Expression of Interest s15

EXPRESSION OF INTEREST Calling for Expression of Interest from Civil Society Organizations for the implementation of scaling up of HIV/AIDS preventive interventions to key affected populations, Female Sex Workers (FSW), Men Having Sex with Men (MSM), Drug Users (DU), Beach Boys (BB) and People Living with HIV (PLHIV). Background: The Family Planning Association of Sri Lanka (FPA Sri Lanka), the pioneer in Family Planning and Reproductive Health Education is an accredited member of the International Planned Parenthood Federation (IPPF) in United Kingdom. The Global Fund for AIDS, Malaria and Tuberculosis (GFATM) is supporting the government of Sri Lanka to scale up HIV/AIDS preventive interventions to most at risk populations (MARPS) in 15 Districts. The overall goal is to prevent new HIV infections and provision of comprehensive care and treatment for people living with HIV for the next two years. In its role as the Principal Recipient 2 (PR2), FPA Sri Lanka is responsible for the implementation of the scaling up of preventive interventions to key affected populations. PR2 will work with partner organizations who will work with key groups of key affected populations. FPA Sri Lanka is looking for partner organizations in the following Districts under mentioned categories. J A K P P A K a m u u o n a f p r t l u l f a u t o r u n r n a n a t a a e l n d a g a a h r a m r a a l a u p a w u a r a FSW √ √ √ √ MSM √ √ √ BB √ √ PLHIV Undefined

Who may apply: Organisations working at national, provincial or district level on HIV/AIDS prevention interventions, sexual and reproductive health that possess strong organizational, financial management and M&E systems. Note: - Those who have already applied and not selected may re-submit your application forms, in the required format with supportive documents for reconsideration. Please note that applications will be considered only for the above mentioned districts and components. What Documents to submit: A letter expressing interest specifying - Desired role in the project

1 o Sub Sub Recipient (SSR), PLHIV networks, prospective dropping In centres for key affected populations to work as a district level or provincial/regional level organization having the capacity to network with people or groups of people representing most at risk populations.

- Focus area

o FSW, MSM, DU, BB, PLHIV

- District/s in which the organization intends to operate

An organizational profile consisting of - Name, Address, contact details of organization and its sub offices

- Copies of Registration Certificates

- Vision, mission, Governance and management structures Strategic plan of the organization

- History of projects and programmes highlighting HIV related activities,

- Bio data of key personnel attached to the organization (accountant/ M&E/ management/)

- M&E mechanism of the organization

- Financial statements of projects

- Final Annual report with last year’s audited accounts and bank statements

- A recent MoU signed with other organization/s

- Proof to show that the organization is capable of operating the desired Districts

- Confirmations received by funding agencies and other agencies on successful completion of project/s

Application procedure: Duly Completed application form (format available in www.fpasrilanka.org) and letter expressing interest with a detailed organizational profile should be submitted to FPA Sir Lanka on or before 22 June 2017 by post or via e mail to the Project Director-GFATM/HIV FPA Sri Lanka, 37/27, Bullers Lane, Colombo 07. For any queries, please contact the GFATM project on [email protected].

2 For office use ONLY

Sri Lanka Global Fund NFM HIV and AIDS Proposal Family Planning Association of Sri Lanka ______

CAPACITY ASSESSMENT QUESTIONNAIRE

Service delivery area (Tick as appropriate ONLY areas covered in your (Most at Risk populations) proposal area)

Female Sex workers.

Men who have sex with Men.

Beach Boys

Drug Users/ Injecting DU

Disease Area HIV and AIDS

Total number of Pages

Contact person

e-mail

Applying Organisation Category: (please tick accordingly)

 Category 1: Sub Recipient: National NGOs, Private Sector Institutions

 Category 2: Sub Sub Recipient: Grassroots Organisations, NGOs, CBOs

3 Instructions

This capacity assessment form is to be used by prospective organisations wishing to be included in the Sri Lanka Global Fund NFM HIV project as sub-sub recipients. This form seeks information on your organisation’s profile and capacity.

Please answer all questions, as accurately as possible and attach all the required documents. All information provided in this questionnaire will be verified. GF Country Team reserves the right to terminate any engagement entered into with your organisation at any time it discovers that information provided in this questionnaire is false.

Please fill in this form as clearly and legibly as possible. The information you provide in this questionnaire will be treated with confidence and will only be used to assess your organisation’s capacity to implement components of NFM HIV project.

4 Sub Recipients/ Sub Sub Receipients Organisational Capacity Assessment Questionnaire

Sri Lanka Global Fund NFM HIV Prospective Partners

Section 1: Organisational profile

1. Full name of the organisation

2. Acronym (Where applicable)

3. Name of person filling this questionnaire

4. Position of the person filling this questionnaire

5. Postal address of your organisation

6. Tel. number

7. E-mail

8. Fax number

9. Name of key contact person for your organisation

10. Position of key contact person

11. Physical location of your head Town: office

Street:

12. Physical location of your Town: organisation’s branch offices Street: (if any) Office 1 Office 2 Town: Street: Office 3 Town: Street:

If you have more than three offices, please attach a separate list.

5 Section 2: Background information

13. Is your organisation registered?(Tick as appropriate)

a) Yes b) No

If Yes – fill the Registration Numbers of your Certificates? ------

(Attach copies of your registration certificates) 14. If yes, under which legislation is your organisation registered? ______

10. In which year was your organisation registered? ______

6 Section 3: Governance and Management

15. Does your organisation have a board of directors, executive committee or board of trustees?

a) Yes b) No

16. How often does the board / committee meet? (Attach the two latest board meeting minutes and organisational governance and management structure) a) Quarterly b) Every six months c) Once a year d) Does not meet e) Other, Specify ______

17. Please list the management board / committee members/ board of trustees of your organisation?

Name Profession Sex Position on the Number of Contact Tel. board years on the Number board

Attach an additional page if needed

7 Section 4: Experience in implementing/ supporting activities in the HIV and AIDs field.

19. Indicate the areas where you are currently implementing/ Supporting HIV and AIDS activities:

Name of County / Name of Years of Type of Target groups/ Sectors (e.g. Grant/ Support Project/ implementing activities Men having sex with men, agency Programme activities / female sex workers, PLHIVs, Supporting CBOs FBOs etc) initiatives in this Project area.

20. List below all HIV and AIDS projects implemented / Supported by your organisations in the last three years (2013 to 2015).

Year Project District Project/ Beneficiaries of the project Programme/ Consultancy 2015

8 Year Project District Project/ Beneficiaries of the project Programme/ Consultancy

9 Section 5: Technical capacity to plan, organise, implement/ Support and report on projects (as evidenced by reported qualifications of key staff)

21. Provide the information in the table below:

Number of Number Number Number that Number that are employees working full working part are paid volunteers time time

22. List the names of the key staff members of your organisation in the table below:

Name of staff member Position in the Highest Number of years in the organisation Qualification organisation

10 23. What type of office equipment/ facilities you have?

Type of equipment (Give details of the equipment e.g. model of Number Year equipment, internet facility ) of Units purchased

24. Does your organisation have a programme monitoring and evaluation plan? a) Yes b) No

25. Do you have an employee(s) who is responsible for monitoring and evaluation a) Yes b) No

26. If yes, indicate the name(s) and position or job title and academic and professional qualifications of the employee(s)?

Name & Position of monitoring and evaluation officer 1.

Highest Academic qualifications

Highest Professional qualifications

Name & Position of monitoring and evaluation officer 2.

11 Section 6: Evidence of audited accounts, financial management systems and internal controls

27. What was your organization’s annual budget for the last three years?

Year Amount (in LKR) 2015 2014 2013

28. What was the source(s) of funding for your organisation in the last three years (2013, 2014 to 2015 Indicate the main sources of funding for projects / activities.

Name of the organisation/ Year(s) covered Amount in Project/Activity funded person(s) from which you by funding SLRs. received funds

29. When your organisation was last audited? ______

Please attach certified copies of the latest bank statements and attach copies of audited accounts for the last 3 years if available.

30. Do you have employee(s) who is or are responsible for financial management and accounting?

a) Yes b) No

12 31. If yes, indicate the name(s) and position or job title and academic and professional qualifications of the person(s)?

Name & Position of Finance Officer 1.

Name & Position of Finance Officer 2.

13 Section 7: Linkages to communities/ Partnership with local implementers/ support activities / initiatives in which the organisation proposes to implement the round 9 project

14 Section 8: Focus of the proposal, geographical coverage 32. Which county and district does your organisation propose to implement activities under the Global Fund NFM proposal?

Component District Reason for selecting the Component and district

(Please attach an additional list in the event the space provided is not sufficient)

15 Annex 1:

Letter of support from relevant health authorities for applications made by community based organisations.

The undersigned who is the (officer in charge of the STD Clinic) wishes to officially support this application from the premise that the organisation applying is known in the district as an implementation organisation for district and/or grassroots level community support activities in HIV/AIDS.

I also wish to ascertain that the proposal falls within the organisation’s scope of activities and is likely to be implemented.

Name: ______

Signature: ______

Designation: ______

Date: ______2015

Official stamp:

Please attach the following documents. - Copies of Registration Certificates

- Organisation Profile with Vision, mission, Governance and management structures Strategic plan of the organization

- Bio data of key personnel attached to the organization (accountant/ M&E/ management/)

- M&E mechanism of the organization

- Financial statements of projects

- Final Annual report with last year’s audited accounts and bank statements

- A recent MoU signed with other organization/s

- Proof to show that the organization is capable of operating the desired Districts

16 - Confirmations received by funding agencies and other agencies on successful completion of project/s

- Letter of support from relevant health authorities for applications made by community based organisations.