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Cscf Proposal Form GPAF COMMUNITY PARTNERSHIP PROPOSAL FORM (Round 1) The proposal documentation provides detailed information about your proposed project. This information is used to assess the strengths and weaknesses of the initiative and will ultimately inform the DFID funding decisions. It is very important you read the GPAF Community Partnership Window Guidelines for Applicants and related documents before you start working on your Proposal to ensure that you understand and take into account the relevant funding criteria. Please also consider the GPAF Proposals - Key Strengths and Weaknesses document which has been adapted from the document prepared following the appraisal of full proposals submitted to GPAF Innovation windows. This document identifies the generic strengths and weaknesses of proposals submitted in relation to the key assessment criteria. How?: You must submit a Microsoft Word version of your Proposal and associated documents by email to [email protected]. It should be written in Arial font size 12. We do not require a hard copy. When?: All Proposal documents must be received by Triple Line on or before 23:59 GMT on Friday 5th April 2013. Proposal documents that are received after the deadline will not be considered. What?: You must submit the following documents: 1. Narrative Proposal : Please use the form below. The form has been designed to allow you to record all the information DFID needs to assess your proposed project. Please note the following page limits: . Sections 1 – 8 : Maximum of 15 (fifteen) A4 pages . Section 9 : Maximum of 3 (three) A4 pages per partner Please do not alter the formatting of the form and guidance notes. Proposals that exceed the page limits or that have amended formatting may not be considered. 2. Logical framework: All applicants must submit a full Logical Framework/Logframe and Activities Log. Please refer to the GPAF Logframe Guidance and How-To-Note and use the Excel logframe template provided. 3. Project Budget: Applicants must submit a full project budget with the Proposal. Please refer to the GPAF Community Partnership Window Guidelines for Applicants and Financial Management Guidelines and the notes on the budget template (for Round 4). The Excel template has three worksheets/tabs: Guidance Note; Budget; and Budget Notes. Please read all guidance notes and provide full and detailed budget notes to justify the budget figures. 4. Your organisation's governance documents: e.g. Memorandum and Articles of Association, Trust Deed, Constitution. We need this to check your eligibility. If you have any doubts about your eligibility please contact Triple Line Consulting immediately. 5. Organisational Accounts: All applicants must provide a copy of their most recent (less than 12 months after end of accounting period) signed and audited (or independently examined) accounts. 6. Project organisational chart/organogram: All applicants must provide a project organisational chart or organogram demonstrating the relationships between the key project partners and other key stakeholders Please use your own format for this. 7. Project Schedule or GANTT chart: All applicants must provide a project schedule or GANTT chart to show the scheduling of project activities (please use your own format for this). 1 Before submitting your Proposal, please complete the checklist below to ensure that you have provided all of the necessary documents. CHECKLIST OF PROPOSAL DOCUMENTATION Please check boxes for each of the documents you are submitting with this form. All documents must be submitted by e-mail to: [email protected] Check Mandatory items for all applicants Y/N Proposal form (sections 1-8) Y Proposal form (section 9 - for each partner) Y Project Logframe Y Project Budget (with detailed budget notes) N* Your most recent set of audited or approved organisational annual Y accounts Project organisational chart / organogram Y Project bar or GANTT chart to show scheduling Y Please provide comments on the documentation provided (if relevant) *Reference telephone conversation with Tony Maher on 4 April 2013. Budget to be provided on Monday 8 April 2013. 2 GLOBAL POVERTY ACTION FUND (GPAF) – COMMUNITY PARTNERSHIP WINDOW PROPOSAL FORM SECTION 1: INFORMATION ABOUT THE APPLICANT 1.1 Lead organisation name 1.2 Main contact person Name: Sheaian Lee Position: Project Officer Email: [email protected] Alternative email address: [email protected] Tel: 0207 794 4856 1.3 2nd contact person Name: Mimi St John Austen (If applicable) Position: Executive Director Email: [email protected] Alternative email address: [email protected] Tel: 0207 794 4856 1.4 Please use this space to inform The applicant named on the Concept Note, Tom Hoyle, of any changes to the applicant is no longer with our organisation. organisation details provided in Our income for year ending October 2012 was your Concept Note (including £279,590 any more up to date income figures) SECTION 2: BASIC INFORMATION ABOUT THE PROJECT 2.1 Concept Note Reference No. INN-05-CN-1031 2.2 Project title Treating young rural Ethiopians with cleft conditions 2.3 Country(ies) where project is to Ethiopia be implemented 2.4 Locality(ies)/region(s) within Somali (Zonal authorities) country(ies) 2.5 Duration of project (in months) 36 months 2.6 Anticipated start date of project 1st January 2014 (not before 01 April 2013) 2.7 Total project budget? (In GBP £175,000 sterling) 2.8 Total funding requested from £175,000 DFID (in GBP sterling and as a % of total project budget) 100% 2.9 If you are not requesting the full Source: amount from DFID, please list the amounts and sources of any £ other funding (In GBP sterling and as a % of total project funds) % 3 2.10 Year 1 funding requested from To be supplied on Monday 8 April 2013 (reference DFID (In GBP sterling) telephone conversation with Tony Maher on 4 April 2013) 2.11 Please specify the % of project 100% funds to be spent in each project country 2.12 Have you approached any other NO part of DFID to fund this If Yes, please state which fund or department: project? 2.13 ACRONYMS (Please list all acronyms used in your Proposal in alphabetical order below, spelling out each one in full. You may add more rows if necessary) HEP Health Extension Programme HEWs Health Extension Workers PHE Project Harar Ethiopia PHUK Project Harar UK SLT Speech and Language Therapy SECTION 3: CAPACITY OF THE APPLICANT ORGANISATION 3.1 EXPERIENCE: Please outline your organisation's experience that is relevant to the proposed areas of work Project Harar has more than 10 years' experience in providing health outreach to rural communities in eastern and southern areas of the Oromia region of Ethiopia, for those specifically affected by facial disabilities, namely cleft lip and palate, noma, burns, tumours, accidents and animal attacks. Our organisation acts as a bridge, collaborating with families, HEWs and Ethiopian surgeons to enable rural patients to access treatment, commonly available in the capital city Addis Ababa. In 2012, we arranged treatment for 538 young people with serious facial disabilities, at a cost of less than £250 per person. As a result of our success and reputation we have built, PHE has recently extended their work across the Oromia region and in parts of the Afar region, with expanded coverage from 3% to 26% in two years. An important aspect of our work is to carry out check-ups and follow-up with patients who have been treated. In 2011, we began a ground-breaking piece of research, assessing the impact of treatment for 400 previously treated cleft patients and evaluating our outreach model. This evaluation demonstrated that treatment is vitally important not only aesthetically but for education; only 44% of school-age students in this study attended school prior to surgery, after surgery 78% of these students attended school, as a direct result of greater self-confidence and a decrease in bullying. PHE’s outreach team come from the communities in which they work and have strong local links, ensuring cultural sensitivity and practical understanding. Furthermore, PHE’s senior staff has extensive experience in diplomacy and partnership building, especially with government officials and partner organisations, which has led to significant expansion of our work over the last decade. 3.2 FUNDING HISTORY: Please describe your organisation's main sources of funding, with an indication of the amounts received and the purpose of the funding. The most recent financial statements (October 2012) show annual income of £279,590. Funding received from the following sources enables PHUK to fund year round identification of 4 young people with cleft conditions and other facial disabilities, predominantly in the Oromia region, and their transport to Addis Ababa for treatment and recovery. The funding also enables the organisation to fund an annual surgical mission, made up of a volunteer medical team from the UK and Europe, to treat patients with complex facial conditions and build the capacity of local medical teams. Individual donations 16.9% Regular giving 3.1% Trusts and Foundations 46.1% Appeals 7.4% High net worth donations 11.9% Fundraising events 3.9% Fee for service 5.0% CAF/Other 5.7% 3.3 CHILD PROTECTION (projects working with children and youth (0-18 years) only) What is your organisation's capacity and experience in relation to child protection? How will you work with your partner(s) to ensure children are kept safe? PHUK and PHE have an overarching child protection policy which is adhered to by all staff and volunteers. The UK office intend to work closely with the local partner office (PHE) to develop a more comprehensive local policy, to comply with the International Convention on the Rights of the Child and will be overseen by specialist lawyers. At the recruitment stage, PHE employees are carefully screened and references are sought and provided.
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