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Federal Agency Name: United States Agency for International Development Funding Opportunity Title: MOMENTUM (Moving Integrated, Quality

Maternal, Newborn, and Child Health and Family Planning and Reproductive Health Services to Scale)

Announcement Type: Annual Program Statement (APS) Funding Opportunity Number: 7200AA19APS00002 Catalog of Federal Domestic Assistance (CFDA) Number: 98.001 Issuance Date: April 22, 2019 (revised May 8, 2019) Closing Date: September 30, 2025 Questions Deadline for this APS Document: April 29, 2019 at 12:00 pm ET For questions on this APS document, please submit all questions to Mrs. Samantha Pierre via email at spierre@usaid.gov by the deadline specified above. Please see individual Round documents for each Round’s deadlines and submission instructions for concept papers. For a USAID Mission or USAID/Washington Office wishing to issue a Round under this APS, the program description must fit within Section I of this document. Please contact Samantha Pierre (spierre@usaid.gov) for review of the Round document - it must be reviewed before being posted publicly under this APS. All new Rounds must be posted as a MOMENTUM APS Round on the USAID Business Forecast.

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To Interested Applicants: This Annual Program Statement (APS) publicizes the intention of the United States Government (USG), as represented by the United States Agency for International Development (USAID), Bureau for Global Health (GH), to fund one or multiple awards to address the overarching APS program purpose. The purpose is to accelerate reductions in maternal, newborn, and child mortality and morbidity in high-burden, USAID-supported countries by increasing the capacity of host country institutions and local organizations to introduce, deliver, scale up, and sustain the use of evidence-based, quality maternal, newborn, and child health (MNCH), voluntary family planning (FP) and reproductive health (RH) services. This main APS document outlines the goal, purpose, expected results, and priorities of MOMENTUM (Moving Integrated, Quality Maternal, Newborn, and Child Health and Family Planning and Reproductive Health [MNCH/FP/RH] Services to Scale), and may result in multiple awards issued under subsequent APS Rounds. Note: When referencing MOMENTUM in this document, it is referring to the full portfolio of possible awards under this overall purpose. This specific document is an umbrella APS and will not be accepting concept papers or applications. Prospective applicants will be provided a fair opportunity to develop and submit competitive concept papers to USAID for potential funding via discrete Rounds under this APS. For the purposes of the MOMENTUM APS, a “Round” is defined as a specific program description that falls under the larger MOMENTUM APS goal, purpose, and results but is tailored to a certain focus. Under each Round, applicants will first submit a short concept paper that will be reviewed for responsiveness to the overall MOMENTUM purpose, selected results, and Round’s focus and then scored according to the evaluation criteria provided in the Round document. If an applicant is successful in the concept paper stage, applicant representatives may be invited to join a co-creation workshop. Following the co-creation process, selected applicants (individual organizations and/or consortia developed at concept paper stage or during co-creation) will be requested to submit a Full Application, the content and format of which will be provided in greater detail by the Agreement Officer. Publishing this APS does not commit USAID to make any awards. USAID also reserves the right to not conduct a co-creation workshop and request Full Applications from successful applicants at concept paper stage. As Rounds occur, notifications will be posted on Grants.gov. Sincerely, /s/ Alisa J. Dunn Alisa J. Dunn Supervisory Agreement Officer Office of Acquisition & Assistance

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TABLE OF CONTENTS

SECTION I: Funding Opportunity Description........................................................................5 A. Background........................................................................................................................8 B. Statement of APS Goal, Purpose, and Expected Results….........................................18 C. Cross-cutting Programmatic Principles and Approaches…........................................20 D. Legislation.........................................................................................................................20 SECTION II: Award Information.............................................................................................21 A. Funding ............................................................................................................................21 B. Period of Performance.....................................................................................................21 C. Expected Number of Awards..........................................................................................21 D. Expected Implementation Mechanism ..........................................................................21 E. USAID’s Substantial Involvement ................................................................................22 F. Intellectual Property .......................................................................................................23

G. Environmental Impact ……............................................................................................24 H. Authorized Geographic Code.........................................................................................25 I. Benefiting Geographic Areas .........................................................................................25 SECTION III: Eligibility Information.......................................................................................26 A. Eligibility Criteria............................................................................................................26 B. Cost Share.........................................................................................................................27 SECTION IV: Concept Paper Submission Information..........................................................28 SECTION V: Evaluation Criteria..............................................................................................33 Appendices: Appendix A: MCH and FP Priority Countries Appendix B: USAID Gender Equality and Female Empowerment Policy, 2012 Appendix C: Youth in Development Policy, 2012 Appendix D: USAID Frontiers in Development – Ending Extreme Poverty, 2014 Appendix E: USAID Multi-Sectoral Nutrition Strategy, 2014-2025, 2014 Appendix F: USAID Maternal Health Vision for Action, 2014 Appendix G: Every Newborn Action Plan, 2014 Appendix H: USAID Risk Appetite Statement, 2018 Appendix I: USAID Private Sector Engagement Policy, 2018 Appendix J: USAID Acquisition and Assistance Strategy, 2018 Appendix K: USAID Essential Considerations for Engaging Men and Boys for Improved Family Planning Outcomes, 2018 Appendix L: US Strategy to Prevent and Respond to Gender-Based Violence, 2016 Update Appendix M: USAID Discussion Note: Adaptive Management

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ACRONYM TABLE ADS Automated Directives System AO Agreement Officer AOR Agreement Officer’s Representative APS Annual Program Statement BEO Bureau Environmental Officer CA Cooperative Agreement CFR Code of Federal Regulations DUNS Data Universal Numbering System EA Environmental Assessment FAM Fertility Awareness Methods FP Family Planning GH Global Health Bureau GNI Gross National Income HIV Human Immunodeficiency Virus HTSP Healthy Timing and Spacing of Pregnancy IEE Initial Environmental Evaluation IR Intermediate Result LARC Long-Acting Reversible Contraceptives LMIC Low- and Middle- Income Countries MCH Maternal and Child Health MCHN Office of Maternal Child Health and Nutrition MDGs Millenium Development Goals MEL Monitoring, Evaluation, and Learning MNCH Maternal, Newborn, and Child Health MNH Maternal and Newborn Health MRC Merit Review Committee NGOs Non-Governmental Organizations OFDA Office of Foreign Disaster Assistance PEPFAR President’s Emergency Plan for AIDS Relief PRH Office of Population and Reproductive Health RCE Request for Categorical Exclusion RH Reproductive Health SBC Social and Behavior Change SAM System for Award Management, Registration, Renewal, & Migration SDGs Sustainable Development Goals USAID United States Agency for International Development USG United States Government WASH Water, Sanitation, and Hygiene WHO World Health Organization

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Moving Integrated, Quality MNCH/FP/RH Services to Scale (MOMENTUM)

SECTION I: FUNDING OPPORTUNITY DESCRIPTION The U.S. Agency for International Development’s Office of Maternal and Child Health and Nutrition (MCHN) and Office of Population and Reproductive Health (PRH) are pleased to announce the Moving Integrated, Quality Maternal, Newborn, and Child Health, Family Planning and Reproductive Health (MNCH/FP/RH) Services to Scale (MOMENTUM) Annual Program Statement (APS). MOMENTUM seeks to accelerate reductions in maternal, newborn, and child mortality and morbidity in high-burden, USAID-supported countries by increasing the capacity of host country institutions and local organizations to introduce, deliver, scale up, and sustain the use of evidence-based, quality maternal, newborn, and child health (MNCH), voluntary family planning (FP) and reproductive health (RH) services.1 MOMENTUM is designed to build upon existing evidence and best practices, as well as to catalyze new ideas, partnerships, and approaches. Despite tremendous improvements in the health status of women and children over the past three decades, these gains have not been equal across or within countries, leaving an unfinished agenda to improve maternal, newborn, and child health and access to voluntary family planning and reproductive health services. In response, under the guiding framework of the Sustainable Development Goals (SDGs), the global health community has committed to ending all preventable deaths of women, children, and adolescents within a generation and ensuring their well-being. Achieving these ambitious global goals by 2030 necessitates a coordinated and integrated approach to further accelerate progress in mortality and morbidity reduction to ensure that mothers, their children, and families survive and thrive. USAID will continue to play an integral and guiding role in the achievement of these global goals.

For many years, analyses found scant evidence of the benefits of MNCH/FP/RH integration.2 Studies did however, document the impressive benefits to society that could be achieved through greater investment in women’s and children’s health. One study, for example, found that increasing health expenditure by just five dollars per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits.3 While practitioners called for a more holistic continuum of care,4 compelling data from rigorous integration studies remained elusive. By 2015, however, a stronger body of evidence had

1 MNCH/FP/RH services encompass the management and delivery of health interventions ranging across health promotion, disease prevention, diagnosis, and treatment. Example interventions include skilled attendance at birth, newborn resuscitation, oral rehydration solution, zinc for childhood diarrhea, voluntary family planning services, and post-abortion care, as well as those that address gender-based violence, child marriage, early sexual initiation, and male engagement, among other conditions. Abortion services are not included in USAID-funded programs. 2 Lindgren ML et al. Integration of HIV/AIDS services with maternal, neonatal, and child health, nutrition, and family planning services. Cochrane Systematic Review. 12 Sept 2012 DOI: 10.1002/14651858.CD010119 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010119/abstract 3Stenberg K et al. Advancing social and economic development by investing in women’s and children’s health: a new Global Investment Framework. The Lancet. 2014;383: 1333-54 https://www.sciencedirect.com/science/article/pii/S014067361362231X 4 Kerber K et al. Continuum of care for maternal, newborn, and child health:from slogan to service delivery. The Lancet. 2007;370:1358-1369.

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emerged. One rigorous study demonstrated the long-term positive impact (over 20 years) of integrated MNCH/FP/RH services on women’s and children’s health in Bangladesh.5 Recent, multi-country research has provided evidence on the increased health impact and cost-benefits of MNCH/FP/RH integration in broad country programs.6 And multiple studies reveal positive outcomes achieved by integrating specific interventions -- for example, family planning and immunization, post-abortion care and family planning, and immediate postpartum family planning.7

In line with this research, the MOMENTUM APS seeks to build on USAID’s progress to date in advancing a holistic continuum of care and integrated MNCH/FP/RH services. USAID programs have been dedicated to improving the health of women and children throughout the world via coordinated, programmatic investments in maternal, newborn, and child health and voluntary family planning and reproductive health. USAID will continue supporting the promotion of healthy behaviors, prevention of illness and disability, and management of health conditions at the household, community, and facility levels, while supporting the needs of health systems (public and market-based) to provide evidence-based, quality interventions and care to reduce preventable deaths. These evidence-based interventions are set forth in USAID’s first Acting on the Call Report,8and are described for the following areas: newborn health, immunization, childhood illnesses, nutrition, maternal health, family planning and water sanitation and hygiene (WASH). Additional practices and interventions may be promoted by USAID as new evidence becomes available.

While MOMENTUM will build upon the successes and lessons learned of the GH Bureau’s current and previous centrally-managed MNCH/FP/RH projects, including but not limited to, the flagship Maternal and Child Survival Program (MCSP), the Maternal and Child Health Integrated Program (MCHIP), the Basic Support for Institutionalizing Child Survival (BASICS) awards, Advancing Partners and Communities (APC), and Evidence to Action (E2A), MOMENTUM also reflects an evolution in USAID’s centrally-managed MNCH/FP/RH programming from a one-size fits all approach to a more targeted, contextualized approach which demands greater co-creation and collaboration throughout the design process. Through a coordinated portfolio of centrally- and mission-managed awards, MOMENTUM is designed to facilitate countries’ journey toward self-reliance9 and help ensure that USAID’s investments (which span the humanitarian-to-development continuum) are tailored to country contexts and needs. Fundamental to MOMENTUM is a recognition that USAID-supported countries have different epidemiologic and demographic profiles, and unique context-specific challenges, that require unique support at national and sub-national levels. The impact of

5 Joshi S, Schultz TP. Family planning and women’s and children’s health: long-term consequences of an outreach program in Matlab, Bangladesh. Demography. 2013;50(1):149-180. https://link.springer.com/article/10.1007/s13524-012-0172-2 6Investing in Contraception and Maternal and Newborn Health in the Ouagadougou Partnership Countries. 2017. Fact Sheet, New York: Guttmacher Institute and FP2020, Core indicator estimates: FP2020 2017-2018 Progress Report, 2018. 7 www.fphighimpactpractices.org 8Acting on the Call Annual Report, Ending Preventable Child and Maternal Deaths. USAID. 2014. https://www.usaid.gov/sites/default/files/documents/1864/USAID_ActingOnTheCall_2014.pdf 9According to USAID, 2018: “Self-Reliance” is a country’s ability to finance and implement solutions to its own development challenges. The two mutually reinforcing factors determining self-reliance are a country’s commitment and a country’s capacity. See: https://www.usaid.gov/selfreliance

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additional determinants such as gender equality, urbanization, climate change, and economic development will affect countries differently and will require context-specific knowledge and approaches. All awards under MOMENTUM will be designed to provide countries with the tailored support that they need to progress along the continuum of development towards self-reliance. MOMENTUM will include a greater focus on building the capacity, sustainability, and resilience of local partner institutions, while maintaining an emphasis on advancing the scale-up of evidence-based approaches and interventions. MOMENTUM awards will seek to issue performance-based, capacity-building, and/or innovation sub-awards and sub-grants to local organizations which may, in time, become transition awards.10 All sub-awards to local organizations will specify clear, achievable, and measurable outcomes mapped to priority health indicators, and connect to specific, national priorities and milestones on the journey to self-reliance. At the global level, MOMENTUM will contribute to global technical leadership and evidence generation and dissemination for MNCH/FP/RH, continuing USAID’s pivotal role in this area. MOMENTUM will ensure the linkages between knowledge generation, global dialogue, and country action to achieve global MNCH/FP/RH goals. MOMENTUM builds upon USAID’s strategic pillars of respecting American taxpayers’ investments, advancing national security, and advancing countries on their journey to self-reliance, by:

(1) Working with local systems, institutions, and organizations, thereby strengthening the long-term effectiveness and durability of investments; (2) Using a variety of assistance models to help countries advance from recipients of assistance to enduring strategic partners; (3) Aligning USAID investments with country-owned and -led national and subnational health, social, and economic investment plans to maximize cost-efficiency and increase sustainability; (4) Optimizing strategic partnerships and engagement to increase financial investments and establish long-term, enduring, and sustainable engagement by non-donor stakeholders towards mutual goals. Partners may include public sector and private provider organizations, non-governmental organizations (NGOs), community-based and faith-based organizations, and professional associations, among other civil society actors, including non-health organizations; and (5) Increasing coordination across bureaus and offices within USAID to maximize efficiencies and impact, including (but not limited to) the Office of Population and Reproductive Health, Office of Maternal and Child Health and Nutrition, Office of Health Systems, and the Office of Infectious Disease within the GH Bureau; Regional Bureaus; the Bureau for Humanitarian Assistance, the Bureau for Resilience and Food Security, the Bureau for Conflict Prevention and Stabilization, and the Bureau for Democracy, Development and Innovation.

10 Under MOMENTUM, a transition award is defined as a partner which previously received funding as a sub-awardee and has now transitioned to receiving direct funding from USAID or other donors.

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A. Background As a global leader in maternal and child health and the world’s largest bilateral donor for voluntary family planning, USAID partners with governments to meet the health needs of women, couples, and children. For more than 50 years, USAID programs have saved lives and improved health outcomes across the globe. When USAID's maternal and child health activities began in the 1960s, maternal and newborn mortality data were not routinely collected and the under-five mortality rate was estimated to be 241.5 per 1,000 births in lower-income countries.11 Today, due in part to USAID investments, there has been a 44 percent reduction in global maternal mortality and a 51 percent reduction in newborn mortality since 1990 when these indicators were first measured,12 13 while the global under-five mortality rate has fallen to 39 deaths per 1,000 live births.14 When USAID launched its family planning program in 1965, less than 10 percent of women in low- and middle-income countries (LMIC) were using a modern contraceptive method, and the average family size was over six. Today, in the 31 countries where USAID focuses its family planning support, on average, modern contraceptive prevalence has increased to 30 percent, and family size has dropped to 4.4.15 To date, USAID has successfully graduated numerous countries (Thailand, South Korea, Chile, Costa Rica, Jamaica, Indonesia, Mexico, Colombia, Brazil, Paraguay, El Salvador, Nicaragua, Honduras, Peru, Dominican Republic, Ecuador, Kazakhstan, Uzbekistan, Turkey, Tunisia, Morocco and Ukraine) from family planning assistance.16 USAID has led the introduction of a wide range of interventions -- from oral rehydration therapy, to kangaroo mother care, to active management of the third stage of labor, to doorstep delivery of family planning, mobile outreach, and new contraceptive technologies, to name only a few -- contributing to improved health outcomes for women, newborns, and children around the world. In the past ten years alone, USAID investments have helped save an estimated five million children and 200,000 women in 25 priority countries.17 MOMENTUM will build upon these achievements and apply lessons from previous and current USAID health projects. To ensure that future investments maintain past gains, MOMENTUM will catalyze the development of new ideas, mobilize local resources, build capacity, improve the quality of health care, and accelerate progress by uniting partners around the common goal of ensuring that women and children have the same opportunities to survive and thrive, regardless of where they give birth or are born.

11 USAID 50 Years of Global Health, Saving Lives and Building Futures 12 Trends in maternal mortality:1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. 13 Levels and Trends in Child Mortality, United Nations Inter-Agency Group for Child Mortality Estimation, Report 2018. 14 Levels and Trends in Child Mortality, United Nations Inter-Agency Group for Child Mortality Estimation, Report, 2018. 15 USAID, Family Planning and Reproductive Health Program Overview, November, 2017. https://www.usaid.gov/sites/default/files/documents/1864/FP-program-overview-508.pdf 16 USAID considers a country’s family planning program a candidate for graduation within a 2-10 year time period when the Total Fertility Rate is 3.4 or less; and the Modern Contraceptive Prevalence Rate is 48 percent or higher. 17 https://www.usaid.gov/what-we-do/global-health/maternal-and-child-health

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Technical Analyses During the Millennium Development Goals (MDG) period, the world witnessed some of its greatest advances in maternal and child health and unprecedented reductions in preventable mortality. From 1990 to 2015, maternal mortality declined by 44 percent from 385 deaths per 100,000 live births to 216 deaths per 100,000 live births.18 Child mortality declined from 93 deaths per 1,000 live births in 1990 to 39 per 1,000 live births in 2017, an impressive 58 percent reduction.19 Despite this progress, 303,000 women and 5.4 million children continue to die every year, with newborns representing an increasing proportion of all under-five deaths (47 percent).20 Country-specific analyses of annual rates of mortality reduction, based on 2000-2016 trends, reveal a need for accelerated mortality reductions to meet the 2030 Sustainable Development Goal (SDG) under-five mortality target of no more than 25 deaths per 1,000 live births in every country, and a global average maternal mortality ratio target of 70 per 100,000 live births.21 With 210 million women becoming pregnant and 140 million newborns delivered each year, accessible, quality MNCH/FP/RH services are a global imperative to accelerate mortality reduction. Maternal Health The world has made impressive progress in reducing maternal mortality over the past two and a half decades. Despite progress, approximately 830 women continue to die each day from complications of pregnancy and childbirth.22 Ninety-nine percent of these women live in lower- and middle-income countries (LMICs), and the disparity with high-income countries is immense: the lifetime risk of maternal mortality for women living in a LMIC is 1 in 180 versus 1 in 4,900 for women living in high-income countries.23 In countries designated as fragile states, the risk is 1 in 54, pointing to the dire consequences of breakdowns in health systems in these settings.24 There are large maternal mortality disparities between countries, but also within countries. Key factors of inequity in coverage and access to quality antenatal, intrapartum, and postpartum care may include poverty, cultural and gender norms, education, age, ethnicity, religion, economic status, social stigma, and geographical location. These factors necessitate innovative and multi-sectoral approaches to increase equity in access to and use of health services. Postpartum hemorrhage (primary cause of nearly one quarter of all maternal deaths globally), pre-eclampsia and eclampsia, maternal sepsis, complications during delivery, and unsafe abortion are the major causes of maternal mortality, accounting for nearly 75 percent of all

18 Trends in maternal mortality:1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division 19 Levels and Trends in Child Mortality, United Nations Inter-Agency Group for Child Mortality Estimation, Report 2018 20 Ibid. 21 Sustainable Development Goals Targets https://www.globalgoals.org/3-good-health-and-well-being 22 Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Lancet. 2016; 387 (10017): 462-74. 23 https://www.who.int/news-room/fact-sheets/detail/maternal-mortality 24 Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Lancet. 2016; 387 (10017): 462-74.

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maternal deaths.25 The majority of these causes are both preventable and/or treatable. In addition to the key, evidence-based clinical interventions that address these major causes of death, USAID’s Maternal Health Vision for Action 2014-2020 (Appendix F) promotes ten strategic drivers that together enable and mobilize individuals and communities, advance quality, promote respectful care, and strengthen health systems to reduce maternal mortality. A mother’s death as a result of pregnancy or childbirth threatens her newborn’s chance of survival, lowers her other children’s chances for survival and education, threatens family stability, and undermines her country’s prosperity. Success in achieving USAID’s core mission of partnering to end extreme poverty and promoting resilient democratic societies rests, in part, on its success in helping to end preventable maternal mortality. Newborn Health While major strides have been made in reducing under-five mortality rates, there has been slower progress in reducing newborn deaths. Each year, 2.5 million babies die within the first 28 days of life, with more than three-quarters of these deaths occurring in sub-Saharan Africa and South Asia.26 One million of these deaths occur within the first 24 hours of life.27 An additional 2.6 million babies are stillborn each year, with half of these babies alive in the beginning of labor but dying before birth.28 More than 80 percent of newborn deaths are the result of premature birth, complications during labor and delivery, and infections such as sepsis, meningitis, and pneumonia. Similar causes, particularly complications during labor, account for a large share of stillbirths.29 The periods of greatest risk for morbidity and mortality are the hours that precede, and the hours and days that follow, birth. Intervention in this critical time period provides the greatest potential for ending preventable newborn deaths and stillbirths. When interventions are delivered during labor and childbirth, and immediate newborn care is provided, there is a 51 percent reduction in newborn mortality and 70 percent of stillbirths are averted.30 National neonatal mortality rates often mask variations within countries. Babies born to mothers with no education face almost twice the risk of dying during the newborn period as babies born to mothers with at least a secondary education; and babies born to the poorest families are over 40 percent more likely to die during the newborn period than those born to the least poor.31

25 Global Causes of Maternal Death: A WHO Systematic Analysis. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels JD, et al. Lancet Global Health. 2014;2(6): e323-e333. 26 Levels and Trends in Child Mortality, United Nations Inter-Agency Group for Child Mortality Estimation, Report 2018. 27 Ibid. 28 Every Newborn Action Plan: Reaching Every Newborn, National 2020 Milestones, Country Progress, Plan and Moving Forward, WHO, UNICEF, May 2017. 29 Ibid. 30 Bhutta, Z, Das J, Bahl, R, Lawn J, Salam R, Paul V, Sankar J, Blencowe H, Rizvi A, Chou V, Walker N. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?. The Lancet. 2014; 384. 10.1016/S0140-6736(14)60792-3 31 United Nations Children’s Fund, Committing to Child Survival: A Promise Renewed – Progress Report, 2014, UNICEF, New York.

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USAID’s newborn health program aligns with the World Health Assembly endorsed Every Newborn Action Plan (Appendix G), which sets out a vision for a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies, and children survive, thrive, and reach their full potential. Child Health The approximately 60 percent reduction in child mortality in 27 years is one of the most significant achievements in global health and development. USAID’s multi-sectoral approach supporting innovative research and implementation of evidence-based interventions, including its investments at global, regional, and country levels in maternal and child health, immunization, family planning, nutrition, water and sanitation (WASH), HIV, tuberculosis, and malaria programs, has helped contribute to this significant mortality reduction. However, almost 15,000 children under-five still continue to die each day, largely due to conditions that can be prevented or treated with access to simple, affordable interventions.32 The high rates of preventable death and poor health and well-being of children under-five are indicators of the uneven coverage of life-saving interventions and, more broadly, of inadequate social and economic development. Poverty, poor nutrition, and insufficient access to clean water and sanitation are all harmful factors, as is insufficient access to quality health services. The leading causes of death in children under-five are preterm birth complications, pneumonia, birth asphyxia, diarrhea, and malaria. Malnourished children, particularly those with severe acute malnutrition, have a higher risk of death from common childhood illnesses; and nutrition-related factors contribute to about 45 percent of deaths in children under-five years of age.33 USAID’s child health programs support partner countries’ health systems to deliver state-of-the-art, evidence-based interventions to ensure that children not only survive the first five years of life but that they thrive. A healthy child is better able to grow, learn, and thrive, leading to more opportunities to succeed and provide economically for themselves and their family, and to contribute to the society in which they belong. Family Planning and Reproductive Health When women bear children too closely spaced together, too early or too late in life, or after five previous births, the health of the mother and baby are at risk. A 2016 review of 52 countries found that, depending on the country, between 8 and 38 percent of married women between the ages of 15-49 years have an unmet need34 for family planning.35 Providing couples and individuals with access to voluntary family planning is vital to ensuring safe motherhood, healthy families, and prosperous communities.

32 Levels and Trends in Child Mortality, United Nations Inter-Agency Group for Child Mortality Estimation, Report, 2018. 33 Ibid. 34Unmet need for family planning is defined as the percentage of women of reproductive age, either married or in union, who wish to delay or end childbearing, but are not using any method of contraception. Unmet need is measured using more than 15 different survey questions (DHS). 35 Sedge G et. al. Unmet need for contraception in developing countries: examining women’s reasons for not using a method. Guttmacher Institute. 2016; New York.

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In 2012, to measure progress and catalyze renewed commitment to family planning, FP202036 established an ambitious goal of enabling access to modern contraception for an additional 120 million more women and girls in the world’s 69 poorest countries by the year 2020. Recent measures of progress indicate that there are an additional 46 million voluntary users of modern contraception compared to 2012.37 While the pace of change is slower than anticipated, this represents about 30 percent more additional users than would have been achieved at historical growth rates alone (24 million).38 Despite this growth in the number of voluntary users, evidence-based, quality interventions are still necessary to address key gaps in family planning programming. Sustainable service delivery approaches are needed to reach women and couples who have never used contraception as analyses found that “never users” account for high percentages of unmet need and unintended pregnancies (62 and 67 percent, respectively).39 Service delivery approaches are also needed to reach women and couples who have discontinued contraceptive use -- in developing countries, about 38 percent of women with unmet need have discontinued contraceptive use, while about 33 percent of unintended births are attributable to contraceptive discontinuation.40 Approaches are also needed to address a skewed method mix/limited method choice in many countries as analyses found that, of 109 countries surveyed, 30 percent had a skewed method mix.41 42 This skewed method mix may reflect individual preferences, lack of contraceptive choice, provider bias, lack of provider competency, absence of contraceptive commodities, supplies or instruments, restrictive policies, financial barriers, or a combination of these factors. Recent evidence shows a rise in the popularity of long-acting, reversible contraception (LARC), including in crisis settings.43 While female sterilization is the most used method worldwide, it is less available in low-resource settings and use of vasectomy is very low.44 At the other end of the method spectrum, widespread misperceptions contribute to low investment in Fertility Awareness Methods (FAM), even though FAMs do not require clinical intervention and can be offered through a variety of service delivery channels.45 (USAID considers FAMs as modern contraceptive methods.) USAID wants to ensure that a range of methods are available in country programs to support informed choice. 36 https://www.familyplanning2020.org/ 37 http://progress.familyplanning2020.org / 38 Stover J, Sonnenfeld E.. Progress toward the goals of FP2020. Studies in Family Planning. 2017; 48(1):83-88. 39 Jain AK, Winfrey W. Contribution of contraceptive discontinuation to unintended births in 36 developing countries. Studies in Family Planning. 2017; 48(3): 269-278. See also, Policy Brief at www.popcouncil.org/uploads/pdfs/2017RH_ContraceptiveDiscontinuation.pdf 40 Ibid. 41 Bertrand JT et al. Contraceptive method skew and shifts in method mix in low- and middle-income countries. Int Perspect Sex Reprod Health. 2014; 40(3):144-53. 42 Skewed method mix is defined as one in which 50 percent or more of contraceptive users in a given country rely on a single method. 43Long-acting reversible contraceptives: an important focus at the 2016 International Conference on Family Planning. Glob Health Sci Pract. 2016;4 Suppl 2:S1. http://dx.doi.org/10.9745/GHSP-D-16-00241 44 Kotingo E, Allagoa D, Tamunomie N. Evolving trends in female sterilization: a review article. Elite Research Journal and Medicine and Medical Sciences. 2014; 2(2):11-16. 45 Malarcher S et al. Fertility awareness methods: distinctive modern contraceptives. Global Health Science and Practice. 2016; 4(1):13-15.

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Empowering women to voluntarily choose the number, timing, and spacing of their pregnancies is not only a matter of health but also touches on many multi-sectoral determinants vital to sustainable development, including women’s education and status in society. Without universal access to family planning and reproductive health, the impact and effectiveness of other health interventions will be reduced, will cost more, and will take longer to achieve. Integrated Programming MNCH/FP Integrated MNCH and FP programming can lead to important, mutually-reinforcing, positive health outcomes, ultimately contributing to improving the lives of women and children. Fifteen million babies are born premature each year and preterm birth complications are the leading cause of death among children under five years of age.46 USAID-funded research in Bangladesh found that adding family planning to a community-based program of maternal and newborn care led to a 19 percent reduced risk of short birth intervals and a 21 percent reduced risk of preterm birth in the next pregnancy.47 Now, through integrated, high-impact services such as immunization-FP integration, immediate postpartum family planning, post-abortion family planning, and community-based MNCH/FP services, integrated MNCH/FP/RH programs are contributing to increased reductions in maternal and newborn mortality and morbidity across the globe.48 Nutrition Evidence also supports the importance of integrating nutrition interventions with MNCH/FP/RH services for improved health outcomes. Adequate maternal nutrition during the “first 1,000 days” window is especially critical from conception through the first two years of life to improve the nutritional status of both the woman and infant and to reduce the risk of adverse birth outcomes, such as low birthweight and preterm birth.49 Marked reductions in child undernutrition can be achieved through: improving women’s nutrition before and during pregnancy, practicing early and exclusive breastfeeding, and providing good-quality complementary feeding for infants and young children, with appropriate micronutrient interventions. Large-scale programs—including the promotion, protection, and support of exclusive breastfeeding, providing vitamins and minerals through fortified foods and supplements, and community-based treatment of severe acute malnutrition—have been successful in many countries.50 WASH Adequate WASH conditions and practices are a cornerstone to providing high-quality MNCH/FP/RH health care services. An estimated 10-15 percent of maternal deaths are due to

46 WHO Preterm Births, Key Facts,19 February, 2018. www.who.int 47 Baqui A et al. Impact of integrating a postpartum family planning program into a community-based maternal and newborn health program on birth spacing and preterm birth in rural Bangladesh. Journal of Global Health. 2018; 8(2). doi.10.7189/jogh.08.020406 48 For an overview of family planning high impact practices, go to www.fphighimpactpractices.org 49 USAID Multi-Sectoral Nutrition Strategy 2014-2025 50 United Nations Children’s Fund (UNICEF). Tracking progress on child and maternal nutrition: A survival and development priority. UNICEF Publications, November 2009.

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infections linked to unhygienic conditions during labor and poor hygiene practices during the six-week postpartum period.51 Simple, clean birth practices, including handwashing with soap for mothers and birth attendants in homes and health facilities, have been shown to improve newborn survival rates by 44 percent.52 Studies have also shown that handwashing alone (included as a core intervention in both A Promise Renewed53 and the Integrated Global Action Plan for Pneumonia and Diarrhea54) can dramatically reduce the rates of two of the leading causes of under-five mortality, diarrhea and respiratory infections such as pneumonia, by 4755 and 1656 percent respectively. Improving WASH conditions and practices is not only entirely feasible but also affordable and cost-effective. Every dollar invested in water and sanitation yields a $4.3 return in increased productivity and decreased health care costs.57 Cross-Cutting Considerations Quality of Care The 2018 Lancet Global Health Commission on High Quality Health Systems (HQSS) found that poor quality care is now a greater barrier to reducing mortality than lack of access to health care in LMICs. The Commission states that 60 percent of deaths in LMICs from conditions that are amenable to health care, are now due to poor-quality care, whereas the remaining deaths result from non-utilisation of the health system. The challenge has shifted from ensuring that populations have access to and utilize health services to ensuring populations receive quality health services. Critical gaps in the quality of MNCH/FP/RH care include services that are non-effective, unsafe, undignified, disrespectful, and uncoordinated. In LMICs, mothers and children receive less than half of recommended clinical actions in a typical preventive or curative visit. Diagnoses are frequently incorrect for serious conditions such as pneumonia and newborn asphyxia, and care is often too slow for conditions that require timely action, reducing chances of survival. The HQSS found that one in three people across LMICs cited negative experiences with their health system in the areas of attention, respect, communication, and length of visit; on the extreme end of these experiences were disrespectful treatment and abuse. Quality of care will become an even larger driver of population health as utilisation of health systems increases and as the burden of disease shifts to more complex conditions.58 Health Systems As with most interventions in the health sector, the sustainability, quality, and coverage of

51 Gravett CA et al. Serious and life-threatening pregnancy-related infections: opportunities to reduce the global burden. PLoS Med 2012; 9: e1001324. 52 Rhee; V et al. Maternal and birth attendant handwashing and neonatal mortality in southern Nepal. Arch Pediatr Adolesc Med.2008;162(7): 603-608. 53 https://www.unicef.org/publications/files/APR_2015_9_Sep_15.pdf 54 https://www.who.int/maternal_child_adolescent/documents/global_action_plan_pneumonia_diarrhoea/en/ 55 Curtis V et al. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis, 2003; 3(5):275-81. 56 Rabie T et al. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health, 2006; 11(3): 258-67. 57 UN-water global analysis and assessment of sanitation and drinking-water (GLAAS) 2014 - Report Investing in water and sanitation: increasing access, reducing inequalities. WHO, UN-Water. 58 The Lancet Global Health Commission. High Quality Health Systems in the SDGs Era: time for a revolution.Lancet Glob Health 2018; 6:e1196-252.

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MNCH/FP/RH services is, to a large extent, determined by the performance of the overall health system in which they are implemented. As such, health systems are the backbone of USAID’s efforts to reduce preventable maternal, newborn, and child mortality. Reaching all women and children requires investment in every aspect of the health system, including leadership and governance, policies, the workforce, infrastructure, commodities and supplies, service delivery, information systems and financing. Different contexts require tailored approaches, with specific attention to preparedness for, and rapid response to complex humanitarian emergencies or fragile settings. Social and Behavior Change While biology and physiology are important contributors to an individual’s health, the social determinants that shape human interaction also play an important role in health at the individual, family, and community levels. These factors include knowledge, attitudes, social and cultural norms and conventions, and behaviors. Improving the quality or coverage of health services is not, in many cases, sufficient to improve health outcomes on its own. Improving health outcomes also requires changing the health-seeking behaviors of individuals and communities, as well as the norms that underpin those behaviors. Interventions that seek to change behaviors by addressing factors such as knowledge, attitudes, and norms, known collectively as social and behavior change (SBC) interventions, complement and enhance the role played by clinical interventions. In fact, evidence presented at the 2013 Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change, showed that some behavioral change interventions compare favorably to evidence in clinical research fields of biomedical interventions.59 Social and behavior change interventions shape not only demand, but also communication between health providers and clients, families’ and couples’ communication, and the engagement of community leaders and other influencers in promoting the adoption of healthy behaviors and practices. Communities, families, and healthcare workers with the right skills and information can maximize access to lifesaving commodities and high-quality health services. Gender Investing in women and girls is essential to strengthening the self-reliance of partner countries and transforming communities. When women do better, families, communities, and nations do better. Gender equality and women’s empowerment are not just a part of development; they are the core of development. While a range of gender gaps have narrowed over the past two decades, substantial inequities remain across every development priority worldwide. USAID’s Gender Equality and Female Empowerment Policy (Appendix B), USAID’s Essential Considerations for Engaging Men and Boys for Improved Family Planning Outcomes (Appendix L), and the United States Strategy to Prevent and Respond to Gender-Based Violence (Appendix M) highlight USAID priorities including engagement of men and boys as family planning users, supportive partners, and agents

59 Elder, J. et al.(2014) Caregiver Behavior Change for Child Survival and Development in Low- and Middle-Income Countries: An Examination of the Evidence. Journal of Health Communication 19:sup1, pages 25-66.

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of change,60 and the need to address gender-based violence.61 Within integrated MNCH/FP/RH service delivery, strategies are needed to address key, gender-related barriers to health seeking and service use. Barriers include access to and control of assets and resources; cultural norms and beliefs; gender roles, responsibilities, and time use; laws, policies, regulations, and institutional practices; and patterns of power and decision-making. Research shows that when women are empowered to make decisions within their families, and exert greater control over resources and household finances, economic outcomes for families improve and child survival rates, food security, and educational attainment increase.62 Adolescents In developing regions, approximately 21 million girls aged 15 to 19 years and 2 million girls under age 15 become pregnant annually.63 Adolescent pregnancy contributes significantly to maternal and child mortality, and to intergenerational cycles of ill-health and poverty. Pregnancy-related complications are the leading cause of death among 15 to 19 year-old girls globally, with low and middle-income countries accounting for 99 percent of global maternal deaths of women ages 15 to 49 years.64 Studies in Latin America have found that all age groups of adolescents face higher risks of postpartum hemorrhage, puerperal endometritis, and preterm delivery, than women aged 20 to 24 years.65 Each year, about 15 million girls are married before the age of 18 years, and 90 percent of births to girls aged 15 to 19 years occur within marriage.66 Sustainable service delivery strategies are needed to empower youth, both boys and girls, to make healthy decisions starting at a young age (aged 10-14) and to continue to do so throughout the life-cycle. Evidence shows that access to adolescent-friendly services for those with unmet need, linked, as appropriate, with positive youth development activities, are needed and can be effective in helping youth avoid risk behaviors.67 MNCH/FP/RH and the Journey to Self-Reliance According to metrics68describing population magnitude, maternal and child mortality severity, and selected high-impact intervention coverage indicators, including various dimensions of FP need, USAID-supported countries are on different points along the development continuum towards sustainability and self-reliance. This continuum ranges from countries that have many development challenges and rely on external support to meet the MNCH/FP/RH needs of their 60 USAID. Essential considerations for engaging men and boys for improved family planning outcomes. 2018. Office of Population and Reproductive Health, Bureau for Global Health. https://www.usaid.gov/sites/default/files/documents/1864/Engaging-men-boys-family-planning-508.pdf 61 United States Strategy to Prevent and Respond to Gender-Based Violence. 2016 Update. https://www.state.gov/documents/organization/258703.pdf 62 H.R.5480 - Women's Entrepreneurship and Economic Empowerment Act of 2018 63 World Health Organization. Adolescent Pregnancy. 23 February 2018. https://www.who.int/en/news-room/fact-sheets/detail/adolescent-pregnancy 64 Ibid. 65 Conde-Agudelo A et.al. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: cross sectional study. Am J Obst Gyn. 2004; 192:342-9. 66 UNICEF. Child Marriage: 39,000 Every Day. 7 March 2013 https://www.unicef.org/media/media_68114.html 67 Alvarado G et al. A Systematic Review of Positive Youth Development Programs in Low and Middle-Income Countries. 2017. USAID Youth Power Learning. Making Cents International. https://static.globalinnovationexchange.org/s3fs-public/asset/document/Systematic%20Review%20of%20PYD%20Programs%20in%20LMICs-V1-1%20Revised_0.pdf?Gvs1HeO6CLQvw7SECxtKsRwshub5gK3t 68 USAID, Acting on the Call Report, 2018 available at https://www.usaid.gov/sites/default/files/2018ActingontheCall_508.pdf

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populations (e.g., South Sudan) to countries that themselves have become health donors (e.g., India). Countries furthest from self-reliance have relatively few resources and limited capacity to address their population’s health and family planning needs. These countries may have sub-national or national areas of fragility, which can disrupt the ability of MNCH/FP/RH programs to effectively meet the needs of their population. Such fragile and/or non-permissive environments, whether due to man-made or natural conditions, contribute to an increased burden of maternal, newborn, and child mortality. They require health care delivery models for MNCH/FP/RH programming that are more integrated, flexible, dynamic, and comprehensive, and able to function in these settings. These are not static situations, geographically or over time. Some countries or sub-national areas move in and out of fragility, while others retain fragile state status for many years. According to Save the Children’s 2014 report State of the World’s Mothers: Saving Mothers and Children in Humanitarian Settings, 56 percent of all maternal and child deaths occur in fragile countries.69 According to the World Bank, two billion people live in countries where development outcomes are affected by fragility, conflict, and violence. The share of the extreme poor living in conflict-affected situations is expected to rise to more than 60 percent by 2030.70 According to country-specific analyses, countries facing political instability and violence are often the countries with lower historic annual rates of reduction in under-five mortality and therefore require significantly accelerated progress to achieve global targets.71 Concurrently, the distributions of income and health within and across USAID partner countries are rapidly changing, with many countries experiencing impressive economic growth over the last several decades. As these countries transition along the economic development continuum, so does their need for development health assistance. Increased domestic resource mobilization offers new opportunities to transform traditional development partnerships and increase self-reliance. USAID’s development assistance for health in these countries has already, or will progressively, shift focus from funding intervention-specific and comprehensive service delivery programming to providing technical guidance and capacity-building for overall health systems strengthening, achievement of health care for all, increased accountability for sustained public and private MNCH/FP/RH programs, and progression along the pathway to self-reliance. USAID’s self-reliance metrics and country-specific road maps can be found at https://selfreliance.usaid.gov/.

69 Calculations represent the share of global maternal and under-5 deaths (according to WHO and UN Interagency Group for Child Mortality Estimation) that occur in the 51 fragile states as identified by OECD [Fragile States 2014: Domestic Revenue Mobilisation]. 70 World Bank, Fragility Overview: http://www.worldbank.org/en/topic/fragilityconflictviolence/overview 71 Fragile States Index 2018 Annual Report

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B. Statement of APS Goal, Purpose, and Expected Results Goal: The goal of this APS is to contribute to the Agency’s priority of preventing maternal and child deaths, by assisting USAID-supported FP and MCH priority countries72 in meeting global goals in maternal, newborn, and child health and voluntary family planning by 2030. Further, activities under this APS will help the Agency advance countries toward increased self-reliance. Purpose: The purpose of this APS is to accelerate reductions in maternal, newborn, and child mortality and morbidity by increasing the capacity of host-country institutions and local organizations to introduce, deliver, scale-up, and sustain the use of evidence-based, quality MNCH, voluntary family planning and reproductive health services. Expected Results: Collectively, Rounds under this APS will seek to meet this purpose through achievement of four results and fourteen intermediate results, as described below. Each Round will address one or more of the four MOMENTUM APS results through a myriad of modalities. Please see Round specific documents for this information. Result 1: Access to and use of evidence-based, quality MNCH/FP/RH information, services, and interventions scaled-up and sustained. MOMENTUM will improve the health status of women and children by increasing effective coverage of evidence-based and culturally acceptable interventions and services that address their health needs. This will be achieved through the following intermediate results:

IR1.1 Improved service readiness to provide quality MNCH/FP/RH interventions in public and private sectors, including emergency care.

IR1.2 Improved MNCH/FP/RH practices at the individual, family, and community level. IR1.3 Increased demand for and utilization of quality MNCH/FP/RH interventions and

care by individuals, families, and communities. Result 2: Capacity of host-country institutions, local organizations, and providers to deliver evidence-based, quality MNCH/FP/RH services improved, institutionalized, measured, documented, and responsive to population needs. MOMENTUM will maximize health gains by increasing the capacity of country institutions and local organizations to anticipate, plan for, and respond to the health needs of their population. MOMENTUM awards will reflect capabilities to issue performance-based, capacity-building, and/or innovation, sub-awards to local organizations, as requested by missions, that have the possibility to become transition awards. Such sub-award strategies will result in clear, achievable, and measurable milestones, and include plans to strengthen the capacity of local organizations to receive direct USAID or other donor funding. MOMENTUM will help institutionalize evidence-based, quality interventions and innovative solutions within sub-awardees and a broad range of host-country institutions and local organizations, and measure and document local organizations’ strengthened capacity and progress toward self-reliance. Intermediate results include the following:

72 MOMENTUM’s focus is on the Maternal and Child Health and Family Planning Priority Countries listed in Appendix A, however, if Mission-proposed work fits within the MOMENTUM program description and/or specific Round, it is possible to include USAID-supported non-priority countries.

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IR2.1 Increased effectiveness of country institutions and systems to sustainably plan and manage quality MNCH/FP/RH services, including anticipating and responding to crises, as well as long-term demographic and epidemiologic transitions.

IR2.2 Enhanced capacity of country governing bodies to align MNCH/FP/RH policies and guidelines with international standards and evidence-based, innovative, and promising practices.

IR2.3 Strengthened engagement with civil society, local institutions, community-based and faith-based organizations to narrow MNCH/FP/RH equity gaps,73improve quality of care, and hold health systems accountable.

Result 3: Adaptive learning and use of evidence in MNCH/FP/RH programming through sustained USAID and host country technical leadership increased. MOMENTUM will advance the field of MNCH/FP/RH through research and innovation, and support efforts to disseminate and deploy those advances in country programs. MOMENTUM will work to increase the systematic collection and analysis of data, data translation, and knowledge management, and use of data and evidence for improved MNCH/FP/RH policies and programs. All MOMENTUM awards will be required to collaborate and share data with a portfolio-wide monitoring and evaluation and knowledge management award (TBD, to be competed in a Round) to ensure the systematic analysis, synthesis, translation, and dissemination of learning from across the entire suite of MOMENTUM awards. MOMENTUM will also utilize USAID’s catalytic, global leadership role to advance MNCH/FP/RH. This will be achieved through the following:

IR3.1 Increased appropriate and timely availability and use of data for decision making

in MNCH/FP/RH policy and programs at global, regional, and sub-national country levels.

IR3.2 Increased knowledge generation, translation, and management strategies adopted to support best practices in MNCH/FP/RH policies and programs at the global, regional, and sub-national country levels.

IR3.3 Testing and adoption of innovative practices to improve MNCH/FP/RH outcomes. IR3.4 USAID’s catalytic global technical leadership in MNCH/FP/RH supported and

sustained.

Result 4: Cross-sectoral collaboration and innovative partnerships between MNCH/FP/RH and non-MNCH/FP/RH organizations increased. MOMENTUM will advance a holistic, multi-sectoral approach to meet the health needs of women and children across the MNCH/FP/RH continuum, exploring strategies to support cross-sectoral linkages and priorities where possible with both traditional and non-traditional organizations. IR4.1 International and national public-private partnerships increased. IR4.2 Health partnerships with educational institutions expanded. IR4.3 Health partnerships with corporate and philanthropic organizations increased. IR4.4 Health and non-health organization partnerships expanded.

73 For purposes of this APS, MNCH/FP/RH equity gaps refer to inequities in access to MNCH/FP/RH services; inequities in the quality of available services; and inequities in how responsive services are in meeting the needs of different populations (e.g. ethnic, religious, or geographic groups).

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C. Cross-cutting Programmatic Principles and Approaches Under each Round, applicants are requested to incorporate fundamental cross-cutting principles underlying each of the expected results above. These principles are:

● promoting dignity, respect, and equity in healthcare services; ● fostering gender equality by increasing use of approaches designed to empower

vulnerable populations including women, and couples, and engage men more fully in MNCH/FP/RH;

● building and bolstering the resilience74of populations and communities, thereby encouraging sustainability, and leveraging the work of other US government agencies and donors;

● addressing the role of social norms, both as barriers and contributors to achieving health and development outcomes;

● improving the quality of care provided across the continuum from household to facility;

● promoting client-centered care by listening to and engaging individuals, families, and communities;

● implementing evidence-based approaches and interventions; ● fostering iterative, continuous learning and adaptive management; ● coordinating monitoring and evaluation efforts across MOMENTUM awards to

effectively monitor collective results and impact; and ● partnering with a range of health and non-health actors.

D. Legislation This APS is issued under the Foreign Assistance Act of 1961, as amended. In each Round, award(s) will be made under relevant federal regulations and agency policy. For U.S. non-governmental organizations, awards must be administered according to 2 Code of Federal Regulations (CFR) 200 and 2 CFR 700, and USAID Standard Provisions will apply (http://www/usaid.gov/policy/ads/300/303maa.pdf). For non U.S. non-governmental organizations, USAID provisions for non U.S. non-government organizations will apply (http://www.usaid.gov/policy/ads/300/303mab.pdf).

End of Section I

74 USAID defines resilience as “the ability of people, households, communities, countries and systems to mitigate, adapt to, and recover from shocks and stresses in a manner that reduces chronic vulnerability and facilitates inclusive growth” (USAID, 2012)

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SECTION II: AWARD INFORMATION A. Funding The funding for the Rounds under this APS may be provided through GH offices, as well as USAID mission field support for USAID/W issued Rounds, and direct USAID mission funds for USAID/Mission issued Rounds. As determined by the source of funding, awardee(s) will be expected to comply with the legal and USAID policy requirements that govern the Agency’s programming. Pending funding availability, there may be multiple Rounds for this APS that will all aim to meet the Purpose and Results mentioned above. The financial range for award(s) will be specified in each Round. Issuance of this APS does not constitute an award or commitment on the part of the USG, nor does it commit the USG to pay for costs incurred in the preparation and submission of a concept paper or an application. USAID reserves the right to close or amend the APS on or before the closing date, stated on page 1. Therefore, for each issued Round, organizations are encouraged to apply as soon as possible to be considered for review to maximize the possibility of receiving available funding. B. Period of Performance The proposed period of performance for each agreement awarded as a result of each Round(s) under this APS will not exceed five years in duration beginning from the negotiated start date, and subject to availability of funds. Concept papers—and later in the process, full applications—should propose activities for a five-year period of performance—nothing more or less. If the expected period of performance will be less than five years for a specific Round, that Round document will include that information. Additionally, the anticipated start date for a possible award(s) will be specified in each Round. C. Expected Number of Awards Multiple awards may be made as a result of the Round(s) of this APS. The actual number of awards under the Round(s) of this APS is subject to the availability of funds and the viability of applications received. Accordingly, USAID reserves the right to award multiple awards, one award, or no awards at all under each Round. Note: As appropriate, feasible, and as requested by missions, the initial award(s) resulting from this APS will seek to transition direct USAID or other donor funding to local organizations that were sub-awardees on the initial award(s) by the end of the initial award(s). D. Expected Implementation Mechanism One or more cooperative agreements (CAs) may result from the Round(s) of this APS.

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E. USAID’s Substantial Involvement USAID’s substantial involvement during the implementation of cooperative agreements will be limited to approval by the Agreement Officer’s Representative (AOR)—delegated to the AOR by the Agreement Officer (AO)—of the elements listed below, except for any changes to the program description, key personnel, or the approved budgets that require AO approval.

1. Approval of the Recipient’s Implementation Plans: Implementation plans include, but are not limited to, annual work plans, including planned activities for the following year and any subsequent revisions, international travel plans, planned expenditures, international meeting preparation, research studies/protocols, and any changes to any activities, locations, and beneficiary population under the cooperative agreement. USAID requires the approval of implementation plans annually to ensure alignment with stated goals, milestones, and outputs. The implementation plan communicates how and when the Recipient will complete award activities and is drafted annually to describe new and ongoing activities. This plan will be developed in partnership between the Recipient and the AOR team. The AOR will ensure that the implementation plans fit within the program description and the terms and conditions of the agreement.

2. Approval of Specified Key Personnel: Unless the Round document states differently, the Key Personnel for each Round will include the following positions:

a. Project Director/Chief of Party b. Minimum of One Key Personnel Technical Expert (to be further specified in each

Round) c. Monitoring, Evaluation, and Learning Director

Any additional Key Personnel positions will be specified in each Round. Key personnel positions will require concurrence from the AOR and approval from the AO.

3. Agency and Recipient Collaboration or Joint Participation:

a. Approval of the recipient’s Monitoring and Evaluation plans. This describes USAID involvement in monitoring progress toward the achievement of program objectives during the performance of the award, including written guidelines for the content of annual reports and final evaluations in accordance with 2 CFR 200.328 and guidance conforming with PEPFAR reporting requirements at country level, if necessary. While an illustrative Activity Monitoring, Evaluation, and Learning (MEL) Plan may be requested in the full application submission, the final Activity MEL Plan will be developed in consultation with USAID post-award. During the initial award planning period, the awardee shall work closely with USAID to establish major milestones, program monitoring indicators, as well as baseline data and performance targets that will demonstrate successful achievement of the results addressed in the cooperative agreement. The Activity MEL plan shall be finalized within 90 calendar days of the award. The awardee and USAID will jointly review progress on a periodic basis.

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b. Collaborative involvement in selection of advisory committee members, if the

program will establish an advisory committee that provides advice to the recipient. USAID will participate as a member of this committee as well. Advisory committees must only deal with programmatic or technical issues and not routine administrative matters.

c. Monitor to authorize specified kinds of direction or redirection because of

interrelationships with other projects. Activities will be included in the program description, negotiated in the budget, and made a part of the award. Note: the AOR will provide review of the proposed change, and the AO is the only individual who can provide approval for this element of substantial involvement.

d. Concurrence on the substantive provisions of sub-awards. 2 CFR 200.308 (or

Mandatory Provision 3. Amendment of Award and Revision of Budget (August 2013) for non US NGOs) requires the recipient to obtain the AO’s prior approval for the sub-award, transfer, or contracting out of any work under an award. The term ‘sub-award’ includes both sub-agreements and contracts under assistance. Some of the sub-award approval responsibilities may be delegated to the AOR. Please note that any sub-awards (sub-agreements or contracts) to foreign governmental organizations or parastatals of any amount must be approved by the AO, and may warrant additional clearances.

4. Agency Authority to Halt a Construction Activity. The AO may immediately halt a

construction activity if identified specifications are not met. However, major construction activities are not anticipated under any award(s) resulting from each Round under this APS pursuant to Automated Directive System (ADS) 303. On a case-by-case basis, the awards under each Round(s) of this APS may have the ability to engage in minor renovation and small-to medium-scale rehabilitation75 of health facilities to improve the quality and/or availability of MNCH/FP services. Examples may include, but are not limited to, installation of water and sanitation facilities such as handwashing stations, refurbishment of maternity wards, repair of roofing, and enhancements for client privacy. Any minor renovation or rehabilitation of health facilities will be funded by field support with the exception of any possible unforeseen emergency appropriation directives (i.e. Ebola). Therefore, USAID Missions must complete relevant risk assessments before the partner can incur costs for any minor construction work as per ADS 201.3.4.3, ADS 201maw Construction Risk Management, and ADS 303maw USAID Implementation of Construction Activities.

F. Intellectual Property Intellectual Property is discussed in 2 CFR 200.448 (for US NGOs) and in Mandatory Provision 7. Title to and Use of Property (December 2014) (for non-US NGOs). In general, awardee(s) may elect to pursue ownership of intellectual property that is developed as a result of an award from a Round of this APS. In such cases, USAID would typically retain a nonexclusive, non- 75 ADS 304.3.4.2 states “USAID has determined that construction activities are rarely appropriate under Assistance.”

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transferable, royalty-free license to use any such intellectual property. G. Environmental Impact The Foreign Assistance Act of 1961, as amended, Section 117 requires that the impact of USAID’s activities on the environment be considered and that USAID include environmental sustainability as a central consideration in designing and carrying out its development programs. This mandate is codified in 22 CFR 216 and in USAID’s ADS Parts 201 and 204, which, in part, requires that the potential environmental impacts of USAID-financed activities are identified prior to a final decision to proceed and that appropriate environmental safeguards are adopted for all activities. All recipient’s environmental compliance obligations under these regulations and procedures are specified in the following paragraphs of this APS. In addition, the recipient must comply with host country environmental regulations unless otherwise directed in writing by USAID. In case of conflict between host country and USAID regulations, the latter shall govern. No activity funded under this APS will be implemented unless an environmental threshold determination, as defined by 22 CFR 216, has been reached for that activity, as documented in a Request for Categorical Exclusion (RCE), Initial Environmental Examination (IEE), or Environmental Assessment (EA) duly signed by the Bureau Environmental Officer (BEO). (Hereinafter, such documents are described as “approved Regulation 216 environmental documentation”). It has been determined that the activities conducted under this APS will not negatively impact the environment. In accordance with the 22 CFR 216, an IEE recommended a negative determination with conditions as any award(s) resulting from a Round under this APS will not have a significant effect on the human, physical, and biological environment. The AOR management teams will provide the awardee(s) with a copy of the IEE, and will continue to collaborate with the GH Environmental Officer to ensure the award(s) and associated activities incorporate environmentally sound principles in implementation, and adhere to this determination of a “Negative Determination with Conditions.” All awardees will comply with country, USAID, and World Health Organization (WHO) guidance for disposal of sharps and biohazards, as necessary, in preparing an integrated Waste Management Plan (WMP) or equivalent standard operating procedures (SOPs). All awardee(s) will also prepare and implement an Environmental Mitigation and Monitoring Plan (EMMP), as well as annually prepare and submit an Environmental Mitigation and Monitoring Report (EMMR) to the AOR, the latter of which will include a screening in the annual work plan for all on-going and planned activities to ensure they are within the scope of the IEE. Any activities found to be outside the scope of the IEE shall be modified to comply or halted until an amendment to the IEE is submitted and approved. Any sub-awards (sub-agreements, contracts, and grants) must reference and require compliance with the IEE, and completion of all requirements for ethics review and adequate medical monitoring of human subjects who participate in research trials must be documented and in place prior to initiating any trials. Any program activities involving the procurement, use, research or disposal of pesticides and/or larvicides and their waste products will require a supplemental IEE or Pesticide Evaluation Report and Safer Use Action Plan (PERSUAP).

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H. Authorized Geographic Code The authorized geographic code for the procurement of services and commodities is 937. I. Benefiting Geographic Areas MOMENTUM award(s) will provide global leadership and will implement activities in countries with the greatest magnitude and severity of child, neonatal, and maternal mortality. These countries are primarily in Asia and Sub-Saharan Africa, with a limited number of countries in the Latin American and Caribbean region. Current MCH and PRH priority countries are Afghanistan, Bangladesh, Benin, Burkina Faso, Burma (MCH only), Cote d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Haiti, India, Indonesia (MCH only), Kenya, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Nepal, Niger, Nigeria, Pakistan, Philippines (FP only), Rwanda, Senegal, South Sudan, Tanzania, Togo, Uganda, Yemen, and Zambia. This does not, however, preclude activities in other USAID-supported countries. If a Round of this APS has a specific geographic focus, it will clearly state this.

End of Section II

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SECTION III. ELIGIBILITY INFORMATION A. Eligibility Criteria U.S. and non-U.S. public, private, for-profit, and nonprofit organizations, as well as institutions of higher education, public international organizations, and non-governmental organizations, are eligible to submit a concept paper under each Round(s) of the APS. Further, the organization must be a legally-recognized, organizational entity under applicable law, legally registered in a country within the geographic code 937 (“the United States, the recipient country, and developing countries other than advanced developing countries, but excluding any country that is a prohibited source,” per ADS 310.3.1.1). Each recipient must be a responsible entity. The AO may determine a Pre-Award survey is required and if so, would establish a formal survey team to conduct an examination that will determine whether the prospective recipient has the necessary organization, experience, accounting and operational controls, and technical skills – or ability to obtain them – in order to achieve the objectives of the program. Organizations in developing countries are strongly encouraged to apply, inasmuch as they will support not only the objectives of this APS and the Round(s) they are applying to, but also USAID's objectives to build the capacities in local organizations that are needed for sustainable development. USAID strongly encourages applications from potential new partners who meet the eligibility requirements and are willing to be subjected to a Pre-Award Survey. Concept papers from organizations that do not meet the above eligibility criteria will not be reviewed and evaluated. Individuals are not eligible to apply for any Rounds of this APS. While for-profit firms may participate, pursuant to 2 CFR 200.400(g) it is USAID’s policy not to award profit to prime recipients and sub-recipients under assistance instruments. However, while profit is not allowed for sub-awards, the prohibition does not apply when the recipient acquires goods and services in accordance with 2 CFR 200.317 -326, “Procurement Standards.” This is discussed more specifically in ADS 303sai “Profit Under USAID Assistance Instruments,” which can be found at this link: https://www.usaid.gov/sites/default/files/documents/1868/303sai.pdf. Program income may be generated under awards resulting from this APS. Program income for all award(s) resulting from Rounds under this APS may be used for cost-sharing or matching in accordance with 2 CFR 200.307(e) for US NGOs and the Required as Applicable Provision “Program Income” (December 2014) in ADS 303 for non-US NGOs. If the program income is to be utilized in a different way, the Round document will include this information. It must be used in a manner allowable under the CFR and ADS references above. If an organization does not submit a successful concept paper and is not invited to attend the co-creation workshop/submit a full application in a specific Round, that organization may still submit another concept paper in a future Round(s), if one occurs. Evaluation criteria will be revised to the specifics of the Round; another submission in another Round does not guarantee a successful concept paper and invitation to attend the co-creation workshop/submit a full application.

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B. Cost Share Cost share will be required in each Round (unless the Round document specifies otherwise). A required range for cost share will be provided in the request for full applications for each Round; the range will allow for the proposed amount to be commensurate with an eligible organization’s financial capabilities and access to resources, especially those that have not previously partnered with USAID. Such funds may be mobilized from the recipient; other multilateral, bilateral, and foundation donors; host governments; and local organizations, communities and private businesses that contribute financially and in-kind to the implementation of activities at the country level. Mobilization of funds from outside sources through cost share of award activities is highly encouraged. For guidance on cost sharing in grants and CAs, please see the ADS 303.3.10 and 2 CFR 200.306 for US NGOs. For non-US NGOs, all cost sharing would be subject to the Required as Applicable Provision “Cost Sharing” in ADS 303mab.

End of Section III

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SECTION IV. CONCEPT PAPER SUBMISSION INFORMATION Concept papers will be accepted under issued Rounds of this APS. Please refer to the specific Round documents for detailed information on the concept paper submission guidance including concept paper requirements and evaluation criteria for the specific Round. General guidance for all Rounds under this APS is provided below. NOTE: To be considered as a potential prime on a full application, an organization must submit a concept paper (as a prime or sub-partner) to the relevant Round. If an organization is named as a sub-partner on a concept paper submitted by a prime on behalf of an already proposed consortium, the sub-partner is not required to submit its own stand-alone concept paper; however, it can submit a solo concept paper if it wants to be considered independent of the consortium too. Please note that a single organization may not submit more than two concept papers, in total, to any given Round (either 1) one as an individual organization and one as a part of a consortium; or 2) two concept papers submitted as part of two different consortiums). If an organization submits more than two concept papers to any Round, only the first two received will be evaluated. Concept Paper Process Concept papers received under MOMENTUM APS Rounds will be reviewed based on full and open competition and under the procedures and evaluation criteria identified in Section V of each specific Round documentation. Competition under MOMENTUM APS Rounds will consist of a two-step process where applicants first submit a concept paper for an initial competitive review:

1. All concept papers received during a Round will be evaluated by a USAID Merit Review Committee (MRC) for responsiveness to the evaluation criteria outlined in each Round. After a concept paper is received, USAID reserves the right to pose clarifying questions and conduct discussions with any applicant, but may not opt to do so if it believes it has sufficient information in the concept paper itself. Posing clarifying questions and conducting discussions with one applicant does not obligate USAID to do so with all applicants.

2. After the concept papers are evaluated, all successful applicants will be invited to continue the co-creation and collaboration process to identify and develop the activities that will help achieve the results desired under this APS and specific Round(s); identify and incorporate additional partners; and determine respective roles and responsibilities related to the implementation of those activities. Additional instructions and criteria for full application submissions will be provided after evaluation of concept papers, co-creation workshop (if necessary), and when full applications are requested.

For applicants seeking to receive USAID funding to implement proposed activities under a Round of this APS, USAID’s discussions with those applicants will take place within the parameters of publicly available information. These parameters provide ample room for extensive, robust discussions regarding the development problem/goal in question (Section I of this APS, and specified in each Round), best practices, lessons learned in the relevant technical sectors, and pertinent research and evaluations and various other matters. After concept papers have been submitted, USAID personnel can have highly specific, detailed activity design

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discussions with the applicants throughout the remainder of the process, e.g., up to and through any award that might be issued under a Round of this APS. USAID also reserves the right to make an award without discussions if determined to be in the Government’s best interest. Additionally, USAID may make an award on the basis of initial concept papers received, without scheduling a co-creation workshop. Concept papers should be free of any intellectual property that the applicant wishes to protect, as the concept papers may be shared with other organizations as part of the co-creation process. However, once potential partners have been invited to engage in further discussions, they will work with USAID to identify proprietary information that requires protection. Therefore, organizations submitting concept papers provide USAID a royalty free, non-exclusive, and irrevocable right to use, disclose, reproduce, and prepare derivative works, and to have, or permit others to have, use of any information contained in the concept paper submitted under each Round(s) of this APS. If USAID engages with the organization regarding its concept paper, the parties can negotiate further intellectual property protection for the organization’s intellectual property. Organizations must ensure that any submission under all Round(s) of this APS is free of any third party proprietary data rights that would impact the license granted to USAID herein. Concept papers are not evaluated against other concept papers, but rather against the concept paper evaluation criteria in Section V for each specific Round. The evaluation of the content in the concept papers against Section V for each specific Round will allow USAID to determine if an organization could make valuable technical contributions to the co-creation process; the ideas in the concept papers may or may not be the same approaches developed further during co-creation, though the solutions and strategies generated may draw from these ideas. No additions or modifications to concept papers will be accepted after the submission date for each Round of this APS. Concept papers that are submitted late or are incomplete may not be considered for the co-creation workshop or request for full applications (if co-creation workshop is not held). Additional information in the concept paper not requested by each Round of the APS may be removed and may adversely affect an applicant’s evaluation/review. Not every organization that submits a concept paper through a Round of this APS will automatically be selected to participate in co-creation. Due to the number of concept papers received, USAID is not able to provide details on why concept papers were not selected. USAID may limit the number of initial submissions selected to move forward based on efficiencies. If requested to submit a full application, the applicant(s) (unless the applicant is an individual or Federal awarding agency that is excepted from those requirements under 2 CFR 25.110(b) or (c), or has an exception approved by the Federal awarding agency under 2 CFR 25.110(d)), is required to: i. Be registered in SAM (System for Award Management) before submitting its application; ii. Provide a valid DUNS (Data Universal Numbering System) number in its application; and iii. Continue to maintain an active SAM registration with current information at all times during

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which it has an active Federal award or an application or plan under consideration by a Federal awarding agency. USAID will not make a Federal award to an applicant until the applicant has complied with all applicable DUNS and SAM requirements and, if an applicant has not fully complied with the requirements by the time USAID is ready to make an award, USAID may determine that the applicant is not qualified to receive a Federal award and use that determination as a basis for making a Federal award to another applicant. Per 2 CFR Appendix I to Part 200, Full Text of the Notice of Funding Opportunity, Section E, 3, USAID informs all potential applicants: “i. That the Federal awarding agency [USAID], prior to making a Federal award with a total amount of Federal share greater than the simplified acquisition threshold, is required to review and consider any information about the applicant that is in the designated integrity and performance system accessible through SAM, currently Federal Awardee Performance and Integrity Information System (FAPIIS) (see 41 U.S.C. 2313); ii. That an applicant, at its option, may review information in the designated integrity and performance systems accessible through SAM and comment on any information about itself that a Federal awarding agency [USAID] previously entered and is currently in the designated integrity and performance system accessible through SAM; iii. That the Federal awarding agency [USAID] will consider any comments by the applicant, in addition to the other information in the designated integrity and performance system, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in CFR 200.205 Federal awarding agency review of risk posed by applicants.” Co-Creation Process Co-Creation Workshop. The primary component of the co-creation process will be a focused and intensive group workshop that may extend beyond one (1) day; location and duration may differ by each Round. In-person participation in the workshop will be required for all successful concept paper applicants, regardless of whether the applicant has indicated interest in being a prime- or a sub-partner in an eventual award; virtual participation of proposed sub-partners may be considered only if they are financially unable to attend the co-creation workshop. Discussions may continue between USAID and applicants and among applicants after the workshop is completed. Note: Travel costs - and any other costs associated with attending the workshop - will not be reimbursed by USAID. If a successful concept paper applicant cannot attend the co-creation workshop in person or virtually, their concept paper will be removed from consideration for award. The goals of the co-creation workshop will be to explore and validate key challenges and problems, and then jointly develop promising solutions or adapt and expand upon existing solutions, which will in turn become the potential sub-intermediate results or activities that will

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ultimately lead to the accomplishment of the Results (specific to the Round(s)). Ideas described within the concept papers may be discussed and further developed in the workshop, but workshop thinking, and possible eventual full applications, will not be limited to these ideas. The workshop is also intended to help identify potential consortia and partnerships to support these new or existing solutions and activities. This may result in organizations moving forward with implementation, if an award is made, of the solution(s) based on essential and complementary knowledge, skills, capacities, and networks. More broadly, the workshop will facilitate learning, sharing, and networking across a range of partners and relevant technical experts. The workshop therefore may include technical experts, potential resource partners,76 and end users invited by USAID, in addition to those applicants who submitted successful concept papers. Given these goals, potential participants must be willing to share expertise and ideas, and must welcome a diversity of perspectives and expertise, with the common goal of learning and innovating together to achieve the expected results. Note on additional partners/resources: Until full applications are submitted, both the applicant and USAID may identify and include potential additional technical partners and/or potential resource partners that may or may not have submitted concept papers. Additional partners may be included as sub-partners on a full application if there is an agreement to do so between the potential sub-partner, the original concept paper applicant, and USAID, but this is not guaranteed. Discussions with potential technical and/or resource partners may continue throughout each Round’s process and during implementation. USAID reserves the right to remove any co-creation participant from award consideration should the parties fail to reach agreement on activity concept, design, award terms, conditions, or cost/price within a reasonable time, the participant fails to provide requested additional information in a timely manner, or the U.S. Government believes it is in its best interest. Note: None of USAID’s communication during the co-creation process in all Rounds of this APS should be interpreted as a commitment to making an award of USAID funding. Applicants are advised that participation in the co-creation process under Rounds of this APS is entirely at their own risk; the Government is not responsible for any costs incurred by the applicant, if the applicant decides to accept the invitation to co-create with USAID. A commitment to an award of USAID funding is only made when a cooperative agreement is signed by the Agreement Officer. Full Application Process After the co-creation workshop, if the Merit Review Committee decides a full application(s) is warranted, full application instructions and criteria will be provided to the selected applicant(s) 76 Shared resourcing may be accomplished through funding by USAID, the award recipient, and/or third parties (“resource partners”), either through cash resources or the exchange of other resources, both tangible and intangible, such as in-kind contributions, expertise, intellectual property, brand value, high-value coordination, and access to key people, places, and information. Co-investing does not require equally shared resourcing (such as 1:1 leverage), but rather resource contributions that are appropriate to the specific project’s objectives, considering the comparative advantages brought by the participation of each party and the award type.

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or groups of applicants that are proposing to work together. All full applications will be reviewed for their technical merit against the full application evaluation criteria by the Merit Review Committee. Using its technical expertise, the Merit Review Committee may suggest revisions and additions to the proposed project as well as potential partners and resources. USAID will continue to have robust communication with applicants, potential partners, and other key stakeholders regarding the technical substance of the evolving approach, as well as the identity and roles of proposed or additional partners. USAID may request that key personnel of applicants deemed responsive and eligible deliver an oral presentation describing their proposed technical approach to inform the technical merit review. Agreement Officer Determination. If the Merit Review Committee selects application(s) for funding, its review will be shared with the Agreement Officer for cost analysis, final approval and award negotiation. During this stage, the Apparently Successful Applicant(s) and USAID can further design the technical approach, and clarify general resource requirements, additional partner involvement, and management control of the project under the guidance of the Agreement Officer. The Apparently Successful Applicant(s) may also be asked to provide additional information about its technical approach, capacity, management and organization, proposed cost and budget, responsibility, and representations and certifications. The Agreement Officer will engage in final review, negotiation, and determinations of award responsibility, and cost reasonableness, and will draft a cooperative agreement, to be reviewed by the Apparently Successful Applicant(s). The standard provisions for awards are generally prescribed by law and regulation for cooperative agreements. Information regarding possible award provisions will be offered to all selected applicants that are invited to submit a full application, as well as the final award provisions to the Apparently Successful Applicant(s) when the cooperative agreement is drafted. USAID reserves the right to accept applications in their entirety or to select only portions of the application to award. If the Apparently Successful Applicant(s) and USAID cannot arrive at a mutually agreeable arrangement, the Agreement Officer will not make the award(s), which will be at no cost to the Government. If multiple awards are made under Rounds of this APS, these recipients are expected to collaborate closely throughout the entire implementation phase. Funding Restrictions Major construction is not an allowable activity under this APS. Relevant risk assessments must be completed before the awardee(s) can incur costs for any minor renovation work per Section II(E)(4) in this document. Also, USAID does not allow reimbursement of pre-award costs under any Round of this APS.

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SECTION V. EVALUATION CRITERIA Evaluation criteria are specific to each Round. Please see Round documents for evaluation criteria.