Opportunity Information: Apply for RFI 687 17 002
Accessible Continuum of Care and Essential Services Sustained (ACCESS) is a USAID health funding opportunity in Madagascar designed to strengthen the public health system by building practical, day-to-day capacity within the Ministry of Public Health (MOPH), especially at the district level and below. The core idea is to help local health actors plan and run health services more effectively in their own catchment areas, not just deliver services in the moment. ACCESS is framed around improving how health programs are designed, managed, delivered, monitored, and evaluated across all districts within the project s implementation regions, with the expectation that stronger local systems will translate into more reliable, higher quality care for communities.
A major emphasis is district-level systems strengthening. ACCESS aims to equip MOPH staff and front-line health teams with the skills and structures needed to manage routine health services and programs, including the ability to track performance and adjust based on evidence. Alongside district support, the activity also includes targeted engagement with regional health authorities. That regional work is described as more limited in scope, but important for coordination and planning, so districts are not operating in isolation and so health activities are managed consistently and effectively across administrative levels.
At the national level, ACCESS is intended to feed into broader health sector improvements by informing policy and guideline development and supporting advocacy around key service delivery issues. In practice, that means lessons learned and implementation experience from districts can be used to improve national standards, protocols, and decision-making, helping align what happens in facilities and communities with national priorities and evidence-based approaches.
Clinically, ACCESS focuses on strengthening primary health care. It aims to improve both clinical skills and health governance skills among primary health care providers so they can deliver accessible, high-quality preventive and curative services. The inclusion of governance skills signals that the activity is not limited to clinical training; it also targets how facilities and local health offices are led and managed, such as planning, supervision, quality improvement, accountability, and use of data for decisions.
ACCESS also seeks to extend the reach of the formal health system through community health volunteers. The activity plans to improve volunteers skills and motivation to deliver quality services, while also reinforcing supervision links to their respective CSB (Centre de Sante de Base, or basic health center). This supervision component is crucial because it ties community-level service delivery to the formal system, supporting consistency, referral pathways, and quality oversight rather than leaving volunteers to work independently.
Behavior change is another central pillar. ACCESS is expected to promote positive health behaviors, including improved care-seeking, through a comprehensive and contextualized social and behavior change (SBC) approach. This suggests programming that is tailored to local realities, beliefs, and barriers, rather than generic messaging. Just as importantly, the activity aims to build the capacity of MOPH and local institutions to design, implement, monitor, and evaluate SBC interventions, which positions SBC as a sustained capability within local systems rather than a one-off campaign.
From a funding and administrative standpoint, the opportunity was issued by USAID Madagascar (USAID Antananarivo) as a discretionary Cooperative Agreement in the health sector (CFDA 98.001). Eligibility was listed as unrestricted, indicating that a broad range of applicants could compete. The opportunity carried an award ceiling of 85,000,000, with an original closing date of October 2, 2017, and a creation date of September 18, 2017. Overall, ACCESS is best understood as a large-scale health systems strengthening effort that combines service quality improvements, workforce and volunteer capacity building, multi-level governance and coordination, and community-facing behavior change to improve access and continuity of essential health services in Madagascar.Apply for RFI 687 17 002
- The Madagascar USAID-Antananarivo in the health sector is offering a public funding opportunity titled "Accessible Continuum of Care and Essential Services Sustained (ACCESS)" and is now available to receive applicants.
- Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 98.001.
- This funding opportunity was created on 2017-09-18.
- Applicants must submit their applications by 2017-10-02. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
- Each selected applicant is eligible to receive up to $85,000,000.00 in funding.
- Eligible applicants include: Unrestricted.
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ACCESS (USAID Madagascar) Grant Opportunity FAQs
1) What is the ACCESS opportunity?
Accessible Continuum of Care and Essential Services Sustained (ACCESS) is a USAID health funding opportunity in Madagascar focused on strengthening the public health system by building practical, day-to-day capacity within the Ministry of Public Health (MOPH), especially at the district level and below.
2) What is the main goal of ACCESS?
The core goal is to help local health actors plan and run health services more effectively in their own catchment areas, not only deliver services at a single point in time. ACCESS is framed around improving how health programs are designed, managed, delivered, monitored, and evaluated so communities receive more reliable, higher quality care.
3) Which level of the health system is most emphasized?
District-level systems strengthening is a major emphasis. ACCESS aims to equip MOPH staff and front-line health teams with skills and structures to manage routine health services and programs, track performance, and make evidence-based adjustments.
4) Does ACCESS include support beyond the district level?
Yes. In addition to district support, ACCESS includes targeted engagement with regional health authorities. The regional work is described as more limited in scope, but important for coordination and planning so districts are not operating in isolation and activities are managed consistently across administrative levels.
5) How does ACCESS connect to national-level health improvements?
At the national level, ACCESS is intended to inform broader health sector improvements by feeding lessons learned from district implementation into policy and guideline development, and by supporting advocacy around key service delivery issues. This is meant to help align local implementation with national priorities and evidence-based approaches.
6) What clinical area does ACCESS focus on?
ACCESS focuses on strengthening primary health care, aiming to improve the ability of providers to deliver accessible, high-quality preventive and curative services.
7) Is ACCESS only about clinical training?
No. ACCESS includes both clinical skills and health governance skills for primary health care providers. Governance skills described in the opportunity include areas like planning, supervision, quality improvement, accountability, and using data for decision-making.
8) How does ACCESS involve community health volunteers?
ACCESS seeks to extend the reach of the formal health system through community health volunteers by improving volunteers' skills and motivation to deliver quality services.
9) What role do CSBs (Centre de Sante de Base) play in the community component?
The opportunity highlights strengthening supervision links between community health volunteers and their respective CSB (basic health center). This is positioned as important for maintaining consistency, supporting referral pathways, and ensuring quality oversight, rather than having volunteers work independently.
10) What is the behavior change component of ACCESS?
Behavior change is described as a central pillar. ACCESS is expected to promote positive health behaviors, including improved care-seeking, through a comprehensive and contextualized social and behavior change (SBC) approach tailored to local realities, beliefs, and barriers.
11) Does ACCESS aim to build long-term SBC capacity?
Yes. ACCESS aims to build the capacity of MOPH and local institutions to design, implement, monitor, and evaluate SBC interventions, positioning SBC as a sustained capability within local systems rather than a one-off campaign.
12) Who issued the funding opportunity?
The opportunity was issued by USAID Madagascar (USAID Antananarivo).
13) What type of award mechanism is described?
The opportunity is described as a discretionary Cooperative Agreement.
14) What sector does this opportunity fall under?
It is a health sector funding opportunity.
15) What CFDA number is associated with this opportunity?
The CFDA number listed is 98.001.
16) Who was eligible to apply?
Eligibility was listed as unrestricted, meaning a broad range of applicants could compete.
17) What was the award ceiling?
The opportunity carried an award ceiling of 85,000,000.
18) What were the key dates for this opportunity?
The creation date was September 18, 2017, and the original closing date was October 2, 2017.
19) What kinds of improvements is ACCESS ultimately trying to achieve for communities?
ACCESS is designed to strengthen local systems so health services are planned and managed more effectively, performance is monitored and improved over time, and primary health care is delivered more reliably and with higher quality across the project implementation regions.
20) What is a simple way to summarize ACCESS?
ACCESS is best understood as a large-scale health systems strengthening effort in Madagascar that combines service quality improvements, workforce and volunteer capacity building, multi-level governance and coordination, and community-facing social and behavior change to improve access and continuity of essential health services.
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