Care First Foundation P.O.Box 34 Multan
0000

Project Proposal

Humans First

Dengue and Malaria Project Proposal

Executive Summary

CareFirst Foundation is a non-governmental, non-profit organization incorporated in Multan, Pakistan with the primary aim and vision of poverty alleviation through a specific focus on public health of the rural villages, especially in Southern Punjab. Southern Punjab has been the worst hit region in the dengue and malaria outbreaks in years, past and present owing to frequent seasonal flooding, stagnant water and the non-availability of basic health services. The Dengue and Malaria epidemic has been a vicious cycle problem for Pakistan with 3.5 million people at risk of contracting Malaria and 20,000 people diagnosed with the fatal Dengue hemorrhagic fever annually. Moreover, women and children have been particular victims of these diseases, owing to a lack of the basic health service and education infrastructure in the region.
The CareFirst Foundation’s mission is a two-pronged approach towards the alleviation of this problem, focusing on personal capacity building of the rural population in the form of home-based health education to help them identify and protect against the diseases; as well as providing the tools for disease prevention, cure and control, particularly in the villages of Muzaffargarh, Alipur and Kot Addu in Southern Punjab. This involves mobilizing health workers under the umbrella of the CareFirst Foundation to visit these poverty-stricken areas regularly before, during and immediately after the Dengue and Malaria season to hold sessions with the local population, provide free testing of diseases and referrals for secondary or tertiary medical care to the closest institutions. Bed nets, mosquito repellants and other personal hygiene supplies will be provided regularly to the households in these areas to not help in the moment of need but also build the awareness of their use habitually in the population. Lastly, trained professionals will deliver seminars not only in these areas to promote awareness, but also in neighboring cities to spur the local communities to come together against these epidemics. Furthermore, the project brief can be referred to view all aspects of the project and organization in detail as well as the cost breakdown structure.

Project Brief

 

  1. Project Title: DENGUE, MALARIA AND RIGHT TO HEALTH

 

 

 

  1. Project Location: Local population of Muzaffargarh, Alipur and Kot Addu; Rural population in Southern Punjab.

 

  1. Recipient Organization and Contact Person: (name of organization

address and telephone No.):

 

CareFirst Foundation

Waseem Khan Niazi

27-Gillani Colony, Ghaus Al Azam Road, Multan

Contact #: +92300-8736163

email: carefirstfound@gmail.com

 

 

  1. Brief description of project:

Purpose:

 

BACKGROUND:

 

The links between the concepts of poverty, equity, and human rights in relation to health are many and profound. Both equity and human rights principles dictate striving for equal opportunity for health for groups of people, particularly women and children, who have historically suffered discrimination or social marginalization. This scenario exists in Pakistan since its birth. Dengue and malaria epidemic present a major challenge to public health and human rights in Pakistan. Approaches focusing on poverty, equity, or human rights in relation to health have been viewed as major factors in the developing world.

 

Dengue and malaria continue to be a major public health problem in Pakistan. The government claims that there are approximately 3.5 million people at risk of malaria each year in the country and approximately 20,000 people are diagnosed with Dengue fatal stages annually (Directorate of Malaria Control, 2019; Ahmad, et al., 2017). The major developments in the industrial sector without proper sewerage, extensive agricultural practices, vast irrigation network, hap hazard urbanization and poor sanitary conditions have made perfect conditions for the expansion of dengue and malaria.

 

Pakistan is trying to emerge from devastated flooding of 2010.  Southern Punjab has been one of the worst floods hit areas of Pakistan. Most of the flood victims, particularly women and children, lack access to health care, education, clean water and sanitation. The region’s lack of services coupled with chronic insecurity, human right issues and debilitating poverty has had profound implication on health conditions of the village populations.

It is estimated that over 75 % of the Southern Punjab population living in endemic areas are at high risk of dengue and malaria due to poor sanitation and stagnant water. In Southern Punjab, dengue and malaria is hyper-endemic. Local capacity for response to dengue and malaria is inadequate due to poverty and extreme climatic factors leading to proliferation of mosquito breeding sites, poor infrastructure and poor education. As a result, the majority of the population has little or no information and limited access to the prevention and management of dengue and malaria.

 

The CareFirst Foundation is a privately-owned organization working to improve the basic health conditions of the communities that are at a great risk of public health diseases.

 

 

Expected Results: Dengue and malaria prevention, and sustainable public education for prevention of diseases. _______________________________________________________

 

Recipient/Target Group/beneficiaries (men, women, children, farmers, refugees and so forth):

 

Local individuals, women, children, flood victims, doctors and relief workers.

_______________________________________________________

 

 

Organization Information:

 

1

Name:

CareFirst Foundation (CFF)

 

Mailing Address:

27-Gillani Colony, Ghaus Al Azam Road Multan, Pakistan

 

Phone Numbers:

Cell # 0300-873-6163

 

Email:

carefirstfound@gmail.com

 

Website:

To be developed

 

Key Contact person

Waseem Khan Niazi

 

2-    Date of establishment of organization: 2nd November 2010

3-    Registered under Societies Registration Act 1860

 

 

 

 

5

Organizational Mission and Capacity

 

 

Our Vision:

Nation with adequate healthy environment for all and free from burden of diseases

 

Our Mission:

 

CareFirst Foundation fights against diseases and is committed to the dissemination and application of ecological methods that sustainably improve healthy conditions in Pakistan. CareFirst gives help to promote protection and prevention activities against diseases to vulnerable population of Pakistan.

 

 

6: Goals:

·         Aid communities in, hygiene, sanitation, and diseases prevention.

·         Access to better health care facilities

·         Educate communities for self-protection against diseases

 

7: Description of the services /activities:

So far CareFirst Foundation has been providing following limited activities:

  • Provide dengue and malaria control services to the vulnerable communities
  • Public outreach activities

 

 

8: Beneficiaries:

Local population of Muzaffargarh, Alipur and Kot Addu which is most prone to dengue and malaria outbreak in Southern Punjab.

 

 

 

 

9: Direct experience of working with local communities:

We have been working for the local communities since last ten years.  Our mission has been communicated through the slogans of “FIGHT THE BITE!” & “Hand Washing” messages.

One of our consultants has more than 20 years of experience in dealing with vector borne diseases in Pakistan and USA. He has worked with the communities, as well as international and national organizations in the field of public health and has provided expertise to civic associations and general public on vector borne diseases internationally.  The other consultant is from the University of Agriculture, Faisalabad and has more than 10 years of experience dealing with vector borne diseases.  The CareFirst Foundation has also a Consultant from NIH, Islamabad and has more than 10 years of experience working on dengue and malaria control in Pakistan.   The team is comprised of highly experienced and skilled members, specializing in their relevant fields.

 

10: List of partnerships:

 

Name of Organization, Business or Institution

Description of Partnership

Department of Malaria Control, Ministry of Health, Islamabad.

Consulting on on-going public sector projects and working on linkage and capacity building

University of Agriculture, Faisalabad, Pakistan

Providing seminars and workshops on awareness and need for action on epidemics

NIH, Islamabad

Exchange of knowledge and working on linkage and capacity building

 

 

 

11: Past Programs implemented:

 

  • Provided limited mosquito control services to flood victims
  • Public Outreach activities related to public health issues in rural locations across Southern Punjab, especially areas affected by massive seasonal flooding

 

 

 

 

 

 

 

 

12: Monitoring, Evaluation and Accountability

 

 

The CareFirst Foundation (CFF) has planned monitoring and evaluation set up.

 

Monitoring and evaluation are essential components of our program since monitoring measures the implementation of CFF range of strategic activities while evaluation measures the extent to which its objectives are being accomplished. Monitoring is a continuous on-going activity and allows step-by-step recording of the progress made by CFF. Monitoring, which measures process indicators, is carried out at the district level. Apart from ensuring that CFF activities are being implemented in the agreed manner, it allows decision-makers to stay aware of all problems and constraints which may slow down progress and provide the information they may need to refine planning.

 

Evaluation is based on indicators, which allow periodic assessment of the way in which strategies and implemented activities reach the planned objectives. Evaluation indicators fall into two groups:

 

Outcome-based: By collecting information on, for example, the number of Dengue and malaria sufferers who have been able to access timely treatment, or by measuring changes in the population's knowledge, attitude and practice of the population to dengue and malaria and the use of dengue and malaria interventions.

 

Impact-based: By measuring, for example, the evolution of mortality, morbidity or even the economic losses caused by dengue and malaria.

 

Evaluation:

CFF has developed a well-established evaluation plan for this proposed project and will implement with the help of consultants.

 

 

 

13: Methods and Tools to assess progress:

 

Indicators:

 

INDICATORS:

  • Vector borne diseases (i.e. Dengue and malaria, dengue etc.) death rate (probable and confirmed cases) among target groups (under-fives and other targets groups); and
  • Number of cases (Dengue and malaria/dengue), severe and uncomplicated (probable and confirmed) among target groups (under-fives and other target groups).
  • Proportion of households having at least one insecticide-treated mosquito net/ or one mosquito control spray
  • Percentage of patients with uncomplicated Dengue and malaria/dengue getting correct treatment at health facility and community levels, according to the national guidelines, within 24 hours of onset of symptoms.
  • Number of patients report to consulting physician

All monitoring and evaluation data are collected at village level and used to improve the management of dengue and malaria control programs. Results are shared with CFF partners.

Tools:

  • Public outreach- Through seminars; family participation; home based visits by Dengue and malaria educationists and by other means of public outreach
  • Communication- With all stakeholders
  • Survey-Survey data collected at village level
  • Supplies: Mosquito control sprays, dengue and malaria control medications

 

 

 

14: The objective of the proposed Project:

 

 

·         Provide home-based health education and timely testing for dengue and malaria and other diseases.  Refer patients, if needed, to the nearest public health facilities or consulting physician.

·         Mobilizing people in dengue and malaria outbreak regions, dengue and other diseases prevention, facilitating access to mosquito control spray, mosquito nets and dengue and malaria treatment by public outreach.

·         Distribution of mosquito bed nets to children and families for prevention against mosquito bites.

·         Collaboration/Training of health providers to improve prevention and protection against vector borne diseases practices.

·         Training of parents, particularly young mothers in improving healthy environment.

 

 

 

15: Project Implementation:

 

 

The program will be implemented in June 2019, preceding the seasonal outbreak of dengue and malaria which takes place in July each year. This provides the organization the singular opportunity to create awareness and tackle this epidemic at the root, providing imperative support before the outbreak can take place. Proposed staff will be hired, and equipment will be purchased within one month. A quick survey will be made to select the areas and vulnerable population in and around the Southern Punjab regions of Muzaffargarh, Alipur and Kot Addu.  The Malaria Control Department, Islamabad and University of Agriculture, Faisalabad will be contacted to provide last five years data of vector borne diseases in the given areas. After the survey, 3-5 villages in southern Punjab will be selected; from each village 5-7 families will be selected randomly for evaluation study, whereas the rest of village population will get outreach services, educational material, medical supplies and counseling.

Number of Beneficiaries; The beneficiaries of services will depend upon the age, sex and poverty level of the population.  Pregnant women, young mothers and children under age five will be given the highest priority.  Free bed nets, mosquito spraying, dengue and malaria testing and medical drugs will be provided.   About 3-5 villages of southern Punjab, including flood hit areas, will be benefited from this project.  All dengue and malaria positive cases in the project areas will be referred to a consultant physician. Dengue and malaria positive cases who will be participating in the group studies will be provided dengue and malaria control drugs as well as consultant physician services.  Flood victims will also be beneficiaries of this project.

Monitoring/evaluation of the proposed activity; The progress will be monitored by collecting data of dengue and malaria cases in the following community groups:

Group1: Bed nets, mosquito spraying, educational counseling will be provided to this group. This group will be tested for dengue and malaria twice a month.

 

Group 2: Mosquito spraying, educational services and counseling will be provided, and the population will be tested for dengue and malaria twice a month.

 

Group 3: Bed nets, educational services & counseling will be provided to this group. This group will also be tested for dengue and malaria twice a month.

 

Group 4: Only educational material/services and counseling will be provided to this group. The group will be tested for dengue and malaria twice a month.

Group 5: This group will be selected randomly where service will not be provided. The data from this group will be used for comparison only.

** All positive dengue and malaria cases will be referred to consulting physician and will also be provided free drugs.

 

  • The number of positive cases will be recorded from all groups for comparison.
  • The data will be provided to an independent institution for analysis.
  • The results will be used for monitoring the success and adjustment of the program.
  • Data will also be collected from local dengue and malaria clinics

 

16: Other Comments and Observations

 

Dengue and malaria control would also benefit child survival and their healthy growth. Family is the first hospital for any child. Improved home management of dengue and malaria will therefore have a positive impact on its treatment and control specificaly for young children whose growth and survival is adversaly effected by dengue and malaria. Proper information on its control and prevention alongwith information on anti-dengue and malarial drug administration in improving dengue and malaria treatment in the target communities is the key to the success of this project . Adequate health education on how to reduce human-vector contact, proper use and treatment of bednets with insecticides, correcting myths that surround many diseases at the community level, would be a boost in reducing the infant/child mortality rate due to dengue and malaria in children in Southern Punjab.

 

Dengue and malaria is predominantly a rural illness most acutely affecting impoverished groups such as agricultural workers, with children and pregnant women being at particular risk. Disease episodes impose high and regressive cost burdens on patients and their families.

 

The objectives under this project is to achieve dengue and malaria education and coverage of all the rural areas with poor access to health care services will be covered with a coverage goal of achieving 85% coverage in all households. In order to improve capacity building in dengue and malaria education, diagnosis and treatment, Carefirst has developed a comprehensive and integrated training program that addresses gaps in knowledge and practice among health care providers at different levels, from doctors and nurses of rural health centres. All training curriculum is developed by our experts incorporating the most recent international protocols and WHO guidelines while being tailored to the specific needs of the trainees and their districts.

 

Additionaly the following areas will be part of a strengthened project management approach for ensuring that the capacity for an expanded programme is systematically managed over time:

 

• Organizational Alignment

• Stewardship, Coordination and Partnership

• Local Programme Planning and Design

• Human Resources Management

• Financial Management

• Supportive Supervision

• Capacity Building

• Technical Resource Mobilization

• Procurement and Supply Chain Management

 

CFF has developed a well-established evaluation plan for this proposed project and will implement it with the help of leading consultants in the area.

 

 

 

 

17: Anticipated risk and ways to minimize them.

 

 

The following chart shows risk impact definitions across each of the potentially impacted project areas (cost, schedule, scope, and quality).

 

Project Objective

Risk Level

 

Very Low

0.05

Low

0.10

Moderate

0.20

High

0.40

Very High

0.80

Cost

 

 

 

 

Rising exchange rates lead to great risk

Schedule

 

 

Important to implement before outbreak

 

 

Scope

 

Extensive planning keeps this risk low

 

 

 

Quality

Project guidelines and best practice ensure quality

 

 

 

 

Risk Management Approach

The following overall risk management approach will be adapted for the project as shown in the following diagram:

Risk Identification

During risk identification, the sources of risk, potential risk events, and symptoms of risk will be identified.

Risk Analysis

During risk analysis, the value of opportunities to pursue vs. the threats to avoid, and the opportunities to ignore vs. the threats to accept will be assessed.

Response Planning

To address any/all identified risks detailed response planning, risk management and contingency plans will be developed to mitigate the risks.

Risk Monitoring and Control

For risk monitoring and control, corrective action plans will be developed, implemented, and monitored.

 

17.1: Cost and Financing

See Appendix A for detailed budget break down.

Budget Justification

Due to the enormous brain drain and the socio-economic decline which has led to staff demotivation and loss, the project will incorporate appropriate staff salaries and deliver up to date materials to ensure continuity in deliverance of services and retention of trained manpower.

 

Regarding cooperation with local health authorities and social activists for implementing the project, we have incorporated their human resources costs (for the period of the proposal), which constitute a major portion of our budget. This support entails the provision of published materials, incentives (in some cases), supervision and training. Without this continued support there cannot be a transfer of capacity from us to the local Health Teams or health staff.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX A

 

Detailed Project Cost Breakdown (Annual)(8 Month Operation Season of Dengue and Malaria Outbreak)

 

Activity A

Provide home-based health education & Testing

 

 

 

 

 

 

CFLI (Rs)

 
 

 

20 full-time nurses Staff Salary @ Rs. 25,000/month

4,000,000

 

 

4 Health Provider Educationists @ Rs. 25,000/month

800,000

 

 

4 Drivers @ Rs. 10,000/month

 

320,000

 

 

Salaries of Accountant + 4 Admin Staff @ 25,000/month

1,000,000

 

 

Consultant Fee & Travel

 

 

1,100,000

 

 

Consultant Boarding and Lodging/fee etc.*

800,000

 

 

Other Fringe Benefits

 

 

100,000

 

 

Petty Cash

10,000,000

 

 

Consultant physician @ 100,000/month

 

 

800,000

 

 

Testing @ 20,000 villagers of total 3 villages. @ 75/testing kit

 

 

12,000,000

 

 

Sub Total

 

 

 

30,920,000

 

Activity-B

Distribution of repellents/bed nets for prevention @20,000 total population

 

 

 

 

 

 

 

 

 

Bed nets @ 1 per family of 6 people @ 1,200/bed net

 

 

 

4,000,000

 

 

Fumigation of Surroundings @ once a day @ 1,000/day

 

 

240,000

 

 

Other Personal Hygiene Supplies (Antibacterial Soaps, etc.) @20,000 people @ 40/soap

 

800,000

 

 

Mosquito Repellant @ 20,000 villagers of total 3 villages. @ 2 bottles consumed per individual per month @ 150/50ml bottle

 

48,000,000

 

 

Sub Total

 

 

 

53,040,000

 

Activity-C

Collaboration/Training of health providers & recipients

 

 

Seminars, Conferences, Meetings & Dengue and Malaria Clinics.

1,000,000

 

 

Travel and Logistics Allowance for Speakers**

800,000

 

 

 

 

 

 

Activity-D

 

Operational Costs for Organization

 

 

Office Rent @ 100,000/month

800,000

 

 

Office Electricity Bill @ 17,000/AC for 4 Air Conditioners

544,000

 

 

Toyota Fortuner Vehicle(4x4)

7,600,000

 

 

Toyota Revo Truck(4x4)

5,100,000

 

 

Sub Total

 

 

 

14,044,000

 

 

 

 

 

 

 

 

 

 

 

 

 

CFLI (Rs)

 

 

Grand Total:

 

 

98,004,000

 

 

Grand Total CAD:

 

 

928,068.18 CAD

 

 

*Consultant will have to make regular visits to organization headquarters to provide important insights and debriefings. For this he will have to spend on average, 5 days in Multan city per month.

** 2 speakers from Malaria Control Unit who will arrange and provide 2 seminars per month in different locations in Southern Punjab @25,000/seminar

 

 

Account Details

 

Account Title: Care First Foundation

Branch Code: 5976

Account Number: 0020058831550028

SWIFT Code: ABPAPKKA

Allied Bank GBS Road Branch Multan

 

References

Ahmad, S. et al., 2017. Epidemiology of dengue in Pakistan, present prevalence and guidelines for future control. International Journal of Mosquito Research, 4(6), pp. 25-32.

 

Directorate of Malaria Control, 2019. About Us. [Online]
Available at: http://dmc.gov.pk/index.php?option=com_content&view=article&id=55&Itemid=78
[Accessed 04 April 2019].