NOFO: Ensuring Accessibility to Quality HIV Services in Kazakhstan

Deadline: 15-Jul-24

The United States Agency for International Development (USAID) is seeking applications for a fixed amount award cooperative agreement from qualified entities to implement the Ensuring Accessibility to Quality HIV Services (SAPA) in Kazakhstan.

Building upon the prior CLM and S&D projects, the goal of the SAPA activity is to improve the access and quality of HIV services in East Kazakhstan, A bay, and Pavlodar regions. There are two components to achieve this:

• Development and implementation of a comprehensive system of interventions aimed at creating friendly stigma‐free environments at medical facilities. Interventions will focus on health systems and infrastructures as well as capacity of the providers to deliver friendly services through routine, regular and joint efforts by the community and AIDS Centers
• Continuation of CLM ‐ cyclical monitoring of medical services led by the people who are most interested in ensuring high quality of those services as their direct recipients. Findings of the CLM should be regularly incorporated into a national database, ensuring action upon identified problems and further monitoring of the achieved results.

Goals and Objectives 

• The main goal of this activity is to reduce new HIV infections and improve health outcomes for key populations and people living with HIV.
• Objective 1: Access to HIV services improved through reduction of S&D by health care providers 
  • Under Objective 1, through a collaborative process between government‐supported AIDS centers in Pavlodar, East‐Kazakhstan, and A bay regions, community‐based organizations, and other stakeholders including representatives of the community of PLHIV and KPs, a “safe spaces ‐ friendly providers” program will be developed and implemented to improve access of clients to HIV services. This program will be aimed at health care facilities and providers with a focus on (but not limited to) polyclinics through improvement of health systems and infrastructures as well as building the capacity of medical workers and healthcare providers to deliver friendly and client‐centered services.
  • IR1.1 Health system and facility infrastructure improved to facilitate service delivery that is free of stigma and discrimination. 
    • Within this IR the Activity will focus on making healthcare systems and organizational and administrative infrastructure more accessible and friendly to the clients. The purpose is to create an enabling environment at healthcare facilities that would in turn lead to more friendly service delivery through establishment of business processes, motivational programs, elimination of administrative and operational barriers in the healthcare system, etc. Systematic changes supported by clinic management and moving ‘downward’ might make the process of shifting the clinic to be a safe place for the community more natural and smooth. It is also important to highlight that addressing the barriers at the systematic level is more effective in the long run rather than solely providing educational training.
    • Illustrative activities: 
      • Desk review of successful programs addressing S&D in health care settings
      • Using best practices and routinely, actively engaging with community representatives and healthcare providers to identify, develop and implement a holistic program addressing S&D within health care settings.
      • Identify and justify adequate number of PHC facilities and private medical centers to be covered with the interventions.
    • Illustrative Key Indicators: 
      • Quantitatively measured level of S&D at public medical facilities at different stages of project implementation
      • Frequency of conducted interventions at/for medical facilities.
      • Percentage of primary health care facilities reached by the interventions by the end of each year of program implementation.
    • Illustrative Outputs: 
      • Number of ‘review cycles’ done in coordination with health care providers and facilities.
      • Quantitatively measured decrease in a level of S&D at public medical facilities.
      • Quantitatively measured decrease in a level of self‐stigma among PLHIV/KPs
  • IR1.2 Capacity of health providers strengthened to provide care that is free of stigma and discrimination. 
    • Under IR1.2, health care providers are the target audience for an innovative and holistic program addressing issues of S&D. This sub‐objective is aimed to improve health care providers’ knowledge, awareness and practice of S&D‐free service delivery and facility environments.  It is important to ensure that the program is attuned to the perception and needs of the healthcare providers that are the target audience.  The program will be  delivered in a person‐centered, humanistic, and ethical way. The program will be interactive, based on practical experience, and will involve direct communication with the community.   This program is expected to be delivered at outpatient clinics on a regular basis to ensure the maximum coverage of the staff as well as knowledge refreshment. The program is aimed at the private medical centers staff as well, but will be delivered on a voluntary basis.
    • The program also implies a development of a system of recognition/certification of the interested staff as “Friendly providers” with further creation of the Friendly‐providers communication platform.   The intervention will contribute to the creation of Safe spaces in Kazakhstan’s HIV service delivery domain.  Adaptation of existing successful models is acceptable provided they are relevant to the Kazakhstan context. The model should be developed to allow for it to be replicated at some interval to ensure that health care providers remain up‐to‐date on anti‐S&D skills and approaches, and new providers can be trained.
    • Illustrative activities: 
      • Using best practices and routinely, actively engaging with community representatives and healthcare providers to identify, develop and implement a holistic program addressing S&D within health care settings
      • Identify opportunities for recognition and/or certification of “Friendly providers”
      • Develop an ongoing communication portal for certified Friendly providers
    • Illustrative Key Indicators: 
      • Frequency of conducted interventions at/for medical facilities
      • Percentage of primary health care facilities reached by the interventions by the end of each year of program implementation
      • Number of private medical centers reached by the interventions by the end of each year of program implementation
    • Illustrative Outputs: 
      • Number of ‘review cycles’ done in coordination with health care providers and facilities.
      • Quantitatively measured decrease in a level of S&D at public medical facilities
      • Quantitatively measured decrease in a level of self‐stigma among PLHIV/KPs
• Objective 2: Quality of HIV services improved through routine community‐led monitoring 
  • Objective 2 focuses on the improvement of the quality of services through the development of the CLM system in Kazakhstan in close cooperation with the National CLM Working Group. The objective will be achieved through two sub‐ objectives.
  • IR2.1. Community capacity to conduct monitoring of services is strengthened 
    • Under this IR, the routine CLM process will be conducted to identify areas for improvement in delivering HIV services both at PEPFAR‐supported AIDS centers and CBOs, as well as primary health care facilities. The CLM process has been developed and is currently implemented in Pavlodar and Ust‐Kamenogorsk, in accordance with PEPFAR CLM steps in a cyclic manner:
      • Data collection and analysis. Community actors collect qualitative and quantitative data on service quality at PEPFAR facilities and selected sites, conduct analysis, triangulate, and capture actionable insights. Indicators may include patient‐provider interactions, infrastructure that supports confidentiality; service delivery hours and wait times; and turnaround times for lab results or treatments.
      • Advocacy and action planning. Community representatives engage decision makers and health care providers, share data and insights, agree upon corrective actions, and advocate for change in policies and practices.
      • Monitoring and accountability. Communities monitor implementation of corrective actions and gather data on impact to identified barriers and new barriers/enablers that arise
    • As a result, the community will develop necessary capacities to conduct CLM that will lead to a more sustainable monitoring of the services in the country and will result in the quality of services improvement
    • Illustrative activities: 
      • Identify and justify two or three geographic areas (including remote ones) within each PEPFAR‐ supported region to conduct CLM
      • Convene quarterly CLM meetings with CBO and AIDS centers representatives and clients to kick off data collection cycle
      • Annually, conduct at least two data collection cycles in each region including monitoring actions taken as collecting information on the results of the anti‐S&D interventions delivered under Objective 1 and assessing improvements in reducing S&D at PHC. Subsequent data collection cycles can either follow‐up the previous ones or cover other areas, depending on the issues and demand.
    • Illustrative Key Indicators: 
      • Number of CLM cycles conducted in PEPFAR sites
      • Number of clients of HIV services participated in data collection
      • Interventions to address the identified barriers are proposed and organized as an action plan according to the level of their priority: low, medium, high
    • Illustrative Outputs: 
      • At least two full CLM cycles are conducted in each PEPFAR region site every year of program implementation. It can be various sites within the regions upon necessity
      • At least 85% of high priority, 70% of medium priority, and 50% of low priority recommendations developed and barriers identified during the course of the project have been successfully addressed, or reconsidered as no longer relevant
      • At least 150 community members (PLHIV and/or KPs) participate at each data collection cycle
  • IR2.2 Identified issues are addressed through collaborative efforts of AIDS Centers and community‐based organizations. 
    • The implementing partner will facilitate a process that enables stakeholders to plan for elimination of barriers identified within the routine CLM conducted. Through cooperation with AIDS centers and other stakeholders, low, medium, and high priority issues will be identified and addressed to the highest extent possible. As a result of the interventions systematic changes are expected to be made on both region and national levels. However, it is important to note that the purpose of CLM is not for the implementing partner to resolve issues through this activity, it is rather to bring actors together and guide them to make necessary changes.
    • Illustrative activities: 
      • Obtain buy‐in from local organizations about the advantages of CLM that would lead to voluntary monitoring of services conducted by the community
      • Contribute to transformative partnerships to unite local organizations in a joint effort to ensure the self‐operating CLM in the region/country
      • Facilitate addressing low, medium and high priority issues through CLM
    • Illustrative Key Indicators: 
      • Interventions to address the identified barriers are proposed and organized as an action plan according to the level of their priority: low, medium, high
      • Percentage of low, medium, and high priority issues identified that have been addressed
      • Percentage of repetitive issues reported
    • Illustrative Outputs: 
      • At least 85% of high priority, 70% of medium priority, and 50% of low priority recommendations developed and barriers identified during the course of the project have been successfully addressed, or reconsidered as no longer relevant
      • Annually decreasing number of repetitive issues reported
      • Decrease in cases reported
• Cross‐cutting IR. Accessible and quality interventions are sustained as routine practice. 
  • USAID and PEPFAR have supported several interventions aimed at combating stigma and discrimination as well as conducting CLM in the country. However, some of the efficient interventions have not been adopted by the government and the achieved results were lost. Therefore, sustainability of the developed practices has to be set out as a separate IR. The implementing partner will advocate for sustainable funding mechanisms as well as other means to preserve the achieved results. Together with the national CLM working group (see section Implementation considerations, Strategic alignment) the IP will analyze the existing model, including lessons learned, and work with the GOK to introduce a system of CLM that is capable of independent operation at the national scale. CLM findings will be utilized at the national level to improve decision‐making processes.
  • Illustrative activities: 
    • Suggest a continuity plan to ensure independent/supported operation of CLM and sustainability of anti‐S&D interventions after the end of project, facilitate implementation of the plan.
    • Advocate for social contracting or other sustainable funding mechanisms
    • Advocate for sustainability of the developed interventions
  • Illustrative Key Indicators: 
    • Number of CBOs and community members engaged in the process of the CLM
    • Number of the developed interventions adopted by the GoK
  • Illustrative Outputs: 
    • Inclusion of CLM model into the sustainability roadmap developed by GOK, PEPFAR and UNAIDS.
    • Adoption and replication of the stigma‐eradicating interventions by the GoK
    • CLM data institutionalization mechanisms in place
  • Important: The partner is expected to work on both objectives simultaneously and approach them in a logical cohesive and efficient way to ensure the sustainable and systemic nature of interventions.

Funding Information

• Start Date and Period of Performance for Federal Awards
  • The anticipated period of performance for Phase 1: Initial Award Period for this Fixed Amount Cooperative Agreement is three (3) years with a possible extension for two additional years under the Renewal mechanism. The start date of the activity will be determined at the time of the award.
  • Phase 2: Award Renewal Period: Based on a programmatic review prior to the end of year 3, subject to a programmatic review of the progress and implementation successes of the initial award period, and subject to availability of funds, this award may be renewed for an additional two (2) years.
• Estimate of Funds Available and Number of Awards Contemplated
  • USAID intends to award one Fixed Amount Cooperative Agreement for the period of three years with a possible extension of up to two years as a Renewal Award, pursuant to this notice of funding opportunity. Subject to funding availability and at the discretion of the Agency, USAID intends to provide up to $500,000 for initial three years and additionally up to $300,000 for the following two years, subject to programmatic review of the progress and implementation successes of the initial award period, and subject to availability of funds.
  • The actual amount of the Phase 2: Renewal Award Period is an estimated figure. The actual amount of the Renewal Award Period may be higher or lower depending on the specific activities to be performed and adaptations of the activity in the future context and needs.
  • USAID obligates the amount of $98,000 for program expenditures. With this obligated amount, the Recipient may commence with activities leading to the achievement of Management Milestones and Performance Milestones for Project Year 1, up to Quarter 3. The Recipient will be given written notice by the Agreement Officer if additional funds will be added. USAID is not obligated to reimburse the Grantee for the expenditure of amounts in excess of the total obligated amount or outside of the Award Agreement period, as provided in the Schedule.

Eligibility Criteria

• Eligibility for this NOFO is restricted to local organizations.
• Only local organizations as defined below are eligible for award. USAID defines a “local entity” as an individual, a corporation, a nonprofit organization, or another body of persons that:
  • Is legally organized under the laws of the Republic of Kazakhstan; and
  • Has as its principal place of business or operations in the Republic of Kazakhstan; and
  • Is majority owned by individuals who are citizens or lawful permanent residents of the Republic of Kazakhstan; and
  • Is managed by a governing body the majority of who are citizens or lawful permanent residents of the Republic of Kazakhstan.
• For purposes of this section, ‘majority owned’ and ‘managed by’ include, without limitation, beneficiary interests and the power, either directly or indirectly, whether exercised or exercisable, to control the election, appointment, or tenure of the organization’s managers or a majority of the organization’s governing body by any means.
• These eligibility requirements apply to only the principal applicant.
• USAID welcomes applications from organizations that have not previously received financial assistance from USAID.

For more information, visit Grants.gov.