UK AID MATCH PROPOSAL FORM

SECTION 1: INFORMATION ABOUT THE APPLICANT

1.1 Lead organisation name Orbis Charitable Trust (an affiliate of Orbis International)

1.2 Contact person Name: David Bennett Position: Head of Programme Support Email: dbennett@orbis.org.uk Tel: + 44 20 7608 7260

SECTION 2: BASIC INFORMATION ABOUT THE PROJECT

2.1 Project title Vision for Zambia

2.2 Country(ies) where project is to be implemented

Zambia

2.3 Locality(ies)/region(s) within country(ies)

Copperbelt Province

2.4 Duration of grant request (in months)

36 months

2.5 Project start date (month and year)

July 2016

2.6 Total project budget? In GBP sterling

£905,836

2.7 How much do you expect your appeal to raise? What percentage is this of the total project/programme budget?

£905,836 has been raised. 100%

2.8 Please specify the % of project funds to be spent in each project country

100% Zambia

SECTION 3: PROJECT DETAILS

3.1 ACRONYMS For words which you would normally use acronyms for, please write these words in full the first time you use them, followed by the acronym in brackets, and use the acronym after that. Where you feel that it would be useful to provide an explanation of any acronym, please add these here.

CEHTF Child Eye Health Tertiary Facility CRF Children’s Radio Foundation HBP Hospital Based Programme KCH Kitwe Central Hospital KEA Kitwe Eye Annexe MoH Ministry of Health OCO Ophthalmic Clinical Officer OCT Orbis Charitable Trust ON Ophthalmic Nurse PMO Provincial Medical Office(r) PCDO Provincial Community Development Office PHC Primary Health Care STEPS Social Transformation and Empowerment Projects

3.2 PROJECT SUMMARY: maximum 5 lines - Please provide a brief project summary including the overall change(s) that the initiative is intending to achieve and who will benefit. Please be clear and concise and avoid the use of jargon (This should relate to the outcome statement in the logframe).

Orbis aims to increase the uptake of quality paediatric eye health services and follow-up care within the district health system in Copperbelt province. We will build the capacity of key health care personnel at primary, secondary and tertiary levels and strengthen referral systems so that a high quality eye health service is delivered. We will also provide the local community with relevant information relating to eye disease to ensure that demand for services and quality is maintained.

3.3 PROJECT RATIONALE (PROBLEM STATEMENT) Describe the context for the proposed project, by considering the following questions. What specific aspects of poverty is the project aiming to address? What are the causal factors leading to poverty and/or disadvantage? (If applicable) what gaps in service delivery have been identified and how has your proposal considered existing services or initiatives? Which specific groups/people do you expect to benefit? Why and how were these groups chosen? How does the proposal fit with national/regional development plans and with other efforts (eg. of governments, donors, the private sector) to address the development challenges which your proposal aims to address? How does it fit with activities of other development actors? Why has the particular project location(s) been selected and at this particular time?

Poor eye health is one of the most common health problems for people in developing countries. Globally, an estimated 285 million people are visually impaired, including 39 million people who are blind, 90% of whom live in low-income countries [i]. Paradoxically, over 80% of blindness in the developing world is preventable. Cataract is the leading cause of visual impairment in the developing world with approximately 18 million people blind as a result [ii]. It is widely understood that people with visual impairment are more likely to be income poor, unemployed and excluded from education, health care and social networks. Conversely, problems that predominantly poor people face, including malnutrition and a lack of education, can compound the prevalence and incidence of preventable eye diseases. Poorer people are more likely to take risky forms of employment making them more prone to accidents that can leave them blind or visually impaired. Equally, avoidable blindness disproportionately affects women and girls [iii], but for

various socioeconomic reasons, they are much less likely to seek help. Furthermore, many conditions that lead to blindness in children also cause mortality1 and regular eye screening may help early detection and treatment of these conditions. Blindness and visual impairment are both a cause and a consequence of poverty. Investing in preventing blindness and low vision dramatically improves the lives of individuals and their families; this includes the economic benefit raised by not only the patients but also their family members being able to return to work. Zambia is one of the poorest countries in the world; approximately 78% of Zambia’s 14 million inhabitants live in poverty. Furthermore, it is estimated that approximately 140,000 people are suffering unnecessarily from blindness in Zambia. Children, who make up almost half of the population, are approximately four times more likely to suffer from blindness than those living in developed countries, despite half of all childhood blindness being entirely avoidable or treatable. To compound this problem, the first two years of a child’s life are the most important for visual development. Whilst auditory perception matures before birth, visual perception needs the stimulation that occurs after birth to become fully developed. It is therefore a priority to treat children with visual impairment as early as possible to avoid affecting a child’s long term brain development and risking losing their sight permanently. Good vision is necessary for children to access formal learning, as well as other opportunities to participate in society. Nowhere is this truer than in low income settings, where good vision is critical to improving a child’s potential and freeing them from the poverty cycle. The Copperbelt is made up of ten districts covering a vast area of northern Zambia. Just over 40% of the Copperbelt’s population are under 15 years of age; among those 46.2% live in rural areas [iv]. The region relies heavily on the informal health care system for its population’s primary health care and there is a lack of awareness of the public eye health care system. District health officials estimate that 50% of people have first sought treatment through their local traditional healers. It can delay diagnosis, treatment, prolong pain and discomfort and result in irreversible blindness. In 2011, it was estimated that around 800 children had untreated cataract in the province. Each year between 150 and 190 children are born with or develop cataracts and many more require treatment for other causes of blindness, such as trachoma, trauma and glaucoma, or simply require spectacles for refractive error. Reducing this backlog is therefore a key priority within the region. However, there are limited eye health resources and services to address this burden in Zambia. Those that do exist are distributed unevenly, favouring urban centres such as the capital, Lusaka. Currently one ophthalmologist serves over 645,000 Zambians and there is one Ophthalmic Clinical Officer (OCO) for every 373,000 people. The World Health Organization (WHO) recommends at least 2 ophthalmologists and 4 mid-level workers per 1 million population. Staff attrition from the public to private sector is commonplace due to lack of motivation, training and incentives. Child eye health human resources have been particularly poor, with specialised paediatric services virtually non-existent before Orbis’s initial intervention in 2011. Children are a core focus of all Orbis work in Sub-Saharan Africa and we have over 30 years’ experience in dealing with and treating the complexities of childhood blindness. Orbis began its investment in Zambia at the tertiary-level hospital Kitwe Eye Annexe (KEA) in 2011 and, over a period of 4 years, developed human resources and provided much-needed equipment and consumables, improving service delivery for paediatric eye health. Full details of our impact during Phase 1 can be seen in section 3.5. As a result of this intervention, KEA is able to accept increasing numbers of cases. However, challenges still exist:

Many children are not accessing public health care services due to travel costs, travel distance and cultural beliefs.

Due to a lack of training and resources at the primary and district levels there are often

1 Community Based Interventions for Control of Blindness and Visual Impairment – a manual for district level

ophthalmologists by Community Ophthalmology Unit, Dr R P Centre for Ophthalmic Sciences, All India Institute for Medical Science, New Delhi and ORBIS India, 2007.

misdiagnoses of children who do visit a public health facility. These cases are then not treated or referred appropriately. Mistrust in the public health care system exists as a result.

Many children present directly at KEA for simple eye problems: currently, 50% of cases are for conjunctivitis, an infection that can be treated with eye drops dispensed at a primary or secondary facility.

Given these challenges, the next logical step is to extend our support to the district level; this is in alignment with the Zambian government’s policy to ensure health services are available to all as close to the home as possible. However, the health services that currently exist at district level do not prioritise eye health. Consequently equipment and consumables are lacking and staff have had very little, or no, eye health training. Furthermore, health workers often work in isolation, rarely receiving feedback on the cases they do refer. The direct beneficiaries will be the children in need of eye services in the Copperbelt province. A typical user-journey will include a child having improved access to screening and awareness and education in blindness prevention, along with access to treatment closer to home through strengthened referral networks. Other direct project beneficiaries will be a broad range of eye health staff and other public health workers who will benefit from skills transfer and capacity building across the primary, secondary and tertiary health care levels. Through targeted and appropriate capacity building of individuals and eye health teams, Orbis will play a key role in strengthening the existing health system. As this service will be available to the entire community, indirectly all members of the Copperbelt community can benefit from this service. Certainly, the families of children appropriately treated will have their quality of life improved, which will in turn benefit the entire community. Having already gained keen support from the Ministry of Health (MoH) and Ministry of Community Development, this project fits directly within the eye health priorities identified by the Zambian government. Zambia is a signatory to VISION 2020, the global initiative for the elimination of avoidable blindness (a joint programme between the World Health Organisation (WHO) and the International Agency for the Prevention of Blindness (IAPB) with an international membership of NGOs, professional associations, eye care institutions and corporations). The Zambian MoH has developed its National Eye Health Strategic Plan (NEHSP) to meet the targets of the VISION 2020 initiative. Orbis’s project will contribute directly to the focus areas of the NEHSP2 by working throughout the health care system to strengthen both quality of services through capacity building, infrastructure and support for equipment and supplies, and through improving access to services through community engagement and strengthening referral mechanisms. Other key development actors in eye health in the Copperbelt are CBM and the Kilimanjaro Centre for Community Ophthalmology (KCCO). CBM is an international disability and development organisation which has supported the development of the eye health service at KEA, including funding the new eye annexe. KCCO’s mission is to strengthen African health systems and partnerships to achieve the goals of VISION 2020 and the Global Elimination of Trachoma 2020. Through this project Orbis will complement their work as well as fill in gaps left by other major peer eye health NGOs who have withdrawn their support of primary and secondary level services to focus on trachoma elimination and wider disability services. This project will also complement and utilise the expertise of other actors, such as the Provincial Community Development Office (PCDO), for some of our community engagement and demand creation interventions.

2 The NEHSP focuses on: 1) Infrastructure development, 2) Mobilisation of equipment and consumables, 3)

developing human resources, 4) strengthening trachoma control, 5) sub-specialised services, 6) creating funded eye care positions.

3.4 TARGET GROUP (DIRECT AND INDIRECT BENEFICIARIES) Who will be the DIRECT beneficiaries of your project, where direct means those benefiting at outcome level? Describe the direct beneficiary groups, and state how many people are expected to benefit, differentiating between male and female beneficiaries where possible, as well as other sub-groups. Also explain how you have calculated the beneficiary numbers.

DIRECT:

a) Description of groups: Total number of children who take up eye health services in the districts supported (includes all children screened for an eye health conditions at the facilities supported) Total number of health care personnel trained (includes ophthalmologists, biomedical staff, general nurses, general clinical officers, ophthalmic nurses (ONs), ophthalmic clinical officers (OCOs), community health workers) in eye health care.

b) Number of beneficiaries: Total: 69,808 children aged 0-5 years Total: 777 health workers (766 at primary and district level, 11 at tertiary) Female (618) Male (159)

Who will be the indirect (wider) beneficiaries of your project intervention and how many will benefit? Please describe the type(s) of indirect beneficiaries and then provide a total number.

INDIRECT:

a) Description The whole of the Copperbelt population

b) Number Total: 1,972,317 Female (980,242) Male (992,075)

3.5 POTENTIAL PROJECT IMPACT Please describe the anticipated impact of the project in terms of poverty reduction. What changes are anticipated for the beneficiary target groups identified in 3.4 (both direct and indirect beneficiaries) within the lifetime of the project?

As outlined in the logframe, this project aims to reduce childhood blindness and visual impairment of children in 10 districts in the Zambia Copperbelt Province. It is known that a high percentage of children in developing countries with visual impairment do not attend school or drop out early. By intervening early we prevent potential long-term visual impairment and/or blindness, enabling a child to remain in school and reducing their likelihood of entering the poverty trap. This project will relieve children and their families of the burden and stigma of disability, enabling them to continue or begin education and earn a living in later life. The financial burden that travelling for treatment currently places on rural communities will be reduced by having Community Health Workers (CHWs) trained to screen for eye health issues in rural areas nearer to home. Should a child need to be referred beyond the primary care level, the travel costs will be covered partially or entirely for the poorest patients, ensuring children in need are referred and receive treatment. We are exploring more long term, locally sustainable solutions to these access issues. Whilst this is a child-focused project, services are offered equitably to the entire community. So adult

family members affected by cataract or other eye diseases may also be identified and referred to the appropriate facility. If able to be treated successfully, they will be able to return to employment and social activities, which will help secure a family income, reduce the burden of poverty and improve their quality of life. Additionally, mainstreaming Gender throughout the project will help ensure women and girls (who are less likely to seek medical services) are able to take up our services alongside men and boys. Indirectly, the entire family will be positively impacted, allowing the carer to return to his or her daily activities which will in turn provide an added benefit for the entire community of the province of Copperbelt. Taking a health systems strengthening approach ensures eye health services become embedded into an existing, government-funded service. Additionally having an adequately and appropriately trained workforce (including Primary Health Care Workers (PHCs), CHWs, ONs and OCOs) with the right equipment will incentivise staff, improve staff morale and quality of service and ultimately reduce staff attrition. All of the above will complement and reinforce the tertiary level services established with Orbis support in Phase 1 of the Kitwe project. During this phase (2011-2013): 8,169 children (46% female, 54% male) were screened in total. 1,555 children (55% female, 45% male) were medically treated and 1,194 surgeries (43% female, 57% male) were carried out. At the end of Phase 1, KEA was able to provide high-quality paediatric eye health services to children, not only in Copperbelt but in all four provinces within its catchment. Whilst maintaining our hospital-based training at tertiary level, during Phase 2 we aim to increase the number of children we reach and help to a total of over 69,000.

3.6 DESIGN PROCESS Describe the process of preparing this project proposal. Who has been involved in the process and over what period of time? How have the intended beneficiaries and other stakeholders been involved in the design? What lessons have you drawn on (from your own and others’ past experience) in designing this project? Please describe the outcomes achieved and the specific lessons learned that have informed this proposal.

Preparation for Phase 2 of this project was initiated in 2013. Consequent groundwork and planning for the project and for this proposal in particular, has heightened over the last year. Over this period of time, Orbis has engaged with beneficiaries and key stakeholders in the project and their contributions have been incorporated into the design of Phase 2 and into the preparation of this proposal. Similarly, internal quarterly progress reports during Phase 1 ensured that Orbis and KEA’s plans for project expansion into Phase 2 remained in line with each other. Similar internal monitoring will occur in Phase 2, as outlined in section 5.1. A mid-term evaluation was carried out in April 2013 by Dr Parikshit Gogate, a paediatric ophthalmologist, community eye health specialist and a member of Orbis’s International Volunteer Faculty3. The assessment led to recommendations that form part of this project’s approach and design. For example, we will be strengthening links between the community and the eye health services by training key community stakeholders, such as Community Health Workers. Similarly, Orbis’s programme technology unit will seek to streamline the patient referral process in Phase 2 by piloting an innovative method of enhancing detection and referral of eye problems in rural settings utilising low-cost advances in technology (see section 3.7 for details). In 2013, Orbis engaged Dr Susan Levine, a medical anthropologist, to conduct interviews with 20 parents whose children underwent cataract surgery at Kitwe. She also researched the barriers to accessing services within the community. This research has been instrumental in the design of the targeted community engagement and demand creation strategies within this project.

3 Medical volunteers are the backbone of Orbis programmes. More than 400 medical volunteers from all over the world donate their

time and energy to work with Orbis to prevent blindness and restore sight. Referred to as volunteer faculty, these specialists include ophthalmologists, optometrists, biomedical engineers, anaesthetists and ophthalmic nurses

One of the most significant processes that has shaped the design of the project and this proposal was a situational gap analysis of eye health services in Copperbelt province, carried out in April 2014 by Orbis consultant, Celeste Robinson in conjunction with the PMO. The analysis was informed by an assessment visit to 4 districts in the Copperbelt which included interviewing a number of intended beneficiaries including primary, secondary and tertiary level health care workers. She also conducted a workshop which included all stakeholders to this project, in particular the District Health Officers who represent, amongst others, the primary and secondary health units in all 10 districts. Other participants were the PMO, three District Medical Superintendents, senior managerial and medical staff from KEA and the Orbis Programme Manager. The main aim of this workshop was to allow all stakeholders to provide input to the key needs in their respective districts, and issues surrounding strengthening the referral pathways which underpin the need for Phase 2 of this project, as outlined in section 3.3. Importantly, this information also provided significant information to design the human resource strengthening aspect of this project. Upon notification from DfID that the Orbis concept note was successful, a follow-up visit to Copperbelt was carried out in November 2014 by Orbis Programme, M&E and Technology staff. Meetings at national, provincial and district level during this visit helped further define core elements of the proposal, assess collaboratively any anticipated challenges and increase opportunities for stakeholder buy-in from project inception. In late 2015, further pre-project planning and preliminary activities commenced. These activities (primarily provincial and district level meetings and workshops) provided Orbis the opportunity to up-date our understanding of needs at different levels – including equipment needs, learning and skills gaps, as well as requirements for Orbis staffing to efficiently manage the project.

3.7 PROJECT APPROACH Please provide details on the project approach proposed to address the problem(s) you have defined in section 3.3. Why do you consider this approach to be the most effective way to achieve the project outcome? Please justify the timeframe and scope of your project and ensure that the narrative relates to the logframe and budget.

With over 30 years of experience in eye care, Orbis is uniquely qualified to carry out this project. In addition, the project activities, which are fully outlined in the activities log, logframe and budget narrative, have been designed to adhere to the core strategies of VISION 2020 The Right to Sight. These are human resource development; infrastructure and equipment provision and intervention on targeted major eye diseases. We always work in partnership with the government to embed our practices into the national health system. Our approach uses existing structures, such as the KEA, rather than developing parallel ones. This ensures equitable access to services and ensures their sustainability. At the same time, we make sure that our clinical approaches (such as cataract surgery procedure) remain high quality, whilst adaptable to low technology and low income settings. Zambia is one of the poorest countries of the world (section 3.3) with few services dedicated to eye health. Prior to Orbis’s intervention there were high rates of untreated cataract and other eye diseases amongst children. The attrition rate of the few health care personnel was high. The project will therefore reach out to marginalised groups in Zambia who would otherwise have no access to eye health. Orbis supported research shows that elderly people, women and rural residents are at greater risk of low vision and blindness, reflecting the social inequalities in promoting and accessing health services in Zambia. Whilst the project is focused on Childhood Blindness, all members of the community including adults and those who are unable to attend outreach clinics will be served. In this project, Orbis proposes to pursue Phase 2 of a planned three-phase approach to reducing childhood blindness and visual impairment in Copperbelt province. Phase 1 focused on building a

highly trained clinical and non-clinical paediatric ophthalmology team at tertiary level within a fully equipped department. Phase 2 seeks to expand into primary and secondary levels and focuses on increasing patient mobilisation and strengthening human resource for eye health. This is the phase for which we are seeking DFID funding. Phase 3 intends to continue to strengthen the health system and also shifts some of the focus back to tertiary level with training provided on complicated sub-specialties and working towards supporting the institution to eventually achieving financial independence. During Phase 2, Orbis will implement a number of interlinked and complementary community awareness, capacity-building and system-strengthening interventions which aim to ensure that a total of 69,808 children in the Copperbelt Province are taking up quality eye health services and receiving follow up care at the appropriate health care level. Through research commissioned by Orbis, we have a clear understanding of the critical barriers people face when seeking out our services (Levine Research in 3.6 above). This has impacted upon our approach to mass communication messages. We have learned that programmes such as this can only realise their full potential if knowledge is shared effectively and that traditional health messaging alone does not do this. As creating and maintaining demand for our services is crucial to the success and sustainability of the eye health care system, we will implement two core interventions by partnering with two specialist local organisations. The first is the use of facilitated film screenings, in partnership with Social Transformation and Empowerment Projects (STEPS) who develop films as a tool to create awareness amongst community members regarding a range of health issues. Since the submission of the original proposal to DFID, Orbis has worked with STEPS to produce an eye health-focused documentary film in Copperbelt Province. Entitled Amakumbi Yabuta (The Clouds Have Cleared), the film features eleven year-old David who regained his childhood through sight-saving surgery. The film encourages the viewer to seek treatment immediately if they notice any problem with their child’s vision or their own. As part of the project, the film will be rolled out across the 10 districts. Working within the theoretical framework of Communications for Social Change, STEPS films are always contextualised using, for example, personal testimonies of people who have been blind or whose child has been blind. They frequently encourage lively debate after their screening, helping to dispel myths about the health system. The facilitator’s role is to encourage the audience to decide on individual and group action following the screening. This can include challenging stigma and discrimination, the decision to seek services or to advocate for access to high quality services. STEPS programmes have been used successfully in other public health approaches (particularly HIV/AIDS). Their success is due to programmes being locally relevant and accessible, having been directed by local film makers. Orbis believes the approach will lend itself well to the eye health context given the similar barriers that communities face such as awareness of and access to, services. The film will encourage viewers to recognise risk factors and when to seek appropriate medical attention and enable more informed decision-making about where to access services. It will also increase uptake and demand and improve compliance to post-surgery or treatment follow-ups. Upon completing the production of Amakumbi Yabuta in 2015, Orbis has had initial discussions with the province and at district level about the most strategic methods for delivering the screenings, and will utilise OCOs as the key facilitators, as they are considered well-placed and qualified to ensure the screening of the film is as far-reaching as possible.

The second intervention is the use of radio to increase awareness and education on eye health, and increase children and their caregivers’ access and uptake of eye health care services. Orbis will partner with Children’s Radio Foundation (CRF) to broadcast information on eye care issues affecting children and youth. This aims to amplify community-based conversations around eye care. CRF trains young people to create well-informed youth-oriented radio programmes that broadcast on local radio stations. CRF youth reporters take on issues that resonate with children and young people in their community; speaking in local languages and in a youth-friendly style, they interview

community members, host debates and bring out local perspectives. This intervention builds on work that Orbis has been successfully piloting with CRF in KwaZulu-Natal, South Africa. Orbis plans to initially work with Kitwe-based Radio Icengelo and Yar FM, stations with whom CRF already has an existing and strong relationship. Given the significant volume of radio listeners in Zambia, Orbis believes this will prove an effective approach to public awareness, promoting a constructive view and understanding of children’s eye care at the community level, prioritising detection, treatment and follow-up. Orbis is committed to taking a gendered approach to this project, as it is with projects in other settings in sub-Saharan Africa, and will aim to influence greater access to services for girls and women. In terms of community engagement, Orbis will use the film and tailored radio programmes to raise issues relating to girls’ access to services. Film and radio content will interrogate and reflect on this issue and to help shape attitudes of key influencers and decision-makers in the communities in which the project is located, by rolling out facilitated film screenings with traditional and other community leaders. Orbis will produce gender-sensitive IEC materials and utilise advocacy fora such as the annual World Sight Day to raise awareness of increasing girls’ access and uptake of eye health services. Rural communities will also be particularly targeted in this project. Our community engagement interventions (facilitated film screenings and radio programmes) are especially targeted towards this group. With high levels of illiteracy and reliance on radio communications, health messaging needs to be visually and aurally stimulating. Orbis’s objective of making quality services available means that significant investment will be placed in training different eye health and primary health care cadres and equipping facilities as a complementary approach to the community engagement and mobilisation interventions. Empowerment is a specific aim of our work within the community. We believe that a workforce trained in the appropriate skills and with the right equipment for the role will feel empowered and motivated to deliver a quality service. Training community health workers (CHWs) in basic eye care is one of the most effective ways of ensuring that children with eye problems are identified early and referred for medical or surgical interventions, especially in rural areas. A number of different CHW cadres exist in Copperbelt province – some volunteers, some on stipends and others as salaried MoH employees. Orbis is currently in discussion with the National Eye Care Coordinator, the PMO and PCDO regarding on which particular cadre Orbis should focus its investment to ensure optimal and most sustainable results. Appropriate targeted training for CHWs will aim to equip them to refer children with visual problems to health centres at both primary and secondary level staffed by Ophthalmic Clinical Officer (OCOs) and Ophthalmic Nurses (ONs).There, newly trained staff will be able to accurately assess, diagnose, treat and/or refer children to the appropriate care level if requiring more complicated treatment. All the different cadres that Orbis has trained will then be instrumental in ensuring that only appropriate cases are sent through to tertiary levels of care, thus strengthening the referral pathway, reducing travel times and costs for patients and preventing lost time and money caused by using inappropriate referral channels. Orbis will also train general nurses and general clinical officers from approximately 250 primary health care facilities to screen, treat and refer basic eye health problems. Orbis will simultaneously provide refresher training for Copperbelt’s main mid-level eye health personnel: OCOs and ONs, focusing on childhood blindness prevention, paediatric eye disease and use of new evaluation devices. This approach to capacity-building this critical cadre of eye health personnel will support the more effective management of child eye health cases in a situation where the over-referring of children is commonplace. Orbis is currently in discussions with the National Eye Care Coordinator and stakeholders at provincial level regarding optimal approaches to training the different cadres outlined above. Where possible, Orbis will use and adapt existing curricula and work with existing MoH trainers/facilitators. Orbis will be investing in the training of a predominantly female CHW and nursing workforce that is

trusted by communities and will be able to identify girls and boys who need treatment. The training will include a session on Gender and how to effectively counsel families to encourage the uptake of services by girls. To strengthen the referral pathway further, Orbis will test an innovative technology approach with a sample of general nurses. Utilising smartphones, Orbis aims to assess the feasibility of training nurses to administer a visual acuity test and take digital photographs of the eye. We will then assess the ability of an in-country eye health professional to receive and evaluate nurse-administered visual acuity tests and eye photographs electronically and make a preliminary assessment of whether a referral is required. It would then be for Orbis to assess whether this approach results in more appropriate eye problem referrals than current approaches. As part of Phase 2, Orbis will continue to strengthen the capacity of specialised and allied eye personnel at Kitwe Eye Annexe and the province’s other tertiary level hospital, Arthur Davison Children’s Hospital. This is to ensure the continued provision of high quality sub-speciality paediatric eye surgery and post-operative care. Orbis will implement this approach to up-skilling through its proven and cost-effective hospital-based programmes (HBPs), using the expertise of Orbis’s volunteer faculty. HBPs comprise contextually appropriate, specialised training to all members of the eye health medical team to advance human resource development and promote clinical excellence. Having the appropriate eye health diagnostic equipment, consumables and supplies is a critical complementary intervention to capacity building and up-skilling of key eye care staff. Orbis will purchase core materials and equipment for facilities at primary, secondary and tertiary levels – and include technical training as appropriate. All purchased equipment and supplies will be donated to the MoH, supported by use and maintenance agreements. Orbis recognises that its proposed project outcome relies on an enabling and well-coordinated environment to ensure children take up quality service and remain in care. Orbis will facilitate clinical co-ordination workshops in conjunction with the PMO and District Community Medical Officers on referral approaches, common challenges, expectations and follow-up feedback mechanisms. Following on, regular district clinical coordination meetings will be scheduled throughout the project period specifically for eye health to provide a forum for planning, feedback and information sharing on the referrals system. Additionally, through targeted meetings with national and provincial level MoH stakeholders, Orbis will continue to use project evidence to advocate for adequate eye health staffing and resource priorities within the targeted districts. Orbis will also take advance of ‘World Sight Day’ to communicate with all relevant stakeholders. WSD will be marked with partners in district hospitals, rural health facilities, schools and community structures, with support from the PMO/MoH. Before and during WSD, screening points will be set up at five key locations throughout the province. These screening points will such services as eye screening, refraction and appropriate treatment. Referrals will also be managed from the screening point, with all complicated paediatric cases referred to KEA. WSD presents a good promotion opportunity, with teeshirts, caps and banners helping to raise awareness of key messages. Radio and TV will also be used to spread awareness – the latter is appropriate in a province where more than 80% of the population lives in urban areas. High profile and influential government figures such as the President and Minister of Health will also be engaged through WSD. The aim will be to advocate for the prioritisation of eye care at national level. Orbis intends to provide full coverage of Copperbelt province with the proposed interventions. Five districts will be covered in 2016 and 2017, and the remaining districts in 2018 and 2019. The rationale for this phased expansion is two-fold: 1) Orbis will need to first target those districts that are better positioned and have facilities to accommodate new or trained personnel, equipment and consumables; 2) a targeted approach allows for internal strengthening and understanding of the referrals process without measures that will dramatically increase the number of patients being seen either by

unqualified, unequipped staff or creating a bottleneck at the tertiary level.

3.8 SUSTAINABILITY AND SCALING-UP How will you ensure that the benefits of the project are sustained? How will costs of any posts or maintenance of infrastructure provided by the project be paid for after project funding finishes? Please provide details of any ways in which you see this initiative leading to other funding or being scaled up through work done by others in the future.

Orbis believes that our phased approach and our focus on strengthening existing health systems provides a sustainable and comprehensive approach to ensuring eye health for all and we would like to take the opportunity during this project to gather evidence to support this approach (see section 5.3). During the project period, it is the government and not Orbis who owns the project. The role of Orbis is to provide support where it is needed so that health systems can be strengthened. In the case of Copperbelt, it is around training and capacity building of key staff within the health care system, educating the public on eye health to drive demand for the service and advocating to the government to maintain eye health as a priority. The government, particularly the MoH, has been central to the project design and planning from the start and fully supports our project approach. Additionally, apart from supporting the costs of Project Officer, Finance Officer and Project Assistant (M&E) in Copperbelt Province, Orbis does not cover any other salary costs as those we train are already in post. As stated in section 3.7 above, any equipment purchased is the property of the government and will be maintained locally, after the project has provided appropriate training. The project has already seen sustained behavioural changes within the referral system such as completing existing documentation accurately and consistently so that when a patient is referred to another doctor, he or she will have access to properly completed records to give the doctor a full picture. Experience has informed us that traditional community education methods do not work in effecting lasting change. We have therefore decided to adopt the innovative approach of using film and radio for education which we have described in section 3.7. Given its success in other sectors, we believe this approach will be successful in eye health. We will be carrying out rigorous monitoring and evaluation to assess its effectiveness and adapt it where necessary. We believe that this approach together with the training we will provide will contribute to the sustainability of the project impact. Only an appropriately-trained workforce can provide a quality service which will continue to drive demand. We wish to create a virtuous circle whereby a higher demand for services will enable trained practitioners to practice and continually improve their skills and quality of work. This will in turn also improve staff motivation, patient confidence and ensure programme sustainability and during this project we will gather evidence to support this approach (see section 5.3). As stated in section 3.3, Orbis’s work is supporting the Zambian government’s national eye health development plans which means that the success of this project may encourage and enable the expansion of similar projects in other areas of the country. This will create more extensive impact in sustainable delivery of eye health services across the country and ensure progressive ownership of eye health strategies by the relevant government Ministries. In addition, lessons from this project will be assimilated into the rest of Orbis’s work globally and feed into current and future projects that form part of our Sub-Saharan African Strategy. Orbis’s initial investment in KEA has already been a catalyst in leveraging further funding through the Standard Chartered Bank ‘Seeing is Believing’ Programme. Orbis is using this funding to develop comprehensive eye health services in North-Western Province adjacent to the Copperbelt, with paediatric and complex adult cases being referred to KEA. It is also recognised that the gaps and inefficiencies that affect the referral system around eye health also affect other areas of medicine. So this project will provide a template for strengthening the referral system that could be

adapted to address other areas, both in terms of medical condition and geographical area.

3.9 SCALING YOUR PROJECT UP OR DOWN How will you expand or reduce the scope of the project if your appeal income is different from what you have estimated it will be?

Our appeal income far exceeded our estimates. Instead of expanding the scope of the project, Orbis chose to use DFID’s match funds to cover 100% of the project.

SECTION 4: PROJECT RISKS AND MITIGATION

4.1 How does your organisation approach the identification and management of risks associated with the delivery of a project? What systems and processes do you have in place? Please also include with your application a separate risk register/matrix showing the risks associated with your proposed project and how you will mitigate them, for which you should use your own format.

Orbis conducts risk assessments of all its major projects. As part of project design, risks and assumptions are assessed by Orbis Project Managers and field staff in consultation with our in-country partners and other key stakeholders. This assessment shared with the Orbis UK Programme Committee, which currently includes senior professionals with significant experience in developing world ophthalmology, finance and nursing. During the project, risks will be regularly reviewed by Orbis Africa staff. Key risks for this project are summarised in the attached risk register.

4.2 ENVIRONMENT AND CLIMATE CHANGE What are the opportunities and the risks of the project in relation to environmental sustainability and climate change? Please specify what overall impact (positive, neutral or negative) the project is likely to have on the environment and climate change. Where relevant, please also specify what impact the environment and climate change are likely to have on the project. In each case, what steps have you taken to assess any potential impact? Please note the severity of the impacts and how the project will mitigate any potentially negative impacts, as well as how it will make use of opportunities to increase the positive impacts.

Orbis anticipates that the overall impact on the environment and climate change of this project will be minimal.

SECTION 5: MONITORING, EVALUATION, LESSON LEARNING This section should clearly relate to the project logframe and the relevant sections of the budget.

5.1 How will the performance of the project be monitored? Who will be involved? What tools and approaches are you intending to use? What training is required for partners to monitor and evaluate the project?

As with all Orbis projects, this one will implement a rigorous monitoring and evaluation (M&E) system. The project logframe provides a framework for the M&E system, detailing the project performance indicators, data sources, baseline and targets. A draft M&E Operational Plan has been developed by the Orbis Africa M&E Manager, the Project Officer and relevant project stakeholders, including details on data flow and reporting requirements. The M&E plan will be finalised at the start of the project and a training workshop will be organised to finalise and orientate all stakeholders to the system. M&E will be incorporated into the training of trainers (CHWs, PHC workers, OCOs and ONs). Orbis has an existing reporting system whereby projects are required to submit progress reports on a quarterly basis. In addition, quarterly meetings will be held to review the reports and lessons learnt to inform ongoing implementation. The Orbis Africa M&E Manager will conduct a comprehensive

Data Quality Assurance (DQA) audit annually. As far as possible, existing monitoring systems of the partners will be used to ensure no parallel systems are developed. The following tools will be used to monitor project performance: Uptake of services among children: the existing HMIS provides data on children accessing services at primary and district level facilities. However, there are limitations in the disaggregation of data generated by the HMIS currently - no gender disaggregation and limited age disaggregation. The implications are that only the 0-5 year age group can be monitored. The Zambian Ministry of Health is implementing a pilot to improve the disaggregation of data reported in the Copperbelt Province at district hospitals, however the pilot will not be extended to primary level in time for the project to use the data for monitoring purposes. Orbis will however support the pilot process. % of patients referred receiving treatment: A rapid assessment of referral system will be conducted annually. This will entail a review of a sample of referred patients based on referral records and patient files to see whether they arrived at the referral facility and received treatment and, if necessary, explore reasons for not completing the referral. Follow up of surgical patients: Hospital follow up records. Tools to monitor training: Attendance registers, post assessments of trainees, and interview schedules. Tools to monitor community awareness activities: registers of films screenings, radio station listenership statistics and group interviews after film screenings and radio shows to measure understanding and improvements in knowledge of eye health. A sample of film screening audience members will be followed up to explore the possible outcomes of the strategy. Tools to monitor coordination: Qualitative tracking of changes in the levels of coordination, including analysis of coordination meeting minutes, quarterly monitoring visits by the Orbis Africa project team, interviews with relevant personnel, project documents and referral records. The M&E Manager will oversee the implementation of the aforementioned M&E Operational Plan. The Orbis Africa Project Officer will conduct quarterly visits including follow up interviews with a sample of trainees. The Orbis Africa Project Assistant (M&E) and M&E Manager will conduct annual rapid referral system assessments. The Orbis Africa Project Assistant (M&E) will receive data from the relevant stakeholders (Provincial Health Information Officer, Children’s Radio Foundation, Facilitators, Trainers, and the health facilities) and consolidate the data. The Project Officer will complete internal quarterly reports based on the data, together with quarterly beneficiary case studies. Quality assurance of training and community awareness events will be monitored through observation. Orbis will use monitoring data to inform further project improvements, as well as advocacy at provincial and national levels to support prioritisation of eye health and in particular gendered programming for eye health. An internal mid-term assessment will be conducted by the Orbis Africa Head of Programme Management and the Orbis Africa M&E Manager. The purpose of the evaluation will be to assess project performance and quality to date and capture lessons learnt to inform project implementation. The mid-term assessment will also be the critical juncture to assess the effectiveness of the technology pilot.

A final end-of-project evaluation will be conducted by an external independent evaluator. The purpose of the evaluation will be to assess project effectiveness, efficiency, relevance of project design, sustainability and impact orientation.

5.2 Please use this section to explain the budget allocated to M&E. Please ensure there is provision for baseline and on-going data collection and an end of project review. If you think there is a case for undertaking an independent mid term review of the project, or a final independent evaluation (eg. if the project is testing a new approach, or working in a particularly difficult or sensitive context, or is high value), please include costs for this in your budget.

The budget allocated to M&E consists of: 1. Data collection tools such as registers and referral forms where necessary 2. Training to relevant stakeholders on data collection, data quality and use 3. Quarterly M&E visits which includes follow ups of personnel trained, annual rapid data quality

audits, rapid assessment of referral system and quarterly monitoring review meetings. 4. Data capturing of quarterly data such as pre and post-test assessments and other output

data. 5. Annual Review meeting 6. Mid-term assessment and end of project evaluation

5.3 Please explain how the learning from this project will be incorporated into your organisation and disseminated, and to whom this information will be targeted (e.g. project stakeholders and others outside of the project). If you have specific ideas for key learning questions to be answered through the implementation of this project, please state them here.

To ensure that data is used regularly to inform project decision-making, quarterly and annual meetings will be held between Orbis Africa and relevant district health personnel to review progress in project implementation and results achieved. This will be an opportunity to identify successes, challenges, reflect on monitoring data collected and highlight areas of underperformance to formulate action plans for solutions and document key lessons learnt. During subsequent monitoring visits, progress in implementing those action plans, and in addressing underperformance issues, will be reviewed. A management response will be completed detailing the key recommendations from the midterm assessment and monitored for implementation. A number of reports will be produced to inform project learning and these will be circulated internally as well as to project partners and will be used during quarterly and annual meetings to reflect on the project performance. Information and learning will be tabled during our programme review meetings for the region to be shared with colleagues managing programmes in other countries. Key highlights and learning will be shared globally and amongst our international networks such as VISION 2020. As referred to in section 3.8, Orbis Africa has a number of key areas of learning that we are keen to explore through the implementation of this project. These include: 1) Assessing the effectiveness and impact of facilitated film screenings and targeted radio programmes on improving awareness on eye health and encouraging service uptake and social change; 2) Assessing the most effective and sustainable approaches to training and up-skilling of health personnel on eye health.

SECTION 6: EXPERIENCE/TRACK RECORD

6.1 What is the value added of your organisation in delivering the proposed intervention? What is your organisation’s track record in delivering similar interventions in similar contexts for a similar cost? Please include the details of the development results achieved. If your organisation has not delivered this type of intervention before, what learning/evidence

underpins your proposal?

As described in section 8.10 in the ‘Capacity of the Implementing Partner’ section, Orbis has had considerable experience in delivering similar interventions in similar contexts for similar costs in sub-Saharan Africa. Orbis currently runs two comparable projects - in North Western Province, Zambia (NWP) and KwaZulu-Natal, South Africa and is the planning stages for Ghana. Over the last 4 years in KwaZulu-Natal, Orbis has been implementing a project aimed at strengthening a quaternary hospital Inkosi Albert Luthuli Central Hospital (IALCH) to provide paediatric eye health services. Phase 2 of implementation has seen expansion to secondary hospitals, primary health care level and the community. Radio shows and facilitated film screenings are in progress and learning from the implementation of these will be carried into the implementation in Zambia.

128 Ophthalmologists and doctors have been trained 3,857 children have been screened at IALCH 2,329 children have been treated at IALCH 1,064 children have received eye surgery at IALCH

Budget is currently about $300,000 per year, which is due to increase as expansion activities (focusing on community awareness) take hold. In North Western Province, Orbis is implementing a project aimed at strengthening comprehensive eye health, targeting both adults and children across 8 districts. In the first two years of implementation, the following results were achieved:

307 primary health care professionals have been trained. 88,456 people have received medical treatments 122,509 people have been screened for eye health conditions 5,319 people have received spectacles 898 adult cataract surgeries have been conducted

The total project value over 5 years is $1.25 million. There is a Project Officer and a Finance Officer in place, reporting to the Country Representative in Zambia. Management, authorisation and reporting systems are in place and operating well. Approximately 70% of this annual budget is spent in Zambia, mostly on outreach and service delivery at hospital and primary health care level, community awareness, as well as training.

SECTION 7: PROJECT MANAGEMENT AND IMPLEMENTATION

7.1 PROJECT MANAGEMENT Please outline the management arrangements for this project. This should include: A clear description of the roles and responsibilities of each of the partners. This should

refer to the separate project organogram, which is required as part of your proposal documentation.

An explanation of the human resources required (number of full-time equivalents, type, skills).

An explanation of how your organisation will manage the delivery of the project, including arrangements for managing delivery partners and how they will report to your organisation.

DFID’s direct relationship on this project will be with Orbis Charitable Trust (OCT). OCT is the grant manager for the project and as such, will receive the funding which it will then disburse to the implementing partner, Orbis Africa. OCT will also have direct responsibility for all financial and project reporting to DFID. Overall management of the project itself will be the responsibility of Orbis Africa, with day-to-day management and implementation led by Orbis Africa’s Project Officer based in Copperbelt province, in close collaboration with the PMO and PCDO.

Orbis Africa has built a highly-qualified and experienced team to manage this project. Eleanor McNab, Orbis Africa’s Head of Programme Management based in Cape Town, will be responsible for overseeing the implementation of the project (0.2 FTE), providing programmatic and technical oversight for project activities. Ms McNab has over ten years’ experience working for health-focused international NGOs, with responsibility for programme development and management across multiple countries in Sub-Saharan Africa. Lucia Nadaf, the Orbis Zambia Copperbelt Project Officer, will be responsible for the day-to-day on-ground co-ordination and implementation of the project (1 FTE), with country level management by Orbis Zambia’s Country Representative (0.3 FTE). Boyd Kamayoyo, the Orbis Copperbelt Finance Officer (1 FTE), will be responsible for ensuring effective, efficient and accurate financial and administrative operations for the project. The Project Assistant (M&E) (0.8 FTE) will provide support in all day-to-day monitoring, evaluation, reporting and learning activities of the project. To ensure integration and streamlining of this project within the province, the Copperbelt project team is based at the Provincial Medical Officer (PMO) in Ndola, Copperbelt province. Although having no direct project management responsibilities, the PMO will be an integral partner on this project, working hand-in-hand with the Project Officer to provide strategic input on project activities, support planning and logistics and help with ongoing troubleshooting and solutions to project challenges. Orbis Africa already has a well-established relationship with the PMO, Dr Mwale. Throughout the project, the Country Representative will also continue to work closely with the MoH’s National Eye Care Coordinator, to ensure continued alignment with national eye care strategy and plans for 2016-2020. Chantel LeFleur-Bellerose, Orbis Africa Monitoring & Evaluation Manager (0.1 FTE), will be responsible for managing all M&E activities in relation to this project, overseeing execution of routine M&E activities, supporting the in-country Project Officer and Project Assistant (M&E), as well as providing technical oversight for the project mid-term assessment and end of project evaluation. Ms LeFleur-Bellerose has over 10 years’ experience in managing the M&E of regional programmes within international development organisations in southern and eastern Africa with specific experience in M&E of health and gender programmes. Orbis Africa’s Grant & Compliance Manager will be responsible for the financial management of this project, including oversight of the project budget and expenditure in-country, financial reporting and ensuring implementation of sound financial practices (0.15 FTE). The core project management team will be backed up by a strong and experienced Orbis Africa executive management team, with core expertise and experience in eye health programming, technical programme development, business and financial management. The Orbis Africa structure has clear reporting lines and all staff have specific job profiles that outline the requisite skills and experience for each role. Orbis has a robust performance development management system that provides clear performance systems for managers and employees at all levels. In addition, targeted technical support will be provided by collaborative partners such as STEPS and Children’s Radio Foundation. During the first year of the project, their support will focus on strategic input into adaptation of film screening and radio approaches for the Copperbelt context.

7.2 NEW SYSTEMS, INFRASTRUCTURE, AND/OR STAFFING Please outline any new systems, infrastructure, and/or staffing that would be required to implement this project. Note that these need to be considered when discussing sustainability and project timeframes.

As described in Section 7.1, new positions required to implement the project are as follows: Project Officer, Finance Officer and a Project Assistant (M&E). Along with staff recruitment, the project necessitates the establishment of a new Orbis office. As of 2016, this has been achieved within the

PMO in Ndola. As well as being cost-effective (Orbis’s contribution to rental is minimal), it is strategic for Orbis to be situated within the broader Copperbelt government health office – to ensure continued buy-in for the project from key stakeholders, project ownership, providing proximity to key technical/clinical staff for input into ongoing project activities, as well helping to promote the integration of eye health into the broader health agenda and activities at provincial level.

7.3 COLLABORATION AND COORDINATION WITH OTHER DEVELOPMENT ACTORS How will you coordinate project implementation with other development actors and ensure no duplication of effort (including with other DFID funded activities)? How will you work with local/national government and private sector providers?

Housing the Orbis office within the Provincial Medical Office gives Orbis an advantage in terms of strategic and operational collaboration and coordination, not only with provincial government, but also other development actors. Just as Orbis has been doing over the last three years in North Western Province, the Project Officer will participate in the PMO’s weekly meetings in Ndola. This is a forum for each government unit as well as NGO partners/projects to provide information on current activities, but also seek technical input as necessary. Orbis is one of the key eye health partners in Zambia and the Country Representative has a seat on the eye health working group which meets periodically. Development actors are also keenly involved in eye health policy and planning discussions at national level in Zambia, and Orbis, amongst others, recently played an active role in providing input to the latest National Eye Health Strategic Plan (NEHSP), 2016-2020. Further, at provincial level, the project will participate in the Ministry of Health’s annual planning and budgeting process, providing Orbis the opportunity to integrate project plans and budgets at all levels of care. As well as auguring well for sustainability of interventions beyond the life of the project, this activity also provides good opportunity for Orbis and other development actors to ensure complementarity, rather than, duplication of activities.

SECTION 8: CAPACITY OF APPLICANT ORGANISATION AND ALL IMPLEMENTING PARTNER ORGANISATIONS (Max 3 pages each) Please copy and fill in this section for your organisation AND for each implementation partner

8.1 Name of Organisation Orbis Charitable Trust (An affiliate of Orbis International)

8.2 Address 4th Floor, Fergusson House 124-128 City Road London EC1V 2NJ

8.3 Web Site www.orbis.org.uk

8.4 Registration or charity number (if applicable)

1061352

8.5 Annual Income Income (original currency): 5,741,581 Income (£ equivalent): 5,741,581 Exchange rate: N/A Start/end date of accounts (dd/mm/yyyy) From: 01/01/2014 To: 31/12/2014

8.6 Number of existing staff 22

8.7 Proposed project staffing staff to be employed under this project (specify the total full-time equivalents - FTE)

Existing staff 1: Finance Manager (0.05 FTE) 1: Head of Programme Support (0.1 FTE)

New staff Nil

8.8 Organisation category (Select a maximum of two categories)

Non-Government Org. (NGO) Local Government

Trade Union National Government

Faith-based Organisation (FBO) Ethnic Minority Group or Organisation

Disabled Peoples’ Organisation (DPO) Diaspora Group or Organisation

Orgs. Working with Disabled People Academic Institution

Other... (please specify)

8.9 A) Summary of expected roles and responsibilities, AND B) Amount (and percentage) of project budget which this partner will directly manage.

A): OCT will manage the grant, ensure compliance, disburse the funds and support the field teams. B): £29,143 (3%)

8.10 EXPERIENCE: Please outline this organisation's experience and track record in relation to its roles and responsibilities on this project (including technical issues and relevant geographical coverage). What development results has this organisation achieved which are relevant to this proposal (ie. for similar interventions in similar contexts for a similar cost)? Please include details of any external evaluations of this organisation’s work (relevant to the proposed project) which have been completed and whether they are available.

Orbis Charitable Trust is an affiliate of Orbis International which started in 1982 and has many years’ experience of establishing and strengthening eye health services in countries around the world. Much of our work has focussed on paediatric eye health and on working in remote rural areas to embed eye health services into the existing public health system. Orbis is very well qualified to address the problem of unnecessary vision loss among children in Zambia, having already established or strengthened more than 45 children’s eye health centres globally. Orbis employs tried and tested methods to carry out all its programmes and Orbis projects are monitored on an on-going basis and the major ones are evaluated twice; once during and once after completion. The findings are used to inform and refine the design of current and future projects. Orbis programmes and projects are also designed around the latest research relating to blindness and health systems to ensure that we also remain relevant. As members of VISION 2020 and the IAPB, Orbis is well-placed to access the latest research relating to issues around preventable blindness. Our research partners also include the WHO, African Vision Research Institute and the African Child Policy Forum. With these partners, Orbis is active in adding to the body of knowledge surrounding avoidable blindness. For example, Orbis International recently co-created and funded a multi-centre observational study assessing cataract surgical outcomes in settings where follow-up is poor, the findings of which are impacting upon our project design processes where relevant. Section 8.11 below shows OCT’s experience in managing grants from a number of institutional and corporate donors.

8.11 FUND MANAGEMENT: Please provide a brief summary of this organisation's recent fund management history. Please include source of funds, purpose, amount and time period covered.

In 2014, OCT secured £5,741,581 in voluntary income, comprising £3,408,968 in donations, £1,996,011 in legacies, £295,973 in grants and £40,629 in investment income.

Our biggest donors are: Sightsavers International is funded by DFID to deliver the Trachoma (SAFE) Elimination

programme in Ethiopia. It sub-grants coordination of the £15 million five year project to OCT, along with implementation in the SNNPR zone (more than £6m over 5 years).

Jersey Overseas Aid Commission (JOAC) has been a generous funder to OCT for the last 14 years. Since 2012, they have given OCT a number of grants including almost £500,000 towards child eye health in Kitwe, Zambia. In 2014 £98,932 was towards eliminating blinding trachoma and establishing a comprehensive rural eye health programme in two districts in Ethiopia.

States of Guernsey Overseas Aid Commission (GOAC) in 2014 made a grant of £33,325 for Strengthening Cataract, Trachoma and Refractive Error in Kembata-Tembaro Zone, Ethiopia

Other key donors include Euromoney who have given us £242,572 towards establishing Comprehensive Rural Eye Care in two districts of Ethiopia, the European Society of Cataract and Refractive Surgeons donated £13,330 towards our project contributing to the reduction in childhood blindness in Gondar, North West Ethiopia and Cofra have donated £27,273 for paediatric eye care in Bangladesh.

8.12 CHILD PROTECTION (for projects working with children and youth (0-18 years) only) How does this organisation ensure that children and young people are kept safe? Please describe any plans to improve the organisation's child protection policies and procedures for the implementation of this project.

In 2015, OCT invested considerable effort into improving its child protection policy. This updated document was approved by the OCT Board of Trustees in November 2015. OCT has conducted sensitisation workshops with all staff based in the UK to ensure policies and procedures are understood and actioned.

8.13 FRAUD: Has there been any incidence of any fraudulent activity in this organisation within the last 5 years? How was the fraud detected? What action did your organisation take in response? How will you minimise the risk of fraudulent activity occurring?

No cases have been recorded in the last 5 years. OCT has updated its fraud and corruption policies and comprehensive finance procedures to minimise risk as much as possible.

8.14 DUE DILIGENCE: How has your organisation assessed the capacity and competence of this organisation to deliver the proposed intervention and to manage project funds accountably? What is your assessment of their capacity and what is the evidence to support this? How will your organisation manage the risks of under-performance and financial mis-management by this organisation throughout the lifetime of the project?

The KPMG Due Diligence audit in 2015 was well-received and has enabled OCT to strengthen its policies, procedures and systems. Evidence of this has already been provide to DFID and more will be provided, according to the agreed timetable.

SECTION 8: CAPACITY OF APPLICANT ORGANISATION AND ALL IMPLEMENTING PARTNER ORGANISATIONS (Max 3 pages each) Please copy and fill in this section for your organisation AND for each implementation partner

8.1 Name of Organisation Orbis Africa

8.2 Address Kings Cross Corner 9 Queens Park Avenue Salt River Cape Town 7925 South Africa

8.3 Web Site www.orbis.org

8.4 Registration or charity number (if applicable)

Company registration number: 2011/120291/08 NPO registration number : 126-853 NPO

8.5 Annual Income Income (original currency): R41,959,892 Income (£ equivalent): £2,330,732 Exchange rate: 17.8467 (Oanda average for 1/1/14 – 31/12/14) Start/end date of accounts (dd/mm/yyyy) From: 1 January 2014 To: 31 December 2014

8.6 Number of existing staff 20

8.7 Proposed project staffing staff to be employed under this project (specify the total full-time equivalents - FTE)

Existing staff Eleanor McNab: Orbis Africa Head of Programme Management (0.2 FTE)

Chantel LeFleur-Bellerose: Orbis Africa Monitoring & Evaluation Manager (0.1 FTE)

Orbis Africa Grants & Compliance Manager (under recruitment) (0.15 FTE) Country Representative (0.3 FTE)

New staff Project Officer in Copperbelt – 1 FTE Finance Officer in Copperbelt – 1FTE Project Assistant (M&E) – 0.8 FTE

8.8 Organisation category (Select a maximum of two categories)

Non-Government Org. (NGO) Local Government

Trade Union National Government

Faith-based Organisation (FBO) Ethnic Minority Group or Organisation

Disabled Peoples’ Organisation (DPO) Diaspora Group or Organisation

Orgs. Working with Disabled People Academic Institution

Other... (please specify)

8.9 A) Summary of expected roles and responsibilities, AND B) Amount (and percentage) of project budget which this partner will directly manage.

A): Orbis Africa will be responsible for day-to-day implementation, monitoring and evaluation, liaison with in-country partners and management of funds.

B): £876,693 (97%)

8.10 EXPERIENCE: Please outline this organisation's experience in relation to its roles and responsibilities on this project (including technical issues and relevant geographical coverage). Please include details of any external evaluations of this organisation’s work (relevant to the proposed project) which have been completed and whether they are available.

In 2010 Orbis International established an affiliate office in Cape Town, Orbis Africa. The purpose of this was to expand Orbis’s presence into sub-Saharan Africa, an area of extreme need when it comes to eye care services, particularly paediatric eye care services.

In the five years since it began working in the region, Orbis Africa has developed two paediatric tertiary eye care centres - one at Kitwe Central Hospital (KCH) in Zambia and a second at Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa. This centre was strengthened as part of a childhood eye care project in the KwaZulu-Natal province of South Africa. A core element of this project focuses on strengthening capacity at primary health care level, and improving the paediatric referral and follow-up network. This includes work with both STEPS and CRF to increase awareness of eye health issues, as well as training PHC workers and Community Care Givers to improve earlier identification and referral of eye health problems. To date this project has screened 3,091 children and 973 have received surgery. The experience and learning from the KwaZulu-Natal setting is instrumental to the Copperbelt project. As mentioned in Section 4.8, the initial investment in paediatric eye health services at KEA has helped to leverage further funding for eye health in Zambia through the Standard Chartered Bank ‘Seeing is Believing’ Programme. Since January 2013, SiB funding has been used to develop comprehensive eye health services in Zambia’s North-Western Province, with paediatric and complex adult cases being referred to KEA. Within this new project, Orbis Africa will be using the same model of working with the PMO to strengthen the district health system’s capacity to provide eye health services and accurate referral through to tertiary level.

Orbis Africa has developed strong relationships with partners in the country, enabling them to expand their human resource training and child eye health advocacy work, both of which are integral aspects of this proposal. In 2013, for example, Orbis Africa and COECSA (The College of Ophthalmology of Eastern Central and Southern Africa) created a partnership in collaboration with the IAPB Africa to effectively roll out Human Resources for Eye Health strengthening in the East, Central and Southern Africa region through the Human Resources for Eye Health Strengthening Initiative. This consultative partnership aims to strengthen training institutions to deliver high quality training and service delivery and advocate for a political environment conducive to promoting sustainable HReH across Africa. It aims to create dialogue amongst eye health professionals to promote professional skills exchange, knowledge development and build health information systems to generate useful data on health determinants and health system performance. Elsewhere, Orbis Africa has started an initial collaboration with the Office of the High Commission on Human Rights on the Right of the Child to effective, efficient and timely eye care. It organised an advocacy workshop Advocating for Action to Ensure Child Eye Health for Africa which was attended by representatives from eye care organisations, child rights organisations and advocacy organisations from across sub-Saharan Africa. The outcome of the workshop was the development of an advocacy plan to support the provision of comprehensive child eye services across the continent. Orbis Africa also published an advocacy brief Children Have the Right to Sight which includes recommendations for children’s organisations, civil society and governments. With regard to evaluations, the CEHTF in Durban has undergone a mid-term review and we have also evaluated Phase 1 of both the projects in the Copperbelt and North Western Province.

8.11 FUND MANAGEMENT: Please provide a brief summary of this organisation's recent fund management history. Please include source of funds, purpose, amount and time period covered.

Since 2011, the organisation has received and administered a number of grants and donations. Only the ones over £5,000 (equivalent) are listed below and converted to GBP: 2011 - Bausch & Lomb gave £ 31,867 for Research - Paediatric Cataract Initiative 2012 - 2013: Standard Chartered Bank gave Orbis Africa a three year grant of £638,000 for our project,

Developing Comprehensive Eye Care Services in NW Province, Zambia The Foundation for Human rights gave £18,324 a one year grant for our work on Advocacy for

Eye Health Capital Equipment Group gave a one year grant of £5,480 Research - Poverty and Eye Health 2013-2014: We received grants from the Embassy of the USA for £7,185, the Discovery Fund for £16,868

and Victor Daitz Foundation for £21,615 for our Training Programme in KwaZulu-Natal, South Africa. The Embassy of Japan gave £58,626 for the Equipment and Consumables of the project.

2015: £14,834 received from the Conservation, Food & Health for eye health collaboration with

Traditional Healers in KwaZulu-Natal, South Africa. £14,553 received from Discovery Fund Trust for training of primary health care nurses,

community health workers and Early Childhood Development practitioners in basic eye health in KwaZulu-Natal, South Africa.

Discovery Fund Trust gave a one year grant of £63,516 to implement a smartphone technology pilot in one district in KwaZulu-Natal, South Africa.

8.12 CHILD PROTECTION (for projects working with children and youth (0-18 years) only) How does this organisation ensure that children and young people are kept safe? Please describe any plans to improve the organisation's child protection policies and procedures for the implementation of this project.

Orbis Africa has strengthened its existing child protection policies and procedures since the submission of the original proposal to DFID. A revised policy was approved by the Board in August 2015. In early 2016, Orbis contracted RAPCAN (Resources Aimed at the Prevention of Child Abuse and Neglect), to deliver a 2-day workshop with all Orbis Africa staff, including core staff who will work on the Copperbelt project. RAPCAN, an organisation with many years of experience in the child protection arena in South Africa, and most recently in Zambia, supported Orbis Africa to explore the practical implementation of the newly revised policy, and will be providing further support in 2016 to strengthen particular elements and to ensure the policy can be implemented effectively.

8.13 FRAUD: Has there been any incidence of any fraudulent activity in this organisation within the last 5 years? How was the fraud detected? What action did your organisation take in response? How will you minimise the risk of fraudulent activity occurring?

No cases reported. Risk is minimised through our existing finance and procurement policies and procedures and though a schedule of annual internal auditing.

8.14 DUE DILIGENCE: How has your organisation assessed the capacity and competence of this organisation to deliver the proposed intervention and to manage project funds accountably? What is your assessment of their capacity and what is the evidence to support this? How will your organisation manage the risks of under-performance and financial mis-management by this organisation throughout the lifetime of the project?

A number of the due diligence actions placed on Orbis Charitable Trust by the KPMG audit in 2015, have been cascaded to Orbis Africa, thereby strengthening the organisation. Since 2010 OCT has routed a significant amount of restricted and unrestricted funding through OA. The monitoring and reporting of outputs and expenditure has been satisfactory to OCT and its donors.

SECTION 9: CHECKLIST OF PROPOSAL DOCUMENTATION

Please check boxes for each of the documents you are submitting with this form. All documents must be submitted by e-mail to: ukaidmatch@dfid.gov.uk

Mandatory Items Check Y/N

Proposal form (sections 1-7) Y

Proposal form (section 8 - for applicant organisation and each partner or consortium member)

Y

Project Logframe Y

Project Budget (with detailed budget notes) Y

Risk register/matrix Y

Project organisational chart / organogram Y

Communications Plan - 2 documents: C1 (communication plan form) and C2 (communications activity timetable)

n/a

Written evidence of confirmed appeal communications partnership(s), e.g. an email or letter

n/a