Project Request Form (PRF)

If you wish to submit a Project Request Form please go to the Projects page.

The Project Request Form (PRF) has the following format:

1.Title for the project/programme.

2.Applicants, and their roles and affiliations.

3.Contact details for the applicants.

4.Information about the proposed project location(s):
a.Country, region, and location name(s)
b.Area (in km2)
c.Population
i.Total population
ii.Female population
iii.Females under 35 years of age
d.Infra-structure
i.Roads
ii.Public transport
iii.Private transport
iv.Water
v.Electricity
vi.Telecommunications
e.Learning institutions (numbers and nature)
i.Primary
ii.Secondary
iii.Higher Education
f.Level of poverty
g.Level of malnutrition
h.Safety (civil unrests and other conflicts)
i.Governmental policy and regulatory frameworks relating to maternal health.

5.Information about existing health systems
a.Health facilities
i.Teaching Hospitals
ii.District General Hospitals
iii.Smaller health facilities and clinics (with obstetric theatres)
iv.Smaller health facilities and clinics (without obstetric theatres)
b.Healthcare workers
i.TBAs
ii.SBAs
1.midwifes and obstetrically-trained nurses
2.primary care physicians
3.hospital doctors
c.Medicinal Drug availability
d.Equipment availability
e.Charities functioning in the project location(s)
f.Existing maternal mortality/mobidity reduction projects and programmes.

6.Information about the state of maternity care provision (please provide estimates if no definite data available):
a.Number of maternities
b.Number of maternal deaths (per year)
c.Causes of maternal deaths (quantitative and qualitative information if available)
d.UN Process Indicators (context specific help button to show how to estimate these)
i.Amount of EmOC services available.
ii.Geographical distribution of EmOC facilities
iii.Proportion of all births in EmOC facilities
iv.Met need for EmOC services
v.Cesarean sections as percentage of all births
vi.Case fatality rates.

7.Details about the project. Please describe in less than 5000 words your project’s:
a.background,
b.objectives,
c.specific targets,
d.needs,
e.proposed implementation programme,
f.monitoring proposals
g.evaluation plans,
h.support from the community, collaborators, and government
i.risk management steps, and
j.plans for sustainability
k.Help required from Ammalife (select all relevant options)
i.Evidence appraisal
ii.Project development
iii.Project implementation
iv.Project monitoring and evaluation
v.Funding
vi.Research and Research Funding
vii.Training
viii.Advocacy
ix.Specific needs (eg equipment, materials, human resources etcetera)

8.Project Budget. Provide a detailed account of the projected monetary needs with justifications. The needs may include:
a.human resources,
b.buildings,
c.vehicles,
d.equipment,
e.medicinal products,
f.stationary,
g.utilities,
h.servicing and maintenance
i.managerial, financial and administrative services.

9.Please provide a project schedule.