real opportunities and gaps are in terms of creating a strong and sustainable national scale-up of PIHI. Illustrative activities that ANCRE may include following the findings of the assessment may include but not limited to: facilitating quality improvement approaches for PIHI performance; strengthening routine health information system and data-based decision making at all levels; expanding the package of high impact interventions offered at the community level and advocacy for PIHI within all levels of RAMU. It is expected that ANCRE will strengthen supply chain management capacity at CAME as well as the National Programs for Maternal and Child Health and Immunization at the central level, and the zonal warehouses nation-wide for reproductive, maternal and child health commodities. This will include strengthening the supply chain MCH and FP/RH supplies for the private sector. Illustrative Activities under IR 1 include:

B.1.1.IR 1.1 Improved planning and management of health systems and services especially at decentralized level Provide technical assistance to the MOH to support national scale-up of PIHI, including

rationalization of community health service delivery Provide technical assistance to the MOH’s family planning program to offer a wider range of

contraceptives at the health center and community levels (e.g. injectable contraceptives by CHWs and implants at health centers)

Provide technical assistance to the MOH’s immunization program to prepare for the introduction of new vaccines against pneumococcus and rotavirus for children in Benin

Inform the package of health services for inclusion in RAMU Strengthen the National Health Information System, including routine data collection at health facilities and CHWs, validation, analysis and presentation of data for decision-making at all levels,

as well as supports the provision of appropriate information technology to enable timely transmission and analysis of data at the peripheral level (health facilities and local health departments)

Support decentralized planning and resource mobilization around PIHI, involving commune leaders and civil society organizations in the designated 10 Health Zones

B.1.1.IR 1.2 Improved quality service delivery, especially for women and young children, at public health facilities

Provide technical assistance to MOH to operationalize PIHI at the public health facilities and community levels in the 10 designated health Health Zones in both urban and rural settings

Enhance the skills of public health care providers for focused antenatal services, with the use of Active Management of the Third stage of Labor (AMTSL), to prevent postpartum hemorrhage as a core element in reducing maternal deaths and Essential/Emergency Obstetric and Neonatal Care (EONC/EmONC) to ensure essential care for pregnant women and newborns through support of training, coaching and supportive supervision


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Advocate and support the MOH to scale-up new high impact interventions by CHWS as applicable (e.g. injectable contraceptives and essential newborn care)

Support the application of new approaches to enhance respectful maternal care by health workers to improve demand for early antenatal care, delivery assistance, and post-partum period stays of at 48 hours after delivery

Promote quality improvement approaches and supportive supervision of health care workers to ensure that essential norms and standards of care are provided among PIHI services.

Provide technical and financial support to pre-service training institutions to incorporate quality improvement approaches into the curricula

B.1.1. IR 1.3 Essential commodities more available at service and product delivery points Strengthen supply chain management capacity at CAME as well as the national programs for

immunization and MNCH at central level and zonal warehouse nationwide Support contraceptive security planning, reporting and coordination efforts at the national and

zonal levels (including the use of MEDISTOCK) to improve coordination and prevent stock-outs as demand increases for contraceptive and maternal health products

Institutionalize essential MNCH commodity availability within the MOH/DSME, including quarterly contraceptive security reporting

Indicators pertaining to ANCRE under IR 1 and all its sub-IRs include: Modern contraceptive prevalence rate Couple-years protection in USG-supported public sector programs Percent of USG-assisted service delivery sites providing family planning counseling and services Percent of children who received DPT3 vaccine by 12 months of age Non-polio acute flaccid paralysis (AFP) rate Percent of births attended by a skilled doctor, nurse or midwife Percent of deliveries using AMTSL in USG-assisted departments Number of health zones staffed and equipped to provide EmONC Percent of Health Zones reporting morbidity and mortality indicators to the national program on a

monthly basis during the previous 12 months Number of USG-assisted health zones correctly quantifying MNCH and FP/RH commodity needs

according to procurement protocols B.1.2. IR2: Improved private health sector performance in delivering integrated family health services Enabling private and NGO health providers to deliver consistent, high quality services is central to this IR. The private health care sub-sector is an increasingly important source of health care for the Beninese. Its potential to improve the health status of Beninese families is enormous, and its coverage of services rises to 60-70 percent of care provided nationally when the public health sector is on strike. The size of the target group of private sector and NGO health providers in Benin is currently unknown, as it is a mix of large private hospitals run by faith-based organizations, private clinics run by licensed health practitioners, pharmacies and dispensaries, unlicensed traditional practitioners, and itinerant service providers and drug vendors (mostly unlicensed). Building on the findings from USAID’s 2006 Health System Assessment and the private sector census commissioned by the European Union (8ème Fonds Européens de Développement), USAID has engaged the Strengthening Health Outcomes through the Private Sector (SHOPS) project to assist the MOH map and quantify private sector providers. Working from the results of this work, ANCRE will be able to provide support and technical assistance to scale up the delivery of PIHI in private health services. PIHI will be assessed and modified, if necessary, for the private sector, focusing on quality improvement,


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AMTSL, essential obstetric and newborn care, and post-partum family planning counseling, among others. Furthermore, ANCRE will help the MOH establish a PIHI accreditation system for private health services. Illustrative Activities under IR 2 include:

Build the capacity of the GOB/MOH to engage private health providers using successful quality assurance models and to engage private health sector providers to follow national policies on PIHI

Facilitate the alignment of clinical practices and standards of both the private and public sectors along the lines of best practices recommended by WHO or UNICEF

Improve private provider’s understanding of government standards and provider rights and responsibilities and include the private sector

Facilitate representation of the private sector in health policy dialogues

B.1.2. IR 2.1 Improved quality service delivery, especially for women and young children, at private health facilities

Mentor and provide technical assistance and exchange visits will be organized in collaboration with other donors and Beninese health professional associations to upgrade the capacity of Benin’s private health sector to deliver high impact MNCH, RH/FP interventions under PIHI

Continue the scale-up of AMTSL, EONC, and post-partum family planning counseling through expansion of PIHI implementation in the private sector

Support the application of new approaches to enhance respectful maternal care by health workers to improve demand for early antenatal care, delivery assistance, and post-partum period stays of at 48 hours after delivery

Indicators pertaining to ANCRE under IR 2 and all its sub-IRs include:

Couple-years protection in USG-supported private sector clinics Percent of assisted deliveries using AMTSL in USG- supported private clinics Percent of births delivered by caesarean section Percent of USG-supported private service delivery sites providing family planning counseling and

services

B.1.3. IR 3 Improved prevention and care-seeking behavior of an empowered population This IR focuses on activities that will positively influence decisions and actions taken by individuals, households and communities to improve or maintain health. USAID/Benin’s Integrated Family Health Program (IFHP) seeks to increase: complete antenatal care attendance (four visits) among pregnant women; skilled delivery attendance; postnatal check-ups of newborns within first two days of birth; full vaccination coverage for children by their first birthdays; timely care seeking for sick children; and increased use of modern contraception among women of reproductive age. USAID/Benin recognizes the central role women play in maintaining family health in both the home and in the community. Further, care-seeking behaviors of women are largely influenced by the social support of their male partners. Assessing gender norms, expectations, and roles and responsibilities can help lend insight and overcome bottlenecks that may crop up in the project’s lifetime. Gender integration will be important for overcoming these bottlenecks. Gender integration entails the identification and subsequent treatment of gender differences and inequalities during program/project design, implementation, monitoring, and evaluation. The project activities will include gender-sensitive indicators and sex-disaggregated data for all activities in which the anticipated results would affect women and men differently and where the different roles and status of women and men within the community, political


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sphere, workplace, and household affect the activities to be undertaken. The recipient will be expected to develop strategies to monitor gender-based inequities and promote solutions to inform approaches implemented by USAID/Benin’s community health partners. Overall, they are expected to demonstrate positive health benefits for women, and both girl and boy children under five. The social mobilization and health communications work will carefully analyze gender considerations and will focus around MOH’s community strategy for PIHI. USAID/Benin will establish innovative systems to implement community health promotion for preventive behaviors and appropriate and timely care-seeking practices as articulated in the PIHI community guidelines. ANCRE will work with DSME and partners in the field to ensure the delivery of an integrated communication strategy for PIHI and effective implementation of the package itself. Illustrative activities under IR 3 include: B.1.3. IR 3.1 Increased appropriate health-promoting behaviors made by households and especially women

Support the Directorate of Public Health (DNSP) to maintain a catalogue of effective, field-tested health communication materials

Provide technical assistance to the DNSP and supporting MOH programs and partners for develop an integrated communication strategy for the full PIHI package

Provide technical assistance to national working groups to develop and strengthen guidelines for health promotion messaging and approaches

Assess and document successful and promising approaches for scale-up with the MOH

B.1.3. IR 3.2 Informed families make appropriate choices on accessing public and private health services and commodities

Conduct gender and cultural belief analysis around PIHI related behaviors Strengthen Community Health Worker Support Systems through periodic system assessments (to

identify bottlenecks in selection, training, supplies, motivation, M&E, and quality of care) and participatory action planning with District Health Teams, Mayors offices and other key stakeholders

Pilot conditional cash transfers, vouchers and/or other financial incentives to help cover household costs for transportation and treatment to improve access to care

B.1.3. IR 3.3 Strengthen community-level contribution to health sector decisions and financing

No specific activities are designated under this mechanism Indicators pertaining to ANCRE under IR 3 include:

Percent of Health Zones with functional CHW systems Percent of births receiving at least 4 antenatal care visits during pregnancy Percent of newborns receiving postnatal health check within first week by a CHW or other trained

health worker In addition to the indicators presented above, the implementing partner will be expected to develop indicators for and report on service integration, gender considerations, environmental protection, sustainability, and other program activities. The illustrative indicators may change in the life of the program.


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C - STRATEGIC AND PROGRAM PRINCIPLES Increasing access to and utilization of PIHI services by the targeted populations will be guided by a set of principles linked to USAID/Benin’s GHI Results. Program strategies and approaches shall be guided by and must reflect the following principles: C.1 Cultural and Regional Considerations Benin is a complex and culturally diverse country. This reality can impact the successful roll-out and implementation of programs. The recipient is expected to demonstrate sensitivity and flexibility when taking into account the different regions of the country and their cultures, population size, and geographical makeup, while at the same time adhering to USG regulations and ensuring transparency in doing business. In Benin, the adult literacy rate is at 41 percent, well below the 63 percent rate for Sub-Saharan Africa11. Adult literacy for women aged 15 and older is just over 30 percent, far below the rate for all of Sub-Saharan Africa12. The mean number of years of schooling for adults is 3.3 years13. Thus, audio, such as radio programs, and visual health education materials with minimal text must be designed for a less than primary education attainment population. There are also a variety of languages and dialects spoken, including French, the official language, as well as Fon, Yoruba, Goun, Dendi, Bariba, Mena and others. Depending on where activities will take place, languages, and other socio-cultural issues will need to be adjusted to suit the needs of the targeted populations. Other issues include rapid urbanization; porous borders on all sides; importance of commerce, ports and trafficking to the economy; role of the unions; importance of the informal economy; and heterogeneity of country along with different preoccupations and concerns between north and south and rural and urban. C.2 Gender Differences in women’s and men’s roles and responsibilities and gender inequities in access to resources, information, and power are reflected in gender differences and inequalities in their vulnerability to illness, health status, access to preventive and curative measures, burdens of ill health, and quality of care. Increasing gender equity in the health sector is an important building block to health improvement and is a major concern of USAID. Traditional Beninese socio-cultural values are strongly pro-natalist – giving respect and status towards women who bear many children, while sterile women may be ridiculed. These values lead Beninese women to bear many children, which not only affects the health of mothers and children, but also substantially reduces women’s ability to engage in productive activities outside their home. Men are often resistant to or simply uninformed about family planning/child spacing. Activities and approaches must be properly tailored to meet all of these challenges. There are many barriers that stand in the way of women accessing care. Largely, women have less access and rights to livelihood assets than men. The low level of female literacy and low status of women in Benin are reflected in their health status. Longstanding cultural traditions and practices in Benin have disadvantaged women to the point that they do not have the power to seek the care, products and services

11 UNESCO, 2010 12 UNESCO, 2010 13 National Human Development Report for Benin, 2011


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that they need for themselves and their young children. For example, in December 2011, USAID/Benin supported a rapid reproductive and maternal health gender assessment which confirmed that men in Zou-Collines are the major decision-makers for seeking medical care outside the home and that women were uncomfortable discussing family planning with their husbands for fear of being rejected. If labor is prolonged, women are perceived to have had been unfaithful and are taken to spiritual healers for confession before being evacuated to a hospital. Physical violence against women, including rape, is common and often not challenged. These findings are generalizable to the wider Benin context. Access to health services by women and children is limited by factors such as husbands’ unwillingness to spend money on health services and women’s lack of decision-making and spending authority, together with the classic limiting factors of distance and the relatively high cost of services and medicines. Because men tend to hold the power in health decision-making and access to health services, working with, and including, men in the community will be key to this project. Targeting men, their parents (in-laws of women of reproductive age) and community leaders for longer-term changes in the distribution of power and decision-making around health will contribute to the growing number of activities in Benin that focus on improving gender equity. This is a long-term endeavor and it is not expected that this project alone will be sufficient to completely change these long-standing practices and attitudes. Factors within the health system also affect use of services, including disrespectful and unwelcoming treatment of women by health care workers, untidiness of health centers, the effects of class differences between providers and clients, and common factors like the lack of medicines and lack or absenteeism of competent personnel. Women’s access and participation in the health system, particularly in rural areas, are also limited. C.3. Involvement of Civil Society and Local Partners USAID/Benin highly encourages further appropriate linkages with local government, the private sector, civil society and communities. Building local ownership and increasing demand for relevant services are especially important to ensure program sustainability, equity, and community empowerment and involvement. Also, building effective partnerships with local groups is important to ensure an authentic, culturally appropriate, indigenous response. Participatory approaches are also needed to ensure that all appropriate community actors are engaged in program development and implementation. C.4 Sustainability The recipient should ensure that proposed activities in support of the technical areas are, to the extent possible, sustainable. Sustainability is not only financial; it also refers to the simplicity of management and culturally adapted approaches which are readily owned by the local people. By the end of the project, local stakeholders, from the MOH to the communities in the various health zones, should have not only improved health status but also an increased ability to maintain the progress that has been made. Project monitoring and evaluation should assess the effectiveness of the program by demonstrating that progress has been made and by the likelihood of continued progress. To ensure that activities undertaken in this project continue following its completion, the transfer of knowledge, capacity and responsibilities to public and private sector institutions is vital. ANCRE’s work with the public health sector is to be implemented within and through established government structures. Strategies and approaches must be developed from the onset that will ensure progressive takeover and long-term sustainability. The recipient shall implement measures to develop competencies among a number of Benin counterparts at all levels to ensure long-term sustainability for the project activities. As


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appropriate, government staff and private sector counterparts should be involved in such a way that they have the capacity to implement activities directly following the completion of the project. C.5 Innovation While innovation and adaptation of approaches is encouraged, it is not expected that this program include extensive operations research or pilot test new approaches. Its main function is to reach high coverage with existing proven interventions. All innovative or adapted approaches ANCRE wishes to introduce must be done in consultation with the MOH and USAID/Benin. C.6 Complementarity Collaboration is important among the various in-country partners and stakeholders. As noted earlier, this project is central to the achievement of Benin’s MDGs for health. This is an important aspect of the program since the MDGs commit the international community to an expanded vision of development, one that promotes human development as the key to sustaining social and economic progress in all countries. ANCRE aims to work with the variety of health partners present in Benin to ensure that collaboaration is occuring and make sure that unnecessary duplication is being avoided. Please see section D on Roles of Partners for more detailed information.


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D - ROLES OF PARTNERS As mentioned in Section B, the recipient of the ANCRE award will be expected to work hand in hand with the MOH/DSME, USAID/Benin’s Family Health Team (FHT) as well as the Mayor’s office, District Health Teams, and local NGOs and health providers in the ten designated Health Zones. In addition, the recipient must be a key partner within a wider community of USAID-supported projects and activities describe in this section.

D.1 Involvement of the MOH Collaboration among different departments of the MOH and various partners in Benin will increase the impact of Project investments. Support and commitment from the MOH is essential to the success of this project. The recipient should develop and maintain collaborative relationships to ensure ownership and support throughout all phases of planning, implementation and monitoring and evaluation. The ANCRE project implementer will work closely with the DSME’s office under the MOH. Benin’s DSME has a clear strategy and operational plan for the reduction of maternal and neonatal mortality through the scale up of PIHI. All activities implemented under this program should be consistent with MOH priorities and policies. Appropriate MOH and local government staff must be involved or consulted, as appropriate, in the implementation of the work plan.

D.2 Linkages with Other USAID/Benin Implementing Partners As part of ANCRE, the recipient shall work with partners and cooperating agencies to ensure all activities are clearly linked with or complementary to other activities concerning PIHI. Key targets for activity integration are other USAID and USG-funded partners in Benin to ensure there is a unified, consistent and technically sound approach to PIHI and complementary interventions. The recipient will be responsible for setting up a coordinating committee with key IFHP implementing partners to facilitate the synergy of selected PIHI activities. The coordinating committee must meet on a regular basis to ensure harmonization of activities. The recipient shall also link with appropriate private sector partners with the goal of increasing access to the key health services represented by this activity. Most importantly, ANCRE will need to collaborate and coordinate very closely with the following four projects: D.2.1 Leadership, Management, and Governance (LMG)

Like ANCRE, LMG will work with the MOH, but not specifically on PIHI issues. Through LMG, USAID/Benin will support a national, long-term strategy to build leadership, management, and governance capacity in the MOH, to be incorporated into all phases of development, implementation, and monitoring and evaluation of priority health programs in Benin. This initiative will be implemented by LMG in partnership with the Regional Institute of Public Health (IRSP). A 3-year initiative, LMG will offer core training and mentoring to managers and establish competency expectations/standards (e.g. at the end of this training, decentralized managers should be able to develop annual plans to budget, oversee essential commodities to avoid stock outs, oversee human resources to ensure compliance with standards of care).


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The work of LMG is initially targeted towards leaders at the centralized level for several MOH programs, including NMCP, DSME, DRH, DPP, and ANV (EPI). In year two, activities will be expanded to the six Department Medical Directors, select Zonal Medical Coordinators, and major private health facility managers and network leaders. Expected results include changes to human resources policies within the MOH that will create a motivated workforce; strengthened capacity within IRSP to develop and institute leadership, management and governance courses; the development of accreditation standards for leadership courses; conferences aimed at bringing together the public and private health sectors; and the establishment of coordinating bodies within the MOH to ensure adherence and also to introduce sustainability measures such as training of trainers and institutionalization into courses at IRSP. ANCRE will work closely with LMG to reinforce capacities at all levels of the health system.

D.2.2 Accelerating the Reduction of Malaria Morbidity and Mortality (ARM3)

ARM3 is a five year cooperative agreement to Medical Care Development International (MCDI), awarded in October 2011 to increase coverage and use of key life-saving malaria interventions in support of Benin’s National Malaria Strategy. ARM3 works to scale-up malaria control, accelerate the reduction of morbidity and mortality, and build local capacity for sustained control. ANCRE will collaborate closely with ARM3 to ensure the full integration of malaria control and prevention into the PIHI strategy. In addition, ARM3 and ANCRE will need to closely collaborate to strengthen the supply chain management capacity at CAME as well as the National Programs for Malaria, Immunization, and Maternal and Child Health at the central level, and the zonal warehouses nation-wide with ARM3 for malaria and ANCRE for FP/RH and MNCH commodities respectfully.

D.2.3 Community Health Service Delivery of PIHI Under an Annual Program Statement (APS), local NGOs will compete to implement the national PIHI behavior change strategy that will support individual behaviors and social change that lead to disease prevention and health maintenance, with a focus on child spacing and family planning, HIV prevention, antenatal care and maternal nutrition, skilled delivery assistance, post-partum and newborn care, breastfeeding and child nutrition, immunizations, diarrheal disease control, pneumonia care seeking, and malaria prevention (IPT, sleeping under nets) and care seeking within 24 hours of onset of symptoms. The scope will include: training local broadcasters; managing radio spot diffusion; organizing campaigns and other public health events; interpersonal communication skill building of social opinion leaders, CHWs, and health workers; dissemination of job aids; monitoring knowledge, attitudes and practice; and adapting messages and communication channels to improve gender sensitivity and effectiveness. These rolling grants will be delivered in the 10 designated Health Zones where ANCRE is expected to concentrate its efforts. ANCRE is expected to provide technical assistance to the DSME in providing guidance, monitoring and documenting promising approaches. ANCRE must establish a coordinated approach with these implementing local partners.

D.2.4 Health Financing & Governance (HFG)

This activity will provide technical support in the development and delivery of a strategy to advance a privatized health insurance system (RAMU), enhancing the GOB’s capacity to work with the private sector providers and banks; developing insurance collection and reimbursement; and, preparing policies and guidelines for reimbursement of procedures and services. HFG will support the professionalization and federalization of grass-roots mutuelles to provide a universal health insurance option for the population working outside the formal sector (as part of RAMU).

HFG will provide support in the implementation of financial instruments to offer high performing clinics’ credit following recommendations developed from the 2012 private sector assessment carried out by SHOPs described below. To update health care financing levels and sources information (last


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national account completed in 2008), USAID/Benin will also commission the Health Finance Group (HFG) to work with the Ministries of Health and Finance to conduct the financial assessment. ANCRE will work with the GOB and HFG to inform the PIHI for inclusion in RAMU, improve private provider’s understanding of government standards and provider rights and responsibilities and include the private sector, and include private sector in policy dialogues.

In addition, the recipient will need to stayed informed and incorporate, as relevant, findings, results, and best-practices from USAID/Benin’s other partners, namely: Strengthening Health Outcomes through the Private Sector (SHOPS)

SHOPs has recently completed a private sector assessment to identify strategic opportunities for strengthening public-private partnerships and the quality of service delivery in the formal private health care sector with USAID/Benin and its partners, including ANCRE. This assessment built on the 2006 health sector assessment conducted by USAID in Benin and will include an updated policy review including registration and accreditation, and management needs prioritization. This assessment identified gaps and areas in national guidelines that are impeding the wider coverage of the public and private sub-sectors. Recommendations are framed around the themes of improving public-private partnership, increasing registration of eligible providers, accreditation and performance based credits, and universal access and scaling-up PIHIA comprehensive mapping of the formal private sector services including registered pharmacies is planned in the coming months. ANCRE will use the results of the SHOPS work to provide support and technical assistance to scale up the delivery of PIHI in private health services.

WASHplus for urban water, sanitation and hygiene

WASHplus will establish innovative approaches to effectively improve water and sanitation in high risk urban populations and promote multi-sectoral action in collaboration with the city authorities, local health department, and UNICEF. Contributing to IR 3, “increased health-promoting behaviors,” USAID/Benin’s investment will focus priority neighborhood mapping, partnership building for multi-sectoral action to conduct a needs assessment and action planning, making water treatment products more available at points-of-use and hand washing with soap behavior promotion. USAID/Benin will leverage this experience to further shape its response to the urbanization of the population. The work of WASHplus in Benin will not only inform the ANCRE project but will also serve as the implanting body of WASH activities as part of the package of high impact interventions.

Support to International FP Organizations/Population services International (SIFPO/PSI) This is a three-year initiative to advance the ProFam network of private clinics initiated with USAID/Benin financial and technical support. SIFPO/PSI will play a complementary role to SHOPs in the realization of IR 2. Its objective is to improve delivery of reproductive and maternal health services among the ProFam franchise of 50 private clinics. The project will collaborate with UNFPA and the MOH to review and modify training and communication materials on maternal and newborn care and post-partum family planning. SIFPO will also assume social marketing of health products. It will train and mentor staff at ProFam clinics to integrate active management of third stage labor, essential newborn care and post-partum family planning counseling through expansion of PIHI implementation. Building on USAID/Ghana’s work, SIFPO/PSI will assess the feasibility and if appropriate, introduce vasectomy services to expand long term contraception options for men. SIFPO/PSI will take the lead in working with the MOH to develop an accreditation and performance recognition system for private clinics. Efforts will focus on strengthening the organizational capacity of the franchise with business and financial skill building to enhance its sustainability.


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Advancing Partners & Communities To support USAID/Benin in its efforts to efficiently channel an increasing level of funding to PVOs/NGOs and their partners in Benin and increase civil society participation, Advancing Communities will provide the following services: screen potential civil society recipients; organize information events about funding opportunities; contribute to the Annual Program Statements; manage the selection, vetting and award process; organize capacity building for local organization recipients as needed (e.g. work planning, results based management, best practices in reproductive health and family planning, gender analysis, and financial management). ANCRE will work in partnership with Advancing Communities and relevant PVOs/NGOs to strengthen PIHI integration and implementation at the community level.

Inform Decision-Makers to Act (IDEA)/Population Reference Bureau

To position Benin for reproductive health and family planning policy change, including making a wider range of services more accessible, USAID/Benin will invest in bringing RH/FP to the attention of decision makers and leaders from civil society, public sector and the development and donor communities to re-invigorate national family planning efforts to build demand and political commitment to improving the availability and use of modern contraceptives. This work will creating a multi-media feature piece on the key messages, hosting special events for its viewing and discussion, and orienting journalists on key issues and messages.

USAID/Benin also works with other partners to strengthen the health system and achieve project results. USAID/Benin works with the DSME, the NMCP and ANVSSP to directly co-fund integrated planning, supervision, roll-out of national training, and to collect and use data for national program management. Further, USAID/Benin partners with UNICEF to procure additional PMTCT kits for work to eliminate mother-to-child transmission of HIV and reduce AIDS-related maternal and child deaths and to improve vaccination coverage in priority Health Zones. The United States Peace Corps implements small-grant projects funded by USAID, focusing on MNCH, nutrition, water and sanitation, and HIV prevention. USAID/Benin is collaborating with UNFPA to double the number of women undergoing fistula repair with annual funding to support the women’s travel and other non-hospital expenses. USAID/Benin will continue to support the WHO’s polio surveillance activities through a grant to the Polio Eradication Program through the Africa Polio Grant. Under PMI, the Centers for Disease Control and Prevention (CDC) will source the resident malaria advisor and other international malaria expertise as needed. D.3 Involvement of Donors USG efforts are coordinated with other national and international partners, including civil society and private sectors, to ensure complementary investments and achievement of MDGs. USAID collaborates with major international donors supporting the Ministry of Health, including the World Bank, WHO, the Global Fund, UNICEF, UNFPA, the European Union, German Agency for International Cooperation (GTZ), the Dutch and French Development Agencies, Belgian Technical Cooperation, and Swiss Cooperation.


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E. Authorizing Legislation The authority for the Request for Applications (RFA) is found in the Foreign Assistance Act of 1961, as amended. F. Award Administration

22 CFR 226, OMB Circulars, and the Standard Provisions for U.S. Nongovernmental Recipients will be applicable. For non-U.S. organizations, the Standard Provisions for Non-U.S., Nongovernmental Recipients will apply. While 22 CFR 226 does not directly apply to non-U.S. applicants, the Agreement Officer will use the standards of 22 CFR 226 in the administration of the award. These documents may be accessed through the world-wide-web at: http://www.usaid.gov/business/regulations/ APPLICABILITY OF 22 CFR PART 226 (MAY 2005)

(a) The provisions of 22 CFR Part 226 and the Standard Provisions that will be attached to the agreement

upon award are applicable to the recipient and to sub-recipients which meet the definition of "Recipient" in Part 226, unless a section specifically excludes a sub-recipient from coverage. The recipient shall assure that sub-recipients have copies of all the attached standard provisions.

(b) For any awards or sub-awards made to Non-US organizations, the "Standard Provisions for Non-US

Nongovernmental Grantees" shall apply. All recipients are required to ensure compliance with monitoring procedures in accordance with OMB Circular A-133.

G. Audits It is a Federal statutory and regulatory requirement (see Section 641, Foreign Assistance Act of 1961, as amended, 22 CFR 226 and OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations) that all overseas programs, projects, activities, public communications, and commodities that USAID partially or fully funds under an assistance award or sub-award over $300,000 must complete an annual audit.

[END OF SECTION I]


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SECTION II – AWARD INFORMATION A. Estimate of Funds Available Subject to the availability of funds, USAID intends to provide approximately $10,000,000.00 in total USAID funding for the life of the activity. B. Type and Number of Awards Contemplated USAID/Benin anticipates awarding one (1) Cooperative Agreement resulting from this RFA to the responsible applicant whose application conforming to this RFA offers the greatest value (see Section I of this RFA) to the U.S. Government (USG). The U.S. 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. USAID reserves the right to fund any or none of the applications submitted. C. Period of Performance The period of performance anticipated herein is approximately four () years from the effective date of award. D. Substantial Involvement USAID/Benin considers collaboration with the Recipient crucial for the successful implementation of this program. A Cooperative Agreement implies a level of “substantial involvement” by USAID through the Agreement Officer’s Representative (AOR) or the Agreement Officer (AO). The intended purpose of USAID involvement during the award is to assist the recipient in achieving the supported objectives of the agreement. USAID/Benin’s Health Team expects active participation in certain programmatic elements of the program during the performance of the activities. The USAID/Benin’s Family Health Team has two full-time MNCH experts and a Commodities and Logistics Specialist on staff. Their technical knowledge in the areas of commodities logistics systems, activity implementation, and monitoring and evaluation is an essential resource for ANCRE, and the awardee can benefit from their expertise for the successful accomplishment of program objectives. Specific areas for substantial involvement in the form of collaboration or joint participation of USAID include:

a) Approval of the Recipient’s annual work plans that describe the specific costed activities to be carried out under the Agreement b) Approval of specified Key Personnel c) Agency and Recipient collaboration or joint participation

1) Approval of a monitoring and evaluation plan, with clear benchmarks and indicators, which shows that Recipient’s intermediate results are being attained, as laid out in a timeframe over the course of the Agreement


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2) Collaboration and concurrence, in close consultation with the GOB, in any proposed changes in geographic focus

3) Concurrence on the substantive provisions of sub awards

[END OF SECTION II] SECTION III – ELIGIBILITY INFORMATION A. Eligible Applicants Qualified applicants may be U.S. private voluntary organizations (USPVOs) and/or U.S., other non-U.S. non-governmental organizations (NGOs) or private, non-profit organizations (or for-profit companies willing to forego profits). In support of the Agency’s interest in fostering a larger assistance base and expanding the number and sustainability of development partners. B. Local Registration All local institutions or affiliates of international organizations must be registered as a legal entity in Benin. Local registration is not a requirement at application time, but it is required prior to the launch of program activities. C. Cost Share or Matching The required cost share for this award is Five Percent (5%) or $500,000 of the total estimated U.S. Government cost. In addition to USAID funds, applicants are required to contribute resources from their own, private or local sources for the implementation of this program. Contributions can be either cash or in-kind and can include contributions from the applicant, local counterpart organizations, program clients, and other donors (but not other U.S. government funding sources). Cost sharing contributions must be in accordance with OMB Circular A-122 – Cost Principles for Non-Profit Organizations which can be found at the following link http://www.whitehouse.gov/omb/circulars/a122/a122.html. Information regarding the proposed cost share should be included in the SF 424 (for U.S. organizations only) and the Budget as indicated on those documents. The cost sharing plan should be discussed in the Budget Notes to the extent necessary to demonstrate its feasibility and applicability to the activity.

[END OF SECTION III]


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SECTION IV – APPLICATION AND SUBMISSION INFORMATION A. POINT OF CONTACT Francine E. Agblo Acquisition & Assistance Specialist USAID/Benin Rue Caporal Bernard Anani 01 BP 2012 Cotonou, Benin Email: [email protected] and [email protected] Any questions concerning this RFA must be submitted in writing to Francine Agblo via internet at [email protected] and copy to Ms. Martina Wills, Agreement Officer, via email at [email protected] and to be submitted no later than 3:00 p.m. Cotonou, Benin local time on August 14, 2013. Oral explanations or instructions given before award will not be binding. Any information given to a prospective applicant concerning this RFA will be furnished promptly to all other prospective applicants as an amendment of this RFA. B. REQUIRED FORMS All Applicants must submit the application using the SF-424 series, which includes the: • SF-424, Application for Federal Assistance • SF-424A, Budget Information - Nonconstruction Programs, and • SF-424B, Assurances - Nonconstruction Programs C. PRE-AWARD CERTIFICATIONS, ASSURANCES AND OTHER STATEMENTS OF

THE RECIPIENT In addition to the certifications that are included in the SF 424, both U.S. and non-U.S. organizations (except as specified below) must provide the following certifications, assurances and other statements. Complete copies of these Certifications, Assurances, and Other Statements may be found as an attachment to this RFA. a. For U.S. organizations, a signed copy of the mandatory reference, Assurance of Compliance with Laws and Regulations Governing Nondiscrimination in Federally Assisted Programs. b. A signed copy of the certification and disclosure forms for “Restrictions on Lobbying” (see 22 CFR 227); c. A signed copy of the “Prohibition on Assistance to Drug Traffickers” for covered assistance in covered countries; d. A signed copy of the Certification Regarding Terrorist Funding required by the Internal Mandatory Reference AAPD 04-14; e. A signed copy of “Key Individual Certification Narcotics Offenses and Drug Trafficking”


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f. Survey on Ensuring Equal Opportunity for Applicants; and g. All applicants must provide a Data Universal Numbering System (DUNS) Number. D. APPLICATION PREPARATION GUIDELINES USAID will accept applications from the qualified entities listed in Section III A of this RFA. Applications may be submitted by institutions individually or in group. In the case of a group, the application must include only one prime applicant, which shall enter into sub-agreements or contracts with partnering institutions. In this case, the Prime Applicant(s) will be responsible for establishing and maintaining sub-agreement and/or contracting relationships with proposed partners. For the purposes of this RFA, the term “applicant” is used to refer to the prime and any proposed partners. 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. All applications received by the deadline will be reviewed for responsiveness to the specifications outlined in these guidelines and the application format. Section V addresses the technical evaluation procedures for the applications. Applications which are incomplete are not directly responsive to the terms, conditions; specifications and provisions of this RFA may be categorized as non-responsive and eliminated from further consideration. Applications shall be submitted in two separate volumes: (a) technical and (b) cost or business application. Technical portions of applications should be submitted in an original and two (2) copies and cost portions of applications in an original and one (1) copy. All copies of the technical and cost/business applications must be separately placed in sealed envelopes clearly marked on the outside with the following words "USAID Benin 680-13-000001 RFA Technical or Cost/Business (as appropriate) Application". These individual envelopes must then be bundled together to be received as one complete package. One CD with the same contents as the Technical and Cost Applications hardcopy must also be included in this package. The application should be prepared according to the structural format set forth below. Applications must be submitted no later than the date and time indicated on the cover page of this RFA, to the location indicated on page two (2) of the cover letter accompanying this RFA. Applications shall be prepared in English. Applications in any other language shall be treated as non-responsive and eliminated from further consideration. 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. Telegraphic, e-mailed or faxed applications are not authorized for this RFA and will not be accepted. Applications that are submitted late, incomplete or are considered to be non-responsive to this RFA may be eliminated from further consideration.


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E. TECHNICAL APPLICATION FORMAT The technical application will be the most important item of consideration in selection for award of this proposed program. The application should demonstrate the applicant’s capabilities and expertise with respect to achieving the goals of this program. Therefore, it should be specific, complete and concise and arranged in the order of the evaluation criteria contained in Section V. The Technical Application should not exceed 33 pages in length, exclusive of annexes and shall consist of the following sections: (1) Cover Page (1 page) (2) Application Executive Summary (maximum of 2 pages) (3) Program Narrative (maximum of 30 pages)

i) Technical Approach ii) Management and Institutional Capacity iii) Performance Monitoring Plan; and iv) Past Performance

(4) Annex i) Resumes & Letters of Commitment ii) Past Performance References

Page limitations are specified above for each section; applications must be in MS Word and/or Excel on letter paper (8-1/2 by 11 inch), single spaced, 11 pitch or larger type font “Times New Roman”, and have at least one inch margins on the top, bottom and both sides and tabs to distinguish each section. One CD with the same contents as the Technical Application hardcopy must also be included within the Original Application. Applications may contain matrices, tables and figures if they synthesize needed information. Applications may contain text boxes, and text may be in no smaller than 10-point font, as long as the boxes are formatted so as to not unduly interfere with readability. Cover pages, dividers, table of contents, graphs and attachments (specifically key personnel resumes (no more than 2 pages each), and letters of commitment, supporting documentations do not count within the 18 page limitation. Applicants who include data that they do not want disclosed to the public for any purpose or used by the U.S. Government except for evaluation purposes, should: (a) Mark the title page with the following legend: "This application includes data that shall not be disclosed outside the U.S. Government and shall not be duplicated, used, or disclosed - in whole or in part - for any purpose other than to evaluate this application. If, however, a grant is awarded to this applicant as a result of - or in connection with – the submission of this data, the U.S. Government shall have the right to duplicate, use, or disclose the data to the extent provided in the resulting grant. This restriction does not limit the U.S. Government's right to use information contained in this data if it is obtained from another source without restriction. The data subject to this restriction are contained in sheets (applicant to specify); and


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(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." E.1 Cover Page: A single page (1) with the names of the organizations/institutions involved in the proposed application. In the case of a group, please indicate the lead or primary applicant clearly; followed by any proposed sub-grantees and/or contractors (hereafter referred to as “subs”), including a brief narrative describing the unique capacities/skills being brought to the program by each institutions. In addition, the Cover Page should include information about a contact person for the prime applicant, including this individual’s name (both typed and his/her signature), title or position with the organization/institution, address, e-mail address and telephone and fax numbers. Also state whether the contact person is the person with authority to contract for the applicant, and if not, that person should also be listed. E.2 Application Executive Summary: A maximum two (2) page brief description of proposed activities, goals, and anticipated results (both quantitative and qualitative). Briefly describe technical and managerial resources of your organization. Describe how the overall program will be managed. State the bottom line funding request from USAID and the bottom line funding secured from other sources (state sources and amounts) for the proposed program. The application summary should be concise and accurate. E.3 Program Narrative: Within a maximum of thirty (30) pages, please describe your proposed strategy and approach and the experience and personnel capabilities of the Applicant, excluding bio-data and other attachments. The narrative should provide a clear description of what the Applicant proposes to do and application's structure should reflect the evaluation criteria listed in Section V. The following sections should be included: Technical Approach i) The Technical Approach must include a clear description of the conceptual approach and the general strategy (i.e. methodology and techniques) being proposed; identify mechanisms to ensure ongoing coordination with other donors, implementing agencies, and related programs; outline specific, focused activities; include a well-articulated strategy for replication and long-term impact; explain how the approach is expected to achieve the proposed objectives; and describe a plan that will enable the activities to continue after the grant is completed. Applicants must specify annual and end-of-program results in the design of the program that directly contribute to the expected results. Applicants are encouraged to propose innovative programs designed to reach the desired outcomes/results. ii) Applicants must discuss how resources will be organized to obtain expected results. The applicant should discuss fully the “what” and the “how” of its plan. The purpose of this approach is to allow the applicant greater creative freedom to develop a plan for resource organization and use. iii) Applicants must provide a description of any partnership, including with the MOH/DSME and sub-recipient relationships planned with partners. The Applicant should detail any existing relationships with partner organizations and/or the methods proposed to establish new relationships. In this regard it is necessary to describe how elements of the grant will be implemented with non-governmental organization partners and other types of partners.


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iv) Gender equality: In accordance with USAID policies, activities will address gender issues as appropriate, and promote gender equality as a goal of program activities. The Recipient should address gender concerns in a fundamental way. USAID encourages all applicants to provide additional or alternative recommendations on how to address gender consideration in this program. v) Applicants must provide a program implementation plan (chart) including main activities of the program. List on the vertical axis the activities, and on the horizontal axis the following information: (a) name of implementer(s); and (b) time frame, noting estimated dates of completion. Indicate when the proposed program will be fully operational. vi) The applicant must provide an illustrative First Year Implementation Plan for achieving expected program results. The applicant is encouraged to propose innovative implementation mechanisms to reach the desired results and an aggressive but realistic schedule of performance milestones as steps toward achieving proposed results. The implementation plan should clearly outline links between the proposed results, conceptual approach, and performance milestones, and should include a realistic timeline for achieving the annual and end-of-program results This plan will be considered illustrative for the purposes of evaluating applications; however, once the award is made, finalizing the implementation plan within the first 60 days will be a key activity. Management and Institutional Capacity As part of the technical application, applicants must submit a Management Plan. The applicant should specify the organizational structure of the entire program team, including home office support and implementing partners, if any, for the entire program, and describe how each of the components will be managed. “Implementing partners” are organizations that will have substantial implementation responsibilities. The management plan should identify potential implementing partners and clearly state the responsibilities of each proposed implementing partner in achieving the proposed results and the unique capacities/skills they bring to the program. Note that documentation that reflects an “exclusive” relationship between implementing partners is not requested and should not be submitted. Applicants must also offer evidence of their technical and managerial resources and expertise (or their ability to obtain such) in program management and their experience in managing similar programs in the past. Information in this section should include (but not limited to) the following information: a) Brief description of organizational history and experience; b) Examples of accomplishments in developing and implementing similar programs; c) Relevant experience with proposed approaches; d) Institutional strength as represented by breadth and depth of experienced personnel in program relevant disciplines and areas; e) Sub-recipient or subcontractor capabilities and expertise, if applicable; f) Proposed field management structure and financial controls; g) Home office backstopping and its purpose.


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Performance Monitoring Plan Illustrative Performance Monitoring and Evaluation Plan As part of the program approach, Applicants shall submit a Performance Monitoring and Evaluation (PMEP). However, within 60 days of the effective date of the award, the successful Applicant will be required to submit a revised/updated plan, which will be approved by the USAID Agreement Officer’s Representative (AOR). The Applicant shall propose a plan for establishment of baseline data for indicators and performance targets, data collection and annual reporting. Organizational Past Performance Describe at least five (5) contracts, grants and cooperative agreements which the organization, both the primary Applicant (as well as any partners substantially involved in implementation) has implemented involving similar or related program over the past three years. Applicants should include the following:

• Name and address of the organization for which the work was performed and primary location(s) of work • Current telephone number and e-mail address of a 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; beginning and ending dates • A brief description of the program/assistance activity

USAID may contact references (for both the applicant and for personnel proposed) and use the past performance data regarding the organization, along with other information to determine the applicant’s responsibility. The Government reserves the right to obtain information for use in the evaluation of past performance from any and all sources inside or outside the Government. Required Qualifications for Key Personnel The following positions are considered key for the performance of this cooperative agreement:

A. Chief of Party (COP) B. Private Sector Technical Advisor C. Maternal and Child Health Technical Advisor D. Community Health Systems Technical Advisor E. Monitoring and Evaluation Specialist

Other necessary personnel will include other technical, financial, administrative, and support staff as appropriate to implement project activities. All key personnel must have excellent oral and written communication skills in French and English. Possessing other languages of Benin is a plus. All key personnel must have experience working in developing countries and preferably in Sub-Saharan Africa. All must have graduate degrees in relevant subject areas and possess a minimum of eight years professional experience, with the COP having a minimum of ten.


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ANCRE is expected to increase the performance and functionality of health care delivery in Benin. Consequently, project personnel must have strong technical skills in the designated areas which they can transmit to their Beninese counterparts. Chief of Party (COP): The COP is responsible for the overall strategic direction and technical and managerial oversight for ANCRE. S/he will oversee the administration of the program, will deploy all financial, technical, and human resources, and will manage and supervise the implementation of all agreed-upon strategies and plans. Critical to the position’s success is the COP’s ability to be a leader, to effectively network, and to motivate colleagues to a high level of performance. The COP is responsible for maintaining the morale and effectiveness of the staff and ensuring that USAID/Benin’s goals for the ANCRE project are met. Responsibilities:

Provide programmatic leadership and set priorities for ANCRE goals and priorities. Ensure that project activities are technically sound, evidence-based, and responsive to the needs of

the country and USAID Cultivate strategic relationships with USAID, global and regional institutions, private sector

entities, GOB ministries (as allowed), and other stakeholders for the smooth implementation of program activities

Facilitate and ensure positive relationships between the team and the multi-lateral and bi-lateral partners currently implementing in Benin

Meet regularly with USAID/Benin FHT Leader and attend USG meetings as requested. Mentor, support, supervise, and manage a team of highly qualified staff and align their efforts with

ANCRE goals Facilitate the development of annual work plans and budgets prior to their submission to

USAID/Benin Review work plans, financial reports, cost share and performance monitoring plans Directly supervise the key technical team members, including the Maternal and Child Health

Advisor, the Private Sector Advisor, and the Community Health Systems Advisor Requirements:

Public health professional with advanced degree (MPH, PhD or DrPH) or equivalent combination/blend of training and experience

At least ten (10) years of direct experience in MNCH/FP policy development, program planning, implementation and/or evaluation in a developing country setting

Demonstrated ability to manage complex, multi-intervention health development programs in collaboration with national health ministries and international partners

Familiarity with: o the MNCH/FP interventions that will be the focus of this project o health management information systems o supply chain management, commodities, and logistics

Prior experience working with Benin or other West African public health system is preferable. Proven ability to develop highly effective teams of public health professionals and a supportive

and empowering management style Excellent interpersonal and communication skills, including the ability to work effectively with a

culturally and linguistically diverse team of staff, consultants and counterparts Strong oral and written communication skills, including substantial presentation experience to

high-level audiences (policymakers, program managers, donors), as well as experience in facilitation and small group process


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English (Level 4) and French fluency (verbal and written) required Ability to travel nationally and internationally Commitment to producing high quality project deliverables on time and under budget Qualified Beninese nationals and international candidates are encouraged to apply

Private Sector Technical Advisor: The Private Sector Technical Advisor (Advisor) will provide technical services to further the objectives of ANCRE. The Advisor will substantively contribute to the implementation and evaluation of ANCRE. S/He will also be available to assist with private sector designs, evaluations and other private sector assistance. The Advisor will be responsible for: (a) assisting in the management and technical support of ANCRE; (b) providing technical support to the field regarding the private health sector; (c) serving as a technical resource on private and commercial health sector initiatives, and (d) providing technical support and other duties as assigned. S/He will report to and receive guidance from the COP. Responsibilities:

Under the leadership of the COP, lead the design, implementation, monitoring and evaluation of ANCRE project activities as they relate to the private sector

Build the capacity of the GOB/MOH to engage private health providers using successful quality assurance models and to engage private health sector providers to follow national policies on licensing, staff skills and service standards

Increase awareness of the role that the private sector plays in improving health outcomes. Provide information, guidance and technical support to field missions to improve private sector

programming as it relates to PIHI Serve as a technical resource on private and commercial health sector programs and initiatives. Keep abreast of major developments in the private health sector and disseminate state-of-the-art

findings on private sector topics Provide ANCRE with technical expertise, strategic planning guidance and management support in

implementing PIHI in the private health sector Conduct visits to assist in the design, implementation, management and/or evaluation of

MNCH/FP activities Assist, as needed, with the preparation of information briefs, work plans, budgets, etc., including

information for MOH, USAID, and others Requirements:

Master’s degree in public health, business, social sciences or other related field. At least eight (8) years of experience implementing developing country health programs in the

private sectors, preferably with at least two years’ experience in an international or resource-poor setting

Technical expertise in public health and the private sector, preferably with a focus on family planning, maternal, newborn, and child health, or other private sector health

Demonstrated understanding of MNCH/FP issues in developing countries Familiarity with commodities, logistics, and supply chain management is desirable. Excellent management and interpersonal skills English (Level 4) and French fluency (verbal and written) required Qualified Beninese nationals and international candidates are encouraged to apply


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Maternal, Newborn and Child Health Technical Advisor The MNCH Technical Advisor is responsible for the oversight and technical direction at the central, periphery and community levels to further reduce maternal and child mortality and morbidity in the 10 peri-urban health Health Zones by ANCRE. Program activities include a full-range of maternal and child health interventions. Responsibilities:

Under the leadership of the COP, provide technical direction, oversight, and management for overall strategy for implementing PIHI and improving maternal and child services in Benin

In collaboration with other team members, support training and capacity-building for health service providers and MOH staff at the central, periphery and community levels to manage and implement successful maternal and child health programs and collaborate in the development of training curricula and strategies

Provide technical assistance and participate in program planning relating to PIHI Oversee the design, development, and implementation of monitoring and evaluation strategies and

systems to effectively capture and communicate project results in MNCH Lead the development and documentation of effective tools and approaches for MNCH services,

and maintain an inventory of successful strategies and approaches Document and share lessons learned in the area of MNCH in the format of project reports,

publications and presentations at all levels Requirements:

Advanced degree in public health or related area Minimum of eight (8) years of experience working in developing country health systems with a

focus on newborn, child and maternal health Medical or nursing degree or special training in pediatrics is highly desirable, but not required. Demonstrated understanding of MNCH issues in Benin or other West African countries will be an

added advantage Demonstrated experience working effectively with program staff, implementing partners, civil

society organizations, community leaders and local and national government authorities to implement high impact MNCH and FP/RH services

Previous experience in implementing high-impact interventions for maternal and neonatal health a plus

Excellent management and interpersonal skills English (Level 4) and French fluency (verbal and written) required Qualified Beninese nationals and international candidates are encouraged to apply

Community Health Systems Technical Advisor The Community Health Systems Advisor will help the MOH roll out and systemize PIHI at the health facility and community levels in ten peri-urban health zones. S/He will provide leadership and strategic program implementation to develop community-based, integrated MNCH and FP services within the overall continuum of health care available at the local level. S/He will develop and implement a community-based service delivery strategy to support overall project objectives and country strategies.


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Responsibilities: Oversee the implementation of PIHI at the health facility and community levels in ten peri-urban

health zones Strengthen local technical capacity for continuous quality improvement in community-based

MNCH and FP service delivery, integrated into the regional and national-level health systems Support efforts that contribute to reducing communities’ dependency on external human and

financial resources, and higher-level health services and infrastructure Strengthen community-level technical capacity to deliver PIHI, including vision and capacity to

replicate and bring to scale successful activities Support the expansion of community-based PIHI services, such as activities that encourage

exclusive breastfeeding, immunization of children, offering a wider range of contraceptives at the health center and community levels; expanding the “Reaching Every District” (RED) approach with communal authorities; and introducing community-based approach to emergency obstetric care (EmONC)

Create and guide community-initiated opportunities for leadership, skills development, advocacy and community-led resource mobilization initiatives to sustain MNCH and FP services

Adapt and apply continuous MNCH and FP quality improvement tools, national standards and guidelines and best practices for use at the community and health facility level

Strengthen community-level advocacy efforts to reduce gender inequality and discrimination

Requirements: Advanced degree in public health, international development or related field At least eight (8) years of experience implementing health programs in developing and

transitioning countries, with at least 5 years’ experience providing technical assistance to MNCH/FP programs

Demonstrated ability in program design, and integrated approaches to community-level service delivery

Demonstrated experience working effectively with program staff, implementing partners, civil society organizations, community leaders and local government authorities to implement community-based MNCH and FP/RH services and locally-led community engagement initiatives

Proven ability to carry out local level advocacy, capacity building and social empowerment initiatives

Proven ability to create and maintain effective working relationships with national and local level government officials, stakeholders, NGOs, and implementing partners.

Excellent management and interpersonal skills English (Level 4) and French fluency (verbal and written) required Qualified Beninese nationals and international candidates are encouraged to apply

Monitoring and Evaluation Technical Advisor Under the direct supervision of the COP, and working closely with the project technical team, the Monitoring and Evaluation Expert will be responsible for the project’s compliance with USAID performance reporting requirements and the implementation of project activities aiming to develop MOH monitoring and evaluation capabilities, including health information systems.


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Responsibilities:

Developing M&E framework and operational plan for the ANCRE strategy, including roles and responsibilities; monitoring indicators and targets; data sources; measurement and reporting methods; evaluation topics and methodologies; and use of monitoring and evaluation data and findings for increased efficiency and effectiveness

Overseeing the development and implementation of a project monitoring and evaluation plan that is capable of clearly and adequately reporting data that represent project performance to USAID in a timely manner

Supervising the design and implementation of operational research and quality assurance protocols to identify issues hindering the project performance or to document best practices to be multiplied and shared with other stakeholders in Benin

Supporting and the MOH to plan, advocate for, implement and assess activities that would strengthen their capacities in operations and management of data

Developing and maintain professional relationships with international, national, and local monitoring and evaluation policy makers, universities and schools of public health, and key personnel in appropriate monitoring and evaluation

represent the project on monitoring and evaluation related activities and respond to any specific requirements from the COP

Requirements:

Master’s degree in public health, social sciences or other related field At least eight (8) years of experience in health sector/systems monitoring and evaluation, with at

least two years’ experience in an international or resource-challenged setting Demonstrated leadership in the development and implementation of an M&E strategy and/or

implementation plan for an effort of similar magnitude Ability to provide advice, guidance, and consultation to high level officials on the interpretation

and application of monitoring and evaluation data and findings Demonstrated ability to develop and conduct robust assessments and evaluations. Demonstrated knowledge of information and communications technology and its application to

performance monitoring and evaluation High degree of judgment, maturity, ingenuity and originality to interpret strategy, to analyze,

develop and present work results, and to monitor and evaluate implementation of programs Excellent management and interpersonal skills English (Level 4) and French fluency (verbal and written) required. Qualified Beninese nationals are encouraged to apply

N.B. Any individual that was involved in the design of this program description at any level is precluded from participation in this procurement process i.e. evaluation, recruitment of any position for any potential applicant. E.4 Annex:

Resumes and Letters of Commitment

Resumes and letters of commitment are to be included as an Annex for each individual who is proposed as key personnel and/or long-term staff (individual who will work at least 75% of his/her time) on the program, for both the Applicant and proposed key sub-grantees. Resumes should use a common format, not to exceed two (2) pages and should include at least three references with telephone numbers and e-mail addresses for each reference. Letters of commitment must not exceed a single page each. Please note that


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documentation that reflects an “exclusive” relationship between an individual and an applicant is not requested and should not be submitted. E.5 Environmental Compliance Requirements 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. The Recipient environmental compliance obligations under this regulations and procedures are specified in the following paragraphs of this RFA. 1b) In addition, the Recipient must comply with Benin 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 Cooperative Agreement 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.”) An Initial Environmental Examination (IEE) (Program/Activity Number 680-232 of September 2012) has been approved for Family Health Program funding this Request for Application. USAID has determined that a Negative Determination with conditions applies to one or more of the proposed activities. This indicates that if the activities are implemented subject to specified conditions, they are expected to have no significant adverse effect on the environment. The Recipient shall be responsible for implementing all IEE conditions pertaining to activities to be funded under this solicitation. a) As part of its Work Plan, and all Annual Work Plans thereafter, the recipient, in collaboration with USAID Agreement Officer Representative (AOR) and the Mission Environmental Officer, as appropriate, shall review all ongoing and planned activities under this cooperative agreement to determine if they are within the scope of the approved Regulation 216 environmental documentation. b) 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 amendment. c) 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.


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Sub-grants: a) A provision for sub-grants is included under this award; therefore, the recipient will be required to use an Environmental Review Form (ERF) or Environmental Review (ER) checklist using impact assessment tools to screen grant proposals to ensure the funded proposals will result in no adverse environmental impact, to develop mitigation measures, as necessary, and to specify monitoring and reporting. Use of the ERF or ER checklist is called for when the nature of the grant proposals to be funded is not well enough known to make an informed decision about their potential environmental impacts, yet due to the type and extent of activities to be funded, any adverse impacts are expected to be easily mitigated. Implementation of sub-grant activities cannot go forward until the ERF or ER checklist is completed and approved by USAID. Recipient is responsible for ensuring that mitigation measures specified by the ERF or ER checklist process are implemented. b) The recipient will be responsible for periodic reporting to the USAID Agreement Officer’s Technical Representative (AOR), as specified in the Program Description of this solicitation. 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. One CD with the same contents as the Cost Application hardcopy must also be included within the Original Application. The Cost Application shall consist of the following:

1. Cover Page 2. SF-424, SF-424A and SF-424B 3. Mandatory Certifications and Assurances 4. Acknowledgement of any amendments to the RFA 5. Budget 6. Budget Narrative 7. Current Negotiated Indirect Cost Rate Agreement (NICRA) 8. Teaming documents (if any) 9. Documentation for applicants who do not have a current NICRA or who have never received an

award from the U.S. government as explained more fully below The following sections describe the documentation that applicants for 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 details to address the following: Cover Page: A single page with the names of the organizations/institutions involved and the lead or primary Applicant clearly identified. Any proposed sub grantees (or implementing partners) should be listed separately. In addition, the cover Page should provide a contact person for the prime Applicant, including this individual’s name (both typed and his/her signature), title or position with the organization/institution, address, telephone and fax numbers and e-mail address. State whether the contact person is the person with authority to contract for the Applicant, and if not, that person should also be


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listed with contact information. 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. Erasures or other changes must be initialed by the person signing the application. The TIN and DUNs numbers of the applicant should also be listed on the cover page. SF-424, SF-424A and SF-424B All Applicants must submit their applications using the SF-424 series which includes:

‐ SF-424 Application for Federal Assistance ‐ SF-424A Budget Information – Non-construction Programs, and ‐ SF-424B Assurances – Non-construction Programs

The SF-424 forms are not included in this RFA but can be found at the following website: http://www.grants.gov/agencies/aapproved_standard_forms.jsp Mandatory Certifications and Assurances Applicants must submit the following mandatory certifications:

PART I – Certifications and Assurances ‐ Assurances of Compliance with Laws and Regulations Governing Non-Discrimination in ‐ Federal Assisted Programs ‐ Certification regarding Lobbying ‐ Certification Covering Terrorist Financing ‐ Certification of Compliance with standard provisions entitled “Condoms” and ‐ “Prohibition on the Promotion or Advocacy of the Legalization or Practice of Prostitution or Sex

Trafficking”

PART II – Other Statements of Recipient These certifications and assurances are attached as Attachment 1 to this RFA Acknowledgement of Any Amendments to the RFA Applicants shall acknowledge receipt of all amendments, if any, to this RFA by signing and returning the amendment as part of the cost application. The Government must receive the acknowledgement by the time specified for receipt of applications. Budget Applicants must submit an overall summary budget as well as a detailed annual budget defined by result area or component. Stated another way, the budget should relate to results while also showing a type of cost for each result. The budget must clearly display: -The breakdown of all costs associated with the program according to costs of, if applicable, headquarters, regional and/or country offices


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-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 -The potential contributions of non-USAID or private commercial donors to this Cooperative Agreement Budget Narrative To support the costs proposed, please provide detailed budget narrative for all costs that clearly identifies the basis of all costs, such as market surveys, price quotations, current salaries, historical experience, etc. The combination of the cost data and breakdowns specified above and the budget narrative must be sufficient to allow a determination whether the costs estimated are reasonable and realistic. The following section provides guidance on issues involving specific types of costs. Please note that applicants are not required to present their costs in the budget or budget narrative in the format or order below. i. Salaries and Wages – Direct salaries and wages should be proposed in accordance with the applicant’s personnel policies. ii. Fringe Benefits – If the applicant has a fringe benefit rate that has been approved by an agency of the U.S. Government, such rate should be used and evidence of its approval should be provided. If a fringe benefit rate has not been so approved, the application should include a detailed breakdown comprised of all items of fringe benefits and the costs of each, expressed in dollars and as a percentage of salaries. iii. Travel and Transportation – The application should indicate the number of trips, domestic and international, and the estimated costs per trip. Specify the origin and destination for each proposed trip, duration of travel, and number of individuals traveling. Per diem should be based on the applicant’s normal travel policies (applicants may choose to refer to the Federal Standardized Travel Regulations for cost estimates). iv. Equipment – Specify all equipment to be purchased, including the type of equipment, the manufacturer, the unit costs, the number of units to be purchased and the expected geographic source. v. Materials and Supplies – Specify all materials and supplies expected to be purchased, including type, unit cost and units. vi. Communications – Specific information regarding the type of communication cost at issue (i.e. mail, telephone, cellular phones, internet etc.) must be included in order to allow an assessment of the realism and reasonableness of these types of costs. vii. Subcontracts/Sub-awards/Consultants – Information sufficient to determine the reasonableness of the cost of each specific subcontract/sub-award and consultant expected to be hired must be included. Similar information should be provided for all consultants as is provided under the category for personnel.


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viii. Allowances – Allowances should be broken down by specific type and by person. Allowances should be in accordance with the applicant’s policies and the applicable regulations and policies. ix. Direct Facilities Costs – Specific information regarding the cost of any facilities needed to perform program activities. The information provided should include the unit cost (rent), the time period the facilities are needed and the number of facilities. Only facilities that directly benefit the program activities should be included in this category; all other facility costs should be included in the indirect cost category. x. Other Direct Costs – This may include the costs not elsewhere specified, such as report preparation costs, passports and visas fees, medical exams and inoculations, insurance (other than insurance included in the applicant’s fringe benefits) as well as any other miscellaneous costs which directly benefit the program proposed by the applicant. The narrative should provide a breakdown and support for all other direct costs. If seminars and conferences are included, the applicant should indicate the subject, venue and duration of proposed conferences and seminars, and their relationship to the objectives of the program, along with estimates of costs. xi. Indirect Costs – The applicant should support the proposed indirect cost rate with a letter from a cognizant U.S. Government audit agency or with sufficient information for USAID to determine the reasonableness of any such costs proposed to be associated with this agreement. (For example, a breakdown of labor bases and overhead pools, the method of determining the direct versus the indirect costs, a description of all costs in the pools, etc.). Local Institutions usually do not have a Negotiated Indirect Cost Rate Agreement (NICRA) letter with the US Government. Therefore no indirect costs should be included in the cost/business application submitted by local NGOs. Local institutions submitting applications should treat all indirect costs as direct costs. xii. Seminars and Conferences - The applicant should indicate the subject, venue and duration of proposed conferences and seminars, and their relationship to the objectives of the program, along with estimates of costs. xiii. Foreign Government Delegations to International Conferences: Funds in this agreementmay 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 or as approved by the COTR http://www.info.usaid.gov/pubs/ads/300/refindx3.htm. xiv. Source and Origin Requirements – The authorized geographic code for goods and services provided by the Recipients under this USAID-financed award is 935 and shall comply with 22 CFR 228 requirements. Current Negotiated Indirect Cost Rate Agreement (NICRA) - A current Negotiated Indirect Cost Rate Agreement must be submitted, if the applicant has one. Other Documentation a. Teaming: If the applicant is a group of organization that has actually formed a separate entity – i.e. a joint venture – for the purposes of this application, then the cost application must include a copy of the documents that set forth the legal relationship between the partner organizations. If no joint venture is involved, the cost application should include a complete discussion of the relationship between the


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applicant and its partner organizations, how work under the program will be allocated and how work will be organized and managed. The Budget Narrative described above should discuss which team member is bearing a particular cost where appropriate and justify and explain the cost in question. b. Financial and Other Resources: The cost application should include information on the applicant’s financial status and management. All applicants should submit information relating to whether there has been approval of the organization’s accounting system by a U.S. Government agency, including the name, address, and telephone number of the cognizant auditor. If the applicant has made a certification to USAID that its personnel, procurement and travel policies are compliant with applicable OMB circular and other applicable USAID and Federal regulations, a copy of the certification should be included with the application. Organizations that have never been awarded a U.S. government contract or grant must present the following documentation: (a) Audited financial statements for the past three years (b) Organization chart, by-laws, constitution, and articles of incorporation, if applicable (c) Copies of the applicant’s accounting, personnel, travel and procurement policies. Please indicate whether any of these policies have been reviewed and approved by any agency of the U.S. government. If so, provide the name, address, email and phone number of the cognizant reviewing official. Similar information should be submitted for all partner organizations. Unnecessarily elaborate applications: unnecessarily elaborate brochures or other presentations beyond those sufficient to present a complete and effective application in response to this RFA are not desired and may be construed as an indication of the applicant's lack of cost consciousness. Elaborate artwork, expensive paper and bindings, and expensive visual and other presentation aids are neither necessary nor wanted. c. Responsibility: Applicants should submit any additional evidence of responsibility deemed necessary for the Agreement Officer to make a determination of responsibility. The information submitted should substantiate that the Applicant: (a) Has adequate financial resource or the ability to obtain such resources as required during the performance of the Agreement (b) Has the ability to comply with the Agreement conditions, taking into account all existing and currently prospective commitments of the applicant, non-governmental and governmental (c) Has a satisfactory record of performance. In the absence of evidence to the contrary or circumstances properly beyond the control of the applicant, applicants who are or have been deficient in current or recent performance (when the number of grants, contracts, and Cooperative agreements, and the extent of any deficiency of each, are considered) shall be presumed to be unable to meet this requirement. Past unsatisfactory performance will ordinarily be sufficient to justify a determination of non-responsibility, unless there is clear evidence of subsequent satisfactory performance. The Agreement Officer will collect and evaluate data on past performance of applicants using information from sources provided in accordance with Paragraph 10 above.


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(d) Has a satisfactory record of integrity and business ethics (e) Is otherwise qualified and eligible to receive a Cooperative Agreement 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. The contents of the Budget Narrative and Detailed Budget documents shall mirror and reflect one another. The Budget Narrative shall have appropriate headings that match those of the Detailed Budget. For example, the Budget Narrative shall explain how salaries and wages were determined and give the appropriate rational under the Salaries and Wages heading. The Detailed Budget shall display the estimated costs for salaries and wages under the Salaries and Wages budget line item. The Budget Narrative shall explain in great detail how costs were derived and the methodologies used to derive and estimate costs. The Detailed Budget shall display the estimated costs proposed for each budget line item.

[END OF SECTION IV]


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

A. SELECTION CRITERIA 1. Technical Approach 40 points Evaluation of the applicant’s technical understanding and approach will be based on the extent to which applicant’s proposal is consistent with objectives of the Program Description, including the extent to which the following are appropriately, clearly, and logically addressed:

Demonstrated clear understanding of program objectives, responsiveness to RFA requirements Year One workplan with activities that are clear, ambitious and achievable, and that reflect state-

of-the art technical knowledge and creativity with a convincing plan to scale-up Clear articulation how results will be achieved; including an implementation plan that presents

robust and realistic performance that is capable of achieving the objectives of the program. Proposed activities incorporate gender considerations, state specific groups to be addressed,

including gender involvement and segregation, related to health services access issues in Benin 2. Management Plan and Organizational Capacity 25 points Overall, the management plan demonstrates assurance that the Applicant and partners (if any) will manage the program in a sound, efficient and collaborative manner that maximizes the ability of the program to build national capacity and achieve stated objectives. The applicant and any proposed sub- partners will demonstrate clear capacity and experience to accomplish the range of technical interventions described in the RFA in collaboration with a range of partners.

Application demonstrates ability to collaborate with the MOH and work with the DSME to strengthen or improve existing national or sub-national performance monitoring systems

The proposed organizational chart/matrix including proposed other professionals is appropriate to accomplish the different aspects of the program in an effective and efficient manner and responsive to the different phases of the program, including progressive transfer of skills and responsibilities to local institutions and entities

Demonstrated capability of good organizational and management practices, including demonstrated performance in planning, scheduling, and monitoring programs, and in implementing programs of similar complexity and magnitude

Demonstrated management and organizational approach integrating local expertise, including detailed knowledge of local conditions and developed networking capacity to draw on other sources of local expertise

The Applicant (and partners, if any) must demonstrate readiness to initiate implementation rapidly.


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3. Performance Monitoring Plan 15 points USAID will evaluate the applicant’s demonstrated performance monitoring plan based on the criteria below, to be weighted equally:

Performance Monitoring Plan includes appropriate results and indicators as well as appropriate and cost-effective methods of data gathering for monitoring program results

The draft PMP must provide a comprehensive approach to allow for monitoring over overall program performance and measure accomplishment of key tasks, as well as the relevant goals over the course of the program, including indicators with clear relationships between the activities and what is being measured and harmonized with existing nationally and internationally accepted indicators

The recipient provides a comprehensive approach to allow for tracking data quality insurance over the course of the program and explain how produced data will be used

4. Key Personnel 10 points

Extent to which the skills, experience and education of the proposed Chief of Party and other Key Personnel meet or exceed those required

Demonstrated effectiveness of key personnel including prior training and experience, appropriateness of nominees for the job, and prompt and satisfactory changes in personnel when problems with clients were identified

5. Past Performance 10 points

Extent to which the applicant and its teaming organizations, if any, demonstrate the capacity to achieve results and to ensure sustainability in similar programs, preferably in the West Africa Region, and demonstrate the ability to conform to the agreement requirements

Quality of product or service, including consistency in meeting goals and targets, achievement of clearly defined results, and cooperation and effectiveness in resolving and learning from problems, including but not limited to personnel issues

Demonstrated prior ability to ensure cost control, adhere to the budget (including initial vs. final budget of projects used to illustrate corporate capabilities), including forecasting costs as well as accuracy in financial reporting

Demonstrated timeliness of performance, including adherence to schedules and other time-sensitive project conditions, timely delivery of short-term technical advisors, and effectiveness management to make prompt decisions and ensure efficient operation of tasks (includes planned start and finish date and actual start and finish dates of projects used to illustrate corporate capabilities)

Cost Evaluation Cost has not been assigned a weight but will be evaluated for realism, reasonableness, allocability, allowability and cost-effectiveness. Cost sharing will be evaluated on the level of financial participation proposed and the added value it represents to the program. Applicants are required to include cost sharing as a sub-element of cost effectiveness.


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B. BRANDING STRATEGY AND MARKING PLAN It is a Federal statutory and regulatory requirement (see Section 641, Foreign Assistance Act of 1961, as amended and 22 CFR 226.91) that all overseas programs, projects, activities, public communications, and commodities that USAID partially or fully funds under an assistance award or sub-award must be appropriately marked with the USAID identity. The Agreement Officer will review the branding strategy and marking plan of the successful applicant 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. See Section VIII C. AWARD Award will be made to responsible applicant whose application offers the greatest value, cost and other factors considered. The final award decision is made, while considering the recommendations of the TEC, by the Agreement Officer. The Agreement Officer’s decision about the funding of an award is final and not subject to review. Any information that may impact the Agreement Officer’s decision shall be directed to the Agreement Officer. Authority to obligate the Government: the Agreement Officer is the only individual who may legally commit the U.S. Government to the expenditure of public funds. No costs chargeable to the proposed Agreement may be incurred before receipt of either an Agreement signed by the Agreement Officer or a specific, written authorization from the Agreement Officer.

[END OF SECTION V]

SECTION VI – AWARD AND ADMINISTRATION INFORMATION Notice of Award signed by the Agreement Officer is the authorizing document, which shall be transmitted to the Recipient for countersignature to the authorized agent of the successful organization electronically, to be followed by original copies for execution. A. ROLES AND RESPONSIBILITIES The recipient shall be responsible to USAID/Benin for all matters related to the execution of the agreement. Specifically, the recipient shall report to the USAID Agreement Officer Representative (AOR) located within the Family Health Team office.


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B. ANNUAL WORKPLANS AND REPORTING 1. Monitoring and Evaluation System Applicants are required to: ‐ Propose a Monitoring and Evaluation plan that includes a Performance Monitoring Plan

‐ Identify key MNCH indicators, data collection method, type, and source of information to be collated for program management ‐ Describe how USAID reporting requirements will be met ‐ Describe how progress towards program objectives will be measured ‐ Indicate timelines for data analyses and reporting consistent with the DSME monitoring plan and data needs The progress of the project will be monitored in accordance with the Performance Monitoring Plan. In executing the monitoring and evaluation functions under this program, the recipient shall collaborate and coordinate with the DSME and the National Health Information System. Within 60 days of award, the recipient will submit a PMP for approval to the AOR. The recipient should develop a robust data collection system which includes adequate data quality controls and complies with all USAID data quality requirements. USAID expects that the recipient will be innovative and creative in their efforts, capture, document, and report all the outcomes of USAID assistance and comply with the reporting requirements. 2. Quarterly Reports Within 30 days after the end of each quarter, the recipient shall submit quarterly narrative reports which give insight into the progress of planned activities. The performance reports must contain the following information:

Progress in achieving planned targets reflected in the annual work plan: The emphasis in quarterly reporting should be on activities in the previous quarter and project outputs. However, if the Performance Monitoring Plan requires data collection for outcome indicators in a given quarter, then the quarterly report should present data and analysis for those/each indicators. Performance should be broken out by area/region and national level activities as well as disaggregated by gender where appropriate.

Description of Activities: Description of accomplishments shall include sub-grants and assistance to beneficiaries and care-givers made, the name of the sub-grantee/partner, the amount of the grant, the purpose of the grant, and the results expected/achieved from the grant. The description of trainings, workshops and specific activities shall include the number of participants and the objectives and impact of the training/workshops or activities.


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Other pertinent information shall specifically include description of applicant’s accomplishments suitable for distribution to stakeholders and the media and/or “success stories.”

The quarterly report should be accompanied by any reports/documents/other materials which may have been produced as a result of this program. If implementation falls behind projections or is behind schedule significantly, the implementing partner will explain the problem and present strategies for solving the problem. Financial status including spending to date and planned next quarter expenditures should be presented. Planned expenditures for the coming quarter should include a complete estimated budget for that quarter: management costs, technical assistance, expected sub-grants and assistance to beneficiaries, travel and so on. The quarterly report should provide information on which organizations and the activities were funded and are planned to be supported. Each quarterly report should provide an updated chart containing names of all beneficiaries/sub-grantees; funds disbursed to them, start and expected completion dates. The quarterly reports shall as much as possible include success stories and pictures to reflect the real impact of activities on the lives of beneficiaries. Following receipt of the report a quarterly review meeting will be held to discuss results, challenges and a way forward. 3. Mid-term Evaluation At the midpoint in the life of the project, USAID/Benin will conduct an independent mid-term evaluation to assess progress toward the objectives and expected results. This midterm evaluation will guide implementation in the last two years of ANCRE. USAID/Benin may request special evaluation studies if deemed necessary to improve the quality of services. 4. Annual Progress Reports

The annual progress report should concentrate on outcome and impact based on performance indicators in the Performance Monitoring Plan. It will report on achievements against targets and will account for any shortfalls. The analysis in the annual section shall not be limited to performance measures – it will also summarize progress during the previous year in a qualitative fashion. Annual performance data will disaggregate indicators as required in the Performance Monitoring Plan but will also address separately in narrative the target areas/regions and the achievements in each. Anecdotal and case studies, pictures and any other information that gives insight into the success of the program should be included. Annual progress on the performance indicators and the accompanying narratives shall be submitted to the AOR by the latest on November 10 of the calendar year. 5. Final Report

The final performance report will report on all performance indicators and will draw conclusions about the overall impact of the program. It will report on lessons learned and problems encountered and will offer recommendations for the future. The report will be due in the project’s final month. The recipient shall prepare and submit three copies of a final/completion report to the AOR that summarizes the accomplishments of this agreement, methods of work used, budget and disbursement activity, and recommendations regarding unfinished work and/or program continuation. The final/completion report shall also contain an index of all reports and information products produced under this agreement. The final report shall be submitted no later than 90 days after the estimated completion date of this agreement.


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In addition, the recipient should be prepared to submit ad hoc reports, including success stories, on the status of their activities as requested by USAID/Benin.

[END OF SECTION VI]

SECTION VII – AGENCY CONTACTS The Agreement Officer for this Award is: TBD Agreement Officer USAID/West Africa The A&A Specialist for this Award is: Francine E. Agblo USAID/Benin - OAA The AOR for this Award is: TBD USAID/Benin - FHT

[END OF SECTION VII] SECTION VIII – OTHER INFORMATION 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, program, 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 sub awards.


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(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.


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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. 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


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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)).


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(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.


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(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.


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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 sub agreement. 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.

Subrecipient 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.


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(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 sub-award 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.

(1) 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 a 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


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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;


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(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 Contracting Officer Technical Representative. 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.

(a) Non-retroactivity. The requirements of this provision do not 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.


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Applicable Regulations and References http://www.usaid.gov/pubs/ads/300maa.pdf

- Mandatory Standard Provisions for U.S., Non-governmental Recipients - Mandatory Standard Provisions for Non-U.S. Non-governmental Recipients

http://www.usaid.gov/policy/ads/300mab.pdf - 22 CFR 226

http://www.access.gpo.gov/nara/cfr/waisidx_02/22cfr226_02.html - OMB Circular A-122

http://www.whitehouse.gov/omb/circulars/a122/a122.html - OMB Circular A-110

http://www.whitehouse.gov/omb/circulars/a110/a110.html - ADS Series 300 Acquisition and Assistance

http://www.usaid.gov/pubs/ads/ - SF-424 Downloads

http://www.grants.gov/agencies/approved_standard_forms.jsp

ATTACHMENTS AND ANNEXES

ANNEX A - Additional Resources ANNEX B - Progress of Benin’s Strategy to Reduce Maternal and Neonatal

Mortality November, 2012 ANNEX C - Overlaps between the National Health Plan and GHI Country Strategy: Attachment 1- Certifications, Assurances, and Other Statements of the Recipient (May 2006) Attachment 2- Acronyms and Glossary

[END OF SECTION VIII]

[END OF USAID Benin 680-13-000001 RFA]


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ANNEX A Additional Resources

Revue_Rapide_de_la_Strategie_Nationale_

Benin HSA_9_28_2012.pdf

http://www.beninsante.bj/documents/DSME/paquet_haut_impact.pdf http://www.measuredhs.com/pubs/pdf/PR24/PR24.pdf


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ANNEX B Progress of Benin’s Strategy to Reduce Maternal and Neonatal Mortality November, 2012 Progress on the eight specific objectives of Benin’s strategy:14 Specific Objectives Expected Results Level Achieved Ensure 24/24 hour availability of the optimal package of high-impact obstetric and neonatal interventions in 7 national and departmental hospitals and in all health facilities in the 15 health zones.

Seven (7) national and departmental hospitals and 15 zonal hospitals offer quality SOUC 24/24 hours in addition to other interventions directly related to the optimal package

At least 30 CHCs offer quality SOUB 24/24 hours plus the other interventions directly related to the optimal package.

At least 60 CSA offer quality SOUB 24/24 in addition to other interventions directly related to the optimal package

Norms and standards revised for staff in zonal hospitals

Functional system developed qualified human resources are motivated and in place

Only 17 Health Zones (HZs)/34 are involved, due to the fact that not all HZs were functional during the planning phase in 2006.

All national hospitals offer Emergency Obstetric and Neonatal Care (EONC),of which 80% are Departmental Hospitals, and 56% are in Health Zones (exceeding the target of 44% HZs), and 3% are private clinics. However, 7.4% of community health clinics offer EONC.

No significant improvement in availability and distribution of EONC: in urban areas, 3.9% of health centers offer basic Emergency obstetric care (EmONC) and 13% complete EmONC. Only 1.7% of health centers offer all the seven (7) functions of basic EmONC, ranging from 5.9% in the Littoral to 2% in Ouémé

2. Make accessible geographically and financially the optimal package of high-impact interventions for obstetric and neonatal cares within the seven existing national and departmental hospitals and in all health facilities in the 15 health zones.

An organized reference system functioning in all the 34 health zones existing within the seven national and departmental hospitals

A system for financing emergency obstetric and neonatal care affordable for communities

Free cesarean sections Free treatment of malaria in

pregnant women and children under 5

Newborns still need more attention

14 Taken from “Revue Rapid de la Stratégie Nationale pour la Réduction de la Mortalité Maternelle, Néonatale au Bénin, November 2011.


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3. Improve the quality of obstetric and neonatal services in the existing seven national and departmental hospitals, and in all the health facilities in 15 health zones.

Quality of care improved in 7 national and departmental hospitals in all health facilities in 15 health zones

Benin is a lower income country according to the World Bank’s scale.

4. Improve the utilization of obstetric and neonatal services in the existing seven national and departmental hospitals, and in all health facilities in 15 health zones.

-Use of health facilities providing the optimal package of interventions for women and newborns in great need improved

SNIGS does not take into account these kinds of information

5. Improve the proportion of births attended by skilled health personnel in the seven existing national and departmental hospitals, and in all health facilities.

-Rate of births attended by skilled and competent health personnel improved in the existing seven national and departmental hospitals, and in all health facilities in 15 health zones

SNIGS does not take into account these kinds of information

6. Strengthen the capacity of individuals, families and the community to improve the health of the mother and newborn.

-Capacity of individuals, families and the community to improve the health of the mother and newborn reinforced

Few HZ conduct community-level activities, activities related to interventions to reduce maternal and neonatal mortality

7. Strengthen partnership with the private sector to ensure the availability, accessibility and quality of the optimal high impact package for obstetric and neonatal interventions.

-Enhanced partnership with the private sector to ensure the availability, accessibility and quality of the optimal package of high-impact interventions -Regulation of the exercise of private care to clients enforced

Very weak private sector involvement and regulation

8. Monitor and evaluate progress and program for the period 2011-2015.

-Monitoring and Evaluation Plan developed and implemented

2010 survey results and report on EONC level of implementation of MNCH activities available


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ANNEX C Overlaps between the National Health Plan and GHI Country Strategy: Three MDGs directly relate to health, and are central to the GHI vision in Benin. Both the GOB and the GHI Country Strategy share the below targets to be achieved by 2015:

MDG 4: Reduce the under-five mortality rate to 62/1,000 live births (from the 1990 MDG baseline level of 184/1,000 live births and the estimated 2006 Demographic and Health Survey [DHS] level of 125/1,000).

MDG 5: Improve maternal health – by reducing the maternal mortality ratio to 125/100,000 live births (from the 1990 MDG baseline of 790/100,000 live births and the estimated 2006 DHS level of 397/100,000 live births).

MDG 6: Combat HIV/AIDS, malaria, and other diseases – by reducing by half the estimated annual malaria deaths using the 2006 baseline.

The GHI Country Strategy has the goal of “Improved health status of Beninese families” to be achieved through Intermediate Results (IRs) organized to improve the supply of quality services and products in both the public and private sectors. It also seeks to increase appropriate prevention and care-seeking behavior in the population. Benin’s Ministry of Health (MOH) recently chose the interventions included in an integrated package of low-cost, high impact services that will be delivered at community and household levels: the Paquet d’Interventions à Haut Impact (PIHI). The PIHI concentrates on health promotion, disease prevention and treatment-seeking behaviors. It has major overlaps with the GHI Country Strategy, and will be promoted through public and private sector facilities, and for some items in the package, at the household and community levels. The strengthening of a dual-track health system – public and private – will ensure that the supply of quality services and goods is able to match household and community demand for health services and products at all times. USAID/Benin’s GHI Country Strategy reflects much of the GOB’s PIHI strategy. The interventions under PIHI overlap with both the MDGs and GHI as shown in the table below. Table 2: Overlap between GOB Priorities and GHI Country Strategy Priorities

MDG MOH PIHI Package Benin GHI Country Strategy Mechanism of Implementation

MDG 4: Reduce child mortality rates

Case management of low birth weight newborns

Integrated Management of Childhood Illness (IMCI)

Expanded Program on Immunization (EPI), by Reaching Every District (RED)

Free malaria treatment with artemisinin-based combination therapy for under-5s

Improving infant and young child nutrition and combating malnutrition

Addressing maternal attitudes

Case management of low birth weight newborns

Community IMCI through Community Health Workers (CHWs), including Antibiotics for pneumonia

Artemisinin-based combination therapy for malaria in children

Nutrition promotion in mothers and young children under-five

Breastfeeding promotion Social marketing/ BCC for

diarrhea prevention and treatment, other healthy behaviors

ANCRE

ANCRE

ARM3

ANCRE


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toward breastfeeding Nutrition Rehabilitation for

children Hand washing with soap at

critical times (before eating, after using latrines)

Prevention of Mother-to-Child Transmission (PMTCT) of HIV

Hand washing with soap at appropriate times

ANCRE SIFPO

WASH

ANCRE

Advancing Newborn, Child and Reproductive Health …globalreach.med.umich.edu/sites/default/files/files/USAID-BENIN... · OMB Circular A-122 for non-profit organizations, ... This

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