SECTIONS IV – VIII: Detailed information on each component of the proposal
PLEASE COMPLETE THE FOLLOWING SECTIONS FOR EACH COMPONENT
Please copy sections IV – VIII, as many times as there are components
Please note: a component refers to a disease, i.e. your proposal will have more than one
component only if it covers more than one disease. There should only be 1 component per
disease.
If there are any objectives or broad activities within a particular component that are of a
system-wide/cross-cutting nature such as capacity building or infrastructure development
that may go beyond the scope of that particular component, please indicate those aspects
clearly and specify how they would relate to other components of the proposal when
detailing them in Question 27. (Guidelines para. IV.47 – 49)
If this is a fully integrated proposal, where two or more components are linked in such a
way which would not make it realistic or feasible to separate, mark the boxes in Table
IV.23 to identify all diseases which would be directly affected by this integrated
component. (Guidelines para. 50)
SECTION IV – Scope of proposal
23. Identify the component that is detailed in this section (mark with X):
Table IV.23
Component
HIV/AIDS
(mark with X):
Tuberculosis
X
Malaria
HIV/TB
24. Provide a brief summary of the component (Specify the rationale, goal, objectives,
activities, expected results, how these activities will be implemented and partners
involved) (2–3 paragraphs):
Malaria in Sudan is a major public health problem. The whole country is considered
endemic, with varying degrees of endemicity. The country shoulders an estimated 50% of
all malaria cases in the WHO Eastern Mediterranean Region an estimated 7.5 million
cases resulting in 35 000 deaths per year. The disease accounts for about about a fifth of
outpatient cases, nearly a third of inpatient cases and a fifth of all hospital deaths. The
malaria case fatality rate for paediatric hospitals ranges between 5% and 15%.
The overall goal of RBM in Sudan is to reduce the malaria burden to an extent that it is
no longer a public health problem.
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The objective of the Malaria component is to malaria morbidity and mortality by40% by
2010.
The specific objectives, main activities and outcomes are as follows:
1. To improve disease management:
a. Introduce malaria home management
b. Improve clinical diagnosis and treatment
c.
d.
Improve laboratory diagnosis
Ensure availability and rational use of antimalarials
2. To improve disease surveillance and epidemic management:
a. Establish early warning system
b. Ensure rapid response to epidemics
3.
To implement cost-effective and evidence-based multiple prevention
a.
Develop policy on rational use of insecticides
interventions:
b. Scale up use of insecticide treated nets (ITNs )
c. Prevent malaria during pregnancy through introduction of intermittent
preventive treatment (IPT) with sulphadoxine-pyremethamine (SP) through
antenatal clinics
4. To upgrade capacity and strengthen institutional work:
a. Expand the RBM support system in 13 states in the southern and western parts
of the country
b. Support and expand the available training centers
Implementation:
Technical intervention is based on epidemiological stratification of malaria, as seen in
the table below. More emphasis will be given to areas of high malaria transmission.
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Strata
Desert
fringe
Endemicity
Hypoendemic
Population
States
Selected Interventions
2,000,000
Northern, River Nile,
Red Sea except Port
Sudan and North
Darfour except
Elfashir
Case management, ITNs,
source reduction where
appropriate (with community
involvement), IRHS during
emergency, epidemic
preparedness
Case management, ITNs,
IRHS during emergency,
epidemic preparedness
Poor
savannah
with
seasonal
malaria
Hypoendemic
Mesoendemic
15,000,000
Rural areas in
Greater Darfour,
Kordofan, Blue Nil,
White Nile, Sinna
Gezira Gedarif,
Kassala, Khartoum
Stable
perennial
transmissio
n
HyperendemIc
4,000,000
Southern Sudan
Case management, ITNs and
IPTs.
8,000,000
Khartoum and all
large cities e.g. Port
Sudan, Wad Medani
Case management, ITNs,
source reduction where
appropriate (with community
involvement), larviciding,
IRHS during emergency
2,000,000
All large- scale
irrigated schemes
(Gezira, Elrahad,
Kinana, Asalia, West
Sinnar, New Halafa
and Elzidab)
Case management, ITNs,
targeted IRHS, IPTs, source
reduction where appropriate
(with community involvement)
during emergency
Urban
malaria
Hypoendemic
Mesoendemic
Irrigated
Schemes
Usually in the
mesoendemic
zones
The implementation of RBM interventions and activities will be at all levels and will be the
responsibility of all partners (Government, NGOs, unilateral, bilateral and multilateral
organizations, private sector and community-based organizations). Management of the malaria
component will therefore focus on brokering and coordinating the partnership.
25.
Indicate the estimated duration of the component
Table IV.25
From
(month/year):
January 2003
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To (month/year):
Dec. 2007
26. Detailed description of the component for its FULL LIFE-CYCLE:
Please note: Each component should have ONE overall goal, which should translate into a series of
specific objectives. In turn each specific objective should be broken-down into a set of broad activities
necessary to achieve the specific objectives. While the activities should not be too detailed they should be
sufficiently descriptive to understand how you aim to achieve your stated objectives.
Indicators: In addition to a brief narrative, for each level of expected result tied to the goal, objectives
and activities, you will need to identify a set of indicators to measure expected result. Please refer to
Guidelines paragraph VII.77 – 79 and Annex II for illustrative country level indicators.
Baseline data: Baseline data should be given in absolute numbers (if possible) and/or percentage. If
baseline data is not available, please refer to Guidelines paragraph VII.80. Baseline data should be from
the latest year available, and the source must be specified.
Targets: Clear targets should be provided in absolute numbers (if possible) and percentage.
For each level of result, please specify data source, data collection methodologies and frequency of
collection.
An example on how to fill out the tables in questions 26 and 27 is provided as Annex III in the Guidelines
for Proposals
26.
Goal and expected impact (Describe overall goal of component and what impact, if
applicable, is expected on the targeted populations, the burden of disease, etc.), (1–2
paragraphs):
The overall goal of RBM in Sudan is to reduce the malaria burden to the extent that it is
no longer a public health problem. This goal is to be achieved through overall health
sector development, improved strategic investments in malaria control, and increased
coverage of malaria treatment and prevention interventions, especially at the community
level.
Expected impact:
•
•
Raising awareness and empowering the community so that the community can take
actions that add to the program sustainability
Reduction of malaria disease burden (morbidity and mortality)
Please note: the impact may be linked to broader national-level programmes
within which this component falls. If that is the case, please ensure the impact
indicators reflect the overall national programme and not just this component.
Please specify in Table IV.26.1 the baseline data. Targets to measure impact are
only required for the end of the full award period
Table IV.26.1
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Goal:
To reduce the malaria burden to an extent that it is no longer a public
health problem
Impact indicators (RBM Global indicator)
Baseline
Target (last year of
proposal)
(Refer to Annex II)
Year:
Year: 2007
Malaria death rate (probable and confirmed)
among hospital admitted cases
N/A
Reduced by 40% from
baseline
No. of malaria cases, simple and severe
complicated (probable and confirmed) among
total health facilities attendence
N/A
Reduced by 40% from
baseline
Proportion of households having at least one
treated bednet
N/A
Increased by 50% from
base line
Percentage of patients with simple malaria
getting correct treatment at health facility and
community level according to national
guidelines within 24 hours of onset of
symptoms
N/A
Increased by 50% from
baseline
Percentage of health facilities reporting no
disruption of stock of antimalarial drugs (as
specified in the national drug policy) for more
than one week during the previous three months
N/A
Increased by 50% from
baseline
* Annual targets may be adjusted in line with baseline survey results
27. Objectives and expected outcomes (Describe the specific objectives and expected
outcomes that will contribute to realizing the stated goal), (1 paragraph per specific
objective):
Objective I: To treat malaria cases according to the national guidelines in >90% of
cases: The capacity and access to early diagnosis and treatment at all level should be
improved. Home management will be introduced in areas with high transmission and low
coverage with services.
Chloroquine (CQ) and sulphadoxine-pyremethamine (SP) will be under monitoring.
Combination therapy (CT) will be tested in certain areas (Q+SP and artesinate-based
combination).
Guidelines for simple and severe malaria will be updated every 2–3 years (to fit with
WHO guidelines and with the result of studies) and distributed to prescribers. Training of
health personnel will be conducted within the context of IMCI.
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Expected outcomes:
Simple and severe malaria case management will be improved at all levels, leading to
reduction of mortality and suffering.
To treat malaria cases according to the national guidelines in >90% of cases as
Objective I: early as possible
Outcome/coverage
indicators
Baseline Targets
(Refer to Annex II)
Year:
Year 2:
2003
Year 3:
2004
Year 4:
2005
% of mothers/ caregivers
able to recognize signs and
symptoms of severe febrile
illness
N/A
25%
50%
75%
100%
% of children <5 with fever
treated according to IMCI
guidelines
N/A
25%
50%
90%
90%
% of patients with
uncomplicated malaria
getting correct treatment at
health facility
N/A
75%
75%
100%
100%
% of health facilities with no
disruption of antimalarials
for 2 wks in the last 3
months
N/A
50%
75%
90%
90%
Year 5:
2006
* Annual targets may be adjusted in line with baseline survey results
a.
Broad activities related to each specific objective and expected output (Describe
the main activities to be undertaken, such as specific interventions, to achieve the stated
objectives) (1 short paragraph per broad activity):
•
•
•
•
National guidelines will be updated periodically (every 2–3 years) in light of
therapeutic efficacy studies. The guidelines will be distributed to prescribers in the form
of booklets and a flow-chart.
(CQ+SP) as a combination therapy will be introduced in pilot areas, and at the same
time artesinate-based CT will be studied in certain areas.
Training of health personnel/ mothers in community and PHC units will be carried out
in collaboration with IMCI.
IEC will follow the introduction of each new guideline and will be sustained.
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•
Efforts will be made to maintain availability of drugs at all levels free of charge.
Objective I:
Broad
activities
To treat malaria cases according to the national guidelines in >90% of cases as
early as possible
Process/Output
Baseline
indicators (indicate
one per activity)
(Refer to Annex II)
(Specify
year)
Year 1
2003
Year
2
2004
Updated document
actually distributed.
0
80%
100%
NMCP, SMCP, NGOs,
private sector
Operational resea Research completed
0
50%
100%
NMCP, SMCP, NGOs,
research institutes
Training (100 in % of personnel
each state
trained out of the
*26=2600)
target
0
20%
(520)
60% NMCP, SMCP, NGOs,
(1560) private sector
Updating
treatment
guidelines
Targets
Responsible/Implementin
g agency or agencies
IEC
% of target group
with adequate
knowledage,
attitude and
practice (>80%)
N/A
50%
80%
NMCP, SMCP, NGOs,
private sector
Availing drugs
% of facilities with
no disruption of
drugs for 2 weeks
during the last 3
months
N/A
25%
50%
NMCP, SMCP, NGOs,
private sector
* Annual targets may be adjusted in line with baseline survey results
27. Objectives and expected outcomes (Describe the specific objectives and expected
outcomes that will contribute to realizing the stated goal), (1 paragraph per specific
objective):
Objective II: To improve malaria laboratory diagnosis to reach >90% sensitivity and
specificity in 100 districts: The situation of malaria laboratory diagnosis (in public,
private and NGOs sectors) will be explored. The training, supplies and equipment as well
as supervision will be directed according to the results. The state quality assurance (QA)
laboratory will be strengthened to carry out this work.
Expected outcomes:
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Laboratory capacity diagnosis of malaria will be improved with subsequent rise in
sensitivity and specificity.
Objective II:
To improve malaria laboratory diagnosis to reach >90% sensitivity and
specificity at 100 districts
Outcome/coverage
indicators
Baseline
Targets
(Refer to Annex II)
Year:
Year 2:
2003
Year 3:
2004
Year 4:
2005
Year 5:
2006
% of districts with improved
laboratory diagnosis (target
100 district )
N/A
26% (26)
50% (50)
75% (76)
100%
(100)
% of laboratories with >90
sensitivity and specificity
(total no. will be available
later)
N/A
50%
75%
90%
% of states with functioning
QA laboratory
N/A
50% (13)
75% (20)
100% (26)
90%
100% (26)
* Annual targets may be adjusted in line with baseline survey results
a. Broad activities related to each specific objective and expected output (Describe
the main activities to be undertaken, such as specific interventions, to achieve the
stated objectives) (1 short paragraph per broad activity):
As this is a problem-solving approach, in each district the following activities will be
carried out:
•
•
•
•
•
•
Assessment of laboratory work in 100 districts (one from each state) and
recommendations for a solution package for each area
Provision of necessary S&E as described in the recommended package
Refresher courses (100 courses/7 days)) for laboratory technicians (at least
2000) as indicated by the package
Regular supervision of quality assurance (QA) laboratories over services
laboratories and enforcement of Giemsa stain use laboratories at urban
area level
Strengthening of existing 13 QA laboratories services and developing new
ones in another 13. Development and distribution of documents and bench
aids on laboratory diagnosis sites through provision of equipment and
consumables
Development and distribution of documents and bench aids on laboratory
diagnosis
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Objective II:
Broad
activities
To improve malaria laboratory diagnosis to reach >90% sensitivity and
specificity at 100 districts (at least one in each state during the first 2 years)
Process/Output
indicators (indicate
one per activity)
(Refer to Annex II)
Baseline
Targets
Responsible/
Implementing
agency or agencies
(Specify
year)
Year 1
2003
Year 2
2004
0
26%
(26)
50%
(50)
NMCP, SMCP,
NGOs, private sector
Provision of S&E % of S&E available
out of the total need
0
50%
75%
NMCP, SMCP,
NGOs, private sector
Training (target
2000)
% of trained
personnel
0
26%
(520)
50%
(1000)
NMCP, SMCP,
NGOs, private sector
Supervision
% of the districts
visited
0
90%
90%
NMCP, SMCP,
NGOs, private sector
QA laboratories
establishment
(26 labs)
% of functioning
laboratories out of
the total
N/A
50%
(13)
75%
(20)
NMCP, SMCP
Distribution of
guidelines and
bench aids
% of laboratory
personnel with
bench aids and
guidelines
N/A
26%
(520)
50%
(1000)
Situation
analysis
% of districts
finished with
situation analysis
out of target
NMCP, SMCP,
NGOs, private sector
* Annual targets may be adjusted in line with baseline survey results
28. Objectives and expected outcomes (Describe the specific objectives and expected
outcomes that will contribute to realizing the stated goal), (1 paragraph per specific
objective):
Objective III: To reduce deaths due to malaria at hospital level by 75% from the
registered deaths during 2002 by the end of the period
This a problem-solving approach to address malaria mortality. Effort at hospital level are
required not only to adequately manage the severe malaria cases but also to identify the
determinants of severe malaria and malaria mortality. Admitted malaria patients will
receive the necessary treatment and at the same time they will be given an in-depth
interview to identify mortality determinants and any related behavioural, social or
economic factors. Based on such interviews, malaria information, education and
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communication (IEC) programme will be developed and implemented. So, this objective
entails a package composed mainly of focal discussion with caregivers, proper diagnosis,
treatment and health education.
Expected outcomes:
Improved quality of care for severe complicated malaria at hospital level with free
drugs will eventually reduce malaria mortality
Objective III:
To reduce deaths due to malaria at hospital level by 75% from the registered
deaths during 2002 by the end of the period
Outcome/coverage
indicators
(Refer to Annex II)
Baseline
Targets
Year:
Year 2:
2003
Year 3:
2004
Year 4:
2005
Year 5: 2006
% of hospitals
implementing the
suggested package (target
75 hospitals)
N/A
60% (45)
100% (75)
100% (75)
100% (75)
% of reduction in malaria
mortality at each hospital
separately
N/A
50%
75%
75%
75%
100%
100%
% severe malaria cases
N/A
50%
75%
treated according to policy
at hospital where the
package was implemented.
* Annual targets may be adjusted in line with baseline survey results
27.1.
Broad activities related to each specific objective and expected output
(Describe the main activities to be undertaken, such as specific interventions, to achieve
the stated objectives) (1 short paragraph per broad activity):
In each hospital (starting with target hospitals with higher mortality during 2001–
2002) the broad activities include:
•
Focal group discussion (FGD) with caregivers with review of hospital set-up aiming
to identify mortality determinants in 75 hospitals (each separately) with suggestion
of solution package
•
Assessment of patient’s knowledge, attitudes, practices and ability to afford
treatment
•
Appropriate training (case management, laboratory)
•
Procurement of supplies and equipments (S&E) for case management including (as
2 packages): diagnostic tools package for each doctor and patient treatment package
•
Formation of mortality committees at hospital level to monitor the progress with
introduction of case auditing
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•
•
•
Supportive supervision from state and national level control program
National seminar to discuss the results of the first round and to launch the second
round
Operational research: (treatment of SCM with artemether or quinine: cost and
outcome, 3-day treatment with quinine (Q) followed by effective antimalarial
compliance, cost and outcome compared with the current regimen – Q for 7 days)
Objective
III:
To reduce deaths due to malaria at hospital level by 75% from the registered
deaths during 2002
Broad activities
FGD with
caregivers at each
hospital separately
guided by a trained
team
KAP to assess factors
Related to the patient
Procurement of
diagnostic
package for doctors
(composed of basic
diagnostic tools)
Procurement of
treatment
package for patients
(drugs,fluids)
Training of at least
30 staff from each
hospital (doctors,
laboratory staff
nurses)
Formation of
hospital mortality
committee for case
auditing
Process/Output
indicators
(indicate one per
activity) (Refer to
Annex II)
Baseline
Targets
Responsible/Implementing
agency or agencies
(Specify
year)
Year 1
2003
Year 2
2004
% of targeted
hospitals in which
FGD was carried
out
0
60%
(45)
100%
(75)
NMCP, SMCP, NGOs
% of targetd
hospitals carried
out KAP study
% of targeted
hospitals provided
doctors with
diagnostic package
0
60%
(45)
100%
(75)
SMCP, Mortality
committee
0
60%
(45)
100%
(75)
NMCP, SMCP, Mortality
committee
% of hospitals with 0
ready-made
treatment package
60%
(45)
100%
(75)
NMCP, SMCP, Mortality
committee
No. of health
personnel trained
20%
(300)
50%
(750)
NMCP, SMCP, Mortality
Committee
60%
(45)
80%
(60)
SMCP
N/A
% of hospitals with N/A
functioning
committee
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Supervision to
hospitals involved
Researches
(minimum 2
research studies)
% of hospitals
visited twice per
year out of total
target
No. of research
studies initiated or
completed
0
80%
(36)
80%
(60)
NMCP, SMCP
N/A
50%
100%
NMCP, SMCP, Academic
institutes
* Annual targets may be adjusted in line with baseline survey results
27. Objectives and expected outcomes (Describe the specific objectives and expected
outcomes that will contribute to realizing the stated goal), (1 paragraph per specific
objective):
Objective IV: To detect and adequately respond to malaria epidemics within 2 weeks of
initiation:
• An epidemic in Sudan is defined as occurrence of cases clearly in excess of the
normal expected number. The normal expected number is the average of at least
3 years, or the average + 2 SD
Establishing a system for proper forecasting and for early detection and initiating
measures for quick containment is critical for sustainable reduction of the number and
severity of epidemics.
•
All epidemic-prone states (16 states) are to be supported to establish an effective and
efficient system to respond to and contain epidemics through proper planning, timely
surveillance and maintaining an adequate stock of drugs.
•
Closer collaboration with National Disaster Committee (Multidisciplinary, higher
committee dealing with disasters in Sudan) is needed for coordination of efforts in
managing epidemics.
Question 27 must be answered for each objective separately. Please copy
Question 27 and 27.1 as many times as there are objectives.
Please note: the outcomes may be linked to broader programmes within which
this component falls. If that is the case, please ensure the outcome/coverage
indicators reflect the overall national programme and not just this component.
Specify in Table IV.27 the baseline data to measure outcome/coverage
indicators.Targets are only required for Year 2 onwards.
Table IV.27
Objective IV:
To detect and adequately respond to malaria epidemics within 2 weeks of
initiation
Outcome/coverage indicators
Baseline Targets
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(Refer to Annex II)
Year:
% of state teams able to use
composite indicator for
forecasting correctly
(according to RBM guidelines:
malaria early warning system)
N/A
50% (13)
100% (26)
100% (26)
100% (26)
Proportion of states meeting
criteria for epidemic
preparedness as stated by the
NMCP
N/A
30% (8)
50% (13)
75% (20)
100% (26)
Proportion of states with buffer N/A
stock
30% (8)
50% (13)
75% (20)
100% (26)
Year 2:2003 Year 3:
2004
Year 4: 2005
Year 5:
2006
* Annual targets may be adjusted in line with baseline survey results
27.2.
Broad activities related to each specific objective and expected output (Describe the main
activities to be undertaken, such as specific interventions, to achieve the stated objectives) (1 short
paragraph per broad activity):
Strengthening of early detection through sentinel site monitoring system:
• Re-assess current sentinel sites, to be at least 5 sites per state
• Ensure weekly monitoring of epidemic indicators during high risk months
• Develop and distribute simple guidelines for forecasting, early detection and
epidemic containment
• Conduct training workshops for state and sentinel site staff on the above
guidelines.
Establishment of epidemic warning thresholds for states and areas at risk of seasonal
malaria epidemics:
• Conduct desk analysis of historic malaria morbidity and mortality data
• Strengthen links with related sectors (metrology, agriculture, etc.) for monitoring
malaria risk factors.
Mapping and forecasting of seasonal malaria epidemics risk areas:
• Expand forecasting project to remaining states (now started in five states
supported by RBM).
Improvement of feedback on malaria situation to states and sentinels sites:
• Develop and implement standard timely feedback system from NMCP to states
and related sectors.
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Finalization of malaria contingency plan for federal and state level:
•
Adapt epidemic response contingency plan at state level.
Improvement of availability of buffer stock at onset of epidemic season (covering at
least two weeks of control intervention):
•
Developing buffer stock management system for S&E.
•
Make available adequate supplies for malaria epidemics.
Please note: Process/output indicators for the broad activities should directly
reflect the specified broad activities of THIS component.
Specify in Table IV.27.1 below the baseline data to measure process/output
indicators. Targets need to be specified for the first two years of the component.
For each broad activity, specify in Table IV.27.1 who the implementing agency or
agencies will be.
Table IV.27.1
Objective
IV:
To detect and adequately respond to malaria epidemics within 2 weeks of
initiation
Broad activities
Process/Output
indicators (indicate
one per activity)
(Refer to Annex II)
Baseline Targets
(Specify
year)
Year 1
2003
Responsible/
Implementing
agency or agencies
Year
2 2004
Training for statelevel rapid
assessment and
response teams
(90)
No. of teams trained
N/A
50% (45)
100%
(90)
NMCP, NGOs,
Academic institutes
Collection and
analysis of historic
malaria morbidity
and mortality data
(1990–2002) at
state and sentinel
sites.
% of sites with
epidemic threshold
N/A
25%
75%
NMCP, SMCP
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Development and
implementation of
standard timely
feedback system
% of states/sectors
recieving feedback
within one week of
filing the report
N/A
100% (30 )
100%
(30)
NMCP, SMCP and
Partners.
Establishment of
buffer stock
management
system in the
existing supply
infrastructure
% of states having
system to maintain
buffer stock
N/A
30% (8)
75%
(20)
NMCP, central
medical Store and
NGOs
Adoption of
epidemic
contingency plan
at state level
% of states adopting
the plan
N/A
50% (13)
75%
(20)
NMCP, SMCP and
Partners
* Annual targets may be adjusted in line with baseline survey results
27. Objectives and expected outcomes (Describe the specific objectives and expected
outcomes that will contribute to realizing the stated goal), (1 paragraph per specific
objective):
Objective V: to increase the number of pregnant mothers protected from malaria by
80% in high transmission areas
This objective will be achieved by distribution of Long Lasting Insecticide Treated Nets
(LITNs) and by introducing IPT with SP. Pregnant mothers in high transmission strata
(around 900 000), especially in irrigated schemes and high transmission areas in the
South, will be encouraged to use LLITNs by providing subsidized or free of charge
LLITNs. Public–private partnership will be encouraged to promote the importation of
bednets, and to create demand for their use by pregnant women and children under 5
years. In areas of high transmission, intermittent preventive treatment (IPT) with SP will
be introduced through antenatal clinics in close collaboration with reproductive health
services.
Expected outcomes: Reduced malaria incidence among pregnant mothers and increased
birth weight of children, which will eventually lead to reduction of infant mortality rate.
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Objective V:
To increase the number of pregnant mothers protected from malaria by
80% in high transmission areas
Outcome/coverage indicators
Baseline
(Refer to Annex II)
Year: 1
Targets
Year 2:
Year 3:
Year 4:
Year 5:
% of pregnant women sleeping
under bed net (LLITNs)
N/A
30%
(300,000)
50%
(450,000)
70%
(630,000)
90%
(810,000)
% of pregnant women who have
taken IPT according to national
guidelines
N/A
30%
(270,000)
50%
(450,000)
70%
(630,000)
90%
(810,000)
* Annual targets may be adjusted in line with baseline survey results
a. Broad activities related to each specific objective and expected output (Describe
the main activities to be undertaken, such as specific interventions, to achieve the
stated objectives) (1 short paragraph per broad activity):
•
Procurement of LLITNs through public–private partnership. In order to sustain the
project, a targeted subsidy system will be developed in which the private sector will
provide the nets and ANC according to a colour-coded card system. A health visitor
will register the pregnant women, enroll them in the program, distribute SP and assess
their ability to afford a net. After the affordability assessment, the mother will be
given a colored card according to whether she can pay for the net in full (red) or in
part (yellow), or whether she should be provided with a net free of charge (green).
• Introduction of IPT with SP through antenatal clinics in collaboration with the
reproductive health directorat
Objective V: To increase the number of pregnant mothers protected from malaria by
80% in high transmission areas
Broad
activities
Process/Output
Baseline
indicators (indicate
one per activity)
(Refer to Annex II)
Procurement
% ofLL ITNs
and
procured out of
distribution of estimated needs
LLITNs
(900,000 nets)
Targets
Responsible/
Implementing
agency or agencies
(Specify
year) ?
Year 1
2003
N/A
30%
50%
SMOH, NMCP
(300,000 (450,000 WHO, UNICEF,
)
)
NGOs. .
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Year 2
2004
Procurement
N/A
of
SP % of tabs. Produced
(2,700,000
out of estimated
tabs)
30%
50%
(900,000 (1,350,0
)
00)
FMoH, WHO,
UNICEF, NGO and
communities
Impact
evaluation of
IPT
50%
FMoH, WHO,
academic institutes
Report published
and disseminated
N/A
75%
* Annual targets may be adjusted in line with baseline survey results
26. Objectives and expected outcomes (Describe the specific objectives and expected
outcomes that will contribute to realizing the stated goal), (1 paragraph per specific
objective):
Objective VI: To increase the number of children <5 sleeping under the LLITNs by
20% every year:
Children <5 years are more susceptible to malaria infection than adults. As children in
Sudan go to sleep early, use of LLITNs may decrease malaria incidence among them.
A public–private partnership will be encouraged to promote the importation of bednets,
and to create demand for their use. Community-based organizations (e.g. women, youths)
will be part of distribution.
Expected outcomes: the use of LLITNs with proper case management will reduce
malaria incidence among children <5 years, in addition to reducing the general mosquito
population.
Objective VI:
To increase the number of children <5 sleeping under LLITNs by 20% every year
Outcome/coverage indicators
Baseline
Targets
(Refer to Annex II)
Year: 1
Year 2:
Year 3:
Year 4:
Year 5:
% of households with children
under 5 having at least one
bednet (LLITNs)
N/A
20%
(1,200.000)
40%
(2,400,000)
60%
(3,600,000)
80%
(4,800,000)
* Annual targets may be adjusted in line with baseline survey results
b.
Broad activities related to each specific objective and expected output (Describe
the main activities to be undertaken, such as specific interventions, to achieve the stated
objectives) (1 short paragraph per broad activity):
•
Procurement of LLITNs through public–private partnership. A revolving system
will be developed to sustain the project.
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•
Promotion and distribution of LLITNs in collaboration with community-based
organizations and NGOs.
Objective VI: To increase the number of children <5 sleeping under ITNs by 20%
every year
Broad
activities
Process/Outpu Baseline
t indicators
(indicate one
per activity)
(Refer to Annex
II)
Targets
(Specify
year) ?
Year 1
2003
Year 2
2004
Responsible/
Implementing
agency or
agencies
Procurement
and
distribution of
LLITNs
% of LLITNs
procured out of
total estimated
N/A
30%
(1,500,000)
50%
(2,400,000)
SMOH, NMCP
WHO,
UNICEF,
NGOs. .
Impact
evaluation of
LLITNs on
malaria
incidence
among <5
Report
published and
disseminated
N/A
50%
75%
FMoH, WHO,
academic
institutes
*Annual targets may be adjusted in line with baseline survey results
27.
Objectives and expected outcomes (Describe the specific objectives and
expected outcomes that will contribute to realizing the stated goal), (1 paragraph per
specific objective):
Objective VII: To conduct cost-effective and evidence-based vector control activities
where appropriate (environmental management, larviciding, indoor residual house
spraying [IRHS])
•
The use of insecticides will be limited in the first years to irrigated schemes
(interim period), and then their use will be reserved for epidemic control.
•
In irrigated schemes and with the financial assistance of the Scheme Board,
targeted IRHS can be applied. However, more effort will be directed for
application to be effective.
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•
In urban areas and in areas where the breeding sites are limited and where the
breeding sites cannot be eliminated by environmental measures, there is a place
for larviciding using temephos. This will be helpful if there is community
involvement.
Expected outcome:
•
Vector density will be reduced, and hence with other measures the disease
incidence will decrease.
•
Reliance on insecticide will be reduced by increasing the coverage with ITNs.
Objective VII:
To conduct cost-effective and evidence-based vector control
activities where appropriate (Larviciding, indoor residual
spraying)
Outcome/coverage indicators
Baseline Targets
(Refer to Annex II)
Year:
Year 2: Year 3:
Year 4:
Year 5:
% of target households sprayed (based
on 2002 target)
% of CBOs involved in malaria control
N/A
80%
60%
40%
25%
N/A
30%
50%
75%
100%
*Annual targets may be adjusted in line with baseline survey results
a.
Broad activities related to each specific objective and expected output (Describe
the main activities to be undertaken, such as specific interventions, to achieve the stated
objectives) (1 short paragraph per broad activity):
•
•
As insecticides are widely used in Sudan, a policy on rational use of insecticide
needs to be developed.
Insecticide to be used for IRHS in irrigated scheme must be procured.
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Objective
VII:
To conduct cost-effective and evidence-based vector control activities where
appropriate (larviciding, indoor residual spraying)
Broad activities
IEC to raise
community
awareness
Sensitization of
irrigated schemes
towards
intermittent
irrigation
Procurement of
insecticide
(deltamethrine,
temephos)
Process/Output
Baseline
Targets
Responsible/Implementin
g agency or agencies
(Specify
year)
Year
1 2003
Year
2 2004
% of CBOs
involved in
environmental
management
N/A
35%
60%
NMCP, SMCP
% of irrigated
schemes adopting
intermittent
irrigation
N/A
40%%
60%
NMCP, SMCP
% of quantities
procured out of
total requested
N/A
60%
100%
NMCP, SMCP
* Annual targets may be adjusted in line with baseline survey results
27.
Objectives and expected outcomes (Describe the specific objectives and
expected outcomes that will contribute to realizing the stated goal), (1 paragraph per
specific objective):
Objective VIII: To upgrade the RBM capacity at national and state level
It is obvious that RBM cannot succeed in Sudan without some investment in the entire
health system. The decentralized health system will be strengthened through efforts to
increase the capacity of state focal points for RBM to facilitate the achievement of the
goals and objectives of RBM in Sudan.
Partnership mechanisms will be strengthened between departments and programmes
within health sector; with and between government sectors; with and between
development agencies; with and between NGOs, the private and informal sectors; and
with the community and traditional health providers.
The malaria training centre Blue Nile Training and Research Institute (BNRTI), will
upgraded and supported by a sub-centre in Juba. Serial training courses will be then
conducted.
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Expected outcome: the RBM capacity at local level will be improved and the training
centre environment will be upgraded.
Objective VIII:
To upgrade the RBM capacity at national and state level
Outcome/coverage indicators
Baseline
Targets
(Refer to Annex II)
Year:
Year 2: Year 3:
Year 4:
Year 5:
Malaria training centres set up or
updated (at Wad Medani and Juba)
N/A
40%
75%
100%
100%
% of states with structure for RBM
partnership
N/A
50%
(13)
100%
(26)
100%
(26)
100%
(26)
Proportion of states performing as
required by the NMCP
N/A
50%
(13)
75%
(20)
100%
(26)
100%
(26)
* Annual targets may be adjusted in line with baseline survey results
c.
Broad activities related to each specific objective and expected output
(Describe the main activities to be undertaken, such as specific interventions, to achieve
the stated objectives) (1 short paragraph per broad activity):
•
•
•
Expansion of the RBM support system in 13 states not yet having such a system
in the southern and western part of the country; review and address of human
resources development, transport and communication issues.
Improvement of training environment in malaria centers
Monitoring and evaluation of progress towards RBM
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Objective VIII:
To upgrade the RBM capacity at national and state level
Broad activities
indicators
Baseline
(indicate one
per activity)
(Refer to Annex
II)
Targets
(Specify
year)
Year
1 2003
Year
2 2004
Responsible/Implementin
g agency or agencies
Develop subcentres for the Blue
Nile Research and
Training Institute
(BNRTI) in Juba
Juba sub-centre
developed as
planned
N/A
50%
100%
NMCP, WHO, UNICEF
Upgrade the BNRTI
to be able to
accommodate more
participants
(library, rest
rooms,
laboratories)
BNRTI meets
required criteria
N/A
50%
100%
NMCP, WHO, UNICEF
Conduct short
courses on malaria
epidemiology,
planning for vector
control and
integrated vector
management (total
of 225)
% of personnel
trained out of
total target
N/A
20%
(45)
60%
(135)
NMA, WHO, UNICEF,
BNRTI
Ensure good
communication
between state and
federal level
% of states with
regular
communication
with the NMCP
N/A
40%
(10)
75%
(20)
FMOH, WHO and
UNICEF
Encourage the use
of Healthmapper at
state level with
provision of
computers and
internet connection
% of states
using
Healthmapper
N/A
40%
(10)
75%
(20)
NMCP, WHO, UNICEF
Identify focal
person for each
states with support
% of states
focal points
supported
N/A
75%
100%
NMCP, WHO, UNICEF
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Monitor progress
Evaluate activities
Supervisory
visits conducted
and Reports
received
N/A
80%
100%
Evaluation
completed and
report
disseminated
0
100%
100%
NMCP, All partners
NMCP, Partners
* Annual targets may be adjusted in line with baseline survey results
28.
Describe how the component adds to or complements activities already
undertaken by the government, external donors, the private sector or other relevant
partner: (e.g., does the component build on or scale-up existing programs; does the
component aim to fill existing gaps in national programs; does the proposal fit within the
National Plan; is there a clear link between the component and broader development
policies and programs such as Poverty Reduction Strategies or Sector-Wide Approaches,
etc.), (Guidelines para. III.41 – 42),(2–3 paragraphs):
•
•
•
As an integral part of the Sudan strategic plan and in line with the Sudan RBM
objectives, the primary aim of this component is to conduct targeted actions to
scale up evidence-based cost-effective interventions to reduce malaria burden in
Sudan (northern and southern parts).
This component is arranged by the National Malaria Control Program (NMCP)
in collaboration with WHO, UNICEF, NGOs and other partners aiming to
accelerate the implementation of the strategic plan to RBM in Sudan.
Resources requested from the GFTAM will fill the existing gaps in national
resources and funding from the international donors.
Governmental component:
This is calculated from the actual total sum released by the government (Ministry of
Finance). The annual budget allocated for malaria is used for the following:
•
Salaries, for health and non-health personnel working in the national and state
malaria control programs
•
Maintenance of vehicle, buildings, furniture
•
Running cost of the program
•
New construction and rehabilitation of the old buildings, e.g. Sennar Training
Center (STC) and Blue Nile Research and Training Institute
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•
Transportation for field work
•
Wages for permanent seasonal laborers (Gambia project).
Partners' component:
This is calculated from the annual and biannual contributions of the current partners.
Partners who have had direct contributions to the program for the previous three years are
WHO and UNICEF.
Estimated resource gap is the result of the difference between the total resource
requirements and the estimated available resources.
29.
Briefly describe how the component addresses the following issues (1
paragraph per item):
29.1.
The involvement of beneficiaries such as people living with HIV/AIDS:
The beneficiaries include the general public with particular emphasis high-risk groups
(pregnant women and children < under 5 years), so activities are closely linked with the
issue of community participation, as below.
29.2 Community participation:
The NMCP and partners are aware of the value of community involvement in malaria
control, as a safeguard for the sustainability of control activities. Strategy, specific
objectives and activities have been set within the national RBM, to increase community
awareness about the socioeconomic impact of malaria and control measures for active
community participation in malaria prevention and control. Main activities include:
raising the awareness of community leaders, conducting health education sessions
targeting special groups (mass media personnel, teachers, etc.), “malaria weeks”.
Activities related to raising community awareness are incorporated within the activities
for strategic directions of RBM in Sudan.
Community-based organizations will play an important role in the advocacy for,
procurement and distribution of ITNs.
The community should also have the right disposition and capacity to adopt desired
practices in a sustainable manner. Caregivers in the community should be able to
recognize cases of malaria in the home and provide correct treatment, including referrals
as indicated.
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29.2.
Gender equality issues (Guidelines paragraph IV.53):
Some strategies and activities in the national strategic plan for RBM in Sudan included in
this component promote balance among men and women in allocation of opportunities
and in access to services. Training opportunities and eligibility for positions are equally
open for both sexes. In addition, there is the home management activity (the majority of
caregivers in Sudan are women) and IPT for pregnant women (which includes training of
midwives and traditional birth attendants).
29.3.
Social equality issues (Guidelines paragraph IV.53):
The interventions cover both northern Sudan and some of the most underserved areas in
southern part of the country. To increase coverage for malaria treatment and prevention,
special attention will be given to the most deprived areas in terms of workforce and
service availability. In such areas, the capacity of non-health workers such as teachers
and informal treatment outlets will be strengthened to provide proper information on
malaria treatment. In areas of civil strife, essential drug kits will be distributed through
partner NGOs.
29.5.
Human resources development:
Planning and conducting training at all levels as necessary are well addressed in this
component. This will help to ensure that health personnel are available in sufficient
quantities at all levels with skills and capacities to facilitate control of malaria. The Blue
Nile Research and Training Institute will be improved, and its capacity increased, and a
new training center in the south (Juba) will be established.
29.6. For components dealing with essential drugs and medicine, describe which
products and treatment protocols will be used and how rational use will be ensured
(i.e. to maximize adherence and monitor resistance), (Guidelines para. IV.55), (1–2
paragraphs):
Summary of malaria treatment policy in Sudan (which is being revised according to
WHO recommendations):
a.
Simple malaria (not complicated)
1st – line treatment: chloroquine
2nd –- line treatment: sulphadoxine pyrimthmine
3rd – line treatment: quinine.
b.
Severe and complicated malaria:
- Quinine infusion
- Artemether injections
Activities to ensure adherence of prescribers (specialists, general practitioners, medical
assistants, assistant pharmacists) to the national protocol and guidelines include
workshops, national training activities, development and distribution of educational
materials, and coordination and collaboration with the Federal Directorate General of
Pharmacy.
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Drug sensitivity monitoring is being carried out through 10 permanent sentinel posts in
different strata to monitor chloroquine and SP efficacy.
SECTION V – Budget information
30. Indicate the summary of the financial resources requested from the Global Fund by year
and budget category, (Refer to Guidelines paragraph V.56 – 58):
Table V.30
Resources
Year 1
Year 2
Year
3 Year
4 Year
5 Total
needed (USD)
(Estimate)
(Estimate)
(Estimate)
74,400
74,400
74,400
74,400
74,400
Human
372,000
Resources
234,000
50,000
45,000
45,000
Infrastructure/ 280,000
654,000
Equipment
406,656
673,197
223,200
191,000
193,200
1,687,253
Training/
Planning
2,375,000
2,220,000 2,265,000
2,170,000
2,215,000
Commodities/
11,245,000
Products
3,016,100
3,216,100 3,050,000
3,000,000
3,000,000
Drugs
15,282,200
294,000
Monitoring
and Evaluation
Administrative 600,000
Costs
0
Other
174,000
174,000
184,000
174,000
1,000,000
600,000
600,000
600,000
600,000
3,000,000
0
0
0
0
0
Total
7,191,697 6,436,600
6,264,400
6,301,600
33,240,453
7,046,156
The budget categories may include the following items:
Human Resources: Consultants, recruitment, salaries of front-line workers, etc.
Infrastructure/Equipment: Building infrastructure, cars, microscopes, etc.
Training/Planning: Training, workshops, meetings, etc.
Commodities/Products: Bednets, condoms, syringes, educational material, etc.
Drugs: ARVs drugs for opportunistic infections, TB drugs, anti-malaria drugs, etc.
Monitoring & Evaluation: Data collection, analysis, reporting, etc.
Administrative: Overhead, program management, audit costs, etc
Other (please specify):
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30.1. For drugs and commodities/products, specify in the table below the unit costs,
volumes and total costs, for the FIRST YEAR ONLY:
Table V.30.1
Item/unit
Unit
cost Volume
Total cost
(USD
(specify
(USD)
measure)
Chloroquine Syrup 50mg/ 5ml
1 / Bottle
1,500,000
1,500,000
Chloroquine Tabs 150mg/Tabs
7/1000
Tablets
15,000 cont.
105,000
Quinine Inj 300/ml (2ml ampls)
10,000 boxes
120,000
30000 boxes
91,000
7813 cont.
200,000
Pimaquine 15 mg Tabs
12/100
Ampouls
31/1000
Tablets
26.5/1000
Tablets
6/1000 Tabs
IV fluids
Bed nets(Permanent)
Educational materials
1/bottle
4/ net
0.5/ copy
1,000,000
500,000 nets
74,000
Quinine Tabs 300 mg Tabs
Sulfadoxine-Pyremethamine Tabs
15 cont.
100
1,000,000
2,000,000
30,000
30.2. In cases where Human Resources (HR) is an important share of the budget, explain
to what extent HR spending will strengthen health systems capacity at the patient/target
population level, and how these salaries will be sustained after the proposal period is over
(1 paragraph):
Human resources budget is about 1.1% out of the total
31. If you are receiving funding from other sources than the Global Fund for activities
related to this component, indicate in the Table below overall funding received over the
past three years as well as expected funding until 2005 in US dollars (Guidelines para. V.62):
Table V.31.1
1999
Domestic
(public in
million )
External
(in million)
Total
(in
million)
2000
1.2
2001
2.2
2002
1.4
2003
1.4
2004
1.4
2005
1.4
1.0
2.312
1.27
0.5
0.5
0.5
2.2
4.512
2.67
1.9
1.9
1.9
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Please note: The sum of yearly totals of Table V.31.1 from each component should
correspond to the yearly total in Table 1.b of the Executive Summary. For example, if
Year 1 in the proposal is 2003, the column in Table 1.b labeled Year 1 should have in
the last row the total of funding from other sources for 2003 for all components of the
proposal.
32. Provide a full and detailed budget as attachment, which should reflect the broad
budget categories mentioned above as well as the component’s activities. It
should include unit costs and volumes, where appropriate
(Attachment VIII)
33. Indicate in the Table below how the requested resources will be allocated to the
implementing partners, in percentage (Refer to Guidelines para. V.63):
Table V.33
Resource
allocation to
implementing
partners* (%)
Government
Year 1
Year 2
Year 3
(Estimate)
Year 4
(Estimate)
Year 5
(Estimate)
Total
(average)
55%
55%
50%
50%
50%
52%
NGOs
/
CommunityBased Org.
Private Sector
12%
12%
18%
18%
18%
16%
10%
10%
10%
10%
10%
10%
People living
with HIV/ TB/
malaria
Academic
/
Educational
Organisations
Faith-based
Organisations
Others
10%
10%
10%
10%
10%
10%
5%
5%
5%
5%
5%
5%
2%
2%
2%
2%
2%
2%
5%
5%
5%
5%
5%
5%
100%
100%
100%
100%
100%
100%
Total
Total in USD
If there is only one partner, please explain why.
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