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GPAF COMMUNITY PARTNERSHIP PROPOSAL FORM (Round 2) 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 and Community Partnership windows, and identifies the generic strengths and weaknesses of proposals submitted in relation to the key proposal appraisalcriteria. How?: You must submit a Microsoft Word version of your Proposal and associated documents by email to gpafcommunity@tripleline.com. It should be written in Arial font size 12. We do not require a hard copy.

When?:All Proposal documents must be received by the GPAF Fund Manager (Triple Line/Crown Agents)on or before 23:59GMTon Thursday 3rdOctober2013. Proposal documents that are received after the deadline will not be considered.

What?: You must submit the following documents:

1. NarrativeProposal : Please use the form below. The form has been designed to allow you to record all theinformation required 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. 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 us 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).

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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: gpafcommunity@tripleline.com

Mandatory items for all applicants Check

Y/N

Proposal form (sections 1-8) Y

Proposal form (section 9 - for each partner) Y

Project Logframe and Activity Schedule Y

Project Budget (with detailed budget notes) Y

Your most recent set of audited or approved organisational annual accounts

Y

Project organisational chart / organogram Y

Project bar or GANTT chart to show schedulingof activities Y

Please provide comments on the documentation provided (if relevant)

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GLOBAL POVERTY ACTION FUND (GPAF) – COMMUNITY PARTNERSHIP WINDOW PROPOSAL FORM

SECTION 1: INFORMATION ABOUT THE APPLICANT

1.1 Lead organisation name The Welbodi Partnership

1.2 Main contact person Name: Dr Emily Spry Position: Director Email: emily@welbodipartnership.org Alternative email address: emilyspry@gmail.com Tel: 07957248494

1.3 2nd contact person (If applicable)

Name: Ryann Manning Position: Director Email:ryann@welbodipartnership.org Alternative email address: rmanning@hbs.edu Tel: +1-603-465-8071

1.4 Please use this space to inform of any changes to the applicant organisation details provided in your Concept Note (including any more up to date income figures)

N/A

SECTION 2: BASIC INFORMATION ABOUT THE PROJECT

2.1 Concept Note Reference No. INN-06-CN-1353

2.2 Project title Improving maternal and neonatal health outcomes for at least 30,000 women and newborn babies in Sierra Leone through community engagement and health systems strengthening.

2.3 Country(ies) where project is to be implemented

Sierra Leone

2.4 Locality(ies)/region(s) within country(ies)

Western Area

2.5 Duration of project (in months) 36 months

2.6 Anticipated start date of project (not before 01 April 2014)

01 June 2014

2.7 Total project budget (in GBP) £ 249,945

2.8 Total funding requested from DFID (in GBP sterling and as a % of total project budget)

£249,945 % 100%

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Amounts and sources of any other funding (In GBP sterling and as a % of total project funds)

Source: N/A £ 0

2.10 Year 1 funding requested from DFID (In GBP sterling)

£79,034

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2.11 Please specify the % of project funds to be spent in each project country

100% of funding will be spent on the Sierra Leone project

2.12 Have you approached any other part of DFID to fund this project?

No

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)

DHS Demographic and Health Survey

DMO District Medical Officer for the Western Area

GOSL Government of Sierra Leone

MCIS Multi Cluster Indicator Survey

MDG Millennium Development Goal

MEL Monitoring, Evaluation and Learning

MOHS Sierra Leone Ministry of Health and Sanitation

NGO Non-Governmental Organisation

ODCH Ola During Children’s Hospital

PCMH Princess Christian Maternity Hospital

PHU Peripheral Health Unit

PLA Participatory Learning and Action

SLICH Sierra Leone Institute for Child Health

WCF Women and Children First

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

Welbodi has a proven track record of catalysing quantifiable and cost-effective improvements in the quality of health care delivery in Sierra Leone. We utilise a participatory, stakeholder-driven approach that fosters local ownership and innovative solutions to human resources, clinical quality, and management challenges in a resource-constrained environment. We have worked closely with the MOHS and other health sector partners in Sierra Leone for the past five years, and have gained a deep understanding of the cultural and political context. Our technical expertise and strong relationships with local stakeholders allow us to deliver sustainable, locally-led projects.Our Directors, staff, and volunteers bring decades of clinical and managerial experience in the health sector and from the private sector and academia. Our current Project Manager is a nurse midwifeand Sierra Leonean national with 20 years’ experience in the NHS, and our Senior Technical Advisor is a physician with nearly a decade of experience in child health in Sierra Leone. We also draw upon our network of experts around the world, many of whom volunteered in Sierra Leone, for advice and assistance to our staff and our local partners.As Welbodi has grown, we have invested in our organisational capacity, enlisting external experts to help strengthen our financial and human resource management systems, provide training for staff and partners, and review core organisational policies. The result is robust governance systemsthat haveenabled us to successfully implement, monitor, and report upon larger and more complex grants, most notably the grant from Comic Reliefand a £200,000 project with multiple funders to establish a radiology department at

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ODCH and PCMH.In all our work, we strive to deliver maximal value for money.

FUNDING HISTORY: Please describe your organisation's main sources of funding, with an indication of the amounts received and the purpose of the funding.

Our funding comes from donations (23% from businesses and individuals in 2012) and grants (66% from Comic Relief in 2012 and 11% from other sources). Major funders in recent years include: 2011Comic Relief, Common Ground Initiative (Health): £377,804 over 36 months for a partnership

with SLICH to improve healthcare delivery and community engagement at ODCH and a PHU 2011T & J Meyer Foundation: £19,939 over 12 months to support healthcare equipment and

infrastructure at ODCH and an affiliated PHU 2012Children’s Research Fund: £20,000to employ a nurse trainer and mentor and develop a

comprehensive programme of in-service training for children’s nurses at ODCH 2012Vitol Foundation: £72,599 towards a radiology department for ODCH and PCMH 2012T & J Meyer Foundation:£19,985 towards a radiology department for ODCH and PCMH 2013G3 Foundation (UECF): £38,000 towards accreditation of ODCH by the West African College of

Physicians as a training institution for paediatric consultants

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?

We are committed to protecting the children with and for whom we work. Our Child Protection Policy rests on four pillars: awareness, prevention, reporting, and responding. We require criminal record checks for all staff and volunteers working with children and other vulnerable groups. Staff and volunteers are familiarized with the policy during induction and commit to it in writing. Adherence to our child protectioncommitment is closely monitored by the Directors. Further details on our child protection policy and the specific procedures in place can be provided on request.

3.4 FRAUD: Are you aware of any fraudulent activity within your organisation within the last 5 years?How will you minimise the risk of fraudulent activity occurring in future?

There have been no known instances of fraud at Welbodi, but we remain acutely aware of the risks involved inthis type of work and the geographic location of our projects, and have implemented rigorous safeguards. Last year, with support from Mango (Management Accounting for NGOs), we trained key staff in financial management and developed a customized accounting system designed to maximise transparency and security. Our accounts are presented quarterly to the Welbodi board, audited annually, and made publicly available through the UK Charity Commission.Accounts fromour main implementing partner, SLICH, are auditedby KPMG in Freetown, and our staff and Directors provide close oversight of funds delivered through local partners.Robustpolicies and regular risk assessments provide additional due diligence, and we regularly review and strengthen our systems, most recently with pro bono consultation from The Good Governance Group (G3).

SECTION 4: FIT WITH GPAF COMMUNITY PARTNERSHIP WINDOW

4.1 CORE SUBJECT AREA - Please identify between one and three core project focus areas (insert '1' for primary focus area; '2' for secondary focus area and; '3' for tertiary focus area)

Agriculture Health (general) 1

Appropriate Technology HIV/AIDS / Malaria / TB 3

Child Labour Housing

Climate Change Income Generation

Conflict / Peace building Justice

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Core Labour Standards Land

Disability Livestock

Drugs Media

Education & Literacy Mental Health

Enterprise development Reproductive Health / FGM 2

Environment Rural Livelihoods

Fisheries / Forestry Slavery / trafficking

Food Security Water & sanitation

Gender Violence against women/ girls/children

Governance

Other: (please specify)

4.2 Which of the Millennium Development Goals will your project aim to address? Please identify between one and three MDGs in order ofpriority (insert '1' for primary MDG focus area; '2' for secondary MDG focus area and; '3' for tertiary MDG focus area)

1. Eradicate extreme poverty and hunger

2. Achieve universal primary education

3. Promote gender equality and empower women 3

4. Reduce child mortality 2

5. Improve Maternal Health 1

6. Combat HIV/AIDS, malaria and other diseases

7. Ensure environmental sustainability

8.Develop a global partnership for development

4.3 Explain why you are focusing on these specific MDGs. Are the above MDGs “off track” in the implementing countries? If possible please identify sub-targets within not just the national context but also related to the specific geographical location for the proposed project. Please state the source of the information you are using to determine whether or not they are “off track”. Your response should also inform section 5.3.

With among the world’s highest maternal and child mortality rates (IGME 2012, DHS 2008), Sierra Leone remains “off track’” to achieve MDGs 4 and 5 by 2015 (UNSTATS 2012) and the Government has said that MDG 3 “will not be met” (GOSL 2010). The 2013 UN MDG Report specifically identifies Sierra Leone as a country in need of concentrated efforts to decrease child mortality. Over 25% of childhood deaths in Sierra Leone occur during the neonatal period, while thousands of women each year lose their lives to wholly preventable and treatable complications of pregnancy. Our proposed intervention focuses on the Western Area, a densely populated region surrounding Freetown. Despite its proximity to the country’s economic centre, this area remains both under-served and under-developed. Of the hundreds of international organisations providing maternal and child health support in Sierra Leone, relatively few focus their efforts on the urban and peri-urban communities of the Western Area. However, the most recent national DHS found mortality rates in the Western Area that were similar to, and often worse than, other regions in the country: an Infant Mortality Rate of 109 per 1,000 live births over the last ten years, second only to the Northern Region in severity; and an Under-FiveMortality Rate of 147 per 1,000 live births, significantly worse than the Southern Region (DHS 2008). Region-specific rates for maternal mortality were not available, but data from Freetown health providers suggest rates similar to elsewhere in the country.Moreover, these rates mask great

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disparities (World Vision 2013) and are muchworse inthe poor communities targeted by this project.

4.4 Please list any of the DFID’s standard output and outcome indicators that this fund will contribute to? Please refer to the DFID Standard Indicators document on the GPAF website.Please note that if you are using the standard indicators, these also need to be explicit in your logframe.

• Standard outcome indicator: Proportion of births attended by skilled health personnel

SECTION 5: PROJECT DETAILS

5.1 PROJECT SUMMARY: maximum 5 lines - Please provide a brief and clear project summary includingthe overall change(s) that the initiative is intending to achieve, who will benefit, and the approach proposed to achieve the change. (This is for dissemination about the fund and should relate to the outcome statement in the logframe. Please avoid jargon).

We take a dual approach to saving the lives of women and children in poor urban areas. First, we use a proven participatory process to empower communities, particularly women, to develop strategies for preventing health problems and seeking needed care. Second, we use data from the community to challenge and support health facility staff to improve the quality and accessibility of health services, thereby addressing both the supply and demand of essential maternal and child health interventions.

5.2 PROJECT DESIGN PROCESS Describe the process of preparing this project proposal. Who has been involved in the process and over what period of time? Were representatives of the target group consulted, and if so, how?If a consultant or anyone from outside the lead organisation and partners assisted in the preparation of this proposal please describe the type of assistance provided.

This project builds on longstanding relationships between Welbodi and the MOHS, ODCH, and affiliated PHUs, and engagement with poor slum communities in the Western Area. We first met with leaders at PCMHin 2008 to discuss expanding our work to include maternal health. Over the past year, responding to growing enthusiasm and strong leadership at PCMH,plus heightened recognition of the persistent challenges facing urban slums in the Western Area, we have worked jointly with senior hospital staffand MOHS officials to develop plans for collaboration.TheSLICH Boardvoted in July 2013 to expand its focus on perinatal healthto include maternal health interventions. Wereached out to women in the local communities through the “Tok fo Pikin Welbodi” (“Speak for Children’s Health”) patient advocacy group,established in 2012 with support from Welbodi, which includes members from ten communities in the Western Area. That group’s recognition of the link between the health of pregnant women and that of their children has greatly informed the design of this project. While developing detailed plans, we consulted withWCF, our UK-based technical partner, and metwith representatives from the MOHS, the DMO, and clinical staff at PCMH and at six PHUs in possible target communities. We also consulted representatives at UNICEF, international NGOs, and local health providers to ensure this project addresses a true gap in existing interventions. No consultants or outside parties were involved inproposal development.

5.3 PROJECT CONTEXT /PROBLEM STATEMENT Describe the context for this project. What specific aspects of poverty is the project aiming to address? Why have these particular project locations and communities been selected and at this particular time? What gaps in service delivery have been identified that necessitate the intervention that you are proposing?

This project will address the health needs of pregnant women and infants in poor urban communities in the Western Area of Sierra Leone. Due to rapid and unplanned urbanisation during and after the country’s civil war, Freetown is home to roughly one fifth of the country’s population, many living in densely-populated slums. Reliable population data for these communities are lacking, but studies suggest there are hundreds of thousands of residents squeezed into just a few square kilometres (GOAL 2009;Spry & Martineau 2011). Many live in crowded and substandardhousing, lack access to

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clean water and sanitation, and are endangered during the annual rainy season by flooding, landslides, and disease (GOAL 2011). The Western Area has an HIV prevalence nearly twice that of the nation as a whole (DHS 2008) and it was at the epicentre of the 2012 cholera outbreak, accounting for 52% of all reported cases, driven by poor sanitation, overcrowding, and poor access to treatment (WHO Cholera Task Force 2013).Although health facilities and skilled personnel are available in the Western Area, they are often out of reach for the poorest residents. Despite the Government’s free healthcare initiative, surveys of households in the Western Area and interviews with doctors at PCMH reveal that social norms, transportation difficulties, opportunity costs, concerns about the quality of care, and ignorance about the importance of care continue to delay or prevent people from accessing essential health services (Spry & Martineau 2011; Welbodi 2013). This threatens the lives of women and infants, as evidenced by a 2008 report that documented numerous deaths of pregnant women living in and near Freetown (Amnesty International 2008). Those who do access care oftendo so in under-resourced and overwhelmed public facilities, which struggle to provide quality service. In 2012, PCMH had the fourth-highest hospital-specific maternal mortality rate in the country (2,542/100,000 live births), while ODCH had a 26.7% case fatality among newborns.

5.4 ANTICIPATED IMPACTON POVERTY(within the lifetime of the project) Please describe the anticipated real and practical impact of the project in terms of poverty reduction and changes to the lives of people within the beneficiary communities identified in 5.5, within the lifetime of the project.

Our community intervention will employ a participatory process to empower women to identify and prioritise health problems, and to plan and implement locally feasible strategies to address them. Four thousand participating women and their children will benefit directly from improved knowledge and health practices, which will save lives. A recent meta-analysis of seven randomized controlled trials found that women’s groups were associated with a 37% reduction in maternal mortality and a 23% reduction in newborn mortality in rural, high-mortality areas(Prost et al, Lancet 2013). The only urban trial, conducted in Mumbai, was inconclusive on mortality effects, butit demonstrate feasibility, and recommended combining women’s groups with efforts to improve the quality and accessibility of care, as we have in this project (More et al, PLoS Medicine 2012). We also believe that Freetown differs from Mumbai in ways that will enhance the effectiveness of the intervention: it has a higher baseline mortality, less linguistic and ethnic diversity, no caste divisions, and more limited availability of health providers. Economic activity is less vibrant, so the opportunity cost for women’s group members is lower, likely resulting in higher participation and lower attrition rates. In addition, group members will spread knowledge among their neighbours and family members, and some groups will devise strategies to address health problems affecting their neighbours as well as their own families. This indirect benefit will extend to 100,000 individuals living in the target communities. Our health systems intervention uses Quality Improvement Groups to improve the quality and accessibility of care in PCMH and PHUs. As a result, at least 30,000 mothers and babies – and possibly many more – will benefit directly from improved perinatal and obstetric care at PCMH during the course of the project. (We anticipate a significant increase in patient numbers due to improvements in the quality of care and increaseddemand for health services thanks to the community intervention.) This too will save lives, through reduced mortality of mothers and babies born in these facilities. It will also further enhance the impact of the community intervention.

5.5

TARGET GROUP (DIRECT AND INDIRECT BENEFICIARIES) Who will be the direct beneficiaries of your project and how many will be expected to benefit directly from the anticipated poverty-reducing changes within the lifetime of the project?Please describe the direct beneficiary group(s) under a) below, differentiate where possible and provide numbers for each sub-category and then provide a total number in b).

DIRECT:

a) Description Women and infants who receive higher-quality obstetric and neonatal care at PCMH, as a result of changes implemented by Quality Improvement Groups (this also includes women participating in women’s groups and those accessing antenatal

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care, the majority of whom will deliver at PCMH): 5,000 deliveries per year * 3 years = 15,000 mothers + 15,000 babies = 30,000 beneficiaries (75% female). This is a conservative estimate, as we expect patient numbers to increase over the life of the grant.

b)Number 30,000 (75% female)

Who will be the indirect (wider) beneficiaries of your project and how many will benefit within the lifetime of the project? Please describe the indirect beneficiary group(s) and numbers on each category under a) and then provide a total number in b).

INDIRECT: a) Description Individuals in targeted communities who benefit from strategies devised by women’s groups to improve health community-wide, as well as from shared learning around preventive care practices and health-seeking behaviours: target catchment population for this project = 100,000 (50% female)

b)Number 100,000 (50% female)

5.6 PROJECT APPROACH / METHODOLOGY Please provide details on the project approach (or methodology) proposed to address the problem(s) you have defined in section 5.3. How will the project work at the community level? Please justify the timeframe and scope of your project and ensure that the narrative relates to the logframe and budget.If this project is based on similar project experience, please describe the outcomes achieved and the specific lessons learned that have informed this proposal.

Our approach comprises two complementary and interlinked groups of interventions: 1) community engagement through women’s groups to improve preventive health practices and increase demand and uptake of maternal and neonatal health services; and 2) health system strengthening initiatives to improve the quality and accessibility of care. In both areas, we will utilise a participatory, stakeholder-driven approach that fosters local ownership and innovation – focusing on empowering women in the community, and health workers within health facilities to become agents of change. 1. Community Engagement: Participatory Women’s Groups. (See Gantt chart for details). Phase 1: Community selection.Begins with project approval, completed by June 2014. Our staff in Freetown will use existing data and consult with partners to select communities with a total population of 100,000 and high rates of poverty and ill-health. Incorporating lessons from prior projects, we will also consider population stability, community cohesion, presence of pre-existing women’s groups,proximity to health facilities, and receptivity by community leaders. Phase 2:Materials adaptation and group facilitator recruitment and training. Jul-Aug 2014. WCF and Welbodistaff will adapt existing women’s group training and facilitation manuals to the specific context, testing these materials with local women. Meanwhile, project staff will work with community leaders to identify women of reproductive age, preferably mothers, who live in target communities and would like to serve as group facilitators. In line with lessons from women’s group projects elsewhere (WCF 2011) facilitators must be literate in English and speak the language(s) of their target community; have leadership potential and group management skills; show commitment to participatory approaches; and have the support of their families and communities. We will start training 40 candidates, selecting after one week the best-performing 25 to train further and recruit. Phase 3: Member recruitment and group formation.Sep-Oct 2014 for 25 pilot groups (one per facilitator); Feb-Apr 2015 for remaining groups (8 per facilitator, 200 total, with 4,000 members).Most groups will be created de-novo for this project, although we will explore the possibility of using some existing groups (e.g., those affiliated with churches, mosques, or other NGO or CBO projects). Facilitators will first each recruit 20 members for a pilotgroup, targeting women who are pregnant or recently married, but also including any women of reproductive age. A small number of men and older women may also be involved, because evidence shows this can help build community support (WCF 2011). Pilot groups begin meeting in Nov2014, with on-going support and training for facilitators. Full-

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scale recruitment and formation of 200 groups begin Feb 2015 with community events in target neighbourhoods. Facilitators will work with community leaders and local CBOs to identify potential group members. All groups will meet at least once by April 2015. Phase 4: Women’s group meetings.Nov 2014-Oct 2016 for pilot groups; May 2015- Apr 2017 for remaining groups. Each women’s group will meet monthly for two years, and facilitators will take members through a participatory learning and action cycle aimed at delivering key messages about safe delivery and care seeking through stories and games. Group members will be encouraged to identify maternal and newborn health problems in their community, to generate and select relevant strategies to address these problems, and to implement and assess the results of these strategies. Facilitators will help groups choose strategies that require only resources they can generate themselves, though members will also enlist the support of the wider community, thus ensuring greater acceptance and embedding change in the community as a whole.Based on prior projects, strategies might address transportation issues, limited knowledge or awareness regarding good health practices, or problems with the perceived quality of care at health facilities.Data from women’s groups will be collected by facilitators and presented regularly to the Quality Improvement Groups at PHUs and PCMH (see below for details), thereby informing their discussions. Facilitators will also communicate with women’s groups about initiatives at PCMH and PHUs. 2. Health System Strengthening: Quality Improvement Groups(See Gantt chart for details). Phase 1: Group Formation.Preliminary consultations Jun-Aug 2014; Groups formed by Oct 2014. We will work with staff and managers at PCMH and PHUs to identify clinical and non-clinical staff who are enthusiastic about improving the quality and accessibility of healthcare at their facilities. These will come from range of cadres and seniority and will join select district health representatives and community leaders to form five groups of 15 members each: two based at PCMH (one affiliated with the antenatal clinic, and one with the labour wards) and one at each of three PHUs. Groups will be tasked with developing and implementing strategies to improve quality and accessibility of care. Phase 2: Quality Improvement Group meetings. Oct 2014-Apr 2017. Groups will meet monthly to discuss barriers to the delivery of high-quality antenatal, obstetric, and postpartum care to women and infants, and to develop strategies to overcome those barriers. The Project Manager will coordinate these meetings, provide technical support and training, and convey information and ideas from the women's groups. Quality Improvement Group members will diagnose the reasons for delayed care-seeking and poor health outcomes, and will devise strategies that have the potential for meaningful impact. They will be specifically encouraged to address barriers identified by women’s groups and other stakeholders. Based on prior experience at ODCH, effective strategies might include in-service training or improved supervision of healthcare workers; clinical improvements; or upgrades to medical equipment, supply chain management, and facilities. Each group will complete the process at least three times: developing plans by 2015 for their first substantial quality improvement intervention; revising this intervention or planning a new strategy by 2016; and developing plans for continuing an existing strategy and/or implementing new strategies beyond this project by 2017. Phase 3: Implementation, monitoring and evaluation. At least two cycles, starting mid-2015 and mid-2016 (exact dates will differ by group and according to the strategies chosen). Each group will implement at least two quality improvement projects over the life of the project. PCMH and PHU managers and district health officials will review and approve all strategies. Groups whose strategies require funding can apply through the SLICH process, whereby hospital and PHU staff submit proposals quarterly for review by the SLICH board. This project will provide funding for small grants (up to £2000 per cycle per group), and some strategies may also be eligible for additional SLICH funding to support neonatal and child care. SLICH will manage disbursement and hold groups accountable for delivery. This process that been in place since 2008 for staff of ODCH, and since 2010 for staff from an affiliated PHU; with this project we would extend eligibility to staff of PCMH and two other PHUs. Groups will also be encouraged to leverage resources from district health budgets, performance-based financing for health facilities in Sierra Leone, or other sources.During the second planning cycle, groups will review data on the effectiveness of their own strategies and those of other groups, and will also continue to incorporate data and ideas from the women’s groups.

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5.7

SUSTAINABILITY OF BENEFITS How will you ensure that the poverty reduction benefits for the beneficiary population will be sustained?

At the core of this project is investment in women and communities, delivering education and empowering women to actively engage in their own health and that of their children, and in so doing, delivering poverty reduction benefits that will outlast the life of this grant. The benefits of this approach will be transmitted vertically from mothers to their children, and horizontally amongst peers, spouses, and across communities. Prior studies have found that women’s groups continue to meet even after the project is completed, showing that women value these groups as a source of social support, an opportunity for learning, and a forum for taking action to improve their lives. In our approach to health systems strengthening, this project builds on longstanding collaboration between the MOHS, ODCH, Welbodi, and local communities, and will extend those efforts to maternal health and to PCMH. We increase sustainability by using existing structures and systems; for instance, by channelling quality improvement plans through the existing SLICH board, we deliver greater project efficiency and further strengthen this established mechanism. From its inception in 2008, SLICH was envisioned to mirror the hospital management boards that are required by statute by MOHS strategic plans, but are not currently functioning. As the quality of governance in Sierra Leone improves, SLICH will provide a foundation of skill and experience which can eventually be absorbed by the hospital management boards and thus enhance their effectiveness. Meanwhile, the experience of participating in Quality Improvement Groups will give individual staff members greater skills, confidence, and vision – as well as greater understanding of the perspectives of the women who use their services. Some of these individuals will stay at PCMH or local PHUs, and some will later be transferred to other facilities around the country, carrying with them the lessons they have learned.

5.8 SCALING-UP AND REPLICABILITY What is the potential for future continuation, replication or larger-scale implementation of the proposed intervention? Please provide details of any ways in which you see this initiative leading to accessing other funding or being scaled up by others in the future. Describe how and when this may occur and the factors that would make this more or less likely.

This projectwill provide an opportunity to test new approaches to improving maternal and child health in an urban low-resource setting, with significant potential for continuation, scale-up and replication both locally and across the region. We have selected an approach that has already been applied, cost-effectively and at scale, in rural areas of India, Bangladesh and Malawi and will leverage highly-skilled technical expertise to adapt global best practices to our setting. If we can demonstrate impact in the urban areas of Sierra Leone, as we believe we can, there will be significant potential for scale and replication in urban slums across the globe. Within health facilities, we will invest judiciously in staff-initiated clinical improvements that will improve the provision of care, while at the same time building local capacity to manage resources and develop ways to enhance care delivery. We focus on PCMH because, as the country’s only tertiary maternity hospital, it plays a central role in developing national standards, training essential health workers, and caring for the sickest patients. Successful quality improvement projects from PCMH will be poised for replication in other facilities across the country, facilitated by our close collaboration with MOHS officials.

5.9 CAPACITY BUILDING, EMPOWERMENT & ADVOCACY If your project includes capacity building, empowerment and/or advocacy components, please explain how these elements will contribute to the achievement of the project's outcome and outputs? Please also refer to the Additional guidance for GPAF Initiatives focused on Empowerment & Accountability

A key component of this project is empowering women to participate in their own health and wellbeing and that of their children. This approach is inspired by the idea that the roots of many health problems lie in powerlessness, and that health education is more effectively conveyed through dialogue and collective problem-solving rather than didactic message-giving. By engaging in participatory cycles of learning and action, communities can develop critical consciousness to recognise and address the

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social and political determinants of health (Prost et al, 2011). In Sierra Leone, disempowerment plays a key role in perpetuating cycles of poverty and low health utilisation. Disempowerment, cultural norms around gender roles, and misinformation prevent women from accessing health services during pregnancy and labour (Amnesty International, 2008). Our core beneficiaries for this project, women living in urban slums, have been particularly powerless and voiceless – even in efforts designed to address their wellbeing. By engaging women through their peers, talking with instead of at them, and encouraging them to identify problems and solutions, we will empower these women to become agents of change for themselves, their children, and their communities as a whole. Based on the experiences of others using this methodology, we anticipate that this will lead directly to increased utilisation of evidence-based perinatal health promotion behaviours, improved timely and effective antenatal care, and an increase in the proportion of deliveries performed in health facilities.

5.10 GENDER AND SOCIAL INCLUSION How was the specific target group selected and how are you defining social differentiation and addressing any barriers to inclusion which exist in the location(s) where you are working? Please be specific in relation to gender, age, disability, HIV/AIDs and other relevant categories depending on the context (e.g. caste, ethnicity etc.). How does the project take these factors into account?

The majority of the beneficiaries of this project are women, including pregnant women and the predominately female health workforce. We also recognize the important role of men, and we will actively engage with male community leaders to ensure their support for this project. An estimated 1.5% of adults in Sierra Leone, and 2.9% in the Western Area, are HIV-positive (DHS 2008). Disability is a major issue, and includes war amputees, women suffering from obstetric fistula, children who suffered hypoxic brain damage at birth, and polio survivors, among other causes. We will consult with organisations working with disabled and HIV-affected populations to ensure those communities are included in the women’s groups. The Western Area is an ethnically and religiously diverse region, and we will aim to select staff, facilitators, and target communities that reflect this diversity.

5.11 VALUE FOR MONEY (VFM) Please explain why you believe that the proposed project would offer optimum value for money. How have you determined that the proposed approach is the most cost efficient way of addressing the identified problem? Please ensure that your completed proposal and logframe demonstrate the link between activities, outputs and outcome, and that the budget notes provide clear justifications for the inputs and budget estimates.

This project adapts and expand interventions already proven to be cost effective for saving lives. It also offers optimum value for money, a concept that we have embedded in the programme lifecycle. Identification. Stakeholders at every level recognise the importance of addressing Sierra Leone’s unacceptably high maternal and neonatal mortality rates, from community members to Government officials and large international donors – including DFID, which has put maternal mortality at the centre of its health strategy. After interrogating available data and our own experiences in child health, we identified the critical role that low uptake of services coupled with poor delivery of care in public health facilities plays in driving poor health outcomes. Breaking this cycle by simultaneously stimulating demand for services and improving the quality of healthcare delivered in the densely-populated Western Area will have a profound and direct impact on thousands of lives. Meanwhile, our participatory approach will yield indirect benefits for years to come throughout these communities and across the health sector. Based on the prior proven effectiveness of these approaches, we anticipate that this project will leverage a relatively modest amount of funds to achieve potentially tremendous impact on one of Sierra Leone’s most pressing problems, and make progress toward MDGs 3, 4&5. Planning.Plans for this project built on our past experience in delivering high-impact, cost-effective programmes in Sierra Leone. We remain committed to minimising costs, but for this project, we recognised that significant investments in quality staff were required to ensure resources are well-managed and the multiple project components are implemented to maximal effectiveness. Although the result is a larger human resource budget than our typical project, we believe it is ultimately an

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investment in greater value for money. Our theory of change deploys a community-based model that has been proven to be cost-effective in improving maternal and neonatal outcomes in low-resource settings (Proust et al, 2013). By combining this with activities to address supply-side barriers to access and quality, we hope to leverage the potential created by Sierra Leone’s free healthcare initiative (which has been subsidised by international donors) and help realise its full benefits. Implementation and monitoring. Consistent with our mandate to empower beneficiaries, many of our grant’s key activities will be implemented by participants in the women’s groups and Quality Improvement Groups. We will leverage the skills of our existing teams in Freetown and the UK for delivering technical assistance and project management, and to utilise volunteers where appropriate. The SLICH board represents a highly cost-effective means of administering quality improvement projects, due to its voluntary membership and very low operational costs. Evaluation and Learning. Ultimately, we are accountable to the goal of improving maternal and neonatal outcomes in the Western Area. To clearly measure the cost-effectiveness of our intervention, we chose specific, measurable, achievable, relevant and time-bound output and outcome indicators.

5.12

COUNTRY STRATEGY(IES) AND POLICIES How does this project support the achievement of DFID’s country or regional strategy objectives? How would this project support national government policies and plans related to poverty reduction or other key sectoral areas?

This project is directly in line with the core strategic priorities of both DFID and the Government of Sierra Leone. DFID has focused heavily in its latest operational plan on improving health outcomes, particularly reproductive, maternal, and newborn health (DFID 2012). The Government has similarly made meeting the MDGs for maternal and child health a priority, most notably with its Free Healthcare Initiative. Though tremendously important, the elimination of user fees did not remove all barriers to the delivery of high quality, life-saving maternal and neonatal healthcare. This project will complement the efforts of the Government, DFID, and other actors by empowering poor communities and health workers in the Western Area to develop strategies for overcoming those remaining barriers.

5.13 ENVIRONMENT Please specify what overall impact (positive, neutral or negative) the fund is likely to have on the environment. What steps have you taken to assess any potential environmental impact?Please note the severity of the impacts and how the project will mitigate any potentially negative effects.

We foresee a possible positive impact if women’s groups’ strategies include improved sanitation practices (e.g., reducing open defecation). The project was designed to minimise travel and source equipment locally where possible in an effort to decrease its carbon footprint.

SECTION 6: PROJECT MANAGEMENT AND IMPLEMENTATION

6.1 IMPLEMENTING PARTNERS Please provide a list of all organisations to be involved in project implementation including overseas offices of the applicant and any partners starting with the main partner organisation(s). Please only include those partners that will be funded from the project budget. Please provide full details for each of the partners in section 9.

Welbodi Partnership:Unit 19, Garrick Industrial Centre, London NW9 6AQ Women and Children First (UK): United House, North Road, London, N7 9DP Sierra Leone Institute of Child Health: Ola During Children’s Hospital, Fourah Bay Road, Freetown

6.2 PROJECT MANAGEMENT Please outline the project implementation and management arrangements for this project. This should include:

• A clear description of the roles and responsibilities of the applicant organisation and each of the partners. You must also provide an organogram (in a separate document) of the

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project staffing and partner management relationships.

• A clear description of the added value of each organisation (including the applicant).

• An explanation of the human resources required (number of full-time equivalents, type, skills, background, and gender).

The Welbodi Partnership is the lead implementing organisation. Roles and responsibilities: Managing project funds, implementing core activities, delivering project objectives, coordinating partner activities, liaising with stakeholders. Value added: Long experience in Sierra Leone, deep relationships with local partners, understanding of the context, experience managing large grants and ensuring financial management, rigorous M&E, and project delivery. Human resource requirements: - Women’s Group Coordinators(2.0 FTE): Responsible for community activities and relevant MEL. Both Sierra Leonean women, experienced with the health sector, community outreach (esp. urban), project management, and participatory techniques. Nursing or public health training preferred. - Project Manager(1.0 FTE): Responsible for recruiting and supervising project staff, coordinating partners, managing both finances and reporting. Will also coordinate and support Quality Improvement Groups. Significant health sector and project management experience. Preferably a woman from the Sierra Leonean diaspora. - M&E Project Officer (0.1 FTE): Responsible for training and supporting medical records clerks at PCMH to use a computerised medical records database, and for quality assurance of monthly mortality and morbidity reports. Current employee (Sierra Leonean man, employed since 2009) was closely involved in design and implementation of a similar database at ODCH. - Development Manager (0.1FTE): Responsible for technical support for project management, human resources, and financial management. Current employee (UK male, employed since 2012) helped build robust governance systems and capabilities for Welbodi and SLICH. - Directors (0.5 FTE, no cost – voluntary roles): Responsible for ultimate oversight of project and financial management. Board meets quarterly by Skype and annually in person; individual Directors meet weekly with Freetown staff. Currently two men (UK and Freetown) and three women (US and UK); 3 clinicians, 1 academic, and 1 business manager. All have lived and worked in Freetown.

Women and Children First (WCF). Roles and Responsibilities: Technical expertise and support for implementation of the community intervention. Value-added: Experience and deep understanding of the relevant academic literature and current best practice around women’s group interventions; experience delivering major donor funded programmes. Human resource requirements: - PLAC expert (20 days in Y1): Responsible for a needs assessment; detailed design of intervention in line with the methodology described; assisting project staff to adapt manuals; and training staff to deliver intervention. Expertise inPLA cycles, with experience of successful women’s group interventions at scale, and the ability to train and motivate staff. Could be male or female, and either European or from one of WCF’s African partners. - Programme Manager (0.1 FTE): Responsible for providing technical support throughannual visits to Sierra Leone, initially to support facilitator training, plus on-going backstopping remotely, estimated at 1 day per month. Will have expertise in women’s group interventions in developing countries, project management, and MEL. Current post holder is a British woman.

Sierra Leone Institute of Child Health (SLICH) Roles and responsibilities: Review and oversee strategies proposed by Quality Improvement Groups, and administer small grants to support these initiatives. Value-added: Local ownership and expertise; a Sierra Leonean charitable organisation with an established process for assessing, funding, and ensuring financial and programmatic accountability for staff-initiated projects to improve healthcare delivery (from 2008-2012, SLICH funded more than 200 proposals at a cost of approximately £80,000). Human resource requirements: - SLICH board members (0.1 FTE, no cost – voluntary roles): Responsible for reviewing proposals and overseeing implementation and M&E of projects. Currently 7 members representingMOHS, ODCH, Welbodi and the local community; for this project, SLICH will consider adding a representative from PCMH, the DMO, and/or additional community representation. - ODCH financial manager (0.2 FTE, no cost – employed by MOHS): Responsible for SLICH

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bookkeeping and financial reporting, with support from Welbodi. Currently a Sierra Leonean woman.

6.3 OTHER ACTORS Include details of any other key stakeholders or collaborative partners who will have a role in the project (but will not be funded from the project budget). How does this intervention link to or integrate with other programmes especially those of other government agencies?

PCMH and three PHUs serving our target communities will be ourmain collaborative partners. PCMH is the national maternity hospital, performing around 5,000 deliveries and providing 8,000 antenatal and postnatal consultations visits per year. It also delivers obstetric and gynaecological training for medical and nursing students. PCMH shares a compound with ODCH, the national children’s hospital and our primary partner since 2008. PHUs should be the first point of access for women seeking care for themselves or their children, although in practice many seek care directly from the hospitals.The DMO is the senior government health official for the Western Area, under the auspices of the local government, which is responsible for PHUs in the Western Area and for administering a centrally-agreed budget for the city’s hospitals. There is regular liaison between the DMO and the management of PCMH and ODCH.The MOHS oversees all health facilities and activities. Welbodi has worked closely MOHS since 2008, and two MOHS representatives sit on the SLICH board.

6.4 NEW SYSTEMS, STRUCTURES AND/OR STAFFING Please outline any new systems, structures and/or staffing that would be required to implement this project. Note that these also need to be considered when discussing sustainability and project timeframes.

We will employ a Project Manager and 2 Women’s Group Coordinators for the duration of this project.Recruitment for these roles will begin immediately after project approval,to ensure they are in place by the project start date. We will incorporate this project into our existing management systems, including accounting and human resourcessystems. The Project Manager will be supported by Welbodi’s Development Manager in London, who developed many of these systems over the past two years. Sec. 7 details new MEL systems, including improved data collection at PCMH andthe PHUs.

SECTION 7: MONITORING, EVALUATION, LESSON LEARNING This section should clearly relate to the project logframe and the relevant sections of the budget. Please note that you will be required to undertake a project evaluation towards the end of the funding period to assess the impact of the fund. Please allow sufficient budget for monitoring and evaluation (M&E) and note the requirements for external and independent evaluation.

7.1 How will the performance of the project be monitored? Who will be involved? What tools and approaches are you intending to use? How will your logframe be used in M&E? What training is required for M&E? How will you ensure that beneficiaries and other stakeholders have opportunities to feed back on project implementation?

We strive to integrate MEL into every stage of the project cycle, and to use data and methodologies that are informative for our partners and beneficiaries, as well as for our own future work. Monitoring. We will use simple, readily available data sources. Coordinators and Project Manager will collect data monthly, which the Project Manager will report quarterly to the Welbodi Directors. Monitoring indicators map directly to the activity log, which also gives details of each activity: Activity 1.1Indicators: # of qualified communities identified; # of meetings with community leaders, % of materials adapted to local context, # of facilitators recruited, # of facilitators completing training, # of facilitators meeting the passing standard, # of facilitators employed. Data sources: Project Manager and Coordinator activity logbooks, attendance roster at training, results of end-of-training evaluation. Activity 1.2Indicators:# of group members recruited, % breakdown of members by gender, age, pregnancy, parental status, ethnicity, educational status, and disability status, # groups holding first meeting, % of group members attending each meeting. Data sources:Coordinator activity logbooks, member registration information, attendance rosters from women’s group meetings.

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Activity 1.3Indicators: # of women’s group meetings held, # of strategies developed, # of strategies implemented, # of groups with high or very high community support for their strategies. Data sources: Group facilitators’ logbooks, attendance rosters from women’s group meetings. Activity 2.1 Indicators: # of members in each group, # and location of groups per facility, % breakdown of members by gender, age, level of training, job title / cadre, ethnicity, and disability status. Data source: Project Manager’s logbook, member registration information. Activity 2.2. Indicators: # of attendees at each meeting, # of meetings conducted, # of groups with detailed plans for quality improvement strategies, # of groups that accessed resources for strategy implementation, # of strategies successfully implemented. Data sources: Project Manager logbook.

In addition, we will collect routine monitoring data around the delivery of health services at PCMH and the PHUs, as required by the MOHS. To improvethe quality of these data, we will assist PCMH in adopting a simple computerised medical records system, akin to one we developed for ODCH in 2009. Our M&E Officerwill train and support MOHS records clerks. Data will include: # of patients attending pre/postnatal, # of deliveries and # of maternal and neonatal complications.

Evaluation.The project evaluation will be a prospective analysis of the impact of women’s groups and health systems strengthening on maternal and neonatal outcomes in the Western Area. We will conduct a baseline study at the beginning of the project, and utiliseroutine health services delivery monitoring data described above, with a final external evaluation at the end of the grant. The evaluation will test whether we have met our intended outcomes byanswering the following questions:

• Do women’s groups result in increased demand and uptake of obstetric services? • Do women’s groups result in improved preventive health practices? • Do Quality Improvement Groups result in improved maternal and neonatal care? • Does the combination of women’s groups and Quality Improvement Groups result in lower

maternal and neonatal mortality among low-income communities in the Western Area? We will employ an external consultant to conduct data collection at the end of the project and to collate and analyse data collected during the preceding three years. We will incorporate the best available data from other sources (as reflected in our logframe).

7.2 Please use this section explain the budget allocated to M&E, and to demonstrate that there is adequate budget provision to support the M&E processes described in 7.1. The budget must include provision for an independent external evaluation.

Our MEL budget has been informed by our previous monitoring and evaluation activities. We selected monitoring indicators that are either already required by the MOHS, or that require simple tools and minimal additional systems. The most significant investment we will make in monitoring is a new computer and technical support for a computerised medical records system at PCMH and PHUs, modelled on the system we have developed for ODCH. In developing our evaluation plan, we recognised the dearth of quality baseline data on maternal and neonatal outcomes in the Western Area. Thus, we will invest up-front in a baseline study, using in-country researchers and skilled field workers with whom we have worked in the past. For the final external evaluation, we propose to hire a local consultant to conduct an independent analysis of our outcomes as described in Section 7.1. By computerising the collection of our health indicators and designing a clean prospective baseline study, we will save both time and money in the final evaluation and maximise the quality of these findings.

7.3 How will lessons from your project be identified and learned, and disseminated to a wider audience? - Please explain how the learning from this project will be usedwithin your organisation and disseminated to others.

Welbodi is committed to continuous reflection and learning. The Board of Directors meet quarterly to review programmes, discuss challenges and incorporate learning into strategic planning, and we frequently involve local staff and external partners in these discussions. We constantly re-examine the assumptions that drive our program design, and we have a standing item at Directors’ meetings to consider any programmatic or organisational challenges and to identify lessons learned. We actively share on-going learning with our local and international partners. For this project, much of our learning

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and sharing will be embedded within the participatory action and learning cycles carried out by women’s groups and Quality Improvement Groups.In addition, we will disseminate relevant findings from our monitoring and evaluation activities 1) to community leaders and women’s group members through meetings and community events; 2) to officials at the MOHS and staff of various health sector partners in Sierra Leone through reports, meetings and regular interaction; and 3) internationally through conferences, research symposia, and academic publications, and through a program summary and best practices document made available on our website and shared widely. Our staff interact daily with local partners, including MOHS officials, and are active participants in health sector and international NGO forums in Sierra Leone,as well as research symposia and technical groups.

SECTION 8: PROJECT RISKS AND MITIGATION

8.1 Please outline the main risks to the success of the project indicating if the potential impact and probability of the risks are high, medium or low. How will these risks be monitored and mitigated? If the risks are outside your direct control, is there anything you can do to manage their potential effects? If relevant, this may include an assessment of the risk of engagement to local partners. The risk assessment for your programme needs to clearly differentiate the internal risks and those that are part of the external environment and over which you will have less (or little) control. (You may add extra rows if necessary - as long as you do not exceed the overall page limits).

Explanation of Risk Potential impact

Probability

Mitigation measures

Unable to recruit/retain appropriately skilled, experienced and motivated project staff (primarily internal)

High Low Start recruitingas soon as funding awarded. Robust selection procedurewith clear criteria and deadlines. Leveragenetworksin Sierra Leone and diaspora. Strong support for project staff by Development Manager and Directors. Regular monitoring ofperformance and team dynamics by Directors.

Not achieving desired gender balance in project staff, groups etc. (primarily internal)

Medium Medium Sharegender targets with all partners and in project communications. Closely monitor of gender balance during recruitment and proactively address emerging problems.

Lack of support from key stakeholders, such as community members and leaders, healthcare facility management (external)

High Low Leverage existing contacts, relationships, and reputation. Community sensitisation. Close monitoring, incl. feedback from SLICH members and other partners. Proactively address concerns.

Community members not motivated to become facilitators or to join and participate fully in women’s groups (external)

High Low Leverage existing contacts, relationships, and reputation. Community sensitisation. Appropriate stipend and support for facilitators. Close monitoring,incl. feedback from SLICH community representative. Proactively address concerns.

Staff not motivated to join and participate fully in Quality Improvement Groups (external)

Medium Low Leverage existing contacts, relationships, and reputation. Sensitisation of staff. Grantsto support implementation of strategies. Close monitoring, incl. feedback from facility representatives and other management and staff. Proactively address concerns.

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SECTION 9: CAPACITY OF ALL PARTNER ORGANISATIONS (Max 3 pages each) Please copy and fill in this section for each partner organisation identified in section 6.1

9.1 Name of Organisation Women and Children First (UK)

9.2 Address United House, North Road, London, N7 9DP

9.3 Web Site www.womenandchildrenfirst.org.uk

9.4 Registration or charity number (if applicable)

1085096

9.5 Annual Income (from latest set of approved accounts)

Income (original currency): £948,579 Income (£ equivalent): £948,579 Exchange rate: N/A From: 01/01/2012 To: 31/12/2012

9.6 Number of existing staff 4.2 FTE

9.7 Proposed project staffing staff to be employed under this project (specify the total full-time equivalents - FTE)

Existing staff Programmes Manager (0.1 FTE) PLAC expert (Year 1 only, 30 days consultancy or approximately 0.1 FTE)

New staff N/A

9.8 Partner organisation category (Select a maximum of two categories)

Non-Government Org. (NGO) x Local Government

Trade Union National Government

Faith-based Organisation (FBO) Ethnic Minority Group or Organisation

Disabled Peoples’ Organisation (DPO) Diaspora Group or Organisation

Orgs. Working with Disabled People Academic Institution

Other... (please specify)

9.9 A) SUMMARY OF EXPECTED ROLES AND RESPONSIBILITIES OF THIS PARTNER, AND B) AMOUNT OF BUDGET (GBP) MANAGED BY THIS PARTNER

A): Provide Technical Assistance to support the women’s groups community intervention to include:

• Visiting the Welbodi partnership and communities for consultation and to conduct a needs assessment and agree preliminary community intervention options and ideas

• Designing the community intervention including support for materials development • Follow up visit to support initial implementation • Refining the design following piloting • Ongoing backstopping and support over email and phone from the UK and including one

monitoring visit per annum. B): Amount of budget allocated to WCF : £ 36,248 Percentage of budget allocated to WCF : 15%

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9.10 EXPERIENCE: Please outline the experience of your partner in relation to their role and responsibility in this fund (including technical issues and relevant geographical coverage)

WCF has managed 20 major donor funded international programme and advocacy contracts and has been engaged in international programmes with governments, NGOs and other stakeholders since 2002. Its work spans both the demand and supply side of health systems and MNH and focuses specifically on maternal, newborn and child health. Programmes which demonstrate its expertise and successes on the demand side include: • Improving maternal and newborn health in low income countries, India and Bangladesh:

2008-2013. The portfolio of projects in this strategic programme worked towards coverage of effective interventions in three districts in Bangladesh and two states in India and influenced maternal and child health policy and practice in Asia through focused advocacy and dissemination to policymakers. The project resulted in a 38% reduction in newborn death rates in Bangladesh (Fottrell et al, 2013) and a 31% reduction in newborn death rates in India (Tripathy et al, 2013) as well as improved home delivery practices and increases in antenatal care visits (ibid.). WCF has led on the development a “Good Practice Guide” to facilitate spread and scale up of the women’s groups methodology by other actors which has been taken up by actors including NGOs, academic institutions and technical agencies in Asia, Africa and the Americas.

• Improving maternal and newborn health through health system strengthening and community mobilization, Malawi: 2010 – 2015. In collaboration with the Directorate of Nursing Services at MOH Ntcheu, Malawi. 144 women’s groups have been led initially by Health Surveillance Assistants, and more recently by women’s group members themselves, trained to facilitate the groups, thus ensuring a high level of sustainability. The local project manager was successful in promoting HSAs running groups and group facilitation is now included in the MOH HSA training curriculum. The project has built the District Hospital’s capacity to collect data on maternal and newborn health which is now instrumental in hospital decision-making. A low cost population level data collection system has been established to support health service planning as well as an informal referral service to ensure the timely provision of skilled care. A high level of commitment has been gained from the Traditional Authorities in the district.

• Improving maternal and newborn health in Malawi: 2006-2012. WCF provided technical assistance to the community intervention arm of this 6-year programme which combined community mobilisation with quality improvement (QI) in health facilities. 802 women’s groups led by volunteer community-based facilitators achieved a 16% reduction in perinatal mortality in community intervention (CI) areas and a 22% reduction in newborn mortality in areas where CI was coupled with QI (Colbourn et al, 2013).

Two programmes have also worked to improve care, make it more accessible and sustain outcomes on the supply side beyond the end of a funded programme: • Improving maternal, newborn and child health for the poorest in Mumbai (India) through

promoting access to quality basic health services: 2010-2011. This DFID funded project improved the provision of basic health service delivery for women and children in slum areas in Mumbai. The project, delivered by SNEHA with technical support for project delivery, advocacy and communications provided by Women and Children First, facilitated scale up of the provision of free MNH services through health posts, established MNH referral systems across Mumbai, and improved MNH state policy and implementation through advocacy and communications.

• Perinatal Training and Resource Centre, Nepal: 2002-05. In collaboration with the Nepal Training Institute, this project established a national Perinatal and Resource Training Centre in Kathmandu, developed training materials on safe motherhood and essential newborn care, and designed training courses for all cadres of staff approved by government. In addition, all cadres of staff in Makwanpur district were trained in safe motherhood and essential newborn care.

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9.11 FUNDING HISTORY Please provide a brief summary of your partner(s) funding history.

Women and Children First’s funding has come from DFID, UNFPA, UK and US trusts and foundations and individual giving. Funding sources active over the last 12 months include: • Big Lottery Fund - Strategic Grant, Improving maternal, newborn and child health in low-income

countries (India and Bangladesh) - £803,876 – 2008-2013 • Comic Relief - Improving maternal, newborn and child health (Malawi) – £387,945 – 2010-2013;

Improving maternal, newborn and child health (Malawi) -£175,734 – 2013 – 2015; Organisation Development Grant (UK) – £39,160– 2011-2012; Planning Grant (Ethiopia) – £53,338– 2012

• UNFPA - MDG 4 and 5 advocacy (UK) - $10,000 - 2013 • Conservation Food and Health - Jut: increasing the update of family planning in Mumbai’s slums

(India) - $50,000 – 2012-2013 • Ernest Kleinwort Charitable Trust – Unrestricted funding - £25,000 - 12 months from May 2012

9.12 CHILD PROTECTION (funds working with children and youth (0-18 years) only) What is this partner's capacity and experience in relation to child protection? How will you work with your partner(s) to ensure children are kept safe?

WCF has a Child Protection Policy and is developing a policy for working with vulnerable people. Both of this will be shared with all WCF staff and/or freelancers who work on this project and their adherence to the policy will be monitored. However, it is not anticipated that WCF employees or contracted experts will work directly with children and youth on this project.

9.13 FRAUD: Has there been any incidenceof any fraudulent activity in your partner organisation within the last 5 years? How will you minimise the risk of fraudulent activity occurring?

No. Women and Children First has a comprehensive Financial Policy and Procedures Manual which has a comprehensive description of internal controls which are applied by the Finance Officer and monitored regularly by the Chief Executive. The Board’s Finance and Administration Committee has ultimate oversight over finance and administration arrangement. An operating budget is agreed by the Board at the beginning of each year and management accounts and a cash flow forecast, including information on use of restricted funds clearly set out per project, are prepared quarterly. These are distributed to the Treasurer and other members of the Finance and Administration Committee who scrutinise them on receipt and meet quarterly to discuss any issues arising. The organisation is audited annually by a respected firm of auditors who are highly experienced in working with charities. Women and Children First also has an Anti-Bribery and Corruption Policy which is reflected in its MOUs with partners.

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SECTION 9: CAPACITY OF ALL PARTNER ORGANISATIONS (Max 3 pages each) Please copy and fill in this section for each partner organisation identified in section 6.1

9.1 Name of Organisation Sierra Leone Institute of Child Health

9.2 Address Ola During Children’s Hospital, Fourah Bay Road, Freetown, Sierra Leone

9.3 Web Site www.welbodipartnership.org/our_work.html

9.4 Registration or charity number (if applicable)

N/A

9.5 Annual Income (from latest set of approved accounts)

Income (original currency): 98,241,466 SLL Income (£ equivalent): 13,894.50 GBP Exchange rate: 0.00014 (30th Sept 2013) From: 1 Jan 2011 To: 31 Dec 2011

9.6 Number of existing staff Voluntary Board of 7 members 1 Financial Officer (employed by MOHS)

9.7 Proposed project staffing staff to be employed under this project (specify the total full-time equivalents - FTE)

Existing staff N/A

New staff N/A

9.8 Partner organisation category (Select a maximum of two categories)

Non-Government Org. (NGO) X Local Government

Trade Union National Government

Faith-based Organisation (FBO) Ethnic Minority Group or Organisation

Disabled Peoples’ Organisation (DPO) Diaspora Group or Organisation

Orgs. Working with Disabled People Academic Institution

Other... (please specify)

9.9 A) SUMMARY OF EXPECTED ROLES AND RESPONSIBILITIES OF THIS PARTNER, AND B) AMOUNT OF BUDGET (GBP) MANAGED BY THIS PARTNER

A):The SLICH board members will: - Consider proposals for quality improvement projects put forwards by Quality Improvement

Groups at PCMH and participating PHUs, and award small grants (up to £2,000) as appropriate to the goal of increasing access to and the quality of maternal and child healthcare services in the project communities

- Manage disbursement and ensure accountability from Quality Improvement Group members, holding them to account against a budget and M&E plan

- Regularly report on these small grant outcomes, taking into account monitoring, evaluation and learning data and financial reporting from stakeholders, Quality Improvement Groups and Welbodi staff

- Consider regular reports on project progress from Project Manager and provide feedback and guidance based on needs and views of the key stakeholders represented by the Board

B): Amount of budget allocated to the Sierra Leone Institute of Child Health : £ 20,000 Percentage of budget allocated to the Sierra Leone Institute of Child Health : 8%

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9.10 EXPERIENCE: Please outline the experience of your partner in relation to their role and responsibility in this fund (including technical issues and relevant geographical coverage)

The Sierra Leone Institute of Child Health (SLICH) was founded in 2008 to improve child health in Sierra Leone. SLICH initially represented a partnership between the Ministry of Health and Sanitation, the Ola During Children’s Hospital (ODCH) and the Welbodi Partnership, but soon expanded to include representation from the local community who are the primary users of ODCH and nearly primary health units. The SLICH Board consists of representatives of these key stakeholders, with their unique insights into the myriad factors influencing child health and health services in our target community. The Board has recently decided to expand their area of influence to maternal health, given the potential synergies with their work for children under 5, and this project proposal was inspired in part by that intention. The Board will consider appointing several new members to bring in appropriate expertise, most likely including representation from the maternity hospital (PCMH) and the District Medical Office (DMO). The Board meets quarterly and invites proposals for projects to improve child health in urban Freetown from health facility management, staff, and users, as well as the communities that live around ODCH. If approved and funded, these projects are implemented by the stakeholders who proposed them. The Board scrutinizes the outcomes of these projects, utilising monitoring and evaluation by Welbodi staff and financial reporting by the ODCH financial officer, who also manages SLICH finances. Considering these outcomes, in addition to regular review of facility data on health outcomes (e.g. utilisation and mortality/morbidity data at ODCH), allows the Board to continually refine its perspective on how best to improve child health outcomes in these facilities and communities, as well as giving it the ability to hold key stakeholders to account. To take one example, the Board often challenges the ODCH leadership on its response to health service and access issues and makes recommendations on possible resources they might leverage – e.g., from district health budgets or the MOHS – as a complement or alternative to SLICH funding. This process has been in place since 2008, with the amount of funding available for projects gradually increasing over that time. In the past two years, SLICH has distributed more than £124,000 of funding from Comic Relief for projects to improve child health in the target communities and facilities, with projects ranging from infrastructure to training to community engagement. It has also managed substantial funds from other donors (9.11) and has appropriate financial management capacity (9.13)

9.11 FUNDING HISTORY Please provide a brief summary of your partner(s) funding history.

SLICH income and project spend over the past three years (in the SL Leones currency) is as follows: - 2010: 170 million SLL income / 169 million SLL project spend - 2011: 98 million SLL income / 97 million SLL project spend - 2012: 362 million SLL income / 310 million SLL project spend

The 2012 accounts are prepared but awaiting audit. The vast majority of this revenue comes first to the Welbodi Partnership, which then disburses committed funds to SLICH as needed. Major donors to SLICH-funded projects are as follows, listed in the original currency (GBP). Some funds were not disbursed until the calendar year after they were received; in particular, all funds related to the x-ray project were disbursed and spent in 2013, once fundraising for the major capital requirement was complete. 2011 November - Comic Relief, Common Ground Initiative Grant – £377,804 total grant over 36

months, of which £230,374 to be disbursed by SLICH for infrastructure, equipment, training, capacity building and community projects that improve healthcare delivery and community engagement at the Ola During Children’s Hospital and Jenner Wright Clinic. Also, £11,091 for

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financial management capacity building for Welbodi Partnership and SLICH.

2011 December - T & J Meyer Foundation, £19,939.26, to be disbursed by SLICH for infrastructure and equipment at ODCH and Jenner Wright PHU.

2012 September - Children’s Research Fund, £20,000 to be disbursed by SLICH to develop a comprehensive programme of in-service training for children’s nurses at ODCH

2012 September - Vitol Foundation, £72,599 towards delivery of an X-Ray department for ODCH and PCMH, as approved by SLICH.

2012 December – T & J Meyer Foundation, £19,985 towards the X-Ray department

2013 March – G3 Foundation (UECF, £38,000 towards a project to have ODCH accredited by the West African College of Physicians as a training institution for Paediatric consultants

9.12 CHILD PROTECTION (funds working with children and youth (0-18 years) only) What is this partner's capacity and experience in relation to child protection? How will you work with your partner(s) to ensure children are kept safe?

SLICH provides funding and oversight for projects, but does not implement them directly. For example, when deploying a nurse trainer and mentor at ODCH, SLICH asked the Welbodi Partnership to employ and manage this individual on its behalf. To avoid the duplication of effort, SLICH utilizes the Welbodi Partnership’s policies and procedures on Child Protection. The Welbodi Partnership has a well-established child protection policy, which is thoroughly implemented and regularly monitored and reviewed by the Board of Directors. Criminal record checks are done on all staff and volunteers working with children and other vulnerable groups. Staff and volunteers are familiarized to the policy during their induction and asked to commit to it. As an organization, The Welbodi Partnership reviews all its policies and updates their risk assessments regularly, as well as responding to any concerns that arise. The most recent such review was completed by the Board in Summer 2013.

9.13 FRAUD: Has there been any incidenceof any fraudulent activity in your partner organisation within the last 5 years? How will you minimise the risk of fraudulent activity occurring?

No. SLICH has robust financial policies and procedures in place that are scrutinized by the board and also supported and overseen by the Welbodi Partnership office in Freetown. Bookkeeping and monthly accounts are kept by the Financial Officer of ODCH, who has completed Mango basic financial training and is mentored by the Welbodi Project Manager. The system used is a custom one based in Excel, developed with Mango, which mirrors the Welbodi accounting system, making it easier for Welbodi Partnership staff in Freetown and London to support the SLICH finance office and the SLICH Board in appropriate financial management. Quarterly financial reports are presented to the SICH Board. Annual accounts are audited in full by KPMG in Freetown.