|
Global Grant Proposal Form for Project G-2947 Last updated by Daphne Fletcher <daphne@ledgemedia.net> on 30-Jun-22 Project Title MCH Model Districts for Uganda Type of Project [X] Humanitarian [ ] VTT [ ] Scholarship Primary Host Partner Information
Primary International Partner Information
Grant Host Committee
Grant International Committee
Do any of these committee members have potential conflict of interest? If so, please briefly explain. No Tell us a little about your project. What are the main objectives of the project, and who will benefit from it? A consortium of Rotary Clubs in US and Uganda is teaming up to provide badly needed MCH equipment, support services, and clinical training to 63 public hospitals and maternity centres in 6 local government districts serving the poor in rural Uganda. These facilities provide the full range of women’s health services, including maternity, C-sections, perinatal care, and family planning counseling, to 105,000 maternity patients annually. To reach this target group, Rotary will partner with Bulamu Healthcare International, a US non-profit & Ugandan NGO that has 2 Memorandums of Understanding (MOUs) in place to provide medical services and management systems to 12 partner districts in Uganda that operate 347 health facilities treating 3.3 million patients each year. Together these districts account for 11% of the public healthcare facilities in Uganda and serve 17% of the country’s population of 47 million. (See Exhibit 1: Bulamu Partner District Map, and Exhibit 2: Bulamu Partner District Data.) The Bulamu partner districts are providing a demonstration project for the Ministry of Health (MOH) to show what can be accomplished by introducing private-sector solutions to address endemic problems while strengthening the public health system. The 6 target MCH districts fall below average in a composite of 12 MCH-related performance factors that are used by the MOH in its annual District League Table ranking of all 140 districts on their level of patient care. The goal is that after the implementation of this MCH initiative, the target districts will become MCH Model Districts, justifying funding from public agency and private foundations to extend these programs across all public health facilities in Uganda. Which area of focus will this project support?
Which goals of this area of focus will your project support? - How will you measure your project impact?
Do you know who will collect information for monitoring and evaluation? -
Humanitarian Project In the local government districts in rural Uganda of: Kyegegwa, Kakumiro, Mayuge,Bunyangabu, Amuru, Gulu.
Cooperating Organization (Optional)
Why did you choose to partner with this organization and what will its role be? Bulamu Healthcare International was chosen because it is a major provider of medical services in Uganda, working in partnership with 12 local government districts and with the blessing of the senior leadership of the Ministry of Health. As exhibits, you will find letters from Dr. Diana Atwine, MOH Permanent Secretary, and Dr. Henry Mwebesa, Director General, of the MOH indicating their support. (Exhibits 8 and 9.) While the MOH has a 700-page Standard Operating Procedure Manual for its 3200 health facilities, they have allowed Bulamu to install its Health Center Excellence (HCE) program with different forms, procedures, and reports, viewing Bulamu as an R&D arm that is developing novel solutions which could be incorporated into its standard model once it has proven its efficacy. Because Bulamu has established relationships with 347 public health facilities, Rotary is able to have impact that would be impossible without relying on Bulamu’s professional staff and distribution network for equipment, supplies, and training. Founded in 2016, Bulamu is a US non-profit corporation registered in California and Ugandan NGO regulated by the Ugandan government's NGO Board. Bulamu is a clinically oriented organization. Using its "Core Team" of 80+ licensed Ugandan clinicians that supplements its 10 full-time staff members, Bulamu provided general healthcare to 56,028 patients in 2021 at an average cost of $5.77 per patient through its Clinical Support Team (CST) program. It also treated or supported 5,085 surgery cases, including 1,920 surgeries performed at 8 weeklong Surgery Intensives at a cost of $163 per patient. Bulamu also has close ties to Rotary International, with its three top officers Rotarians: • Dick Chandler, Executive Board Chair, Rancho Santa Fe RC (California) • Richard Siegler, President & CEO, Chicago RC (#1) • Mackay Masereka, Vice President & Uganda Country Director, Kampala Naguru The MOH network of 3,194 public hospitals and clinics represents 51% of the country’s health facilities but accounts for 65% of those that treat in-patients. For the 80% of Uganda’s population living in rural poverty, the MOH network is their only option, as all private facilities rely on fees in some form to support their work. Partners (Optional) List any other partner that will participate in this project. Based on the MOUs that have already been signed by Bulamu with each district local government, the six districts will be de facto partners as the recipient of the equipment and services Bulamu and Rotary will be jointly providing. Volunteer Travelers (Optional) Provide name, email of traveler(s). N/A Describe this person's role in the project. N/A Rotarian Participants Describe the role that host Rotarians will have in this project. The responsibilities of the Host Club are spelled out in the Organizing Organization MOU, attached as Exhibit 5. When the GG funds are ready to be transferred to Uganda, the Host Club will establish a dedicated bank account, review its purchasing and cash control policies, and identify who the authorized parties will be to oversee disbursement of the funds. The Host Club will also review with Bulamu the needs assessment requests that have come in from the districts, which Bulamu will have to vet based on field assessments and funds available. When asked for its equipment needs, some districts interpreted this as a wish list, trying to turn every Health Center III maternity center for natural childbirths into a full-fledged community hospital rather than transport premature infants and C-section cases to the district Health Center IV. Exhibit 5 establishes a standard “kit” of equipment each HC III and HC IV should have and estimates the gaps that will have to be filled at a minimum to have each health unit performing its prescribed mission. Such assessments about need will be made in the field by Bulamu medical experts on a facility-by-facility basis before the necessary equipment is purchased and shipped, along with Bulamu staff members who will oversee the delivery and training. Once the available budget funds have been allocated with the agreement of both parties, Bulamu will provide a requisition list organized by health unit and equipment item. The current list involves 14 items, which could be supplemented based on what the district doctors consider their highest priorities. Equipment Item Cost $ Equipment Item Cost $ C-Section Set 632 Manual Aspirator 48 Resuscitation Kits 147 Scale (Infant) 99 Oxygen Concentrator 932 Delivery bed 1,207 Fetal Doppler Scope 599 Baby Warmer 180 Suction Machine 1,042 Ultrasound Scanner 5,507 Autoclave 26 ltr 1,054 Blood Bank Fridge 2,394 Incubator 2,178 Generator 3,662 The Host Club will secure bids for each item from at least 3 vendors. The decision on product and vendor will be made jointly Kabarole and Bulamu, taking into consideration both price and other relevant factors, such as the supplier’s ability to honor the manufacturer’s warranty and if necessary, service the equipment in the field. Rotary will then purchase the necessary equipment, have it delivered to Bulamu’s Kampala warehouse, and get it engraved as “Property of Rotary International” before the Bulamu’s training team distributes it to the upcountry locations. At that time, Kabarole and other Rotary club representatives will be invited to participate in a ribbon-cutting ceremony with local media coverage when the equipment is handed over to the District. After completion of the equipment distribution and clinical training, Bulamu will submit its receipts for travel expenses, accommodations, and training personnel at approved per diem rates. As the project progresses, Kabarole and Bulamu will collaborate on a monthly report to the International Host describing the tasks performed and funds expended. After conclusion of the operational phases, the Host Club will participate with Bulamu in M&E studies to measure the program’s impact and achievement of its objectives identified above. Describe the role that international Rotarians will have in this project. The Encinitas Club will take responsibility for editing the final version of this GG application, submitting it online to the TRF, amending it as needed until project completion, and providing general liaison for the project with the TRF Regional Grants Officer in Evanston. On the financial side, Encinitas will lead in building the US funding base for this project, funnel those funds to Uganda via wire transfer, and keep the otoher US clubs informed when receiving reports from Uganda on the project’s progress. Throughout this process, Club representatives will participate in Zoom calls with Kabarole and Bulamu, initially to report on fundraising progress and later to get updates on the operational details as the program is implemented. What is the budget for this grant?
Tell us about the funding you have secured for your project.
Humanitarian Projects - Project Planning Describe the community needs that your project will address. Note: A detailed description of the community needs can be found in Exhibit 7: Global Grants Community Assessment Results. The Ugandan MOH operates 3,194 health facilities broken down as follows: Type of Facility Description Number Referral Hospitals Operated by MOH (150-500 beds) 19 District Hospitals General care (100-150). DHO supervision. 55 Health Center IVs Community hospitals (20-40 beds) 180 Health Center IIIs Maternity hospitals (8-20 beds) 1,041 Health Center IIs Walk-in clinics staffed by nurses. (outpatient) 1,899 Total Public Health Facilities 3,194 Of these facilities, 3,175 are managed by the District Local Governments under the direct supervision of the District Health Officer (DHO). Bulamu’s partnerships are with these government entities, although with the encouragement and support of the senior MOH officials. Because Bulamu’s programs cover districts dispersed across Uganda, we interpret this question to mean the collective communities that are served by all the health facilities in the six MCH partner districts. Everyone in the Ugandan public health system recognizes that these district level facilities are chronically short of essential medical equipment, medicines, and supplies. Bulamu has recognized this while extending its HCE hospital/clinic management system across its 12 partner districts that operate 347 public health units. Exhibit 2 shows the breakdown of health units by type for all districts. The table at the bottom shows the 6 MCH districts that will be part of this grant, which have 63 inpatient hospitals and maternity centers that together served 105,527 maternity patients in 2021. How did your project team identify these needs. The two club project teams became aware of this opportunity after encountering Bulamu’s Rotarian leadership team. They learned of this opportunity to have a positive impact on the health system that poor rural residents of Uganda rely upon, reaching over 100,000 expectant mothers each year at relatively modest cost. In April 2022, Bulamu conducted a needs assessment survey at its partner districts for 13 equipment items that the DHOs and staff doctors considered necessary to conduct safe natural deliveries and C-sections. That list was then whittled down to the six districts most in need. The results of the survey by district and equipment item are shown in Exhibit 6, along with the standard MCH equipment list and item costs. The UG and US grant teams will endeavor to raise the funds needed to fulfill these critical equipment needs, demonstrating for the MOH what happens when its clinicians are given the equipment necessary for proper patient care. The final allocation of equipment will be based on physical inspections at each facility to assess the condition or absence of the items requested. The clinical training in current best practices for maternal and perinatal care will be provided at all 63 maternity and general hospitals. How were members of the benefiting community involved in finding solutions. The five solutions that make up the MCH program were developed in numerous conversations over many months with doctors and nurses employed at health centers in the field. Bulamu held its first District Officers Conference February 24-25, 2022, bringing together the District Health Officers and Biostats of its 11 (at that time) partner districts. Dick Chandler introduced the MCH Program idea with a 4-page case statement that described all 5 program elements, clarifying that the MCH equipment and clinical training were not in our current budget and would a require new funding, with Rotary International our first choice. The program was enthusiastically received by everyone in the room, as they all live with the frustrations of treating patients with inadequate equipment and supplies. They have the feeling that the national government hospitals in the urban centers get whatever they need, while the smaller community hospitals in upcountry districts are largely ignored. Bulamu followed up with a detailed needs assessment survey in March, got responses from everyone in April, and began the detailed planning that has resulted in this application. On June 20, Bulamu Country Director Mackay Masereka and Rotary District Governor John Magezi (District 9213) met with Dr. Richard Mugahi, the Commissioner of Reproductive Health in the Ministry of Health, who also happens to be a Rotarian. Dr. Mugahi was very positive about all elements of the MCH program and encouraged us to proceed. He asked especially that we make sure each HC IV has a portable ultrasound scanning machine, which is critical for antenatal care and often lacking. It was added to the list of MCH equipment for HC IVs. He offered to send us a letter for prospective donors underscoring the great need for this program, which we will follow up on. How were community members involved in planning the project. As stated above, the planning for equipment procurement and distribution was made in consultation with the partner district DHOs. The clinical training program is being planned with a Ugandan member of the Bulamu Advisory Council, Dr. Margaret Nakakeeto, a pediatric specialist who is Chairperson of the Newborn Steering Committee, MCH Technical Working Group of the MOH. Dr. Nakakeeto has a team of consulting midwives and nurses who provide on-site training in WHO-approved processes (Helping Babies Breathe, etc.) that demonstrably save lives. Besides the MOH, her clients include UNICEF and other international organizations. The curriculum uses an infant mannequin, realistic in size, weight, and choking fluids, to train midwives in using both mechanical and manual suction devices and will cover all 63 facilities. The MCH specialists at each district headquarters will be trained as ongoing trainers for new staff members as they arrive. Humanitarian Projects - Project Implementation Summarize each step of your project's implementation.
Will you work in coordination with any related initiative in the community? If yes, briefly describe the other initiatives and how they relate to this project. If no, please explain. Are local initiatives not addressing these needs? Or, if they are, why did you decide not to work with them? Yes. The Bulamu-HCE component of the HCE Initiative (treatment forms, emergency transport, essential surgical supplies) will be going on in parallel with the Rotary components of equipment and clinical training. In addition, the MOH typically is conducting MCH pilot programs of its own in selective districts, typically sponsored by government entities (USAID, CDC, UNICEF, WHO, etc.) and sometimes private NGOs (EGPAF, World Vision, Partners in Health.) Bulamu will make sure its programs are conducted in concert with any similar initiatives, especially ones in the six target MCH districts. Please describe the training, community outreach, or educational programs this project will include. As described above, Bulamu will organize and provide training at the time of delivery on all medical equipment being donated. Dr. Nakakeeto’s staff of MCH clinical trainers will follow up several weeks after equipment delivery with training on WHO’s Ensuring Newborn Care curriculum. How were these needs identified? Training on new equipment is based primarily on materials provided by the manufacturers. Bulamu will develop this expertise in house now that equipment is becoming a key element in its HCE Program for district partners. The clinical training needs and priorities for MOH clinicians will build on the priorities set by the MOH Newborn Steering Committee, MCH Technical Working Group, of which Dr. Nakakeeto is chairperson. What incentives (for example, monetary compensation, awards, certification, or publicity), will you use, if any, to encourage community members to participate in the project? No incentives are needed when you are providing desperately needed medical equipment that will allow clinicians to provide a higher level of patient care than was possible previously. Similarly, health unit In-charges are required to provide their staffs with 1-2 hours of formal skills training every week, so Dr. Nakakeeto’s trainers will be welcomed. After the Global Grant program has been completed, Bulamu will use statistical analysis of Key Performance Indicators to identify standards for awarding recognition as a MCH Model District to those which meet established standards for improved patient care. The standards will be developed once a baseline performance level has been established, since many KPIs have not been previously tracked. Taken together, these standards will define what we consider to be above-average level of achievement, which can then be recognized with banners, plaques, etc. and publicized so as to motivate the lower performers to move into this upper bracket. List any community members or community groups that will oversee the continuation of the project after grant-funded activities conclude. The hospitals and maternity health units that are being given the medical equipment under this grant have full-time maintenance staffs on premises whose job is to keep all the equipment running. Bulamu also has an annually renewing MOU with each HCE partner that agrees it will provide the same bundle of services indefinitely. Bulamu’s sustainability strategy is to have the MOH adopt key elements in this program mix so that eventually they become part of the MOH’s standard operating model. This will require that the MOH re-directs existing international funding streams to Bulamu’s cost-effective solutions from other, less compelling uses. Budget Will you purchase budget items from local vendors? Explain the process you used to select vendors. Yes. All equipment products referenced in this grant after available from global manufacturers through their local distributors. There is generally a range of products to choose from, varying between higher priced, higher featured, more durable products from the US and Europe versus lower priced, simpler featured, less durable products from India or China. Product selections must be made with those trade-offs in mind. In general, there will be 4 or 5 product options in each category available from 3 or 4 alternative local distributors with offices in Kampala and sometimes regional warehouses. The Kabarole RC will be involved in all such purchase decisions. Did you use competitive bidding to select vendors? If no, please explain. Yes. Please provide an operating and maintenance plan for the equipment or materials you purchased for this project. This plan should include who will operate and maintain the equipment and how they will be trained. As described above, Rotary will be donating all equipment to MOH hospitals and maternity centers that have full-time maintenance professionals on hand. Bulamu staff will provide initial training on donated products at the time of handoff, using materials provided by the manufacturers, and may provide a leave-behind manual for routine maintenance thereafter if it seems appropriate. The Ugandan distributors of these products provide free repairs during the manufacturer’s warranty period. Thereafter, they can be hired for servicing and parts replacement if needed. Describe how community members will maintain the equipment after grant-funded activities conclude. Will replacement parts be available? Equipment maintenance has been covered above. All products being provided have replacement parts available from the distributors. If the grant will be used to purchase any equipment, will the equipment be culturally appropriate and conform to the community's technology standards? If yes, please explain. If no, describe how the project team will help community members adopt the technology. Yes. All equipment selections will be made after weighing carefully whether the level of sophistication goes beyond what is appropriate for the upcountry, rural settings where the equipment will reside. The ability to get the equipment repaired when necessary is also an important factor in product selection. After the project is completed, who will own the items purchased by grant funds? No items may be owned by a Rotary district, club, or member. Title to all equipment transfers to the Ministry of Health at the time of its original handoff. However, it is normal practice in Uganda to engrave or label all donated products as “Property of XXXXX”, as a deterrent to theft. In the four years since Bulamu started providing desktop computers to its HCE partner health units, now numbering more than 100, no computer has ever been stolen or lost. If Rotary prefers not to have this engraving or label applied, the engraving can reference “Bulamu Healthcare.” A rotary label could still be affixed, without reference to ownership. Funding Have you found a local funding source to sustain project outcomes for the long term? If yes, please describe this funding source. The local funding will come from two sources: Bulamu Healthcare International, a Ugandan-based NGO, and the government of Uganda. Under the terms of its HCE Program partnership, Bulamu will continue to provide the ongoing services specified in its MOU that is annually renewable. The MOUs do not mention an ongoing obligation to provide medical equipment, although our district partners periodically come to us requesting help in replacing a piece of essential equipment, which we do if we can raise the funding on an item-by-item basis. Our clinical training effort is designed as a “train the trainer” strategy, although we have clinicians on staff who could conduct follow-on training if time and funding permitted. As of today, we don’t have the budget for that but would like to add it in the future as part of our HCE services. Bulamu’s annual revenues were $1,214,190 in 2021 and are budgeted for $1.6 million in 2022. The Uganda MOH recognizes that it is ultimately each country's responsibility to provide a minimum level of free medical care for its impoverished citizens. Many international organizations and NGOs contribute to that funding in Uganda and other sub-Saharan countries. Bulamu’s longer term sustainability strategy is to demonstrate to the MOH that its programs merit adoption into the government’s standard health unit operating model in order to raise its own Standard of Care. It could do this by re-allocating a small portion of its existing healthcare budget or redirecting outside agency donations. As a partner in that demonstration project, Rotary International is well-positioned to influence that public debate in Uganda, so that Bulamu’s innovative, cost-effective solutions can be extended nationally. To validate the MOH’s interest in Bulamu’s innovative programs for improving patient care, attached are two letters from the senior leaders of the MOH. The letter from Dr. Diana Atwine, Permanent Secretary of the MOH (Exhibit 8), is addressed to the three top officials in all 140 districts and endorses Bulamu’s programs as a demonstration project for possible incorporation into their standard health unit model. A second letter (Exhibit 9) addressed to the Gates Foundation from Dr. Henry Mwebesa, Director General of the MOH (#2) provides a further strong endorsement of Bulamu’s work in Uganda. Will any part of the project generate income for ongoing project funding? If yes, please explain. Since all grant equipment and training support is being donated to public health facilities, and it is government doctors, midwives, and nurses who are treating the impoverished patients, it would be up to the government to charge for the medical services being provided. Today, primary care is provided for free at all MOH facilities, and no cash transactions or insurance billings occur for these basic medical services—although surgeries generally require fees even at public hospitals. We do not believe Bulamu or Rotary International would be able to change that policy. Is your economic and community development activity a microcredit project? If yes, upload your microcredit supplement file. No. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||