Application Form English-GOSANET

Challenge Facility for Civil Society (CFCS)

Name of Organization: GOSANET FOUNDATION

CHALLENGE FACILITY FOR CIVIL SOCIETY (CFCS)

Application Form

ROUND 3

Please note: The deadline for receipt of completed proposals, including all supporting documents1 is 10 February 2010 at 23.59 GMT.

COVER SHEET

NAME OF THE PROJECTTUBERCOULOSIS ADVOCACY, PREVENTION & BEHAVIOURAL CHANGE COMMUCATION IN VOLTA.

NAME OF THE ORGANIZATIONGOSANET FOUNDATION.

COUNTRY IN WHICH THE WORK WILL BE DONEGHANA

TOTAL AMOUNT REQUESTED (Indicate amount in US Dollars)TWENTY THOUSAND US DOLLARS (US$ 20,000.00)

TARGET COMMUNITY (people living with TB, HIV/AIDS, MDR-TB, women, children, poor/neglected communities, or people living in remote rural areas)

Nabu,Koni,Yeganbo,Ogyeri,Ubanja,Hodzo ,Akoefe Tokor,Avenuie,Gadza,Kpetoe, Adaklu ,Kodzobi etc.

OPINION LEADERS, POOR/NEGLECTED COMMUNITIES AND PEOPLE LIVING IN REMOTE RURAL AREAIMPORTANT: Applicants are strongly encouraged to read the Guidance for CFCS Applicants - Round 3 before completing this application form.

1 Former grant recipients must provide a copy of their project completion and financial report for the previous grant awarded. CSOs that already received 2 grants from CFCS are not eligible to apply.

Page 1



CHECKLISTPlease indicate whether your Organization has:

documentation to confirm that it is a registered organization, either nationally or provincially (Please include it with your submission)

Yes

been operating for at least one full yearYes

an overall manager Yes

regular contacts to health care facility(s)Name: Ho Municipal Hospital Location: Ho Nkwanta District Hospital Nkwanta

Yes

regular funding sources

No

Please indicate annual budget for year 2009: ___us_30, 00___ and year 2010: ____us_89, 00___________.

any outstanding debts. If so, how much: _US$__________

No

Please indicate the number of staff your organization has

Full-time staff: _3__

Part-time staff: _5__

Volunteers: _14__

Are you a Stop TB Partner?

No

Page 2

Has someone from the local, city or regional health authority (e.g. director of health centre) provided a letter of support for this application? (Please include it with your submission)

Yes



BACKGROUND DETAILS OF THE GRANT APPLICANT

Please type or print clearly.

Name of person from the organization responsible for managing the grant: SAMUEL YAO ATIDZAH

Mailing address:GOSANET FOUNDATIONP. O. BOX HP 637

HO. VOLTA REGION, GHANA, W/AFR.

Telephone No(s): +233 208221964 / 244158139 Fax No:

Email address: [email protected]

Please use half a page per question when responding the following:

1) What are the mission and objectives of your organization?

To provide opportunities for people who live in circumstances of social and economic deprivation to eradicate poverty and provide for T.B. and HIV prevention.

- To create awareness on T.B/HIV Counselling, Testing, Prevention, Treatments and care services.

- To provide Care and Support for people living with T.B,HIV/AIDS and orphans vulnerable Children (OVCs)

- To strengthen the socio-economic capacity of families to meet the challenges of caring for children who become, T.B, HIV/AIDS positive, disabled and orphaned.

- To help individuals to develop effective communication skills, which will enable them to educate others about Tuberculosis (T.B) HIV and AIDS, Malaria and other related diseases.

- To help reduce illiteracy.- To promote Child education. - To promote Community Development Programmes.- To assist Women, Youth, Teenagers, School drop outs, Street Children

in the region to acquire skills.

2) What are the current funding sources of your organization?

PROJECT DONOR IMPLIMENTATION

Page 3



NBHADA Sensitizing Programme

GOSANET Foundation February 2006

Skill Training Workshop Gosanet Delade women Group

May 2008

Community Project on HIV/AIDS

Ghana AIDS Commission August 2008

Prevention, Behavior Change Communication

Ghana AIDS Commission Dec, 2009

3) Do you have a track record in capacity building or community engagement at the grass roots?

Give 3 concrete but short examples (e.g. report the results of an assessment and say how you used these results to improve your work).

1. Gosanet Foundation organized Training for 2 volunteers each from 13 communities in Ho municipality.

2. Form Anti HIV/AIDS educational club in 10 community schools.

3. Train 25 HIV/TB peer educator at Kpassa in North Nkwanta District.

4) Has your organization been involved with advocacy, communication or social mobilization efforts related to health in the past?

- Give 2-3 concrete examples. Gosanet Foundation organized Sensitization Programmes on T.B, HIV/AIDS, Counseling, and Testing to prevent mother and child transmission in five Ho Municipality. They are Tokokoe, Atikpui, Nyive, Shia and Akoefe.

- Ghana Planner, National Black HIV/AIDS Awareness Day(NBHAAD) in communities in Volta Region since 2006. To create awareness HIV/AIDS community mobilization effort designed by Strategic Leadership Council- U.S.A.

- Trained 25 peer educator at Kpassa and Sensitized 518 in school youth on HIV and AIDS, T.B. Prevention and behavior Change Communication, in Nkwanta North District.

5) How and which part of the Country's Tuberculosis Control Programme (NTP) does the work of your organization support? If none, please describe another national health initiative that your organization focuses on.

Gosanet Foundation form and support four different P.L support groups at Ho Municipal Hospital.

- Care and support services for OVCs and PLWHAs.- Education on T.B. Prevention, HIV/AIDS and Malaria.

Page 4



- Skill Training and capacity building.

6) Do you work with other international or national development initiatives (e.g. UNDP, NEPAD, ActionAID)? Yes. 1. Ghana Health Service 2. Ghana Coalition of NGOs in Health. 3. Ghana HIV/AIDS Network (GHANET) 4. National HIV/AIDS Awareness Day.- U.S.A. 5. World AIDS Day Campaign.

Page 5



FUNDING PROPOSAL

Please type or print clearly. You may attach up to 2 additional pages for this section

1. Introduction (Please provide a brief introduction to the gap/challenge you are trying to address)

The Tuberculosis disease, deadly as can be image, but curable has a global concern due to the difficult to eradicate nature of it, especially in developing countries like Ghana, as a result of lack of knowledge on its prevention. Tuberculosis is destroying individuals, families, communities and the Nation as whole.

The development agenda of Ghana as it reflects in the Poverty Reduction Strategy and National Tuberculosis Control Programme’s Framework are aimed at preventing the deadly disease of T.B. in a way of;

- Sensitizing on Tuberculosis to prevent people from contracting the disease.- Access to testing and treatment.- Access to care and support

In spite of increased awareness the prevalence rate of infection in Ghana and the Volta Region is alarming and frightening. If something drastic is not done through community commitment and comprehensive education, the most vulnerable groups-youth, men and women will soon, will soon be wiped away. Available statistics have shown that each year, over 52,00 people suffer from this disease and it is feared that about half of this number is likely to die without proper treatment. TUBERCULOSIS CASES DETECTION AT NKWANTA GOVERNMENT HOSPITAL

YEAR CASES MALE FEMALE2006 37 21 162007 34 26 82008 54 31 27

3 YEARS 129 78 51

TUBERCULOSIS CASES DETECTION AT HO

YEAR CASES COVERAGE % UNCOVERED %2007 148 43 572008 180 51 492009 153 43 57

It is for this reason, that the Ghana Government is concern with public education on the disease through professional Association and NGO partners.

GOSANET Foundation is one of the functionary groups that have been carry out public education activities in collaboration with other CSOs in North Tongu, Nkwanta North, Ho and Adaklu Anyigbe districts of the Volta Region.

This alarming situation is what Gosanet Foundation in collaboration with District Health Officers and Community Health Workers seeks to salvage by mounting this project to help in the prevention of the disease in Ghana, when given the opportunity

Page 6



2. Objectives (Clearly state objectives which are specific, measurable, achievable and realistic for the timeframe of the project -- max. 3)

To reduce the morbidity of Tuberculosis and HIV in the Ho, North Tongu and Adaklu Anyigbe Districts.

To enable the activities of NTP and NACP in providing quality care, prevention and support for the people living with T.B and HIV at risk.

Facilitate curative measures by encouraging the public to avail themselves for free medication for T.B and HIV patients through public education.

3. Activities (What are the specific activities and interventions you propose to carry out to deliver on the objectives outlined in 2)

1. Peer Educators Training and Year-long advocacy education.2. Dialogue and Advocacy promotion with community Elders/Chiefs/Opinion

leaders.3. Behaviour Change Film shows and Innovative Communication.4. Comprehensive Information, Education and Behaviour Change

Communication (IE & C/BCC)5. Inter Schools/Youth groups Competition on prevention and Protection of T.B.

and HIV.6. Effective Project, Supervision, Monitoring and Evaluation.7. Care and Support for infected and affected Persons/Communities/Caregivers.

4. Expected Outcomes - grant results(identify outcome measures / indicators: For each outcome, identify one or more outcome indicators that could be measured to track progress towards the outcomes, see Guidance for Applicants)

Outcome 1:

Indicator 1: 4000 Women and adolescent girls reached and demonstrated changed behaviour

Indicator 2:2000 Men/ drivers/workers/farmers and young adults adopted responsible behaviour

Outcome 2:20 Schools mobilized and advanced to carry out peer education on T.B and HIV in target population.

Indicator 3:

Page 7



Outcome 3: community Elders/peer educators/ behaviour change advocate trained and engaged in comprehensive Education and counselling.

Indicator 4: Community members are aware of free medication and TB is curable.

[use "Delete Row" from "Table" menu in Microsoft Word menu bar to delete or add Indicators as necessary]

5. Workplan

You should support your proposal for a Challenge Facility grant by attaching a detailed work plan for the duration of the grant (attached as a separate annex). The detailed budget for these activities should also be provided in the relevant section (11) of this application form.

No INTERVENTION AREA

SPECIFIC OBJECTIVE TIME FRAME

EXPECTED OUTPUT

1 Prevention and Behaviour change communication

1.Train Peer Educators for year -long advocacy /Education

2.Dialogue and Advocacy promotion with community Elders/chiefs/opinion leaders.

6 months

50 selected community leaders/strategic persons selected, trained and engaged in behaviour change advocacy.

3.Behaviour change film shows and innovative communication

6 months

50 communities/villages 6000 people educated on TB prevention and protection.

4.Comprehensive information education and behaviour change community(IE&C/BCC)

6 months

No. Of Posters, Notice Boards, fliers developed and distributed to 20 schools,40 religious groups.

5.Inter School/Youth groups competition on Prevention and Protection of TB.

8 months

2000 youth demonstrated changed behaviour through participation in prevention

[Insert Annex name of detailed Work Plan]

Page 8



competition.

6.Effective Project Supervision Monitoring and Evaluation.

8 months

No. Of M&E meetings held. No of field visits effected progress report /Feedback compiled and comprehensive project report written and delivered on time.

Treatment Care and Support

7. Care and support for infected and affected persons/community/caregivers.

8 months

No. Of PLWTB/HIV identified and supported with food, counselling and welfare provisions.

No. of caregivers/affected families educated.

6. Monitoring

The purpose of monitoring the grant is to follow progress in implementation, measure performance, inform decisions during implementation, and help identify problems that need the attention of managers.

Applicants are requested to describe the monitoring system that will be used to monitor the grant activities against the indicators defined in 4.

INTERVENTION AREA

ACTIVITY OUTPUT INDICATOR

MEANS OF VERIFICATION

Prevention and Behaviour change communication

1.Peer educators Training and Year-long advocacy/Education

Peer Educators Workshop held

*Attendance records.

*Reports

*Official observation.

2.Dialogue and Advocacy Promotion with community

Peer educator hold no. Of education

*Attendance record

[Insert Annex name of Monitoring Plan]

Page 9



Elders/Chiefs/ Opinion Leaders.

throughout target communities.

*Reports

*Resolutions

3.Behaviour change film shows and innovative communication

No. Of communities/community members reached with film shows.

*Pictures

*Community feedback

*Reports

4.Comprehensive Information, Education and Behaviour change communication

IE&C/BCC materials developed and distributed.

*Observation

*Pictures

*Samples reports

* No. Of patients reporting to Health Facilities with TB.

5.Inter School/Youth groups competition on prevention and protection.

20 schools and no. Of students. Youth participate in prevention competition.

*Records

*Pictures

*Official Observation

6.Effective project supervision, Monitoring and Evaluation/Report writing/submission

Project officers and District/Regional Health officers engage in Monitoring of Project and Report developed.

*Data

*Minutes of meetings

*Picture

*Reports

7.Care and support for infected and affected persons/communities/caregivers.

No. Of PLWTB Identified and supported with welfare provisions.

No. Of caregivers affected families educated.

*Media Coverage

*Picture

*Reports

Page 10



7. Time frame (specify start and completion date of project)From March 2010 to January 2011

8. Sustainability -- Plan to ensure the sustainability / continuation of the project activities after this grant:

The object of the stakeholder’s orientation is also a strategy for institutionalizing all the findings, best practices and update on TB incidence in the area using the resolution as a tool for ensuring corporate commitment and sustenance of the project activities and objectives.The community and corporate bodies will therefore own the project outcomes, be guided to sustain all their efforts through the community programs and eagerly in subsequent initiative by the PMI.

9. Depending on the objective(s) of the grant, explain how the activities will forge new collaborative work relationships (e.g. with health workers , district authorities, NTP officers, other NGOs)Government agents, community leaders/Assembly men/women, District and Local health personnel, chiefs, family heads, midwives, drug dealers, faith based organization leaders and other opinion leaders shall be assembled for intensive discussions with professional resource persons. They will be educated on the new drug policy, TB prevention, use of health facilities and community participation in TB prevention interventions.

Page 11

Challenge Facility for Civil Society (CFCS) Name of Organization: GOSANET FOUNDATION

10. Summary Table

Objective Activity GH¢ US$ Duration PERFORMANCE INDICATORSA 3 day Workshop to train peer educators/volunteers

Training of 50 voluntary local based assistants

7,774.50 5183.00 3 DAYS

WHO HOW WHEN

Protect Coordinator Training One Month

Advocacy promotion with community leaders/chiefs

Community entry (50 communities)

3,375.00 2250.00 6 MONTHSProtect Coordinator

Public DurbarsPublic Forums April-Dec 2010

Behaviour change initiatives communication IE&C/BCC

Organize

Film shows, raising notice boards, Distribution of fliers in 20 villages/schools

Sensitize Promote

3,607.5 2405.00 6 MONTHSProtect Coordinator

Public Education Advocacy Programmes

6 months

competition in 20 schools

Prevention/Protection of TB. 6,000 4000.00 6 MONTHS

Protect CoordinatorVolunteers

Seminars, Group discussions in 2010

6 months

Care and Support for infected persons

Monitoring and Supervision/Report Writing.

Treatment, Care and support. 6,300 4200.00 6 MONTHS

Protect CoordinatorVolunteers

Provide Welfare, Food, counselling

6 months

Monitoring and Evaluation of Project

2,943.00 1962.00 6 MONTHSProtect CoordinatorStakeholders

Project monitored

6 months

[use "Insert Row" or "Merge Cell" from "Table" menu in Microsoft Word menu bar to add as many additional rows, merge or delete as required]

Page 12



11. BUDGET DETAILS

Please ensure that your budget reflects an appropriate balance between salary and activities (75% or more for activities and 25% or less for salaries)

Objective no. Specific Activity & Cost CategoryLocal

Currency

US$ equivalen

t1

A 3 day Workshop to train peer educators/volunteers

Training of 50 voluntary local based assistants

1.1 50 [email protected] each1.2 Hall rental @ 70.00*3

days1.3 Hiring Training material

@ 20.00*31.4 Feeding of 60

participants @ 12.00*3 days

1.5 T&T refund for 50 participants @ 25.00

1.6 Honorarium for Resource Persons @ 3*80.00*3 days

7,774.50 5183.00

Advocacy promotion with community leaders/chiefs

Community entry (50 communities)

1.1.1 Writing letter & Telephone calls @ 120.00

1.1.2 Fuel for Personnel 5*50*20

1.1.3 Protocols 20*50

3,375.00 2250.00

Behaviour change initiatives communication IE&C/BCC

Organize

Film shows, raising notice boards, Distribution of fliers in 20 villages/schools

Sensitize Promote

1.1.2 Film show in 30 communities @ 50*30Raising 5 Notice board @ 40*5Developing & Distribution of fliers in 20 schools @ 100*20*50RentalsAllowance for 50 volunteers

3,607.50 2405.00

competition in 20 schools

Prevention/Protection of TB.

1.2 30 Sachet of water @ 100*20

1.3 200 T-shirts @ 4.50 each

1.4 News coverage@ 120.00

1.5 Refreshment for 100 Dignitaries @ 5.00*100

1.6 Honorarium for Resource Persons 2*70*20

6,000.00 4000.00

Care and Support for infected persons

Treatment, Care and support.

1.3 Welfare services for estimated 200*15.00Provision for caregivers 200*10

6300.00 4200.00

2

Monitoring and Monitoring and 2.1 Per diem for 3 Field 2,943.00 1962.00

Page 13

mailto:[email protected]



Supervision/Report Writing.

Evaluation of Project

[email protected] for 6 monthsFuel for officials @ 70*3 monthsTyping, Printing of Reports 90*6

2.2

2.2.1

3

Monitoring Visits 3.1 Fuel for Resource persons/Consultancies 2,100.00 1,400.00

3.2

3.3

Total: 24,403.00 3,400.00

Amount of grant being requested: US$ 20,000.00

ACTIVITY IMPUTS CONTRIBUTION FROM GOSANET

TOTAL GH

US$

Monitoring Visits Fuel for Resource persons/Consultancy

2,100.00 1,400.00

GOSANET 2,100.00 1,400.00

Budget Justification:If the budget approved, it will be used to implement programmes and activities as mentioned in the implementation plan.

Page 14

mailto:[email protected]



Annex I MID-TERM REPORT

1. Disbursements (Indicate amounts in US Dollars)US $

A Approved grant

B Funds received

C Total amount spent as per budget details

D Balance (B-C)

E Outstanding payment on receipt of this report 2

2. Narrative ReportPlease type or print clearly. You may attach up to 5 additional pages for this section.

2.1 Summary Table

Objective ActivityPlanned Output

Output achieved

Baseline outcome indicator

Outcome achieved so far (if any at this point)

[use "Insert Row" or "Merge Cell" from "Table" menu in Microsoft Word menu bar to add as many additional rows, merge or delete as required]

10 IPCC trainings

11 IPCC trainings

70% of patients satisfied with the counselling

72% of patients satisfied with the counselling

2.2 For you, which are the unexpected outcome(s) of the funded grant (different from 2.1) to this date?

2 Applicable only to grant exceeding US$ 10,000

Page 15



2.3 What have been the challenges thus far with implementing the grant?

[use as much space as required, the boxes can be expanded]

2.4 What have you learned about your program through the data gathering and outcome tracking process?

2.5 Course of Action: What changes are you considering that might improve your efforts and your performance?

2.6 How can CFCS staff be helpful in terms of building capacity and going smoothly through the grant cycle?

3. Please provide the contact details of the main stakeholders to this grant (e.g. local health authorities)

Stakeholder Phone number Email address Location

4. Please provide a detailed Financial Report(you may attach it to this report)

Page 16



Annex II COMPLETION REPORT

1. Please provide a copy of the grant budgeting expenses(you may attach it to this report)

At the end of the financial report, please add a declaration signed by an appropriately authorised officer of the funded organisation stating the following:

‘I declare that:

this report is complete and accurate

the expenditure detailed in the financial report has been extracted from the organisation’s financial accounting records

a detailed record of income and expenditure at an individual item level is available

the funds allocated to this project were used in accordance with the contract and the Application Form, including any variations to the project approved by the Stop TB Partnership Secretariat in writing.’

Signature:Full name of authorised officer:Position in the organisation:Date:

2. Narrative ReportYou may attach up to 5 additional pages for this section.

2.1 Summary Table

Objective ActivityPlanned Output

Output achieved

Time span

Baseline outcome indicator

Outcome achieved

ExampleIncrease awareness of the importance of treatment adherence among TB patients in community X

ExampleImprove counselling services through interpersonal counselling and communication (IPCC) training for health-care providers

10 IPCC trainings

11 IPCC trainings

Apr-Dec 2010

(pre-test) 70% of patients satisfied with the counselling

(post-test) 72% of patients satisfied with the counselling

Page 17



2.2 For you, which are the most important expected and unexpected outcome(s) of the funded grant (different from 2.1)

2.3 Did your project encourage community members to take action to address a health issue? Please explain:

3. Some results (you may add more results related to HIV or MDR-TB, as required)

Total number of persons:

Approximate number of beneficiaries reached in person:(e.g. small awareness raising mtgs, house-to-house visits, etc.)

xx

Approx. number of beneficiaries reached through other means:(e.g. radio, media, public events, large meetings)Approx. number of people that received printed information about TB:Number of referred cases:

Number of those resulting in TB diagnose:

Number of defaulters traced:

e.g. Number of people supported through a community mechanism:

e.g. Number of cases diagnosed with MDR-TB:

e.g. Number of HIV patients tested for TB:

4. Did you find a way to sustain the activities you started with the grant? Please describe it:

Page 18



Page 19

Documents

Application Form English-GOSANET