Application Form for Country Proposals

Providing approximately two years of support for an 
HPV Demonstration Programme

Submitted by

The Government of the Republic of Niger

Date of submission: 25 October 2012

Deadline for submission: 31 October 2012

Please submit the Proposal using the form provided.

Enquiries to: proposals@gavialliance.org proposals@gavialliance.org or representatives of a GAVI partner agency. The documents can be shared with GAVI partners, collaborators and general public. The Proposal and attachments must be submitted in English, French, Spanish, or Russian.

Please ensure that the application has been received by the GAVI Secretariat on or before the day of the deadline.

The GAVI Secretariat is unable to return submitted documents and attachments to countries. Unless otherwise specified, documents will be shared with the GAVI Alliance partners and the general public.

GAVI ALLIANCE
GRANT TERMS AND CONDITIONS

Countries will be expected to sign and agree to the following GAVI Alliance terms and conditions in the application forms. These terms and conditions may also be included in a grant agreement to be agreed upon between GAVI and the country.

FUNDING USED SOLELY FOR APPROVED PROGRAMMES
The applicant country ("Country") confirms that all funding provided by the GAVI Alliance for this application will be used and applied for the sole purpose of fulfilling the programme(s) described in this application. Any significant change from the approved programme(s) must be reviewed and approved in advance by the GAVI Alliance. All funding decisions for this application are made at the discretion of the GAVI Alliance Board and are subject to IRC processes and the availability of funds. 

AMENDMENT TO THIS PROPOSAL
The Country will notify the GAVI Alliance in its Annual Progress Report if it wishes to propose any change to the programme(s) description in this application. The GAVI Alliance will document any change approved by the GAVI Alliance, and this application will be amended.

RETURN OF FUNDS
The Country agrees to reimburse to the GAVI Alliance, all funding amounts that are not used for the programme(s) described in this application. The country's reimbursement must be in US dollars and be provided, unless otherwise decided by the GAVI Alliance, within sixty (60) days after the Country receives the GAVI Alliance's request for a reimbursement and be paid to the account or accounts as directed by the GAVI Alliance. Any funds repaid will be deposited into the account or accounts designated by the GAVI Alliance.

SUSPENSION/ TERMINATION
The GAVI Alliance may suspend all or part of its funding to the Country if it has reason to suspect that funds have been used for purpose other than for the programmes described in this application, or any GAVI Alliance-approved amendment to this application. The GAVI Alliance retains the right to terminate its support to the Country for the programmes described in this application if a misuse of GAVI Alliance funds is confirmed.ANTICORRUPTION

ANTICORRUPTION
The Country confirms that funds provided by the GAVI Alliance shall not be offered by the Country to any third person, nor will the Country seek in connection with this application any gift, payment or benefit directly or indirectly that could be construed as an illegal or corrupt practice.

AUDITS AND RECORDS
The Country will conduct annual financial audits, and share these with the GAVI Alliance, as requested. The GAVI Alliance reserves the right, on its own or through an agent, to perform audits or other financial management assessment to ensure the accountability of funds disbursed to the Country. 

The Country will maintain accurate accounting records documenting how GAVI Alliance funds are used. The Country will maintain its accounting records in accordance with its government-approved accounting standards for at least three years after the date of last disbursement of GAVI Alliance funds. If there is any claims of misuse of funds, Country will maintain such records until the audit findings are final. The Country agrees not to assert any documentary privilege against the GAVI Alliance in connection with any audit. 

CONFIRMATION OF LEGAL VALIDITY 
The Country and the signatories for the government confirm that this application is accurate and correct and forms a legally binding obligation on the Country, under the Country’s law, to perform the programmes described in this application.
CONFIRMATION OF COMPLIANCE WITH THE GAVI ALLIANCE TRANSPARENCY AND ACCOUNTABILITY POLICY
The Country confirms that it is familiar with the GAVI Alliance Transparency and Accountability Policy (TAP) and will comply with its requirements. 

ARBITRATION
Any dispute between the Country and the GAVI Alliance arising out of or relating to this application that is not settled amicably within a reasonable period of time, will be submitted to arbitration at the request of either the GAVI Alliance or the Country. The arbitration will be conducted in accordance with the then-current UNCITRAL Arbitration Rules. The parties agree to be bound by the arbitration award, as the final adjudication of any such dispute. The location of arbitration shall be Geneva, Switzerland. The language of the arbitration shall be English. 

For any dispute for which the amount at issue is US$ 100,000 or less, there will be one arbitrator appointed by the GAVI Alliance. For any dispute for which the amount at issue is greater than US $100,000 there will be three arbitrators appointed as follows: The GAVI Alliance and the Country will each appoint one arbitrator, and the two arbitrators so appointed will jointly appoint a third arbitrator who shall be the chairperson.
 
The GAVI Alliance will not be liable to the country for any claim or loss relating to the programmes described in this application, including without limitation, any financial loss, reliance claims, any harm to property, or personal injury or death. Country is solely responsible for all aspects of managing and implementing the programmes described in this application.

USE OF COMMERCIAL BANK ACCOUNTS
The eligible country government is responsible for undertaking the necessary due diligence on all commercial banks used to manage GAVI cash-based support, including HSS, ISS, CSO support and vaccine introduction grants. The undersigned representative of the government confirms that the government will take all responsibility for replenishing GAVI cash support lost due to bank insolvency, fraud or any other unforeseen event.

Application Specification

Q1.	Please specify for which type of GAVI support you would like to apply.

Preferred vaccine
(quadrivalent [Merck])
See below for more information	Month and year of first vaccination	Preferred second presentation1	
Quadrivalent vaccine (Merck)	April 2013	Bivalent [GSK]	
For more information on vaccines: http://www.who.int/immunization_standards/vaccine_quality/PQ_vaccine_list_en/en/index.html
1 This “preferred second presentation” will be used in case there is no supply available for the preferred presentation of the selected vaccine (“Vaccine” column). If left blank, it will be assumed that the country will prefer waiting until the selected vaccine becomes available.

Executive Summary

Q2.	Please summarize the country's HPV Demonstration Programme plan.

[In 1987 Niger launched its Expanded Programme for Immunisation (EPI) in order to reduce morbidity and mortality related to diseases avoidable by immunisation, in accordance with the recommendations of the World Assembly of 1974. A 2011-2015 Complete Multi-Year Plan (cMYP) for immunisation that is based on the major thrusts of the Global Immunisation Vision and Strategy (GIVS) and the Millennium Development Goals (MDG) was prepared. It established objectives for improving, by up to 90%, immunisation coverage for all antigens. This plan targets the establishment of equal access to all immunisation services, an increase in the use of immunisation services by a greater number of persons, the introduction of new vaccines as well as the integration of immunisation with other health promotion interventions.
In this new landscape, since 2008 Niger has introduced the Hepatitis B vaccine and the Haemophilus Influenzae B (Hib) vaccine, combined with DTC, yielding a pentavalent vaccine, the DTC-HepB-HiB vaccine. Administrative DTC-HepB-HiB coverage is 92% at the national level, with 90% of health districts having reached the 80% cap at the end of 2011. 
The Ministry of Public Health of Niger and its Technical and Financial Partners encourage and oversee the introduction of other new vaccines, including the addition to the routine EPI calendar of the Pneumococcal vaccine, the rota virus vaccine and the Human Papilloma Virus Vaccine (HPV) within the context of the fight against cervical cancer. 

This document relates to the introduction, beginning in 2013, of the Human Papilloma Virus vaccine, in a "demonstration programme."
Two Health Districts were selected for this demonstration programme. The target population comprises 19 232 girls 11 years of age for 2013, and 19 867 girls of the same age for 2014. These girls aged 11 years represent 20.64% of the adolescent population 9-13 years old (93 150) and 3.57% of the total female population (INSMEN: Institut National de la Statistique and the Ministry of National Education. The proportion of girls attending school is 41.18% in the three selected locations.
The strategy selected to cover these target populations is the organization of immunisation campaigns in accordance with the procedure for using the HPV vaccine (requirement of 3 administrations:  M0, M2 and M6).
The following essential activities will be carried out during the implementation of this demonstration program.  They are. 
- Promotion of awareness and mobilisation of populations with the support of local elected officials, political and administrative leaders, Traditional Leaders, religious leaders, other community managers and participants in civil society; 
¥	- The training of the primary participants (community relays, care providers, logistics);
- The organization of correct waste management after immunisation campaigns;
- Surveillance of Adverse Effects Following Immunisation (AEFI);
- and the evaluation of campaigns.

The tentative budget for this HPV vaccine introduction programme is 264 645 USD (Operating Costs).]
Immunisation Programme Data

Q3.	Please provide national coverage estimates for DTP3 for the two most recent years from the WHO/UNICEF Joint Reporting Form in the table below. If other national surveys of DPT3 coverage have been conducted, these can also be provided in the table below. 

Trends of national DTP3 coverage (PENTA3) (percentage)					
Vaccine	Reported	Survey			
	2010	2011	2010 	2010 (Whole country)	
DTC3 (PENTA3)	92 %	97 %	91% (Niamey Region)
98% (Maradi Region)	78 %	

Q4.	If survey data is included in the table above, please indicate the years the surveys were conducted, the full title, and if available the age groups the data refer to.

[National vaccine coverage survey - EPI 2010 Programme Review Children from 12 to 23 months

Note: The IRC may review previous applications to GAVI for a general understand of country's capacities and challenges.
HPV Demonstration Programme Plan
District(s) profile

Q5.	Please describe which district or districts have been selected for the HPV Demonstration Programme, completing all components listed in the table below.

Component	District 1 NIAMEY 2 	District 2 MADAROUNFA	
Topography (% urban, % semi-urban, % rural, % remote, etc.)	[96% urban, 4% rural], data source [% obtained from INS data]	[14,1% urban ; 85,9% rural], data source [INS/MEF ]	
Number and type of administrative subunits, e.g., counties, towns, wards, villages 	[Municipal district Niamey 3 and 4;  28 neighborhoods and 6 villages], data source [District Niamey2]	[415 villages], data source [RGP 2001] 	
Total population in 2012	 604 909], data source [INS]	[419 325 hts], data source [INS]	
Total female population (%) in 2012	[326 255 of 53,93%], data source [INS]	[211 984 or 50.55%], data source [INS]	
Total female population aged 9-13 years (% of total female population)	[45 944 or 14.08%], data source [INS]	[47 206], data source [Departmental Population Office of Madarounfa]	
Number and type of public health facilities 	[26 health facilities, including one reference maternity center: 1 Regional hospital; 20 IHCs and 4 health huts], data source [District Niamey2]	[19 IHCs, 1 HD, 38 Health Huts] data source [District of Madarounfa-PDSD 2011- 2015]	
Number and type of health workers in all district public health facilities	[628 incl. 68 physicians, 215 nurses, 23 social workers, 11 THA, 39 laboratory assistants and 55 helpers, another 67], source of data [District Niamey 2]	[7 physicians, 1 Manager, 1 Epidemiologist, 1 communications specialist, 1 TSSI, 54 Nurses, 5 THA ,12 S F, 2 TSCGO,1 TSAR, 3 TL , 2 AS, 35 ASC, 2 drivers, 2 ambulance drivers, 5 operators], source of data [District of Madarounfa]	
Number and type of private health facilities 	[55 incl. 2 multi-clinics, 15 clinics, 13 medical offices, 24 treatment rooms and 1 ophthalmological hospital], data source [Niamey 2 District]	[3 treatment rooms, 1 Leprosy Hospital], data source Madarounfa District]	
Number and type of health workers on staff in private health facilities in the district	63  including  14 physicians, 19 nurses, 2 midwives, 10 laboratory assistants and 18 helpers  and data source [District Niamey 2]+	3 physicians and 12 nurses], data source [District of Madarounfa]	
Number and type of public and private primary and secondary schools	[191 Primary, traditional and franco-arab schools, public and private], data source [Inspectorates Niamey 3 and 4]	330 primary schools, 23 secondary schools], data source [Basic education inspectorate and Departmental Ministry of Education of Madarounfa	
Number of teachers in public and private primary and secondary school	[1 774], data source [DREN/A/PLN]	[1 583], data source [Basic education inspectorate and Departmental Ministry of Education of Madarounfa 	
Estimates of the number and percent of girls attending school for each of the following ages:
9 year old girls
10 year old girls
11 year old girls
12 year old girls
13 year old girls	[25 023 or 54.46%], data source [DREN/A/PLN]

6 368 …….…..67%
5 529…………59%
5 399…………59%
5 083…………56%
2 644…………30% Without secondary data	10 795 or 44.8%], source of data [Inspectorate of Basic Education of Madarounfa]]
2288..............19.06%
2261..............28.67%
2521..............25.15%
1743..............22.87%
1982..............18.58%
source of data [Inspectorate of Basic Education of Madarounfa]]	
Estimates of the number and percent of girls out of school for each of the following ages:
9 year old girls
10 year old girls
11 year old girls
12 year old girls
13 year old girls	[20 921 or 45.53%], data source [DREN/A/PLN]

3077..............33%
3,802..............41%
3,808..............41%
3,982..............44%
6,252..............70%	36 411 or 55.2%], source of data [Inspectorate of Basic Education of Madarounfa]]
9717..............80.94%
5626..............71.33%
7504..............74.85%
5879..............77.13%
8685..............81.42%	

Q6.	Please give a brief description of why this district (or districts) was (were) selected to participate in the HPV Demonstration Programme.

[Ease of access and resupply in the Niamey District. Opportunity to compare the Niamey II District with the Madarounfa District which is a rural district with more spread out targets (question of resupply and supervision and coordination).
The program proposes focusing on marginalized adolescents and the most at-risk living in a rural environment.
So, very young, unmarried adolescents will be targeted first, both those who attend school and those who do not, at sites where the communities have already undertaken a change in social behavior due to grassroots initiatives and interventions, such as husbands' schools set up by UNFPA, grassroots interventions conducted by UNICEF (hygiene,  education of young women, early marriage) and in particular the new initiative titled "Respect adolescents' rights and respond to their needs" intended to reduce early marriage in adolescent girls that UNFPA will implement starting in 2013 with technical support from the Population Council (See Annex 1).
In addition, the programme will support work in progress under the multi-country Int+IEC research project (Integration of Health-community education) that is intended to conduct interventions that will provide evidence-based instructions to guide Adolescent Reproductive Health Policy in Niger. ]

Q7.	Please describe the operations of the EPI programme in the district(s) selected for the HPV Demonstration Programme.

Component	District 1 NIAMEY 2 	District 2 District of MADAROUNFA	
Number and type of administrative subunits (e.g. health facilities) used for routine vaccine delivery 	[17 health facilities authorized to perform immunisations]	[19 health facilities authorized to perform immunisations]	
Number and type of outreach sessions in a typical month used for routine vaccine delivery	[236 IEC/EPI meetings]	[247 IEC/EPI meetings]
 [18 radio broadcasts]	
DPT3 coverage	[See Pentavalent 3]	[See Pentavalent 3]	
Polio3 coverage  	[64%], year [2011]	[75%], year [2011]	
Measles first dose coverage 	[79%], year [2011]	[92%], year [2011]	
Pentavalent 3 coverage 	[91%], year [2011]	[99%], year [2011]	
TT2+ (pregnant women)	[74%], year [2011]	[88%], year [2011]	
‘* : Source: Administrative data

Q8.	Please summarize the performance of the district EPI programme as reported in any recent evaluation, for example identifying resources available, management, successes, and challenges.

[The two selected health districts experienced an improvement of their vaccine coverage aside from OPV3, related to an interruption in supply of this vaccine. Good functionality of the cold chain, the availability of human resources, logistics as well as strengthening of the EPI through technical and financial support from the partners has been observed.
In the District of Madarounfa  we have also observed promotion of awareness in secondary schools regarding sexual and reproductive health of youth and adolescents, the implementation of SSRAJ committees in schools in 2010 and tetanus immunisation (prevention of maternal and neonatal tetanus) in secondary  schools in 2012 (which will continue through the 1st quarter of 2013)   ]

Q9a.	Please describe any current or past linkages the district EPI programme has had with the primary and/or secondary schools in the district, e.g., going to schools for health education, delivery of vaccinations, outreaches, etc.

[The visit of the EPI programme in schools takes place within the context of the student immunisation campaigns (Campaigns for Measles, Maternal and Neonatal Tetanus, meningitis and poliomyelitis). 
Health promotion activities for adolescents are also conducted in schools, in particular the prevention of sexually transmitted diseases and unwanted pregnancies, prevention of tetanus and drug addiction.]

Q9b.	Please indicate if gender aspects relating to introduction of HPV vaccine are addressed in the demonstration programme?

[The demonstration program will only involve girls 11 years of age. Boys will be covered later with the generalisation throughout the whole country.]

Q9c.	Please describe any recent evidence of socio-economic and/or gender barriers to the immunisation programme through studies or surveys?

[Studies conducted to that point have shown:
¥	♣	a lack of information among mother regarding immunisation dates (24% review EPI 2010);
¥	♣	that mothers do not consider the importance of immunisation (17% Review EPI 2010);
¥	♣	that mothers' occupations (miscellaneous domestic work) has an effect on the use of immunisation services (17% Review EPI 2010) 

Nevertheless, there are other forces, including: 
¥	♣	the absence of rumors regarding immunisation; 
¥	♣	parents no longer oppose the immunisation of children;
¥	♣	religious have a very favorable opinion towards immunisation; 
¥	♣	the significant involvement of political authorities and service providers (EPI Review, 2010)

Objective 1: HPV vaccine delivery strategy

Q10.	Please describe the HPV vaccine delivery strategy selected (school-based, facility-based, outreach, mixed, other, etc.) and the rationale for its selection.

Note:  If the application proposes to use school as a venue for HPV vaccine delivery the minimal proportion of girls of the target vaccination cohort or target grade that is enrolled in school must be 75% nationwide (not only in the selected district). 

[The strategy selected is to organize 3 mass campaigns in schools for girls attending school and at specific sites for girls not attending school. The provision of health training and immunisation teams will be conducted by level: From the central level towards the districts and from the districts to the CSI. The latter refresh the immunisation teams during campaigns. This strategy allows 100% of the target to be reached.
It is important to note that the activities of this demonstration program will be fully integrated into the implementation of the multi-sectoral initiative titled "Respect adolescents' rights and meet their needs" directed at adolescent girls in the selected districts, and it will be based, for example, on the implementation of an overall health checkup for each participating girl in the programme (see the conceptual memo on the adolescent girl programme, attached).  It is expected that HPV immunisation of adolescent girls will facilitate first contact by adolescents with the health system, will facilitate visits to health centers for unmarried girls and will thus open the door to making a complete package of information and services on sexual and reproductive health available (including family planning and protection from HIV/AIDS and other STDs) for adolescents in targeted zones.]

Q11.	If schools are being used as a venue for HPV vaccine delivery, please state the percentage of girls in the target age group which are attending school in the district(s).

[NA:  Schools are not vaccine delivery points, however they were chosen as sites for the immunisation of students. The proportion of the target in the schools is 7 920 girls 11 years of age, i.e. 41.18% of the total target of 11 year old girls (18,232). 

Q12. Please identify a single year of age (or single grade in school) target vaccination cohort within the target population of 9-13 year old girls. Describe the total number of girls included and the proportion of the adolescent (10-19 year old) and female (all ages) population they represent. Identify the data source for this information and state whether these data have been validated by other means.

[Girls 11 years of age (19 232) represented 20.64% of the population of adolescents 9-13 years of age (93 150) and 3.57% of the total female population (Source INS/MEN). Data validated by the Institut National de la Statistique and the Ministry of National Education.]

Q13.	If the target population is a single grade in school, describe the percentage of girls in the target grade which are between the ages of 9 and 13 years and the data source.

Note:  If the strategy selects eligible girls based on their grade in school, then at least 80% of the girls in the target age group should be between 9 and 13 years of age (the WHO recommended age group for HPV vaccine). 

[The target population is present in primary as well as secondary school. It also includes girls that do not attend school.]

Q14.	Please describe how eligible out-of-school girls will be identified and the mechanism for providing them an opportunity to receive HPV vaccine.

[Girls who attend school are identified based on data supplied by the INS and the inspectorates of primary and secondary education, neighborhood chiefs, community contact persons and family heads. The specific sites selected in the strategy described above will allow girls who do not attend school to be reached in the neighborhoods.
In addition the programme will directly include participants in the "Respect adolescent rights and meet their needs" initiative, that is based on the methodology developed by the Population Council in order to identify the most at-risk girls in the communities. This involves analyzing the data collected by National demographic and health censuses to locate girls in rural communities and in neighborhoods. 
This analysis will be supplemented by a qualitative evaluation that for example will collaborate with the health initiatives intended for communities and children that use door to door contacts to identify the girls and boys at risk and locate services where girls (and boys) that are at-risk are located such as bus stops, youth centres, markets.  

Q15.	Please describe the mechanism for reaching all the target girls with three doses who were missed on the main vaccination days, specifying plans for reaching hard-to-reach or marginalized girls. 

[Catching up targeted girls with routine EPI during the early days will be accomplished at health facilities after excessive promotion of awareness among the population. Involvement of community relays to search for non-immunised girls and those that have lost contact and a cellular telephone identification system

Q16.	Please summarize ability to manage all the technical elements which are common to any new vaccine introduction, e.g. cold chain equipment and logistics, waste management, vehicles and transportation, adverse events following immunization (AEFIs), surveillance, and monitoring, noting past experience with new vaccine introductions (such as rotavirus, pneumococcal vaccine, etc.). 

[Districts have gained certain experience in organizing mass immunisation campaigns, in particular for measles (2004, 2008 and 2010), the introduction of MenAfrivac in (2010-2011). They are able to effectively manage difficulties related to logistics, waste management, monitoring of Adverse Events Following Immunisation (AEFI).  Recent evaluations of cold chain and logistics during general surveys of immunisation in September 2012 have determined the capacity of districts to introduce new vaccines to be effective. The strengthening of capacities of participants at all levels and supervision are still a factor contributing to the success of the various campaigns.]

Q17.	Please describe the cold chain status for the selected district and the data source(s) for this information. Information such as the number of cold storage facilities, function and working order of the facilities, storage capacity (and any excess capacity), distribution mechanism for routine delivery of vaccines, status of vaccine carriers and icepacks (e.g., supply shortages or excesses), and plan for HPV vaccine storage and distribution during the HPV Demonstration Programme. 

Component	District 1 NIAMEY 2	District 2 District of MADAROUNFA 	
Number and type of cold storage facilities 	[See answer to Question No. 18]	[See answer to Question No. 18]	
Functioning and working order of the facilities	[Good]	[Good]	
Storage capacity (any excess)	[140 m3 positive and 30 m3 negative. See Q18]	[47 refrigerators]	
Distribution mechanism	[See answer to Question No. 18]	[Monthly resupply]	
Number and status of vaccine carriers 	[180 units]	[168 units]	
Number and status of icepacks (any shortages or excess)	[30 units]	[47 units for a need of 73 refrigerators] 	

Q18.	Additional district cold chain information if necessary:

[With contributions from development partners like JICA, UNICEF, WHO, KOICA, etc., today Niger has at the central level (City of Niamey), 3 positive cold chambers with a total gross capacity of 130 m3 and 1 negative cold chamber with total gross capacity of 30 m3. Four backup power generators assure the operational continuity of the cold chambers in case of electric outage.
Districts in the Niamey region, considering their proximity, are supplied directly from the central EPI warehouse in Niamey. This is the case for the Niamey II district, in spite of the availability of 30 refrigerators, that could if necessary be supplied directly from the EPI cold chain.
The district of Madarounfa may also be supported by the cold chamber in the Maradi region for the storage of vaccines.
. ]

Q19. Please describe initial plans for training of health workers and others who will be involved in the HPV Demonstration Programme.

•		Preparation of an ongoing medical education (FMC) module for the various participants comprising the following subject areas: illness and the causal agent, immunisation, surveillance, communication, monitoring, follow-up and evaluation:
¥		Training of trainers from the central and regional level (numbering 10 supervisors and 6 health representatives)
¥		Training of trainers from the departmental level by the regional level under the supervision of the central level (Training of 5 members ECD and 1 CDI, 45 CSI heads, 10 contact points and supervisors of HD units, all CSI, care center and surface representatives for waste management, 40 team supervisors and 12 independent monitors, 45 vaccinators and 328 community relays);
¥		Development of a system for coordination and follow-up/evaluation

Q20.	Please describe initial communication plans for sensitizing and mobilizing communities for the HPV Demonstration Programme.

The anticipated communication plans comprise:

1.	1.	Development of lobbying 

•		The organization of meetings, information meetings and lobbying with political officials (President of the Republic, First Lady), religious and traditional leaders, local elected officials and economic operators (cellular telephone, Insurance, etc.) at the level of the 2 health districts.
•		The organization of lobbying meetings to address health supervisors to strengthen the communication capabilities of health personnel, in particular at the peripheral level. 
¥		The creation of a framework for exchanges with decision-makers, health agents and the community to share results

1.	2.	Reinforcement of social mobilization and partnership. 

•		The organization of meetings to promote awareness and for social mobilisation with NGOs, associations and community leaders at all levels in favor of the introduction of the HPV vaccine.
¥		Contracting partners (NGOs, Associations, Media, etc.) to contribute to organizing communication activities in favor of the introduction of the HPV vaccine (training supervision, monitoring and evaluation, etc.).

1.	3.	Communication for behaviour change: 

Preparation and implementation of microplans for communication at the level of the 2 districts;
•		The preparation, production, translation and dissemination of messages and educational materials regarding HPV immunisation and pharmacovigilance.
•		The production and implementation of activities to promote awareness regarding the new vaccine through community relays.

Q21.	Briefly describe any initial thinking about potential barriers or risks to community acceptance and the process or communication plan that might be used to address this. Consider briefly describing any positive leverage points that might be beneficial for programme implementation to promote acceptability. 

Obstacles
-	Reticence of the community regarding selecting the target
-	Risk that the vaccine will be perceived as a means of sterilising young girls;
Communication process to be put into place

-	Share a maximum level of information with the community;
-	Ensure that the messages disseminated through various channels are identical;  
-	Involve all organized groups (government authorities, religious leaders, associations and NGOs);
Accomplishments 

-	Integration of the HPV vaccine demonstration is part of a broader approach intended to respond to needs and respect the rights of adolescent girls supported by an alliance of technical and financial partners in particular those of the United Nations System (UNICEF, UNWOMEN, UNFPA) and national and international NGOs 
-	Girls' school attendance rate of 50.02% in Niamey;
-	Door to door communications strategy carried out by community relays;
-	Highest-level political involvement
-	"Husbands' Schools" Strategy 
-	Significant involvement by vendors;
-	Existence of a national plan to fight cancer for 2011-2015;
-	Existence of a programme for the screening and early treatment of pre-cancerous cervical lesions since 2002;
-	Free care for gynecological and mammary cancers since 2007;
-	Existence of a management committees for rumors and reluctance;
-	Existence of a mass media network.

Objective 1: HPV vaccine delivery evaluation plan

Q22.	Indicate the agency/person who will lead the evaluation required for the “Learn by Doing” objective.

The agency selected for evaluation of immunisation during the first year is the Institut National des Statistiques du Niger which has experience conducting major surveys (RGP/H, EDSN-MICS, SONU survey, vaccine coverage survey, etc.) and that is the guarantor of the quality of surveys in Niger.
Objective 2: Assessment of adolescent health interventions

Q23.	Please summarize the anticipated activities for the assessment of adolescent health interventions, such as planning milestones, stakeholder meetings, methodology for the assessment, process for identifying a lead for this activity, and the process to involve the TAG in this work.

Strategies:

1. Strengthening information, Education and Communication to change Behavior in regards to Reproductive Health (RH):
-	Support in the media for dissemination of programmes regarding the introduction of the HPV vaccine;
-	Social mobilisation and education activities for adolescents:
-	Support for the production and dissemination of social-educational media and promotional media regarding Adolescent and Youth Sexual and Reproductive Health (SSRAJ).

2. Strengthening of lobbying activities regarding Reproductive Health and for the reduction of barriers limiting access to Reproductive Health services.

- 	Support for religious in regards to the promotion of SSRAJ;
 - 	Support for motivation of parliamentary networks and of journalists to support the promotion of the rights of adolescents and youth in the area of their Sexual and Reproductive Health.

3. Strengthening of existing structures to respond to the needs of youth in regards to Reproductive Health services.

-	Trainings and workshops to strengthen the skills of participants:
-	Strengthening of capacities of structures to treat youth (youth-friendly sites):
-	Support for anonymous and voluntary HIV/AIDS testing among youth and adolescents.
-	Immunisation of youth and adolescents for certain diseases targeted by the EPI.
-	Campaign for deworming of youth and adolescents
-	Sexual education in schools.
Procedures for follow-up and evaluation
 
Follow-up/evaluation of the program will be integrated into existing regional and national mechanisms. It will be built around the following points: (i) the annual review; (ii) field visits/;Supervisions; (iii) periodic meetings of the technical team; (iv) evaluation of mass campaigns; (v) post-campaign coverage surveys.

Identification of the leader for this activity 

The Directorate of Mother's and Children's Health (DSME) through the Adolescent and Youth Sexual and Reproductive Health Division (SSRAJ) in collaboration with the Ministries responsible for Education, Youth and Culture.

The process anticipated for involving TAG in this work

The review of the composition of the SSRAJ steering committee to take into consideration all the TAG participants.

Objective 3: Development or revision of cancer control or cervical cancer prevention and control strategy

Q24.	Please summarize the planned activities for the development or revisions of a national cervical cancer prevention and control strategy, such as planning milestones, stakeholder meetings, methodology for developing the strategy, process for identifying a lead for this activity, and the process to involve the TAG in this work.

In the context of fighting the disease, Niger has prepared a National Strategic Plan to Prevent and Fight Cancer covering the period of 2011 through 2015. 
The principal thrusts of this process are: (i) institutional and partnership development; (ii) primary prevention (lobbying, IEC/CCC, immunisation); (iii) secondary prevention (early screening of pre-cancerous lesions); (iv) tertiary prevention (diagnosis and treatment)'; (v) strengthening of capacities; (vi) strengthening of legislation and regulations; (vii) promotion of research and monitoring/evaluation. 

In the context of the introduction of the HPV vaccine, emphasis will be placed on the following strategies: (i) institutional and partnership development; (ii) primary prevention (lobbying, IEC/CCC); (iii) strengthening of capacities; (iv) strengthening of legislation and regulations; (v) promotion of research and monitoring/evaluation. 

The main strategies adopted are as follows:
¥	-	Preparing a plan for communication and awareness regarding prevention and the fight against cervical cancer;
¥	-	Preparing training guides regarding the introduction of the HPV vaccine;
¥	-	Register the HPV vaccine with the National Regulatory Authority (ANR);
¥	-	Make the ethics committee aware for its approval of the introduction of the new vaccine;
¥	-	Organize HPV immunisation campaigns for the targeted populations;
¥	-	Organize supervision visits
¥	-	Organize periodic informational meetings with the primary participants;	
¥	-	Establish and strengthen partnerships with NGOs, institutions and research foundations;
¥	-	Organize a mid-point evaluation;
¥	-	Organize a final evaluation;

The methodology selected for the implementation of the strategy will place specific emphasis on: quality assurance, the principal of equity, the involvement of all participants in lobbying meetings and social mobilisation, trickle-down training sessions. 

The leader will be identified based on experience acquired from organizing mass campaigns, therefore the choice shall be made by the Directorate of Immunisations (DI). 

This strategy shall be implemented under the supervision of the TAG.

The agency responsible for reviewing the national strategic plan for fighting and preventing cancer is the Programme National de Lutte contre les Maladies non Transmissibles (PNLMNT) of the Ministry of Public Health.
This is a national document prepared by a committee to fight cancer created by ministerial decree and validated at a national workshop that brought together executives from the Ministry of Public Health and from other sector ministries, the Technical and Financial Partners, civil society and think tanks.
The leadership and national appropriation require compliance with these cardinal values for reviewing the national strategic plan for fighting and preventing cancer in order to develop HPV immunisation aspects.
The activities planned in this regard are:
- A retreat of the technical committee extended to the Directorate of Immunisations and the partners (UNICEF, WHO, UNFPA) will be organized on 28-30 January 2013 at Dosso with UNFPA financing.
- the revised document will be shared with all participants by email for review and amendments on 31 January 2013.
- a validation workshop will be organized on 12 February 2013 at Niamey with UNFPA financing.
  - Integration meeting for all comments and amendments selected during the workshop by the Coordinator of the Programme National de lutte contre les Maladies non Transmissibles (PNLMNT) and the Director of Immunisations on 13 February 2013.
- The revised National Strategic Plan for fighting Cancer will be sent to all workshop participants for final verification that the document reflects the conclusions of the workshop.
- Dissemination of the revised National Strategic Plan to Fight Cancer.  

Technical advisory group

Q25.	Please identify the membership and terms of reference for the multi-disciplinary technical advisory group established that will develop and guide implementation of the HPV Demonstration Programme and list the representatives (at least positions, and ideally names of individuals) and their agencies.

•		Countries are encouraged to use their ICC or a subset of the ICC as the multi-disciplinary TAG.
•		The TAG must at least have representatives from the national EPI programme, cancer control, education, and the ICC (if separate from the ICC), and adolescent and/or school health (if they are represented within the Ministry of Health).

Enter family name in capital letters.
Agency/Organisation	Name/Title	Area of Representation1	
MSP	SANDA Soumana, Minister	Public Health	
MSP	Dr  EKOYE Saidou, SG	Public Health	
MSP	HASSANE Namaka, SGA	Public Health	
MSP	SALIFOU Abdramane, CT	Public Health	
MSP	Dr MAIMOCTAR  Hassane, IGS	Public Health	
MSP	Dr  GALI ADAM  Asma, DGSR	Reproductive Health	
MSP	Dr SIDDO MOUMOUNI Daouda	Public Health	
MSP	Dr KAINE Abdoul-Aziz  ,DGR	Public Health	
MSP	OUSMANE Oumarou, DEP	Public Health	
MSP	Dr HAMIDOU  Oumi ,DOS	Public Health	
MSP	ADAKAL  Aboubacar, DS	Health information	
MSP	SADOU Boureima , DHP / ES	Communication pour la santé	
MSP	Dr MAIGA Idrissa, DSRE	Surveillance	
MSP	Dr HAMADOU Adamou, DI	Immunisation	
MSP	Dr ISSOUFOU Aboubacar, DLM	Public Health	
MSP	Dr Yayé Youssouf, Coord PNLMNT	Fight against cancer	
MSP	Dr ASSAN Abdoul Nasser, DI	Immunisation	
MSP	Dr GARBA  Mata,  DI 	Vaccination	
MSP	Mrs HASSANE  Hadjara,  DI	Vaccination	
MSP	Mrs. DEJEAN  Mariama,  DI	Immunisation	
Ministry of Education	Representative	School health	
UNFPA	Representative	Reproductive Health	
OMS	Representative	Public Health	
Unicef	Representative	Public Health	
Faculty of Sciences and Health (FSS)	Pr NOUHOU Assan	Cancer Registry	
Société de gynéco-obstétrique du Niger	Pr Madi  NAYAMA, Président	Lutte contre le cancer	
Société de cancérologie	Pr. HAROUNA Yacouba, Président	Lutte contre le cancer	

These other participants may be invited to certain meetings
Minister of Education, Minister of Foreign Affairs and Integration, Minister of National Defense, Minister of Population, Promotion of women and Protection of Children, Minister of Youth and Culture, Minsiter of Communication, Minister of the Interior, Minister of Finance, Helekene Heller International [sic], Rotary International, Save the Children, Jica, Koica, World Vision, Plan Niger, Nurses Association of Niger, Network of Health Communicators, Nigerian Public Health Association, /Association of Midwives, Tatalli Foundation, NGO SOS Cancer, NGO TUCC, Health Training Schools, Association of Traditional Leaders, Associations of Religious Leaders, ROASSN, PNUD, World Bank, PAM, European Union, Care International

1 Area of representation includes cancer control, non-communicable disease, immunisation, adolescent  health, school health, reproductive health, maternal or women’s health, cervical cancer prevention, nursing association, physicians, health communications, midwives, civil society group, education, etc.

The TAG may, as necessary, call upon any person with skills that may be useful to the establishment of the program to introduce the HPV vaccine.

The TAGs role is to assist the Ministry of Public Health in the implementation, monitoring and evaluation of the program to introduce the HPV vaccine. 
In this regard it has the authority to:
¥	♣	Develop and implement immunisation strategies;
¥	♣	Adopt assistance in the examination and approval of the plan to introduce the HPV vaccine;
¥	♣	Assist the Immunisations Directorate in ensuring transparent and effective management of the programme;
¥	♣	Support and encourage the exchange of information and feedback at all levels of the national health system and with partners;
¥	♣	Ensure the coordination of intervention by partners in regards to HPV immunisation;
¥	♣	Coordinate the planning of all activities for HPV immunisation.

Q26.	If known, please indicate who will act as the chair of the technical advisory group.

Enter family name in capital letters.
	Name/Title	Agency/Organisation	Area of Representation	
Chair of Technical Advisory Group	Mr. SANDA Soumana, Minister	Ministry of Public Health	Public Health	

Project manager/coordinator

Q27.	List the contact details, position, and agency of the person who has been designated to provide overall coordination for the day-to-day activities of the two-year HPV Demonstration Programme, taking note that a technical officer/lead/manager from EPI might be most suitable as a part of their current role and responsibilities. 

Enter family name in capital letters.

The person responsible for the demonstration project, in Niger, is Dr HAMADOU OUSSEINI Adamou, Director of Immunisations.  If necessary, Professor NAYAMA Madi may fill in for him.

Name	Title	Contact information:	
Dr HAMADOU  OUSSEINI Adamou	Director 	Directorate of Immunisations
Tel : +22796831392; 
+227 90167015
Email: adamhama@yahoo.ca	
Pr  NAYAMA Madi 	Professor of Obstetric Gynecology/Technical Advisor to the Minister of Public Health	Faculty of Health Sciences
Issaka Gazobi Maternity Center
Tel : +22796495369
Email: madinayama@hotmail.com

Timeline 

The HPV Demonstration Programme will include immunization of the cohort of girls in two consecutive years (Figure I). Countries are required to begin vaccination in the demonstration district within two years of the application.
Figure I. HPV Demonstration Programme timeline
	First round of vaccination	Evaluation of first round	Second round of vaccination	
	Assessment feasibility integrated delivery 
Start cancer control strategy	If feasible, test joint delivery of services
Finalisation of cancer control strategy	
				
Planning	Year 1: demo project implementation	Year 2	

Q28.	Please modify as necessary and complete the timeline below for the main activities for HPV vaccination, assessment of adolescent health interventions, and development/revision of a national cervical cancer prevention and control strategy planned for the HPV Demonstration Programme. Applicants may want to complete this in MS Excel.

	 HPV Vaccine Demonstration Programme	
Year	2012	2013	2014	2015	
Quarter	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	
Activity	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Establish TAG	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Draft implementation plan	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Brief key stakeholders	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Establish implementing team	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Establish team to conduct assessment of ADH interventions	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Establish team to work on cervical cancer strategy	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Adapt IEC materials &communication plan	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Review and revise immunization forms	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Confirm space in district cold store	 	 	 	 		 	 	 	 	 	 	 	 	 	 	 	
Register the HPV vaccine with the National Regulatory Authority (ANR)	 	 	 	 			 	 	 	 	 	 	 	 	 	 	
Make the ethics committee aware for its approval of the introduction of the new vaccine	 	 	 	 			 	 	 	 	 	 	 	 	 	 	
Clear vaccine supply from customs	 	 	 	 			 	 	 	 	 	 	 	 	 	 	
Develop methodology for assessment of ADH interventions	 	 	 	 	 		 	 	 	 	 	 	 	 	 	 	
Preparation of a training plan	 	 	 	 	 			 	 	 	 	 	 	 	 	 	
Develop plan with key stakeholders for process of developing / revising cervical cancer strategy	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Microplanning at district	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Implement training plan	 	 	 	 	 				 	 	 	 	 	 	 	 	
Implement communication strategy in district	 	 	 	 	 	 			 	 	 	 	 	 	 	 	
Receive and transport vaccine to district	 	 	 	 	 	 	 			 	 	 	 	 	 	 	
Preparation of a training plan	 	 	 	 	 	 	 		 	 	 	 	 	 	 	 	
Conduct assessment of ADH interventions	 	 	 	 	 	 	 		 	 	 	 	 	 	 	 	
Deliver dose 1	 	 	 	 	 	 	 	 		 	 	 	 	 	 	 	
Mop-up sessions for dose 1	 	 	 	 	 	 	 	 		 	 	 	 	 	 	 	
Deliver dose 2	 	 	 	 	 	 	 	 		 	 	 	 	 	 	 	
Mop-up sessions for dose 2	 	 	 	 	 	 	 	 		 	 	 	 	 	 	 	
Deliver dose 3	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Mop-up sessions for dose 3	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Collect data to evaluate feasibility	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Conduct coverage survey	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Collect cost data	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Analyze evaluation data	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Write preliminary report of evaluation	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Write preliminary report of feasibility assessment of ADH interventions	 	 	 		 	 	 	 	 	 	 	 	 	 	 	 	
Review results from year 1 and outline any programme delivery changes for year 2, including whether to do joint delivery of HPV vaccine and an ADH intervention	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Submit financial report to GAVI (15 months after funds disbursed from GAVI)	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Submit progress report to GAVI 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
As appropriate, complete and submit GAVI application for national introduction	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Top up training or programme material revisions for year 2	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Microplanning for year 2 delivery	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
If joint delivery done in year 2, revise evaluation plan from year 1 for year 2	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
If joint delivery done in year 2, revise immunization forms, as needed	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Transport vaccine supply to district for year 2	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Implement communication strategy in district	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Prepare first draft of full cervical cancer strategy	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Deliver dose 1 in year 2	 	 	 	 	 	 	 	 		 	 	 	 	 	 	 	
Mop-up sessions for dose 1 in year 2	 	 	 	 	 	 	 	 		 	 	 	 	 	 	 	
Deliver dose 2 in year 2	 	 	 	 	 	 	 	 		 	 	 	 	 	 	 	
Mop-up sessions for dose 2 in year 2	 	 	 	 	 	 	 	 		 	 	 	 	 	 	 	
Deliver dose 3 in year 2	 	 	 	 	 	 	 	 	 	 		 	 	 	 	 	
Mop-up sessions for dose 3 in year 2	 	 	 	 	 	 	 	 	 	 		 	 	 	 	 	
If no joint delivery, gather routine programme and monitoring reports for synthesis of outputs	 	 	 	 	 	 	 	 	 	 	 		 	 	 	 	
If joint delivery done in year 2, conduct coverage survey	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
If joint delivery done in year 2, conduct cost analysis	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
If joint delivery done in year 2, collect and analyse feasibility data	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Prepare second draft of full cervical cancer strategy	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Analyse coverage, feasibility and cost data, if joint delivery done in year 2	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Draft evaluation report of year 2 vaccinations	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Final recommendations to TAG and MOH for national scale-up of HPV vaccine, including decision on joint delivery	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Submit financial report to GAVI (12 months after last report)	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Submit final progress report to GAVI 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Submit last draft of cervical cancer strategy to MOH	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Hold dissemination meeting to key stakeholders	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	

Budget

Q29.	Please provide a draft budget for year 1 and year 2, identifying activities to be funded with GAVI’s programmatic grant as well as costs to be covered by the country and/or other partner’s resources. 

Note:  If there are multiple funding sources for a specific cost category, each source must be identified and their contribution distinguished in the budget.

Cost category	Funding source	Estimated costs per annum in US$	
		Year 1	Year 2	
TAG meetings	[GAVI]	[4 409]	[0]	
Programme management and coordination	[GAVI]:	[21 980]	[11 736]	
Programme management and coordination	[WHO]	[11 209]	[7 334]	
Cold chain equipment	[GAVI]:	[3 596]	[1 284]	
Other essential equipment (immunisation cards)	[GAVI]:	[2 813]	[2 957]	
Personnel, including salary supplements and/or per diems	[GAVI]:	[20 170]	[17 840]	
Personnel, including salary supplements and/or per diems	[State]	[10 109]	[9 970]	
Personnel, including salary supplements and/or per diems	[WHO]	[13 448]	[8 863]	
Transport	[GAVI]:	[31 028]	[9 803]	
Training	[GAVI]:	[1009]	[1 022]	
Training	[UNFPA]	[989]	[1175]	
Community sensitization and mobilization	[GAVI]:	[76 965]	[10 023]	
Community sensitization and mobilization	[UNICEF]	[43 700]	[21 600]	
Waste disposal	[GAVI]:	[5 986]	[4 211]	
AEFI monitoring	[GAVI]:	[6 136]	[1 970]	
Monitoring and supportive supervision	[GAVI]:	[11 791]	[4 531]	
Monitoring and supportive supervision	[UNFPA]	[3 154]	[9 241]	
Evaluation of vaccine delivery	[]	[      0   ]	[      0   ]	
Assessment of feasibility of integrating AHD with HPV vaccine delivery	[]	[      0   ]	[      0   ]	
Draft national uterine cancer prevention and control strategy 	[UNFPA] 
	[      21 001   ] 	[  0 ]	
Technical assistance from local experts	[GAVI]:	[13 489]	[0  ]	
Subtotal for which GAVI funds are being requested	[       GAVI       ]	[199 381]	[65 264]	
Subtotal from other funding sources	[    Gov't., WHO, UNFPA, UNICEF          ]	[  103 558 ]  	[  58 227 ]	
TOTAL	[             ]	[302 939]	[123 491]	

Procurement of HPV vaccine

HPV vaccines must be procured through UNICEF. Auto-disable syringes and disposal boxes will be provided.

Q30.	Using the estimated total for the target population in the districts and adding a 10 % buffer stock contingency, please describe the estimated supplies needed for HPV vaccine delivery in each year in the table below.

2013 target = 19 232 - girls 11 years of age
2014 target = 19 867 - girls 11 years of age
Required supply item	Quantity year 1	Quantity year 2	Cost-Year 1	Cost-Year 2	
Number of vaccine doses	63 466	65 560	[1 237 592 $US] 	[1 278 424 $US] 	
Number of AD syringes	N/A	N/A	I0] 	[0]	
Number of safety boxes	635	656	[418 $US] 	[432 $US] 	
TOTAL	#		[1 238 010 $US]	[1 278 856 $US] 	

Q31.	Please indicate how funds for operational costs requested in your budget in section 6 should be transferred by the GAVI Alliance (if applicable).

¥	♣	[Preparation of the plan to introduce HPV and requests; 
¥	♣	Validation of the introduction plan and requests by the IACC;
¥	♣	Submission to GAVI and other Technical and Financial Partners for release]

Financial Management Arrangements Data Sheet

Information to be provided by the recipient organization/country		
1. Name and contact information of the recipient organization(s)	Ministry of Public Health (MSP) - Niger
BP 623/ Niamey/ Niger
Telephone No.: +227 20 72 25 34
The Directorate of Immunisations and the decentralized structures (Regional Directorate of Public Health of Niamey and the Niamey I, Niamey II and Niamey III Health Districts) are the implementation structures. 
	
2. Experiences of the recipient organization with GAVI, World Bank, WHO, UNICEF, GFATM or other donors-financed operations (e.g. receipt of previous grants) 	Yes 

If YES, indicate title, years and amount of grant : 
Introduction of the pentavalent vaccine in 2008
Amount of common funds, SSV, GAVI, SSI, RSS 

and provide the following: 

For completed Grants: 
¥	What are the main conclusions with regard to use of funds? 
Penta3 vaccine coverage increased from 2008 to 2012 (see coverage values)
For on-going Grants: 
¥	Most recent financial management (FM) and procurement performance rating?
Eligibility of Niger to introduce the pneumo 13 vaccine in 2013 and the rota virus vaccine in 2014 
¥	Financial management (FM) and procurement implementation issues? 
None	
3. Amount of the proposed GAVI HPV Demo grant (US Dollars)	264 645 $US	
4. Information about financial management (FM) arrangements for the GAVI HPV Demo Programme:		
•		Will the GAVI Demo Programme resources be managed through the government standard expenditure procedures channel?	Yes:
¥	♣	Resources in the program are managed according to the common funds procedures supporting the implementation of the 2011-2015 Health Development Plan.	
•		Does the recipient organization have an FM or Operating Manual that describes the internal control system and FM operational procedures? 	Yes: It is the common funds management and procedures manual (FC).	
•		What is the budgeting process? 	Existence of a joint device of the Ministry of Public Health / Technical and Financial Partners from the sector in regards to programming, monitoring and evaluation of plans of action for health structures through annual reviews.
This document is within the context of this device for the allocation of resources to the three selected Health Districts.	
•		What accounting system is used or will be used for the GAVI HPV Demo Programme? Is this system manual or computerised? 	Accounting system decentralised via common funds financial and accounting procedures.
The accounting system is computerised: software used = Tompro® 	
•		What is the staffing arrangement of the organization in accounting, auditing, and reporting? Does the implementing entity have a qualified accountant on its staff assigned to the GAVI HPV Demo Programme?  	¥	♣	Are there qualified personnel (common funds accountant at the central and regional level, and managers at Health District levels) trained in common funds procedures, who prepare reports?
¥	♣	An external audit of allocated funds is conducted each year;
¥	♣	A plan for implementation of the audit recommendations is prepared.
	
•		What is the bank arrangement? Provide details of the bank account at the Central Bank or at a commercial bank proposed to receive GAVI HPV funds and the list of authorized signatories. Include titles. 	National level: Composition of the Common Funds 
Bank Account:
Banque Internationale pour l’Afrique (BIA)-Niger
BP 10 350, Niamey-Niger 
No. NE040 01001 02511 0033847 89
SWFT: BIANNENI

Authorised signatures: 
Dr MALLAM EKOYE Saidou : Secretary General of the Ministry of Public Health
Mr NIANDOU   Adamou
	
•		 In the implementation of the HPV Demonstration Programme, do you plan to transfer funds from central to decentralized levels (provinces, districts etc.)? If yes, how will this funds transfer be executed and controlled?	Yes:
¥	♣	Transfer of funds from the Common Funds account of the Regional Directorate of Public Health of Niamey and the Health Districts in question;
¥	♣	The Secretary General of the Ministry of Public Health sends to the facilities the funds transfer notification and expense authorization letters;
¥	♣	The monitoring of bank documents is provided by the Financial Comptroller of the common funds. 	
•		Does the implementing entity keep adequate records of financial transactions, including funds received and paid, and of the balances of funds held?	Yes:
¥	♣	Ledger of bank accounts
¥	♣	Cash ledger
¥	♣	Reconciliation status of bank accounts with bank statements
¥	♣	Financial statements
¥	♣	Accounting components
¥	♣	Copies of bank checks issued 
¥	♣	Reference Terms and Conditions
¥	♣	Technical and Financial Reports
¥	♣	Internal auditing
¥	♣	External audit reports	
•		How often does the implementing entity produce interim financial reports?  	Interim financial reports are generated each month 	
•		Are the annual financial statements audited by an external audit firm or Government audit institution (e.g. Auditor General Department…)?	Yes: An external audit is conducted each year 	
5. Information about procurement management arrangements for the GAVI HPV Demo Programme:		
•		What procurement system is used or will be used for the GAVI HPV Demo Programme?	¥	♣	The supply of vaccines and consumables takes place quarterly from the Directorate of Immunisations to the Regional Directorate of Public Health and monthly from the Regional Directorate of Public Health to the Health Districts   
¥	♣	Immunisation centres are resupplied monthly from the Health Districts.
¥	♣	During mass immunisation campaigns, the facilities and teams are systematically resupplied upon receipt of vaccines and consumable supplies.	
•		Does the recipient organization have a procurement plan or a procurement plan will be prepared for this HPV Demo Programme? 	The Ministry of Public Health through the Directorate of Immunisations has a supply plan. It is valid for this HPV vaccine demonstration program.	
•		Is there a functioning complaint mechanism? 	Yes, there are IACC immunisation meetings at the central level and the Prevention and Epidemic Management Committees at the decentralized level.	
•		What is the staffing arrangement of the organization in procurement? Does the implementing entity have an experienced procurement specialist on its staff?	Qualified personnel responsible for supplying facilities is available at all levels (Directorate of Immunisations, Regional Directorate of Public Health, Health District and Integrated Health Center, Health Shacks).	
•		Are there procedures in place for physical inspection and quality control of goods, works, or services delivered?	Yes: They are supervision missions by level and monitoring during and after campaigns.
The partners (WHO, UNICEF) send consultants for the same purpose.
Immunisation Coverage Surveys 
Data Quality Survey (DQS)	

Signatures
Government

The Government of Niger acknowledges that this Programme is intended to assist the government to determine if and how it could implement HPV vaccine nationwide. If the Demonstration Programme finds HPV vaccination is feasible (i.e. greater than 50% coverage of targeted girls) and acceptable, GAVI will encourage and entertain a national application during the second year of the Programme. Application forms and guidelines for national applications are available at www.gavialliance.org. The data from the Demonstration Programme and timing of a national application are intended to allow uninterrupted provision of vaccine in the demonstration district and nation-wide scale-up.

The Government of Niger would like to expand the existing partnership with the GAVI Alliance for the improvement the health of adolescent girls in the country, and hereby requests for GAVI support for an HPV Demonstration Programme. 

The Government of Niger commits itself to improving immunisation services on a sustainable basis. The Government requests that the GAVI Alliance and its partners contribute financial and technical assistance to support immunisation of targeted adolescent girls with HPV vaccine as outlined in this application.

The Government of Niger acknowledges that some activities anticipated in the demonstration programme could be considered research requiring approval by local ethics committees (e.g., collecting data from a random sample of parents of eligible girls for the HPV vaccine coverage survey). We acknowledge we are responsible for consulting and obtaining approval from appropriate local ethics committees (e.g., human subject protection committee or Institutional Review Boards) in our country, as required. By signing this application, the Government of Niger and the TAG members acknowledge that such approval may be necessary and that it will obtain such approval as appropriate. 

The table in Section 6 of this application shows the amount of support requested from the GAVI Alliance as well as the Government of [Niger]’s financial commitment for the HPV Demonstration Programme.

Please note that this application will not be reviewed by GAVI’s Independent Review Committee (IRC) without the signatures of both the Minister of Health and Minister of Education or their delegated authority.

Q33.	Please provide appropriate signatures below.

Enter family name in capital letters.
Minister of Health
(or delegated authority)	Minister of Education (if social mobilization, vaccination or other activities will occur through schools)
(or delegated authority)			
Name	[M. SANDA Soumana ]	Name	[Mrs ALI Mariama Elhadj Ibrahim]	
Date	10/29/2012	Date	10/29/2012	
Signature		Signature		
See Annex 2 for signatures of authorities

Q34.	This application has been compiled by:

Enter family name in capital letters.
Full Name	Position	Telephone	Email	
[Dr Hamadou Adamou]	[Director of immunisations	[+227 96 83 13 92]	[adamhama@yahoo.ca]	
[Pr Madi  NAYAMA]	[Technical Advisor to the Minister, Professor of Obstetrics and Gynecology, Faculty of Health Sciences of Niamey]	[+227 96 49 53 69]	[madinayama@hotmail.com]	
[Dr Mariam DJAKOUNDA PASCAL]	[Responsible for the Reproductive Health Program, UNFPA]	+227 90 90 98 03	[mariama@unfpa.org]	
[Dr YAYE Youssouf]	[National Coordinator, National Program to Fight Non-communicable Diseases]	[+227 96 33 66 58]	[ysyaye@yahoo.fr]	
[Dr CHITOU Abdou Moudjibou]	[Unicef, EPI Contact Person]	[+227 96 35 32 32]	[mchitou@unicef.org]	
[Mr DOULAYE Boureima]	[Coordinator, Office of School Health, Ministry of National Education]	[+227 96 28 46 19]	[boureimadoulaye@yahoo.fr]	
[Mr SANI Oumarou]	[Director of Statistics and Demographic and Social Studies, Niger Institute of Statistics]	[+227 96 96 07 72]	[soumarou@ins.ne]	
Dr LAOUALI Aissata Abdou	Assistant General Secretary of the Ministry of the Population, Promotion of Women and Protection of Children	[+227 96 98 56 79]	aissatabdou@yahoo.fr

National Coordinating Body – Inter-Agency Coordinating Committee (ICC) for Immunisation

Q35.	We the members of the ICC, HSCC, or equivalent committee met on [24 October 2012]to review this proposal. At that meeting we endorsed this proposal on the basis of the supporting documentation which is attached. 

The endorsed minutes of this meeting are attached as DOCUMENT NUMBER : [Annex 3].

Enter family name in capital letters.
Name/Title	Agency/Organisation	Signature	
[Type text]	[Type text]		
[Type text]	[Type text]		

See the list of IACC meeting participants: Annex 4

Q36.	In case the GAVI Secretariat has queries on this submission, please contact:

Enter family name in capital letters.
Name	[Dr Hamadou Adamou]	Title	[Director of Immunisations]	
Tel No.	[+227 96 83 13 92]			
Fax no	[Type text]	Address	[Directorate of Immunisation, Ministry of Public Health, BP 623, Niamey-Niger]	
Email	[adamhama@yahoo.ca]			
Optional supplemental information

Q37. If available, countries may provide additional detail in the table below on training content, role, and framework.
Who will be trained	Role in vaccine delivery
(e.g., sensitization, mobilization, immunization, supervision, monitoring, etc.)	Training content
(e.g., basics on cervical cancer, HPV, HPV vaccine, IEC messages, safe injections, AEFI monitoring, etc.)	Who will provide the training?	
Health workers	[Estimate of needs, preparation of orders]	[Office of HPV vaccines, surveillance of AEFI]	[Supervisory teams from health districts]	
Supervisors	[Audit of vaccine availability in health facilities]	[Office of vaccines, DQS, RED/ACD]	[Immunisations Management Team]	
District leaders	[Resupply of health centers and immunisation sites]	[DQS, RED/ACD, Office of Vaccines, Surveillance of AEFI, destruction of waste]	[Immunisations Management Team]	

Q38. If available, countries may provide additional detail in the table below on the types of information and/or materials that may be used/disseminated, to which audience, by which mechanism, and the frequency of each.

Types of information or materials
(e.g., leaflet, poster, banner, handbook, radio announcement, etc.)	Audience receiving material
(girls, parents, teachers, health workers, district officials, community groups, etc.)	Method of delivery
(e.g., parent meetings, radio, info session at school, house visit, etc.)	Who delivers
(e.g., teachers, health workers, district official, etc.)	Frequency & Timing
(e.g., daily, weekly, twice before programme starts, etc.; day of vaccination, two weeks before programme begins, etc.; )	
Brochures 	Students, teachers	Informational meetings in schools, conferences	Health agents, teachers	Weekly before the program	
Posters	School institutions 	Primary and secondary inspections	Health agents, teachers	Illustration 	
Banners	Public spaces	communities	Local participants	sporadic	
Advertisements and magazine press	Urban readership
Targeted types	Advertising announcements, appropriate messages	Health bulletin 
media	Monthly / Quarterly	
Radio	Community groups	Community awareness, encouraging discussions, public assemblies (participation)	Health workers
Media professionals, opinion leaders, coordinators 	Partnership for public understanding	
Television	Larger audience	Dialogues, Leaders and local participants (networks)	Officials and Participants 	Monthly	

The mass media, in particular radio, are most effective a priori because they allow greater dissemination, broader circulation of information with a direct impact.

Q39. (optional) Technical partners (e.g. local WHO staff) are required to participate in planning and conducting the evaluation of HPV vaccine delivery. Please specify if such (an) expert(s) already exist on the country team (name, title, organization). Alternatively, or in addition, an international participant can be requested through technical partners if additional expertise is thought necessary.

[Dr Gervais Gahonganos-OMS-+227 96 84 68 68- gahonganog@ne.afrowho.int; Mr Harou Moussa-WHO- +227 96 96 77 19-moussah@ne.afro.who.int; ,  Dr ABDOU MOUDJIBI Chitou –UNICEF- +227 96 35 32 32 mchitou@unicef.org; Dr HAMISSOU Maoudé-UNICEF- 97 06 76 71- hmaoude@unicef.org; ]

Q40. (optional)	In the table below, countries can provide a brief summary of the current adolescent health services or interventions and health education activities and implementing agencies in the district selected to implement the HPV Demonstration Programme. 

Please add additional tables if necessary.
	intervention	intervention	intervention	intervention	
Description of intervention	Creation of health services adapted to Reproductive Health needs of adolescents and youth 

	Training of health providers and peer educators for approach to youth and current life skills	Promotion of health services adapted to adolescents and youth and lobbying among political and traditional leaders for the promotion of SSRAJ 	Peer education in youth organisations and school institutions	
Agency and provider delivering the intervention	Min. Public Health / DSME / SSRAJ Division 	Min. Public Health / DSME / Division 	Min. Public Health / DSME
Division 	Min. Public Health / DSME / Division  	
Target population by age, grade, and sex	Girls and boys 10-24 years of age	Girls and boys 10-24 years of age 	Girls and boys 10-24 years of age	Girls and boys 10-24 years of age	
Number and types of facilities implementing	26 centers set up and equipped to respond to youth needs  	Personnel from centers friendly to youth and peer educators	All Ministries related to youth issues (health, youth, education, population	Primary and secondary school institutions as well as youth organizations (formal and non-formal)	
Geographic location(s) of the intervention (where in the country)	All the 8 regions of the country	All the 8 regions of the country 	Central and regional leaders 	All regions of the country	
Timing of the intervention (when)	Between 2004 and 2010	From 2010 to date	From 2011 to date	From 2006 to date	
Frequency of the intervention (how often)	Annual 	Annual	Quarterly 	Weekly 	
Coverage of the target population (recent year)	10-24 years	10-35 years 	Political and religious leaders	10-24 years	
Coordinating agency	DSME / SSRAJ Division	DSME/
SSRAJ Division	DSME/
SSRAJ Division	DSME / SSRAJ Division	
Collaborating partners	Ministry of youth and youth organisations 	Ministry of youth and youth organisations 	 Ministry of youth	Ministry of Education and Higher Instruction	
Implementation costs of the intervention, if known	USD 151 000	USD 240 284	USD 165 000	USD 379 633	
Funding source, if known	UNFPA 	UNFPA 	UNFPA and European Union 	UNFPA 	
Data source(s) for the information on each intervention	Annual report of activities of the DSME/SSRAJ	Annual report of activities of the DSME/SSRAJ and youth organisations 	Annual report of activities of the DSME/SSRAJ 	Annual report of activities of the DSME/SSRAJ 	

Q41. (optional) 	Provide a brief summary of the current cervical cancer prevention and treatment services and implementing agencies in the district selected to implement the HPV Demonstration Programme. If available, countries can include information on target populations, delivery structure, and funding sources.

[Treatment of cervical cancer is primarily provided at the Centre National de la Santé de la Reproduction for the early screening of precancerous lesions using the IVA and IVI method followed by a biopsy of the cervix in the case of suspect lesions. In addition, mass screening campaigns are organized periodically in the regions. For surgery and chemotherapy for cervical cancer, the treatment is provided through the IssaKa Gazobi maternity hospital and the National Hospital at Niamey. For radiation therapy (since the national radiation therapy centre is under construction, opening in the first quarter of 2013) evacuation is necessary for treatment and the primary destinations are France, Tunisia, Morocco and Ghana)

Q42. (optional)	Describe the plan for securing Ministry of Health approval of the draft national cervical cancer prevention and control strategy and any activities for dissemination to national, sub-national, and/or local partners and stakeholders.

[The Ministry of Public Health has a national plan for treating cancers. The Ministry of Public Health is the Chair of the Technical Consultation Group that will coordinate this pilot program.]

Q43. (optional)	If known, please indicate the representatives of the TAG that will be involved in the assessment of the feasibility of integrating selected adolescent health interventions with delivery of HPV vaccine. 

Enter family name in capital letters.
	Name/Title	Agency/Organisation	Area of Representation	
TAG member involved in assessment of ADH interventions 	[Mr. ISSA SADOU]	[UNFPA]	Responsible for the Gender and Human Rights Programme lead youth cluster]	
TAG member involved in assessment of ADH interventions 	[Dr YOUSSOU YAYE  ]	Ministry of Public Health	[National Coordinator, National Program to Fight Non-communicable Diseases]	
TAG member involved in assessment of ADH interventions 	Dr HAMISSOU MAOUDE	UNICEF	Immunisation	
	[Dr ASSAN ABDOUL NASSER]	[Ministry of Public Health]	[Head, Immunisation Division, Directorate of Immunisations]	
TAG member involved in assessment of ADH interventions 	Dr ADAMA OUEDRAGO	UNICEF	Maternal Health	
TAG member involved in assessment of ADH interventions 	Dr EMILIE HOMAWOO	UNICEF	Maternal Health / HIV / AIDS	

Q44. (optional)	If known, please indicate the representatives of the TAG that will be involved in the development or revision of a draft national cervical cancer prevention and control strategy.

Enter family name in capital letters.
	Name/Title	Agency/Organisation	Area of Representation	
TAG member involved in cervical cancer strategy	[Pr Madi  NAYAMA]	[Faculty of Health Sciences of Niamey]	[Technical Advisor to the Ministry of Public Health	
TAG member involved in cervical cancer strategy	Pr NOUHOU HASSANE	[Faculty of Health Sciences of Niamey]	Anatomy-Pathology Laboratory	
TAG member involved in cervical cancer strategy	Dr TAHIROU ALMOUSTAPHA	[MSP	National Radiation Therapy Center	
TAG member involved in cervical cancer strategy	Mr HASSAN ATAMO	MSP	National Reproductive Health Center	
TAG member involved in cervical cancer strategy	[Dr HAMADOU ADAMOU]	[Ministry of Public Health]	[[Directors of Immunisations]	
TAG member involved in cervical cancer strategy	[Dr Mariam DJAKOUNDA PASCAL]	[UNFPA]	[Supervisor, Reproductive Health Program, UNFPA]	
TAG member involved in cervical cancer strategy	ISSA SADOU]	[UNFPA]	[Responsible for the Gender and Human Rights Program lead youth cluster]	
TAG member involved in cervical cancer strategy	[Dr YOUSSOU YAYE  ]	Ministry of Public Health	[National Coordinator, National Program to Fight Non-communicable Diseases]	
TAG member involved in cervical cancer strategy	[Dr ASSAN ABDOUL NASSER]	[Ministry of Public Health]	[Head, Immunisation Division, Directorate of Immunisations]	
TAG member involved in cervical cancer strategy	Dr GERVAIS GAHONGANO	WHO	Directorate of Immunisations	
TAG member involved in cervical cancer strategy	Dr CHITTOU ABDOU MOUDJIBI	UNICEF	Directorate of Immunisations	

TAG member involved in cervical cancer strategy	Dr ADAMA OUEDRAGO	UNICEF	Maternal Health	
TAG member involved in cervical cancer strategy	Dr EMILIE HOMAWOO	UNICEF	Maternal Health / HIV / AIDS	

Q45. (optional)	If present, please describe the distribution of de-worming medication (anti-helminths) in the district(s). 
Component	District 1 [NIAMEY 2] 	District 2 (if applicable) [Type text] name	
Organization of the de-worming programme	[Distribution of albendazole, ivermectin and praziquantel]	[Distribution of albendazole, ivermectin and praziquantel]	
Lead agency	[National Programme to fight bilharziasis and geohelminths and the National Programme to fight onchocercose and lymphatic filariases]	[National Programme to fight bilharziasis and geohelminths and the National Programme to fight onchocercose and lymphatic filariases]	
Implementing agency and partners	[WHO]	[WHO]	
Funding source(s)	[WHO, HKI, Merck, GSK]	[WHO, HKI, Merck, GSK]	
Frequency and timing of implementation, e.g. twice yearly in March and October	[Annual]	[Annual]	
Number of beneficiaries in target population by age group and sex	[214 990 subjects 24 to 59 months old reached in 2011 out of a target of 285 000], data source [Data for Niamey II District]
	[99 135 subjects 24 to 59 months old reached out of 104 762 ], data source [Data for Madarounfa District]	
De-worming coverage by age group and sex	[75.43%], data source [Data for Niamey II District]
	[94.62%], data source [Data for Madarounfa District]	

Q46. (optional) 	If present and relevant, please describe any organized semi-annual health days (e.g., Child Health Days) that are currently implemented in the district(s). 
Component	District 1 [Type text] name	District 2 (if applicable) [Type text] name	
Organization of the semi-annual health days	[Type text]	[Type text]	
Lead agency	[Type text]	[Type text]	
Implementing agency and partners	[Type text]	[Type text]	
Funding source(s)	[Type text]	[Type text]	
Frequency and timing of implementation, e.g. twice yearly in March and October	[Type text]	[Type text]	
Services delivered	[Type text]	[Type text]	
Number of beneficiaries in target population by age group and sex	[Type text], data source [Type text]	[Type text], data source [Type text]	
Coverage of the various services delivered by age group and sex	[Type text], data source [Type text]	[Type text], data source [Type text]	

Q47. (optional)	If present, please describe any organized health education programmes implemented at schools and/or in the community that are currently implemented in the district(s). 

Component	District 1 [NIAMEY 2] name	District 2 (if applicable) [Type text] name	
Organization of the health education programme 	Creation of youth clubs in schools	[Type text]	
Lead agency	Min. Public Health / DSME 	[Type text]	
Implementing agency and partners	DSME / SSRAJ Division 	[Type text]	
Funding source(s)	UNFPA 	[Type text]	
Frequency of services, e.g. once a month, weekly, etc.	2 times / month 	[Type text]	
Services delivered	Awareness regarding various subjects of SSRAJ (STDs/HIV/AIDS, Youth Friend Centres, PF, induced abortion, ...) [	[Type text]	
Location(s) of service delivery	School institutions 	[Type text]	
Number of beneficiaries in target population by age group and sex	Students from 10 schools (12-24 years) 	[Type text], data source [Type text]	
Coverage of the various services delivered by age group and sex	10 school institutions in Niamey (12-24 years)	[Type text], data source [Type text]