CFAs: Urban Health Activity to enhance Health System Resilience (Uganda)

CFAs: Urban Health Activity to enhance Health System Resilience (Uganda)

Deadline: 20-May-24The Uganda USAID-Kampala has announced submissions for Urban Health Activity to enhance health system resilience and improve the survival and well-being of the residents of Kampala city, Mukono, and Wakiso districts.The Uganda USAID-Kampala has announced submissions for Urban Health Activity to enhance health system resilience and improve the survival and well-being of the residents of Kampala city, Mukono, and Wakiso districts.

The Activity will strengthen public and private health systems at the facility and community levels to deliver responsive, timely, evidence-based, quality services. The Activity will strengthen maternal, newborn, and child health (MNCH); malaria; family planning (FP)/reproductive health (RH); nutrition; and Global Health Security (GHS) services in the Target Districts.The Target Districts feature a combined population of 5.7 million people and host a third of Uganda’s urban population, according to the Uganda Bureau Of Statistics 2022 report. Uganda’s overall urban population is rising and projected to reach 50 percent of the total population by 2050. The rapid urbanization and rise in the number of informal settlements in the Target Districts increases the risk of infectious disease spread in the event of an outbreak and further exacerbates health vulnerability among its residents.

Problem Statement

The convergence of several key factors contribute to the poor health outcomes among residents in the Target Districts: Poor quality of health services, missing critical human resource cadres, lack of basic laboratory equipment, high staff absenteeism, overcrowded public health facilities, an ineffective referral system, underdeveloped community networks and surveillance systems, limited private sector capabilities, and systemic gaps within the enabling environment.

Challenges

Service Delivery: The public health facilities in the three Target Districts face several important health system challenges, including essential medical commodity shortages, lack of critical medical equipment, gaps in health management information systems (HMIS), staff absenteeism, and a shortage of critical health worker cadres like medical officers, anesthetists, and cold chain assistants. FP/RH, nutrition, and MNCH services are not fully integrated, creating missed opportunities for increased client satisfaction, cost efficiency, and enhanced health outcomes. Further, the urban health patient referral system is largely dysfunctional: There is poor pre-referral preparation, poor coordination between referring and receiving sites, and missing patient information provided to the referring facilities.Community system: The Target Districts’ community health systems do not function well due to: (1) limited numbers of and undermotivated Village Health Teams (VHTs); (2) delivery of fragmented health services that focus on treatment rather than prevention; (3) failure to consult key audiences in health programming processes; and (4) weaknesses in community health reporting and supply chain systems. Social barriers further hinder adoption of positive health behaviors through misinformation, lack of knowledge and awareness about modern health services, unsupportive socio-cultural norms, and lack of empowerment, especially among vulnerable women and adolescents. Distance to health facilities and health service costs remain major obstacles for women accessing health services, even in urban districts, according to the MCHNA and FPA Evaluation Report of 2022.Private sector: Uganda’s private sector offers potential innovative new approaches in eHealth, logistics management, and patient referral tracking, while further enhancing domestic resource mobilization via unlocking new corporate social responsibility resources and business development investment. Given the private health sector’s large footprint, such innovations offer an opportunity to significantly increase its market share of family health services beyond what it currently provides in the Target Districts.Internal and external factors: Though they are often the first entry point for most clients living in urban settings, most private clinics charge high service fees and provide a limited service package. Several internal and external factors, compiled from various Kampala Capital City Authority reports, limit the quality and operations of private health facilities. The internal factors include limited staffing (and, in some cases, high staff turnover), high operational costs, inability to access capital, and inability to report health data into the national HMIS.Leadership and governance: The Target Districts have functional district health structures that provide overall health service coordination in the respective districts and conduct support supervision. They have instituted a functional Local Maternity and Newborn System (LMNS) for effective inter-district referrals. However, district health teams are understaffed and poorly-resourced, limiting their ability to provide comprehensive support supervision to both the public and private health facilities in their jurisdictions. The new Government of Uganda (GoU) human resources for health (HRH) structure, approved in 2023, is not yet operationalized; there is limited use of health data for decision making; and poor coordination and collaboration among partners subnationally.

Funding Information

USAID intends to provide $34,000,000 in total USAID funding over a five-year period.To achieve the desired results for the Activity in a manner that supports long-term sustainability, builds local capacity, and empowers local ownership in addressing urban health issues in the Target Districts, an important component of this Activity will be a strategically-linked to at least $2,000,000 in small grants to local organizations.Applications must state a period of performance. The period of performance must be 60 months or less. The period of performance is subject to negotiation during co-creation. The estimated start date will be October 1, 2024.

Expected Results

Intermediate Result 1: Quality of care improved 

• The focus of this IR is to create a sustainable, high-quality public and private health system that is centered around the people. It should build people’s confidence by measuring and responding to the urban population’s health needs, expectations, and perspectives, in addition to improving health outcomes.
  • Sub IR 1.1 Quality of health services improvedSub IR 1.2 Patient referral pathways/system strengthened

Intermediate Result 2: Private sector service provision strengthened 

• IR2 will enhance the capacity of the private health sector to provide quality health services through an innovative accreditation and quality assurance system. This IR will also support private health facilities to provide the Activity’s target health services and operate as viable and profitable businesses with a more diverse range of health services through business model optimization. This Activity will use proven approaches to spur private sector innovations to 10 address specific urban health challenges. In addition, this IR will enhance partnerships between public and private health facilities to make them more responsive to the needs of the community.
  • Sub-IR 2.1 Accreditation, standards. and quality assurance systems improvedSub-IR 2.2 Sustanainble and equitable business model implementedSub-IR 2.3 Implementation of public-private partnerships for health improved.

Intermediate Result 3: Community health strengthened 

• IR3 will seek to create a more inclusive and supportive environment for health-seeking behaviors. It will address barriers to accessing healthcare and adoption of healthy behaviors, including cultural beliefs and gender dynamics. This Activity will build community capacity to demand better health services and may use social accountability approaches such as community-led monitoring of service delivery.
  • Sub-IR 3.1 Adoption of healthy behaviors improvedSub-IR 3.2 Access to community health services improvedSub-IR 3.3 Community surveillance enhancedSub-IR 3.4 Community-based activities to reduce plastic waste and pollution improved

Intermediate Result 4: Improved coordination and multi-sectoral collaboration for urban health programming 

• IR4 will improve coordination for urban health programming within the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) National Technical Working Groups (TWGs) and multi-sectoral coordination for nutrition. In addition, this Activity will strengthen coordination structures in the Target Districts. The Activity will also improve health data management and use and supply chain systems at district- and facility-levels.
  • Sub-IR 4.1 Coordination and multi-sectoral collaboration for urban health improvedSub-IR 4.2 Supply chain systems strengthenedSub-IR 4.3 Data management and utilization strengthened

Eligibility Criteria

Eligible Applicants 

• Eligibility is unrestricted. USAID/Uganda is particularly interested in working with Local Entities, Locally Established Entities, Private Sector Partners, New Partners, and Non-traditional Partners as Implementing Partners (IPs). However, this solicitation is not specifically limited to these categories, and USAID/Uganda strongly encourages applications from all interested entities.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.

Cost Share                

• USAID has established a mandatory Recipient cost share of 10% for this Cooperative Agreement. Such funds may be provided directly by the Recipient; other multilateral, bilateral, and foundation donors; host governments; and local organizations, communities, and private businesses that contribute financially and in-kind to implementation of activities at the country level. This may include contribution of staff level of effort, office space or other facilities or equipment which may be used for the program, provided by the Recipient. For guidance on cost sharing in grants and cooperative agreements.Cost sharing will help the Government of Uganda identify potential adequate alternative sources of funding and/or increase the diversity and optimization of non-U.S. government financial or in-kind resources.

For more information, visit Grants.gov.