Centers for Disease Control and Prevention (CDC)

“Strengthening Access to and Delivery of Quality Public Health Services for Prevention, Care and Treatment of HIV, STIs, and TB, Addressing Diseases of Public Health Importance, and Advancing Global Health Security in Jamaica under PEPFAR”

For the Period April 1, 2024 to March 31, 2025

 

BACKGROUND 

HIV prevalence in Jamaica is estimated to be 1.7% in the general population (UNAIDS, 2017), with key populations (KPs) disproportionately affected; 29% of men who have sex with men (MSM) and 51% of transgender women are living with HIV (MOHW, 2018). Due to the double burden of stigma and discrimination linked to HIV/AIDS and KPs in Jamaica, many of these individuals encounter difficulties accessing life-saving HIV services. For the country to reach the UNAIDS 90-90-90 targets by 2020, and subsequently, 95-95-95 by 2030, all stakeholders must intensify their efforts and transform the response.

A programmatic gap in reaching 90-90-90 is that over 9,000 PLHIV previously diagnosed are not presently on ART. As of March 2019, 9,392 patients were diagnosed but not on ART. Of these, 4,440 (47%) were never linked, 4,624 (49%) were LTFU, and 328 (4%) were linked but not on ART. Achieving the second 90 will require a multi-pronged approach to reach those who have ‘fallen out’ at different stages of the care and treatment continuum. 

Data has shown only 57% of ART patients are virally suppressed, with the gap being a combination of persons who are either unsuppressed or with unknown viral loads (VL). Further review shows correlations between age and viral suppression and differences between males and females. In designing strategies to address the unsuppressed population, the contextual factors within each age band will be taken into consideration. 

International best practices and policies based on WHO recommendations will have to be fast-tracked to accelerate progress in the HIV response and strengthening the overall health sector in Jamaica. 

On October 1, 2020 the Government of Jamaica (GoJ) and the United States Government signed an agreement committing to a health collaboration. The platform for this collaboration is the Cooperative Agreement (CoAG) #GH002267 between the Centers for Disease Control and Prevention (CDC) and the Ministry of Health & Wellness Jamaica (MoHW). The grant has a project implementation period of September 30, 2020 through September 29, 2025. A non-Federal entity that expends $300,000 or more during the non-Federal entity’s fiscal year in Federal awards must have a single or program-specific audit conducted for that year in accordance with the provisions of the US Government.  Funding for the grant is received on an annual basis.   

Funding in the amount of US$3,000,000 was approved for the Year 4 budget period, which was September 30, 2023 through September 29, 2024. This was given on Notice of Award (NOA) # NU2GGH002267-04-00 issued September 9, 2023.  Budgeted activities for year 4 was revised for the original approved amount of US$3,000,000 and this was given on NOA # NU2GGH002267-04-01 issued November 28, 2023. 

Funding in the amount of US$2,000,000 was approved for the Year 5 budget period, which was September 30, 2024 through September 29, 2025. This was given on Notice of Award (NOA) # NU2GGH002267-05-00 issued August 26, 2024.  Budgeted activities for year 4 was revised for the amount of US$1,960,000 and this was given on NOA # NU2GGH002267-05-02 issued December 09, 2024. 

The audit for the period April 1, 2024 to March 31, 2025 will span two financial years for the CDC. April – September 2024 from budget year 4 and October 2024 – March 2024 from budget year 5. Total funding approved over the audit period of April 1, 2024 – March 31, 2025 valued US$2,390,000. This detail in the table below.

 

 

The Key areas for which funding where received are as such:

Prevention, care and treatment (PCT): address critical gaps in HIV diagnosis, linkage, retention and viral suppression. Emphasis will be on the scale up and expansion of index case testing (ICT)/partner notification services (PNS) as the primary case finding strategy, differentiated service delivery to improve adherence and retention, and optimization of medical care to ensure all patients become virally suppressed. 

Strategic Information (SI): focus on improving the quality, availability, timeliness and use of SI by strengthening quality assurance procedures, digitization of data collection tools and enhanced interoperability of information systems.

Laboratory Strengthening: focus will be on improving the Lab-Clinic interface to enable more effective patient management. 

Global Health Security Agenda: this is a COVID-19 Crisis Response activities and focus on Outfitting Rural Health Centres with Generators and Refrigerators to Enhance Cold Chain Capacity.

The Ministry of Health & Wellness (MOHW) is the pre-eminent Government organization whose mandate is “To ensure the provision of quality health services and to promote healthy lifestyles and environmental practices”. Activities to be audited relates to expenses under the CDC HIV CoAG. Expenditure is recorded using the ACCPAC Accounting software and spread sheets. Accounting records are kept at The Ministry of Health & Wellness, 10-16 Grenada Way.

 

AUDIT OBJECTIVES

The specific objectives of the audit of the CDC funds are to:

Auditors must design steps and procedures in accordance with General Accepted Government Auditing Standards (GAGAS). A financial audit of the funds provided by CDC must be performed in accordance with GAGAS, or other approved standards where applicable, and accordingly includes such tests of the accounting records as deemed necessary under the circumstances.

 

SCOPE OF AUDIT

The audit must be conducted in accordance with GAGAS, GAAP and Code of Federal Regulation, title 2 part 200 (2 CFR 200) and title 45, subtitle A, Sub-chapter A, Part 75 (45 CFR 75). The audit will cover the period April 1, 2024 to March 31, 2025. 

The audit must cover the entire operations of the auditee, or, at the option of the auditee, such audit must include a series of audits that cover departments, agencies, and other organizational units that expended or otherwise administered Federal awards during such audit period, provided that each such audit must encompass the financial statements and schedule of expenditures of Federal awards for each such department, agency, and other organizational unit, which must be considered to be a non-Federal entity. The financial statements and schedule of expenditures of Federal awards must be for the same audit period. 

The auditor must determine whether the financial statements of the auditee are presented fairly in all material respects in accordance with generally accepted accounting principles. The auditor must also determine whether the schedule of expenditures of Federal awards is stated fairly in all material respects in relation to the auditee’s financial statements as a whole. 

The auditors should pay special attention to the following requirements:

(1) All project funds have been used in accordance with the condition of the relevant financing     agreements.

(2) Goods, Works and Services financed have been procured in accordance with the relevant financing agreement and procurement guidelines.

(3) All supporting documents, records and accounts have been maintained in respect of all project activities and expenditure.

Internal control. 

(1) The compliance supplement provides guidance on internal controls over Federal programs based upon the guidance in Standards for Internal Control in the Federal Government issued by the Comptroller General of the United States and the Internal Control – Integrated Framework, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). 

(2) In addition to the requirements of GAGAS, the auditor must perform procedures to obtain an understanding of internal control over Federal programs sufficient to plan the audit to support a low assessed level of control risk of noncompliance for major programs. 

(3) Except as provided in paragraph (c)(4) of this section, the auditor must: 

(i) Plan the testing of internal control over compliance for major programs to support a low assessed level of control risk for the assertions relevant to the compliance requirements for each major program; and 

(ii) Perform testing of internal control as planned in paragraph (c)(3)(i) of this section. 

(4) When internal control over some or all of the compliance requirements for a major program are likely to be ineffective in preventing or detecting noncompliance, the planning and performing of testing described in paragraph (c)(3) of this section are not required for those compliance requirements. However, the auditor must report a significant deficiency or material weakness in accordance with § 75.516^***  assess the related control risk at the maximum, and consider whether additional compliance tests are required because of ineffective internal control. 

*** Electronic Code of Federal Regulations (e-CFR )> Title 45. Public Welfare > Chapter A. Department of Health and Human Services > Subchapter A. General Administration > Part 75. Uniform Administrative Requirements, Cost, Principles, and Audit Requirement for HHS Awards. > Subpart F. Audit Requirements “https://www.law.cornell.edu/cfr/text/45/part-75/subpart-F”

 

Compliance. 

(1) In addition to the requirements of GAGAS, the auditor must determine whether the auditee has complied with Federal statutes, regulations, and the terms and conditions of Federal awards that may have a direct and material effect on each of its major programs. 

(2) The principal compliance requirements applicable to most Federal programs and the compliance requirements of the largest Federal programs are included in the compliance supplement. 

(3) For the compliance requirements related to Federal programs contained in the compliance supplement, an audit of these compliance requirements will meet the requirements of this part. Where there have been changes to the compliance requirements and the changes are not reflected in the compliance supplement, the auditor must determine the current compliance requirements and modify the audit procedures accordingly. For those Federal programs not covered in the compliance supplement, the auditor must follow the compliance supplement’s guidance for programs not included in the supplement. 

(4) The compliance testing must include tests of transactions and such other auditing procedures necessary to provide the auditor sufficient appropriate audit evidence to support an opinion on compliance. 

 

AUDIT RESPONSIBILITIES

The auditee/management has the responsibility for the following: 

 (a) Prepare and fairly present the financial statements, including the schedule of expenditures of Federal awards in accordance with applicable rules and regulation that governs the operation. There should also be the inclusion of the notes that describe the significant accounting policies used in preparing the schedule.

(b) For such internal control as management determine is necessary to enable the preparation of financial statement that are free from material misstatement, whether due to fraud or error.

 (c) Provide the auditor with unlimited access to all information (accounts, books, records, supporting documentation), explanations and any other information considered necessary to facilitate the audit, including legal documents, project preparation and supervision reports, reports of review and investigations, correspondence, and credit account information. The auditor may also seek written confirmation of amounts disbursed and outstanding in the Bank records. 

(d) Promptly follow up and take corrective action on audit findings, including preparation of response to audit findings, a summary schedule of prior audit findings and a corrective action plan in accordance with  §75.511(b) and § 75.511(c), respectively. 

 (e) Audit documentation must be made available upon request to the cognizant or oversight agency for audit or its designee, cognizant agency for indirect cost, a Federal agency, or GAO at the completion of the audit, as part of a quality review, to resolve audit findings, or to carry out oversight responsibilities consistent with the purposes of this part. Access to audit documentation includes the right of Federal agencies to obtain copies of audit documentation, as is reasonable and necessary.

The auditor has responsibility for the following: 

(i) Conduct entrance audit interview meeting to discuss audit related matters with the CDC project team and exit interview meeting of the engagement.

(ii) Perform an audit of the financial statement(s) for the Federal program in accordance with GAGAS; 

(iii) Obtain an understanding of internal controls and perform tests of internal controls over the Federal program consistent with the requirements of § 75.514(c) for a major program; 

(iv) Perform procedures to determine whether the auditee has complied with Federal statutes, regulations, and the terms and conditions of Federal awards that could have a direct and material effect on the Federal program consistent with the requirements of § 75.514(d) for a major program; 

(v) Follow up on prior audit findings, perform procedures to assess the reasonableness of the summary schedule of prior audit findings prepared by the auditee in accordance with the requirements of § 75.511, and report, as a current year audit finding, when the auditor concludes that the summary schedule of prior audit findings materially misrepresents the status of any prior audit finding; 

(vi) The auditor must retain audit documentation and reports for a minimum of three years after the date of issuance of the auditor’s report(s) to the auditee, unless the auditor is notified in writing by the cognizant agency for audit, oversight agency for audit, cognizant agency for indirect costs, or pass-through entity to extend the retention period. When the auditor is aware that the Federal agency, pass-through entity, or auditee is contesting an audit finding, the auditor must contact the parties contesting the audit finding for guidance prior to destruction of the audit documentation and reports.

(vii)  The auditor must provide a report in accordance to the audit reporting section of this document.

 

AUDIT REPORTING

The auditor’s report(s) may be in the form of either combined or separate reports and may be organized differently from the manner presented in this section. The auditor’s report(s) must state that the audit was conducted in accordance with this part and include the following: 

(a) An opinion (or disclaimer of opinion) as to whether the financial statements are presented fairly in all material respects in accordance with generally accepted accounting principles and an opinion (or disclaimer of opinion) as to whether the schedule of expenditures of Federal awards is fairly stated in all material respects in relation to the financial statements as a whole. 

(b) A report on internal control over financial reporting and compliance with provisions of laws, regulations, contracts, and award agreements, noncompliance with which could have a material effect on the financial statements. This report must describe the scope of testing of internal control and compliance and the results of the tests, and, where applicable, it will refer to the separate schedule of findings and questioned costs described in paragraph (d) of this section. 

(c) A report on compliance for each major program and a report on internal control over compliance. This report must describe the scope of testing of internal control over compliance, include an opinion or disclaimer of opinion as to whether the auditee complied with Federal statutes, regulations, and the terms and conditions of Federal awards which could have a direct and material effect on each major program and refer to the separate schedule of findings and questioned costs described in paragraph (d) of this section. 

(d) A schedule of findings and questioned costs which must include the following three components: 

(1) A summary of the auditor’s results, which must include: 

(i) The type of report the auditor issued on whether the financial statements audited were prepared in accordance with Generally Accepted Accounting Principles (GAAP) (i.e., unmodified opinion, qualified opinion, adverse opinion, or disclaimer of opinion); 

(ii) Where applicable, a statement about whether significant deficiencies or material weaknesses in internal control were disclosed by the audit of the financial statements; 

(iii) A statement as to whether the audit disclosed any noncompliance that is material to the financial statements of the auditee; 

(iv) Where applicable, a statement about whether significant deficiencies or material weaknesses in internal control over major programs were disclosed by the audit; 

(v) The type of report the auditor issued on compliance for major programs (i.e., unmodified opinion, qualified opinion, adverse opinion, or disclaimer of opinion); 

(vi) A statement as to whether the audit disclosed any audit findings that the auditor is required to report under § 75.516(a); 

(vii) An identification of major programs by listing each individual major program; however in the case of a cluster of programs only the cluster name as shown on the Schedule of Expenditures of Federal Awards is required; 

(viii) A statement as to whether the auditee qualified as a low-risk auditee under § 75.520. 

(2) Findings relating to the financial statements which are required to be reported in accordance with GAGAS. 

(3) Findings and questioned costs for Federal awards which must include audit findings as defined in § 75.516(a). 

(i) Audit findings (e.g., internal control findings, compliance findings, questioned costs, or fraud) that relate to the same issue must be presented as a single audit finding. Where practical, audit findings should be organized by Federal agency or pass-through entity. 

(ii) Audit findings that relate to both the financial statements and Federal awards, as reported under paragraphs (d)(2) and (d)(3) of this section, respectively, must be reported in both sections of the schedule. However, the reporting in one section of the schedule may be in summary form with a reference to a detailed reporting in the other section of the schedule. 

 

 AUDIT FINDINGS

(a) Audit findings reported. The auditor must report the following as audit findings in a schedule of findings and questioned costs: 

(1) Significant deficiencies and material weaknesses in internal control over major programs and significant instances of abuse relating to major programs. The auditor’s determination of whether a deficiency in internal control is a significant deficiency or material weakness for the purpose of reporting an audit finding is in relation to a type of compliance requirement for a major program identified in the Compliance Supplement. 

(2) Material noncompliance with the provisions of Federal statutes, regulations, or the terms and conditions of Federal awards related to a major program. The auditor’s determination of whether a noncompliance with the provisions of Federal statutes, regulations, or the terms and conditions of Federal awards is material for the purpose of reporting an audit finding is in relation to a type of compliance requirement for a major program identified in the compliance supplement. 

(3) Known or likely fraud affecting a Federal award, unless such fraud is otherwise reported as an audit finding in the schedule of findings and questioned costs for Federal awards. This paragraph does not require the auditor to report publicly information which could compromise investigative or legal proceedings or to make an additional reporting when the auditor confirms that the fraud was reported outside the auditor’s reports under the direct reporting requirements of GAGAS. 

(7) Instances where the results of audit follow-up procedures disclosed that the summary schedule of prior audit findings prepared by the auditee in accordance with § 75.511(b) materially misrepresents the status of any prior audit finding. 

(b) Audit finding detail and clarity. Audit findings must be presented in sufficient detail and clarity for the auditee to prepare a corrective action plan and take corrective action, and for Federal agencies and pass-through entities to arrive at a management decision. The following specific information must be included, as applicable, in audit findings: 

(1) Federal program and specific Federal award identification including the CFDA title and number, Federal award identification number and year, name of Federal agency, and name of the applicable pass-through entity. When information, such as the CFDA title and number or Federal award identification number, is not available, the auditor must provide the best information available to describe the Federal award. 

(2) The criteria or specific requirement upon which the audit finding is based, including the Federal statutes, regulations, or the terms and conditions of the Federal awards. Criteria generally identify the required or desired state or expectation with respect to the program or operation. Criteria provide a context for evaluating evidence and understanding findings. 

(3) The condition found, including facts that support the deficiency identified in the audit finding. 

(4) A statement of cause that identifies the reason or explanation for the condition or the factors responsible for the difference between the situation that exists (condition) and the required or desired state (criteria), which may also serve as a basis for recommendations for corrective action. 

(5) The possible asserted effect to provide sufficient information to the auditee and Federal agency, or pass-through entity in the case of a sub-recipient, to permit them to determine the cause and effect to facilitate prompt and proper corrective action. A statement of the effect or potential effect should provide a clear, logical link to establish the impact or potential impact of the difference between the condition and the criteria. 

(6) Identification of questioned costs and how they were computed. Known questioned costs must be identified by applicable CFDA number(s) and applicable Federal award identification number(s). 

(7) Information to provide proper perspective for judging the prevalence and consequences of the audit findings, such as whether the audit findings represent an isolated instance or a systemic problem. Where appropriate, instances identified must be related to the universe and the number of cases examined and be quantified in terms of dollar value. The auditor should report whether the sampling was a statistically valid sample. 

(8) Identification of whether the audit finding was a repeat of a finding in the immediately prior audit and if so any applicable prior year audit finding numbers. 

(9) Recommendations to prevent future occurrences of the deficiency identified in the audit finding. 

(10) Views of responsible officials of the auditee. 

 

DELIVERABLES AND REMUNERATION:

The key deliverables under this consultancy are as specified in the table below.

 

No.	Deliverables	Due Date	% Remuneration
1	Submission of Audit Plan	Within seven days (7) of signing the contract and entrance meeting	20 %
2	Submission of Draft Audit Report	Within forty days (40) of submitting audit plan	40%
3	Submission of Final Audit Report and Management Letter with responses, that is accepted by CDC & MoHW	Within forty days (40) of submitting the draft report	40%

 

The duration of the contract will be for four (4) months. The audit firm must submit the draft and final audit reports in English and be stated in United States Dollars (USD). The audit firm must submit to the MoHW – Project Management Unit one (1) electronic copy in PDF and four (4) hard copies of the final report.

 

QUALIFICATIONS AND EXPERIENCE OF FIRM

The Firm

• Must have a valid Tax Compliance Certificate / Tax Compliance Letter.
• Must be a certified licensed Public Accounting Firm.
• Practicing and providing auditing services for at least five (5) years. 
• Provided auditing services for Bilateral and Multilateral Projects for Ministries or any other Governmental Organization for at least five (5) years.
• Demonstrated organizational ability to plan, implement, and support an audit program.

 

Key Professional Staff

• Partner/Team Lead – 
  1. Master’s degree in Auditing or Accounting, ACCA, CPA. 
  2. At least five (5) years’ experience in auditing. 
  3. Relevant and appropriate experience in auditing donor partner funded projects for at least five (5) years.

• Other Staff – 
  1. Bachelor’s degree in Auditing or Accounting, ACCA or CPA for field staff
  2. At least five (3) years’ experience in auditing. 
  3. Relevant and appropriate experience in auditing donor partner funded projects for at least two (2) years.

 

EVALUATION CRITERIA

	Evaluation Criteria	Score
1	Experience   Practicing and providing auditing services for at least five (5) years   Practicing and providing auditing services for five (5) including audits for Bilateral and Multilateral Projects for Ministries or any other Governmental Organization.	5     10	10
2	Adequacy of the proposed technical approach, methodology and work plan in responding to the Terms of Reference		30
3	Key professional staff qualifications and competence for the assignment:    Partner   Team Leader/Manager             Audit Assistant (s)	25 20 15	60
	Total Score		100

 

NB.

 

The number of points to be assigned to each of the above staff positions shall be determined considering the following three sub criteria and relevant percentage weights:

1)         General qualifications (25%)

2)         Experience in auditing donor related projects (50%)

3)         Experience in auditing (25%)

            Total weight:   100%

 

The minimum technical score required to pass is: 75 Points

The consultant firm submitting the lowest cost will then be considered for selection.

Please note that the Ministry of Health and Wellness reserves the right to abort the procurement process at any time without making an award.