AFD – Call for projects proposals “improving access to quality primary health services for vulnerable populations in Lebanon ”

  • Purpose of the project :

This call for projects aims to take into account the primary health care needs of vulnerable populations (Lebanese, refugees, or others) in a context where improving access to care and strengthening existing public health care systems appear essential.

The projects must therefore contribute to strengthening the Lebanese public health care system, so that it can best respond to the challenges of quality of primary health care, equity and social cohesion, in a context of inequalities and social tensions. They will implement short, medium and long-term activities with the most direct outcome possible for the most vulnerable populations to promote their access to quality primary health care.

The purpose: Vulnerable populations in Lebanon receive quality primary health care through the existing national health care system.

Specific objectives of the project :

In the health sector, the objectives of the MoPH’s response strategy from 2016 (“Health Response Strategy of the Ministry of Public Health – 2016 and beyond”) as well as those of the Lebanon Crisis Response Plan 2017-2020 (“Lebanon Crisis Response Plan 2017-2020”) focus on two priorities:

  • Improve access to health services for Syrian refugees and vulnerable Lebanese;
  • Strengthen health facilities and allow them to respond to increased needs in a context of limited resources.

For this project, the specific objectives will be aligned with the above-mentioned objectives:

• Vulnerable populations living in Lebanon have access to preventive and curative primary health care services
• Existing health care systems are strengthened and able to respond to the increase in health demand of vulnerable populations residing in Lebanon
• Primary health care centers are vectors of social cohesion between communities

Content of the project :

The project aims to reduce access barriers to primary health care for vulnerable populations residing in Lebanon through:

  • subsidizing the cost of consultations, laboratory and imaging tests in primary care;
  • supporting PHCCs to improve the quality of services and the management of the medicine supply chain, and increase their capacity to cope with an increased patient load;
  • community awareness to disseminate key health messages and provide information on access to health care.

The activities to be developed must be integrated within the framework of the priorities of the Primary Health Care Department of the MoPH and must be aligned with the LCRP response objectives.

The projects selected within the framework of the Call must:

  • have a community component which ensures the link between the community and the PHCC;
  • take into account the different needs and interests of women and men in terms of access to health care services;
  • be attentive to the specific vulnerabilities of children and youth, the elderly and people with disabilities;
  • guarantee the accessibility of services for all vulnerable populations, regardless of their nationality;
  • take into consideration the pricing policy for services proposed by the government;
  • take into account the logic of humanitarian – development nexus by guaranteeing sustainable access to quality primary health care services;
  • consolidate the health care system by strengthening the capacities of actors at different levels: institutional, health establishments, medical and paramedical personnel (including the use of the existing information system, Phenics);
  • follow a method of coordination with the other implemented actions in the field of primary health care in Lebanon by actively participating in the various coordination platforms;
  • define and implement a method of consultation and participation of local populations during the project life cycle allowing the needs of host populations as well as refugee populations to be taken into account, particularly in perspective of contributing to tension reduction[1];
  • be implemented in one or more area (s) within the defined perimeter (s) (villages or a group of villages, or districts), in order to facilitate the exchange with local actors and their participation in the project, to encourage the involvement of the local civil society and to promote the emergence and the implementation of community action;
  • propose a process of capitalization and knowledge sharing based on the project;
  • take into consideration the security constraint in the construction of offers.

The project implemented must include a reinforced monitoring-evaluation-capitalization component (including monitoring of the changes observed and progress made, taking into account changes in the context and relying on a process of consultation with the beneficiaries of the project) and a visibility-communication component.

The project will have to take into account the objectives of the “Minka Middle East Initiative”, namely to mitigate the risks of propagation of the Syrian conflict beyond its borders by supporting the humanitarian-development transition and by acting in response but also to prevent future crises. The project should allow the implementation of the first tangible activities during the first six months, be reactive to changes in the intervention context, plan a “Do No Harm” approach, target the areas most affected by the Syrian refugee crisis, aim to directly improve access to basic services for vulnerable populations and reduce community tensions. The project area (s) can thus be located throughout the Lebanese territory as long as it (they) is (are) highly vulnerable (situations of poverty for Lebanese and Syrians, concentration of refugees, limited access to primary health care services, etc.).

The project should ensure that it does not duplicate activities undertaken by other civil society actors or by government entities. As previously mentioned, it will have to be aligned with the national health and response strategies to the Syrian crisis, in particular the national strategy of the MoPH (2016-2020), the LCRP (2017-2020), and their updates. The proposal must indicate how the project is linked to them and must detail the exit strategy.

Eligible structures and partnerships :

In order to respond to (i) a requirement for responsiveness and complementarity of the proposed actions, (ii) following a logic of durability and good integration, the AFD suggests that NGOs present a project developed in consortium. Within this consortium, a leading NGO will ensure the development of the Project, the coordination of the various NGOs, as well as the administrative and financial management of the Project. As a consortium lead, it will sign the grant agreement with the AFD.

In addition, the consistency of the consortium’s composition must be based on the comparative advantages and complementary expertise of its members. A holistic approach to primary health care will be more appreciated than a project that settles for a broad coverage of Lebanese territory or a division of the territory between several NGOs.

In the framework of the implementation of the “localization of aid” agenda, bidders are strongly encouraged to work in partnership with national and local public organizations and civil society organizations in order to strengthen their abilities. Projects based on this type of partnership and following the principles of strengthening local entities will be favored.

While it encourages partnerships and transfer of skills between international and national organizations, the AFD will favor projects in which aid will mainly be deployed by local organizations. The AFD assigns great importance to strengthening Lebanese NGOs and their involvement in assisting the most vulnerable. As vectors of change and social cohesion, Lebanese NGOs can contribute to mitigating the effects of the crisis and ensure that efforts are maintained over time allowing a greater sustainability, in a context where political and economic actors are still discredited.

Therefore, particular attention will be paid to ensure that the consortium demonstrates a dynamic of transfer of skills and that the position of Lebanese NGOs in the governance of the project is reinforced at the end of the project.

The NGO members of the consortium must therefore be:

  • non-profit organizations, local or international;
  • already registered (or in the registration process) and operational in Lebanon;
  • having previous experience working in a consortium (both for the lead NGO of the consortium and for the NGO members of the consortium);
  • having previous experience in the targeted region / area;
  • having experience in implementing projects in crisis contexts;
  • having experience in implementing health projects, particularly in the primary health care sector;
  • having a communication capacity i) with central authorities (MoPH / Primary Health Department) and local authorities, and ii) with the AFD;
  • capable of demonstrating their capacity to implement large-scale projects ( the budget for the project submitted should not represent more than 35% of the lead NGO’s annual resources for the last 3 certified fiscal years);

Finally, the fiduciary risks related to the Lebanese crisis should be taken into consideration, and especially a possible decision by the Central Bank of Lebanon to significantly reduce the value of deposits. In order to prevent this, the project funds should first be paid into a bank account held abroad by a bank “acceptable” to the AFD, if the lead NGO considers it necessary. To achieve this, the organization that signs the agreement with the AFD and represents the consortium must be able to provide this guarantee.

The leading organization of the consortium should therefore be:

  • capable of receiving funds in an account abroad and ensuring transfers to the bank accounts of its partners;
  • able to deploy its own import and supply circuits or to contract with other structures to supply medical inputs if necessary (medicines, equipment and other medical consumables) to the PHCCs.

Type of eligible projects :

a) Geographical location of the intervention

The geographic areas favored in this call for projects will be the areas particularly affected by the Syrian crisis, namely those hosting a large number of Syrian refugees and where community tensions surrounding access to services are the strongest. The impact of the recent economic and financial crisis should also be taken into account. Complementarity with existing projects, financed in particular by the EU, the World Bank, the BPRM and the GAC should be considered in order to optimize the coverage of the entire Lebanese territory and to prevent any duplication. Thus, the location of the intervention is left to the candidates’ initiative based on established needs and operational capacities.

b) Selection of primary health care centers (PHCCs)

It is required that the PHCCs included in the project are part of the PHCC network of the MoPH, or that they are already following the process necessary to be part of it. It is also required that the choice of PHCCs is made in consultation with the Primary Health Care Department of the MoPH.

In the current context, the display of a non-political and non-confessional action seems essential today. NGOs that respond to the call for projects should therefore select only PHCCs that guarantee free and secure access to all, regardless of their religious affiliation and origin. PHCCs openly associated with religious or political obedience will be discarded. The AFD will have to provide a Notice of No Objection on the proposed PHCC list for the selected project.

c) Mobile clinics

The AFD is not inclined to encourage the deployment of mobile clinics. Projects wishing to integrate funding for this system should therefore demonstrate its relevance and added value.

d) Monitoring: strengthening of the MoPH management tools

The project will help promote the PHENICS system (Primary Healthcare Network Information and Communication System), which was launched in 2016 at the initiative of the MoPH, and is gradually being deployed across all PHCCs. It is an information management tool, from awareness raising to patient registration, service delivery and referrals.

In addition, the other monitoring tools developed by the MoPH should be integrated into the project as much as possible:
• User satisfaction questionnaire: post verification of the quantity of services and user satisfaction by questioning a random sample of beneficiaries;
• Quality checklist: pre-verification of the quality of PHCC services through visits by field coordinators;
• Complaint system: collection and monitoring of complaints / complaints transmitted to the MoPH monthly by hotline, website, mobile application, or via the patient satisfaction questionnaire.

Thus, the project will help facilitate staff training and the deployment of monitoring and evaluation tools for PHCCs proposed by the MoPH.

e) Improving the quality of health services offered at the PHCC level

Accreditation process: A PHCC accreditation process was initiated in 2008 by the MoPH, in conjunction with Accreditation Canada. This system is considered as an essential quality assurance mechanism by the MoPH. It includes training, several phases of assessment, and ultimately entitles you to a “basic”, “advanced” or “excellence” status. The process takes an average of 2 years. 52 PHCCs are accredited and 66 are in the process of accreditation, till present. The AFD considers that this process deserves to be supported.

Continuum of care: Referral of patients to hospitals and their follow-up must be ensured at PHCC level. Within the framework of this project, financial support for the remaing unpaid amount for secondary health care of vulnerable patients could be considered for the Lebanese as well as the Syrian refugees. However, since referral and management of secondary care can prove to be very expensive, it should be limited to the vital emergencies of the most vulnerable patients.

f) Vaccination

There is no need to provide funds for the purchase of vaccines under this project. On the other hand, the involvement of PHCCs in vaccination campaigns could be considered.

g) Cross-cutting themes that the AFD wishes to see integrated into the project (non-exhaustive list) :

  • Mental health: Contribute to the implementation of the action plan of the National Mental Health Program.
  • Gender: Health needs and usages of women and men differ and require a specific approach. NGOs that have developed activities or an action plan to better take into account the differentiated needs and interests of women and men in terms of access to health services and the supply of care will be given priority.

These activities may include, among other things:

  • ensuring the participation of men and women,
  • collecting, analysis and use of sex-disaggregated data,
  • carer-patient relationship,
  • fighting against gender inequalities

Since March 2014, the AFD has adopted a new transversal intervention framework on gender and the reduction of gender inequalities in its activities. The AFD has made the commitment that 100% of the projects funded seek to improve equality between women and men and promote women empowerment.

  • Management of medical waste from PHCCs: The medical waste management of the PHCCs must respect the principles set out by the WHO for better management of medical waste. These principles require that all entities funding or supporting health care activities cover the costs of medical waste management and include them in their budgets.

Among other things, NGOs must:

  • include the promotion of good waste management in their communication
  • implement programs or activities that contribute to the proper management of medical waste
  • develop innovative solutions to reduce the volume and toxicity of the waste produced

 

  • Handicap

 

  • Social cohesion: strengthening resilience and social cohesion (ref. the model developed by the NGOs AMEL and International Alert )

h) Covid-19 Pandemic

NGOs are encouraged to include certain activities relating to this major health crisis in their proposals. However, taking into account the planned grant funding date, these activities would not relate to the screening and treatment of infected persons, but rather to the strengthening in the medium term of epidemiological surveillance and health surveillance in Lebanon as well as infection prevention and control (IPC).The development of capacities in terms of preparedness and response could thus be envisaged: health security systems and awareness campaigns for the populations, healthcare structures designated for the care of infected patients (rehabilitation, equipment, medicines, human resources, etc.).

i) Approaches that the AFD wishes to see developed in the project
• Tangible activities implemented in the first 6 months of the project;
• Linkages between humanitarian and development activities (nexus);
• Application of the “do no harm” approach;
• A monitoring-evaluation-learning process;
• An explicit theory of change.

j) Duration of the project

The AFD intends to contribute to the financing of expenses necessary for the realization of projects designed and defined by NGOs for a period of 36 to 48 months. This provision allows the candidates to have a certain latitude in the duration of implementation.

k) Budgetary framework

The AFD has a grant envelope of 10 million euros for this call for proposal from which it is planned to select one project. However, it is possible for the AFD to retain two projects if it considers it possible / necessary.

l) Provisional calendar of the call for projects

• April 1st, 2020………..Launch of the call for projects and receipt of proposals
• June 15th, 2020.……..Deadline for submitting projects
• June 30th, 2020.……..Transmission of commission results to candidates
• July 2020.…………………Co-construction of the project with the selected consortium
• September 2020.…….Approval of project grant by the AFD decision-making bodies
• October 2020.………….Signature of the grant agreement

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