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Health Research - Supporting Material

Wellcome Grant Proposal on Public Engagement - Breathe Safe, Kick-Out TB Fest

Submitted By

Hano Academy

Address: Hano Academy, KM5.Hodan District, Mogadishu Somalia.

Tel: + 262 (0) 617520777 | (0) 690322188 | (0) 617773650

Website: wwww.hanoacademy.com

Email: [email protected]

Contact Person - Dr Sadiyo Siad at [email protected]

1stMay 2018

Table of Contents

Summary. 3

Project Background. 4

Aims. 5

Objectives. 5

Project Outputs. 6

Project Approach and Methodology. 6

Stage 1 - Planning. 7

Stage 2 - Development. 7

Stage 3 - Implementation. 7

Stage 4 – Monitoring, Evaluation, Review and Dissemination of Information. 8

Monitoring and Evaluation Plan. 8

I. Key Evaluation Questions. 8

II. Evaluation Work plan. 9

Expected Outcomes. 16

Long Term Impacts. 16

Target Population. 17

Past Experience/ Knowledge. 19

Personnel 19

Project Director and Lead Researcher. 19

Consultant. 20

Senior Managing Volunteers Team.. 21

Partners in Universities. 21

Partners in Secondary Schools. 21

Performing Artists Partners. 21

Security Planning. 22

Knowledge Sharing. 22

Risk Register. 23

Budget 26

Summary

Breathe Safe, Kick-Out TB Fest is the first project of its kind in Somalia. The project follows previous reports and research that suggested a high number of tuberculosis (TB) cases in Somalia, Kenya and Ethiopia[1]. It also follows other previous health campaigns in other parts of East Africa, that didn’t include Somalia. These areas are known for refugee crisis due to the instability in Somalia. Hano Academy intends to deliver a high-profile platform for inspirational performances narrating the sad tale of TB and how to counter the spread of TB in the region. Other forms of public engagement include art performance, seminars, workshops, panel discussion, debates, presentations, TB Exhibition Caravan, Breathe Safe, Kick-Out TB Festival related to TB self-awareness for diagnosis purposes and prevention, treatment seeking and precautionary measures for the public at large through health research.

The initiative will involve a minimum of 600 people including university and secondary school students, performing artists, Internally Displaced Persons (IDP’s), Refugee Returnees and the low-income dwellers who live in refugee camps and other informal settlements in Somalia.

The out-layering program is to examine widely and gain public knowledge on TB infection, causes, dangers, diagnosis, treatment and prevention through health researcher - engaging the public thoroughly. The project will also discuss the journey of a TB patient, primitive cultural beliefs on the causes of TB and scientific approach in determining, prevention and treating the disease.

The program targets the wider public but the main intended audience include health professionals specializing in TB treatment, IDPs, Refugee Returnees, TB patients, universities and secondary schools students and young people with interest in studying a course in communicable diseases, especially TB.

At the end of three years, we will have created a national dialogue platform to enable the public including TB patients, healthcare professionals and other participants to explore and discuss the role of Science in preventing, diagnosing and treating TB in Somalia. We also hope to have established TB scientific/health Research Steering Group which will help the establishment of a Research Centre in Mogadishu, Somalia where aspiring and established medical researchers will research for better ways of eradicating TB out of Somalia. As a result, we hope:

(i) To identify ways of improving the support for TB patients and make them feel less-isolated,

(ii) (ii) To clear the misunderstanding and wrong beliefs about the disease through health research explanation. A clear understanding of TB will foster improved patient care, early seeking of treatment and prevention of the spread of TB. All project activities including art performance (drama play, songs, poems and dances), debates, presentations, seminars, workshops, TB Exhibition Caravan and Breathe Safe Kick-Out TB Fest Festival will be video-recorded and shared on our website and other media outlet. Research reports will be compiled and presented to the funding body. The information will also be shared in Somali National TV and Radios.

Project Background

According to the Journal of Infection in Developing Countries (JIDC), [2]Somalia is one of the countries in the world with the highest reported rates of TB. [3]This is attributable to various reasons including cultural beliefs, pollution, mass movement of populations due to civil strife and the movement of refugees from their countries of exile back to Somalia. The journal found out that the areas experiencing armed conflicts are prone to uncontrolled spread of TB. The research cites lack of opportunity to seek medical attention in time as one of the major reasons. The study also suggests that congestion of people in one place doubles the risk of spreading TB. This situation is evident in most parts of Somalia especially in IDP camps and returnee refugee camps.

Armed conflicts fuel TB epidemics escalate poverty and malnutrition thereby increasing the numbers of susceptible TB patients. It also deters the patients from seeking medical attention. This lengthens the infectious period and increases the Postoperative Length of Stay (POLS) of infection in the community. These, coupled with the drought and famine that occurs each year in Somalia, as well as the Somali cultural beliefs concerning TB have made the country a hot spot for the disease. As the population increases, there are fears that the disease will spread faster. Given the lack of health infrastructure in Somalia and lack of public awareness, TB might become a major killer disease in Somalia.

This project seeks to address one of the most important, but neglected sector of the Somali health status. The country is ranked among the countries with the highest number of TB patients in the world[4]. Whereas the neighboring nations have implemented measures and projects to counter this epidemic, however, the situation is different in Somalia. Tuberculosis is caused by bacteria called Mycobacterium Tuberculosis and is spread through the air when the infected person sneezes, laughs or coughs. Living with an infected person increase the chances of getting infected. Currently, Somalia is witnessing massive repatriation of its citizens from countries of refuge back home. The majority of these Refugee Returnees are from Kenya, Ethiopia and Yemen. Most of these refuge returnees end up in Mogadishu where they join the Internally Displaced Persons (IDPs). Life in IDP camps is deplorable and creates a fertile ground for the spread of the tuberculosis. The situation is worsened with pollution arising from incessant bomb attacks in the region. Although the UN agencies have tried to determine the extent of the TB menace, it is impossible to get an accurate figure as most people don’t volunteer their health condition.

According to the WHO reports, Somalia is ranked number 4 among the countries with the highest rate of TB infections[5]. According to the report, 5.03% of deaths in Somalia are caused by TB. This gives an overall death rate of123.01 per100,00 people.

The populations at high risk include family and friends of TB patients, people migrating from areas with TB prevalence, people living in a congested place e.g. IDP settlement centers, and people working in hospitals, prisons, nursing homes and overpopulated residential areas. Our project targets the public within these groups that are at a high risk of getting infected.

Aims

The aim of this project is to engage the public through difference health research educational activities including

(i) Breathe Safe, Kick-Out TB Festival which contains art performances such as drama play, songs, poems and dances; exhibition, symposium, talks and discussions

(ii) TB Exhibition Caravan

(iii) Training including Seminars and Workshops

(iv) Conducting a qualitative and quantitative health research on TB. This will encourage the public to seek early diagnosis and treatment and advise prevention; and make them to be aware of the disease.

Objectives

Hano Academy seeks to achieve the following objectives during the different implementations stages of the project:

· Increase awareness and knowledge on TB including signs and symptoms, modes of transmission, importance of seeking medical attention, efficacy and adherence to the treatment and the summative time taken for treatment.

· Create an understanding of the role of scientific approach in determining and treating TB.

· Change the bad attitudes and wrong perceptions of TB among the community members. This will reduce the stigmatization of TB patients, improve self-efficacy perceptions towards seeking early treatment and encourage adherence to treatment efficacy.

· Increase behavioral change and maintenance among patients, for example achieving an increases rate of at-risk patients attending TB clinics for screening, an increase in the number of patients adhering to the treatment and a high number of treated patients advocating for TB Directly Observed Treatment (TB DOTS).

· Create a Community Based intervention including:

o Develop a platform for dialogue on TB prevention, care and treatment through advocacy and resource support initiatives, health research and training. This is aimed at increasing collaboration among health providers and communities, between family members and neighbors, community and community leaders and all at-risk individuals.

o Empower the influencers such as community leaders, teachers, religious leaders, journalists and health workers with sufficient knowledge on TB through health research and educational activities.

o Create relevant Information, Education and Communication (IEC) tools to aid in the training of main influencers in the community.

(v) Create Annual - Breathe safe, Kick-Out TB Fest Festival, have TB Exhibition Caravan – visiting universities, schools and IDPs Centers and strengthen important areas such as social communication networks, community mobilization, and sensitization of the community and health promotion.

o Cater for the interest of TB prevention and treatment care programs through collaboration and integration of the efforts of all TB intervention programs in Somalia.

Project Outputs

1. Conducting awareness and publicity for the Breathe Safe, Kick-Out TB Fest

2. Select participants from universities and secondary schools

3. Identify, design and equip the research steering group who will conduct a qualitative health research on TB (the aim of the health research is to identify the similarity between the traditional treatment methods and the modern treatment methods and educate the general public on the importance of seeking modern medication. This steering group will also help in the establishment of TB Research Centre

4. Hold a training conference for the school and university students on the theme of the festival, and guide them on coming up with plays, songs, poems and dances

5. Training and commencement of the research activities

6. Visit universities, schools and IDPs Centre using TB Exhibition Caravan

7. Promote and host the Breathe Safe, Kick-Out TB Festivals.

8. Monitoring and Evaluation of the Breathe Safe, Kick-Out TB Fest project, followed by information dissemination.

Project Approach and Methodology

The following is the all-inclusive approach that Hano Academy will adopt in actualizing the three-year project. The stages will take place in different phases of the project.

Stage 1 - Planning

• Conduct participatory stakeholder consultations with universities, secondary schools, IDPs and the government.

• Conduct formative research with target groups and rapid assessments to identify risk settings for a comprehensive, localized, situational analysis.

• Utilize Hano Academy’s Technical staff for coordination of Breathe Safe, Kick-Out TB Fest Festivals planning, development, implementation and review.

• Out-source services as required to private sector for Media Production and awareness

• Develop Planning Documents – Creative Communication and Research Briefs for approval and seek consensus on the way forward.

• Produce inclusive, participatory implementation work-plans that include delegated agencies, timing/phasing considerations, Technical sub-Committee inputs, approval points and adequate budget.

Stage 2 - Development

· Conduct relevant training programs and capacity building to the main participants to ensure effective community-based program delivery.

· Develop communication messages and creative concepts for activities and materials.

· Conduct the pre-testing and report results and recommendations to the Hano Academy project implementing Committee members and other partners.

· Amend and produce final resources and activities in accordance with recommendations made by the Hano Academy project implementation Committee.

Stage 3 - Implementation

· Disseminate resources through the steering committee members, university and secondary school representatives, IDP representatives and community leaders

· Mobilize all representatives for concentrated program activities.

· Design and arrange specific actions to be taken by the steering committee in relation to the planning and conduct of the festival

· Execute supporting multi-media umbrella, media advocacy and integrated range of community-based activities to support the Festival Objectives.

· Organize and hold the Festival with the assistance of government representatives, security operatives and members of the technical sub-committee.

Stage 4 – Monitoring, Evaluation, Review and Dissemination of Information

• Develop a Market Research Brief for tendering of Qualitative (focus group) and Quantitative (pre and post intervention) research and integrate the findings within the Monitoring and Evaluation Framework.

• Measure behavioral determinants through Knowledge Attitudes and Practices (KAP) including indicators for knowledge, attitudes and perceptions, behavioral intentions, actual behaviors, maintenance and advocacy for of behavior.

• Establish input and output indicators (internal measures of capacity, skill, program penetration, and resource distribution).

• Establish impact and outcome indicators (audience-based measures of individual behavior change and population-based measures relating to prevalence, service demand, referral, treatment uptake and adherence).

• Conduct operational research to generate data for problem-solving and decision making.

• Advocate the successes of each Phase of the ACSM program impact and elicit stakeholder feedback at every level and integrate comments into future planning phases of the strategy.

• Provide a mechanism for evaluating the financial expenditure in relation to the Value-earned analysis to gauge if the performance is within the project scope and the ability to achieve the main objectives.

Monitoring and Evaluation Plan

The following is the monitoring and evaluation plan for the Breathe Safe, Kick out TB project.

I. Key Evaluation Questions

Baseline Context: What is the rate of new TB diagnosis cases? What is the target population’s context in which the project will operate?

Needs: What is the difference between desired and actual number of patients willing to undergo TB screening and treatment? What changes in organizational performance are needed to increase service access and quality?

Inputs: Have correct, sufficient and appropriate TB interventions been designed? Are there sufficient human and financial resources and leadership support to design and implement them?

Processes/Implementation: How well is the Breathe Safe, Kick out TB project proceeding? Are all inputs, processes and outputs on track and are milestones being met? What is the quality of training and supervision processes being implemented? To what extent are key stakeholders providing support and involvement needed to achieve results?

Outputs: Have researchers and main participants acquired new knowledge and skills? Have supervisory visits and living environment improvements taken place?

Effects: To what extent did the indicators showing the difference between desired and actual performance change as a result of the interventions we implemented? To what extent has participants’ understanding improved? Do the researchers and project implementation team apply scientific skills and knowledge to solve problems and improve service delivery as a result of project interventions?

Impacts: To what extent have desired strategic results been achieved? How satisfied are the members of the target community with performance improvements? Are there changes in the TB self-diagnosis rates? How sustainable is the project?

II. Evaluation Work plan

Focus/Objective

Indicators (illustrative)

Methodology/ Instruments

When

Person(s) responsible/involved

Baseline Context

To assess the community context and the attitude towards TB in the project area and how it supports or hinders delivery of community-level TB diagnosis and treatment services

Yearly early TB self-diagnosis rates

Existence of trained DOTS with trained Community Health Workers (CHWs)

Community leaders’ opinions about desired quality

DHS/special studies

Assessment

Interviews with members—leaders.

Before project interventions are selected and sequenced

Project implementation team and representatives of the target populations i.e IDPs, refugee returnees and slum dwellers.

Needs

To identify desired and actual project team performance related to TB service delivery; gaps between desired and actual performance; and causes of these performance gaps.

Team performance baseline:

Percent of eligible patients diagnosed

TB diagnosis, counseling and referral according to standards set by MOH

Number of TB patients clients who indicate satisfaction with the Breathe Safe; Kick out TB campaign

Interviews with the Project implementation team.

Observation of providers

participant exit interviews

Before project interventions are selected and sequenced

Project Implementation team

To identify desired and actual organizational performance related to TB service support; gaps between desired and actual performance; and causes of these performance gaps.

Organizational performance:

Selection of student researchers and other participants according to service coverage needs, work specifications and inputs from the community

Off-site TB training of no more than five days duration

Monthly training and supportive supervision offered

Program records

Before project interventions are selected and sequenced

Project Implementation team

Inputs

To assess the extent to which resources are adequate to design, implement and evaluate selection of main participants, expert speeches, drama performances and collaboration with artists during the project.

General: funding from WT

Program records

Project coordinator (with assistance from Lead Researcher and other members of the implementation team)

Selection system:

List of universities and high school

that will perform

List of performing artists contracted to perform during the festivals

Selection criteria of the participants developed in consultation with community

MOU

Research and Training system:

Number of trainers/preceptors

Number and locale of research and practicum sites

Types/number of research supplies

Number and appropriateness of TB service curricula and materials

Interviews

Supervision system:

User-friendly supervisory protocols

Number of supervision visits per quarter

Number of hours slated for performance by the artists

TB testing kits (Self-Diagnosis)

Expert/user review

Interviews

Before project program is made and —project manuals are finalized and copied

Processes

To assess the quality of Performance

Performers and expert speakers selected according to selection criteria

Perceived performer effectiveness, breadth and experience of trainers

Duration, frequency of practicum sessions, logistics and organization of the festival, use of community engagement methods and appropriateness of content delivered during the festival

Adequacy of venue (e.g., sufficient space and secure for the event)

Professional reviews

Participant reaction forms

At the time of training

Project Implementation team with the lead researcher and project coordinator.

To assess the quality of supervision

Number of supervisory visits in a given time period

Perceived effectiveness of supervision

Project records and interviews with participants

Six to eight months before the festival date

Project coordinator and project implementation team

To assess project implementation (timing or quality of deployment/use of inputs)

The project activities completed according to implementation plan

Performance protocols distributed to participating university and secondary schools 6 months before festival begins

School, University $ IDP center visitation and Supervision activities occur according to schedule

TB testing Kits are pre-tested before the Festival date

Leadership (stakeholders’) support and involvement

Document review (, protocols, project implementation plans)

Interviews during project review

Prior to implementation target dates and/or on a yearly basis

Project coordinator (with assistance from lead researcher and other members of the implementation team)

Outputs

To assess immediate outcomes of project outputs

Number of professional and nonprofessional providers who achieve cut-off score for TB knowledge and skills

Number and percent of participants who volunteer for the TB test

Percent of distributed job aids that are used by providers

Percent increase in providers’ communication skills

Comparison of scores to cut-off points

Comparison of actual with expected numbers of Volunteer participants taking self-diagnosis.

On-site assessments

Observations

End of participants workshop and two months after the Festival

Research team and project coordinator

Effects

Provider Performance

To evaluate the extent to which Project performance has improved and performance gap has been closed as a result of project interventions

Percent of eligible patients tested

Provider compliance with CPI norms according to job aids and standards set by MOH

Number of TB cases reported in the DOTs

Number of TB clients from the target community who indicate satisfaction with services offered as a result of the project.

Interviews with providers

Observation

Record review

Exit interviews

Follow up six months after the festival

Consultant or supervisors (with selected participants of project implementation team)

Organizational Performance

Evaluate the extent to which organization uses art and other means of public engagement to ensure that participants are involved in the process of eradicating TB from Somalia.

Number of research students trained to serve in the DOTs

Number of people who attend the festival and give positive reaction on the project

Percent of community participants that have received greater than two supportive supervision visits in last year

Percent of participants TB testing kits effectively, and the performance feedback for expert speakers, student performers and invited artists

Program records

Interviews

Biodata forms

At start and end of project (comparative)

Project implementation team (with trainers and supervisors)

Impact

To evaluate increase in the numbers of people seeking early TB diagnosis

Number of new and continuing users of Self-Diagnosis TB kits

Service statistics and special studies

At start and semi-annually

Project coordinator

To evaluate increased sustainability of performance support systems (selection, training and supervision)

Participants and target community leaders’ feedback is built into the performance system

Institution’s long-term strategic plan incorporates performance support systems

Yearly budgets are assigned to the systems

In-depth interviews with leaders

Institutional (Hano Academy) reviews

Travel logs/records

At start and end of project (comparative)

Project coordinator

Expected Outcomes

1. 270 people comprising of Refugee Returnees, IDPs and locals participate in fact-finding seminars and discussions that help them know the scientific issues on the causes and treatment of TB and how to prevent its spread.

2. 325 University and secondary school students participate in the scientific health research on the causes of TB and how to manage the spread of the epidemic.

3. Artists and drama clubs sign performance contracts to participate in the festivals

4. High school and university students participate in the festivals by staging presentations on different dates of the festival.

5. 5 participating medical researchers undertake a research on the relationship between pollution, congestion and the spread of TB.

6. Members of the local community learn the possible methods of self-diagnosis for TB and study the importance of observing healthy practices including timely taking of medicine.

Long Term Impacts

1. Establishing emergency TB testing centers in the Mogadishu

2. Creating a TB awareness campaign that involves the members of the public

3. Establishment of the pioneer bio-medical TB Research Steering Group which will assist in the establishment of TB Research Center in the country

4. Establishing National Breathe safe, Kick-Out TB Festivals to be held annually. The festivals will involve competitions and presentations from university and secondary schools within Mogadishu and its environs.

5. The project will build on Somalia National TB Control Program Advocacy Communication and Social Mobilization Strategy report[6] that detailed the steps taken towards eradicating TB in both Somalia and Somaliland.

Other Significant and Beneficial long term Impacts

Somali’s health sector is still grappling with the increasing number of TB cases. The majority of health initiatives are implemented by humanitarian organizations. Little has been done in relation to involving the people in getting a lasting solution to the problem. The Breathe Safe, Kick-Out TB festival will not only educate the target population, but also involve them in the actual discussions, debates and fact-finding activities. We shall purchase a T.B Exhibition Caravan’ to visit universities, schools and IDPs Centers to create awareness, market the Festival, select the participants and share knowledge. The project will reduce the burden of Ministry of Health in fighting TB by approximately 75%. At the end of the festival, we shall give out 3000 TB testing kits for free to the participants and attendees.

Although the project will last for only three years, it will change the attitude of many Somalis who view TB as the worst disease in the world. It will;

· Reduce the stigma associated with TB

· Reduce the cases of discrimination of TB patients

· Encourage early-health seeking behavior among the target community

· Promote self-diagnosis of TB thereby reducing the spread of the disease

· Enroll 100 students every year to study TB and other communicable diseases

One important component to self-sufficiency is the ability to access timely basic medical care. Both children and adults cannot stop their daily activities to care for the sick people. The project seeks to promote self-sufficiency by ensuring the affected people learn self-medication and care. This will reduce overreliance on others for care and medication. The project shall be delivered innovatively in collaboration with the entertainment industry including the famous musicians and poets. The mixture of fun and scientific health research will enhance the understanding of the participants and encourage positive change in attitude towards the TB patients

The project also encompasses the goal of replicability. This will ensure the project is replicated in other parts of Somalia as a way of fighting the disease in the whole country. The lessons learnt from this project will be applicable to replication to other parts of the country. The project committee will document reports basing on the information collected in the course of the project. The project will outline both the process and outcome of the project. The same report will be shared on our website and with the funding body. It will also be redistributed to project partners and government health agencies. The report will be used as a marketing tool to encourage governmental and non-governmental agencies dealing with health to adopt the project findings and recommendations in the fight against TB. The report will be succinctly written in a non-technical and jargon free manner for better understanding by the public.

Target Population

Influencing Groups

· Religious and community leaders

· Head Teachers, School Health and other Academic staff at Primary and Secondary

· Colleges and Universities

· TB Stakeholder

· Senior Public Servants, District and Local level administrators.

· Journalists and Media.

· Health Workers including Public and Private Practitioners, Nurses, Health Workers, Volunteers, Rural Doctors, and Pharmacists.

· Traditional Leaders and Traditional Healers.

· Successfully treated TB Patients and their Families

· Business Leaders, Celebrities, Musicians, Sporting Heroes and other Role Models.

Main Project Target Population

The project targets a total of 600 main participants. This includes people suffering from TB, IDPs and Refugee returnees, University and secondary school students, and the health professionals & researchers.

The TB patients will understand their conditions and the importance of seeking medical attention on time. They will also understand the scientific explanation of Mycobacterium tuberculosis [7]and its effects on their health. This will help them understand their health condition and the best ways of remaining healthy.

The IDPs and Refugees from the majority of high-risk population in Somalia. Being involved in the project will help them understand what they need to do in order to protect themselves against the bacteria. They will also learn the importance of seeking early diagnosis to prevent the spread of the disease.

The University and secondary school students will appreciate the role of science in fighting TB through health research. They will learn the importance of scientific approach in the treatment of diseases. The project will also help the students understand how the Mycobacterium tuberculosis works and how to incapacitate it. The intended long-term benefit is to involve the students in the actual scientific/health research in Communicable Diseases. The students will also participate in the art performance such as drama plays, songs, poems and dances; debates; presentations and speeches on TB during the festival.

The health professionals and researchers will lead in the health research that will guide the project and the public will participate in the health research. They will provide the scientific explanation of TB and the effects of pollution and congestion to the spread of TB. The researchers will also work in finding out scientific solution to the problem. The researchers will involve the selected university and secondary school students.

Primary Audience Segments

· TB patients, their families and communities with a history of high TB incidence.

· Females and Males in lower-socio-economic categories including: Internally Displaced Persons (IDPs), Refugee Returnees, slum dwellers, tribal populations, nomadic and migratory populations, fishermen, prisoners in jails and correctional facilities and other marginalized groups.

· Multi-drug Resistant TB patients (MDR) and Extensively Drug-Resistant Tuberculosis (XDR)-TB cases.

Secondary Audience Segments

· General Population - females and males 16 years and above, in urban and peri-urban areas neighboring Mogadishu..

Past Experience/ Knowledge

The project will be led by Dr Sadiyo Siad[8]who has a wealth of experience in communicable diseases especially TB. Dr Siad’s PhD study was on tuberculosis; her first MSc was on Infectious Disease and Immunology (she obtained both degrees at the University of Leicester, UK). Her second MSc was on Medical Diagnosis from University of Canfield, UK. This project follows similar approaches used in neighboring countries such as Uganda and Kenya. The project also follows other previous and existing attempts by UNICEF in the neighboring countries.

The project will build on Somalia National TB Control Program Advocacy Communication and Social Mobilization Strategy report[9]that detailed the steps taken towards eradicating TB in both Somalia and Somaliland.

Personnel

Project Director and Lead Researcher

The Project Director and Lead Researcher of this project is Dr Sadiyo Siad who is the Chancellor at Hano Academy as a Volunteer bases. Dr Siad will work full time on this project in. She is Somali-Danish who has been living, working and study in Leicester, UK for the past 14 years.

Dr. Sadiyo is an experienced medical researcher, lecturer, consultant and social entrepreneur - whose strength and resilience meant that she not only survived but thrived in difficult life circumstances. She enthusiastically embraced lifelong learning with a view of actively and productively engaging in entrepreneurship and philanthropy.

Her medical education includes a PhD in Tuberculosis and Immunology, a Masters Degree in Infectious Diseases and Immunology, another Master Degree in Medical Diagnostics, a PGD in Medical Pathology, with Honors in Undergraduate Degree at the University of Leicester and Cranfield University, and a Diploma in Nursing from her early work as a nurse and midwife assistant.

She is well-versed in matters concerned with communicable diseases in Somalia as she was a consultant at Somalia’s National Tuberculosis Program .She served as a consultant during the establishment of TB referring laboratory in Mogadishu, Drug-Resistant TB management and overseeing their progress.

Key responsibilities in this project:

1. Project contact person

2. Center Coordinator full time Responsible for the whole project

3. Developing working relationships with formal and informal community leaders, the government and educational institutions

4. Establishing links to community youth and women's organizations in Mogadishu and scheduling of programs.

5. Establishing and maintaining working linkage with Somalia Ministry of Health

6. Developing and offering training programs for volunteers

7. Scheduling volunteers jobs during the project lifetime

8. Linking up the top researchers with students and other members of the community

9. Coordinating with the project manager and external monitors to assess and evaluate the project progress

Consultant

Dr Primrose Freestone will be working in this project as a consultant mainly take on as an advisory role.

Dr. Primrose Freestone[10] is a biochemist with vast experience in bacterial physiology and biochemistry. She has played a major role in scientific/health research and other projects related to her field. She is an active inventor and has played a leading role in identifying, isolating, characterizing and in the biotechnical development of bacterial catecholamine-induced auto-inducers. She was also the first person to identify tyrosine phosphorylation as a mechanism for regulating bacteria.

Dr Primrose is a past Medici fellow and a current holder of two innovation fellowships to develop entrepreneurial activities in the area of life science biotechnology as well as a consultant for PDL Technology Ltd in Norwich.

https://www2.le.ac.uk/departments/iii/people/dr-primrose-freestone

Senior Managing Volunteers Team

It is very important to have a senior managing volunteers team and we have identified three important personnel:

1. Ms Muna Jimale (Community Mobilizer)

2. Dr Hassan Osman Mohamed (Physician)

3. Ms Sahro Salad Abdalla (Nurse)

These three individuals will manage and coordinate the rest of the volunteers under Dr Siad’s supervision.

Partners in Universities

The Directors of the following universities based in Mogadishu

1. Engineer Mohamud Ahmed Jimale (President of Jamhuriya University of Science and Technology)

2. Professor Dr Osman Mohamud Mohamed Duffle (Director of Post graduate school at Banadir University)

3. Professor Dr AbdulkhadirWeheliyeAfrah (President of Capital University)

4. Professor Abdiqadir B. Mohamed (Present of Somaville University)

5. MrDaahirHashiAli (Director of Administration University of Somalia)

Partners in Secondary Schools

The principals of the following secondary schools in Mogadishu

1. MrMahad Farah Shaie (Principal of Moasser Secondary School)

2. MrAbduallhi Mohamed Nur (Principal of Banadir zone Primary and Secondary School)

3. MrAbdinur Barre Yeberow (Principal of Albayan Primary and Secondary Schools)

4. Mr Mohamed AbdirahmanMohamud (Principal of Hamuuniye Primary and Seconday School)

5. MrDaud Ahmed Hassan Mahamud (Principal of Al-mannar Primary and Seconday School)

Performing Artists Partners

The following performing artists

1. MrYaxyeDaahir Hussein

2. MrFarxanXiidig

3. MsFarhiyoMuxidin Yusuf

4. MsShaadiyoSharaf

Security Planning

Insecurity is one of the biggest threats to this project. Given Somalia’s fragile security situation[11], Hano Academy through the steering committee will arrange Military-like security for all operatives during the initial campaign for the project. HA will liaise with the government and private security operatives to provide security during all briefings, campaigns, research and the final festival to be held in Mogadishu. HA has developed a security management and programming matrix that has been essential in running of its activities within Somalia. We hope to adopt the same matrix to ensure the safety of all international and local health operatives who will take part in the Breather safe campaign and festivals.

Knowledge Sharing

All activities from this project will be documented in form of videos, reports and recordings. It will be available at the festival website for easy access by the public. The same information will be submitted to the funder (Wellcome) for publication. We shall also have a Facebook page where we shall share the project progress and interact with the public. All information will also be shared through the Facebook and twitter accounts. We shall publish all research findings which shall also be shared with the public. Information shall also be shared among members of the steering committee, schools, universities, Ministry of Health and all participants through the Inmagic Presto Knowledge management software[12].

Risk Register

The following is the register of the risks expected in the course of the project. The register shall be updated continuously from the time the project starts up to the project closure time.

Risk Identification

Qualitative Rating

Risk Response

Mitigation

RiskCategory

Risk

Threat or Opportunity

How likely is the event?

Consequences

Rating

What are the consequences of the event?

Risk Priority

Risk Reduction Measures & Treatment Type

How likely

Is the event

Risk owner

Cost Risks

Design change / additional scope

Threat

Likely

Substantial

Additional work and planning required

Extreme Threat

The project implementation team to manage and agree extent of works

100%

Lead Researcher

Additional design and planning work as design effort is different to that assumed in tender

Threat

Quite Common

Medium

It shall need extra planning and additional time , thereby extending the project timeline

Very High Threat

100%

Project Implementation Team

Delay in securing funding

Threat

Quite Common

Medium

Delay to start and increased cost of project

Very High Threat

Keep Wellcome Fund aware of risks and consequence

30%

Lead researcher

Security

Insecurity as a result of criminal attacks

Threat

Likely

Substantial

Additional security measures including hiring private security required

Extreme Threat

Hire private security and liaise with the government security organs to beef up security.

Community mobilizer

Cultural

Rejection of the project by the target group due to cultural stereotypes

Threat

Unlikely

Medium

The number of willing participants and attendees will be significantly affected

Extreme Threat

Involve the religious and traditional leaders in convincing the people on the importance of the project.

Community Mobilizer

Illiteracy

Most of the target group are illiterate / semi=illiterate.

Threat

Likely

High

Lack of understanding of concepts taught and how to apply them during the Project life.

Extreme Threat

Offer training in basic literacy and numeracy at the beginning of the project

100%

Project Implementation team

Communication Barrier

Threat

Most Likely

High

Lack of communication between the speakers and the participants

Extreme Threat

Enlist the services of a translator during expert speaking sessions

100%

Community Mobilizer

Differences due to High competition

Opportunity

Likely

High

Increased competition will attract quality presentations which will in turn promote the objectives of the project.

Threat

Provide extra training for the participants.

100%

Volunteers

Budget

BUDGET REQUEST

Breathe Safe, Kick-Out TB Fest

1st May 2018

Proposed Budget

(Based on a 36-month budget)

A. Direct Salaries and Wages

Personnel

Total = £90,000.00

Position Title and Name

Monthly

Salary

Time

Months

Amount

Requested

(only for Direct Personnel)

Director/ Lead Researcher

Dr. Sadiyo Siad

£ 2,500.00

100%

36 months

£90,000.00

Justification

Director, Research& Development

Dr. Sadiyo Siad

The project will be led by Dr Sadiyo Siad[13]who has a wealth of experience in communicable diseases especial TB, as Dr Siad’s PhD study was on tuberculosis, her first MSc was on Infectious Disease and Immunology (obtained both degrees at the University of Leicester, UK). Her second MSc was on Medical Diagnosis from University of Canfield, UK. She is well-versed in matters concerned with communicable diseases in Somalia as she was a consultant at Somalia’s National Tuberculosis Program. She served as a consultant during the establishment of TB referring laboratory in Mogadishu, Drug-Resistant TB management and overseeing their progress.

In this project Dr Sadiyo Siad is responsible for oversight of all collaborations and contractual agreements in the course of the project. She will also ensure that all necessary documentation and reports are submitted accordingly. She has the overall coordination of the project and is also the project contact person. Owing to her expertise, she will earn a monthly salary of £ 2,500.00

B. Contractual Costs

Artists Cost

Total=£2400.00

Name

No. of Performance Days

Charges

Number of Events

Total cost

MrYaxye Daahir Hussein

£200.00

£600.00

Mr Farxan Xiidig

£200.00

£600.00

Ms Farhiyo Muxidin Yusuf

£200.00

£600.00

Ms Shaadiyo Sharaf

£200.00

£600.00

Justification

Each artist will perform in the festival annually. This brings a total of 3 presentations by each artist.. They will be paid according to the local rates of £200.00per performance. This totals to£600.00 per every artist. The total amount payable to the artists is £2400.00

C. Expert Speakers Cost

Total: £10,464

All expert travel and accommodation expenses are calculated per person on an average cost basis determined in the following way:

Airfare £769 (Return Ticket) = £769

Accommodations £375 (average for 3-night stay)

Per Diem £600 (average for3-days at £200 per day)

Total £1744 x 6 Expert Speakers = £10,464

Justification

A total of six expert speakers will participate in the Festivals. They will speak on different subject matters related to early diagnosis, treatment and care or TB patients. Other important topics will be on self-responsibility and the role of science in fighting TB infections in Somalia.

Travelling from UK to Somalia (return ticket-economy class) will cost £769 per person. The accommodation rate for a three night stay is averagely £375 per person. Each speaker will receive a per-diem of £200 per day. This gives a total of £1,744per each guest£1,744x 6 speakers = £10,464

D. Equipment

Total: £ 39,460.95

Item Requested

How Many

Unit Cost

Amount

Overhead projectors (New 1080p high lumens full hd digital home theater led lcd overhead projector

£199.00

Film projectors ((HTP DLP-600W) Projector Module Beamer Blue-ray film Full movies Projector-600W) Projector Module Beamer Blue-ray film Full movies

£300.00

£ 600.00

Projection stands

2 pieces

£100

£200.00

Microphones

6 (2 wireless, 2 lapel and 1 headset microphones- Professional UHF Karaoke System Wireless headset Microphone for stage)

£110.00 (wireless mic)

£220.00

£15.00 (Lapel Mic)

£30.00

£200.00(Professional UHF Karaoke System Wireless headset Microphone for stage)

£200.00

Loudspeakers (OVS HM-1 500W professional loudspeakers)

£120

£360.00

CE/ISO Approved TB Test Kit Tuberculosis Virus Test Kit Tuberculosis Test

4,000 pieces

£0.80

£3,200

Branded Rostrum

£100.00

Laptops (MSV GV72 17 INH 8GB 128GB 1TB)

£999.99

£4999.95

Transportation, logistics

£1100

Importation tax

£1500

Caravan

£ 26,842

Justification

1. Overhead projectors

They will be used for broadcasting the information during the seminars and expert speeches. Overhead projectors are effective in capturing information on the laptop screens and broadcasting it for to the public. Since all speeches will be done via laptops, we shall buy one 1080p high lumens overhead projector at a cost of £199.00

2. Film projectors

We shall buy two film projectors for use during the seminars. In the course of the project, we shall interview participants and film their stories. The film projectors will be used in showing these stories during the festival one will be used inside the hall, while the other one will be used for outside display. We will buy two HTP DLP film projectors @ £300x2 = £600

3. Projection Stands

We shall buy 2 pieces of projection stands for use during the festivals. The stands will be used for both inside and outside projection. Each stand costs £100. 2 stands will cost £200

4. Remote Control for Projectors

We shall buy two projector remote controls @ £2.00. This totals to£4.00

5. Microphones

We shall buy a total of six microphones. This includes 2 wireless hand-held microphones @ £110x2 =£220. 2 lapel microphones @ £15.00 x 2 = £30.00 and 1 headset microphones (Professional UHF Karaoke System Wireless headset Microphone for stage) @ £200.00. Different microphones will be used for engaging the audience during expert speeches and presentations. They will also be used during other presentations by the students and the artists.

6. Caravan = £ 26,842

We shall purchase a caravan for use in the marketing, awareness of the project, knowledge sharing, exhibition and a taster of the festival. The caravan will also be used for moving around schools, universities and IDP camps to share knowledge with the participants.

7. Laptop computers

We shall purchase 5 laptops (MSV GV72 17 INH 8GB 128GB 1TB) each costing £999.99. The total cost for the 5 laptops is £4999.95. The laptops will be used by the lead researcher and the 3 volunteers to collect data, and one laptop computer for all information in the course of the project. For the speaker, and other project delivery.

8. Transportation Logistics

We shall source most of the equipment (especially laptops) from the UK. The approximate cost for transporting the equipment is £1000.

Additionally we shall pay the import tax on the same equipment amounting to £1500

E. Materials and Consumables

Total = £ 35,211

Item

Amount(Per year)

Total Cost

Project Specific Stationary including pens, paper, note book etc.

£1,257

Booklets containing project information for the 3 years of the project

4000 @ £1.5

£6,000

Caravan driving and maintenance

£82 (per Month) for 18 months 85

£1,476

Drinking Water

600 x 3 days festival x 3 years @ 0.5

£2,700

Fuel for the caravan

150 per month for 36months

£5,400

Project-specific Telephone

£120 per yearx3 direct staff x 3 years (£1080 )+

£240 x 1 lead researcher (£720) x 3 years

£1,800

Hiring of the project Venues

3 Festival for 3 year @ £5000

£ 15,000

Project-specific Printing & Duplication

£100.00 per year X 3direct staff X 3 years = £900 +

£150 x 1 L R x 3 years = £450

£1,350

Procedure manuals

600 Copies @ £0.38

£228

Justification

Project-specific Telephone

(£120 per yearx3 direct staff x 3 years+ £240 x 3 x 1) = £1,800.00

Hiring of the project Venues

(3 days festival activities for 3 year @ £5000 = £15,000.00

Project-specific Printing & Duplication

(£100.00 per yearx3direct staff x 3 years + £150 x 1 L R x 3 years) - = £ 1,350.00

Procedure manuals -600 Copies @ £0.38 = £228.00

Project Specific Stationary including pens, paper, note book etc. is calculated for a Total = £1,257

Booklets containing project information 4000 @ £1.5 = £6,000.00

The maintenance and driving of the caravan will cost £82. This results in the total of £1,476 for the project period.

The fuel for the caravan will be £150 per month for 36 months totaling to £5,400 for the whole project.

Drinking Water

We shall buy 600 bottles of water x 3 days festival x 3 years @ 0.5 = £2,700

Each member of the main project implementation team apart from the lead researcher will receive a telephone allowance of £10.00 per month. The lead researcher will receive £20.00 per month to cater for project specific telephone calls.

£10.00 x 3 members x 36 months = £1080.00

£20.00 x 1 Lead Researcher x 36 = £720.00

Total cost for project-specific Telephone = £1800.00

Project-specific printing and duplication

The three members of the project implementation team will receive £100 each per year for printing and duplication. £100 x 3members x 3 years = £900.00

The lead researcher will receive £150 each year for printing and duplication. £150 x 1 Lead researcher x 3 years = £450.00

Total costs for project specific printing and Duplication is £1,350.00

We shall print 600 procedure manuals @ £0.38. Total cost for the procedure manuals will be 600 x 0.38 = £228

F. Marketing and Awareness including Production Costs

Total = £12420

Item

Quantity per year

Unit Cost

Number of Events

Total

Billboards

£900

n/a

£5400

Brochures,

6000 pieces

£0.5

n/a

£3000

TV adverts

1 TV Station

£1000

£3000

Road caravan

N/A

£70

£420

Social media adverts

N/A

£100

£300

Radio adverts

One month

£100

£300

Justification

We shall mount6 billboards in Mogadishu to sensitize the general public about the Festival. Each Billboard costs £900. Three billboards will therefore cost£900 x 6 = £5400.

Although we are targeting 3500 attendees, we shall print 6000 brochures for the festival (3 years). The lowest local cost for printing a brochure is£0.5 each. 6000 brochures will cost a total of£3000

As part of awareness we shall use TV and radio adverts to inform the general public about the Festivals. The TV ads will run for one month annually @ £1000. The total charges for TV ads will be£1000 X 3 years = £3000.

The radio adverts will cost£100 for one month (annually). The total expenditure on Radio adverts will be £100 X 3 years = £300

We shall also organize road caravan trips around the city to sensitize the general public and invite them to the festivals. The branding and furnishing of the caravan will be done at a cost of £70annually. Three branding and furnishing will cost a total of £140. We shall also advertise through main social media platforms such as FaceBook. We shall spend £100 annually to promote the advertisement so that it reaches many potential attendees. The total cost for social media advertisement will be £300

G. Travel and Subsistence

Car Rental – £700 per month for 36 months = £25,200

We shall rent a car for the project. This car will be used for coordinating the project, visiting the target group, collecting data and running errands related to the project. The monthly expenditure including service, maintenance and fuel is £700. The overall cost for travel and subsistence is £25,200

H. Monitoring, Evaluation, Review and Dissemination

Total: £1967.00

Justification

Documenting the progress of the project and analyzing the vale earned from the project will be done by the project coordinator. He will also compare between the intended outcome and the actual outcome. This procedure will cost £1500.00

Recording of videos, transcription and updating the website - £467.00

I. Indirect Costs (contingency)

Indicate method of calculating your indirect costs (e.g., Indirect costs= x% of DirectCosts)

Indirect costs = 3.5% of the Direct costs

This calculation is based on unforeseen changes in prices of supplies and equipment. It also caters for any minor expenditure not captured in the main budget.

Total Indirect Costs

Total £7,599

Grand Total Requested £224,721.00

=====================================================================

Summary of the Budget

Salaries: Total = £102,864.00

Project lead Researcher: £90,000.00

Artists: £2,400

Speakers: £10,464

Fees: NIL

Equipment: Total = £39,460

Materials and consumables Total = £35,211