THE  COUNTRY COORDINATING MECHANISM-NIGERIA, FOR THE GLOBAL FUND, CALLS ON ORGANIZATIONS FOR EXPRESSION OF INTEREST TO BE PRINCIPAL RECIPIENTS (PRs) AND TO SUBMIT PROPOSALS ON PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV (PMTCT)  FOR INCLUSION IN THE COUNTRY COORDINATED PROPOSAL (CCP)

 
Background
Human immunodeficiency virus (HIV) infection / AIDS continues to be a leading cause of illness and death among women and the children, particularly in countries of the  sub-Saharan Africa where infection levels are extremely high. According to WHO, an estimated 430,000 children under 15 years of age were newly infected with HIV in 2008, over 90 percent of them through mother-to-child transmission. Twenty low and middle income countries1 account for the highest estimated numbers of pregnant women living with HIV. In the absence of timely treatment, about half of all children infected with HIV will die before their second birthday.

Mother-to-child transmission of HIV has been virtually eliminated in high-income countries and the Global Fund, as a major source of funding for HIV programs, is intensifying its effort in support of rapid expansion of quality PMTCT services. Scaling up PMTCT services will greatly contribute to both maternal and child health outcomes.

In 2003, the United Nations adopted a comprehensive approach to HIV in infants and young children, intended to address a wide range of prevention, care, treatment and support services along a continuum of care from pregnancy through childhood. The prevention of mother-to-child transmission (PMTCT) of HIV covers a package of interventions summarized
as four prongs, which will be implemented simultaneously:

• Primary prevention of HIV infection among women of child bearing age
• Preventing unintended pregnancies among women living with HIV
• Preventing HIV transmission from a woman living with HIV to her infant
• Providing appropriate treatment, care and support to mothers living with HIV and their Children and families UNAIDS has called for the virtual elimination of mother-to-child transmission of HIV by 2015; which can be achieved through universal coverage with this comprehensive package of services with the following targets:

1. Mother to child transmission: 90% reduction in estimated number of new infant
infections and transmission rate of under 5%; 2. HIV-free survival: At least 90% of all infants
born to women living with HIV alive and HIV uninfected to the age of 2 years; 3. Treatment: At least 80% of eligible pregnant women living with HIV are receiving antiretroviral treatment for their own health; 4. Family planning (FP): 50% reduction in unmet need for FP across all women or all women living with HIV in high-burden countries4 for PMTCT; and 5. Primary prevention: 20% reduction in HIV incidence among women 15-24 years.

PMTCT interventions are highly effective and have immense potential to improve both maternal and child health. However, latest estimates show that only 21 percent of pregnant women have been tested for HIV. By the end of 2008, there were 1.4 million HIV positive pregnant women in low and middle countries; of these, only 45 percent received antiretroviral prophylaxis or antiretroviral therapy (ART).

Prevention of mother to child transmission of HIV in Nigeria.
Considerable efforts are being made by the national response to strengthen PMTCT interventions. The 11 experimental PMTCT sites in 2003 had increased to 640 by December 2008. According to WHO/UNAIDS/UNICEF (2008), a total of 207,107 pregnant women had been tested for HIV in 2007, an estimated coverage of 4%. The coverage of PMTCT services in Nigeria for 2009 was also reported as 8% for administration of ART prophylaxis during pregnancy, and 8% for administration of ART prophylaxis to infants born to infected mothers. According to NACA (2009), in 2008 about 675,550 pregnant women received HIV counseling and testing for PMTCT of which 21,478 (3.2%) received ARV prophylaxis. The National AIDS and STD Control Program (NASCP) of the Federal Ministry of Health (FMoH) reported uptake of PMTCT services nationally at 11%, as at July 2009 (Coker, 2009) up from 2% in 2004. The same NASCP report indicates the number of HIV exposed infants receiving ARV prophylaxis has increased from 516 in 2004 to 2,230 babies. Therefore, even if the PMTCT coverage was substantially increased before the end of the current NSF in December 2009, it will be impossible to reach the national PMTCT policy target of reducing “the transmission of the HIV virus through mother-to-child-transmission by 50%, by the year 2011” and a far cry from the national target of Universal Access of 80% by 2015.
 
There are daunting but not insurmountable challenges to accelerating the scale-up of the PMTCT program. These include increasing access to PMTCT services by further decentralizing the services from tertiary and secondary facilities to primary care facilities, increasing access to early infant diagnosis (EID) facilities, and ensuring the operationalization of all four components of the PMTCT program (primary HIV prevention among women of reproductive age, prevention of unintended pregnancies among HIV positive women, prevention of HIV transmission from an infected pregnant woman to her child, and care and treatment for women, their children, and families). The analysis recognizes the need to significantly increase male and community involvement in PMTCT programs and institute policies on task-shifting of some responsibilities in PMTCT to lay people and volunteers on credible, scientific, and context-relevant evidences.

 Strategic recommendations include accelerating the scale up of PMTCT services nationally especially at the grassroots with the development and/or adaptation of training and service manuals for PMTCT for PHC workers (community health practitioners), advocacy for PMTCT programs and implementation needs to be strengthened with special focus on demand generation, promotion of community involvement and ownership of PMTCT programs with local women groups as key targets; strengthen male and community involvement in PMTCT and broaden the focus of PMTCT services to be more comprehensive; and institute policies on task-shifting of some responsibilities in PMTCT to lay people and volunteers based on credible, scientific and context-relevant evidences
 
In view of these the CCM Nigeria is calling on organizations to submit proposal of not more than 15 pages that addresses PMTCT that could form part of the Country Coordinated Proposal(CCP) but must ensure it fits into  the National  HIV/AIDS Strategic Plan  2010-2015.

The proposal elements should be tailored towards the following which would be considered for successful implementation of effective PMTCT services:
- Increasing the number of pregnant women attending antenatal care;
- Raising awareness of care providers to avoid stigma and encourage provider initiated testing and counselling (PITC);
- Integrating PMTCT services with ANC delivery units
- Optimizing HIV testing and STI diagnostic and treatment services;
- Integrating PMTCT into primary health care, MCH and comprehensive sexual and reproductive health services;
- Involving the community, including people living with HIV, to encourage use of ANC and HIV testing as well improving drug adherence;
- Involving male partners and promoting male partner testing;
- Promoting FP in HIV infected pregnant women.
- Ensuring that antenatal care, labor and delivery and postpartum services provide a user-friendly environment for women living with HIV who are also injection drug users.

 Expression of Interest as a Principal Recipient or a Sub Recipient.

The CCM Nigeria is therefore calling for organizations and institutions wishing to participate as the Principal Recipient or Sub Recipient in the Round 10 HIV/AIDS proposal for Nigeria to express their interest to participate by submitting a two page concept paper that highlights examples of their existing programs, core capacities and experiences that can be leveraged to support the implementation of the public sector component of the grant as enumerated above.
Organizations interested in becoming Principal Recipient or Sub Recipient for the Nigeria Global Fund Round 10 Nigeria proposal should in addition to the above information, provide information using the format below. The information should be provided in electronic version, in a document not exceeding 20 pages.

Format of application for Principal Recipient in GF Round 10 HIV/AIDS PROPOSAL

Name of the organization:   

Grant applying for: Please indicate HIV/AIDS.

Indicate whether first time applicant:

Indicate whether served as PR in any GF Nigeria Grant and give specifics if applicable:

A.    GOVERNANCE AND LEGAL STATUS
1.    Does the organization have a legal status? If yes, please attach documentary proof.
2.    What is the overall independent body that oversees the organization?  Provide a list of the people that constitute the body.
3.    Provide a copy of the minutes of the last meeting of the body that oversees the organization.

B.    INSTITUTIONAL AND PROGRAMMATIC CAPACITY
1.    Does the organization have an organizational chart? If yes, please attach a copy.
2.    Attach a document that describes the roles, functions and responsibilities of all the staff in the   organization       
3.     Who in the organization is responsible for preparing short and long-term work and implementation plans?
4.     Who in the organization is responsible for programme development? Please attach a copy of the current organization’s strategic plan. Who was involved in its development?
5.          Who in the organization is responsible for programme monitoring, evaluation and reporting?
6.    How are collection, analysis and dissemination of programme information organized in the organization?
7.    How does the organization design, and evaluate its programme activities?
8.    How does the organization report on its activities? How frequently? To whom does it report?


C.     FINANCIAL MANAGEMENT CAPACITY
1.    Describe the financial system and procedures in place.
2.    Describe how the organization is able to account for separate individual project funds.
3.    Describe how the organization budget is prepared, implemented and controlled.
4.    Describe how financial reporting is done including audit arrangements in place.
5.          Has the organization been involved in grant management? If yes, please provide more details.

D.     PROCUREMENT AND SUPPLY CHAIN MANAGEMENT CAPACITY
1.    Describe the procurement and supply chain management system and procedures in place.
2.    What commodity storage and distribution arrangements are used by the organization?

Note:
The deadline for the receipt of proposal and of Expression of Interest is 12 noon exactly two weeks from the date of this advert.  An electronic copy should be sent to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it   while hard copy should be addressed to The Executive Secretary, CCM Nigeria, 4th floor, Orji Uzor Kalu (Abia) House, Plot 979 1st Avenue, off Ahmadu Bello Way, Central Business District, Abuja.
Note that organizations that are screened and found unsuitable to be Principal Recipients/Sub Recipients will not be contacted. Also, the submission of Expression of Interest and Proposal does not result in automatic qualification as a Principal Recipient or Sub-Recipient. Both National (Public and Private Sector) and International organizations are welcome to apply. The selected organizations will be expected to be fast and proactive in responding to CCM and GF demands and requirements. Also they should be ready to form the nucleus of the proposal development team that will convene on 26th July 2010 to elaborate the Nigeria Coordinated Country Proposal for final submission to the GFATM Secretariat on August 20th 2010.

 

Further information
 
Applicants are strongly encouraged to consult:

a) The Frequently Asked Questions (FAQ) section, on http://www.theglobalfund.org and http:/www.ccmnigeria.org

b) The Global Fund home page (www.theglobalfund.org) to access the complete directory of Global Fund documents as well as information specifically related to GF Round 8.

For further information or questions on any aspect of PR guidelines, please contact the Global Fund Secretariat or the Country Coordinating Mechanism (CCM) at the address given above.