September 03, 2015 Vanessa Bradford Kerry, MD MSc Chief Executive Officer Seed Global Health 125 Nashua St., Ste 722 Boston, MA 02114 Subject: Extension to Peace Corps Cooperative Agreement No. PC-12-5-001 -Global Health Service Partnership Dear Dr. Kerry: In accordance with the authority contained in the Peace Corps Act, Seed Global Health Service (hereinafter referred to as the "Recipient" or "Seed") is hereby awarded this Extension to Cooperative Agreement to provide support as described in the Schedule of this Agreement and Attachment B, entitled "Program Description." This Agreement is effective as of September 10, 2015 and shall apply to commitments made by the Recipient in furtherance of program objectives during the period beginning with the effective date and ending September 30, 2019. This Agreement shall be incrementally funded and at this time is funded in the amount of $400,000.00 to support activities through December 31, 2015. The Peace Corps shall not be liable for reimbursing the Recipient for any costs in excess of the obligated amount. This Agreement is made to the Recipient on the condition that the funds will be administered in accordance with the terms and conditions as set forth in Attachment A, entitled "Schedule"; Attachment B, entitled "Program Description"; and Attachment C, entitled "Mandatory Standard Provisions." Please sign this letter to acknowledge your receipt of the Cooperative Agreement and return a signed copy to the Agreement Officer. Sincerely, Linda D. Brainard Agreement Officer and Chief Acquisition Officer Office of Acquisitions and Contract Management (OACM) Attachments: A. Schedule B. Program Description C. Mandatory Standard Provisions D. Annual indicators Acknowledged by: Name: Dr. Vanessa Bradford Kerry, MD MSc Title: Executive Director Organization: Seed Global Health (Seed) Signature: A Schedule SCHEDULE I. Purpose of Agreement The purpose of this Agreement is to provide support to Seed Global Health (Seed) for the program description in Attachment B to the Agreement entitled "Global Health Service Partnership (GHSP)." II. Authority Peace Corps awards this Cooperative Agreement under the authority of Section lO(a) of the Peace Corps Act (22 U.S.C. 2509). III. Period of Agreement The effective date of this Agreement extension is September 10, 2015. The estimated completion date of this Agreement is September 30, 2019. IV. Amount of Award and Payment A. The total estimated amount of this Award for the period shown in Section Ill above is $6,600,000.00. B. The Peace Corps hereby obligates the amount of $400,000.00 for the performance until December 31, 2015, in accordance with the Budget below in Section V. The Recipient will be given written notice by the Agreement Officer when additional funds will be added. Peace Corps is not obligated to reimburse the Recipient for the expenditure of amounts in excess of the total obligated amount. C. The Recipient will be paid in advance, provided that Seed maintains or demonstrates the willingness to maintain: 1) Written procedures that minimize the time elapsing between the transfer of funds and disbursement by the Recipient. 2) Financial management systems that meet the standards for fund control and accountability as established in 2 CFR Section 215.21. Advance payments to the Recipient shall be limited to the minimum amounts needed and be timed to be in accordance with the actual, immediate cash requirements of the Recipient in carrying out the purpose of the approved program or project. The Recipient shall be authorized to submit monthly requests for advance payments by completing SF270, "Request for Advance or Reimbursement" when electronic fund transfers are not used. Advance payments are subject to 31 CFR part 205. Treasury check advance payments shall be sent to the following address: Seed Global Health, 125 Nashua St, Suite 722, Boston, MA, 02114. D. Additional funds up to the total amount of the Cooperative Agreement shown in IV above may be obligated by Peace Corps subject to the availability of funds, satisfactory progress of the project (related to reporting noted in section IX and targets noted in Attachment D), and continued relevance to the Peace Corps programs. E. Yearly budget amounts are approved by the Office of the Global AIDS Coordinator (OGAC) at the State Department, and approval of said funding is based on adherence to PEPFAR’s goals and objectives, and achievement of results toward established targets. In addition, GHSP may be subject to SIMS (Site Improvement Monitoring System) visits and quarterly data reviews at the POART (PEPFAR Oversight Accountability Response Team) calls, among other monitoring processes deemed necessary by OGAC. V. Budget The following is the Agreement Budget. Revisions to this budget shall be made in accordance with 2 CFR 215.25. CLIN 004 CLIN 005 CLIN 006 CLIN 007 Project Year 4 - $1,590,000.00 Project Year 5 - $1,760,000.00 Project Year 6 - $1,880,000.00 Project Year 7 - $1,370,000.00 Total estimated amount: VI. $6,600,000.00 Authorized Representatives The Agreement Officer (AO) has legal responsibility for this Agreement. Therefore, only the AO can take action on behalf of Peace Corps to enter into, change, or terminate this Agreement. The Agreement Officer’s Representative (AOR) is the person, as designated in writing by the AO, who will assist in technical monitoring and administer certain aspects of this Agreement. This authority is not re-delegable other than as specified in the AO’s designation letter. The AOR will a) maintain communication including liaison with the Recipient, b) review and analyze reports, c) ensure compliance with the terms and conditions of the award and d) perform other duties as delegated by the AO. The AOR for this Agreement is Laura Foradori, Global Health Service Partnership Program Manager, 1111 20th Street NW, Washington, D.C. 20526. 1 VII. Office of Management and Budget (OMB) Circulars The provisions of OMB Circular A-110, “Uniform Administrative Requirements for Grants and Other Agreements” and OMB Circular A-122, “Cost Principles for Non-Profit Organizations” herein to this Agreement are applicable to Seed. Copies of these circulars can be located on the following website: http://www.whitehouse.gov/omb/circulars_index-education VIII. Substantial Involvement Understandings On behalf of the Peace Corps, the AOR will substantially be involved in the administration of this Agreement to help the Recipient achieve the agreement objectives. The AO may delegate the approvals listed below to the AOR, except for authority to change the program description and the approved budget. Substantial involvement under this Agreement shall include: A. Approval of the Recipient's Annual Budgets - Significant changes by the Recipient to the approved budget will require approval from the AO. B. Approval of the Recipient's monitoring and evaluation plan - Significant changes by the Recipient to the approved plan will require approval from the AOR as delegated by the AO. C. Approval of Agency and Recipient Collaboration - When the recipient's successful accomplishment of program activities and objectives would benefit from Peace Corps' technical knowledge, the AO may authorize the collaboration or joint participation of Peace Corps and the Recipient on the program. IX. Reporting and Evaluation A. Financial Reporting - The Recipient shall submit financial reports (Standard Form 269) to the AOR with one copy to the AO on a quarterly basis as provided for in 2 CFR 215.52. The reports shall be submitted no later than 30 days following the end of each quarter. B. Program Reporting - Seed shall submit a Program Report in electronic format (using Microsoft Word or Adobe Acrobat PDF files) to the AOR with one copy to the AO. Program reports shall be submitted every quarter, starting in January 2016 (after the initial quarter of the extension) and ending no later than October 2019. Each report shall contain the table of data noted in Attachment D the Global Health Service Partnership Annual Indicators, as applicable for the quarter. The report shall also contain the following information with an accompanying narrative report summarizing accomplishments and challenges in the most recent quarter: 1) Site selection and expansion:     Completed evaluation of new sites and expansions in additional countries with consideration of areas of highest burden of disease, Peace Corps priorities and U.S. partner programs Number of new country sites and expansions within existing GHSP countries Annual evaluations of existing sites and development of REI objectives for the program and sustainability plans. Number of suspended country sites 2) Recruitment:     Number and type of Volunteer recruiting events/activities conducted (in person, via teleconference or other electronic means, via written communication, or in other ways), engagement metrics and analysis of recruitment activities Annual recruitment strategy planning session and as needed regrouping in conjunction with Peace Corps in an effort to target needed specialists and identify events/activities with highest yield. Annual completed recruitment strategy for upcoming recruitment cycle, and assessment of prior recruitment cycle in conjunction with Peace Corps to evaluate best practices and strategy for the next recruitment season. Number of press placements and social media campaigns produced and cross-promoted for the Global Health Service Partnership. 3) Application and Selection:       Number of Peace Corps-referred applications screened for professional and academic proficiency A minimum of 4-5 applicants per position Conversion rates of applications to invitees to volunteers Analysis of scores of selectees and the correlation with their success and challenges during service Timeliness of invitations and placements to allow REI sufficient time to complete the supplemental application and allow for additional invites for declined invitations Evaluation and review of reasons for withdrawals and non-selections for process improvement 4) Orientation and Training   Revised core orientation materials to ensure appropriate to targeted countries and settings and is up to date with current medical, nursing and other health professional knowledge Extent of assistance with identification and development of content for in-country training 5) Program Field Support:   Number and type of GHSP country team support activities conducted in person, via teleconference or other electronic means, via written communication, or in other ways (e.g. semi-annual conferences with volunteers and site development activities) Outcomes of site visits and site development activities 6) Data Collection (Monitoring and Evaluation)     Number of complete volunteer reporting forms received Number of sites where formalized, measurable outcome or impact data is being collected Number of volunteer project reports and success stories received Long Term Assessment o Impact of program on clinical practice on return o Career paths after the program 7) Volunteer Technical Support:   Number of currently serving GHSP Volunteers provided with individual support in person, via teleconference or other electronic means, via written communication, or in other ways Number of currently serving GHSP Volunteers provided with group support in person, via teleconference or other electronic means, via written communication, or in other ways 8) Volunteer Satisfaction and Retention:    Satisfaction of the volunteers with the program Satisfaction of the sites with performance of volunteers Retention rate of volunteers- How many volunteers completed their first years, and stayed on for further years? o By site o By profession o Time retained C. Annual Report - The Recipient shall submit a final report on project accomplishments and challenges not to exceed 10 (ten) pages not later than October 30 after the end of each project year. The final report shall include a summary of all quantitative program results, identifying where targets were met and plans for addressing areas where target were not met. The narrative should also include efforts undertaken and results achieved in assuring longterm sustainability of the partnership. D. Evaluation – Peace Corps will monitor the ongoing performance of Seed under this Cooperative Agreement through review of quarterly and annual reports, as well as direct experience during collaboration on partnership activities throughout the program. Feedback will be provided via electronic or telephone correspondence on the submitted reports within 3 weeks of receipt to address areas lacking information on activities or showing deficiencies. X. Retention and Access Requirement for Records The Peace Corps, the Inspector general, the Comptroller General of the United States, and any of their duly authorized representatives, shall have the right of timely and unrestricted access to any documents, papers or other record of Seed that are pertinent to the Agreement in order to make audits, examinations, excerpts, transcripts and copies of such documents. This right also includes timely and reasonable access to Seed's personnel for the purpose of interview and discussion related to such documents. The rights of access in this paragraph are further defined in OMB Circular A-110. XI. Use of Peace Corps' Name and Logo Except as otherwise authorized by the Peace Corps, Seed may only use the Peace Corps name and logo on materials to be developed under this Agreement. Prior review and written approval by Peace Corps of such use is required. XII. Closeout Procedures Seed shall submit, within 30 calendars days after the date of completion of the award, all financial, performance, and other reports as required by the terms and conditions of this Agreement. The Agreement Officer must approve extensions when requested. Any funds paid in excess of the amount to which is finally determined to be entitled under the terms and conditions of the award constitute a debt to the Federal Government. ATTACHMENT Program Description Background: Seed Global Health (Seed) is a federally registered 501(c)(3) corporation which invests in sustainable solutions to shortages of health professionals in resource-limited settings. These shortages limit the ability of developing countries to deliver even basic health care, let alone respond to unforeseen epidemics or increased incidence of non-communicable diseases. Limited availability of key cadres of health professionals also compromises health system strengthening and feeds a counter-productive cycle of scarcity of teachers in medical, nursing and other health science schools in many countries. To help address this need, Seed partners with the Peace Corps for a public-private collaboration focused on investment in sustained increases in local healthcare capacity and human capital development. Seed (formally known as Global Health Service Corps and Foundation for Global Health Service) was incorporated as a nonprofit organization in the Commonwealth of Massachusetts on August 22, 2011. Headquartered in Boston, Seed's mission is to improve health education and delivery in places facing a dire shortage of health professionals by working with in-country partners to meet their long term health care human resources and health system strengthening needs. Seed is committed to helping recruit the best-qualified candidates, including those who may have financial constraints to service, by raising and disbursing loan repayment and other appropriate stipends of support to individuals chosen for assignments abroad. Global Health Service Partnership: In 2012, Seed and the Peace Corps launched the Global Health Service Partnership (GHSP), a novel public-private partnership to build stronger health sectors in developing countries. The program capitalizes on the multiplier effect of medical and nursing educators deployed as Peace Corps Response Volunteers (GHSP PCRVs) who can contribute quickly to increase partner countries' clinical care capacity. The GHSP PCRVs will serve terms of at least one year as medical or nursing faculty in medical and/or nursing schools that serve the priority areas. The GHSP PCRVs also provide clinical care requisite to their clinical (as opposed to classroom) education roles. GHSP PCRVs are expected to integrate with and serve as faculty at their receiving educational institution (REI). Volunteers receive substantive and ongoing professional and technical support from Seed to enhance the quality and impact of their clinical and educational endeavors. In the launch year 2012-2013, the GHSP piloted the program by fielding 30 volunteers in groups of 8-11 doctors and nurses in training institutions in each of three partner countries chosen in collaboration with Peace Corps headquarters and overseas leadership. After careful review of multiple factors, including the capacity of individual Peace Corps overseas posts to support a new program, presence of complementary U.S. government and President’s Emergency Plan for AIDS Relief (PEPFAR) investments in human resources for health and other considerations, the program started in Tanzania, Malawi, and Uganda. The initial cohort of GHSP PCRVs included board eligible and board certified doctors in core specialties such as internal medicine, pediatrics, psychiatry, obstetrics and gynecology, family medicine and anesthesia. Nurse participants needed to have completed training and have a minimum of three years of both clinical and teaching experience. The original Cooperative Agreement noted an aggressive schedule for expansion of the program to other countries and additional disciplines, which was revised after the first year of the project due to unobtainable targets for the expansion in terms of numbers of GHSP PCRVs and new countries. The intention is now to scale up the program to two additional countries during the next three one year volunteer cycles, starting with at least one new country in 2016. The expansion to two additional countries, one PEPFAR country and one Ebola-affected country in West Africa, is at the request of the Office of the Global AIDS Coordinator (OGAC), the funder of GHSP. The ongoing activities identified in this Cooperative Agreement extension will be based on the continuation of funding for this program by OGAC. Seed's Value Contribution: The Peace Corps has a rich history of deploying Americans in service as volunteers, and while 23% currently work in the healthcare sector, until GHSP no current volunteer assignments existed for formal practice of medicine or delivery of clinical care. Seed partners with the Peace Corps to provide the needed medical and nursing technical expertise to help support the program. Drawing on its familiarity with medical and nursing education (and other health professions) as well as knowledge of clinical education in developing countries, Seed helps support the GHSP in activities such as site selection, applicant recruitment and screening, orientation and training, field support, and monitoring and evaluation. The GHSP, and Seed’s commitment and vital contributions to the program's success, are well aligned with the Peace Corps mission as well as the opportunities and evolving role it can play in its second half century. The Peace Corps mission describes helping interested countries meet their training needs, and promoting better bilateral understanding between the U.S. culture and population and those being served. GHSP addresses a request from partner governments and REIs for PCVs with specialized skill sets. GHSP – with significant recruitment, screening, training and site selection and enrichment provided by Seed – helps Peace Corps respond to this need in the highly regulated and complex field of health professional education. In addition to helping “interested countries in meeting their need for trained men and women” and promoting “a better understanding of Americans on the part of the peoples served,” GHSP is well aligned with heightened Peace Corps interest in strategic partnerships that support targeted interventions leading to lasting improvements in the health and developmental trajectories of host countries. Finally, the GHSP helps harness the growing interest among U.S. health professionals in contributing to improved global health by investing in medical and nursing education that strengthens human resources for health in partner countries. The GHSP contributes to the PEPFAR 3.0 ongoing strategy of investment in Human Resources for Health to meet the goal of ensuring adequate supply and quality of human resources for health to expand HIV/AIDS services. The GHSP sustainability focus of ongoing training of health professionals through the "multiplier effect" of health professional education, responds to expressed country demand, and provides a 21st century volunteer opportunity for Americans. Seed is committed to the success of the GHSP and the educational impact it yields. The matrix of indicators submitted for the extension of the Cooperative Agreement notes that GHSP PCRVs should reach between 1500-3000 preservice students per year. Seed’s staff includes trained physicians and nurses with strong backgrounds in education and capacity building, many of whom are sitting faculty at medical and nursing schools in the United States, published in the field, and experienced working in international and resource poor settings. Their support staff includes program managers, communications liaisons, and a monitoring and evaluation team. Their program managers and other team members are familiar with the challenges of working in resource-limited settings and the close collaboration with the Peace Corps required to successfully execute the program. To further support the GHSP's mission with greatest efficiency and to harness the experience of premier academic medical centers already working in capacity building in global health, Seed partners with academic medical centers to help carry out components of the programmatic work for medical, nursing and other health professional education. The Massachusetts General Hospital Center for Global Health (MGH Global Health) serves as their flagship partner. MGH Global Health’s mission is to leverage Mass General's 200 year legacy of innovation in medical care and education to improve health among the most vulnerable people in our global community. The hospital's dynamic leadership in health and now global health is an asset in fulfilling Seed's academic mission in medicine and nursing. MGH Global Health helps provide Continuing Medical and Nursing Education credit to the GHSP PCRVs for their time and electronic resources for their use. Additionally, MGH Global Health provides academic acknowledgement of the work of the GHSP PCRVs, awarding them Fellowships in Global Clinical Education at the year’s end. This acknowledgment is an important recognition of their work positioning the GHSP PCRVs for competitive jobs on return. Activities and Support: Seed will provide the needed medical and nursing technical expertise to help support the Peace Corps in the GHSP. With the exception of loan repayment, almost all activities will occur in collaboration with Peace Corps headquarters and country posts. Site Selection and Expansion Seed assists the Peace Corps in the site selection for GHSP PCRV placements. Site selection includes both country selection and expansion as well as in-country site selection. GHSP currently sends well-qualified Volunteers to 17 sites affiliated with 13 institutions in Tanzania, Malawi and Uganda. GHSP will expand to 2 new countries: one PEPFAR country and one Ebola-affected country in West Africa during this 4 year extension period (3 years of volunteer activity) per the approval of additional project funding by OGAC. This expansion will start with at least one new country entry for the 2016-17 academic year. Seed will work with the Peace Corps posts and Peace Corps Headquarters to prepare pre-assessment analyses, participate in site visits, and review of site applications for new country entries. They will also work with Peace Corps posts and headquarters to determine continuation, closure or expansion of placements. Seed possesses the experience and knowledge to help identify core components of a site that will allow the GHSP PCRVs to be able to carry out their jobs effectively, reinforces the essential role of appropriate site-based counterparts, and intervenes where necessary to ensure that Volunteer placements meet both local expectations and the overall GHSP goals of improving health professionals’ education. Seed will also help to review and guide the technical specifics of the individual position’s Terms of Reference (TOR) per Peace Corps’ model. Ongoing site development work with current REIs and decisions about continuation at a site will include evaluation of REI support (based on criteria in the volunteer support section of the GHSP application and experience of the GHSP PCRVs in terms of collegial support and ability to effectively build capacity) and commitment to developing a sustainability plan for HRH efforts. A specific plan for using GHSP PCRV inputs to achieve REI objectives for sustainability needs to be developed at the onset of working with an REI (or by the end of January 2016 for sites without a plan) and reviewed as needed throughout the tenure of working with the GHSP program. The GHSP growth plan was refined after an evaluation of expenses and effort after the first year of program activities when the initial group of GHSP PCRVs were being launched for their year of service. The following table outlines the plan for the next 3 volunteer cycles, starting with the 2016-17 academic year. This plan includes the anticipated number of volunteers, countries, and health professions with the understanding that these plans may be altered or expanded based on host country or REI capacity, abundance of highly qualified applicants, additional health professionals noted in the original Cooperative Agreement and funding requests to OGAC, as well as requests made to Peace Corps from OGAC or partner countries. Year 4: 2016-17 5: 2017-18 6: 2018-19 Number of GHSP PCRVs 57-63 69-72 76 Number of Countries 4-5 5 5 Health Professions MD, RN/Midwives MD, RN/Midwives MD, RN/Midwives Recruitment and Screening Seed works with the Peace Corps to target, amplify, or otherwise assist in the recruitment and screening of volunteers by providing expert guidance in events and activities to target nurse and physician specialists to meet the requests of REIs. Seed will help to refine the job postings and application questions for the highly specific needs of the GHSP PCRV placements. Seed will continue to leverage its contacts within American professional organizations, academic medical centers in medicine and nursing, and the growing GHSP Alumni network to publicize the program. Additionally, Seed will exhibit, present, and publish on the program to help disseminate information and results on GHSP. They will target global health venues, conferences and publications and will participate in online forums as well. Seed will continue to help to screen the GHSP PCRV applicants through contributing to initial screening through triaging of all applications and then verifying applicants' credentials, references, and skills to narrow the field of applicants to the best possible candidates for all available and proposed positions. Seed’s physicians and nurses will conduct in-depth interviews rooted in the known realities of the clinical and educational situations of the GHSP experiences with those applicants who pass initial screening. Selection of short-listed candidates for a general invitation to the program will be led by Seed in collaboration with Peace Corps, as well as the final placement decisions. Final decisions regarding entry into service will be made by Peace Corps based on medical, legal, and security clearances. Marketing and Communications As part of the recruitment efforts for the program, Seed will also promote the program through online media and other targeted marketing materials to aid in the dissemination and exposure of the program. For the purposes of a cohesive GHSP brand identity, Peace Corps will develop a style guide for GHSP communications collateral, which will be followed by both Peace Corps and Seed to ensure consistency across communications. In addition, Seed must comply with PEPFAR branding and communication guidance (http://www.pepfar.gov/reports/guidance/branding/index.htm) in all communications collateral. Peace Corps’ in-house design team will create all co-branded GHSP recruitment and promotional collateral materials with input from Seed and these design files will be shared between both Peace Corps and Seed and used as primary recruitment materials for all GHSP recruitment events. Peace Corps requests preview authority of Seed’s other promotional and communications materials that represent their work as part of the GHSP. Content developed for media spots, publications and presentations (abstracts, posters, etc.) about the GHSP or work of GHSP PCRVs needs to accurately represent the relationship with Peace Corps and PEPFAR as collaborating partners, as well as the identity of the GHSP PCRVs, both current and past. Involvement of the media and communications point of contact at Peace Corps is required for development of media and communications pieces representing the program. Orientation and Training GHSP PCRVs participate in the program for a standard term of service of one year. To prepare these individuals for their year of service, a detailed U.S.-based orientation occurs every year in July. Seed will continue to identify and prepare experts in the field to lead training on medical and nursing healthcare delivery in resource-limited settings, pedagogical methods used for education in partner countries and adaptive teaching skills, as well as primers on the local burdens of disease in each GHSP country. Seed will also continue to help organize skills training to re-orient GHSP PCRVs to critical medical procedures they may be called upon to perform while in service. The U.S.-based orientation will continue to be 1-2 weeks in duration and will be organized and executed in collaboration with Peace Corps, who leads the efforts on the logistical arrangements and Peace Corps specific presentations in areas such as culture and development. Orientation will also take place in the designated country of service and the Peace Corps country teams will lead the execution of these pre-service training events, which will include administrative procedures, safety and security training, cultural competency and language training, Peace Corps policies and core expectations, as well as an introduction to the health and education systems, PEPFAR teams, tours of hospitals and other relevant sites, planning time with counterparts, and other relevant sessions. Seed will provide technical support during the ISTs in the areas of clinical and educational needs identified by GHSP PCRVs during their initial months at their sites. They will also identify and support supplemental training opportunities during volunteer service, with a special focus on continuing professional education during “fallow” times (whether predicted or unexpected) at sites. Field Technical Support and Site Enrichment Starting with the baseline Peace Corps site assessment that determines whether a receiving educational institution (REI) can adequately support GHSP PCRVs, Seed complements the support provided by both Peace Corps and the REI to assist volunteers with their ongoing clinical education expectations and obligations. Seed will provide mentorship, supervision, and resources. Resources include electronic access to journals, up-to-date data, consumables or equipment, and other clinical or educational needs. Seed also will provide support in grant writing for targeted projects meant to yield sustained improvements in educational or clinical capacity. Seed provides volunteers with access to an experienced panel of clinicians and educators to assist with issues/challenges in the field. Seed’s clinical and program staff will continue to visit sites during the year to provide technical oversight and mentoring for clinical and educational needs, as well as collegial support; to solicit mid-program feedback, concerns and needs; to assist with collection of M&E data to demonstrate outcomes and impact; and to help foster exchange between the program and the REI. Additionally, Seed helps design and participates in the in-service trainings, which happen each autumn in the countries where the GHSP PCRVs are located. Seed will continue to expand clinical mentoring capacity to fully support the various nurse and physician specialties in the field through providing advice on clinical questions and challenges that arise. This team of clinicians in the U.S., including former GHSP PCRVs, and new Seed positions being implemented in each country, will work closely with the PC GHSP Program Managers in each country to ensure comprehensive, culturally appropriate and development-focused, and team-based support. Seed also will leverage partnerships to enhance educational offerings at certain sites. One previous example is the receipt of a grant to provide bedside ultrasound training to GHSP PCRVs and their counterparts to enhance clinical care and education in real time. Seed will inform PC posts and headquarters on a regular basis about significant donations of funds, materials, and supplies to REIs, as well as plans for GHSP PCRV engagement in secondary projects for awareness purposes and to allow feedback on these plans. Seed will consistently liaise with Peace Corps posts to give at least 1 month advance notice when planning for site visits whenever possible and utilize a simple site visit planning template to assist with logistical planning and statement of work/objectives. Ideally, a calendar of visits should be shared as early as possible during the new volunteer cycle, which would map out visits for the year. Seed will share summary findings and coordinate on action items coming out of site visits and work to develop a mutually agreeable format for capturing and reporting on the scope and scale of the site enrichment activities that help contribute to GHSP PCRV satisfaction and overall program success. Data Collection & Process Improvement These are activities (also referred to as M&E – monitoring and evaluation) for the GHSP program to understand outcomes and assess early impact, demonstrate the outputs and direct results of the program, and collect feedback for program improvements. Seed will continue to collect data during recruitment, selection and placement; orientation and trainings; service; and at the close of service. The current volunteer activity reporting tool and list of output data collected were created in collaboration with PC GHSP staff and will continue to be refined in collaboration with the PC GHSP team to ensure that essential output data for reporting and presentations is collected on an ongoing basis. GHSP PCRVs are asked to track and self-report on a monthly basis on their activities, hours, number of trainees and deliverables. Qualitative data has been formally and informally collected throughout the year with regular calls and correspondence. Seed has engaged in detailed semi-structured interviews and focus groups with GHSP PCRVs, institutional leadership, faculty, and students during the first 2 years of the program to collect qualitative information such as the program’s perceived benefits, strengths, and overall satisfaction with the experience and program offerings. This information was compiled into a report and shared with sites, Peace Corps, and other interested parties. For existing sites, ongoing yearly collection of similar qualitative feedback should be a secondary priority (and continuation of this activity must be decided in conjunction with Peace Corps) behind the collection of measureable outcome data to demonstrate improvements in breadth quality of medical and nursing education provided by GHSP PCRVs, as well as reporting requirements for OGAC. Seed has developed plans and received IRB approval for outcome data collection and impact assessment and this should be the highest priority for existing sites starting with the current academic cycle. Seed plans to implement pre-and post-testing of set skills and information. Additionally, Seed will put student and graduate tracking systems in place to understand the impact of GHSP on career trajectory and longer term outcomes. Seed will work closely with PC GHSP and M&E colleagues to develop strategies for data collection and respond to requests for reporting data made by OGAC and other partners or stakeholders. Loan Repayment There is domestic precedent for debt repayment to foster health service in underserved areas. Building on this domestic legacy, and recognizing the need for financial support for many professionals to engage in service, Seed will continue to provide debt repayment assistance to eligible individuals. The goal of this support is to encourage service by the best-qualified individuals, including those who may have financial constraints to service. Seed will continue to provide up to $30,000 stipends to individuals with documented educational, mortgage, or other relevant debt to assist with repayment. As the private partner to the GHSP, Seed is able to independently fund and administer this support without requiring legislation or other federal mandates. Seed successfully sourced all funds needed for this critical component of the GHSP through private philanthropy and development during the initial phase and will continue this during the expansion phase. This being the most significant contribution to the partnership, which Peace Corps cannot provide or assist with related to the fundraising, makes it an essential contribution for Seed to continue for support of the program. Any decision to alter this stipend amount or the criteria for provision of this stipend needs to be discussed and agreed upon with the GHSP headquarters program leadership team. Management of Partner Relationships The Peace Corps has the responsibility for managing all U.S. government partner relationships relating to and in connection with the GHSP. Seed will coordinate and consult with the Peace Corps regarding all non-U.S. government partner relationships relating to and in connection with the GHSP. Other Partnership Activities When contemplating the addition of new staff positions, either funded or unfunded by this Cooperative Agreement, for new roles that will contribute to field activities or GHSP PCRV direct support, Seed leadership will appraise PC leadership of these plans and allow sufficient time for discussion and feedback before plans are implemented. When planning new activities for program enhancement that will require significant use of staff time and energy and may divert from essential, core activities for program performance and targets, such as recruitment activities, these plans should be presented to the PC leadership to allow for discussion of the plan for ensuring the maintenance of expected targets for essential program activities. While Peace Corps cannot ultimately control the other activities that Seed engages in through separate agreements and funding sources, the duplication of the same GHSP model at the same sites where GHSP PCRVs are placed should be avoided whenever possible to avoid confusion in the roles in the relationships between Peace Corps, Seed, and the REIs. Projected Outcomes and Impact: Quantitative Indicators The matrix of indicators are noted in Attachment D and based on experience from the first three cycles of GHSP PCRV recruitment and placement and volunteer experience and summarizes Seed’s expectations for the partnership extension in the areas of:       Countries and Sites Marketing, Recruitment, and GHSP Model Dissemination Application, Screening, and Selection Orientation and Training Personalized Volunteer Support, and Volunteer Activity and Impact Results that differ significantly from the noted targets need to be evaluated and accounted for and remedial plans put into place for targets that PC and Seed deem essential for program functioning and accountability. ATTACHMENT Mandatory Standard Provisions (2 CFR 215) All contracts, awarded by the Recipient including small purchases, shall contain the following provisions as applicable: 1. Equal Employment Opportunity--All contracts shall contain a provision requiring compliance with E.O. 11246, "Equal Employment Opportunity" (30 FR 12319, 12935, 3 CFR, 19641965 Comp., p. 339}, as amended by E.O. 11375, "Amending Executive Order 11246 Relating to Equal Employment Opportunity," and as supplemented by regulations at 41 CFR part 60, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor." 2. Copeland "Anti-Kickback" Act (18 U.S.C. 874 and 40 U.S.C. 276c)--AII contracts and subgrants in excess of $2000 for construction or repair awarded by recipients and subrecipients shall include a provision for compliance with the Copeland "Anti-Kickback" Act (18 U.S.C. 874}, as supplemented by Department of Labor regulations (29 CFR part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States"}. The Act provides that each contractor or subrecipient shall be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he is otherwise entitled. The recipient shall report all suspected or reported violations to the Federal awarding agency. 3. Davis-Bacon Act, as amended (40 U.S.C. 276a to a-7)--When required by Federal program legislation, all construction contracts awarded by the recipients and subrecipients of more than $2000 shall include a provision for compliance with the Davis-Bacon Act (40 U.S.C. 276a to a-7) and as supplemented by Department of Labor regulations (29 CFR part 5, "Labor Standards Provisions Applicable to Contracts Governing Federally Financed and Assisted Construction"}. Under this Act, contractors shall be required to pay wages to laborers and mechanics at a rate not less than the minimum wages specified in a wage determination made by the Secretary of Labor. In addition, contractors shall be required to pay wages not less than once a week. The recipient shall place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation and the award of a contract shall be conditioned upon the acceptance of the wage determination. The recipient shall report all suspected or reportedviolations to the Federal awarding agency. 4. Contract Work Hours and Safety Standards Act (40 U.S.C. 327- 333)--Where applicable, all contracts awarded by recipients in excess of $2000 for construction contracts and in excess of $2500 for other contracts that involve the employment of mechanics or laborers shall include a provision for compliance with sections 102 and 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-333), as supplemented by Department of Labor regulations (29 CFR part 5). Under section 102 of the Act, each contractor shall be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than 1\1/2\ times the basic rate of pay for all hours worked in excess of 40 hours in the work week. Section 107 of the Act is applicable to construction work and provides that no laborer or mechanic shall be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. 5. Rights to Inventions Made Under a Contract or Agreement--Contracts or agreements for the performance of experimental, developmental, or research work shall provide for the rights of the Federal Government and the recipient in any resulting invention in accordance with 37 CFR part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. 6. Clean Air Act (42 U.S.C. 7401et seq.) and the Federal Water Pollution Control Act (33 U.S.C. 1251et seq.), as amended--Contracts and subgrants of amounts in excess of $100,000 shall contain a provision that requires the recipient to agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401et seq.) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251et seq.). Violations shall be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). 7. Byrd Anti-lobbying Amendment (31U.S.C. 1352)--Contractors who apply or bid for an award of $100,000 or more shall file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31U.S.C1352. Each tier shall also disclose any lobbying with non-Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the recipient. 8. Debarment and Suspension (E.O.s 12549 and 12689)--No contract shall be made to parties listed on the General Services Administration's list of Parties Excluded from Federal Procurement or Nonprocurement Programs in accordance with E.O.s 12549 and 12689, "Debarment and Suspension." This list contains the names of parties debarred, suspended, or otherwise excluded by agencies, and contractors declared ineligible under statutory or regulatory authority other than E.O. 12549. Contractors with awards that exceed the small purchase threshold shall provide the required certification regarding its exclusion status and that of its principal employees.