This proposal form is for use by applicants seeking to request Health Systems Strengthening (HSS) cash support from the GAVI Alliance. Countries are encouraged to participate in an iterative process with GAVI Alliance partners, including civil society organisations, in the development of HSS proposals prior to submission of this application for funding.

TABLE OF CONTENTS

TABLE OF CONTENTS

PART A - SUMMARY OF SUPPORT REQUESTED AND APPLICANT INFORMATION

PART B – EXECUTIVE SUMMARY

PART C– SITUATION ANALYSIS

1. Key relevant health and health system statistics

2. Description of the National Health Sector

3. National Health Strategy and Joint Assessment of National Health Strategy (JANS)

4. Monitoring and Evaluation Plan for the National Health Plan

5. Health System Bottlenecks to Achieving Immunisation Outcomes

6. Lessons Learned and Past Experience

PART D - PROPOSAL DETAILS

7. Objectives of the Proposal

8. Results Chain

9. Monitoring & Evaluation Framework

10. The Proposal Development Process

PART E – BUDGET, GAP ANALYSIS AND WORKPLAN

11. Detailed Budget and Workplan Narrative

12. Gap Analysis & Complementarity

13. Sustainability

PART F – IMPLEMENTATION ARRANGEMENTS AND RISK MITIGATION

14. Implementation Arrangements

15. Involvement of CSOs

16. Technical Assistance

17. Risks and Mitigation Measures

18. Financial Management and Procurement Arrangements

SUMMARY OF A COMPLETE APPLICATION

A completed application comprises the following documents. Countries may wish to attach additional national documents as necessary (see list at the end of this form).

HSS Proposal Forms and Mandatory GAVI attachments
→ Please place an ‘X’ in the box when the attachment is included
No. / Attachment
/ HSS Proposal Form / X
/ Signature Sheet for Ministry of Health, Ministry of Finance and Health Sector Coordinating Committee (HSCC) members
/ HSS Monitoring & Evaluation Framework / X
/ Detailed work plan and detailed budget / X
Existing National Documents - Mandatory Attachments
Where possible, please attach approved national documents rather than drafts. For a highly decentralised country, provide relevant state/provincial level plan as well as any relevant national level documents.
→ Please place an ‘X’ in the box when the attachment is included
No. / Attachment
/ National health strategy, plan or national health policy, or other documents attached to the proposal, which highlight strategic HSS interventions / X
/ National M&E Plan (for the health sector/strategy) / X
/ National Immunisation Plan / X
/ Country cMYP / X
/ Vaccine assessments (EVM, PIE, EPI reviews), if available / X
/ Terms of Reference of Health Sector Coordinating Committee (HSCC) / X

All applicants are encouraged to read and follow the accompanying guidelines in order to correctly fill out this form. Each corresponding section within the Guidelines provides more detailed instructions and illustrative instructions on how to fill out the proposal form.

GAVI’s Approach to Health System Strengthening

The following bullets outline GAVI’s approach to health system strengthening and should be reflected in an HSS grant:

  • One of GAVI’s strategic goals is to “contribute to strengthening the capacity of integrated health systems to deliver immunisation”. The objective of GAVI HSS support is to address system bottlenecks to achieve better immunisation outcomes, including coverage and equity. As such, it is necessary for the application to be based on a strong bottleneck and gap analysis, and present a clear results chain demonstrating the link between proposed activities and improved immunisation outcomes.
  • GAVI’s approach intends to deliver and document results. The performance of the HSS grant will be measured through intermediate results as well as immunisation outcomes such as diphtheria-tetanus-pertussis (DTP3) coverage, measles coverage, and percent of districts reporting at least 80% coverage. Therefore the application must include a strong Monitoring & Evaluation (M&E) framework aligned with the national M&E plan or national M&E processes.
  • Performance based funding is a core approach of GAVI HSS support. All applications must align with the new GAVI performance based funding (PBF) approach introduced in 2012. Countries’ performance will be measured based on a predefined set of PBF indicators against which additional payments will be made to reward good performance in improving immunisation outcomes.
  • GAVI supports the principles of alignment and harmonization (in keeping with Paris, Accra and Busan declarations and the International Health Partnership, IHP+). The application must demonstrate how GAVI support is aligned with country health plans and processes, complementary to other donor funding, and uses existing country systems, such as for financial management and M&E. The IHP+ Common Monitoring and Evaluation Framework is used as a reference framework in these guidelines.
  • GAVI supports the use of Joint Assessment of National Strategies (JANS). A JANS assessment is not a requirement for a GAVI HSS application. If a country has conducted a JANS assessment the findings can be included in the HSS application. The Independent Review Committee (IRC) will use the findings of a JANS assessment to gain an understanding of the policy and health sector context that will inform their assessment of the credibility and feasibility of the HSS proposal.
  • GAVI encourages a consultative and participatory approach for developing this HSS proposal, particularly across relevant departments in the Ministry of Health (including Planning, EPI, HMIS, M&E), across development partners, and civil society. While the HSCC (or equivalent) is required to sign off on this application, the ICC (or equivalent) also needs to be consulted and involved in the proposal development process.
  • GAVI encourages countries to request funding for technical support in their HSS application for grant implementation, monitoring and capacity building.
  • GAVI encourages countries to identify and build linkages between HSS support and new vaccine introduction support (as GAVI New Vaccines Support). These linkages must be demonstrated in the application. Countries will need to demonstrate systems readiness[1] for new vaccine introductions in the context of routine immunisation services. GAVI HSS support will be for strengthening these routine immunisation services.
  • GAVI’s approach to HSS includes support for strengthening information systems and improving data quality. Strong information systems are of fundamental importance both to countries and to GAVI. Countries are strongly encouraged to include in their proposals actions to strengthen data systems, including surveys and the institutionalization of routine mechanisms to track data quality improvements over time.
  • GAVI supports innovation. Countries are encouraged to be innovative in their identification of activities which will have a catalytic effect on addressing HSS bottlenecks to improving immunisation outcomes.
  • GAVI encourages applicants to include funding for Civil Society Organisations (CSOs) in implementation of HSS support to improve immunisation outcomes. CSOs can receive GAVI funding through two channels: (i) funding from GAVI to MOH and then transferred to CSO, or (ii) direct from GAVI to CSO. Please refer to Annex 4 of the guidelines for further details.
  • Applications must include details on lessons learned from previous HSS grants from GAVI or support from other sources.
  • Applications must include information on how sustainability and equity (including geographic, socio-economic, and gender equity) will be addressed.
  • Applications will need to show the additionality of GAVI support to reducing bottlenecks and strengthening the health system, relative to support from other partners and funding sources.
  • Cash disbursed for HSS support must be used solely to fund HSS activities. These funds may not be used to purchase vaccines or meet GAVI’s requirements to co-finance vaccine purchases, and shall not be used to pay any taxes, customs, duties, toll or other charges imposed on the importation of vaccines and related supplies.

Application and Implementation Process

This application form has key instructions, but for more detailed information please see the attached guidelines for completing a GAVI HSS proposal. The application process for GAVI HSS proposals is similar to the process of applying for new and underused vaccines. The process of taking a decision to apply for GAVI funding and work with GAVI Alliance partners to develop a proposal (Steps 1 and 2 in Figure 1 below) will require adequate time; as much as possible, it should be planned to link with existing country planning processes.

Countries are encouraged to participate in an iterative process with GAVI Alliance partners, CSOs and development partners in the development of HSS proposals prior to submission of this application for funding. Steps 1-7 indicate the standard steps for GAVI HSS application process. Countries should allow 9-12 months for these steps. Steps 1-3 are expected to take 3-4 months, while steps 4-7 typically take 6-9 months.

Please note that if approved your application for HSS support will be made available on the GAVI website and may be shared at workshops and training sessions. Applications may also be shared with GAVI Alliance partners and GAVI’s civil society constituency for post-submission assessment, review and evaluation.

Figure 1: Application and Implementation Process


PART A - SUMMARY OF SUPPORT REQUESTED AND APPLICANT INFORMATION

For further instructions, please refer to the Guidelines for Completing the HSS Application
Applicant: / Federal Ministry of Health
Country: / Sudan
Proposal title: / Health Systems Strengthening for equitable Primary Health Care and Immunization Services in Sudan, 2014-2018
Proposed start date: / May/2014
Duration of support requested: / Five Years
Total funding requested from GAVI: / 33,231,766.0 USD
Contact Details
Name / Mohammed Ali Yahia El Abbasi
Organisation and title / Federal Ministry of Health, Sudan
Director General for Planning and International Health
Mailing address / Directorate General of Planning and International Health
Federal Ministry of Health, Sudan
P. O. Box. 303
Telephone / +249123390050
Fax / 0024983780445
E-mail addresses /
Signatures: Government endorsement
Please note that this application will not be reviewed or approved by GAVI without the signatures of both the Ministers of Health & Finance and their delegated authority.
Minister of Health Minister of Finance
Name: Bahar Idriss Abu Garda Name: Badar El Deen Mahmoud Abbas
Signature: Signature:
Date: Date:

HSCC SIGNATURE PAGE

For submission with GAVI HSS application

Health Sector Coordination Committee
Country: Sudan
Date of HSS application: 22nd January 2014
We the members of the HSCC, or equivalent committee [1] met on 21st January to review this proposal. At that meeting we endorsed this proposal on the basis of the supporting documentation which is attached.
[1] Health Sector Coordination Committee or equivalent committee which has the authority to endorse this application in the country in question.
Name of the HSCC in country NHSCC/HSS CCM Sub-Committee
Health Sector Coordination Committee
Name/Title / Agency/Organisation / Signature / Date
Dr. Isameldin M.Abdallla / Undersecretary FMOH
Dr. Mohamed Ali Yahia Elabbasi / Director General of Planning and international health, FMOH
Dr. Talal Elfadil Mahdi / Director General of Primary Health Care, FMOH
Dr.Igbal Ahmed Elbasher / Director General of Human Resource for Health, FMOH
Dr.Imadeldin Ahmed M.Ismaeil / Director l of International Health
Dr.Nagla Eltigani Elfadel / GAVI/GF Focal Person
Dr. Magdi Salih Osman / Director of EPI program FMOH
Dr. Dorothy Dchola / UNICEF Representative
Dr.Anshu Banerjaa / WHO Representative
Dr. Tatek Mamecha / UNDP Representative
Dr. Mohamed Sidahmed / UNFPA Representative
Mr.Sohaib Elbadawi / Rotary Representative
Dr. Mohamed Hussen / Humanitarian Aid commission Representative
Dr.Mohamed Ahmed Abdelhafez / CSOs Representative
Dr. Mohameed Osman / Director of National HIV/AIDS Control Program
Dr. Hiba Kamal / Director of National Tuberculosis Program
Dr. Fahad Awad Ali / Director of National Malaria Control Program
Miss. Tayba Sayed / Ministry of Finance Representative
Dr. Osman Jafer / International Federation of Red Cross/Red Crescent
Please tick the relevant box to indicate whether the signatories above include representation from a broader CSO platform: Yes  No 

PART B – EXECUTIVE SUMMARY

1

HSS Application Materials– 31/05/2013

For further instructions, please refer to the Guidelines for Completing the HSS Application
→ Please provide an executive summary of the proposal, of no more than 2 pages, with reference to the items listed below:
  1. The main bottlenecks for achieving immunisation outcomes addressed within this proposal and how proposed objectives in this application will address these bottlenecks and improve immunisation outcomes.
  1. Objectives and the related budget for each objective.
  1. The proposed implementation arrangements including the role of government departments and civil society organisations. Please include a summary of financial management, procurement and M&E arrangements.

During the last few years, Sudan has seen many developments. The secession of South Sudan following the 2011 referendum has changed the geographical boundaries, population size and political landscape of the country. With an annual growth rate of 2.8%, the total population as projected from 2008 census is about 33, 419,625 people. Of the total population 88% are settled, including 32.7% in urban areas, while 8% are nomads. Sudan comprises of 18 States each divided into localities, making up a total of 184. Sudan with its multiparty system is a federated republic with powers devolved to States under Federal System Act (1999). Accordingly, legislative and organizational arrangements may vary from state to state.
Sudan National Health Sector Strategic Plan 2012 – 2016 provides the overarching framework and direction for different players in the sector to respond to the identified health challenges. The country is facing economic difficulties due to the loss of 75% of its oil revenue as a result of separation of South Sudan in 2011; the ongoing conflicts in some parts of the country and the $40 billion debt. These constraints have hampered the primary health care services including immunization and excavated the disparities between rural and urban as well as, disparities between and within states and localities.
About 13.7% of the populations have no access to health facilities. A significant portion of these are pastoralists and/or those living in conflict affected areas. Moreover, 39% of the existing facilities are not fully functioning due to staff shortage or poor physical infrastructure. Immunization services are provided in 76% of all functioning health facilities. As such, only 49% of the target children are covered through fixed sites while 51% of them are covered through the outreach/mobile strategy, with variations within and between states. The later strategies for the EPI coverage are used in conflict affected areas. The volunteers, CSOs and NGOs are playing considerable role operating this. The Health Management Information System (HMIS) is largely fragmented, inconsistent and not inclusive. This is due to multiple, parallel vertical disease based information sub-systems. The EPI is a typical example, it implements parallel surveillance systems for five of the VPDs in a fragmented and vertical manner.
The inequity is remarkably reflected in the distribution of HRH, they are mostly concentrated in capitals or major cities in the states. Nearly 70% of them are working in urban settings, of which 38% are in Khartoum state, serving only 30% of the population. EPI is much affected by this situation, there is over dependence on volunteer vaccinators to provide immunization services in most of the states. This coupled with shortage of cold chain technicians at all levels.
The governance, planning and management components are facing serious constraints. The sub national tiers of the decentralized system are lacking appropriate, standardized structures, planning and management capacities due to turnover in qualified staff.
The allocation of public funding has two major problems, firstly only 15% of the public health expenditure goes to the PHC and other public health programs; secondly it is very inequitable across states.
This proposal intends to address these bottlenecks to complement other partners’ efforts through the following objectives:
Objective 1: To improve sustainable and equitable access and utilization of quality Immunization services as part of an Integrated Primary Health Care focusing on underserved and disadvantaged population: The NHSSP 2012 - 2016 is focusing on universal coverage with PHC basic package. This is coupled with National MCH acceleration plan, which was developed jointly with partners, to improve the progress towards MDGs. Both plans focus on reaching the unreached and serve the underserved. This objective goes on the same tract. It intends to overcome the limited access to availing immunization services to underserved, hard to reach populations including nomads, IDP and people living in conflict affected. The planned activities are aimed at addressing this issue by gradually expanding the number of fixed sites, rehabilitation of PHC facilities, provision of equipment and training of health care providers. Services will further be enhanced by engagement of CSOs/NGOs, to deliver standard services to special groups or those with little health system contact including pastoralist. Besides, community-targeted strategies will be implemented to improve PHC and immunization utilization this will use community health workers (CHW) for social marketing to address the cultural barriers. There is a due concern about disparities in service utilization due to gender, a national survey will be supported to assess the effect of gender in accessing and utilizing health services.
Objective 2: To strengthen an integrated, comprehensive, efficient and sustainable Health Information System in support of an evidence-based policy and planning: The planned activities under this objective are geared towards integrating vertical programme. Institutional capacity building for an integrated HIS is central to this proposal for improved efficiency, where capacity development of HIS managers, data producers and analyzers shall be cared for. Support would also be given to promising initiatives such as the community Health Information System (CHIS). The planned activities in this area aim to scale up CHIS by engagement of CHWs and utilizing the available networks of Community Health Volunteers.
Objective-3: To support production, equitable distribution and retention of a multi-tasked facility and community health workforce to meet immunization and PHC needs: This objective aims to scale up the recent shift from monovalent to polyvalent health workers. Efforts will also be made to retain these health workers, especially posted in remote and hard to reach areas.