Deadline: 30-Oct-22
The United States Agency for International Development in Bangladesh (USAID/Bangladesh) is seeking applications from qualified US and non-US organizations to implement an activity titled USAID’s Community Nutrition and Health Activity (CNHA).
The goal of the Community Nutrition and Health Activity (CNHA) is to improve the nutrition and other health outcomes of women and children in the 1,000 days’ households1 in Bangladesh. As part of supporting Bangladesh in becoming self-reliant, the Community Nutrition and Health Activity will address the inequitable nutrition and other health outcomes of the most vulnerable segments of the population through a targeted community-health system strengthening approach. CNHA aims to strengthen sustainably the community health system.
USAID/Bangladesh seeks to improve the nutritional status of women and children within the first 1,000 days of life, as defined as pregnancy to the child’s second birthday. The Community Nutrition and Health Activity (CNHA) will support maternal, infant and young child nutrition status by
- Strengthening public community health systems to deliver quality nutrition, family planning and health services;
- Improving nutrition and health behaviors; and
- Strengthening governance for nutrition at the national, sub-national and community levels. The Activity also seeks to improve communities’ resilience to shocks.
Priorities
- A recent evaluation of the Community-Based Health Care systems identified several priority issues that need to be addressed to improve CC service quality and to increase utilization and demand for such services.
- Most services provided by the CCs are curative: Active provision and demand for promotive and preventive health services is low. There is limited integration of preventive health services when women and children come to seek curative services. Most CCs lack the systemic approach (ability and coordination across DGFP and DGHS) to provide services according to a public health approachpromoting preventive health services.
- Limited coordination and collaboration among CCs and Upazila Health Complex (UHC): Effective teamwork, collaboration, and coordination between all cadres (CHCP, FWA, HAs) and Upazila Health Complex (UHC) is lacking. 18 Domiciliary services are provided by different cadres (FWA, HAs) from two different Directorates of MOHFW with limited coordination also with limited involvement of the CHCP, thus resulting in several missed opportunities.
- Limited continuity of family planning services: FP services are not consistently available in all CCs as these services depend on the availability of Family Welfare Assistants (FWAs) who are expected to provide FP services three times a week within the CCs.
- Limited supervision systems: While the CC supervision system has been defined, the application remains challenging. A team from the Upazila Health Complex is assigned the role of monitoring and supervising CHCPs, HAs and FWAs. However, there is limited coordination among the different supervisors. Supervisory visits to the various cadres at CCs focus primarily on filling out the checklist, and not on assessing competency levels, or providing necessary feedback for quality improvement.
- Limited referral and counter-referral system in place: Protocols for referrals by CCs to higher levels of care, including Union Health and Family Welfare Centers (UHFWC) are in place but most often CCs bypass the UHFWCs (next referral level) and refer directly to the Upazila Health Complex or District Hospitals as CCs perceived UHFWCs as not fully operational. Feedback and counter-referral are limited and not systematically done. Findings show that the receiving facility (higher level of care) often is not ready or informed of the referrals.
- Limited effectiveness of community groups: Community Clinics are a unique model of community engagement and social accountability as communities are expected to play an active role in the governance of these facilities. Community Groups (CGs) and Community Support Groups (CSGs), composed of community representatives, are expected to provide support to the CCs.
- Limited capacity building support of CSGs and CGs: These groups receive limited capacity building support on how to provide oversight and ensure greater allocation of resources for their respective CCs. Greater collaboration and coordination are needed between the Ministry of Local Government, Rural Development and Cooperatives (MoLGRD&C) and the Local Government Division to engage the decentralized LG institutions to strengthen CCs, CSGs, and UH&FWCs .
- In addition to health system issues, socio-cultural barriers limit access and utilization of services provided by CCs. For example, socio-cultural and religious norms limit access to antenatal care for married pregnant adolescents as husbands and/or mothers-in-law define when and where adolescent girls may receive services. Often adolescent married pregnant women remain isolated with very limited access to antenatal and postnatal care services.
- In some regions, awareness of CCs and the services they provide is low: Only 60% of ever-married women (15-49 years) are aware of a community clinic in their locality. Awareness of community clinics is lower among women in Dhaka, Sylhet, and Chattogram divisions.
Funding Information
- Award Ceiling: $40,000,000.
Eligibility Criteria
- This funding opportunity is open to all eligible U.S. and non-U.S. nongovernmental organizations (NGOs) entities (other than those from foreign policy restricted countries), including educational organizations and universities, and public international organizations, etc.
- Pursuant to Code of Federal Regulations (CFR) 2 CFR 200.400(g), the non-Federal entity may not earn or keep any profit resulting from Federal financial assistance. While for-profit firms may participate, pursuant to 2 CFR 700.13(A)(1) Prohibition against profit, no funds will be paid as profit to any for-profit entity receiving or administering Federal financial assistance as a recipient or sub-recipient, and as such, for-profit organizations must waive profits and/or fees to be eligible to apply.
- USAID welcomes applications from organizations that have not previously received financial assistance from USAID.
For more information, visit https://www.grants.gov/web/grants/view-opportunity.html?oppId=343831
