The USAID Regional Development Mission Asia (RDMA) seeks to procure services of an organization, institution and/or consortium to provide technical support to regional and country–based malaria control and artemisinin-resistant malaria (ARM) containment programs in the program entitled “Greater Mekong Sub-region – Malaria Control Project”. The Greater Mekong Sub-region (GMS) includes the countries of Cambodia, the People's Republic of China (specifically Yunnan Province and Guangxi Zhuang Autonomous Region), Lao People's Democratic Republic, Burma, Thailand, and Viet Nam. However, this award will focus on sub-regions with documented cases of artemisinin resistance, currently along the border areas of Burma, Cambodia, and Thailand; preventive activities may also occur in areas threatened by ARM.
Document Type: Grants Notice
Funding Opportunity Number: USAID-RDMA-486-11-037-RFA
Opportunity Category: Discretionary
Posted Date: Jun 14, 2011
Creation Date: Jun 14, 2011
Original Closing Date for Applications: Jul 29, 2011 4:00pm Bangkok time.
Current Closing Date for Applications: Jul 29, 2011 4:00pm Bangkok time.
Archive Date:
Funding Instrument Type: Cooperative Agreement
Category of Funding Activity: Health
Category Explanation:
Expected Number of Awards: 1
Estimated Total Program Funding: $24,000,000
Award Ceiling: $24,000,000
Award Floor: $1
CFDA Number(s): 98.001 -- USAID Foreign Assistance for Programs Overseas
Cost Sharing or Matching Requirement: No
Eligible Applicants: Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled "Additional Information on Eligibility"
Additional Information on Eligibility: Agency Name:Thailand USAID-Bangkok
Contact: pvirasingh@usaid.gov
PURPOSE
Specifically, USAID/RDMA is seeking an organization, institution and/or consortium to achieve the following objectives in affected border regions of Burma, Cambodia and Thailand:
Develop and scale-up cost-effective vector control interventions to prevent the transmission of malaria;
Determine ways to improve the quality and effectiveness of diagnosis and treatment of malaria at the community and health facility levels;
Reduce management bottlenecks of the National Malaria Control Programs and local institutions to implement and monitor malaria control activities, and;
Support the establishment and maintenance of strategic information for malaria prevention and control.
Expected impact: At the end of the 5-year project, USAID/RDMA’s aim is to delay the spread of artemisinin resistant malaria through development and implementation of a successful model to increase preventive and curative services, as measured through the following indicators:
Therapeutic efficacy of malaria treatment drugs; •Test positivity rate; and•Zero-prevalence of malaria parasites.
BACKGROUND
Malaria Context in the Greater Mekong Sub-region
USAID-RDMA-486-11-037-RFA Greater Mekong Sub-Region Malaria Control Project
Malaria epidemiology in the GMS is complex and each country in the region has a different capacity to combat malaria ranging from those on track to achieve elimination of the disease to others that have few malaria control activities. Both Plasmodium falciparum and P. vivax parasites are prevalent in the region, as well as vector species that are not traditionally associated with humans and their domestic environment. In addition, multi-drug resistant strains of malaria occur throughout the GMS with confirmed artemisinin resistance along the Thai-Cambodia border. Much of the malaria burden is concentrated along border areas and in forests or forest-fringe areas.
Approximately three-quarters of the reported cases of malaria in the GMS occur in Burma. In 2009, the incidence of malaria ranged from 0.01 cases per 1,000 people in China to 11.8 cases per 1,000 people in Burma. Similarly, mortality from malaria ranged from less than 0.001 deaths per 100,000 people in China to 1.9 deaths per 100,000 in Burma. However, these 2009 figures from the World Malaria Report under-estimate the actual number of cases and mortality associated with malaria in the region as the figures only reflect data collected from the public sector reports.
In addition, the GMS is the epicenter of the world’s most severe drug-resistant malaria with chloroquine resistance developing in the late 1950s, followed by resistance to sulfadoxine-pyrimethamine, mefloquine, and decreased sensitivity to quinine. The emergence of artemisinin resistance on the Thai-Cambodia border, the same area where chloroquine resistance emerged 50 years ago is of great concern as this is the last remaining efficacious anti-malarial drug for treatment of malaria in the GMS.
Over the past decade, GMS countries made tremendous progress in reducing the number of malaria cases and the number of deaths associated with malaria. From 1998-2007, the GMS countries have collectively noted a 60% reduction in the annual number of deaths attributed to malaria and a 25% reduction in the number of confirmed cases of malaria, decreasing from 418,859 cases in 1998 to 316,078 cases in 2007. Multiple factors have contributed to the progress made in combating malaria in these countries. National governments and partners made malaria control a high priority by increasing investments, obtaining international funds, strengthening political will, integrating malaria control efforts into national health systems, and intensifying cross-border collaboration. At the same time, external factors have contributed to the decrease in morbidity and mortality associated with malaria, including deforestation, economic development, demographic stabilization, political stability, and improved coverage of basic health services.
Gender is also an important dimension of malaria prevention and treatment projects. In forest and forest-fringe areas, the majority of malaria cases occur among adult men because of their unprotected night time work; they expose women and children to malaria by carrying parasites to their families. Many of the migrants crossing the border from Burma into Thailand through forested areas are pregnant women USAID-RDMA-486-11-037-RFA Greater Mekong Sub-Region Malaria Control Project seeking health care services. Programming for malaria control in GMS requires detailed attention to gender-related behavioral patterns.
The national malaria programs in the GMS countries face many challenges that threaten the continued success of the fight against malaria in these countries. These challenges include shortages of financial and human resources, the increasing use of private sector services that often use sub-standard and counterfeit medicines. In addition, the region has highly mobile populations both within and among countries and forested areas that span across political borders. The high prevalence of drug-resistant malaria along the Thai-Cambodia border and the Thai-Burma border in certain areas known as “hotspots” demonstrates the need for a tailored approach to combating drug-resistant malaria. There is currently no mechanism in the region that attempts to work across borders in those hotspots. In the face of the challenges outlined above, the development of new approaches and best practices for control of drug-resistant malaria across the region is paramount to helping prevent a resurgence of cases and limit the spread of artemisinin¬resistant P. falciparum parasite.
United States Government Response to Malaria in the Greater Mekong Sub-region
In May 2009, President Barack Obama announced the Global Health Initiative (GHI), a six-year, comprehensive effort to reduce the burden of disease and promote healthy communities and families around the world. GHI will implement a woman- and girl-centered approach; increase impact and efficiency through strategic coordination and programmatic integration; strengthen and leverage key partnerships, multilateral organizations, and private contributions; encourage country ownership and invest in country-led plans and health systems; improve metrics, monitoring and evaluation; and promote research and innovation.
The President’s Malaria Initiative (PMI) is a core component of GHI, along with HIV/AIDS, and tuberculosis. PMI was launched in June 2005 as a 5-year, $1.2 billion initiative to rapidly scale up malaria prevention and treatment interventions and reduce malaria-related mortality by 50% in 15 high-burden countries in sub-Saharan Africa. PMI expanded to include Southeast Asia with the goal to strengthen efforts to contain the spread of multi-drug resistant Plasmodium falciparum malaria. This will be accomplished by:
•Contributing to a further reduction in the level of transmission of P. falciparum malaria and the number of reported cases in the Greater Mekong Region;
• Supporting well-functioning anti-malarial drug resistance surveillance networks in each country in the region; and,
• Establishing national systems to monitor the quality of anti-malarial drugs as a means of preventing the introduction and dissemination of sub-standard or counterfeit drugs, which contribute to increased drug-resistance.
USAID/RDMA, has funded projects to combat malaria in the GMS since 2005. Those projects have included support for case management, strategic information (including surveillance, monitoring & evaluation and operational research), and P. falciparum elimination as it pertains to artemisinin-resistance containment. The RDMA also works with other donors to control and ultimately eliminate the strains of malaria in the GMS that are resistant to artemisinin-based combination therapies (ACTs).
USAID-RDMA-486-11-037-RFA Greater Mekong Sub-Region Malaria Control Project
The Greater Mekong Sub-region Malaria Control Project also supports the Lower Mekong Initiative (LMI), created by the US Secretary of State and Foreign Ministers of Thailand, Cambodia, Laos and Vietnam in July 2009. Health ministers participating in LMI continue to emphasize the need for cross-border collaboration in malaria control.
The RDMA strategy focuses on limiting the spread of artemisinin-resistant malaria (ARM) in targeted geographic areas and countries where ARM is present or emerging. At present this means focusing on the provinces along both sides of the border between Cambodia and Thailand and expanding to work in other “hotspots” of ARM or threatened ARM, within the limitations of funding. RDMA has provided support to the national malaria control programs and other partners throughout GMS to strengthen management from the national to community levels for containment of ARM. This has included support for management of the commodity supply chain, management of personnel, including supportive supervision, community mobilization and behavior change communication. In addition, support has been provided to ensuring drug quality for effective treatment. Lastly, the strategy aims to address the need for a regional approach to combating and containing artemisinin-resistant malaria. There is a significant mobile population in the GMS who travel through forested border areas. It is a challenge to connect this mobile population with services provided in individual countries. Emerging artemisinin resistance already appears to be regional in Southeast Asia. Compatible national policies and strategies are needed to deal with the regional dimension of drug resistant malaria. Currently, RDMA supports the World Health Organization’s Mekong Malaria Program to provide technical assistance in all six countries of the Greater Mekong Sub-region to address drug resistance, drug quality and supply activities, monitoring and evaluation, and operations research.
USG efforts to combat drug-resistant malaria along the Thai-Cambodia border began in 2007. The USAID/RDMA Malaria Control in Cambodia Project has been supporting technical assistance for the scale-up of comprehensive malaria prevention and control interventions in four western provinces along the Cambodian-Thai border: Banteay Meanchey, Battambang, Oddar Meanchey and Pailin. The project is focused on diagnostic strengthening, case management and behavior change communication activities in the public and private sectors, as well as research related to artemisinin-resistant malaria. The specific objectives of the project are to: 1) Support the National Malaria Control Programme to improve access to and utilization of malaria case management services (public, private and community); 2) Strengthen managerial capacity at the Provincial Health Department and Operational District levels; 3) Support the National Malaria Control Programme to increase access to and utilization of insecticide-treated nets (including among mobile and migrant populations); and, 4) Collaborate in the development of policy and strategic interventions.
To date, USAID/RDMA has provided limited support to Burma’s malaria program but has focused on regional efforts through the Mekong Malaria Project. Support in Burma has included cross-border coordination between Thailand and Burma, therapeutic efficacy studies to monitor anti-malarial drug resistance, technical assistance and supply chain management support for the region. Previous projects have also targeted the Burmese refugees and populations on the Thai-Burma border for the provision of basic health services.
The mandate of the USAID/RDMA Office of Public Health (OPH) is to develop high-impact programs to address the most important epidemiologic needs and infectious diseases (ID); to manage programs in USAID non-presence countries; to design and manage cross-border activities and other programs for mobile populations, and to develop pilot and test innovative model programs, particularly for service provision, that can be scaled up in a partnership with host governments, other donors, and multilaterals. The regional program is expected to enhance opportunities for sharing lessons learned. Consistent with USAID's commitment to gender equality as a critical element of development as described in the USAID-RDMA-486-11-037-RFA Greater Mekong Sub-Region Malaria Control Project
President’s Global Health Initiative (GHI), the OPH strategy integrates activities that promote gender equality and avoids those with adverse gender impacts.
USAID/RDMA will address the Office of Public Health (OPH) assistance objective to increase an effective regional response to prevent and mitigate HIV/AIDS, malaria, tuberculosis, avian influenza and other emerging infectious diseases. Refer to OPH’s results framework below:
The mandate of the USAID/RDMA Office of Public Health (OPH) is to develop high-impact programs to address the most important epidemiologic needs and infectious diseases (ID); to manage programs in USAID non-presence countries; to design and manage cross-border activities and other programs for mobile populations, and to develop pilot and test innovative model programs, particularly for service provision, that can be scaled up in a partnership with host governments, other donors, and multilaterals. The regional program is expected to enhance opportunities for sharing lessons learned. Consistent with USAID's commitment to gender equality as a critical element of development as described in the President’s Global Health Initiative (GHI), the OPH strategy integrates activities that promote gender equality and avoids those with adverse gender impacts.
Moreinfo: http://www07.grants.gov/search/search.do?&mode=VIEW&oppId=99233
