USAID Strengthening Integrated Health Systems in Fragile States Activity

The USAID Strengthening Integrated Health Systems in Fragile States Activity is a multi-year funding opportunity designed to address the systemic health challenges in fragile and conflict-affected environments. These settings often lack resilient health infrastructure, adequate workforce, and sustainable financing, leading to poor health outcomes and vulnerability to disease outbreaks. The activity supports comprehensive interventions that integrate service delivery, governance reform, and community engagement. Applicants must propose interventions that are adaptable, conflict-sensitive, and aligned with national health strategies. The deadline of August 15, 2026, provides a window for thorough preparation, including capacity building through GSLI courses. This opportunity emphasizes collaboration with local actors, requiring that at least 30% of funds be sub-awarded to local organizations. The overall goal is to build self-reliant health systems that can withstand shocks and continue providing essential services. This initiative is part of USAID's broader commitment to achieving Universal Health Coverage and the Sustainable Development Goals. Potential applicants should consider partnering with organizations that bring complementary technical expertise, such as disease surveillance or health financing. GSLI training can help bridge the skills gap in critical areas like proposal writing, project management, and financial compliance, making applications more competitive. This funding represents a significant opportunity to make a lasting impact on health outcomes in some of the world's most vulnerable populations. The successful proposal will demonstrate a clear understanding of fragility, a robust implementation plan, and a commitment to evidence-based practices. The nature of fragility calls for innovative approaches that integrate health interventions with peacebuilding and conflict resolution. Proposals should include strategies to engage with non-state actors, navigate complex political economies, and build trust among communities. USAID encourages the use of digital health solutions to improve data collection and service delivery in remote areas. For instance, mobile health platforms can support community health workers in tracking patients and reporting outbreaks. Additionally, the activity must adhere to strict environmental and social safeguards, ensuring interventions do no harm. Gender equality and social inclusion are cross-cutting requirements; all activities should address the distinct needs of women, children, and marginalized groups. Climate resilience is another layer, with health systems needing to adapt to changing disease patterns and extreme weather events. The donor expects a comprehensive risk management plan that covers security, fiduciary, and programmatic risks. Applicants should also plan for sustainability from the outset, with clear strategies for transitioning activities to local governments or organizations by the end of the project period. The financial management framework must include regular audits, transparent procurement, and anti-corruption measures. GSLI's courses in Grants Management and Financial Management can equip organizations with these essential skills. In terms of geographic focus, the activity targets countries in Sub-Saharan Africa, the Middle East, and South Asia classified as fragile or conflict-affected by the OECD. Examples include Afghanistan, Yemen, Somalia, South Sudan, and parts of the Sahel region. Applicants must demonstrate experience and contextual understanding in at least one of these regions. The proposal should outline a clear theory of change that links inputs to long-term health system strengthening outcomes. Key performance indicators should include reductions in maternal and child mortality, increased immunization coverage, improved disease surveillance, and enhanced health workforce capacity. Financial indicators such as reduced out-of-pocket spending and increased domestic health financing are also important. The evaluation criteria likely include technical approach (40%), organizational capacity (30%), past performance (20%), and budget (10%). Therefore, a well-documented track record of similar work and strong institutional capacity are critical. GSLI's training portfolio can help organizations strengthen their team's competencies across these areas, ensuring a competitive edge. The combination of technical expertise and professional development signals to USAID that the applicant is serious about quality and sustainability.

Strategic Overview

The USAID Strengthening Integrated Health Systems in Fragile States Activity is a multi-year funding opportunity designed to address the systemic health challenges in fragile and conflict-affected environments. These settings often lack resilient health infrastructure, adequate workforce, and sustainable financing, leading to poor health outcomes and vulnerability to disease outbreaks. The activity supports comprehensive interventions that integrate service delivery, governance reform, and community engagement. Applicants must propose interventions that are adaptable, conflict-sensitive, and aligned with national health strategies. The deadline of August 15, 2026, provides a window for thorough preparation, including capacity building through GSLI courses. This opportunity emphasizes collaboration with local actors, requiring that at least 30% of funds be sub-awarded to local organizations. The overall goal is to build self-reliant health systems that can withstand shocks and continue providing essential services. This initiative is part of USAID's broader commitment to achieving Universal Health Coverage and the Sustainable Development Goals. Potential applicants should consider partnering with organizations that bring complementary technical expertise, such as disease surveillance or health financing. GSLI training can help bridge the skills gap in critical areas like proposal writing, project management, and financial compliance, making applications more competitive. This funding represents a significant opportunity to make a lasting impact on health outcomes in some of the world's most vulnerable populations. The successful proposal will demonstrate a clear understanding of fragility, a robust implementation plan, and a commitment to evidence-based practices. The nature of fragility calls for innovative approaches that integrate health interventions with peacebuilding and conflict resolution. Proposals should include strategies to engage with non-state actors, navigate complex political economies, and build trust among communities. USAID encourages the use of digital health solutions to improve data collection and service delivery in remote areas. For instance, mobile health platforms can support community health workers in tracking patients and reporting outbreaks. Additionally, the activity must adhere to strict environmental and social safeguards, ensuring interventions do no harm. Gender equality and social inclusion are cross-cutting requirements; all activities should address the distinct needs of women, children, and marginalized groups. Climate resilience is another layer, with health systems needing to adapt to changing disease patterns and extreme weather events. The donor expects a comprehensive risk management plan that covers security, fiduciary, and programmatic risks. Applicants should also plan for sustainability from the outset, with clear strategies for transitioning activities to local governments or organizations by the end of the project period. The financial management framework must include regular audits, transparent procurement, and anti-corruption measures. GSLI's courses in Grants Management and Financial Management can equip organizations with these essential skills. In terms of geographic focus, the activity targets countries in Sub-Saharan Africa, the Middle East, and South Asia classified as fragile or conflict-affected by the OECD. Examples include Afghanistan, Yemen, Somalia, South Sudan, and parts of the Sahel region. Applicants must demonstrate experience and contextual understanding in at least one of these regions. The proposal should outline a clear theory of change that links inputs to long-term health system strengthening outcomes. Key performance indicators should include reductions in maternal and child mortality, increased immunization coverage, improved disease surveillance, and enhanced health workforce capacity. Financial indicators such as reduced out-of-pocket spending and increased domestic health financing are also important. The evaluation criteria likely include technical approach (40%), organizational capacity (30%), past performance (20%), and budget (10%). Therefore, a well-documented track record of similar work and strong institutional capacity are critical. GSLI's training portfolio can help organizations strengthen their team's competencies across these areas, ensuring a competitive edge. The combination of technical expertise and professional development signals to USAID that the applicant is serious about quality and sustainability.

Who is it For?

This opportunity is designed for a diverse range of actors including international non-governmental organizations (INGOs), local civil society organizations (CSOs), private sector entities, academic institutions, and public-private consortia. Eligible applicants must demonstrate proven experience in health system strengthening, particularly in fragile or conflict-affected states. The USAID emphasizes the inclusion of local partners to ensure sustainability and ownership. Organizations should have a minimum of three years of operational presence in at least one fragile state, with documented capacity to manage complex grants over $5 million. Financial stability, demonstrated by audited financial statements, and a robust compliance framework are mandatory. Consortia are encouraged, with a lead partner responsible for overall coordination. The activity targets implementers who can navigate politically sensitive environments, engage with multiple stakeholders (including ministries of health, community leaders, and donors), and adapt to rapidly changing contexts. Priority will be given to entities with a track record of integrating cross-cutting issues such as gender, human rights, and climate adaptation into health programs.

Priorities

USAID's global priorities for this activity focus on building resilient health systems that can withstand shocks (e.g., pandemics, conflict, climate events). Key investment KPIs include: (1) reduction in maternal and child mortality rates by 20% in target regions, (2) increase in immunization coverage by 30%, (3) strengthening of disease surveillance systems to detect outbreaks within 48 hours, (4) improvement in health workforce density by 15%, and (5) enhanced financial protection, reducing out-of-pocket health expenditures by 25%. The donor expects proposals to align with the U.S. Global Health Security Agenda, which emphasizes preventing, detecting, and responding to infectious disease threats. Additionally, USAID prioritizes localization, requiring that at least 30% of total funding be sub-awarded to local organizations. Integration of digital health solutions for data management and telemedicine is also a cross-cutting theme. Climate resilience must be embedded, with interventions addressing health impacts of climate change, such as vector-borne diseases. Finally, proposals should articulate a clear theory of change linking inputs to long-term health system improvements.

Eligibility

Eligibility criteria are stringent. Organizations must be legally registered entities in the country of operation or the U.S. A minimum of $10 million in annual revenue over the past three fiscal years is required, with audited financial statements. The lead applicant must have managed at least two USAID-funded projects of $5 million or more in fragile states. Spatial audit: the organization must demonstrate a physical presence (office or field operations) in at least three fragile states as defined by the OECD Fragile States Index. Corporate legal compliance includes registration under relevant laws, no debarment from U.S. federal programs, and adherence to anti-terrorism and anti-corruption policies. Financial capacity requires a current ratio of at least 1.5 and debt-to-equity ratio below 1.0. For consortia, each member must meet eligibility individually, and a memorandum of understanding outlining roles and financial flows is required. The donor also requires a conflict of interest disclosure and a past performance assessment. Local organizations may be eligible with waivers for revenue if they have demonstrated in-kind contributions or strong community linkages.

Path to Success

Strategic roadmap to secure this grant with GSLI integration: Step 1: Capacity Strengthening & Proposal Readiness. Enroll GSLI courses in 'Writing Winning Proposals' and 'Project Management for Development' to craft a compelling narrative and design robust work plans. Step 2: Financial & Compliance Auditing. Take 'Financial Management for NGOs' and 'Grants Management' to ensure strict adherence to USAID's financial reporting and audit requirements. Step 3: Technical Design & MEAL Framework. Leverage 'Monitoring & Evaluation (M&E)' and 'Public Health & Epidemiology' to develop a rigorous M&E plan with baseline data and targets. Step 4: Consortium Building & Local Partnerships. Use GSLI's 'Procurement & Supply Chain' and 'Fundraising & Resource Mobilization' to structure partnerships and sub-award management. Step 5: Risk Mitigation & Sustainability Plan. Complete 'WASH' and 'Public Health' courses to incorporate water sanitation and disease control interventions. Throughout, GSLI's 'Humanitarian Leadership' and 'Conflict Sensitivity' courses enhance team preparedness. This integrated approach increases proposal quality and demonstrates institutional capacity, positioning GSLI-trained organizations as preferred implementers.

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Deadline: 2026-08-15

Persona: General

Urgency: Normal