Deadline: 06-Jul-2024
The United States Agency for International Development (USAID) is seeking applications for a Cooperative Agreement from qualified entities to implement the Integrated Health Systems Strengthening (IHSS) program.
Purpose
The purpose of the Integrated Health System Strengthening (IHSS) program is to accelerate countries’ Health System Strengthening (HSS) efforts and achieve sustainable, equitable, and resilient health systems through locally-led, evidence-driven, and context-specific approaches to HSS.
The primary goals are to advance primary health care (PHC), accelerate progress toward universal health coverage (UHC), and improve health outcomes. Investments in HSS help USAID reach its priority global health goals of preventing child and maternal deaths, controlling the HIV/AIDS epidemic, and combating infectious disease, which directly contributes to strengthening global health security. A strengthened and accessible health system is necessary to yield high-quality health services, which are essential for achieving sustainable improvements in health, promoting economic growth, and overall democratic development.
Focus Areas
- Focus Area #1 – Address the root causes of complex health system challenges through systems thinking.
- Integrated HSS activities generally address and impact, or at minimum consider the relevance of, multiple system functions simultaneously, incorporating systems thinking approaches.8 For example, improving health outcomes requires strong institutional arrangements across all levels of the health system, including well-functioning community health systems. Approaches within this activity might therefore address leadership and governance capacity, behaviors, and work to incorporate evidence-based policy processes, mitigate corruption risks, and strengthen accountability at both national and sub-national levels. Simultaneously the activity might support the seamless integration of community health systems into the overall health system architecture with enhanced governance structures, well-established community engagement platforms, strengthened donor coordination platforms, and promotion of country-led efforts to integrate community health workers (CHW) into human resource and health sector plans.
- Focus Area #2 – Strengthen the entirety of the health system, including public and private sectors and across all levels, to meet the population needs of each context, with a focus on Primary Health Care.
- This activity can include work from primary to tertiary levels but needs to include a focus on the system strengthening necessary to advance PHC. PHC is widely regarded as the most inclusive, equitable and cost-effective way to achieve universal health coverage (UHC) and creates more responsive health systems at lower or equivalent costs, with higher standards of quality, greater efficiencies, and with broader community acceptance. It is estimated that ninety percent of essential interventions necessary for UHC can be delivered using a PHC approach.10 Foundational health systems investments (in areas such as financing, the health workforce, governance, digital transformation, and more) support and sustain the delivery of equitable, efficient, and high[1]quality primary health services.
- Focus Area #3 – Promote localization by putting local actors in the lead, strengthening local systems, and being responsive to local communities.
- Aligning with USAID’s definition of localization,12 this activity should seek to put local actors in the lead, strengthen local systems, and be responsive to local communities. Implementation throughout the life of the activity will require a locally-led, whole-of-society approach, with close collaboration with key HSS stakeholders at the global, national, regional, and local levels, including but not limited to country policymakers, the private sector, health service providers, continental and regional partner organizations, other donor representatives, community leaders, faith based organizations, academic institutions, and other actors throughout the health system.
- Focus Area #4 – Increase social inclusion and gender transformation throughout implementation to advance inclusive, equitable, and accessible healthcare systems
- Operationally the activity should center relevant aspects of identity in each context, including gender, disability, etc. and should aim to increase social inclusion and health equity throughout implementation by promoting gender and social equity, advancing gender-transformative HSS approaches, considering intersectionality, and incorporating social determinants of health where appropriate. The activity should be intentional about integrating principles that promote improved health care access and quality for all populations, including marginalized and under[1]served communities, and should seek ways to ensure health systems are designed for and by people.
- Focus Area #5 – Enhance health system resilience and responsiveness capacity to prepare for, mitigate, and adapt to emerging challenges, including infectious disease outbreaks, climate change, and other shocks.
- HSS investments are crucial for strengthening health system resilience, defined as the ability to adapt, respond, and recover from shocks and stressors.13 This award is intended to support health systems to prepare for, mitigate and/or adapt to all emerging and potential challenges by strengthening their capacity to consistently provide acceptable, accessible, and quality care to the communities they serve, including during times of shocks.
- Focus Area #6 – Strengthen monitoring, evaluation, research, and learning (MERL) efforts to understand health system changes and the contributions of HSS activities and facilitate real-time learning and adaptation.
- Programmatic approaches undertaken within this activity should reflect USAID’s cross-cutting HSS priority related to strengthened monitoring, evaluation, research, and learning (MERL). HSS MERL is essential to understanding how health systems and relevant multi-sectoral components interact and impact one another to produce health outcomes, health system changes, and how these changes can be sustained. MERL allows health system practitioners to understand the contribution or impact of HSS efforts.
- Focus Area #7 – Advance health sector integration and collaboration by coordinating efforts across relevant investment areas and fostering multi-sectoral partnerships.
- Finally, this activity will advance health sector integration and collaboration by providing opportunities for jointly-funded or collaborative work across health areas and with multi-sectoral partners. Implementation of effective HSS activities requires coordination and integration of efforts across relevant investment areas. Improving global, regional, national, sub-national, and multisectoral coordination and collaboration can enable timely responses to emerging health system challenges and improve the effectiveness of long-term programs.
Funding Information
- USAID intends to award one (1) Cooperative Agreement pursuant to this notice of funding opportunity. Subject to funding availability and at the discretion of the Agency, USAID intends to provide up to $325,000,000.00 in USAID funding over a five (5) year period.
Results Framework and Components
- The intended result of the contemplated IHSS program is to achieve sustainable, equitable and resilient health systems through locally-led, evidence-driven, and context-specific approaches to HSS, thereby contributing to advancing PHC, accelerating progress toward UHC, and improving health outcomes. The desired results are outlined below in Intermediate Results (IR) 1-3 as well as each results’ components. It is expected that applications will reflect integrated approaches to achieving these results holistically, incorporating the focus areas described above.
- Intermediate Result 1: Increased and equitable access to and use of quality health services that are responsive to population health needs.
- Component 1.1: Improved capacity of health systems to effectively quantify, mobilize, and use financial and other resources to efficiently and equitably achieve health objectives.
- Component 1.2: Strengthened health system capacity to develop a well-managed, supported, and highly skilled workforce to meet countries’ health care needs.
- Component 1.3: Optimized system designs that improve and sustain integrated models of equitable, quality care and improve client outcomes.
- Intermediate Result 2: Strengthened leadership, governance, and management to improve health system performance.
- Component 2.1: Enhanced institutional arrangements, including transparent policies, systems, and processes, to increase efficiency and effectiveness of integrated health system performance and accountability.
- Component 2.2: Improved community health system integration into health system architecture to accelerate achievement of primary health care and health system goals.
- Component 2.3: Improved effective response and adaptation to both unanticipated shocks and ongoing health system stressors22 at all levels of the health system.
- Intermediate Result 3: Improved HSS learning and data and evidence generation, synthesis and utilization to strengthen health system policies and practice.
- Component 3.1: Strengthened HSS monitoring and evaluation for program, country, and global needs through robust metrics, standards, systems, and approaches.
- Component 3.2: Strengthened capacity of government, local and regional partners for monitoring, evaluation, research, and learning (MERL) for health systems strengthening.
- Component 3.3: Increased knowledge synthesis, exchange, and collaboration to improve evidence translation and use by key audiences including USAID Missions and local, regional, and global HSS stakeholders
- Intermediate Result 1: Increased and equitable access to and use of quality health services that are responsive to population health needs.
Illustrative Activities
- Illustrative Activities IR 1
- Component 1.1: Improved capacity of health systems to effectively quantify, mobilize, and use financial and other resources23 to efficiently and equitably achieve health objectives.
- Optimization of strategic purchasing approaches via insurance or contracting.
- Expansion of the utilization of health technology assessments or other such assessments to support decision-making
- Health resource tracking and analysis to improve health budget mobilization, execution, and planning
- Component 1.2: Strengthened health system capacity to develop a well-managed, supported, and highly skilled workforce to meet countries’ health care needs.
- Expand and strengthen human resource for health (HRH) information systems and increase utilization of HRH data and other relevant data to provide evidence-informed HRH decision-making.
- Support health training and educational institutions to strengthen learning platforms, educational content, and learning modalities that contribute to a high-performing health workforce.
- Develop and implement policies, procedures, and regulations to support performance, well-being, motivation, and retention of the health workforce.
- Component 1.3: Optimized system designs that improve and sustain integrated models of equitable, quality care and improve client outcomes.
- Support systematic approaches to strengthening, embedding, and implementing quality improvement processes and approaches across the health system.
- Apply social and behavior change theories and methods to address the underlying reasons for or facilitate shifts in health system actors’25 performance and behaviors.
- Evaluate health system structural interventions to influence system actor behavior, such as health provider behavior to improve quality by closing the “know-do gap,” or to shift norms and reduce corruption.
- Component 1.1: Improved capacity of health systems to effectively quantify, mobilize, and use financial and other resources23 to efficiently and equitably achieve health objectives.
- Illustrative Activities IR 2
- Component 2.1: Enhanced institutional arrangements, including transparent policies, systems, and processes, to increase efficiency and effectiveness of integrated health system performance and accountability.
- Improve coordination, planning, management, and performance monitoring arrangements between national and sub-national health authorities.
- Support institutionalization of evidence-based policy processes and implementation at the national and sub-national level, including private sector providers.
- Strengthen digital health governance including through alignment of digital-enabled activities to country plans and global digital health best practices.
- Component 2.2: Improved community health system integration into health system architecture to accelerate achievement of primary health care and health system goals.
- Enhance community-level governance structures that promote citizen voice, transparency and accountability in program planning and oversight.
- Strengthen platforms for community engagement in local health center planning and oversight.
- Strengthen community digital health systems and other relevant information systems that support integrated programming and health system decision making and quality care management, including both ongoingly and in response to changing environmental and political needs.
- Component 2.3: Improved effective response and adaptation to both unanticipated shocks and ongoing health system stressors27 at all levels of the health system.
- Identify and strengthen health system functions, policies, strategies, and capacities needed to address and mitigate climate and health risks, for example utilizing climate information services to improve health workforce management to utilize staff to meet evolving health needs.
- Ensure effective use of data to inform contingency planning at the sub-national level, including to protect vulnerable populations in advance of possible disruption, and to strengthen early warning systems.
- Support mechanisms for cross-sectoral coordination for continuity of care during emergencies and protracted crises, and for restoration and maintenance of routine service delivery.
- Component 2.1: Enhanced institutional arrangements, including transparent policies, systems, and processes, to increase efficiency and effectiveness of integrated health system performance and accountability.
- Illustrative Activities IR 3
- Component 3.1: Strengthened HSS monitoring and evaluation for program, country, and global needs through robust metrics, standards, systems, and approaches.
- Improve availability, validation, and systematic use of globally-recommended and context-specific quantitative HSS metrics to monitor and evaluate health systems performance, and linkages to health outcomes.
- Improve understanding and use of qualitative approaches and mixed-methods approaches, to help understand health system challenges, opportunities, and outcomes.
- Leverage tools and approaches, including digital technologies, to support health system performance monitoring, data quality improvement, data availability, visualization and interpretation and use at all levels of the health system.
- Component 3.2: Strengthened capacity of government, local and regional partners for monitoring, evaluation, research, and learning (MERL) for health systems strengthening.
- Develop training and resources on using context-appropriate methods and metrics in health system performance monitoring and evaluation, including complexity-aware mixed methods as appropriate.
- Collaborate with local and regional partners to conduct timely implementation research that informs HSS practice and responds to context-specific evidence needs.
- Build capacity of both local and regional partners and government entities across different health system levels, through specific capacity-strengthening approaches, to generate and utilize data and evidence to learn and adapt in response to new information and changes in the health system context.
- Component 3.3: Increased knowledge synthesis, exchange, and collaboration to improve evidence translation and use by key audiences including USAID Missions and local, regional, and global HSS stakeholders.
- Advance global and country HSS learning agendas, support knowledge partnerships and strengthen data and evidence utilization among researchers, implementers, civil society, and policymakers.
- Improve existing networks and communities for HSS knowledge exchange to ensure that local voices are centered in HSS knowledge exchange agendas and can benefit from and/or lead knowledge exchanges to share and adapt local HSS knowledge.
- Synthesize global, regional, and local learning into knowledge products that can be tailored to the differing needs of local, regional, and global HSS stakeholders and shared using tools and platforms that allow stakeholders real time access to HSS knowledge,
- Component 3.1: Strengthened HSS monitoring and evaluation for program, country, and global needs through robust metrics, standards, systems, and approaches.
Geographic Focus
- This activity will work at the global level, and in any country with funded activities. Anticipated regions of focus are Africa and Asia, with more limited activities in LAC, Middle East, and Europe and Eurasia regions. It is anticipated that this activity will annually be active in an average of approximately 15-20 countries and regional programs. While this is the anticipated geographic focus and number of countries, needs can arise in any country or region where USAID receives funding. The number of countries will be determined by programming needs and available funding.
Eligibility Criteria
- USAID welcomes applications from organizations that have not previously received financial assistance from USAID.
- USAID welcomes applications from local organizations and/or consortiums that include local organizations. 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; and
- Has as its principal place of business or operations in; and
- Is
- majority owned by individuals who are citizens or lawful permanent residents of; and
- managed by a governing body the majority of who are citizens or lawful permanent residents of the country receiving assistance.
- Faith-based organizations are eligible to apply for federal financial assistance on the same basis as any other organization and are subject to the protections and requirements of Federal law.
For more information, visit Grants.gov.