SENEGAL PROPOSAL - GLOBAL FUND ROUND 9

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SENEGAL PROPOSAL - GLOBAL FUND ROUND 9 Powered By Docstoc
					                                          Republic of Senegal 

                                               ------
                            One people – One Goal – One Faith
                                               ------
                      Country Coordinating Mechanisms (CCM)/Global Fund Senegal
      National Coordination Commission of the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria



             SENEGAL PROPOSAL - GLOBAL FUND ROUND 9




R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                    1/17
                                       Titles


1. HIV COMPONENT: SPEEDING UP OF UNIVERSAL ACCESS TO PREVENTION, TREATMENT
   AND SUPPORT SERVICES

   AND STRENGTHENING OF THE TRANSVAAL HEALTH SYSTEMS


2. TUBERCULOSIS COMPONENT: ACTION PROGRAMME TO FIGHT TUBERCULOSIS IN
   SENEGAL


3. MALARIA COMPONENT: PROJECT FOR THE STRENGTHENING AND EXTENSION OF
   INTERVENTIONS FOR THE EFFECTIVE CONTROL OF MALARIA IN SENEGAL




R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                         2/17
                                      PROPOSAL FORM – ROUND 9
                                       (SINGLE COUNTRY APPLICANTS)

    Applicant Name                     CCM/Senegal: National coordination authority

    Country                            SENEGAL

    Income Level
    (Refer to list of income levels    Low income
    by economy in Annex 1 to the
    Round 9 Guidelines)


    Applicant Type                       CCM                      Sub-CCM                      Non-CCM



    Round 9 Proposal Elements

                                                                 Does this disease include     Is this a 're-submit'
                                                                cross-cutting Health System    of the same disease
        Disease                           Titles                Strengthening interventions        proposal not
                                                                        in part 4B?             recommended in
                                                               (include in one disease only)         Round 8?

                          SPEEDING UP OF UNIVERSAL ACCESS
    HIV 1                 TO PREVENTION, TREATMENT AND         Cross-cutting HSS               yes
                          SUPPORT SERVICES
                          ACTION PROGRAMME TO FIGHT
    Tuberculosis1         TUBERCULOSIS IN SENEGAL
                                                                                               No
                          PROJECT FOR THE STRENGTHENING AND
                          EXTENSION OF INTERVENTIONS FOR THE
    Malaria               EFFECTIVE CONTROL OF MALARIA IN
                                                                                               No
                          SENEGAL



      If this is a Round 8 proposal being re-submitted, have the TRP Review Form comments
                                 been clearly addressed in s.4.5.2?
                                                                                                      Yes      No

        Are there major new objectives compared to the Round 8 proposal that is being re-
       submitted? If yes, please provide a summary of the changes in the box below by each
                             disease re-submission and section number.                                Yes      No

    ONE PAGE MAXIMUM

    Currency                                   USD                        or                         EURO



Deadline for submission of proposals:                                 12 noon, Local Geneva Time,
                                                                      Monday 1st June 2009



1
    Different HIV and tuberculosis activities are recommended for different epidemiological situations. For further
    information, see the “WHO Interim policy on collaborative TB/HIV activities” available at:
    http://www.who.int/tb/publications/tbhiv_interim_policy/en/


       R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                            3/17
INDEX OF SECTIONS and KEY ATTACHMENTS FOR PROPOSALS

'+' =   A key attachment to the proposal. These documents must be submitted with the completed Proposal
        Form. Other documents may also be attached by an applicant to support their programme strategy
        (or strategies if more than one disease is applied for) and funding requests. Applicants identify these
        in the “Checklists” at the end of s.2 and s.5.

1.      Funding Summary and Contact Details

2.      Applicant Summary (including eligibility)
+       Attachment C: Membership details of CCMs or Sub-CCMs


Complete the following sections for each disease included in Round 9:

3.      Proposal Summary

4.      Programme Description
        4B.   HSS cross-cutting interventions strategy **

5.      Funding Request
        5B.   HSS cross-cutting funding details **

        ** Only to be included in one disease in Round 9. Refer to the Round 9 Guidelines for detailed
        information.

+ Attachment A: “Performance Framework” (Indicators and targets)

+ Attachment B: “Preliminary List of Pharmaceutical and Health Products”

+ Detailed Work Plan: Quarterly for years 1 - 2, and annual details for years 3, 4 and 5

+ Detailed Budget: Quarterly for years 1 - 2, and annual details for years 3, 4 and 5


IMPORTANT NOTE:
Applicants are strongly encouraged to read the Round 9 Guidelines fully before completing a
Round 9 proposal. Applicants should continually refer to these Guidelines as they answer
each section in the proposal form. All other Round 9 Documents are available here.


A number of recent Global Fund Board decisions have been reflected in the Proposal Form. The Round 9
Guidelines explain these decisions in the order they apply to this Proposal Form. Information on these
decisions is available at:
http://www.theglobalfund.org/documents/board/16/GF-BM16-Decisions_en.pdf.

Since Round 7, efforts have been made to simplify the structure and remove duplication in the Proposal
Form. The Round 9 Guidelines therefore contain the majority of instructions and examples that will assist
in the completion of the form.




     R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                    4/17
 1.        FUNDING SUMMARY AND CONTACT DETAILS

 1.1.      Funding summary
 Clarified table 1.1

                                          Total funds requested over proposal term
   Disease
                       Year 1        Year 2               Year 3            Year 4         Year 5             Total

HIV
                    10 036 522   8 491 147              16 648 080    15 381 581        16 494 520        67 051 850
Tuberculosis        2 533 525       2 905 836            2 898 271     3 501 722          3 384 070       15 223 424

Malaria              6 542 525        6 920 919          13 977 280         9 520 498      6 430 406      43 391 628

HSS cross-
                     4 723 224        5 907 544           5 736 407         3 118 026      2 579 253      22 064 454
cutting
interventions
section 4B and
5B within [insert
name of the one
disease which
includes s.4B.
and s.5B. only if
relevant]


                                                            Total Round 9 Funding Request            :    147 731 356



 1.2.      Contact details
         HIV component                       Primary contact                             Secondary contact

Name                             Doctor Ibra Ndoye                             Fatou Nar Mbaye Diouf

Title                            CNLS Executive Secretary                      Global Fund Officer at the CNLS

                                 Conseil National de Lutte contre le SIDA
Organisation                                                                   CNLS
                                 (CNLS - National Council to Fight AIDS)

                                 Immeuble Concorde                             Immeuble Concorde
Postal address
                                 Rue NG-191 - Route de Ngor                    Rue NG-191 - Route de Ngor

                                 (221) 33 869 09 09                            (221) 33 869 09 09
Telephone
                                 (221) 77 638 71 76 /                          (221) 77 644 93 99

Fax                              (221) 33 820 34 79                            ((221) 33 820 34 79

E-mail address                   indoye@cnls.senegal.org                       zawdia@yahoo.fr

Alternate e-mail address                                                       fmbaye@cnls.senegal.org




  Tuberculosis component:                    Primary contact                             Secondary contact

Name                             Mame Bocar Lo                                  Abdoulaye Ly
                                 Programme National de Lutte contre la
Title                            Tuberculose (National Programme to Fight       Senior Technical Officer TB
                                 Tuberculosis) Coordinator




        R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                            5/17
                             Ministry of Health, Prevention and Public
Organisation                 Hygiene                                     FHI
                             Tuberculosis Programme
                                                                         45, Avenue Cheikh Anta Diop BP 3335
Postal address               2, rue Aimé Césaire Fann - Dakar Senegal
                             BP 5899                                     Dakar
                             (221) 33 824 90 09
Telephone                    or (221) 77 641 35 42                       00 221 33 869 70 00/ 77 637 66 47
                             (221) 33 824 73 59
Fax                                                                      00 221 864 05 36
                             lomamebocar@yahoo.fr
E-mail address                                                           abdouly@fhi.sn

Alternate e-mail address     pntsenegal@yahoo.fr                         lysabdoulaye@yahoo.fr



      Malaria Component                Primary contact                            Secondary contact
                             Doctor Moussa Thior                         Doctor Sylla Thiam
Name
                             Programme National de Lutte contre la       Global Fund Officer at the Programme
Title                        Paludisme (National Programme to Fight      National de Lutte contre le Paludisme
                             Malaria) Coordinator                        (National Programme to Fight Malaria)
                             Ministry of Health, Prevention and Public   Ministry of Health, Prevention and Public
Organisation                 Hygiene                                     Hygiene
                             Malaria Programme                           Malaria Programme
Postal address               rue Aimé Césaire x E Fann Résidence -       rue Aimé Césaire x Fann Résidence -
                             Dakar Senegal. BP 25270                     Dakar Senegal. BP 25270
                             (221) 33 869 07 99                          (221) 33 869 07 99
Telephone                    or (221) 77,644 32 21                       or (221) 77 657 64 51
                             (221) 33 864 41 20                          (221) 33 864 41 20
Fax
                             papethior@orange.sn                         syllat@gmail.com
E-mail address

Alternate e-mail address     plcpalu@orange.sn                           thiamsylla@hotmail.com



         HSS Section                   Primary contact                            Secondary contact

Name                         Abdoulaye Sidibé Wade                       Abdoul Lahat Mangane

Title                        Head of the AIDS Division                   Person responsible for logistics

Organisation                 Ministry of Health and Prevention           Ministry of Health and Prevention

                             Institut d’Hygiène Social (Social Hygiene   Institut d’Hygiène Social (Social Hygiene
Postal address               Institute) – Dakar                          Institute) – Dakar
                             BP 7381 Dakar                               BP 7381 Dakar

Telephone                    00 (221) 33822 90 45 / 77 644 82 46         00 (221) 33822 90 45 / 77 550 31 26

Fax                          00 (221) 33 821 02 83                       00 (221) 33 821 02 83

E-mail address               sidaist@yahoo.fr                            lahath@gmail.com

Alternate e-mail address     sabwade@hotmail.com


 1.3.      List of Abbreviations and Acronyms used by the Applicant

Acronym/Abbreviatio         Meaning



        R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                         6/17
           n
ANCS                   Alliance Nationale Contre le SIDA (National Alliance Against AIDS)
CCM                    Country Coordinating Mechanism
CNLS                   Conseil National de Lutte contre le SIDA (National Council to Fight AIDS)
FHI                    Family Health International
CBO                    Community-Based Organisation
NGO                    Non-Governmental Organisation
PNLP                   Programme National de lutte contre le Paludisme (National Programme to Fight
                       Malaria)
PNT                    Programme National de lutte contre la Tuberculose(National Programme to
                       Fight Tuberculosis)
TS                     Technical Secretariat
UNIFEM                 United Nations Development Fund for Women
HIV                    Human Immunodeficiency Virus
                       [use “Tab” key to add extra rows if needed]




       R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                           7/17
2.         APPLICANT SUMMARY (including eligibility)

    CCM applicants: Only complete section 2.1. and 2.2. and DELETE sections 2.3. and 2.4.
    Sub-CCM applicants: Complete sections 2.1. and 2.2. and 2.3. and DELETE section 2.4.
    Non-CCM applicants: Only complete section 2.4. and DELETE sections 2.1. and 2.2. and 2.3.




IMPORTANT NOTE:
Different from Round 7, "income level” eligibility is set out in s.4.5.1 (focus on poor and
key affected populations depending on income level), and in s.5.1. (cost sharing).

2.1.       Members and operations

2.1.1. Membership summary

                          Sector Representation                                    Number of members


       Academic/educational sector                                                           04


       Government                                                                            13


       Non-government organisations (NGOs) and community-based                               11
       organisations


       People living with the diseases                                                       04


       People representing key affected populations 2                                        01


       Private sector                                                                        02


       Faith-based organisations                                                             02


       Multilateral and bilateral development partners in country                            10


    Other (please specify): Coordinator and Assistant to the CCM Technical                   02
       Secretariat

                                                    Total Number of Members:
                                                                                             49
                   (Number must equal number of members in 'Attachment C'' 3 )




2
    Please use the Round 9 Guidelines definition of key affected populations.
3
    Attachment C is where the CCM (or Sub-CCM) lists the names and other details of all current members. This
    document is a mandatory attachment to an applicant's proposal. It is available at:
    http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_AttachmentC_en.xls



      R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                      8/17
 2.1.2. Broad and inclusive membership

Since the last time you applied to the Global Fund (and were determined compliant with the minimum
requirements):

(a)   Have non-government sector members (including any new members
      since the last application) continued to be transparently selected by their
      own sector; and                                                               No       Yes


(b)   Is there continuing active membership of people living with and/or
      affected by the diseases?                                                     No       Yes




      R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                           9/17
    2.1.3. Member knowledge and experience in cross-cutting issues

Health Systems Strengthening
The Global Fund recognises that weaknesses in the health system can constrain efforts to respond to the
three diseases. We therefore encourage members to involve people (from both the government and non-
government) who have a focus on the health system in the work of the CCM or Sub-CCM.
(a)     Describe the capacity and experience of the CCM (or Sub-CCM) to consider how health system
        issues impact programmes and outcomes for the three diseases.
Executives from the academic world, public health and civil society organisations which have been working in
health for more than 15 years all sit on the CCM. There are also others who hold positions at various levels in the
health system. Finally, experts on the monitoring and assessment of programmes and the health system working at
ministerial level and at bilateral and multilateral organisations are members of the CCM.
Experts from both CCM member organisations and other non-member organisations such as regional directors,
divisional heads and Directors from the Ministry of Health have all taken part both in the work of the CCM and in
the drawing up of the application on the strengthening of the health system.


Gender awareness
The Global Fund recognises that inequality between males and females, and the situation of sexual
minorities are important drivers of epidemics, and that experience in programming requires knowledge
and skills in:
•       methodologies to assess gender differentials in disease burdens and their consequences
        (including differences between men and women, boys and girls), and in access to and the
        utilisation of prevention, treatment, care and support programmes; and
•       the factors that make women and girls and sexual minorities vulnerable.

(b)     Describe the capacity and experience of the CCM (or Sub-CCM) in gender issues including the
        number of members with requisite knowledge and skills.

ANCS and UNIFEM have held a number of staff training events dealing with the gender and HIV aspects.
Members of the CCM have taken part in these different events. Other members have acted as hosts and facilitators
of the various workshops.


Multi-sectoral planning
The Global Fund recognises that multi-sectoral planning is important to expanding country capacity to
respond to the three diseases.

(c)     Describe the capacity and experience of the CCM (or Sub-CCM) in multi-sectoral programme
        design.

The CCM members come from the various areas of the health system, civil society organisations, the private sector
and both multilateral and bilateral organisations. Most of these members either have worked or indeed are still
working on multi-sector projects. They take part in the planning work carried out by the Ministries and the
organisations they represent. Some partners are involved in implementing programmes and take part in the partners’
joint reviews (Funding Sources, Governmental and Civil Society) of the implementation of the activities as part of
the sector-specific plans. Finally, the majority have been members of the CCM since 2002 and regularly take part in
the activities involved in drawing up the proposals submitted to the Global Fund. All this wealth of experience goes
to show that the CCM has the ability to draw up multi-sector projects.




    2.2.   Eligibility
    2.2.1. Application history




       R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                            10/17
“Check” one box in the table below and then follow the further instructions for that box in the right hand column.


                                                                                   -   -     Complete all of sections
          Applied for funding in Round 7 and/or Round 8 and was determined             2.2.2 to 2.2.8 below.
          as having met the minimum eligibility requirements.

                                                                                   -   -    First, go to ′Attachment D′
                                                                                       and complete.
          Last time applied for funding was before Round 7 or was determined
          non-compliant with the minimum eligibility requirements when last            Then also complete sections 2.2.5
                                                                                        to 2.2.8 below (Do not complete
          applied.
                                                                                        sections 2.2.2 to 2.2.4)



 2.2.2. Transparent proposal development processes
        Refer to the document "Clarifications on CCM Minimum Requirements" when completing
        these questions.
             Documents supporting the information provided below must be submitted with the proposal as clearly
             named and numbered annexes. Refer to the “Checklist” after s.2.

(a)       Describe the process(es) used to invite submissions for possible integration into the proposal from a broad
          range of stakeholders including civil society and the private sector, and at the national, sub-national and
          community levels. (If a different process was used for each disease, explain each process.)

At its statutory meeting held on 22nd January 2009, after having stated its intention of submitting an application, the
CCM discussed the process to be put into place for the drawing up of the Round 9 Global Fund proposal. So the
following steps were taken in order to ensure widespread dissemination of the information:
      •    TS/CCM meeting held on 5th February 2009, notification of CCM members by electronic mail
      •    The call for proposals is announced: Publication in the newspapers, e-mail to partners through the CCM
           and details of the Global Fund Support Programme website
      •    Process of collecting expressions of interest from 19th February to 20th March 2009
      •    The office of the CCM Technical Secretariat was open to all applicants who wanted additional information
           before submitting their proposals. The CCM secretariat received visits both from representatives of NGOs
           and from private individuals who were looking for information about the Round 9 submissions. These were
           mainly members of civil society who wanted to take part in the process for the first time. (Attachment 5)

(b)       Describe the process(es) used to transparently review the submissions received for possible integration into
          this proposal. (If a different process was used for each disease, explain each process.)

The process used to select the principal Recipient(s) of the proposals comprises two phases:
Phase one
      •  The drawing up and approval of the selection chart for applications received by the CCM Technical
         Secretariat
    • The convening of the Analysis Commission meeting to be held on Friday 27th March 2009. The following
         decisions were taken at the working meeting of the Analysis Committee:
1) first of all to proceed to the classification of Expressions of Interest according to the target area of intervention:
    malaria, AIDS, tuberculosis or cross-cutting area,
2) to use the following four selection criteria with a view to the pre-selection of applicants for the drawing up of
    Senegal’s Round 9 proposal for the awarding of subsidies by the Global Fund STP:
    a) Criterion no. 1 marked out of 15: Relevance of the proposal or gaps addressed: the gaps addressed have
         been clearly defined and are a priority for the national strategic plan. These gaps need to strengthen the
         national strategies or complement interventions during implementation;
    b) Criterion no. 2 marked out of 8: Experience in the area of intervention: any organisation which has already
         implemented a programme in the area of intervention identified, for at least 5 years;
    c) Criterion no. 3 marked out of 8: Organisational capacities: qualified staff, number and quality, suitable
         equipment, implementation of commonly accepted management procedures;
    d) Criterion no. 4 marked out of 4: References: a proven ability to work with international organisations.
In order to be pre-selected, the applicant organisation must be able to show relevance to the drawing up of the
proposal, must have experience in the area and must be a credible stakeholder in the implementation of health
programmes.



          R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                              11/17
Phase two
CCM meeting held on 9th April 2009 for approval of the applications pre-selected by the TS
An ordinary meeting of the Senegal CCM was held on Thursday 9th April 2009
It was decided that only applicants who had scored 50% out of a total of 35 points on the criteria would be pre-
selected to take part in the drawing up of the GF Round 9 proposal.
It was suggested that those applicants with a mark of 50% of the total criteria scores should take part in the drawing
up of Senegal’s Proposal to be submitted to Round 9 of the awarding of Global Fund STP subsidies.
These are as follows:
For the Tuberculosis component: PNT, Family Health International (FHI) - AFRICARE, SENEGALESE RED
CROSS, INTERMONDES and INTRAHEALTH (capacities assessed once by the Commission in relation to the
malaria application)
 For the Malaria component: PNLP, SENEGALESE RED CROSS, THE HUNGER PROJECT SENEGAL,
INTRAHEALTH, RADI, SECOURS ISLAMIQUE France, AQUADEV
Each of these various programmes and organisations has received a letter of notification from the CCM Chairman
inviting it to play an active part in drawing up the proposals. (attachment 6)
(c)    Describe the process(es) used to ensure the input of people and stakeholders other than CCM (or Sub-CCM)
       members in the proposal development process. (If a different process was used for each disease, explain
       each process.)
The CCM used a participative process for the purposes of the submission of the proposals to the Global Fund and
this allowed the stakeholders to get involved, whether or not they are CCM members. The various stages and the
organisation of the drawing up of the components have helped to get non-members - who are often appointed by the
partners according to their capacities - involved alongside CCM members.
So, as soon as the launching of the call for applications for the Global Fund Round 9 was announced, the process
adopted by the CCM in order to guarantee transparency and fairness comprises the following stages:
         call for expressions of interest through the press;
         pre-selection of applicants on the basis of objective criteria decided upon in relation to their skills;
         notification of the chosen applicants so that they can take part in the drafting workshops involving all of the
         State and private stakeholders along with those from civil society who are involved in the respective areas
         (see reports and attendance lists for the various workshops).
         Appointment of the people responsible for organising the drawing up of the documents for each component
         Setting up of restricted drafting groups with a system of periodic meetings with the main expanded group.
         At the extraordinary CCM meeting held on 9th April 2009, the partners were asked to identify any skills
         which were likely to make a contribution to the drawing up of the proposal
         Drafts of the documents were regularly e-mailed to both the CCM members and the non-CCM member
         partners in order to ask them for their contributions
         Holding of workshops by the CCM Secretariat in order to look at the draft proposals and return them to the
         drafting groups;
         Holding of a CCM meeting to look at the documents produced by the task forces. The meetings are open to
         non-CCM members, to the drafting groups, etc.
  This process helped to get other skills from non-CCM members involved at all stages of the drawing up of the
  proposal and the process of drawing up each component is documented. (Attachment 7)

(d)    Attach a signed and dated version of the minutes of the meeting(s) at which the
       members decided on the elements to be included in the proposal for all diseases          Attachment 8
       applied for.


 2.2.3. Processes to oversee programme implementation


(a)    Describe the process(es) used by the CCM (or Sub-CCM) to oversee programme implementation.

The CCM is kept regularly informed of the level of completion of the programmes especially at the quarterly
statutory meetings. The Principal Recipients regularly submit their work plans and their quarterly reports to the
CCM which approves them at the statutory meetings. In addition to this, the principal Recipients regularly invite the




      R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                                 12/17
CCM to meetings and important activities and it is always represented by a member.
The CCM has set up a Technical Secretariat tasked with studying and appraising the state of implementation of the
activities financed by the Global Fund. It has an annual work plan to monitor the implementation of the programmes
and to appraise the efficiency and added value of Global Fund funding.
In the area of the monitoring of the projects implemented on financing from the Global Fund, the CCM handles the
following:
- the approval of the work plans for the projects implemented by the recipients,
- the approval of the Principal Recipients’ technical activity and financial reports,
- the endorsement of decisions about changes to the implementation of the project.
The CCM members also make site visits and visits to the principal Recipients’ workplaces so that they can talk to
the people responsible about the implementation of the programmes. In this respect, there is a scheduled visit to one
principal Recipient every quarter.
Finally, the CCM members take part in the partners’ joint reviews and in the assessments of the programmes in
order to monitor the implementation of the activities as part of the sector-specific plans.

(b)         Describe the process(es) used to ensure the input of stakeholders other than CCM (or Sub-CCM)
            members in the ongoing oversight of programme implementation.

  Ordinary and extraordinary CCM meetings are regularly attended by non-CCM members (observers) who are
  interested in specific subjects on the agenda. At the meetings, the non CCM member partners take part in the
  monitoring activities. As stipulated in the texts of the order creating the CCM, it can recruit any relevant skills
  that it may require.
  The quarterly, six-monthly and annual reviews of the programmes, which offer a forum for discussing and the
  pooling of information with all of the partners, afford an opportunity for both CCM members and non-members
  to get involved in the monitoring process.
  Taking part in site visits organised by the partners involved in the implementation of the targeted programmes is
  part of the activities of joint reviews by the partners (Funding Sources, Governmental and Civil Society) involved
  in the implementation of activities as part of sector-specific plans. These are opportunities to ensure
  complementarity between the activities financed by the Global Fund and those financed from other sources.

 2.2.4. Processes to select Principal Recipients
 The Global Fund recommends that applicants select both government and non-government sector Principal
 Recipients to manage programme implementation.   Refer to the Round 9 Guidelines for further explanation of
 the principles.


      (a)       Describe the process used to make a transparent and documented selection of each of the
                Principal Recipient(s) nominated in this proposal. (If a different process was used for each
                disease, explain each process.)
   The process used to select the principal Recipient(s) of the proposals comprises two phases:
   Phase one
      • The call for proposals is announced: Publication in the newspapers, e-mail to partners through the CCM
           and details of the Global Fund Support Programme website
      • Process of collecting expressions of interest from 19th February to 20th March 2009
      • The drawing up and approval of the selection chart for applications received by the CCM Technical
           Secretariat
      • The convening of the Analysis Commission meeting to be held on Friday 27th March 2009. The following
           decisions were taken at the working meeting of the Analysis Committee:

   3) first of all to proceed to the classification of Expressions of Interest according to the target area of intervention:
      malaria, AIDS, tuberculosis or cross-cutting area,
   4) to use the following four selection criteria with a view to the pre-selection of applicants for the drawing up of
      Senegal’s Round 9 proposal for the awarding of subsidies by the Global Fund STP:
      a) Criterion no. 1 marked out of 15: Relevance of the proposal or gaps addressed: the gaps addressed have
            been clearly defined and are a priority for the national strategic plan. These gaps need to strengthen the
            national strategies or complement interventions during implementation;



        R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                             13/17
        b) Criterion no. 2 marked out of 8: Experience in the area of intervention: any organisation which has already
             implemented a programme in the area of intervention identified, for at least 5 years;
        c) Criterion no. 3 marked out of 8: Organisational capacities: qualified staff, number and quality, suitable
             equipment, implementation of commonly accepted management procedures;
        d) Criterion no. 4 marked out of 4: References: a proven ability to work with international organisations.
   In order to be pre-selected, the applicant organisation must be able to show relevance to the drawing up of the
   proposal, must have experience in the area and must be a credible stakeholder in the implementation of health
   programmes.
   A list of the organisations selected along with the assessment documents was published at the CCM meeting held on
   9th April 2009 which approved the list of applicants chosen to take part in the drawing up of the proposals for Round
   9
   Phase two
   During the course of the proposal drafting process, entities were identified to be principal Recipients of the
   proposals. The entity had to state its intention of being a Principal Beneficiary or be chosen by the CCM in the light
   of its capacity in taking part in the formulation of the proposals, organisational ability and resources. Even so, the
   CCM considered the character of former principal Recipient in order to select organisations or entity with the ability
   to play this role. Thus,
   For the HIV/AIDS Component: this is a resubmit for which the CNLS and the ANCS principal Recipients of R8
   remain the principal Recipients now for Round 9. The same goes for the HSS component with the Ministry of
   Health, Prevention and Public Hygiene’s Division to Fight HIV/AIDS
   For the Tuberculosis Component: for the purposes of Round 8, FHI had already been appointed by the CCM as
   principal Recipient. Now, for Round 9, two entities were identified over the course of the selection of expressions of
   interest and clearly stated their desire to be principal Recipients; these are FHI and the Programme National de Lutte
   contre la Tuberculose (National Programme to Fight Tuberculosis). These two entities are confirmed by the CCM
   For the Malaria Component: a meeting between the various submitting entities took place at the CCM secretariat
   on 14th May 2009 in order to share the draft proposal and pick up contributions from the various parties. This
   meeting afforded an opportunity to discuss the various parties' intentions for the position of principal Recipient.
   Only the Programme National de Lutte contre la Paludisme (National Programme to Fight Malaria) ruled on being a
   principal Recipient, the other organisations having stated their desire to be one.
   sub-recipient. (see Minutes of the meeting held on 14/ 05/ 2009 with the Applicants submitting for Round 9)
   (Attachments 5, 6 and 8)
                                                                                                      Attachments (5-
    (b)
                                                                                                      6 and 8

 2.2.5. Principal Recipient(s)

                           Name                                 Disease                        Sector**

Programme National de lutte contre le Paludisme (National
                                                                 Malaria                      Government
Programme to Fight Malaria)

Conseil National de Lutte contre le SIDA (CNLS - National
Council to Fight AIDS) and the Alliance Nationale Contre le       HIV                 Government and Civil Society
SIDA (National Alliance Against AIDS)

Programme National de Lutte contre la Tuberculose (National
Programme to Fight Tuberculosis) and Family Health            Tuberculosis         Government and international NGO
International (FHI)

Division de Lutte contre le SIDA (Division to Fight AIDS)         HSS                         Government

[use “Tab” key to add extra rows if needed]

 ** Choose a 'sector' from the possible options that are included in this Proposal Form at s.2.1.1.

 2.2.6. Non-implementation of dual track financing



      R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                            14/17
Provide an explanation below if at least one government sector and one non-government sector Principal
Recipient have not been nominated for each disease in this proposal.

For the Malaria Component, a meeting between the various submitting entities took place at the CCM secretariat on
14th May 2009 in order to talk about the draft proposal and ask for contributions from the various parties. This
meeting afforded an opportunity to discuss the various parties' intentions for the position of principal Recipient.
Only the Programme National de Lutte contre la Paludisme (National Programme to Fight Malaria) decided to act as
a principal Recipient, the other organisations having stated their desire to act as sub-recipients. Indeed, it emerged
from the discussions that there are no organisations prepared to become a second principal Recipient alongside the
PNLP.
This documented situation was the subject of a discussion at the CCM meeting held on 25th May. After looking at
the report on the meeting held on 14th May, the CCM chose only the PNLP which has the required capacities to be a
principal Recipient of the current Round 9 Malaria Component, the other organisations (NGOs) and the districts are
chosen solely as pre-identified beneficiaries.
In actual fact, the NGOs working to combat malaria in Senegal have not been operating in this area for very long
and they are not yet very well-established. Some of these NGOs are based at district, region or neighbourhood level.
There is no national NGO drawing on support from other smaller-scale NGOs as sub-Recipient in order to carry out
the activities involved in fighting the disease. All of the NGOs, like the districts, draw on support from the
Community-Based Organisations (CBOs) in order to carry out their activities.
So the CCM asked the principal Recipient, in the event of accepting this proposal, to proceed to the empowerment 4
of the organisation which is best-placed to allow it to play the role of principal Recipient in the near future.


 2.2.7. Managing conflicts of interest


                                                                                                      Yes
(a)     Are the Chair and/or Vice-Chair of the CCM (or Sub-CCM) from the same entity         Provide details below
        as any of the nominated Principal Recipient(s) for any of the diseases in this
        proposal?                                                                            x        No
                                                                                                 go to s.2.2.8.


(b)     If yes, attach the plan for the management of actual and potential conflicts of
                                                                                                  [Insert Annex
         interest.
                                                                                             Number]



 2.2.8. Proposal endorsement by members

Attachment C – Membership              Has 'Attachment C' been completed with the signatures
                                                                                                              X Yes
information and Signatures             of all members of the CCM (or Sub-CCM)?

                                                                                                 List Annex Name
Section 2: Eligibility
                                                                                                   and Number

CCM and Sub-CCM applicants

                            Comprehensive documentation on processes used to
                            invite submissions for possible integration into the
2.2.2 (a)                                                                                    Attachments 7 and 8
                            proposal (if different processes used for each disease,
                            attach as separate annexes).


 4
   Translator’s note: this is a guess at the meaning of “capacitation” here – there’s not much context but
 it at least seems to make some sense.


      R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                               15/17
                       Comprehensive documentation on processes used to
                       review submissions for possible integration into the
2.2.2 (b)                                                                         Attachment 7
                       proposal (if different processes used for each disease,
                       attach as separate annexes).

                       Comprehensive documentation on processes used to
2.2.2 (c)              ensure the input of a broad range of stakeholders in       Attachment 7
                       the proposal development process

                       Comprehensive documentation on processes to
2.2.3 (a)              oversee grant implementation by the CCM (or Sub-           Attachment 4
                       CCM).

                       Comprehensive documentation on processes used to
2.2.3 (b)              ensure the input of a broad range of stakeholders in       Attachment 4
                       grant oversight process.

                       Comprehensive documentation on processes used to
                       select and nominate the Principal Recipient (such as
                                                                                  Attachments 5, 6 and
2.2.4 (a)              the minutes of the CCM meeting at which the PR(s)
                                                                                  8
                       was/were nominated). If different processes used for
                       each disease, then explain.

                       Documented procedures for the management of
                       potential Conflicts of Interest between the Principal      Not applicable to this
2.2.7
                       Recipient(s) and the Chair or Vice Chair of the            case
                       Coordinating Mechanism

                       Minutes of the meeting at which the proposal was
2.2.8                                                                             Attachment 8
                       developed and CCM (or Sub-CCM) endorsed.

                       Endorsement of the proposal by all CCM (or Sub-            Attachment C to the
2.2.8
                       CCM) members.                                              Proposal Form

Sub-CCM applicants only

2.3.3                  Documented evidence (including minutes of the CCM
                       meetings) that the CCM in the country reviewed and
(CCM Endorsement)
                       endorsed the proposal (as relevant).

2.3.4                  Documented evidence justifying the Sub-CCM’s right
                       to operate without guidance from the CCM.

Non-CCM applicants only

                       Documentation describing the organisation such as
                       statutes and by-laws (official registration papers) or
                       other governance documents, documents evidencing
                       the key governance arrangements of the organisation,
2.4.1
                       a summary of the organisation, including background
                       and history, scope of work, past and current activities,
                       and a summary of the main sources and amounts of
                       funding.

                       Documentary evidence justifying the one of the three
2.4.2 (a)              exceptional circumstances for submitting a non-CCM
                       proposal




        R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                               16/17
                             Documentary evidence of any attempts to include the
2.4.2 (b)                    proposal in the relevant CCM’s final approved country
                             proposal and any response from the CCM.

Other documents relevant to sections 1 and 2 attached by applicant:
(add extra rows to this section of the table as required to ensure that documents directly relevant are attached)

                             Terms of reference, Membership and Operation of the
                                                                                              Attachment 3
                             CCM

                             Procedural manual                                                Attachment 4




      R9_CCM_SNG_HHSSTM_PF_s1-2_05Jun09_En                                                                          17/17
                                       REPUBLIC OF SENEGAL
                                                   ---------
                               One people – One Goal – One Faith
                           Country Coordinating Mechanisms (CCM)/Global Fund Senegal

           National Coordination Commission of the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria




                   SENEGAL PROPOSAL MALARIA COMPONENT
                                   - GLOBAL FUND ROUND 9
        PROJECT FOR THE STRENGTHENING AND EXTENSION OF
   INTERVENTIONS FOR THE EFFECTIVE CONTROL OF MALARIA IN
                         SENEGAL
                                                       2009




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                              1/78
                                       PROPOSAL FORM – ROUND 9
                                       (SINGLE COUNTRY APPLICANTS)

  Applicant Name                        CCM/Senegal: National coordination authority

  Country                               SENEGAL
  Income Level
  (Refer to list of income levels by    Low income
  economy in Annex 1 to the Round
  9 Guidelines)


  Applicant Type                            CCM                         Sub-CCM                        Non-CCM



  Round 9 Proposal Elements
                                                                    Does this disease include cross-    Is this a 're-submit' of
                                                                        cutting Health System               the same disease
       Disease                             Title                    Strengthening interventions in            proposal not
                                                                               part 4B?                    recommended in
                                                                      (include in one disease only)            Round 8?


  HIV1

  Tuberculosis1
                            Project for the strengthening
                           and extension of interventions
                             for the effective control of
  Malaria                        malaria in Senegal                                                     NO




  If this is a Round 8 proposal being re-submitted, have the TRP Review Form comments been clearly
                                           addressed in s.4.5.2?
                                                                                                               Yes        No

  Are there major new objectives compared to the Round 8 proposal that is being re-submitted? If yes,
  please provide a summary of the changes in the box below by each disease re-submission and section
                                               number.                                                         Yes        No

  ONE PAGE MAXIMUM


  Currency                                         USD                           or                          EURO

Deadline for submission of proposals:                                       12 noon, Local Geneva Time,
                                                                            Monday 1st June 2009


1 Different HIV and tuberculosis activities are recommended for different epidemiological situations. For more information on this
  subject, please see the ‘WHO Interim policy on collaborative TB/HIV activities’ available at:
 http://www.who.int/tb/publications/tbhiv_interim_policy/en/
R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                             2/78
INDEX OF SECTIONS and KEY ATTACHMENTS FOR PROPOSALS

'+' =   A key attachment to the proposal. These documents must be submitted with the completed
        Proposal Form. Other documents may also be attached by an applicant to support their
        programme strategy (or strategies if more than one disease is applied for) and funding
        requests. Applicants identify these in the “Checklists” at the end of s.2 and s.5.

1.      Funding Summary and Contact Details

2.      Applicant Summary (including eligibility)
+       Attachment C: Membership details of CCMs or Sub-CCMs

Complete the following sections for each disease included in Round 9:

3.      Proposal Summary

4.      Programme Description
        4B.   HSS cross-cutting interventions strategy **

5.      Funding Request
        5B.   HSS cross-cutting funding details **

        ** Only to be included in one disease in Round 9. Refer to the Round 9 Guidelines for
        detailed information.

+ Attachment A: “Performance Framework” (Indicators and targets)

+ Attachment B: “Preliminary List of Pharmaceutical and Health Products”

+ Detailed Work Plan: Quarterly for years 1 - 2, and annual details for years 3, 4 and 5

+ Detailed Budget: Quarterly for years 1 - 2, and annual details for years 3, 4 and 5


IMPORTANT NOTE:
Applicants are strongly encouraged to read the Round 9 Guidelines fully before completing a Round 9
proposal. Applicants should continually refer to these Guidelines as they answer each section in the
proposal form. All other Round 9 Documents are available here.


A number of recent Global Fund Board decisions have been reflected in the Proposal Form. The
Round 9 Guidelines explain these decisions in the order they apply to this Proposal Form.
Information on these decisions is available at:
http://www.theglobalfund.org/documents/board/16/GF-BM16-Decisions_en.pdf.

Since Round 7, efforts have been made to simplify the structure and remove duplication in the
Proposal Form. The Round 9 Guidelines therefore contain the majority of instructions and
examples that will assist in the completion of the form.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                              3/78
ROUND 9 - Malaria
1.       FUNDING SUMMARY AND CONTACT DETAILS
1.1.     Funding summary

                                               Total funds requested over proposal term
             Disease
                             Year 1        Year 2              Year 3           Year 4          Year 5             Total

       HIV

       Tuberculosis

       Malaria              6,542,525       6,920,919         13,977,280        9,520,498      6,430,406        43,391,628

       HSS cross-
       cutting
       interventions
       section 4B and
       5B within [insert
       name of the one
       disease which
       includes s.4B.
       and s.5B. only if
       relevant]

                                                                     Total Round 9 Funding Request      :




1.2.     Contact details
                                        Programme National de Lutte contre la       Global Fund Officer at the Programme
       Title                            Paludisme (National Programme to Fight      National de Lutte contre le Paludisme
                                        Malaria) Coordinator                        (National Programme to Fight Malaria)
                                        Ministry of Health, Prevention and Public   Ministry of Health, Prevention and Public
       Organisation                     Hygiene                                     Hygiene
                                        Malaria Programme                           Malaria Programme
                                        rue Aimé Césaire x E Fann Résidence -       rue Aimé Césaire x E Fann Résidence -
       Postal address
                                        Dakar Senegal                               Dakar Senegal
                                        BP 25270                                    BP 25270
                                        (221) 33 869 07 99                          (221) 33 869 07 99
       Telephone                        or (221) 77 637 19 81                       or (221) 77 657 64 51
                                        (221) 33 864 41 20                          (221) 33 864 41 20
       Fax
                                        papethior@orange.sn                         syllat@gmail.com
       E-mail address

       Alternate e-mail address         plcpalu@orange.sn                           thiamsylla@hotmail.com


1.3.     List of Abbreviations and Acronyms used by the Applicant

               Acronym/Abbreviation                   Meaning
       ABCD                                      Atteindre les Bénéficiaires Communautaires à travers les Districts
                                                 (Reaching Beneficiaries through the Districts)
       IRS                                       Indoor Residual Spraying
       AMFm                                      Affordable Medicines2 Facility malaria
       ARV                                       Antiretrovirals
       CHW                                       Community Health Worker
       IDB                                       Islamic Development Bank

2 Translator’s note: incorrectly spelt in the French source text.
  R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                               4/78
ROUND 9 - Malaria
     WB                                         World Bank
     RHO                                        Regional Health Office
     CDD                                        Conseil Départemental de Développement (Departmental
                                                Development Council)
     IPC                                        Interpersonal Communication
     CLD                                        Conseil Local de Développement (Local Development Council)
     PCC                                        Primary Curative Consultation
     PNC                                        Prenatal Consultation
     CRD                                        Conseil Régional de Développement (Regional Development
                                                Council)
     ACT                                        Artemisinin-based combination therapies
     DPL                                        Direction de la Pharmacie et des Laboratoires (Directorate of
                                                Pharmacy and Laboratories)
     SDA                                        Service Delivery Area
     DSDOM                                      Dispensateurs de Soins à Domicile (Home Care Providers)
     DSRP                                       Document de Stratégie de Réduction de la Pauvreté (Poverty
                                                Reduction Strategy Document)
     DHT                                        District Health Team
     RHT                                        Regional Health Team
     DHS                                        Demographic and Health Surveys
     PPE                                        Personal Protective Equipment
     HE                                         Health Education
     GF                                         Global Fund
     FRP                                        Faire Reculer le Paludisme (Roll Back Malaria)
     CBI                                        Community-Based Initiative
     ICP                                        Infirmier Chef de Poste (Head Nurse)
     SRN:                                       State-Registered Nurse
     IEC / BCC                                  Information Education Communication with Behavioural Change
                                                Communication
     IPD                                        Institut Pasteur, Dakar
     RDI                                        Research and Development Institute
     VC                                         Vector Control
     LNCM                                       Laboratoire National de Contrôle des Médicaments (National
                                                Drug Monitoring Laboratory)
     MDL                                        Mineral Deposits3 Limited
     ITN                                        Insecticide Treated Net
     LLITN                                      Long-Lasting Insecticide Treated Nets
     MINT                                       Ministry of the Interior
     MIS                                        Malaria Indicators Survey
     MMV                                        Malaria Medicine4 Venture
     MNM                                        Malaria No More


3 Translator’s note: incorrectly spelt in the French source text.
4 Translator’s note: incorrectly spelt in the French source text.
  R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                               5/78
ROUND 9 - Malaria
     MoH                                      Ministry of Health
     MSH                                      Management Sciences for Health
     NA:                                      Not Applicable
     ND                                       Not Determined
     WAHO                                     West African Health Organisation
     CBO                                      Community-Based Organisation
     MDG                                      Millennium Development Goals
     WHO                                      World Health Organisation
     OMVS                                     Organisation pour la Mise en Valeur du fleuve Sénégal
                                              (Senegal River Basin Development Organisation)
     NGO                                      Non-Governmental Organisation
     IMCI                                     : Integrated Management of Childhood Illnesses
     PEC                                      Prise en Charge (Care / Treatment / etc.5)
     PECADOM                                  Prise En Charge à Domicile (Home Care)
     EVP                                      Extended Vaccination Programme
     PMI                                      The President’s Malaria Initiative6
     PNA                                      Pharmacie Nationale d’Approvisionnement (National Supply
                                              Pharmacy)
     PNDS                                     Plan National de Développement Sanitaire (National Health
                                              Development Plan)
     PNLP                                     Programme National de lutte contre le Paludisme (National
                                              Programme to Fight Malaria)
     SDP                                      Service Delivery Point
     PRA                                      Pharmacie Régionale d’Approvisionnement (Regional Supply
                                              Pharmacy)
     PRN                                      Programme de Renforcement Nutritionnel (Nutritional
                                              Reinforcement Programme)
     P.S.                                     Poste de Santé (Health Point)
     RBM                                      Roll Back Malaria / FRP: Faire Reculer le Paludisme (Roll Back
                                              Malaria)
     MR                                       Medical Region
     OR                                       Operational Research
     HSS                                      : Health System Strengthening
     SRM                                      : State-Registered Midwife
     AIDS                                     Acquired Immunodeficiency Syndrome
     MIS                                      Medical Information System
     SLAP                                     Section de Lutte Anti Parasitaire (Parasite Control Section)
     SNEIPS                                   Service National de l’Education et de l’Information pour la Santé
                                              (National Health Education and Information Service)
     NHS                                      National Health Service
     SNIS                                     Service National de l’Information Sanitaire (National Health

5 Translator’s note: the precise translation of the term “prise en charge” varies from one context to another. In most
cases in the document the acronym has been translated by a term rather than an acronym, as there’s no single
acronym that would fit all contexts.
6 Translator’s note: the name is given incorrectly in the French source text.
  R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                      6/78
ROUND 9 - Malaria
                                  Information Service)
  SODEFITEX                       Société de Développement des Fibres Textiles (Textile Fibre
                                  Development Company)
  SP                              Sulphadoxine Pyrimethamine
  PHC                             Primary Health Care
  RDT                             Rapid Diagnostic Test
  IPT                             Intermittent Preventive Treatment
  UCAD                            Université Cheikh Anta Diop, Dakar
  WAEMU                           West African Economic and Monetary Union
  UNICEF                          United Nations Children's Fund
  HV                              Home Visits
  VBC                             Vector Biology and Control
  HIV                             Human Immunodeficiency Virus




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                 7/78
ROUND 9 - Malaria
3. PROPOSAL SUMMARY

       3.1.        Duration of Proposal                 Planned Start Date                               To
                             Month and year:
                                                             June 2010                            May 2015
                                (up to 5 years)


       3.2.        Consolidation of grants
                                                                                                           Yes
                                                                                                 (go first to (b) below)
       (a)       Does the CCM (or Sub-CCM) wish to consolidate any existing malaria
                 Global Fund grant(s) with the Round 9 malaria proposal?                                   No
                                                                                                 (go to s.3.3. below)
       ‘Consolidation’ refers to the situation where multiple grants can be combined to form one grant. Under
       Global Fund policy, this is possible if the same Principal Recipient (‘PR’) is already managing at least one
       grant for the same disease. A proposal with more than one nominated PR may seek to consolidate part of the
       Round 9 proposal.
              More detailed information on grant consolidation (including analysis of some of the benefits and areas
              to consider is available at:
              http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_FAQ_GrantConsolidation_en.pdf

       (b)        If yes, which grants are planned to be consolidated with the
                   Round 9 proposal after Board approval?
       (c)        (List the relevant grant number(s))


3.3.         Alignment of planning and fiscal cycles

       Describe how the start date:
       (a)       contributes to alignment with the national planning, budgeting and fiscal cycle; and/or
       (b)       in grant consolidation cases, increases alignment of planning, implementation and
                 reporting efforts.

       ONE PAGE MAXIMUM
       The PNLP currently implements two Global Fund subsidies (Rounds 4 and 7) whose quarterly reporting
       periods have been aligned. So the first quarter of Round 7 in June 2008 coincided with the 12th quarter of
       Round 4. This alignment has made it easier to draw up and send in the quarterly reports. For Round 9 it
       will be a matter of sticking to the same dynamic by planning for the activities actually to get underway in
       early June 2010.

3.4.         Programme-based approach for Malaria
 3.4.1. Does planning and funding for the country's
        response to malaria occur through a programme-
        based approach?                                                        Yes. Answer s.3.4.2


                                                                               No.      Go to s.2.2.8.


                                                                               Yes    Complete s.5.5 as an additional section to
 3.4.2. If yes, does this proposal plan for some or all of the requested       explain the financial operations of the common
 funding to be paid into a common-funding mechanism to support that            funding mechanism.
 approach?


                                                                               No. Do not complete s.5.5

3.5.         Summary of Round 9 Malaria Proposal




  R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                              8/78
ROUND 9 - Malaria
Provide a summary of the Malaria proposal described in detail in section 4.
Prepare after completing s.4.

This proposal is part of the process of strengthening national strategies for the prevention and treatment of malaria,
supported by both Rounds 4 and 7 and the other partners. An analysis of the situation has helped to show a
significant fall in both morbidity and mortality linked to malaria and recommends universal LLITN coverage, together
with the extension of the PECADOM scheme and IRS operations in order to maintain or consolidate this trend.
Although it does cover the whole of the country, this proposal places special emphasis on the regions which are the
most severely affected by the disease. Its aim is to help to bring about a reduction in both morbidity and mortality
linked to malaria. Its goals for the period up until 2014 have been set out as follows:
     • To provide proper home treatment for at least 85% of cases of simple malaria in the areas targeted by the
          PECADOM scheme, as stated in the programme’s guidelines.
     • To get at least 85% of the population sleeping under LLITNs, especially pregnant women and children under
          the age of 5.
     • To provide IRS coverage for at least 90% of the population in the 16 districts targeted for IRS operations.
The following priorities have been chosen for the purposes of achieving these objectives:
- Scaling up of the home care (PECADOM) scheme: In spite of all the efforts made by health training courses and
functional “cases de santé" (health posts), there are still significant variations which can partly be explained by the
difficulties in providing people with access to health care facilities. This is the background against which the
PECADOM strategy was drawn up and implemented by the PNLP in three pilot districts in 2008. Given that this
produced satisfactory results, this proposal includes plans to scale this strategy up to villages which are less easily
accessible or do not have basic health care facilities, with cases of simple malaria being treated by home care
providers (DSDOMs) trained in diagnosing malaria by means of RDT and the use of ACTs. The quality control and
monitoring of the sensitivity of the parasites to anti-malarial drugs will be strengthened. By 2014, we plan to have
985 villages covered by the PECADOM scheme out of which there will be 749 villages (i.e. 515,624 inhabitants) for
whom care will be provided by this proposal.
- Universal LLITN coverage: In spite of all the efforts made LLITN coverage is still low (34%). The needs for the
purposes of bridging the gap and achieving universal coverage have been estimated at 10,120,124 LLITNs. The
PNLP is planning the distribution of these mosquito nets entre 2010 and 2014, through the routine circuit (PNC,
EVP, targeting by means of a “voucher system”), the community system (network of 8500 CBOs) and a mass
campaign in 2012, especially targeting children under the age of 5. The Round 9 subsidy will cover 4,278,427
LLITNs and this will be supplemented by the State and the other partners.
- Extension of IRS operations: Following the three-year indoor residual spraying pilot phase in three districts, the
extension of IRS operations will help to cover 16 districts from 2010 to 2014. It will involve strengthening both the
stakeholders’ capacities and the acquisition of appropriate equipment. The private sector will be asked to contribute
for the purposes of logistical support. Proper insecticide management will be one of the key factors in order to
minimise the risks to both the environment and the populations. The various stakeholders involved in the process
will be trained in the precautions to be taken when using insecticides.
Support activities are essential for a high quality implementation of these priorities. Communication, through the
partnership with the NGOs and contractual agreements with the community-based organisations (CBOs), will be
strengthened as part of an integrated communication plan and a media plan. The involvement of other sectors
(State, private, NGOs) will be fostered in order to popularise the chosen interventions and acquire additional
resources.
The monitoring-evaluation system, implemented in the previous Rounds, will be strengthened by taking on board
recommendations from the self-assessment. The monitoring and assessment procedure manual will be used for this
purpose and coverage and impact studies will be carried out to measure the effects of the various interventions.
The budget amounts to 43,391,628 euros over the period from 2010 to 2014.




 R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                     9/78
    ROUND 9 - Malaria
    4. PROGRAMME DESCRIPTION

    4.1.     National prevention, treatment, care, and support strategies
 (a)    Briefly summarise:
    the current malaria national prevention, treatment, and support strategies;
    how these strategies respond comprehensively to current epidemiological situation in the
    country; and
    the improved malaria outcomes expected from implementation of these strategies.
 This proposal is an ongoing part of the national strategic plan to fight malaria. Indeed, by taking a multi-
 sectoral and multidisciplinary approach, Senegal has defined a framework for the prevention and control of
 malaria for the period from 2006 to 2010 (Attachment 1). This strategic plan complies both with the
 guidelines of the “Roll Back Malaria” Initiative and with the overall WHO targets set in order to fight malaria,
 and aims to reduce the morbidity and mortality linked to malaria by 50% by 2010. It will be assessed in 2010
 and a fresh strategic plan for 2011- 2015 will be drawn up as an ongoing part of the strategy. In order to
 achieve these goals, the national policy to fight malaria is based upon two major strategic guidelines, i.e.
 strengthening prevention and improving the way that cases are cared for, with essential support
 interventions (IEC/BCC, managing the programme to fight the disease, monitoring and assessment).
 1. strengthening prevention: This is based on Intermittent Preventive Treatment (IPT) in pregnant women
 and vector control (VC) through the promotion of the use of Long-Lasting Insecticide Treated Nets (LLITNs),
 the indoor residual spraying of insecticide (IRS) and the destruction of the vectors’ breeding places.
 IPT is currently implemented free of charge at all levels of the health system. It is administered to pregnant
 women in the 2nd and 3rd trimesters under direct observation. Pregnant women are also eligible for a special
 promotion for the use of LLITNs.
 By placing the emphasis on universal access to LLITNs, the PNLP is promoting their use in households and
 especially by children under the age of 5, by organising free distribution campaigns, subsidised distribution
 and social marketing. The other components of VC as contained in the plan to fight vectors (Attachment 2)
 are (i) the IRS operations currently being implemented in three pilot districts with the support of the PMI and
 (ii) the development of community-based approaches for the destruction/treatment of breeding places, in the
 areas in which this intervention may be effective. Prevention interventions are well-supported by the
 availability of inputs (Sulphadoxine Pyrimethamine, LLITNs, insecticides, etc.), by the strengthening of the
 capacities of the service providers and by IEC/ BCC.
 As far as IRS is concerned, the important contribution it is making to the fall in the incidence of malaria in the
 pilot districts (Attachment 3), argued in favour of its extension to other districts of the country, especially in
 areas where there is still a high incidence of malaria. IRS can quickly help to bring about a considerable
 reduction in the vector populations and transmission, with an impact on the incidence of the disease.
 2. Improving the way that cases are treated: this is based upon early diagnosis and the rapid, proper
 treatment of cases on all levels, which are two key components of any overall strategy aiming to reduce the
 mortality caused by malaria. In order to improve the level of confirmation of cases of malaria, Rapid
 Diagnostic Tests (RDT) have been introduced at all health centres and health points since 2007. RDTs are
 currently being gradually introduced at community level. Microscopy is still in use in the laboratories at health
 centres and hospitals which can draw on support in terms of equipment and materials for the carrying out of
 the thick smear test at a lower cost.
 Since 2006 the treatment of cases of simple malaria has used Artemisinin-based combination therapies
 (ACTs), which are available in all health care facilities, from hospitals through to “cases de santé". Serious
 cases and cases of malaria in pregnant women are treated by hospitals with IV quinine (Attachment 4). In
 order to improve access to treatment by the populations, since 2008 the PNLP has begun a Home Care
 (PECADOM) pilot project, with volunteer community ACT providers, once the cases have been confirmed by
 means of RDTs.
 These two major strategic outlines for the fight against malaria in Senegal need to be based upon a certain
 number of support interventions if they are to be adequately implemented. It is a matter (i) of improving
 IEC/BCC, (ii) of strengthening Monitoring & Assessment, (iii) of strengthening operational research, (iv) of
 extending community-based interventions, (v) of strengthening the management of the programme at all
 levels, (vi) of strengthening the capacities (both human and in terms of equipment) and (vii) of improving
 multi-sectoral collaboration. A system of surveillance of areas which are at risk of epidemics has been




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                       10/78
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 introduced in the northern part of the country since 2007 through sentinel sites.
 In 2006, following the assessment of the 2001-2005 strategic plan, the PNLP took a certain number of
 corrective measures:
 - the scaling up of the interventions proven to be effective and recommended by the WHO;
 - the improvement of the quality of care (training of the service providers, confirmation of the diagnosis prior
 to treatment with RDT, adoption of ACTs);
 - the strengthening of the monitoring-assessment system especially by means of improving the quality of the
 data (close peer supervision, verification of the data on sites, quarterly meetings to gather and approve the
 data from health care facilities).
 The implementation of these measures helped to show up a fall in morbidity and mortality linked to malaria
 in the country’s health care facilities. This means that the number of cases of malaria fell by 1,555,310 to
 275,806 between 2006 and 2008. The maintaining and improving of the current interventions and measures
 (including the extension of IRS operations and the PECADOM scheme), will contribute to an effective short-
 term control of malaria.
 It is precisely at a time when the downward trend in the indicators is well underway and the service
 providers, NGOs and communities have all made firm commitments that we need to reinforce the scaling up
 of the interventions which have been proven to be effective by means of a considerable increase in
 resources. Any slackening of the financing efforts on the part of the funding sources could seriously
 compromise the consolidation of the results achieved thanks to the previous subsidies from the Global Fund
 and there would be a risk of wiping out the sustained efforts made by the partners in order to combat malaria
 over the last few years.
 (b)      From the list below, attach* only those documents that are directly relevant to the focus of this
          proposal (or, * identify the specific Annex number from a Round 7 or Round 8 proposal when the
          document was last submitted, and the Global Fund will obtain this document from our files).
 Also identify the specific page(s) (in these documents) that support the descriptions in s.4.1. above.
                                                                     Proposal Annex
                             Document                                                          Page References
                                                                        Number

                                                                   Attachment 1            P 48 - 77
          National Health Sector Development/Strategic Plan

          National Malaria Control Strategy or Plan


          Important sub-sector policies that are relevant to the
          proposal                                                 Attachment 5            P 12-16; 36; 43 - 49
  (e.g. national or sub-national human resources policy, or
         norms and standards)

                                                                   Attachment 6            P 32 - 36
          Most recent self-assessment reports/technical
          advisory reviews, including any Epidemiology report      Attachment 7            P 42 – 77
          directly relevant to the proposal


          National Monitoring and Assessment Plan (health          Attachment 8            P5 – 23
          sector, malaria specific or other)


          National policies to achieve gender equality in regard
          to the provision of malaria prevention, treatment, and   Attachment 5            P 48 – 49
          care and support services to all people in need of
          services




       4.2.    Epidemiological Background

   4.2.1.          Geographic reach of this proposal




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                     11/78
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   (a)   Do the activities target:


         Whole country                Specific Region(s)                  Specific population groups
                               ** If so, insert a map to show      ** If so, insert a map to show where these
                                        where                               groups are if they are in a specific area
                                                                            of the country


    Malaria is endemic in Senegal and it tends to break out over the whole of the country during the rainy
    season. Broadly speaking we can make distinctions between 3 epidemiological facies: an area of
    unstable malaria in the north, an area of intermediate malaria in the centre and stable malaria in the
    south.
    So, if we analyse the incidence and mortality from malaria in Senegal it is clear that all regions are
    affected by the disease. But it is especially in the regions of the Centre, the South and the East of the
    country that malaria is far more of a scourge with the incidence map which is superimposed over the
    mortality map.
    This is why, although it does target the whole of the country for the purposes of universal LLITN
    coverage, this proposal will be emphasising the extension of the PECADOM scheme and IRS
    OPERATIONS, across the regions located in the Centre, the South and the East of the country where
    morbidity and mortality linked to malaria are still high, as described in figures 1 and 2 below:




    Figure 1: Incidence of malaria per 1000 inhabitants in 2008




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                         12/78
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    Figure 2: Proportional malarial mortality per health region in 2008


                     Evolution: Morbidité - Mortalité - Létalité




    Figure 3: Trends in morbidity and mortality from 2007 to 2008

    At present, the epidemiological background to malaria in Senegal has changed a great deal with a
    significant improvement in the indicators for results and impact. An analysis of the situation in the fight
    against malaria has shown significant progress made in terms of reducing mortality due to malaria in
    health care facilities and the case fatality rate between 2000 and 2005. On the other hand, morbidity
    linked to malaria remained stationary up until 2006.
    Since 2006, the scaling up of priority interventions together with the improvement in the quality of care
    and the coverage provided by preventive measures, has had an impact on the scourge of malaria. The
    strengthening of the monitoring-assessment system together with the improvement of the quality of the
    data has helped to reveal a drastic drop in morbidity and mortality due to malaria in 2007 and 2008
    (Attachment 9) as mentioned in figure 3 above.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                   13/78
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    (b)   Size of population group(s)

           Population Groups            Population Size           Source of Data                Year of Estimate

                                                             Senegal – Third Recensement
                                                             Général de la Population et de
                                                           l’Habitat (General Census of the
                                                                Population and Living
    Total country population (all                           Environment) – RGPH – 2002
    ages)
                                          11,615,586              (Attachment 10)                      2008
                                                           Estimated population of Senegal
                                                           from 2005 to 2015, Directorate
                                                            for Forecasting and Statistics,
                                                           January 2006 (Attachment 11)

    Women > 54 years                       418,161                      ditto                          2008

    Women 15 - 54 years                    3,031,668                    ditto                          2008

    Women with a pregnancy in last
    12 months                              418,161                      ditto                          2008

    Men > 54 years                         406,546                      ditto                          2008

    Men 15 - 54 years                      2,787,741                    ditto                          2008

    Girls 5 – 14 years                     1,614,566                    ditto                          2008

    Boys 5 – 14 years                      1,649,413                    ditto                          2008

    Girls 0 – 4 years                      847,938                      ditto                          2008

    Boys 0 – 4 years                       859,553                      ditto                          2008

    Population under the age of 5          2,253,423                    ditto                          2008

    Population Over the age of 5
    (excluding pregnant women)             9,489,934                    ditto                          2008


    Other **:
                                                                                              [use “Tab” key to add
                                                                                              extra rows if needed]


    As far as LLITNs are concerned, although universal coverage is the aim, children under the age of 5
    and pregnant women are still the priority targets. For the other interventions (IRS operations and the
    PECADOM scheme) the whole of the population in the target areas is affected, irrespective of age and
    gender.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                       14/78
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 4.2.2.          Malaria epidemiology of target population(s)

                                               Estimated
            Population Groups                                      Source of Data         Year of Estimate
                                                Number

 Episodes of malaria in past 12 months (all
 population, all ages)                          275,806           (Attachment 9)                2008


 Episodes of malaria in past 12 months:
 Women > 54 years                             Data not gathered by the national information system (SNIS /
                                                                        PNLP)
 Episodes of malaria in past 12 months:
 Women 15 - 54 years

 Pregnant women infected with malaria in         8,572            (Attachment 9)                2008
 the past 12 months

 Episodes of malaria in past 12 months:
 Men > 54 years

 Episodes of malaria in past 12 months:
 Men 15 - 54 years

 Episodes of malaria in past 12 months:
 Girls 5 – 14 years
                                              Data not gathered by the national information system (SNIS /
 Episodes of malaria in past 12 months:
                                                                        PNLP)
 Boys 5 – 14 years

 Episodes of malaria in past 12 months:
 Girls 0 – 4 years

 Episodes of malaria in past 12 months:
 Boys 0 – 4 years

                                                                  (Attachment 9)
 Episodes of malaria in past 12 months:         74,252                                          2008
 Population under the age of 5

                                                                  (Attachment 9)
 Episodes of malaria in past 12 months:
 Population Over the age of 5 (excluding        192,982                                         2008
 pregnant women)
                                                                  (Attachment 9)
 Number of deaths due to malaria per year         722                                           2008


 Other **: Add
                                                                                         [use “Tab” key to add
                                                                                         extra rows if needed]


 N.B. Episodes of malaria shown in this table are cases of malaria confirmed by microscopy or RDT.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                  15/78
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 4.3.        Major constraints and gaps

 (For the questions below, consider government, non-government and community level weaknesses and gaps, and
                                   7
 also any key affected populations who may have disproportionately low access to malaria prevention, treatment, and
 care and support services, including women, girls, and sexual minorities.)


 4.3.1. Malaria Programme
 Describe:
     • the main weaknesses in the implementation of current malaria strategies;
     • how these weaknesses affect achievement of planned national malaria outcomes; and
     • existing gaps in the delivery of services to specific at-risk populations.

        INTERVENTIONS                                     MAIN WEAKNESSES OR GAPS
                                  - The PNLP lacks sufficient resources for the acquisition of LLITNs
                                  - Availability and use are still low
                                  - Frequent LLITN stock outages
                                  - Lack of quality control and monitoring of the effectiveness of the LLITNs
              LLITN               - The prices of unsubsidised LLITNs is still high in the commercial private
                                    sector
                                  - There is still not enough coordination with the private sector.
                                  - Low coverage of the country (4 districts covered up until 2010).
                                  - Lack of sufficient qualified technical staff
                                  - Lack of sufficient motor vehicles at district level
                IRS               - Lack of quality control over pesticides
                                  - Lack of sufficient coordination between the various IEC/BCC
                                     stakeholders and at various levels
                                  - Access to health care facilities is difficult in certain areas
                IPT               - Delay in the first prenatal consultation (CPN1).
                                  - Outages of SP stocks at certain points at which services are provided
                                  - It is difficult for populations to access health care facilities, especially in
               PEC                   rural areas
                                  - Lack of sufficient coverage by community structures for care in cases of
                                     simple malarias
                                  - Cost of caring for serious cases of malaria is still high for low-income
                                     populations
         Prevention and           - Lack of sufficient resources (high-quality human resources, equipment
       fighting epidemics            and financial resources) for detecting and responding to epidemics
                                  - Lack of sufficient resources – especially financial resources – devoted to
            IEC / BCC                communication activities for most interventions
          Multi-sectoral          -    Not much involved by other sectors in the fight against malaria
           approach


 The lack of sufficient availability and accessibility of LLITNs, combined with a lack of communication, are
 major obstacles to an improvement in rates of use. This means that the current use of LLITNs stands at
 34% (Attachment 12).
 Likewise, the low coverage in terms of health care facilities and the insufficiencies noted in IEC in
 particular for the early use of PNCs explain the relatively low rate of coverage of IPT-2 estimated at 63%
 (Attachment 9). Initiatives supported by the State and its partners, especially the Global Fund (Rounds 4
 and 7) and the PMI are in progress in order to correct the gaps in relation to IPT.
 The lack of sufficient resources (human, logistical and financial, etc.) is reducing the speed at which IRS
 operations are being extended to cover the rest of the country. The resources available for the
 management of epidemics need to be strengthened in order to cope with any epidemics which might

 7
     Please refer back to the definition in s.2 and found in the Round 9 Guidelines




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                       16/78
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 break out in view of the fall in cases seen over the last 2 years.
 Poor access to health care facilities maintains self-medication and the use of traditional treatments but
 also leads to a lack of adequate, early treatment. These effects lead to a reduction in the impact of the
 efforts made by increasing the risk of mortality from malaria at community-based level. They go some
 way to explaining the high mortality rates recorded in certain regions such as Tambacounda, Kolda,
 Kaolack and Fatick.
 The lack of sufficient multi-sectoral collaboration also plays a part in the poor coverage of the
 interventions implemented.
 For vulnerable populations (poor communities or inhabitants in areas which are isolated or not easily
 accessible), the gaps are the same as those stated for access to health care and to preventive tools such
 as LLITNs.


 4.3.2.   Health System
 Describe the main weaknesses of and/or gaps in the health system that affect malaria outcomes.
 The description can include discussion of:
 •        issues that are common to malaria, tuberculosis and HIV programming and service delivery; and
 •        issues that are relevant to the health system and malaria outcomes (e.g.: delivery of ITNs or IRS,
           or provision of intermittent preventive treatment to pregnant women (IPTp)), but perhaps not also
           HIV and tuberculosis programming and service delivery.

 4.3.2.   Health System
 Senegal’s national health system is of the pyramid type, organised on three levels: central, regional and
 operational. There are 14 Medical Regions and 69 Health Districts. These administrative structures
 polarise 22 hospitals, 76 health centres and 971 Health Points. The main bottlenecks in the health system
 (Attachments 5, 7 and 13), affecting the results of the PNLP are of a number of kinds:

 Service delivery: Overall, there is a lack of sufficient coverage by health care infrastructures with an
 average of one health point per 11,972 inhabitants, whereas the WHO recommends one point per 5000
 habitants. This shortage is far more keenly felt in certain areas and this results in limited access to health
 care services, especially in rural and peri-urban areas.
 There is also a lack of sufficient quantity of high quality human resources and a lack of sufficient
 managerial capacities, especially in remote areas where the prevalence of malaria is high. In the public
 sector there is one doctor per 18,615 inhabitants, one midwife per 3,946 women of child-bearing age and
 one nurse per 4,183 inhabitants. In addition to this, the qualified staff are unevenly distributed over the
 whole of the country, with the Dakar region concentrating half of staff (302 doctors out of a total of 624 in
 the public sector).
 This situation makes access to proper care difficult for populations who live in remote, deprived areas,
 thus limiting their early, adequate access to anti-malarial diagnosis and treatment.
 The coordination of vertical health programmes is often difficult with an effect on the overlapping of team
 supervision activities on the intermediate and central levels. In addition to this there is also the uneven
 nature of supervision activities which affect the quality of the services.
 All of these shortcomings have a negative impact on the management of the programme and on the
 implementation of priority interventions in deprived areas.
 Drugs and pharmaceutical products: The unwieldiness of the procedure under the new market code is
 an important risk factor in outages of stocks of drugs and other products, due to the constraints on the
 procurement process. On an operational level, the lack of sufficient qualified staff lies behind insufficiently
 high quality stock management and dispensing of drugs. All of these gaps have a negative impact on the
 quality of management of cases of disease.
 The conditions under which drugs are stored in certain structures can adversely affect the quality of the
 products. Furthermore, the system pharmacovigilance national is still not very functional.
 Health information system: The existence of a whole host of data management tools makes the work




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                    17/78
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 of health workers (21 were identified at Health Point level for various programmes and sometimes
 NGOs). In addition to this there is a lack of procedural manuals for the management of the health
 information system have an effect on the completeness, promptness and quality of the data gathered.
 Furthermore, the failure to include health data from the private sector (not received / or incomplete) and
 the slowness of the progress of the health information system at hospital level, are adversely affecting
 the completeness of the data received.


 4.3.3. Efforts to resolve health system weaknesses and gaps
 Describe what is being done, and by whom, to respond to health system weaknesses and gaps
 that affect malaria outcomes.

 ONE PAGE MAXIMUM
 Strategic HSS initiatives are implemented by the Ministry of Health to respond to the weaknesses of the
 health system. These initiatives complement those taken by the PNLP in Rounds 4 & 7 and the partners.
 Service delivery:
      The Plan National de Développement Sanitaire (P N D S – National Health Development Plan) sets
      out to increase the density of the passive coverage in terms of health points whilst making sure that
      it corrects any disparities between districts. This strategy also groups together all of the initiatives
      aiming to improve access for all to drugs and specialist care. In order to do this it is a matter of
      making the system used to treat cases free or heavily subsidised in order to ensure access to health
      care for vulnerable groups (the disabled, pregnant women, children under the age of 5, the elderly)
      In an attempt to improve the geographical accessibility of the services, considerable efforts have
      been made as far as passive coverage is concerned. Thus the number of health centres went from
      60 in 2004 to 76 in 2008, the number of health points during the same period rose from 921 to 971.
      In order to improve access to treatment, the PNLP extended the treatment of cases to 1371 “cases
      de santé” in 2008, then introduced the PECADOM scheme in pilot districts in July 2008. This
      initiative will be extended to other districts in this proposal.
      The Ministry of Health has embarked upon an annual programme to recruit 250 workers since 2004
      and, as a result, training centres for nurses and midwives have been opened in each region. In
      addition to this there are numerous private health training schools
      A national malariology course for senior and middle-ranking executives working in the health system
      and for the partners has been started since 2008 in order to strengthen managerial capacities at
      operational level. As a result 50 doctors have been training in malariology thanks to the Round 7
      funding and with the technical support of the WHO.
      The capacities in the entomology of malaria and VC have been strengthened by the
      training/retraining of health workers from 11 districts, as part of a WHO / B & M Gates Foundation
      project. In the same way the core of national training officers for IRS has been strengthened by the
      training of new training officers from the three pilot regions.
      An internal committee to monitor the implementation of the malaria, HIV and tuberculosis
      programmes was set up under the Department of Health (order no. 03967 of 07/05/2008) by the
      Minister of Health in order to improve the coordination of the various health programmes with a view
      to better synergy between interventions
      The PNLP supports the medical regions and districts for the regular supervision of all points at
      which services are provided
 Drugs and pharmaceutical products:
      In addition to having supplied a lorry to the PNA (Round 7), in 2008 the PNLP trained pharmacists
      from the PNA and from hospitals in procurement and stock (ACT, LLITN, insecticides and other
      products) management and the monitoring and assessment system at national, regional and
      decentralised level;
      Together with MSH, two years ago the PNLP started training the heads of the districts’ drug stores
      in order to improve stock management.
      Working together with the research partners (UCAD and research institutes) has helped to ensure




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                  18/78
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      quality control over anti-malarial drugs and insecticides, pharmacovigilance and also with carrying
      out the operational research activities.
      A close working partnership with the WHO, the anti-poisons centre in Morocco and the various
      competent departments of the Ministry of Health has helped with the introduction of a functional
      pharmacovigilance system for anti-malarial drugs since 2007.
 Health information system:
      Quarterly reviews to share and approve data grouping together the districts, hospitals, military and
      paramilitary health care facilities and NGOs were instituted 4 years ago in order to improve the
      health information system. At these reviews, morbidity and mortality data is gathered along with
      data on the monitoring indicators for Global Fund projects.
      The SNIS was given support by the PNLP, in 2007 and 2008, for the revision of the information
      gathering supports. At present, all health care facilities have these revised tools incorporating the
      various PNLP indicators and those of the other programmes.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                               19/78
    ROUND 9 - Malaria

    4.4.         Round 9 Priorities
    Clarified priorities 1 and 3
    Complete the tables below on a programme coverage basis (and not financial data) for three to six areas identified by the applicant as priority interventions for this proposal.
    Ensure that the choice of priorities is consistent with the current malaria epidemiology and identified weaknesses and gaps from s.4.2.2 and s.4.3.
    Note: All health systems strengthening needs that are most effectively responded to on a malaria disease programme basis, and which are important areas of work in this
    proposal, should also be included here.
    Given the epidemiological situation, the two major strategic outlines in the fight against malaria, in other words strengthening prevention and improving the
    way that cases are cared for, will be discussed at greater length in this proposal:
          -     in the area of care, the priority is access to early, proper treatment of cases of simple malaria through the home care (PECADOM) strategy in areas
                which are not easily accessible. The exploitation of the RBMME database shows that mortality rates are higher in the regions in the centre and south-
                east (Fatick, Kaolack, Matam, Kolda and Tambacounda). These regions cover huge areas with villages which are sometimes isolated and have no
                health care facilities. The scaling up of the PECADOM scheme to these regions will help to improve the accessibility and availability of services
                designed to fight malaria. A total of 34 districts will be covered by the PECADOM scheme, 24 of them using Round 9 funding (Attachment 14).
      -       in the area of prevention, there are two priorities:
                     o universal LLITN coverage by considerably improving their availability and their use across the whole of the country.
                     o The extension of IRS protection for reasons to do with management capacities, this intervention will be targeting a total of 16 districts
                         located in areas worst-affected by the disease.

    Priority 1: Scaling up of the PECADOM scheme
    In 2008, 5605 villages which were isolated or at a great distance from a health structure (more than 5 km) were counted in the eight health regions where
    malarial mortality and incidence are the highest. The total population of these 5605 villages is estimated at 1,809,903 inhabitants.
    The goal is to cover 80% of the populations living in isolated or remote areas either by introducing infrastructures (by the State, local authorities and partners)
    or by home care. A summary is given in the table below:

 Priority No:                                                           History                           Current                               Country targets
                              PECADOM scheme
 1
 Indicators.        Number of inhabitants covered by the         2007          2008               2009              2010        2011         2012             2013            2014
                    PECADOM scheme
  A: Country target (from annual plans where these exist)         NA        1’809’903           1’855’151       1’901’529     1’949’068    1’997’794       2’047’739       2’098’933
  B: Extent of need already planned to be met under other
  programmes
                                                                  NA              9’971            259’700          551’214    832’425     1’049’697       1’254’471       1’464’364

  C: Expected annual gap in achieving plans                       NA        1’799’932           1’595’451       1’350’315     1’116’643      948’097          793’268        634 569

  D: Round 9 proposal contribution to total need                 (e.g. can be equal to or less than full gap)       202’547    334’993       474’049          515’624        515’624




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                               20/78
    ROUND 9 - Malaria
    Line A: country targets

    By applying the 2.5% population growth rate (Attachment 10) the target population is determined from 2009 to 2014 corresponding to line A.

     Year            2007     2008       2009        2010        2011       2012          2013       2014

    Line A: target    ND 1 809 903 1 855 151 1 901 529 1 949 068 1 997 794 2 047 739 2 098 933


    Line B: Needs covered

    It included 3 sections which have been grouped together:
         - the population covered by health points to be set up by the State and its partners by 2014,
         - the population covered by the 574 “cases de santé” which will become functional with Round 7 funding,
         - The population covered by the PECADOM project as part of Round 7.

      Year                                          2007       2008         2009             2010           2011         2012          2013        2014
      Population covered by the setting up of
      new health points by the State and the         ND               0       185 515        375 668         570 575      770 354      975 128     1 185 021
      local authorities
      Population covered by the PECADOM
                                                     ND          9 971           32 810          49 421       66 473       83 966        83 966      83 966
      scheme in Round 7
      Population covered by the “cases de
      santé” which became functional as part         ND               0          41 375      126 125         195 377      195 377      195 377      195 377
      of Round 7
      Population covered by other
                                                     ND          9 971        259 700        551 214         832 425    1 049 697     1 254 471    1 464 364
      programmes: Line B

    Line C: annual gaps
    The population not covered, obtained from lines A and B is given (A-B) by the table below:

     Year                                2007          2008               2009              2010            2011         2012           2013         2014
    Population Not covered. In the
                                          NA            1 799 932         1 595 451         1 350 315       1 116 643     948 097        793 268      634 569
    Need: Line C


    Line D: Round 9 contribution


R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                 21/78
    ROUND 9 - Malaria

    Year                                                                               2010           2011        2012      2013      2014

    Population Not covered. In the Need: Line C                                        1,350,315      1,116,643   948,097   793,268   634,568

                                                                                         202,547       334,993    474,049   515,624   515,624
    Population to be covered by the PECADOM scheme as part of Round 9 =
    line D (15 to 80% of the gap between 2010 and 2014)
                                                                                           (15%)         (30%)      (50%)     (65%)     (80%)



    The map below shows the annual level of growth of coverage of the districts as part of the PECADOM scheme




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                           22/78
      ROUND 9 - Malaria
                                       Priority 2: Universal Long-Lasting Insecticide Treated Nets (LLITN) coverage
      As part of the policy of improving LLITN coverage (availability and use), more than 3,500,000 Insecticide Treated Nets have been distributed in the country,
      for all funding sources, between 2007 and 2009. Even so, the rate of ownership per household as found by the MIS survey in 2008, is still low (60%) with an
      average of 1.7 LLITNs per household.
      In this proposal, we are aiming at an LLITN availability rate of 100% each year so that we can hope to achieve universal coverage. The goal is to get at least
      85% of the population sleeping under LLITNs, especially pregnant women and children under the age of 5. The basic assumption is that one LLITN will be
      shared by 2 people. So we will be asking Round 9 to cover the gap in LLITNs identified after the contribution from Round 7 and the other partners
      (especially the PMI and the IDB).


Priority No: 2   LLITN                                                         History                  Current                                  Country targets
Indicators.      Number of LLITNs distributed;                          2007              2008           2009          2010           2011            2012           2013             2014

A: Country target (number of LLITNs needed according to the
                                                                    3’912’722         4’297’007      5’947’172     6’089’684         6’236’071      6’385’730      6’538’992      6’695’916
annual targets)
B: Extent of need already planned to be met under other
                                                                       2’103’894         2’955’356   5’807’604     5’296’819         5’653’797      3’823’535      5’347’690      5’611’320
programmes

C: Expected annual gap in achieving plans                           1’808’828         1’341’651         139’568        792’865        582’274       2’562’195      1’191’302      1’084’596

                                                                   (e.g. can be equal to or less than full
D: Round 9 proposal contribution to total need                                                                         792’865        582’274       1’537’749        714’781          650’758
                                                                   gap)

          Line A: Country target
      The country target was 70% of the total population in 2007 and 75% in 2008, i.e. 7,825,444 and 8,594,014 people respectively, i.e. 3,912,722 and 4,297,007
      LLITNs. Starting in 2009, the country’s target is the total population, with 100% availability. The theoretically covered population is determined from the
      number of available LLITNs. So the number of people covered by LLITNs is estimated at 4,207,788 in 2007, i.e. 53.8% of the target, 5,910,712 in 2008
      (68.4%) and 11,615,208 (97.6) in 2009.
          Year                                             2007           2008              2009            2010           2011              2012             2013             2014
          General population                              11,343,328    11,615,486        11,894,343      12,179,368     12,472,141       12,771,459      13,077,983        13,391,832
          A. Country target (population to be
          covered)                                             70%              75%              100%       100%              100%           100%             100%             100%

          A: Number of LLITNs needed                       3,912,722      4,297,007        5,947,172      6,089,684      6,236,071        6,385,730          6,538,992      6,695,916

          Line B: Needs covered



R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                           23/78
    ROUND 9 - Malaria
    The needs covered for year correspond to the LLITNs available at the start of the year plus those supplied by the partners. From the LLITNs available at the
    start of the year, we need to subtract those which are over 3 years old (Attachment 15) and 5% of the quantity of LLITNs delivered the previous year to
    cover losses for various different reasons.
    The needs covered in 2010 are made up of the LLITNs available at the start of the year plus those supplied by the partners and those acquired by Round 7.
    Starting in 2011, the needs covered will include the previous year’s Round 9 contribution.


        Year                                                    2007           2008        2009         2010       2011        2012          2013          2014
        Contributions from donors excluding GF              -              -          1,866,300        700,000   400,000      400,000       400,000       400,000
        GF Round 7 contributions                            -              -          1,480,000        369,949   305,139      430,820       501,284          0
        Quantity of LLITNs to be replaced                 364,150        251,575        494,052    1,580,734     1,141,026   3,243,356     1,939,324     1,327,672
        B: Needs covered (other programmes)             2,103,894      2,955,356      5,807,604    5,296,819     5,653,797   3,823,535     5,347,690     5,611,320

    Line C: annual gaps
    Each year, we will need to determine the gap in LLITNs that needs to be filled in order to achieve the target goal of 100% availability. This gap is the
    difference between the target (number of LLITNs needed) and the needs covered by other programmes (number of LLITNs available).

        Year                                              2007           2008           2009            2010       2011        2012          2013          2014
        C: Gap to be covered                           1,808,828       1,341,651      139,568          792,865   582,274     2,562,195     1,191,302     1,084,596

    Line D: Round 9 contribution
    This is all (100%) of the annual gaps determined in 2010 and 2011 (Round 9 phase 1) and 60% for phase 2.

      Year                                                2007           2008           2009            2010       2011        2012          2013          2014
      D: Round 9 application                                                                           792,865   582,274     1,537,749      714,781       650,758
                                                                                                        100%      100%         60%           60%            60%

    N.B. Starting in 2012, 40% of the gap identified will be sought from the State and the partners.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                   24/78
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                                                                 Priority 3: Indoor Residual Spraying (IRS)
    In Senegal, IRS operations are indicated in the various epidemiological situations. Due to the IRS requirements in terms of planning, logistics, infrastructures,
    competent human resources and levels of coverage needed, in order to ensure that the operations are properly managed, the decision has been taken to
    select priority areas where IRS operations will be gradually implemented in order to make an effective contribution to reducing morbidity and mortality due to
    malaria. Thus, in addition to the 3 pilot districts where the strategy has been implemented since 2007 with the support of the PMI, a 4th district will be
    incorporated in 2010 by the same partner and twelve (12) new ones will be gradually enlisted as part of Round 9. This means 16 districts covered by IRS
    operations in 2014. The choice of the 12 new districts is being made from regions where malarial morbidity and mortality are still the highest (Kaolack in the
    centre and Tambacounda in the South – East). In the other regions, the strategies currently being implemented will be strengthened, pending the resources
    needed for an extension of IRS operations in these areas.
    A summary is given in the following table:
  Priority                           IRS                                  History                         Current                                Country targets
  No:
  Indicators.   Percentage of the population protected in the      2007             2008         2009               2010          2011        2012        2013      2014
                districts targeted for IRS operations
  A: Country target (from annual plans where these exist)         1’793’295      1’838’128     1’884’081         1’931’183      1’973’623   2’016’758   2’060’595   2’147’448
  B: Extent of need already planned to be met under other
                                                                                                                                                0           0         0
  programmes                                                        678’971         645’346      679’885            707’451      722’979
  C: Expected annual gap in achieving plans                      1 114 324      1 192 782      1 204 196         1 223 732
                                                                                                                                1’250’644   2’016’758   2’060’595   2’147’448
                                                                (e.g. can be equal to or less than full
  D: Round 9 proposal contribution to total need                                                                     0
                                                                gap)                                                             368’873    1’397’761   1’742’635   2’147’448


    Line A: country targets
    From 2007 to 2009, the target to be covered by IRS operations was the general population in the 3 pilot districts. Starting in 2010, with the aim of extending
    IRS operations to cover 16 health districts, the target will be 100% [of8] the population in these chosen areas.

    Period                              2007           2008         2009              2010                2011                2012           2013           2014
    Target population            635 595           645 346      679 885         1 931 183         1 973 623              2 016 758       2 060 595      2 147 448




    8 Translator’s note: word missing in the French source text.



R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                               25/78
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    Line B: needs covered
    This is the population effectively protected by IRS. From 2007 to 2009, the 3 pilot districts will be handled by the PMI which will be incorporating a 4th district in
    2010. This support from the PMI ends in 2011.

    Year                                      2007         2008        2009             2010            2011           2012           2013         2014
    Population covered                    635 595      645 346      679 885        707 451            722 979            0              0                0

    Line C: annual gaps
    This is the population to be protected but not covered by IRS operations. It is calculated by subtracting the population covered in the PMI’s districts from that
    targeted for the IRS operations.

    Year                                      2007         2008        2009             2010            2011           2012           2013         2014
                                         1 114 324   1 192 782    1 204 196     1 223 732
    Gap to be covered                                                                            1 250 644        2 016 758    2 060 595       2 147 448


    Line D: Round 9 contribution
    Starting in 2011, there are plans to enlist 3 new districts each year. So the number of districts to be covered will rise from 7 in 2011, 10 in 2012, 13 in 2013
    and 16 in 2014. This is a 100% rate of protection for the general target population. For this proposal, 2010 is reserved for the preparation of operations
    (geographical reconnaissance, basic data gathering, planning, training, procurement, etc.) which will be budgeted for.

    Year                                                  2007        2008       2009          2010             2011           2012              2013            2014
    Population to be covered by R9                                                                        368 873        1 397 761           1 742 635       2 147 448
    % Round 9                                                                                                   29%            69%               85%             100%




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                        26/78
    ROUND 9 - Malaria

    The map below shows the level of recruitment of districts for IRS purposes




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                  27/78
    ROUND 9 - Malaria
    4.5.     Implementation strategy
    4.5.1. Round 9 interventions
    Explain: (i) who will be undertaking each area of activity (which Principal Recipient, which Sub-
    Recipient or other implementer); and (ii) the targeted population(s). Ensure that the explanation
    follows the order of each objective, programme work area (or, "service delivery area (SDA)"), activities
    and indicator in the 'Performance Framework' (Attachment A).

    The Global Fund recommends that the work plan and budget follow this same order. Where there are
    planned activities that benefit the health system that can easily be included in the malaria programme
    description (because they predominantly contribute to malaria outcomes), include them in this section
    only of the Round 9 proposal.
    Note: If there are other activities that benefit, together, HIV, tuberculosis and malaria outcomes (and health
    outcomes beyond the three diseases), and these are not easily included in a 'disease programme' strategy, they
    can be included in s.4B in one disease proposal in Round 9. The applicant will need to decide which disease to
    include s.4B (but only once).    Refer to the Round 9 Guidelines (s.4.5.1.) for information on this choice.


    BETWEEN 4 AND 8 PAGES
    AIM:
    The aim of this proposal is to help to reduce reduction morbidity and mortality linked to malaria.
    In order to do this, it is a matter of implementing the existing interventions, especially those supported
    by the FMSTP (Rounds 4 and 7), and the other partners, on a larger scale.
    GOALS:
    The goals of this proposal are defined as follows: by 2014
                •   To provide proper home treatment for at least 85% of cases of simple malaria in the
                    areas targeted by the PECADOM scheme, as stated in the programme’s guidelines.
            •    To get at least 85% of the population sleeping under LLITNs, especially pregnant women
                 and children under the age of 5.
            •  To provide IRS coverage for at least 90% of the population in the 16 districts targeted for
               IRS operations.
    EFFECT/IMPACT INDICATORS
       • Number and percentage of deaths due to malaria in health training courses
       • Number and percentage of confirmed cases of malaria seen by health workers in health
          training courses and in communities (at “cases de santé” and at home)
       • Number and percentage of cases of simple malaria properly cared for at home in accordance
          with the PNLP guidelines
       • Number and percentage of households with at least one LLITN
       • Number and percentage of people who slept under an LLITN the previous night
       • Number and percentage of children under the age of 5 who slept under an LLITN the previous
          night
       • Number and percentage of people covered by IRS operations in the target areas over the last
          12 months


       DESCRIPTION OF THE ACTIVITIES BY TARGETS AND AREAS IN WHICH SERVICES ARE
                                        PROVIDED

    Goal 1: To provide proper home treatment for at least 85% of cases of simple malaria in the
    areas targeted by the PECADOM scheme, as stated in the programme’s guidelines.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                      28/78
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    In areas which are not easily accessible or have no health care facilities, it is a matter of using RDT to
    confirm suspected cases and administering ACTs at home in accordance with the flow chart9

    2 SDAs will be developed in order to achieve this target:
               • Home care (PECADOM)
               • Drug resistance monitoring

            SDA           Indicators.                            Implementing         Target populations
                                                                  entities (PR,
                                                                     S/PR)

                          Number of inhabitants covered by
                          the PECADOM scheme
      1.1: Home care                                            - MSP / PNLP        Populations living in the
                                                                                    villages covered by the
                                                                - Health
                          Number of DSDOMs trained in                               PECADOM scheme
                                                                districts,
                          the PECADOM scheme
                                                                - NGOs

         1.2: Drug        Number of studies in the              - MSP / PNLP        Populations of the
        resistance        sensitivity of parasites to anti-                         sentinel surveillance
                                                                - UCAD
        monitoring        malarial drugs carried out                                sites
                          according to the WHO protocol

                SDA 1.1: Home care (PECADOM)
    As part of Round 7, the PECADOM scheme, a strategy designed to provide treatment for simple
    malaria which aims to improve access to health care for populations living in areas where health care
    facilities are difficult to get to, was drawn up and implemented by the PNLP in three pilot districts. This
    is a community-based intervention relying on the introduction of ACTs combined with RDTs in order to
    guarantee the rational use of these drugs. It is based on the principle that these tools are easy to use
    and that they can be used by properly trained and supervised community-based volunteers
    (Attachment 16). As a result of the satisfactory results obtained during the pilot phase implemented in
    three districts (Attachment 14), there are now plans to extend this initiative.
    Communication will take pride of place in the project involving the scaling up of the PECADOM
    scheme. The communication activities aim to raise awareness among the populations about the
    availability of home health care services and encourage people to make use of them at an early stage.
    Already, with Round 4, the PNLP has scaled the community-based interventions in all of the districts
    of Senegal. Through contractual agreements, this has helped to get all of the community-based
    organisations involved (faith-based, women, young people, traditional healers, etc.) in the fight against
    malaria through prevention and communication activities (Attachment 9). The funding of these
    activities will be included in the communication budget for Round 7 phase 2. After 2012, the needs will
    be included in the overall communication plan described in the LLITN part (cf. activity 25)
    The following activities will be carried out:
    Activity. 1: Identifying the 24 districts which will be enlisted in the PECADOM scheme
    The regions where mortality from malaria is the highest will be targeted in Round 9. Thus 08 districts
    will be enlisted the first year, 8 districts the 2nd and 8 districts the 3rd.

    Activity. 2 Selecting the 749 villages which are to host the PECADOM scheme
    The villages will be chosen by the District Health Teams (DHT) according to the following criteria:
    villages located more than 5 km from a health structure (Health Centre, Health Point or “Case De
    Santé") or permanently or temporarily inaccessible (areas which are not easily accessible, insular
    areas).

    Activity. 3 Selecting the 749 Home Care Providers (DSDOMs)


    9 Translator’s note: or possibly some other form of chart (e.g. an organisational chart, etc.)



R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                   29/78
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    The DSDOMs will be chosen by the village communities based on the following criteria: permanently
    resident in the village, determined, approachable and committed, capable of reading and writing
    (French or other local languages).

    Activity. 4 Organising a two (2) day orientation workshop for the RHTs, DHTs and partners on the
    PECADOM strategy
    This meeting, which will be organised by the PNLP in each region, will consist of:
                      -   Sharing the PECADOM strategy along with the roles and responsibilities of
                          each stakeholder with the health authorities for the medical districts and regions
                      -   Drawing up an operational implementation plan for each district and approving
                          it.

    Activity. 5 Organising a training workshop for the ICP on the PECADOM strategy with 2 x 2-day
    sessions per district.
    This workshop will be hosted by the DHT supported by the medical region. It aims to share
    information and trigger the planning process with the head nurses (ICPs) and the local RBM partners.

    Activity.6: Increasing use of the training manual
    There will be increased use of the manual10 during the pilot phase and it will be made available to the
    DSDOMs, after the training workshop.

    Activity 7: Organising a training workshop for DSDOMs in each district
    The key to the success of the community-based interventions lies partly in the quality of the training of
    the community stakeholders. The DSDOMs will be trained by the DHT. This training course includes a
    three-day theoretical part followed by a fifteen-day hands-on course at the health point.
    This training course will be carried out on the basis of the manual which has already been drawn up
    during the pilot phase. It will deal with recognising the signs of simple malaria, the use of RDTs to
    diagnose malaria, recognising serious signs, treatment and monitoring of cases of simple malaria,
    reference against reference, malaria prevention, IEC/BCC, stock management and the handling of the
    tools used to manage the PECADOM scheme. There will be a special emphasis on hands-on learning.

    Activity 8: Providing the trained DSDOMs with drugs and anti-malarial products
    The district provides some initial free ACTs and RDTs. Restocking is handled by the individual health
    points. RDT remains free and ACTs are sold at 0.23 euros for children and 0.45 euros for adults
    based upon the cost recovery principles currently in force in the health districts.
    The PECADOM scheme does not involve any additional needs in terms of ACTs and RDTs because
    they are included in the country's overall estimated requirement, covered by the Rounds 4 and 7 up to
    2012. Afterwards, the State and its partners will be taking care of ACT and RDT requirements.

    Activity 9: Providing the DSDOMs with equipment and materials
    The PNLP will take charge of supplying each DSDOM with: a case, a bag, two bibs11, two caps and a
    torch.
    The district has the task of supplying gloves, sharps boxes and registers.

    Activity.10 Organising an official moving in ceremony for the DSDOMs in each district
    A moving in ceremony for the DSDOMs and official project launches will be organised in each district
    in the presence of the administrative, religious and customary authorities, and local elected
    representatives. This ceremony will offer the districts an opportunity to popularise this approach, but
    also to promote the DSDOMs to the populations.

    Activity 11: Organising two post-training monitoring visits per district aimed at DSDOMs


    10 Translator’s note: this is one possible meaning of the verb “multiplier” – there are others depending
    on precise context.
    11 Translator’s note: one possible translation of “dossards”, depends on context.



R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                 30/78
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    The purpose of these visits will be to verify the knowledge, skills and practices employed by the
    DSDOMs. Any shortcomings will be highlighted and corrected.

    Activity.12: Regularly supervising the DSDOMs
    PECADOM implementation demands regular supervision of the activities, which is why this
    supervision will be carried out on two levels: monthly supervision of the ICP and quarterly supervision
    of the DHT. This activity will be strongly supported by the sub-beneficiary NGOs.

    Activity.13 Organising bi-monthly meetings to coordinate the activities at the Health Point
    A meeting for monitoring and exchanges will group the DSDOMs into activities around the ICPs every
    2 months.

    Activity 14: Organising quarterly data approval reviews and exchanges of experiences with the DHTs.
    This activity will be incorporated into the quarterly data reviews scheduled by Rounds 4 and 7 up until
    2012. Starting from 2013, it will be included in the Round 9 budget. These reviews will be attended by
    the DHTs, RHTs and the central level. They will allow data from PECADOM activities to be taken on
    board.

    Activity. 15 Assessing the impact of the PECADOM scheme
    This will be done working together with the local research institutes in 2010. Technical assistance from
    the WHO and RBM partners will be requested for this purpose.

    Activity. 16 Carrying out socio-anthropological research on the factors which motivate the DSDOMs
    This work will be entrusted to the local research institutes who are working with the programme in this
    area.

    Activity. 17 Monitoring the incidence of malaria in the areas targeted by the PECADOM scheme
    This research will be carried out by the UCAD parasitology department, which is the programme’s
    leading partner in this area.

    Activity. 18 Studying cases of asymptomatic carrying and the occurrence of malarial access
    This research will be carried out by the UCAD parasitology department, which is the programme’s
    leading partner in this area.


                                   SDA 1.2: Monitoring of drug resistance
    There have been drug resistance surveillance sites since 2000. They are regularly monitored by the
    UCAD, the Institut Pasteur and the RDI. The system introduced to monitor drug resistance allows
    surveillance of the quality, the efficacy and any occurrence of plasmodium resistance to anti-malarial
    drugs. As part of the same activity, a drug quality control system designed to allow tests to be carried
    out on the sentinel sites using a “minilab” and subsequently confirmed at the reference laboratory is
    currently in force. It is supported by the USP (United States Pharmacopeia12) as part of a project
    implemented by the UCAD parasitology laboratory and funded by USAID. For the purposes of the
    PECADOM scheme, the existing sites will be strengthened and their activities extended at community
    level. This involves two activities:

    Activity. 18 Ensuring quality control for the anti-malarial drugs
    This activity, which is already being carried out by the UCAD and the LNCM, will be strengthened in
    Round 9.

    Activity. 19 Ensuring that parasite sensitivity to anti-malarial drugs is monitored
    This activity is already being carried out in Round 4 by the UCAD parasitology department. The PMI is
    supporting this activity until 2010 and Round 7 will be taking over up until 2012. Round 9 will
    subsequently take over to strengthen the monitoring by increasing the number of sites, samples and
    the frequency of collection.
    Goal 2: To get at least 85% of the population sleeping under LLITNs by 2014, especially


    12 Translator’s note: incorrectly spelt in the French source text.



R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                31/78
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    pregnant women and children under the age of 5.
    Four SDAs will be identified in order to achieve this target:
        -   Insecticide Treated Nets
        -   BCC - Mass media
        -   BCC – Community health workers
        -   Development of partnership and coordination (national, community-based, public-private)

            SDA             Indicators.                         Implementing         Target populations
                                                              entities (PR, S/PR)

      2.1: Insecticide      Number of LLITNs distributed      - MSP / PNLP          General population
        treated nets
                                                              - Health districts,
                                                              - NGOs

      2.2: BCC - mass       Number of mass media              - MSP / SNEIPS /      General population
           media            broadcasts on radio and/or        PNLP
                            television
                            Number of NGOs receiving
         2.3: BCC -                                           - Health districts
                            funding from the PNLP to
        community
                            carry out activities designed     - NGOs                  General population
       health workers
                            to fight malaria
                            Number of partners from
     2.4: Development                                               MSP/PNLP
                            other sectors involved in the
       of partnership
                            fight against malaria                                     General population
     and coordination
          (national,
        community-
       based, public-
           private)


    SDA 2.1: Insecticide Treated Nets (ITNs)
    The availability of LLITN is crucial if we are to achieve the goals set out by the programme.
    Considerable efforts will be made to ensure that sufficient quantities of mosquito nets are made
    available in households and, in order to do this, we use the principle of estimating on the basis of
    universal access (1 LLITN for 2 people) together with the principle of replacing the LLITNs after 3
    years of use. The main activities to be carried out are as follows:
    Activity 20: Acquiring 4,278,427 LLITNs for the period from 2010-2014
    These LLITNs will be purchased through the PNA which is the organisation in charge of ordering
    essential drugs and products at national level.
    Apart from the direct costs of acquisition, we need to allow for the cost of services (transport,
    handling, transit and stock management). These costs are estimated at 5% of the purchase costs.

    Activity 21: Distributing 4,278,427 LLITNs between 2010 and 2014
    The LLITNs will join the PNA’s conventional distribution circuit for essential drugs and products. The
    traditional distributors (health care facilities, CBO, NGO, SDP) will be maintained and their numbers
    revised upwards. Dispensaries, through private wholesalers, will be approached about supporting this
    distribution.

    There will be a mass campaign organised in 2012 to distribute 2,548,000 LLITNs to children under the
    age of 5 (target plus 5%). This campaign will also help to replace part of the LLITNs distributed in
    2009.

    Activity 22: Carrying out a post-LLITN distribution campaign survey
    This aims to measure the rates of ownership and use and the impact of the communication activities
    (IEC/BCC) on the populations’ attitudes towards LLITNs. It will be carried out one month after the




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                              32/78
    ROUND 9 - Malaria
    mass campaign.
    It will be a matter of entering a contract with an independent firm of consultants or a specialist institute
    to carry out this survey.

    Activity 23: Ensuring that the effectiveness and quality control of the LLITNs are monitored (2013-
    2014)
    When they come in the LLITNs will be subjected to initial quality control per batch. During use there
    are also plans to perform 2 sorties annual sample collection trips through the Programme’s sentinel
    sites for the purposes of monitoring their residual insecticide content and effectiveness. The LLITNs'
    insecticide dosage will be carried out by the LNCM and CERES Locustox; the monitoring of
    effectiveness will be carried out by the UCAD and the research institutes. This work is scheduled to
    take place in the Round 7 phase 2 (2010-2012) and then Round 9 will subsequently take over for 2013
    and 2014.

                                          SDA 2.2: BCC - Mass media
    An integrated communication plan, targeting the adoption of positive behaviour in the fight against
    malaria will be drawn up to support the implementation of the priority interventions. The Round 9
    subsidy will emphasise mass communication (radio, TV, display, etc.) without overlooking locally-
    based communication through NGOs, the districts and other operational stakeholders.
    Activity 24: Drawing up and implementing a new communication plan for the fight against malaria in
    2012
    In 2010 there are plans to draw up a communication plan for Round 7 phase 2. This plan will include
    all of the activities relating to the LLITNs, the PECADOM scheme and IRS operations (including the
    organisation of the workshop for the drawing up of the IRS communication plan, the production and
    dissemination of the IRS supports).
    A new communication plan will be drawn up in collaboration with the partners in 2012. The results of
    the Round 7 communication plan assessment report will be used to adapt the communication
    strategies, if necessary.
    The implementation of these Round 9 mass communication activities will be handled by the SNEIPS
    and the PNLP, working in partnership with the DHTs and the partners.
    The plan will be assessed by an independent firm of consultants or by a specialist institute.

                                 SDA 2.3: BCC – Community health workers
    For this SDA, the Round 9 subsidy will emphasise interpersonal communication (chats, home visits,
    distribution of communication media with illustrations about malaria, etc.) The aim of this
    communication through community health workers is to encourage the mobilisation of the
    communities and the adoption of behaviour likely to promote the availability and proper use of
    LLITNs. The main activities to be carried out are as follows:
    Activity 25: Supporting the implementation of the districts' micro-plans.
    Each year, the districts will draw up micro-plans with a package of activities including the distribution
    of LLITNs, the promotion of the PECADOM scheme and IPT, hygiene and the cleaning up of the
    environment, locally-based communication, chats, HV and community radio stations. These micro-
    plans supported by Round 4 are implemented by the community networks which are essentially
    made up of community-based organisations (CBOs). In this proposal it will be a matter of continuing
    with this support to strengthen the training provided to members of community-based networks
    about the new PECADOM strategy and monitoring the activities involved in the fight against malaria.

    Activity 26: Supporting the implementation of the NGOs’ micro-plans.
    Each year, like the districts, the sub-beneficiary NGOs draw up micro-plans. These latter have the
    same goals as those drawn up by the districts. This support will be provided under the same terms
    as for the districts.

      SDA 2.4: Development of partnership and coordination (national, community-based, public-
                                              private)
    The involvement of other sectors will be fostered in order to mobilise more resources in the fight
    against malaria. The incorporation of a fight against malaria element into development projects, the




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    ROUND 9 - Malaria
    programmes drawn up by NGO and companies including those from the private sector, will help to
    improve the PNLP’s performances and to reduce the negative impact of malaria on the population. A
    cross-sector committee on the fight against malaria including various ministerial departments was set
    up as part of Round 7. The main activities to be carried out are as follows:

    Activity 27: Organising six-monthly coordination meetings with the partners
    These coordination meetings will offer an opportunity to exchange information about funding, stock
    levels, interventions, the difficulties faced by the various stakeholders, in order to rationalise resources
    and better coordinate the action taken by the partners.

    Activity 28: Supporting the implementation of sector-specific plans by the ministries targeted
    This is a matter of supporting the implementation of the plan to fight against malaria produced by five
    (05) ministerial departments (Education, Armed Forces, Women-Family-Children, Environment and
    Agriculture). These plans will be oriented according to the programme’s priorities and the sectors’
    areas of competence.

    Activity 29: Organising an annual forum with the private distributors (importers, wholesalers-
    distributors)
    This forum will offer an opportunity to exchange information about forecasts, stock levels, distribution
    (both quantity and how it is distributed), the difficulties faced by the various stakeholders and the
    prospects for collaboration with the Ministry of Health/PNLP.


    Goal 3: Providing IRS coverage for at least 90% of the population in the 16 districts targeted for
    IRS operations by 2014.

    In order to achieve this objective, three (3) service delivery areas are chosen:
        - Indoor residual spraying
        - Monitoring resistance to insecticides
        - BCC community health workers


             SDA             Indicators.                        Implementing            Target populations
                                                              entities (PR, S/PR)

         3.1: Indoor         Number and percentage of         - MoH / PNLP /           Population of the
      residual spraying      rooms treated by IRS over        NHS                      areas targeted by IRS
                             the last 12 months                                        operations
                                                              - Health districts
                                                              - NGOs

       3.2: Monitoring       Number of studies in the         - MoH / PNLP
        resistance to        sensitivity of vectors to
                                                              - UCAD and               General population
         insecticides        insecticides carried out
                                                              research institutes
                             according to the WHO
                             protocol
                             Number of community
         3.3: BCC -                                           - MoH / PNLP             Population of the
                             health workers trained in
      community health                                                                 areas targeted by IRS
                             using IEC techniques for         - NGOs
          workers                                                                      operations
                             IRS purposes



                                   SDA 3.1: INDOOR RESIDUAL SPRAYING
    IRS operations have been implemented in 3 pilot districts since 2007, with the support of the PMI
    project; the same partner will be incorporating a 4th in 2010. Twelve (12) new districts will be gradually
    enlisted as part of Round 9, in other words a total of 16 districts covered by IRS operations in 2014.
    The activities below will be carried out:
    Activity 30: Introducing IRS management units at central and operational levels




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                    34/78
    ROUND 9 - Malaria
    It will be a matter of introducing an IRS operations management unit within the PNLP and each district
    enlisted, and strengthening the stakeholders’ capacities through recruitment and training in order to
    support the scaling up operation. The management units’ and partners’ supervision and coordination
    capacities will be strengthened. There are plans to recruit executives (2 entomologists, 2 technicians)
    to the central IRS management unit.

    Activity 31: Organising information assignments by the local health and administrative authorities.
    First of all there will be assignments in the twelve districts targeted, informing the administrative and
    health authorities, and secondly assessing any local opportunities in terms of factors such as facilities
    for storage, logistics, and gathering other data relevant to the planning of the operations. These
    assignments will be carried out by teams from the central level with the support of the regional level
    and the district.

    Activity 32: Mapping IRS areas and gathering supplementary data
    It is a matter of subdividing the districts into areas, identifying potential bases, obstacles and natural
    constraints. There are also plans to update the demographic data again and estimate the number and
    average size of the structures to be dealt with. The summary mapping of the various areas which have
    been targeted will be finalised before operations get underway in the target areas. This work will be
    carried out by teams from the central level with the support of the regional level and the district
    (Attachment 17).

    Activity 33: Organising an environmental assessment assignment
    The environmental impact will be assessed by a multidisciplinary team, involving experts from the
    Ministry of the Environment, before the IRS operations get underway in each district. The aim is to
    determine any environmental risk factors in order to minimise the negative effect of IRS on the
    ecosystem.

    Activity 34: Gathering the basic data in the districts to be enlisted for IRS operations
    The gathering of this data will be carried out on a sentinel site for each of the three districts selected
    from among the 12 new districts to be enlisted for IRS OPERATIONS. It will be a matter of gathering
    reference data (before intervention) over a period of from 2 to 4 years depending on the districts. This
    will involve gathering entomological, parasitological and conventional clinical data at a pace of 4 visits
    per year. (Attachment 18).

    Activity 35: Training/retraining training officers in VC and environmental management techniques.
    In the first year ten technicians from the central or regional level (NHS and other partners) will be
    provided with 3 weeks' training. Subsequently, one 5-day retraining session is scheduled every year.
    The training of training officers will be handled by the group of facilitators. This training will mean that
    each of the targeted medical regions will have a group of 3 or 4 training officers to handle the
    training/retraining of the application staff, supervisors and other personnel, with the support of the
    central level.

     Activity 36: Training/retraining the districts’ operators and supervisors in IRS techniques
    In order to train/retrain the operators and supervisors, 207 sessions lasting one week each will be held
    over the 4 years of the IRS implementation.
    The operators, who are selected on the basis of a certificate of medical aptitude, will be given
    appropriate training in the application technique and safety measures.

    Activity 37: Training/retraining of operatives handling the maintenance of the IRS application
    equipment
    This will be a matter of organising 21 sessions lasting 5 days each to train/retrain the operatives in
    charge of maintaining the IRS application equipment.
    In each of the 5 IRS regions, the medical region’s maintenance office technician will be trained by the
    supplier of the application devices.

    Activity 38: Providing training in the form of 53 one-day sessions for support staff (drivers, laundry
    women, warehouse keepers, security guards) on safety measures between 2010 and 2013.
    There are certain risks involved in handling insecticides, for the IRS stakeholders and the populations,




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                    35/78
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    in spite of the precautions for use laid down.

    Activity 39: Providing training in the form of 27 two-day sessions, 684 health care service providers
    (public and private) on treatment in the event of intoxication
    This training, provided by the toxicology department, will allow the health care service providers to
    handle any cases of intoxication.

    Activity 40: Acquiring the equipment and consumables necessary for the IRS operations
    - 652 spraying devices and spare parts
    - 3,440 Personal Protective Equipment (PPE)
    - 720 rinsing tanks
    - Miscellaneous necessary equipment and consumables.

    Activity 41: Purchasing 3 vehicles
    To boost the operational capacities of 3 freshly created districts.

    Activity 42: Handling the transportation of the equipment and operators during the intervention period
    In addition to the 3 newly acquired vehicles, the vehicles already available in the districts will be
    mobilised and supplemented by vehicles from the region’s administrative pool and hire vehicles.

    Activity 43: Acquiring the insecticide for the IRS operations
    The insecticide will be purchased by the PNA.

    Activity 44: Laying out storage and waste management premises
    Storage premises for the insecticides, equipment and waste will be laid out in each district. Solid
    waste will be stored quite safely in warehouses prior to being transferred to the central level or
    appropriately treated at regional level. The renovation of these premises is taken care of by the State.

    Activity 45: Organising workshops to draw up operational IRS plans
    These are as follows:
        -    A workshop lasting three (3) days at central level to draw up a national plan and
        -    A workshop lasting two (2) days per district to draw up an operational plan (micro-plan)
    The operational plan drawn up in each health district will include the IEC/BCC activities, the
    application of insecticide in the structures/rooms targeted and the supervision of the various activities.

    Activity 46: Implementing the IRS operations
    The implementation of the IRS operations will be based upon the WHO’s IRS Manual of Standard
    Operating Procedures adapted to the local context (Attachment 17). There are plans to carry out one
    round of treatment per district per year, just before the main period when malaria is transmitted (the
    rainy season). The implementation is planned for a period of 45 days per district. Details of the tasks
    incumbent upon each stakeholder are given in the manual.

    Activity 47: Supervising the IRS operations (IEC and application)
    In addition to the day-to-day supervision of the activities by the local supervisors, the central and
    regional levels will make 3 visits (start-up, during and afterwards) to ensure that the activities are
    carried out properly and to put right any mistakes / difficulties noted.
    Activity 48: Checking the quality of the implementation and monitoring the effectiveness of the IRS
    operations.
    The quality control activities for the application will be carried out in all districts, once during the month
    following application. The monitoring of the effectiveness of the application (duration) will be carried
    out in the three pilot districts (the PMI) and the three selected new districts. For these two activities it is
    a matter of carrying out bio-tests with the females of an An. gambiae s.s. strain which is sensitive to
    the insecticide.
    The data from the implementation (tools/supports/data gathering sheets) will be analysed and the
    epidemiological data (entomological, parasitological and clinical data) will be gathered after the
    intervention. The frequency of the visits will be the same as for the collection of the reference data (4
    assignments per year on the sentinel sites in the 6 selected districts).



R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                       36/78
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    Activity 49: Organising a workshop to assess the IRS operations in each district
    After each campaign, the health districts, together with the local stakeholders involved, will be
    organising a workshop to assess the activities. This assessment will be carried out under the
    supervision of the medical regions.

    Activity 50: Organising a workshop to assess the IRS operations at national level
    The purpose of this workshop will be to share the health districts’ assessment results and to learn from
    this activity. It will be organised by the PNLP on an annual basis with all of the partners from central
    level and representatives of the regions and health districts.

    Activity 51: Estimating the levels of exophily in the populations of the malaria vectors in the
    Kédougou region (South-East of Senegal), prior to the introduction of IRS operations
    This study on the populations of malaria vectors aims to measure the proportion of female vectors
    which rest outside the homes during the day (exophily). This piece of data is essential for the
    purposes of extending IRS operations in the Kédougou region where this behaviour is flagged up in
    An. gambiae s.l. populations (Attachment 18). Three villages which are representative of the eco-
    epidemiological diversity will be selected in the region for this study which is scheduled to last for 2
    years with 6 visits per year.

    Activity 52: Determining the productivity of the breeding places and the risks of the transmission of
    malaria in the Dakar region.
    This is a study of the distribution of potential breeding places and the dynamic of the pre-imaginal
    populations of malaria vectors. All of the health districts in the region will be subject to prospecting for
    breeding places in order to search for pre-imaginal stages of malaria vectors. All of the potential
    breeding places, whether on water or not, will be described, geo-referenced and mapped during the
    dry season. The exercise will be repeated during the rainy season in order to prospect for all of the
    breeding places and to map any which are newly formed. These activities are carried out twice (once
    per season) over the course of the first year and once per quarter over the course of the second year,
    with the aim of determining any time and space-related variations both in the productivity of the
    breeding places (frequency and abundance) and in the composition of the larval populations of the
    malaria vectors in the districts/neighbourhoods being studied.

    Activity 53: Drawing on the preparation for and response to malaria epidemics in the Sahelian area
    The surveillance network for malaria epidemics in the River Senegal Valley will be strengthened by the
    introduction of a surveillance site in the Ferlo Sahelian area (Attachment 18).
    An emergency stock (drugs, insecticide, spraying appliances, PPE, etc.) will be pre-positioned for a
    rapid response in the event of an epidemic in the at-risk area.
                               SDA 3.2: Monitoring resistance to insecticides
    The fight against malaria vectors often calls on the use of supports treated with insecticides (mosquito
    nets and IRS operations). For the choice of insecticides and in order to ensure the lasting
    effectiveness of the interventions, the vectors’ sensitivity to insecticides needs to be measured and
    monitored regularly. In areas where it is difficult to implement IRS operations, there are plans to carry
    out studies on the feasibility of other measures such as larval control. The following activities will be
    carried out:

    Activity 54: Assessing and monitoring the malaria vectors’ sensitivity to insecticides
    The tests are carried out on the basis of the WHO’s standard protocol with wild specimens 2 – 3 days
    old (from larvae harvested in the site’s breeding places). The molecules to be tested are those from
    the various classes of insecticide chosen for the IRS operations. These tests are carried out in 4 or 5
    series in order to give a sample of at least 100 individual mosquitoes tested. The tests will be carried
    out once every two years in each of the 6 selected IRS districts (Attachment 18).


    Activity 55: Assessing the effectiveness of larvicides/bio-larvicides in malaria vector breeding places
    in the city of Dakar.
    This is a matter of assessing the effectiveness of larvicides (Temephos, BTi, B. sphaericus and growth
    regulators) on populations of malaria vectors. The tests will be carried out both in the laboratory and




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                    37/78
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    under real-world conditions in the field. The miscellaneous products recommended and available will
    be used for the tests which will help to strengthen the range of measures used to combat the disease
    to be implemented in the Dakar region.
                              SDA 3.3: BCC COMMUNITY HEALTH WORKERS
    There needs to be a significant IEC element to go along with the IRS operations. The communication
    will take place essentially through the media and the community health workers. This is why it is so
    important to train the operatives who are responsible for IEC about IRS operations and to develop the
    tools needed for good communication. The new communication plan which will be drawn up for the
    purposes of Round 7 phase 2 will incorporate the design, production and dissemination of the IEC
    supports about IRS operations. The following activities will be carried out:

    Activity 56: Organising a 5-day training workshop for IEC training officers on VC aimed at 15
    communication specialists from the central level and from the regions
    Every year, a meeting is planned for the purposes of reviewing / harmonising the modules.

    Activity 57: Organising a one-day IRS information event aimed at journalists and community radio
    presenters (central and district levels).
    This will involve 50 press officers the first year and 75 starting from the second year, with 25 per
    region. The aim is to popularise IRS, boost the press officers’ knowledge about IRS and specify
    sources of information in order to avoid the distribution of inaccurate news.

    Activity 58: Providing training for Head Nurses and the officers responsible for health education in the
    chosen districts in using IEC techniques for IRS purposes.
    37 one-day training sessions on using IEC techniques for IRS purposes will be organised. These will
    take place at district level and will be handled by the 15 training officers (SNEIPS and BREIPS) prior
    to each year’s campaign.

    Activity 59: Providing training for the chosen districts’ community health workers in using IEC
    techniques for IRS purposes
    The community health workers, who are volunteers living in and appointed by the communities, will be
    trained in the area of prevention for IEC. The training will be provided by the head nurses (ICPs) with
    the support of the health districts’ HE teams.




     4.5.2. Re-submission of Round 8 (or Round 7) proposal not recommended by the TRP
     If relevant, describe adjustments made to the implementation plans and activities to take into
     account each of the 'weaknesses' identified in the 'TRP Review Form' in Round 8 (or, Round 7, if
     that was the last application applied for and not recommended for funding).

     TWO PAGES MAXIMUM
     NOT APPLICABLE TO THIS PROPOSAL!!!




     4.5.3. Lessons learned from implementation experience




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                38/78
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      How do the implementation plans and activities described in 4.5.1 above draw on lessons learned
      from programme implementation (whether Global Fund grants or otherwise)?

      TWO PAGES MAXIMUM
      For the last few years, the fight against malaria in Senegal has been receiving very special
      attention from the government authorities and partners. This has granted eligibility for 3 Global
      Fund subsidies (Rounds 1, 4 and 7) and various kinds of funding from other sources such as
      USAID and the World Bank.
      When it was assessed, Round 1 was given a “No Go” for the transition to phase 2. This poor
      performance encouraged the Ministry of Health to reorganise and strengthen the PNLP for the
      adequate implementation of the subsidies. So Round 4, which is currently in its 4th year of
      implementation, has helped to provide ACTs and RDT in all the country’s public health care
      facilities and to strengthen the stakeholders’ capacities from central level right through to
      community level. This is the angle from which Round 7 (which got underway a year ago) is also
      being approached with the consolidation of what was learned from Round 4 and the scaling up of
      the interventions to community level. These forms of funding have helped to bring about manifest
      improvements: (i) the quality of diagnosis with a case confirmation rate which went from 14.9% in
      2007 to 72.95% in 2008 ((Attachment 9) and (ii) quality of care of cases thanks to the training and
      supervision of the service providers.
      In order to improve access to treatment as part of Round 7 in 2008, the PNLP had started a
      community initiative studying the feasibility of implementing the PECADOM project in 3 pilot
      districts. 6 or 7 villages were targeted in each district and, in the space of 6 months (between
      September 2008 and February 2009), the DSDOMs from the 3 pilot districts had consultations with
      516 patients, out of whom, 512 underwent RDT, 259 of which were positive. All of the latter were
      given ACT treatment and they were all cured. No deaths which can be attributed to malaria were
      recorded in the 20 villages covered by the PECADOM scheme (Attachment 14). These very
      satisfactory results justify the extension of this initiative to villages which are not easily accessible
      by giving priority to areas where mortality linked to malaria is still high.
      For IRS purposes, the pilot phase supported by the PMI has helped to protect 98% of the
      population of the three districts with a significant contribution to reducing morbidity linked to
      malaria. This finding justifies extending this strategy to the areas where morbidity and mortality
      linked to malaria are the highest.
      The positive effects of the financing from the Global Fund supported by funding from other partners
      in the area of prevention are expressed through:
                  o    The drastic fall in the number of cases of malaria recorded by the health structures.
                       Indeed, proportional morbidity dropped from 33.57% in 2006 to 5.52% in 2008.
                  o    the improvement in the availability of mosquito nets which rose from 52% in 2005
                       to 68% in 2008 (Attachment 12). Efforts need to be made to increase the
                       availability and use of LLITNs. This is why, in this proposal, we will be emphasising
                       universal mosquito net coverage by combining mass distribution and routine
                       distribution.
                  o    good acceptability and good implementation of IRS operations in the pilot districts.
                       In this proposal, we propose to strengthen the capacities of the stakeholders from
                       the IRS management unit, the National Health Service and giving greater
                       responsibility to malariologists who were already trained during Round 7 for
                       purposes of coordinating and monitoring activities in the field. NGOs will be also be
                       approached about working directly with the health districts on the IEC activities.




   4.5.4. Enhancing social and gender equality
   Explain how the overall strategy of this proposal will contribute to achieving equality in your country in
   respect of the provision of access to high quality, affordable and locally available malaria prevention,




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                   39/78
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   treatment and/or care and support services.
   (If certain population groups face barriers to access, such as women and girls, adolescents, sexual
   minorities and other key affected populations, ensure that your explanation disaggregates the
   response between these key population groups).

   TWO PAGES MAXIMUM
   In developing countries, malaria usually affects pregnant women and young children, because of their
   immune statuses. As a result, these two groups are considered to be vulnerable. In Senegal, the question
   of equal opportunities has always been part of the country’s sector-specific policies. As a result the
   Ministry of Health has developed strategies designed to minimise inequality in health care and thus the
   national policy on the fight against malaria and the PNLP guidelines state that, in order to improve
   prevention and access to health care for vulnerable groups, the following are to be promoted:
   - the providing of free LLITNs during the mass campaigns (children under the age of 5) and these are
      also sold at heavily subsidised prices (1.45 euros) to the rest of the population. When natural disasters
      occur, LLITNs are distributed free of charge to pregnant women and children aged under 5
   - ACTs are sold at heavily subsidised prices (less than 0.23 cents for children and 0.45 euro cents for
      adults);
   - RDTs are free of charge for all patients;
   - IPT is free of charge for all pregnant women seen at PNCs;
   The three priority areas stated in this proposal aim to reach all the populations of the target areas
   (universal coverage).
   IRS is essentially an intervention offering universal coverage. All accommodation in the target areas will
   be treated and the mass effect will even benefit any occupants of accommodation which is not suitable for
   treatment.
   The PECADOM scheme, as designed, aims to provide the populations (who are usually poor) in isolated
   areas or those with poor transport links with access to health care services. The strategy of improving the
   accessibility of health care by means of the PECADOM scheme significantly reduces the cost of care and
   lessens the risk of exclusion of destitute people in rural communities and peri-urban areas. Even so, there
   is a system to handle social cases through the health committees in accordance with decree no. 92-
   118/MSPAS of 17th January 1992.
   Prospects of items free of charge are glimpsed with the implementation of the Affordable Medicines
   Facility malaria (AMFm) initiative, launched by the Global Fund, MMV and the Clinton Foundation.
   Similarly, there is thinking underway about free LLITNs for pregnant women seen at PNCs.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                   40/78
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   4.5.5. Strategy to mitigate initial unintended consequences

   If this proposal (in s.4.5.1.) includes activities that provide a disease-specific response to health system
   weaknesses that have an impact on outcomes for the disease, explain:
           the factors considered when deciding to proceed with the request on a disease specific basis;
           and
           the country's proposed strategy for mitigating any potentially disruptive consequences from a
           disease-specific approach.


      Weaknesses of the health             Specific impact on the           Factors taken into account
              system                              disease
       - Lack of sufficient                - Poor access to                    -   Strengthening of
          qualified human                     resources used to fight              preventive resources
          resources                           malaria
       - Poor coverage in terms              high morbidity                    -   Improvement in access
          of health care facilities                                                to early, effective
          especially in remote             -     Care for cases is late            treatment
          areas                                 and insufficient
       - Lack of sufficient                    high mortality
          procurement and stock
          management




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                   41/78
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                 Disrupting consequences                                       Corrective strategies
        -    Development of the black market in LLITNs                 -   Reorganisation of the distribution
             and other anti-malarial products and a risk of                systems for LLITNs and other
             them being siphoned off13 to bordering                        products from the PNA through to
             countries                                                     community level by way of the PRAs
                                                                           and the districts, with the systematic
                                                                           maintaining of suitable management
                                                                           tools

                                                                       -   Regular monitoring and supervision of
        -    Irrational use of ACTs: Prescribing of ACTs                   the DSDOMs at various levels
             in spite of a negative test
                                                                       -   Raising of awareness in the
        -    Some DSDOMs may get distracted from their                     communities and close supervision of
             core work through wanting to handle                           the DSDOMs
             conditions other than malaria

        -    Poor management of the waste from IRS                     -   Involvement of other sectors such as
             operations                                                    the Ministry of the Environment in the
                                                                           implementation of IRS operations and
                                                                           raising the awareness of the
                                                                           populations
        -    Intoxication of the populations by insecticides
                                                                       -   Training for technicians in handling
                                                                           the side effects of IRS operations.
                                                                       -   Raising the awareness of the
                                                                           populations on what to do in the event
                                                                           of an adverse effect
        -    Development of unofficial IRS operations
                                                                       -   Raising the awareness of the people
                                                                           responsible for the districts and
                                                                           regions about the dangers of
                                                                           uncontrolled IRS operations.

    4.6.      Links to other interventions and programmes


   4.6.1. Other Global Fund grant(s)
   Describe any link between the focus of this proposal and the activities under any existing Global Fund grant. (e.g.,
   this proposal requests support for a scale up of ACT treatment and an existing grant provides support for service
   delivery initiatives to ensure that the treatment can be delivered).
   Proposals should clearly explain if this proposal requests support for the same interventions that are already planned
   under an existing grant or approved Round 7 or Round 8 proposal, and how there is no duplication. Also, it is
   important to comment on the reason for implementation delays in existing Global Fund grants, and what is being
   done to resolve these issues so that they do not also affect implementation of this proposal.

   BETWEEN 2 AND 4 PAGES
   Vector control has not always been the weak point of strategies to fight malaria in Senegal. Up until now
   the subsidies from the Global Fund and other forms of support from partners have been used for curative
   purposes (ACT, RDT) and some preventive elements, such as LLITNs. None of the previous Global Fund
   subsidies which the PNLP has received have in any way dealt with the vector control element (apart from
   mosquito nets). However, it has been accepted that in order to bring malaria effectively under control, no
   element of the fight must be overlooked. This is why in this subsidy the PNLP is asking for support to
   achieve universal LLITN coverage quickly and to develop the IRS element; along with the larval control
   element in the form of operational research in the Dakar region.
   So this proposal followed on from the previous Round 4 and 7 subsidies. It aims to scale up new


    13 Translator’s note: this is a guess at the meaning here, there’s not much context to go on.



R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                             42/78
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   strategies, (especially IRS operations and the PECADOM scheme) which will be added to those already
   implemented in the previous subsidies, in order to enhance the drop in mortality and morbidity in order to
   bring malaria effectively under control in Senegal quickly. Indeed, this funding has helped with handling
   the scaling up of ACTs and RDTs at health centres, points and “cases de santé”. The Round 4 funding
   allowed Senegal to acquire ACTs and RDTs for health care facilities in 2006 and 2007 respectively.
   Round 7 helped to strengthen the setting up of this system and to extend the introduction of these anti-
   malarial products at community level. In order to promote access to treatment, this setting up process
   was accompanied by a heavy subsidy on the ACTs, free RDTs and regular training and supervision for all
   service providers. This has helped to bring about a clear improvement in the quality of care offered by the
   health services and a positive impact on proportional mortality linked to malaria which fell from 20.7% in
   2005 to 7.14% in 2008.
   Even so, it has to be acknowledged that, in spite of these efforts, there are still challenges linked to
   access to health care in certain areas. This is because most of the subjects who are the most exposed to
   malaria are beyond the reach of the health care facilities and therefore have only limited access to
   diagnosis and treatment. This is why with Round 7 the PNLP had begun a pilot project on the feasibility of
   implementing the PECADOM scheme in three districts, which has shown encouraging results. In this
   proposal it will be a matter of strengthening and extending this initiative, especially in areas where
   mortality is still very high.
   It must be specified that this proposal does not lead to any additional requirements in terms of ACTs and
   RDTs, because the requirements are already covered by Rounds 4 and 7 up until 2012, beyond the
   requirements which will be covered by the State and its partners.
   For prevention purposes, in spite of the results obtained with Round 4, efforts still need to be made. The
   availability of LLITN is poor (60% of households have at least one LLITN). Likewise the average rate of
   ITN coverage is low (34%). With the Round 7 subsidy the plan is to organise a mass campaign on a
   national scale for children under the age of 5. However, in order to achieve the goal of universal LLITN
   coverage with one LLITN for every 2 people, we need a substantial increase in LLITN availability and to
   persuade the populations to make greater use of them. In this Round 9 subsidy application, we plan to
   acquire more LLITNs with the aim of achieving at least 85% coverage.



   4.6.2. Links to non-Global Fund sourced support

   Describe any link between this proposal and the activities that are supported through non-Global Fund sources
   (summarising the main achievements planned from that funding over the same term as this proposal).
   Proposals should clearly explain if this proposal requests support for interventions that are new and/or complement
   existing interventions already planned through other funding sources.




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   ONE PAGE MAXIMUM

   For treatment purposes, USAID - through its implementing agencies - is taking part in the CBIs making
   1297 of them functional through the training of community-based staff and the introduction ACTs.
   Similarly, the PMI is supporting treatment and prevention interventions by funding operational research.
   As part of the AMFm initiative, Senegal is planning to make ACTs more accessible, especially in the
   private sector. This will supplement the efforts already made in the public sector in order to improve
   access to treatment.
   USAID, through the PMI, has implemented the IRS pilot phase in 3 districts in Senegal.
   As far as promoting the use of LLITN is concerned, partners such as the PMI and the World Bank/PRN
   are supporting the PNLP as part of campaigns offering free distribution of LLITNs to children under the
   age of 5.
   The IDB and the World Bank (Booster programme/PGIRE) are planning to supply mosquito nets, which
   will help to increase the availability of LLITNs still further. In addition to this, the IDB is emphasising the
   training of health personnel and the strengthening of the diagnosis of cases of malaria by means of
   diagnostic testing support.
   UNICEF is also supplying mosquito nets to the Tambacounda, Kolda and Matam regions as part of its
   child survival programme.
   Other partners such as the Red Cross and Malaria No More are also supporting the PNLP for the
   purposes of promoting LLITNs.
   Since 2008 Senegal has been receiving funding from the Bill and Melinda Gates Foundation (VBC
   project). The aim of this project is to strengthen national capacities (infrastructures, human resources and
   institutional capacities) for (i) a proper implementation of operations designed to fight malaria vectors, (ii)
   the introduction of new VC tools and (iii) the management of resistance to insecticides.
   As part of the AMFm initiative, Senegal is planning to make ACTs more accessible in the private sector.
   This will supplement the efforts already made in the public sector in order to improve access to treatment.
   All these initiatives carried out or supported by the partners complement this proposal and will help with
   achieving its goals.




   4.6.3. Partnerships with the private sector
   (a)    The private sector may be co-investing in the activities in this proposal, or participating in a way that
          contributes to outcomes (even if not a specific activity), if so, summarise the main contributions anticipated
          over the proposal term, and how these contributions are important to the achievement of the planned
          outcomes and outputs.
   (Refer to the Round 9 Guidelines for a definition of Private Sector and some examples of the types of financial and
   non-financial contributions from the Private Sector in the framework of a co-investment partnership.)




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   ONE PAGE MAXIMUM
   The private sector is especially involved in two areas: the distribution of both ACTs and LLITNs. Over the
   proposal term, this sector will be approached about continuing to support the PNLP.
   • A number of private companies, such as SODEFITEX and Total Senegal, have managed to acquire
   stocks of LLITNs through private operators, and these have been passed on to their employees and their
   families free of charge. Total Senegal has set up a huge national awareness-raising programme about
   malaria, in partnership with the Ministry of Health. This programme was launched on World Malaria Day,
   on 25th April 2009.
   • As far as the social marketing of mosquito nets is concerned, the Netmark project, funded by USAID,
   has played an important role in the availability, accessibility and use of LLITNs, especially aimed at
   vulnerable targets (pregnant women and children under the age of 5).
   • The private pharmaceutical sector is taking part in the distribution of anti-malarial drugs. This means that
   the PNLP’s ACTs are available in dispensaries at the same prices as in the public sector. This sector is
   also taking part in the distribution of LLITNs, although the accessibility of these mosquito nets is limited
   due to the lack of any subsidy (average cost of an LLITN: 11 euros).
   Collaboration from the private sector is helping to improve the accessibility of both ACTs and LLITNs.
   • In the Kédougou region, mining companies, especially Mineral Deposits Limited14 (MDL), have been
   carrying out IRS activities in the villages around their mines since 2006.
   • For treatment purposes, private service providers have been trained by the PNLP about current policies
   and strategies in Senegal.
   • The pharmaceutical company Pfizer is supporting the IntraHealth NGO in the implementation of a
   community-based project designed to fight against malaria in 3 districts in the Tambacounda region.
   This contribution made by the private sector is extremely important and undoubtedly contributes to the
   success of the anti-malaria programme. Indeed, the private sector stakeholders help to mobilise more
   resources. Their work can often help to persuade other stakeholders from their communities to get
   involved in the public – private partnership to fight against malaria in Senegal. Finally, the implementation
   of these projects by the private sector allows certain community-based organisations from their areas of
   intervention to draw on their management and organisational know-how, thus helping to strengthen the
   capacities of these vital stakeholders in the fight against malaria.
   (b)      Identify in the table below the annual amount of the anticipated contribution from this private sector
            partnership. (For non-financial contributions, please attempt to provide a monetary value if possible, and at a
            minimum, a description of that contribution.)
                         Population relevant to Private Sector co-investment
       (All or part, and which part, of proposal's targeted population group(s)?)

                                            Contribution Value (in USD or EURO)
                                        Refer to the Round 9 Guidelines for examples
                         Contribution
    Organisation         Description          Year 1     Year 2      Year 3         Year 4         Year 5         Total
       Name
                           (in words)
                      Setting up of a
   Total for          large-scale              76,220
   Senegal            awareness-raising         euros
                      project
                      Improvement of
                      access to health
                      care, the creation of   217’706   217’706       217’706                                       653’118
   Phizer15
                      “cases de santé”,         euros     euros         euros                                         euros
                      training and
                      equipment
   [use the [...]16
   key




     14 Translator’s note: incorrectly spelt in the French source text.
     15 Translator’s note: should this not be “Pfizer” (i.e. the pharmaceutical company)?
     16 Translator’s note: the sentence is incomplete in the French source text.



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    4.7.     Programme Sustainability

   4.7.1. Strengthening capacity and processes to achieve improved malaria outcomes
   The Global Fund recognises that the relative capacity of government and non-government sector
   organisations (including community-based organisations), can be a significant constraint on the ability to
   reach and provide services to people (e.g., home-based care, outreach prevention, etc.)

   Describe how this 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. Refer to country assessment reviews, if available.
   ONE PAGE MAXIMUM
   For the purposes of the scaling up of the anti-malaria interventions, the activities involving communication
   and improving stakeholders’ skills are important in order to treat and prevent malaria. Thus, in order to
   guarantee the sustainability of the services provided and the obtaining of efficient results, the PNLP sees
   community participation in all phases of the project as particularly important, from the identification of
   needs through to assessment and also including the implementation of the activities. The advocacy
   activities are aimed at the authorities and opinion leaders in order to obtain their commitment. In the same
   way awareness-raising activities are carried out aimed at communities in order to encourage them both to
   get involved in the implementation and appropriation of anti-malaria interventions.
   For the implementation of Community-Based Interventions (CBIs), every year the districts and the NGOs
   draw up operational plans to fight malaria. In this proposal, contractual agreements will be strengthened
   with the CBOs which will receive in the technical, administrative and accounts management of CBIs, thus
   helping them to carry out their implementation work (HV, chats, distribution of LLITNs, destruction of
   breeding places, etc.) The CBOs’ activities are regularly supervised by the district DHT or ICPs and two
   monthly coordination meetings and an end-of-quarter assessment are organised. Similarly, a Manuel des
   Procédures (MDP - procedural manual) for the management of CBO activities is in gestation. It should be
   finalised by the end of June 2009. This manual will be a very clear document so that each community
   level stakeholder has an accurate idea of the role expected of him or her. It will cover all of the
   administrative and technical tasks and will describe - in all circumstances – how the community
   stakeholder should proceed. For each of them it will also give details of what to do and how to do it (the
   information to be processed and points requiring improvement). The adoption of this MDP, following the
   example set by international organisational standards, is designed to fulfil quality assurance regulations.
   For the purposes of the PECADOM scheme, the DSDOMs are chosen by the community on the basis of
   pre-defined criteria. Thanks to their training on the malaria package, these DSDOMs will handle simple
   cases at community level. The extension of their areas of competence to IEC/BCC could be used to good
   effect by other programmes (STDs/HIV, Tuberculosis, EVP, PRN, IMCI, etc.) The DSDOMs will be
   supervised on a monthly basis by the ICPs and every three months by the DHT with the support of the
   sub-beneficiary NGOs. Regular coordination meetings are held.
   For IRS operations, the implementation staff are recruited from the community. They are trained either in
   application techniques as operators, or in IEC/BCC techniques so that they can act as intermediaries or
   simply in safety measures as support staff. The activities are supervised by the DHT strengthened by the
   neighbouring districts, the RHT and the central level.
   On an operational level, the ICPs play an important role as an intermediary between the community
   (CHWs, health workers, CBOs, population, etc.) in the area in which they operate and the health district.
   Thus, their skills are strengthened in all areas of community-based activity to allow them to handle the
   coordination and monitoring. In this proposal, they will be responsible for supervising the DSDOMs, the
   CBOs for the CBIs, health workers for the purposes of both IRS operations and treating any cases of
   intoxication with insecticides. The district level coordination meetings allow the ICPs and the DHT to
   share the results of the various activities and to improve the implementation.
   The operational level coordination unit is represented by the health district. The orientation of the DHTs
   always takes place before the introduction of an intervention. In order to strengthen their skills in the area
   of malaria, a malariology course is organised for doctors and intermediate executives from the health
   districts. The DHT handles the coordination and monitoring of all the activities. The NGOs support the
   health districts for better cover of the initiatives to be carried out. The medical regions support the health
   districts in implementing the working plans. Quarterly reviews are organised by the central level to gather




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   data from the districts and regions and to exchange ideas about the work carried out on all levels.
   The management of the procurement and stocks of anti-malarial drugs and products is handled by the
   PNA. Target Ministries (Education, Environment, Armed Forces, Women-Family-Children and Agriculture)
   are supported (training, financial and technical support) for the implementation of the sector-specific plans
   to fight malaria. The private sector is asked to contribute various services; which will require training,
   monitoring and coordination activities.
   The research partners (university, SLAP and research institutes) handle the monitoring of the
   effectiveness of the various interventions (the PECADOM scheme, LLITNs, IRS operations). Contracts /
   agreements will be established with the research institutes, laboratories, university or firms / consultants
   in order to carry out any activities requiring specific skills on behalf of the PNLP. Amongst other things
   this includes the areas of medical entomology, parasitology, toxicology, assessment and operational
   research. This partnership helps the research institutions to strengthen their capacities and to improve
   their performances on a regular basis.
   The consultation framework for the partners - including those from the private sector - which is
   strengthened in this proposal, helps to bring about regular exchanges about the implementation of the
   interventions, to identify any constraints and to propose solutions.

   4.7.2. Alignment with broader developmental frameworks
   Describe how this proposal’s strategy integrates within 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, and other important initiatives,
   such as the 'Global Roll Back Malaria Strategic Plan 2006-2015' for malaria collaborative activities.
   ONE PAGE MAXIMUM
   The PNLP’s strategic plan fits into a context in which the government of Senegal has made a
   commitment, through its Document de Stratégie de Réduction de la Pauvreté (DSRP - Poverty Reduction
   Strategy Document) to offering an overall response designed to reduce the incidence of poverty in
   households by 50% by 2015 ((Attachment 19).
   Malaria is a disease which mainly affects the most deprived strata of the population. In 2003, the DSRP’s
   monitoring indicators showed a favourable trend for the social indicators, especially in terms of human
   development and access to basic social services. The activities designed to strengthen the capacities of
   the technical ministries including the Ministry of Health will supplement the steps taken to allow the
   various stakeholders in the fight against malaria to play their roles in the implementation and the
   monitoring of the “Roll Back Malaria in Senegal” Initiative to the fullest extent. Thus we expect a 75%
   reduction in the morbidity and de mortality rates attributable to malaria in 2015 compared to their 2005 levels
   (Attachment 20). The significant increase in access to effective treatment, combined with adequate
   LLITN, IRS operations and IPT coverage for pregnant women, will reduce the mortality and morbidity
   attributable to malaria. As a result, the protection of the population, and especially the vulnerable strata,
   will have a positive impact on the populations’ productivity by reducing the economic blight of disease.
   In the context of malaria developing favourably since 2006, towards unstable malaria, IRS operations and
   the use of LLITN are the most suitable means of prevention in the general population if we are to achieve
   the RBM/FRP targets (Attachment 20).
   In Senegal, promoting prevention is a priority which emerges out of the political will expressed by the
   country’s highest authorities. It is also an effective response to most diseases, including endemic and
   epidemic diseases such as malaria and it is the major strategy in the fight against the disease. For proper
   prevention and control of malaria, the strategic outlines of the 2009 - 2018 Plan National de
   Développement Sanitaire (PNDS - National Health Development Plan) are as follows: (i) BCC, (ii)
   improving proper, early treatment of cases at all levels, (iii) increasing ITN coverage for the priority
   targets, IPT for pregnant women and for all districts, (iv) strengthening partnership and multi-sectoral
   collaboration. (Attachment 5).
    in spite of the importance of these prevention strategies (IRS operations and Use of LLITNs), the
   treatment of cases of malaria at community level is a major concern for the PNLP which is why
   community-based care (the PECADOM scheme) is so worthwhile. This is one of the three priority areas
   for the PNLP for the period from 2010 to 2014. In order to contribute to universal access to health care,
   one of the primary health care (PHC) principles of the 1987 Alma Ata world conference, the PECADOM
   scheme is recommended for isolated areas, which have no functional health structures and usually in low




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                      47/78
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   social and economic level populations.
   Thus, these three priority areas for the PNLP (IRS operations, use of LLITNs and the PECADOM
   scheme), are covered by the sector-specific targets broken down into the PNDS for Senegal and are
   perfectly consistent with the MDGs. This is because "The achieving of six MDGs out of eight depends
   upon effectively fighting malaria." The speeding up of the achieving of these MDGs is one of the major
   challenges of the 2009-2018 PNDS. Hence the relevance of this proposal which aims to come up with
   innovative ideas in the systems for the prevention and treatment of cases of malaria in order to guarantee
   access to health care especially for vulnerable groups (pregnant women, children under the age of 5, the
   elderly, the disabled) and subsequently develop mechanisms to encourage solidarity and or the funding
   of health as part of the CBOs.


    4.8.      Measuring impact

    4.8.1. Impact Measurement Systems
   Describe the strengths and weaknesses of in-country systems used to track or monitor achievements
   towards national malaria outcomes and measuring impact.
   Where one exists, refer to a recent national or external assessment of the IMS in your description.
    ONE PAGE MAXIMUM
   The PNLP has set up a system to monitor implementation and performance. It is supported by the
   national health system and integrates into the Service National de l’information Sanitaire (SNIS - National
   Health Information Service) system with which it has dynamic relations for the gathering of routine data
   from health training courses.
   In order to improve the M/E system and the quality of the data generated in order to measure the success
   of the activities implemented, an assessment of the aforesaid system was carried out using the “tool for
   strengthening programmes’/projects’ M&E systems” designed by the Global Fund. Many strong points
   were detected especially in terms of the gathering and transmission of data and feedback, but also the
   use of the data (Attachment 6).

       ANALYSIS OF THE STRENGTHS AND WEAKNESSES OF THE MONITORING/ASSESSMENT
                                       SYSTEM

                                            STRENGTHS                                    WEAKNESSES
                            -    Organisation into 3 levels (central,       There is a lack of a sufficient
                                 intermediate and operational)              mechanism for the monitoring of
                            -    Organisation in line with the              coverage and impact indicators down to
     Organisation of             national health system down to             community level
       the system                community level
                            -    This organisation facilitates the
                                 monitoring and assessment of the
                                 interventions
                            -    Existence of data gathering tools at       -    No procedural manual for the
                                 all levels: from hospitals down to              operational definitions and
                                 community level                                 guidelines
                            -    Gathering of data on all                   -    No filling guide for the data
                                 interventions by the PNLP                       management tools at community
     Data gathering         -    Organisation of quarterly reviews to            level
    and transmission             share, approve and gather data             -    Lack of sufficient quality control
                                 from the sub-beneficiaries                      over the data17 at operational level
                            -    Good level of completeness in the               prior to sending
                                 transmission of the data (93.6%            -    There are sometimes errors on
                                 according to the 2008 report)                   certain reports submitted
                                                                            -    Delay in the transmission of data by
                                                                                 certain sub-beneficiaries
                            -    There is an organisational chart           -    No reliable system for the archiving

    17 Translator’s note: repeated in the French source text.



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                               clearly identifying the positions and       and backing up of the data at
                               responsibilities of each stakeholder        operational level
                          -    There is a national database
                               (RMBME) for data management at          -   There is no systematic analysis and
                               central, regional and operational           quality control of the data at
                               level                                       operational level
         Data             -    Systematic feedback to the sub-
      management               beneficiaries
                          -    Introduction of a quality control
                               element into the supervision chart
                               for data from the points where
                               services are provided
                          -    Annual drawing up and distribution      There is a distribution plan but it is not
                               of reports (activities, financial,      stated in the monitoring and
      Distribution of          statistics, pharmacovigilance) to the   assessment plan
         the data              sub-beneficiaries and partners
                          -    Strategic use of the data by the
                               coordination unit
    Human resources       -    There is an office entrusted with       There is a lack of sufficient training for
                               monitoring and assessment within        the staff responsible for data gathering
                               the PNLP headed up by a public          at peripheral and community level
                               health doctor, assisted by a data
                               manager/planner, a supervisor and
                               a focal point whose task is to
                               monitor the sub-beneficiaries
                          -    Training for all heads of districts
                               and hospitals in using the RBMME
                               database

   This means that weaknesses have been seen, essentially relating to aspects to do with the non-existence
   of documents on:
       •   operational definitions,
       •   storage guidelines,
       •   on-site checking of data,
       •   the methodology to be used or the approach to be taken in the event of any delays in sending in
            reports, missing data, errors or other malfunctions, etc.
   It should be possible to find a solution to all of these gaps by drawing up a monitoring and assessment
   procedural manual (Attachment 21). This document, which has already been drawn up, will be widely
   distributed.
   The monitoring and assessment system will be improved in order to fill any gaps relating to:
       •   the lack of sufficient sites and the number of visits for the purposes of gathering data in order to
            monitor the effectiveness of anti-malarial drugs and the sensitivity of vectors;
       •   the lack of a mechanism for the monitoring of indicators on coverage (availability and use of ITNs,
            early treatment, IPT) and impact (infant mortality, malarial mortality including community level);
       •   the lack of recent data on the epidemiological profile of malaria in the country.




   4.8.2. Avoiding parallel reporting
   To what extent do the monitoring and assessment ('M&E') arrangements in this proposal (at the PR, Sub-
   Recipient, and community implementation levels) use existing reporting frameworks and systems




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                     49/78
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   (including reporting channels and cycles, and/or indicator selection)?




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   HALF PAGE MAXIMUM
   The interventions targeted in this proposal supplement what was done during the previous Rounds. So
   for instance there will be no changes to the types of data require for the purposes of monitoring
   implementation and performance and their formats. In addition to this, there are no special requirements
   in terms of periodicity in transmission altering the provisions already made in this respect.
   Thus the consultation registers and the districts’ reports on activities will continue to be used as supports
   for the recording and notification of health information. The data gathering supports which are currently in
   use will not undergo any alterations. Management tools tailored to community level have already been
   drawn up and made available to the “cases de santé” and health service providers involved in the
   PECADOM pilot project.
   For LLITNs, the indicators of coverage chosen in this proposal tally with those chosen previously in
   Rounds 4 and 7.
   As far as IRS operations are concerned, the same indicators chosen during the implementation of the
   pilot project will continue to be monitored.
   For the purposes of the monitoring and assessment plan drawn up by the PNLP, there are plans to hold
   quarterly reviews18. These meetings involve all of the operational level stakeholders on a sector-specific
   basis. As a result, separate meetings are held with the districts, hospitals, NGOs and military health care
   facilities. At these reviews, each organisation presents its own data which is approved by all levels
   (operational, intermediate and central). This way of proceeding helps to avoid any risk of the
   development of a parallel reporting system, double reporting and, to a certain extent, it also helps to
   ensure high quality data. The on-site checking of the data, carried out at each supervision, supplements
   the arsenal introduced by the PNLP’s monitoring and assessment unit in order to ensure high quality data
   and to harmonise the data gathering methods.




    18 Translator’s note: the French source text says “periodic quarterly reviews” but that seems rather
    tautological.



R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                    51/78
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                            DESCRIPTION OF THE INFORMATION CIRCUIT




   4.8.3. Strengthening monitoring and assessment systems
   What improvements to the M&E systems in the country (including those of the Principal Recipients and
   Sub-Recipients) are included in this proposal to overcome gaps and/or strengthen reporting into the
   national impact measurement systems framework?
      The Global Fund recommends that 5% to 10% of a proposal’s total budget is allocated to M&E activities, in order
       to strengthen existing M&E systems.
   ONE PAGE MAXIMUM
   The PNLP has made considerable efforts on routine data gathering with a good degree of completeness
   and appreciable promptness. Survey data is also regularly available. The lessons which have been
   learned will be consolidated or even improved in this proposal.
   Additional efforts will be made to strengthen entomological and parasitological monitoring:
       •   The monitoring of the effectiveness of the LLITNs will be strengthened by expanding the study
           sites and more regular visits to gather and analyse the data. This approach has the advantage of
           allowing the monitoring of differences between batches of mosquito nets distributed at different
           times. From now on this will be done on the basis of two visits per year.
       •   The sensitivity of vectors to insecticides is currently being monitored on 11 sites. It will be
           strengthened by increasing this by 4 new sites. This will make the data more representative and
           will allow decisions to be taken based on more relevant criteria.
       •   Quality control for the application of insecticides for IRS purposes will be carried out at least once
           in each district after every campaign. The effectiveness of the IRS operations will be monitored
           for 6 to 10 months in the 6 selected districts.
       •   The epidemiological profile of malaria in Senegal needs to be redefined. The environmental
           changes brought about by development projects, natural events and the impact of the
           interventions carried out over the last ten years or so have certainly largely altered many
           parameters including those relating to transmission. This means that updating the basic data is




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                         52/78
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           now an essential option.
   From the point of view of improving the monitoring and assessment system still further, the PNLP is
   planning to set up a system for the monitoring of coverage and mortality indicators (including community-
   based indicators) combined with a monitoring of the entomological and parasite-related parameters. This
   monitoring will be carried out by targeting communities spread out among the country’s various
   epidemiological facies and residing in clearly-defined geographical areas. These areas, which will still be
   known as sentinel observatories, will take part in producing information which will be relevant to the
   decision-making process.


    4.9.      Implementation capacity

      4.9.1 Principal Recipient(s)
      Describe the respective technical, managerial and financial capacities of each Principal Recipient
      to manage and oversee implementation of the programme (or their proportion, as relevant).
      In the description, discuss any anticipated barriers to strong performance, referring to any pre-existing
      assessments of the Principal Recipient(s) other than 'Global Fund Grant Performance Reports'. Plans to
      address capacity needs should be described in s.4.9.6 below, and included (as relevant) in the work plan and
      budget.


   PR 1          Ministry of Health, Prevention and Public Health
   Address      Rue Aimé Césaire Fann Résidence Dakar – Senegal
   The principal beneficiary of this proposal is represented by the Ministry of Health.
   The PNLP, which will be handling the implementation of the proposal on behalf of the Ministry of Health,
   has seen a strengthening of its staff over the last few years together with a restructuring of its
   organisation.
   From the point of view of its technical capacity, the programme’s coordination unit has human resources
   with various skills relating to the programme’s needs. So, for instance, the programme’s staff include 4
   doctors specialising in public health and in epidemiology, 2 pharmacists, 1 medical entomologist, 1
   economist / planner, 1 biomedical engineer and 1 advanced health technician. This team coordinates the
   implementation which is handled at operational level by the districts’ doctors specialising in public health
   who are supported by qualified technicians and health workers and by community health workers. The
   PMI project has provided the PNLP with an epidemiologist and a malaria adviser, who provide
   considerable support in the carrying out of the activities.
   This is a team with a diverse range of strategic initiatives taken to find answers to a certain number of
   clearly identified problems, especially in the area of community matters. These are essentially
   community-based initiatives which are drawn up and implemented working together with the operational
   level partners. This is the case with the ABCD, and P15 projects and, more recently, pilot projects for the
   implementation of the PECADOM scheme. All of the policy and strategy documents relating to the
   treatment of cases and the prevention of malaria in Senegal have been drawn up and approved with all of
   the partners. The same goes for the training manuals for each area of activity.
   The coordination unit has also handled the drawing up and development of a functional
   pharmacovigilance system for anti-malarial drugs. In addition to this, the PNLP was also the driving force
   behind the development of the national pharmacovigilance system. Indeed, with the technical support of
   the WHO, and the technical collaboration of the national pharmacovigilance centre of the Kingdom of
   Morocco, the PNLP has been able to train dozens of national experts in pharmacovigilance and has thus
   triggered a dynamic of reorganisation and strengthening of the national pharmacovigilance system in
   Senegal. So, for the past two years, the PNLP has been producing an annual pharmacovigilance report.
   Similarly, an annual meeting on the issue of pharmacovigilance is held. It offers a forum for exchanges
   and discussion about problems linked to the culture of notification, to the strengthening of the technical
   committee entrusted with accountability and opportunities to strengthen the national pharmacovigilance
   system.
   As far as managerial capacity is concerned, the programme structuring leads to a clear organisation
   defining the terms of reference for each position (Attachment 22). Underlying this organisation there is a
   functional coordination system which has helped to improve the day-to-day management of the
   programme. In addition to this, in order to ensure the close monitoring of the sub-beneficiaries’ activities




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                      53/78
    ROUND 9 - Malaria
   including the districts, each PNLP technician has been appointed as a focal point who is responsible for
   monitoring the districts in a specific region. (Attachment 8).
   The PNLP has an accounts and financial management unit made up of an administrative and financial
   manager, an internal auditor and 3 accountants. This unit has a technical and accounts management
   program (Hiprojet) and an accounts and financial procedural manual.
   The programme’ accounts are audited annually by an independent firm of chartered accountants.

                            Organisational chart for the PNLP coordination unit




      PR 2         [Name]
      Address      [street address]




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     [Description]


     PR 3            [Name]
     Address         [street address]
     [Description]
      Copy and paste tables above if more than three Principal Recipients


     4.9.2 Sub-Recipients


     (a)    Will sub-recipients be involved                in     Yes
            programme implementation?



     (b)    If no, why not?




                                                                  1-6


                                                                  7 - 20
     (c)    If yes, how many sub-recipients will
            be involved?
                                                                  21 – 50



                                                                  more than 50


     (d)    Are the sub-recipients already
            identified?                                           Yes
     (If yes, attach a list of sub-recipients, including          (Attachment 23)
             details of the 'sector' they represent, and the
             primary area(s) of their work over the
             proposal term.)                                    Answer s.4.9.4. to explain

     (e)    If yes, comment on the relative proportion of work to be undertaken by the various sub-
            recipients. If the private sector and/or civil society are not involved, or substantially involved,
            in programme delivery at the sub-recipient level, please explain why.

     TWO PAGES MAXIMUM
     The sub-recipients identified for the purposes of this proposal are broken down into all sectors, both
     public and private, government and non-government.
     The main areas in which these sub-recipients provide services are as follows:
         • The Implementation and monitoring of the PECADOM scheme;
         • IRS implementation;
         • Promoting the use and distribution of LLITNs;
         • The training and supervision of technical staff and community health workers;
         • The implementation of community-based plans to fight malaria;
         • Hygiene-cleaning up as part of the implementation of community-based plans to fight
            malaria;
         • IEC/BCC at community level;




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           • IEC/BCC: mass media.

     This proposal involves the private sector and civil society in the implementation to a greater degree.
     In Rounds 4 and 7 which are currently in the process of implementation, these two entities have
     allowed the PNLP , to scale up and monitor most of the priority interventions at operational level.
     This involvement has helped to achieve the current level of performance by compensating for the
     lack of sufficient human resources and technical capacities in the State public system at the same
     time thus increasing the Programme’s implementation capacities.
     This type of sub-beneficiary will be asked to make a significant contribution.




    4.9.3.   Pre-identified sub-recipients
    Describe the past implementation experience of key sub-recipients. Also identify any challenges for
    sub-recipients that could affect performance, and what is planned to mitigate these challenges.


     Order    Sub-           Sector of work       Main areas in which they provide             Areas of
      no.     recipient’s                         their services                               intervention
              name                                                                             (region, districts
                                                                                               or the whole
                                                                                               country)

                                                  - Maternal and Child Welfare/Family
                                                  Planning (MCH/FP),
                                                  - Malaria Prevention Project (PMI),
                                                  - Community-based project to prevent
                                                  malaria in Tambacounda                       3 districts in the
              INTRA-                              Intervention in three areas:                 Tambacounda
       1      HEALTH         NGO                  - Strengthening of the health system         region
                                                  - strengthening the range of                 (Tambacounda,
                                                  community-based services                     Koumpentoum and
                                                  - Improving access to subsidised ACTs        Makacoulibanta)

                                                      -    IEC/BCC,                            The whole country
              SENEGALES                               -     Distribution of mosquito nets,     with specific
              E RED          Auxiliary to the              (to people living with HIV)         programmes for the
       2      CROSS          public authorities       -    Treatment of malaria at             following regions:
                                                           community level                     Louga, Saint Louis,
                                                      -    Community IMCI                      Diourbel, Fatick,
                                                                                               Kolda, Ziguinchor.
                                                  :                                            4 regions:
                                                      -    IEC/BCC at community level          Saint Louis, Louga,
                                                      -    LLITN promotion                     Thiès and Diourbel
                                                      -    Raising IPT awareness               (which is the region
              HUNGER                                  -    Supporting the CHW on               targeted by this
       3      PROJECT        NGO                           treatment                           application)
              SENEGAL                                 -    Food safety
                                                      -    training & literacy
                                                      -    village hydraulics,
                                                      -    Environment and hygiene,
                                                      -    Health and nutrition,
                                                      -    Microfinance and income-
                                                           generating activities,
                                                      -    construction of infrastructures

                                                  Food safety and basic community
                                                  support programmes, 3 main areas of
                                                  intervention:
                                                  -    participation by the beneficiaries in
       4      AQUADEV        NGO                       diagnosis, planning,
                                                       implementation and monitoring of
                                                       the initiatives which contribute to




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                                                     their development,                      Louga region
                                                 -   strengthening partnership with the
                                                     collective interest stakeholders in
                                                     social and political life (NGOs,
                                                     academics, beneficiaries acting as
                                                     associations, mutual societies or
                                                     cooperatives, and public
                                                     authorities on a decentralised
                                                     scale)
                                                 -   research applied to tools and
                                                     instruments allowing actual
                                                     inequalities to be measured

                                                                                             Fatick region
                                                 -   IEC, IEC/BCC on a community             (Department of
                                                     level,                                  Foundiougne)
       5     RADI               Private sector   -   Cleaning up of the environment
                                                 -   Training of community-based
                                                     stakeholders in the fight against
                                                     malaria

                                                 Project involving fighting malaria in the   5 communes in the
                                                 suburbs of Dakar through:                   arrondissement of
                                                 -   Prevention and awareness-raising        Guédiawaye (a
             SECOURS            NGO                  campaign (social and HV                 suburb of Dakar)
       6     ISLAMIQUE                               mobilisation)
             France                              -   Distribution of LLITNs
                                                 -   Larval control in areas subject to
                                                     flooding

                                                 -   Training for service providers in
                                                     the public sector and on the            Various towns in the
             ENDA SANTE         NGO                  community level,                        country
       7                                         -   implementation of community-
                                                     based plans to fight malaria
                                                     (Round 4)

       8     Health districts   Government       Implementation of policies and
                                sector           strategies to fight malaria on an           69 districts spread
                                                 operational level                           across the whole of
                                                 -    Training of service providers          the country
                                                 -    Diagnosis and treatment of cases
                                                 -    Distribution of LLITNs
                                                 -    IEC / BCC
                                                 -    IRS implementation
                                                 -    implementation of community-
                                                      based plans to fight malaria

    The difficulties faced by sub-recipients which are likely to affect performance are linked to a number of
    factors usually encountered in the implementation of Community-Based Interventions (CBIs), including
    the following:
    - access to certain isolated areas of Senegal. Some roads are very difficult to use at any time of the
    year, and especially during the rainy season;
    - finding people in certain target villages to be trained as CHWs or health workers due to the low rate
    of school attendance / literacy;
    - the diligence with which activities are implemented. The work plans funded are quarterly; not only do
    they need to be implemented within the deadlines, there also has to be transparent justification of the
    use of the resources allocated in order to have any chance of obtaining fresh funding.
    In order to cope with this, the principal recipient shall, if necessary, strengthen the sub-recipients
    capacities. These latter must have both the capacities and the experience in implementing the
    targeted activities and they also must have a branch in their areas of intervention. The administrative
    and financial heads of the sub-beneficiaries will be trained in using the PNLP's management




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    procedures and a knowledge of the Global Fund’s procedures. In addition to this, the PNLP has
    introduced a system of close supervision of the sub-beneficiaries. In the event of any difficulties in
    selecting community health workers, local solutions will be suggested. The mechanism used to
    transmit reports on activities and supporting documents, which has already been set up, will be
    strengthened in order to provide timely identification of any problems or difficulties and to provide any
    necessary assistance. Quarterly reviews, involving the PNLP and the sub-beneficiaries, are
    opportunities to discuss any difficulties and to find solutions to them.


     4.9.4. Sub-recipients to be identified
     Explain why some or all of the sub-recipients are not already identified. Also explain the
     transparent, time-bound process that the Principal Recipient(s) will use to select sub-recipients so
     as not to delay programme performance.

     The sub-recipients have already been identified for Round 9. However, there are plans to continue
     working together with any sub-recipients from Rounds 4 and 7 who have proven themselves to be
     capable of performing well.

     4.9.5. Coordination between implementers
     Describe how coordination will occur between multiple Principal Recipients, and then between the
     Principal Recipient(s) and key sub-recipients to ensure timely and transparent programme
     performance.

     Comment on factors such as:

     •       How Principal Recipients will interact where their work is linked (e.g., a government
             Principal Recipient is responsible for procurement of pharmaceutical and/or health products,
             and a non-government Principal Recipient is responsible for service delivery to, for example,
             hard to reach groups through non-public systems); and

     •       The extent to which partners will support programme implementation (e.g., by
             providing management or technical assistance in addition to any assistance requested to be
             funded through this proposal, if relevant).
     The Ministry of Health, which is the sole principal beneficiary, has been identified for the purposes
     of coordinating the implementation of the proposal through the PNLP. This latter has already set up
     a system for the coordination of activities carried out by the sub-beneficiaries for the purposes of
     Rounds 4 and 7. This system incorporates the following:
         •    meetings with the sub-beneficiaries for the purposes of planning activities. This authority
              helps to ensure good coverage of the country by sub-beneficiaries and approval of the
              working plans by the PNLP’s coordination unit;
         •    quarterly data review meetings with all of the sub-beneficiaries. These meetings offer an
              opportunity to check the carrying out of the activities in line with the approved plans, to talk
              about experiences, to suggest solutions to any problems encountered during
              implementation and to proceed to approve and transmit the data;
         •   visits to the sub-beneficiaries in order to appraise their implementation capacity and to
              ensure an institutional reinforcement if required.
         The bilateral or multilateral partners will also provide technical assistance dealing with aspects
         linked to implementation, assessment and research, as part of a memorandum of
         understanding or a request for technical assistance.


     4.9.6. Strengthening implementation capacity
     The Global Fund encourages in-country efforts to strengthen government, non-government and
     community-based implementation capacity.

     If this proposal is requesting funding for management and/ or technical assistance to ensure strong
     programme performance, summarise:




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     (a)    the assistance that is planned;**

     (b)    the process used to identify needs within the various sectors;

     (c)    how the assistance will be obtained on competitive, transparent terms; and

     (d)    the process that will be used to evaluate the effectiveness of that assistance, and make
            adjustments to maintain a high standard of support.
     ** (e.g., where the applicant has nominated a second Principal Recipient which requires capacity development
     to fulfil its role; or where community systems strengthening is identified as a "gap" in achieving national
     targets, and organisational/management assistance is required to support increased service delivery.)

     TWO PAGES MAXIMUM
     Most of the SDAs used in this proposal, in this case the PECADOM scheme and IRS operations,
     are innovations for the PNLP. Technical assistance is required in order to guarantee high levels of
     implementation performance (Attachment 24).
     For the purposes of the PECADOM scheme this will involve calling on the services of specialists
     with skills relating to organising the monitoring and assessment of community-based systems. This
     technical assistance will be requested from the PNLP’s traditional partners, i.e. the WHO and the
     WAHO19.
     The strengthening of current interventions and measures (proper treatment of cases of malaria in
     health care facilities and promotion of the use of LLITNs) combined with the extension of the
     PECADOM scheme and IRS operations, will help to bring about a quicker reduction in morbidity
     and mortality linked to malaria
     This new situation combined with changes to the conditions or the ways in which malaria is
     transmitted, deserve to be taken into account in relation to changing the epidemiological profile.
     Technical assistance will be required in order to:
                  -   set up sentinel observatories starting in 2010
                  -   assess these sentinel observatories every two years
                  -   reassess the epidemiological profile of malaria in 2014
     These two activities require the drawing up of terms of reference and protocols. Institutions such as
     the WHO, the research institutes and the UCAD will be approached about carrying out the
     activities.
     The impact studies will be carried out in order to measure the effect of the various interventions.
     This work will require technical assistance for the purposes of drawing up the terms of reference,
     the approval of the protocols and the carrying out of these studies.
     Technical assistance will also be required for the dosing of the quality of the batches of insecticide
     used for IRS operations and also for the monitoring of the impact of the insecticides used on the
     environment.
     The annual monitoring of the effectiveness of the LLITNs (2013-2014) is an activity qui will be
     carried out by the partners (UCAD, SLAP and research institutes). This activity is part of the quality
     control of the LLITNs. Technical assistance will be required for the development of the insecticide
     dosing protocol in the LLITN with the LNCM and CERES LOCUSTOX, the only stakeholders who
     currently have skills in this field in Senegal.
     As far as certain activities relating to the documentation of the processes and the auditing of the
     monitoring-assessment system are concerned, there will be a limited outsourced consultation with
     a firm or individuals. In order to identify the needs within the various sectors, the PNLP will carry
     out an internal and external diagnosis of its organisation. This exercise will help to show up the
     strengths, weaknesses, opportunities and threats it will have to cope with in orders to go about its
     work.


    19 Translator’s note: the French source text says “OOAAS” we assume this to be a typo for “OOAS”.



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      The recommendations from this technical assistance will be enshrined in an work plan which will
     be implemented and assessed at the end of the process. In order to appraise the effectiveness of
     this assistance, this assessment will also look at any discrepancies between the problems identified
     and the results obtained.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                             60/78
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    4.10.      Management of pharmaceutical and health products

    4.10.1. Scope of Round 9 proposal



       Does this proposal seek funding for any
       pharmaceutical and/or health products?
                                                                                  Yes
                                                                           Continue on to answer s.4.10.2.



   4.10.2. Table of roles and responsibilities

   Provide as complete details as possible. (e.g. the Ministry of Health may be the organisation responsible for the
   ‘Coordination’ activity, and their ‘role’ is Principal Recipient in this proposal). If a function will be outsourced, identify
   this in the second column and provide the name of the planned outsourced provider.
                                     Which organisations and/or                                                  Does this
                                                                           In this proposal what is the role
                                     departments are responsible for                                             proposal
                                                                           of the organisation responsible
                                     this function?                                                              request
                                                                           for this function?
                                     (Identify if Ministry of Health, or                                         funding for
              Activity                                                     (Identify if Principal Recipient,
                                     Department of Disease Control,                                              additional
                                                                           sub-recipient, Procurement            staff or
                                     or Ministry of Finance, or non-
                                                                           Agent, Storage Agent, Supply          technical
                                     governmental partner, or
                                                                           Management Agent, etc.)               assistance?
                                     technical partner.)

                                                                                                                         Yes
   Procurement policies &
                                            Ministry of Health                            PR
   systems
                                                                                                                         No
                                     Direction de la Pharmacie et
                                                                                                                         Yes
   Intellectual property               des Laboratoires (DPL -
                                                                                          PR
   rights                            Directorate of Pharmacy and
                                             Laboratories),                                                              No


   Quality assurance and                                                                                                 Yes
   quality control                             DPL/LNCM                                   PR
                                                                                                                         No
   Management and
   coordination                                                                                                          Yes
                                               PNLP/MSP                                   PR
   More details required in
   s.4.10.3.                                                                                                             No

                                                                                                                         Yes
   Product selection                           PNLP/MSP                                   PR
                                                                                                                         No


   Management Information                                                     PR/Officer in charge of                    Yes
                                               PNLP/PNA                      procurement, distribution
   Systems (MIS)
                                                                              and stock management
                                                                                                                         No

                                                                                                                         Yes
   Forecasting                                 PNLP/MSP                                   PR
                                                                                                                         No

   Procurement and                                                            PR/Officer in charge of
                                               PNLP/PNA                                                                  Yes
   planning                                                                  procurement, distribution




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                                                                      and stock management
                                                                                                              No
   Storage and inventory
   management                      PNA, PRA, The districts’           Officer in charge of                    Yes
                                  stores of drugs and health       Procurement, storage and
   More details required in          care establishments            Distribution/Dispensing
   s.4.10.4                                                                                                   No
                                   PNA, PRA, The districts’
   Distribution to other         stores of drugs, health care         Officer in charge of
   stores and end-users                establishments,                                                        Yes
                                                                    Procurement, Storage,
   More details required in          NGOs/CBOs, private           Distribution/Dispensing and
   s.4.10.4                         pharmaceutical sector,              Sub-Beneficiaries                     No
                                  commercial private sector

   Ensuring rational use
   and patient safety                    PNLP/DPL                              PR                             Yes
   (pharmacovigilance)
                                                                                                              No


      4.10.3. Past management experience
      What is the past experience of each organisation that will manage the process of procuring, storing and
      overseeing distribution of pharmaceutical and health products?

                                                        PR, sub-           Total value procured during
                Organisation Name                     recipient, or             last financial year
                                                         agent?           (Same currency as on cover of proposal)
      Pharmacie Nationale                          Procurement,
      d’Approvisionnement (PNA - National          storage and                    13,719,512 euros
      Supply Pharmacy)                             distribution agent


      4.10.4. Storage and distribution systems
      Describe the extent to which this proposal uses existing country systems for the management of
      the additional pharmaceutical and health product activities that are planned, including
      pharmacovigilance systems. If existing systems are not used, explain why.
      ONE PAGE MAXIMUM
       The national system for the procurement of pharmaceutical and medical products is essentially
       based on the Pharmacie Nationale d’Approvisionnement (PNA - National Supply Pharmacy).
       The PNA is a non-hospital public health establishment under the supervision of the MSP, with
       management autonomy and is the organisation in charge of acquiring drugs, medical products
       and other health products for the public. It is governed by the Public Contract Code and carries
       out its procurement work by means of a process of international tendering.
       The PNA has capacities allowing it to handle procurement and a distribution system allowing the
       drugs to be supplied to the peripheral organisations.
       The PNA will have responsibility for the acquisition, storage and distribution of medical products
       on behalf of Round 9. An agreement for the management of the products which are the subject
       of this proposal will need to be negotiated with the organisation.
       For product quality assurance purposes, this proposal will call upon various bodies and
       institutions such as the Direction de la Pharmacie et des Laboratoires (DPL - Directorate of
       Pharmacy and Laboratories), the LNCM, the Commission Nationale de Gestion des Pesticides
       et Produits Chimiques (National Commission for Pesticide and Chemical Product Management)
       housed at the Ministry of the Environment and Nature Protection.
       For the purposes of monitoring the safety of these products, along with their rational use, the
       pharmacovigilance system currently developed by the PNLP and in the process of adaptation by
       the DPL into a national policy, will be strengthened and asked to contribute. Similarly, for the
       pesticides used to treat the LLITNs and those used for the IRS operations, the Centre Anti-




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                     62/78
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      Poison (CAP - Anti-Poison Centre) will be involved in strengthening the toxicovigilance system.
      For the purposes of operational research (monitoring the effectiveness, quality and safety of the
      products) research projects will be carried out by the UCAD and the research institutes.


     4.10.5. Storage and distribution systems


                                                          National medical stores or equivalent
     (a)       Which        organisation(s)
               have                primary           Sub-contracted national organisation(s)
               responsibility to provide      (specify)
               storage and distribution
               services      under     this
               proposal?          National           Sub-contracted international organisation(s)
               medical       stores      or   (specify)
               equivalent
                                                     Other:
                                              (specify)
     (b)         For storage partners, what is each organisation's current storage capacity for
                 pharmaceutical and health products? If this 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.

     For the purposes of this proposal the Pharmacie Nationale d’Approvisionnement (PNA - National
     Supply Pharmacy) has the task of storing the drugs and other medical products. This organisation
     which handles the procurement of essential drugs has recently increased its storage capacities:
           -    its regional branches increased in number from 8 in 2006 to 11 in 2007, in line with the
                administrative division of the country into 11 regions at the time;
           -    two large warehouses are currently under construction at its headquarters;
           -    the PNA has warehouses loaned by the Secrétariat à la Sécurité Alimentaire (Food Safety
                Secretariat) in two regions;
           -    the Ministry of Health has provided the PNA with two (2) large warehouses loaned by the
                country’s Army since 2006 for the purposes of managing products used to fight malaria.
     However, because of the increasing volumes of medical products which need to be acquired not
     just for malaria, but also for the Ministry’s other programmes, the PNA’s storage capacities could
     quickly be exceeded in spite of all the efforts made. This is all the more so as there are plans for
     the purchasing of large quantities of LLITNs and insecticides, both by the Global Fund and by the
     other funding sources and partners. In order to hold all of the expected stocks, the State plans to
     renovate 3 large sheds on the roads to the north (Saint-Louis), centre (Thiès) and south
     (Ziguinchor) on behalf of the PNA, in order to allow it to increase its storage capacities.

     (c)       For distribution partners, what is each organisation's current distribution capacity for
               pharmaceutical and health products? If this 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.
     The Pharmacie Nationale d’Approvisionnement (PNA - National Supply Pharmacy) has a
     distribution system organised from the central warehouse in Dakar to the Pharmacies Régionales
     d’Approvisionnement (PRA - Regional Supply Pharmacies) which allow the drugs to be shipped to
     peripheral organisations. The PNA has a fleet of 5 lorries used for logistical purposes: two 30-
     tonne, two 16-tonne and one 10-tonne. A sixth 30-tonne lorry was purchased on behalf of the PNA
     by Round 7 (delivery scheduled in June 2009).
      The distribution of the expected insecticides and LLITNs, both for the mass campaign and for
     routine distribution, will call for significant logistics. The transfer of the stocks to the districts will call




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                         63/78
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     for the services of private sector carriers.




     4.10.6. Pharmaceutical and health products for initial two years
     Complete 'Attachment B-Malaria' to this Proposal Form, to list all of the pharmaceutical and health products that are
     requested to be funded through this proposal.

     Also include the expected costs per unit, and information on the existing 'Standard Treatment Guidelines ('STGs').
     However, if the pharmaceutical products included in ‘Attachment B-Malaria’ are not included in the current national,
     institutional or World Health Organisation STGs, or Essential Drugs Lists ('EMLs'), describe below the STGs that are
     planned to be utilised, and the rationale for their use.



     See 20 attachment B malaria




    4B.     PROGRAMME DESCRIPTION – HSS CROSS-CUTTING INTERVENTIONS

       Optional section for applicants

       SECTION 4B CAN ONLY BE INCLUDED IN ONE DISEASE IN ROUND 9 and only 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 perhaps also benefit other health outcomes); and
                Section 4B is not also included in the tuberculosis or HIV proposal
       Read the Round 9 Guidelines to consider including HSS cross-cutting interventions
       Section 4B can be downloaded from the Global Fund website. Applicants should click here if they
       intend to include any "cross-cutting interventions to strengthen health systems" ("HSS cross-cutting
       interventions") in their proposals.




    20 Translator’s note: the French source text says “voire” (or even) but we assume this to be a typo
    which should read “voir” (see).



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    5. FUNDING REQUEST

    5.1.       Financial gap analysis - Malaria
    Clarified table 5.1
      Summary Information provided in the table below should be explained further in sections 5.1.1 – 5.1.3 below.

   Financial gap analysis (same currency as identified on proposal coversheet)
   N.B.    Adjust headings (as necessary) in tables from calendar years to financial years (e.g., FY ending 2008 etc.) to align with national planning
   and fiscal periods
                                                     Actual                          Planned                                                  Estimated

                                              2007              2008          2009              2010              2011                 2012                2013             2014

   Malaria programme funding needs to deliver comprehensive prevention, treatment and care and support services to target populations
   Line A     Provide annual amounts       32’393’807         34’770’388    27’463’623     26’933’198         28’106’956         41’629’830          28’165’337           27’886’245 
                                                                                          (combined total need over Round 9 proposal
                        Line A.1     Total need over length of Round 9 Funding Request    term)                                                            152’721’566 


   Current and future resources to meet financial need
      Domestic source B1: Loans and
   debt relief (provide name of source)                                      1’543’893         1’543’893        3’087’786 

                   Domestic source B2
            National funding resources
                                              381’097           381’097       381’097           381’097           381’097              381’097             381’097          381’097 
                   Domestic source B3
            Private Sector contributions
                              (national)

         Total of Line B entries   Total
          current & planned DOMESTIC          381’097           381’097      1’924’990         1’924’990        3’468’883              381’097             381’097          381’097 
      (including debt relief) resources:


                     External source C1
                 (provide source name)     13’639’138         13’639’138    13’639’138         1’425’398        1’425’398         1’425’398               1’425’398        1’425’398
                               USAID




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                          65/78
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                     External source C2
                 (provide source name)          771’392         771’392          771’392       771’392       771’392         771’392       771’392       771’392
                               UNICEF
                     External source C3
                 (provide source name)          150’000         195’000          195’000                                              
                                   WHO
                     External source C4
           Private Sector contributions                                                        293’926       217’706         217’706              0             0
                         (International)

         Total of Line C entries Total
    current & planned EXTERNAL (non-         14’560’530      14’605’530       14’605’530      2’490’716     2’414’496       2’414’496     2’196’790     2’196’790
         Global Fund grant) resources:

   In line D below, insert additional separate lines for each separate Global Fund grant. This will ensure that you show information on
   different Global Fund grants.
    Line D: Annual value of all existing
          Global Fund grants for same
     disease: Include unsigned ‘Phase         4’715’994      14’189’590        9’722’011      9’745’411     8’619’710       8’507’795             0             0
     2’ amounts as “planned” amounts
                      in relevant years


    Line E  Total current and planned
    resources (i.e. Line E = Line B total
                                       +     19’657’621      29’176’217       26’252’531     14’161’117    14’503’089      11303’388      2’577’887     2’577’887 
             Line C total + Line D Total)


   Calculation of gap in financial resources and summary of total funding requested in Round 9 (to be supported by detailed budget)
            Line F    Total funding gap
           (i.e. Line F = Line A – Line E)
                                             12’736’186       5’594’171        1’211’092     12’772’081    13’603’867      30’326’442    25,587,450    25,308,358 


                                              Line G = Round 9 malaria funding request
                                                                                              6’542’525     6’920’919      13’977’280     9’520’498     6’430’406
                                  (same amount as requested in table 5.3 for this disease)




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                    66/78
    ROUND 9 - Malaria
   Part H – 'Cost Sharing' calculation for Lower-middle income and Upper-middle income applicants

   In Round 9, 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 programme reaching not more than 65%
         of the national disease programme 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 programme reaching not more than 35% of
         the national disease programme funding needs over the proposal term.

   Line H    Cost Sharing calculation as a percentage (%) of overall funding from Global Fund


   Cost sharing =   (Total of Line D entries over 2010-2014 period + Line G Total) X 100
                                                                                                                                                     %

                                                          Line A.1




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                         67/78
    ROUND 9 - Malaria
     5.1.1. Explanation of financial needs – LINE A in table 5.1

     Explain how the annual amounts were:
     •      developed (e.g., through costed national strategies, a Medium Term Expenditure Framework
            [MTEF], or other basis); and
     •      budgeted in a way that ensures that government, non-government and community needs
            were included to ensure full implementation of country's malaria programme strategies.


     The overall specific needs for the disease between 2007 and 2014 amount to 247,349,384
     euros. The costs have been estimated on the basis of the 2006 – 2010 PNLP strategic plan, the
     cost of the new needs (scaling up of indoor residual spraying, system to detect and fight epidemics,
     rapid diagnosis tests (grants Round 7 malaria for the period between 2007 and 2014 21 ) and the
     PECADOM scheme.



     5.1.2. Domestic funding – 'LINE B' entries in table 5.1

     Explain the processes used in the country to:
     •      prioritise domestic financial contributions to the national malaria programme (including HIPC
            [Heavily Indebted Poor Country] and other debt relief, and grant or loan funds that are
            contributed through the national budget); and
     •      ensure that domestic resources are utilised efficiently, transparently and equitably, to help
            implement treatment, prevention, care and support strategies at the national, sub-national
            and community levels.

     Since the introduction of the strategic plan to fight malaria, the State has been supporting its
     implementation by an annual budget, sector-specific support (remission of taxes, subsidy on ACTs,
     procurement of ITNs and recruitment of staff) and has committed to handling the supply of
     Sulphadoxine Pyremetamine (SP) to the health care facilities.
     The total value of the current and planned State funding from 2007 to 2014 is estimated at
     3,048,776 euros The Islamic Development Bank (IDB) has granted a loan of 6,175,572 euros which
     is scheduled to be implemented over the period from 2009 to 2011


     5.1.3. External funding excluding Global Fund – 'LINE C' entries in table 5.1

     Explain any changes in contributions anticipated over the proposal term (and the reason for any
     identified reductions in external resources over time). Any current delays in accessing the external
     funding identified in table 5.1 should be explained (including the reason for the delay, and plans to
     resolve the issue(s)).
     Current and planned external funding excluding Global Fund between 2007 and 2014 is estimated
     at 55,484,878 euros.
     It breaks down as follows:
         1. USAID/PMI/CDC/ (+ USAID implementing agencies: IntraHealth, a consortium of NGOs
            under the management of CCF: Plan, Africare, CCF and World Vision, Ademas, Netmark,
            Research Triangle Institute, MSH, RPM US Pharmacopeia, RTI): 48,044,404 euros
         2. UNICEF: 6,171,136 euros
         3. WHO 540,000 euros
         4. Private sector: 729,338 euros




    21 Translator’s note: this sentence doesn’t make much sense in the original French.



R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                              68/78
    ROUND 9 - Malaria

    5.2.   Detailed Budget

    Suggested steps in budget completion:
    1.     Submit a detailed proposal budget in Microsoft Excel format as a clearly numbered
           annex. Wherever possible, use the same numbering for budget line items as the programme
           description.

           •   FOR GUIDANCE ON THE LEVEL OF DETAIL REQUIRED (or to use a template if there is
               no existing in-country detailed budgeting framework) refer to the budget information
               available at the following link: http://www.theglobalfund.org/en/Rounds/9/single/#budget

    2.     Ensure the detailed budget is consistent with the detailed workplan of programme
           activities.

    3.     From that detailed budget, prepare a 'Summary by Objective and Service Delivery Area'
           (s.5.3.)

    4.     From the same detailed budget, prepare a 'Summary by Cost Category' (s.5.4.).

    5.     Do not include any CCM or Sub-CCM operating costs in Round 9. This support is
           now available through a separate application for funding made direct to the Global
           Fund (and not funded through grant funds). The application is available at:
           http://www.theglobalfund.org/en/ccm/




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                           69/78
    ROUND 9 - Malaria
    5.3.      Summary of detailed budget by objective and service delivery area

                       Service delivery area
  Objective
  Number       (Use the same numbering as in programme    Year 1       Year 2       Year 3         Year 4          Year 5       Total
                         description in s.4.5.1.)

     1        SDA 1.1: PECADOM                             311’586       612’272      708’644            803’407     691’883     3,127,792
              SDA 1.2: MONITORING OF DRUG
     1                                                      10’000        10’000       14’859             44’301      49’160      128,320
              RESISTANCE
              SDA 2.1: INSECTICIDE TREATED
     2                                                    4’449’934     3’269’803    9’276’732      4’012’172       3’660’171   24,668,812
              NETS
     2        SDA 2.2: BCC / MASS MEDIA                            0            0      16’203             45’087      45’087      106,377
              SDA 2.3: COMMUNITY HEALTH
     2                                                     828’713       828’713      828’713            828’713     828’713     4,143,565
              WORKERS
              SDA 2.4: DEVELOPMENT OF THE
     2                                                      44’326        44’326       59’465             44’326      44’326      236,769
              PARTNERSHIP
              SDA 3.1: INDOOR RESIDUAL
     3                                                     751’340      1’872’671    2’672’004      3’273’562       1’079’967    9,649,544
              SPRAYING
              SDA 3.2: MONITORING OF
     3                                                      62’353        18’143       40’092             27’592      31’099      179,279
              RESISTANCE TO INSECTICIDES
              SDA 3. 3: COMMUNITY HEALTH
     3                                                      84’273       264’991      360’568            441’338            0    1,151,170
              WORKERS
              [Use "Add Extra Row Below" from "Table"
              menu in Microsoft Word menu bar to add as
              many additional rows as required]

  Round 9 malaria funding request:                        6 542 525     6,920,919   13,977,280      9,520,498       6,430,406   43,391,628




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                  70/78
    ROUND 9 - Malaria
    5.4.       Summary of detailed budget by cost category (Summary information in this table should be further explained in sections 5.4.1 – 5.4.3 below.)
 Avoid using the "other" category unless                                                 (same currency as on cover sheet of Proposal Form)
 necessary – read the Round 9 Guidelines.                   Year 1             Year 2              Year 3              Year 4                 Year 5            Total
 Human resources                                                 29,270             176,379            550,879               700,071             843,117      2,299,716

 Technical and Management Assistance                             32,134              16,294              47,266               18,293              36,987       150,974

 Training                                                       349,977             897,880           1,021,013           1,160,035                    0      3,428,905

 Health products and health equipment                         4,402,145           3,611,179           8,831,297           4,567,613             3,472,249     24,884,483

 Pharmaceutical products (drugs)                                      0                   0                   0                   0                    0          0

 Procurement and supply management costs                        211,524             155,342            410,248               190,693             173,612      1,141,419

 Infrastructure and other equipment                             169,768             163,441            191,072               221,197                   0       745,478

 Communication Materials                                         47,789              51,313              71,729              116,224              45,087       332,142

 Monitoring & Assessment                                        288,302             496,088            917,225               946,149             997,102      3,644,866

 Living Support to Clients/Target Populations                         0                   0                   0                   0                    0          0

 Planning and administration                                    970,452           1,202,074           1,750,657           1,377,682              862,252      6,163,117

 Overheads                                                       41,164             150,929            185,894               222,541                   0       600,528

 Other: (Use to meet national budget planning
 categories, if required)


 Round 9 malaria funding request
                                                              6,542,525           6,920,919          13,977,280           9,520,498             6,430,406     43,391,628
 (Should be the same annual totals as table 5.2)




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                      71/78
    ROUND 9 - Malaria

     5.4.1. Overall budget context

     Briefly explain any significant variations in cost categories by year, or significant five year
     totals for those categories.

     HALF PAGE MAXIMUM
     MEDICAL PRODUCTS CATEGORY
     The “medical products” cost category which includes the procurement of insecticide treated nets
     amounts to 57.35% of the proposal’s overall budget, i.e. 24,884,483 euros. 68% of the budget for
     this category is planned over Round 9 phase two which covers the organisation of a free mosquito
     net distribution campaign in 2012.
     PLANNING AND ADMINISTRATION CATEGORY
     The budget for this cost category amounts to 6,163,117 euros over the whole duration of the
     proposal, i.e. 14.20% of the total budget. 67% of the budget for this category, i.e. 4,143,564 euros
     is intended to be used to support the sub-beneficiaries’ (non-governmental organisations and
     health districts) community-based plans.
     The importance of the category in 2012 breaks down into the cost of organising the free distribution
     campaign.
     TRAINING CATEGORY
     The budget for this category, which stands at 3,428,905 euros, amounts to 7.9% of the proposal.
     The gradual increasing of this budget year on year can be explained above all by training needs for
     the purposes of IRS operations, which vary according to changes to the number of districts
     involved in IRS operations (3 districts in 2011, 10 in 2012, 14 districts in 2013 and 17 in 2014).
     The training workshops are held a few months before the IRS campaign, which explains the time
     lag in relation to the year of the campaign.
     MONITORING AND ASSESSMENT CATEGORY:
     This category amounts to 8% of the overall budget and can be explained by the strengthening of
     supervision activities for the purposes of the new PECADOM and IRS strategies.



     5.4.2. Human resources
     In cases where 'human resources' represents an important share of the budget, summarise: (i) the
     basis for the budget calculation over the initial two years; (ii) the method of calculating the
     anticipated costs over years three to five; and (iii) to what extent human resources spending will
     strengthen service delivery.
     (Useful information to support the assumptions to be set out in the detailed budget includes: a list of the
     proposed positions that is consistent with assumptions on hours, salary etc included in the detailed budget;
     and the proportion (in percentage terms) of time that will be allocated to the work under this proposal.
        Attach supporting information as a clearly named and numbered annex

     HALF PAGE MAXIMUM
     The human resources budget which amounts to 5.3% of the proposal’s total budget, i.e. 2,299,716
     euros covers staff costs in the IRS campaign.
     These are allowances paid to staff in the field (maintenance operatives, team leaders, laundry
     women, application staff, a logistician, health workers, group leaders, etc) recruited for the 45 days
     of the campaign. Their pay packages are determined according to the work to be carried out and
     are paid solely over the quarter during which the campaign takes place.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                     72/78
    ROUND 9 - Malaria
      5.4.3.    Other large expenditure items
      If other 'cost categories' represent important amounts in the summary in table 5.4, (i) explain the basis for the
      budget calculation of those amounts. Also explain how this contribution is important to implementation of
      the national malaria programme.
           Attach supporting information as a clearly named and numbered annex

      HALF PAGE MAXIMUM


    5.5.       Funding requests in the context of a common funding mechanism

    In this section, common funding mechanism refers to situations where all funding is contributed into a
    common fund for distribution to implementing partners.

    Do not complete this section if the country pools, for example, procurement efforts, but all
    other funding is managed separately.

   5.5.1. Operational status of common funding mechanism

   Briefly summarise the main features of the common funding mechanism, including the fund's
   name, objectives, governance structure and key partners.
     Attach, as clearly named and numbered annexes to your proposal, the memorandum of understanding, joint
   Monitoring and Assessment procedures, the latest annual review, accountability procedures, list of key partners, etc.




   5.5.2. Measuring performance
   How often is programme performance measured by the common funding mechanism? Explain whether
   programme performance influences financial contributions to the common fund.



   5.5.3     Additionality of Global Fund request
   Explain how the funding requested in this proposal (if approved) will contribute to the achievement of
   outputs and outcomes that would not otherwise have been supported by resources currently or planned
   to be available to the common funding mechanism.
   If the focus of the common fund is broader than the malaria programme, applicants must explain the process by
   which they will ensure that funds requested will contribute towards achieving impact on malaria outcomes during the
   proposal term.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                                            73/78
    ROUND 9 - Malaria
    5B.   FUNDING REQUEST – HSS CROSS-CUTTING INTERVENTIONS



      Applying for funding for HSS cross-cutting interventions is optional in Round 9

      SECTION 5B CAN ONLY BE INCLUDED IN ONE DISEASE IN ROUND 9 and only if this
      disease includes the applicant's programmatic description of HSS cross-cutting interventions in
      s.4B.

      Read the Round 9 Guidelines to consider including HSS cross-cutting interventions

      Section 5B can be downloaded from the Global Fund website. Applicants should click
      here if they intend to apply for 'Health systems strengthening cross-cutting interventions'
      ('HSS cross-cutting interventions') in Round 9 and has completed section 4B and included
      that section in the Malaria proposal sections.




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                         74/78
    Checklist for sections 3 to 5 of the malaria proposal

   Sections 3 and 4: Programme Description                   List Annex Name and Number
                                                             Attachment 1: National strategic plan to
   4.1            Supporting documentation for National
                                                             fight malaria in Senegal (2006-2010)
                  Strategy
                                                             Attachment 2: Work plan to fight malaria
                                                             vectors in Senegal,

                                                             Attachment 4: National guidelines for the
                                                             treatment of malaria
                                                             Attachment 5: 2009-2018 Plan National de
                                                             Développement Sanitaire (PNDS - National
                                                             Health Development Plan)

                                                             Attachment 9: Annual report on the
   4.2.1          Map if proposal targets specific
                                                             activities of the PNLP, Dec. 2008.
                  region/population group
                                                             Attachment 13: Health map of Senegal,
   4.3.2          Any recent report on health system
                                                             2008
                  weaknesses and gaps that impact
                  outcomes for the three diseases (and
                                                             Attachment 7: Assessment of needs for the
                  beyond if it exists).
                                                             fight against malaria in Senegal (from 2008
                                                             to 2013): RBM Needs assessments
                                                             Attachment 3: Report on the workshop
   4.4            Document(s) that explain basis for
                                                             assessing Indoor Residual Spraying
                  coverage targets
                                                             operations in 3 districts in Senegal. WHO,
                                                             from 30th March to 1st April 2009

                                                             Attachment 12: National survey on malaria
                                                             (ENPS-II), 2008-2009, preliminary report.
                                                             Malaria Indicators Survey (MIS), 2008
                                                             Attachment 14: Report on the halfway
                                                             stage workshop assessing the PECADOM
                                                             scheme in Senegal, February 2009
                                                             Attachment 15: Net Mapping Project March
                                                             2009

   4.5.1          A completed 'Performance
                  Framework' by disease
                                                                            Attachment A
                  Refer to the M&E Toolkit for help in
                  completing this table.

   4.5.1          A detailed component Work Plan
                  (quarterly information for the first two
                                                                              Work plan
                  years and annual information for years
                  3, 4 and 5) by disease.

   4.5.2          A copy of the Technical Review
                  Panel (TRP) Review Form for
                  unapproved Round 7 or Round 8
                  proposals (only if relevant).
                                                             Attachment 6: Report on the Self-
   4.8.1          A recent assessment of the ‘Impact
                                                             Assessment Workshop on systems for the
                  Measurement Systems’ as relevant to
                                                             Monitoring and Assessment of the Global
                                                             Fund Principal Beneficiaries for the fight



R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                            75/78
    Checklist for sections 3 to 5 of the malaria proposal
                   the proposal (if one exists)                 against HIV/AIDS, Malaria and Tuberculosis
                                                                in Senegal, from 6th to 10th August 2007


   4.9.1           A recent assessment of the Principal
                   Recipient capacities (other than
                   Global Fund Grant Performance
                   Report).
                                                                Attachment 22: Terms of reference for the
   4.9.1           Document describing the
                                                                Programme National de Lutte contre le
                   organisation such as: official
   (for non-CCM                                                 Paludisme (National Programme to Fight
                   registration papers, summary of
   applicants)                                                  Malaria), February 2008
                   recent history of organisation,
                   management team information


   4.9.2           List of sub-recipients already
                   identified (including name, sector they
                                                                Attachment 23: List of sub-recipients
                   represent, and SDA(s) most relevant to
                   their activities during the proposal term)

   4.10.6          A completed ‘List of Pharmaceutical
                   and Health Products’ by disease (if                        Attachment B
                   applicable).

   Section 4B: HSS Cross-cutting (once only in whole
                                                                List Annex Name and Number
   country proposal)

   4B0.2           A completed separate HSS cross-
                   cutting 'Performance Framework' (or
                   add a separate “worksheet” to the
                   disease ‘Performance Framework’                            Attachment A
                   under which s. 4B is submitted)
                   Refer to the M&E Toolkit for help in
                   completing this table.

   4B0.2           A detailed separate HSS cross-
                   cutting Work Plan (or add a separate
                   “worksheet” to the disease Work
                   Plan under which s. 4B is submitted)                         Work plan
                   (quarterly information for the first two
                   years and annual information for years
                   3, 4 and 5).

   Section 5: Financial Information                             List Annex Name and Number

   5.2             A ‘detailed budget’ (quarterly
                   information for the first two years,
                                                                             Detailed Budget
                   and annual information for years 3, 4
                   and 5)

   5.4.2           Information on basis for budget
                   calculation and diagram and/or list of
                   planned human resources funded by
                   proposal (only if relevant)

   5.4.3           Information on basis of costing for
                                                                             Detailed Budget
                   ‘large cost category’ items




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                              76/78
    Checklist for sections 3 to 5 of the malaria proposal

   5.5.1           Documentation describing the
                   functioning of the common funding
   (if common
                   mechanism
   funding
   mechanism)

   5.5.2           Most recent assessment of the
                   performance of the common funding
   (if common
                   mechanism
   funding
   mechanism)

   Section 5B: HSS Cross-cutting financial information      List Annex Name and Number

   5B.1            A separate HSS cross-cutting
                   ‘detailed budget’ (or add a separate
                   “worksheet” to the disease ‘detailed
                   budget’ under which s. 4B is                           Detailed Budget
                   submitted). Quarterly information for
                   the first two years, and annual
                   information for years 3, 4 and 5).

   5B.4.2          Information on basis for budget
                   calculation and diagram and/or list of
                   planned human resources funded by
                   proposal (only if relevant)

   5B.40.3         Information on basis of costing for
                   ‘large cost category’ items

   Other documents relevant to sections 3, 4 and 5
                                                            List Annex Name and Number
   attached by Applicant:

   ‘4.1.b                                                   Attachment 8: National PNLP monitoring
                                                            and assessment plan
                                                            Attachment 10: Third Recensement
   ‘4.2.1
                                                            Général de la Population et de l’Habitat
                                                            (RGPH - General Census of the Population
                                                            and Living Environment) 2002



   4..2.1                                                   Attachment 11: Estimate of the population
                                                            of Senegal from 2005 to 2015, Direction de
                                                            la Prévision et de la Statistique (Directorate
                                                            for Forecasting and Statistics), January
                                                            2006

   4.4                                                      Attachment 14: Report on the halfway
                                                            stage workshop assessing the PECADOM
                                                            scheme in Senegal, February 2009
                                                            Attachment 16: Strategy for improving
   4.5.1
                                                            access to treatment by means of home
                                                            treatment of malaria: PECADOM project
                                                            document, July 2008




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                                              77/78
    Checklist for sections 3 to 5 of the malaria proposal
                                   Attachment 17: Training manual for training
   4.5.1
                                   officers on vector control and Indoor
                                   Residual Spraying in the Fight Against
                                   Malaria, WHO 2009, adapted to the
                                   Senegalese context

                                   Attachment 18: Research protocols used
   4.5.1
                                   by UCAD/ Research institutes

                                   Attachment 19: Document de Stratégie
   4.7.2
                                   pour la croissance et la Réduction de la
                                   Pauvreté (DSRP - Strategy Document for
                                   Growth and the Reduction of Poverty), 2006
                                   to 2010



                                   Attachment 20: Roll Back Malaria
   4.7.2
                                   worldwide strategic plan (RBM/FRP),
                                   2005-2015

                                   Attachment 21: Draft manual of procedures
   4.8.1
                                   for the monitoring and assessment of
                                   activities in the fight against malaria, 2009

                                   Attachment 24: Technical assistance
   4.9.6
                                   protocol budget

                                   Attachment 25: Round 9 modelling
   4.5.1




R9_CCM_SNG_M_PF_s3-5_05Jun09_En                                                    78/78