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Resilient and Responsive Health Systems (RRHS) Initiative – South Sudan

Grants to USA, Canada, and International Nonprofits,
For-Profits, and IHEs to Improve Health Resources in South Sudan

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Funding Source:

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U.S. Department of Health and Human Services (HHS) - Health Resources and Services Administration (HRSA), HIV/AIDS Bureau

Deadline Date:

01/02/18 11:59 PM ET


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Grant to a USA, Canada, and International nonprofit, for-profit, IHE, or tribe to address public health challenges in South Sudan, including HIV/AIDS, malaria, and tuberculosis. Applicants are advised to ensure the required registrations at least one month prior to the deadline.

This initiative also seeks to achieve health system resiliency by addressing fundamental health systems constraints that impede the availability of and access to quality health services by supporting the implementation of national health strategies and recovery plans to respond to emerging epidemics, prevent, manage and control HIV/AIDS, TB, malaria, and other communicable and non- communicable diseases, and improve population health outcomes.

The resilience of a health system is its capacity to respond and adapt to planned and unplanned needs, and the ability to absorb shocks, such as a disease outbreak, natural disaster, or conflict. Decades of experience in health systems development in fragile states have demonstrated a need to address weaknesses in HRH, policy, leadership, management capacity, service delivery, and data collection and evaluation through the World Health Organization’s health system building blocks framework, also taking into consideration the capacity, security situation, and state of health in each state. In fragile states, these core structural components of the health system are, by definition, weak and incomplete, and often characterized by the inability to provide health services to a large proportion of the population. They present as insufficient coordination, oversight, and monitoring of health services; ineffective or nonexistent referral systems; inadequate management capacity; lack of health equity; lack of health infrastructure for delivering health services; lack of mechanisms for developing, establishing, and implementing national health policies; and non-operational health information systems.

Achieving an AIDS-free generation is dependent upon the ability of people at-risk for and/or living with HIV and AIDS to find and access quality health services, providers, and products. A well-functioning and resilient health system meets these needs, effectively supporting prevention, care, and treatment for HIV/AIDS, TB, malaria, and other communicable and non-communicable diseases.

In just eleven years, PEPFAR has moved from an emergency program to one specifically focused on controlling the HIV epidemic. PEPFAR has now entered what may be its most challenging, but exciting, phase yet—Phase III focusing on sustainable control of the epidemic. To reach the Joint United Nations Program on HIV/AIDS’ (UNAIDS) ambitious 90-90-90 global goals (90 percent of people with HIV - diagnosed, 90 percent diagnosed - on ART, and 90 percent on ART - virally suppressed by 2020), PEPFAR is pivoting the scale-up of resources and services towards health service delivery sites with moderate and high yield of patients, communities that link patients to those sites, and geographic areas with a high burden of HIV. Meeting the demand in those settings requires an adequate supply and appropriate skill mix of HRH available to provide quality HIV services along the continuum of care.

Between 2009 and 2014, PEPFAR strengthened countries’ health systems to address HRH barriers to service delivery broadly and specifically HIV services. The PEPFAR 3.0 pivot, which was implemented to reach 90-90-90 and achieve epidemic control despite budget constraints, narrowed the focus of PEPFAR-funded activities to geographic regions and sites with the highest burden. The RRHS supports this shift.

This notice is specific to activities in South Sudan and refugee camps outside South Sudan (e.g., northern Uganda where almost 850,000 South Sudanese reside).

By 2022, the RRHS will contribute to achieving progress towards the following objectives in South Sudan:

1) Improved health outcomes, with a targeted focus on decreasing maternal and child mortality, decreasing new HIV infections, and improving HIV-related health outcomes;
2) Improved use of HRH information in decision-making;
3) Improved coordination and monitoring of HRH functions; and
4) Improved HRH workforce performance and management.

HRSA, in collaboration with partner country governments and other U.S. Government (USG) agencies and donors, conducted an engagement with stakeholders in South Sudan. The engagement identified opportunities and gaps in HRH programming and facilitated high-level coordination and priority mapping to harmonize and provide a platform for leveraging and maximizing HRH investments. Areas that have been prioritized for support at the time of this notice of funding opportunity (NOFO) release are described below. HRSA expects that the RRHS – South Sudan recipient will adapt to priorities determined by HRSA and the interagency USG field team as the program progresses.

The recipient must implement a two-pronged approach to address HRH challenges in South Sudan:

-Support in-country training of medical officers, nurses, and midwives through a rotating tutor program in South Sudan.

-Support training of displaced South Sudanese health care professors and students to provide care to displaced South Sudanese in refugee camps outside South Sudan (e.g., northern Uganda).

Inside South Sudan: Strengthen clinical service capacity of physicians, nurses, midwives, clinical officers, and community health workers (CHWs) in selected hospitals and clinics in South Sudan. HRSA expects that the recipient will bring in expert trainers for extended periods to provide in-service training to improve health services in South Sudan based on the HRH needs. For continuity and sustainability, the recipient will be encouraged to collaborate with the South Sudanese College of Physicians and Surgeons, the South Sudanese School of Nursing and Midwifery, the Ministry of Health, and USG agencies in South Sudan.

Outside South Sudan: Strengthen clinical service capacity of physicians, nurses, midwives, clinical officers, and CHWs who are displaced in refugee camps outside South Sudan (e.g., northern Uganda) to provide better health services to the South Sudanese refugees. HRSA expects the recipient to work closely with established South Sudanese health care professors and students who are currently located in northern Uganda and are actively engaged in pre-service training. By working with displaced South Sudanese health care workers, rapid deployment of health care workers can occur to provide health services for those who are displaced as well as for nationals upon their return to South Sudan.

The RRHS will work with South Sudan stakeholders to collectively prioritize and develop sustainable and country-led solutions to address national priorities that include the following:

Priority 1: Build a skilled fit-for-purpose-and-practice health workforce that increases the quantity and quality of health services for the people of South Sudan.

HRH has a pivotal role in the accessibility of health services and the overall population health of any country. The ability of a country to meet its health goals depends largely on the knowledge, skills, motivation, and deployment of the people responsible for organizing and delivering health services. HRH and the challenge of the shortage of skilled health workers are significant issues in fragile states as many experience major losses in personnel and have substantial difficulties in retaining staff in rural areas. Similar to many other low-income countries, the questions in these countries also include how to recruit, train, and retain staff, and how to optimize the competence and capacity of the health workforce. There are also questions on how to ensure payment of salaries, ensuring trust and enhancing motivation, and accelerating training of health staff within an uncertain context of security and stability.

Recruiting, training, and supporting health workers to provide services at all levels are vital to a state’s recovery, as well as fundamental to its ability to respond to ongoing health challenges like HIV/AIDS, TB, malaria, and other communicable and non- communicable diseases. The primary care level should be a priority in this process. There is a need for rapid capacity building in key areas such as planning and management, clinical skills, and education in order to manage, operate, oversee, or finance programs. The RRHS aims to ensure an adequate supply and appropriate skill mix of HRH available to provide quality care for HIV/AIDS, TB, malaria and other communicable and non-communicable diseases.

Priority 2: Improve the quality and use of HRH information in decision-making.

The foundation of decision-making across health system building blocks is sound and reliable health information. Appropriate government stewardship of health information collection is central for the health system to operate with up-to-date information on current health status, epidemics, locations of health facilities, health workforce distribution and quantity, and other important indicators.

Accurate and timely health workforce data are crucial for HRH planning, training, improving regulation of practice, and tracking health worker licensure. The need for comprehensive, reliable, and timely information, including numbers, demographics, skills, services delivered, and factors influencing recruitment and retention, has become even more urgent in view of the international effort to scale-up education and training of health workers, particularly in countries with critical shortages of highly skilled health professionals. On national and global levels, better HRH data and evidence are needed as critical enablers for enhanced planning, policymaking, governance, and accountability. The “evidence-to-policy” feedback loop is an essential feature of resilient health systems, defined as those with the capacity to learn from experience and adapt accordingly to changing needs. Forecasting of workforce priorities and needs, informed by reliable and updated health workforce data, will enable the development, implementation, monitoring, impact assessment, and continuous updating of workforce strategies.

The RRHS aims to strengthen the human resource management systems and the quality and use of information to improve recruitment, deployment and retention of health workers providing HIV/AIDS and other clinical care.

Priority 3: Enhance community-based care and its ability to respond to current and future health needs.

In fragile states where health professionals are particularly scarce, the need to harness community resources and collaborate with communities in meaningful ways will be an important first step towards re-engagement with the state and a return to an effective civil society.

CHWs, for example, are vital in reducing child and maternal mortality and morbidity, addressing malnutrition, and providing HIV/AIDS treatment and prevention services. CHWs promote health and wellbeing, bridge health system gaps, improve the quality of life, and play an integral role to prevent and end epidemics like HIV/AIDS and Ebola. Despite overwhelming evidence of the indispensable and increasing contribution of the role of CHWs in public health and epidemic control, there are still challenges with the lack of formal policy or legal framework to support their function and officially integrate the CHW cadre into the mainstream health system. There is need for facilitating support and linkages between service facilities and the CHWs. This is a critical factor for PEPFAR as more efficient service delivery models are being explored to achieve sustained epidemic control.

Priority 4: Strengthen country capacity to plan, implement, manage, and monitor the health system through policy, regulation, and leadership development.

At the center of many poorly functioning health systems is ineffective governance of the health sector. Fragile countries are among the most difficult environments in which to coordinate and deliver aid. Governance systems can be weak, institutional capacity low, and absorptive capacity limited. A weaker governance structure that fails to pay its health workers faces migration of the workforce out of the country, while poor working conditions may have the same effect.

Ministries of Health (MOHs) in many fragile states have limited capacities to assume a proper stewardship role, develop and implement policies, design and enforce regulation, and provide leadership to develop the health system. Good intentions to strengthen governance and the health system may be challenged by limited availability of human resources, competing priorities, and coordinating between many stakeholders, including multiple donors.

Developing management capacity and building multi-stakeholder coalitions are critical to building capacity in fragile states. Fragile states often lack the management capacities that allow for developing budgets, tracking expenditures, assessing workloads, managing human resources, and carrying out disease surveillance. For sustained HIV epidemic control, a well-coordinated, transparent governance process is essential. Moreover, analyzing the political and economic dynamics in the country can assist in shaping effective strategies for leadership and management development as well as institutional strengthening.

Priority 5: Promote an enabling fiscal environment for health workforce development.

HRH commands the largest single cost element for health in developing countries, often representing over half of ministries’ recurrent health expenditures. However, HRH is often the least strategically planned and managed resource, and many countries are challenged to find the resources and the necessary methods to sustain an adequate supply and mix of health workers. Accountability systems are needed to improve the effectiveness and efficiency of health and HRH spending. In addition to measures such as excising ghost workers from the public sector payroll, it will be critical to adopt appropriate and cost-effective approaches to ensure the provision of effective, responsive, and quality care, especially for HIV/AIDS.

Significant barriers constrain efforts by governments and donors to increase HRH spending. To overcome these barriers and optimize health worker performance, there must be greater attention from country policy-makers and international partners to the economic factors that influence health workers.

GrantWatch ID#:

GrantWatch ID#: 173196

Estimated Total Program Funding:


Number of Grants:

HRSA expects to annually fund one (1) recipient.

Estimated Size of Grant:

You may apply for a ceiling amount of up to $2,000,000 total cost (includes both direct and indirect/facilities and administrative costs) per year.

Term of Contract:

The project period is June 1, 2018 through May 31, 2022 (4 years).

Funding beyond the first year is dependent on the availability of appropriated funds for the RRHS in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.


  • City or township governments
  • County governments
  • Independent school districts
  • Native American tribal organizations (other than Federally funded tribal governments)
  • Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education
  • See RFP and/or Grant Guidelines for full eligibility
  • Special district governments
  • State governments

Additional Eligibility Criteria:

Eligible applicants include domestic and foreign public and private nonprofit entities, including institutions of higher education, for-profit entities, faith-based and community-based organizations, tribes, and tribal organizations.

Due to the challenging working environment and ongoing political conflicts, in order to apply you must have at least three years of experience in successfully implementing health programs in South Sudan.

The applicant institution must meet the eligibility requirements and assumes all legal, programmatic, and financial responsibilities under the award.

Consortium Requirements:

Applicants are required to apply as a consortium that at minimum includes two impact partner entities from South Sudan. HRSA strongly encourages lead applicants from United States domestic organizations to include African institutions with the relevant expertise as consortium partners, with the long-term goal of strengthening networks within Africa. African applicants may include collaboration with institutions in the United States, other high-income countries (HICs), or other low and middle income countries’ (LMIC) institutions with particular expertise in the proposed priority areas as consortium partners.

The applicant must meet the eligibility requirements and assumes all legal, programmatic, and financial responsibilities under the award. All consortium members must provide a significant contribution to the project; and they each must have an identifiable role, specific responsibilities, and a justifiable reason for being a consortium member. You should carefully consider the selection of partners to ensure that the consortium positively contributes to the success and sustainability of project goals. Appropriate institutional commitment to the proposed project may include the provision of adequate staff, facilities, and educational resources. The successful recipient must enter into a formal written agreement with each consortium participant that addresses the negotiated arrangements for meeting the programmatic, administrative, financial (if applicable), and reporting requirements of the award, including those necessary to ensure compliance with all applicable federal regulations and policies and facilitate an efficient collaborative venture.

All entities directly or indirectly receiving funds through this NOFO must be able to demonstrate past performance with managing USG global health grants and/or cooperative agreements, and must collectively have at minimum five active global health grants, cooperative agreements, subawards or contracts from the USG (e.g., Department of Defense (DOD); Department of Health and Human Services (HHS) Centers for Disease Control and Prevention (CDC), HRSA, and/or National Institutes of Health (NIH); United States Agency for International Development (USAID)) or non- USG funders (e.g., Wellcome Trust, Doris Duke, Bill and Melinda Gates Foundation) involving low and middle income countries. These global health awards must be active on the application due date for this NOFO. Applications must also include up to three (3) references describing successful administration of funds from international donors.

Funds may not be used for the following purposes:
1) Research
2) Construction
3) To promote or advocate the legalization or practice of prostitution or sex trafficking
4) Travel, per diem, hotel expenses, meals, conference fees or other conference costs for any member of a foreign government’s delegation to an international conference sponsored by a multilateral organization, as defined below, unless approved by HRSA in writing
5) To perform or actively promote abortion as a method of family planning in foreign countries or provide financial support to any other foreign non-governmental organization that conducts such activities. In accordance with the United States Protecting Life in Global Health Assistance policy, all non-governmental organization (NGO) applicants acknowledge that foreign NGOs that receive funds provided through this award, either as a prime recipient or subrecipient, are strictly prohibited, regardless of the source of funds, from performing abortions as a method of family planning or engaging in any activity that promotes abortion as a method of family planning, or to provide financial support to any other foreign non-governmental organization that conducts such activities.

Pre-proposal Conference:

HRSA held a technical assistance webinar on November 16, 2017 to help applicants understand, prepare, and submit an application.

HRSA has made the webinar available on the TARGET Center website at:

Pre-Application Information:

Ensure your and registrations and passwords are current immediately. Deadline extensions are not granted for lack of registration. Registration in all systems, including and, may take up to one month to complete.

HRSA requires you to apply electronically through

The due date for applications under this NOFO is January 2, 2018 at 11:59 PM Eastern Time.

View this opportunity on

Contact Information:

Before starting your grant application, please review the funding source's website listed below for updates/changes/addendums/conferences/LOIs.

You may request additional information regarding business, administrative, or fiscal issues related to this NOFO by contacting:

Olusola Dada, Grants Management Specialist
Division of Grants Management Operations
OFAM Health Resources and Services Administration
5600 Fishers Lane
Rockville, MD 20857
Telephone: (301) 443-0195
Fax: (301) 443-9810

You may request additional information regarding the overall program issues and/or technical assistance related to this NOFO by contacting:

Naomi Van Dinter, Project Officer
Office of HIV/AIDS Training and Capacity Development
Division of Global Program
Health Resources and Services Administration
Telephone: (301) 443-0802
Fax: (301) 443-2697

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International country outside of the USA, Israel and Canada.