GPAF COMMUNITY PARTNERSHIP PROPOSAL FORM (Round 1)The proposal documentation provides detailed information about your proposed project. This information is used to assess the strengths and weaknesses of the initiative and will ultimately inform the DFID funding decisions. It is very important you read the GPAF Community Partnership Window Guidelines for Applicants and related documents before you start working on your Proposal to ensure that you understand and take into account the relevant funding criteria. Please also consider the GPAF Proposals - Key Strengths and Weaknesses document which has been adapted from the document prepared following the appraisal of full proposals submitted to GPAF Innovation windows.. This document identifies the generic strengths and weaknesses of proposals submitted in relation to the key assessment criteria.

How?: You must submit a Microsoft Word version of your Proposal and associated documents by email to gpafcommunity@tripleline.com. It should be written in Arial font size 12. We do not require a hard copy.

When?: All Proposal documents must be received by Triple Line on or before 23:59 GMT on Friday 5th April 2013. Proposal documents that are received after the deadline will not be considered.

What?: You must submit the following documents:

1. Narrative Proposal : Please use the form below. The form has been designed to allow you to record all the information DFID needs to assess your proposed project. Please note the following page limits:

Sections 1 – 8 : Maximum of 15 (fifteen) A4 pages Section 9 : Maximum of 3 (three) A4 pages per partnerPlease do not alter the formatting of the form and guidance notes. Proposals that exceed the page limits or that have amended formatting may not be considered.

2. Logical framework: All applicants must submit a full Logical Framework/Logframe and Activities Log. Please refer to the GPAF Logframe Guidance and How-To-Note and use the Excel logframe template provided.

3. Project Budget: Applicants must submit a full project budget with the Proposal. Please refer to the GPAF Community Partnership Window Guidelines for Applicants and Financial Management Guidelines and the notes on the budget template (for Round 4). The Excel template has three worksheets/tabs: Guidance Note; Budget; and Budget Notes. Please read all guidance notes and provide full and detailed budget notes to justify the budget figures.

4. Your organisation's governance documents: e.g. Memorandum and Articles of Association, Trust Deed, Constitution. We need this to check your eligibility. If you have any doubts about your eligibility please contact Triple Line Consulting immediately.

5. Organisational Accounts: All applicants must provide a copy of their most recent (less than 12 months after end of accounting period) signed and audited (or independently examined) accounts.

6. Project organisational chart/organogram: All applicants must provide a project organisational chart or organogram demonstrating the relationships between the key project partners and other key stakeholders Please use your own format for this.

7. Project Schedule or GANTT chart: All applicants must provide a project schedule or GANTT chart to show the scheduling of project activities (please use your own format for this).

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Before submitting your Proposal, please complete the checklist below to ensure that you have provided all of the necessary documents.

CHECKLIST OF PROPOSAL DOCUMENTATIONPlease check boxes for each of the documents you are submitting with this form.All documents must be submitted by e-mail to: gpafcommunity@tripleline.com

Mandatory items for all applicants CheckY/N

Proposal form (sections 1-8) Y

Proposal form (section 9 - for each partner) Y

Project Logframe Y

Project Budget (with detailed budget notes) Y

Your most recent set of audited or approved organisational annual accounts

Y

Project organisational chart / organogram Y

Project bar or GANTT chart to show scheduling Y

Please provide comments on the documentation provided (if relevant)

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GLOBAL POVERTY ACTION FUND (GPAF) – COMMUNITY PARTNERSHIP WINDOW PROPOSAL FORM

SECTION 1: INFORMATION ABOUT THE APPLICANT1.1 Lead organisation name Women and Children First (UK)

1.2 Main contact person Name: Ros DaviesPosition: Chief Executive OfficerEmail: r.davies@womenandchildrenfirst.org.ukAlternative email address: N/ATel: 020 7700 6309 ext. 202

1.3 2nd contact person(If applicable)

Name: Ruth DuebbertPosition: Head of Policy and AdvocacyEmail: r.duebbert@womenandchildrenfirst.org.ukAlternative email address: N/ATel: 020 7700 6309 ext. 204

1.4 Please use this space to inform of any changes to the applicant organisation details provided in your Concept Note (including any more up to date income figures)

N/A

SECTION 2: BASIC INFORMATION ABOUT THE PROJECT2.1 Concept Note Reference No. INN-05-CN-1066

2.2 Project title Improving Maternal and Newborn Health for 52,976 Women and 11,517 Neonates in Nkhotakota District, Malawi

2.3 Country(ies) where project is to be implemented

Malawi

2.4 Locality(ies)/region(s) within country(ies)

Nkhotakota district

2.5 Duration of project (in months) 31 Months

2.6 Anticipated start date of project (not before 01 April 2013)

01 April 2014

2.7 Total project budget? (In GBP sterling)

£246,101

2.8 Total funding requested from DFID (in GBP sterling and as a % of total project budget)

£246,101

100%

2.9 If you are not requesting the full amount from DFID, please list the amounts and sources of any other funding (In GBP sterling and as a % of total

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project funds)

2.10 Year 1 funding requested from DFID (In GBP sterling)

£109,706

2.11 Please specify the % of project funds to be spent in each project country

UK: 24%Malawi: 76%

2.12 Have you approached any other part of DFID to fund this project?

NO

2.13 ACRONYMS (Please list all acronyms used in your Proposal in alphabetical order below, spelling out each one in full. You may add more rows if necessary)

ANC Antenatal care PNC Post natal care

BLM Banja La Mtsogolo (Marie Stopes International partner)

(P)MTCT (Prevention) of Mother to Child Transmission of HIV

CBMMNH Community Based Management of Maternal and Newborn Health

RCT Randomised Controlled Trial

CHAM Christian Health Association of Malawi

SRHR Sexual Reproductive Health and Rights

DHO District Health Office SSDI Support for Service Delivery Integration (Jhpiego led)

FPAM Family Planning Association of Malawi

SWAM Society for Women and AIDS

HAC Health Advisory Committee TA Traditional Authority

HSA Health Surveillance Assistant TBA Traditional Birth Attendant

MNH Maternal and newborn health WMF World Medical Fund

MOH Ministry of Health WRA Women of Reproductive Age

SECTION 3: CAPACITY OF THE APPLICANT ORGANISATION3.1 EXPERIENCE: Please outline your organisation's experience that is relevant to the proposed

areas of work

Women and Children First UK (WCF) is an international NGO working to improve the health and wellbeing of women and children in poor communities, with a focus on pregnancy and the first month of life. WCF has a successful 11 year track record of managing and delivering over twenty major maternal and newborn health programmes, mostly focusing on demand side interventions, with partners in Bangladesh, Ethiopia, India, Malawi, Nepal and Uganda. WCF plays a critical role in supporting local partners by providing technical assistance and building partners’ capacity in mobilising communities, policy analysis, advocacy and communications and project and financial management. WCF and MaiKhanda have worked together since 2006 and have developed a unique approach which encompasses a) a scientifically proven evidence base that mobilising communities can effectively reduce maternal and neonatal death rates and improve maternal and newborn health (MNH); b) MaiKhanda’s community-facility linkage approach and expertise; and c) WCF’s strong MNH and policy and advocacy expertise. WCF’s Chief Executive has over twenty years experience in SRHR and MNH; WCF’s Head of Policy and Advocacy has over ten years experience of working on MNH programmes, policy and advocacy and direct experience of building the capacity of partner organisations in Asia and Africa to advocate.

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3.2 FUNDING HISTORY: Please describe your organisation's main sources of funding, with an indication of the amounts received and the purpose of the funding.

Funding sources active over the last 12 months include: Big Lottery Fund - Strategic Grant, Improving maternal, newborn and child health in low-income

countries (India and Bangladesh) - £803,876 – 2008-2013 Comic Relief - Improving maternal, newborn and child health (Malawi) – £387,945 – 2010-2013 Comic Relief - Improving maternal, newborn and child health (Malawi) - £175,734 – 2013 - 2015 Comic Relief - Organisation Development Grant (UK) – £39,160 – 2011-2012 Comic Relief - Planning Grant (Ethiopia) – £53,338 – 2012 UNFPA - MDG 4 and 5 advocacy (UK) - $10,000 - 2012 Conservation Food and Health - Jut: increasing the update of family planning in Mumbai’s slums

(India) - $50,000 – 2012-2013 The Health Foundation – Improving maternal and newborn health (Malawi) - £42,000 for TA

provision – 2007-2012 Ernest Kleinwort Charitable Trust – Unrestricted funding - £25,000 - 12 months from May 2012

3.3 CHILD PROTECTION (projects working with children and youth (0-18 years) only)What is your organisation's capacity and experience in relation to child protection? How will you work with your partner(s) to ensure children are kept safe?

Not applicable for this project. WCF has a Child Protection Policy, available on request.

3.4 FRAUD: Are you aware of any fraudulent activity within your organisation within the last 5 years? How will you minimise the risk of fraudulent activity occurring in future?

No. WCF has a comprehensive Financial Policy and Procedures Manual which has a comprehensive description of internal controls which are applied by the Finance Officer and monitored regularly by the CEO. The Board’s Finance and Administration Committee has ultimate oversight over finance and administration arrangement. An operating budget is agreed by the Board at the beginning of each year and management accounts and a cash flow forecast, including information on use of restricted funds clearly set out per project, are prepared monthly. These are distributed to the Treasurer and other members of the Finance Committee who scrutinise them on receipt and meet quarterly to discuss any issues arising. The organisation is audited annually by a respected firm of auditors who are experienced in working with charities. WCF also has an Anti-Bribery and Corruption Policy and Value for Money Statement reflected in its MOUs with partners.

SECTION 4: FIT WITH GPAF COMMUNITY PARTNERSHIP WINDOW4.1 CORE SUBJECT AREA - Please identify between one and three core project focus areas

(insert '1' for primary focus area; '2' for secondary focus area and; '3' for tertiary focus area)

Agriculture Health (general) 2

Appropriate Technology HIV/AIDS / Malaria / TB

Child Labour Housing

Climate Change Income Generation

Conflict / Peace building Justice

Core Labour Standards Land

Disability Livestock

Drugs Media

Education & Literacy Mental Health

Enterprise development Reproductive Health / FGM 1

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Environment Rural Livelihoods

Fisheries / Forestry Slavery / trafficking

Food Security Water & sanitation

Gender Violence against women/ girls/children

Governance

Other: (please specify)

4.2 Which of the Millennium Development Goals will your project aim to address? Please identify between one and three MDGs in order of priority (insert '1' for primary MDG focus area; '2' for secondary MDG focus area and; '3' for tertiary MDG focus area)

1. Eradicate extreme poverty and hunger 3

2. Achieve universal primary education

3. Promote gender equality and empower women

4. Reduce child mortality 2

5. Improve Maternal Health 1

6. Combat HIV/AIDS, malaria and other diseases

7. Ensure environmental sustainability

8. Develop a global partnership for development

4.3 Explain why you are focusing on these specific MDGs.Are the above MDGs “off track” in the implementing countries? If possible please identify sub-targets within not just the national context but also related to the specific geographical location for the proposed project. Please state the source of the information you are using to determine whether or not they are “off track”. Your response should also inform section 5.3.

The project focuses on MDGs 4 and 5 and the wider impact will also address MDG 1. Malawi is one of only two sub Saharan African countries on track to meet MDG 4. However, infant mortality, at 66 per 1,000 live births (DHS 2010) is high and neonatal deaths (first 28 days of life) are an increasing proportion of under five deaths (currently 40%). With a national Neonatal Mortality Rate (NMR) of 31 per 1,000 live births (DHS 2010, no district level data) addressing newborn survival is critical for achieving MDG 4 (Zimba et al, 2012). With a national Maternal Mortality Ratio (MMR) of 675 per 100,000 live births (DHS, 2010) and lifetime risk of maternal death at 1 in 36 (Countdown 2015), Malawi stands little chance of reaching the MDG 5 target of 155 by 2015. The situation is particularly acute in Nkhotakota where the MMR is a staggering 806 (District Profile, 2010). Ranking at 160 out of 182 countries on the Human Development Index, Malawi is off track to meet MDG 1. With a GDP of $290 per capita, more than 1 in 5 people in Malawi live in ultra poverty. The poverty rate in Nkhotakota at 65% (District Development Plan, 2010-2013) reflects the national average. High maternal and neonatal mortality ratios and low child survival are in the top three development issues in the district (Nkhotakota District Council Social Economic Profile, 2010).

4.4 Please list any of the DFID’s standard output and outcome indicators that this fund will contribute to? Please refer to the DFID Standard Indicators document on the GPAF website. Please note that if you are using the standard indicators, these also need to be explicit in your logframe.

Outcome indicators: Proportion of births attended by skilled health personnel; Proportion of women who attended post natal care within 7 days.Output indicators: Percentage of birth assisted by skilled attendant; Women attended four times for antenatal care during pregnancy; Proportion of women attended ANC in the first trimester; Proportion of high risk pregnant women delivering at appropriate facility; Proportion of women attended the

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recommended PNC; Advocacy capacity of MaiKhanda built; MOH MNH policies implemented.

SECTION 5: PROJECT DETAILS5.1 PROJECT SUMMARY: maximum 5 lines - Please provide a brief and clear project summary

including the overall change(s) that the initiative is intending to achieve, why it is considered to be innovative and who will benefit. (This is for dissemination about the fund and should relate to the outcome statement in the logframe. Please avoid jargon).

WCF and MaiKhanda will empower rural women to access quality maternal and newborn health services in Nkhotakota, Malawi. Direct beneficiaries are 52,976 women and 11,517 newborns. Our innovation is to combine evidence that mobilising communities reduces maternal and newborn mortality with MaiKhanda’s experience that facilitating community/facility dialogue and communities and holding healthcare providers accountable can improve maternal and newborn health services.

5.2 PROJECT DESIGN PROCESSDescribe the process of preparing this project proposal. Who has been involved in the process and over what period of time? Were representatives of the target group consulted, and if so, how? If a consultant or anyone from outside the lead organisation and partners assisted in the preparation of this proposal please describe the type of assistance provided.

Having worked together since 2006, WCF and MaiKhanda have been planning this project since early 2012, jointly drafting the concept note in 2012 and final project proposal in early 2013. An up to date and thorough community consultation was conducted in March 2013 by MaiKhanda’s Community Programme Manager. This entailed visiting Nkhotakota to better understand and assess the current demographics and maternal and newborn health situation in the district. The visit included discussions at Nkhotakota district hospital, Nkhotakota district assembly office, TA Mwadzama, Mtosa health centre, and the maternity wing of the district hospital, as well as interviewing HSAs, and conducting focus group discussions with the community, including the Health Advisory Committee, with the support of a group of village heads. The proposal was written by WCF’s Head of Policy and Advocacy and MaiKhanda’s Director, Community Programme Manager and Finance and Administration Manager during a WCF visit to Malawi in March 2013. The proposal was reviewed by WCF’s Chief Executive and Finance Manager and WCF’s MNH consultant in Malawi.

5.3 PROJECT CONTEXT / PROBLEM STATEMENTDescribe the context for this project. What specific aspects of poverty is the project aiming to address? Why have these particular project locations been selected and at this particular time? What gaps in service delivery have been identified that necessitate the intervention that you are proposing?

The project addresses the direct link between maternal and neonatal health and poverty. Each year, emergency health spending pushes 100 million people into poverty. Poor health prevents many more from getting an education or working, meaning they are unable to fulfil their potential and to contribute to and benefit from economic growth. According to WHO estimates, maternal and newborn mortality will cost over $15 billion in lost productivity globally in 2013. The project will be located in the central region of Malawi in Nkhotakota district (estimated population 345,495 (2013)) and will serve a population of 230,330. The district has a very high total fertility rate (7.5 compared to the national average of 6, DHS, 2010). There are 21 health facilities (10 public health centres, seven private health centres including CHAM facilities, one government district and one government rural hospital, and two CHAM rural hospitals). There is a shortage of health workers and supplies, frontline staff skills are poor and referral systems ineffective. The location has been selected because: 1. High maternal and neonatal mortality ratios and low child survival are in the top three main development issues prioritised by the district (Nkhotakota District Council Social Economic Profile, 2010). Maternal and newborn health service use is very low - ANC in the first trimester is 5.4% (12.4% nationally); delivery by skilled personnel is 61% (71%) and post natal checks are 9% (32%); 2. The district management team and community representatives have requested support from MaiKhanda; 3.

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MaiKhanda can apply existing evidence, knowledge of the region and MNH programme expertise to launch an effective new project and establish a model which has been shown to be effective in improving MNH in the central region with minimal start-up costs and learning curve; 4. MaiKhanda already has strong working relations with the DHO; 5. Very few stakeholders are present in the project area and no other stakeholder is mobilising communities to improve MNH. We propose to address major gaps in the demand for ANC and PNC services and institutional deliveries in the four (out of a total of six) neediest TAs of Nkhotakota district.

5.4 ANTICIPATED IMPACT ON POVERTY (within the lifetime of the project)Please describe the anticipated real and practical impact of the project in terms of poverty reduction. What changes are anticipated for the main target groups identified in 5.5 within the lifetime of the project?

Our theory of change is rooted in the “three delays” model - 1: Delay in seeking medical care; 2: Delay in reaching a medical facility; 3: Delay in receiving appropriate treatment at the facility (Thaddeus & Maine, 1994). This project will directly improve the health and survival chances of women of reproductive age and newborns in Nkhotakota and indirectly contribute to increased potential for income generation, educational opportunity and gender equality. Change will be achieved by 1. Creating demand and reducing delays in deciding to seek MNH care through community mobilisation (women’s groups); and 2. Reducing delays in identifying and reaching appropriate health facilities (for ANC, PNC and delivery) by community/health facility links through safe motherhood task forces. Key drivers in achieving this change are empowered women, empowered and proactive men, supportive communities and effective communication with health facilities. The approach this project is based on has been tested and results published by MaiKhanda and other WCF partners in Africa and Asia. It shows increased community confidence and solidarity, particularly among women who learn to mobilise and change behaviour through devising and delivering their own strategies to meet their priority MNH needs. Strategies include income generation and improving nutrition which address specific causes and results of extreme poverty. The approach has achieved significant reductions in maternal and newborn mortality, up to 55% and 45% respectively (Prost et al, pending, the Lancet); (Tripathy et al, 2010 The Lancet). The women’s groups approach can improve MNH and reduce mortality by increasing institutional deliveries but can also achieve impact without a significant increase in skilled attendance (Prost et al. 2013) - where mortality rates are high changes in behaviour at community level – e.g. thermal care of the newborn - can make a big difference. Based on MaiKhanda’s experience with safe motherhood taskforces we anticipate the community will be better placed to access MNH services through strengthened linkages with healthcare facilities (transport, communication, referrals) and, by working with government staff, that these improvements can be sustained. Predicting impact of the advocacy component is difficult, but we will build MaiKhanda and community’s capacity to advocate more strategically. Community capacity to collect data and use this to advocate for the implementation of Government of Malawi (GOM) MNH policies will be enhanced.

5.5 TARGET GROUP (DIRECT AND INDIRECT BENEFICIARIES)Who will be the direct beneficiaries of your project and how many will be expected to benefit directly from the anticipated poverty-reducing changes within the lifetime of the project? Please describe the direct beneficiary group(s) under a) below, differentiate where possible and provide numbers for each sub-category and then provide a total number in b).

DIRECT: a) Description Women of Reproductive Age; neonates

b) Number 52,976; 11,517

Who will be the indirect (wider) beneficiaries of your project and how many will benefit within the lifetime of the project? Please describe the indirect beneficiary group(s) and numbers on each category under a) and then provide a total number in b).

INDIRECT: a) Description Direct number of Women of Reproductive Age x 2 (for each woman attending a group 2 more benefit from the messaging)

b) Number 105,952

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5.6 PROJECT APPROACH / METHODOLOGYPlease provide details on the project approach (or methodology) proposed to address the problem(s) you have defined in section 5.3. Please justify the timeframe and scope of your project and ensure that the narrative relates to the logframe and budget. If this project is based on similar project experience, please describe the outcomes achieved and the specific lessons learned that have informed this proposal.

The project is adapted from a cluster randomised controlled trial (RCT) implemented by MaiKhanda with technical support from WCF and evaluated by UCL’s Institute for Global Health (IGH). The RCT focused on a community (women’s groups) and facility based intervention implemented in the central districts of Salima, Kasungu and Lilongwe to reduce perinatal, neonatal and maternal mortality. The community mobilisation intervention is believed to be the largest in Africa. The RCT demonstrated that the community intervention averted 951 perinatal deaths and reduced perinatal mortality by 16%. (Colbourn et al, pending International Health). It was not possible to demonstrate statistically significant decreases in MMR at population level but maternal deaths in the project area did decrease. A UCL meta analysis of seven women’s groups trials in Africa and Asia (including Malawi) shows a 55% reduction in maternal mortality where at least 30% of pregnant women participated in groups (Prost et al, op cit). The approach builds the capacities of communities to organise and mobilise to take individual, group and community action to address the structural (e.g. educational status, gender), and intermediary (i.e. material or psychosocial circumstances or behavioural and biological factors) determinants of health. The evidence suggests that using participatory women’s groups as a community engagement strategy for MNH alongside other evidence based strategies, such as home visits, could influence both the demand and supply sides of healthcare (Prost, ibid.).Key findings from the MaiKhanda-WCF RCT include: 1. Health centres were severely under resourced in terms of basic emergency obstetric care and human resources; 2. Hospital deliveries increased by as much as 30% (from around 45% to 75%) – however, this increase coincided with a change in MOH policy which banned the use of TBAs and encouraged delivery at healthcare facilities, but without any concomitant increase in staffing and other resources to meet this major additional demand; 3. The effect on MNH and mortality is highly cost effective according to WHO criteria (see section 5.11).Lesson learned include: 1. Specific targeting of women of reproductive age and pregnant women is essential; 2. Optimal coverage for women’s groups to be effective in reducing neonatal mortality is one women’s group per 450-750 population; 3. It is important for newly married and newly pregnant women to join the groups; 4. Income generating partnerships and emergency funds appear to be the glue that keeps women’s groups and communities working together after project implementation; 5. Safe motherhood taskforces can successfully encourage women to attend health facilities for ANC, PNC and delivery as well as follow up high risk pregnant women (identified at ANC); 6. Advocacy is needed to press for MOH MNH policy implementation especially regarding the shortage of skilled birth attendants; 7. Volunteer safe motherhood taskforce members and HSAs working together can ensure integration within the existing health system and full community ownership. 8. Learning from another WCF partner in Ntcheu Malawi demonstrated that using HSAs to run women’s groups is effective and group facilitation is now included in the MOH HSA training curriculum.We propose a three pronged approach which encompasses: a) a scientifically proven evidence base that mobilising through women’s groups can increase community participation and improve MNH ; b) MaiKhanda’s community-facility linkage approach using safe motherhood taskforces to strengthen community leadership and improve community-facility communication and c) WCF’s strong advocacy expertise to build MaiKhanda’s capacity to use evidence generated by the project to advocate and bring learning, community voices and best practice to key influencers and hold decision makers to account - all of which will contribute to reductions in maternal and neonatal death rates (as above).Output one: 300 women's groups empowered to recognise and address MNH challenges and access appropriate care Facilitated by 200 HSAs and mobilising communities by using a participatory, learning and action (PLA) cycle methodology 300 women’s groups (25 to 35 women per group, with a coverage of one women’s group per 750 population) will meet monthly to identify MNH problems, needs and priorities; plan and implement strategies to address these problems; and self-evaluate their

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strategies. We will target women of reproductive age and pregnant women but groups are open to men as male involvement is vital to success. The groups discuss danger signs and raise community-wide support for MNH. Example strategies to improve MNH outcomes include: bicycle ambulances, health education, vegetable gardens and use of treated bed nets. Activities include training HSAs in women’s group formation, facilitation and Community Based Management of Maternal and Newborn Health (CBMMNH), conducting community sensitisation meetings and MNH community open days.Output two: Capacity of 200 safe motherhood taskforces built to link communities and health facilitiesSafe motherhood taskforces consisting of male and female village heads, HSAs and other community representatives will sensitise the community on MNH, track and mobilise pregnant women (especially those with high risk pregnancies) to go for ANC and PNC and deliver at facilities; link with health service providers, including engaging in advocacy to hold service providers to account. Activities include training HSAs in CBMMNH, forming and running the safe motherhood taskforces, tracking and following up (high risk) pregnant women through home visits, establishing linkages with health facilities in line with local requirements and participating in community open days.Output three: Community capacity to advocate for available and good quality MNH services builtWCF will build MaiKhanda’s advocacy capacity to ensure that evidence generated in the project, including best practice and community voices, targets decision makers and that they are held to account. This will include taskforces collecting community level data on the availability of and access to MNH services. Activities include WCF training and supporting MaiKhanda to develop and implement an advocacy strategy and develop and use advocacy materials; MaiKhanda staff will train and support the safe motherhood taskforces to advocate to health facilities at the district level (and HCs through Health Advisory Committees; participating in community, district and/ or national MNH forums and technical working groups, and organising project dissemination events towards the end of the project. MaiKhanda has already defined and documented its approach and developed materials for community action cycles to be completed in two years so we anticipate that 31 months will provide adequate time to set up in a new district and conduct all necessary activities with optimum population coverage (around one group:750 population) as well as an external independent evaluation in the final quarter. The existing MaiKhanda management and M&E systems will reduce start up time and costs.

5.7 SUSTAINABILITY OF BENEFITSHow will you ensure that the poverty reduction benefits for the beneficiary population will be sustained?

Sustainability is integral to project design and exit strategies which build on learning in Malawi are in place. The community and TAs were consulted regarding the community needs and appropriate ways to address them to ensure buy-in and ownership. We anticipate that this vital ownership by traditional leaders may also result in much longer term inter-generational benefits as they have a role in defining community norms. Output one - PLA methodology ensures the challenges and solutions are identified and owned by the communities themselves. Evidence from a WCF partner in Nepal demonstrates that 75% of the women’s groups continue to function uo to five years after external funding has ceased. MaiKhanda has also observed that six months after funding ceased for women’s groups in Kasungu and Lilongwe the women’s groups are still meeting. Inter-generational change has also been noted by beneficiaries in Malawi. Devising strategies for reaching health facilities and establishing village funds (which women’s groups normally do) appear to be important mechanisms for sustaining post-project activities and benefits. We anticipate greater sustainability by working with government HSAs rather than paying incentives to community volunteers as they will continue their work in the villages under MOH supervision. Output two - we anticipate that the community will be more likely to continue to access MNH services on a longer term basis as strengthened linkages and communication with healthcare providers will have increased their confidence in using facilities. By working closely with facilities and staff to improve community/facility communication, we predict that these improvements can be sustained. Output three will combine opening a channel for community leaders to press for improved MNH services and hold service providers to account with a more strategic approach contributing to the implementation of GOM’s MNH policies and ensuring that lessons learnt are shared with decision makers. Directly addressing policy ensures potential for long term impact sustainability.

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5.8 SCALING-UP AND REPLICABILITYWhat is the potential for future continuation, replication or larger-scale implementation of the proposed intervention? Please provide details of any ways in which you see this initiative leading to accessing other funding or being scaled up by others in the future. Describe how and when this may occur and the factors that would make this more or less likely.

The model proposed is based on a methodology that has already been adapted and tested for scale up and achieved significant results in Bangladesh and India. MaiKhanda itself has implemented the approach at scale in Malawi with 802 women’s groups in three districts. The evidence suggests that the optimal coverage of one women’s group per 450 to 750 population can result in reductions in neonatal mortality of around one third and 55% for maternal deaths (where at least 30% of pregnant women participate in the women’s groups) (Prost op cit). It is plausible that, even with adequate coverage of pregnant women, effects at scale would be smaller than those seen in the studies cited above which were largely high coverage interventions (ibid.). We estimate that for every woman who attends a women’s group another two will also benefit through word of mouth communication within the community. When extrapolated to rural areas of Countdown 2015 countries, the overall impact of the women’s group’s intervention compares well to others and could save many lives (ibid.). We aim to support the DHO in taking up the safe motherhood taskforce element of the project because it is based on a two way linkage system between the communities and facilities. There is a high likelihood of success because interest has already been expressed during the various community consultations. In the meantime MaiKhanda is working with NGOs such as Care in Kasungu and Lilongwe to support them to implement and scale up this approach. The advocacy element of the project will prepare MaiKhanda and the communities to input into the development of the 2016 Road Map and district implementation plans. Funding is also being sought to complement this project by working in the remaining two TAs in Nkhotakota as well as health facilities across the district (WCF concept note pending with the Big Lottery Fund for a project to start in early 2014).

5.9 CAPACITY BUILDING, EMPOWERMENT & ADVOCACYIf your project includes capacity building, empowerment and/or advocacy components, please explain how these elements will contribute to the achievement of the project's outcome and outputs? Please also refer to the Additional guidance for GPAF Initiatives focused on Empowerment & Accountability

This project builds the capacity of communities to organise and mobilise to take individual, group and community action to address the structural and intermediary determinants of health. Capacity building, empowerment and advocacy are all central to the project, addressing the elements of choice, challenge and change. Output one directly focuses on empowering women (in groups) to recognise and address MNH challenges and access appropriate care. The women are provided with relevant information so that they can make individual informed decisions regarding the importance of attending all four recommended ANC visits and PNC; birth preparedness including good nutrition; how, why and where to deliver at a health facility; and how to engage wider male and family support. The anticipated increase in demand will improve MNH through the following behaviour change: more institutional deliveries; improved immediate postnatal care at home (including higher breast feeding rates and improved thermal care of the newborn and hygienic cord care). Output two will strengthen community capacity (through a group) to challenge and claim their rights and entitlements and ensure that decision makers are held accountable. The safe motherhood taskforces play multiple roles including communicating changes in government policy (e.g. the abolition of home births) to communities; identifying and following up pregnant women who are eligible for ANC and PNC; supporting high risk pregnant women to deliver in an appropriate facility; meeting health care providers monthly to hold them to account for services provided to the community; collecting community data on the number of pregnancies, high risk women and institutional deliveries for use in maternal and newborn death audits and to track the implementation of government policy. Output three will build community capacity to advocate for available and good quality MNH services, challenging the current situation where MNH policies exist but they are not implemented adequately. The project will lead to more

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active citizen participation by building MaiKhanda’s organisational capacity to advocate and MaiKhanda will, in turn, train and support the safe motherhood taskforces to advocate. This will include ensuring that evidence generated in the project, including best practice, community voices and community data, target decision makers.5.10 GENDER AND SOCIAL INCLUSION

How was the specific target group selected and how are you defining social differentiation and addressing any barriers to inclusion which exist in the location(s) where you are working? Please be specific in relation to gender, age, disability, HIV/AIDs and other relevant categories depending on the context (e.g. caste, ethnicity etc.). How does the project take these factors into account?

Malawi ranks 120 out of 136 countries in the Gender Inequality Index and MDG 3 is off track. Women work longer hours than men, earn less, receive less education, are subject to high levels of domestic violence, are more at risk from HIV and have limited access to resources and decision making (DFID, 2013). We will target poor, rural women of reproductive age (WRA) (15-49 years) and especially those who are pregnant. We will empower WRA to address their own MNH challenges because they are directly affected by poor maternal and newborn health. A key predictor of project impact is the proportion of pregnant women participating in the groups so we will aim to ensure that 30% of group members are pregnant. Evidence from Asia also indicates that working with women’s groups successfully reaches the most marginalised and excluded in the community (Houweling et al, 2013). The community consultation process has addressed the following:1. Gender – The initial community sensitisation meetings, during the project start up phase, will

involve key male and female community leaders. This is essential to ensure buy-in to the project and ensure that where necessary women are permitted to attend by male relatives (particularly husbands). Some of the women’s groups will be facilitated by male HSAs and the women’s groups are also open to men when MNH problems and solutions are shared. This is an essential part of the process because men are often key to implementing the solutions e.g. they will ride the bicycle ambulance. The safe motherhood taskforces will also consist of male and female members.

2. Age – Mothers-in-law and older women can act as a barrier to younger women attending and/ or participating fully in the women’s groups. To address this MaiKhanda has developed a system of “secret mothers” who work specifically with younger women one-to-one and encourage older women to engage with younger group mothers. The safe motherhood taskforces are open to all ages with the community selecting the most appropriate membership.

3. Class – the members of the women’s groups and safe motherhood taskforces are from the same community so there is little class differentiation. Differentiation has only occurred when a chief’s wife is involved. She may expect to play a more significant role e.g. as chair person. These rare instances are an opportunity as she has a direct line to the chief and is therefore very influential.

4. Disability – women’s groups are open to all, including disabled women in the community, who are particularly encouraged to attend. Where a disability could prevent a woman leaving the home women’s group and safe motherhood taskforce members conduct home visits and provide them with the required support. Reproductive morbidities such as a prolapsed uterus are addressed directly by the women’s groups and women are encouraged to go to a health facility to access treatment for their disabilities where possible.

5. HIV/ AIDS – There is a very high HIV prevalence rate in Malawi, disproportionately affecting women and girls and MTCT is the leading cause of HIV infections in children. This MNH project is part of the PMTCT cascade and PMTCT information and messages will be included in the work of the women’s groups and safe motherhood taskforces. Where necessary women will be referred to HIV services such as Voluntary Counselling and Testing.

6. Cultural practices – In some areas improving MNH is hindered by cultural practices such as arranged and child marriages, initiation ceremonies (where adolescent girls must sleep with older men) and widow inheritance (chokolo). By working with the TAs we will provide them with information about the disadvantages of such practices, especially related to the spread of HIV. The safe motherhood taskforces play a key role in identifying and supporting high risk girls and women.

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5.11 VALUE FOR MONEY (VFM)Please explain why you believe that the proposed project would offer optimum value for money. How have you determined that the proposed approach is the most cost efficient way of addressing the identified problem? Please ensure that your completed proposal and logframe demonstrate the link between activities, outputs and outcome, and that the budget notes provide clear justifications for the inputs and budget estimates.

This project delivers value for money in the following ways:a. Economy – we will minimise the cost of inputs by: working with volunteers (safe motherhood

taskforce members) and government paid HSAs instead of paying voluntary facilitators incentives; taking a training of trainers approach (in CBMMNH and advocacy); minimising start up costs – MaiKhanda has already streamlined its management team, existing staff are familiar with this project methodology, and we will use pre-existing M&E systems; quotes for all capital purchases are obtained before purchase.

b. Efficiency – we will maximise the number of communities reached by: working with community volunteers (safe motherhood taskforce members) and HSAs while also providing the required coverage to achieve results; working with existing systems and building the capacity of the MOH; locating the project within the communities themselves; working with traditional leaders to develop and implement the project ensuring buy-in and community ownership; monitoring the women’s groups’ strategies and all pregnancies (especially those that are high risk) and disseminating learning and best practice from the project using appropriate methods.

c. Effectiveness - The effect on MNH and death rates is highly cost effective (i.e. incremental cost per neonatal death averted and life year saved). According to WHO-recommended standards, women’s groups practising participatory learning and action are a highly cost effective intervention in all settings in which they had a statistically significant impact on neonatal deaths (Prost et al., 2013). For Malawi, this was less than $5,400 per stillbirth or neonatal death averted and was therefore highly cost effective. The safe motherhood taskforce and advocacy elements of the project empower the communities to use the community MNH data collated to hold decision makers to account and demand better quality services.

5.12 COUNTRY STRATEGY(IES) AND POLICIESHow does this project support the achievement of DFID’s country or regional strategy objectives? How would this project support national government policies and plans related to poverty reduction or other key sectoral areas?

This project directly supports DFID’s Malawi country strategy especially related to the strong focus on girls and women, skilled birth attendance and increasing institutional deliveries. The empowerment focus of this project could also positively impact on non-MNH specific areas of DFID’s strategy such as direct assets to women and girls (improved hygiene); getting girls through secondary school (mother groups to support girls in school); preventing violence against girls and women (holding decision makers to account). This project approach is supported by the MOH at all levels. MaiKhanda has provided advice to the MOH on community mobilisation, and recent MOH policies demonstrate a commitment to community mobilisation and to health care improvement. The project activities are squarely aligned with the MOH Health Sector Strategic Plan (HSSP) (2011-2016) and strategy eight of the revised MOH Roadmap (2011-2016) focuses on community and facility linkage. Excellent lines of communication have already been established between MaiKhanda and all levels of the MOH and DHO. A key policy development of direct relevance to this project was the 2008 banning of TBAs. No provisions were made for alternative home–based delivery and women are actively encouraged to deliver at health facilities (women who do not can even be fined through by-laws set by some traditional leaders). This change in policy alone has resulted in increased deliveries in facilities (from around 45% to around 75%), with no corresponding increase in staffing or other resources, placing additional burden on already overstretched facilities. This project will also encourage women to deliver in facilities but we will address the availability and quality of care issue in our advocacy work and we are seeking funding from other sources for quality improvement at health facilities across the district.5.13 ENVIRONMENT

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Please specify what overall impact (positive, neutral or negative) the fund is likely to have on the environment. What steps have you taken to assess any potential environmental impact? Please note the severity of the impacts and how the project will mitigate any potentially negative effects.

The project is not expected to have negative environmental impacts. The project’s own carbon footprint will be minimised by use of electronic communications and data collection and locating the project team near to the communities. International travel will be minimal.

SECTION 6: PROJECT MANAGEMENT AND IMPLEMENTATION6.1 IMPLEMENTING PARTNERS

Please provide a list of all organisations to be involved in project implementation including overseas offices of the applicant and any partners starting with the main partner organisation(s). Please only include those partners that will be funded from the project budget. Please provide full details for each of the partners in section 9.

Women and Children First (UK) (WCF); MaiKhanda

6.2 PROJECT MANAGEMENTPlease outline the project implementation and management arrangements for this project.This should include: A clear description of the roles and responsibilities of the applicant organisation and each

of the partners. You must also provide an organogram (in a separate document) of the project staffing and partner management relationships.

A clear description of the added value of each organisation (including the applicant). An explanation of the human resources required (number of full-time equivalents, type,

skills, background, and gender).

WCF will be responsible for overall contract management and ensuring the project is delivered efficiently and effectively. WCF will provide support and technical assistance on project delivery and advocacy (including training). WCF will monitor project progress at a distance monthly and receive and check quarterly financial and narrative reports, processing financial claims and transferring funds in a timely fashion and providing feedback to MaiKhanda as appropriate. Monitoring visits will be carried out once a year. WCF will disseminate learning from the project in the UK and more widely. WCF will manage the final evaluation. WCF’s value added is to: provide design expertise; facilitate MaiKhanda’s understanding of DFID sector priorities and VFM; use its expertise to help develop advocacy strategy and messaging to influence MOH, civil society, multilateral organisations, think tanks and research bodies; provide guidance and support for the development of advocacy materials to be used for influencing; share cutting edge research and relevant learning from other WCF programmes and other leading practitioners in MNH to inform MaiKhanda’s delivery of the programme and own capacity development; and work with MaiKhanda to mitigate any risks to success encountered during project delivery. Human resource requirements are: 1 Programme Manager (0.20 FTE, existing role, female) – overall project management (including financial), technical assistance, advocacy training and support, reporting to DFID. Over 10 years experience managing policy and programmes in Africa and Asia. MSc in Development Studies; 1 Administrator (0.05 FTE, existing role, female) – administration associated with the project; 1 Accountant (0.02 FTE, existing role, female) – budgeting and financial reporting; 20+ years organisation and project accountingMaiKhanda will be responsible for overall project design and project execution, including recruitment and management of staff, coordination with other stakeholders and partners, implementation of project activities and reporting. MaiKhanda value-added: MaiKhanda will use its eight year partnership with the MOH, its relationship with the community, position on various technical working groups and excellent contacts to facilitate project coordination and implementation. MaiKhanda has experience of implementing women’s groups and safe motherhood task force interventions to deliver results and is well known locally for using a three pronged facility, community and advocacy approach.

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Human resource requirements are: 1 Director (0.05 FTE; existing role, male) – direction, support, advocacy, donor reporting. MPH, over 10 years experience; 1 Programme Officer (1 FTE; new role, female) – direct implementation, training of HSAs. Diploma in Community Development, over 3 years experience working with communities; 1 Project Support Officer (1 FTE, new role, female) – administration and logistical support, book keeping. Certificate in Business/ Secretarial studies/ financial accounting. At least 3 years experience; 1 Community Programme Manager (0.10 FTE; existing role, male) – overall management and oversight, technical assistance. MBA, over 10 years experience working on community interventions; 1 Advocacy Officer (1 FTE; new role, male) – training safe motherhood taskforces, advocacy material development, dissemination event organisation. Bachelor’s degree. Over 5 years experience in international development in Malawi; 1 M&E Officer (1 FTE; new role, male) – data collection and analysis. Diploma in community development. Over 3 years experience in data collection and data management; 1 Finance and Administration Manager (0.1 FTE; existing role, male) – financial reporting, budget monitoring, support for bookkeeping. Chartered accountant affiliated with ACCA. Experienced auditor. Over 5 years experience.

6.3 OTHER ACTORSInclude details of any other key stakeholders or collaborative partners who will have a role in the project (but will not be funded from the project budget). How does this intervention link to or integrate with other programmes especially those of other government agencies?

No other stakeholders work on MNH and with communities in this way in Nkhotakota. We recognise that it is essential to work with others in the project area, especially with the communities, who we consider an equal partner with a primary role in design and delivery. A key role of the project is ensuring that women’s group and safe motherhood taskforce members are aware of other stakeholders and the MNH services they offer. These include 1. the MOH, with whom we will work directly through HSAs. The taskforces will play a key role in linking the community with the government MNH facilities and strengthening existing systems; 2. local government – the TAs are under local government and key TA stakeholders have been involved in the community consultations and they will continue to play a key role in the community open days with the women’s groups and as safe motherhood taskforce members; 3. BLM is a private provider of family planning services; 4. SWAM provides HIV and AIDS services; 5. WMF provides basic medical care through outreach services to villages; 6. SSDI provides an essential health package with a community component which focuses on malaria and family planning. MaiKhanda will continue to operate through various technical working groups (on SRHR; Safe Motherhood subcommittee; HIV/ PMTCT) and with NGOs and international organisations including the following: BLM, Care, Engenderhealth, FPAM, Jhpiego, MaiMwana, PACHI, Perinatal Care Project, Presidential Initiative on Safe Motherhood, Save the Children, Uchembere network (safe motherhood), UNICEF, UNFPA, WHO, White Ribbon Alliance.

6.4 NEW SYSTEMS, STRUCTURES AND/OR STAFFINGPlease outline any new systems, structures and/or staffing that would be required to implement this project. Note that these also need to be considered when discussing sustainability and project timeframes.

The project will entail setting up a new district office in Nkhotakota with the following new staff positions: 1 Programme Officer (1 FTE) and 1 Project Support Officer (1 FTE). In the MaiKhanda head office in Lilongwe we will also require new staff: 1 Advocacy Officer (1 FTE) and 1 M&E Officer (1 FTE). An open and competitive recruitment process will be followed as per MaiKhanda policy. We anticipate a short project start up (max. 4 months) because existing staff are familiar with the project methodology and know there is a pool of appropriate candidates for the new positions above. It is anticipated new staff would be deployed on other MaiKhanda work in future.

SECTION 7: MONITORING, EVALUATION, LESSON LEARNINGThis section should clearly relate to the project logframe and the relevant sections of the budget. Please note that you will be required to undertake a project evaluation towards the end of the funding period to assess the impact of the fund. Please allow sufficient budget for monitoring and

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evaluation (M&E) and note the requirements for external and independent evaluation.7.1 How will the performance of the project be monitored? Who will be involved? What tools and

approaches are you intending to use? How will your logframe be used in M&E? What training is required for M&E? How will you involve beneficiaries and other stakeholders?

We will develop a results framework with indicators and milestones to monitor progress towards achieving the project outcomes. A baseline study will be carried out at inception. WCF, MaiKhanda, MOH and the community will jointly agree indicator targets. We will use MaiKhanda’s already developed “data dashboard” which captures process, outcome and financial measures to monitor performance. Results will be shared with the community and health facilities to identify areas for improvement. The M&E system will track output and outcome level indicators using quantitative and qualitative data collection methods – e.g. project staff will collect data on the number of training sessions and community meetings held and task forces will collect community level data such as the use of ANC and PNC services by women in their villages. Data will be triangulated with the HMIS when possible. Focus groups at institutional and community levels will identify MNH awareness, service quality etc. Case studies will be documented by project staff. Information on impact indicators will be collected from existing sources (HMIS) and reviewed in the baseline and final evaluation. WCF will monitor progress against indicators and milestones quarterly; ensure data are being collected in a timely, efficient fashion; carry out annual monitoring visits, including meeting project stakeholders; work with MaiKhanda to design the baseline and develop TORs for a final independent evaluation and collaboratively identify and engage suitable personnel to carry out these exercises. MaiKhanda will be responsible for operational monitoring. The Programme Officer will supervise the activities of the women’s groups through the HSAs, including the registers of meeting attendance, and will monitor performance against milestones using the logframe as above. The Community Programme Manager will conduct monthly field visits, prepare monthly and quarterly reports using the logframe and will conduct quarterly review meetings with the Programme Officer, safe motherhood taskforces, HSAs and MaiKhanda’s Director. The data collated will be used for community based monitoring by feeding back to the communities for decision making during monthly community meetings with the safe motherhood taskforces. This will enable community assessment of local performance and can be used to hold decision makers and service providers to account. No M&E training will be needed because existing staff are familiar with the M&E system. An experienced M&E Officer will be recruited.

7.2 Please use this section explain the budget allocated to M&E, and to demonstrate that there is adequate budget provision to support the M&E processes described in 7.1. The budget must include provision for an independent external evaluation.

The M&E budget covers running costs for the “dashboard” data collection system, travel for data collection purposes and data analysis. One full time M&E Officer will be employed which is the main M&E cost. The system will be used to collect most of the quantitative baseline and end line data. We anticipate that we can collect the data needed for a full baseline using the existing M&E system. The budget includes one annual monitoring trip by WCF to monitor progress towards outputs and outcomes, identify lessons learnt and support advocacy efforts (including conducting advocacy training in the first quarter). MaiKhanda senior staff will carry out operational M&E; a percentage of their time is budgeted. The final evaluation will de done by an external consultant and this has been budgeted for. Based on previous experience we believe the budget allocated to M&E will be sufficient.

7.3 How will lessons from your project be identified and learned, and disseminated to a wider audience? - Please explain how the learning from this project will be used within your organisation and disseminated to others.

Identifying and sharing lessons learnt is a key component particularly for advocacy. Lessons and key changes will be identified through community open days and testimonies. We will document case studies illustrating Nkhotakota specific MNH challenges and solutions. Learning will be disseminated to others at community open days; district and national level dissemination events in the final year of the project; using the WCF and MaiKhanda websites (www.womenandchildrenfirst.org.uk (www.maikhandatrust.org); we will produce a final evaluation report and disseminate this to key

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stakeholders including MOH; through the quarterly WCF newsletter; using the WCF Facebook and Twitter pages (@WCF_UK); through WCF partners in Africa and Asia; and where possible we will encourage local journalists to visit the project areas to generate media interest. Internally, lessons and learning will be shared at staff and board meetings (quarterly) for both MaiKhanda and WCF.

SECTION 8: PROJECT RISKS AND MITIGATION8.1 Please outline the main risks to the success of the project indicating if the potential impact and

probability of the risks are high, medium or low. How will these risks be monitored and mitigated? If the risks are outside your direct control, is there anything you can do to manage their potential effects? If relevant, this may include an assessment of the risk of engagement to local partners. The risk assessment for your programme needs to clearly differentiate the internal risks and those that are part of the external environment and over which you will have less (or little) control. (You may add extra rows if necessary.) (E=External, I=Internal)

Explanation of RiskPotential impact

High/Med/Low

ProbabilityHigh/

Med/Low

Mitigation measures

1. Community may not respond/ be interested in engaging E

High Low Develop the project in line with requests from the community.

2. HSAs and other health facility staff may be disinterested or disallowed from engaging with the project E

High Low Ensure HSAs and health service providers understand benefits and identify means to motivate them.

3. Increased demand cannot be met adequately at health facilities E

High Medium Advocate for improved quality services. Collect community level data to enable health facilities to respond better to community needs.

4. MaiKhanda staff turnover may be high. I

Medium Low Ensure adequate budget for recruitment, orientation, training and follow up.

5. MaiKhanda staff may be exposed to hostility from healthcare providers for advocating on behalf of communities I

Medium Low Ensure staff are well versed with messaging to justify their work

6. HSAs and safe motherhood taskforces do not implement training they receive I

High Low Monthly monitoring and follow up by MaiKhanda staff.

7. Unsuitable safe motherhood taskforce members are selected by the communities E

Medium Low Maximise opportunities through strong individual members.

8. Changes in the political environment to be less safe motherhood friendly E

Medium Medium Strengthen existing structures which will be in place despite political changes.

9. Seasonal and weather disruption e.g. flooding E

Medium Low Allow sufficient time to implement project activities accounting for scheduling changes

SECTION 9: CAPACITY OF ALL PARTNER ORGANISATIONS (Max 3 pages each)Please copy and fill in this section for each partner organisation identified in section 6.1

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9.1 Name of Organisation Women and Children First (UK)

9.2 Address United House, North Road, London, N7 9DP

9.3 Web Site www.womenandchildrenfirst.org

9.4 Registration or charity number (if applicable)

1085096

9.5 Annual Income (from latest set of approved accounts)

Income (original currency): £1,021,296Income (£ equivalent): N/AExchange rate: N/A

Start/end date of latest set of approved accounts (dd/mm/yyyy)

From: 01/01/2011To: 31/12/2011

9.6 Number of existing staff 4.5 FTE

9.7 Proposed project staffing staff to be employed under this project (specify the total full-time equivalents - FTE)

Existing staff Programmes Manager 0.2 FTEAdministrator 0.05 FTEAccountant 0.02 FTE

New staff None

9.8 Partner organisation category (Select a maximum of two categories)

Non-Government Org. (NGO) X Local Government

Trade Union National Government

Faith-based Organisation (FBO) Ethnic Minority Group or Organisation

Disabled Peoples’ Organisation (DPO) Diaspora Group or Organisation

Orgs. Working with Disabled People Academic Institution

Other... (please specify)

9.9 A) SUMMARY OF EXPECTED ROLES AND RESPONSIBILITIES ANDB) FUNDING AMOUNT RESPONSIBLE FOR

A): (i) Providing Technical Assistance to include: Facilitating MaiKhanda’s understanding of DFID sector priorities (RMNH) and how to deliver

VFM within the project Facilitating learning process, including and annual stakeholder consultation and development

of operations research, and ensuring learning is fed into plans for following project year Using its expertise to train MaiKhanda and provide ongoing support in advocacy and

development of related advocacy materials to influence decision makers Sharing relevant learning from other WCF programmes and other leading practitioners in

MNH to inform MaiKhanda’s delivery of the programme and own capacity development Working with MaiKhanda to mitigate any risks to success encountered during project delivery

(ii) Responsibility for overall contract management and project administration, including: Ensure the project is delivered as per proposal, log frame and budget Ensure reports are properly prepared and submitted to DFID in a timely fashion Process financial claims and transfer funds

B): Amount of budget allocated to WCF : £64,986

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Percentage of budget allocated to WCF : 26%9.10 EXPERIENCE: Please outline the experience of your partner in relation to their role and

responsibility in this fund (including technical issues and relevant geographical coverage)

WCF has managed 20 major donor funded international programme and advocacy contracts and has been engaged in international programmes with governments, NGOs and other stakeholders since 2002. Our work spans both the demand and supply side of health systems and MNH is one aspect of our technical repertoire.Programmes which demonstrate our expertise and successes on the demand side include: Improving maternal and newborn health in low income countries, India and Bangladesh:

2008-2013. The portfolio of projects in this strategic programme is working towards coverage of effective interventions in three districts in Bangladesh and two states in India and to influence maternal and child health policy and practice in Asia and Africa through international and national workshops with policymakers. WCF has led on the development a “Good Practice Guide” to facilitate spread and scale up of the women’s groups methodology by other actors which has been taken up by actors including NGOs, academic institutions and technical agencies in Asia, Africa and the Americas.

Improving maternal and newborn health through health system strengthening and community mobilization, Malawi: 2010 – 2015. In collaboration with the Directorate of Nursing Services at MOH Ntcheu, Malawi. 144 women’s groups have been led by Health Surveillance Assistants trained to facilitate the groups as part of their ongoing duties, thus ensuring a high level of sustainability. The local WCF project manager was successful in promoting HSAs running groups and group facilitation is now included in the MOH HSA training curriculum. The project has built the District Hospital’s capacity to collect data on maternal and newborn health which is now instrumental in hospital decision-making. A low cost population level data collection system has been established to support health service planning as well as an informal referral service to ensure the timely provision of skilled care. A high level of commitment has been gained from the Traditional Authorities in the district.

Improvement in the quality of maternal and newborn care, Malawi: 2006-2012. WCF provided technical assistance to the community intervention arm of this 6-year programme which combined community mobilisation with quality improvement (QI) in health facilities. 802 women’s groups led by volunteer community-based facilitators achieved a 16% reduction in perinatal mortality in community intervention (CI) areas and a 22% reduction in newborn mortality in areas where CI was coupled with QI.

Two programmes have also worked to improve care, make it more accessible and sustain outcomes on the supply side beyond the end of a funded programme: Improving maternal, newborn and child health for the poorest in Mumbai (India) through

promoting access to quality basic health services: 2010-2011. This DFID funded project improved the provision of basic health service delivery for women and children in slum areas in Mumbai. The project, delivered by SNEHA with technical support for project delivery, advocacy and communications provided by Women and Children First, facilitated scale up of the provision of free MNH services through health posts, established MNH referral systems across Mumbai, and improved MNH state policy and implementation through advocacy and communications.

Perinatal Training and Resource Centre, Nepal: 2002-05. In collaboration with the Nepal Training Institute, this project established a national Perinatal and Resource Training Centre in Kathmandu, developed training materials on safe motherhood and essential newborn care, and designed training courses for all cadres of staff approved by government. In addition, all cadres of staff in Makwanpur district were trained in safe motherhood and essential newborn care.

9.11 FUNDING HISTORY Please provide a brief summary of your partner(s) funding history.

Funding sources active over the last 12 months include: Big Lottery Fund - Strategic Grant, Improving maternal, newborn and child health in low-income

countries - £803,876 – 2008-2013 Comic Relief - Improving maternal, newborn and child health – £387,945 – 2010-2013

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Comic Relief - Organisation Development Grant (UK) – £39,160 – 2011-2012 Comic Relief - Planning Grant (Ethiopia) – £53,338 – 2012 UNFPA - WCF’s UK advocacy work - $10,000 - 2012 Conservation Food and Health - Jut: Increasing the update of family planning in Mumbai’s slums -

$50,000 – 2012-2013 The Health Foundation - Improving Maternal and Newborn Health, Malawi - £42,000 for TA

provision - 2007-2012 Ernest Kleinwort Charitable Trust - Unrestricted funding - £25,000 - 12 months from May 20129.12 CHILD PROTECTION (funds working with children and youth (0-18 years) only)

What is this partner's capacity and experience in relation to child protection? How will you work with your partner(s) to ensure children are kept safe?

Not applicable for this project, but WCF has a Child Protection Policy, available on request.9.13 FRAUD: Has there been any incidence of any fraudulent activity in your partner organisation

within the last 5 years? How will you minimise the risk of fraudulent activity occurring?

No. Women and Children First has a comprehensive Financial Policy and Procedures Manual which has a comprehensive description of internal controls which are applied by the Finance Officer and monitored regularly by the Chief Executive. The Board’s Finance and Administration Committee has ultimate oversight over finance and administration arrangement. An operating budget is agreed by the Board at the beginning of each year and management accounts and a cash flow forecast, including information on use of restricted funds clearly set out per project, are prepared monthly. These are distributed to the Treasurer and other members of the Finance and Administration Committee who scrutinise them on receipt and meet quarterly to discuss any issues arising. The organisation is audited annually by a respected firm of auditors who are highly experienced in working with charities. Women and Children First also has an Anti-Bribery and Corruption Policy which is reflected in its MOUs with partners

SECTION 9: CAPACITY OF ALL PARTNER ORGANISATIONS (Max 3 pages each)Please copy and fill in this section for each partner organisation identified in section 6.19.1 Name of Organisation MaiKhanda Trust

9.2 Address MaiKhanda Trust, P/Bag B437, Lilongwe, MALAWI

9.3 Web Site www.maikhandatrust.org

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9.4 Registration or charity number (if applicable)

Not applicable

9.5 Annual Income (from latest set of approved accounts)

Income (original currency): MWK 352,377,572.69Income (£ equivalent): £ 592,957Exchange rate: £1 to MWK 594.27From: 01st March 2011To: 28th February 2012

9.6 Number of existing staff 23

9.7 Proposed project staffing staff to be employed under this project (specify the total full-time equivalents - FTE)

Existing staff 1 Director (0.05 FTE)1 Community Programme Manager (0.10 FTE)1 Finance and Administration Manager (0.1 FTE)

New staff 1 Programme Officer (1 FTE)1 Project Support Officer (1 FTE)1 Advocacy Officer (1 FTE)1 M&E Officer (1 FTE)

9.8 Partner organisation category (Select a maximum of two categories)

Non-Government Org. (NGO) X Local Government

Trade Union National Government

Faith-based Organisation (FBO) Ethnic Minority Group or Organisation

Disabled Peoples’ Organisation (DPO) Diaspora Group or Organisation

Orgs. Working with Disabled People Academic Institution

Other... (please specify)

9.9 A) SUMMARY OF EXPECTED ROLES AND RESPONSIBILITIES ANDB) FUNDING AMOUNT RESPONSIBLE FOR

A): MaiKhanda will be responsible for overall project design and project execution on the ground, including recruitment and management of staff, coordination with other stakeholders and partners, implementation of project activities and reporting. MaiKhanda will also ensure that the project is disseminated to all relevant stakeholders including advocating for further expansion into other vulnerable communities in the central region of Malawi.

B): Amount of budget allocated to MaiKhanda : £184,925 Percentage of budget allocated to MaiKhanda : 74%9.10 EXPERIENCE: Please outline the experience of your partner in relation to their role and

responsibility in this fund (including technical issues and relevant geographical coverage)

MaiKhanda (meaning “mother-baby” in Chichewa) is a Malawian NGO established in 2006 to deliver maternal and newborn health programmes in the Central Region of Malawi. MaiKhanda has become known in the Malawian health care community for its integrated approach that focuses on both the community and facility based aspects of improving maternal and neonatal health, particularly through community groups and safe motherhood safe motherhood taskforces. MaiKhanda has experience of implementing multi-year programmes that focus on women’s groups, safe motherhood taskforces and quality improvement in facilities. Having delivered an RCT, MaiKhanda has a robust monitoring and evaluation system in place and can produce and analyse results accurately. MaiKhanda’s Executive Director has an MPH and is a state registered nurse with over ten years international and national experience working on reproductive health, family planning, HIV and AIDS (including paediatric) and PMTCT, having served as PMTCT specialist with the Clinton Health Access Initiative.

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MaiKhanda has strong links with CDC, DFID, MOH (represented on the HIV/ PMTCT, Safe Motherhood, Sexual and Reproductive Health technical working groups), the National AIDS Commission, NAPHAM, UNICEF, USAID and excellent working relations with key stakeholders in Nkhotakota.9.11 FUNDING HISTORY Please provide a brief summary of your partner(s) funding history.

The Health Foundation - Implementation of community and facility MNH interventions in Lilongwe, Salima and Kasungu from 2007 – 2009 (£531,646)

The Health Foundation - Implementation of community and facility MNH interventions in Lilongwe, Salima and Kasungu from 2009 - 2012 (£2,842,763)

The Health Foundation - Implementation of community and facility interventions in Salima District from 2012-2015 (£1,000,000)

The Institute of Healthcare Improvement (IHI) - Bridging funds for quality improvement at Bwaila hospital and core activities from 2012- 2013 ($126, 262)

Elma Foundation - Funding to build capacity of MaiKhanda Trust to be able to support the Malawi Health System in its effort to improve maternal and neonatal outcomes in three districts in central Malawi from 2013-2016 ($1,250,000)

9.12 CHILD PROTECTION (funds working with children and youth (0-18 years) only)What is this partner's capacity and experience in relation to child protection? How will you work with your partner(s) to ensure children are kept safe?

Not applicable for this project. WCF is currently supporting MaiKhanda to develop an appropriate organisational child protection policy.9.13 FRAUD: Has there been any incidence of any fraudulent activity in your partner organisation

within the last 5 years? How will you minimise the risk of fraudulent activity occurring?

There has never been any incidence of fraudulent activity in the organisation. MaiKhanda hasFinance and Procurement guidelines which describe in detail internal financial and procurementcontrols which are applied by the Finance team and always monitored by the Executive Directorwho provides final authorization on any financial transactions. The MaiKhanda Board of Trusteeswhich has an accounts and audit expert has ultimate oversight over finance and procurementactivities. Annual budgets are developed by the team and approved by the board of trustees at thebeginning of each year and Senior Management provides financial reports to the board everyquarter.

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