[Federal Register Volume 70, Number 171 (Tuesday, September 6, 2005)]
[Notices]
[Pages 53010-53018]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-17590]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Announcement of Availability of Funds for a Cooperative Agreement 
To Improve and Sustain the Leadership and Management Capacity and To 
Improve Operations and Delivery of Quality Health Care Within the Rabia 
Balkhi Women's Hospital

AGENCY: Department of Health and Human Services, Office of the 
Secretary, Office of Public Health and Science, Office of Global Health 
Affairs.
    Announcement Type: Cooperative Agreement--FY 2005 Initial 
Announcement.
    Funding Opportunity Number: OGHA 05-018.
    OMB Catalog of Federal Domestic Assistance: TBD, In Process.

    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 $1.5 million in fiscal year (FY) 2005 funds are available for 
one (1) cooperative agreement to strengthen leadership, healthcare 
administration and facility management and to improve operations and 
improve health care delivery 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 Public Health (MOPH). The goal of this project is to create 
equitable and high quality care at Rabia Balkhi Women's Hospital by 
developing effective leadership and management and improving 
operations. The funding will provide essential material resources 
within budgetary limitations for patient care, operations, facility 
management and for grant activities related to leadership and 
management development at RBH. A Memorandum of Understanding (MOU) 
between the grantee and the Afghan MOPH will detail the differentiated 
responsibilities of the awardee toward RBH and the conditions under 
which the MOPH will transfer operational and logistical authority and 
responsibility for management and operations of RBH to the awardee. 
Alongside this support, through a separate, ongoing cooperative 
agreement, HHS is currently providing support for staff development and 
continuing education at RBH, and the Department of Defense is providing 
approximately $1.4M in infrastructure upgrades. This new cooperative 
agreement is not anticipated to involve training of the clinical staff 
at RBH, but should include limited training and capacity-building of 
administrative or executive management staff.
    HHS, in partnership with other relevant United States Government 
(USG) agencies anticipates involvement in the development, 
administration and oversight of this hospital management improvement 
program. The program will be approved initially for a three-year 
period. It is estimated that approximately $1.5 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: Application Availability: September 6, 2005. Optional Letter of 
Intent due by 5 p.m. e.t. September 13, 2005.
    Application due by 5 p.m. e.t.: September 21, 2005.
    Award date: September 30, 2005.

ADDRESSES: Application kits may be requested from, and applications 
submitted to: Ms. Karen Campbell, Director, Office of Grants 
Management, Office of Public Health and Science (OPHS), HHS, 1101 
Wootton Parkway, Suite 550, Rockville, MD 20852.

I. Funding Opportunity Description

Purpose of the Agreement

    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 Badakhshan 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 government of Afghanistan has established the improvement in 
women and child health as one of its highest priorities. Hospital 
management within Afghanistan is of great concern to the MOPH and the 
international donor community. Competent hospital and clinic 
administration is critical to the efficient and effective provision of 
health care, particularly in resource-constrained environments. 
Afghanistan is recovering from more than twenty years of civil unrest 
and war. This period has taken its toll on the quality of the entire 
spectrum of health care delivery, public health and health professional 
education.
    The public hospitals in Afghanistan, including those that provide 
critical care to women and children, face overwhelming problems in the 
areas of staffing, training, equipment, supplies and pharmaceuticals. 
One area of increasing concern is hospital leadership and management. 
Without effective and efficient administration, investments in the 
problem areas will have little probability of success. Without 
functioning hospital support services, such as patient record-keeping, 
human resources, financial management, housekeeping, laundry, physical 
plant and grounds maintenance, security and many other departments that 
allow a hospital to function well, the physicians, nurses and other 
clinical staff are not able to provide quality care.
    Rabia Balkhi Hospital was one of the referral hospitals for women 
under the Taliban and was declared the only women's hospital in 1997. 
It is located adjacent to a major bazaar in District 2 of Kabul and 
consists of a large two-story building and two ancillary buildings 
within a courtyard. It has a theoretical in-patient capacity of 212 to 
250 beds of which 80 to 100 are designated for Gynecology and 
Obstetrics. Approximately 25 to 30 deliveries occur each day and 
approximately 7,500 to 11,000 babies are delivered there each year. The 
hospital sees approximately 300 to 400 out patients daily. It is a 
referral hospital with no formal relations with other maternity 
departments or pediatric hospitals. Its main partner for sick newborns 
is Indira Gandhi Children's Hospital, also in Kabul.
    A study of hospitals in Afghanistan by the Embassy of France (2002) 
indicated there were 95 physicians and 100 paramedics at RBH while MOPH 
data (2002) stated there were 265 health care

[[Page 53011]]

workers at RBH of which 110 were doctors and 120 other workers. 
Medicins du Monde (2002) reported 110 doctors, 75 nurses, 100 workers 
and 8 administrative staff. Both French Mission data and MOPH data 
indicate approximately a 1.00 total staff to bed ratio at RBH.
    MOPH leadership has approached the U.S. Government with a request 
for assistance to augment their capacity to develop policy and 
implement best practices in hospital management and operations. HHS and 
its partners are committed to working with the MOPH and Ministry of 
Finance (MOF) to address these problems.
    The United States Government is currently engaged in numerous 
cooperative efforts with other countries, NGOs, donor and implementing 
organizations to assist the MOPH improve the health status of Afghan 
people. Former HHS Secretary Tommy G. Thompson signed a Memorandum of 
Understanding (MOU) with the Afghanistan Minister of Health (MOH) on 
October 9, 2002, pledging the support of American citizens to help in 
these efforts. In early 2003, HHS entered into collaboration with the 
MOPH to improve the maternal and child health services available within 
Afghanistan. One of the long-term goals of this HHS-MOPH collaboration 
is to develop an Afghan-appropriate OB/GYN graduate medical education 
program in Kabul that reflects Afghan culture within the context of 
evidence-based obstetrical and gynecological medical practice and meets 
appropriate international standards.
    As a first step, HHS funded a clinical knowledge and skills 
refresher training program at RBH in April 2003. The intent of this 
refresher training has been to update the knowledge and skills of the 
current RBH attending physicians and other professional staff. HHS is 
providing focused, short-term training to the RBH staff to improve 
their basic knowledge levels and to update the clinical skills needed 
to respond to the critical needs of the high-risk patient community 
accessing care at this facility. Additionally, HHS, through HHS/Centers 
for Disease Control and Prevention (CDC), provides expert technical 
guidance and advisory consultation for the continued development and 
implementation of a facility-based Health Management System (HMIS), 
Surveillance, Quality Assurance and Hospital Infection Program (HIPP) 
at RBH. Simultaneously, the Department of Defense (DoD) is providing 
critical infrastructural improvements to the physical plant.
    In 2004, HHS provided funding to continue the RBH training program 
through a $2.2 million cooperative agreement with the implementing NGO, 
International Medical Corps (IMC). The cooperative agreement between 
IMC will continue to support the provision of staff development and 
refresher training for clinical staff, including physicians, nurse 
midwives and ancillary health care workers and is working toward the 
development of a Residency program for Obstetrics and Gynecology.
    Throughout 2004 it became increasingly clear to various USG 
representatives that ongoing significant investments in Kabul hospitals 
were unsustainable without improved hospital management. Discussions 
with MOPH leadership, including the Minister of Health, led to a 
request for USG assistance in improving health facility management in 
general throughout Afghanistan, and in particular in Kabul Maternal-
Child Hospitals (to which the USG had already been providing 
significant assistance). At the request of the MOPH, the USG agreed to 
facilitate and sponsor an international health facility management 
summit in Kabul, under the leadership of the MOPH, to raise awareness 
of and seek assistance in health facility management issues.
    Around this time, the Ministry was also beginning to explore unique 
solutions to the complex challenge of improving management at tertiary/
national hospitals. To this end, the Ministry entered into non-profit, 
public-private partnerships with Cure International to manage Darulaman 
hospital and Loma Linda University to manage Wazir Akhbar Khan 
hospital. Through Formal Memoranda of Understanding, the MOPH agreed to 
transfer significant authority and autonomy to these organizations to 
manage these hospitals utilizing current best practices, thus 
overtaking some of the entrenched bureaucratic and political hurdles to 
hospital management reform. Another novel component of the agreements 
was that the Ministry would continue to provide baseline funding and 
staffing to these hospitals, which Loma Linda and Cure are free to 
augment with other sources of funding, including sliding-scale fee-for-
service proceeds--provided that indigent persons still receive care 
free of charge. USG representatives and MOPH counterparts began to view 
this approach as holding promise for improving management and 
operations of Kabul Maternal-Child Hospitals. Discussions led to the 
notional concept of a non-profit, public-private Kabul maternal-child 
hospital consortium, with a common Board of Directors, but with each 
hospital managed by a private sector partner in a fashion similar to 
the arrangements with Cure and Loma Linda.
    This Cooperative Agreement is intended to complement and build upon 
the work of the MOPH Hospital Management Task Force and its efforts to 
implement the Essential Package of Hospital Services (EPHS) and the 
recommendations of the Joint USG/MOPH health facility management 
planning team as outlined above. Implementation and adherence to 
recognized evidence based healthcare and facility management standards 
will be essential elements of successful proposals.
    The primary role of the award recipient of this cooperative 
agreement will be to implement and support effective leadership and 
management and improve operations and health care delivery in RBH, 
while building the Afghan capacity to assume these functions in the 
future.
    It is anticipated that multiple sources of significant revenue, in 
addition to this cooperative agreement, will be available for 
leveraging in accomplishment of the objectives. These include:
     Current MOPH operating expenses, supplies, and staff for 
RBH will continue to be provided.
     DoD is contributing $1.4M to infrastructure upgrades at 
RBH.
     The awardee will be given the authority (similar to Cure 
and Loma Linda) to establish a sliding-scale, fee-for-service revenue 
enhancement program.
     With professional management in place, it is likely that 
international donors will be willing to make additional donations or 
in-kind contributions to improve health care delivery at RBH; the 
Afghan and U.S. governments will continue to solicit such additional 
assistance.
    The grantee will be expected to optimally leverage these funding 
streams, in addition to the grant funds, to accomplish grant 
objectives.
    This cooperative agreement is not anticipated to involve training 
of the clinical staff at RBH, but should include limited training of 
administrative or executive management staff. Upon award, the award 
recipient will develop and implement a formal three-year work plan. 
This plan is expected to include all of the below mentioned activities 
with timelines for completion and designated responsible agents. 
Measurable goals, objectives, and

[[Page 53012]]

outcomes are expected to be integrated into the workplan:
     Provide a mission statement, including projected scope of 
service, definition of the catchment area, bed capacity and projected 
length of stay.
    [cir] Including a plan to draw down specialty services at RBH to 
focus on Obstetric and Gynecologic care
     Develop an assessment of all available equipment with the 
status of functionality; identification of the extent and estimated 
cost for repair/rehabilitation and a plan for maintenance and regular 
inventory inspection and control.
     Develop an annual operational and personnel budget.
    [cir] Including a plan to identify, optimize, consolidate and 
effectively utilize all available funding sources for RBH.
     Listing and justification, including cost for procurement, 
of essential equipment, supplies and pharmaceuticals.
     Describe a method for elimination of waste and abuse of 
equipment and supplies and development of a hospital security system.
     Description of all support services including 
transportation and ambulance service with staffing details and a three 
year plan for future technical development of services.
     Description of a Hospital Management Board, Hospital 
Buying/Purchasing Committee and a Hospital Community Board to include 
membership qualifications, terms of reference and the identification of 
methods to increase community input into the overall oversight of the 
hospitals responsibilities.
     Description of the salary scale plus merit for 
performance, which yields, increased efficiency payment system for the 
providers
     Design for job descriptions/performance appraisals for all 
personnel.process
     Coordinate educational efforts to support the management 
training with the presently funded IMC and CDC Plans for clinical 
education and training. Include a discipline specific needs assessment, 
training plan with objectives using a variety of teaching 
methodologies; evaluation measures and include i timelines for 
competency skill assessment and testing.
     Create a plan for executive and management training which 
may consist of planned exercises, mentoring by international experts 
and facilitation by peer networking. All efforts must compliment MOPH 
efforts and reflect Institute of Health Sciences training standards.
     Building upon the current referral system with Basic 
Health Centers, refine the referral processes between all appropriate 
health care facilities to ensure a seamless delivery system. Build in a 
method to ensure accountability and lay the foundation for a system-
wide integrated continuum of care.
     Plan for incorporation of the HHS/CDC-developed Health 
Management Information system, including patient record-keeping.
     Plan to improve and modernize information and 
communication technology capabilities--appropriate to the Afghan 
environment.
     Plan for incorporating and implementing evidence-based 
standards of care and best practices, including quality assurance and 
quality improvement programs.
     Plan for development and implementation of case 
management.
     Plan for internal monitoring and evaluation to include 
clinical and management processes, output and outcome indicators.
     Plan to identify services which would more efficiently be 
shared with other Kabul maternal-child hospitals, such as laboratory, 
advanced imaging, etc. * * *
     Plan to identify services which would be more efficiently 
privatized, such as laundry, cleaning, security, etc. * * *
     Plan to cooperate with and facilitate development of the 
non-profit, public-private Kabul maternal-child hospital Consortium, of 
which RBH will be a key component.
    Finally, the award recipient will monitor and report progress 
quarterly and conduct a comprehensive evaluation of all required 
elements and conditions, including outcome measures for effectiveness 
and efficiency.

SUPPLEMENTARY INFORMATION: The OGHA/OS/HHS 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.
    Through this cooperative agreement, HHS will collaborate in an 
advisory capacity with the award recipient, especially during the 
development and implementation of a mutually agreed-upon work plan. HHS 
will actively participate in periodic progress reviews and a final 
evaluation of the program.

Obligations of OGHA/OS/HHS:
    1. Assurance of the services of appropriately experienced HHS or 
other subject matter experts from other relevant agencies to 
participate in the planning, development, implementation, and 
evaluation of all phases of this project.
    2. Assistance in establishing and maintaining USG, MOPH, and non-
governmental organizations (NGOs) contracts and agreements necessary to 
carry out the program.

II. Award Information

    The administrative and funding instrument to be used for this 
program will be the cooperative agreement in which HHS scientific and 
program involvement with the grantee is anticipated during the 
performance of the maximum funding level of up to $1.5 million 
(including indirect costs) is available for the initial 12-month budget 
period. Two successive 12-month periods may be funded during the life 
of this agreement. Continuation of this project from one budget period 
to the next and level of funding are 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 notice are contingent upon the 
availability of funds for this purpose.

III. Eligibility Information

1. Eligible Applicants

    Applications may be submitted by non-profit entities with offices 
in the United States and partner country or incorporated and 
headquartered in the United States with offices in the United States. 
Additionally, organizations or consortiums of organizations, including 
faith-based and community based organizations, that have collective 
experience with accepting donated medical technology, upgrading drug 
formularies, training health care providers, local and international 
transportation, and other logistics are encouraged to apply for a grant 
under this announcement.

2. Cost Sharing or Matching

    Cost sharing, matching funds, and cost participation is not a 
requirement of this agreement.

3. Other--(If Applicable): N/A

IV. Application and Submission Information

1. Address To Request Application Package

    This Cooperative Agreement project uses the Application Form OPHS-
1, Revised 8/2004, which is enclosed in

[[Page 53013]]

your application packet. This generic form is used by many different 
programs funded through the Public Health Service (PHS). Some parts of 
it are not required; other sections need to be filled out in a fashion 
specific to the program. Instructions for filling out OPHS-1, Revised 
8/2004 will be included in the application packet. These forms may also 
be obtained from the following sites by: Downloading from https://egrants.osophs.dhhs.gov and clicking on Grant Announcements or http://www.grants.gov/ or by writing to Ms. Karen Campbell, Director, Office 
of Grants Management, OPHS, HHS Tower Building, 1101 Wootton Parkway, 
Suite 550, Rockville, MD 20852; or contact the Office of Grants 
Management at (240) 453-8822. Please specify the OGHA program(s) for 
which you are requesting an application kit.

2. Content and Form of Application Submission

Application Materials
    A separate budget page is required for the budget year requested. 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. 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 OPHS Office of Grants Management identified in Section VII 
of this announcement.
    All applications must be accompanied by a Project Abstract 
submitted on 3.5 inch floppy disk. The abstract must be typed, single-
spaced, and not exceed 2 pages. 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.
    All grant applications must be accompanied by a Project Narrative. 
In addition to the instructions provided in OPHS-1 (Rev 8/2004) 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 1 inch at 
the top and 1 inch at the bottom and both sides; and typeset must be no 
smaller than 12 cpi 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.
Application Format Requirements
    If applying on paper, the entire application may not exceed 80 
pages in length, including the abstract, project and budget narratives, 
face page, attachments, any appendices and letters of commitment and 
support. Pages must be numbered consecutively.
    Applications submitted electronically that exceed 80 pages when 
printed will be deemed non-compliant. All non-compliant applications 
will be returned to the applicant without further consideration.
    a. Number of Copies
    Please submit one (1) original and two (2) unbound copies of the 
application.
    Please do not bind or staple the application. Application must be 
single sided.
    b. Font
    Please use an easily readable serif typeface, such as Times Roman, 
Courier, or CG Times. The text and table portions of the application 
must be submitted in not less than 12 point and 1.0 line spacing. 
Applications not adhering to 12 point font requirements may be 
returned.
    c. Paper Size and Margins
    For scanning purposes, please submit the application on 8\1/2\'' x 
11'' white paper. Margins must be at least one (1) inch at the top, 
bottom, left and right of the paper. Please left-align text.
    d. Numbering
    Please number the pages of the application sequentially from page 1 
(face page) to the end of the application, including charts, figures, 
tables, and appendices.
    e. Names
    Please include the name of the applicant on each page.
    f. Section Headings
    Please put all section headings flush left in bold type.
    Application Format: Applications for funding must consist of the 
following documents in the following order:
i. Application Face Page
    Public Health Service (PHS) Application Form OPHS-1, provided with 
the application package. Prepare this page according to instructions 
provided in the form itself.
DUNS Number
    All applicant organizations are required to have a Data Universal 
Numbering System (DUNS) number in order to apply for a grant from the 
Federal Government. The DUNS number is a unique nine-character 
identification number provided by the commercial company, Dun and 
Bradstreet. There is no charge to obtain a DUNS number. Information 
about obtaining a DUNS number can be found at https://www.dnb.com/product/eupdate/requestOptions.html or call 1-866-705-5711. Please 
include the DUNS number next to the OMB Approval Number on the 
application face page. Applications will not be reviewed without a DUNS 
number.
    Additionally, the applicant organization will be required to 
register with the Federal Government's Central Contractor Registry 
(CCR) in order to do electronic business with the Federal Government. 
Information about registering with the CCR can be found at http://www.hrsa.gov/grants/ccr.htm.
    Finally, applicants applying electronically through Grants.gov are 
required to register with the Credential Provider for Grants.gov. 
Information about this requirement is available at http://www.grants.gov/CredentialProvider.
    Applicants applying electronically through the OPHS E-Grants System 
are required to register with the provider. Information about this 
requirement is available at https://egrants.osophs.dhhs.gov.
ii. Table of Contents
    Provide a Table of Contents for the remainder of the application 
(including appendices), with page numbers.
iii. Application Checklist
    Application Form OPHS-1, provided with the application package.
iv. Budget
    Application Form OPHS-1, provided with the application package.
v. Budget Justification
    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 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 project year. Please note that if indirect costs are 
requested, the applicant must submit a copy of the latest negotiated 
rate

[[Page 53014]]

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 sponsored programs will be held at 
26% of total direct costs except, in cases where there is no 
established rate, applicants may only request 10% of salaries and 
wages. However, if an applicant's established rate for other sponsored 
programs exceeds 26%, but would be advantageous to the government, the 
OGHA/HHS may honor that indirect rate cost.
    Personnel Costs: Personnel costs should be explained by listing 
each staff member who will be supported from funds, name (if possible), 
position title, percent full time equivalency, annual salary, and the 
exact amount requested.
    Indirect Costs: Indirect costs are those costs incurred for common 
or joint objectives which cannot be readily identified but are 
necessary to the operations of the organization, e.g., the cost of 
operating and maintaining facilities, depreciation, and administrative 
salaries. For institutions subject to OMB Circular A-21, the term 
``facilities and administration'' is used to denote indirect costs. If 
the applicant does not have an indirect cost rate, you may obtain one 
by visiting the Division of Cost Allocation Web site: http://rates.psc.gov.
    Fringe Benefits: List the components that comprise the fringe 
benefit rate, for example health insurance, taxes, unemployment 
insurance, life insurance, retirement plan, tuition reimbursement. The 
fringe benefits should be directly proportional to that portion of 
personnel costs that are allocated for the project.
    Travel: List travel costs according to local and long distance 
travel. For local travel, the mileage rate, number of miles, reason for 
travel and staff member/consumers completing the travel should be 
outlined. The budget should also reflect the travel expenses associated 
with participating in meetings and other proposed trainings or 
workshops.
    Equipment: List equipment costs and provide justification for the 
need of the equipment to carry out the program's goals. Extensive 
justification and a detailed status of current equipment must be 
provided when requesting funds for the purchase of computers and 
furniture items.
    Supplies: List the items that the project will use. In this 
category, separate office supplies from medical and educational 
purchases. Office supplies could include paper, pencils, and the like; 
medical supplies are syringes, blood tubes, plastic gloves, etc., and 
educational supplies may be pamphlets and educational videotapes. 
Remember, they must be listed separately.
    Subcontracts: To the extent possible, all subcontract budgets and 
justifications should be standardized, and contract budgets should be 
presented by using the same object class categories contained in the 
Standard Form 424A. Provide a clear explanation as to the purpose of 
each contract, how the costs were estimated, and the specific contract 
deliverables.
    Other: Put all costs that do not fit into any other category into 
this category and provide an explanation of each cost in this category. 
In some cases, grantee rent, utilities and insurance fall under this 
category if they are not included in an approved indirect cost rate.)
vi. Staffing Plan and Personnel Requirements
    Applicants must present a staffing plan and provide a justification 
for the plan that includes education and experience qualifications and 
rationale for the amount of time being requested for each staff 
position. Position descriptions that include the roles, 
responsibilities, and qualifications of proposed project staff must be 
included in Appendix XX. Copies of biographical sketches for any key 
employed personnel that will be assigned to work on the proposed 
project must be included in Appendix XX.
vii. Project Abstract
    Provide a summary of the application. Because the abstract is often 
distributed to provide information to the public and Congress, please 
prepare this so that it is clear, accurate, concise, and without 
reference to other parts of the application. It must include a brief 
description of the proposed grant project including the needs to be 
addressed, the proposed services, and the population group(s) to be 
served.
    Please place the following at the top of the abstract:

 Project Title
 Applicant Name
 Address
 Contact Phone Numbers (Voice, Fax)
 E-Mail Address
 Web Site Address, if applicable

    The project abstract must be single-spaced and limited to two pages 
in length.
vii. Program Narrative
    This section provides a comprehensive framework and description of 
all aspects of the proposed program. It should be succinct, self-
explanatory and well organized so that reviewers can understand the 
proposed project.
    Use the following section headers for the Narrative:
     Introduction: This section should briefly describe the 
purpose of the proposed project.
     Work Plan: Describe the activities or steps that will be 
used to achieve each of the activities proposed in the methodology 
section. Use a time line that includes each activity and identifies 
responsible staff.
     Resolution of Challenges: Discuss challenges that are 
likely to be encountered in designing and implementing the activities 
described in the Work Plan, and approaches that will be used to resolve 
such challenges.
     Evaluation and Technical support Capacity: Describe 
current experience, skills, and knowledge, including individuals on 
staff, materials published, and previous work of a similar nature.
     Organizational Information: Provide information on the 
applicant agency's current mission and structure, scope of current 
activities, and an organizational chart, and describe how these all 
contribute to the ability of the organization to conduct the program 
requirements and meet program expectations.
iii. Appendices
    Please provide the following items to complete the content of the 
application. Please note that these are supplementary in nature, and 
are not intended to be a continuation of the project narrative. Be sure 
each appendix is clearly labeled.
    (1) Appendix A: Tables, Charts, etc.--To give further details about 
the proposal.
    (2) Appendix B: Job Descriptions for Key Personnel--Keep each to 
one page in length as much as is possible. Item 6 in the Program 
Narrative section of the PHS 5161-1 Form provides some guidance on 
items to include in a job description.
    (3) Appendix C: Biographical Sketches of Key Personnel--Include 
biographical sketches for persons occupying the key positions described 
in Appendix B, not to exceed two pages in length. In the event that a 
biographical sketch is included for an identified individual who is not 
yet hired, please include a letter of commitment from that person with 
the biographical sketch.
    (4) Appendix D: Letters of Agreement and/or Description(s) of 
Proposed/Existing Contracts (project specific)--

[[Page 53015]]

Provide any documents that describe working relationships between the 
applicant agency and other agencies and programs cited in the proposal. 
Documents that confirm actual or pending contractual agreements should 
clearly describe the roles of the subcontractors and any deliverable 
Letters of agreements must be dated.
    (5) Appendix E: Project Organizational Chart--Provide a one-page 
figure that depicts the organizational structure of the project, 
including subcontractors and other significant collaborators.
    (6) Appendix F: Other Relevant Documents--Include here any other 
documents that are relevant to the application, including letters of 
supports. Letters of support must be dated.

3. Submission Dates and Times

Notification of Intent To Apply
    A letter of intent is not required. However, if a letter of intent 
is submitted, the letter should identify the applicant organization and 
its intent to apply, and briefly describe the proposal to be submitted. 
Receipt of Letters of Intent will not be acknowledged.
    This letter should be sent by September 13, 2005, by mail or fax 
to: Department of Health and Human Services, Office of the Secretary, 
Office of Global Health Affairs, 5600 Fishers Lane, Suite 18-101, 
Rockville, MD 20857, Facsimile Number: 301-443-2820.
    Application Submission: The OPHS provides multiple mechanisms for 
submission of applications as described in the following sections.
    Electronic Submission: The OPHS electronic grants management 
system, eGrants, provides for applications to be submitted 
electronically. While applications are accepted in hard copy, the use 
of the electronic application submissions capabilities provided by the 
eGrants system is encouraged. Information about this system is 
available on the Office of Population Affairs Web site at http://opa.osophs.dhhs.gov, or may be requested from the OPHS Office of Grants 
Management at 240-453-8822. Applications sent via any other means of 
electronic communication, including facsimile or electronic mail, 
outside of the OPHS eGrants system will not be accepted for review.
    The body of the application and required forms can be submitted 
using the e-Grants system. In addition to electronically submitted 
materials, applicants are required to provide a hard copy of the 
application face page (Standard Form 424 [Revised 07/03]) with the 
original signature of an individual authorized to act for the applicant 
agency or organization and to assume for the organization the 
obligations imposed by the terms and conditions of the grant award. The 
application is not considered complete until both the electronic 
application and the hard copy of the face page with the original 
signature are received.
    Electronic grant application submissions must be submitted no later 
than 5 p.m. eastern time on the deadline date specified in the DATES 
section of the announcement. All required hard copy original signatures 
and mail-in items must be received by the OPHS Office of Grants 
Management no later than 5 p.m. eastern time on the next business day 
after the deadline date specified in the DATES section of the 
announcement.
    Applications will not be considered valid until all electronic 
application components, hard copy original signatures, and mail-in 
items are received by the OPHS Office of Grants Management according to 
the deadlines specified above. Any application submitted electronically 
after 5 p.m. eastern time on the deadline date specified in the DATES 
section of the announcement will be considered late and will be deemed 
ineligible. Failure of the applicant to submit all required hard copy 
original signatures to the OPHS Office of Grants Management by 5 p.m. 
eastern time on the next business day after the deadline date specified 
in the DATES section of the announcement will result in the electronic 
application being deemed ineligible.
    Upon completion of a successful electronic application submission, 
the eGrants system will provide the applicant with a confirmation page 
indicating the date and time (eastern time) of the electronic 
application submission. This confirmation page will also provide the 
receipt status of all indicated signatures and items to be mailed to 
the OPHS Office of Grants Management. As items are received by the OPHS 
Office of Grants Management, the electronic application status will be 
updated to reflect the receipt of mail-in items. It is recommended that 
the applicant monitor the status of their application to ensure that 
all signatures and mail-in items are received.
    Applicants are encouraged to initiate electronic applications early 
in the application development process, and to submit early on the due 
date or before. This will aid in addressing any problems with 
submission prior to the application deadline.
    Mailed Hard Copy Applications: Applications submitted in hard copy 
must include an original and two copies of the application. The 
original application must be signed by an individual authorized to act 
for the applicant agency or organization and to assume for the 
organization the obligations imposed by the terms and conditions of the 
grant award.
    Mailed applications will be considered as meeting the deadline if 
they are received by the OPHS Office of Grants Management on or before 
5 p.m. eastern time on the deadline date specified in the DATES section 
of the announcement. The application deadline date requirement 
specified in this announcement supercedes the instructions in the OPHS-
1. Applications that do not meet the deadline will be returned to the 
applicant unread.
    Hand-Delivered Applications: Hand-delivered applications must be 
received by the OPHS Office of Grants Management, 1101 Wootten Parkway, 
Suite 550, Rockville, Maryland, 20852, no later than 5 p.m. eastern 
time on the deadline date specified in the DATES section of the 
announcement. Hand-delivered applications must include an original and 
two copies of the application. The original application must be signed 
by an individual authorized to act for the applicant agency or 
organization and to assume for the organization the obligations imposed 
by the terms and conditions of the grant award.
    Applications will be screened upon receipt. Those that are judged 
to be incomplete or arrive after the deadline will be returned without 
review or comment. Applications that exceed the requested amount may 
also be returned without review or comment. Applicants that are judged 
to be in compliance will be notified by the OPHS Office of Grants 
Management. Accepted applications will be reviewed for technical merit 
in accordance with DHHS policies.
    Applications should be submitted to: Director, Office of Grants 
Management, OPHS, HHS, 1101 Wootten Parkway, Suite 550, Rockville, MD 
20852. Technical assistance on budget and business aspects of the 
application may be obtained from the Office of Grants Management, OPHS, 
HHS, 1101 Wootten Parkway, Suite 550, Rockville, MD 20852, telephone: 
(240) 453-8822.

4. Intergovernmental Review

    This program is not subject to the review requirements of Executive 
Order 12372, Intergovernmental Review of Federal Programs.

[[Page 53016]]

5. Funding Restrictions

    Allowability, allocability, reasonableness, and necessity of direct 
and indirect costs that may be charged are outlined in the following 
documents: OMB-21 (Institutes of Higher Education); OMB Circular A-122 
(Nonprofit Organizations) and 45 CFR part 74, appendix E (Hospitals). 
Copies of these circulars can be found on the Internet at: http://www.whitehouse.gov/omb.

6. Other Submission Requirements: N/A

V. Application Review Information

1. Criteria

    Applications will be screened by OGHA staff for completeness and 
for responsiveness to the program guidance. Applicants should pay 
strict attention addressing these criteria, 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.
    Applications that are complete and responsive to the guidance will 
be evaluated for scientific and technical merit by an appropriate peer 
review group specifically convened for this solicitation and in 
accordance with HHS policies and procedures. As part of the initial 
merit review, all applications will receive a written critique. All 
applications recommended for approval will be discussed fully by the ad 
hoc peer review group and assigned a priority score for funding. 
Eligible 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 with adequate 
explanation, substantiation and justification for methods for handling 
the projected needs of the partner institution.
     The successful applicant must demonstrate a clear 
understanding of the scope and objectives of the cooperative agreement, 
recognition of potential difficulties that may arise in performing the 
work required, presentation of adequate solutions, and understanding of 
the close coordination necessary between the OGHA/HHS, Afghanistan 
Ministry of Public Health, U.S. Agency for International Development, 
and other organizations, such as the World Health Organization and 
United Nations Children's Fund.
     Applicants must submit a strategic plan that outlines the 
schedule of activities and expected products of the Group's work with 
benchmarks at months six, 12. The strategic plan should specifically 
address the expected progress of the Quality of Care program.
    (4) Personnel Qualifications and Experience (20 points):
     Project Leadership--For the technical and administrative 
leadership of the project requirements, successful applicants must 
demonstrate documented training, expertise, relevant experiences, 
leadership/management skills, and availability of a suitable overall 
project manager and surrounding management structure to successfully 
plan and manage the project. Successful applicant will provide 
documented history of leadership in the establishment and management of 
training programs that involve training of health care professionals in 
countries other than the United States. Expertise in maternal and child 
health care and services including documented training, expertise, 
relevant experience, leadership skills, and maternal and child health 
specific medical expertise. Documented managerial ability to achieve 
delivery or performance requirements as demonstrated by the proposed 
use of management and other personnel resources and to successfully 
manage the project, including subcontractor and/or consultant efforts, 
if applicable, as evidence by the management plan and demonstrated by 
previous relevant experience.
     Partner Institutions and other Personnel--Applicants 
should provide documented evidence of availability, training, 
qualifications, expertise, relevant experience, 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.
     Staffing Plan--Applicants should submit a 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, lines of authority. Applicants 
should also provide an organizational chart for each partner 
institution named in the application showing relationships among the 
key personnel.
     Administrative and Organizational Framework--Adequacy of 
the administrative and organizational framework, with lines of 
authority and responsibility clearly demonstrated, 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.
    (5) Experience and Capabilities of the Organization (30 Points):
     Applicants should submit documented relevant experience of 
the organization in managing projects of similar complexity and scope 
of the activities.
     Clarity and appropriateness of lines of communication and 
authority for coordination and management of the project. Adequacy and 
feasibility of plans to ensure successful coordination of a multiple-
partner collaboration.
     Documented experience recruiting qualified medical 
personnel for projects of similar complexity and scope of activities.
    (4) Facilities and Resources (10 Points):
    Documented availability and adequacy of facilities, equipment and 
resources necessary to carry out the activities specified under Program 
Requirements.

2. Review and Selection Process

    Applications will be reviewed in competition with other submitted 
applications, by a panel of peer reviewers. Each of the above criteria 
will be addressed and considered by the reviewers in assigning the 
overall score. Final award will be made by the Deputy Director, Asia 
and Pacific Division of the Office Global Health Affairs on the basis 
of score, program relevance and, availability of funds.

VI. Award Administration Information

1. Award Notices

    OGHA/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 be notified 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 Award, which specifies to the awardee the 
amount of money awarded, the purpose of the agreement, the terms and 
conditions of the agreement, and the amount of funding, if any, to be 
contributed by the awardee to the project costs.

[[Page 53017]]

2. Administrative and National Policy Requirements

    The regulations set out at 45 CFR parts 74 and 92 are the 
Department of Health and Human Services (HHS) rules and requirements 
that govern the administration of grants. Part 74 is applicable to all 
recipients except those covered by part 92, which governs awards to 
state and local governments. Applicants funded under this announcement 
must be aware of and comply with these regulations. The CFR volume that 
includes parts 74 and 92 may be downloaded from http://www.access.gpo.gov/nara/cfr/waisidx_03/45cfrv1_03.html.
    Reporting: Each party to this Cooperative Agreement has agreed to 
undertake the following obligations:
    The applicant (recipient) agrees to:
    a. Provide a budget for the acquisition and installation of the 
necessary equipment to complete the HHS Project, using the provided HHS 
Guidelines on Medical Equipment Donation;
    b. Facilitate the acquisition, refurbishment and calibration of the 
necessary equipment at a reduced cost;
    c. Prepare the necessary items for shipping including preparation 
of shipping documents for entry into partner country;
    d. Provide manuals for the donated equipment which can be 
translated into the primary language, at a sixth grade reading level 
and contain illustrations. Manuals must include content on the proper 
storage, cleaning and care and repair of the equipment;
    e. Ensure that the training method or module includes essential 
content regarding the adherence to established infection control 
principles;
    f. Provide technical training and examination of proficiency by the 
user on agreed upon technologies and supplied equipment;
    g. Ensure that training is provided by a certified trainer at a 
time closely coordinated with the delivery of the equipment or 
materials; and,
    h. Accompany the equipment and supplies for the purpose of 
overseeing the distribution, installation, and training in partner 
institution.
    HHS agrees to:
    a. Identify the funds necessary for the acceptance of the necessary 
equipment in keeping with the approved budget; and,
    b. Identify the funds or transportation necessary for the shipping 
of goods to partner country.
    All projects 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 
knowledge and skills that can be attributed to the project. Project 
funds may be used to support evaluation activities.
    In addition to conducting their own evaluation of their projects, 
successful applicants must be prepared to participate in an external 
evaluation, to be supported by OGHA/HHS and conducted by an independent 
entity, to assess efficiency and effectiveness for the project funded 
under this announcement.
    Within 30 days following the end of each of quarter, submit a 
performance report no more than ten pages in length must be submitted 
to OGHA/HHS. A sample monthly performance report will be provided at 
the time of notification of award. At a minimum, monthly performance 
reports should include:
     Concise summary of the most significant achievements and 
problems encountered during the reporting period, e.g. number of 
training courses held and number of trainees.
     A comparison of work progress with objectives established 
for the quarter using the grantee's implementation schedule, and where 
such objectives were not met, a statement of why they were not met.
     Specific action(s) that the grantee would like the OGHA/
HHS to undertake to alleviate a problem.
     Other pertinent information that will permit monitoring 
and overview of project operations.
     A quarterly financial report describing the current 
financial status of the funds used under this award. The awardee and 
OGHA will agree at the time of award for the format of this portion of 
the report.
    Within 90 days following the end of the project period a final 
report containing information and data of interest to the Department of 
Health and Human Services, Congress, and other countries 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:
     A summary of the major activities supported under the 
agreement and the major accomplishments resulting from activities to 
improve mortality in partner country.
     An analysis of the project based on the problem(s) 
described in the application and needs assessments, performed prior to 
or during the project period, including a description of the specific 
objectives stated in the grant application and the accomplishments and 
failures resulting from activities during the grant period.
    Quarterly performance reports and the final report may be submitted 
to: Ms. Karen Campbell, Director, Office of Grants Management, OPHS, 
HHS, 1101 Wootton Parkway, Suite 550, Rockville, MD 20852, phone (240) 
453-8822.

VII. Agency Contacts

    For assistance on administrative and budgetary requirements, please 
contact: Ms. Karen Campbell, Director, Office of Grants Management, 
OPHS, HHS, 1101 Wootton Parkway, Suite 550, Rockville, MD 20852, phone 
(240) 453-8822.
    For assistance with questions regarding program requirements, 
please contact: Dr. Amar Bhat, Asia-Pacific Division, Office of Global 
Health Affairs, Office of the Secretary, Department of Health and Human 
Services, 5600 Fishers Lane, Suite 18-101, Rockville, MD 20857. Phone 
Number: 301-443-1410.

VIII. Tips for Writing a Strong Application

    Include DUNS Number. You must include a DUNS Number to have your 
application reviewed. Applications will not be reviewed without a DUNS 
number. To obtain a DUNS number, access http://www.dunandbradstreet.com 
or call 1-866-705-5711. Please include the DUNS number next to the OMB 
Approval Number on the application face page.
    Keep your audience in mind. Reviewers will use only the information 
contained in the application to assess the application. Be sure the 
application and responses to the program requirements and expectations 
are complete and clearly written. Do not assume that reviewers are 
familiar with the applicant organization. Keep the review criteria in 
mind when writing the application.
    Start preparing the application early. Allow plenty of time to 
gather required information from various sources.
    Follow the instructions in this guidance carefully. Place all 
information in the order requested in the guidance. If the information 
is not placed in the requested order, you may receive a lower score.
    Be brief, concise, and clear. Make your points understandable. 
Provide accurate and honest information, including candid accounts of 
problems and realistic plans to address them. If any required 
information or data is omitted, explain why. Make sure the

[[Page 53018]]

information provided in each table, chart, attachment, etc., is 
consistent with the proposal narrative and information in other tables.
    Be organized and logical. Many applications fail to receive a high 
score because the reviewers cannot follow the thought process of the 
applicant or because parts of the application do not fit together.
    Be careful in the use of appendices. Do not use the appendices for 
information that is required in the body of the application. Be sure to 
cross-reference all tables and attachments located in the appendices to 
the appropriate text in the application.
    Carefully proofread the application. Misspellings and grammatical 
errors will impede reviewers in understanding the application. Be sure 
pages are numbered (including appendices) and that page limits are 
followed. Limit the use of abbreviations and acronyms, and define each 
one at its first use and periodically throughout application.

    Dated: August 26, 2005.
Mary Lou Valdez,
Deputy Director for Policy, Office of Global Health Affairs.
Cristina V. Beato,
Acting Assistant Secretary for Health, Office of Public Health and 
Science.
[FR Doc. 05-17590 Filed 9-2-05; 8:45 am]
BILLING CODE 4150-38-P