REPUBLIQUE DE GUINEE

Proposition de la Guinée à la série 10 du Fonds Mondial pour la lutte contre le Sida, la Tuberculose et le Paludisme Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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FORMULAIRE DE PROPOSITION – SERIE 10 CANDIDAT PAYS SEUL RUBRIQUES 1 - 2 Date limite de soumission: 20 Août 2010 à 12:00, heure locale de Genève Nom du candidat

CCM-Guinée : Comité de coordination multisectoriel

Pays

République de Guinée

contre le VIH/sida, la tuberculose et le Paludisme

Niveau de revenu  Se référer à l’Annexe 1 des Directives de la Série 10

Pays à faible revenue

X CCM (Instance de

Type de candidat

coordination nationale)

Si votre pays participe également à une proposition multi-pays pour la Série 10, indiquer sur quelle(s) maladie(s) porte cette proposition multi-pays Monnaie

VIH

Sous-CCM

Non-CCM

Tuberculose

Paludisme

x Dollar américain

Maladie

Titre

Euro La proposition inclutelle des interventions transversales de Renforcement des Systèmes de Santé dans la partie 4B ?  Répondre par oui ou non

S’agit-il d’une proposition maladie consolidée ?  Répondre par oui ou par non

NON

et inclure les rubriques 4B et 5B dans une seule proposition OUI

VIH  Choisir soit « Ordinaire » soit « Réserve pour les populations les plus

X

Ordinaire Réserve pour les

Programme de renforcement et de décentralisation de la riposte nationale contre les IST/VIH

 Il n’est pas possible

d’inclure une demande pour des interventions transversales de renforcement des systèmes de santé dans une

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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population s les plus exposées au risque

exposées au risque »

pour l’accès universel d’ici 5 ans en République de Guinée

proposition soumise dans le cadre de la réserve pour les populations les plus exposées au risque

Tuberculose Mise à échelle des interventions de lutte contre le paludisme dans les zones hyper et holoendémiques de la Guinée

Paludisme

INDEX DES RUBRIQUES DE LA PROPOSITION

REMARQUE IMPORTANTE : Nous recommandons vivement aux candidats de se référer aux informations ci-dessous lorsqu’ils remplissent le Formulaire de proposition et autres documents relatifs à leur candidature. Il est important de lire attentivement chaque section des Directives de la Série 10 en remplissant la proposition et autres documents de candidature, afin de soumettre une candidature complète. Tous les autres documents de la Série 10 sont disponibles sur le site Internet du Fonds mondial.

RUBRIQUES OBLIGATOIRES DU FORMULAIRE DE PROPOSITION : A) Remplir les rubriques 1 - 2 une seule fois par candidat1 Rubrique 1

Résumé du financement et interlocuteurs

Rubrique 2

Résumé du candidat et recevabilité o o

Renseignements sur les membres (du CCM ou sous-CCM) Formulaire de recevabilité (le cas échéant)

B) Remplir les rubriques 3 - 5 une fois pour chaque proposition maladie2 1 2

Le candidat doit soumettre les rubriques 1 - 2 une seule fois, même si sa demande porte sur plusieurs maladies. Le candidat doit soumettre les rubriques 3 - 5 pour chaque proposition maladie.

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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Rubrique 3

Résumé de la proposition

Rubrique 4

Description du programme Cadre de performance ou Cadre de performance consolidé Liste des produits pharmaceutiques et sanitaires (le cas échéant) Plan de travail

Rubrique 5

Demande de financement Budget détaillé

RUBRIQUES OPTIONNELLES DU FORMULAIRE DE PROPOSITION : Si cela est pertinent, remplir les rubriques 4B et 5B une seule fois par candidat et inclure ces rubriques dans une seule proposition maladie Rubrique 4B

Interventions transversales de renforcement des systèmes de santé

Rubrique 5B

Financement des interventions transversales de renforcement des systèmes de santé

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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RUBRIQUE 1 : RESUME DU FINANCEMENT ET INTERLOCUTEURS Clarified Section 1.1

1.1

Résumé du financement Demande de financement – Série 10 Maladie Année 1

Année 2

Année 3

Année 4

Année 5

Total

6 971 834

5 828 587

11 232 744

10 092 193

10 731 424

44 996 783

Paludisme

4.558.458,00

27.488.480,00

5.270.705,00

4.690.886,00

4.617.119,00

46.625.648,00

RSS

4.394.209,99

3.682.885,43

1.942.305,18

1.002.650,43

906.604,09

11.928.655,00

VIH

Interventions transversales de RSS  Insérer le nom de la maladie Rubrique 4B et 5B des interventions de RSS transversales dans le cadre [VIH/Sida]

Financement total demandé pour la Série 10

1.2

103.551.084,00

Interlocuteurs Interlocuteur principal

Interlocuteur secondaire

Nom

Mgr Albert Guillaume David GOMEZ

Dr Fatou BARRY

Fonction

Président CCM Guinée

Point Focal CCM Guinée

Organisation

Diocèse Anglican de Guinée

ROSIGUI, société civile

Adresse postale

BP 1187, Conakry

BP 1187, Conakry

Téléphone

(224) 60 20 46 60

(224) 68 12 76 88, 60 29 01 01

[email protected]

[email protected]

Fax Adresses de courrier électronique

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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

1.3

Liste des abréviations et acronymes utilisés par le candidat

Acronyme/ Abréviation

Signification

AGR

Activités Génératrices de Revenus

ACDI

Agence Canadienne de Développement International

ALF/LFA

Agent Local du Fonds Mondial

ARV

Antirétroviraux

AC AGUIPLUS

Agents communautaires Association Guinéenne des Personnes vivant avec le VIH

AGLAT

Association Guinéenne de Lutte Antituberculeuse

AGBEF

Association Guinéenne pour le Bien Etre Familial

ASFEGMASSI

Association des femmes guinéennes contre les maladies sexuelles et le SIDA

AFRF

Association Française Raoul Follereau

BAD

Banque Africaine de Développement

BM

Banque Mondiale

BP

Bénéficiaire principal

BS

Bénéficiaire Secondaire

BK

Bacille de Koch

CAMEG

Centrale d'Achat des Médicaments Essentiels et Génériques

CAT

Centre antituberculeux

CCC

Communication pour le Changement de Comportement

CCM

Country Coordination Mechanism

CDV

Conseil Dépistage Volontaire

CDVA

Conseil Dépistage Volontaire Anonyme

CD4

Lymphocytes T4

CHU

Centre Hospitalier Universitaire

CHR

Centre Hospitalier Régional

CMC

Centre Médical Communal

CMG

CMG= Chambre des Mines de Guinée

CPN

Consultation Prénatale

CNLS

Comité National de Lutte contre le Sida

CNTS

Centre National de Transfusion Sanguine

CSN

Cadre Stratégique National de Lutte contre le Sida et les IST

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CRLS-IST

Comité Régional de Lutte contre le Sida et les IST

CPLS-IST

Comité Préfectoral de Lutte contre le Sida et les IST

DIU

Diplôme Inter Universitaire

DNSP

Direction Nationale de la Santé Publique

DNHP

Direction Nationale der l’Hygiène Publique

DNEHS

Direction Nationale des Etablissements Hospitaliers et des Soins

DNPL

Direction Nationale des Pharmacies et Laboratoires

DPS

Direction Préfectorale de la Santé

DSF

Division Santé Familiale

DSRP

Document de Stratégie de Réduction de la Pauvreté

EDS

Enquête Démographique et de Santé

IFAD

Fonds international de Développement Agricole

FENOSIGUI

Fédération Nationale des ONG de lutte contre le Sida en Guinée

FM

Fonds Mondial

FMG

Fraternité Médicale de Guinée

FS

Formation Sanitaire

GFATM

Global Funds Against Aids, Tuberculosis and Malaria

GAS

Gestion Achat & Stock

GTZ

Coopération Technique Allemande

GAVI

Global Alliance for Vaccine and Immunization

HSH

Homme ayant des rapports sexuels avec de Hommes

IEC/CCC

Information Education Communication / Communication pour le Changement de Comportement

IO

Infections opportunistes

IST

Infections Sexuellement transmissibles

KFW

Kreditanstalt für Wiederaufbau – Banque de développement allemande

MAP

Multisectoriel Aids Projet

MJS

MJS= Ministère de la Jeunesse et des Sports

MSP

Ministère de la Santé Publique

MSF

Médecin Sans Frontière

MPA

Mission Philafricaine

MCM

Médecins chargé de la lutte contre la Maladie

OMD

Objectif du milliaire pour le Développement

OHFOM

Œuvres Hospitalières Françaises de l’Ordre de Malte

OMS

Organisation Mondiale de la Santé

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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ONG

Organisation Non Gouvernementale

OSC

Organisation de la Société Civile

ONG

Organisation Non gouvernementale

ONUSIDA

Programme commun des Nations Unies sur le VIH/Sida

OBC

Organisation à Base Communautaire

OEV

Orphelins et Enfants Vulnérables

OMS

Organisation Mondiale de la Santé

OIM

Organisation Mondiale pour l’Immigration

PAM

Programme Alimentaire Mondial

PCG

Pharmacie centrale de Guinée

PCIMAA

Prise En Charge Intégrée des Maladies de l'Adulte et de l'Adolescent

PCR

Polymérases Chain Réactions

PEC

Prise En Charge

PECG

Prise En Charge globale

PEV

Programme Elargi de Vaccination

PFR-DSVCO

Planification-formation-Recherche-Direction Santé Ville de Conakry

PMS

Projet Multi Sectoriel de lutte contre le Sida

PNDS

Plan Nation de Développement Sanitaire

PNLP

Programme National de lutte contre le Paludisme

PNPCSP

Programme National de Prise en Charge Sanitaire et de Prévention des IST/VIH/Sida

PNLAT

Programme National de Lutte contre Anti-Tuberculose

PNPCSP

PNPCSP= Programme national de prise en charge sanitaire et de prévention

PNUD

Programme des Nation Unies pour le Développement

PS

Professionnels du Sexe

PSI

Population Services International

PTME

Prévention de la Transmission Mère-Enfant

PVVIH

Personnes Vivant avec le VIH

REGAP+

Réseau Guinéen des Associations des Personnes vivant avec le VIH/Sida

ROSIGUI

Réseau des ONG de lutte contre le Sida en Guinée

RGPH

Recensement Général de la Population et de l’Habitat

RSS

Renforcement du Système de Santé

SA

Service Adapté

SB

Sous Bénéficiaire

SC

Société Civile

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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SE

Suivi et Evaluation

SIDA

Syndrome de l’Immunodéficience Acquis

SP/CCM

Secrétariat Permanent du CCM

SE/CNLS

Secrétariat Exécutif du CNLS

SR

Santé de la Reproduction

SSB

Sous Sous Bénéficiaire

TARV

Traitement Antirétroviral

TB

Tuberculose

TDR

Termes De Référence

TRP

Technical Review Panel

UNFPA

United Nation Funds for Population

UNGASS

United Nations General Assembly Special Session

UNICEF

United Nations Children Funds

VIH

Virus de l'Immunodéficience Humaine

VIH/TB

Co infection VIH/TB

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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RUBRIQUE 2 : RESUME ET RECEVABILITE DU CANDIDAT

Candidats CCM

Candidats sous-CCM

Candidats Non-CCM

 Remplir les rubriques 2.1 et 2.2  Supprimer les rubriques 2.3 et 2.4

 Remplir les rubriques 2.1, 2.2 et 2.3  Supprimer la rubrique 2.4

 Remplir la rubrique 2.4  Supprimer les rubriques 2.1, 2.2 et 2.3

2.1

Membres et mode de fonctionnement

2.1.1 Résumé de la composition  Cocher la case appropriée Secteur représenté

Nombre de membres

x

Secteur universitaire / éducatif

x

Gouvernement

x

Organisations non gouvernementales (ONG) /organisations communautaires

6

x

Personnes vivant avec les maladies

1

x

Personnes représentant les populations clés3

1

x

Secteur privé

2

x

Organisations confessionnelles

2

x

Partenaires de développement nationaux, bilatéraux et multilatéraux

5

1 14

Autres (précisez) :

- Syndicat

2

- Ordres Professionnels de santé

2

- Fondation

1 Nombre total de membres :

 Ce nombre doit être égal à celui indiqué dans le formulaire « Renseignements sur

les membres»

37

2.1.2 Composition large et inclusive Depuis votre dernière demande recevable effectuée auprès du Fonds Mondial : (a) Y a-t-il eu des changements dans la composition depuis la dernière fois que le CCM (ou sous-CCM) a été déclaré recevable ? 3

Non

 Passer à la rubrique

X

Oui

 Passer à la rubrique

Voir définition de « populations clés » dans les Directives de la Série 10.

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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2.1.2 (c)

2.1.2 (b)

(b) Si vous avez sélectionné « Oui » à la question (a), veuillez décrire dans l’espace ci-dessous la façon dont les nouveaux membres ont été sélectionnés UNE PAGE MAXIMUM Il n y a pas eu des changements majeurs dans la composition depuis la dernière fois que le CCM Guinée a été déclaré recevable. Le CCM a reçu des correspondances, de la représentation du Système des Nations Unies, des Organisations internationales, du ministère de la défense, de la Fondation Mama Henriette CONTE désignant de nouveaux titulaires.

(c)

Y a-t-il une représentation continue et active de personnes vivant avec et/ou touchées par les maladies ?

(d) Y a-t-il autant d’hommes que de femmes parmi les membres actifs et/ou une amélioration de l’équilibre hommes/femmes parmi les membres ?

Non

Non

x

Oui

x

Oui

14 femmes et 22 hommes

2.1.3 Connaissances et expériences des membres en matière de questions transversales (a) Renforcement des systèmes de santé : Décrire la capacité et l’expérience de le CCM (ou sous-CCM) en matière de renforcement des systèmes de santé UNE DEMIE PAGE MAXIMUM Le CCM Guinée compte parmi ses membres du secteur gouvernemental, de la société civile et des ONG une forte expertise en système de santé et jouit de leur pleine participation. Il s’agit notamment des représentants du Ministère de la Santé et de l’hygiène publique, de la Faculté de Médecine et de Pharmacie de l’Université de Conakry, des représentants des Ordres Professionnels de Santé, des Représentants de l’OMS, de l’UNICEF, de l’UNFPA, de l’ONUSIDA, les représentants de certaines institutions bilatérales telles que la GTZ, des Organisations internationales telles que SOLTHIS, Fondation DAMIEN, PSI Guinée, le Centre DREAM et les représentants du secteur privé. Plusieurs d'entre eux gèrent des programmes dans le secteur de la santé connaissant ainsi les enjeux des systèmes de santé des pays en developpement. Ils reconnaissent aussi pleinement l'importance d’allocation des ressources adéquates visant l’amélioration de l’état de santé des populations démunies. Ensemble, les intervenants en partenariat ont contribué à la rédaction de la proposition de la dixième série en faisant une analyse situationnelle du système de santé en fonction des trois maladies prioritaires, à savoir le VIH/ sida, la Tuberculose et le Paludisme. Ils ont également fait de bonnes suggestions pour l'intégration des interventions transversales de RSS à la proposition. En dehors de ces membres cités ci haut, le CCM Guinée a mis en place des groupes de travail incluant de nombreuses expertises nationales et partenaires en système de santé. Tout ceci a permis à le CCM de disposer d’une capacité suffisante pour évaluer et programmer les besoins en renforcement du système de santé dans la présente proposition.

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(b) Genre : Décrire la capacité et l’expérience du CCM (ou sous-CCM) en ce qui concerne les questions de genre et les questions liées à l’orientation sexuelle et aux identités sexuelles. 

Compétences et connaissances des méthodologies d'évaluation des différences liées au genre en matière d’impact des maladies et de leurs conséquences (y compris les différences hommes/femmes et garçons/filles), ainsi que des moyens requis pour accéder à et utiliser les programmes de prévention, de traitement, de soins et de soutien ; et  Connaissance globale des facteurs qui rendent vulnérables les femmes et les jeunes filles, ainsi que les minorités sexuelles, telle que les normes, les comportements, les attitudes et les pratiques néfastes qui sous-tendent les différences dans la propagation du VIH (par exemple : violence liée au genre, discrimination et stigmatisation, mutilation génitale féminine, mariage précoce, masculinité, etc.) UNE DEMIE PAGE MAXIMUM

Le CCM Guinée compte dans sa composition les Représentants de certains membres de la société civile, tel que ROSIGUI, WAFRICA, ASFEGMASSI, FENOSIGUI, les confessions religieuses, les Femmes OULEMAS de Guinée et le Réseau Guinéen des Associations des Personnes vivant avec le VIH/Sida -REGAP+ ( le leadership de ces Associations est assuré par des femmes), du Ministère de la solidarité, de la condition féminine et de l’enfance, l’UNFPA, l’UNICEF, le PNUD, SOLTHIS, l'OMS, Population Services International (PSI). Ces intervenants travaillant sur des thématiques du genre et les questions liées à l’orientation sexuelle et aux identités sexuelles, apportent à le CCM Guinée des compétences et expériences en matière d’adaptation des programmes et services de santé aux besoins des femmes et des adolescents, à l’'égalité des sexes, aux minorités sexuelles liées à l'accès au savoir et aux compétences à la vulnérabilité aux risques d'infection des trois maladies (VIH/sida, Paludisme et Tuberculose). En outre, le CCM Guinée fait appel à l’expertise du Conseil Guinéen des Femmes (COGUIFEM) chaque fois que nécessaire. Cette structure a été mise en place pour identifier, formuler et appliquer la politique d’intégration de la femme, de la jeune fille et de l’enfant au sein des instances de décision pour le développement national. Il faut noter en outre la participation du CCM à la mise en place d’un certain nombre d’acquis pour l’amélioration de la prise en charge globale de lutte contre les IST/VIH/sida, de la lutte contre le PALUDISME et la TUBERRCULOSE en prenant en compte l’égalité des sexe et des groupes sociaux à travers les propositions des ROUND 2, 5 et 6 acceptées par le Fonds mondial. Enfin, le CCM Guinée compte en son sein 15 femmes et 22 hommes, reflet de sa volonté d’assurer l’équité des hommes et des femmes en son sein.

(c) Combien de membres du CCM (ou sous-CCM) disposent de compétences importantes dans l’un ou dans les deux domaines décrits dans la rubrique 2.1.3 (b) ?

 Insérer le nombre

11/37

(d) Planification multisectorielle : Décrire la capacité et l’expérience du CCM (ou sous-CCM) dans l'élaboration de programmes multisectoriels. UNE DEMIE PAGE MAXIMUM Le Guinée s’est engagé depuis 2001 dans le processus participatif de lutte multisectorielle contre le VIH/sida intégrant tous les secteurs de développement. Cette lutte multisectorielle est concrétisée par la mise en place du Comité National de Lutte contre le sida (CNLS) qui est multisectoriel et dont la fonctionnalité a été concrétisée par le processus de planification stratégique multisectorielle. Le Secrétaire exécutif de cette Instance de coordination nationale multisectorielle est membre du CCM. Le CCM Guinée dispose en son sein des membres provenant aussi bien des secteurs gouvernementaux que non gouvernementaux. Les différents membres représentent tous, les secteurs de développement : santé, éducation, jeunesse, production agricole et industrielle, finances, affaires sociales, défense nationale. etc. Les partenaires du CCM ont participé à différents exercices de planification multisectorielle notamment l’élaboration des Cadres stratégiques de lutte contre les IST/VIH/sida 2003-2007 et 2008-2010, le Plan Stratégique de lutte contre le Paludisme (RBM), l'élaboration des documents stratégiques de lutte contre la pauvreté (DSRPI et

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DSRPII, 2004-2007 et la coordination de nombreuses propositions présentées au Fonds mondial. Ces documents cardinaux sont la résultante de la participation de tous les acteurs membres du CCM des secteurs publics, privés, civils, mais aussi les représentants du CCM des agences onusiennes et des structures de la coopération bilatérale. Ces membres apportent leur expertise de planification et de programmation multisectorielle au sein du CCM.

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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2.2

Recevabilité

2.2.1 Historique de la candidature Demande de financement récente effectuée dans le cadre de la Série 8, de la Série 9, ou des Processus de reconduction des subventions 5 - 8, et déclarée recevable.

 Remplir les rubriques 2.2.2 à 2.2.8

 Compléter le formulaire de recevabilité

Dernière demande effectuée avant la Série 8 ou avant le Processus de reconduction des subventions 5.

 Remplir les rubriques 2.2.5 à 2.2.8  Ne pas remplir les rubriques 2.2.2 à 2.2.4

 Compléter le formulaire de recevabilité

Dernière demande déclarée non recevable.

 Remplir les rubriques 2.2.5 à 2.2.8  Ne pas remplir les rubriques 2.2.2 à 2.2.4

2.2.2 Processus d’élaboration de la proposition

(a) Décrire le processus suivi pour solliciter les contributions - en vue d’une intégration éventuelle à la proposition - d'un large éventail d’acteurs, de la société civile comme du secteur privé, sur les plans national, infranational et communautaire, ainsi que des principales populations affectées, si cela est pertinent.  Expliquer le processus pour chaque proposition maladie incluse dans la candidature

UNE PAGE MAXIMUM Basé sur les recommandations du TRP du Round9, le CCM Guinée a mis en place un processus national et transparent pour solliciter les candidatures afin d’élaborer la proposition R10 à soumettre au Fonds mondial. Ce processus a permis à un large éventail d’acteurs (ONG/associations, secteurs public, privé et confessionnel) de participer à l’élaboration de cette proposition depuis sa phase de conception à sa phase de rédaction. Plusieurs étapes attestent de la démarche participative adoptée par le CCM conformément à la feuille de route élaborée: -

4 février 2010: Le CCM Guinée a tenue l’Assemblée Générale de lancement des travaux préparatoires du Round10 au NOVOTEL Conakry de au cours de laquelle les Comités de Pilotage, commissions techniques de rédaction mises en place incluant les représentants des organisations de la société civile, secteur privé et des organisations internationales (composantes VIH/sida, Paludisme et RSS) ont été instruit d’analyser les carences programmatiques et financières par maladie, en référence aux critiques et recommandations du TRP de la soumission du round 9 Guinée et de proposer les buts, objectifs, domaines de prestation de services et actions de la présente soumission au Fonds mondial. En marge de cette réunion, une feuille de route du processus d’élaboration de la proposition a été adoptée pour chaque commission tenant compte des dates d’harmonisation. (Voir PV Assemblée générale du 4 février 2010 Annexe n° 02).

-

Le 23 février 2010 : Lettre de Manifestation d’intérêt du Président du CCM Guinée pour le Round10, au Directeur Exécutif du Fonds Mondial à Genève, Suisse. (Voir Lettre en Annexe 02b).

-

Les 24 et 25 mai 2010, à TAADY CLUB, organisation par le CCM Guinée de l’atelier de consensus sur les priorités de la soumission Guinée (VIH/sida, Paludisme et RSS) au Round10. (Voir PV atelier de consensus Annexe n°03).

-

Du 08 au 18 juin 2010, Tenu à Fria des premiers ateliers de rédaction du Draft1 de la proposition du VIH/sida. et du au 16 au 23 juin 2010, du 14 au 21 juillet 2010 et du 08 au 13 août 2010, toujours à Fria rédaction du Draft1 de la composante Paludisme. (Voir Rapports d’ateliers Annexes n°07et 08).

-

Du 21 au 24 juin 2010, tenu à Maferinyah de l’atelier de rédaction de la proposition RSS (Voir

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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Rapport atelier Annexe n°09).

-

Du 29 juin au 2 juillet 2010, participation de 10 membres des équipes techniques de rédaction VIH/sida et RSS à l’atelier de la revue des propositions par les pairs à Ouagadougou (Voir Rapport d’atelier Annexe n°10).

-

Du 29 juins au 1er juillet 2010, l’équipe technique Paludisme composée de 5 membres s’est rendue à Dakar pour prendre part aux travaux de l’atelier de revue des propositions par les pairs. (Voir Rapport d’atelier Annexe n°11).

-

Le 22 juillet 2010, organisation par le CCM guinée d’une Assemblée générale au NOVOTEL pour évaluer l’état d’avancement de la rédaction des volets VIH/sida, Paludisme et RSS au regard des recommandations de l’atelier de consensus des 24 et 25 mai 2010 et sélectionner les PR (Voir Rapport AG Annexe n°04)

-

Le 23 juillet et le 26 juillet 2010, le CCM guinée a organisé un atelier d’harmonisation entre les 3 Composantes (VIH/sida, Paludisme et RSS) à TAADY CLUB afin d’éviter les duplications des activités et harmoniser certains coûts unitaires. (Voir Rapport d’atelier Annexe n° 12).

-

Le 16 août 2010, les Draft finalisés des composantes VIH/sida, Paludisme et RSS ont été présentés à la CCM Guinée, lors de son Assemblée générale pour validation. (Voir PV de l’assemblée générale, Annexe N°05).

(b) Décrire le processus suivi pour examiner de façon transparente les contributions reçues en vue d’une intégration éventuelle à cette proposition.  Expliquer le processus pour chaque proposition maladie incluse dans la candidature

UNE PAGE MAXIMUM Tous les partenaires du CCM Guinée de la riposte contre le VIH/sida, le Paludisme et la Tuberculose, ont été invités à participer à toutes les étapes d’élaboration de la proposition du 10è round du Fonds mondial tenant compte des critiques et recommandations du TRP de la neuvième soumission de la Guinée. Basés sur des termes de références et feuilles de routes respectifs, des rencontres ont eu lieu dans différents ateliers organisés par les commissions VIH/sida, Paludisme, RSS et le CCM aux différents endroits et à différents moments, depuis le mois de février 2010, mois de lancement de la soumission, jusqu’au mois d’août 2010. La révision des domaines prioritaires contenus dans le R9 et l’Affectation des domaines prioritaires retenus par groupes de travail pour la redéfinition des actions spécifiques à inclure dans la proposition nationale ont été faite conformément aux directives de la soumission du Round10. Au sein des groupes de travail, les domaines prioritaires et les actions spécifiques ont été analysés et sélectionnés de façon transparente et participative. Les différents acteurs aussi bien du secteur public, privé que communautaire ont été invités à la sélection de ces domaines et actions avec des critères bien définis et retenus de façon consensuelle et acceptés par tous. Sur cette base, les domaines et actions ont été analysés et ceux ayant répondu aux critères de sélection, notamment leur pertinence par rapport à l’analyse de gap programmatique, leur conformité par rapport aux buts et axes stratégiques ainsi que leur cohérence et les stratégies de mise en œuvre ont été prises en compte. Pour la composante VIH/Sida Le groupe technique de travail VIH/sida, piloté par la commission VIH/sida est composé des cadres du ministère de la santé et de l’hygiène publique, du Secrétariat Exécutif du CNLS, des représentants des différents départements ministériels, des réseaux nationaux et fédérations (REGAP+, ROSIGUI, FENOSIGUI, AGEBEF,..) des organisations Internationales (PSI Guinée, SOLTHIS, GTZ, le Centre DREAM…), les agences des Nations Unies, ONUSIDA, UNICEF, UNFPA, PAM, PNUD, OMS.., et du secteur privé, la chambre des mines de guinée. Pour la Composante Paludisme Le groupe technique de travail Paludisme est composé des cadres du ministère de la santé et de l’hygiène publique, de 6 ONG nationales et du consortium de 5 ONG internationales (Catholic Relief Services, Plan Guinée, Population Services International, Christian Children Fund, Helen Keller International) et une Société minière (BHP Billiton). Plusieurs concertations avec le Programme National de lutte contre le Paludisme (PNLP) ont été organisées afin d’évaluer les besoins non satisfaits durant les rounds précédents et de prendre en compte les besoins spécifiques du programme et également dégager les priorités nationales en matière de lutte contre le paludisme durant les 5 années à venir.

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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Pour la Composante RSS Les partenaires qui ont contribué à l’élaboration de cette composante RSS sont les représentants du Ministère de la Santé et de l’hygiène publique, de la Faculté de Médecine et de Pharmacie de l’Université de Conakry, des représentants des Ordres Professionnels de Santé, des Représentants de l’OMS, de l’UNICEF, de l’UNFPA, de l’ONUSIDA, les représentants de certaines institutions bilatérales telles que la GTZ, des Organisations internationales telles que SOLTHIS, Fondation DAMIEN, PSI Guinée, le Centre DREAM et les représentants du secteur privé. La plupart d’entre eux ont participé à l’un ou l’autre atelier. Mais avec tous, les contacts et échanges ont été permanents durant la période de l’élaboration de la composante pour ce round10.

(c) Décrire le processus suivi pour assurer l'implication d’acteurs autres que les membres du CCM (ou sous-CCM) dans le processus d'élaboration de la proposition.  Expliquer le processus pour chaque proposition maladie incluse dans la candidature

UNE PAGE MAXIMUM Le CCM Guinée dispose en son sein des commissions qui s’occupent de l’élaboration des propositions en rapport avec les différents programmes de lutte contre la maladie et qui sont appuyés par des personnes ressources ainsi que des consultants tant nationaux qu’internationaux. La proposition du Round10 pour la Guinée a été élaborée par un comité multisectoriel composé d’acteurs choisis pour leur compétence et pour leur contribution à la lutte contre la maladie (VIH/sida, le PALUDISME et la TUBERCULOSE…) et le Système de Santé. Plusieurs dispositions témoignent de cette implication : -

De la composition de ces groupes techniques de rédaction : la plupart des membres des groupes de rédaction ne sont pas membres du CCM. Sur 36 membres titulaires des groupes de rédaction, seuls 07 sont membres du CCM.

-

Le recours du comité de rédaction à des personnes ressources non membres du CCM pour complément d’informations telles que les représentants du Bureau de stratégie et de développement (BSD) du MSHP, du PNPCSP, du PNLAT, du PNLP, ACTION DAMIEN, le PLAN GUINEE, le CRS, Helen Keller International, RENALP, SIDALERTE Guinée, FENOSIGUI, l’Institut de Statistiques du Ministère du Plan, MSF Belgique, Mission Phil africaine, et autres structures publiques et privées (chambre des mines etc.).

-

La prise en compte des préoccupations des acteurs communautaires par leurs représentants au sein du comité de rédaction lors des séances de travail et d’échanges.

Enfin, la prise en compte des propositions de projets des différents acteurs engagés dans la lutte contre le VIH/sida, la Tuberculose et le Paludisme.

(d) Joindre le compte-rendu daté et signé de la réunion (ou des réunions) au cours de laquelle le CCM (ou sous-CCM) a décidé des éléments à inclure dans chaque proposition maladie.

 Insérer le numéro de l’Annexe

AG du 4 février 2010, Annexe N°02

2.2.3 Processus de supervision de la mise en œuvre des programmes (a)

Décrire le processus suivi pour assurer l'implication d’acteurs autres que les membres du CCM (ou sous-CCM) pendant la supervision continue de la mise en œuvre des programmes

UNE PAGE MAXIMUM Le CCM Guinée a mis en place, pour son compte, une Commission de supervision transversale pour VIH/sida, RSS Paludisme et Tuberculose en appui aux différentes Composantes. Cette Commission de supervision a pour mission d’élaborer la feuille de route et de suivre l’exécution programmatique et financière des projets financés par le Fonds mondial. La Commission, lors des réunions trimestrielles du CCM, fait le compte rendu des revues périodiques sur les éléments suivants : le niveau de réalisation des activités ; le niveau de réalisation des indicateurs de performance le niveau de décaissement ; le niveau de réalisation du plan de suivi évaluation interne du Bénéficiaire Principal ; les informations sur les approvisionnements des propositions, particulièrement les intrants de première

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

16

ligne ; La restitution des résultats de ce suivi a pour but d’orienter les prises de décisions du CCM. Deux visites de terrain par an pour lui permettre de constater lui-même les réalisations sont programmées. Aussi, le CCM organise chaque année une revue de son plan d’action et des résultats obtenus dans la mise en œuvre des Propositions. Plusieurs types de participations des partenaires externes aux questions prioritaires du CCM s’opèrent à l’intérieur de leurs structures respectives. Beaucoup des dossiers pertinents du CCM sont aussi portés à l'ordre du jour lors des réunions statutaires des représentants gouvernementaux, de la société civile, du système des Nations Unies à travers le groupe thématique ONUSIDA Elargie se réunissant avec d'autres acteurs de leurs structures. De plus, les commissions techniques, les équipes techniques de rédaction des composantes de lutte contre la maladie et des cabinets professionnels, chargés par le CCM de la majorité des dossiers importants sont composés non seulement de membres du CCM, mais aussi de représentants de nombreuses autres organisations. Afin de mieux assumer ses missions y compris celle citée ci dessus, le CCM Guinée s’est engagé dans un processus de réforme depuis juillet 2007 avec l’appui technique de l’USAID grâce au financement du Gouvernement Américain. Cette réforme s’est traduite par (i) un renforcement institutionnel marqué par un nouveau Arrêté constitutif du CCM ; l’élaboration d’un manuel de procédures intégrant la gestion des conflits d’intérêt, la définition claire des rôles et responsabilités des parties prenantes, le renforcement des capacités des membres, (ii) une plus forte représentation des secteurs nationaux non gouvernementaux, (iii) l’adoption d’un plan de travail annuel.

(b)

Décrire le processus suivi par la CCM (ou sous-CCM) pour superviser la mise en œuvre des programmes.

UNE PAGE MAXIMUM Afin d’impliquer des acteurs autres que les membres du CCM au suivi régulier des projets financés par le Fonds mondial, la composition de la Commission de supervision a été élargie à des personnes ressources issues des institutions non membres du CCM. Chaque réunion du CCM permettra de discuter et de faire le compte-rendu de l'évolution de la mise en œuvre des composantes de subvention depuis la dernière réunion. Cette commission élargie assure la supervision, le suivi de la mise en œuvre du programme, étudie les rapports d'activité semestriels des bénéficiaires principaux et leurs fourni une rétro information. Il est également prévu des visites conjointes de terrain qui associent les membres du CCM et d’autres acteurs de mise en œuvre et de partenaires au développement. Pendant toute la mise en œuvre des programmes, tous les partenaires membres ou non membres du CCM en fonction de leur zone d’intervention seront invités à prendre part aux activités de supervisions qui seront organisées à cet effet. Il en est de même de la participation de tous ces membres aux réunions portant l’évaluation et la prise des décisions correctrices en vue de l’amélioration de la mise en œuvre des activités.

2.2.4 Processus de sélection du ou des Récipiendaire(s) principal (aux) (a)

Décrire le processus suivi pour sélectionner de façon transparente et documentée chaque Récipiendaire principal désigné dans cette proposition.

 Expliquer le processus pour chaque Récipiendaire Principal pour chaque maladie

UNE PAGE MAXIMUM Le CCM Guinée a opté pour le financement de la série 10, du Fond mondial de lutte contre le VIH, le Paludisme et la Tuberculose, la soumission à deux voix pour les composantes VIH/sida et Paludisme et à une voix pour la composante RSS. Concernant les sous bénéficiaires, des lots indépendants d’activités ont été identifiés pour les trois composantes de la soumission.

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

17

le CCM Guinée a lancé, par voix de presse (Journaux à grand tirage : LYNX N°948 du 14 juin 2010, Indépendant et Horoya) et la Radio Diffusion Télévision nationale, un appel à candidature pour la sélection des Récipiendaires principaux (coordination) et des sous bénéficiaires (mise en œuvre les activités) de la proposition. Cet appel à candidature a été lancé le 11 juin 2010, (pour le 28 juin 2010, date limite de dépôt de dossiers) pour les PR Gouvernementaux et secteur privé, société civile. Le 9 juillet 2010 (pour le 26 juillet 2010, date limite de dépôt de dossiers) a été la date concernant les Sous bénéficiaires. Le CCM Guinée a mandaté deux commissions multidisciplinaires indépendantes, composées de représentants des institutions nationales, internationales et de la société civile, choisis en fonction de leur connaissance des enjeux et de leur expertise, de procéder à la présélection des Bénéficiaires Principaux et des Sous bénéficiaires sous la responsabilité du Bureau Exécutif et de lui présenter des recommandations. Ces commissions ont évalué, conformément aux termes de référence pour la présélection, le mérite technique des candidatures, en fonction d’une grille élaborée lors de l’atelier de consensus. La commission de présélection des Bénéficiaires Principaux (PR) a travaillé le 20 juillet 2010, à la sélection des dossiers. Dans un premier temps, elle a statué sur le choix des PR. Six (6) dossiers ont été déposés, dont 3 pour la composante VIH/sida, 2 pour la composante Paludisme, et 1 pour la composante transversale RSS. Chaque membre du comité a accordé une note à chacune des manifestations au moyen d'une formule de pointage normalisée. La commission a compilé, analysé et commenté les résultats. Après ce dépouillement des dossiers, les PR ont été présélectionnés et la commission a émis un rapport au CCM Guinée qui a été soumis à l'approbation de l'ensemble des membres lors de l’Assemblée générale organisée au Novotel le 22 juillet 2010, pour la sélection des PR (annexes N°04 et 13). Durant la plénière, les membres ont choisi, à travers un vote à main levée, les deux candidats ayant obtenu les plus hautes notes pour les composantes VIH/sida et Paludisme et le candidat pour le RSS. La commission de présélection des Sous bénéficiaires a travaillé le 04 août 2010 et le 13 août 2010 sélection des dossiers

à la

Quant à l’approbation de la sélection de ces sous bénéficiaires, elle à eu lieu lors de l’Assemblée générale du 16 août 2010(annexes N°05, 14a et 14b).

(b)

 Insérer le numéro

Joindre une version datée et signée du compte-rendu de la ou des réunion(s) pendant laquelle/lesquelles le CCM (ou sous-CCM) a désigné le Récipiendaire principal (ou les Récipiendaires principaux) pour chaque maladie.

de l’Annexe

PV AG du 22 juillet 2010 Annexes N°04

2.2.5 Absence de mise en œuvre d'un financement à deux voies Le financement à deux voies implique qu’au moins un Récipiendaire principal du secteur gouvernemental et un Récipiendaire principal du secteur non-gouvernemental soient désignés pour chaque maladie dans la proposition. Le cas échéant, fournir ci-dessous une explication pour justifier l’absence de mise en œuvre d’un financement à deux voies dans une ou plusieurs des propositions maladies de la candidature UNE DEMIE PAGE MAXIMUM

2.2.6 Gestion des conflits d’intérêts (a)

Le Président et/ou le Vice-président du CCM (ou sous-CCM) appartiennent-ils à la même entité que l'un des Récipiendaires principaux désignés dans cette proposition - quelle que soit la maladie ?

Oui

 Passer au point (b) puis à la rubrique 2.2.8

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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X

Non

 Passer à la rubrique 2.2.8

(b)

Si oui, joindre le plan de gestion des conflits d'intérêt réels et potentiels.

 Insérer le numéro de l’Annexe

x Cocher cette case 2.2.7 Approbation de la proposition par les membres Le formulaire « Renseignements sur les membres » a été signé par tous les membres du CCM (ou sous-CCM)

pour confirmer que le formulaire « Renseignements sur les membres», contenant les signatures de ceux-ci, a été annexée à la candidature

LISTE DE CONTROLE DE LA PROPOSITION : RUBRIQUES 1 ET 2

Rubrique 2 : Recevabilité

Indiquer le nom et le numéro de l’Annexe

Candidats CCM et sous-CCM uniquement

2.2.2(a)

Processus suivi pour solliciter les contributions en vue de leur intégration éventuelle dans chaque proposition maladie

PV de l’AG du 4 février 2010, décidant la soumission de la CCM à la proposition R10 pour les volets VIH/sida, Paludisme

et RSS ANNEXE 02 2.2.2(b)

Processus suivi pour examiner les contributions reçues, en vue de leur intégration éventuelle dans chaque proposition maladie

Rapport Atelier consensus

ANNEXE 03

2.2.2(c)

Processus suivi pour assurer l’implication d'un large éventail d’acteurs dans le processus d’élaboration de la proposition

Rapport Atelier consensus

2.2.3(a)

Processus de supervision de la mise en œuvre des subventions par le CCM (ou sous-CCM)

Règlement Intérieur CCM

2.2.3(b)

Processus suivi pour assurer la contribution d'un large éventail d'acteurs dans le processus de supervision de la subvention

2.2.4(a)

Processus suivi pour sélectionner et désigner le (ou les) Récipiendaire(s) principal (aux) pour chaque proposition maladie

2.2.7

Politique sur les conflits d’intérêt

2.2.8

Compte-rendu de la réunion au cours de laquelle la proposition a été finalisée et approuvée par le CCM (ou sous-CCM)

ANNEXE 03

ANNEXE 01 Règlement Intérieur CCM

ANNEXE 01 PV AG du 22 juillet 2010

ANNEXE 04 Règlement Intérieur CCM

ANNEXE 01 Procès Verbal Assemblée Générale du 16 août 2010 ANNEXE 05

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2.2.8

Approbation de la proposition par tous les membres du CCM (ou sous-CCM)

Annexe C du Formulaire de proposition Le formulaire « Renseignements sur les membres

Autres documents relatifs aux rubriques 1 et 2 joints par le candidat : Ajouter des lignes supplémentaires à ce tableau si besoin, pour s’assurer que les documents directement nécessaires sont annexés

2.1.2

Lettre du SNU, désignant les titulaires et Suppléants

Annexe No 06a

2.1.2

Lettre des Partenaires bilatéraux, désignant les titulaires et Suppléants

Annexe No 06b

2.1.2

Lettre des Organisations internationales, désignant les titulaires et Suppléants

2.1.2

Lettre de la Fondation Mama Henriette CONTE, désignant le titulaire sans suppléant

2.1.2

2.1.2

d’Industrie titulaire

et et

2.2.2 (a)

Lettre de manifestation d’intérêt Président du CCM Guinée pour le R10

du

2.2.2

Rapport atelier de rédaction du Draft 1 de la Composante VIH/sida du 08 au 18 juin 2010 à Fria

2.2.2

2.2.2

2.2.2

2.2.2

2.2.2

2.2.4 2.2.4

Rapport des ateliers de rédaction du Draft de la composante Paludisme à Fria Rapport atelier de rédaction du Draft 1 de la Composante RSS du 21au 24 juin 2010 à Maférinyah Rapport de la revue de la proposition par les pairs à Ouagadougou pour les composantes VIH/sida et RSS du 23 juin au 2 juillet 2010 Rapport de la revue de la proposition par les pairs à Dakar pour la composante Paludisme du 29 juin au 1er juillet 2010 Rapport atelier d’harmonisation entre les trois composante tenu à Taady Club les 23 et le 26 juillet 2010 Rapport de la commission de sélection des PR Rapport de la bénéficiaires

Annexe No 06d

Annexe No 06e

Lettre du Ministère de la Défense, désignant le titulaire et suppléant Chambre de commerce, d’Artisanat, désignant le suppléant

Annexe No 06c

commission de sélection des Sous

Annexe No 06f

Annexe No 02b

Annexe No 07

Annexe No 08

Annexe No 09

Annexe No 10

Annexe No 11

Annexe No 12

Annexe No 13 Annexe No 14a

Formulaire de proposition de la Série 10 du Fonds Mondial – Candidat pays seul : Rubriques 1 - 2

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2.2.4

Rapport de la commission de sélection amandée Sous bénéficiaires

Annexe No 14b

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ROUND 10 – Malaria

PROPOSAL FORM – ROUND 10

SINGLE COUNTRY APPLICANT SECTIONS 3-5: Malaria 3. PROPOSAL SUMMARY Clarified Section 3.1(b) Option 1: Transition to a single stream of funding by submitting a "consolidated disease proposal"  go to section 3.1 (b)

(Relevant sections are marked in RED throughout the proposal form)

3.1 Transition to a stream of funding

single

(a) Select only one of the three options:

X Option 2: Transition to a single stream of funding during grant negotiation  go to section 3.1 (b)

(Relevant sections are marked in RED throughout the proposal form) Option 3: No transition to a single stream of funding in Round 10 (Relevant sections are marked in RED throughout the proposal form)

(b) For options 1 or 2, list the grant numbers.

 GIN-607-G05-M

3.2 Duration of Proposal Month and year:

Planned Start Date

To

July 2011

June 2016

3.3 Alignment to in-country cycles (a) Describe how the proposal duration was selected in section 3.2 and how it contributes to alignment with the national fiscal cycle(s), programmatic reporting, or in-country program reviews; (b) Describe the systems in place for regular national program reviews and evaluations (including Operations and Implementation research). ONE PAGE MAXIMUM (a) The present proposal covers the period from July 1st, 2011 to June 31, 2016 which, shifted by a half-year, aligns with the fiscal cycle of Guinea, which runs from January 1st to December 31 of each year. In September of each year, the Loi de Finances rectificative (Corrective Budget Law), which makes it possible to incorporate the budget of the present proposal (Appendix D) into the national development budget, is drafted and adopted. The start of its implementation will begin when the grant is signed and on the date of the 1st disbursement of the funding. These disbursements will be aligned with the quarters of Guinea's fiscal cycle, as was the case with the funding of Global Fund (GF) Rounds 2 and 6. During and after the execution of the budget, the government may order tests and management audits to ensure compliance with the procedures and the quality of the expenses and

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ROUND 10 – Malaria public income. (b) The Monitoring and Evaluation (M&E) and health information reporting system are unified in Guinea. Reporting is yearly on the national level (Coordination Technical Committee), twice-yearly on the regional level (Regional Health Technical Committee, CTRS), and quarterly for the health districts (Prefectural Health Technical Committee, CTPS). Twice-yearly, quarterly, and monthly monitoring are also in place, in the order in which the levels of the health pyramid are listed (national, regional, and prefectural levels). At the end of every year, a review of primary health care is carried out (the review is currently being expended to hospitals) in order to evaluate the activities performed, learn lessons, and consider possibilities for the year to come. Finally, periodic surveys dealing with the healthcare sector are conducted. They include the Enquête Démographique et Sanitaire ("Health and Demographic Survey" or EDS – Appendix 10), the Multiple Indicator Cluster Survey (MICS), the Enquête de la couverture des interventions contre le paludisme ("Malaria Care Coverage Survey"), antimalarial effectiveness studies, and malaria vector insecticide resistance monitoring studies. The schedules of these surveys are indicated as part of the performance of the present proposal (Appendix A).

3.4 Summary of Round 10 Proposal Provide a summary of the malaria proposal. THREE PAGES MAXIMUM In Guinea, malaria represents the leading cause of doctors' visits (33.8%), hospitalization (31%), and deaths (14.2%) in public health sites, all ages combined. Among children under five, the number of cases of malaria recorded in public health sites was 282,502 in 2007, with an incidence rate of 141 per thousand and a mortality rate of 29.7%. According to PNLP data, the number of cases of malaria recorded in this age bracket was 206,961 in 2008 and 305 701 in 2009. In pregnant women, SNIGS only began to disaggregate the data in 2009 in order to take this target group into account when collecting data on cases of malaria (29,623 cases in 2009). Malaria is currently a long seasonally recurring (6 to 8 months) stable endemia, with 100 to 400 transmissive bites per person per year. Morbidity is greater during the rainy season (about 80% of all cases of fever in children). Plasmodium falciparum is the primary plasmodial species detected (98%). There are 4 zones with different levels of endemicity: 1. A hypo-endemic zone located in Lower Guinea, made up of two population centers on the Atlantic coast (the cities of Conakry and Kamsar). The predominant vector is Anopheles melas. 2. A meso-endemic zone, which concerns the northern region bordering Senegal and Mali, with low rainfall, in which the major vector is A. funestus, and the Atlantic coast with high rainfall, in which A. melas dominates. 3. A hyper-endemic zone, which stretches from the southeast of Lower Guinea to the Guinean tropical forest (the border with Liberia and Côte d’Ivoire). This is a high-rainfall zone (6 to 10 months of rain). The dominant vector is A. gambiaes.s. 4. A holo-endemic zone located in Upper Guinea, a heavily irrigated savannah- and plains-covered area with medium rainfall. The dominant vectors are A. funestus and A. arabiensis. This proposal intends to implement prevention and care services in the holo- and hyper-endemic zones, which are home to 57% of the Guinean population. These intervention zones include 19 health districts located within the administrative regions of Kankan (Kankan, Kérouané, Kouroussa, Mandiana and Siguiri), N’Zerekore (N’Zerekore, Macenta, Beyla, Lola, Yomou and Gueckedou), Faranah (Faranah, Dabola and Kissidougou), Mamou (Mamou, Dalaba and Pita) and Kindia (Kindia and Télimélé). These Districts total 216 sub-prefectures, 248 healthcare centers, and 611 healthcare stations for an estimated population of 6,316,720 inhabitants in 2011. In the health district of Gueckedou, the incident care activities will be handled by MSF Suisse. However, for prevention activities, the project will provide the inputs (LLINs, SP) and MSF will cover the operational costs. This proposal, entitled "Mise à échelle des interventions de lutte contre le paludisme dans les zones hyper et holoendémiques de la Guinée" ("Upgrading malaria-fighting services in the hyper- and holoendemic zones of Guinea") is part of the effort to reduce the burden of malaria through key interventions. Its priority targets are pregnant women, children under the age of five, and vulnerable

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ROUND 10 – Malaria rural populations. It also aims to achieve universal coverage targets for malaria prevention, with the goal of achieving the Millennium Development Goals. The goal of the proposal, which is fully in line with the primary healthcare effort undertaken by the country in response to the April 2008 Ouagadougou Conference, is to contribute to reducing morbidity and mortality attributable to malaria by 50% by 2016. In order to achieve this goal, the project's proposed objectives are: 

Achieving a 100% coverage of the population with LLINs within the intervention zone by 2016



Achieving an 80% coverage of pregnant women receiving 2 doses of SP as part of IPT by 2016



Detect and treat 50% of all cases of fever/malaria on the community level among children under five in accordance with national directives by 2016



Strengthen the program's management and coordination capabilities

Seven service delivery areas have been chosen for the implementation of the project: a) Prevention by LLINs This SDA involves making LLINs available in all households and promoting their use. Two distribution strategies will be used: routine distribution and mass campaigns. All of this SDA's activities will be carried out by the SRs (Child Fund, BHP Billiton and Population Services International) under the responsibility of the civilian principal recipient (Catholic Relief Services USCCB). b) CCC-Mass Media The CCC-Mass Media activities will be implemented by Population Services International under the responsibility of CRS. To that end, all of the communication strategies (broadcasting TV and radio ads, roundtables, etc.) will be designed to promote the use of the services by the entire population, in particular the most vulnerable groups (pregnant women and children under five). c) CCC-Community Leaders Interpersonal communication activities will be implemented in order to encourage the participation of community leaders in promoting malaria-preventing measures and community care. Its activities will be implemented by community agents, basic community organizations, national non-governmental organizations, and international non-governmental organizations (Child Fund and Helen Keller International) under the responsibility of Catholic Relief Services USCCB. d) Prevention of malaria during pregnancy The principal government recipient, the Ministry of Health and Public Hygiene, will ensure that the healthcare structures in the intervention zone will be supplied with sulfadoxine-pyrimethamine. Trained community agents will promote prenatal consultation on the community level and will monitor and implement intermittent preventive treatment. e) Community malarial care The community agents will be trained to provide basic community malarial care and to refer serious cases to the healthcare structures. The Ministry of Health and Public Hygiene will be responsible for implementing and monitoring the community care activities. f)

Developing partnerships and coordination (national, community, public-private)

To get all stakeholders involved in the fight against malaria and to coordinate their activities in order to achieve results, the Ministry of Health and Public Hygiene will strengthen the existing coordination mechanism and will initiate a community-level cooperative framework. g) Strengthening human, logistical, and management capacities of the project's stakeholders This service delivery area aims to train personnel, provide logistical support, and monitor the implementation of the interventions. The implementation of the proposal will be insured by the two principal recipients, one of which is governmental (the Ministry of Health and Public Hygiene) and the other one civilian (Catholic Relief Services USCCB). Each of the recipients will contract with sub-recipients or technical departments depending on their field of competence in fighting malaria. The proposal will extend over a 5-year period running from July 1st 2011 to June 30, 2016 with a

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ROUND 10 – Malaria budget of US$46,625,648, 8.22% of which is for Monitoring & Evaluation.

4. PROGRAM DESCRIPTION 4.1 National program Describe: (a) current malaria national prevention, treatment, and care and support strategies; (b) how these strategies respond comprehensively to current epidemiological situation in the country; and (c) the improved malaria outcomes expected from implementation of these strategies. TWO PAGE MAXIMUM (a) The National Malaria Policy Document (Appendix 5) defines the prevention, treatment, care, and support strategies, which are: 1. Proper care of cases at home and in healthcare sites, including early diagnosis and appropriate treatment of cases o

o

o

o

On the community level, the trained Community Agents (CAs) will provide care in basic cases of fever/malaria (syndromic approach) with Artesunate-Amodiaquine (ASAQ) in children under the age of five and will or for serious cases to the nearest healthcare sites. Within the healthcare instructors, national policy recommends treating basic cases with ASAQ. Concordantly, Artemisinin-Based Combination Therapies (ACTs) were introduced in 448 healthcare structures in 2009 thanks to the GF Round 6 Guinean Proposal, Malaria Division (R6). The biological confirmation of malaria by Rapid Diagnostic Tests (RDTs) or microscope use is indicated for people over the age of five, while the syndromic approach is applied for children under the age of five. Before the sixteenth week of pregnancy, cases of malaria among pregnant women are treated orally with quinine, and after the 16th week are treated with ASAQ. If ASAQ tolerance has been developed, the second treatment is done using artemether-lumefantrine. With regard to treating serious malaria, the National Anti-Malaria Program (PNLP) has instituted guides and protocols within the Healthcare Centers (HCCs) and hospitals. Treatment is done with quinine administered intravenously in glucose serum. To conduct drug monitoring, when ACTs were introduced in Guinea in 2009, a monitoring form was created and approved in cooperation with the National Department of Pharmacies and Laboratories (DNPL) for detecting and managing the undesirable side effects of medication (including antimalarials). Some of the staff (1 person per district hospital) was trained in the use of the form.

2. The prevention of malaria by intermittent preventive treatment using Sulfadoxine– Pyrimethamine (SP) Intermittent Preventive Treatment (IPT) in pregnant women o

o

This strategy is implemented by healthcare sites (HCCs, Healthcare stations-HCSs, Communal Medical Centers) through Prenatal Consultation (PNC) services. National directives recommended administering 2 doses of SP to a pregnant woman before her 9th month of pregnancy, with a minimum interval of one month between two doses. Three doses are required in immunodepressed pregnant women (Human Immunodeficiency Virus HIV, Drepanocytose). On the community level, the CAs are tasked with providing awareness to pregnant women about the importance of IPT, to refer them to the Healthcare stations (HCSs) for care in the event of fever/malaria, and to rely on healthcare agents in actively seeking out pregnant women and children who have missed their appointments.

3. Prevention through the use of insecticide-impregnated mosquito nets. The goal is to achieve universal coverage, which is defined as the availability of one mosquito net for two people. Based on the number of mosquito nets available, the coverage achieved by the country and the availability of the logistical and financial means, three implementation strategies are being used: o

Routine distribution through Expanded Vaccination Program, Primary Healthcare and Essential Medications (PEV/SSP/ME) and PNC services carried out in the healthcare sites. This means providing one mosquito net for each vaccinated child and each pregnant women

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ROUND 10 – Malaria o

o

treated with IPT. It is used to maintain coverage while protecting new targets. Community distribution to households, which consists of distributing Long-Lasting Impregnated Nets (LLINs) to households with the support of local and international NonGovernmental Organizations (NGOs), local elected officials and decentralized structures. This strategy involves taking a census of households; it was used in 2009 by 9 health districts and made it possible to distribute 754,724 LLINs financed by GF Round 2 Guinean Proposal, Malaria Division (R2) and R6. Mass distribution campaigns, which may either be integrated within the PEV/SSP/ME's vaccination campaigns which target children under five, used in November 2009 to distribute 1,990,290 LLINs (financed by GFR6, the United Nations Children's Fund-UNICEF/ United Nations System Aid-UNITAID, the World Bank (WB)/ Appui au Programme National de Développement Sanitaire (APNDS), and the Senegal River Basin Development Authority (OMVS), with the support of international NGOs in implementing the campaign), or systematic distribution campaigns (one mosquito net for two people).

4. The involvement of base-level communities, NGOs/Based Community Organizations (OCBs see Appendix H for a detailed description of community actors) and the private and religious sector in fighting malaria by means of: (1) building awareness among the people on the services being offered and how to use them; (2) strengthening the communication capabilities of the network of community communicators; (3) strengthening the partnership between the PNLP, NGOs, and the private and religious sector in implementing anti-malaria strategies. 5. Support strategies, which include: (1) epidemiological monitoring of morbidity - mortality, parasites and vectors; (2) Monitoring/Evaluation (supervision, monitoring, and evaluation); (3) support for implementing quality control among the medication and biological diagnostics used for malaria; (4) operational research; (5) communication to change conduct (CCC); (6) drug monitoring; (7) integration into other initiatives (PEV/SSP/ME, the Program for Integrated Care of childhood illnesses (PCIME), School Health, Health of Mothers and Children, occupational medicine, etc.); (8) strengthening the institutional capabilities and management of the PNLP; (9) developing partnerships between the Ministry of Health and Public Hygiene (MSHP), the departments whose actions are health-related, bi- and multi-lateral partners, the private sector, and communities. (b) The combination of the various strategies described above constitutes an appropriate response to the country's epidemiological context: 

The introduction of ACTs into healthcare sites in July 2009 for the care of ordinary cases in response to the development of resistance to monotherapies;



IPTs using SP to prevent malaria among pregnant women introduced in 2005 in order to counter chloroquine resistance;



Promoting the use of LLINs by means of mass distribution campaigns and PNC and vaccination services among children under five in view of achieving universal coverage;



An additional community-based strategy for handling cases among children under five and promoting preventive measures in order to counter the low geographic and financial accessibility to care and services (distance, low income and weak channels of communication in rural areas).

(c) The improvement of the expected result of implementing the strategy is to have at least 80% of the population sleeping under a LLINs; to have 80% of pregnant women benefit from intermittent preventive treatment in accordance with national policy; to diagnose and correctly treat 80% of all cases of malaria admitted into the health-care sites, to correctly care for 80% of all children under five suffering from fever/malaria at the community level; to strengthen the capabilities of the various stakeholders, specifically the PNLP, local and national NGOs, OCBs/Community-Based Services (CBSs), and service providers. Ultimately, the expected impact is to reduce morbidity and mortality attributable to malaria by 50% between now and 2015, in particular among vulnerable populations (children under five and pregnant women).

4.2 Epidemiological profile of target populations (a) Describe the current epidemiological profile of the target populations, and how this profile is R10_CCM_GIN_M_PF_s3-5_27Sept10_En.doc

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ROUND 10 – Malaria changing with respect to malaria. ONE PAGE MAXIMUM In Guinea, malaria is currently a long seasonally recurring (6 to 8 months) stable endemia, with 100 to 400 transmissive bites per person per year. Morbidity is greater during the rainy season (about 80% of all cases of fever in children). Plasmodium falciparum is the primary plasmodial species detected (98%). There are 4 zones with different levels of endemicity (see map below): 

A hypo-endemic zone located in Lower Guinea, made up of two population centers on the Atlantic coast (the cities of Conakry and Kamsar). The predominant vector is Anopheles melas.



A mesoendemic zone, which concerns the northern border region near Senegal and Mali, where rainfall is low and the major vector is A. funestus, and the Atlantic coast, where rainfall is high and A. melas predominates.



A hyper-endemic zone, which stretches from the southeast of Lower Guinea to the Guinean tropical forest (the border with Liberia and Côte d’Ivoire). This is a highrainfall zone (6 to 10 months of rain). The dominant vector is A. gambiaess.



A holo-endemic zone located in Upper Guinea, a heavily irrigated savanna- and plains-covered area with medium rainfall. The dominant vectors are A. funestus and A. arabiensis.

Map of the Republic of Guinea (West Africa) with its four natural regions: Lower Guinea, Middle Guinea, Upper Guinea, and Forest Guinea (the dashed lines separate the four zones) and malaria endemicity (P. Carnevale et al; 2010 - Appendix 7)

The data aggregated by the National Information and Statistics Management Service (SNIGS) does not show a correlation of the clinical profile of malaria with the 4 zones of endemicity, nor any breakdown of the disease by sex. However, the available data does show the following situation: 

All ages combined, malaria represents the top cause of consultations (33.8%), hospitalizations (31%), and deaths (14.2%) in public healthcare sites (Directory of Statistics, 2007).



Among children under the age of five, the number of cases of malaria recorded in public health sites was 282,502 in 2007, with an incidence rate of 141 per thousand and a mortality rate of 29.7% (Directory of Statistics, 2007). According to PNLP data, the number of cases of malaria recorded in this age bracket was 206,961 in 2008 and 305 701 in 2009. This apparent increase in the number of cases in 2009 is due to the increase in the use of services owing to the introduction of ACTs in health sites.



In pregnant women, SNIGS only began to disaggregate the data in 2009 in order to take this target group into account when collecting data on cases of malaria (29,623 cases in 2009).

(b) Do the activities in the proposal target: Whole country

Specific geographic region(s)

Specific population group(s)

This proposal is intended to implement preventive and care interventions in the holo- and hyperendemic where 57% of the population of Guinea live (see facing map). These intervention zones concern 19 Health Districts (Prefectures) located in the administrative regions of Kankan, N’Zerekore, Faranah, Mamou, and Kindia. These Districts total 216 subprefectures, 248 HCCs, 611 HCSs for an estimated population of 6,316,720 inhabitants in 2011. In the health district of Gueckedou, the incident care activities will be handled by MSF Suisse. However, for prevention activities, the project will provide the inputs (LLINs, SP) and DWB will cover the operational costs. R10_CCM_GIN_M_PF_s3-5_27Sept10_En.doc

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ROUND 10 – Malaria For prevention activities, the project will provide the inputs (LLINs, SP) and DWB will cover the operational costs (leaving only 18 target prefecture is for community care activities).

Intervention zones

(c) Size of population group(s)

Population Groups

General Population Size

Intervention Zone Population Size

Source of Data

Year of Estimate

10,824,262

6,126,790

General Census of the Population and Homes (RGPH-Appendix 9)-1996, Demographic outlooks

Females five years old and above

4,502,893

2,548,747

RGPH-1996, Demographic outlooks

2010

Males five years old and above

4,156,517

2,352,687

RGPH-1996, Demographic outlooks

2010

Children: females over 12 months to under five years

900,579

509,749

RGPH-1996, Demographic outlooks

2010

Children: males over 12 months to under five years

831,303

470,537

RGPH-1996, Demographic outlooks

2010

127,437

RGPH-1996, Demographic outlooks

2010

117,634

RGPH-1996, Demographic outlooks

2010

275,706

RGPH-1996, Demographic outlooks

2010

Total country population (all ages)

Infants: females 12 months and under

225,145

Infants: males 12 months and under

207,826

Women pregnant during the last 12 months

487,092

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2010

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ROUND 10 – Malaria (d) Malaria epidemiology of target population(s)

Population Groups

Episodes of malaria in past 12 months (all populations, all ages)

Estimate d number

Estimated number in the intervention zones

885,391

420,530

Episodes of malaria in past 12 months: females 15 years and above

NA

Episodes of malaria in past 12 months: males 15 years and above

NA

NA

Episodes of malaria in past 12 months: females 5 – 14 years

NA

NA

Episodes of malaria in past 12 months: males 5 – 14 years old

NA

NA

Episodes of malaria in past 12 months: pregnant females

29,623

12,907

Episodes of malaria in past 12 months: female children under five

NA

NA

Episodes of malaria in past 12 months: male children under five

NA

NA

Episodes of malaria in past 12 months: infant females 12 months and under

NA

NA

Episodes of malaria in past 12 months: infant males 12 months and under

NA

NA

Episodes of malaria in past 12 months: children under five

305,701

165,314

Episodes of malaria in past 12 months: over age five

550,067

241,114

Source of Data

Year of Estimate

SNIGS (data from public structures)

2009

SNIGS (data from public structures)

2009

NA

Other: SNIGS (data from public structures) SNIGS (data from public structures)

2009 2009

4.3 Major constraints and gaps in disease, health, and community systems 4.3.1 Malaria program Describe: (a) the main weaknesses in the implementation of current malaria strategies; (b) existing gaps and inequities in the delivery of services to target populations; and (c) how these weaknesses affect achievement of planned national malaria outcomes. ONE PAGE MAXIMUM

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ROUND 10 – Malaria (a) The main weaknesses in implementing the current malaria strategies are: 1. Low capacity in caring for cases o

o

o

Diagnostic: i) low RDT coverage in health sites: the RDTs were deployed in two regions out of eight (Faranah and Kankan) in the first quarter of 2010; ii) failure to integrate private, association, and religious structures into caring for cases; iii) weakness of the biological diagnostics' quality control system. Treatment: i) insufficient monitoring of service-providing agents responsible for applying the national policy; ii) insufficient training/refresher courses for service providers in the use of ACTs on the community level and in the private sector. Referrals: i) insufficient application of guidelines for referring serious cases from centers/HCSs to hospitals; ii) insufficient referral/counter-referral tools on the community level.

2. Insufficient implementation of IPTs among pregnant women o o o o

Low IPT 2 coverage (46.7% according to the PNLP's 2010 coverage survey - Appendix 11); Low availability of SP in health sites (just 58% did not record any interruption in SP supply, according to the PNLP's 2010 coverage survey ); Non-involvement of private and religious structures in implementing the IPT; Low involvement of CBSs in building awareness among pregnant women and referring them for PNC.

3. Insufficient popular awareness of LLINs Despite the distribution of 3,024,459 LLINs in 2009, the proportion of households which have at least one LLIN is 62.3%. Insufficient coordination of distribution activities between stakeholders, the low involvement of NGOs/OCBs in distribution, and the weakness of the LLIN usage monitoring system are also noted. 4. Low social engagement With respect to Advocacy  and Information, Education, and Communication (IEC)/CCC, noted the low involvement of opinion leaders; the low involvement of the private sector; the low implementation of IEC/CCC activities planned in the PNLP's communication plan (Appendix 12), the low involvement of the communities, including women's associations, in anti-malaria activities, and the near-absence of evaluations of communication activities. (b) existing gaps and inequities in the delivery of services to target populations; and 

Care of cases: to date, treatment by ACTS is incorporated into public health sites (HCCs and hospitals). The visitation rate of these structures is 38.9 %, so it may be estimated that the majority of the population has no access to treatment. This low access to ACTs may be linked to low geographic and financial accessibility, an awareness deficit, low quality of services (supply gaps, behavior of staff, etc.), the failure of the PNLP to supply the private sector with ACTs, and the absence of home care, among other things.



Preventive strategies: the low availability of LLINs requires the program to target the most vulnerable populations in distribution (children under five and pregnant women), which constitutes an obstacle to the universal coverage recommended by the World Health Organization (WHO). With respect to IPT, the low accessibility of the health sites and the low integration of community activities constitutes a barrier to the use of this strategy by pregnant women. Today, documented information on obstacles to the use of malaria preventive and curative services by women and other underprivileged populations is not available in this country.

(c) how these weaknesses affect achievement of planned national malaria outcomes. 

The current levels of coverage and show that the weaknesses mentioned above have significantly affected the achievement of the expected outcomes (see table below). Expected outcomes by end of 2010

80% of the population sleeps under a LLIN 80% of pregnant women receive IPT

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Current levels 51% 46.7%

Source PNLP 2010 coverage survey PNLP 2010 coverage survey

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ROUND 10 – Malaria 80% of all cases of malaria are diagnosed and treated correctly within health sites 80% of children under five suffering from fever/malaria are correctly cared for at the community level.

4.3.2

68.8% 1%

PNLP 2010 coverage survey PNLP 2010 T9 R6 report

Health Systems

Describe the main weaknesses of and/or gaps in health systems that affect malaria outcomes. ONE PAGE MAXIMUM The weaknesses of the health system in fighting malaria were identified and analyzed during the needs assessment process, the report of which is attached to this proposal (Report on Malaria needs assessment, April 2009 - Appendix 13, 14). These witnesses may be summarized as follows: a) Human resources o o o

little ability of health agents in support provided to OCBs and civilian organizations (NGOs, Associations, or Groups) in planning and implementing activities; insufficient healthcare personnel qualified at all levels of the health pyramid and unequal distribution nationwide favoring the capital and major cities; low motivation of staff, due to low wages and lack of incentives for staff in underprivileged areas (rural areas, enclaved areas).

b) Not enough medication, devices, equipment, and logistics o o o o

Not enough microscopes or laboratory reagents in the major structures (prefectural, regional, and national hospitals); lack of emergency kits for caring for serious cases in the major structures; lack of second-line antimalarial supplies (Artemether-Lumefantrine) in health sites; No enough patient evacuation means (ambulances) in emergencies.

c) Coordination o

o o

not enough intervention coordination: poor operation of the program-monitoring and tracking team (CCSP) at the Ministry of Health and Public Hygiene (MSHP); poor operation of the malaria working group within PNLP; not enough concerted planning with actors involved in fighting disease; low level of multisectoral work in fighting malaria.

d) Monitoring & Evaluation o o o o o

weak data collection and transmission system at all levels of the health pyramid; weak database functionality (PNLP, SNIGS); not enough computer equipment, communication tools (Internet, VHF radio, etc.) and sources of power in the peripheral structures; not enough monitoring vehicles/motorbikes/bicycles in some health districts; not enough operational research into the effectiveness of the PNLP's various strategies.

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ROUND 10 – Malaria 4.3.3

Community Systems

Describe the main weaknesses of and/or gaps in community systems that affect malaria outcomes. ONE PAGE MAXIMUM In order to boost primary healthcare, the MSHP and the Ministry of Decentralization and Local Development, in cooperation with the development partners, wrote "The New Vision for Community Participation Centered Around the Appropriation of Basic Healthcare Services" in April 2010 (Appendix 23). The main weaknesses identified in this document are ranked below based on the six components of community systems: 1. Enabling environments and advocacy o o o o o

Unsuitability of texts on the basic health structures management committee; Low level of distribution of legal texts governing the operation and appropriation of the health system (code of local governments, etc.); Absence of law application texts (Law on Reproductive Health, Law on HIV) No status for community health agents Lack of community participation in planning and discussions concerning their health problems

2. Networks, links, partnerships and community coordination o o

Low capacity to coordinate interventions between OCBs themselves, and between OCBs and the government/partners; Low level of OCB networking and information-sharing.

3. Strengthening resources and capacities o o o o o

Not enough local malaria NGOs with the human, technical, financial, and material capacities to lead activities at the community level; Low level of support among decentralized and community organizations (NGOs, OCBs, and Rural Development Communities) for health structures; Low capacity to mobilize resources to help with community interventions; Low capacity for financial management of management committees and OCBs; Low financial motivation of community actors.

4. Community activities and providing services o o o

No map showing workers in the community field as well as their impact on the availability and use of care and services; Not enough involvement from communities (OCB, NGOs) in fighting malaria; Attrition of community actors and occasional CA activities.

5. Organizational reinforcement and leadership o o

Not enough leadership from local governments and management committees when managing basic health structures and fighting disease; Decentralized technical support services have not helped local elected officials and community leaders develop leadership when appropriating the health system.

6. Monitoring & evaluation and planning o o o

No planning and monitoring system; Low coordination of community activities; Lack of ability among community actors to collect and analyze data and distribute information regarding the fight against malaria.

4.3.4 Efforts to resolve weaknesses and gaps Describe what is being done, and by whom, to respond to health and community system weaknesses and gaps that affect malaria outcomes, as outlined in sections 4.3.2 and 4.3.3. ONE PAGE MAXIMUM Several efforts have already been initiated to respond to the identified weaknesses:

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ROUND 10 – Malaria Health system level a) Human resources o o

Recruiting and training personnel and Technical Assistance (TA) in implementing activities (Guinean Government, APNDS, Plan Guinea, Communities) Increasing the wages of staff and giving out travel bonuses

b) Medication, material, equipment, and logistics o o o

o

Providing microscopes and laboratory reagents to major structures (R6 GF) Supplying health structures with medication, including quinine and glucose serum (UNICEF, German Technical Cooperation Society for Development (GTZ), Plan Guinea) Building and furnishing the HCSs, HCCs, Regional Health Office (DRS), Prefectural Health Office (DPSanté) (KFW, Plan Guinea, Christian Children’s Fund, Programme d’Appui aux Communautés Villageoises, African Development Bank (AFDB), World Bank, National Institute of Public Health (INSP), United Nations Development Programme (UNDP), United Nations Environment Program, United States Agency for International Development-USAID, WHO, UNICEF, GF and the Communities) Introducing ACTs (training, supplying, Monitoring/Evaluation) into the 448 health structures the country had in 2009 (R6 GF)

c) Coordination o o

Setting up a coordination and monitoring unit at the MSHP level (GF R2) Supporting the organization of technical health committees on the peripheral level (APNDS, PSS/GTZ, BAD)

d) Monitoring & Evaluation o o

o

o o

Support for developing and implementing the M&E plan (R6 GF, WHO) Strengthening personnel's technical capacities in epidemiological monitoring and responses to epidemics (Integrated Epidemiological Monitoring Project, West African Health Organization) Strengthening SNIGS' logistics, equipment, and TA capabilities, as well as those of the Central Pharmacy of Guinea (PCG) and the Office of Administrative and Financial Affairs (DAAF) (R6 GF) Strengthening monitoring logistics and VHF radio in certain health districts (ADB) Strengthening the communication system for collecting data (WHO)

Community system level a) Enabling environments and advocacy o o

Writing, adopting, and distributing the "New Vision for Community Participation Centered Around the Appropriation of Basic Healthcare Services" Training the Trainers in distributing the "New Vision for Community Participation Centered Around the Appropriation of Basic Healthcare Services"

b) Networks, links, partnerships and community coordination o o o o

Instituting and guiding 410 health committees in their assignments; these health committees include women and young people Instituting a consortium of international NGOs working to fight malaria on the community level Intervention of a network of national NGOs in fighting malaria (National Network of Malaria Associations - RENALP) On the HCC level, traditional communicators are used in social mobilization

c) Strengthening resources and capacities o o

Integration of community care by the CAs (training, supplying with ACTs) Strengthening the social mobilization capacities of the CAs (training, providing picture boxes, etc.)

d) Community activities and providing services o

Providing bikes (700) to some CAs (GF Malaria R6 and GF TB R5, IMCI, SR, PLAN GUINEA)

e) Organizational reinforcement and leadership

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ROUND 10 – Malaria o

f)

In 2010, in order to boost primary healthcare, the MSHP and the Ministry of Decentralization and Local Development instituted health committees within the subprefectures and village health communities, as a replacement for the management communities. These committees have broader mandates in managing health problems.

Monitoring & evaluation and planning o

PNLP set up data collection tools on the community level (2009)

4.4 Proposal strategy Complete this version of section 4.4.1 if the applicant selected option 2 or 3 in section 3.1 of the Proposal Form Option 2 = Transition to a single stream of funding during grant negotiation Option 3 = No transition to a single stream of funding in Round 10

4.4.1 Interventions This section should be completed in parallel with the Performance Framework and detailed budget and work plan

Describe the objectives, service delivery areas (SDA), and activities of the proposal. The description must be organized in that exact order and the numbering system must match the Performance Framework, detailed budget and work plan. The description must reference: (a) who will implement each area of activity (e.g. Principal Recipient, Sub-recipient or other implementer); and (b) the targeted population(s). FOUR - EIGHT PAGE MAXIMUM The following pages describe the goals, service delivery areas (SDAs), and activities of this proposal. The numbering system corresponds to the Performance Framework (Appendix A), the detailed budget (Appendix D), the work plan (Appendix C), the Quantification of Activities (Appendix E), and the Work Plan with numbers (Appendix F). This proposal, entitled "Mise à échelle des interventions de lutte contre le paludisme dans les zones hyper et holoendémiques de la Guinée" ("Upgrading malaria-fighting services in the hyper- and holoendemic zones of Guinea") is part of the effort to reduce the burden of malaria through key interventions. Its priority target in areas with high malaria endemicity throughout the country, with a particular focus on pregnant women, children under five, and poor rural populations. It also aims to achieve universal coverage targets for malaria prevention, with the goal of achieving the Millennium Development Goals (MDGs). The proposal is fully in line with the primary healthcare effort undertaken by the country in response to the April 2008 Ouagadougou Conference. It also responds to the adoption and popularization of the code of local governments by Guinea. This is because the local governments are competent within their territories in all areas that fall under their mission. They have their own areas of competence and 32 local administrative and public services, which include i) creating, organizing, managing, altering, and canceling the local government's administrative and public services, ii) and primary health care. Given the epidemiological profile of malaria described in section 3.2 (see map), the interventions of the Round 10 Guinean Proposal, Malaria Division (R10) will be developed in the hyper- and holoendemic zones which cover the country's 19 prefectures as shown in the table below. Intervention zones Hyperendemic

Regions Kindia Mamou Faranah N’Zerekore

R10_CCM_GIN_M_PF_s3-5_27Sept10_En.doc

Prefectures Kindia, Télimélé Mamou, Dalaba, Pita Faranah, Kissidougou N’Zerekore, Macenta, Lola, Beyla, Yomou, Gueckedou

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ROUND 10 – Malaria Holoendemic

Kankan Faranah

Kankan, Kouroussa, Mandiana, Kérouané, Siguiri Dabola

The diagram below illustrates the option chosen in this proposal, which aims to develop a community approach that targets the entire population, with a particular focus on children under five and pregnant women. It indicates the connections between the workers a different levels, as well as their respective roles and responsibilities in implementing the interventions. The steps below describe the goal, objectives, SDA and activities provided in this proposal. Goal: Contribute to reducing morbidity and mortality attribute both to malaria by 50% between now and 2016 Objective 1: Achieving a 100% coverage of the population with LLINs within the intervention zone by 2016 SDA 1.1: Prevention by LLINs This SDA involves making LLINs available in all households and promoting their use. Two distribution strategies will be used: routine distribution and a mass campaign. All of this SDA's field activities will be carried out by the Subrecipients (SR) under the responsibility of the civilian Principal Recipient (PR) (Catholic Relief Services USCCB - CRS). Given the impressive outcomes of the 2009 integrated campaign implemented by the MSHP, the members of the Guinean anti-malaria consortium and the bi- and multilateral partners; and further given the high capacity for managing resources and supplies and the existing bonds with the target communities, the SRs chosen for implementing the activities of this SDA are: BHP Billiton, Child Fund, and Population Services International (PSI). For more information on the capabilities of the SR, see 4.7.2 Subrecipients. 1.1.1. Purchasing long-lasting insecticideimpregnated mosquito nets (LLINs) CRS will identify the LLIN needs and will be responsible for the purchasing procedures, from ordering to delivery. 3,368,241 LLINs will be purchased over the duration of the project. 1.1.2. Paying LLIN management expenses The management fees represent 5% of the cost of the mosquito nets. These expenses take into account the preparation of the calls for tenders, General organization chart of interventions and receipt, storage, and transport from the PCG's planned for R10 warehouses to the health districts (prefecture capitals). The expenses of the service will be paid for after delivery. CRS will make contact with the PCG to carry out this activity. 1.1.3. Routine transport of LLINs from health districts to health centers Under the responsibility of CRS, the LLINs intended for routine distribution from the health district capitals to healthcare centers will be transported by BHP Billiton, Child Fund, and PSI. 1.1.4. Routine distribution of LLINs Routine distribution for year one of the project is covered by the LLINs available with the other partners. Due to the mass campaign, there will be no further routine distribution in year two. R10's routine distribution will begin during the year three of the project The distribution of 347,020 LLINs as part of the routine strategy will target infants less than a year old and pregnant women. It will be done through routine Prenatal Consultation (PNC) and vaccination services during the fixed and advanced strategies. It will be provided by the PNC agents and by the Expanded Vaccination Program (EVP) under the supervision of the healthcare center (HCC) leaders. 1.1.5. LLIN distribution campaign (year 2 of the project) A mass LLIN distribution campaign will be organized during the 4th quarter of year 2 of the project. Its

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ROUND 10 – Malaria objective is to achieve universal coverage. CRS will work in concert with BHP Billiton, Child Fund, and PSI, local governments,national NGOs and OCBs, international institutions, and public, private, and religious health sites at all levels in order to carry out this mass campaign using a voucher strategy. The voucher strategy will consist of first taking a census of the population by household. Each recorded household will receive a different-colored voucher depending on its size. During distribution, each household will take its voucher to the distribution site in order to receive the corresponding number of LLINs. For the details of the campaign's subactivities and workplan, see Appendix G. 1.1.6. Conducting LLIN effectiveness studies This refers to conducting studies at 2 pilot sites in order to evaluate the effectiveness of the LLINs distributed to the population. The MSHP will contract with a research institution to conduct these studies. A TA of the WHO will be solicited to conduct this activity planned for year three. 1.1.7. Conducting studies of vector sensitivity to insecticides The MSHP will put out a call for candidates in order to select a research institute they'll be responsible for assessing vector sensitivity to insecticides during year four of the project, as a complement to the one planned for the end of R6 in 2012. This assessment will be done within 2 pilot sites covering the 2 hyper- and holoendemic zones. SDA 1.2: CCC-Mass Media Given its high capacity in terms of communication to change conduct, the CCC-mass media activities will be implemented by PSI under the responsibility of CRS. All communication strategies will be designed to promote the use of the services by the entire population, in particular the most vulnerable groups (pregnant women and children under five). For example, the messages will target heads of families regarding their responsibilities to follow the priority targets (pregnant women) for the use of the services. Although the country has television channels, lack of electricity reduces a large portion of the population's access to them This is why radio will be preferred for this project. Guinea has a National Radio station, about 10 private radio stations, and about 30 rural and community radio stations which cover the country. 1.2.1. Production and distribution of radio broadcasts Every year, 15 radio broadcasts will be produced in French and in the four national languages (Soussou, Pular, Maninka, and Kpelle) about the 3 components of the fight against malaria (LLINs, IPT, and care). They will be rebroadcast twice a month in all 5 languages (French and the four national languages) for each component. The national radio station, 5 rural radio stations, 2 private radio stations, and numeral for community radio stations covering the intervention zone will be targeted to cover the mass media activities. This activity will began in the 2nd quarter of year 1. In total, 20,520 public broadcasts will be made during the project. 1.2.2. Design, production, and broadcast of radio ads Four radio ads will be produced for the first two years of the project, in French and in the 4 national languages, on all three components. Design will be done by a communications agency recruited by a call for tenders. During year three of the project, 3 ads will be produced to correct or update the messages. The ads will be broadcast 4 times a day per issue in French and in the area's predominant national language. The ads will be broadcast for 12 days and months and will cover a period of six months every year intermittently. The ads will be broadcast on all 12 radio stations under contract to cover mass media activities. This activity will began in the 3rd quarter of year 1. In total, 19,152 radio ads will be broadcast during the project. 1.2.3. Design, production, and broadcast of public service TV ads for the LLIN distribution campaign A public-service TV ad will be produced and broadcast on national television only for the LLIN distribution campaign during the 4th quarter of year two of the project. The ad will be produced in French, translated into the four national languages, and broadcast every day for a month. In total, 150 broadcasts will air during the campaign. 1.2.4. Production and broadcast of roundtable discussions Every year, 15 roundtable discussions will be conducted in French and in the four national languages on LLINs, IPT, and care. These discussions will be produced in cooperation with health authorities and opinion leaders from the targeted regions. They will be rebroadcast twice a year on the 12 target radio stations to cover the mass media activities. This activity will began in the 2nd quarter of year 1. In total, 1800 roundtable discussions will be broadcast during the project.

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ROUND 10 – Malaria 1.2.5. Design and production of posters Two designs are planned during the project, on all three components. The 1st design will be done for the first two years, and the second is planned for the 3rd in order to update the messages. 51,540 A3format posters will be produced during the first two years, and 51,000 hundred 40 more during the last three years of the project. A quantity of 9,700 posters will also be produced for the LLIN distribution campaign in year 2. The posters will be displayed at health sites, public places, and areas commonly visited by the target audience. 1.2.6. Design and production of communication items for the LLIN campaign For the LLIN distribution campaign, 200 banners, 20,000 caps, and 20,000 T-shirts will be produced during the 3rd quarter of year 2 to publicize the activity and identify the field agents. 1.2.7. Monitoring the broadcast of mass media (radio) materials During the 2nd quarter of year one, PSI will identify the monitoring agents within the sub-sub‐recipient (SSR) and OCB. Twelve monitoring agents will be identified (1 agent per radio station) within the SSRs and OCB in order to ensure the broadcast of the materials. A monthly bonus will be paid each agent. 1.2.8. Purchasing receiving radios for the ad, roundtable discussion, and radio transmission broadcast monitoring agents As part of the broadcast of the roundtable discussions, radio ads, and radio transmissions, 12 receiving radios will be purchased during the 2nd quarter of year 1 and 12 receiving radios during year 3 to renew them. These purchases will be done by call for tenders by the SR. 1.2.9. Conducting pre-tests of radio ads and posters PSI will conduct pre-tests during each radio ad's and poster's production process to confirm that the messages are understood by the target audience. Six pre-tests will be connected over the course of the project: 2 in the 2nd quarter of year 1, 2 during the 3rd quarter of year 2 (for the campaign) and 2 during year 3. 1.2.10. Conducting evaluation studies of the level of message comprehension Two evaluation studies of the level of message comprehension will be conducted by PSI during the 3rd quarter of year 2 and year 4 of the project. These activities will serve to evaluate and adapt the messages. They will be done by a call for tenders, and a firm will be recruited for this purpose. SDA 1.3: CCC-Community leaders This interpersonal communication (IPC) activity aims to emphasize the participation of community leaders in promoting preventive measures against malaria and community care. These leaders are: religious associations, Sèrès (woman's association), socioeconomic interest groups (dyers, soap boilers, fishmongers, market farmers), and CECOJEs (youth guidance and advocacy centers). Given their existing bonds with the target communities, the SRs select to implement the activities of this SDA for CRS are Child Fund and HKI. These two SRs will work in partnership with the SSRs, and national and international NGOs which have a heavy presence and competence in the field. 1.3.1. Production of picture boxes For carrying out IPC activities, 3484 picture boxes will be produced and distributed to the CAs, healthcare centers, the SSRs' agents, and the OCBs. CRS will be responsible for the design and production in the 2nd quarter of year one of the project. The picture boxes will be distributed during the training of the agents in question. 1.3.2. Photocopying the IPC training module This module is intended for the heads of HCCs, the CAs, the OCB's leaders and SSRs' agents 3,484 photocopies of the training module will be produced during the 2nd quarter of year one. Child Fund will contract with a service provider based on a call for tenders. 1.3.3. Training SSR agents in IPC techniques The SSR agents/trainers will be trained in IPC techniques in 19 prefectures. In total, 108 agents will be trained in 4 sessions of 27 participants for 5 days during the 2nd quarter of year one of the project by Child Fund and HKI under the responsibility of CRS and the supervision of the regional health team. A three-day refresher course for the SSR agents is planned for year three of the project. 1.3.4. Training OCBs in IPC techniques The 1296 leaders of the 648 OCBs (2 per OCB) will be trained in 52 three-day sessions with 25 participants each. This training will deal with IPC techniques. These trains will take place in the subprefectures during the 3rd quarter of year 1 and will deal with prevention through the use of LLINs, IPT, and care. They will be facilitated by the two SRs (Child Fund and HKI) of this activity under the

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ROUND 10 – Malaria responsibility of CRS and the supervision of the prefectural health team. A two-day refresher course for the OCBs' leaders is planned for year three of the project. 1.3.5. OCBs holding educational forums The leaders of the OCBs will hold educational forums in their areas on the prefectural, sub-prefectural, and village levels. Each OCB will conduct 2 educational forum sessions per month, for a total of 69,984 forums over the duration of the project. These activities will begin during the 3rd quarter of year on and will be supervised monthly by the NGOs and quarterly by the SRs. 1.3.6. CAs organizing home visits Each community agent will visit 20 households per month to intimately build awareness on the prevention of malaria through the use of LLINs, IPT, and care. In total, 2,678,400 home visits will be conducted during the five years of the project. These activities will begin during the 3rd quarter of year 1 and will continue until the end of the project under the supervision of the center leaders and the NGOs' agents. Given the diverse activities implemented by the CAs, the proposal includes a financial bonus for the CAs in order to add value to their contribution to community care of malaria. This support comes with the filing of the monthly activity report. CRS, with Child Fund and HK, will pay these bonuses quarterly on the basis of each CA's performance. 1.3.7. Organizing hosted sessions during the celebration of World Malaria Day Financial support will be provided to the SSRs in the 19 prefectures to carry out awareness activities (skits, mass awareness-building) during the celebration of World Malaria Day. These activities will be done under the supervision and responsibility of Child Fund and HKI. Objective 2: Achieving an 80% coverage of pregnant women receiving 2 doses of SP as part of IPT by 2016 SDA 2.1: Preventing malaria during pregnancy This involves training PNC agents, supplying structures with SP, promoting PNC on the community level and tracking the implementation of IPT. This SDA also contributes to MDG 5 (Improve maternal health). All of the SDA's activities will be carried out by the MSHP and its decentralized structures. 2.1.1. Revision of the CA training module Under the responsibility of the MSHP, during the 2nd quarter of year one of the project, a national workshop will be organized to revise the CA training module. This workshop will include 25 managers for three days. 2.1.2. Photocopying the revised CA training module 2728 photocopies of the training module will be reproduced (1 for each CA and HCC leader) during the 2nd quarter of year 1, and 2728 more in year 3 for refreshers. The MSHP, which is responsible for this activity, will contract with a service provider according to its manual of procedure. 2.1.3. Creating a referral voucher for the CAs A national workshop will be organized by the MSHP during the 2nd quarter of year 1 for creating the referral voucher for the CAs. A single voucher template will be designed for referring pregnant women, serious cases of malaria, and cases of side effects of antimalarials. This workshop will run two days and will include 25 participants with experience in the fields in question. 2.1.4. Training the CAs' trainers A pool of trainers on the national level will train the CAs' trainers (the 248 heads of the health-care centers) in each region of intervention zones. This training will deal with care, prevention through the use of LLINs, IPT, and reporting on the community level. The training will take place during the 2nd quarter of year 1, in 10 five-day sessions with 25 participants each, under the responsibility of the MSHP. 2.1.5. Training/Refreshing the CAs in the fight against malaria (care, LLINs, IPT, data collection) This training will deal with all aspects of the fight against malaria: caring for cases including drug monitoring, prevention through LLINs, IPTs in pregnant women, and data collection. It will be provided by the heads of the HCCs in 248 three-day sessions with 10 participants each. It will take place during the 3rd quarter of year 1, under the responsibility of the MSHP. A refresher will be organized in year 3. 2.1.6. Support for the photocopying of PNC forms, health notebooks, referral vouchers, and the CA's monthly report Under the responsibility of the MSHP, which will contract with the service provider, during the 2nd quarter of year one, 1,512,155 PNC forms (corresponding to the expected number of pregnancies), 1,512,155 health notebooks for the HCCs, 270 000 referral vouchers (for the PNCs, serious cases of R10_CCM_GIN_M_PF_s3-5_27Sept10_En.doc

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ROUND 10 – Malaria malaria, or side effects of treatment) and 4700 monthly report notebooks for the CAs (2 notebooks of 30 forms per CA) will be photocopied. These quantities cover the five years of the project. 2.1.7. Distributing data collection tools (PNC forms, health notebooks, referral coupons, CA monthly report notebooks) and ACT distribution kits The distribution of PNC forms, health notebooks, and referral vouchers will be ensured by the MSHP which will use the normal circuit for distributing medication and management tools. Health-care centers and CMCs will be supplied based on the needs expressed per half-year. On the community level, the data collection tool will be made available to the CAs by the HCCs they are assigned to. 2.1.8. Training/Refreshing the center leaders and PNC agents from the health-care centers in IPT for pregnant women This training covers the center leaders and PNC agents from the health-care centers, for a total of 496 agents to be trained. The training will take place on the health district level and will be provided by the prefectural training teams under the oversight of the regional team. It will take place in 20 sessions of 25 participants and will stretch out over a period of 5 days in each health district. This training is planned for the 2nd quarter of year one, and a three-day refresher will be organized in year 3. 2.1.9. Referring pregnant women to the HCCs for PNC and administration of IPT Under the responsibility of the health-care centers' leaders, the trained CAs will detect and refer pregnant women to the health-care centers on a daily basis, where they will receive free PNC, sulfadoxine-pyrimethamine, and LLINs. The referral system will consist of detecting pregnant women and guiding them towards the HCCs. To track the activity, a referral voucher will be given to the woman by the CA, who will give it to the HCC. 2.1.10. Purchasing Sulfadoxine-Pyrimethamine (SP) for IPT in Healthcare Centers The project will ensure that the HCCs have a regular supply of SP. To do so, it is planned to purchase 2,248,104 doses of IPT (or 6,744 313 SP tablets) over the duration of the project. Pending the reinforcement of the PCG's capabilities planned by the Health System Reinforcement (HSR), purchasing during the first two years will use the mechanism "Voluntary Pooled Procurement" (VPP). Beginning in year 3, the estimated needs will be purchased by the PCG. 2.1.11. Payment of management expenses for purchasing the SP The MSHP will pay PCG its management expenses for up to 5% of the cost of the SP, as in previous rounds. The expenses take into account the preparation of documents, tracking the order, acceptance, storage, and transport to the regional warehouses. 2.1.12. Distribution of SP The distribution of SP will be ensured by the MSHP, which will use the normal medication supply circuit and management tools from the central level to the health districts, with the regional PCG warehouses in between. The supply of healthcare centers and CMCs will be done based on the expressed needs. The distribution costs from health districts to healthcare centers are assumed by the budgets of the health sites. Objective 3: Detect and treat 50% of all cases of fever/malaria on the community level among children under the age of five in accordance with national directives by 2016 SDA 3.1: Community care of malaria This SDA is intended mainly to improve the accessibility of ACTs at the community level, in accordance with the recommendations of the new primary healthcare strengthening vision, which places particular emphasis on the appropriation of basic health services by communities. The deployment of the ACTs on the community level began with R6 in 5 regions. As part of R10, this strategy will be developed in 18 prefectures. The 19th prefecture (Gueckedou) which completes the intervention zone is covered by the NGO MSF/Suisse. The high prevalence of malaria infestation in these areas justifies the use of the syndromic approach in caring for simple cases in children under five, who are the most vulnerable. Cases will be detected passively, based on fever. The activities of IECs targeted to mothers/guardians will support this activity. Deployment will be done under the oversight of the HCCs, around which an average of10 CAs will developed. The CAs will ensure the therapeutic care of basic malaria cases among children under five in the community. Appendix H describes in detail the roles, responsibilities, and criteria for choosing the OCBs and CAs. For referring serious cases, the CA will be trained in detecting signs of severity and administering prereferral measures (cold compress, 1st dose of ACT if possible). The head of HCC and the NGOs' agents

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ROUND 10 – Malaria will be charged with providing technical support to the CAs during oversight to ensure these measures are complied with. Families, local elected officials, and community leaders will be solicited to encourage the refer patients to visit the HCC. 3.1.1. Purchasing ACT The purchase of 1,728,548 doses of ACT for community care will be made by the PCG, under the responsibility of the MSHP in year 3 of the project, as a complement to the quantities planned in R6. 3.1.2. Paying management expenses for purchasing ACTs As with SP, the MSHP will pay PCG management expenses up to 5% of the cost of the ACTs. 3.1.3. Supplying CAs with ACTs The supply of 2480 CAs with ACTs will be insured by the MSHP, which will use the normal medication supply circuit and management tools from the central level to the health districts and healthcare centers through the PCG and the Prefectural Health Offices. The CAs will take supplies from the HCCs according to the needs expressed and during the monthly oversights. 3.1.4. Purchasing care kits for the CAs Quantity of 12020 kits (bags, one-meter pictures, spoons, soap, napkins, plastic envelope folders) will be provided to the CAs for the five-year period. For year one of the project, 2100 kits will be purchased as a complement to the 2000 kits stipulated in R6 to cover the country. This means that to obtain the 2480 kits stipulated for the zone in R10, 380 will be provided out of the stock from R6. Due to losses and deterioration, the kits will be replaced every year. 3.1.5. Referring serious cases to HCCs for care. Under the responsibility of the leaders of the health care centers, the trained CAs will provide detection and referral of serious cases among children under five to health care centers on an everyday basis. The referral system will consist of detecting the cases, guiding them to the HCC, and the CA submitting the referral vouchers to centralize them within the HCC. 3.1.6. Training the trainers in self-evaluation of malaria skills CRS will use the pool of trainers at the central level to provide training in itself-a valuation of malaria skills among 76 trainers in 3 three-based sessions with 25 participants in each session. This training will be organized by Child Fund and HKI. It will include the teams from the health districts (DMR, training manager, one center leader and one community secretary) during the 3rd quarter of year 1 of the project. 3.1.7. Training the OCBs in self-evaluation of malaria skills Under the oversight of the SRs and teams from the health districts, the trainers will train the 1296 leaders of the OCBs (2 per OCB) in self-evaluation of skills in 52 two-day sessions with 25 participants. This training will take place in the capital of each sub-prefecture during the 4th quarter of year 1 of the project. 3.1.8. Self-evaluation of malaria skills in the districts/neighborhoods Under the oversight of the SSR, the 1296 leaders of the OCBs will implement the self-evaluation in 1588 districts/neighborhoods in one day during the 1st quarter of year 2 of the project. This activity will consist of conducting the focus group self-evaluation for each district/neighborhood at a rate of 10 people per group (10 women, 10 men, and 10 young people); the three groups will meet to decide on three practices to upgrade. Once this choice is made, each district/neighborhood will write a microplan that is achievable with the community's own funds. 3.1.9. Monitoring the therapeutic effectiveness of the ACTs The MSHP will contract with a research institution chosen through a call for tenders to conduct a study monitoring the therapeutic effectiveness of the antimalarials. The study is planned for year 4 of the grant within 2 pilot sites, as a complement to that of phase 2 of R6. Objective 4: Reinforce the program's management and coordination capacities SDA 4.1: Development of the partnership and coordination (national, community, public - private) In order to get all stakeholders involved in the fight against malaria and coordinate their activities to achieve outcomes, the MSHP will reinforce the existing coordination mechanism and initiate a consultation framework on the community level. 4.1.1. Quarterly meetings and national coordination A national quarterly coordination meeting for reviewing and planning the implementation and monitoring of the activities will be scheduled. Under the responsibility of the MSHP, the meeting will be attended by 3 representatives of the MSHP, 2 representatives from CRS, the 5 DRS of the project's R10_CCM_GIN_M_PF_s3-5_27Sept10_En.doc

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ROUND 10 – Malaria zone and a representative from each SR. This meeting will be held over 4 days at the start of each quarter. 4.1.2. Support for biannual prefectural meetings for reporting outcomes to the representatives of local elected officials, community leaders, NGOs/OCBs and health and administrative officials. During the biannual meetings of the Prefectural Health Technical Committee (CTPS), which lasts 3 days, the project will take a 4th day to enable stakeholders and community leaders to analyze the outcomes, identify any problems, and come up with corrective measures. This meeting will be attended, under the responsibility of the prefectural authority, by the representatives of all the project's stakeholders, for a total of 40 participants. 4.1.3. Support for biannual sub-prefectural meetings for reporting outcomes of malaria-fighting activities A meeting for reporting the outcomes of the malaria-fighting activities will be held at the end of each half-year period. This meeting will be attended by local elected officials, the representatives of the health committees, the OCBs and the CAs, and the health administrative officials, for a total of 25 participants. 4.1.4. Organizing a national workshop for sharing and harmonizing different sectors' approaches and activities in fighting malaria Under the responsibility of CRS, a national workshop for sharing and harmonizing different sectors' approaches and activities in fighting malaria will be held during the 4th quarter of year 1. It will be attended by 30 participants from the private sector, public sector, bi- and multilateral partners, and NGOs intervening in the fight against malaria in Guinea. SDA 4.2: Reinforcing the human, logistical, and management capabilities of the project's stakeholders This SDA aims to recruit and trained personnel, and to equip them with logistical means to monitor and evaluate implementation of the interventions. 4.2.1. Training 23 managers in M&E of malaria A national malaria indicator M&E training seminar will be organized during the 2nd quarter of year 1, and will be attended by five managers from the DRSs and 18 managers from DPSanté for 5 days, under the responsibility of the MSHP. The training will include managing community-level data. 4.2.2. Training/refreshing agents responsible for managing data on the level of the HCCs at hospitals This training will target the heads of HCCs (248 agents) and Hospitals (19 agents) and will take place over 11 three-day sessions in the health districts, under the responsibility of the prefectural team of trainers in operation with the M&E unit of the PNLP (MSHP) and SNIGS. It will be held during the 2nd quarter of year 1. A refresher will be organized for them during year 3. 4.2.3. Monitoring community-level activities (CAs, OCBs) by the HCCs and the SSR agents As part of tracking anti-malaria activities, monitoring of the CAs and OCBs developing in the communities will be organized every 2 months, for a period of 10 days. This monitoring aims to identify problems in view of providing corrective measures for them. This monitoring will be conducted by 1 agent from the HCC and 1 agent from the NGO. 4.2.4. Prefectural monitoring by NGOs of anti-malaria activities on the community level The NGOs responsible for implementation on the health district level will make monitoring visits once per quarter to reinforce the healthcare centers and agents of the NGOs in the sub-prefectures. This monitoring will be carried out in cooperation with DPSanté. The monitoring team will be made up of 1 member of the NGO and one member from the health team for a period of 2 days per HCC. 4.2.5. Monitoring sub-sub-recipients (SSRs) of health districts by SRs Each SR will make quarterly monitoring visits to reinforce the NGOs responsible for implementation and the health districts. This monitoring will be carried out in cooperation with the DRSs. This monitoring will effect the SSRs and a sampling of the HCCs, OCBs, and CAs. 4.2.6. Biannual monitoring of the SRs by the PRs Each SR (Child Fund, PSI, BHP Billiton and HKI) and the MSHP's decentralized structures will be supervised by its PR once every half-year to reinforce its implementation capabilities. This monitoring will be carried out by a team of 2 people for 5 days per SR. 4.2.7. Payment of administrative expenses to PRs/SRs Each of the PRs, MSHP and CRS, will receive operating expenses. The PR will pay the SRs the R10_CCM_GIN_M_PF_s3-5_27Sept10_En.doc

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ROUND 10 – Malaria management expenses in accordance with their internal management procedures. 4.2.8. Support for the operation of the health districts' SSRs In order to ensure the implementation of community-level activities, a quarterly grant of financial resources to the SSRs is provided in order to cover operating expenses (wages, operating the office, communication and travel expenses, etc.). This support will be based on a budget drawn up by each SSR for implementing the activities. 4.2.9. Purchasing computer kits for the PRs, SRs and SSRs. The PRs will contract with the supplier chosen to a call for tenders to purchase 57 computer kits: CRS: 5 laptops, 3 desktops, MHSP: 6 laptops, 4 desktops, for the 4 SRs: 3 laptops/SR, 2 desktops/SR, SSRs: 9 laptops. 4.2.10. Purchasing 4x4 vehicles for coordinating interventions This plans to purchase ten (10) 4x4 vehicles for coordinating, overseeing, and monitoring the training and monitoring the project's research activities, 2 of them for CRS, 5 for the SRs in year one and 3 for the PNLP in year three to replace those purchased by R6 in 2008. This acquisition will be done through a call for tenders as stipulated in the management procedures manual. 4.2.11. Purchasing motorbikes for the NGOs' agents Purchasing motorbikes is justified because the leaders of the NGOs must, in addition to monitoring and training the community stakeholders, ensure data collection and coordination of interventions within their zones. The capital SRs, and within each prefecture, each agent of the SSRs will be given a motorbike to cover two sub-prefectures. CRS will contract with a supplier for the delivery of 131 motorbikes intended for these agents during the 2nd quarter of year 1. 4.2.12. Purchasing work kits for CAs (flashlights, batteries, pens, plastic schoolbags, boots, slickers) To provide their activities, the CAs will each be equipped with a work kit. The MSHP will contract with the supplier based on standards and procedures for the delivery of kits during the 2nd quarter of year 1. Due to losses and deterioration, the work kits will be replaced during the 3rd quarter of year 3. 4.2.13. Purchasing bicycles for CAs The MSHP will contract with a supplier chosen through a call for tenders to deliver 2480 bicycles which will be delivered to the CAs according to the equipment plan, during the 3rd quarter of year 1. Since the CAs cover multiple localities, the bicycles will be used to travel within these intervention villages for home visits and social mobilization activities. 4.2.14. Coverage surveys of anti-malaria interventions As a complement to the surveys stipulated in phase 2 of R6, the MSHP will contract with a firm chosen through a call for tenders to conduct the coverage survey during the 1st quarter of the last 3 years of the grant. 4.2.15. Conducting a Knowledge, Attitudes, and Practices (KAP) survey on malaria The KAP survey planned for 2011 using R6 funding will provide basic data on the project to evaluate the population's level of knowledge regarding LLINs, IPT and care. A second KAP survey will be conducted during year 3 by the MSHP to evaluate the outcomes of the CCC activities and adapt the messages. 4.2.16. Training the personnel of the research institutions in studies on the therapeutic effectiveness of antimalarials This training concerns the personnel of the school of medicine/pharmacy at the University of Conakry, the National Institute of Public Health, and the Rural Health Research Institute. It deals with 25 researchers who will be trained during a five-day session with the technical support of the WHO and the West Africa Roll Back Malaria Network under the responsibility of the MSHP. 4.2.17. Training the personnel of research institutions (University, National Institute of Public Health, Rural Health Research Institute) in studies on vector resistance to insecticides. This training concerns the personnel of the school of medicine/pharmacy at the University of Conakry, the National Institute of Public Health, and the Rural Health Research Institute. 15 researchers will be trained over 10 days with the technical support of the WHO under the responsibility of the MSHP. 4.2.18. Training of RENALP in managing human and financial resources The purpose of this training is to reinforce the implementation capabilities of the national network of NGOs fighting malaria. Under the responsibility of CRS, it will be held during the 3rd quarter of year 1 and will deal with 25 participants from the NGOs in the network: Association Guinéenne de Lutte

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ROUND 10 – Malaria contre le Paludisme, Association Guinéenne pour faire reculer le paludisme, Association Guinéenne de Lutte contre le Paludisme, Association Guinéenne de Lutte anti Paludique, etc. 4.2.19. Organizing an exploratory survey into gender and social inequalities This survey is planned in order to identify the opportunities to integrate the contributions of women and vulnerable social strata, and to take into account the gender approach in the project's community interventions. CRS will contract with a firm or consultant to conduct this survey during the 4th quarter of year 1 of the project. 4.2.20. Midpoint evaluation The MSHP will put out a call for tenders at the start of the 3rd year to recruit a firm that will conduct a midpoint evaluation of the grant activity implementation process. 4.2.21. Final evaluation The MSHP will put out a call for tenders during the 4th quarter of the 5th year to recruit a firm that will conduct an end-of-project evaluation to appraise the outcomes actually achieved during the funding period. 4.2.22. Annual audit of the project The MSHP and CRS will contract with an audit agency approved by the country and by the GF according to the audit plan. The two PRs will work in concert to draft the Terms of Reference and the audit plan.

4.4.2 Addressing weaknesses from a previous category 3 proposal If relevant describe how the weaknesses identified in the "Technical Review Panel" (TRP) of a previous category 3 proposal have been addressed. TWO PAGE MAXIMUM (See TRP Review Form from the Round 9 Guinean Proposal, Malaria Division-R9, Appendix 15) Main weaknesses Response 1: For round 10, the interventions take into account not only the epidemiology of malaria in the country as described in section 4.2, but also the case care activities deployed within the health sites as part of the GFR6 grant. Thus, it is planned to implement prevention strategies (LLINs and IPT) and caring for cases in children under five at the community level in the hyper- and holoendemic zones. This approach aims to obtain a greater impact on malaria-related morbidity and mortality, especially among children under five. The choice of sub-recipient NGOs in implementing the interventions is based on their fields of competence, as well as their connections with the communities in the interventions zones. At the same time, the PNLP is heavily involved, and its role and responsibilities are clearly described. This is because, out of a desire to make its interventions sustainable for better impact, the Ministry of Health has been chosen by the Country Coordinating Mechanism (CCM) as the principal recipient in the government sector: as such, the PNLP will be responsible for all case care, partnership/coordination, and capacity-reinforcing activities. Response 2: In order to avoid inconsistencies and contradictions between the tables concerning the needs, the budget, action plan, and performance framework have all been drafted in a coordinated fashion in accordance with the GF's directives. The numbering of the objectives, SDAs, and activities is the same in the action plan, budget, and performance framework. The calculations of the activities to the needs estimate into account. During the entire proposal development process, reviews were conducted in order to make sure that the figures contained in the tables and those described in the activities were consistent. Response 3: In this proposal's action plan, all activities were defined explicitly with a detailed execution calendar per quarter and per year. The description of the activities gives the details on who is responsible for implementation, locations, and execution periods. All costs are described in detail; the activities drawn from the National Communication Plan were better described (see objective 1, SDA 2 and 3 of the present proposal) with a cost breakdown. Furthermore, the various indirect management cost R10_CCM_GIN_M_PF_s3-5_27Sept10_En.doc

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ROUND 10 – Malaria elements were explained (reference?). The purchase of motorbikes was justified by the fact that the NGOs' leaders must, in addition to monitoring and training the community stakeholders, ensure data collection and coordination of interventions within the zones they are responsible for. Response 4: The needs estimate and deficiencies analysis took into account the previous funding, particularly R6 which is underway. The drafting of the R10 workplan was done with consideration for the R6 work plan and all of the funding available in the fight against malaria in the country over the next five years. In section 4.4.7, the description of the link with the other grants from the GF was clearly spelled out, and the planned consolidation with R6 will make it possible to prevent overlaps. For example, R6 and the other partnerships plan to purchase 515,621 LLINs for the intervention zones of R10. This quantity will be completed in the R10 through the purchase of 1,982,305 LLINs in order to ensure and maintain universal coverage through 2015. Response 5: The analysis of deviations in this proposal took into account global contributions by all partners involved in the fight against malaria. To do so, an exhaustive inventory of expected funding from all partners in each area of intervention and for each year was conducted. Thus, in section 4.4.8 all of the available resources besides those of the GF will be described clearly, and were taken into account in quantifying needs that were not covered (Appendix 15). Response 6: Point 4.5.5: the communication activities adopted in this proposal were drawn from the PNLP's Communication Plan. They were described in section 4.4.1 as objective 1, SDA 2, and 3. The assumptions that were used to budget these activities are given in Appendix E regarding quantification. Point 5.7.1: the Round 9 budget did not include the wages and taxes of U.S.- based personnel. In fact, the five lines of international personnel took into account a percentage of the wages of the representative and the assistant representative based in Guinea (two lines) and the travel expenses for three people based in the United States for their technical missions in Guinea. Point 5.7.2: fixed in professional expenses have been replaced with the operating expenses of NGOs and associations (section 4.4.1 under objective 4, SDA 2) whose various sections has been justified and better detailed. Point 5.10.1: For R10 all of the M&E activities were detailed with the unit costs specified within the budget (section 4.4.1 under objective 4, SDA 2). Minor weaknesses Response 1: All unit costs have been harmonized and verified. The unit costs of the inputs have been updated based on information available on the GF's website. The unit costs not available on this website (conical LLINs, IPT) were obtained from information based on the most recent purchases bythe PCG for R6 and corresponding to internationally acceptable values. Response 2: For this proposal, no first aid kits will be purchased. As part of the effort to boost primary health care, the government and partners (UNICEF, Plan Guinea, Islamic Development Bank) will ensure the availability of essential medication, including for the care of serious cases and 2nd-level treatment (Artemether-Lumefantrine). Response 3: The operating costs for each PR and SR were detailed in Appendix 1B Calculation Details. For the R10 proposal, we have inserted a new sheet into the detailed budget in order to facilitate the appraisal of the nature of these costs. Additionally, some operating costs have been reduced; for example, the SR no longer have sub-offices in the budget.

4.4.3 Lessons learned from implementation experience How do the implementation plans and activities described in 4.4.1 above draw on lessons learned from program implementation (from either Global Fund financed or non-Global Fund financed programs)?

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ROUND 10 – Malaria TWO PAGE MAXIMUM Based on the analysis of reports of partner-financed programs (progress report and R2 and R6 of the GF, LLIN Social Marketing Plan (2004 - 2007) by PSI - Appendux16, ACT distribution pilot project conducted by DWB Switzerland in Dabola - Appendix 17, the community approach of UNICEF) and various surveys (MICS survey by UNICEF 2008 – Appendix 18, 2009 and 2010 coverage surveys by the PNLP – Appendices 19 and 11, respectively), the lessons learned from implementing activities for each intervention field are given in the following table: Domain

Purchasing and widescale distribution of LLINs

Lesson learned The integration of the distribution of LLINs into the PEV/SSP/ME's integrated campaign and the community distribution campaigns to households via local elected officials and NGOs/OCBs made it possible to distribute more LLINs to the populations in 2009 Partnership between the Government, bi- and multilateral partners, national and international NGOs, the private sector, and communities enabled the success of campaigns organized in 2009 The delay in purchasing LLINs from previous rounds (R6 and R2) compromised the achievement of the expected outcomes

IPT coverage

IPT integrated into the PNC (recentered PNC) developed in the health sites in cooperation with the Reproductive Health program and the Programme Elargi de Vaccination /Soins de Santé Primaire ("Expanded Vaccination/Primary Healthcare Program") improved coverage. Delays in purchasing SP during R2 lead to interruptions in drug supplies. Bringing ACT only into public health sites limits people's access to ACT.

Caring for cases

IEC/CCC Social mobilization

The organizational reinforcement, training, and monitoring approaches applied to NGOs/OCBs, members of the ACT distribution pilot project consortium carried out by DWB Switzerland in Dabola, UNICEF, and the PNLP's community interventions in the country's 5 regions financed by GF R6 made it possible to increase access to care. The LLIN Social Marketing program (2004 - 2007) developed by PSI, has shown that IPC and microprograms in rural community radio stations constitute effective communication approaches (Appendix 16) The social mobilization activities using local elected officials and NGOs/OCBs, developed during the LLIN mass distribution campaign, make it possible to make interventions much more effective. The weakness of the health information system lead to difficulties in measuring monitoring and evaluation indicators in previous rounds.

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Measures for R10 Distribution through mass campaigns will continue with R10 The partnership will be continued over the course of the distribution campaign planned for R10, through advocacy at all levels (subactivity 1.1.5.g) Reinforcement of the PCG's capabilities (planned in the HSR) and direct purchasing by CRS This strategy, by training/refreshing PNC Agents, providing management tools, SP, and social mobilization. Reinforcing the PCG's capabilities (planned in the HSR) and the use of group buys (VPP) R10 will make it possible to reinforce this intervention on the community level. These approaches will be capitalized over the course of R10 through partnership between the Government, NGOs/OCBs, and partners.

These activities will be given priority in this R10 proposal The activities to strengthen the NGOs/OCBs' capabilities are planned for round 10 in view of their participation in social mobilization. The indicators in R10 are drawn from the PNLP's Monitoring and Evaluation plan

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ROUND 10 – Malaria Monitoring and Evaluation

The weakness of the community-based information system makes measuring community-based interventions difficult

Coordination

Difficulties of coordinating interventions led to significant delays in the implementation of the R2 and R6 grants,

Delay in acquiring inputs during the previous rounds (R6 and R2) compromised the achievement of the expected outcomes Supply Management The gaps related to supply management did not make it possible to get a good estimate of the ACT needs (needs overestimated, with the risk of oversupply)

R10 will strengthen the community data collection system on care and prevention (activities: 2.1.5, 2.1.6, 2.1.7) Coordination activities are planned at all levels to make up for these deficiencies (activities #: 4.1.1, 4.1.2, 4.1.3) Strengthening the PCG's capabilities (planned in the HSR) and the use of group buys (VPP) will make it possible to acquire inputs on time during R10 The strengthening of supply tracking within the health sites (supervision, monitoring) will make it possible to obtain data for better estimating needs.

4.4.5 Strengthening social equality and equality of the sexes Using specific references to objectives, SDAs, and activities included in section 4.4.1, explain how the Round 10 interventions address issues related to social and gender equality and confirm that these items have been properly costed in the budget. TWO PAGE MAXIMUM This proposal's objective is universal access to malaria preventive measures and care. Unfavorable socioeconomic factors may limit the achievement of this objective. For this reason, this issue has been taken into account in the objectives, SDA, and activities of the present proposal. Objective 1: Raise the proportion of the population covered by LLINs in intervention zones to 100% by 2016 Despite significant natural resources, Guinea is suffering from a high level of poverty, particularly in rural areas where access to basic services, education, and health care remain very limited. According to the UNDP, the Human Property Index (HPI) in 2009 is 50.5% in Guinea, which puts Guinea 129th out of the 135 countries surveyed (Appendix 21). This score indicates the wide disparity that exists in the distribution of wealth and well-being within the population. The poverty level varies by region. Three target regions are among the most heavily affected by poverty: Faranah (61% of the population), N’Zerekore (56%), Kankan (67%). This high poverty rate in the intervention zones has a considerable impact on the prevention and care of cases of malaria, and justifies the scale of the use of CAs in home care for malaria (SDA 3.1) and the free distribution of mosquito nets (SDA 1.1) Households affected by poverty, with multiple needs to finance and limited resources, are less inclined to fight malaria by taking preventive measures. Malaria prevention activities aim to overcoming these social inequalities by providing universal coverage of LLINs within the target area (see section 4.4.1, SDA 1.1, Prevention by LLINs). Objective 2: Raise the proportion of pregnant women receiving the two required doses of SP as part of IPT to 80% by 2016 Malaria disproportionately strikes pregnant women compared to other population groups. Among this demographic, which is highly vulnerable to malaria, the disease causes severe anemia, miscarriages, premature births, and children with low birth weight. This is why pregnant women constitute a priority group of the Guinean government's national malaria policy. To achieve the goal of protecting us at-risk population, this proposal aims to reinforce and upgrade already-proven strategies within the national policy (see section 4.4.1, SDA 2.1, Preventing malaria during pregnancy).

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ROUND 10 – Malaria Objective 3: Detect and treat 50% of all cases of fever/malaria on the community level among children under the age of five in accordance with national directives by 2016 In general, less than 40% of the Guinean population has access to the formal services in the Poverty Reduction Strategy Document (DSRP-Appendix 20). Because of economic and geographic factors, vulnerable households (generally poor and rural ones) have less access to quality health care services than wealthier households. These restrictions access to formal health services, as well as a preference for traditional folk medicine, contribute to the use of community health services. This proposal relies on this existing trend and aims to strengthen the CAs' capacity to improve access to antimalarials on the local services level (see section 4.4.1, SDA 3.1: community care of malaria). Objective 4: Reinforce the program's management and coordination capacities Although the proposal takes into account the sex-specific dimensions and the needs of women, children, and other vulnerable populations, many opportunities remain to be explored in order to better integrate the gender-based approach and the principles of social equality in fighting malaria. It is believed that these opportunities exist not only in implementing the activities, but also in the development of interventions. In order to reinforce the SRs' abilities to capitalize on these opportunities, and to ensure the participation of these vulnerable populations, the proposal plans, at the end of the first year, an exploratory survey to evaluate and enhance the integration of the gender-related aspects and social inequalities in all of the approaches and interventions of R10. The survey will evaluate how the aspect of gender equality and social inequalities will integrate: On the basic level: 

during CCC and LLIN distribution campaigns (SDA 1.2: CCC-Mass Media and SDA 1.1: Distribution of LLINs), in particular in: o o

building awareness among the population regarding the different effects/consequences of malaria in women, men, and children; and have these activities may transform power dynamics within the family regarding making decisions to consult health services for women (including pregnant women), men, and children under 5 (which may have an impact on access by women to PNC and IPT, and access by children to treatment; see SDA 1.1; SDA 2.1; SDA 3.1);

On the community level: 

during the implementation of community relay activities (SDA 1.3: CCC-Community relay) o



especially concerning the involvement of women and women's organizations/associations in crafting and implementing community interventions, as well as in identifying OCBs to supply with TA;

In recruiting women qualify to become CAs (SDA 3.1: community care of malaria) so that they can receive health/CA training, capacity reinforcement activities, and financial support.

On the political level: 

in strengthening anti-malaria partners (SDA 4.2: Reinforcing the human, logistical, and management capabilities of the PRs/SRs and OCBs) o o o

to promote an environment favorable to the integration of gender issues within stakeholders, including through sex-specific training; to ensure proper replication of women in decision-making/leadership in the malaria division; to craft sex-specific policies in fighting against malaria.

On the monitoring-evaluation level: 

to ensure the institution of a data collection system broken down by age, sex, and environment, in order to enable the analysis of the impact of malaria-fighting activities on different groups of the population (cross-disciplinary SDA).

This is budgeted in the TA needs section.

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ROUND 10 – Malaria 4.4.6 Partnerships with the private sector Describe how contributions related to: (i) co-investment from the private sector, and (ii) donated goods or services, will add value to the planned outcomes of the proposal. Make specific reference to the associated objectives, SDAs, or activities to which they are linked. HALF PAGE MAXIMUM Despite an abundance of natural resources and national policy centered around the liberalization of economic activities, the Guinea private sector remains very rudimentary. Le DSRP II (2007-2010) (Appendix 20) identifies five main restrictions to the development of the private sector and the Guinean economy in general: (i) an administrative environment that stifles private investors; (ii) corruption; (iii) a lack of production infrastructure and assistance structure; (iv) structural problems which make the financial system defective; and (v) poor access to reliable information combined with poor collaboration between the government and the private sector. According to the DSRP, these factors results in the formal private sector being dominated by the informal economy. Unfortunately, this background eliminates any possibility of co-investment, except with mining and telephone companies. Nonetheless, the Guinean government has established some public-private partnerships with multinational companies that will contribute to the achievement of the project's goals as co-investors. BHP Billiton is active in the fight against malaria through IRS, the distribution of LLINs, reinforcement of the capabilities of DPSanté and local NGOs as well as mobilization in favor of the health and cleanliness of the communities surrounding its sites of operations since 2006 (Lola, Boffa and Boké). An agreement between BHP Billiton and the PNLP has enabled better operations in these prefectures. However, it is important to note the non-existence of a co-investor partnership between BHP Billiton and the Guinean government as part of financing health programs in Guinea. BHP Billiton's current contributions (LLINs, IRS), as well as those planned in the coming years, specifically the training of OCBs in the use of ACTs, the reinforcement of the capabilities of prefectural health offices, as well as local NGOs, will help achieve the objectives of Round 10. At the time of the proposal, no donated goods or services have been announced to contribute to the intended outcomes of this proposal, hence the difficulty in identifying co-investors or donors. The present proposal includes recruiting a national consultant to explore the possibilities of public-private partnership for achieving the R10 goals. This consultant will organize a national workshop for sharing and harmonizing approaches and activities from different sectors in fighting malaria in order to show the contributions of each one and mobilize contributions from the private sector. Only complete section 4.4.7 if the applicant selected Option 2 or 3 in section 3.1 of the Proposal Form, DO NOT COMPLETE section 4.4.7 if the applicant selected Option 1 in section 3.1 of the Proposal Form Option 1 = Transition to a single stream of funding by submitting a consolidated disease proposal Option 2 = Transition to a single stream of funding during grant negotiation Option 3 = No transition to a single stream of funding in Round 10

4.4.7 Links to other Global Fund resources Describe in the table below the linkages between this Round 10 proposal and existing Global Fund resources. It is important to list the SDAs and activities as outlined in the proposal in the left hand column, add a description as to how they relate to previous grants in the middle two columns, and then outline how the Round 10 proposal specifically addresses this in the right-hand column. Key SDA and activity as proposed in the Round 10 proposal

Existing grants R2

Round 10 proposal R6

SDA 1.1: Prevention by LLINs

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ROUND 10 – Malaria 1.1.1 Purchasing LLINs

1.1.7 Conducting studies of the effectiveness of insecticides on vectors

Yes: 121,527 LLINs distributed in 2009 No

Yes: 1,229,433 LLINs distributed in 2009 and 210,208 planned for phase 2 Yes: one study planned for year 5 (2012)

3,368,241 LLINs to ensure and maintain universal coverage On study in year 4 (2014)

SDA 1.2: CCC-Mass Media 1.2.2 Design, production, and broadcast of radio ads

1.2.3 Design, production, and broadcast of TV ads 1.2.5 Conception and production of posters

No

No

No

Yes: 2880 broadcasts on 15 radio stations years 3 – 4 – 5 (2010, 2011 and 2012) Yes: 360 broadcasts years 3 – 4 – 5 (2010, 2011 and 2012) Yes: 95750 posters years 3 – 4 – 5 (2010, 2011 and 2012)

19,152 ads in 12 rural and community radio stations within the zone of the project 150 broadcasts during the LLIN mass distribution campaign 112,780 posters

SDA 1.3: CCC-Community leaders 1.3.1 Production of picture boxes

Yes: 2,810 boxes produced and distributed to CAs

3336 boxes to distribute to CAs, OCBs, agents of NGOs and HCCs

No

Yes: 1190 CAs trained in phase 1 R6 and 810 ASC in phase 2, year 3

Training 2480 CAs in the zone of the project

No

Yes: Purchasing 5,468,372 doses for the entire country

No

Yes: 2000 kits year 3 and 5

No SDA 2.1: Preventing malaria during pregnancy 2.1.5 Training/Refreshing CAs in fighting malaria (care, LLINs, IPT, IPC, Data collection) SDA 3.1: Community care of malaria 3.1.1 Purchasing ACT

3.1.4 Purchasing care kits for CAs 3.1.9 Monitoring the therapeutic effectiveness of ACTs

Purchasing 1,532,204 doses to cover community care in the intervention zones during phase 2 Purchasing 2,100 kits the cover the zone of the project

Yes: a study A study planned for planned for 5 year 4 at 4 pilot sites (2012) SDA 4.2: Reinforcement of human, logistical, and management capabilities of PRs/SRs and OCBs No

4.2.9 Purchasing computer kits for the PRs, SRs and SSRs

4.2.10 Purchasing 4x4 vehicles for Coordinating interventions

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No

Yes: 41 kits (desktops) and 11 laptops provided in 2008 to PNLP, SNIGS, DAAF, CCSP and health districts

No

Yes: 5 vehicles provided in 2008 to the PNLP, SNIGS

57 computer kits: CRS: 5 laptops, 3 desktops, PNLP: 6 laptops, 4 desktops, SR: 2 laptops, 2 desktop/SRs, SSR: 19 laptops 10 vehicles: 2 for the civilian PR (CRS), 5 for the SRs and 3 for the PNLP in year 28/68

ROUND 10 – Malaria three 4.2.13 Purchasing bicycles for the CAs No 4.2.15 Coverage survey of malaria prevention and treatment interventions 4.2.16 Conducting a KAP survey on malaria

No No

Yes: 737 bicycles in 2009 were distributed outside of the R10 zone Yes: 3 in surveys years 3, 4 and 5 of R6 (2010, 2011 and 2012) Yes: a survey in year 4 (2011)

2,350 to distribute in the R10 zone 3 surveys in years 3, 4 and 5 (2013, 2014 and 2015) A survey in year 5 (2015)

4.4.8 Links to non-Global Fund resources Describe whether the Round 10 interventions (e.g. goals, objectives, SDAs, and activities) listed in section 4.4.1 have linkages to programs financed through non-Global Fund resources. If such linkages exist, list the non-Global Fund financed programs and their activities, and explain how the proposal complements those programs and activities. In addition, explain how the Round 10 interventions do not duplicate existing programs and activities supported by non-Global Fund resources. ONE PAGE MAXIMUM The following table describes the linkages between the R10 interventions and other funding to fight malaria in Guinea. When planning for R10, funding from the IsDB for purchasing LLINs and first aid kids, the OMVS (Senegal River Basin Development Authority) for LLINs, DWB Switzerland which cares for cases in the prefecture of Gueckedou, the WHO which finances TA and Plan Guinea, UNICEF and the Government which supports the structures in purchasing essential drugs. The MSHP has instituted a malaria workgroup which is tasked, among other things, with taking care to avoid duplicating funding when fighting malaria. Given the insufficiency of information in funding from partners, it has been planned within this proposal to organize a national workshop for sharing and harmonizing approaches and activities by the different stakeholders in fighting malaria. Malaria-fighting interventions Preventing malaria via LLINs

Care of cases (care)

Partner-financed programs

Round 10 proposal

Producing 1,200 000 LLINs financed by the Islamic Development Bank (IsDB), and 490,000 financed by OMVS/CRS WHO: Providing TA for monitoring vector resistance to insecticides

SDA1.1 Prevention via LLINs: planned purchase of 3,368,241 LLINs for the routine distribution and replacement campaign in the zone of the project SDA 1.1: Prevention via LLINs: Assumption of operational costs by R10

Anti-malaria project by MSF/Suisse in the prefecture of Gueckedou: care of cases on the HCC and community level

SDA 3.1: For Gueckedou, community care of cases of malaria is handled by MSF. For all other interventions, the R10 plans to include the supply of inputs (except for operational activities, which will be provided by MSF)

Drugs purchased for serious cases and second-line treatment by UNICEF, Plan Guinea, the IsDB and the Guinean government

SDA 3.1: R10 purchases the first-line ACTs (ASAQ) for the zone of the project

Providing TA for monitoring drug resistance

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SDA 3.1: community care of malaria (Activity 3.1.8)

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ROUND 10 – Malaria 4.4.9 Strategy to mitigate unintended consequences of additional program support on health systems Describe the potential risks and unintended consequences on health systems that may result from the implementation of the proposal. Describe the proposed strategy for mitigating these potentially disruptive consequences. TWO PAGE MAXIMUM The potential risks and unintended consequences on the health system that may result from the implementation of this proposal are: 

Overworked healthcare personnel, who are often too few in number to meet the requirements of many health programs (oversight, caring for referred cases, managing drugs, collecting data, etc.);



Overworked CAs, who, in addition to being used by other programs, will provide care for cases, home visits, CCC activities, etc.



Failure to make gains from the program's activities last, due to dependence on outside funding and low mobilization of government resources;



The development an extension of vector resistance to insecticides, as has already been observed and reported in a recent publication within the intervention zone of R10, in which 79% of the studied population of Anopheles gambiae exhibited the kdr insecticide-resistance gene (P. Carnavale et al., 2010; Appendix 7);



The development of malarial parasite resistance to ACTs, which may be encouraged by the large-scale use of these drugs, especially in the absence of a biological confirmation of the diagnosis;



Risk of overusing ACTs, owing to the syndromic approach adopted for the care of cases on the community level;



The medicalization of ACTs, who may become health agents and care for other illnesses;



The hijacking of drugs to be sold illegally on parallel markets;



The effects on the environment of used LLINs and packages.

To minimize these risks, several interventions will be conducted in integrated fashion along the entire health pyramid: 

The recruitment and assignment of personnel to health structures by the Department of Health;



Advocacy for mobilizing national resources: government, private sector, community participation;



The implementation of drug monitoring;



Monitoring vector resistance to insecticides and parasite resistance to antimalarials within the pilot sites with the support of the research;



Integrated supervision and coordination of CA and OCB activities by health agents and SSRs;



The supervision and monitoring of activities including drug management;



The implementation of directives for managing waste within health structures and during mass campaigns.

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ROUND 10 – Malaria 4.5

Program Sustainability

4.5.1 Strengthening capacity and processes in malaria service delivery to achieve improved health and social outcomes Describe how the proposal contributes to overall strengthening and/or further development of public, private and community institutions and systems to ensure improved malaria service delivery and outcomes.  if available, refer to country evaluation reviews  Support explanation with excerpts from documents that the country has adopted, identifying the source, such as a National

Disease Strategy

ONE PAGE MAXIMUM The implementation of the present grant will make it possible to strengthen the existing systems in order to enable the population have access to better-quality services and improve outcomes: 1. Strengthening community systems As part of the effort to boost primary health care, the completion of the activities planned within the present grant will contribute to achieving the objectives of "The New Vision for Community Participation Centered Around the Appropriation of Basic Healthcare Services" (Appendix 23). The strengthening of national OCBs and ONGs in terms of training (SDA 1.3 and 2.1), computer equipment, and logistics (SDA 4.2) will make it possible to enable them to conduct malaria-fighting activities (caring for cases by CAs, awareness-building, leadership, etc.). The final goal is to make these organizations capable of connecting interventions beyond malaria-fighting activities. 2. Strengthening the decentralized health structures: Regional Health Offices (DRS) and Prefectural Health Offices (DPSs) The various planned training (training trainers, training health agents in PNC and data management, etc.), support for supervision, granting logistics and means of communications enabling the health structures to be more effective in implementing, coordinated, and monitoring malaria-fighting activities. 3. Strengthening the National System for Monitoring and Evaluating Anti-Malaria Activities (training, computer hardware, logistical means) With the introduction of community care of malaria, collecting data on the community level is planned. This will enable SNIGS to incorporate the community data. This is why R10 has planned to strengthen the capabilities of health agents to collect, analyze, and retrieve data on the community level (SDA2: 2.1.5, 2.1.6, 2.1.7, SDA4:4.2.1 and 4.2.2.) 4. Strengthening the National Supply System The improvement of the storage, distribution, and management capacities of the various health zones' distribution warehouses is planned by the HSS component. Furthermore, the payment of drug and health product purchasing management fees planned in this grant will enable PCG (official structure tasked with purchasing and supply) to have financial resources for its operation and thereby to strengthen its sustainability. 5. Strengthening the Research Institutions The strengthening activities (activities 4.2.17 and 4.2.18) planned to ensure the monitoring of drug resistance and of vector resistance to insecticides will make it possible to improve the capabilities of the INSP, the School of Medicine at the University, and the National Rural Health Research Institute, which will be tasked with the operational research identified within the framework of this grant.

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ROUND 10 – Malaria 4.5.2 Alignment with broader developmental frameworks Describe how the proposal’s strategy aligns with broader developmental frameworks such as:  Poverty Reduction Strategies;  The Highly-Indebted Poor Country (HIPC) initiative;  The Millennium Development Goals;  An existing national health sector development plan;  Any other important initiatives. ONE PAGE MAXIMUM The implementation of this proposal whose interventions are centered around the MDGs, the Poverty Reduction Strategy (PRS) and the strategies of the National Health Development Plan (PNDS) will, through synergistic action, produce lasting effects within the communities. According to the 2010 interim PRS document*, all macroeconomic indicators show that the country is in an unfortunate situation. In 2010, the economy's growth rate is not high enough to bring poverty down (3.7%). The rate of inflation is still high (18.2%) and contributes to eroding the purchasing power of the people, who continue to grow poorer. Also, according to the results of the Brief Poverty Evaluation Study (ELEP-2007), the poverty rate, which was 49.2% in 2002, reached 53% in 2008. Domestic and foreign debt heavily increased over the past few years, thereby compromising any chance of reaching the endpoint of the Highly-Indebted Poor Country initiative, which would have enabled the country to substantially reduce its debt. In view of rectifying the situation, the government adopted in 2002 and revised in August 2007 the Poverty Reduction Strategy (PRS) document, which incorporates all of the country's sectors of socioeconomic development. This strategy is inspired by the document "Guinea, Vision 2010", whose ultimate goal is to improve the living conditions of the population. The documents on health policy and strategic planning to fight diseases (including malaria) draw inspiration from this approach. Furthermore, Guinea has joined the "Santé pour Tous" global strategy, having adopted its national health policy, which fundamentally relies on the strategy of primary health care (PHC) adopted by the WHO in 1978 and in the global "Roll Back Malaria" (RBM) plan. This primary healthcare strategy relies on the harmonious integration of curative, preventive, and promotional care, the promotion of individual, family, and community health, and the participation of the community in designing, funding, carrying out, and evaluating health actions. The general objective is to ensure that all men and women living in the country, regardless of geographical, economic, and socio-cultural barriers, receive quality health services. This means instituting an accessible health system capable of meeting the population's health needs. Having signed the Roll Back Malaria plan, the country has set specific goals for 2015 in accordance with the MDGs to reduce specific mortality due to malaria by 40% from 2003 to 2015, and immortality of children under five from 177 per thousand to 90 per thousand. R10 will effectively contribute to achieving these goals. With respect to the PNDS, which covers the period 2003-2012, five strategic paths have been adopted; they are i) the integrated fight against illness and maternal mortality; ii) strengthening institutional and management capacity; iii) improving the care offered and the use of services; iv) developing human resources; and v) promoting health. The goals of R10 are also aligned with the strategies of the PNDS. Thus, we can state that R10 is truly in keeping with the PRS, the MDGs (especially MDGs 4, 5, 6) and the PNDS; and it is plausible that the current restoration of constitutional rule, the best indicator for instituting good governance in managing public affairs, will enable us to earn back the trust of partners in development and resume growth that can substantially reduce poverty. (Reference: Interim Poverty Reduction Strategy Document (2010-2011).)

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ROUND 10 – Malaria 4.5.3 Improving value for money Explain how the program that the proposal contributes to represents good value for money. Specifically, given the context of the epidemic in the country and the definition of value for money provided in the Guidelines, describe how the key interventions in the proposal represent the best balance of costs and effectiveness, with consideration to the desired achievement of both short and long term impacts. ONE PAGE MAXIMUM The "Mise à échelle des interventions de lutte contre le paludisme dans les zones hyper et holoendémiques de la Guinée" project aims to significantly reduce the incidence of malaria in these zones, where the risks of morbidity and mortality are high within the population. This reduction in the incidence of malaria will contribute to improving the productivity of the community as well as its income and reducing expenses related to caring for cases. Supplying structures with LLINs, following the normal supply chain for drugs, will make it possible to reduce transport- and distribution-related costs. Likewise, the free distribution of LLINs in health structures encourages the use of PNC services, while improving the end of pregnancy, saving resources that will be necessary to handle complications later on. The implementation of CCC-Media and CCC-Community leader interventions will make it possible to improve the use of the LLINs, and the mobilization of populations for community care of malaria by the CAs. The OCB will also be mobilized to ensure the awareness of the communities in methods of preventing and treating malaria. Through popular songs, staged scenes, and skits, the OCBs will convey educational messages on preventing malaria. Additionally, the CAs will make home visits that will make it possible to dispense advice, evaluate the use of LLINs, and detect cases of malaria and refer pregnant women to help structures for preventing malaria during pregnancy; all of these interventions will engender a moderate cost, with regard to the long-term benefits of preventing malaria and acquiring knowledge in malaria protection methods. Community care of cases of malaria, which includes training CAs, distributing ACTs, and improving the population's access to care services, and thereby reduces the occurrence of serious cases whose care would require greater outlays. The community agents, well-trained and equipped with appropriate means for care, represent a good investment in the sustainability of long-term interventions. The organization of monitoring-evaluation on the community level improves the notification of cases, favors fast decision-making, and thereby contributes to implementing corrective actions in a short period of time. This increases the performance of the system. A high-performance monitoringevaluation system enables a better allocation of human and financial resources, effective control of the expense chain, and improvement of quality of service. Finally, the strengthening of the capacities of national NGOs, OCBs, and CAs will contribute to amplifying and making sustainable the interventions on the community level while encouraging a better appropriation of these interventions by the population. These structures will be able to continue after the end of the project to promote good actions taken during the project. Although the proposed budget for each activity is based on the experience of the PRs in fighting malaria in Guinea, historical data on the costs of antimalarial interventions is lacking on the national level. The RBM document from March 2010 (Progress and impact series) Roll Back Malaria Progress & Impact Series: Malaria Funding and Resource Utilization: The First Decade of Roll Back Malaria does not include any overview of the financing of antimalarial activities in Guinea. Nonetheless, the financial monitoring of the activities proposed for R10 with EDS scheduled for 2011 will produce reliable data enabling an analysis of the value for money of antimalarial interventions in Guinea.

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ROUND 10 – Malaria 4.6

Monitoring and Evaluation System

4.6.1 Impact and outcome measurement systems Describe the impact and outcome measurement systems, including strengths and weaknesses, used to measure achievements of the program at impact and outcome level. The situational analysis of the PNLP's Monitoring and Evaluation (M&E) plan conducted in March 2008 with the support of the GF enable the implementation of a reinforcement plan. By the end of this plan's review, the system's strengths and weaknesses became clear. These strengths and weaknesses concern the institutional framework, data collection tools, activity monitoring tools, and the M&E system's funding. Strengths 

Existence of a PNDS 2003-2012 in which the global framework of the M&E; and a coordination and tracking mechanism for the health sector that takes into account the M&E aspects;



Existence of a session in charge of the national health information system with clearly defined missions, and decentralized structures in charge of statistics at the intermediate and peripheral levels;



Existence of a national malaria policy document (Appendix 5), a strategic anti-malaria plan 2006-2010 (Appendix 6) whose evaluation is planned for early 2011 in view of drafting the 2011-2015 plan (3rd generation) with the support of the WHO;



Existence of a M&E plan 2008-2012 which is currently being updated to cover the periods 2013-2015, and an M&E framework for the components of the GF (Round 2 and Round 6);



Existence of an M&E unit within the PNLP with the personnel made up of three public health doctors trained in M&E;



Instituting a M&E referral group with a malaria technical group.



The malaria data are integrated into the SNIGS's primary tools: care for cases, IPT, routine distribution of insecticide-treated nets



The SNIGS database (Monthly Health Information Reports - RAMIS) from the central level and from the DRS takes into account the PNLP's main routine data needs;



An additional database exists at the PNLP for specific information.



The data on malaria-fighting activities on the community level has been collected since 2009;



The integrated monitoring tools used by the different levels of the health system in order to give information on the health programs (monthly, quarterly, and biannual reports; 2007 statistics directory - Appendix 8, monitoring) take into account anti-malaria interventions;



The PNLP and the various parties involved in fighting malaria occasionally collect information specific to the program depending on the partners' needs and requirements;



The PNLP measures the national coverage indicators, outcomes, and impact of the program by way of representative national EDS, MIS, and MICS surveys and surveys in health sites;

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ROUND 10 – Malaria 

The M&E system receives financial support from the government and its development partners, particularly USAID, Global Fund, WHO, UNICEF, WB, and RBM.

Weaknesses Performance insufficiencies by the PNLP's M&E system remain: 

Little coordination of the interventions implemented by the various parties involved in fighting malaria;



Insufficient collection, analysis, and distribution of malaria data at different levels of the health pyramid;



The absence of harmonized monitoring tools like the technical M&E guide for malaria-fighting interventions;



The absence of data quality verification and management procedures collected in the field;



Low functionality of the SNIGS and PNLP databases;



Insufficiency in the operation of the pilot sites;



The absence of an integrated M&E system for community-based services;



The budget devoted to M&E remains insufficient and did not match the recommended rate of 5-10% of the budgets of PNLP plans.

4.6.2 Impact and outcome measurement (a)

Has impact and/or outcome data been collected in the last 2 years?

No

X Yes  answer section 4.6.2 (b)

 go to section 4.6.2 (c)

(b) What was the source(s) of the measurement?

 insert source (large scale surveys, demographic surveillance, vital registration systems, other)

(c) It is important to guarantee that there are systems in place to measure all impact and outcome indicators in the performance framework. In order to do this, fill in the table below, fully describing all planned surveys, surveillance activities and routine data collection in country used to measure impact and outcome indicators relevant to the proposal. Add rows as needed. Data Source Source 1 Directory of health statistics Source 2 Demographic and Health

Funding Total cost Secured funding amount and funding source Funding gap Round 10 funding request for Source 1 Total cost Secured funding amount and funding source

2011 10000 USD

Years of Implementation 2012 2013 2014 10000 USD 10000 USD 10000 USD

2015 10000 USD

10000 USD UNICEF

10000 USD UNICEF

10000 USD UNICEF

10000 USD UNICEF

10000 USD UNICEF

0

0

0

0

0

0

0

0

0

0

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700,000 USD 700,000 USD USAID, WP,

Impact/Outcome Indicators relevant to the proposal to be measured by data source

Incidence of clinical cases of malaria (estimated and/or declared)

- Death rate due to malaria; mortality rate for children under five, all cases combined; - Percentage of households with at least one impregnated mosquito net; 35/68

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UNFPA 0

Funding gap

Round 10 funding request for Source 2

0

Total cost Secured funding amount and funding source Funding gap

200000 USD

Round 10 funding request for Source 3

0

200000 USD

0

Source 3 MICS

Source 4 Coverage surveys of anti-malaria interventions

Total cost Secured funding amount and funding source Funding gap

Round 10 funding request for Source 4

60000 USD

60000 USD

60000 USD

60000 USD

60000 USD

60000 GF R6

60000 GF R6

0

0

0

0

0

60000 USD

60000 USD

60000 USD

0

0

60000 USD

60000 USD

60000 USD

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- Percentage of children under five sleeping under an impregnated mosquito net; - Percentage of pregnant women sleeping under an impregnated mosquito net; - Percentage of pregnant women who received at least 2 doses of SP during the IPT - Percentage of children under five (and other target groups) suffering from malaria/fever and receiving appropriate treatment within 24 hours (community/health structure) - Percentage of households with at least one impregnated mosquito net; - Percentage of children under five sleeping under an impregnated mosquito net; - Percentage of pregnant women sleeping under an impregnated mosquito net; - Percentage of pregnant women who received at least 2 doses of SP during the IPT - Percentage of children under five (and other target groups) suffering from malaria/fever and receiving appropriate treatment within 24 hours (community/health structure) - Percentage of households with at least one impregnated mosquito net; - Percentage of children under five sleeping under an impregnated mosquito net; - Percentage of pregnant women sleeping under an impregnated mosquito net; - Percentage of pregnant women who received at least 2 doses of SP during the IPT - Percentage of children under five (and other target groups) suffering from malaria/fever and receiving appropriate

ROUND 10 – Malaria treatment within 24 hours (community/health structure)

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ROUND 10 – Malaria 4.6.3 Links with the National M&E System (a) Describe how the monitoring and evaluation (M&E) arrangements in the proposal (at the Principal Recipient, Sub-recipient, and other levels) use existing national indicators, data collection tools and reporting systems including reporting channels and cycles. ONE PAGE MAXIMUM A performance framework for the present proposal (Appendix A) was drafted based on the M&E Indicators of PNLP's national M&E plan (Appendix 22). This plan was drafted in response to the selfevaluation of the M&E systems performed in 2008 with the support of the GF and the WHO. The reinforcement plan (Appendix 3) drafted at the end of this exercise made it possible to strengthen SNIGS and PNLP's M&E du PNLP unit in terms of supervision logistics, computing tools, databases, data collection tools and training personnel. The data collection needed to fill in the indicators will be done using the national health information system (SNIGS), which collects data on morbidity, mortality, and the use of services in all health sites. With regard to outcome and impact indicators, the surveys planned within the performance framework have already been conducted in the country. There are local skills (consultants, research offices) for conducting these surveys. For surveys which require skills that are not available (For example, EDS and MIS), a TA will be requested from the partners (WHO, RBM, USAID, WB, etc.). With respect to community interventions that will be carried out as part of R10, the collected data will follow the MSHP's normal circuit. As part of introducing care for simple cases of malaria with ACTs, the PNLP has drafted and distributed data collection tools (CA pointing notebook, CA monthly report form). These tools will be used, with adaptations if necessary, to collect data. The personnel of the decentralized structures and the central level (SNIGS, PNLP) is responsible for collecting, compiling, analyzing, and distributing the information. Biannual monitoring of health sites will incorporate the activities planned in this project. Monitoring makes it possible to reveal all health activities, and the findings are presented during the Prefectural Technical Health Council, the Regional Technical Health Council, and the Annual National Review. The forwarding circuit will go by the SNIGS' normal circuit. However, in order to satisfy the need to inform civilian stakeholders, all the reports will be produced in duplicate, one copy of which will be transmitted to the civilian PR and SRs.

(b) Are all of the M&E arrangements planned for the proposal using the national M&E system?

X Yes  go to section 4.6.4

No  continue to section 4.6.3 (c)

(c) If no, explain why not and list any service delivery areas (SDAs) and/or activities that will not be monitored through the national M&E system. N/A

4.6.4 Strengthening monitoring and evaluation systems (a) Has a multi-stakeholder national M&E assessment been recently conducted (in last 2 years)? (b) If yes, has a costed M&E action plan been developed or updated to include identified M&E strengthening

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X Yes

No

 continue to section 4.6.4 (b)

4.7

X Yes

No



 go to section

continue to section

 go to section

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ROUND 10 – Malaria measures?

4.6.4 (c)

4.7

(c) Describe whether the proposal is requesting funding for any M&E strengthening measures. These strengthening measures may have been identified through a national M&E assessment or any other relevant evaluation or review process. HALF PAGE MAXIMUM M&E system weaknesses Institutional framework and coordination  analyzing, distributing, and using the data in view of planning and management is performing poorly  irregular supervision  nonexistence of a community-based information system Data collection  Lack of qualified personnel to collect and process data from hospitals Data transmission  incompleteness of health establishment reports  lateness of health establishment reports  nonexistence of basic information and communication technology equipment (telephones, Internet access)

R10_CCM_GIN_M_PF_s3-5_27Sept10_En.doc

       

Planned strengthening measures training sophistical managers and data collection agents in media, statistics software and database software, etc.; integration of supervision activities at all levels of the health pyramid adaptation, production and distribution of data collection tools intended for CAs training CAs in collecting health data Granting hospitals computer equipment Training hospital agents in collecting and processing static data Revision of the plan and contents of the health statistics directory connection to the Internet for facilitating transmission of health data

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ROUND 10 – Malaria 4.7

Implementation Capacity

4.7.1 Principal Recipient(s) Describe the technical, managerial and financial capacities of each Principal Recipient (PR) to manage and oversee implementation. Include any anticipated limitations to strong performance and refer to any existing assessments of the PR, other than Global Fund reporting mechanisms. Copy and paste tables below if there more than three Principal Recipients

PR 1 Name

Ministry of Health and Public Hygiene

Street Address

Boulevard du Commerce, BP 585, Conakry, Republic of Guinea

Sector

Government

The primary mission of the Ministry of Health and Public Hygiene is to design and draft the government's health policy; to coordinate and control the execution of the activities of the agencies which are charged with implementing that policy; to draft legislation and national regulations regarding health and medicine; and to regulate the professional practice of doctors and pharmacists. As part of designing and managing the programs, the MSHP implements sectorial programs whose main focuses are: i) fighting disease and maternal and neonatal mortality, ii) strengthening institutional and management capabilities, iii) improving care that is offered and the use of services, iv) developing human resources, and v) promoting health. For this purpose, it conducts, among other things: 

Three (3) health system strengthening project with AFDB;



Three (3) projects with the World Bank on Reproductive health and the improvement of health coverage;



Six funding agreements with the WB: 2 for malaria, 2 for AIDS, 2for tuberculosis;



Multiple projects with the UNFPA, UNICEF, European Union, GTZ, AFD, WHO etc.

With the support of partners (Global Fund, WHO, RBM, UNICEF) the Ministry of Health and Public Hygiene has instituted the technical tools needed to plan, implement, and monitor/evaluate in the fight against malaria in the country: National Health Development Plant, National Anti-Malaria Policy, Anti-Malaria Strategic Plan, Monitoring/Evaluation plan, etc. In the field of financial management, the Office of Financial Affairs has a pool of specialists in financial management and accounting. Within the sectorial programs and projects, there is an administrative and financial department which ensures the management of financial and material resources. The projects financed by the GF are managed based on administrative, financial, and accounting procedures instituted by the MSHP and approved by the GF. The training of accountants, the recruitment of an accounting agency, and the installation of accounting software (Tom Pro) have made it possible to strengthen the PNLP's financial management and the MSHP's DAAF. The National Anti-Malaria Program (PNLP) which acts as the MSHP's technical agency in fighting malaria brings together all stakeholders who work within the country. It is led by a National Coordinator assisted by and Assistant National Coordinator and includes: 

an M&E and Research section



a vector-fighting section



a disease care section



a Community-Based interventions section



a pharmacy section



an administrative and financial department

As part of its Strategic Plan and annual operational plans, the PNLP implements activities funded by the government and by various partners in the fight against malaria: grants from the Global Fund, GUINEA WHO Cooperation, GUINEA UNICEF Cooperation, etc. Since 2004, it has executed two rounds of the GF (round 2 and round 6) under the authority of the Ministry of Health (principal recipient). The implementation of this funding has made it possible to achieve results in implementing the

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ROUND 10 – Malaria interventions, which include: 

Popularizing LLINs (More than 3,024,000 LLINs distributed in 2009)



Integrating care of cases with ACTs in all public health sites (448 structures supplied)



Training service providers (650) and community agents (3600) in fighting malaria



Instituting the IPT strategy on a national scale;



Promoting community participation in anti-malaria activities;



Implementing the monitoring & evaluation plan: training, instituting data collection tools and databases

The main difficulties encountered may be summarized as an insufficiency of human resources within the Program's management unit, insufficient coordination of interventions, difficulties in managing the data for M&E and a low level of contracting activities with implementation partners. The challenge to address over the years to come is upgrading anti-disease interventions within an unfavorable political and economic environment particularly characterized by a low level of funding in the sector (3.5% of the national budget is allocated for health). The plan solutions are primarily strengthening the PNLP's human and logistical capabilities (recruiting a pharmacist and a financier), strengthening the Program Monitoring and Coordination Team, setting up the functional M&E technical group, strengthening the PNLP's absorption capabilities by contracting with partners, and advocacy for mobilizing financial resources.

PR 2 Name

Catholic Relief Services USCCB

Street Address

1992B Rue DI 263 Cité Ministérielle, Camayenne, Conakry, Guinea

Sector

Civilian

 Description CRS was founded in 1943 by the United StatesConference of Catholic Bishops in order to assist the poor and underprivileged abroad and has been present in Guinea since 2000. To date, CRS has received more than $85 million to support 33 projects in 19 countries through seven of the GF's eight regions. Currently, CRS executes 17 projects, 3 of them as a Principle Recipient, in 10 countries, with a total program value of $80 million. CRS supports international assistance and development actions in more than 100 countries and territories around the world. CRS' personnel includes 5000 employees around the world, 91% of whom are national employees of the countries in which CRS operates. CRS' total expenses for fiscal year 2009 were $806 million. Experience with the GF CRS is currently a principal recipient in three countries: Benin and Niger for the Seventh Round and Gambia for the Ninth Round, all for malaria. It was also the principal recipient for the Second Round for HIV in Madagascar. CRS' country programs are supported by a special grants support unit (SGSU) based at headquarters and financed by CRS' private funds, made up of three high-level managers with vast experience in program management and quality. The SGSU offers assistance to the CRS program countries in starting up and managing grants financed by the GF. Furthermore, the unit reviews progress updates and requests for withdrawals in order to ensure that there is proof of performance and that the financial reports are clear, accurate, and well-documented. Managing sub-recipients As a Principle Recipient of the GF in Benin, Niger, and Gambia, CRS currently manages 11 sub-grants through local and international organizations. Thanks to high-quality withdrawal systems, accurate and complete documentation of its grant decision processes, a proactive commitment and reinforcement of sub-recipients' capabilities, CRS has successfully managed more than 20 large multi-institution program consortiums all at once. During fiscal year 2009, the total value of the grants to the SRs and contracts signed with execution partners was $429 million.

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ROUND 10 – Malaria CRS' interventions on the operational level are almost always done by the local partners such as diocesan structures, government agencies, and local NGOs, using a contracting approach. This enables it to manage large projects, coordinate operations with multiple stakeholders for better integration of interventions, and strengthen the abilities of local stakeholders. This ensures the basis of appropriation and sustainability of interventions on the local level. Financial Capacity CRS manages grants using its current proven management model, which facilitates the simultaneous management of multiple programs supported by a large panoply of donors. CRS uses Sun Systems' accounting software for all operations in the field and JD Edwards for office operations and the agency's consolidated reporting. These systems enable the CRS' operations in the field to identify and check the source and use of funds coming from all sources of financing within a bank account in each country. The financial management systems operated by CRS are compliant with United States Generally Accepted Accounting Principles (USGAAP) for auditing, transparency, and documentation. CRS has detailed policies and procedures governing financial management and transactions, both internally and with its partners. CRS' ledgers contain information about all grants, authorizations, debts, unpaid balances, advances, assets, expenses, income, and interests. The highly qualified financial personnel at CRS and the management quality coordinators in the representation-countries ensure the integrity of the financial operations, budgeting, and reporting. Furthermore, CRS' program-countries are supported by a regional quality management team, made up of an assistant regional director for managing quality, a regional finance manager, and a regional information systems administrator. Work in all the program-countries is also supported and reviewed by accounting and financial professionals at CRS' headquarters. Annual external audits of CRS are conducted by an independent chartered accountancy firm. Regular audits of the program-countries are conducted by the internal audit department at CRS' headquarters and contribute to the agency's formal auditing process. The internal audits are conducted about once every two years. Technical capacity Technical capacity - Monitoring and Evaluation CRS has a well-developed Monitoring & Evaluation and reporting system for all projects. The design, management, and application of these systems are detailed in the Monitoring and Evaluation reference works in CRS' ProPack series. CRS' Monitoring & Evaluation systems are designed and implemented to generate useful, timely information and to provide project managers and other stakeholders with reliable data about the results and outcomes of interventions. Efforts underway to strengthen the project monitoring systems will enable project personnel to generate the necessary information which support programmatic decision-making in management. Technical capacity - Malaria During fiscal year 2009, CRS managed 106 projects with health components, including malaria, in more than 29 pays around the world for a total value of more than $60 million. Funding for these projects come from a variety of backers. CRS has been successfully managing GF resources for malaria projects since 2005 in countries like Bolivia, the Democratic Republic of the Congo, the Philippines, Senegal, and Sierra Leone. Women and young children are the primary target beneficiaries, and the design of CRS' projects integrates changes in behavior for men, grandparents, and community leaders as well as mothers. Working in direct collaboration with national health authorities as well as local organizations, CRS strengthens community capacities and contributes to intensifying anti-malaria programs in order to maximize coverage and access. CRS also encourages best practices through rigorous operational research. CRS' interventions against malaria deal with prevention, case management, and advocacy, and contribute to the development of technical standards. The agency takes note of national priorities and strategies in fighting malaria, particularly prevention and management strategies. CRS has an excellent understanding of the challenges posed by anti-malaria programs, particularly including building awareness among mobile and migrant populations and combating expired or counterfeit drugs, and the problems posed by the unregulated private health sector. CRS has formal relationships and agreements with the main ministers and local and international NGOs active in fighting malaria.

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ROUND 10 – Malaria 4.7.2 Sub-recipients X (a)

Yes go to section 4.7.2 (c)

Will Sub-recipients be involved in implementation? No  go to section 4.7.2 (b)

(b)

If no, why not?

HALF PAGE MAXIMUM (c)

If yes, how many Sub-recipients will be involved?

X 1-6

(d)

Are all Sub-recipients already identified?

X Yes

7-20

21-50

50+

No go to section 4.7.3

(e)

List the identified Sub-recipients and describe:  The work to be undertaken by each Sub-recipient;  Past implementation experience of each Sub-recipient;  Any challenges that could affect performance of each Sub-recipient as well as a mitigation strategy to address this.

TWO PAGE MAXIMUM For implementing interventions, SRs have been selected by an independent board made up of a research office, a representative from the CCM, a representative from the WHO, and a representative from the United Nations Joint Programme on HIV/AIDS based on their experience and ability to intervene in one or more service delivery areas. Each SR will work in direct collaboration with the national NGOs and existing OCBs in the various localities of the project's zone. BHP Billiton: BHP Billiton Is a mining company which carries out indoor residual spraying within the prefectures that are home to their mining claims (Boffa, Lola, Boké-Sangaredi). For Round 10, BHP Billiton proposes intervening in the region of N’Zerekore with regard to the activities of SDA 1.1. BHP Billiton is a multidisciplinary global portfolio that has been present in Guinea since 2006, which has made sustainable development key to its success. The main interests of BHP Billiton In Guinea are bauxite, aluminum, and iron ore. Since November 2007, as part of sustainable support for communities, taking into account its experience in the fight against malaria in southern African nations particularly including South Africa and Mozambique (where the prevalence of malaria after 10 years of intervention went from 90% to 2% by late 2007 among children under five), BHP Billiton implements an anti-vectorial program focused on IRS. The main zones of intervention (Boffa, Lola and Sangarédi) correspond to areas where BHP Billiton has developed its business. In addition to IRS, malaria awareness-building sessions and community mobilization for health and cleanliness and the environment are conducted with the participation and involvement of health agents, community and prefectural leaders, and the people of the project's zones of intervention. From the start of this program in November 2007 to January 2010, 6 rounds of Indoor Residual Spraying (IRS) covered 50,404 structures for a population of 51,000 people; 10,000 LLINs were also distributed. Child Fund: This NGO intervenes in SDA1.1 and 1.3, respectively devoted to prevention through LLINs and CCCCommunity leaders in the regions of Kindia, Mamou, Faranah and N’Zerekore (SDA 1.3 only). For three years, Child Fund Guinea has been developing rich experience with the communities of the towns of Kindia, Mamou and Dabola in the field of fighting malaria. This experience, which is largely built on community participation in efforts to live free from malaria has brought several findings and encouraging attitudes to light. They include: the distribution of more than 10,000 impregnated mosquito nets in more than 20 communities; recording and airing radio broadcasts on malaria via

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ROUND 10 – Malaria community radio stations in Kindia. Mamou. and Dabola; medical monitoring (malaria) for at least 4500 children by 30 health agents recruited for that purpose; training CAs and social workers in awarenessbuilding and communication techniques regarding malaria; organizing awareness and hygiene campaigns against malaria; HCs in Kindia, Mamou and Dabola for fast malaria screening, training HCC and HSC managers in the use of quick-test strips; supplying centers and HSCs with antimalarial drugs. Population Services International: PSI will implement the activities of SDA 1.1 in the region of Kankan as well as SDA 1.2 regarding CCCMass Media on the national level. Communication for changing conduct is one of its major areas of intervention in Guinea. To that end, it will work in collaboration with the PNLP and the national, rural, or community radio broadcasts under the coordination of CRS to ensure as large a coverage of the project's zone as possible. PSI/Guinea, the Guinean affiliate of PSI, is a local non-profit NGO created in 1991. PSI/Guinea is headquartered in Conakry and has regional offices in Kamsar, Mamou, Labé, Kankan and N’Zerekore. PSI/Guinea works in partnership with the MSHP of Guinea and other local and international actors to prevent malaria in Guinea. PSI/Guinea launched the first LLIN social market project in 2004. Through this project, PSI designed, developed, and released multiple communication campaigns for preventing malaria through the use of LLINs and distributed 140,399 LLINs. PSI/Guinea has great experience in the field of preventing malaria. The organization took part in the recent LLIN distribution campaign, during which it directly distributed 406,297 LLINs to children under five (November 2009). PSI's current programs in Guinea make it possible to provide infrastructure and resources needed to implement, monitor, and manage the activities proposed in Round 10. The PSI/GUINEA team is made up of highly qualified public health professional with great experience in managing and implementing malaria prevention programs. As a subsidiary of PSI, PSI/GUINEA's personnel also act as technical support for the regional office of PSI Malaria and Child Survival Department based in Nairobi, Kenya, and for PSI headquarters in Washington. These two offices provide it with general management guidelines, specialized TA and a device in setting up effective financial and administrative reporting procedures. PSI Guinea's team has a M&E research department that enables it to guide interventions and measure their impact. (f) If the private sector and/or civil society are not involved as Sub-recipients in implementation, or only involved in a limited way, explain why. HALF PAGE MAXIMUM

4.4.7.3Sub-recipients to be identified Describe why some or all of the Sub-recipients are not already identified. Describe the transparent, time-bound process that the Principal Recipient(s) will use to select Sub-recipients and not delay program performance. ONE PAGE MAXIMUM NA

4.7.4 Coordination between or among implementers Describe: (a) how coordination will occur between multiple Principal Recipients if there is more than one nominated Principal Recipient for the proposal; and (b) how coordination will occur between each nominated Principal Recipient and its respective Subrecipient to ensure timely and transparent program performance. TWO PAGE MAXIMUM In the course of implementing previous GF grants, the MSHP set up a CCSP. This team is tasked with ensuring the coordination and monitoring of the implementation of the HIV, tuberculosis, and malaria programs funded by the GF. For the present proposal, two principal recipients have been retained by the CCM; they are the MSHP and the CRS. With respect to the division of responsibilities between the two PR, the MSHP will be

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ROUND 10 – Malaria charged with all forms of treatment and CRS with prevention. The capacity-strengthening aspect will be shared between the two PR, based on the same criterion. To facilitate the implementation of the planned interventions, the following coordination mechanism is in place: a) Coordination between the PRs The two PRs will institute a coordination committee made up of 8 members: 

MSHP: National director of public health, Coordinator of the PNLP, the head of the M&E unit at PNLP and the Head of PNLP's administrative and financial department



CRS: the Representative, the national coordinator of the GF project FM, the resource management coordinator and the M&E manager

The coordination committee meets in ordinary sessions twice a month, or at the request of one of the PRs, in a special session. The chair and the secretariat are rotated between the two PRs. The Coordination Committee's roles are to: i) approve the activity plans drafted by each PR, ii) give progress reports on the implication of the activities and the indicator achievement level, iii) identify the obstacles/challenges and propose corrective solutions, and iv) schedule and ensure joint supervision. For this purpose, terms of reference will be drafted and approved by both PRs. All of the SRs' activity reports,the quarterly reports on the indicators, the audit reports, and the annual reports will be approved by the Coordination Committee before being transmitted to the GF. b) Coordination mechanisms between PRs and Sub-recipients For implementing the project, the CCM has selected 4 SRs in accordance with the terms of reference of the call for candidates. In order to guarantee performance and transparency in managing the project, the following mechanisms will be used to ensure good coordination: o

o

o

o

Establishment of a detailed activity implementation timeline: this timeline will be based on the work plan and the activities allocated to each SR. It must be submitted by each SR to the PR, and a contract must be signed between the PR and the SR, in which the roles and responsibilities of each of the parties will be defined. Examining periodic reports from the SRs: Each SR provides two types of reports: one report for each activity completed (at the end of each activity) and a consolidated quarterly report. The PR analyzes these reports in order to ensure that the objectives assigned to the SR has been met and sends feedback. Organizing quarterly coordination meetings between the PR and SR: To facilitate the execution of the SR's timelines and in order to prepare the progress report to submit to the GF, quarterly meetings will be organized on the national level to analyze the SRs' programmatic reports and management reports, track the indicators' level of achievement, approve each SR's biannual activity plans, identify the problems, and come up with corrective solutions. Field supervision visits: Each CR will organize biannual supervision visits in order to ensure the execution of the SRs' action plans in accordance with the set standards and timelines. These visits will make it possible to identify the problems encountered by the SRs during implementation and to propose corrective measures.

c) The MSHP's coordination bodies As part of the alignment of the national coordination system, the PRs and the SRs will take part in the coordination and monitoring bodies organized by the MSHP for each level (Prefectural Technical Health Council, Regional Technical Health Council, and Annual Review). These bodies will make it possible to ensure effective coordination of SR interventions and other partners on the national level and in the field.

4.7.5 Strengthening implementation capacity (a) The applicant is encouraged to include a funding request for management and/or technical assistance to achieve strengthened capacity and high quality services, supported by a summary of a technical assistance (TA) plan based on the indicative percentage range in the Guidelines. In the table

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ROUND 10 – Malaria below provide a summary of the TA plan.  Refer to the Strengthening Implementation Capacity information note for further background and detail Management and/or technical assistance need

Prevention by LLINs

CCC operational research

Strengthening technical skills Managing projects/programs

Operational research

Management and/or technical assistance activity

Conducting a postcampaign study (Activity 1.1.5.o.ii ) Conducting a study evaluation of the message comprehension level. (Activity 1.2.10) Training the OCBs in self-evaluation of malaria skills (Activity 3.1.7b) Training of RENALP in managing human and financial resources (activities 4.2.18) Organizing an exploratory survey into gender and social inequalities (activities 4.2.19)

Intended beneficiary of management and/or technical assistance

Estimated timeline

MSHP and local partners

Year 2

NGO, OCB

Year 2 and 4

OBC

Year 1 and 2

RENALP

Year 1

NGO, OCB

Year 1

Estimated cost Same as proposal currency

17,750

16,000

3,750

28,150

58,878

(b) Describe the process used to identify the assistance needs listed in the above table. HALF PAGE MAXIMUM The various audits conducted in 2008 and 2009 within the health information system (Appendix 4), the PCG, the DAAF of MSHP, the evaluation of the Coordination and Project/Program Management Team using funding from the GF and the European Union, the various reviews of R6 of the malaria component with GF's local agent (LFA) and the authoring of R9 and R10 enabled the identification of TA needs at all of these levels. Aware of insufficiencies and weaknesses detected during these evaluations, Guinea has planned to supply the types of TA listed above to make up for the identified shortfalls. Given the technical implementation capacities of the various SRs which are for the most part international NGOs, the proposal holds that additional TA needs may be taken into account by these stakeholders. (d) If no request for management and/or technical assistance is included in the proposal, provide a justification below. Or, if the funding request is outside the indicative percentage range, provide a justification below. HALF PAGE MAXIMUM

4.8

Pharmaceutical and Other Health Products

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ROUND 10 – Malaria 4.8.1

Scope of Round 10 proposal

Does the proposal seek funding for any pharmaceutical and/or health products?

X Yes  go to section 4.8.2 No  skip the remainder of section 4.8

4.8.2

Table of roles and responsibilities

Function

Name of the organization(s) responsible for this function

Procurement policies, systems, and planning

MSHP/DNPL

Intellectual property regulations

MSHP/ DNPL/Professional health orders

Quality assurance and quality control

DNPL

Management and coordination  more details required in section 4.8.3

MSHP via the PCG, the DNPL and the PNLP including the National Quantification Committee

Product selection Management Information Systems (MIS)

MSHP

Forecasting Storage and inventory management more details required in section 4.8.4 Distribution to other stores and end users  More details required in section 4.8.4 Ensuring rational use and patient safety

PCG and PNLP

Role of the organization(s) responsible for this function

Regulatory body of the pharmaceutical industry; reviews the country's National Pharmaceutical Policy Regulatory and legislative body of the pharmaceutical industry; authorizes the installation and authorization to practice the pharmaceutical trade; reviews the pharmaceutical industry's regulatory and legislative texts Ensures the quality of drugs and other medical products - Coordination ensured by MSHP - Expression of needs ensured by the PNLP and the multisectoral quantification committee - Purchasing/inventory managed by the PCG Selecting the various products Collect, analyze and distribute data regarding product management

Does the proposal request funding for additional staff or technical assistance?  indicate Yes or No

Yes (TA: TA)

Yes (TA)

Yes (TA) Yes (Additional Personnel: AP) No Yes (TA)

The PNLP and the National Quantification Committee

Selecting and quantifying the programs' various products

No

PCG

Ensures storage and inventory management

No

2 levels: PCG and Regional and Prefectural Health Office/SR - DNPL - National Quality Control Laboratory (NATIONAL QUALITY

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Distribution from central level to regional level and district level / distribution from district level to HCC level / distribution from HCC level to community level - Authoring and distributing care guides, protocols, and algorithms. - Authorization to market drugs. - Drug quality control.

Yes (PS)

No

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ROUND 10 – Malaria CONTROL LABORATORY). - Inspection of pharmacies. Drug resistance Surveillance

- Fighting drug fraud and counterfeiting. Study into antimalarial drug resistance

PNLP

Yes (TA)

4.8.3 Past management experience Describe the past experience of each organization that will be involved in managing pharmaceutical and other health products. Short description of management experience

Organization name

Total value procured during last financial year

 same currency as proposal

The PCG, created by decree #D/92/133/PRG/SGG of December 17, 1992, is the national structure for the procurement of Medications, Consumables, and Reagents. As its mission, it purchases medications, reagents, consumables, and medical devices for all public health structures, NGOs, and the health department of the country's armed forces. By dint of its status, the PCG has administrative independence, a board of directors which is its decision-making body.

PCG

For purchasing, a National Committee for Opening and Judging Bids made up of three ministerial departments, NGOs, and Development Partners (WHO, UNICEF, UNAIDS) is in place. It is tasked with the technical and financial a valuation of tenders. For national programs (National Anti-Malaria Program or PNLP, PNPCS-IST VIH SIDA, National Anti-Tuberculosis Program), the GF with the agreement of the MSHP has designated the PCG as the procurement agent. Within this framework, the PCG, under Round 6, has executed contracts for the following programs: 

The PNLP



The National Program for Health care and Prevention of STIs HIV -AIDS (PNPCS/P IST VIH SIDA)

In 2009, the PCG purchased 1,280,259 LLINs for a value of 8,897,800 USD - Purchased 3,545,250 doses of Artemisinin-based Combination Therapies (ACTs) for a value of 2,364,551 USD - In 2009, purchased 236,648 RDTs for a value of 135,174.48 USD To be completed for other programs - In 2009, PNPCP-IST VIH SIDA as part of year 2 of Round 6, the PCG purchased Antiretroviral Medications (ARV) for a value of 928,021.05 USD. And a value of 46 000 Dollars for screening and biological monitoring reagents. Two contracts for supplying the PNPCS with medical devices totaling 343,731 USD are currently being negotiated. In purchases from its own funds, the PCG spent a total of 525,220 USD for fiscal year 2009

4.8.4 Alignment with existing systems Describe how the proposal uses existing country systems for the management of the additional pharmaceutical and health product activities that are planned, including pharmacovigilance and drug resistance surveillance systems. If existing systems are not used, explain why. ONE PAGE MAXIMUM

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ROUND 10 – Malaria Pharmacovigilance: In writing this proposal, the strengthening of the pharmacovigilance system should be taken into account to identify the side effects of ACTs. For this purpose, a side effect data collection sheet has been written, and 50 service providers trained through the support of the WHO, GF, and RBM. However, all stakeholders believe that the pharmacovigilance activity cuts across all programs and that it should therefore be integrated into the health system strengthening (HSS) component. Pharmacoresistance to antimalarials and resistance to insecticide vectors: Therapeutic effectiveness studies of antimalarials and vector resistance to insecticides are carried out within the pilot sites by research institutions (School of Medicine, INSP) under the supervision of the PNLP with the support of the technical and financial partners. The studies planned for R10 fall under the PNLP's monitoring and evaluation plan, in order to complete those planned within R6 and by the other partners. Quality control of medication and LLINs: The quality control of medication falls under the competence of the National Medication Quality Control Laboratory. This laboratory is planned to be strengthened in Round 6 by supplying control kits and training personnel Round 10 will complete the strengthening of this structure. Quality control when purchasing medication and health products is done in advance by a WHO-certified laboratory in accordance with the PCG's procedures. Supply system: As in Round 2 and Round 6, the purchasing, storage, and distribution of products planned for R10 will be incorporated into the national supply system managed by the PCG (see diagram below). Schéma de Distribution des Produits de Santé à la PCG Financement Achats Produits

Programmes

Partenaires

MSHP

PCG Centrale PCG

Magasins Régionaux

DRS

M R PCG

DPS DPS

DPS CS PS OCB

CS

CS

DRS/PCG Régionale Supervision Analyse des données de consommation DPS Supervision Collecte et compilation des données Facilitation mécanismes de réapprovisionnement

CS PS OCB

CS Rapport mensuel de consommation et d’inventaire

PS/OCB

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ROUND 10 – Malaria 4.8.5

Storage and distribution systems

(a) Which organization(s) have primary responsibility to provide storage and distribution services under the proposal?

 National medical stores or equivalent

Central Pharmacy of Guinea (PCG) Sub-contracted national organization(s)  specify

Sub-contracted international organization(s) 

Tick the corresponding boxes to the right and enter the name of the organization(s)

 specify

Other:  specify

(b) For storage partners, what is each organization's current storage capacity for pharmaceutical and health products? If the proposal represents a significant change in the volume of products to be stored, estimate the relative change in percent, and explain what plans are in place to ensure increased capacity. ONE PAGE MAXIMUM The PCG is a commercial-industrial public authority; its mission is to provide public health structures, NGOs, and the health service of the country's armed forces with quality generic drugs, reagents, devices, and medical consumables. It is placed in the oversight of the MSHP, which, through the DNPL, acts with strict respect for the administrative independence of the PCG. Its Board of Directors is made up of 11 members representing the ministries of Health, Finance, Trade, and Decentralization and the health sites. Not far from the port and airport of the capital city of Conakry, the PCG has standardized, well-sized locations at the central level, with a total surface area of 37 255 m³. These premises are equipped with: 

Two service elevators for transporting packages into warehouses



Circulating fans are in all of the rhythms for ventilation



Metal aisles suitable for the volume of packages to be stored; their capacity may be doubled just by rearranging them



Trans-pallets for handling

It also has four (4) regional warehouses located in the regions of Labé (7,200 m³), Faranah Kankan and N’Zerekore (6000 m³ each) which have the same facilities except for the service elevators; for the Region of Lower Guinea, there is a Guinea Maritime warehouse within the headquarters with12 000 m³ of storage space. At the central level Finally, the existence of two (2) cold rooms which total 55 m ³ should be noted for storing lowtemperature products, and four warehouses for storing inflammable products (alcohol) and chemical products. A 40 m³ cold room is currently being installed as part of the GF's institutional support. Within the regional warehouses, the storage capacity of the cold-storage chain is low, so it is planned to strengthen this capacity in this proposal. The UNFPA has offered institutional support by purchasing two cold-storage rooms for the warehouses in Labé and Kankan. The PCG has a staff of 56 people including 15 pharmacists, who though sufficient and competent must be increased in number as activities grow.

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ROUND 10 – Malaria (c) For distribution partners, what is each organization's current distribution capacity for pharmaceutical and health products? If the proposal represents a significant change in the volume of products to be distributed or the area(s) where distribution will occur, estimate the relative change in percent, and explain what plans are in place to ensure increased capacity. ONE PAGE MAXIMUM In the course of distributing pharmaceutical and health products, the PCG has received institutional support from the GF, which consists of having purchased a seven-tonne vehicle. In addition to its central warehouses, it has four regional warehouses and a regional warehouse in Conakry. Its existing, aging automobile fleet enables it to make deliveries to the various regional warehouses and several of the country's health sites. This fleet is currently made up of: 

one (1) five (5)-tonne truck in poor condition;



one (1) seven (7)-tonne truck in poor condition;

Four (4) 1.5-tonne vans at the outlying warehouses, in poor condition. For large volumes (LLINs, equipment), transportation is done by subcontractors, with private carriers, selected from a call for tenders launched by the PCG. Experience in this field is as follows: In 2008, the PCG transported and prepositioned 115 000 LLINs to the regional warehouses on behalf of the APNDS. In 2009, the PCG transported and pre-positioned 1,274,757 LLINs to the regional warehouses on behalf of the PNLP (Round 6 of the GF). As part of R2, it also transported and prepositioned 127 000 LLINs within the regional warehouses. From the Regional Warehouses a second level of distribution to Health Districts, HCCs, and HSCs occurs. In application of the relevant procedures, the Prefectural Health Office ensures the second level of Distribution to the service delivery points (Regional Warehouses, DPSanté, HCCs, HSCs) Sufficient storage spaces exist at each level of intervention to receive the pharmaceutical and health products. For large volumes (LLINs), warehouses will be subcontracted to provide storage. The PCG also has a computer network which enables it to manage the purchasing, reception, storage, and distribution procedures in an integrated manner. The management software (Sage SAARI) manages the stocks by batch and date of expiration, which enables: 

improved management of expiration dates



improved inventory control



full traceability of inputs



option to recall a batch if needed

Inventories at all storage levels are carried out monthly by the managers, and report is transmitted to the central level. Supervision at all levels of storage are organized once per quarter. During these two provisions, all parameters are evaluated, including, among others, inputs, outputs, and available usable stock. A quarterly report is written out and addressed to the Office with the copy to the concerned programs.

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ROUND 10 – Malaria 4.8.6

Pharmaceutical and health products for initial two years

Complete the Pharmaceutical and Health Products List and list all of the products that are requested to be funded through the proposal. If the pharmaceutical products included in the Pharmaceutical and Health Products List are not included in the current national, institutional or World Health Organization Standard Treatment Guidelines (STGs), or Essential Medicines Lists (EMLs), describe below the STGs that are planned to be utilized, and the rationale for their use. Applicants are invited to justify the prices based on either the guidance provided in the Unit Costs for Selected Key Health Products information note or with another published international reference source. If the provided price is out of range, provide justification. Also, if local legislation is preventing access to low cost prices through local manufacturers or similar mandates, clarification should be provided as well as a plan for addressing such barriers over the life of the proposal. ONE PAGE MAXIMUM The products listed on the form in Enclosure B (Appendix B) are the "Freight on board" (FOB) prices conveyed by the GF. In order to obtain the "Cost Insurance Freight" price (PCG warehouse), a rate of 7% (seven per cent) will be applied to these FOB prices. As for LLINs, the price of the rectangular shapes is available in the form, while within PNLP, the conical shape is recommended (Ref: Call for Tenders for Technical Specifications). For other antimalarial medication (sulfadoxine-pyrimethamine, quinine hydrochloride), we have consulted the Price Indicator of Management Science for Health Edition 2009 to obtain median prices.

4B. CROSS-CUTTING HEALTH SYSTEM STRENGTHENING (HSS) - PROGRAM DESCRIPTION Read the Round 10 Guidelines to consider including optional cross-cutting HSS interventions SECTION 4B can only be included in the Round 10 malaria proposal if:  the applicant has identified gaps and constraints in the health system that have an impact on HIV, tuberculosis and malaria outcomes;  the interventions required to respond to these gaps and constraints are 'cross-cutting' and benefit more than one of the three diseases (and potentially benefit other health outcomes); and  section 4B is not included in the Round 10 HIV or tuberculosis proposal. Section 4B can be downloaded from the Global Fund's website if the applicant intends to apply for cross-cutting HSS.

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ROUND 10 – Malaria 5. FUNDING REQUEST The Round 10 Guidelines contain different guidance for sections 5.1 and 5.2 depending on whether the applicant selected Option 1, 2 or 3 in section 3.1 of the Proposal Form Option 1 = Transition to a single stream of funding by submitting a consolidated disease proposal Option 2 = Transition to a single stream of funding during grant negotiation Option 3 = No transition to a single stream of funding in Round 10

5.1 Financial Gap Analysis Section D and H of the Gap Analysis table below must be completed differently depending on whether applicant selected Option 1, 2 or 3 (see above)  Summary Information provided should be described further in sections 5.1.1 – 5.1.3  Currency must be the same as identified on the proposal cover page  Adjust the years as necessary in the table from calendar years to financial years to align with national planning and fiscal periods

Financial gap analysis Actual 2008

Planned 2009

Estimated

2010

2011

2012

2013

2014

2015

24,504,560

17,623,260

51,870,972

18,605,085

21,842,072

67,466,103

SECTION A: Funding needs for the full national malaria program LINE A  Provide annual amounts

20,819,333

25,694,001

LINE A.1  Indicate the amount of the funding need for the full national malaria program over the full term of the Round 10 proposal.

177,407,491

SECTIONS B, C AND D: Current and planned resources to meet the funding needs of the full national malaria program Section B: Domestic Domestic source B1: Debt and loan relief

0

0

0

0

0

0

0

0

-

-

5,917,489

4,180,759

4,180,759

4,150,909

4,150,909

4,150,909

WORLD BANK Domestic source B2: National funding resources

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ROUND 10 – Malaria Financial gap analysis Actual

Planned

2008

2009

2010

-

-

-

-

-

-

Domestic source B3 : Private sector contributions (national): BHP Biliton, Rio

Estimated 2011

2012

2013

2014

2015

200,000

200,000

200,000

200,000

200,000

5,917,489

4,380,759

4,380,759

4,350,909

4,350,909

4,350,909

-

3,915,000

3,915,000

3,915,000

3,915,000

3,915,000

3,915,000

-

-

-

121,000

121,000

121,000

121,000

121,000

-

-

-

3,127,168

-

-

-

-

-

-

-

-

-

-

-

-

-

-

3,915,000

7,163,168

4,036,000

4,036,000

4,036,000

4,036,000

Tinto LINE B: Total current & planned DOMESTIC resources

 Total of Section B entries

Section C: External (non-Global Fund) External source C1

UNICEF/UNITAID External source C2

WHO External source C3

OMVS External source C4 Private sector contributions (International) LINE C: Total current & planned resources (non-Global Fund)  Total of Section C entries

Complete this version of Section D if the applicant selected Option 2 or 3 in section 3.1 of the Proposal Form: Section D: External (Global Fund)  Insert additional lines below if there are more than two existing malaria Global Fund grants Grant D1

Round 2 (R2) Grant D2

Round 6 (R6) LINE D: Total current & planned EXTERNAL resources (Global Fund)

316,679

1,764,359

-

-

-

-

-

-

13,337,132

4,002,267

4,981,568

5,216,238

1,548,354

-

-

-

13,653,811

5,766,626

4,981,568

5,216,238

1,548,354

-

-

-

 Total of Section D entries

Complete this version of Section D if the applicant selected Option 1 in section 3.1 of the Proposal Form: Section D: External (Global Fund)  Insert additional lines below if there are more than two existing malaria Global Fund grants

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ROUND 10 – Malaria Financial gap analysis Actual

Planned

Estimated

2008

2009

2010

2011

2012

2013

2014

2015

13,653,811

5,766,626

14,814,057

16,760,165

9,965,113

8,386,909

8,386,909

8,386,909

Section D1: Grants not included in consolidated disease proposal Grant D1-A

  provide grant number here Grant D1-B

 provide grant number here Section D2: Grants included in consolidated disease proposal and listed in section 3.1(b) Grant D2-A

  provide grant number here Grant D2-B

 provide grant number here LINE D: Total current & planned EXTERNAL (Global Fund) resources

 Total of Section D entries LINE E : Total current and planned resources

 Line E = Line B + Line C + Line D

Calculation of gap in financial resources and summary of total funding requested in Round 10  must be supported by detailed budget LINE F: Total funding gap Line F = Line A – Line E

7,165,522.07

19,927,374. 54

9,690,503.3 8

LINE G: Round 10 malaria funding request

 must be same amount as requested in tables 1.1, 5.3, 5.4 and detailed budget for this disease

R10_CCM_GIN_M_PF_s3-5_27Sept10_En.doc

863,095.47

4,558,458

41,905,859. 16

10,218,175. 61

13,455,162. 67

59,079,193 .54

27,488,480

5,270,705

4,690,886

4,617,119

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ROUND 10 – Malaria Part H – Cost Sharing calculation for Lower-middle income and Upper-middle income applicants In Round 10, the total maximum funding request for malaria in Line G is: (a) For Lower-Middle income countries, an amount that results in the Global Fund's overall contribution (all grants) to the national program being not more than 65% of the national disease program funding needs over the proposal term; and (b) For Upper-Middle income countries, an amount that results in the Global Fund overall contribution (all grants) to the national program being not more than 35% of the national disease program funding needs over the proposal term. Line H = Cost Sharing calculation as a percentage (%) of overall funding from Global Fund

Complete this cost sharing calculation if the applicant selected Option 2 or 3 in section 3.1 of the Proposal Form: Cost sharing =

(Total of Line D amounts for proposal period + Total of Line G amounts) X 100

30.09%

Line A.1

Complete this cost sharing calculation if the applicant selected Option 1 in section 3.1 of the Proposal Form: Cost sharing =

(Total of Line D1 amounts for proposal period + Total of Line G amounts) X 100 Line A.1

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ROUND 10 – Malaria 5.1.1 Explanation of financial needs and additionality of Global Fund financing Describe how the annual amounts were: (a) developed; (b) budgeted in a way that ensures that government, non-government and community needs were included to reflect implementation of the country's malaria program strategies; and (c) developed in a way that demonstrates the funding requested in the proposal will contribute to the achievement of outputs and outcomes that would not be supported by currently available or planned domestic resources. ONE PAGE MAXIMUM (a) Pending the drafting of the new 2011-2015 national strategy plan, annual national needs were calculated based on the Needs Assessment drafted in 2008 with the aid of RBM (Appendix K: Financial gap analysis). This assessment tool made it possible to estimate needs with a goal of universal coverage of the Guinean population by means of priority interventions adopted by the national malaria program: 

prevention through LLINs; for this purpose, in addition to the routine strategy, it was chosen to conduct 2 mass distribution campaigns in 2012 and 2015;

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IPTs among pregnant women,

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diagnosing malaria with microscopes and TDRs;

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treating ordinary cases of malaria with ACTs at health sites, but also on the community level among children under five;

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cross-cutting interventions: monitoring and evaluation, Advocacy/IEC/CCC, coordination, managing the program and institutional strengthening, including integrated epidemiological monitoring.

(b) The budgeting of the interventions listed above takes into account governmental needs, both institutionally and on the different levels of the health pyramid. Non-governmental structures' needs are also taken into account, through private and religious health sites, and NGOs. The same holds true for community needs, particularly in prevention through LLINs, care through ACTs, and IEC/CCC. (c) The annual amounts obtained reflect shortfalls between the planned malaria-fighting needs and the resources available through contributions from the government and communities, as well as biand multilateral partners and the Global Fund. As part of the drafting of this proposal, the search for resource additionality has been decisive in choosing which activities to implement and the scale of the interventions. This is why in the proposal's intervention zone (limited to the hyper- and holoendemic regions), emphasis has been placed on the community approach, particularly caring for cases of malaria in children under five in promoting preventive interventions among pregnant women and the communities in question. To do so, local governments, OCBs, and community agents have been heavily involved. Ultimately, the funding solicited under this proposal will contribute to making up a financial and program shortfall, and to improve the health service coverage and usage indicators.