US Peace Corps Of?ce of Acquisitions and Contract Management JUSTIFICATION FOR EXCEPTION TO COMPETITION (JEC) TO: Linda Brainard, Chief Acquisition Of?cer, FROM: Marie McLeod, Director, OGHH SUBJECT: JUSTIFICATION FOR EXCEPTION TO COMPETITION (JEC) EXTENSION OF EXISTING ASSISTANCE PROGRAM REQUIREMENT (PC-12-5-001) 1. This document sets forth facts and rationale justifying the use of an exception to chpetition and was prepared by the Peace Corps Of?ce of Global Health and HIV (OGHH). 2. The nature and/or description of the action being approved. The purpose of this justi?cation is to request approval for a four-year extension to Cooperative Agreement in the amount of $6,420,000. Under this action, the Peace Corps will continue its Global Health Service Partnership with Seed Global Health (formerly ?Global Health Service Corps?) from September 10, 2015 through September 30, 2019. 3. Description of the assistance program or assistance activity under the proposed action including an estimated dollar value and period of performance. The Global Health Service Partnership (GHSP) was created as a result of an unsolicited proposal to the Peace Corps Director from Seed Global Health (then Global Health Service Corps) to form a medical academic corps of nurses and physicians to help increase the capacity of nursing and medical schools in countries with critical shortages of healthcare providers. Peace Corps accepted the proposal to partner with Seed Global Health (Seed) for the GHSP program and requested funding from the State Department?s Office of the Global AIDS Coordinator (OGAC) to implement activities in the U.S. President?s Emergency Plan for AIDS Relief (PEPFAR) Human Resources for Health (HRH) strategy area. Peace Corps was awarded funds by OGAC to implement the program in three initial countries (Malawi, Tanzania, and Uganda) in partnership with Seed. A cooperative agreement was awarded to Seed in September 2012 as a three year partnership. The cooperative agreement provides technical support for all aspects of GHSP, including recruitment and evaluation of applicants, site development, monitoring and evaluation of the program, and clinical technical support for volunteers during service. Under this cooperative agreement, both Seed and Peace Corps provide funding to execute the program. The total estimated budget at award for the three year agreement was for which Peace Corps contributed (See Attachment 1). Modi?cation 002 to provided an additional $859,808 in Peace Corps funding based on an initial underestimation of the costs for implementing the activities outlined in the cooperative agreement. Most notably, the workload for the chief medical and nursing of?cers needed to be shared with a deputy of?cer assigned to each position due to the time requirements of applicant screening and interviewing, attendance of domestic recruitment events and professional conferences, site development, and technical support in all three GHSP countries. There was also an underestimation in the amount of overseas travel required to provide the comprehensive volunteer technical support needed to ensure the success of the program. US Peace Corps Office of Acquisitions and Contract Management GHSP has been a successful program in that it is realizing its objectives of increasing capacity and improving the quality of medical and nursing education in the host institutions at which GHSP physicians and nurses are working as faculty members. Thirty-one Volunteers served in 11 institutions during the 2013-14 academic year and 42 Volunteers served at 13 institutions during the 2014-15 academic year. These Volunteers have educated over 3,000 nursing and medical students and other healthcare trainees have spent more than 10,000 hours providing clinical training during each of the 2013-14 and 2014?15 academic years. In addition to furthering Peace Corps? mission ful?llment in all three of its goal areas, the GHSP project contributes to the Human Resources for Health strategy of PEPFAR. Due to the program?s success and impact, the r'3'eace Corps intends to extend this partnership for an additional four years. PEPFAR funds have bee approved for FY16 FY19. This request ensures the continuation of this assistance program in the three current GHSP countries as well as expansion of the program into two additional countries. The estimated increase in cost of the cooperative agreement for the next four years is $21,338,397 from $6,369,366 to approximately $27,707,763. Of this $21,338,397 increase in cost, Seed will contribute $14,916,057 and Peace Corps will contribute up to $6,420,000. As such, Peace Corps estimated costs under PC-12-5-001 increase by $6,420,000, from $2,859,808 to approximately $9,279,808. 4. A description of the market research conducted and the results or the reason market research was not conducted. In its market research efforts, the Peace Corps has been unable to identify any potential partners which satisfy the needs of the GHSP program. Sipeci?cally, no vendors have been located with the (1) expert se in supporting all phases of the lifecycle of the GHSP Volunteer from recruitment to post?service engagement for reintegration into the U.S. workforce, and (2) willingness to contribute the signi?cant ?nancial resources that are essential for the program to attract quali?ed Volunteers each year. Similar programs exist in individual countries one program sends healthcare professionals to work as faculty in Rwanda to build up the healthcare provider capacity). However, these organizations? efforts do not Span over multiple countries. Additionally, their recruiting efforts are dependent on various institutions of higher education and the funding of volunteers dependent on foreign governments. This model does not have one organization providing the type of comprehensive support and ?nancial contribution that the GHSP requires for multi-cou ntry implementation. 5. Exception to competition. This extension is requested under the Peace Corps draft Manual Section 735 exception to competition X.b.6 ?Follow-on Awards and Extensions?. 6. The facts and rationale that justi?es the use of the restriction cited in Section 5. Seed is uniquely quali?ed to implement the Peace Corps medical academic corps program. The GHSP program is a unique and innovative idea that was brought to Peace Corps by the founders of Seed to strengthen health education and delivery in places facing dire shortages of health professionals. As the creators and subject matter experts dedicated to this program, Seed contributes a clinical team of nurses and physicians with decades of experience supporting clinical and educational efforts in developing countries. The organization also brings over three years of experience working with Peace Corps and an in-depth understanding of the Peace Corps? systems and regulations. US Peace Corps Of?ce of Acquisitions and Contract Management The work of the partnership has been very successful as demonstrated by continued funding of the Program and the GHSP achieved objectives of increasing the capacity of medical and nursing educators and improving the quality of clinical education. Seed offers the Agency an innovative approach to recruitment and retention of physician and nurse educators with experience in resource limited settings. Before implementing the GHSP Program, Peace Corps had occasional programs in which nurses and physicians could use their clinical skills to build local capacity, but never on a large scale effort that spanned multiple countries. Seed?s innovative program provides need-based debt repayment stipends of up to $30,000 per year to help clinicians offset ?nancial barriers to service, including significant student debt payments. These stipends, which are a contribution of Seed under the agrement, are supported through the organization?s private flidraising efforts. The debt repayment sti end is critical to the success to the GHSP program in that it akes the opportunities within Peace Corps? support-for-service model an attractive option for physicians and advanced degreed nurses. Peace Corps is not in a position to provide student loan repayment to its volunteers. As such, Seed?s financial commitment to the debt repayment stipend provides the Agency with clinicians that the Peace Corps may not otherwise be in a position to recruit. Seed continuing to support and manage this program is essential to its success as the organization is involved in all aspects of the volunteer lifecycle, from recruitment to returned volunteer activities. As such, if a cooperative agreement were to be awarded to a new partner, applicants that were recruited and vetted by Seed may be unable to be placed in the ?eld. As a result, the Peace Corps would be required to stand up another recruitment process, training, and program administration with the alternative organization, which would cause a 12-18 month delay in placing volunteers in country and a significant duplication of cost (estimated at 51-2 million). The Peace Corps would also be at risk of loss of the strong relationships with healthcare and education administrators and leaders in Sub-Saharan Africa that Seed has built through its experience abroad. Over the past three years, the Peace Corps has bene?tted from Seed?s previous and current work with other clinical education and capacity building programs in the GHSP countries. The relationships Seed has brought forth are essential to the Program in determining the best places to assign GHSP Volunteers and the types of skills that are needed in the partner countries. Rebuilding these relationships would be challenging and require signi?cant cost and time investments. If another entity took on Seed?s role, the Peace Corps may risk facing the withdrawal of some of its existing partner institutions. Peace Corps may also risk recruiting advantage with a new partner as Seed has leveraged the program?s alumni network recruiting assistance, which is critical for growth of the program. Recruiting doctors and nurses to volunteer for the program is a challenging task because there is a signi?cant opportunity cost; participants who volunteer give up the potential of earning sizable salaries during the time they participate in the program. Both medicine and nursing professionals are high demand, well paid career ?elds. In order to be successful at attracting quality volunteers, the partnership has built and leveraged networks with educational institutions and, over time, with the alumni of the program. Bringing a new organization to ful?ll Seed?s roles would represent a signi?cant step back and would require duplication of cost and time in rebuilding those networks that are considered key to program recruitment. If another entity were to be awarded the cooperative agreement, the GHSP Program would regress in the great learning that has occurred over the last three yea rs in terms of site selection, leveraging local support, and building relationships with institutions both domestically and abroad. The GHSP Program is concluding its third year and Peace Corps staff and posts are still working through the issues of fully integrating it into post operations. Once volunteers are recruited, a complex support system is required 3 US Peace Corps Of?ce of Acquisitions and Contract Management in order to safely and effectively place volunteers to serve. The current stage of the partnership allows the Peace Corps to leverage that knowledge and support to better meet the program objectives. As Peace Corps plans to expand this program in two additional countries, it is essential that there be continuity and understanding of the post environment and Peace Corps culture. Seed, unlike any other potential paterner, will be able to utilize its lessons learned and gain efficiencies in the program?s expansion efforts from its experience in implementing the program within the three established countries. Starting with a new partner and adjusting to transition issues would expose the two new country programs to risk of signi?cant duplication of cost, time delays, and/or program failure. In addition, a transition would put the Peace Corps evaluation of the established country programs at risk. Continuation of the rogram at Peace Corps will be dependent on an evaluation fthe GHSP after it has been in operation several years. Based on market research conducted and potential risks to programmatic accomplishments thus far, Peace Corps does not foresee potential bene?ts of bringing in a new partner that would offset the transitional costs or would justify the negative impact to the program?s mission. As a result of the information herein, it is the Peace Corps determination that it is in the Government?s best interest, cost and mission objectives considered, to extend the current agreement with Seed. US Peace Corps Office of Acquisitions and Contract Management CERTIFICATIONS: I certify that the facts and representations under my cognizance that are included in this justi?cation and that form a basis for this justification are complete and accurate. Agreement Officer?s Representative (AOR): d?b?u?i %1ch1?4 59/1 Laura Forador?i Date 8%9/5/ Ma rie?McLeod Date CLEARANCE: Agreement O?'icer: \Maqo. 9/10 Vijaya?Mupih Chief of Procurement Policy: Office of General Counsel (OGC): Wmciocm? qualms Waliace Date APPROVAL: Vac/who 9/ 20/6 inda Bra nag Date Chief Acwition Officer: