ESTHER Switzerland Partnership ProjectGrant

2017Application Form

Proposal N°
Please leave this void, it will be filled by the ESTHER Secretariat
  1. PROPOSAL

  1. AT A GLANCE

Project Title
Country / Country of the partner institution
Goal / max 3 lines
Swiss institution / Name
Address
Name, position and contact detail (e-mail, phone) of the contact person
Partner institution(s) / Name
Address
Name, position and contact detail (e-mail, phone) of the contact person
Requested grant (CHF)
(max. CHF 100’000.--)
Project Timeframe

N.B.:

  • Please provide as an attachment short resume of applicants’ professional experience (relevant to the application)
  • Please read the document “Guidelines for submission of proposals, 2017” and write your proposal accordingly.

  1. CONTEXT

  • Key information on the health status of the population, in the country and the zone of intervention, with a particular focus on the topic of the project.
  • Key information on the health system in which the partner hospital is embedded (e.g. reference to the 6 WHO building blocks[1]), with a particular focus on the topic of the project.
  • If applicable, how is the project linked to other ESTHER/SDC funded projects.
(max. 400 words)
  1. PARTNERSHIP

  • Short description of both partner institutions (please provide internet links to relevant institutions pages)
  • Short description of the partnership between the Swiss and the partner institution (rationale for partnership, past/current/planned collaboration, including areas of collaboration; please provide internet links to relevant existing materials about the partnership, if available).
  • Is the partner involved in collaborations with other ESTHER or non-ESTHER partners in high income countries? If so, with whom and on what type of project?
  • Explain why the project in this area is needed; what is the advantage toeach institution of implementing the proposed project?
  • Explain how the proposed project fits with the overall ESTHER goals and principles framework (ESTHER Switzerland, EEA Charter etc., EEA Strategic Framework 2015-2020; and, if applicable, with health strategies of the partner country).
(max. 600 words)
  1. GOALS and OBJECTIVES

  • State the overall goal(s) and 3 to 4 specific objectives for each goal of your project. The overall goal(s) should be realistic and the specific objectives should relate to the goal(s).In formulating your objectives, please refer to the SMART criteria:
(max. 400 words)
  1. Target Group(s)

  • Which are the main groups/populations that should benefit from the project activities and why?
(max. 200 words)
  1. ACTIVITIES

  • For each of the main activities and milestones,state when they will take place and who is responsible.

Timeframe / Activity / Milestones / Responsible person

Add rows, if needed.

  1. Methods

  • What methods will you use to conduct your project? According to the main activities described in Section 6, describe how they will contribute to fulfil the objectives.
  • If pertinent, what data will be collected and how will they be used?
(max. 200 words)
  1. Intended Project Results

  • For each Goal and Objectives (Section 4 and Section 6), please describe the expected project outcomes, indicators and means of verification.
  • The numbers should be measurable and achievable and clearly linked to the project goals and objectives (Section 4) and activities (Section 6)
(max. 400 words)
  1. Impact

  • Describe the relevance of the project, the potential for change, criteria used to measure the impact.Describe how the project could potentially have an effect beyond the involved health institutions.
  • How your institutional health partnership (IHP) could contribute to the Sustainable Development Goals (SDG) an in particular to SDG 3 (see Guidelines)
(max. 400 words)
  1. Monitoring and Supervision of Activities

  • Describe the planned monitoring and supervision of activities including frequency, by whom and how
(max. 200 words)
  1. Sustainability

  • Describe how continuation of the partnership and continuation of project results will be ensuredafter project completion.
(max. 300 words)
  1. Any other relevant information

  • Any additional information that could be of relevance
(max. 200 words)
  1. RISKS AND MITIGATION

  • List main potential risk that are involved (risk externally to the start-up period and particularly risks related to the start-up proposal, activities, etc.), assess the likelihood of the risk to occur, the severity if the risks occurs and mitigation measures taken, to avoid or reduce the risk.
(max. 400 words)
Risk / Probability, that the risks occurs
(low / medium / high) / Impact, if the risks occurs
(low / medium / high) / Mitigation measure

Add rows, if needed.

  1. Project Management

  • Explain how the project management will be organized, both at a programmatic and at a financial level
  • (max. 200 words)

  1. BUDGET

  • Indicate the total costs per category (detailed budget as Annex)
  • Hotel and food, according to SDC guidelines on “Lump-sum food reimbursements and standard hotel allowances”
  • If necessary, please add a separate detailed budget as an annex document

Travel:
Accommodation:
Food:
Communication:
Workshop/meeting:
Other (specify):
TOTAL requested (CHF)
Own contribution (partners)
Financial or in kind contributions from the partner institutions: /
  • Describe own contribution
  • …

Other Funding Sources
Financial or in kind contributions from other institutions: /
  • In case of other funding sources, please describe
  • …

  1. PARTNERSHIP AGREEMENT AND SIGNATURE

☐ / A formal agreement between the partner institutionswill be signed or already exists.
(please join the document)
…………………………………………………………. / ………………………………………………………….
Name of signatory:
Institution:
Date: / Name of signatory:
Institution:
Date:

Completed and signed proposal formshould be submitted by e-mail and normal mail to the ESTHER Switzerland Secretariat:

Luciano Ruggia

Secretariat ESTHER Switzerland

Institute of Social and Preventive Medicine

University of Bern

Finkenhubelweg 11

3012 Bern

Tel. +41 22 372 96 58

E-mail:

1

Version May 2017

[1]WHO defines 6 building blocks for strengthening the health systems, for more details see: WHO, Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies, Geneva, 2010 ( )