The United States Agency for International Development (USAID) is seeking applications for a Cooperative Agreement with a Total Estimated Amount of $45,000,000 from qualified entities to implement the program entitled Strengthening Integrated Health Services Activity (SIHSA) in Sierra Leone.USAID anticipates awarding a five-year cooperative agreement (CA) to advance and sustain improved health outcomes for Sierra Leoneans with a focus on, but not limited to: children under five, pregnant and postpartum women, youth and especially adolescent girls, and women and children living in hard-to-reach areas with limited access to health services. Special attention will be paid to those especially vulnerable within these groups, such as the disabled, gender andsexual minorities (GSM), and ethnic and religious minorities.SIHSA seeks to build a sustainable and resilient health system response to improving access, quality, and effectiveness of family planning (FP), reproductive health (RH), maternal, newborn and child health (MNCH), adolescent health, and malaria services. In addition, SIHSA aims at strengthening communities;apos; active engagement for community-driven solutions to improve health outcomes. Finally, SIHSA seeks to promote a paradigm shift within the health system, supporting system-wide action, especially at community and district levels, including reforms that act on the foundations of the health system and create opportunities for partnering with the local civil society and private sector for improved health outcomes.