Deadline: 14-Sep-23
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 Tuberculosis Diagnostic Network Strengthening Activity.
The purpose of this activity is to enhance Bangladesh’s capacity to operate highly functional, quality assured, accessible, and equitable Tuberculosis (TB) diagnostic networks that swiftly detect TB cases and link them to life-saving care and treatment. This activity will be a cooperative agreement and awarded through a full and open solicitation. The total estimated contribution of the Mission is $20 Million, with an expected life of five years.
Goal: to operate highly functional, quality assured, accessible, and equitable diagnostic networks, including its laboratories and use of other technologies, that swiftly detect TB cases and link them to life saving care and treatment.
Objectives
- Objective 1: Improve TB Diagnostic and Treatment Services
- It is crucial to expand a diagnostic network’s reach and consider non-laboratory testing sites, non-public facilities, and mechanisms for moving specimens rather than patients, and other health system strengthening interventions capable of reaching everyone with the diagnostic services they require. Diagnostic services should maintain high quality and standards, irrespective of the client’s socioeconomic status, gender identity, physical ability, or geographic location. Accordingly, USAID will strengthen health systems to ensure anyone potentially infected or at risk of falling sick with any form of TB has access to high quality and reliable diagnostic services to identify their status.
- Intermediate Result 1: Equitable Access to Diagnostic Networks Obtained
- The laboratory network is not equitably distributed across Bangladesh, which limits and disadvantages clients of lower socioeconomic status, those living in hard-to-reach areas, and other groups of populations that do not have equitable access to diagnostic services. TB is still characterized as a “disease of the poor,” which fuels stigma and discrimination among clients, decreasing the chances of clients who seek services out of fear of being judged. Among existing laboratories, the range and availability of TB diagnostic tests is also a limitation.
- The applicant is expected to work hand-in-hand with the NTP, at the national and local levels, to develop and implement evidence-based, systems strengthening interventions supporting the NTP’s objectives that include, but are not limited to, the following lines of effort.
- Conduct context-specific and appropriate systems level bottleneck assessment to understand the current status of the diagnostic network, especially among low performing networks (national to local), and an equity gap analysis to understand the diagnostic network’s inability to deliver equitable access to testing services for anyone that seeks them.
- Build diagnostic network capacity to swiftly detect all forms of TB and ensure availability for anyone seeking diagnostic services, regardless of their socioeconomic status or ability to pay.
- Support NTP in developing a realistic and budgeted plan to expand the use of globally proven molecular testing technologies and tools across Bangladesh’s existing diagnostic network (national to local).
- Intermediate Result 2: Linkages to Care and Treatment Ensured
- Upon identifying positive TB cases, it is paramount to link cases to the appropriate care and treatment, depending on the type of TB diagnosed. Linking TB cases to care and treatment will help control the spread of the disease. Despite Bangladesh’s high treatment success rate, many TB positive cases are not referred and linked to care and treatment services immediately after diagnosis. In Bangladesh, medical providers who identify TB cases need to personally (and often manually) link the TB positive patient to a public care and treatment center, such as a Directly Observed Treatment (DOTs) center where treatment is provided by healthcare or community workers. This modality can prevent timely treatment initiation or even increase the number of pre-treatment losses-to-follow-up. Additionally, the laboratories found across the levels of the national diagnostic network do not link with one another.
- The applicant is expected to work hand-in-hand with the NTP, at the national and local levels, to develop and implement evidence-based, systems strengthening interventions supporting the NTP’s objectives that include, but aren’t limited to, the following lines of effort.
- Strengthen existing referral systems between public and private sector diagnostic networks to ensure appropriate linkages to care and treatment centers of the clients choosing.
- Identify and address the social determinants and equity gaps preventing TB patients from linking to care and treatment, once diagnosed, and subsequently, develop interventions to close these equity gaps.
- Developing inclusive strategies to encourage behaviors to initiate care and treatment—without delay— at the treatment center of the patient’s choosing.
- Objective 2: Enhance TB Diagnostic Network Quality
- To ensure high quality in a TB diagnostic network, standard operating procedures (SOP), quality control measures for handling and testing TB samples, appropriate infection prevention and control protocols, and technical capacity among human resources need to be guaranteed. To enhance quality across the diagnostic network, this Activity will support the NTP to ensure international quality standards are adhered to, plan and budget for the appropriate human resources needed to operationalize the diagnostic network with existing national resources, and reinforce information systems that track diagnostic and supply chain performance and needs nationally and locally.
- Intermediate result 1. Diagnostic network standards implemented
- Implementation and compliance with internationally proven standards are vital when diagnostic networks aim to ensure quality to accurately diagnose TB in any laboratory or testing site. Although reflected in the NTP’s NSP, effective and standard implementation at the national, divisional, district, and community level is lacking.
- The applicant is expected to work hand in hand with the NTP, at national and local levels, to strengthen systems that promote quality, including the implementation of international standards that ensure quality and reinforce the NTP’s regulatory functions. The applicant will develop and implement evidence-based interventions supporting the NTP’s objectives that include, but aren’t limited to, the following lines of effort.
- Align national policies and strategies with international recommendations and develop corresponding strategic implementation plans, guidance, SOPs, etc.
- Advocate for internationally-recommended standards to be included in national and local policy frameworks.
- Institutionalize quality assurance methods (e.g. quality improvement cycles, EQA, etc.) in laboratories and testing sites at national and local diagnostic network levels and ensure appropriate GOB funding is allocated.
- Intermediate result 2. Human resources expertise strengthened
- A diagnostic network depends on highly skilled professionals to operationalize and ensure the delivery of high-quality services. The NTP faces serious human resources shortages that limit the diagnostic networks’ capacity to deliver TB diagnostic services to anyone seeking them, and prevent quality assurance oversight.
- This Activity will not supplant or replace the NTP’s human resources function by hiring project-funded staff to fill human resources gaps, but rather work with the existing workforce to maximize the diagnostic network’s effectiveness. To strengthen the NTP’s existing and future workforce capacity to effectively operate a diagnostic network, the applicant is expected to work hand in hand with the NTP, at national and local levels, to develop and implement evidence-based interventions supporting the NTP’s objectives that include, but aren’t limited to, the following lines of effort.
- Analyze current workforce versus demand gaps of the TB diagnostic network.
- Mobilize government allocated resources to ensure realistic and budgeted workforce planning to hire and retain the human resources needed to meet the diagnostic networks’ demand.
- Evaluate existing human resources skills and knowledge gaps and deploy state of the art capacity strengthening interventions to improve their competency skills to operationalize, maintain, and sustain the effectiveness and quality assured diagnostic network, which include laboratories and testing sites at the national and local level.
- Intermediate result 3. Information management systems enhanced
- Consequently, the NTP risks losing patients by not immediately linking or referring them to appropriate care and treatment once the diagnostic network identifies them as TB positive. Similarly, the NTP’s information management system lacks the capacity to monitor the logistic and supply chain ecosystem needed to oversee and operate its diagnostic network. The NTP lacks a strong logistic and supply chain information management system, which should track laboratory equipment, reagents, testing kits, and other supplies needed to ensure access to those diagnostic services and to maintain quality and minimize laboratory stock outs, deficiencies, and disruptions.
- To link the diagnostic network with the national patient tracker information system and ensure an effective logistic and supply chain information management system for the NTP, the applicant is expected to work hand in hand with the NTP, at national and local levels, to develop and implement evidence-based interventions supporting the NTP’s objectives that include, but aren’t limited to, the following lines of effort.
- Ensure interoperability between the NTP’s diagnostic network and the national patient tracking information management systems to facilitate appropriate, timely, equitable, and effective linkages to care and treatment services.
- Advance the use and expansion of open-source data and information management systems should the need arise to complement existing information systems and after a robust assessment is conducted.
- Enhance and improve existing logistic and supply chain information management systems to track laboratory needs and operational requirements, ensure procurements and commodities are made available for timely use, and to avoid diagnostic services disruptions.
Funding Information
- Subject to funding availability and at the discretion of the Agency, USAID intends to provide twenty million dollars ($20 million) in total USAID funding over a Five (5) year period.
Risk and Assumptions
Over the course of this Activity’s implementation cycle, the following assumptions and risks should be considered. This list is not exhaustive.
- Continuous NTP leadership turnover that disrupts ongoing progress/implementation because of policy shifts or lack of buy-in from new leadership.
- Global and local shocks/interruptions in supplying diagnostic testing equipment can disrupt the availability of diagnostic services, therefore, detecting less TB cases.
- Human induced and/or natural emergencies disrupt routine TB diagnostic testing services and consequently, reprioritize human resources away from the NTP lines of duty.
- Political and social disruption related to the 2024 national elections might affect access to diagnostic services.
- The MOHFW is able to finalize the 5th Health, Population and Nutrition Sector Program as scheduled, with no disruptions to health programming.
Intended Beneficiaries
- The intended beneficiary of this activity is anyone potentially infected or at risk of falling sick with any form of TB, regardless of their demographic, socioeconomic status, gender identity, physical ability, or geographic location. There will be a particular emphasis on closing equity gaps and ensuring diagnostic services are made available for anyone needing them, and subsequently link all forms of TB cases to appropriate and evidence based care and treatment. Beyond this, the applicant may identify and propose populations of interest in order to close equity gaps, meet this activity’s objectives, and maximize USAID impact.
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.
- The non-Federal entity may not earn or keep any profit resulting from Federal financial assistance. While for-profit firms may participate, 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.
- Individuals are not eligible to apply.
For more information, visit Grants.gov.