proposal form round 7 - the global fund to fight aids, tuberculosis...

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PROPOSAL FORM – ROUND 7

The Global Fund to Fight AIDS, Tuberculosis and Malaria is issuing its Round 7 Call for Proposals for grant funding. This Proposal Form should be used by eligible applicants ('Applicants') to submit proposals to the Global Fund. Please read the accompanying Round 7 Guidelines for Proposals carefully before completing the Proposal Form.

Applicant Name Country Coordination Mechanism (CCM) - Pakistan

Country/countries Pakistan

Components included in this Proposal Form (Check each applicable box below)

HIV/AIDS1

Tuberculosis1

Malaria

Timetable: Round 7 Deadline for submission of proposals: 4 July 2007 Board consideration of recommended proposals: 14 - 16 November 2007

1 In contexts where HIV/AIDS is driving the tuberculosis epidemic, HIV/AIDS and/or tuberculosis components should include

collaborative tuberculosis/HIV activities. Different tuberculosis and HIV/AIDS activities are recommended for different epidemic states; for further information see the ‘WHO Interim policy on collaborative TB/HIV activities,’ available at http://www.who.int/tb/publications/tbhiv_interim_policy/en/.

Index

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PROPOSAL SECTIONS FOR COMPLETION BY ALL APPLICANTS Page

1. Proposal Overview...................................................................................1 2. Country Eligibility ....................................................................................8 3. Applicant Type and Proposal Eligibility

3A: Applicant Type (including rules on eligibility)............................13 3B: Proposal Endorsement ............................................................26

4. Component Section ...........................................32 and/or 68 and/or 103 5. Component Budget............................................59 and/or 94 and/or 128

REQUIRED ATTACHMENTS

A. Targets and Indicators Table (Complete a separate table for each component) B. Preliminary List of Pharmaceutical and other Health Products (Complete a separate

table for each component) C. Membership details of CCM, Sub-CCM or RCM (Complete once only) + Detailed Budget (Complete a separate detailed budget for each component) + Detailed Work plan (Complete a separate detailed workplan for each component)

A checklist of all annexes to be attached to the Proposal Form by an Applicant can be found at the end of sections 3 and 5 (per disease component) of the Proposal Form.

REFERENCE DOCUMENTS FOR APPLICANTS (These and other documents are available at http://www.theglobalfund.org/en/apply/call7/documents/) Country Coordinating Mechanisms: The Global Fund’s 'Revised Guidelines on the Purpose,

Structure and Composition of Country Coordinating Mechanisms and Requirements for Grant Eligibility' (CCM Guidelines)

'Clarifications on CCM Minimum Requirements – Round 7' Monitoring and Evaluation: Multi-Agency ‘Monitoring and Evaluation Toolkit’, Second

Edition, January 2006 (M&E Toolkit)

'M&E Systems Strengthening Tool', June 2006 Procurement and Supply Management: The Global Fund’s 'Guide to Writing a Procurement and

Supply Management Plan', January 2006

How to use this form

Round 7 Proposal Form_En iii

1. Before you start - Ensure that you have all documents that accompany this form:

• The Round 7 Guidelines for Proposals • A complete copy of this Proposal Form • A complete copy of Attachments A, B and C to this Proposal Form

2. Read the accompanying Round 7 Guidelines for Proposals before completing this Proposal Form. 3. Further guidance for completing specific sections is also included in the Proposal Form itself, printed

in blue italics. Where appropriate, indications are given as to the recommended maximum length of the answer.

4. To avoid duplication of effort, we recommend that you make maximum use of existing information

(e.g., national health sector development plans, national monitoring and evaluation frameworks, situation analyses of strengths and weaknesses of the existing responses to the disease(s), and documents written to report to the Global Fund on existing grants and/or work supported by other donors/funding agencies).

5. Complete the Checklists at the end of sections 3 and 5 of the Proposal Form to ensure that you

are submitting a fully complete application. 6. Attach all documents requested throughout the Proposal Form including a budget, work plan, and

all documents you are requested to annex to the proposal. 7. Consult our “Frequently Asked Questions” link:

http://www.theglobalfund.org/en/apply/call7/documents Important notes: 1. Some or all of the information submitted to the Global Fund by Applicants will be made

publicly available on the Global Fund website after the Board funding decision for Round 7. 2. The Global Fund Board is currently considering whether to post the evaluation forms

prepared by the Technical Review Panel during the proposal review process ('TRP' Review Forms') on the Global Fund website. If this decision is taken, the TRP Review Forms for all Round 7 proposals (both approved and unapproved) will be published on the Global Fund website after the Board funding decision for Round 7.

How to use this form

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WHAT IS DIFFERENT COMPARED TO ROUND 6? Amendments aimed at improving the ease of completing the Proposal Form include: 1. all CCM, Sub-CCM and RCM information needs (including the eligibility requirements) are

now with other 'Applicant Type' information in section 3A; 2. Section 4 has been re-ordered to better enable Applicants to describe the overall

strategy/country context, how the funding request harmonizes with other in-country actions, and then what will be achieved under this proposal;

3. Section 4 also requests detailed information on three key lessons learned arising from the

Technical Review Panel's review of Round 6 proposals. These are: (a) addressing the comments of the TRP from proposals not approved in prior Rounds (section

4.6.1) and attaching the relevant TRP review form(s); (b) explaining a Round 7 request for additional funding for the same key services covered by earlier

Global Fund grants, where there are large undisbursed amounts of money under those earlier grants, including unsigned Round 6 grants (section 4.6.4(a)); and

(c) describing how bottlenecks in performance experienced by Principal Recipients ('PR') who are

again nominated as PR for Round 7 have been addressed in the proposal; 4. Section 5 requests less complex budget details, responding to the comments of Applicants

and the Technical Review Panel in Round 6; 5. Attachment A (Targets and Indicators Table) has been prepared by disease. Applicants may

use the pre-filled list of potential indicators where relevant to their proposal, or overwrite the table; 6. Attachment B (Preliminary List of Pharmaceutical and other Health Products) has been

prepared in Microsoft Excel to assist Applicants to identify key information about products, their pricing and intended suppliers. Again, it has been prepared by disease; and

7. Contact details and proposal endorsement signatures for CCM, Sub-CCM and RCM

Applicants are now located in a new Attachment C. This is to facilitate an automatic upload of this material into our data base to ensure that we have current contact details accurately displayed on the Global Fund website.

Health Systems Strengthening – Round 7

As in Round 6, there are no separate health systems strengthening (HSS) component in Round 7.

Applicants should request funding support for HSS on a per disease component basis within the disease specific sections of this proposal (section 4 and 5). Applicants are very strongly encouraged to review the Round 7 Guidelines for Proposal (sections 4.4 and 4.5) and this Proposal Form (introduction in section 4.4) before they complete these sections.

1 Proposal Overview

Round 7 Proposal Form_En 1

1.1 General information on proposal

Applicant Type

Please check one of the boxes below, to indicate the type of applicant. For more information, please refer to the Guidelines for Proposals, section 1.1 and 3A.

National Country Coordinating Mechanism

Sub-national Country Coordinating Mechanism

Regional Coordinating Mechanism (including small island developing states)

Regional Organization

Non-Country Coordinating Mechanism Applicant

Proposal component(s) and title(s)

Please check the appropriate box or boxes below, to indicate component(s) included within your proposal. Also specify the title for each proposal component. For more information, please refer to the Guidelines for Proposals, section 1.1.

Component Title

HIV/AIDS2 “Targeted HIV and AIDS prevention, treatment and care services for street based injecting drug users and associated risk networks across Pakistan.”

Tuberculosis2 “Bridging the gap for TB Treatment”

Malaria “To reduce the prevalence of Malaria in highly endemic districts of Pakistan”

Currency in which the Proposal is submitted

Please check only one box below. Please note that you must use this same currency throughout the whole Proposal Form (that is, for all components for which funding is sought). It will be assumed that all financial amounts indicated in your whole proposal are in this one currency.

US$

Euro

2 In contexts where HIV/AIDS is driving the tuberculosis epidemic, HIV/AIDS and/or tuberculosis components should include

collaborative tuberculosis/HIV activities. Different tuberculosis and HIV/AIDS activities are recommended for different epidemic states; for further information see the ‘WHO Interim policy on collaborative TB/HIV activities,’ available at http://www.who.int/tb/publications/tbhiv_interim_policy/en/.

1 Proposal Overview


Summary of Technical Assistance Provided During Proposal Preparation

Please check the applicable box or boxes in the left hand column to indicate whether you received any technical assistance during preparation of this proposal for the sections set out below, and then in the other columns also indicate which organization(s) (if any) provided that assistance, and over what duration this was provided. Information on technical and management assistance to be obtained during the proposal term is requested in section 4.11.

Section/Component Name of organization or organizations providing assistance and type of assistance

provided

Duration of technical assistance

Sections 1 to 3B

HIV/AIDS component, and/or budget

WHO ( TA for proposal development consultant)

CIDA (International Peer Review Consultant)

10 Weeks

3 Weeks

Tuberculosis component, and/or budget

Malaria component, and/or budget

USAID , DFID & WHO ( TA for proposal & budget preparation) One Month

1.2 Proposal funding summary per component Funds requested for each component (i.e. HIV/AIDS, tuberculosis and/or malaria) in table 1.2 below must be the same as the totals of the corresponding budget summary by cost category in table 5.3 for each disease component. The currency in the table below must be the same currency as indicated in section 1.1 above.

Table 1.2 – Total funding summary

Total funds requested over proposal term Component

Year 1 Year 2 Year 3 Year 4 Year 5 Total

HIV/AIDS 7,712,699 9,698,694 10,443,529 11,210,929 12,111,538 51,177,389

Tuberculosis 10,241,745 4,376,034 3,309,554 3,591,374 3,729,286 25,247,993

Malaria 4,403,976 8,482,704 4,259,239 2,187,193 2,224,593 21,557,704

Total all components 22,358,420 22,557,432 18,012,322 16,989,496 18,065,417 97,983,086

1 Proposal Overview


1.3 Contact details for enquiries by the Global Fund Please provide full contact details for two persons who will be available and duly authorized to provide the Global Fund with responses to any questions about the whole Proposal Form after 4 July 2007 (that is, all of the components which are applied for and not on a disease by disease basis). This is necessary to ensure fast and responsive communication. These persons need to be readily accessible for technical or administrative clarification purposes, for a time period of approximately three months after the submission of the proposal.

Table 1.3 – Contact details for enquiries by the Global Fund

Contact Details for Enquiries on the Applicant's Proposal after Submission

Primary contact Secondary contact

Name Khushnood Akhtar Lashari Zarina Kauser

Title Federal Secretary Health Senior Project Officer (CCM)

Organization Public Sector, Ministry of Health CCM Pakistan

Mailing address Room No.113, Block-C, Pak Secretariat, Islamabad.

CCM Secretariat, 2nd Floor, Bewal Plaza, Fazal-e-Haq Road , Blue Area, Islamabad, Pakistan.

Telephone +92 (51) 9211622

+92 (51) 9201782

+92-333-5635617

+92-51-7107469

+92-51-9210662

Fax +92 (51) 9205481 +92-51-9210663

E-mail address [email protected] [email protected]

Alternate e-mail address [email protected] [email protected]

1 Proposal Overview


1.4 Overview Summary of the Applicant's Proposal

Provide a brief overview of the components included in this proposal and the main focus of the work to be undertaken. Applicants applying for more than one disease component should briefly refer to each component here, but provide a disease specific 'Executive Summary' in section 4.2 for each component. (Maximum length of this section is one page in total)

The Government of Pakistan’s commitment to the MDGs is fully reflected in Pakistan’s overall

development strategy as embodied in the Medium-Term Development Framework (2005-10) and Poverty

Reduction Strategy Paper (PRSP). Three out of eight Millennium Development Goals are directly related

to health sector such as: reducing child mortality, improving maternal Health and combating HIV/AIDS,

TB, Malaria and other diseases. Apart from the socio-economic significance of health, a rights based

approach has remained an integral part of the Government’s overall policies. In this context, Pakistan’s

National Health Policy 2001 has pledged support for an overall national vision based on a “Health for All”

approach. Besides, the National Health Policy, Pakistan Poverty Reduction Strategy Paper and Vision

2030 (recently approved by the GOP), all recognize the need to substantially increase financing and to

enhance efficiency of spending through organizational and management reforms. All these policy

documents specially refer to the Government’s sustained and enhanced commitment for AIDS, TB and

Malaria.

Pakistan is currently facing the double burden of disease. Communicable diseases contribute 40% of the

total burden of disease in Pakistan. Whereas HIV / AIDS has emerged as a growing concern, Pakistan

contributes a major share to the global burden of TB and is designated ‘category 3’ in WHO EMRO’s

classification of malaria endemicity.

The HIV and AIDS epidemic in Pakistan is mainly driven by high-risk practices undertaken by street-

based injecting drug users (IDUs) due to high levels of needle and syringe sharing. The essential goal of

this proposal is “Expand the coverage and range of existing, comprehensive and specific interventions in

order to prevent the further transmission of HIV and to provide AIDS treatment and care services for

street based injecting drug users, their spouses and associated risk networks across Pakistan.” Pakistan

seeks to provide services to 30,000 street based IDUs, 8,000 spouses, and 33,000 people from the

associated risk networks.

Regular and uninterrupted supply of high quality TB drugs is one of the essential elements of DOTS. For

the past 3 years, a regular supply has been ensured through national resources (40%) and GDF support

(60%). Pakistan's TB proposal seeks to address the critical gap in the regular supply of anti TB medicine

emerging out of closure of GDF.

The malaria component aims to reduce malaria burden by 50% by 2012 in 19 high risk districts and tribal

agencies mostly located along the western border of Pakistan adjoining Afghanistan and Iran. The

1 Proposal Overview


proposal aims to build on the internal reform process undertaken in the implementation of the RBM

strategy and adopts global best practices with regard to prevention and treatment regimes.

All three disease components further strengthen the adopted policies of public-NGO partnerships, health

system improvement and focus on the poor, especially women and children.

1.5 Overview of rationale for multi-country proposal approach Only complete this section if your proposal targets more than one country. Importantly, the difference between a 'Regional Coordinating Mechanism' and 'Regional Organization' Applicant is explained in the Round 7 Guidelines for Proposals. Please refer to that material before completing this Proposal Form including, in particular, section 3A.4 (RCM), or 3A.5 (Regional Organization). The Global Fund is very supportive of proposals which respond to cross-border or multi-country issues which are most effectively addressed through a regional/multi-country proposal that has been developed in close consultation with in-country stakeholders from each of the countries included in the proposal. Preferably, the CCM of each country will have been involved in identification of relevant issues and the development of the multi-country response from an early time so that the CCMs and RCM or RO Applicants can agree which aspects are appropriate for a multi-country approach. In this section, please describe: (a) the common issue for these countries which presents a strong argument for a regional or cross-border

approach; (b) why a multi-country proposal will be more effective in responding to the issues presented than if each

CCM presented the same activities on a country by country basis; and (c) how the applicant (RCM or RO) worked with the CCM** of each country during the proposal

development process to ensure that the funding requested in this proposal does not merely replace existing financing, but contributes additional financing to increase the regions capacity to respond to the disease(s).

(**Where there is no CCM for a specific country included in the multi-country proposal because the country is a small island developing state, the applicant should describe how a broad cross-section of stakeholders were transparently and effectively consulted to ensure that there is broad in-country support and understanding of the multi-country approach in such countries).

Overview of rationale for multi-country approach (maximum one page)

N/A

1 Proposal Overview


1.6 Previous Global Fund grants/proposals recommended for funding For each component applied for in Round 7, please provide specific details of the amounts disbursed by the Global Fund and also expended under existing Global Fund grants (by Round) as at 31 March 2007. For more detailed information, see the Guidelines for Proposals, section 1.6. Combined HIV/TB grants from Rounds 1, 2 and/or 3, should be included in only the HIV/AIDS table below, or the TB table below.

Table 1.6.1 – Previous Global Fund HIV/AIDS financial support

HIV/AIDS

Total cumulative amount disbursed by

Global Fund under grants to Principal

Recipient(s) as at 31 March 2007

Total cumulative amount already

expended under prior Global Fund grants as

at 31 March 2007

[For RCM and RO applicants only]

List the countries included in the relevant proposal

Round 1

Round 2 6,403,075 4,319,635

Round 3

Round 4

Round 5

Round 6

Total 6,403,075 4,319,635

Table 1.6.2 – Previous Global Fund tuberculosis financial support

Tuberculosis






at 31 March 2007



Round 1

Round 2 2,456,237 2,294,498

Round 3 4,776,518 4,281,799

Round 4

Round 5

Round 6

Total 7,232,755 6,576,297

1 Proposal Overview


Table 1.6.3 – Previous Global Fund malaria financial support

Malaria






at 31 March 2007



Round 1

Round 2 3,537,802 3,270,301

Round 3 1,382,784 789,193

Round 4

Round 5

Round 6

Total 4,920,586 4,059,494

Table 1.6.4 – Previous Global Fund HSS and other financial support

HSS or Integrated






at 31 March 2007



Round 1

Main disease targeted

Round 2


Round 5


Total

2 Country Eligibility


Only those applications that meet all applicable eligibility criteria will be reviewed by the Technical Review Panel. These eligibility criteria are:

Section 2 – Country eligibility Section 3A – Applicant Type eligibility Section 3B – Proposal signature and endorsement

Country eligibility is a multi-step process that depends on World Bank’s classification of the income level of the country (or countries) targeted in the proposal at the time of the call for proposals (not the closing date). Please read through this section carefully and consult the Guidelines for Proposals, section 2, for further guidance on the steps to be followed by each Applicant. 2.1 Income Level Please check the appropriate box(es) in the table below for the relevant country (or countries for multi-country proposals only), and include the country name in the relevant box(es). Multi-country applicants (i.e., RCM or Regional Organization Applicants) see the Guidelines for Proposals, section 2.1 regarding eligibility of your proposal, and complete all relevant sections depending on the income levels for the respective countries.

World Bank classification of Income level of

countries/ economies included in proposal

Country/economy name(s)

(include the name of each country/economy and its relevant income level for multi-country proposals)

Low-income Pakistan Go straight to section 3A, Applicant Type

Lower-middle income Complete both sections

2.2 and 2.3, and then go to section 3A

Upper-middle income

Complete each of sections 2.2 and 2.3 and 2.4, and then go to section 3A



2.2 Counterpart financing and greater reliance on domestic resources Complete if any country/economy targeted in this proposal is classified as Lower-middle or Upper-middle income under the World Bank's classification of income level. 2.2.1 CCM and Sub-CCM Applicants The table should be completed for each component included in this proposal. For definitions and details of counterpart financing requirements, see the Guidelines for Proposals, section 2.2.1. Amounts included in line A and line B in the tables below should be in figures not percentages. Important notes: 1. The field “Total requested from the Global Fund” in tables 2.2.1(a) to (c) below must equal the budget

request in section 1.2, section 5 and the budget breakdown by cost category in table 5.3 for each corresponding component.

2. Non-CCM Applicants do not have to fulfill any counterpart financing requirement.

Table 2.2.1(a) – Counterpart financing HIV/AIDS

HIV/AIDS (same currency as selected in section 1.1) Financing sources Year 1 Year 2 Year 3

estimate Year 4

estimate Year 5

estimate

Total requested from the Global Fund in Round 7 (A) [from table 5.3]

N/A N/A N/A N/A N/A

Counterpart financing (B) [linked to the disease control program]

Counterpart financing as a percentage of total financing: [B/(A+B)] x 100 = %

% % % % %



Table 2.2.1(b) – Counterpart financing tuberculosis

Tuberculosis (same currency as selected in section 1.1) Financing sources Year 1 Year 2 Year 3

estimate Year 4

estimate Year 5

estimate


N/A



% % % % %

Table 2.2.1(c) – Counterpart financing malaria

Malaria (same currency as selected in section 1.1) Financing sources Year 1 Year 2 Year 3

estimate Year 4

estimate Year 5

estimate


N/A



% % % % %



2.2.2 Regional Coordinating Mechanism (RCM) and Regional Organization (RO) Applicants only

RCM and RO Applicants are required to demonstrate compliance with the Global Fund's minimum counterpart financing requirements for each Lower-middle income or Upper-middle income country/economy included in the RCM or RO application which is also eligible to apply in Round 7 in its own right. Eligible countries/economies are listed in Attachment 1 to the Guidelines for Proposals.

RCM and RO Applicants may either:

(a) Complete table 2.2.2 below and ensure that the CCM endorsements (required under section 3B.1.3 for RCMs, and 3B.2.1 for ROs) for each country/economy eligible in Round 7 include information by that country/economy on its counterpart financing levels;

If table 2.2.2 is completed, RCM and RO Applicants are reminded that the CCM

endorsement letter required under either section 3B.1.3 or 3B.2.1 must also include information validating that country/economy's counterpart financing level for the relevant disease.

OR

(b) Fully complete the applicable table(s) in section 2.2.1 above for each country/economy

listed as eligible in Round 7.

Table 2.2.2 – RCM or Regional Organization summary of Country/Economy Counterpart financing level

Country/Economy CCM Confirmed Counterpart

Financing – first year of proposal term **

CCM Confirmed Counterpart Financing – last year of

proposal term **

% %

% %

N/A %

% %

% %

** Note RCM and Regional Organization Applicants must show that each of the countries targeted in

this proposal are moving from:

(a) 10% to 20% counterpart financing over the proposal term if a Lower-middle income country; or (b) 20% to 40% counterpart financing over the proposal term if an Upper-middle income country.



2.3 Focus on poor or vulnerable populations All proposals which target Lower-middle income and/or Upper-middle income countries/economies (including multi-country proposals which include countries/economies other than Low-income countries/economies) must demonstrate a focus on poor or vulnerable population groups. Proposals may focus on both population groups but must predominantely focus on at least one of the two groups. Complete this section in respect of each disease component.

2.3 Describe which poor and/or vulnerable population groups your proposal is targeting; why and how these populations groups have been identified; how they were involved in proposal development and planning; and how they will be involved in implementing the proposal. (Maximum half a page per component).

N/A

2.4 Upper-middle income high disease burden minimum thresholds Proposals from Upper-middle income countries/economies must also demonstrate that they currently face a high national disease burden. Please complete the section(s) below relevant to each disease component included in your proposal. Please note that if the Applicant falls under the 'small island economy' lending eligibility exception as classified by the World Bank/International Development Association, this requirement does not apply (see section C in Annex 1 to the Guidelines for Proposals).

(a) HIV/AIDS Current High National Disease Burden

For Round 7, the Global Fund has determined that the only Upper-middle income countries which may apply for funding for HIV/AIDS (whether a single country proposal, or as part of a multi-country proposal) are Botswana, Equatorial Guinea and South Africa. (See the Guidelines for Proposals, section 2.4 for more information.)

(b) Tuberculosis Current High National Disease Burden

Confirm that the Upper-middle income country(ies) targeted in this proposal is(are) currently facing a high national disease burden, as defined by data from WHO.(See the Guidelines for Proposals, section 2.4 for more information on the definition of high disease burden.)

N/A

(c) ©Malaria Current High National Disease Burden

Confirm that the Upper-middle income country(ies) targeted in this proposal is(are) currently facing a high national disease burden, as defined by data from WHO. (See the Guidelines for Proposals, section 2.4 for more information on the definition of high disease burden.)

N/A

3A Applicant Type and Eligibility for Funding


This section requires all Applicants to: (a) Describe what type of applicant they are; and (b) Describe how they meet the minimum requirements to be eligible to submit a proposal. Throughout this section, Applicants are requested to attach documents to support the information summarized below. At the end of section 3B all Applicants must complete a ‘checklist’ to ensure that they attach all documents. All Coordinating Mechanism Applicants (whether CCM, Sub-CCM or RCM) and Regional Organizations must also complete section 3B of this Proposal Form and provide the documented evidence requested. Non-CCM Applicants do not complete section 3B. These Applicants must complete section 3A.6 of this Proposal Form and attach documentation supporting their claim to be considered as eligible for Global Fund support outside of a Coordinating Mechanism (whether CCM, Sub-CCM or RCM) structure. Confirmation of Applicant Type

Table 3A – Applicant Type

Please check the appropriate box in the table below. Then go to the relevant section in this Proposal Form as indicated on the right hand side of the table as this sets out the road map to fully complete section 3A and 3B.

National Country Coordinating Mechanism � Complete sections 3A.1 and 3A.4 and 3B.1

Sub-national Country Coordinating Mechanism � Complete sections 3A.2 and 3A.4 and 3B.1

Regional Coordinating Mechanism for multi-country proposals (including small island developing states)

� Complete sections 3A.3 and 3A.4 and 3B.1

Regional Organization for multi-country proposals � Complete section 3A.5 and 3B.2

Non-CCM Applicants for single country proposals only � Only complete section 3A.6

Importantly Each Applicant should only complete one version of the relevant sections set out above and not a new version for each disease component. Applicants should also only complete those sections set out in table 3A above that are indicated as relevant to their application to ensure that they do not expend unnecessary resources on completing sections that do not apply to them.



3A.1 National Country Coordinating Mechanism (CCM) Applicants For more information, please refer to the Guidelines for Proposals, section 3A.1, and the CCM Guidelines.

Table 3A.1 – National CCM: overview information

Name of CCM

Country Coordination Mechanism (CCM) Pakistan.

3A.1.1 Mode of operation

Describe how the national CCM operates. In particular:

(a) The extent to which the CCM acts as a functional partnership between government and other key stakeholders, including the academic and educational sector; non-government and community-based organizations; people living with and/or affected by the diseases and the organizations that support them; the private sector; religious and faith-based organizations; and multi-/bilateral development partners in-country; and

(b) How it coordinates its activities with other national structures tasked with responsibility for oversight and harmonization in regard to the disease(s) (such as National AIDS Councils, Parliamentary Health Commissions, National Monitoring and Evaluation Offices and other key bodies).

(For example, address topics including decision-making mechanisms and rules, constituency consultation processes, the structure and key focus of any sub-committees, frequency of meetings, implementation oversight processes, etc. The recommended length of response is a maximum of one page. Please provide a diagram setting out the interrelationships between all key actors in the country as an annex to this proposal. Please indicate the applicable annex number in your checklist to sections 1 to 3B before the start of section 4.)

(a) The extent to which the CCM acts as a functional partnership between government and other key stakeholders:

CCMs partnership role has been dully recognized by the Government of Pakistan. This is reflected in the

composition and structure of the CCM.

Federal Secretary Health is the CCM Chair and attends CCM meetings regularly in compliance of CCM

minimum Eligibility Criteria of the Global Fund. Its 29 CCM Members represent a wide diversity of

Government and Non Government sectors. It follows By Laws, which were adopted by CCM after a

consultative process. CCM Pakistan operates in line with the GF guidelines. CCM Secretariat acts as its

focal point and drafts agenda/s for CCM and varies other meetings which is circulated a week earlier to all

CCM Members and other stakeholders for their input and approval. This also ensures constituency

Consultation Process. Once the agenda is approved by the CCM Chair, CCM Secretariat provides

electronically all the reference materials related to agenda to members and other stakeholders. Since

2003 CCM and its sub committees have held meetings and has met on over 20 occasions. CCM

Secretariat has successfully circulated the minutes of meetings containing ist of discussions and decisions

taken are also circulated.

All the matters related to GF grants are discussed on forum. Quorum of 50% of voting members is



required to finalize and approve CCM decision(s) related to GF grants. The multi stake partnership is

reflected from the first step of advertising EOIs for GF grants through the entire proposal development

process, grant(s) allocation and implementation., the , and vote of majority is announced by the Chair

CCM. It is also assured that the taken decisions are in accordance with the CCM By Laws and in line with

the GF requirements including the constituency consultation process. It is clearly stated in CCM By Laws

that each sector represented on CCM has to provide both way constituency consultation. Once sufficient

funds are available, constituency consultation will be assured by arranging once a year meeting with

constituency of each sector represented on CCM forum. The CCM Pakistan has also constituted various

committees. The sub committees generally include members representing Public Sector, the development

partner(s) specializing in a requisite area and where necessary NGOs/Private Sector/Effected Person

constituency are also involved. The CCM Pakistan has constituted (a) CCM Core Committee which

deals with matters of urgent nature to recommend decisions on behalf of the grand CCM. (b) CCM Sub Committee Technical which looks in to technical aspects, especially impediments to right through the

proposal development process. (c) The CCM Monitoring & Evaluation Sub Committee which focuses on

oversight role over SRs and PRs to facilitate and support the programme implementation activities. (d) Special Committees are set up by CCM on temporary basis for specific purposes, like assessing and

recommending selection of PRs for Round-6 & also in Round-7. The reports of the various committees are

dully minuted and circulated among CCM members. Record shows enormous interest taken y Members in

commenting on such proceedings. Again CCM meetings are utilized for discussion on broader health

related issues among stakeholders especially related to inputs of bilateral and multilateral agencies and

development partners. Capacity around is on areas specially focused upon during discussion. ,

(b)

Oversight and Programme harmonization in the health sector are ensured by the Ministry of Health which

has a full fledge Planning and Development Section as well as a Technical Wing in place under Director

General Health. The Financial and Physical Progress of these programmes both with respect to Federal

projects and progress of districts based activities are monitored on a quarterly basis and reported to

Planning Commission where it is evaluated by Health Section reporting to Member Social Sector and an

Inspection and Monitoring Wing under Member (I&M). The impact of all activities in the country in

HIV/AIDS, TB and Malaria is critically examined by the Centre for Poverty Reduction with regard to MDG

indicators and reported to the Prime Minister. PC-Is are approved project documents generally require

independent /third party evaluations for important project. A key feature of harmonization is the bringing

together on CCM forum of Provincial level stakeholders in the proposal development process. A diagram

of inter-relation ship between key actors in this field is shown below. CCM’s role for M&E is acknowledged

as a useful impact in the above system through the CCM Chair/ Secretary Health. Planning Commission is

also represented on CCM. Government of Pakistan has agreed in principle to institutionalize the CCM role

in oversight and M&E an recognition of the utility of a forum composing national and international

stakeholders.

A PC-I is under formulation to provide additional funds for M&E activities for these programmes and in

consultations with the planning commission. Ministry of health calls for programmes presentations to

share the performance rate of each project. The programmes present overall progress which also includes



GF grants implementation status. In addition the annual and quarterly M&E plans of national programmes

HIV/AIDS, TB and Malaria also include GF grants component. National programmes i.e. Primary Health

Care (PHC) and other key bodies also conduct M&E as a whole also addressing the of GF component as

part of National Programme Implementation Strategy. Provincial Government Health Departments at

national level contributes to the exercise of programmatic and Budget Gap Analysis conducted for GF

proposals. Direct linkage has been created with Planning Commission of Pakistan which is the highest

level to approve and conduct M&E of development projects. The Planning Commission has agreed with

CCM. For development project plan (PC-I) has been formulated by MOH and submitted to planning

commission. This PC-I will strengthen and create direct linkage by providing addition funds for M&E on

public private partnership basis.

After completing this section, complete BOTH section 3A.4 AND section 3B.1.



3A.2 Sub-national Country Coordinating Mechanism (Sub-CCM) Applicants For more information, please refer to the Guidelines for Proposals, section 3A.2, and the CCM Guidelines.

Table 3A.2 – Sub-national CCM: overview information

Name of Sub-CCM

N/A


Describe how the Sub-CCM operates. In particular:

(a) The extent to which the Sub-CCM acts as a functional partnership at the strategic and implementation levels between government and other key stakeholders in the region in which the Sub-CCM operates, including the academic and educational sector; non-government and community-based organizations; people living with and/or affected by the disease(s) and the organizations that support them; the private sector; religious and faith-based organizations; multi-/bilateral development partners in-country;

(b) The process by which the Sub-CCM developed under the guidance of a functional CCM and how it became to be formally recognized by that CCM (Note: if there is evidence of a legal framework for the sub-national entity stating its autonomy please provide such evidence); and

(c) How the Sub-CCM coordinates its activities with other sub-national and national structures tasked with responsibility for oversight and harmonization in regard to the disease(s) (such as Regional and/or National AIDS Councils, Municipal, State or National Parliamentary Health Commissions, Regional and/or National Monitoring and Evaluation Offices and other key bodies).

(For example, address topics including decision-making mechanisms and rules, constituency consultation processes, the structure and key focus of any sub-committees, frequency of meetings, implementation oversight processes, etc. The recommended length of response is a maximum of one page. Please provide a diagram setting out the interrelationships between all key actors as an annex to this proposal including, in particular, the interrelationships with the National CCM. Please indicate the appropriate annex number in your checklist to sections 1 to 3B before the start of section 4.)

N/A

3A.2.2 Rationale

(a) Explain why a Sub-CCM approach represents an effective approach in the circumstances of your country. (Maximum of half a page.)

N/A

(b) Describe how this proposal is consistent with and complements the national strategy for responding to the disease and/or the national CCM plans. (Maximum of half a page.)

N/A

After completing this section, complete BOTH section 3A.4 AND section 3B.1.



3A.3 Regional Coordinating Mechanism Applicants (includes small island developing states without national CCMs) For more information, please refer to the Guidelines for Proposals, section 3A.3, and the CCM Guidelines.

Table 3A.3 – Regional Coordinating Mechanism: overview information

Name of Regional Coordinating Mechanism (RCM)

N/A

RCM Secretariat Office Address

N/A


Describe how the RCM operates. In particular:

(a) The extent to which the RCM acts as a functional partnership at the strategic and implementation levels between government and other key stakeholders, including the academic and educational sector; non-government and community-based organizations; people living with and/or affected by the disease(s) and the organizations that support them; the private sector; religious and faith-based organizations; multi-/bilateral development partners in-country;

(b) How the RCM coordinates its activities with the national structures of the countries that are included in the proposal (such as national AIDS councils, national CCMs, national monitoring and evaluation offices, or the national strategies of small island developing states who are not required to have their own national CCM or other national coordinating body); and

(c) The RCM’s governance structure and processes, and how the implementation strategy and timelines have taken into account the regional context, including the need to coordinate between multiple entities.

(For example, address topics including decision-making mechanisms and rules, constituency consultation processes, the structure and key focus of any sub-committees, frequency of meetings, implementation oversight processes, etc. The recommended length of response is a maximum of one page. Please provide terms of reference, statutes, by-laws or other governance documentation relevant to the RCM, and a diagram setting out the interrelationships between key stakeholders across the included countries as an annex to this proposal. Please indicate the appropriate annex number in your checklist to sections 1 to 3 before the start of section 4.)

N/A

3A.3.2 Rationale

(a) Describe how this proposal is consistent with and complements the national strategies of countries included and/or the national CCM plans. (Maximum of half a page.)

N/A

(b) Explain how the RCM represents a natural collection of countries and describe what measures will be taken to maximize operational efficiencies in administrative processes of the RCM. (Maximum of half a page.)

N/A



After completing this section, complete BOTH section 3A.4 and section 3B.1. 3A.4 Functioning of Coordinating Mechanism (CCM, Sub-CCM and RCM Applicants) IMPORTANT NOTE FOR APPLICANTS: All CCM, Sub-CCM and RCM Applicants must meet, and continue to meet, the Global Fund's minimum requirements for eligibility for funding. This section asks Applicants to describe the operations of their Coordinating Mechanism, and update information provided in Round 6. You will be asked to re-confirm this in the Checklist at the end of sections 1 to 3B of this Proposal Form. For additional information regarding these requirements, see: CCM has been constituted in accordance with the Global Fund guidelines. The distribution of membership among various sectors is as under;

• Public sector (12

• Private sector 02

• Civil society (4 NGOs and 2 FBOs) 06

• People living with or affected by the disease 02

• Private Academic and Research institutions 02

• Multilateral/Bilateral agencies 05

Total CCM members are : 29

The members representing the public sectors are nominated by the respective departments while the

members from other sectors are elected from the relevant constituencies through a process of election

according to the by laws of CCM.

The members represent their constituency and share and disseminate the proceedings and information to

their respective groups. The process is further supported by CCM secretariat which ensures that the

members are informed about all the activities. GF related decisions are made through consensus. There are

sub committees formed with specific TORs. These sub-committees are responsible for reporting the results

of their work back to the CCM and then the whole CCM votes to make a decision e.g. CCM sub committees

were formed for short listing the PRs and SRs for Round- and also for Round-7 for HIV/AIDS, TB and

Malaria. Recently, CCM has constituted CCM Core Committee comprising of CCM members representing

each sector, elected through transparent election.

Committee meet frequently on urgent matters related to the GF grant implementation in consultation with

grand CCM forum. The important CCM Sub committees are the ones related to M&E and Technical Committee. However, final policies are approved by CCM members. Examples of policies approved by CCM

are By Laws, Conflict of Interest Policy, Terms of Reference of Sub Committees etc. Before the convening of

formal meetings, a draft agenda indicating tentative date and time of meeting are shared among the CCM

members electronically to get CCM members consensus and approval for meeting date, time and the

agenda items.

The CCM secretariat communicates with /and obtain the feedback from the other national structures and key

bodies. The National programme Managers of all the three disease programme are the members of CM and



they attend all the meetings regularly. The members from private sector , civil society, the people living from

disease and other sectors also share their concerns and comments with the programme directly. The

programme authorities are responsible to share the progress of various GF grants with CCM. The

programme authorities also facilitate the M & E committee of CCM.

• The CCM Guidelines; and • 'Clarifications on CCM Minimum Requirements'.

3A.4.1 Round 6 Application History

Table 3A.4.1 – Applicant's Round 6 Application History

Please check the appropriate box in the table below. Then go to the relevant section in this Proposal Form, as indicated on the right hand side of the table to complete other important questions.

Applied in Round 6 and determined as having met the minimum requirements for Round 6

� Complete section 3A.4.2 and each of Requirements 3(a), 3(b), 4(a) and 5(a) within sections 3A.4.5 and 3A.4.6.

Did not apply in Round 6 or determined ineligible in Round 6

� Complete sections 3A.4.2 to 3A.4.6 inclusive.

3A.4.2 Changes in CCM, Sub-CCM or RCM from Round 6 Application

Describe in detail any changes in the membership or operations of the Coordinating Mechanism (i.e., CCM, Sub-CCM or RCM) since submission of your Round 6 application to the Global Fund. In particular, describe if new processes have been adopted for the selection of members by their own sectors, or to manage conflicts of interest; or oversee the work of implementation partners. If new processes have been adopted, these must be described, and relevant documents attached as an annex to your Round 7 proposal.

After Round-6 proposal submission, CCM Pakistan conducted the elections for the Selection of Vice Chair CCM from Civil Society, Elections for the Chair CCM from Public Sector and re-election of Bilateral Sector representatives on CCM. Also election process for the formation of CCM Core Committee comprising of representative of each sector on CCM was completed. The process of nomination of CCM members from Private Corporate Sector, Academic and Research Institution Sectors was also accomplished. CCM Secretariat’s independence was assured by de-linking it from any of the National Programme Organization based on the principal of avoiding Conflict of Interest.

Please note that the following sections follow the order set out in the document entitled 'Clarifications on CCM Minimum Requirements – Round 7' at: http://www.theglobalfund.org/en/apply/call7/documents Applicants are reminded that 'Coordinating Mechanism' ('CM') for the purposes of this section means either a CCM, Sub-CCM or RCM Applicant as relevant. (National CCM – Pakistan)



Applicants are reminded that 'Coordinating Mechanism' ('CM') for the purposes of this section means either a CCM, Sub-CCM or RCM Applicant as relevant. (National CCM – Pakistan)

3A.4.3 Principle of broad and inclusive membership

(a) Requirement 1 Selection of non-governmental sector representatives

Provide evidence of how the CM members representing each of the non-governmental sectors

(i.e. academic/educational sector, NGOs and community-based organizations, private sector, or

religious and faith-based organizations), have been selected by their own sector(s) based on a

documented, transparent process developed within their own sector.

The CCM as presently constituted has representation from various sectors. The CCM representatives are

elected from their constituency through an election process , carried out, according to CCM guidelines.

CCM secretariat developed the guide lines for the selection of CCM members representing various non

government sectors. The Global Fund guidelines were modified in country context after consultation with

CCM members. These guidelines were shared with academic/educational sector, NGOs and community-

based organizations, private sector, religious/faith-based organizations, and multi-/bilateral development

partners in the country. The constituency for every sector was defined which was followed by the election.

The whole process stands documented and shared with CCM members.

Academic / Educational Sector: CCM Secretariat has coordinated closely with the highest statutory and independent body dealing with

highest academic and educational sector. HEC, The Higher Education Commission, Pakistan and

explained about Country Coordination Mechanism and its importance. The Higher Education Commission

took the lead role and through a consultative transparent process involving many high academic and

research institutions/Universities and nominated two representatives. One CCM member representing

Academic / Educational Sector is the Director of Dow University Karachi, Ojha Institute for Chest Disease.

HEC has a committee of Vice Chancellors from all over the country. The second member is Vice

chancellor of Khyber Medical University, NWFP. All supporting documentation is maintained by the CCM

Secretariat.

Civil Society: The current representation of Civil Society on CCM-Pakistan is the result of a transparent election

mechanism. The initiative in this regard was taken by the CCM - Green star Social Marketing, Health Net

International, Amal HDN, Nai Zindagi, and along with other partners including Family Health International,

Mercy Corps, PNAC, SCF-US,ASD and others. .Several meetings were held and a framework for electing

the members for CCM developed and finalized. The Asia Foundation chalked out a plan for an electronic

(web based) election process. It was also decided that the proecess needs to be approved by the CCM

including the setting up of a committee to oversee the election process.



On the basis of a consensus amongst Civil Society membership, it was decided that UNAIDS may house

the "election cell" to ensure transparency and keeping in mind possible conflict of interest resulting from

the consideration that participants NGOs may like to take part in the election process. Documentation

supporting the web based elections process is available in CCM Secretariat and is attached with the

proposal.

Private Sector : As per the CCM recommendation, CCM Secretariat corresponded with Federation Chamber of

Commerce and Industry which is the recognized representative body of the private corporate business

entities. The Chamber has been authorized to nominate members representing the Private Sector on

many Statutory Bodies. Its members are elected through widely closed elections. The President of the

Federation Chamber of Commerce and Industry through a consultative and transparent process, made

two nominations. These were officially notified to the CCM Secretariat. The CCM endorsed the

nomination process. The names of two members to represent private corporate sector were finalized

through this well established procedure.

Religious/ Faith Based Organizations: Inter religious faith based Council and the AIDS Awareness Society working as faith based

organization at large scale were contacted to act as lead organization to carry out the

transparent process for CCM members nomination The AIDS awareness society agreed to

carry out the process. Elections were conducted as per the GF specified format to elect

faith based constituency member to represent in CCM . All relevant correspondence is attached with the

proposal.

Multi-/bilateral development partners in country: The constituency of multi/bilateral development partners in country conducted the

election process electronically to chose two multilateral development partners for membership of CCM.

Similarly there was an electronically coordinated election process followed by the Bilateral agencies in

Pakistan to decide on three CCM members to represent them. All relevant documentation record is kept

by the CCM Secretariat and is be annexed to the proposal.

People Living with and or Affected by Disease: In accordance with the CCM By Laws, transparent consultative election process was organized to choose

the representative of Sector People Living with and or Affected by Disease. The process started with

invitation letter sent out by CCM Secretariat to Pak Plus Society as lead organization. CCM guidelines

for the identification of the people living with disease / affected by disease were highlighted to them. An

election process to be coordinated by Pak Plus Society for PLWHA and Pakistan Anti TB Association for

TB was decided. The identification of people and the election process was documented by the both

organizations shared with all CCM members.

CCM Secretariat has maintained the record which will be provided with the proposal. CCM endorsed the



process as well as the process membership of the successful representative, to represent the sector of

People Living with and or Affected by Disease.

Please indicate below (via the check-box below) which documents are relied on to support the

Applicant's statement of compliance with this requirement AND attach as an annex the

documents showing each sector’s transparent process for CM representative selection, and

each sector’s meeting minutes or other documentation recording the selection of their current

representative.

Documentation relied on to support compliance with Requirement 1

Identify which annex to this proposal contains these documents

Please indicate the applicable annex number in your checklist to sections 1 to 3B

before the start of section 4.

Selection criteria for each sector developed by each respective sector

CCM Annexure 2

Minutes of meeting(s) at which the sector transparently determined its representative CCM Annexure 2

Rules of procedure, constitution or other governance documents of a sector representative body identifying the process for selection of their member

CCM Annexure 2

Letters and other correspondence from a sector describing the transparent process for election and the outcome of the selection process

CCM Annexure 2

Newspaper advertisements or other publicly circulated calls for members of each sector to select a representative of that sector for membership on the CCM, Sub-CCM or RCM.

CCM Annexure 2 – only for civil society (web based AD)

Other: (please specify):

(b) Please briefly summarize how the information provided within the annexes listed above satisfies Requirement 1

A brief summary of process has been provided depicting the transparency followed by each CCM sector/constituency in order on selection process as per GF specified requirements. CCM Secretariat has provided assistance sought by all concerned to fulfill the GF requirements. All the supporting documents are maintained by CCM Secretariat as record and are provided with the proposal.



3A.4.4 Principle of involvement of persons living with and/or affected by the disease(s)

Requirement 2 People living with and/or affected by the disease(s)

Describe the involvement of people living with and/or affected by the disease(s) in the CCM.(Importantly, Applicants submitting HIV/AIDS and/or tuberculosis components must clearly demonstrate representation of this important group. Please carefully review the Global Fund's 'Clarifications on CCM Minimum Requirements – Round 7' document before you complete this section).

Active participation of representatives of this sector in CCM discussions at every stage, including

proposal development and the CCM oversight role over grants and PR performance. Government’s /

Ministry of Health (MOH) policy of involving affected people in the Disease Programmes both in service

delivery matters and policy review emerging HIV/AIDS plicy regarding t their social and legal rights.

Members of some important CCM committees/Sub committees e.g. CCM Core Committee and Sub

Committee M&E. A mid term review workshop involving people living with a and or affected by disease

was organized by CCM to obtain wider inputs on implementation specifics. NACP has involve PLWHA

organizations being managed by the HIV/AIDS positive people for the treatment and care support

component so that discrimination free interaction between people effected people and organizations

can be established.

For TB control strategy, Pakistan Anti TB Association (PATA) is NGO with strong network as an

implementing partner for the TB control strategies. PATA as TB focused NGO has developed very

close interaction with communities through awareness raising activities and is well aware with the

strategies how to address TB related discrimination aspects and also focuses on TB case

management for the TB effected people.

3A.4.5 Principle of transparent and documented proposal development processes (Requirements 3, 4 and 5)

As part of the eligibility screening process for proposals, the Global Fund will review supporting documentation setting out the CM’s proposal development process, the submission and review process, the nomination process for Principal Recipient(s), as well as the minutes of the meeting(s) where the CM decided on the elements to be included in the proposal and made the decision about the Principal Recipient(s) for this proposal. We will also review how, during the program term, the CM will oversee implementation.

Please describe and provide evidence of the applicant's documented, transparent and established processes to respond to each of the 'Requirements' set out below:

Requirement 3(a) Process to solicit submissions for possible integration into this proposal.

The required Technical Assistance Plan for Round-7 was approved by CCM during CCM meeting held on

January 16, 2007 and shared with multi stake holders. During a two days CCM workshop, CCM had

chalked out and approved a proposal development process in three phases. The Global Fund announced

the Round-7 RFP in March 2007. CCM Secretariat circulated the information to all CCM members and

the stakeholders. CCM Secretariat prepared draft of EOIs to invite Expressions of Interest for Sub

Recipients (SRs) and Principal Recipients (PRs) for Round-7. EOIs was shared with all three disease

specific programmes and then with all CCM member for their input and approval. Upon receiving approval

of CCM, to ensure a wider circulation, both EOIs for PRs and SRs were published in the nation wide

English and Urdu newspapers. Fifteen days margin was provided to submit EOIs.



As approved in the TA plan, CCM contracted out national and international level consultants and a

national expert as proposal manager to facilitate and oversee the Round-7 proposal development.

Simultaneously, all three disease specific programmes started the Gap Analysis exercise involving wide

range of stakeholders i.e. various Federal and Provincial level Institutions and multi/bilateral agencies. A

series of CCM Technical Committee and CCM meetings were held to discuss and finally approve the

gaps analysis strategy and the priority gaps identified by each programme for Round-7 proposal. In this

way, an opportunity was provided to all stakeholders to contribute both in terms of procedure and content

of proposals.

In addition to Gaps analysis for Round-7, programmes also shared their draft ObjectivesTargets and

Indicators for Round-7. After comments and discussions, they were endorsed and approved by CCM.

Based on CCM endorsement, all three disease specific programmes started the technical proposal writing process. Meanwhile, CCM Secretariat coordinated with programmes to submit the proposed

short listing criteria for SRs by each programme. CCM Secretariat circulated the proposed short listing

criteria to all CCM members. Several meetings were held to finalize the short listing criteria. The finalized

criteria was forwarded to programmes to conduct the short listing exercise of SRs. During this process,

CCM Secretariat received EOIs for SRs and PRs and prepared a data base and forwarded the EOIs of

SRs to each disease specific programme. Based on CCM approved criteria, programmes conducted

short listing of SRs for Round-7 and shared with the CCM Members in CCM meeting held on April 30,

2007 for approval as well as the endorsement of SRs selection Process and identified SRs. CCM

endorsed the short listing process and the short listed SRs. In line with the approved Round-7 proposal

development strategy, all three disease specific programmes invited the selected SRs and conducted one

– two days workshop to interact with SRs to list down the areas of their expertise to contribute towards

Round-7 programme implementation and to finalize budgets and work plans. Simultaneously all disease

specific programmes prepared initial draft of Round-7 disease specific proposals which were circulated to

all CCM members and other stakeholders for their comments. Inputs were received by CCM Secretariat

and communicated to the relevant programme. Several meetings between programmes, CCM Sub

Committee technical and multi and bilateral donors experts were held. All three disease specific

proposals were finalized which involved a wide range of stakeholders and an extensive consultative

process to meet the Global Fund Standards o f soliciting wide range stakeholders involvement. Final

drafts of each disease specific proposal was further shared with multi stake holders to ensure their inputs

during a workshop organized by the proposal manager. Final comments were incorporated and the

integrated version of final CCM was circulated to all CCM members and other stakeholders involved in

the Round-7 proposal development process. CCM meeting was called on 29th June 2007 for final

endorsement of the Round-7 proposal.



Requirement 3(b) Process to review submissions received by the CCM for possible integration into this proposal.

CCM exercised two pronged process to review submissions received by the CCM, wide range of

stakeholders reviewed draft proposals and provided their inputs through consultative process for

possible integration into Round-7 proposal and sent their comments to CCM Secretariat. CCM

Secretariat shared the comments with other CCM members and the proposal writing teams and the

comments were incorporated. The disease specific porgrammes shared the draft proposal with the

selected Sub Recipients for preparing Round-7 proposal budgets and work plans.

Requirement 4(a) Process to nominate the Principal Recipient(s) for proposals.

EOIs were published in the nation wide newspapers. EOIs were screened by CCM committee

constituted to carry out a transparent process for short listing potential PRs for Round-7. PR short

listing criteria was drafted by the CCM Secretariat and circulated to all CCM members. Input comments

were received from members and thus the PRs for Round-7 short listing criteria was finalized. All PR

short listing committee members met on 11th May 2007 and through consultative process, ranked the

EOIs identifying PRs for HIV/AIDS, TB and Malaria for Round-7.

Requirement 4(b) Process to oversee/review program implementation by the Principal Recipient(s) during the proposal term.

As per the GF guidelines, the Principal Recipient will receive grants from the Global Fund and is responsible to disburse the grants to the implementation partners of Round-7 as per agreed work plan and budgets. PR to have M&E section which will monitor the grants implementation to certify the SRs reported progress. PR M&E activities include field visits, desk reviews and if need arises FGDs with the target populations during the M&E Process. PR/s will collect quarterly progress reports from SRs and will be responsible to compile comprehensive quarterly progress report and will submit to LFA for verification of the reported progress and copy to the Global Fund’s Portfolio Manager. LFA will conduct regular financial and programmatic audits of PR and PR will be liable to facilitate the audits. In addition to LFA, CCM Sub Committee M&E will perform its oversight role over PR which also includes filed visits and desk review to review PR performance in terms of overall management, programmatic and financial coordination with Round-7 implementation partners.

Requirement 5(a) Process to ensure the input of a broad range of stakeholders, including CCM members and non-CM members, in the proposal development process.

Donors meeting was called by the Chair CCM to share the Round-7 proposal related aspects and the technical Assistance Plan for Round-7.

Gap analysis exercise also involved a broad range of stakeholders at provincial, federal level and also the multi/bilateral stakeholders.

Disease specific programme’s draft proposals were shared with the broad range of stakeholders for inputs and comments. All programmes addressed the partners comments to improve the proposals.

Final drafts of disease specific proposals and the CCP drafts were also shared electronically and by arranging meeting of international and national stakeholders.



Requirement 5(b) Process to ensure the input of a broad range of stakeholders, including CCM members and non-CM members, in grant oversight processes.

CCM has constituted CCM Sub Committee M&E and approved its TORs to perform oversight role over

Grants Implementation and PR performance to facilitate speedy implementation process of the GF

grants. CCM Secretariat shares PR quarterly progress reports of GF grants with CCM and non-CCM

members (CCM observers group). Based on the quarterly reports, CCM M&E have agreed to engage

third party to perform oversight by conducting some field visits to either by CCM Sub Committee M&E

members or by engaging a third party. CCM observers who are non CCM members are constantly

involved in M&E by sharing PR quarterly progress reports which include PR and SRs performance

details. In addition MOH also performs overall M&E of all three disease specific programmes including

the components funded by the GF grants. The M&E component of GF grants is further strengthened

by the disease specific programmes by including each programme’s own M&E of the whole disease

component.

3A.4.6 Principle of effective management of actual and potential conflicts of interest

Yes Requirement 6 Are the Chair and/or Vice-Chair of the Coordinating Mechanism from the same entity as the nominated Principal Recipient(s) in this proposal? No

If yes, summarize below the main elements of the Applicant's documented conflict of interest policy to mitigate any actual or potential conflicts of interest and attach a copy of the Conflict of Interest policy/plan to this proposal as an annex.

CCM has in place a comprehensive Conflict of Interest (COI) policy to address the component of inherent conflict of Interest. Attached at annexure CCM 1(3A.4.6)

3A.4.7 Financial Support for Coordinating Mechanism operations

Yes provide details below

Does the applicant intend to apply for funding of CCM operations?

Details on the availability of such funding are provided in Section 3A.4.7 of the Guidelines, and Applicants should refer to this information before completing this section.

No go to section 3B.1

If yes, please specify the amount requested and describe how the amount complies with the time limitation and funding categories available, as explained in Section 3A.4.7 of the Guidelines for Proposals.

Applicants must ensure that the amount requested is included in the detailed component budget (section 5.1) in a separate identifiable budget line.

After completing this section, go to section 3B.1.



3A.5 Regional Organization Applicants (including Intergovernmental Organizations and International Non-Government Organizations) For more information, please refer to the Guidelines for Proposals, section 3A.5.

Table 3A.5 – Regional Organization: overview information

Name of Regional Organization

Sector represented by the Regional Organization (Check the relevant box below)

Academic/educational sector

Government

Non-Government Organizations

People living with and/or affected by HIV/AIDS, tuberculosis and/or malaria

Private sector

Religious/faith-based organizations

Other (please specify)


In addition to answering the questions below, Regional Organizations must provide (as additional annexes to this proposal) documentation describing the organization, such as:

• Statutes, by-laws of organization (official registration papers); and

• A summary of the main sources and amounts of funding over the past three years.

Describe below how the Regional Organization operates. In particular:

The manner in which the Regional Organization gives effect to the principles of inclusiveness and multi-sector consultation and partnership in the development and implementation of regional cross-border projects;

The extent to which people living with and/or affected by the disease(s) targeted in the Regional Organization's proposal were involved in development of your proposal; and

The coverage and past experience of the Regional Organization’s operations, with a particular focus on outcomes relevant to the subject of this proposal (Maximum of half a page.)

N/A



3A.5.2 Rationale

(a) Describe how this regional proposal is consistent with and complements the national plans for responding to the disease of each country involved. (Maximum of half a page.)

N/A

(b) Explain how the countries targeted in the Regional Organization's proposal represent a natural collection of countries and describe what measures will be taken to maximize operational efficiencies in administrative processes. (Maximum of half a page.)

N/A

After completing this section, complete section 3B.2.



3A.6 Non-CCM Applicants Non-CCM proposals are only eligible for funding under exceptional circumstances listed in section 3A.6.1 below. For more information, please refer to the Guidelines for Proposals, section 3A.6. In addition to answering the sections below, all Non-CCM proposals should include as annexes additional documentation describing the organization, such as: statutes and by-laws of organization (official registration papers) or other documents evidencing the key governance arrangements of the organization; a summary of the background and history of the organization, scope of work, past and current activities; and a summary of the main sources and amounts of existing funding over the past three years.

Table 3A.6 – Non-CCM Applicant: overview information

Name of Non-CCM Applicant N/A

Business address (including street, town/state and country)

Primary contact Secondary contact

Name

Title

Organization

Mailing address

Telephone

Fax

E-mail address

Alternate e-mail address

Indicate the sector represented (check appropriate box):

Academic/educational sector

Government

Non-government Organization (NGO)/community-based organizations

People living with and/or affected by HIV/AIDS, tuberculosis and/or malaria

Private sector

Religious/faith-based organizations

Other (please specify)



3A.6.1 Rationale for applying outside of a CCM, Sub-CCM or RCM

(a) Non-CCM proposals are only eligible if they satisfactorily explain that they originate from one of the following:

(i) Countries without legitimate governments;

(ii) Countries in conflict, facing natural disasters, or in complex emergency situations (which will be identified by the Global Fund through reference to international declarations such as those of the United Nations Office for the Coordination of Humanitarian Affairs [OCHA]); or

(iii) Countries that suppress, or have not established partnerships with civil society and NGOs.

Describe in detail which of the above condition(s) apply (Maximum of two pages. Please refer to the Guidelines for Proposals, section 3A.6.1 for further information on how the Global Fund will interpret these criteria.)

3A.6.2 Attempts to have Non-CCM proposal included in the CCM, Sub-CCM or RCM proposal

(b) Describe all attempts by your organization to submit this proposal and have it included in the relevant final proposal of a CCM, Sub-CCM or RCM (as appropriate to the content of your proposal), providing details of any responses received.

(Maximum of one page. Please provide documentary evidence of these attempts and any response from the CCM, Sub-CCM or RCM as an annex to the proposal. Please ensure that your description clearly sets out whether you provided a copy of your proposal for consideration by the CCM**, Sub-CCM** or RCM**,and if not, why not.)

(** Contact details for CCMs, Sub-CCMs and RCMs are available on the Global Fund website, or by contacting [email protected] )

(c) If you are aware that a CCM is also submitting a proposal in Round 7 for a country or countries included in your proposal, provide a detailed explanation of why you believe that your non-CCM proposal merits consideration and recommendation for funding as well as any national CCM proposal.

(Maximum of one page. In this section, please set out any particular issues which you believe support the submission of a Non-CCM Applicant proposal in circumstances where a CCM has applied.)

If this Non-CCM proposal originates from a country in which no CCM exists (for example, a small island developing state), please also complete section 3A.6.3.



3A.6.3 Consistency with national policies

Describe how this proposal is consistent with, and complements, national policies and strategies (or, if appropriate, why this proposal is not consistent with national policy). (Maximum of one page. Provide evidence [e.g., letters of support] from relevant national authorities in an annex to the proposal.)

After completing this section, complete the checklist for sections 1 to 3B before completing sections 4 and

5 on a per-disease component basis.

3B Proposal Endorsement


3B.1 Coordinating Mechanism Applicants (CCM, Sub-CCM and RCM) membership and

endorsement All national (CCM), sub-national (Sub-CCM) and regional Coordinating Mechanisms (RCM) Applicants must: (a) Fully complete this section; and (b) Complete and attach 'Attachment C' to list all of the members of the Coordinating Mechanism, their

contact details and email addresses. (This excel file is available for completion by downloading it from the Round 7 documents website of the Global Fund.)

3B.1.1 Leadership of the Coordinating Mechanism

Table 3B.1.1 – National/Sub-national/Regional (C)CM leadership information (not applicable to Non-CCM and Regional Organization Applicants)

Chair Vice Chair

Name Mr. Khushnood Akhtar Lashari Dr. Muhammad Amir Khan

Title Federal Secretary Health Chairman

Organization Public Sector, Ministry of Health Civil Society Organization, Association for Social Development

Mailing address Room No.113, Block-C, Pak Secretariat, Islamabad.

H. # 12, Street # 48, Marvi Road, F-7/4 Islamabad Pakistan

Telephone +92 (51) 9211622

+92 (51) 9201782

+92 (51) 2871251 +92-(51) 2871252

Fax +92 (51) 9205481 + 92 (51) 2871254

E-mail address [email protected] [email protected]

Alternate e-mail address [email protected] -

Go to section 3B.1.2 (membership information).



3B.1.2 Membership information of CCM, Sub-CCM or RCM Please note that to be eligible for funding, CCM, Sub-CCM and RCM Applicants must demonstrate evidence of membership of people living with and/or affected by the disease(s). Also, it is recommended that the membership of the CCM, Sub-CCM or RCM comprise a minimum of 40% representation from non-governmental sectors. For more information on this, see the Guidelines for Proposals section 3B.1 and the CCM Guidelines.

Table 3B.1.2 – Summary of Coordinating Mechanism members

Summary of Membership of CCM, Sub-CCM or RCM

The table below must be completed by each CCM, Sub-CCM or RCM Applicant. This table is a summary only of the detailed membership information that must be provided in 'Attachment C' to this Proposal Form.

Under the heading 'Sector Representation' in the left hand column below, please check each box which describes the sectors that have representation on the CCM, Sub-CCM or RCM. In the right hand column below, please indicate, in figures, the number of representatives who are included in the corresponding sector.

Please make sure that the total number of members in the table below equals the total number of members in 'Attachment C' to your proposal.

Sector Representation Number of members representing the sector

Academic/educational sector 02

Government 12

Non-Government Organizations (NGOs)/community-based organizations 04

People living with and/or affected by HIV/AIDS, tuberculosis and/or malaria 02

Private sector 02

Religious/faith-based organizations 02

Multilateral and bilateral development partners in country 05

Other (please specify): Observers (Non-Voting ) Group of International Agencies (UNICEF, CIDA & World Bank, UNODC, ).

03

Total Number of Members 29

Go to section 3B.1.3 (proposal endorsement)



3B.1.3 CCM, Sub-CCM and RCM proposal endorsement Level 1 Endorsement CCM, Sub-CCM and RCM members must endorse their own proposal for an application to be eligible. This is demonstrated by each member of the Coordinating Mechanism (whether CCM, Sub-CCM or RCM) signing Attachment C in the final column once all membership information has been completed. Please note that the original (not photocopied, scanned or faxed) signatures of the CCM, Sub-CCM or RCM members must be provided in Attachment C. The minutes of the CCM, Sub-CCM or RCM meeting at which the proposal was considered and endorsed must be attached as an annex to this proposal. The entire proposal, including Attachment C and the minutes, must be received by the Global Fund Secretariat by 4 July 2007.

Level 1 endorsement Check this box only if the CCM, Sub-CCM or RCM has completed the membership details and members have signed Attachment C to the Proposal Form

Level 2 Endorsement – Sub-CCM and RCM Applicants only For sub-national (Sub-CCM) and regional Coordinating Mechanism (RCM) Applicants only, the national CCM of the country (or countries for RCM applications) must also endorse the Sub-CCM or RCM proposal. This endorsement must be evidenced by providing the Global Fund with written confirmation of the endorsement from the Chair and/or Vice-Chair of the relevant CCM(s) together with a copy of the minutes of the CCM meeting at which the Sub-CCM or RCM proposal was presented for review by the national CCMs and transparently discussed and endorsed by the membership of the CCM under its transparent documented rules and procedures. Please refer to the Guidelines for Proposals, section 3B.1.3.

Table 3B.1.3 – Sub-national or regional (C)CM proposal endorsement by national CCMs

Level 2 endorsement of Sub-CCM or RCM proposal by National CCMs

List below each of the national CCMs that have agreed to this proposal and provide documented evidence of this endorsement, including copies of the CCM meetings at which the Sub-CCM or RCM proposal was discussed and endorsed. For Sub-CCM proposals which only cover one part of a country, only that country should be listed.

Country Date of CCM Endorsement Annex number to this proposal





3B.2 Regional Organization proposal endorsement 3B.2.1 National CCM endorsement of Regional Organization proposal: Regional Organizations must receive an endorsement in writing from the CCM for all countries targeted in the proposal unless the country does not have a CCM (by reason that it is a small island developing state without a CCM, or it is a country which has never been eligible for funding from the Global Fund and does not therefore have a functional CCM). This endorsement must be evidenced by written confirmation from the Chair and/or Vice-Chair of all relevant CCMs and a copy of the minutes of the CCM meeting at which the Regional Organization's proposal was transparently discussed and, if relevant, endorsed by the membership of the CCM under its transparent documented rules and procedures. Please refer to the Guidelines for Proposals, section 3B.2. List below each of the national CCMs that have endorsed this proposal and provide documented evidence of this endorsement. (If no national CCM exists in a country targeted in the proposal, include evidence of support from other relevant national authorities.)

Table 3B.2.1 – Regional Organization proposal endorsement by national CCMs

Country Date of CCM Endorsement Annex number to this proposal



4 Component Section Malaria


The table below provides a list of the various annexes that should be attached to the proposal. Please complete this checklist to ensure that everything has been included. Please also indicate the applicable annex numbers and the precise title of the document on the right hand side of the table.

Relevant item on the Proposal Form

Description of the information required in the Annex

Title of the Document and annex number given to each annex

Section 3A: Applicant Type and Eligibility for Funding

Coordinating Mechanisms only (CCM, Sub-CCM or RCM Applicants):

3A.1.1 (CCM), 3A.2.1 (Sub-CCM) or 3A.3.1 (RCM)

Documents that describe how the national/sub-national or regional Coordinating Mechanism operates (terms of reference, statutes, by-laws or other governance documentation and a diagram setting out the interrelationships between all key actors).

CCM By Laws Approved by CCM Pakistan.

CCM Annexure 1

Documentation describing compliance with the minimum Coordinating Mechanism requirements (sections 3A.4.3 to 3A.4.6 inclusive):

Minimum Requirement 1

Comprehensive documentation on processes used to select non-governmental sector representatives of the Coordinating Mechanism.

Civil Society Election Process

CCM Annexure 2

Minimum Requirement 3(a)

- solicit submissions for possible integration into the proposal.

Coordination Correp. & Minutes of Meetings

CCM Annexure 3

Minimum Requirement 3(b)

- review submissions for possible integration into the proposal.

Doc. Progs. Meetings with Partners & other stakeholders, Provincial partners

CCM Annexure 4

Minimum Requirement 4(a) and 4(b)

- select and nominate the Principal Recipient (such as the minutes of the CCM meeting at which the PR(s) was/were nominated) and to oversee grant implementation.

Minutes of CCM & CCM Committee to Short list PRs

CCM Annexure 5

Minimum Requirement 5(a) and 5(b)

- ensure the input of a broad range of stakeholders in the proposal development process and grant oversight process.

Meetings with SRs and Donors Group. Minutes

CCM Annexure 6

3A.4.6 – Minimum Requirement 6

Documented procedures for the management of potential Conflicts of Interest between the Principal Recipient(s) and the Chair or Vice Chair of the Coordinating Mechanism

Policy

CCM Annexure 7

Regional Organization Applicants:

3A.5.1 Documents that describe the organization such as statutes, by-laws (official registration papers) and a summary of the main sources and amounts of funding.

N/ A






Non-CCM Applicants:

3A.6

Documentation describing the organization such as statutes and by-laws (official registration papers) or other governance documents, documents evidencing the key governance arrangements of the organization, a summary of the organization, including background and history, scope of work, past and current activities, and a summary of the main sources and amounts of funding.

N/A

3A.6.2 b Documentary evidence of any attempts to include the proposal in the relevant CCM’s final approved country proposal and any response from the CCM.

N/A

3A.6.3 (if submitted for a country where no CCM exists)

Provide evidence from relevant national authorities that the proposal is consistent with national policies and strategies.

N/A

Section 3B: Proposal Endorsement

3B.1.3 Level 1 Proposal Endorsement (CCMs, Sub-CCMs and RCMs)

Minutes of the meeting at which the proposal was developed and CCM endorsed.. Attachment C to the

Proposal Form

3B.1.3 (Level 2 Proposal Endorsement = Sub-CCMs and RCMs only)

Documented evidence (including minutes of the CCM meetings) that all national CCM(s) have reviewed and endorsed the proposal. N/A

3B.2.1 (Level 2 Proposal Endorsement Regional Organizations only)

Documented evidence that the national CCMs have reviewed and endorsed the proposal.

N/A

Other documents relevant to sections 1 to 3B attached by Applicant: (add extra rows to this section of the table as required to ensure that documents directly relevant are attached)






PLEASE NOTE THAT SECTION 4 and SECTION 5 MUST BE COMPLETED FOR EACH SEPARATE DISEASE COMPONENT. This section is only for your malaria component, and sections 4 and 5 for HIV/AIDS and tuberculosis occur earlier in this Proposal Form (refer to the section headings to find the section relevant to your proposal). For more information on the requirements of this section, please refer to the Guidelines for Proposals, section 4. 4.1 Requested proposal term for this disease component Please take note of the timing of proposal approval by the Board of the Global Fund (described on the cover page of the Proposal Form). The aim is to sign all grants and commence disbursement of funds within six months of Board approval. Approved proposals must be signed within 12 months of Board approval. Important note: If your proposal term is less than five years, please first refer to the Global Fund's Round 7 'Frequently Asked Questions' (No. 132) at: http://www.theglobalfund.org/en/apply/call7/documents/documentsfaqs/

Table 4.1.1 – Proposal start time and duration

From To

Month and year: April 2008 Dec 2012



4.2 Disease specific component executive summary

4.2.1 Executive summary

Describe the overall strategy of the proposal component, by referring to challenges, existing and/or new needs, goals, objectives and planned outcomes and outputs to be achieved through the additional funding requested in this proposal, specifying the main beneficiaries (including target populations and their estimated number). Also specify any institution/facilities that will benefit from any support for health systems strengthening strategic actions.

(Maximum of one page in length, highlighting, in a summary format only, key aspects from information described in your answers to the questions within section 4).

Malaria has been as a major cause of morbidity in Pakistan and it continues to be a major threat to the health of millions who live in malarious areas. Malaria in Pakistan is of unstable pattern and transmission is mainly post-monsoon from July to November. Plasmodium falciparum and P.vivax are the only species of parasites widely distributed in Pakistan An. culicifacies and An. stephensi are traditionally believed vectors of malaria in the country. Recently two new species An. fluviatilis and An. annularius have also been reported as confirmed malaria vectors in Balochistan. The malariogenic potential of Pakistan has a negative impact on its socio-economic growth and productivity, as the main transmission season is spiraled with the harvesting and sowing of the main crops (wheat, rice, sugar cane). Seasonal transmission variations, drought, irrigation systems and hydrological changes, population movements, high level antimalarial drugs and insecticide resistance in the parasite, and vectors are the major determining factors working behind the high endemicity of these districts. poor access of the population to early diagnosis, effective treatment and effective prevention measures have further compounded the situation.

Afghanistan

India Iran

Arabian Sea

China



Province/ Territory wise API (Malaria Burden) 2006

0.020.89 0.76

5.445.92

0.070.73

0.001.002.003.004.005.006.007.00

Punjab

Sind

NW

FP

FATA

Baluchistan

AJK

PAK

ISTAN

Cas

es/1

000

During 2006, a total of 124,910 microscopically confirmed cases were reported from public sector malaria microscopy centres all over the country. The overall reported API of Sindh, Balochistan, FATA and NWFP provinces in 2006 was 4.0 per thousand population. However the actual API may be 5 times higher than the reported figures, as the public sector FLCFs report only 20% of the malaria cases. According to WHO-EMRO estimates the case load may be as high as 1.6 million cases per year (WHO EMRO, RD Annual Report, 2005). WHO estimates place Pakistan in category 3 countries (with low to moderate endemicity) in the Eastern Mediterranean Region. Approximately 95 out of 161 million total population, live in malaria endemic areas of the country. Out of the total 136 administrative units (districts including tribal agencies), 30 share the highest burden of malaria disease. Most of these districts and agencies are bordering with Afghanistan and Iran. More than 40% of the cases reported from these districts are P. falciparum. (MIS,2006) Reduction of malaria burden in these districts is both a national,

and provincial priority. On the basis of set criteria (API,AFI,SPR poor health infrastructure, location along international borders with Iran and Afghanistan) 19 top ranking units have been selected for additional funding through Global Fund in the current Round. The remaining 11 high risk districts /agencies are being supported through national resources. Pakistan is committed to combat malaria and achieve its national targets, which are in line with the Global Roll Back Malaria and MDGs. The current

National Health Policy provides the basic framework for all disease control interventions. Government of Pakistan is also keen for joint collaborative efforts with neighboring countries, who had signed the “Kabul Declaration 2006” for cross border disease control efforts. The objectives of this proposal are in conformity with the National Health Policy and with the National Malaria Strategic Plan 2007-2011 and international commitments made. Significant programmatic and financial gaps exist and it is necessary to strengthen programme management capacities and to broaden and upgrade activities to achieve better disease prevention and control. These programmatic gaps will widen very significantly if additional funding is not available to build on the activities supported under the existing National Programme. There have been major changes in the program recently and new strategies in terms of case management, prevention in line with international and regional best practices have been adopted. The National Strategic plan has been reviewed and updated in line with the WHO Global Malaria Programme, International experiences in highly endemic countries and results of operational research within the country. ACT (Ast+SP) has been found highly effective against falciparum malaria in highly endemic districts of the country. National malaria treatment policy has been revised and ACT adopted as first line treatment for confirmed falciparum malaria cases in the whole country. Injudicious and excessive use of antimalarial drugs particularly in private care settings, has resulted in high level failure rates in patients treated with CQ and AQ. To promote best practices and rational use of antimalarial drugs MoH Government of Pakistan has initiated the process of dialogue with the pharmaceutical industry to halt the production and subsequent use of oral Artemisinin Monotherapies from November 2007. This step will help slow down the speed of resistance development against the available effective antimalarial drugs. To improve early diagnosis and prompt treatment practices, Rapid Diagnostic Tests (RDTs) are being introduced through this proposal as a main supportive diagnostic tool particularly for areas where microscopy is not available or inaccessible. The introduction and use of RDTs is likely to reduce the cost of treatment at individual, and community level by reduction in irrational use of antimalarial drugs. It is also expected that the introduction of RDTs at BHU



level as per national policy will provide 1 malaria diagnosis facility per 15,000 of population. Malaria surveillance tools and reporting system are also planned to be reviewed and re-designed to capture the maximum information on malaria disease and the coverage of major interventions. The use of Insecticide treated bed nets (LLINs) has been proved to be a powerful prevention tool world wide. LLINs introduced in some districts during R-II project got high acceptance among the people of the target districts. Pregnant women and children below 5 years of age are the major target groups for the use of bed nets during the current proposal. WHOPES approved long-lasting insecticide treated bednets (LLINs) will be provided free of charge to all children under five years and all pregnant women in selected districts. This proposal will address the gap of US$ 21.5 million from the Global Fund to cover 19 districts with high malaria burden. Key beneficiaries will be the 12,019,987 people living within these districts. Within these populations, High Risk groups (pregnant women and children under 5) will be specifically targeted for preventive interventions. It is anticipated that successful accomplishment of the intended actions mentioned in the proposal will not only help reduce the malaria related morbidity and mortality in target communities, but also serve as a path towards achieving the National RBM targets and Millennium Development Goals. The overall goal of the proposal is to reduce malaria burden by 50% in 19 high risk districts by 2012. Three main objectives have been set to achieve this target, which are as follows: 1. To improve early diagnosis and prompt treatment services in the 19 target districts The existing 116 diagnostic services in the 19 highly endemic target districts established under Round-II Grant, will be strengthened through the provision of equipment, commodities, reagents and training of health workers. Eight (8) new microscopy centres will be established in 8 RHCs lacking functional microscopy facilities. Diagnostic services will be further extended to the FLCFs (BHUs) offering MCH services in all the target districts. Private clinics and hospitals in 4 pilot districts will also be distributed RDTs free of cost. Staff involved in performing malaria microscopy and RDTs will be provided refresher training for microscopy and one day sessions for RDTs use. The provincial and district quality assurance mechanisms will be intensified to ensure quality diagnosis through the strengthening of Provincial and District Reference Labs System. Capacities of public and private sector health care providers in proper case management as per national guidelines will be enhanced and availability of ACTs to 100% of the public sector health facilities in 19 target districts will be achieved from both the Global Fund and domestic financial sources. Involvement of private sector care providers in the provision of proper diagnosis and prompt treatment services, will be assessed in 4 out of 19 target districts during the current round. 2. To scale up coverage of LLIN and other effective vector control measures in 19 high risk districts LLINs as a major prevention tool for pregnant women and children <5 were introduced and piloted in 11 districts under GFATM Round 2 Grant. Three renowned international and national NGOs used three different methods for LLINs promotion in the target communities, which helped the programme to design national LLINs distribution policy. Using the newly developed Vector Control Guidelines and LLINs distribution Policy, more than 80% pregnant women and children less than 5 years of age will be protected through free distribution of LLINs using FLCFs delivering MCH services , NGOs and LHWs networks in areas where MCH centres are lacking. Overall one million LLINs will be distributed to people living in selected high risk districts in the first three years. The target population’s knowledge and awareness about LLINs will be improved through BCC/IEC campaigns using various promotion modes depending on the strengths of the sub-recipients. The coverage of LLINs will significantly reduce malaria transmission. Effective indoor residual spray with pyrethroids in all the target districts epidemic prone localities will continue and further brought to desired coverage level of 80% through national resources.



3. To strengthen & build management capacity of NMCP to co-ordinate, plan, implement and Monitor effective curative & preventative interventions nationwide

A mechanism for longitudinal testing of antimalarial drugs efficacy and insecticides resistance will be established at 4 selected sentinel sites in the country including the target districts. A malariometric and entomological survey in the first year will establish a baseline for the existing malaria burden in the highest risk districts including the current target 19 districts. National and provincial technical and management capacities will be enhanced through long and short term technical advisory support using the WHO as recruitment agency.

A functional Monitoring and Evaluation (M&E) system both at national and provincial levels and improvement in the existing surveillance system for quality and effective programme management is the aim, which is planned to be achieved through the implementation of functional M&E system designed during R-II Grant. All the surveillance tools (used in Eradication Era) currently being used will be reviewed and the number will be reduced to the minimum requirements of reporting at facility and district level.



4.3 National program context for this component The information below helps reviewers understand the disease context, what is working well and will be built upon, which problems the proposal will address and the major constraints for the implementation of the proposed component. Please refer to the Guidelines for Proposals, section 4.3. 4.3.1 Indicate whether you have any of the following documents** (check the appropriate

box), and if so, please attach them as an annex to your proposal:

National Health Sector Development/Strategic Plan

National Disease Control Strategy or Plan including national targets and indicators, together with the relevant budget and costings

Important sub-sector policies that are relevant to the proposal (e.g., national or sub-national human resources policy, or norms and standards)

Most recent evaluation reports/technical advisory reviews directly relevant to the proposal

National Monitoring and Evaluation Plan (health sector, disease specific or other)

** Applicants will be asked to refer to these documents, where they exist, throughout this section

4 as further support for the proposal's overall strategy.

4.3.2 Epidemiological and disease-specific background

(a) In table 4.3.2 below: (i) identify the total population of the country/countries; and (ii) then provide current estimates of the stage of the disease in the listed population groups. The 'source of estimate' (final column in the table below) may be from recent published estimates of WHO, but may also be published national estimates or statistics.

Table 4.3.2 – Estimated disease prevalence within key population groups

Population Estimated number

Year of estimate Source of estimate

(i) Total Population (all ages)

161 million 2007

NIP

Projections based on 1998 Census.

Pakistan Bureau of Statistics 1998

(ii) Current estimates on the stage of the disease in the following population groups:

Population at risk for malaria (all ages) 95 million 2006 National Annual surveillance

Report 2006, DOMC

Pregnant women at risk of malaria 3.9 million 2006 Demographic Survey 2003

Children under 5 at risk of malaria

17.1

2007 Demographic Survey 2003

Estimated malaria episodes per year

1.6 million

June 2006 WHO EMRO 2006 RD Annual

Report 2006.



Population Estimated number

Year of estimate Source of estimate

Reported malaria episodes per year 124,910 2006 Annual MCP Data 2006

Malaria deaths per year (all ages) 09 2006 Annual Surveillance Report

DOMC

Under 5 child mortality (per 1000) NA

Number of bed nets in country 220,000 2006

Nets procurement and distribution record of the GF R-2 and the DOMC

Proportion of children under 5 protected by bed nets

<5% 2006 HealthNet International Report 2006

(b) By reference to table 4.3.2 above, describe any changes in the stage, type or dynamics of the disease, including in the most affected population group(s) over the past three to five years. Also summarize the main treatment regimes in use or to be used during the proposal term and the reasons for their use. Any data on drug resistance should also be included (where relevant).(Maximum two pages.)

Malaria in Pakistan is categorized in group 3 countries according to the epidemiological classification of WHO Regional Office of the Eastern Mediterranean Region. Transmission could be characterized as of low to moderate prevalence with pronounced seasonal transmission and prone to the development of out break situations in certain geographical areas. Malaria has been a significant public health problem in Pakistan and will continue to pose a threat to the health of millions of people due to poor socioeconomic conditions conducive to the spread of disease. Disease surveillance program of MIS had registered 124,910 cases of malaria in 2006 with an Annual Parasite Incidence around 8 case per ten thousand populations at national level. These results are based on reports from microscopy centers functional in public sector FLCFs. However the actual case load may be 5 times higher, since the public diagnostic facilities do not cover more than 30% of total cases. Data on age and sex is routinely collected at the facility level, but not reported. Recent surveys in two district revealed equal distribution among the sexes and different age groups from 0-1, 1-5 and 5-15 years( TAMA, National Strategic Plan 2006). Malaria particularly the falciparum form of the disease is more prevalent and problematic in border areas and valleys of Balochistan, and Sindh provinces. Recent P.falciparum resistance surveys indicated high failure rates (83%) in Chloroquine and Amodiaquine treated patients after 28 days of follow up - Based on these results national treatment policy has been revised to include the combination therapies with artemisinin derivatives( Artesonate + SP). which will be freely available at all malaria diagnosis and treatment centers in the target districts during the life of current proposal and will be sustained by the district, provincial and federal governments after the completion of the project. (Annex- Guidelines). Moreover, Ministry of Health has taken a step recently to put a ban on the production and use of oral artemisinin monotherapies. Vector resistance monitoring has so far not revealed any significant resistance to pyrethoriods used in the malaria control activities in Pakistan. Current prevention measures are based on vector control by indoor residual spraying and larvicidal activities in selected union council (UC)3 in a district, introduction of Long Lasting Insecticides treated bed Nets (LLINs) and behaviour change communication activities using COMBI approaches.

3 Basic administrative units in country.



4.3.3 Disease-prevention and control initiatives and broader development frameworks

Proposals to the Global Fund should be developed based on a comprehensive review of disease-specific national strategies and plans, and broader development frameworks. This context should help determine how successful programs can be scaled up to achieve impact against the three diseases. Please refer to the Guidelines for Proposals, section 4.3.3.

(a) Describe, comprehensively, the current prevention and control strategies for the disease, together with planned outcomes. Applicants should ensure that the information provided below takes into account the cumulative outcomes based on all current and planned support from all stakeholders (government, major international initiatives, international donors and partnerships etc).

The National Malaria Control Strategy is based on the principles of Global Roll Back Malaria (RBM) initiative and Global Malaria Programme recommendations adopted in the country context. It has been tailored to meet the specific needs of program beneficiaries and takes full account of local epidemiological considerations (biological, cultural, etc.). The proposed interventions and services are consistent with the Millennium Development Goal, MTDF, RBM initiative of Pakistan and “Vision 2030 Programme of Government of Pakistan, which has planned targets beyond the set targets by 2015. The Government of Pakistan is implementing the health sector reforms and increasing the resource allocation for the implementation of disease control interventions. Malaria has remerged as a major cause of morbidity & mortality amongst the poor communities and in less developed areas. Malaria mortality and morbidity figures would be reduced through improved case management and enhanced vector control using the proposed public-private partnership interventions. The goals of the current programme are directly linked to the current RBM and MD Goals The National Malaria Control Program has five strategic priorities (Early Diagnosis and Appropriate Treatment, Multiple Prevention, Epidemic Preparedness, Behavioral Change Communication and M&E and two conditional priorities (Program Management and Operational Research) upon which these strategic priorities depend. The detailed strategies underlying each of these five priorities are presented below. 1. Multiple Preventions Prevention of malaria can be achieved through a variety of means including the control of adult vectors (killing mosquitoes or reducing their longevity), personal protection (preventing vectors from reaching their hosts) or source reduction (preventing vector breeding). Measures may be physical (use of bednets), chemical (larviciding, IRS, insecticide on bednets) or biological (use of predacious fish). An integrated approach based on community mobilization to achieve high impact, preferably on a range of vector borne diseases, at minimal cost is the aim of the Integrated Vector Management approach promoted by WHO and adopted by DOMC. 1.1 Operational Strategies Vector Control

• Routine indoor residual spraying (IRS) will be carried out annually

• IRS activities will be implemented in-line with internationally recognized best practices.

• Preliminary selection of union councils for IRS will be made by federal DOMC (in consultation with provincial partners) according to the previous year’s reported incidence. Selection will be based on spray thresholds according to national vector control guidelines: [API = 30/1,000 and AFI = 5/1,0004 to be discussed with provincial.] Preliminary selection will be reviewed and finalized in collaboration with provincial and district level staff. [In the event of limited insecticide stocks union councils will be prioritized according to malaria burden].

• All IRS operations will aim to achieve 80% coverage of union council households.

• IRS will be applied both to dwellings and to animal sheds (walls and ceilings).

• Routine IRS operations will be carried out during July and August before the peak transmission 4 Thresholds will be raised as the quality of passive case detection data improves (at present actual caseload is thought to be 5 times higher than reported caseload)



period.

• In the event of an outbreak, focal IRS will be carried out in the union council*5 where the outbreak was detected and in all adjacent union councils.

• WHOPES approved Long-Lasting insecticide treated Nets (LLINs) will be provided free of charge to all children under five years (one net per child) and to all pregnant women (one net per pregnancy) in 525 high transmission union councils in the high endemic districts.

• In order to achieve immediate high level coverage delivery of LLINs to children under five will be through a one-off campaign style approach

• Delivery of LLINs to pregnant women will be through the FLCFS offering the MCH services or through the LHW network where MCH coverage is lacking [Beneficiaries 6.0 million}

• WHO PES approved LLINs will also be provided free of charge to all confirmed falciparum cases (RDT/microscopy) to benefit about 0.5 million additional people directly

Environmental Management

• In areas where breeding sites are relatively few, accessible and manageable, the community based source reduction will be carried out. Communicable Disease Control Inspectors (Malaria Supervisors) , Lady Health Workers (LHWs) will encourage volunteer participation of the communities in the source reduction. The countrywide network of volunteers recently established by National Commission for Human Development (NCHP) and the existing village development committees (VDCs) will be tapped for participation in environmental management in target communities.

• Strengthening intersectoral collaboration for integrated environmental management by the involvement of the relevant line departments, as Agriculture, Public Health WASA, Irrigation and Education Departments.

Expected outcomes:

• 80% of vulnerable groups and 40% of overall population in the 525 highest risk union councils will have access to a LLIN by 2010.

• Up to 4.2 million households sprayed and up to 24.5 million people directly protected by IRS

• Another 6 million people protected indirectly through ‘community effect’.

• 55 million people protected through larviciding

• 2.3 million (80%) of households in target union councils with at least one LLIN by 2011.

• 100% MCH Centres and 20 % of rural public sector health facilities functioning as distribution outlets for LLINs by 2010.

• 80% of pregnant women in high risk union councils sleeping under LLINs by 2011.

• 80 % of children under 5 in high risk union councils sleeping under LLINs by 2011.

• By 2008, the annual routine IRS campaign will cover 80% of households in union councils which exceed IRS target thresholds. in epidemic prone areas in the target districts

2. Early Diagnosis and Appropriate Treatment

The provision of early diagnosis and prompt treatment with effective antimalarial drugs soon after the patient develops the symptoms of malaria, is the most important intervention in the current National Malaria Strategic Plan 2007-2012. In Pakistan in most of the endemic areas, malaria cases

5 Basic Administrative unit 6 By the end of 2007, all MCP microscopes currently situated at BHU level will be reallocated to fill gaps at RHC level. 7 An outbreak at any given health facility is defined as an increase in weekly reported incidence exceeding double the mean weekly incidence for the previous 3 years. 8 Outbreak (at any given health facility): an increase in weekly reported incidence exceeding double the mean weekly incidence for the previous 3 years.



are managed on clinical grounds both in public and private sector health facilities. This has resulted in excessive and irrational use of antimalarial drugs with resultant loss of efficacy due to high level resistance development in the parasite. Available malaria microscopy facilities are few in numbers and can not cope with the existing and growing needs of the populations. Quality Assurance (QA) system is based on the old pattern of Eradication Era, which has been recently reviewed and updated. Strengthening the existing microscopy centres and extension of the services to increase the coverage through the establishment of new microscopy centres have been duly prioritized in the National Malaria Strategic Plan. RDTs are the new diagnostic toll available which can distinguish between falciparum and other species of the parasite. These tests are best suited for areas where establishment of microscopy centres is not feasible.

A range of antimalarial drugs are available for the treatment of malaria. Although chloroquine is no longer effective against falciparum malaria (in recent years the parasitological failure rate has risen from 40 to 80 percent in Pakistan), but remains the drug of choice for treating infections caused by P .vivax. P. falciparum exhibits reduced sensitivity to sulphadoxine-pyrimethamine in few areas of the country, but the drug is still considered suitable because of higher efficacy when given in combination with artesunate (97% effective combination if given for 3 days). Artesunate and sulphadoxine-pyrimethamine combination therapy is therefore currently the first line treatment for all confirmed falciparum cases. In most of the areas of Punjab, FATA and even the high risk Balochistan P.vivax is the predominant species, which fortunately responds to the CQ and PQ. Public health facilities fulfill all the treatment needs of vivax cases through local sources.

Operational Strategies

Diagnostic Services

• Public sector diagnostic services for malaria will be provided free of charge.

• Microscopy will form the diagnostic method of choice at hospital level (will be implemented in partnership with National Tuberculosis Control Program)6.

• Below hospital and Rural Health Centres level facilities, falciparum specific and pan-specific RDTs will form the diagnostic method of choice. [TSE for nationwide BHU = RDT requirement]

• Provinces shall implement a comprehensive quality assurance system for malaria microscopy and RDTs through the referral laboratory network . This will be linked to needs-based refresher training.

• To minimize wastage, use of RDTs will be strictly limited to diagnosing clinically suspected cases.

• During epidemic or emergency situations RDT-based diagnostic services will be established.

Appropriate treatment

• Antimalarial drugs will be provided free of charge at all public sector health facilities.

• Antimalarial drugs will be provided free of charge throughout the LHW network by 2010 according to national treatment guidelines

• Artemisnin-based combination therapy (ACT) will be provided for confirmed falciparum malaria cases throughout the country as per national treatment guidelines.

• Chloroquine as first line drug will be provided to all confirmed vivax cases

• Primaquine will be provided radical cure of confirmed vivax cases as per national treatment guidelines.

• National malaria treatment guidelines will be reviewed regularly and revised based on the findings of surveillance as appropriate.

• National malaria treatment guidelines (and any revisions to them) will be implemented at all public sector health facilities throughout the country within one year of ratification. Recommended antimalarials, including ACT, will be incorporated into the essential drug list and the provincial medicine procurement list.

• National malaria treatment guidelines (and any revisions to them) will be communicated to private sector health care providers throughout the country within one year of ratification



(through drug regulatory authority/PMA).

Outbreak response

• In the event of an outbreak, district-level teams will carry out active case detection in the outbreak union council and in all adjacent union councils. Confirmed cases will be treated according to the newly endorsed National Treatment Guidelines.

Expected outcomes:

• 80% of public sector health facilities have clinical staff trained in the use of ACT by 2009.

• 80 % of care providers at rural public sector PHC facilities providing appropriate diagnosis and treatment to suspected malaria cases by 2011.

3. Epidemic Preparedness

Many areas of the country are epidemic prone and major outbreaks in recent past have occurred in these areas. Prolonged drought followed by years with higher than average rainfall, irrigation channel systems in highly endemic provinces, mass movement from high endemic areas to the areas of low transmission, high level drug resistance and low immunity of people living in low endemic areas are the major underlying factors working behind the development of epidemic situation. National Malaria Strategic Plan (2007-2012) has identified the following Operational Guidelines for Epidemic Detection and Response.


• A simple malaria outbreak early warning system will be established in selected public health faculties by 2009 (one sentinel site per district). This will be complimentary, rather than additional, to existing surveillance networks.

• Federal and provincial MCPs will earmark 10% of the budget to deal with emergency situations. Technical and operational linkage between districts, provinces and federal MCPs will be strengthened for an effective coordinated action in response to epidemics.

• Adequate revolving resources will be provided as an epidemic control reserve. The required materials will be procured every year and the reserve stock of the past year will be distributed for routine IRS.

Expected outcomes:

• All reported outbreaks responded to within one week of detection.

• By 2009, 60% of outbreaks detected within one week of incidence rising above threshold level. • Weekly incidence of confirmed malaria in all outbreak7 union councils brought below outbreak

threshold level within one month of detection by 2009. 4. Behavior Change Communication


• Carefully tailored locally appropriate malaria related IEC/BCC will be delivered through 5 methodologies: interpersonal communication (health workers, religious and community leaders); primary and secondary education (malaria incorporated into vector borne disease control module); mass media (electronic and print); special events (malaria day); and, advocacy.

• The primary development of all new educational materials and methodologies for BCC will be carried out at federal DOMC in association with the PHC Program’s Health Education Cell . All new provincial BCC initiatives will be based on these primary sources and will be developed in close collaboration with federal DOMC.

• Final development and production of BCC materials will be outsourced to private sector specialists.

• Maximum use will be made of promotional opportunities such as articles in newspapers, and news bulletins, documentaries and appropriate programs on television and radio.

• Every year BCC materials and methodologies at all levels will be reviewed by the BCC technical working group and revised as appropriate.



Expected outcomes:

• Comprehensive communication strategy developed and implemented in partnership with Health Education Cell of MOH by 2008.

• 80% of women of child bearing age who live in high transmission Union Councils know the

preventive benefits of LLINs by 2011.

• 90% of women of child bearing age know the benefits of Early Diagnosis and Appropriate Treatment by 2011.

5. Program Management

Operational Strategies Planning

• By 2008, Technical Working Groups (TWGs) will be established and maintained for all key technical areas including: diagnostics; case management; vector control; IEC/BCC; monitoring & evaluation; and operational research.

• A comprehensive set of technical guidelines including guidelines on vector control, epidemic preparedness and control, monitoring drug and insecticides resistance will be developed by the TWGs and disseminated by the end of 2008.

• Policies, strategies and guidelines will be reviewed regularly by TWGs in light of findings from periodic evaluations and in view of recommendations resulting from surveillance and operational research activities.

• To ensure equitable and evidence-based distribution of services, allocation of all program commodities will be carried out by the relevant TWG.

• Inter Agency Coordination Committee (IACC) for malaria will be established on the lines of the already existing TACOM and will be further strengthened. The committee will have representation from MoH, DOMC, NIMRT, PHDs, and the NGO sector, WHO and USAID/DFID and other multilateral and bilateral agencies. This committee will meet on quarterly basis and be responsible for exploring the possibilities of extended partnership and resource allocation for the emerging needs.

• By 2010 organizational restructuring of the malaria control program will be carried out in-line with the principles of RBM.

• DOMC will further strengthen links with the Primary Health Care (PHC) Program and the National TB Program and take full advantage of any opportunities for synergy with these programs.

• The national and provincial malaria control program will be adequately equipped to ensure effective program implementation.

Coordination

• Quarterly meetings will be held with key counterparts (provincial directors, donor agencies, technical agencies and representatives from implementing partners) to ensure the smooth functioning of program implementation.

• Additional coordination meetings with selected partners may be carried out on an ad hoc basis as necessary.

• The Malaria Control Program will be represented at all TACOM meetings.

Procurement and logistics

• DOMC’s technical specialists will ensure that tendering documents include detailed and explicit specifications of all products required (“WHOPES approved”, “ISO certified” or “GMP standard” commodities will be given preference).

• Procurement of all commodities will be organized to maximize economies of scale and to ensure timely delivery.

• All centrally procured commodities will be delivered to provincial level under DOMC



management.

Quality assurance of commodities

• DOMC will manage quality assurance of all commodities at national and international reference centers. Multi-stage sampling will be carried out to ensure effective supply of quality products to all program beneficiaries.

Program representation

• The program will foster enhanced visibility and greater political commitment through high level advocacy and broad dissemination of program achievements.

Monitoring and evaluation

• Routine monitoring will be carried out according to national M&E guidelines under the supervision of the DOMC’s M&E unit and in collaboration with WHO.

• A full programmatic review will be conducted every three years by an external team.

Surveillance

• Routine epidemiological surveillance will be carried out by all public sector healthcare providers according to national guidelines.

• Hospital-based (THQs/DHQs) surveillance for severe and complicated malaria and associated mortality will be established by 2009

• Routine surveillance of drug resistance will be carried out annually in 4 out of 8 sentinal sites (in vivo, in vitro and genotypic)

• Routine surveillance of insecticide resistance in primary vectors will be carried out annually in 4 out of 8 sentinal sites (bioassays, PCR analysis and biochemical analysis)

Capacity building

• Two long term international advisors will be recruited by 2008 (one for institutional capacity building and other for technical program management including vector control).

• A technical assistance call-down facility will be established for technical and managerial capacity development at federal level.

• Strengthening of provincial technical capacity through the availability of services of NPOs with desired expertise.

• Training to develop the skills of the Programme staff will be conducted.

• Training to diploma level will be provided for provincial and district staff.

• A holistic package of carefully tailored technical and management training will be developed by DOMC/TA and will be implemented through provincial and district level staff in order to strengthen the functionality of service provision in the periphery.

• Partnerships will be developed with community based groups in order to enhance accountability within the peripheral public sector health network.

Expected outcomes:

• IACC, TACOM independently judged to be fully effective from 2008. • Provincial/District plans for malaria control are developed and implemented by 2008. • Adherence to national M&E plan by all implementing partners from 2008.

6. Operational research

Operational Strategies • The program will implement a modest needs-based package of operational research in association

with national and international research institutes.

• Research priorities will be reviewed annually by a TWG and the resulting research agenda will be


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ratified by the malaria advisory committee.

• Before commencing, all clinical research projects will be passed by the national ethical review committee.

• The National Institute for Malaria Research and Training (NIMRT) in Lahore is being developed as the national centre of excellence for vector borne diseases research and training.

Programmatic Targets The following targets have been set for National Programme for the period 2007-2011: Impact level:

• Overall incidence of confirmed malaria in Pakistan brought below 1 case per 1,000 by 2011. • Incidence of confirmed malaria in rural areas of Balochistan, NWFP/FATA, Sindh and Punjab

brought below 5, 3, 2 and 1 case per 1,000 respectively by 2011. • Proportion of malaria cases caused by P. falciparum reduced to 10% by 2011. • Hospital-based severe malaria case mortality rate reduced to below 10% by 2011.

Coverage level: • 70 % of pregnant women in high risk union councils sleeping under LLINs by 2011. • 80 % of children under 5 in high risk union councils sleeping under LLINs by 2011. • By 2008, the annual routine IRS campaign will cover 80% of households in union councils which

exceed IRS target thresholds. • 80 % of care providers in the public sector providing appropriate diagnosis and treatment to

suspected malaria cases by 2011. • Weekly incidence of confirmed malaria in all outbreak8 union councils brought below outbreak

threshold level within one month of detection. • 80% of women of child bearing age who live in high transmission Union Councils know the

preventive benefits of LLINs by 2011.

• 90% of women of child bearing age know the benefits of Early Diagnosis and Appropriate Treatment by 2011.

(b) Describe how these disease prevention and control strategies fit within broader developmental frameworks such as Poverty Reduction Strategies, a Health Systems Strengthening Strategy, the Highly-Indebted Poor Country (HIPC) Initiative, and/or the Millennium Development Goals, emphasizing how the additional support requested in this proposal is aligned with developmental frameworks relevant to the country context. (Also include an overview of any links to international initiatives such as the WHO/UNAIDS ‘Universal Access Initiative’ or the 'Global Plan to Stop Tuberculosis 2006-2015' (e.g., for HIV/TB collaborative activities) or the 'Roll Back Malaria Global Strategic Plan').

Pakistan ranks 65th among the developing countries with a Human Poverty Index (HPI) of 39.2%. Although HDI has shown a steady improvement from 0.343 in 1975 to 0.498 in 1999, but the country still ranks 144 out of 175 UN member countries. The government strategy for reviving growth rests on macroeconomic sustainability; market liberalization and deregulation; privatization; and targeted interventions to support small and medium size private enterprises. Pakistan’s broad development agenda has been defined in the “Poverty Reduction Strategy Paper for Pakistan - Accelerating Economic Growth and Reducing Poverty: The Road Ahead”. It outlays a comprehensive development agenda across all sectors with special emphasis on poverty reduction and social sector development. The Poverty Reduction Strategy Paper (PRSP) envisages increased financing and enhanced efficiency in the health sector through organizational and management reforms. The strengthening of district health systems as well as involvement of private sector under current programme approaches are well placed in this context to alleviate poverty. On the programmatic aspects the focus is on control of communicable diseases (especially TB, malaria, HIV/AIDS, Hepatitis B, and cluster of immunizable childhood diseases), reproductive health, child health and nutrition. The proposed interventions and services are consistent with the Millennium Development Goal for communicable diseases and RBM initiative of Pakistan.

Public sector health allocations and expenditures at the Federal level (2001-

52



The Government of Pakistan is implementing the health sector reforms and has gradually increased in the resource allocation for the implementation of disease control interventions. The goals of the current programme are directly linked to the current RBM and MD Goals.

(c) Describe how this proposal seeks to: (1) use, to the extent that they exist, country systems for planning and budgeting, procurement and supply management, monitoring and evaluation and auditing; and (2) achieve greater harmonization and alignment of partners to country cycles in regard to procedures for reporting, budgeting, financial management and procurement.

The proposed project aims to synchronize the current policies and the management system of the MoH particularly the planning, supply management, budgeting and M&E cycles and designed in such a manner to further strengthen the delivery and drug management system at national, provincial and district levels. Public Procurement Regulatory Authority (PPRA) is the national level body for defining procurement rules and setting QA assurance standards in public health items procurements. Procurement of antimalarial drugs, RDTs, LLINs and technical expertise (services) through WHO will further strengthen the supply management chain and will ensure uninterrupted drug supply to the health facilities in the remote health system; it will also ensure the maximum transparency in procurement of goods and services.

Quarterly Reports on the project activities from the implementing partners and financial management will be harmonized with the MoH quarterly reporting system

4.3.4 National health system

(a) Briefly describe the main health systems constraints related to this component by focusing on the strengths, weaknesses, opportunities and threats of the health system.

Please consider the list of health systems strengthening strategic actions ('HSS Strategic Actions') outlined in section 4.4.2 of the Guidelines for Proposal when providing this description.

The public sector is the key source for provision of preventive care and hospital care to the urban and rural population. At the Federal level, The Ministry of Health is headed by a Minister and managed by a Secretary (administrative head) and a Director General (technical head). The federal setup is responsible for policy formulation, overall planning and coordination, and implementation support to health services in the country. At the provincial level, a Minister heads the department whereas a provincial Secretary exercises administrative control over teaching hospitals and other key affairs of the department. A provincial Director General Health is responsible for preventive and curative services through district and sub-district hospitals and primary health care facilities, out-reach preventive programs and female community health workers. At district level Executive District Officer (Health) EDO (H) is the over all head of the district health management team to plan and implement curative and preventive activities at district level.

The National Malaria Control Program (MCP) is a national body, under the Ministry of Health, responsible for overall coordination of the Malaria Control activities in the country. The MCP is not directly involved in the Malaria care delivery, which is the responsibility of the provincial/district health services. The main responsibilities of MCP includes: a) policy formulation and strategic planning, b) technical support for implementation of preventive actions to the provinces,FATA and AJK/NA, c) supervision, monitoring and evaluation support to the provinces,FATA and AJK/NA, d) coordination and communication with partners, and e) developing research Capacity and undertaking research related activities in collaboration with the Provinces.

The Provincial Malaria Control Programs (PMCP), under their respective departments of health, are responsible for coordinating the planning, implementing, managing and financing of the Malaria control activities in their respective provinces/regions. The PMCPs are involved in supporting the district health services, and other partners, for effective implementation of RBM strategies in the districts. The main responsibilities of the PMCPs includes: a) participation in strategic, programme and operational planning, b) technical support to the districts, c) supervision, monitoring and evaluation support to the districts, d) coordination and communication with partners, and e) operational research.

The district authorities, in context of devolution, are primarily responsible for advocating, planning, financing, implementing, and monitoring Malaria care services in their respective districts. The



delivery and management of malaria care has been integrated within district healthcare services so that continuing care can be provided close to the patient's home.

The hospitals (924), and rural health centers (560) work as diagnostic centers where microscopy services are available for confirmed diagnosis and management of malaria. The basic health units (5336) and dispensaries (4712) work as treatment centers where patients are managed on the basis of clinical diagnosis. The secondary/tertiary hospitals offer care to severe and complicated malaria cases.

There has been gradual increase on public health spending as the very recent budgetary allocation for 2006 saw an almost 40% jump in the health sector investments compared to the figures of 2005 . However there is a problem of inequitable distribution and in-efficient utilization of health resources.

The public sector health coverage is supported by the non-government organizations including both not-for-profit NGOs and for-profit private sector. Contribution of local, national and international NGOs in malaria control activities is there, but their technical and managerial capacity varies widely and funding sources are limited. Recently NGOs of international repute (Merlin, Mercy Corps etc) with experience of implementation in other parts of the world have established their set up in the country and they are being involved in the development of the current proposal and will be implementation partners too. Technical and managerial capacity of the partner NGOs will be enhanced through the recruitment of trained HR and they will be provided technical guidance by the DOMC to ensure the quality of the implemented activities.

Private sector is estimated to be catering to about 80% of curative primary healthcare needs of population besides low cost hospital care according to a 1998 DFID Mission Survey. However, this figure varies significantly regionally in Pakistan. The situation in Balochistan, FATA and NWFP regions reflect less investment in both public and private sector health care. It is reasonable to assume that a higher proportions of curative care may also be provided by the public health sector in these regions. Involvement of private sector in malaria diagnosis and treatment services in line with the national malaria treatment policy will be assessed in 4 pilot districts of the current round. Capacity building of private care providers together with the provision of RDTs and ACTs will enhance the participation of private sector in malaria control interventions. More over in these pilot districts private sector will also be involved in malaria surveillance activities.

(b) Describe the national priorities in addressing these constraints.

There is increasing awareness about the need to invest more in the formation of social capital through

increased public spending on health and education benefiting from the sustained economic growth in thcountry;

Equity and social protection are high on the political agenda as reflected in the poverty reduction strategy and safety nets;

The Government of Pakistan “Vision 2030” initiative provides a long term vision and strategy for national development including health whereby malaria is cited as priority area ;

Specific disease programs are being integrated through District Health Systems;

Priority areas for support to Health System Development

The following aspects will be strengthened directly or indirectly through this proposal.

• A well financed and equitable health system that progressively reduces out of pocket payment for those who cannot afford, secures financial risk protection and protects the poor from catastrophic health expenditures;

• Clear evidence based vision for health needs;

• A better managed and regulated public private mix that harnesses the private health sector to help achieve public health goals;

• A balanced, skilled, well distributed and motivated health workforce;



• Improved access to a well defined package of quality health services;

• A well functioning district health system aligned to the devolution process;

• A health information system that provides valid, reliable and disaggregated information on important health determinants, programs and system functions for informed decisions and is backed up by an effective disease surveillance system in the country.

The present proposal will contribute towards health system strengthening through coordination with other national health programmes, coordinated M&E through Ministry of Health and CCM, and improved service delivery and supervision system at district level.

(c) Coordination and Synergies

Briefly describe how disease specific programs are coordinated within the framework of the National Health Sector Development Plan, where one exists. For instance how the proposed component relates to (where appropriate) the national communicable disease strategy and to priorities in the plan.

If the Applicant's proposal covers more than one component, also describe any synergies expected from the combination of different components. For example, linkages between HIV and malaria prevention and control strategies. (By synergies, we mean the added value that the different components bring to each other, or how the combination of these components may have broader impact.)

The major synergetic activity is expected under the component of malaria and Tuberculosis is in the service delivery area of diagnosis at all levels, where expansion of microscopy under the umbrella of Tuberculosis and Malaria Control Program in 3 target districts of Balochistan in R-6 (TB Component) will extend the coverage of diagnosis for both the diseases. The current proposal Malaria components aims to establish and strengthen peripheral microscopy centers, which would ultimately serve as diagnostic centers for both the diseases. First Level Health Care facilities offering MCH services, will be identified as LLINs distribution points for the pregnant women attending these facilities, which will improve the utilization of these services at these outlets.

There is a functioning network of >95,000 LHWs across the country, linking the health services to the families in the target communities. This network is now the back bone of the Primary Health Care and “Family Planning” activities at the community level. Distribution of LLINs to the expected mothers and children <5 years using the “Health Houses” of these LHWs, will not only result in enhanced confidence of the LHWs on one hand and increase the “trust” of the catchment’s area population on the service package of these workers on the other hand.

4.3.5 Common funding mechanisms

This section seeks information on funding requested in this proposal that is intended to be contributed through a common funding mechanism (such as Sector-Wide Approaches (Swap), basket or pooled funding (whether at a national, sub-national or sector level).

Yes answer questions

below. (a) Is part or all of the funding requested for the disease component intended to be contributed through a common funding mechanism?

No go to section 4.4

(b) Will the funding requested be channeled to implementation partners/beneficiaries through a common funding mechanism for all years of the proposal, and in regard to all proposed interventions/activities? If not, which years, what activities, and why this approach?

NA



(c) Describe the common funding mechanism, whether it is already operational and the way it functions. In your response, identify development partners who are part of the common funding mechanism and their respective level of financial contribution (in percentage terms) to the common funding mechanism. (Please also provide documents that describe the functioning of the mechanism as an annex. These documents may include: the agreement between contributing parties; joint Monitoring and Evaluation procedures, management details, joint review and accountability procedures, etc.)

NA

(d) Describe the process for independent supervision of the performance of the common funding mechanism. Also describe the outcomes of any recent assessment of the common funding mechanism undertaken according to these processes. In particular, Applicants should fully explain any adverse outcomes, and what actions were taken to respond to these findings.Attach, as an annex to your proposal, the most recent external assessment of the operations of the common funding mechanism.

NA

(e) Describe the Applicant's assessment (including by reference to any criteria used during the assessment process) of the capacity of the common funding mechanism to absorb the additional funds generated by this proposal and ensure effective supervision of the work that is proposed. Where relevant, provide details of any changes that have been agreed with the common funding mechanism as a result of this proposal to ensure that the funding (if approved) will be used in a transparent, efficient and timely manner.

NA

(f) Explain how the funding requested in this proposal (if approved) will contribute to the achievement of outputs and outcomes that would not otherwise have been supported by resources currently or planned to be available to the common funding mechanism.If the common funding mechanism is broader than this disease component, Applicants must explain the process by which they will ensure that funds requested will be used for malaria activities during the proposal term.

NA



4.4 Overall Needs Assessment The outputs and outcomes planned to be achieved under this proposal (if approved) should be based on an analysis of financial and programmatic gaps in national plans/programs to prevent and control the disease. To help Applicants identify these gaps: Step 1 Section 4.4.1 requests Applicants to identify gaps in the main programmatic areas targeted

by this proposal, and the level of additional coverage that is requested through this proposal. This is a summary of the main gaps only. Applicants must still describe the specific interventions/activities planned under this proposal (in section 4.6) and the targets and indicators that are proposed to evaluate performance during the proposal term (in the 'Targets and Indicators Table', Attachment A);

Step 2 Section 4.4.2 requests Applicants to describe any health systems strengthening strategic

actions ('HSS Strategic Actions') that are essential to ensure that the planned outputs and outcomes of this proposal will be achieved, and to identify how much support for these actions is requested in this proposal. HSS Strategic Actions are more fully discussed in the Round 7 Guidelines for Proposal (section 4.4.2). Section 4.4.2 below also requests information on other current and planned levels of support for these same actions; and

Step 3 Section 4.5 requests Applicants to identify the overall disease specific financial need for the

country/countries targeted in this proposal. This table asks Applicants to identify, on a national disease specific basis, the overall financial needs required to prevent and control the disease. Thus 'Line A' in table 4.5 should include both program and essential disease specific health systems needs. All other lines in the table should also include both program and health systems needs if these are essential to the national disease prevention and control plan. This is a summary of the financial needs only. Applicants must provide a detailed budget request by disease component (within section 5) and summarize this request in table 1.2.

Thereafter, in section 4.6, Applicants should fully describe the specific interventions/activities which are included in this proposal to ensure that the programmatic needs targeted by this proposal are fully met. See the Guidelines for Proposals, sections 4.4 and 4.5, for further explanation.



4.4.1 Programmatic Needs Assessment

4.4.1 Overall programmatic needs assessment

(a) Based on an existing Health Sector Strategic Plan (or, if not in existence, an analysis of national/regional goals, together with careful analysis of disease surveillance data and target group population estimates for relevant prevention and control strategies), describe the overall programmatic needs in terms of people in need of these key services. Please indicate the quantitative needs for three to five main services that are intended to be delivered for this disease component (e.g., long lasting insecticide treated bed nets, and ACTs and other pharmaceuticals for malaria treatment). Also specify clearly how much of this need is currently covered (or will be covered) over the proposal term by domestic sources or other donors. Please note that this gap analysis should guide the completion of the Targets and Indicators Table required under section 4.6. When completing this section, please refer to the Guidelines for Proposals, section 4.4.1.

The Government of Pakistan has accorded high priority for the control of malaria and other communicable diseases as embodied in its current National Health Policy . The policy further emphasizes the focus on primary health care and strengthening the district-health systems. Malaria Control Programme is one of the 7 priority programmers of the MoH. The goal of the Programme is to reduce the burden of malaria by 50% by the year 2010 through the implementation of RBM interventions in the country. The key elements of the national malaria control strategy includes: 1. Early diagnosis and rapid treatment.

2. Multiple prevention including LLINs promotion and rational use of insecticides.

3. Effective behavior change communication (BCC) interventions for care providers, opinion leaders and communities in general.

4. Early detection and response to epidemics.

5. Operational research.

6. Partnerships with international and in-country government and non-government partners.

The Pakistan malaria programme is currently minimally supported by WHO and DIFD only. Global Fund is the major possible source of external funding to fill the financial gaps of the programme. During the current round of GFATM the requested funding will expectedly contribute achieve the planned national targets National Strategic Plan 2007-2011 with the following planned activities.

Under strategy of rapid diagnosis and early treatment, it is expected to;

a) Strengthen the service delivery capabilities of present 276 centers by training/refresher training and provision of new microscope and reagents,

b) Increase diagnostic capacity by establishing about 1500 more diagnostic centers (30% of 4825 Basic Health Units – introduction of Rapid Diagnostic Test (RDT),

c) Training of 2000 health workers from public sector in Pakistan over next 5 years on the subject of national treatment and case management guide lines,

d) Training of 500 health workers from private sector in Pakistan over next 5 years on the subject of national treatment and case management guide lines,

e) No of health facilities administrating ACT’s as a first line treatment for lab. confirmed P.falciparum will reach to 276 during the project period.

f) Distribute about 1 million bed nets ( 4.1% pregnant and 18% under 5 out of target population- family bed net shared by 3 members) to cover 80% of pregnant and under 5 rural population in high risk districts,

g) Training/awareness about early seeking of diagnosis and treatment

The total needs of programmatic interventions in 19 districts during the current GF Grant have been carefully calculated through technical assistance. A Major portion of the resources is planed to be made available from national sources particularly for the distribution of CQ and PQ to treat vivax cases and the whole indoor residual spraying component in selected epidemic prone localities. However an additional funding of US$ 21.5 million is required to be met from the current Round for



the provision of effective services in 19 high risk districts.. The gap analysis based on population figures and service delivery personnel is attached as Attachment 3.

b) Based on an analysis of the national goals and objectives for fighting the disease component, describe the overall financial needs. Such an analysis should recognize any required investment in health systems linked to the disease. Provide an estimate of the costs of meeting this overall need and include information about how this costing has been developed (e.g., costed national strategies, medium term expenditure framework). (Actual targets for past years and planned and estimated costing for future years should be included in table 4.5.1-3 [line A].)

The estimate is based on preliminary costing carried out in year 2007 as a part of a national strategic planning exercise, which requires about US$ 40 million for the investment in health infrastructure development to establishing about 2500 more malaria diagnostic laboratories at the basic health units offering MCH services. .

(b) Complete table 4.4.1

Table 4.4.1 is designed to assist Applicants to clearly illustrate overall programmatic needs in terms of people in need of key services. Applicants should note that this gap analysis should be used to guide the completion of the Targets and Indicators Table in Attachment A to the Proposal Form (see section 4.6 of the Guidelines for Proposals).

In addition, please specify below relevant information concerning the groups targeted and any assumptions including target size.

All the calculations made for analysis of gap are based on the available information from MIS and health survey of the country. The assessment clearly indicates the major focus on the health of expected mothers and <5 children, the highly effected group of the population particularly in poor stratum of the population. The over all needs of 52 million population living in 30 high risk districts including the target 19 districts for the current round, have been estimated to benefit at least 12 million people of these 19 districts sharing major burden of the disease and major source of imported malaria to “malaria free” gulf countries (UAE, etc). The project will to augment the GOP efforts for extension of its health agenda to the most marginalized populations of the country.

Pregnant women (4%) and children <5 (18%) who constitute 22% of the target population, are the major target groups for the provision of quality assured diagnosis ( RDTs), treatment (ACTs) and protective interventions (LLINs) in all the 19 districts. It is estimated that 30% of pregnant women use health facilities for antenatal care, 50 percent of them are anemic at the time of first visits, 20% of these women if tested through RDTs will be Mp positive. Half (10 out of 20 positive pregnant women) of these +ive cases will account for falciparum and 10 for vivax malaria. A total of 1.84 million RDTs and 0.5 million ACTs will be required to achieve the desired coverage (>60%). A total 1,000,000 LLINs will be required for achieving 80% coverage (sleeping under an LLIN) of target groups for initial 2 years.

Acts and RDTs will also be distributed to private clinics in 4 pilot target districts.


R7_CCM_PKS_M_PF_4Jul07_EnXXX 60

Please refer to the M&E Toolkit when completing this table for information on key services and service delivery areas. Important Note: For at least three (but not more than five) "key service" areas targeted by this proposal, list the size of the target group in Part A of table 4.4.1 below, and then complete Parts B, C and D for the same "key service" area. [For example, if the country's planned outcome by 2012 is 3,000,000 children under 5 protected by LLINs (Part A in the table below), and current and planned support, including all existing Global Fund and other donor support, is expected to ensure that 800,000 children protected by 2012 (Part B in the table below), the overall unmet need will be 2,200,000 (Part C in the table below). In Part D of this table, Applicants should then describe the extent of additional coverage for this key service targeted by this proposal.]

Programmatic Gap Analysis Actual Anticipated

2005 2006 2007 2008 2009 2010 2011 2012

Part A: People in NEED of Key Services (i.e. Country desired/planned outcomes up to 2012)

Key Service 1 Early Diagnosis 2,397,950 2,443,511 2,489,938 2,537,247 2,585,454 2,527,933 2,589,548 2,666,433

Key Service 2 Prompt and effective antimalarial treatment 315990 316938 317888 318842 319798 256606 225204 161342

Key Service 3 Long-lasting insecticide treated bednets9 2,275,456 2,318,690 2,362,746 2,407,639 2,284,185 2,330,800 2,330,800 2,330,800

Part B: People CURRENTLY RECEIVING or EXPECTED TO RECEIVE Key Services relevant to this proposal as financed by current or anticipated resources:

Key Service 1 Early Diagnosis 1,918,000 1,954,442 1,991,576 2,029,416 2,067,975 2,107,267 2,147,305 2,188,104

Key Service 2 Prompt and effective antimalarial treatment 157,995 158,469 158,944 159,421 159,899 128,303 112,602 80,671

Key Service 3 Long-lasting insecticide treated bednets 325,907 326,073 766,655 1,207,671 1,330,777 1,330,777 1,330,777 1,330,777

Part C: TOTAL UNMET NEED for people in need of the 'Key Services' relevant to this proposal (A1 – B1 = C1, A2 – B2 = C2 etc.)

Key Service 1 Early Diagnosis 479,950 489,069 498,362 507,831 517,479 420,666 442,243 478,329

Key Service 2 Prompt and effective 157,995 158,469 158,944 159,421 159,899 128,303 112,602 80,671



Programmatic Gap Analysis Actual Anticipated

2005 2006 2007 2008 2009 2010 2011 2012 antimalarial treatment

Key Service 3 Long-lasting insecticide treated bednets 1,949,549 1,992,617 1,596,091 1,199,968 953,408 1,000,023 1,000,023 1,000,023

Part D: PORTION OF UNMET NEED COVERED BY THIS PROPOSAL

Key Service 1 Early Diagnosis10 253,915 517,479 420,666 442,243 478,330

Key Service 2 Prompt and effective antimalarial treatment 20,000 158,899 128,303 112,602 80,671

Key Service 3 Long-lasting insecticide treated bednets

Information provided in the adjacent columns should be consistent with the annual targets for these "key services" in the 'Targets and Indicators Table' (Attachment A) to the Applicant's proposal.

200,000 600,000 1,000,000 1,000,000 1,000,000

10 It includes both RDT and microscopy.



4.4.2 Strategic actions to strengthen health systems As explained at the start of section 4.4, certain 'HSS Strategic Actions' may be essential (dependent on country specific contexts) to ensure achievement of the outputs and outcomes targeted by this proposal. These HSS Strategic Actions may include actions to improve grant performance, address current or anticipated barriers, and/or support and sustain expansion/scale-up of interventions to prevent and control the disease. The Global Fund therefore strongly encourages Applicants to include in their proposal a request for support of relevant HSS Strategic Actions which are coordinated with the national disease control strategy. Before completing this section, Applicants should refer to the Round 7 Guidelines for Proposals, section 4.4.2. where significantly greater detail is provided on HSS Strategic Actions supported in Round 7.

4.4.2 Description of HSS Strategic Actions included in this component

(a) Complete table 4.4.2 below to describe for up to five actions (copy the table as many times as relevant):

(i) the HSS Strategic Actions that are essential to achieve the planned outputs and outcomes of this disease component;

(ii) how the actions link to the planned work during the program term and address key points arising from the analysis of the health system referred to in your response to question 4.3.4 above; and

(iii) what other support is currently available or planned for the same actions to ensure achievement of the planned outputs and outcomes of this proposal.

Ensure that the HSS Strategic Action(s) is/are consistent with (where one exists) the national Health Sector Development Plan/Strategic Plan and its time frame (please also ensure you provide this Plan as an annex to the proposal as requested in section 4.3.1).

To clearly demonstrate the link requested in (ii) above, Applicants should relate proposed HSS Strategic Actions to disease specific goals and their impact indicators.Refer to the information on the revised indicators for HSS in the Guidelines for Proposal at section 4.4.2. (Where only one strategic action is proposed, Applicants must explain the rationale behind this decision with reference to the guidance provided in the Guidelines for Proposals.)

Remember to expand the table for up to five HSS Strategic Actions.

Table 4.4.2A – Summary of essential HSS Strategic Actions requested in Round 7

4.4.2A Summary of funding requested for HSS Strategic Actions in Round 7

In the table below summarize, on a per year basis, the total of the funding requested for HSS Strategic Actions in this proposal for this disease component. This will be the sum of the 'Funding Request' for each year for each HSS Strategic Action included in this disease component, as detailed by you in table 4.4.2 (on the following page, copied for up five HSS Strategic Actions). Applicants are reminded that they must ensure that the overall funding needs (table 4.5) include both program and essential disease specific health systems needs to ensure that the financial gap analysis reflects all available, planned and required resources.

Total funds for essential HSS Strategic Actions requested over proposal term

Year 1 Year 2 Year 3 Year 4 Year 5 Total



Table 4.4.2 – Summary of Strategic Actions essential to this proposal

Action 1

(Description of the HSS Strategic Action, its rationale and linkages to this proposal – not more than half a page for each HSS Strategic Action)

Describe below the planned outputs/outcomes that will be achieved in regard to these HSS Strategic Actions during the proposal term, and, as a total only, the amount requested for each year.(Specific financial information on the funds requested must be included in section 5 in the detailed budget).

Year 1 Year 2 Year 3 Year 4 Year 5

Round 7 Funding

Request Year 1

Round 7 Funding

Request Year 2

Round 7 Funding

Request Year 3

Round 7 Funding Request Year 4

Round 7 Funding Request Year 5

Describe below other current and planned support for this action over the proposal term

In the left hand column below, please identify the name of other providers of HSS strategic action support. In the other columns, please provide information on the type of outputs.

Name of supporting stakeholder

Timeframe of support for HSS action

Level of financial support provided

over proposal term (same currency as

this proposal)

Expected outcomes from

existing and planned support

Government

Other Global Fund Grants (with HSS elements)

4.4.2 HSS Strategic Actions continued Risks arising from support for the actions and cross-cutting issues

Applicants are strongly encouraged to refer to the Guidelines for Proposals before completing (b) to (g) below.

(b) Describe your consideration of the broader implications of the proposed strategic actions and their potential impact on the functioning and performance of the health system, key institutions and stakeholders and other health programs (through a SWOT or other similar exercise). Describe, especially, any risk mitigation strategies in response to potential threats to the health system, and proposed options for ensuring long-term sustainability of the strategies built into this proposal.



Yes complete (d) and (e), and

then (f) (c) Are there cross-cutting HSS Strategic Actions integrated within this component that will benefit any other disease component also submitted for funding in Round 7? No

go to section 4.4.2(f)

(d) If yes to (c), provide a short description of which component(s) and how the HSS Strategic Actions in this component will benefit achievement of the outputs and outcomes targeted in the other component(s).

(e) If relevant, provide a detailed justification (with clear information on direct linkages to this disease component) for those cross cutting HSS Strategic Actions in this component which you believe should still be funded even if one or both (as relevant) of the other components submitted in Round 7 are not recommended for funding.

(Two page maximum, including summary details of relevant actions and budget amounts. Also ensure that the budget amounts for HSS Strategic Actions are clearly indicated in the detailed budget required in section 5 for this component). Refer to the Guidelines for Proposals, section 4.4.2(d) for additional guidance.

Yes, Tuberculosis

Yes, Malaria

(f) Are there any cross-cutting HSS Strategic Actions integrated within another component in your Round 7 proposal that will benefit this component?Applicants should ensure that the detailed budget in the other component(s) clearly identify the costs of the HSS Strategic Actions. Applicants must also ensure that there is no duplication of costs included in the various components. No

(g) CCM and RCM Capacity for Health Systems Strengthening Issue identification.

Describe below how the CCM(s) and RCM(s) of countries targeted in this proposal are ensuring that they have, or are developing and/or strengthening, their capacity and experience in the identification of strengths, weaknesses, threats and opportunities in the health system relevant to national plans to prevent and control the disease(s). Applicants must also describe if there have been any changes in the relative capacity of the CCM(s) or RCM(s) since Round 6.

Refer to the Guidelines for further information,, section 4.4.2(g)

CCM role as an independent entity has been acknowledged. CCM Technical Sub Committee has been proactive and has held a number of meetings to take decisions on matters related to strengthening of health system. A linkage has been established with the Planning Commission, which is the apex planning body headed by the Prime Minister of Pakistan, with a full time deputy chairman with a rank of Minister of state as a chief executive In addition, sharing of information with wide range of stakeholders and the multi-sectoral CCM response have helped to effect salutary improvements in the national plans relevant to specific program of HIV/AIDS, TB and Malaria. Technical Assistance needs have been better coordinated. MDR issues have received more attention than before. Coordination among programs has improved. Secretary Health as Chair of CCM has been an effective link between National programs & CCM inputs. Additionally the presence of representatives of Ministry of Education, Ministry of Women Development, Ministry of Planning and Development Division, Provincial Health Program and the National Program Mangers on the CCM has created a congenial atmosphere of exchanging ideas. CCM meetings take up holistically all the factors related to the implementation of HIV/AIDS, TB and Malaria program at national level. Multi-sectoral CCM forum Pakistan recommends actions to strengthen the health system and identifies strengths & weaknesses and areas of reform. Proper focus on target groups is a positive outcome. The inputs of



CCM members representing various Federal Ministries in line with the CCM recommendations have helped to redefine the strategies. For example, there has been a noticeable change in the concept of Public Private partnership which has been extended as a necessary dimension in the national program on more institutionalized basis. The other strengthening aspects include joint M&E of disease specific program by MOH and progress shared with Planning Commission. It has been decided that all projects even outside the TGF of HIV/AIDS, TB and Malaria will require inputs from CCM before being submitted to planning commission processing in future under public sector development programs.

4.5 Financial Needs Summary

4.5.1 Overall Financial Needs Assessment

Based on an analysis of the national goals and objectives for preventing and controlling the disease, describe the overall disease specific financial needs. Include information about how this costing has been developed (e.g., through costed national strategies, Medium Term Expenditure Framework [MTEF] or other basis). As described in step 3 under section 4.4, such analysis should recognize any required investment in the HSS Strategic Actions described in section 4.4.2 above.

Summarize the overall financial need in table 4.5.

The overall financial gaps analysis has been carried out by keeping in view the available resource envelope of Government of Pakistan which amount to US $ 38 Million for this disease component.

The costing for the implementation has been carried out using the unit costs for service delivery developed by NMC through a consultative process in early 2007.

4.5.2 Current and planned sources of funding

(a) Domestic Sources

Describe current and planned financial contributions, from all relevant domestic sources (including loans and debt relief) relating to this component. Please also explain the process of prioritization of such funding to ensure that resources are utilized efficiently and on a timely basis (e.g., explain if there are significant available in-country resources, such as HIPC [Heavily Indebted Poor Country] debt relief or other such resources which are available to support disease prevention and control strategies, and how these resources are being efficiently used).

Also summarize such financial amounts for past and future years in table 4.5 and provide an overall total in Line B.

Following is the major chunk of domestic resources planned to be available during the project period. These include all the provincial and national level planned finances for the year 2007-2011

Y-1 million Y-2 million

Y-3 million

Y-4 million

Y-5 million TOTAL

Sindh 45.58 52.51 54.09 0.00 0.00 152.18

Bal 55.34 36.17 37.34 43.00 45.47 217.32

Federal 433.00 504.00 360.70 213.70 209.16 1720.56

Punjab 56.56 42.00 34.00 17.10 20.20 169.86



Totals Pak. Rs 689.96 699.51 549.69 329.74 330.04 2598.93

US$ 11.50 11.66 9.16 5.50 5.50 43.32 (b) External Sources

Describe current and planned financial contributions anticipated from all relevant external sources relating to this component (including, based on section 1.6, existing grants from the Global Fund and any other external donor funding).

Also summarize such financial amounts for past and future years in table 4.5 and provide an overall total in Line C.

WHO has been providing financial and technical support on biennial basis. WHO provided US$ 0.127 million support during the current biennium (2006-2007).

DFID provides support to the health sector through NHF as arrangement of national budgetary support provided to Ministry of Finance called “National Health Facility’ MoH directly through a unique system of NHF (National Health Facility) where the funds are pooled for all the disease control programmes and released on performance basis.

4.5.3 Overview of Financial Gap

In table 4.5, Line E, provide a calculation of the gap between the estimated overall need (Line A, table 4.5) and current and planned available resources for this component (Line D, table 4.5).

This table is a summary only of overall funding gap. Applicants must provide a detailed budget (see section 5) to identify the amount requested in this proposal in section 5..

4.5.4 Additionality

Describe how Global Fund resources received will be additional to existing and planned resources, and will not substitute for such sources. Explain plans to ensure that this will continue to be true for the entire proposal term.

The national strategic plan outlines the priority activities and input requirements for the years 2005- 2010. This has enabled the National Malaria Program to guide the project formulation exercise for addressing the identified priorities and gaps, without duplicating or substituting the ongoing efforts. This has been achieved through sharing the strategic priorities and plans as well as interacting frequently with the non-government partners, during the project formulation exercise. The interventions included in the proposed project addresses only the programme gaps, which are not already addressed through other means. The National malaria programme at federal and provincial level operate through 5 year planning cycles and the work plans are prepared by the Ministry of Health and approved by the ECNEC for funding by the Government of Pakistan. The district level planning is for common disease control which is funded and executed annually by district governments. The gaps identified are mostly at the district levels and both federal and provincial programmes fundamentally support district implementation and supervision of the activities. The proposed project activities under GFATM are to support district level programmes with emphasis on Western border districts in partnerships with locally operating NGOs and community organizations. By design the current approach of the project also aims to enhance the capacities of such organization to deliver health care services in areas where government infrastructure and service delivery is inadequate.. The proposed set of case management enhancement activities under objective 1 is based on the principle of continued, public sector material inputs including drugs, laboratory materials, print materials etc. in the districts. The Proposal has included only about 30% of the estimated required materials, to fill in the gaps/short delays in the public sector supply of drugs, laboratory and other supplies and materials for the 19 project districts. Similarly the project inputs will also supplement/augment the existing arrangements for training, supervision and monitoring of RBM



implementation in these 19 districts. The Proposal inputs for introduction of RDT Basic health units level would also augment the public sector inputs for the functioning/operations of the diagnosis network in these 19 districts of the country. Project resources will be utilized to enhance the involvement of private practitioners in offering diagnosis and treatment according to national guidelines. In GFATM Round II & III, a set of activities had already been initiated for strengthening the malaria case management in 30 selected districts. The proposed intervention under objective 1 would enable the Programme to expand the case management capacity enhancement into another 19 high priority districts. The proposed set of ITN promotion activities under objective One (1) would enable four (4) non-government partners to scale-up the ITN promotion activities in 2 ongoing districts (GFATM-II supported), and expand these activities to another 17 districts. The ITN promotion activities would be carried out in the districts with strengthened case management (through current proposal). The proposed set of BCC activities under objective 3 would supplement the ongoing BCC activities through public sector funding. The proposed set of activities would help to expand the scope of ongoing BCC interventions and to address the information gaps in community groups of special interest including school children, women and local opinion leaders. The proposed activities would specially focus on the boarder districts and grass root level interactive BCC approaches for underprivileged communities.

As briefly described above, the proposal is to supplement the ongoing activities without duplicating any intervention already being supported through GFATM or through national support.

The CCM is the main national level body, with participation of government, donors and other civil society partners. Through this platform, the performance, issues and plans of the Malaria Program are regularly shared and discussed with partners. This practice helps the Malaria Program to ensure that the Global Fund resources will fill the existing gap in the resources available from Federal and Provincial Governments and avoid any duplication of efforts.

4.5.5 Strategy for achieving sustainability

Describe the strategies and approaches that will be used during the proposal term to ensure that the interventions/activities initiated and/or expanded by this proposal will more likely be sustainable (continue) beyond the proposal term. (See section 4.5.5 of the Guidelines for Proposals.)

Note Applicants are not required to demonstrate financial self-sufficiency for the targeted interventions by the end of the proposal term. Rather, their description should include how the country/countries targeted in the proposal are addressing their capacity to absorb increased resources and recurrent expenditures, and how national planning frameworks are seeking to increase available financial and non-financial resources to ensure effective prevention and control of the disease(s)..

As per National Strategic Malaria Control Plan, new diagnostic, treatment and prevention tools as ACTs, RDTs, IRS and LLINs have been planned to be scaled up in 19 target districts through GFATM R-7 grant support. The diagnostic, treatment and prevention of malaria in the rest of the districts have been budgeted in the new National and Provincial PC-Is, which will remain the main source of funding to sustain the planned interventions after the project life. The adoption of these interventions in the overall national strategy framework is the best guarantee of government support and sustainability.

The proposed strategy for sustainability of RDT is that during the Phase-I of the R-7 project i.e. initial two years the distribution will be free to all public and private (4 pilot districts only) health outlets, while from year three (3) onwards the private sector health facilities may charge the patients for the actual cost of the tests (RDTs) and treatment (ACT). District Health offices will ensure the prescription of ACTs to the parasitologically confirmed falciparum cases through district M&E/ supervisory mechanism. At public sector health outlets the diagnostic and treatment facilities are free and will remain free after the project life. All these commodities and products will be procured and sustained through district, provincial and national financial resources as planed in their respective next five yearly budgeted plans.

Long Lasting Insecticide Treated Nets (LLINs) will be distributed free of cost to the target vulnerable groups during and after the project time. Replacement of old nets and distribution of LLINs to those



falling on the criteria of vulnerable groups, in the subsequent years is planned to be budgeted from national resources in the forthcoming five yearly budgeted plans. The Government will encourage the market forces and private organizations, through tax and tariffs exemption to initiate social marketing of LLINs in the country. This will ensure sustained availability of LLINs in the commercial market.

Investment on the interactive community based BCC intervention will be investment in human capacities aiming at improving the knowledge of target population on the benefits of early diagnosis and treatment seeking behaviors and the cost effectiveness of adopting preventive measures as LLINs. The cost benefits will be the impact on the disease burden reduction through better treatment seeking behaviors and preventive practices.



Table 4.5 - Financial contributions to national response

Financial gap analysis (same currency as selected in section 1.1)

Actual Planned Estimated Refer back to instructions under section 4.4, step 3 2005

2006 2007 2008 2009 2010 2011 2012

Line A Overall disease specific needs costing including essential disease specific health systems needs 40,243,192 40,992,649 20,932,026 22,815,908 24,869,340 27,107,581 29,547,263 32,206,517

Domestic source B1 : Loans and debt relief (provide donor name)

Nil Nil Nil Nil Nil Nil Nil Nil

Domestic source B2 :National funding resources 900,000 1,600,000 11,499,000 11,658,00 9,161,000 5,495,000 5,500,000 5,500,000

Domestic source B3: Private Sector contributions (national) Nil Nil Nil Nil Nil Nil Nil Nil

Total of Line B entries Total current & planned domestic resources 900,000 1,600,000 11,499,000 0 9,161,000 5,495,000 5,500,000 5,500,000

External source C1: All current & planned Global Fund (R-II)

4,410,000 0 439562 0 0 0 0 0

R-III 930,000 615,000 883000 0 0 0 0 0

Sum C1 5,340,000 615,000 1322562 0 0 0 0 0

External source C2:(provide donor name)

WHO/JPRM 36,000 63,000 64,000 0 0 0 0 0

External source C3 (provide donor name) 0 0 0 0 0 0 0 0



Financial gap analysis (same currency as selected in section 1.1)

Actual Planned Estimated Refer back to instructions under section 4.4, step 3 2005

2006 2007 2008 2009 2010 2011 2012

External source C4:Private Sector grants/ contributions

(International) 0 0 0 0 0 0 0 0

Total of Line C entries Total current & planned external resources 10,716,000 1,293,000 2,709,124

0 0 0 0 0

Line D Total current and planned resources (i.e. Line D = Line B Total +Line C Total) 11,616,000 2,893,000 14,208,124 1,165,800 9,161,000 5,495,000 5,500,000 5,500,000 Line E Total Unmet need (Line A – Line D) - 28,627,192 38,099,649 6,723,902 22,815,908 15,708,340 21,612,581 24,047,263 26,706,517 The table above is provided for planning purposes to identify the ceiling of funding needs. The Global Fund recognizes that the proposal term (if approved) may straddle calendar years depending on the start date of the grant agreement that may be signed.



4.6 Malaria component/implementation strategy This section describes the strategic approach of the proposal, and the activities that are intended to be supported over the proposal term. Section 4.6 contains important information on the goals, objectives, service delivery areas and activities, as well as the indicators that will be used to measure performance. For more detailed information on the requirements of this section, see the Guidelines for Proposals section 4.6. In support of this section 4.6, all applicants must submit by disease component: 1. A Targets and Indicators Table This is included as Attachment A to the Proposal Form.

When setting targets in this table, please refer explicitly to the programmatic needs analysis in section 4.4. All targets should be measurable and identify the current baseline. Importantly, this table will be utilized to measure performance of the program over the whole proposal term. For definitions of the terms used in this table, see the 'Explanatory Note' provided on the first sheet in 'Attachment A' (Targets and Indicators Table) to the Proposal Form. Refer to the Guidelines for Proposals, section 4.6.

and 2. A Work Plan which must meet the following criteria. (Refer to the Guidelines for Proposals, section

4.6):

a. Structured along the same lines as the Component Strategy - i.e. reflect the same goals, objectives, service delivery areas and activities.

b. Covers the first two years only of the proposal term and is:

i detailed for year 1, with information broken down by quarters; ii indicative for year 2, with information at least half yearly.

c. Consistent with the Targets and Indicators Table (Attachment A to the Proposal Form) mentioned

above. Please note that other documents are also required to be submitted to ensure a complete application for Round 7 funding. Applicants are strongly encouraged to use the by-disease checklist after section 5 to ensure that all necessary documents are attached to the proposal submitted to the Global Fund.

IMPORTANT INFORMATION FOR APPLICANTS RE-SUBMITTING A PREVIOUSLY UNAPPROVED ROUND 5 or ROUND 6 PROPOSAL FOR THIS SAME DISEASE COMPONENT

4.6.1 Re-submission of an unapproved Round 5 and/or Round 6 proposal

If this proposal is a resubmission of proposal for the same disease component from either Round 5 and/or Round 6 that was not approved, attach the 'TRP Review Form' provided by the Global Fund to the Applicant after the Board decision for the earlier Round(s).(The TRP Review Forms should be listed as an annex to the proposal in the checklist at the end of section 5 of this disease component).

In the section below, please describe what specific adjustments have been made to this proposal to take into account each of the 'weaknesses' listed by the TRP in the 'TRP Review Form'.(Maximum two pages. Applicants should ensure that they clearly detail which earlier proposal is being referred to, and what specific actions have been taken to remedy issues raised by the TRP. Applicants should provide details on what has been strengthened about this proposal, compared to an earlier unapproved proposal.)

NA



4.6.2 Goals and objectives and service delivery areas

Referring to your overall needs assessment in section 4.4.1 above, provide a summary of the proposal’s overall goal(s), objectives and service delivery areas.(The information below should be no longer than a one page summary, and Applicants should provide detailed quantitative information in Attachment A ('Targets and Indicators Table') to this Proposal Form).

The goal of the GFATM Malaria proposal is “Reduce burden of malaria in 19 high endemic districts” of the 3 highly endemic provinces of the country. The proposal aims to reduce 50% burden of malaria in 12 million population living in 19 high endemic districts. The goal of the proposal is to reduce malaria specific morbidity by 50% from the baseline year 2006 by the end of a five-year proposal period. Objective 1: To improve early diagnosis and prompt treatment services in the 19 target districts. The targeted 19 districts share the maximum load of malaria cases in the country. Most of these districts are located along the Southern borders of Afghanistan and Eastern borders of Iran with Pakistan. Communication is difficult in most of the areas of these districts. Health facilities and service providers are inadequate. Presently about 40 % of the people have access to public sector diagnosis and treatment facilities. Health facilities offering MCH facilities still lacking the early diagnosis and effective treatment component accessibility to quality diagnosis and effective treatment will be increased to 80% by setting up new microscopy centers, enhancing accessibility to community based service provision and providing RDTs and ACT. Service delivery areas 1.1 Strengthening of existing diagnostic services in target districts: The existing functional

microscopic centers established in GFATM round 2 will be further strengthened through the uninterrupted logistic support and refresher training of the microscopists and laboratory technicians working at these health facilities. Eight Rural health centers with nonfunctioning microscopy centres will be made functional through the provision of lab equipment, reagents and commodities. Newly developed quality assurance guidelines and training manuals developed through GFATM round 2 grant will be used for training purposes.

1.2 Expansion of malaria diagnostic facilities (RDT's): Early diagnostic services will be extended to

all the MCH centers in the target districts and private health facilities in the four pilot districts through the distribution of RDTS.

1.3 Strengthening National (NIMRT) and provincial quality assurance mechanisms to ensure quality diagnosis and prompt treatment.

1.4 To enhance the capacities of malaria related health professionals: The skills of all health

workers in the public facilities and private health workers in the pilot districts in malaria case management will be enhanced by training on newly endorsed national malaria treatment guidelines.

1.5 To pilot test involvement of private sector health care providers at community levels in

provision of proper diagnosis and prompt treatment services in four of the 19 target districts. 1.6 To Roll out ACTs to 165 MCH centers in 19 districts and 4 pilot districts in the private sector

(Mardan, Khairpur, Zhob, and Kech) as per confirmed cases of Falciparum Malaria. (Appropriate and timely malaria treatment): ACT has been adopted as first line treatment for all laboratory confirmed P. falciparum cases by the national malaria control programme. The selected combination has recently been registered with the Drug Regulatory Authority in the MoH. The selected combination will replace the treatment regimen . All the public health facilities are planed to be provided with ACTs through the national resources which will extend full coverage to those accessing these health facilities. In four pilot districts ((Mardan, Khairpur, Zhob, Kech) private health facilities using RDTs will also be provided with ACTs free of charge.



Objective 2.

To scale up coverage of LLIN in the 19 high risk districts In the target districts LLIN coverage from GFTAM rounds 2 & 3 is < 5% for a population of 12 million. LLIN will be distributed free of charge to high risk group and confirmed cases of falciparum malaria. Selective IRS will be done to control outbreaks effectively through the national resources. Service delivery areas: 2.1 To scale-up LLIN coverage with special emphasis on pregnant women and children under 5 years of age and introduction of LLIN through MCH centres and other identified outlets. Malaria transmission in high risk groups will be reduced by ensuring that in target districts at least 80 % of pregnant women and children under 5 years of age are using the nets by 2012. About 1.0 million nets will be provided to pregnant women and children in the target districts and replaced in the fourth and fifth year of the proposal term. 2.2 To enhance target population’s knowledge and awareness on increased uptake, proper utilization of LLINs and timely treatment seeking behavior through aggressive BCC/IEC campaigns. Behavior Change Communication (BCC) will be done at all levels. In addition to mass media, interpersonal communications will be used ,including innovative approaches aiming to increase the utilization of LLIN in line with local cultural context. Objective-3: To strengthen & build management capacity of NMCP to co-ordinate , plan, implement and Monitor effective curative & preventative interventions nationwide The management capacity of national malaria control programme at all levels will be strengthened by deploying additional human resource and through long term technical assistance. A national malariometric survey nationwide in 2008 to establish baseline data will be conducted and a comprehensive programme of needs based operational research will be developed. Monitoring and evaluation and surveillance systems will be sestablished. Service delivery areas 3.1 Establishment of a mechanism for monitoring drug and insecticide resistance: Sentinel sites for monitoring of drug efficacy and insecticide resistance will be established. Therapeutic efficacy trials will be conducted to modify drug policy when required. 3.2 Enhancement of management and technical capacities of NMCP: National program’s management and technical capacities will be enhanced through external long term technical assistance at national and provincial level. 3.3 Malariometric survey country wide to estimate malaria burden in Pakistan: A baseline malariometric survey of international standard will be conducted in the first year of the proposal nationwide which will help the national malaria control programme in developing future strategies and priorities. 3.4 Improvement / upgrade / strengthen M & E system at all levels. A properly functional national malaria M& E system will be strengthened



3.5 Improvement of existing epidemiological surveillance system Additionally:

• The technical advisory committee on malaria (TACOM) represented by stakeholders from various sectors for increased coordination and parternership building will be supported from the local sources.

• A comprehensive programme of operational research will include building the national research capacity through a combination of training and technical assistance.

• The national institute of malaria research (NIMRT) and training will be strengthened through capacity building of existing technical staff and recruitment of highly qualified experts, development of links with the international renowned institutions, development of various curricula for degree, diploma and certificate courses and provision of research facilities for research workers.

• Information system in NMCP will be reinforced at federal, provincial and district levels in data management units, training and transport facilities. Revised malaria reporting tools which are field tested and approved will be printed and distributed. Linkage with HMIS will be established and additional human resources and necessary equipment will be made available.



4.6.3 Specific Interventions, Target Groups and Equity

(a) Specific Interventions/Activities supported by this proposal

Provide a clear and detailed description of the activities that will be implemented within each service delivery area for each objective. Please include an overview of all the activities proposed, how these will be implemented, and by whom.(Where actions to strengthen health systems are planned, applicants are also required providing additional information at section 4.4.2.)

Objective 1: To improve early diagnosis and prompt treatment services in the 19 target districts

Service delivery areas:

1.1 Strengthening of existing diagnostic services in target districts

At present there are 116 functional and 8 non-functional malaria microscopy centers for a population of 12 million in the target districts. The 116 functional microscopy centers will be strengthened by the replacement of equipment and furniture and by the provision of commodities and reagents over the project life. Yearly 15% of the health centers will be strengthened to reach 50% coverage by three years. WHO will be responsible for the procurement whereas distribution will be exercised by the NGOs working in the respective districts. Refresher trainings will be organized for 52 microscopists and malaria health workers and laboratory technicians, performing microscopy in the existing health facilities. The 8 non-functional diagnostic centers in these 19 districts will be made functional by the provision of equipment, reagents, commodities and furniture. Human resource will be provided for these centers by internal arrangement with the district health offices (EDOs) by transfers and placements. The human resource will be trained in malaria microscopy.

1.2 Expansion of malaria diagnostic facilities (RDT's)

1,559,250 RDTs will be procured through WHO and distributed to 165 MCH centers in the target districts for 5 years. This will ensure availability of diagnostic facilities to the high risk group of pregnant women, utilizing MCH services for antenatal care. The staff in the MCH centers will be trained in diagnosis of malaria using RDTs. For cold chain maintenance EPI centers will be utilized and at places where this facility is not available, cold boxes will be provided. The public sector BHUs will be provided with RDTs through government resources.

1.3 To strengthen National (NIMRT) and provincial reference laboratories to ensure quality diagnosis and prompt treatment.

Quality assurance of microscopy and RDTs will be carried out by provincial referral laboratories in association with NIMRT. This QA will be linked to needs-based refresher training of microscopists and health staff using RDTs..

1.4 Enhancement of capacities of malaria related health professionals

600 public sector health care providers and private practitioners in the targeted private sector will be trained in the new updated malaria management strategies. These trainings will be conducted by the SRs in their respective districts. The training material inculcating the new malaria guidelines prepared during R2 grant will be used.

1.5 Pilot test involvement of private sector health care providers

Private sector is a major contributor in provision of health services and to establish their role in malaria control, private health facilities in the 4 districts (Zhob, Kech, Mardan, Khairpur) have been selected as pilot districts to evaluate the role of private district in early diagnosis. After mapping of registered medical professionals. They will be provided with 282,600 RDTs free of charge for diagnosis and will be offered training in the use of RDTs. A nominal prefixed price will be charged by the private practitioners for RDTs as an incentive.



1.6 Roll out ACTs to 165 MCH centers in 19 districts and 4 pilot districts in the private sector (Mardan, Khairpur, Zhob, Kech) as per confirmed cases of Falciparum Malaria. (Appropriate and timely malaria treatment)

100% of the public health facilities apart from MCH centers will be provided with ACTs through national resources and global fund will extend this to 165 MCH centers (equipped with RDTs) in the target districts and the private sector in the 4 pilot districts. The aim is that by the end of five years 100% of the MCH centers and private sector in the pilot districts will be administering ACTs as a first line treatment. ACT will be free of charge and WHO has been selected as a procurement agency not only to ensure the timely availability of ACTs but also to ensure the quality of all the items procured. An estimated 184,185 courses of ACTs will be required in the five years period.

Objective 2: To scale up coverage of LLIN in the 19 high risk districts

Service delivery areas:

2.1 To scale-up LLIN coverage with special emphasis on pregnant women and children under 5 years of age and introduction of LLIN through MCH centres and other identified outlets.

Currently <5% of the community in the target districts has LLINs from the R2 GF. The gap in national resources through which free LLINs will be provided is of one million LLINs. This gap will be filled through the GF specially targeting pregnant women and children under 5 in the target districts. To ensure the use of LLINs the following activities will be undertaken: One million LLINs will be procured by WHO and distributed to pregnant women and children under 5 through the MCH centers and other identified distribution outlets free of charge, considering the poor socioeconomic status of community in these districts. The nets will be collected from and distributed by the NGOs. The aim is that 80% of pregnant women and children under 5 should be sleeping under the nets in the target districts at the end of 5 years.

2.2 To enhance target population’s knowledge and awareness on increased uptake, proper utilization of LLINs and timely treatment seeking behavior through aggressive BCC/IEC campaigns.

NGOs will be responsible for executing BCC and promotional activities in line with COMBI. The BCC will include community level activities as well as through mass media. The purpose of these activities will be to create awareness about the preventive aspects and to augment utilization of malaria diagnostic and treatment facilities. Local culture and language will be utilized. Community based seminars and interpersonal innovative methodologies and approaches will be used by the NGOs for behavioral change. Prime messages will be disseminated through popular TV channels and by local news papers and print media on regular basis, especially throughout the high transmission period. These promotional activities will be ensured by the directorate of malaria control. Three Bill boards per district, leaflets, stickers, posters and mobile advertisement materials will be prepared by professional agencies and disseminated through NGOs. Selected master trainers from the sub recipients will be trained in the strategies of malaria control programme with particular reference to BCC. BCC activities will be undertaken at community level and through mass media. NGOs will mostly implement these activities at the community level and DOMC will be responsible for mass media coverage. The main objective of BCC will be to increase demand for LLINs and increase awareness on prevention.

Objective-3: To strengthen & build management capacity of NMCP to co-ordinate , plan, implement and Monitor effective curative & preventative interventions nationwide

Service delivery areas

3.1 Establishment of a mechanism for monitoring drug resistance:

Monitoring of drug resistance will be done regularly each year in 4 new sentinel sites. Workshops will be held by experts from DoMC/NIMRT/WHO to train microscopists and research assistants in WHO protoocol. Therapeutic efficacy trials will be conducted following international standards and results used to inform drug policy.

3.2 Enhancement of management and technical capacities of NMCP:

Multi-sectoral partnership and collaboration with the different stakeholders will strengthen the capacity of



NMCP to implement the activities effectively. Regular meetings with stakeholders including local indigenous groups and civil society at different levels will be organized and seminars and conferences will be arranged to share the experience. National programme’s management and technical capacities will be enhanced through external long term technical assistance at national and provincial level using WHO recruitment rules.

3.3 Malariometric survey in target districts to establish baseline and estimate malaria burden in these districts.

There is a dire need for a malariometric survey in the country to establish baseline. This will be undertaken in-line with international standards and will be implemented by the directorate of malaria control.

3.4 Improvement / upgrade / strengthen M & E system at all levels.

Currently Malaria control activities are monitored and evaluated through routine reporting to DOMC and HMIS. Linkage with HMIS will be established and additional human resource and necessary equipment will be made available. The existing MIS unit within NMC will also be strengthened. The MIS unit will regularly compile and analyze the program data and publish the annual report. A functional M & E system both at national and provincial levels and improvement in the existing surveillance system for quality and effective programme management is the aim, which is planned to be achieved through the implementation of functional M&E system designed during R-II Grant. A properly functional malaria surveillance system including early detection of malaria epidemics will be formed: new surveillance tools and reporting formats will be developed. PR will visit each SR-NGO at least once in a quarter to monitor their financial and programmatic activities

3.5 Improvement of existing epidemiological surveillance system

Information system in NMCP will be enhanced at federal, provincial and district levels. The data management units will be established and supported and training of the staff in data management will improve the information system. Transport facilities will be provided. Revised malaria reporting tools according to the latest guidelines which are field tested and approved will be printed and distributed.

(b) Target groups

Provide a description of the target groups (and, where relevant, the rationale for inclusion or exclusion of certain groups). In addition, describe how the target groups were involved during planning, implementation and evaluation of the proposal prior to submission to the Global Fund. Describe the impact that the program will have on these group(s).

The target groups are the populations living in 19 high risk district, pregnant women, under 5 children, school children, teachers, religious leaders, community leaders, fever patients attending treatment centers. The planning of the proposal is based on the national programmatic requirement identified on the basis of health data and previous data obtained from specific KAP surveys carried out during R-2 & 3 GFATM proposals. Further the country CCM is a body, representative of all key stakeholders which will be involved in important decision making. Implementation will always be in partnership with the target groups and quarterly monitoring and evaluation will ensure the feed back from those groups. The mid term and second year evaluation are planned to be carried out by independent mechanisms that would also consider the appraisals from these target groups.

(c) Equitable access to services

Describe how principles of equity will be ensured in the selection of clients to access services, particularly if the proposal includes services that will only reach a proportion of the population in need (e.g., some antiretroviral therapy programs).

NA



(d) Social inequalities targeted in this proposal

Describe how this proposal addresses the needs of specific marginalized groups in the country/countries targeted in this proposal. For example, if your proposal targets a gender, age-group or other demographic presently excluded or underrepresented in existing service delivery activities, identify this and describe how the group(s) will be targeted.

Please ensure that you include appropriate targets and indicators to monitor performance against these strategies in 'Attachment A' (Targets and Indicators Table).

The service delivery areas and activities are specifically designed for identified target groups as women and children under 5. The access to treatment with ACT and diagnosis by RDT will be free initially for two years to any body who will be attending both private and public health centers. It is normally observed that there is gender imbalance or specific preference in the treatment seeking behaviour in Pakistan. The bed net implementation planning has identified the highly vulnerable group of pregnant women and under 5 children as their primary targets. Although it is generally assumed that gender inequity exists, the additional mechanisms of promoting the bed nets distribution through the FLCFs offering Mother and Child Health services, the vast network of Lady Health Workers (LHWs) working in the PHC Programme of the MoH and the community volunteers of the nominated SRs will ensure the universal access to the bed net by the vulnerable groups mainly the pregnant women and <5 children.

Community based interactive BCC interventions are not gender oriented and are designed to be accessed by both the genders equally. Further by implementing school and religious gathering based programmes as well as Lady Health Worker programmes, the messages of BCC will be accessible to all target groups of the population in these selected districts.

(e) Stigma and discrimination

Describe how this proposal will contribute to reducing stigma and discrimination against people living with and/or affected by HIV/AIDS, tuberculosis and/or malaria, as applicable, and other types of stigma and discrimination that facilitate the spread of these diseases.

NA

Linkages to other programs

4.6.4 Performance of and linkages to current Global Fund grant(s)

(a) If this proposal is asking for support for the same "Key Services" or interventions supported by earlier Global Fund grants (including unsigned Round 6 grants), explain in detail why.

Applicants should specifically refer to the Programmatic Gap Analysis Table in section 4.4 when completing this section, and clearly indicate if the goals, objectives and service delivery areas in this proposal represent an expansion of planned outputs and outcomes already supported through earlier Global Fund grants, complementary but not overlapping interventions, or new and independent interventions. Applicants are strongly encouraged to include a diagram to explain expansion-focused interventions where relevant.

Applicants are strongly encouraged to comment on any significant levels of undisbursed funds under earlier Global Fund grants (including 'Phase 2' amounts anticipated to become available) in this section. The reason(s) why a Round 6 grant remains unsigned at the time of submission of this proposal should also be explained.

Current proposal seeks support to sustain the public and private sector service delivery in the target districts and strengthen the already established diagnostic centres during R-II project in its Phase-I. A total 116 microscopy centres were established during R-II project in 23 target districts. Current round support will further expand the diagnostic and treatment facilities down to the Basic Health Units offering MCH services and for the first time to the private sector clinics in 4 pilot target districts. RDTs and ACTs will be distributed to all the centres offering confirmed diagnosis. Eight more microscopy centres will be established in the same target districts, which were targeted in R-II.



(b) Where there are any linkages in this proposal to planned interventions already supported by Global Fund grants, describe, by reference to information generated in regard to those existing grants**, how implementation bottlenecks and lessons learned have been incorporated into the implementation strategy for this proposal to better ensure the overall feasibility of the planned interventions(maximum one page).

(**Applicants should refer to, for example, the most recent 'Progress Updates and Disbursement Requests' from a Principal Recipient, or the 'Grant Scorecard' published by the Global Fund after a grant has completed Phase 1.)

During the current project all the gaps of previous rounds have been addressed. Malaria Programme has been nominated as PR by the CCM after assuming the desired capacity through administrative action of the MoH. WHO has been selected as the sole procurement agency to ensure timely and quality assured procurement of goods and services.

To ensure working in harmonized manner with the SRs, the programme has completed the whole process of the proposal development in close collaboration with the provincial programmes, SRs and the CCM members.

The desired TA has been sought to ensure timely implementation of the interventions.

Targets have been set through close consultation with the provinces / stake holders.

4.6.5 Performance of and Linkages to other donor funding for the same disease

Provide an overview of the main achievements (in terms of outcomes and impact on the disease) which are planned over the same term as this proposal through the support of other external donors, whether bilateral or multi-lateral. Also describe if there are any major bottlenecks to implementation in those grants/programs which may be relevant to the implementation strategy for this proposal, and if so, what steps will be taken to mitigate such challenges.

NA ( May please refer to 4.5.2 (b) )



Private Sector Contributions

4.6.6 Private Sector contributions

(a) If the Private Sector is intended to be a contributor/co-investor to the overall objectives of this proposal, describe below a summary of the main contributions (whether financial or non-financial) anticipated from the Private Sector during the proposal term, and how these contributions are important to the achievement of the outcomes and outputs.

Refer to the Guidelines for a definition of Private Sector and some examples of the types of financial and non-financial contributions from the Private Sector in the framework of a co-investment partnership.

Most of the components of the project will be implemented through Public-Private-Partnership which is the best approach to achieve the target of RBM strategies. Presently, MIS data shows that there are 124910 cases of malaria in a year with an Annual Parasite Incidence (API) 0.8 cases/1000 populations country wide. These results are based on the reports from around 850 public sector malaria microscopy centers in the country. According to DIFD Review Mission report (1998) the numbers of malaria cases in the country are at least 5 times higher than what is being currently reported since public sector diagnosis facilities only caters for 20% of the attending patients. The private sector is operating independently and has minimum contact with the public health care system especially the malaria related infrastructure. They also have little knowledge of the malaria policy and guidelines developed by the DOMC in the MoH. So far the efforts of the private sector in Malaria Control Programme have been limited. There has been dire need to improve malaria case management skills of care providers, which has been addressed in the current Round Proposal. However, no specific financial contribution from private sector is envisaged in this proposal.

(b) Referring to the population group(s) that will be the focus of the Private Sector co-investment partnership, identify in the table below the annual amount of the anticipated contribution. (For non-financial contributions, please attempt to provide a monetary value if at all possible, and at a minimum, a description of that contribution.)

Size of population group that is the focus

of the Private Sector contribution

Refer to Guidelines for examples on ‘Contribution

Description’

** Add extra rows below to identify each main Private

Sector contributor

Contribution Value

(same currency as selected in section 1.1)

** Private Sector

Contributor Name

Contribution Description

(in words) Year 1 Year 2 Year 3 Year 4 Year 5 Total



4.7 Principal Recipient information In this section, Applicants should describe their proposed implementation arrangements, including the nominated Principal Recipient(s). See the Guidelines for Proposals, section 4.7, for more information. Where the Applicant is a Regional Organization or a Non-CCM Applicant, the term ‘Principal Recipient’ should be read as the planned implementing organization. The Applicant may nominate one or several Principal Recipients to lead implementation and undertake reporting to the Global Fund during the proposal term. To be eligible for funding in Round 7, CCM, Sub-CCM and RCM Applicants must ensure that each Principal Recipient has been transparently selected (refer to section 3A.4.5 of this Proposal Form)

Table 4.7: Nominated Principal Recipient(s)

One Indicate whether implementation will be managed through one or several Principal Recipients. Several

Responsibility for implementation

Name of Nominated Principal Recipient(s) Sector Represented Name of Contact

person

Address, telephone, fax numbers and e-mail address

of contact person

Directorate of Malaria Control Program Malaria Dr. Faisal Mansoor +92-3335254085

4.8 Program and financial management

4.8.1 Management approach

Describe the proposed approach of management with respect to planning, implementation and monitoring the program. Explain the rationale behind the proposed arrangements. (Outline management arrangements, roles and responsibilities between partners, the nominated Principal Recipient(s) and the CCM, Sub-CCM, or RCM where relevant. Maximum one page.)

The DOMC’s management approach is based on lessons learned from previous rounds and builds on the long-standing spirit of collaboration and cooperation between government and NGO partners. SRs will submit annual work plans to the PR three months prior to the proposed start of implementation. Earmarked funds will be disbursed directly to the SR on approval of these annual work plans. The SRs will submit quarterly statements of expenditure and external audit reports to the PR along with updated quarterly action plans. This arrangement should ensure timely release of funds and at the same time allow the PR to identify any potential problems in implementation at an early stage. The external auditing requirement ensures the transparency of implementation. Quarterly programmatic progress reports from the SRs will give a detailed overview of output indicators allowing the PR (and the SR) to manage resources efficiently. The PR may request any additional information it deems necessary to satisfy itself on the financial management practices of the SRs. Monitoring and supervision will be overseen by the CCM, the Steering Committee of the MOH, the LFA and ultimately the GF Secretariat. The PR will be responsible for managing the day to day operations of the GF program in Pakistan. The PR will sign the project grant agreement with GF and will be held accountable for the overall performance of the grant. The PR will sign grant agreements with the SRs, budget project activities, request Grant Funds from the GF, manage and disburse Grant Funds to SRs,



maintain proper accounting records and account books, implement an effective computerized Project Financial and Accounting Management System (in line with GF requirements), prepare and submit Project Financial Reports, periodically check and monitor disbursement reports from the SRs and from implementation sites, maintain efficient filing of project documentation (original supporting documents such as invoices, receipts, contracts will be kept at the offices of SRs and at implementation sites), consider and approve budget reallocation of SRs as appropriate, contract external auditors and submit annual external financial audit reports to the CCM and LFA.

4.8.2 Principal Recipient capacities

Please note that if there are multiple Principal Recipients, section 4.8.2 below must be completed separately for each one.

(a) Describe the relevant technical, managerial and financial capacities for each nominated Principal Recipient ('PR'). Please also discuss any anticipated shortcomings that these arrangements might have and how they will be addressed, referring to any assessments of the PR(s) undertaken either for the Global Fund or other donors (e.g., capacity-building, staffing and training requirements, etc.).

The CCM has nominated the Directorate of Malaria Control (DOMC) as PR for the malaria component during GF R7. DOMC is a department of the Ministry of Health and has an extended human resource network from National down to Union Council level. Capacity strengthening measures detailed in this application will ensure that DOMC has the necessary capacity to: assist SRs with planning and implementation (where appropriate); monitor implementation by the SRs; provide QA (in association with WHO); and, channel funds to the SRs for implementation of planned activities in an efficient and transparent manner.

After its establishment in 1960, DOMC developed a very strong technical and managerial capacity. Integration of malaria control activities into routine PHC services in the early 1990s, retirement of experienced staff, and decentralization of the programme (initially to provincial level and later on in 2002 to district level) has necessitated a transitional phase of re-shaping for the programme. Since GF support for malaria control in Pakistan began, the DOMC has been acting as not only as an SR but also in GF R2, as overall custodian of the project. Delayed achievement of time-bound targets during Phase I of R2 resulted in rejection of the Phase II application. Various factors were responsible as highlighted in the report of the specially instigated high level Independent Review Mission. A number of these were beyond the control of DOMC. One of the major gaps identified in the report was the inadequate managerial and technical capacity within the Programme. The Ministry of Health responded to the recommendations by taking several administrative steps including the replacement of key managerial staff and the recruitment of qualified technical staff to fill vacant positions. Financial management capacity of the Programme was enhanced through the recruitment of well qualified financial experts. The new management team successfully implemented the remaining activities during the close out phase of R2 and achieved all the remaining set targets in good time. The dramatically improved capacity of the programme has been duly recognized by international agencies including WHO, USAID, DFID and national and international NGO partners.

Experiences and lessons learned during R2 will be used to ensure that R7 project activities are implemented smoothly through enhanced collaboration with SRs. In order to ensure that the programme is able to absorb the high level of support requested under R7, technical managerial and financial management capacities of DOMC will be further strengthened through the recruitment of long-term and short-term technical assistance.

Yes (b) Has the nominated PR previously managed a Global Fund grant?

No

If yes to (b), explain the rationale for nominating the same PR(s) to manage the activities in this proposal.



Yes (c) Is the nominated PR currently managing a large program funded by another donor? No

(d) Identify the total budget (current and planned) under management by each nominated Principal Recipient.

Total PR cost has been estimated as US$ 887,400 US$ during the current proposal time

(e) Describe the performance history of the nominated PR in managing these programs/grants.

Specifically, where the nominated PR(s) management of a prior program/grant has not been fully satisfactory, describe the changes that will be made to the implementation arrangements by the PR under this, and the earlier grants, to ensure more consistent, transparent and effective performance towards the planned outputs and outcomes.

NA

(f) Describe how the Applicant has satisfied itself (including by reference to any assessment criteria) that the nominated PR will be able to absorb the additional work and funds generated by this proposal in a transparent, efficient and timely manner.

4.8.3 Sub-Recipient information

Yes complete the rest of 4.8.3 (a) Are sub-recipients expected to play a role during the term

of the proposal? (Only in the very rarest of cases would the Global Fund expect there to be no sub-recipients.) No

go to 4.9

1 – 5

6 – 20

21 – 50

(b) How many sub-recipients will or are expected to be involved in the implementation?

more than 50

Yes complete 4.8.3. (d) –(e) and (f)

and then go to 4.9 (c) Have the sub-recipients already been identified?

No go to 4.8.3. (g) – (h)

(d) Describe:

(i) The transparent process by which sub-recipients were identified, the rationale for the number of sub-recipients and the criteria that were applied in the identification process.

(ii) Referring to sub-paragraph (b) above, describe the past implementation experience of sub-recipients who will either receive a significant proportion of the funding from this proposal or who will be involved in on-granting of funding to sub-sub-recipients(Also identify significant potential bottlenecks to transparent strong performance by these sub-recipients, and actions that will be taken by the PR during implementation to alleviate such risks).

The process to select partner organizations as sub recipients was done through competitive and open



bidding, accomplished in two stages. First a public invitation was floated in national news papers by CCM asking for expressions of interest (EOIs) specifying the applicant’s human resources capacities, financial back ground and registration process, annual turnovers and the past experiences with health related projects and any malaria related work experiences. Of the 41 applicants that submitted their EOIs, 07 were selected based on their merit by a technical committee of the Directorate of Malaria Control. The selection was then endorsed by the sub committee technical of the CCM. Three organizations National Rural Support Programme (NRSP), Association for Social Development(ASD), Basic Development Needs (BDN) and the DOMC have been involved in R-II implementation. The other 3 organizations i.e. Merlin, Mercy Corps and Association for Community Development (ACD) are the organizations of international and national repute and are also being involved with the implementation of previous rounds in TB.

These 07 candidates were invited for briefing in the Directorate of Malaria Control (DOMC). Through a series of processes all the aspects of the proposal (goals, objectives, planned activities) including the salient features of the proposal were explained in detail. Distribution of target districts amongst the selected SRs was made in accordance with the organizational structure in the target districts. All the SRs were requested to be involved in joint development of the proposal with DOMC and were subsequently asked to budget their activities in accordance with their organizational needs and situation of their target districts

(e) Attach a list of sub-recipients that have been nominated, which includes: (i) the name of the sub-recipient; (ii) the sector they represent (civil society, NGO, private sector, government, academic/educational etc); and (iii) by reference to table 5.2 in the budget section, the primary service delivery area(s) relevant to their work under the proposal.

Below please comment on the relative proportion of interventions that will be undertaken by sub-recipients outside of the government and the reason for this apportionment of work. (maximum two pages).

List of Sub- Recipients with their Primary Service Delivery Areas

Organizations Sector SDAs Target districts

1. Merlin int. NGO Diagnosis, treatment Noshki Sibi Naseerabad

2. ACD NGO Diagnosis, treatment Malakand, Lakki Marwat, Bannu, North Waziristan and South Waziristan

3. ASD NGO Diagnosis, treatment, Prevention

Tharparkar(Mithi), Thatta, Khairpur and Dadu

4. Mercy Corps NGO Diagnosis, treatment Zhob Killasaifullah, Loralai,

5 NRSP NGO Prevention LLINs Khairpur, Mardan, Gwadar, Kech

6. DOMC Government

Diagnosis, treatment

M&E

All Districts

7. BDN NGO Diagnosis, treatment, prevention

Dadu, Mastung

(f) Only if relevant, describe why sub-recipients were not identified prior to submission of the

proposal. (Applicants are reminded that only in rare cases should sub-recipients not be identified. The identification of these key implementation partners assists the assessment of implementation capacity and feasibility.)

NA



(g) Where sub-recipients have not been identified prior to proposal submission, describe in detail the process that will be used to select sub-recipients if the proposal is approved. Include details of the criteria that will be applied in the selection process, the timeframe during which that selection process will take place, and why the Applicant believes this selection process will not adversely impact planned outputs and outcomes during the initial two year period of any grant which is approved.

NA

4.9 Monitoring and evaluation framework The Global Fund encourages the development of nationally owned monitoring and evaluation (M&E) plans and M&E systems, and the use of these systems to report on grant program results in the overall context of country priorities and movement towards reaching the Millennium Development Goals. When completing the section below, applicants should clarify how and in what ways monitoring and evaluating implementation of the work supported by this proposal relates to existing data-collection efforts. Applicants are strongly encouraged to refer to the M&E Toolkit when completing this section.

4.9.1 Monitoring and evaluation plan

Describe how the data relating to performance against planned outputs and outcomes set out in the 'Targets and Indicators Table' (required to be annexed as 'Attachment A' to your proposal, see section 4.6) will be accurately collected, collated and reported by implementing partners during the proposal term to the Applicant (if CCM, Sub-CCM or RCM), the Global Fund and the body responsible for national monitoring and evaluation.

Please also identify any surveys which are planned to be supported (in whole or part) by the funding requested in this proposal, the rationale for such surveys, and how the surveys (and their outcomes) support and feed into single national data collection systems.

(Where a National M&E plan exists, Applicants may attach this to their application as a clearly named and numbered annex.)

Malaria control activities are monitored and evaluated through 2 different types of reporting systems: 1. Malaria Information System (MIS) specific for public sector Malaria Control Programme microscopy centres, which generates information on fever cases through blood examination for malarial parasites, number of confirmed malaria cases by type of plasmodium species, number of houses sprayed during transmission season with a given residual insecticide, and data on resistance to antimalarial drugs and insecticide resistance on a sample basis. This system is partially functional at the Rural Health Centre (2nd step facility in PHC) only. The data reporting and recording tools being used in MIS are >30 in number and have been used since Eradication Era (1960s). Many of these tools are being upgraded. 2. Reporting from below RHC level (Basic Health Units and Civil Dispensaries) currently included within the HMIS using prescribed formats and generates reports on clinical malaria mostly. District hospitals and other tertiary level care institutions don not report to the MIS or HMIS, resulting in missing information on severe malaria morbidity and mortality. Sex and Age specific information is only recorded at the facility level and not reported to the district, province or to national programmes. The proposed project (GFATM-VII) will further strengthen the RBM recording/reporting and monitoring arrangements by: • Developing the monitoring tools (including recording/reporting) of severe malaria cases at tertiary

care level hospitals • Developing and strengthening the laboratory quality control arrangements, including monitoring the performance of microscopy centers in the target districts. • Establishing sentinel sites for monitoring drug and insecticide resistance. • Monitoring the distribution and coverage of target groups by LLINs through public-private partnership and PHC approaches. • Monitoring the impact of BCC awareness raising interventions, through periodic surveys. l


R7_CCM_PKS_M_PF_4Jul07_EnXXX

National

The implementing partners will rely mainly on updated recording/reporting system of the programme for monitoring the case management activities. The LLINs promotion activities will be monitored by refining the already in-place recording/reporting arrangements with non-government partners. The implementing partners would also: • Prepare annual and quarterly work plans with activity-wise disbursement • Prepare and submit quarterly progress as well as financial reports, as per agreed format. • Undertake an annual financial audit. The Ministry of Health has recently approved the integrated disease surveillance system through support from JICA, which is an appropriate opportunity for the Programme to incorporate the envisioned Malaria surveillance and M&E indicators. The implementing partners/sub-recipients will collect data, tabulate, analyze and forward their reports to the Directorate of Malaria Control for endorsement/verification and onward sharing with Principal Recipients, based on the agreed reporting format. The Principal Recipient would in turn consolidate, analyze and present the quarterly reports to the CCM along with challenges and options for improvement. The Principal Recipient would also ensure implementation of decisions made by the CCM through implementers or sub-recipients. These quarterly reports would also form the basis for the next quarterly release of funds to the sub-recipients. The annual progress reports will be ready for sharing within the first quarter after closure of the financial year. The third party assessment will also be done in the last quarter of year two and four. This MIS unit will review and revise formats currently used by the HMIS. The DOMC data management unit will also develop new formats and M&E tools as per program needs. Monthly surveillance reports and quarterly activity reports from FLCFs will be sent and districts health authorities will consolidate the district report and forward them to the Provincial and National Malaria Control Programme. DOMC will conduct drug efficacy studies in collaboration with research organizations such as the WHO. Insecticide resistance study will be conducted by the Entomology section under the DOMC.

Flow of information from the FLCFs to the district, provincial and national malaria control programmes

86

Hospitals

HMIS Cell

Provincial HMIS Cell

MMIISS AATT DDOOMMCC

Provincial Malaria Control Programme

Active case detection

EDO (H) OFFICE District HMIS cell

Microscopy centres at

FLCFsLHWs

Private clinics Survey

Feedback Feedback



4.9.2 M&E Systems Capacity Assessment

Where there is no National M&E plan or the work anticipated under this proposal is anticipated to place additional burden on existing national, regional and/or sub-regional M&E systems, Applicants are strongly encouraged to review the 'M&E Systems Strengthening Tool' and provide, in only a summary format below, a description of the major gaps identified and how this proposal incorporates a plan to overcome those gaps to support an effective monitoring and evaluation framework in the country.

In particular, Applicants should comment on how gaps and potential/actual bottlenecks identified that are relevant to this proposal will be managed or mitigated during the proposal term. Budgetary implications arising from this assessment should be included in the budget information required in section 5.

The Global Fund recommends that between 5 to 10% of the total component budget is utilized to strengthen M&E systems.

Current M&E system although (inherited from eradication Era) but still functioning at the district level. The M&E capacities of the programmes at national and provincial level have been pointed out to be inadequate by the recent missions visiting the country. They had recommended various steps in this direction, which have been followed to the extent of the availability of resources. National and Provincial M&E plans have recently been developed in line with the regional (WHO-EMRO) RBM M&E Framework. It is anticipated that the current proposal will place additional burden on the existing M&E structure. To monitor the processes being implemented by a variety of SRs( International and National organizations) in different sets of environments in target districts, the available M&E capacities of the programme are considered insufficient. This gap is being addressed in the current proposal. Five full time M&E Officers , 4 at provincial and 1 at national programme level, will provide the desired strength to the relevant programmes. M&E officers placed in provincial programmes will directly monitor the processes, outputs and outcomes from their respective units with relatively easy access. Presence of this M&E staff in the target districts will ensure the quality of the planned outputs by the SRs. SRs will work in close coordination with the provincial M&E officers, programmes management united at the provinces and district health departments. The Federal M&E officer will work under the national programme unit in the office of the PR (DOMC) to ensure the flow of information from the provincial M&E officers and timely submission of quarterly reports to the PR and then to the LFA. Coordination meetings will be held regularly in this regard with all concerned.



4.10 Procurement and supply management of health products In this section, applicants should describe the management structure and systems currently in place for the procurement and supply management (PSM) of health products (including medicines). When completing this section, Applicants should refer to the Guidelines for Proposals, section 4.10.

4.10.1 Roles and responsibilities for procurement and supply management of health products

(a) In the table below, describe the planned roles and responsibilities for procurement and supply management. If a function is planned to be outsourced, identify this in the second column and provide the name of the planned outsourced provider.

Activity

Which organizations and/or departments are responsible for this function? (Identify if MOH Department of Disease Control, or MOF, non-governmental partner, technical partner).

In this proposal what is the role of the organization responsible for this function? (Identify if PR, SR, Procurement Agent, Storage Agent, Supply Management Agent, etc).

Indicate if there is need for additional staff or technical assistance

Procurement policies & systems WHO WHO as a sole procurement

agency Yes No

Quality assurance and quality control of pharmaceuticals

WHO WHO approved products will be procured

Yes No

International and national laws (patents) WHO WHO Yes

No

Coordination WHO DOMC Yes No

Management Information Systems (MIS) DOMC PR Yes

No

Product selection DOMC and WHO PR Yes No

Forecasting DOMC PR Yes No

Procurement and planning DOMC PR Yes

No

Storage and Inventory management DOMC, WHO PR & SRs Yes

No

Distribution to other stores and end-users Provinces and districts PR and SR Yes

No

Ensuring rational use DOMC in collaboration with implementing SRs PR and SRs Yes

No



(b) Briefly describe the organizational structure of the unit with overall responsibility under this proposal for procurement and supply management of health products, including medicines. Indicate how it coordinates its activities with other entities such as the National Drug Regulatory Authority, Ministry of Finance (for budgeting and planning), Ministry of Health, drug storage facilities, distributors, etc.

WHO has been selected as the procurement agency for the procurements under the current project. WHO has well organized supply chain mechanism from the manufacturers to the recipient country. All the health items and non health items will be directly delivered to the provincial programmes for onward delivery to the target districts using the government supply chain mechanism

4.10.2 Procurement capacity

Principal Recipient only

Sub-recipients only

(a) Will procurement and supply management of medicines and other health products be carried out (or managed under a sub-contract) exclusively by the Principal Recipient(s) or will sub-recipients also conduct procurement and supply management of these products?

Both

(b) For each organization planned to be involved in the procurement of medicines and other health products, provide details of the current volume of medicines and other health products procured on an annual basis in the table below. Use the "tab" button on your computer to add extra rows at the bottom of the table if more than four organizations will be involved in procurement.

Organization Name Total value of medicines and other health products procured during last financial year (In same currency as this proposal)

DOMC 0.36 million

4.10.3 Coordination

(a) For the organizations described in section 4.10.2.(b) above, indicate in percentage terms, relative to total value, the various sources of funding for procurement, such as national programs, multilateral and bilateral donors, etc.

(b) Specify participation in any donation programs through which medicines or other health products are currently being supplied (or have been applied for), including: the Global Drug Facility for anti-tuberculosis drugs and drug-donation programs of pharmaceutical companies, multilateral agencies and NGOs, relevant to this proposal.

Peoples Republic of China through its Embassy in Islamabad has recently donated 110,000 adult courses of ACTs (Artesunate and Sulfadoxine Pyrimethamin) for the emergency needs of high risk districts.



4.10.4 Supply management (storage and distribution)

Yes continue to (b) (a) Has an organization already been nominated to provide the supply

management (storage and distribution) functions for medicines and other related health products during the proposal term? No

go to 4.10.5

National medical stores or equivalent

Sub-contracted national organization(s) (specify which one(s))

Sub-contracted international organization(s) (specify which one(s))

(b) If yes to (a) above, indicate, which types of organizations will be involved in the supply management of medicines and other related health products during the proposal term. If more than one of the adjacent boxes is checked, also briefly describe the inter-relationships between these entities when answering (c) and (d) below.

Other (specify) WHO

(c) Describe each organization's current storage capacity for medicines and other related health products, and indicate how the increased requirements under this proposal will be transparently and effectively managed.

World Health Organization (WHO) will be the procurement agency for all the health and non health items (RDTs, ACTs, Microscopes, LLINs, vehicles etc and services of experts for technical assistance. Supply and logistic chain will be managed using the existing MoH supply chain mechanism at national, provincial, district and facility level. The system has the capacity to deal with the additional requirements. See below the flow of logistics and storage at various levels.

(d) Describe each organization's current distribution capacity for medicines and other related health products and indicate how the increased coverage will be managed, and potential challenges addressed if any. In addition, provide an indicative estimate of the percentage of the country and/or population covered in this proposal, and the extent of incremental increase that is on existing distribution arrangements.

MoH at the national, provincial and district level has a functional supply and logistic management system with a chain of national, provincial and district ware houses/ medical stores depots capable of coping with all the existing and emerging demands.

Drug/ Supply chain management at all levels

Central ware house

Provincial Drugs Stores

District Drug Stores (134) Tertiary Care Hospital

Stores

Diagnostic and Treatment Center Stores DHQ, THQ, RHC

Treatment Centers Stores BHUs

Quality assurance



4.10.5 Pharmaceutical products selection

Do you plan to utilize national standard treatment guidelines ('STG') that are in line with the World Health Organization's ('WHO') STG during the proposal term? If not, describe below the STG that are planned to be utilized, and the rationale for their use.

In section 5.4.1, Applicants are requested to complete 'Attachment B' to this Proposal Form on a per disease component basis to provide more detail on the STG, and also the expected prices for medicines.

The health items (RDTs and ACTs) will be procured through WHO procurement services using WHO country office and regional office support. WHO has shown its willingness to extend its support in this regard.

Procurement through WHO will be tax free and quality assured as the procurements can only be made from the WHO prequalified manufacturers following GMP standards. All the policies and guidelines adopted by the Malaria Control Programme at all levels are in line with the WHO recommendations and standard procedures. All the procurements of RDTs, ACTs and LLINs will be in line with the WHO standards.

4.11 Technical and Management Assistance and Capacity-Building Technical assistance and capacity-building can be requested for all stages of the program cycle, from the time of approval onwards, including in respect of development of M&E or Procurement Plans, enhancing management or financial skills etc. When completing this section, Applicants should refer to the Guidelines for Proposals, section 4.11.

4.11.1 Capacity building and training

Describe capacity constraints that will be faced in implementing this proposal and the strategies that are planned to address these constraints. This description should outline the current gaps as well as the strategies that will be used to overcome these to further strengthen national capacity, capacity of Principal Recipients and sub-recipients, as well as any target group. Ensure that these activities are included in the detailed budget in section 5.

Most of the implementing organizations have the appropriate capacity to conduct training activities in their respective districts. To further ensure/strengthen the capacities of the organizations, technical and institutional support will be extended from DOMC and its allied institutions to the partners as required. Training of care providers in case management of malaria applying newly developed guidelines in the target districts is planned to be facilitated by the case management experts of the DOMC. Refresher full term microscopy training for the facility microscopists and the hospital lab technicians will be conducted in the provincial reference laboratories and the National Institute of Malaria Research and Training (NIMRT) Lahore, which were made functional in the course of activities during Global Fund Round-II Grant. These institutions are planned to be further strengthened during the current round, to meet the emerging needs.

4.11.2 Technical and management assistance

(a) Needs Assessment

Describe any needs for technical assistance, including assistance to enhance management capabilities to support the attainment of the planned outputs and outcomes under this proposal. Where relevant, link your response in this section to the potential capacity constraints of the Principal Recipient and/or other implementing partners under this proposal.(Please note that technical and management assistance should be quantified and reflected in the component budget section, in section 5). In your description, identify the process by which needs were assessed and evaluated.

Low capacity of the programme to plan, implement and monitor the control interventions and planned outputs is the major gap identified during the gap analysis exercise for the current round (Annex-17). It has



been planned to obtain short term technical and long term managerial support for national, provincial programme level capacity strengthening to attain the planned outputs and outcomes under this proposal. A functional Project Management Unit will be established at DOMC as PR component to share the additional work on the DOMC management and ensure timely channelization of funds to SRs and monitor the programme processes during this project.

(b) Planned sources and mechanisms for procurement of services

Describe how technical and management assistance is planned to be obtained during the proposal term in a transparent and efficient manner. In particular, identify whether local, national and/or international assistance will be obtained, the scheduled timeframe (short term or longer term) and the rationale for this approach. Also describe how the provision of the planned assistance will contribute to long term increased capacity to respond effectively to the disease.

To enhance the technical and managerial capacity of Malaria Control Programme to plan, implement, monitor and manage the programme interventions at all levels has been planned to be enhanced through the current grant. Services of national/provincial level professionals will be hired through WHO country office support, using the WHO recruitment guidelines to ensure transparency.

TA is also sought to strengthen the existing financial and managerial capacity of the programme to cope with the emerging additional work of the federal unit as Principle Recipient. This is short term support for the office of the principal recipient.

5 Component Budget Malaria


5. Malaria Component Budget - Overview and general guidance This section 5 is where Applicants detail their funding request which is summarized in table 1.2. Section 5 must be completed for each disease component included in your proposal. For Round 7, section 5 has been restructured to adopt the following order: 1. prepare a detailed component budget (section 5.1); 2. from that detailed budget, prepare a summary by objective and service delivery area (section 5.2); 3. from that detailed budget, prepare a summary by cost category (section 5.3); and 4. then provide details about key budget assumptions (section 5.4). Funding to be contributed through a common funding mechanism If part or all of the funding requested for this component is to be contributed through a common funding mechanism (relevant for Applicants who completed section 4.3.5), Applicants must: (a) compile the Budget information in sections 5.1 to 5.3 on the basis of the anticipated use, attribution, or

allocation of the requested funds within the common funding mechanism; and (b) provide, as an annex to your proposal, the available annual operational plans/projections for the

common funding mechanism and explain the link between that plan and this funding request in a covering page to that plan.

5.1 Detailed Component Budget A detailed per-disease component budget covering the proposal period must be attached as an annex to your proposal. The detailed budget should also be integrated with the Work Plan referred to in section 4.6. The Detailed Component Budget should meet the following criteria (Please refer to the Guidelines for Proposals, section 5.1): (a) It should be structured along the same lines as the Component Strategy—i.e., reflect the same goals,

objectives, service delivery areas and activities. (b) It should cover the full term of the proposal, and:

(i) be detailed for year 1 and year 2, with financial information broken down by quarters for the first year, and at least half yearly for the second year;

(ii) provide summarized information and assumptions for the balance term of the proposal period (year 3 and beyond).

(c) It should state all key assumptions, including those relating to units and unit costs (avoid using lump-

sum amounts), and should be consistent with the assumptions and explanations included in section 5.4. (d) It should be integrated with the detailed Work Plan for year 1 and indicative Work Plan for year 2

(please refer to section 4.6). (e) Details on HSS Strategic Actions should be clearly identified. (f) It should be consistent with other budget analysis provided elsewhere in the proposal, including those in

this section 5.



5.2 Summary by objective and service delivery area

Please provide a breakdown of the annual budget by objective service delivery area (SDA) derived from your detailed component budget (section 5.1). The objectives and service delivery areas listed should resemble those in the Targets and Indicators Table (Attachment A to the Proposal Form). Totals should be provided in this table both for each Year (vertical total) and for each SDA (horizontal total).

The totals requested for each year, and for the proposal term as a whole, must be consistent with the totals provided in section 5.3 (budget breakdown by cost category).

Table 5.2: Budget breakdown by service delivery area and objective. Budget breakdown by SDA (same currency as in section 1.1 of the Proposal Form)

Objective Number

Service delivery area By reference to your 'Targets and Indicators Table'

(Attachment A to Proposal Form) Year 1 Year 2 Year 3 Year 4 Year 5 Total

1 SDA-1.1 Strengthening of existing diagnostic services in target districts

493,218 342,628 354,493 319,427 319,427 1,829,192

1 SDA-1.2 Expansion of malaria diagnostic facilities (RDT's)

550,237 632,093 632,093 632,093 632,093 3,078,609

1 SDA-1.3 Strengthen National Institute for Malaria Research and Training (NIMRT)

21,615 14,080 14,080 14,080 20,680 84,535

1 SDA-1.4 Enhancement of capacities health professionals

107,690 309,430 175,230 175,230 175,230 942,810

1 SDA-1.5 Assessment of private sector in malaria care delivery

50,050 14,300 - - - 64,350

1 SDA-1.6 Roll out ACTs 72,676 132,153 124,453 124,453 124,453

578,188

TOTALS 1,295,486 1,444,684 1,300,349 1,265,283 1,271,883 6,577,684

2 SDA-2.1 To scale up LLINs 2,219,030 5,901,060 1,985,280 - -

10,105,370



Budget breakdown by SDA (same currency as in section 1.1 of the Proposal Form)

Objective Number

Service delivery area By reference to your 'Targets and Indicators Table'

(Attachment A to Proposal Form) Year 1 Year 2 Year 3 Year 4 Year 5 Total

2 SDA-2.2 Raising awareness about LLINs through BCC

551,210 875,160 817,410 817,410 817,410

3,878,600

2 TOTALS 2,770,240 6,776,220 2,802,690 817,410 817,410

13,983,970

3 SDA-3.1 Monitoring drug and insecticide resistance

37,950 4,400 34,100 2,200 -

78,650

3 SDA-3.2 Strengthening management and technical capacities

82,500 91,300 19,800 - 33,000

226,600

3 SDA-3.3 Malariometric survey 89,100 28,600 - - -

117,700

3 SDA-3.4 Strengthening M&E capacities 107,250 102,300 102,300 102,300 102,300

516,450

3 SDA-3.5 Strengthening malaria surveillance system

21,450 35,200 - - -

56,650

TOTALS 338,250 261,800 156,200 104,500 135,300

996,050

Total of funds requested from the Global Fund: 4,403,976 8,482,704 4,259,239 2,187,193

2,224,593

21,557,704



5.3 Summary by cost category In table 5.3 on the following page, provide a breakdown of the annual budget by cost category derived from your detailed component budget (section 5.1) (a) Different from Round 6, the cost categories in table 5.3 have been expanded to provide greater clarity

between different cost categories. (b) Guidance on the budget categories and the expenses falling within each category is provided in the

Guidelines for Proposal section 5.3. (c) The total requested for each year, and for the proposal term as a whole, must be consistent with the

totals provided in section 5.2 (breakdown by 'service delivery area'). (The “Total funds requested from the Global Fund” must also be consistent with the amounts entered in table 1.2 relating to this component.)



Table 5.3 – Budget breakdown by cost category

Breakdown by cost category (same currency as in section 1.1 of the Proposal Form) Use the “MALTable53Line” button in the standard toolbar to insert row at the end of table Year 1 Year 2 Year 3 Year 4 Year 5 Total

Human resources 507,900 868,800 600,000 331,200 331,200 2,639,100

Technical Assistance 94,000 47,000 32,000 - 30,000 203,000

Training 117,000 247,000 137,000 125,000 125,000 751,000

Health products and Health Equipment 1,649,950 4,214,100 1,828,960 595,980 601,980 8,890,970

Medicines and pharmaceutical products 42,930 81,860 83,860 81,860 81,860 372,370

Procurement and supply management costs 259,735 673,689 273,615 70,717 70,717 1,348,473

Infrastructure and other equipment 492,200 450,000 - - - 942,200

Communication Materials 485,000 836,000 697,500 668,500 668,500 3,355,500

Monitoring & Evaluation 234,900 223,100 161,600 81,600 81,600 782,800

Living Support to Clients/Target Populations 10,000 - 10,000 - - 20,000

Planning and administration 110,000 70,000 47,500 33,500 31,500 292,500

Overheads 400,361 771,155 387,204 198,836 202,236 1,959,791

Other: (To be further defined to meet national budget planning categories) -

Total funds requested from Global Fund 4,403,976 8,482,704 4,259,239 2,187,193 2,224,593 21,557,704



5.4 Key budget assumptions The detailed component budget (section 5.1) should contain all key budget assumptions. Below, Applicants are requested to highlight their budget assumptions for year 1 and year 2 in relation to three key areas.

5.4.1 Pharmaceuticals and other health products and equipment

Applicants must complete Attachment B to this Proposal Form (Preliminary List of Pharmaceuticals and other Health Products) to provide details of the budget assumptions for years 1 and 2 in respect of health products (including consumables), medicines, health equipment and services directly tied to procurement and supply management of health products.Please note that unit costs and volumes must be fully consistent with the information reflected in the detailed component budget. If prices from sources other than those specified below are used, a rationale must be included.

(a) Provide a list (by generic product name) of artemisinin based combination therapies and other anti-malarial medicines to be used in years 1 and 2, and identify which essential medicines list those medicines are included, and whether WHO's standard treatment guidelines are being followed. See also section 4.10.5 above. (Please complete table B.1 in Attachment B to the Proposal Form.)

(b) Identify the average cost per person per year (or average cost per treatment course) for these medicines. (Please complete table B.2 in Attachment B to the Proposal Form.)

(c) Provide the total cost for all other medicines to be used over years 1 and 2. It is not necessary to itemize each product in the category. (Please complete table B.2 in Attachment B to the Proposal Form.)

(d) Provide a list of other health products (e.g., condoms, diagnostics, hospital and medical supplies), health and non-health equipment, and services directly tied to procurement and supply management. Unit costs are requested for Health Products (i.e., consumables).(Please complete tables B.3 and B.4 in Attachment B to the Proposal Form.)

Information on appropriate unit costs is available at, for example:

• Sources and Prices of Selected Drugs and Diagnostics for People Living with HIV/AIDS. Copenhagen/Geneva, UNAIDS/UNICEF/WHO-HTP/MSF, June 2005, http://www.who.int/medicines/areas/access/med_prices_hiv_aids/en;

• Market News Service, Pharmaceutical Starting Materials and Essential Drugs, WTO/UNCTAD/International Trade Centre and WHO (http://www.intracen.org/mas/mns.htm);

• International Drug Price Indicator Guide on Finished Products of Essential Drugs, Management Sciences for Health in Collaboration with WHO (published annually) (http://www.msh.org/what_msh_does/cpm/index.html); and

• First-line tuberculosis drugs, formulations and prices currently supplied/to be supplied by Global Drug Facility http://www.stoptb.org/gdf/drugsupply/drugs_available.asp.)

Provide any additional information on unit costs below

The costing of health products and pharmaceutical products is as follows

RDT’s 1 US$ /unit

ACT 2 US$ /treatment

LLINs 6 US$ /Unit



5.4.2 Human resources costs

In cases where human resources represent an important share of the budget, explain how these amounts have been budgeted in respect of the first two years, to what extent human resources spending will strengthen health systems’ capacity at the client/target population level, and how these salaries will be sustained after the proposal period is over.(Maximum of half a page).

(Useful information to support the budget includes: a diagram/organ gram of the PR; a list of proposed positions showing title, function and planned annual salary; and proportion (in percentage terms) of time that will be allocated to the work under this proposal. Please attach such information as an annex to your proposal and indicate the appropriate annex number.)

Human resource comprises 12.22% of the total cost. A complete Program Management Unit (PMU) has been planned for the directorate of Malaria Control Program. This will enable the Directorate in effective and efficient management of the program. This will comprise of the following

1. Project Support Officer

2. Finance Manager

3. Monitoring and Evaluation Officer – 5 (One at Federal Level and 4 at district level)

4. Office Assistant

5. Finance Assistant

6. Driver

7. Peon

Further more a Malariologist is planned to be hired and is expected to work for 24 months to help in conducting malariometric survey. ()bjective-3 SDA-3). The PMU will be led by a Program Support Officer who will be working under the direct supervision and control of the Director Malaria Control Program. Special emphasis has been placed on monitoring and evaluation for which 5 M&E officers will be supported through this program to re-in force the provincial M&E teams. Some other staff at district level will be hired for the partners (SR’s). The staff on the whole has been kept as the minimum and only very essential staff has been budgeted in the GFATM Round-7 application.

PROGRAM SUPPORT

OFFICER - (1)

Director MCP at DOMC

M&E Officer at DOMC (1)

ADMIN ASSISTANT(

FINANCE ASSISTANT

FINANCE MANAGER (1)

Provincial M&E Officers

DRIVER - (1) at DOMC

PEON - (1)



5.4.3 Other key expenditure items

Explain the rationale for how other expenditure categories which form an important share of the budget (e.g., infrastructure and other equipment; communication materials; or planning and administration), have been budgeted for the first two years.(Maximum of half a page. Please attach an annex and indicate the appropriate annex number.)

Following are the major cost components with their rationale/justification and explanation: -

Human resource

Explained in the section 5.4.2 above

Technical Assistance: -

The issue of low capacity in terms of technical, financial and managerial strengths, has been identified as one of the gaps in the programme by USAID consultant (Annex-17). To enhance these capacities at the programme level will enable the programme and the SRs to plan , implement and monitor the planned actions in the target districts. TA also aims at enhanced capacity of the Project Management Unit at the DOMC to better absorb the additional work of PR and smooth channelization of resources to the SRs. TA is being sought during year-1, at the initial implementation phase for short duration 6 months, at the end of year-2 of Phase-1 for 3 months to prepare the final report for Phase-2 continuation. One of the reasons for the GFATM Round-2 discontinuation to its Phase-2 was the program’s lack of to implement and monitor. TA will also ensure quality reporting to GFATM by the nominated PR (DOMC) on the grant and objectives. It is proposed that WHO will act as the recruitment agency for the hiring of these services.

This component make <1 % of the total requested cost

Training: -

Training component aims at the capacity building of the care providers both public and private, LHWs in malaria case management guidelines. Training in vector control techniques as the use of LLINs and its distribution amongst the target groups and the provincial and district staff in M&E component have also been included in this component. It comprises close to 3 % of the total request. The costing has been made keeping in view the country level costs and the local environment of the target districts. The standard costs were agreed by all the partners first and then indicated in the work plan.

Health Products: -

As a major component, 41% of the total costs have been estimated to be spent on the procurements of products like RDTs, microscopes and LLINs. It will be used to achieve the desired and set target of LLINs coverage in the target groups (80%) and will improve the access of the population to quality diagnosis at their door steps.

Medicines and Pharmaceutical Products: -

Prompt and effective treatment of the patient in line with the national treatment protocol and WHO recommendations have been considered the basic intervention in malaria control programmes. It will not only reduce the malaria specific morbidity and mortality, but at the same time plays vital role in reduction of parasite carrier state. Current National Malaria PC-I is promising to ensure the availability of effective 1st line treatment for both the vivax and falciparum malaria at public health facilities. However current R-7 proposal seeks the GF grant support for the procurement and supply of ACTs for the Basic Health Units offering MCH services for pregnant women and private clinics in 4 selected districts. Treatment of vivax cases by CQ and PQ will be solely provided by the national and provincial programmes through their domestic source. This component constitutes 2 % of the total costs of the project.

Procurement and Supply Management Costs: -

This comprises 6 % of the total costs and will be used to pay the freight and transportation costs on the import of health items. This also includes the procurement and supply management cost of the procuring agency, in our case its is WHO.

Infrastructure and Other Equipment: -

These comprise 4 % of the total request and include furniture and fixture, computer and other office establishments. It has been kept to the minimum with request for funding for essential items only.

Communication material:

This comprises 16 % of the total costs. This includes mainly the BCC component of proposal and includes,



TV Spots, Newspaper advertisement and Bill Boards in the target districts.

Monitoring and Evaluation: -

This comprises 4% of the total costs. Special emphasis has been placed on the proposal on M&E. The principal responsibility of M&E will be of the Directorate of Malaria Control Program and its provincial offices. All the activities proposed in the proposal will be monitored by program to ensure quality implementation and accurate reporting of the outcomes and results.

Living Support to Patients/Target Population: -

Monitoring the efficacy of antimalarial drugs against falciparum malaria cases in accordance with the WHO Protocol should be a routine activity in a country programme. Four sentinel sites country over will be selected and made functional during year 2 and survey conducted. It needs recruitment of about 100 malaria patients at each centre to be followed for 28 days. Most of these patients report health facilities from distant rural villages with very limited sources of travel. The patients recruited for the purpose will be provided living and transportation support during the follow up period. Cost included in this SDA is nominal. (< .09% of the calculated cost).

Planning and Administration: -

It comprises 1 % of the total cost of the project. Special emphasis has been laid on planning and administration to facilitate timely implementation of the planned activities. Regular meetings with the SRs and policy makers of target districts will enable the partners reduce the risks and maximize the opportunities for activities to happen. It will help strengthen the public private partnership with extensive meetings between them.

Overheads: -

Kept at minimum to the extent of possibility so as to achieve cost effective targets. It hardly constitutes 9 % of the total costs. This typically is the operating costs of the implanting agencies. This include administration costs, organizations internal management overheads and all miscellaneous expenses like rent-office space and vehicles, fuel, telephone, internet, insurance, security, utilities etc. These costs will not be approved lump sum by the PR but charging will be allowed after giving proper breakup and rationale of charging.

General: -

The costs in the obove heads have been kept to the minimum to address the program gaps and meeting essential needs only. There are many other costs involved in implementation of the program which all the partners (from public and private sector ) will support from their own resources.

It may also be noted that no separate cost for PR has been made and all the costs indicated in the SDA’s will also be sufficient to cover the Directorate of Malaria Costs acting as PR.

The calculations have been made in round figures.


102

The table below provides a list of the various annexes that should be attached to the proposal after completing sections 4 and 5. Please complete this checklist to ensure that everything has been included. Please also indicate the applicable annex numbers on the right hand side of the table.

Section 4: Component Strategy – Malaria Annex Number to your proposal

4.3.1 Documentation relevant to the national disease program context.

National Malaria Strategic Plan

Annex-1

4.3.5(c) (only if common funding mechanism)

Documentation describing the functioning of the common funding mechanism. NA

4.3.5(d) (only if common funding mechanism)

Most recent assessment of the performance of the common funding mechanism. NA

4.6 A completed 'Targets and Indicators Table' Refer to the M&E Toolkit for help in completing this table.

Attachment A – Malaria

4.6 A detailed component Work Plan (quarterly information for the first year and indicative information for the second year).

Annex-2

4.6 A copy of the Technical Review Panel (TRP) Review Form for unapproved Round 5 or Round 6 proposals.

Annex-3

4.8.3 (c)

List of sub-recipients identified (including name, sector they represent, and SDA(s) most relevant to their activities during the proposal term)

Annex-4

4.9.1 National Monitoring and Evaluation Plan/Strategy (if one exists) Annex-5

Section 5: Component Budget – Malaria Annex Number to your proposal

5.1 Detailed component Budget Annex-6

5.1 (if HSS strategic actions are included – see section 4.4.2)

Details of cross-cutting HSS amount (if not clearly identifiable from the detailed component budget). NA

5.4.1 (and section 4.10.5)

Preliminary List of Pharmaceuticals and Other Health Products (tables B1 – B3)

Attachment B – Malaria

5.4.2 Human resources costs.

5.4.3 Other key expenditure items.


103

Other documents relevant to sections 4-5 attached by Applicant: Annex Number to your proposal

Final report of independent review mission for GF R2. Annex 7

National PC-I Annex 8

Report of the Health System Review

Mission – Pakistan by WHO EMRO

Annex 9

Minutes of the TACOM Meeting Annex 10

National Malaria Treatment guidelines Annex 11

National Health Policy document Annex-12

Minutes of the meeting with pharmaceutical companies regarding ban on production of artemisinin monotherapies

Annex-13

R-2 Close out Report Annex-14

R-3 Final Report Annex-15

GOP Vision 2030 document Annex-16

USAID consultant Report on Gap analysis Annex-17

Annual MIS Data 2006 with graphs Annex-18

Drug efficacy monitoring report Annex-19

Cross border malaria meeting report Annex-20

PakistanMalaria

1

value Year Source Year 1 Year 2 Year 3 Year 4 Year 5TBD year 1 Baseline survey baseline 25% 50% 75% 100%

5% 2006 HNI report 2006 10% 40% 60% 80% 80%

TBD year1 Baseline survey baseline 10% reduction from baseline

20% reduction

30% 50%

10% 2006 Internal and external QA records.

10% 8% 6% <4% <4%

20% 2006 R2 closeout report for malaria

30% 50% 70% 80% 80%

50% 2007 Sentinal survey for malaria cont. activities.

50% 60% 80% 90% 90%

Objective Number

1

2

3 To strengthen and build management capaities of national malaria control programme to co-ordinate and lead effective curative and preventive interventions

outcome

outcome

% of U5 children (and other target group) with uncomplicated malaria correctly managed at health facilities

outcome

80 % of care providers in target districts at rural public sector PHC facilities providing treatment as per revised national treatment guidelines to suspected malaria cases by 2011.

outcome

outcome

Impact and outcome Indicators

impact Prevalence of malaria parasite infection

Comments*

Malaria Attachment A to the Proposal Form

Program Details

To strengthen services and capacities of malaria control programme in Pakistan so that malaria burden in 19 high risk districts is reduced by 50 % in 2012

Country:Disease:Proposal ID:

BaselineIndicator formulation

% of pregnant women (and other target groups) sleeping under an ITN

Program Goal, impact and ouctome indicators

Comments

Targets

Program Objectives, Service Delivery Areas and Indicators

Goals

* please specify source of measurement for indicator in case different to baseline source

Objective description

To improve the coverage and quality of early diagnosis and prompt treatment services in 19 target districts

To scale up and improve coverage of LLINs implementation in 19 target districts

90% of public sector microscopists in target districts performing adequately (<4% wrong reporting)

90% of women of child-bearing age in target districts knowthe benefits of early diagnosis and appropriate treatment (EDAT) by 2011.

Number of women of child bearing age who know the benefits of EDAT / number of women of child bearing age interviewed. 20 interviewies per village, 5 villages per union council, 5 union councils per province, all selected at random.

Number of microscopists performing adequately/total number of micoscopists

Number of care providers providing appropriate treatment to suspected malaria cases/number of care providers providing treatment to confirmed malaria cases. Interviews with all care providers at 6 BHUs and 2 RHCs in 5 districts per Province, all selected at random.

Page 1 of 5M+E

Latest template update 01/03/2006

PakistanMalaria


Program DetailsCountry:Disease:Proposal ID:1.6 Treatment:

Diagnosis and prompt effective anti-malarial treatment (Roll out ACTs).

Number of health facilities administring ACTs as first line treatment for lab confirmed PF

0 2007 MOH (routine reports)

124/276 134/276 144/276 179/276 244/276 260/276 276/276 Y Y Y - over program term

2.1 Prevention: ITNs (Scale-up LLITN coverage).

number of LLINs distributed to pregnant women and children under 5

100'000 2007 Reports: GF R2& R3 & DOMC progress reports

100000 200'000 400'000 800'000 1'100'000 1'100'000 1000000 Y N Y - over program term

2.2 Prevention: BCC -mass media and community outreach (LLINs and early diagnosis and appropriate treatment).

large size pictoral billboards with prime messages on malaria prevention/control displayed

3 2007 Reports: GFR2 progress reports

0 20 40 60 60 60 60 Y N Y - over program term


prime messages aired through local popular TV channels


0 120 180 240 360 480 600 Y N N - not cumulative

quarterly

quarterly

quarterly

in malaria transmission season ( April- Oct) annualy

Page 3 of 5M+E


PakistanMalaria


Program DetailsCountry:Disease:Proposal ID:2.2 Prevention: BCC -

mass media and community outreach (LLINs and early diagnosis and appropriate treatment).

prime messages published in local newqspapers


0 24 36 48 72 96 120 Y Y Y - cumulative annually


community based seminars conducted


0 20 30 40 60 80 100 Y N Y - cumulative annually

3.1 Supportive environment: Monitoring drug and insecticide resistance (Longitudinal testing of antimalarial and insecticide efficacy).

number of sentinel sites reporting on efficacy of antimalarial drugs and insecticides


0 4 4 6 8 8 8 Y N Y - cumulative annually

3.3 HSS: Information system & Operational research (Conduct malariometric survey in year1 to establish baseline).

prevalence surveys conducted to establish malaria and entomological baseline


0 1 Y N Y - over program term

3.4 HSS: Information system & Operational research (Strenghthen M & E system at all levels).

number of people trained in malaria M&E, statistics and data management


0 5/5 5/5 5/5 5/5 5/5 5/5 Y N Y - over program term

3.5 Information system & Operational research (Improve epidemiological surveillance system).

number of people trained in malaria surviellence


0 5/5 5/5 5/5 5/5 5/5 5/5 Y N Y - over program term programme specific surviellence officers to be recruited and trained

weekly during transmission season

one per district per year

annual

study report by end of year 1

programme specific M&E officers to be recruited and trained

Page 4 of 5M+E


PakistanMalaria


Program DetailsCountry:Disease:Proposal ID:

Value Year Source 6 months 12 months 18 months 24 months Year 3 Year 4 Year 5

1.1 Treatment: Diagnosis and prompt effective anti-malarial treatment (Strengthen existing diagnostic services in target districts).

Number of centers for malaria diagnosis with trained microscopists

42.0% (116/ 276)

2006 MOH (routine HMIS)

48.5 % (134/276)

64.8% ( 179/276)

88.4% (244/276)

100% (276/276)

100% (276/276)

100% (276/276)

Y Y Y - over program term

1.2 Treatment: Diagnosis and prompt effective anti-malarial treatment (Expand coverage of RDT-based diagnostic facilities)

Number of RDTs distributed in MCH services centers in target districts and private clinics (in 4 target districts).

0 2006 MOH (routine HMIS)

0 204'650 613'950 1'023'250 1432550 1841850 Y Y Y - cumulative annually

1.3 Treatment: Diagnosis and prompt effective anti-malarial treatment (Strengthen national and provincial quality assurance mechanisms).

number of QACs upgraded 5 2006 MOH (HMIS)

0/5 3/5 4/5 5/5 5/5 5/5 5/5 Y Y Y - cumulative annually

1.4 Treatment: Diagnosis and prompt effective anti-malarial treatment (Provide case management training).

number of health workers trained on new treatment guidelines in public sector


0 800 1500 2000 Y Y Y - over program term

1.5 Treatment: Diagnosis and prompt effective anti-malarial treatment (Provide support for private sector diagnosis and treatment services in four pilot districts).

number of health workers trained on new treatment guidelines in private sector


0 200 300 500 Y N Y - over program term

Objective / Indicator Number

Targets for year 1 and year 2 Baselines

included in targets (Y/N)

Service Delivery Area

Directly tied (Y/N)Annual targets for years 3, 4 and 5

Baseline (if applicable)

Comments, methods and frequency of data collection

Targets cumulative (Y-over program

term/Y-cumulative annually/N-not

cumulative)

quarterly

quarterly

quarterly

quarterly

quarterly data collection

Indicator formulation

Page 2 of 5M+E
