The purpose of the Strengthening Provinces to Deliver Primary Care Health Services contract is to empower provincial authorities to optimize the delivery of health services and to improve the health status of Congolese within their province.   3

Statement of Objectives for Strengthening Provinces to Deliver Primary Care Health Services
Period of Performance: Anticipated five-year activity
Provinces: Lualaba, H. Lomami, H. Katanga, Kasai Oriental
Small Business Subcontracting: At least 10% of the contract amount to Small Business
Purpose
The purpose of the Strengthening Provinces to Deliver Primary Care Health Services contract is to empower
provincial authorities to optimize the delivery of health services and to improve the health status of Congolese
within their province. Health services include family planning, maternal, newborn and child health, malaria,
tuberculosis, and support to build a strong and resilient public health system that can prevent, detect, and
respond to emerging infectious disease threats with a one health approach (Global Health Security-GHS) . .
The core philosophy of the activity is to empower provinces to self-manage their health programs and increase
provincial level decision-making.
The activity is an opportunity for USAID to do things differently. Through the contract, USAID leverages its
assistance as a tool to increase the province's commitments to financially improve health governance and
technically to improve health outcomes. The underlying principle is to build resilient provincial health systems,
catalyze provincial commitment and capacity to mobilize domestic resources, and strengthen governance and
accountability by engaging all actors (executive, legislative, private sector, civil society). Over time, as
provinces' capacities to mobilize and manage domestic resources increase, USAID's financial contribution will
decrease.
The activity will build provinces' public financial management capacity to assist in their transition from fixed
price sub-contracts, managed by the Contractor of this activity, to direct Government-to-Government (G2G)
agreements with USAID. The timing and feasibility of the provinces' transition to G2G will depend on the
results of USAID's Public Financial Management Risk Assessment Framework (PFMRAF) Stage 1 and 2 findings
and USAID/Washington's determination of DRC's G2G eligibility, as defined in ADS 220.
By the end of the contract, it is expected that the four provinces will be able to meet seventy percent of the
cost of their Plan Operationnel d'Action through domestic funding. This activity builds upon the successes and
lessons learned from the Memorandum of Understanding (MOU) approach in the provinces of Lualaba and
Haut Lomami which repositions provincial authorities at the center of governance, management, and
implementation of health programs. Presently, the MOU, a legal document signed by the Governors of these
two provinces, Bill and Melinda Gates Foundation (BFMG), Global Alliance for Vaccines (GAVI), and USAID,
seeks to empower Lualaba and H. Lomami to improve the delivery and financing of primary health care
services. The MOU provides a guiding framework for increasing provincial financial resources and improving
quality of all primary care health services. On a yearly basis, MOU signatories commit with the province's
authorities specific levels of funding for specific health services, based on Plan d'Action Annuel.

The Alliance for Vaccines (GAVI) and BMGF are in the process of consultations and development of primary
care services MOU in Haut Katanga and Kasai Oriental. It is expected that these MOUs will be signed before
December 2024. USAID/DRC will start sensitizing the Haut Katanga and Kasai Oriental authorities about
USAID's intentions to also sign the legal framework in these two provinces as soon as the MOUs have been
signed.
This activity will facilitate discussions for expanding funding of primary care health services within the existing
framework of the Memorandum of Understanding in Lualaba and Haut Lomami, Haut Katanga, and Kasai
Oriental. Expansion of services could include maternal, newborn, child health, family planning, nutrition,
malaria, tuberculosis, and global health security services, based on the annual Plan d'Action
Operationnel(PAO), and their capacity to mobilize resources and deliver equitable quality health services.