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Internship Project: Nomad Children & Infectious Diseases
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Thu Jul 14, 2005 9:08 am    Post subject: Reply with quote

Thanks Maham, Ahsen, and Sajjad.

This is very encouraging; a big step in the right direction. Given the time frame, I'm not inclined to ask CRAC-PPA to flesh this long-term vision out in more detail. I think we have to take them at their word. Do any of you have any doubt that they will follow through with efforts to realize the long-term goals? I worry that we may be forcing the objective on them, without really requiring any commitment on their side.

One issue I don't think was fully resolved is the question about metrics. There were two leading proposals from the group:

1-Conduct an informal survey after training sessions to measure learning.
2-Measure the incidence of related disease in the 'trained' children over time. (This would help assemble data to better market this approach on a larger scale in the future - prototyping...)

Where do we stand on this? If we are not imposing ANY metrics, are there public studies of similar initiatives we can refer to for future promotion/fundraising?

Also, We have also not fully addressed the question of 'why Hep B.' I understand the value of the Hep B vaccination, and I recognize the need to provide something to the children to earn their participation in the education component. But, since the vaccination accounts for 95% of the budget, I am wondering if there is (theoretically) a more cost-effective way to earn their participation. (i.e. How will we market the link between this vaccination and the education component for future expansion of the program?)

Finally, has anyone worked on the last stage - Diligence? Sources of funding, track record, reference for the org or key individuals?

Do others feel the questions above have been sufficiently addressed earlier?

~Justin
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Maham Daher



Joined: 14 Feb 2005
Last Visit: 06 Aug 2006
Posts: 20
Location: Berkeley, CA
PostPosted: Sun Jul 17, 2005 3:03 am    Post subject: Reply with quote

Justin,

Thanks for your email. Here are my thoughts on your questions:

Long-term Plans
-Ahsen, Sajjad and myself have had several rounds of exchanges with CRAC-PPA regarding the long-term plans for the project.
As you will see in the email correspondence, the CRAC-PPA director, Dr.Zafar has expressed his interest in extending the project long-term and has spoken to Godh about this. Further, Sarah Asad the project manager provided us a list of initial steps. Now ofcourse whether they are actually able to do this will depend on funding from additional donors.

Metrics
Since a great deal of evidence already exists about the efficacy of the vaccine, there is no need to test the reduction in incidence of the disease among the children we vaccinate. Instead we would like to measure the following 2 things:

-Compliance with the Vaccine: i.e. Record the number of children returning/ complying with each additional round of vaccination. Godh is confident in being able to have high compliance among children.
-Educational Component: We would like to test the impact of the educational component of the program. To reinforce the educational/ awareness component, CRAC-PPA would like to have additional rounds of seminars with each round of vaccination.We can then survey children on their understanding of the disease and how they can protect themselves.

I do feel we can improve these metrics. As the internship will allow for further development of this project, I am confident that we can work together with Ahsen to flesh these metrics out.

Why Hep. B?
Godh has been working with the community of nomad children as the target audience for all its health and education projects. Godh has a strong background of this community and along with CRAC-PPA has determined that young adolescents are at high risk of contracting Hepatits B and other infectious diseases.

We have previously discussed your concern about 95% of the budget being spent on the vaccine versus the educational/ awareness component. In recent discussions with CRAC-PPA, they have suggested increasing the seminars/ educational component of the project and accordingly decreasing the number of vaccinations. They are willing to adjust this to find a better balance.

NGOs
-PPA is an established organization that has been in existence for close to 40 years and has had some projects on child rights, abuse and health. Godh was founded in 1998 and has been conducting various health and educational projects aimed directly at nomad children. Here are the websites:

http://ppa.org.pk/main/aboutus.asp
http://www.crin.org/organisations/viewOrg.asp?ID=490&name=Godh+Lahore

[b]Confidence in People Managing the Project
-Sajjad and Ahsen have had several visits and meetings with the folks at CRAC-PPA including the director of CRAC-PPA, Dr. Zafar and the manager for the project, Sarah Asad. They both feel confident in CRAC-PPA's ability to sucessfully conduct the
project. If you have specific questions about the organizations, the best people to answer them would be Ahsen and Sajjad.
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Mon Jul 18, 2005 8:40 am    Post subject: Reply with quote

Thanks Maham.

I think we have enough to have faith in the long-term investment, and I'm confident ADP and the internship will help push in this direction...

I'm also comfortable that the second bullet point under metrics is sufficient. Others may disagree.

Let me clarify that the suggestion to test the reduction in incidence of related diseases among the children was not to affirm the efficacy of the Hep-B vaccination, but to measure the impact of the education component r.e. future incidence of other related diseases.

Finally, I understand that we all have confidence in the history and sincerity of the NGOs involved, but we still always need to do the formal due diligence either before a vote, or before funding. If nothing else, this will protect ADP should any malfeasance occur on the part on the NGO or other implementers... Assuming we go forward with the project, will you be able to assemble this info for our records before we transfer funds? I suspect much of it will be available online.

Best!

Justin
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Mon Jul 18, 2005 8:58 am    Post subject: Reply with quote

I vote YES.

While this is not a 'perfect' ADP project, I believe it meets the ADP selection criteria better than any previously funded project, and offers a number of added advantages.

The involvement of an ADP intern (who had an active role in the development of the proposal) will help us to shape the project and build upon it for future growth. Also, supporting the project helps us lauch the internship program with a bang.

Maham, Sajjad, and Ahsen have put in a ton of time working through the details, and developing confidence in the project and NGOs. The NGOs have addressed all of our concerns, have shown a genuine investment in future expansion, and we will have a direct pipeline to the project through Ahsen.

Most importantly, while laying the foundation for addressing the larger public health concern, this project will benefit a large number of children in a population that has largely been ignored.

~Justin
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M. Sajjad Haider



Joined: 23 Apr 2005
Last Visit: 18 Jul 2008
Posts: 55
Location: Pakistan
PostPosted: Sun Jul 31, 2005 3:51 am    Post subject: Reply with quote

An update on the Vaccination of Nomad Children Project.

The internship for Ahsen and work on the project will start from this coming Monday. A copy of the revised project proposal is attached. Only the last two pages have been changed. There is a brief summary of what Ahsen is going to be doing in the coming 4 weeks.

We will be vaccinating 200 youths against Hepatitus B. We will now be having six seminars to give information about STI's and Hepatitus B. There will be seperate seminars for boys and girls. The first two seminars giving information on general health and disease prevention will be followed by the first vaccinations against Hep B. This will be followed by the second and third dose after a month and six months respectively. A questionnaire will be prepared by Ahsen and a survey conducted in the first week and then after the third dose to gauge how knowledge and perception of the disease has changed through the three seminars.
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Tue Aug 02, 2005 8:06 am    Post subject: Reply with quote

Thanks Sajjad. Congratulations on getting another intern started! Do you have any thoughts on how we can sumarize the goals of the internship initiative? For now, we need to start by putting something on the website...

Maham, where do you stand with finalizing the contract? I think you will need to incorporate some of the detail from the revised proposal, and change the relevant language to cite the new version as the blue print. If Ahsen is already working on the project, we need to get this done asap, and have Samira and Humayun review...

Regards!

Justin
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M. Sajjad Haider



Joined: 23 Apr 2005
Last Visit: 18 Jul 2008
Posts: 55
Location: Pakistan
PostPosted: Thu Aug 11, 2005 7:06 am    Post subject: Reply with quote

The project is well and trully underway. A nomad community has been selected. Ahsen has met with the local mobilizers of Godh and other relevant people involved with the project. He is learning more about Hepatitus and other infections so he can pass this information to the people being vaccinated. A questionnaire is in the process of being prepared. This will be used to assess knowledge of the community before and after the seminars.

From next week they need to obtain the vaccinations for the first dose and also make arrangements for the seminar and vaccination sessions. Therefore they need the funds for the project to be sent in immediately. We need the contract signed and the funds allocated to them by early next week at the latest so that further delays are not put into the progress of this project.
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Thu Aug 11, 2005 8:56 am    Post subject: Reply with quote

Thanks Sajjad. I understand the urgency. I will forward the most recent draft of the contract to you. It was sent to Maham on 7/28, but I don't think she has been able to work on it.

In addition to making changes, I have added a number of comments throughout. Would you be able to turn back another draft, based on the open questions?

We will respond as quickly as possible to get this finalized and funds distributed.

Best!

Justin
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Mon Aug 22, 2005 12:02 pm    Post subject: Reply with quote

Everyone,

I think we need to at least acknowledge that we are not performing full due diligence on CRAC. Ahsen has been actively working on this project for at least 2 weeks (not to mention Sajjad's time), the contract is ready, and we have the bank transfer info to initiate at any time.

The string above guides us to websites, and assures us of the reputations of PPA and Godh, and we have the good impressions from multiple visits with the CRAC staff. This is all very encouraging, and it is not likely we would find any obstacle, however we are not exercising any rigor in this effort.

The bottom line is the process has failed at this step. There is no reason not to perform the formal due diligence on CRAC. Sajjad, are you able to help us understand their sources of funding, expenses, leadership, track record, etc. We normally ask for the last 3 years of financial reports. If nothing else, this will protect ADP should any malfeasance occur (or be suggested) on the part on the NGO or other implementers...

I'd like to hear some thoughts on how to proceed. I'm inclined to request the financials and transfer the funds simultaneously. If possible, transfer partial payment while we evaluate the financials. Because we have gotten ahead of ourselves and started work without completing the process, and have had nothing but good communication with CRAC, I'm reluctant to withold funding any longer. But, I'm also very uncomfortable not having any real paper trail on CRAC.

Thoughts?

~Justin
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M. Sajjad Haider



Joined: 23 Apr 2005
Last Visit: 18 Jul 2008
Posts: 55
Location: Pakistan
PostPosted: Tue Aug 23, 2005 5:22 am    Post subject: Reply with quote

Justin,

I spoke with Dr. Zafar and he will be sending the financial statements for CRAC-PPA and i will be posting them here as well as forwarding them to you once i have them. He also suggested that the financial report for PPA, the governing head of CRAC could be made available but that could take a few days to accomplish.

Just a brief overview of PPA and CRAC

CRAC is essentially just a speciality group within PPA. PPA is a much larger body of pediatricians from all over pakistan with over 1500 members.

The Pakistan Pediatric Association (PPA) is a National Association of Pediatricians of Pakistan. It's members are qualified pediatricians with at least a diploma in child health (DCH) & OR Membership or Fellow ship of college of Physicians & Surgeons of Pakistan (MCPS, FCPS) or Royal Colleges of England/ Canada (MRCP,FRCP) or American Board of Pediatrics (DABP).

The PPA has a central management as PPA (Center), which is the parent Body with it's office at Karachi [Secretary General Pakistan Pediatric Association (Center) Pakistan

There are five provincial Branches, which cover geographic regions in the country, with office bearers elected every two years. The term of office extends from one Biennial to other (Two calendar years).There is also an International Chapter which encompass eligible members from out of Pakistan territory

Year of inception 1964 as Association of Pediatricians of Pakistan.
First President Brig Sirajul Haq
Convenor Prof. Hamid Ali Khan
Venue PMA House Karachi
CRAC was formed in 1989

more information is available on PPA's website at http://www.ppa.org.pk
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M. Sajjad Haider



Joined: 23 Apr 2005
Last Visit: 18 Jul 2008
Posts: 55
Location: Pakistan
PostPosted: Tue Aug 23, 2005 8:22 am    Post subject: Reply with quote

Attached are the documents i got from CRAC. They show income and expenditures for the projects undertaken by CRAC in the years 2003-2004.

If you guys feel we need PPA's financial statements , do let me know so i can ask Dr Naeem to retrieve them from the PPA center in Karachi.
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Tue Aug 23, 2005 8:27 am    Post subject: Reply with quote

Thanks Sajjad. That sounds perfect. Also, it is good to know that CRAC is so closesy related to PPA.

I suggest we initiate the fund transfer. Is anyone uncomfortable with this? The orgs have been very responsive, and we have had a lot of exposure to them to date. I don't anticipate having any problem with the financials...

If nobody raises any objections by tomorrow, 8/24, I think we should proceed.

Thanks,

Justin
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Omar Biabani



Joined: 28 Jan 2005
Last Visit: 06 Jan 2008
Posts: 93
Location: Boston, MA
PostPosted: Tue Aug 23, 2005 11:14 pm    Post subject: Reply with quote

Thanks Sajjad.

I am okay with going ahead and transferring the money. I think we have good enough info on CRAC-PPA and the fact that Ahsen and Sajjad have had many rounds of discussions with them builds my confidence even more. But you are right about having a step in the process that should have taken care of the due dilligence part earlier in the game.
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M. Sajjad Haider



Joined: 23 Apr 2005
Last Visit: 18 Jul 2008
Posts: 55
Location: Pakistan
PostPosted: Mon Aug 29, 2005 12:47 pm    Post subject: Reply with quote

I will be getting the contract papers tommorow, and i shall be faxing them to the ADP Fax # tommorow morning (Boston time).

There were quite a few delays and shortcomings in our analysis of CRAC and the project. This is evident from the fact that we are sending the funding for the project over 4 weeks after the project started. That is quite pitiful and we need to make sure, this doesnt happen again.

Any clarifications or issues that we may have regarding the project should have been cleared well before we gave the nod to the project. As PC for the project, i needed to have done a better job in coordinating things better between CRAC and ADP. I was unfamiliar with the details of all that we require before we can actually send in the money. Nevertheless, i will try to ensure that mistakes and delays made this time are not repeated in the future.

A possible remedy could be to ask for the financial reports of the NGO with the project proposal itself. These reports, as we may see in BAAM's case, are also of help when judging the credibility of the organization.
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Mon Aug 29, 2005 2:50 pm    Post subject: Reply with quote

That's great!

Omar is working on improving/articulating our project selection process, so problems like this will be less prevalent in the future. Surely, you had a great challenge getting all of this done without the benefit of being able to sit down in the same room with one of the experienced PCs, or other ADP members. You did a great job. The failure came from this side. Regardless, I think you now have a very good sense of the process and how it should operate.

Your suggestion to request financials with the proposal is a good one. We have tended to shy away from this in the past because:

-It puts additional burden on the NGO and the PC when we are not certain a project is of interest to us.
-It may discourage submission of proposals because of the add'l burden.
-We have not established trust with the NGO and they may not be comfortable sharing this info early on.

Personally, I would like to see a 'trigger' at a later project stage. Perhaps after the preliminary vote to confirm member interest...

Omar will be shaping a proposed revised process, and will distribute it (probably after the concert in September) for everybody's feedback. That should be a good point of departure for refining this as a group. Keep the suggestions coming...

~Justin
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