[Federal Register Volume 69, Number 164 (Wednesday, August 25, 2004)]
[Notices]
[Pages 52284-52290]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-19462]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary


Funding Opportunity: Request for Applications for Cooperative 
Agreement To Provide Training Program to Physicians and Other Staff at 
Rabia Balkhi Women's Hospital in Kabul, Afghanistan

    Announcement Type: Initial.
    Action: Notice.
    Authority: Section 103(a)(1); Section 103(a)(7) of public law 107-
327; Public Health Service Act, Section 307.
SUMMARY: The Office of Global Health Affairs (OGHA) announces that an 
estimated $2.2 million in fiscal year (FY) 2004 funds are available for 
one (1) cooperative agreement to provide continuing education and 
refresher training to physicians and other staff at Rabia Balkhi 
Women's Hospital (RBH) in Kabul, Afghanistan. This effort is a joint 
undertaking by the U.S. Department of Health and Human Services (HHS) 
and the Afghanistan Ministry of Health (MOH). The objective of this 
project is to improve the quality of care at RBH through the provision 
of continuing education and refresher training and related services to 
improve the knowledge base and skills of the physicians, nurses, 
midwives, other health care workers, and support staff at the facility. 
Award recipient will also conduct a comprehensive evaluation of 
conditions and elements necessary for the eventual implementation of an 
OB/GYN residency training program in Afghanistan. OGHA anticipates HHS 
scientific and programmatic involvement in the development and 
administration of the training program. The project will be approved 
initially for a three-year period. It is estimated that approximately 
$2.2 million (including indirect costs) will be available in the first 
year. Funding for the cooperative agreement in subsequent years is 
contingent upon the availability of funds.

DATES: To receive consideration, the Grants Management Office (GMO) of 
the Office of Public Health and Science (OPHS) within HHS must receive 
applications by no later than September 15, 2004. Additionally, a 
letter of intent to apply is required (See Section IV) no later than 
September 1, 2004.

ADDRESSES: Application kits may be requested from, and applications 
submitted to: OPHS Grants Management Office, 1101 Wootton Parkway, 5th 
Floor, Rockville, MD 20852.

SUPPLEMENTARY INFORMATION: This Cooperative Agreement is governed by 
the Afghanistan Freedom Support Act (Pub. L. 107-327, Section 103(a)(1) 
and Section 103(a)(7)), and the Public Health Service Act (Section 307) 
and will be administered by the OGHA, HHS.
    OGHA provides policy and staffing support to the Secretary and 
other HHS leaders in the area of global health, and provides policy 
advice, leadership and coordination of international health matters 
across HHS, including leadership on major crosscutting global health 
initiatives and the Department's relationships with multilateral 
organizations.
    Under this continuing education and logistical support cooperative 
agreement, HHS, in coordination with the Afghanistan MOH, will support 
and guide award recipient's activities by working with the award 
recipient in an advisory role throughout the development and 
implementation of activities. In addition, HHS will participate 
actively in the evaluation of the program.

Obligations of HHS

    1. Assurance of the services of appropriately experienced OGHA and 
other HHS personnel to participate in the planning, development, 
implementation, and evaluation of all phases of this activity;
    2. Participation in periodic meetings and/or communications with 
the award recipient to review mutually agreed-upon goals and objectives 
and to assess program development and implementation progress and, when 
indicated, interval evaluation;
    3. Assistance in establishing and maintaining U.S. Government, 
Afghanistan MOH, and non-governmental organizations (NGOs) contacts and 
agreements necessary to carry out the project.

I. Funding Opportunity Description

    This announcement seeks proposals from appropriately qualified 
public and private not for profit entities to provide clinical, 
administrative, and ancillary staff continuing education and refresher 
training to Afghan healthcare professionals and support staff at RBH. 
For the purposes of this cooperative agreement, continuing education 
and refresher training refer to specific training in appropriate 
Western clinical methodologies and techniques that are identified as 
critical to the knowledge and skills of attending physicians, 
residents, midwives, and nurses. ``Residency training'' refers to a 
sustainable training of physician specialists in obstetrics and 
gynecology based on accredited Western standards and modified for the 
Afghan situation. Funds available under this cooperative agreement will 
improve the quality of care at RBH by providing direct training, 
clinical as well as didactic, for physicians, current residents, 
midwives, and nurses. Clinical training will include the demonstration 
of direct patient care alongside Afghan healthcare providers. As a 
second priority, other allied health care workers such as laboratorians 
and pharmacy technicians, hospital administrators including facility 
and personnel managers, should also benefit from training. Finally, 
award recipient will conduct a comprehensive evaluation of all 
necessary conditions and elements related to the implementation of a 
residency training program in Obstetrics and Gynecology (OB/GYN) in 
Afghanistan, most likely based in Kabul and possibly involving one or 
more hospitals, including Rabia Balkhi Hospital. While not included as 
part of this proposed cooperative agreement, the ultimate goal of HHS 
is to support the establishment of a sustainable OB/GYN residency 
training program in Kabul, once conditions are appropriate for doing 
so. Information and insights gained through this cooperative agreement 
will inform subsequent programming to develop the residency program.

Background

    Afghanistan has one of the highest maternal mortality rates (MMR) 
in the world with a rate of 1,600 maternal deaths per 100,000 live 
births. In Badakshan Province, the MMR is 6,500, the highest maternal 
mortality rate ever reported globally. Preventable complications 
related to childbirth cause more than 85 percent of deaths among women 
of childbearing age in Afghanistan. An estimated one in four children 
dies before reaching their fifth birthday.
    The Rabia Balkhi Women's Hospital (RBH) in Kabul, Afghanistan, is 
the largest full-service women's hospital in the country. The hospital 
treats more than 36,000 patients each year and delivers 14,600 babies 
per year, on an average, 40 babies a day. Other care services provided 
at RBH include gynecology, surgery, dermatology, and internal medicine.

[[Page 52285]]

    RBH, as well as most of health care clinics and hospitals in 
Afghanistan, is struggling with basic facility and human resource 
challenges that exceed those experienced in most other developing 
countries. Healthcare professionals and support staff at RBH are 
working to provide quality services in an environment left neglected 
during years of political upheaval and oppression. As a result, 
fundamental outpatient and in-patient services needed to provide timely 
and accurate assessment and treatment of patients are frequently absent 
or in need of major improvement.
    The United States, other countries, and NGOs have begun cooperative 
efforts toward direct assistance and provision of essential health 
services in Afghanistan. HHS Secretary Tommy G. Thompson signed a 
Memorandum of Understanding (MOU) with the Afghanistan Minister of 
Health on October 9, 2002, pledging the support of American citizens to 
help in these efforts. In early 2003, HHS entered into collaboration 
with the Afghanistan Ministry of Health to improve the maternal and 
child health services available within Afghanistan. One of the long-
term goals of this HHS-MOH collaboration is to develop an OB/GYN 
residency training program that is an adaptation of the American OB/GYN 
residency model.
    As a first step, in April 2003, HHS established a clinical 
knowledge and skills refresher-training program at RBH. The intent of 
this refresher training has been to update the knowledge and skills of 
the attending physicians. Currently, HHS and a partner NGO are 
providing focused, short-term training to the obstetrician-gynecologist 
attending staff at RBH, to update clinical skills and basic knowledge 
which are needed to respond to the critical needs of the high-risk 
patient community accessing care at this facility.
    In addition, training has been extended to other critical members 
of the hospital staff such as residents, nurses, midwives, 
anesthetists, and pediatricians. The numbers of Afghan healthcare 
professionals at RBH and thus exposed to training under this award is 
approximately 148 in the following categories:
     OB/GYN attending physicians--13.
     OB/GYN resident physicians--40.
     Pediatric staff--10.
     Midwife/Nurse staff--60.
     Hospital Administrators--5.
     Pharmacy staff--5.
     Laboratory staff--5.
     Maintenance and housekeeping staff--10.
    The trainers have sought to update the knowledge and clinical 
skills of the existing attending physicians and other healthcare 
professionals at RBH in the fundamentals of clinical medicine so as to 
assure that the attending physicians, residents, and staff at RBH 
possess the core knowledge and skills required to provide the best 
possible care for mothers and their babies. Since 2003, a rotating 
faculty consisting of volunteer Western-trained Obstetrician-
Gynecologists, Pediatricians, Anesthesiologist/Nurse Anesthetists, 
Family Practitioners, Certified Nurse-Midwives and Nurse Practitioners, 
and Hospital Administrators have been teaching the refresher training 
program. Additionally, HHS consultants and NGO staff have provided 
specific training related to administration and upkeep of the physical 
environment of RBH. HHS has determined that these continuing education 
efforts need to be continued for at least three years.

Purposes of the Cooperative Agreement

    The United States Government remains committed to supporting the 
further development of Afghanistan's health infrastructure. The purpose 
of the activities supported by this funding is to provide and support 
formal training for physicians, other healthcare professionals, and 
ancillary hospital staff at RBH that will improve the quality of care 
offered at the hospital so that an OB/GYN residency training program 
modeled after American OB/GYN residency programs can exist in the 
future. This RFA invites cooperative agreement applications from 
qualified applicants, or a consortium of applicants, to participate in 
this endeavor as a critical partner with HHS and Afghanistan MOH in 
their efforts to improve the quality of care at RBH.
    The role of the award recipient of this cooperative agreement will 
be to provide and support training of the physicians, nurses, midwives 
and other staff at RBH. The award recipient will design and implement a 
formal clinical and didactic curriculum that includes modeling of 
direct patient care for professional staff at RBH. Additionally, the 
award recipient will provide critical logistical support to project 
staff and consultants working at RBH on various aspects of the program. 
Finally, the award recipient will conduct a comprehensive evaluation of 
all the necessary elements and conditions required for the eventual 
implementation of an OB/GYN residency training program in Afghanistan.

II. Award Information

    The administrative and funding instrument to be used for this 
program will be the cooperative agreement in which HHS scientific and 
programmatic involvement with the awardee is anticipated during the 
performance of the project. Under the cooperative agreement, HHS will 
support and/or stimulate award recipient activities by working with the 
award recipients in a partnership role. The award recipient will also 
be expected to work directly with and in support of HHS' Centers for 
Disease Control and Prevention (CDC), Health Resources Services 
Administration (HRSA), the Indian Health Service (IHS); Veterans 
Administration (VA); the Afghanistan MOH; and other partners.
    The project period is up to three years with an initial award of 
$2.2 million in total costs (including indirect costs). The initial 
budget period is expected to be 12 months, with subsequent budget 
periods being 12 months. Continuation of any project from one budget 
period to the next, and level of funding, is subject to satisfactory 
performance, availability of funds, and program priorities.
    Although this program is provided for in the financial plans of the 
OGHA, awards pursuant to this RFA are contingent upon the availability 
of funds for this purpose.

III. Eligibility Information

    Applications may be submitted by appropriately qualified not for 
profit entities or consortia of such entities, including U.S. 
universities and medical schools, humanitarian and relief 
organizations, and other NGOs, with offices in the United States and 
Afghanistan or incorporated and headquartered in the United States with 
offices in the United States and Afghanistan. For-profit entities may 
participate but only as a partner organization in a consortium. 
Minimally, applicants must meet Afghanistan MOH requirements for 
registration and participation in healthcare activities in the country. 
Since it is unlikely that all of the required capabilities will be 
located within one institution, the successful applicant will likely be 
multi-institutional, or a consortium that draws from multiple groups in 
the United States and Afghanistan. OGHA can provide information about 
possible partners. Cost sharing or matching is not required.
    Organizations or consortia of organizations that have collective 
experience in the following areas are encouraged to apply:
     Training of physicians and other health care workers in 
resource-poor settings.

[[Page 52286]]

     Training of ancillary hospital staff in resource-poor 
settings.
     Management of an accredited OB/GYN residency training 
program.
     Hospital accreditation.
     Assessment and evaluation of hospitals and critical public 
health infrastructure.
     Supporting the development of quality-assurance programs 
for acute care sites in resource-poor settings.
     Provision of logistical support for project staff 
including travel, on ground transportation and communication systems 
including translation, security, and room and board.

IV. Application and Submission Information

    1. Applications may be requested in one of three ways: (1) 
Telephone: (301)-443-1410; (2) e-mail: [email protected]; and (3) 
Mail: Project Officer Dr. Amar Bhat; Parklawn Building, Room 18C-17; 
Rockville, MD 20857.
    2. Applicants are requested to use Application Form PHS-5161-1 
(revised July 2000), enclosed in your application packet. Instructions 
for filling out PHS-5161-1 are included in the application packet. This 
form is also available in Adobe Acrobat format at the following website 
http://www.cdc.gov/od/pgo/forminfo.htm. Many different programs funded 
through the Public Health Service (PHS) use this generic form. Some 
parts of it are not required; other sections need to be filled out in a 
fashion specific to the program. Applications should be submitted to 
Ms. Karen Campbell, Director, Office of Public Health and Science 
(OPHS) Office of Grants Management, 1101 Wootton Parkway, Suite 550, 
Rockville, MD 20852.
    Notification of intent to apply is required and can be made in one 
of three ways: (1) Telephone: (301)-443-1410; (2) e-mail: 
[email protected]; and (3) Mail: Project Officer Dr. Amar Bhat; 
Parklawn Building, Room 18C-17; Rockville, MD 20857. The letter of 
intent must be received by 4:30 PM on the date specified in the date 
section. For questions specific to project objectives, the nature of 
the training program, or the required letter of intent contact Dr. Amar 
Bhat at [email protected] or by phone at 301-443-1410.
    For cooperative agreements policy, budgetary, and business 
questions contact Grants Management Specialist Mr. Eric West at 
[email protected] or by phone at 301-594-0758.
    A separate budget page is required for each budget year requested. 
For example, if the applicant organization requests three years of 
cooperative agreement support, a line item budget (SF 424A) with 
coinciding justification to support each of the budget years must be 
submitted with the proposal. These forms will represent the full 
project period of Federal assistance requested. This will also provide 
budget information needed for the subsequent year's Summary Progress 
Report. Proposals submitted without a budget and justification for each 
budget year requested in the application may not be favorably 
considered for funding. Specific instructions for submitting a detailed 
budget for this application will be included in the application packet. 
If additional information and/or clarification are required, please 
contact the Grants Management Specialist identified in Section VII of 
this announcement.
    3. Applicants are required to submit an original ink-signed and 
dated application and 2 photocopies. All pages must be numbered clearly 
and sequentially beginning with the Project Profile. The application 
must be typed double-spaced on one side of plain 8\1/2\'' x 11'' white 
paper, using at least a 12 point font and contain 1'' margins all 
around. The Project Summary and Project Narrative must not exceed a 
total of 25 double-spaced pages, excluding the appendices. The original 
and each copy must be stapled and/or otherwise securely bound.
    4. A project abstract submitted on 3.5 inch floppy disk and/or CD-
ROM must accompany all cooperative agreement applications. The abstract 
must be single-spaced, typed, and must not exceed two pages. Margins 
should be 12 inches at the top and 1 inch at the bottom and both sides; 
and typeset must be no smaller than 12 point font and not reduced. 
Reviewers and staff will refer frequently to the information contained 
in the abstract, and therefore it should contain substantive 
information about the proposed projects in summary form. A list of 
suggested keywords and a format sheet for your use in preparing the 
abstract will be included in the application packet.
    A project narrative must accompany all cooperative agreement 
applications. In addition to the instructions provided in PHS 5161-1 
for project narrative, the specific guidelines for the project 
narrative are provided in the program guidelines. Format requirements 
are the same as for the project abstract section; margins should be 12 
inch at the top and 1 inch at the bottom and both sides; and typeset 
must be no smaller than 12 point font and not reduced. Biographical 
sketches should be either typed on the appropriate form or plain paper 
and should not exceed two pages, with publications listed being limited 
only to those that are directly relevant to this project.
    5. E.O. 12372 does not apply to this application.
    6. Funding restrictions do not apply to this application beyond the 
limitations described below.
    The amount of financial support (direct and indirect costs) that an 
applicant is requesting from the Federal granting agency for the first 
year is to be entered on the Face Sheet of Application Form PHS 5161-1, 
Line 15a. Each application should include a request for funds for 
electronic mail capability unless access by Internet is already 
available. The amount of financial support (direct and indirect costs) 
entered on the SF 424 is the amount an applicant is requesting from the 
federal granting agency for the first project year. Projected amounts 
for future budget periods should be entered on SF 424A, Section E. 
Please note that if indirect costs are requested, the applicant must 
submit a copy of the latest negotiated rate agreement. The indirect 
costs rate refers to the Other Sponsored Program/Activities rate and to 
neither the research rate, nor the education/training program rate. 
Those applicants without an established indirect cost rate for other 
sponsored programs will be held at 15 percent of total direct costs, 
except, in cases where there is no established rate, applicants may 
only request 10 percent of salaries and wages. However, if an 
applicant's established rate for other sponsored programs exceeds 15 
percent, but would be advantageous to the U.S. Government, the OGHA/HHS 
may honor that indirect rate cost.
    To receive consideration, the OPHS Grants Management Office must 
receive applications by the deadline listed in the DATES section of 
this announcement. Applications will be considered as meeting the 
deadline if they are actually received by the Grants Management Office 
by 4:30 p.m. on the application due date; for this project, postmark by 
the deadline date will not suffice. Hand-delivered applications must be 
received in the OPHS Grants Management Office no later than 4:30 p.m. 
on the application due date. Applications that do not meet the deadline 
will not be accepted for review. Applications sent via facsimile or by 
electronic mail will not be accepted for review. All applications must 
be submitted to OPHS at the following address: Office of Grants 
Management, 1101 Wootton Parkway, Suite 550, Rockville, MD 20852. 
Receipt of applications will not be acknowledged.

[[Page 52287]]

    A copy of the legislation governing this program and additional 
information that could be helpful will be included as part of the 
application kit. Applicants should use the legislation and other 
information included in this announcement to guide them in developing 
their applications.

Program Requirements/Application Content

    This notice seeks applications for the development, implementation 
and evaluation of a broad-based training program at RBH in Kabul, 
Afghanistan. Successful applications will focus on the development, 
implementation, and evaluation of a training program and curriculum for 
hospital-based healthcare professionals and ancillary staff in a 
resource-poor developing country. Successful applications will include 
a detailed plan for a comprehensive evaluation of the various 
conditions and elements required to implement an OB/GYN residency 
training program in Afghanistan. In addition, the application will 
include in-country logistical support for all project personnel such as 
faculty and trainers. Further, the successful applicants will document 
their proven experience and success in previous, similar projects 
located in developing countries.
    The application will include the following elements:
1. Refresher Training and Continuing Education Program
    Comprehensive topic areas for curriculum development will be 
identified in cooperation with HHS and the Afghanistan MOH but 
minimally will include physician, current resident, midwife and nurse 
refresher training and continuing education to update knowledge and 
skills and medical English classes for the professional staff. As a 
second priority, other allied health care workers such as laboratorians 
and pharmacy technicians, hospital administrators including facility 
and personnel managers, should also benefit from training. Curricula 
will be subject to review and approval by HHS and the Afghanistan MOH.
    At the request of the MOH or other recognized partners, 
participants associated with other training programs in Afghanistan may 
also be included as space and resources permit in the RBH continuing 
education programs. Additionally, the award recipient and the team 
assembled by the award recipient will be expected to collaborate with 
HHS staff (in Kabul and the United States) involved in the design, 
implementation, and maintenance of quality assurance and surveillance 
activities such as the introduction and implementation of a record-
keeping and informatics system at RBH. Any collaboration will be in 
keeping with overall intent of this cooperative agreement.
    Team Composition: Award recipient will recruit and manage a team of 
medically trained professionals responsible for implementation of the 
curriculum as described above.
    The award recipient should provide six Western-trained health-care 
professionals to work at RBH throughout the year. The award recipient 
will be responsible for recruiting and hiring the team members. The 
team should ideally consist of six team members at all times, except 
during brief transitional periods. At a minimum, and only during 
periods of transition, at least one medical doctor, with other 
appropriate team members, will be in country continuously. The team 
members should serve at least three months during a single tour in 
country to become acquainted with the hospital and staff and provide 
continuity. The team members will be licensed to practice and board-
certified (if applicable for the profession) in their field of 
specialty in their country of primary residence.
    The team should consist of at least two (2) OB/GYNs, one (1) 
certified nurse midwife (CNM), one (1) pediatrician or pediatric nurse 
practitioner, and one (1) hospital administrator. The remaining 
professional can be of a category appropriate to specific training 
needs. Consistent with the purposes of this cooperative agreement, 
qualified persons who speak Pashtun and Dari and are familiar with 
Afghan culture should be given due consideration as the medically-
trained team is assembled. Composition of the team and qualifications 
of team members are subject to approval by OGHA/HHS. The team described 
above should be supplemented, as needed, with qualified persons to 
create a team capable of providing the didactic and clinical teaching 
of the curriculum described in Section 1 (Curriculum Development). Team 
members will provide critical hands-on training to hospital staff, 
including attending and resident physicians; nurses; midwives; 
pharmacists, laboratory technicians, administrative staff, maintenance 
staff, and others.
2. Logistical Support
    Given the security considerations of the Afghan environment, to 
successfully carry out the objectives of this cooperative agreement, 
certain logistical needs of project staff will need to be supported by 
the grantee. These include the following:
    a. One-to-three-day orientation of Western-trained team members to 
the Afghanistan project in a mutually agreeable location, on a periodic 
basis as needed, in collaboration with staff at HHS. This will include 
developing agendas, acquiring venue, preparation of materials, and 
travel and hotel accommodations for the participants.
    b. All aspects of international travel to and from Afghanistan, 
including passport and visa assistance, travel per diem, hotel 
accommodations in transit, insurance, etc.
    c. A secure (guarded), walled, furnished housing compound with 
indoor plumbing and provision for electrical services provided by 
generator, with sufficient lodging and beds for team members (no more 
than two individuals per room), and accommodations for female as well 
as male team members;
    d. A backup water filtration system that is operational 24 hours a 
day/seven days a week;
    e. Provision of incidentals, including but not necessarily limited 
to currency assistance, assistance with local government regulations, 
such as work permits, visa extensions and United Nations/commercial 
transportation services.
    f. Provision of dedicated, dependable, safe transportation, with 
operating seat belts, maintenance, repair and operating considerations. 
This must include at least one vehicle comparable to a four-wheel drive 
Sports Utility Vehicle. At least one English-speaking driver must be 
on-call 24 hours per day.
    g. Provision of a secure environment 24 hours per day per 
applicable and commonly accepted international standards for 
Afghanistan, including provision of VHF handheld radios and reliable 
second check system that ensures all team members are accounted for at 
least twice a day;
    h. Provision of language assistance and translator/interpreter 
services during normal business hours and on call 24 hours a day;
    i. Provision of airport facilitator services in Kabul to meet 
project staff/consultants and assist with customs clearance for 
personal effects and program commodities;
    j. Provision of commodity procurement services to include commodity 
pricing, procurement, receipt, transport, storage, inventory and 
accountability. The volume and frequency of procurement requests will 
be intermittent over the course of the project. Funds for commodity

[[Page 52288]]

procurement will be provided by respective sources such as HHS (OS/
OGHA, Indian Health Service, HRSA, Centers for Disease Control and 
Prevention), the Department of Veterans Affairs, and others as needed. 
The nature of the commodities may include, but are not limited to, the 
following: desktop and laptop computers, printers, copy and fax 
machines, two-way radios, personnel protection devices, medical 
equipment, text books, educational and other printed materials, and 
training materials. At the request of the respective commodity funding 
source, arrange for the transfer of property from the U.S. Government-
based funding source to other non-U.S. Government partners such as the 
MOH, an NGO or a private voluntary organization (PVO);
    k. Provision of office support: Office space, desk and access to 
related office-support equipment, telephone, photo-copier, fax, desktop 
computer and software such as MS Office Pro, internet access, email 
account, domestic and international postage/mail/express courier 
service.
3. Residency Training Program
    3.1 Feasibility Assessment of OB/GYN Residency Training Program. A 
long-term goal of this HHS-MOH collaboration is to develop an OB/GYN 
residency training program that is an adaptation of the American OB/GYN 
residency model. Working with HHS and other partners, award recipient 
will conduct a comprehensive evaluation of all the various components 
that would be required to implement an OB/GYN residency training 
program in Afghanistan. Award recipient will provide the final 
feasibility assessment to HHS within four months of award notification 
and delivery. At a minimum, the evaluation will consist of the 
following elements:
    a. Assessment of RBH and other potential residency training 
institutions in Kabul (to be identified by HHS at a later date): Award 
recipient will evaluate the institutional capacity and ability of RBH 
and other selected hospitals to support an OB/GYN residency training 
program based on the Accreditation Council for Graduate Medical 
Education (ACGME) guidelines. Award recipient will evaluate the current 
systems of hospital management, personnel management, performance 
evaluation, and overall day-to-day operations of the hospitals. Award 
recipient will evaluate the current knowledge, skills, and abilities of 
the attending OB/GYN physicians and OB/GYN residents and make specific 
recommendations regarding their role, or propose an alternative source 
of qualified faculty for an OB/GYN residency training program based on 
ACGME guidelines.
    b. Assessment of the medical curriculum that HHS provided to the 
Afghanistan MOH: A draft curriculum of the medical education required 
for an OB/GYN residency training program, based on the ACGME guidelines 
and existing medical education in Afghanistan was developed by HHS and 
its partners. The draft curriculum is currently under review by the 
Afghanistan MOH. The award recipient will work closely with HHS and the 
MOH to assess the feasibility of implementing an OB/GYN residency 
training program based on this medical curriculum provided to the 
Afghanistan MOH. The award recipient will also be responsible for 
negotiating a final version of the medical curriculum with the Afghan 
MOH, the Afghan Ministry of Higher Education (MOHE), and HHS.
    c. Assessment of Afghan MOH and Afghan MOHE: Award recipient will 
evaluate the institutional capacity of the Afghan MOH and the Afghan 
MOHE to support an OB/GYN residency training program based on ACGME 
guidelines, and will provide specific recommendations to address any 
substantial perceived deficiencies.
    d. Assessment of current OB/GYN residency training programs in RBH 
and at least one other hospital in Kabul HHS will identify: The award 
recipient will perform an evaluation of the current OB/GYN residency 
training programs in Afghanistan. The award recipient will evaluate the 
current recruitment and performance evaluation systems used for OB/GYN 
residents. The award recipient will document the current OB/GYN 
residency training requirements and guidelines specified by the Afghan 
MOH and the Afghan MOHE, and will provide specific recommendations 
regarding the required changes to these training requirements, if any, 
that would be needed to successfully implement an OB/GYN residency 
training program in Afghanistan.
    e. Assessment of current training received at medical schools in 
Afghanistan: The award recipient will document the current medical 
school curriculum and training requirements mandated by the MOHE for 
medical school graduates. The award recipient will perform a baseline 
assessment of the knowledge, skills, and abilities of first year 
residents, and if warranted provide specific recommendations to address 
gaps in the basic sciences and the general medical competencies 
required to succeed in an OB/GYN program based on ACGME guidelines.
    3.2 Development of the Residency Training Program: Capability 
Statement. While this announcement and the first year of funding do not 
provide for the longer-term development of the proposed residency 
training program in Kabul,HHS welcomes expression of potential interest 
by applicants, including description of the proposed team, approach, 
and budget to undertake this additional major activity, should 
additional funds become available to incrementally supplement this 
award in future years. Applications will be evaluated principally in 
relation to Program Requirements 1, 2 and 3.1, but those with a strong 
capability statement for the residency training program will receive 
additional favorable consideration.

Program Evaluation

    All applications are required to have an evaluation plan, 
consistent with the scope of the proposed project and funding level 
that conforms to the project's stated goals and objectives. The 
evaluation plan should include both a process evaluation to track the 
implementation of project activities and an outcome evaluation to 
measure changes in patient health outcomes and the knowledge and skills 
of staff that can be attributed to the project. Project funds may 
support evaluation activities.
    In addition to conducting their own evaluations, successful 
applicants must be prepared to participate in external evaluations 
supported by HHS and the Afghanistan MOH and conducted by partner HHS 
agencies and/or NGOs.
    In addition to routine communications with HHS, within 30 days 
following the end of each quarter, award recipient will submit a 
written quarterly performance report no more than ten pages in length 
to OGHA/HHS. At a minimum, monthly performance reports will include the 
following:
     Concise summary of the most significant achievements and 
problems encountered during the reporting period, e.g. number, names, 
and types of training courses held and number of RBH hospital staff in 
attendance.
     A comparison of work progress with objectives established 
for the quarter using the award recipient's implementation schedule, 
and where such objectives were not met a statement of why they were not 
met, and a summary of corrective actions to be taken.
     Specific action(s) that the award recipient would like 
OGHA/HHS and the Afghanistan MOH to undertake to alleviate obstacles to 
progress.

[[Page 52289]]

     Other pertinent information that will permit overview and 
evaluation of project operations.
     Status of commodities ordered, received, and stored/used.
    Within 90 days following the end of the project period a final 
report containing information and data of interest to the HHS or other 
partners must be submitted to OGHA/HHS. The specifics as to the format 
and content of the final report and the summary will be sent to 
successful applicants. At minimum, the report should contain the 
following:
     A summary of the major activities supported under the 
cooperative agreement and the major accomplishments resulting from the 
training of physicians and other staff at RBH.
     An analysis of the project, based on the challenges 
described in background section of the RFA performed prior to or during 
the project period, including a description of the specific objectives 
stated in the cooperative agreement application and the accomplishments 
and failures resulting from activities during the cooperative agreement 
period.
    Quarterly performance reports and the final report should be 
submitted to: Amar Bhat, Ph.D, Parklawn Building, Room 18C-17, 5600 
Fishers Lane, Rockville, Maryland 20857, Telephone Number: (301) 443-
1410, Fax Number: (301) 443-1397, Email: [email protected].

V. Application Review Information

    Applications will be screened for completeness and for 
responsiveness to the program guidance. Applicants should pay strict 
attention to addressing these instructions, as they are the basis upon 
which their applications will be judged. Those applications judged to 
be non-responsive or incomplete will be returned to the applicant 
without review.
    An appropriate peer review group specifically convened for this 
solicitation and in accordance with HHS management policies and 
procedures for cooperative agreements will evaluate for scientific and 
technical merit applications that are complete and responsive to the 
instructions. As part of the initial merit review, all applications 
will receive a written critique. All applications eligible for 
consideration will be discussed fully by the ad hoc peer review group 
and assigned a priority score for funding. Eligible cooperative 
agreement applications will be assessed according the following 
criteria:
    (1) Technical Approach (40 points):
     The applicant's presentation of a sound and practical 
technical approach for executing the requirements specified in the 
Program Requirements section of this announcement, with adequate 
explanation, substantiation and justification for methods for handling 
the projected needs of the cooperative agreement.
     The successful applicant must demonstrate a clear 
understanding of the scope of work and objectives of the cooperative 
agreement, recognition of challenges that may arise in performing the 
work required, and understanding of the close coordination necessary 
between the OGHA/HHS, Afghanistan MOH, the U.S. Agency for 
International Development, and other organizations.
     Applicants must submit a strategic plan that outlines the 
initial (proposed) schedule of activities and expected products of the 
work with benchmarks at months four, six, 12, 18, 24, and 36. The 
strategic plan should specifically address the development of the 
curriculum and implementation of the training program for each category 
of hospital personnel; the proposed logistical support; and the 
activities related to initial assessment toward and (optional) longer-
term development of the residency training program.
    (2) Personnel Qualifications and Experience (30 points):
     Project Leadership--For the technical and administrative 
leadership of cooperative agreement, successful applicants must 
document expertise, relevant experiences, leadership/management skills, 
availability of a qualified project manager, and organizational 
(including cross-organizational) management structure able to 
successfully plan, implement, and evaluate the project. Such 
documentation should include examples of previous relevant experience 
in training health care professionals in developing countries in 
maternal and child health programs; examples of successful management 
of broad scope training programs in hospital settings in resource poor 
environments; examples of successful assessment of and, optionally, 
full responsibility for development of specialty physician (residency) 
training particularly in resource-poor settings; and examples of 
successful collaborations with other partner organizations, 
subcontractors, and/or consultant efforts in similar endeavors. 
Additionally, documentation of previous experience in training 
ancillary hospital staff in developing countries is expected.
     Partner Institutions and other Personnel--Applicants 
should provide documented evidence of availability, training, 
qualifications, expertise, relevant experience, salary history, and 
education and competence of the scientific, clinical, analytical, 
technical and administrative staff and any other proposed personnel 
(including partner institutions, subcontractors and consultants), to 
perform the requirements of the work activities as evidenced by 
resumes, endorsements and explanations of previous efforts. It is 
anticipated that the successful applicant will represent a consortium 
of well-suited parties for the various major activities of the 
cooperative agreement program.
     Staffing Plan--Applicants should submit a detailed 
staffing plan for the conduct of the project, including the 
appropriateness of the time commitment of all staff and partner 
institutions, the clarity and appropriateness of assigned roles, and 
specific lines of authority. Applicants should also provide an 
organizational chart for each partner institution named in the 
application showing relationships among the key personnel. If 
applicants develop legally binding relationships with partner 
institutions for the purpose of this cooperative agreement, copies of 
these agreements should be submitted with the application.
     Administrative and Organizational Framework--Adequacy of 
the administrative and organizational framework, with lines of 
authority and responsibility clearly demonstrated among the applicant's 
internal partners and with HHS and the MOH, and adequacy of the project 
plan, with proposed time schedule for achieving objectives and 
maintaining quality control over the implementation and operation of 
the project. Adequacy of back-up staffing and the evidence that they 
will be able to function as a team. The framework should identify the 
institution that will assume legal and financial responsibility and 
accountability for the use and disposition of funds awarded on the 
basis of this RFA.
    (3) Past Experience and Capabilities of the Organization (15 
points):
     Applicants should submit documented relevant experience of 
the organization in managing projects of similar complexity and scope 
of the activities.
     Adequacy, feasibility, and past experience in successfully 
coordinating multiple partner collaboration. Clarity and 
appropriateness of lines of communication and authority for 
coordination and management of the project.

[[Page 52290]]

     Documented experience recruiting qualified medical 
personnel for projects of similar complexity and scope of activities.
     Documented capability and past history of funds management 
meeting the highest acceptable standards of accounting.
    (4) Facilities and Resources (15 points):
    Documented availability and adequacy of facilities, equipment and 
resources necessary to carry out the activities specified under Program 
Requirements, including logistical support facilities and resources.

VI.1 Award Administration Information

    HHS does not release information about individual applications 
during the review process until final funding decisions have been made. 
When these decisions have been made, applicants will by letter 
regarding the outcome of their applications. The official document 
notifying an applicant that an application has been approved and funded 
is the Notice of Grant Award, which specifies to the award recipient 
the amount of money awarded, the purpose of the cooperative agreement, 
the terms and conditions of the cooperative agreement award, and the 
amount of funding, if any, to be contributed by the award recipient to 
the project costs.

VI.2. Administration and National Policy Requirements

    In accepting this award, the grantee stipulates that the award and 
any activities hereunder are subject to all provisions of 45 CFR parts 
74 and 92, currently in effect or implemented during the period of the 
grant. Within 60 days of receiving the Notice of Grant Award, a 
finalized work plan for year one of the project will be negotiated with 
the OFP Project Officer. In the succeeding years, the training plan and 
other training events will be a part of the continuation application. 
The OFP will identify training priorities for the coming year to the 
male training program within 60 days of the due date for the 
continuation application.
    The Buy American Act of 1933, as amended (41 U.S.C. 10a-10d), 
requires that Government agencies give priority to domestic products 
when making purchasing decisions. Therefore, to the greatest extent 
practicable, all equipment and products purchased with grant funds 
should be American-made.
    A Notice providing information and guidance regarding the 
``Government-wide Implementation of the President's Welfare-to-Work 
Initiative for Federal Grant Programs'' was published in the Federal 
Register on May 16, 1997. This initiative was designated to facilitate 
and encourage grantees and their sub-recipients to hire welfare 
recipients and to provide additional needed training and/or mentoring 
as needed. The text of the Notice is available electronically on the 
OMB home page at http://www.whitehouse.gov/omb.
    The HHS Appropriations Act requires that when issuing statements, 
press releases, requests for proposals, bid solicitations, and other 
documents describing projects or programs funded in whole or in part 
with Federal money, grantees shall clearly state the percentage and 
dollar amount of the total costs of the program or project which will 
be financed with Federal money and the percentage and dollar amount of 
the total costs of the project or program that will be financed by non-
governmental sources.

VI.3 Reporting

    A successful applicant under this notice will submit: (a) Annual 
progress reports; (b) annual Financial Status Reports; and (c) a final 
progress report and Financial Status Report. Reporting formats are 
established in accordance with provisions of the general regulations 
which apply under 45 CFR parts 74 and 92. Applicants must submit all 
required reports in a timely manner, in recommended formats (to be 
provided) and submit a final report on the project, including any 
information on evaluation results, at the completion of the project 
period. Agencies receiving $500,000 or more in total Federal funds are 
required to undergo an annual audit as described in OMB Circular A-133, 
``Audits of States, Local Governments, and Non-Profit Organizations.''

VII. Agency Contacts

    For assistance on administrative and budgetary requirements, Eric 
West, HHS Office of Public Health and Science (OPHS) Grants Management 
Office, (301) 594-0758.
    For assistance with questions regarding program requirements, Dr. 
Amar Bhat, HHS Office of Global Health Affairs, (301) 443-1410.

    Dated: August 20, 2004.
Arthur J. Lawrence,
Assistant Surgeon General, Acting Principal Deputy Assistant Secretary 
for Health, Office of Public Health and Science.
[FR Doc. 04-19462 Filed 8-24-04; 8:45 am]
BILLING CODE 4150-28-U