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I f- 1 I PROSTHETICS ASSISTANCE PROJECT 6. PROJECT ASSISTANCE COMPLETION DATE (PACD) 1 7. ESTIMATED OATE OF OBLIGATION

AGENCY FOR INTERNATIONAL OEVELOPMENT

PROJECTDATASHEET 2 COUNTRY/ENTITY

Mozambique 4. BUREAU/OFFICE

I

1 (Under 'B."below, enter 1, 2, 3, or4)

bANsAaIoN CODE A = Add Amendmcnt Number c = change D = Delete 1

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3 3. PROJECT NUMBER

4 5 6 - 0 2 1 5 2 5. PROJECT TlTLE (maxinruni,BO characters)

l . k hitid FY j8u i. -4 C . F i i F Y

MM DD YY

A. FUNDING SOURCE

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8. COSTS ( $000 OR EQUIVALENT $1 = ) o 17

Other U.S.

A. Code 1 PVON I PVOW I TECH 1 I I 1 B. Amount 1 1.975 I 995 1 325

13. PROJECT PURPOSE (maximum 480 chmactm) .

1. I 1 1 I I I 2

Hast Couney

Other Donor(s)

T O T A L S

the capacity of government and nongovernment entities in Mozambique to address the unmet and growing needs of men, women and children disabled from long-standing civil conflicts or suffering from other crippling mobility disorders. 1

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EL. F X 3,530

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7,530 736 1 7,747

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C o o p e r a t i n g C o u ~ i t r y : Mozambique i

P r o j e c t T i t l e : P r o s t h e t i c s A s s i s t a n c e P r o j e c t

P r o j e c t Number: 656-0215

P u r s u a n t t o t h e F o r e i g n A s s i s t a n c e Act of 1961 a s amended, t h e F o r e i g n O p e r a t i o n s , E x p o r t F i n a n c i n g and ~ e f a t e d Programs A p p r o p r i a t i o n Act , 1 9 9 0 , A f r i c a Bureau D e l e g a t i o n o f A u t h o r i t y (DOA) a s amended, and 90 S t a t e 291569, t h e P r o j e c t A u t h o r i z a t i o n s i g n e d Augus t 2 9 , 1989 f o r t h e P r o s t h e t i c s A s s i s t a n c e P r o j e c t f o r t h e R e p u b l i c o f Mozambique i s h e r e b y amended a s f o l i o w s :

( I ) The p h r a s e "Two M i l l i o n F i v e Hundred and T h i r t y Thousand D o l l a r s ( $ 2 , 5 3 0 , 0 0 0 ) 1 f i n p a r a g r a p h 1 of t h e A u t h o r i z a t i o n i s d e l e t e d and t h e p h r a s e '!Three M i l l i o n F i v e Hundred and T h i r t y Thousand D o l l a r s ( $ 3 , 5 3 0 , 0 0 0 ) " s u b s t i t u t e d i n l i e u t h e r e o f .

( 2 ) The l a s t s e n t a n c e of p a r a g r a p h 1 o f t h e A u t h o r i z a t i o n i s d e l e t e d and t h e f o l l o w i n g s u b s t i t u t e d i n l i e u t h e r e o f :

"Except a s A . I . D . may o t h e r w i s e a g r e e i n w r i t i n g t h e p r o j e c t a s s i s t a n c e c o m p l e t i o n d a t e i s J u l y 3 1 , 1993."

( 3 ) The l a s t s e n t e n c e i n p a r a g r a p h 2 o f t h e A u t h o r i z a t i o n i s d e l e t e d and t h e f o l l o w i n g s u b s t i t u t e d i n l i e u t h e r e o f :

"The Program w i l l p r o v i d e o v e r h e a d , l i m i t e d commodi t i e s ' and c o n s t r u c t i o n s e r v i c e s . I '

Excep t a s amended h e r e i n , t h e A u t h o r i z a t i o n r e m a i n s i n f u l l f o r c e and e f f e c t .

David M u t c h l e r D i r e c t o r ( ~ c t i n g ) USXID/biozarn b i q u e

D r a f t e d : T R i e d l e r , R L A , 0 8 / 2 4 / 9 0 C l e a r e d : E P a l m e 5 , o n t r o l l e r ,

AMar29:5$< P D O , 0 8 / 2 J

MOZAMBIQUE P R O S T H E T I C S F'ROJECT (656-(3215)

PROJECT PAPER SUPPLEMENT

T A B L E O F CONTENTS

F 'aae

F R O J E C T F'AF'ER ALJTHORIZAT ION AHENDWENT NO. I

ACT I Or4 MEHORAI4DUt-l FOF: TI4E GCT I NG I? I RECTDH

I . PROGRAM FACTORS

&. introduction............................ .......... 1

B. F:e.iier-J o f the P r o b l e m ............................. 1

C. G c i v e r n m e n t P o i i c y 2 .................................. - D. F r o g r e s z t o f ra te . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a

I I . F'F:OJECT DESCR I F'T I Gi\i

A. G o a l and F' I - t rpose .................................. 4

3.. R e q u i r e m e n t s f o r Arnendm~nt.................~ ...... 5

(1) C o n s t r u c t i o n o f T r a n s i t C e n t e r s . . . . . . . . . . . . . . 5

( 2 ) T r a i n l n g ..................................... 7

( 3 ) S u b g r a n t t o & D E P l O . . . . . . . ..................... 7

( 4 ) O t h e r Activitie~.........,,~--....=.. ...... 9

C. Additional inputs and O u t p u t s ..................... 9 - . R e v x . s e d 1 m p . i . e m e n t a . t i c t n f ? e ~ p i - 7 r t . ; i t r l i l t i e 5 and Plan.. 1 i:~

.- ......... r. F't-ncuremen t F l an and r-lethmd.= mf Frinancina 1 4

F. F e v i s e c l Finarir;;?l P l a n a n d S c j m m a r . y c2-F F l r , ? ~ ? c * ; + j .

A c t i o n Memorandum F o r The A c t i n g ~ i r e c t o r ,

From: Mary P a t S e l v a g g i o , ,HNP t~[b&kq'?' r b Q.Y-'

Through : ~ u d d y J T ~ % ~ i 'TFPO v S u b j e c t : Amendment t o P r o s t h e t i c s A s s i s t a n c e P r o j e c t (656-021f i

A . P rob lem: Your a p p r o v a l i s r e q u i r e d t o a ) amend t h e P r o j e c t A u t h o r i z a t i o n f o r t h e P r o s t h e t i c s A s s i s t a n c e P r o j e c t t o i n c r e a s e t h e LOP f u n d i n g t o $ 3 , 5 3 0 , 0 0 0 ; b) amend t h e P r o j e c t P a p e r by a d d i n g a S u p p l e m e n t ; and c ) amend t h e P r o j e c t G r a n t Agreemen t .

B . Background : The P r o s t h e t i c s A s s i s t a n c e P r o j e c t was a u t h o r i z e d i n Augus t 1989 w t t h a LOP f u n d i n g o f $ 2 , 5 3 0 , 0 0 0 and a PACD of Augus t 31 ,1992. I n O c t o b e r 1989 , t h e PACD was e x t e n d e d t h r o u g h J u l y 3 1 , 1993 t o p e r m i t c o m p l e t i o n o f p r o j e c t a c t i v i t i e s and p r o v i d e a c l o s e o u t p e r i o d . F u n d i n g f o r t h e p r o j e c t was o b t a i n e d f rom t h e C o n g r e s s i o n a l Ezrmark f o r v i c t i m s of c i v i l s t r i f e c o n t a i n e d i n t h e 1 9 8 9 F o r e i g n A s s i s t a n c e A p p r o p r i a t i o n s A c t . Funds were o b l i g a t e d t h r o u g h a P r o j e c t G r a n t Agreement w i t h t h e Government o f Mozambique (GRY) i n A u g u s t 1989. G r a n t s were t h e n made t o t h e I n t e r n a t i o n a l Commit tee o f t h e Red C r o s s (ICRC); H a n d i c a p I n t e r n a t i o n a l ( H I ) ; S a v e t h e C h i l d r e n F e d e r a t i o n (US) (SCF) ; and H e a l t h V o l u n t e e r s O v e r s e a s (HVO) t o f u n d a v a r i e t y o f a c t i v i t i e s e n c o m p a s s i n g t r a i n i n g , p r o v i s i o n o f s e r v i c e s , p r o d u c t i o n o f p r o s t h e s e s and o r t h o s e s , a n d improved a c c e s s t o c a r e . A d d i t i o n a l f u n d s were r e s e r v e d f o r USAID-managed a c t i v i t i e s i n c l u d i n g p r o j e c t management , t e c h n i c a l a s s i s t a n c e and c o n t i n g e n c y .

I n J u l y 1 9 9 0 t h e M i s s i o n was i n f o r m e d of t h e a v a i l a b i l i t y o f f u n d s from t h e C o n g r e s s i o n a l E a r m a r k c o n t a i n e d i n t h e 1990 F o r e i g n A s s i s t a n c e A p p r o p r i a t i o n s A c t , D i s c u s s i o n s w i t h G r a n t e e s and t h e M i n i s t r y o f H e a l ' t h , D e p a r t m e n t o f S o c i a l A c t i o n , l e d t o t h e d e t e r m i n a t i o n t h a t a d d i t i o n a l f u n d s i n t h e amount of $ 1 , 0 0 0 , 0 0 0 c o u l d be programmed.

C . D i s c u s s i o n :

i . C o n f o r m i t y w i t h M i s s i o n S t r a t e g y . A s s i s t a n c e t o p e r s o n s i n need o f o r t h o p a e d i c s u r g e r y , p h y s i c a l t h e r a p y , o r p r o s t h e t i c o r o r t h o t i c d e v i c e s i s s p e c i f i c a l l y c i t e d i n USAIDrs March 1 9 9 0 C o u n t r y Program S t r a t e g i c P l a n (CPSP) as a d i r e c t r e s p o n s e t o c r i t i c a l n e e d s c r e a t e d by t h e i n s u r g e n c y . AID/Washing t o n h a s a p p r o v e d t h e CPSP.

i i . S p e c i a l L e e i s l a t i v e A u t h o r i t y . . T h e 1 9 9 0 F o r e i g n A s s i s t a n c e A p p r o p r i a t i o n s A c t p r o v i d e s f u n d s f o r v i c t i m s o f c i v i l s t r i f e . The s e c t i o n of t h e l e g i s l a t i o n a u t h o r i z i n g f u n d s f o r t h i s program c o n t a i n s t h e p h r a s e " n o t w i t h s t a n d i n g any o t h e r p r o v i s i o n o f law".

iii. A v a i l a b i l i t y of Funds and FundingMechan i sms . S t a t e 291569 d a t e d August 3 0 , 1990 , p r o v i d e s f u n d i n g d a t a f o r t h e p r o j e c t . ~ u n d s - t o t a l l i n g $1;0b0,000 w i l l be o b l i g a t e d th rough a n Amendment No. 1 t o t h e P r o j e c t G r a n t Agreement between A. I . D . and t h e GRM. Funds w i i l t h e n be a p p o r t i o n e d th rough amendments t o g r a n t s w i t h Handicap I n t e r n a t i o n a l ($150,000) and Save t h e C h i l d r e n F e d e r a t i o n ( $ 6 7 5 , 0 0 0 ) , and i n c r e a s e d f u n d i n g f o r a c t i v i t i e s managed by USAID ($175 ,000) . A d d i t i o n a l f u n d i n g f o r t h e SCF program w i l l be used t o meet i n c r e a s e d c o s t s of c o n s t r u c t i n g h o s t e l s and t r a n s i t c e n t e r s f o r p r o s t h e s e s p a t i e n t s . A d d i t i o n a l f u n d i n g f o r t h e H I program w i l l be used f o r a d d i t i o n a l t r a i n i n g a c t i v i t i e s and a s u b g r a n t t o t h e Mozambican A s s o c i a t i o n f o r t h e D i s a b l e d (ADEMO) f o r v o c a t i o n a l t r a i n i n g and employment g e n e r a t i n g a c t i v i t i e s . A d d i t i o n a l f u n d i n g f o r t h e USAID-managed a c t i v i t i e s w i l l be used f o r p r o j e c t management, t e c h n i c a l a s s i s t a n c e and c o n t i n g e n c y .

i v . O t h e r Funding c o n s i d e r a t i o n s :

a ) C o n s t r u c t i o n A c t i v i t i e s . The o r i g i n a l p r o j e c t p a p e r and p r o j e c t g r a n t agreement p r o v i d e d $150,000 f o r c o n s t r u c t i n g and e q u i p p i n g h o s t e l s and t r a n s i t c e n t e r s . T h i s e s t i m a t e was based o n low-cos t t r a d i t i o n a l c o n s t r u c t i o n methods u s i n g l o c a l l y a v a i l a b l e m a t e r i a l s . S i n c e t h e o r i g i n a l PP d e s i g n , t h e p o l i c y of t h e CRY and USAID r e g a r d i n g c o n s t r u c t i o n h a s changed, i n l a r g e p a r t d u e t o e x p e r i e n c e s w i t h e x i s t i n g h o s t e l s b u i l t u s i n g t r a d i t i o n a l methods , and c o n c e r n a b o u t t h e p o t e n t i a l e n v i r o n m e n t a l impact of u s i n g t r a d i t i o n a l m a t e r i a l s which a r e i n c r e a s i n g l y s c a r c e around u r b a n c e n t e r s . The d i f f e r e n c e i n t h e mode of c o n s t r u c t i o n , t o g e t h e r w i t h an i n c r e a s e i n t h e c o s t s of c o n s t r u c t i o n m a t e r i a l s o v e r t h e p a s t y e a r h a s l e d t o a c o n s i d e r a b l e i n c r e a s e i n t h e c o s t p e r h o s t e l o v e r t h a t o r i g i n a l l y budgeted i n t h e PP. I t i s , however , M i s s i o n o p i n i o n , based on s i t e v i s i t s by a n e x p e r i e n c e d a r c h i t e c t t h a t t h e r e v i s e d c o s t of c o n s t r u c t i n g t h e p roposed h o s t e l s i s r e a s o n a b l y f i r m , and r e a s o n a b l e g i v e n t h e c o s t of m a t e r i a l s , and a l s o t h a t t h e c o s t i s w i t h i n t h e r a n g e of s i m i l a r c o n s t r u c t i o n p r o j e c t s i n t h e p l a n n e d a r e a s .

The FAA S e c t i o n 611Ca) r e q u i r e m e n t t h a t p l a n s f o r a l l c o n s t r u c t i o n a c t i v i t i e s o v e r $ 5 0 0 , 0 0 0 be reviewed and approved i s s a t i s f i e d i n t h a t p r e l i m i n a r y p l a n s have been reviewed by t h e REDSO/ESA Regiona l E n g i n e e r whose a p p r o v a l is i n d i c a t e d i n a memorandum, and t h e P r o j e c t G r a n t Agreement Amendment c o n t a i n s a C o n d i t i o n P r e c e d e n t t o d i s b u r s e m e n t ( s e e S e c t i o n V . f o l l o w i n g ) which s t i p u l a t e s t h a t no f u n d s w i l l be d i s b u r s e d f o r c o n s t r u c t i o n a c t i v i t i e s u n t i l f i n a l p l a n s have been approved by a n A . I . D . e n g i n e e r .

b ) M a i n t e n a n c e o f H o s t e l s . The FAA S e c t i o n b l l l e ) r e q u i r e m e n t t h a t a d e q u a t e m a i n t e n a n c e c a p a c i t y e x i s t 4 f o r a l l b u i l d i n g s c o n s t r u c t e d u s i n g A.I.D. f u n d s d o e s n o t a p p l y i n t h i s c a s e , a s t h e r e q u i r e m e n t p e r t a i n s t o c o n s t r u c t i o n a c t i v i t i e s w i t h a v a l u e i n e x c e s s o f $ 1 , 0 0 0 , 0 0 0 . However , t h e M i s s i o n i s c o n c e r n e d t h a t a d e q u a t e m a i n t e n a n c e c a p a c i t y e x i s t s , a n d t h e r e f o r e t h e P r o j e c t G r a n t Agreement Amendment c o n t a i n s a CP which s t i p u l a t e s t h a t no f u n d s f o r c o n s t r u c t i o n a c t i v i t i e s w i l l b e d i s b u r s e d u n t i l s u c h t i m e a s a d e q u a t e a s s u r a n c e s a r e o b t a i n e d t h a t t h e c a p a c i t y t o m a i n t a i n h o s t e l s and t r a n s i t c e n t e r s e x i s t s . A d d i t i o n a l l y , t h e i s s u e o f m a i n t e n a n c e i s a d d r e s s e d i n a c o v e n a n t . ( S e e S e c t i o n V I . f o l l o w i n g ) . The M i s s i o n was n o t a b l e t o make a d e t e r m i n a t i o n r e g a r d i n g t h e c a p a c i t y t o m a i n t a i n t h e h o s t e l s p r i o r t o e x e c u t i n g t h e P r o j e c t G r a n t Agreement Amendment b e c a u s e o f t h e s h o r t t i m e a v a i l a b l e a n d t h e a b s e n c e f r o m Maputo o f s e n i o r members o f t h e M i n i s t r y o f H e a l t h .

c ) E n v i r o n m e n t a l I m p a c t . ~1.1 h o s t e l s w i l l b e c o n s t r u c t e d on s i t e s i n u r b a n a r e a s w h i c h a r e c u r r e n t l y e i t h e r l a n d a l r e a d y zoned f o r c o n s t r u c t i o n , o r o c c u p i e d b y a s t r u c t u r e s c h e d u l e d f o r r e h a b i l i t a t i o n o r d e m o l i t i o n . No b u i l d i n g s w i l l b e c o n s t r u c t e d o n v i r g i n l a n d o r o n l a n d o u t s i d e o f u r b a n c e n t e r s . A l l p r o p o s e d s i t e s c a n b e a d e q u a t e l y s e r v i c e d w i t h u t i l i t i e s w i t h o u t a n y u n d u e s t r a i n o n l o c a l p u b l i c s e r v i c e s o r u t i l i t i e s , a n d t h u s no e n v i r o n m e n t a l d e g r a d a t i o n i s a n t i c i p a t e d . F u r t h e r m o r e , t h e " n o t w i t h s t a n d i n g " l a n g u a g e was i n t e n d e d t o p r e v e n t d e l a y s c a u s e d by o b t a i n i n g u s u a l l y r e q u i r e d a p p r o v a l s and m e e t i n g b u r e a u c r a t i c r e q u i r e m e n t s . Due t o t h e s e f a c t o r s , i t i s t h e o p i n i o n o f t h e R e g i o n a l L e g a l A d v i s o r t h a t no I n i t i a l E n v i r o n m e n t a l E x a m i n a t i o n i s r e q u i r e d a t t h i s s t a g e . However , a s t h e M i s s i o n i s c o n c e r n e d t h a t e n v i r o n m e n t a l i s s u e s be a d d r e s s e d w h e r e n e c e s s a r y , t h e R e g i o n a l E n v i r o n m e n t a l O f f i c e r w i l l b e r e q u e s t e d t o c o n s i d e r a n y p o t e n t i a l e n v i r o n m e n t a l i s s u e s , and make r e c o m m e n d a t i o n d u r i n g h i s J a n u a r y 1 9 9 1 TDY i n Mozambique. The q u e s t i o n o f a s s e s s m e n t o f p o t e n t i a l e n v i r o n m e n t a l i m p a c t i s a l s o a d d r e s s e d i n a C P , which c o n d i t i o n s d i s b u r s e m e n t f o r c o n s t r u c t i o n on r e v i e w a n d a p p r o v a l by a n A.I .D. e n v i r o n m e n t a l o f f i c e r i f deemed n e c e s s a r y by A.1 .D..

d ) P r o c u r e m e n t . The PP S u p p l e m e n t c o n t a i n s a r e v i s e d a n d a m p l i f i e d p r o c u r e m e n t p l a n , p r e p a r e d i n a c c o r d a n c e w i t h r e g u l a t i o n s c o n c e r n i n g u s e o f D F A f u n d s . I t i s t h e o p i n i o n of t h e M i s s i o n t h a t p r o c u r e m e n t i s s u e s h a v e b e e n a d e q u a t e l y a d d r e s s e d .

e ) , . C o n g r e s s i o n a l N o t i f i c a t i o n .

S t a t e 2 9 0 1 3 9 , d a t e d A u g u s t 2 9 , 1 9 9 0 , i n d i c a t e s t h a t no C N i s r e q u i r e d b o t h b e c a u s e t h e s e f u n d s a r e p a r t o f a s p e c i f i c C o n g r e s s i o n a l E a r m a r k , a n d b e c a u s e o f t h e " n o t w i t 1 1 s t a n d i n g " l a n g u a g e i n t h e a p p r o p r i a t i o n .

f ) Hos t C o u n t r y C o n t r i b u t i o n . No i n c r e a s e i n t h e h o s t c o u n t r y c o n t r i b u t i o n t o t h e p r o j e c t i s r e q u i r e d a s a l l a d d i t i o n a l f u n d i n g w i l l be d i s b u r s e d d i r e c t l y t o PVOs w i t h t h e e x c e p t i o n o f t h o s e f u n d s which w i l l be managed by A . I . D . A d d i t i o n a l l y , . t h e " n o t w i t h s t a n d i n g t i p r o v i s i o n p e r m i t s a l o w e r h o s t c o u n t r y c o n t r i b u t i o n t h a n i s u s u a l l y r e q u i r e d . However , t h e h o s t c o u n t r y c o n t r i b u t i o n w i l l i n f a c t be i n c r e a s e d o n c e t h e C P and Covenan t r e l a t i n g t o m a i n t e n a n c e a r e m e t , a s s u c h m a i n t e n a n c e and u p k e e p w i l l be t h e r e s p o n s i b i l i t y o f t h e Government . The PVO c o n t r i b u t i o n t o funded a c t i v i t i e s w i l l be a s s e s s e d p r i o r t o g r a n t award .

v. C o n d i t i o n s P r e c e d e n t t o D i s b u r s e m e n t

The Amendment No. 1 t o t h e P r o j e c t G r a n t Agreement c o n t a i n s c o n d i t i o n s p r e c e d e n t t o t h e e f f e c t t h a t no f u n d s s h a l l be d i s b u r s e d f o r c o n s t r u c t i o n a c t i v i t i e s u n t i l ( a ) f i n a l p l a n s h a v e been r e v i e w e d and approved by a n A. I . D . e n g i n e e r and A. I . D . e n v i r o n m e n t a l o f f i c e r s h o u l d t h i s be deemed n e c e s s a r y by A . I.D. ; and ( b ) t h e G r a n t e e h a s g i v e n a d e q u a t e a s s u r a n c e s t h a t i t c a n m a i n t a i n and upkeep t h e h o s t e l s , o r t h a t i t h a s s a t i s f a c t o r y a l t e r n a t i v e p l a n s f o r s u c h m a i n t e n a n c e and upkeep.

v i . C o v e n a n t s

The P r o j e c t G r a n t Agreement Amendment c o n t a i n s a c o v e n a n t t o t h e e f f e c t t h a t t h e G r a n t e e ( a ) a c c e p t s r e s p o n s i b i l i t y f o r t h e m a i n t e n a n c e and upkeep o f t h e h o s t e l s ; ( b ) a g r e e s t o a p p o i n t a s u p e r v i s o r o r s u p e r v i s o r s t o t h e h o s t e l s ; and ( c ) a g r e e s t h a t t h e h o s t e l s w i l l be u sed f o r t h e p u r p o s e s a g r e e d upon f o r t h e d u r a t i o n o f t h e p r o j e c t and a minimum p e r i o d of f i v e y e a r s a f t e r w a r d s .

v i i . A p p r o v a l s : S t a t e 291569 d a t e d A u g u s t 3 0 , 1990 p r o v i d e d t h e f i s c a l d a t a f o r t h e Amendment. S t a t e 282296 d a t e d August 2 3 , 1990 i n d i c a t e d t h a t t h e r e q u i r e m e n t t o c o n s u l t w i t h AID/Washington had been met . A l l r e q u i r e d M i s s i o n a p p r o v a l s h a v e been o b t a i n e d , and t h i s A c t i o n Memorandum h a s been c l e a r e d by t h e R e g i o n a l L e g a l A d v i s o r .

D . Your A u t h o r i t y : S t a t e 143941, d a t e d May 5 , 1 9 9 0 , acco rded USAID/hiozambique S c h e d u l e A s t a t u s . P u r s u a n t t o DOA 5 5 1 , you , a s t h e A c t i n g M i s s i o n D i r e c t o r , have t h e a u t h o r i t y t o e x e c u t e t h e a c t i o n s r e q u e s t e d i n t h i s A c t i o n Memorandum. DOA 551 S e c t i o n 4 .A.2 g i v e s you t h e a u t h o r i t y t o amelid p r o j e c t a u t h o r i z a t i o n s e x c e p t i n c e r t a i n c a s e s wh ich do n o t a p p l y i n t h i s c a s e . DOA 5 5 1 S e c t i o n 5 . 0 g i v e s you t h e a u t h o r i t y t o n e g o t i a t e a n d e x e c u t e l o a n and g r a n t a g r e e m e n t s and amendments t h e r e t o .

E . Recommendat ion: T h a t , f o r t h e r e a k o n s o u t l i n e d above,, you a p p r o v e a ) t h e amendment t o t h e P r o j e c t A u t h o r i z a t i o n f o r t h e P r o s t h e t i c s A s s i s t a n c e P r o j e c t (656 -0217) t o i n c r e a s e t h e L O P f u n d i n g t o $ 3 , 5 3 0 , 0 0 0 ; b ) t h e s u p p l e m e n t t o t h e P r o s t h e t i c s A s s i s t a n c e P r o j e c t P a p e r ; and c ) t h e Amendment No. 1 t o t h e P r o j e c t G r a n t Agreement .

Approved: &?z+ D i s a p p r o v e d :

D a t e : 3 0 f y 1 5 6 ~ d

D r a f t e d : Al.la&kalf, PDO C l e a r e d : ~ ~ ~ j ; i . l v a ~ ~ i o , HNP ( 0 8 / 2 7 / 9 0 )

B M i l J e r , Cont . ( 0 8 / 2 8 / 9 0 ) T R i e d l e r , RLA ( t e l e c o n 0 8 / 2 4 / 9 0 ) BDodson, FFPO ( 0 8 / 2 7 / 9 0 )

GLOSSARY OF ABBREVIATIONS

ADEMO Associacao dos Deficientes Mocambicanos (Association of

Handicapped Mozambicans)

AID Agency for International Development/Washington

GRM Government of the Republic of Mozambique

HI Handicap International

HVO Health Volunteers Overseas

ICRC International Committee of the Red Cross

I QC

LOP

MDH

P ACD

P P

PVO

SCF

TA

USA I D

Indefinite Auan ti ty Contract

Life of Project

Ministry of Health

Project Activity Completion Date

Project Paper

Private Voluntary Organization

Save the Children Federation (U.S.)

Technical Assistance

U.S. Agency for International Development/Maputo

I. PROGRAM FACTORS

A . I n t r o d u c t i o n

T h i s P r o j e c t Paper supplement descr ibes t h e requ i rements f o r a d d i t i o n a l fund ing t o implement t he a c t i v i t i e s no ted i n t he o r i g i n a l P r o j e c t Paper, au thor i zed on Ougust 31, 1989. The PP p rov ides fund ing f o r P r o s t h e t i c s / O r t h o t i c s A c t i v i t i e s (expanding p roduc t i on o f p r o s t h e t i c p roduc t ion th rough equipment and m a t e r i a l s suppor t ; t e c h n i c a l ass is tance ; t r a i n i n g ; and c o n s t r u c t i o n o f t r a n s i t c e n t e r s ) and Other A c t i v i t i e s ( p r o j e c t management, eva lua t ions , des ign, needs assessment , e t c ) . Due t o s u b s t a n t i a l l y h i ghe r c o s t s o f c o n s t r u c t i o n and t r a i n i n g m a t e r i a l s , r e s u l t i n g f rom h i g h i n f l a t i o n and r a p i d deva lua t i on o f l o c a l cu r rency , a d d i t i o n a l fund ing i s being p rov ided under t h i s supplement t o meet two p r o j e c t ou tpu t s r e l a t e d t o t r a n s i t c e n t e r c o n s t r u c t i o n and t r a i n i n g . I n a d d i t i o n , an o p p o r t u n i t y now e x i s t s t o a s s i s t a newly es tab l i shed Mozambican NGO f o r t he handicapped, ADEMO, as one o f the p a r t n e r s i n p r o j e c t implementat ion. Supplemental p r o j e c t fund ing w i l l i n c l u d e s a subgrant t o ADEMO f o r v o c a t i o n a l t r a i n i n g a c t i v i t i e s .

T h i s PP supplement p rov ides a rev iew o f t h e problem and i n f o r m a t i o n on t h e need f o r a d d i t i o n a l fund ing. r e v i s e d logf rame i s a l s o i nc l uded t o r e f l e c t the changes i n i n p u t s and o u t p u t s f rom t h e o r i g i n a l P r o j e c t Paper.

B. Review o f t h e Problem

As descr ibed i n t he o r i g i n a l PP, A I D consu l t an t s i n e a r l y 1989 es t imated t h e presence o f a t l e a s t 15,000 amputees i n Mozambique, o f which e i g h t y percent a re be l i eved t o be war - re la ted . These c o n s u l t a n t s a l s o noted t h a t insufficient c a p a c i t y t o produce prostheses, and i n a c c e s s i b i l i t y t o p a t l e n t s due t o war, has r e s u l t e d s e r v i c e d e l i v e r y t o o n l y one i n every t h i r t y c i v i l i a n s r e q u i r i n g ass is tance. I n a d d i t i o n , thousands more c h i l d r e n and a d u l t s a re d i sab led because immunizat ions and c u r a t i v e s e r v i c e s were g e n e r a l l y n o t a v a i l a b l e . These persons, s u f f e r i n g t he r e s i d u a l e f f e c t s o f p o l i o , l ep rosy , and i n j u r i e s , a r e i n need o f o r t h o t i c devices.

At tempts t o v e r l f y the magnitude o f d i s a b i l i t y i n Mozambique is f r a u g h t w i t h problems r e l a t e d t o incomplete data and d i f f e r e n c e s i n account ing. The M i n i j t r y o f Hea l t h recorded more than 4,700 amputat ions s i n c e 1983, bu t because some amputat ions a r e n o t perfcrmed i n MOH cen te r s , and because the MOH da ta i s n o t complete f o r a l l p rov i nces i n a l l years, t he a c t u a l number o f amputat ions performed d u r i n g the l a s t decade i s p robab ly much h i ghe r . Only a f r a c t i o n o f the5e amputees have been f i t t e d w i t h prostheses. From 1981-1989, t he I n t e r n a t i o n a l Committee o f the

Red Cross f i t t e d more than 2,000 amputees w i t h p r o s t h e t i c dev ices. Handicap I n t e r n a t i o n a l and ADEMO (Associacao dos D e f i c i e n t e s Mocambicanos) r e g i s t e r e d , i n 1989 a lone, more than 3,500 d i s a b l e d p a t i e n t s i n f o u r p rov inces i n c l u d i n g amputees and o t h e r d i s a b l e d persons r e q u i r i n g o r t h o t i c dev ices (e.g. l ep rosy and p o l i o v i c t i m s ) .

CI needs,assessment i s now being undertaken t o b e t t e r d e f i n e the e x t e n t o f d i s a b i l i t y i n Mozambique. P r e c i s e i n f o r m a t i o n , however, w i l l n o t be a v a i l a b l e u n t i l peace comes when needs l n i n a c c e s s i b l e areas a r e q u a n t i f i e 8 . Never the less, c u r r e n t i n f o r m a t i o n suggests t h a t t he re a re a minimum 7,000 amputees r e q u i r i n g p r o s t h e t i c suppor t se rv ices , a i t hough t he a c t u a l f i g u r e may reach the o r i g i n a l es t imates o f 15,000 amputees.

The I n t e r n a t i o n a l Committee o f t he Red Cross and Handicap I n t e r n a t i o n a l a s s i s t t he MOH i n ope ra t i ng p r o s t h e t i c and o r t h o t i c workshops i n f i v e p rov inces i n Mozambique. Whi le p roduc t i on c a p a c i t y has increased i n each o f these workshops,

$&&qp&$$ggj;~ demand f o r prostheses con t inues t o i nc rease f a s t e r than the workshops can produce. Whi le p a r t of t h e inc reased demand i s a r e s u l t o f g r e a t e r access t o i n d i v i d u a l s r e q u i r i n g ass is tance , some o f the inc reased demand i s due t o t h e need f o r p r o s t h e t i c replacements f o r growing c h i l d r e n and f o r a d u l t s a f t e r 2-3 years o f use. I C R C has i n d i c a t e d t h a t p r e s e n t l y , one - th i r d o f t h e i r p roduc t i on i s f o r replacement prostheses.

C. Government P o l i c y

A M i n i s t r y o f H e a l t h p l a n f o r phys i ca l and r e h a b i l i t a t i o n medic ine, prepared' 1988, s t a t e s a n a t i o n a l goa l t o "guarantee t h e most comprehensive r e h a b i l i t a t i o n ca re i n a manner which pe rm i t s t h e f a s t e s t and e a s i e s t s o c i a l i n t e g r a t i o n o f t h e d i sab led " .

To reach t h i s goa l , t he MOH has i d e n t i f i e d seve ra l areas where i rn~rovement and as i s t ance i s r equ i red : p r o f e s s i o n a l o r thoped ic and r e h a b i l i t a t i o n t r a i n i n g ; promot ion o f p r e v e n t i v e h e a l t h s e r v i c e s t o avo id p reven tab le d i s a b i l i t y ( p a r a p l e g i a due t o p o l i o o r l e p r o s y ) ; expansion o f p r o v i n c i a l and d i s t r i c t l e v e l se r v i ces ; and s t rengthened capac i t y o f e x i s t i n g o r thoped ic and o t h e r d i s a b i l i t y se rv i ces . The p l an a l s o h i g h l i g h t s t h e v a r i o u s governmental departments and p r i v a t e e n t i t i e s which a r e j o i n t l y and c o l l a b o r a t i v e l y i n v o l v e d i n reach ing the o v e r a l l goa l .

The P r o s t h e t i c Ass is tance P r o j e c t , th rough those activities de f i ned i n b o t h the o r i g i n a l PF and w i t h i n t h i s supplement, a r e a s s i s t i n g t he GPRM i n i t s e f f o r t s . The P r o j e c t focuses on enhancing the c a p a c i t y o f p r o v i n c i a l l e v e l se r v i ces ; i n v o l v e 5 numerous NGOs i n p a r t n e r s h i p w i t h t he MOH; and a s s i s t s i n t he t r a i n i n g o i p r o f e s 5 i o n a l s a t advanced, i n t e r m e d i a t e , and bas ic l e v e l s o f care. F u r t h e r exp lana t ion on s p e c i f i c p r o j e c t a c t i v i t i e s f o l l o w s .

D. P r o j e c t Progress To Date

The P r o s t h e t i c s Ass is tance P r o j e c t funds f o u r p r i v a t e v o l u n t a r y o rgan i za t i ons t o meet t he p r o j e c t ' s goa l and purpose: t h e I n t e r n a t i o n a l Committee o f t h e Red Cross, Save t h e C h i l d r e n Federa t ion , Handicap I n t e r n a t i o n a l , and H e a l t h Vo lun teers Overseas. Al though p r o j e c t implementat ion i n i t i a l l y s u f f e r e d some de lay, g r a n t s w i t h each o r g a n i z a t i o n were s igned by e a r l y 1990 and p r o j e c t implementat ion has proceeded as descr ibed below. A sma l l p o r t i o n o f p r o j e c t funds a r e r e t a i n e d by USAID f o r a needs assessment, e v a l u a t i b n s / a u d i t , p r o j e c t management, and cont ingency. The P r o j e c t PACD was a l s o amended t o 31 J u l y 1993.

The P r o j e c t suppor ts t he l o c a l programs o f the I n t e r n a t i o n a l Committee o f t he Red Cross ( I C R C ) i n o r thoped ic p roduc t i on , training, and rehabilitatlon/construction o f o r thoped ic workshops ($450,000). To date , I C R C has u t i l i z e d p r o j e c t

1 fund lng t o purchase o r t hoped i c equipment; t o c o n s t r u c t a h o s t e l i n Nampula; t o c o n s t r u c t teach ing f a c i l i t i e s i n Be i ra ; t o beg ln r e h a b i l i t a t i n g t he workshop i n Maputo; and t o beg in a t r a i n i n g course f o r i n t e r m e d i a t e - l e v e l o r t h o p r o s t h e t i c t echn l c l ans . A d d i t i o n a l p r o ~ e c t fund ing f o r I C R C programs i s n o t programmed w i t h i n t h l s supplemental PP.

H e a l t h Vo lunteers Overseas (HVO) rece i ves p r o j e c t fund ing (8863,200) f o r ex tens i ve t e c h n i c a l ass i s t ance ( b o t h shor t - te rm and long-term) and p r o v i s i o n o i equ ipment isuppl ies . HVO f i e l d e d a long-term (3-year) o r thoped ic surgeon i n J u l y 1990, who has begun adv i s i ng Mozambique's o n l y o r thoped ic surgeon i n s t reng then ing medical o r thoped ic t r a i n i n g and i n upgrading

.* or thoped ic su rgery s e r v i c e s w i t h i n t he coun t ry . A p l an f o r

complementary shor t - te rm TA is c u r r e n t 1 y be ing developed. HVO consu l t an t s w i l l complement t he t r a i n i n g e f f o r t s o f the o r thoped ic surgeon and the t r a i n i n g a c t i v i t i e s o f Handicap I n t e r n a t i o n a l . A t t h i s t ime, no a d d i t i o n a l funds a r e be ing added t o HVO's component o f t h e p r o j e c t .

Save the Ch i l d ren Federa t ion ( S C F ) r ece i ves p r o j e c t fund ing (8416,800) f o r a d m i n i s t r a t i v e and l o g i s t i c a l suppor t t o t he HVO or thoped ic surgeon. The p r o j e c t a l s o p rov ides SCF w i t h fund ing (8150,000) f o r c o n s t r u c t i o n o f f o u r h o s t e l s t cen t ros de t r a n s i t o ) necessary f o r s h e l t e r i n g those p r o s t h e t i c and o r thoped ic p a t i e n t s t r a v e l l i n g t o p r o v i n c i a l c a p i t a l s from r u r a l areas. To date , des igns f o r two o f the f o u r h o s t e l s have been prepared. bu t due t o s i g n i f i c a n t inc reases i n c o n s t r u c t i o n c o s t s over the l a s t year and increased accommodation requ i rements , c o n s t r u c t i o n i s n o t f e a s i b l e w i t hou t s u b s t a n t i a l supplementary fund ing . F i n a l l y , Handicap I n t e r n a t i o n a l ( H I ) u t i l i z e s p r o j e c t funds ($330,000) f o r o r t h o t i c and p r o s t h e t i c vo lun tee rs i n t h ree Drovinces, and t o develop a n a t i o n a l t r a i n i n g program i n phys i ca l therapy. I n develop ing the c u r r i c u l u m f o r the p h y s i c a l

P a g e 4

t h e r a p y t r a i n i n g c o u r s e , f u r t h e r n e e d s were i d e n t i f i e d f o r t r a i n i n g b a s i c - l e v e l o r t h o p r o s t h e t i c t e c h n i c i a n s . A d d i t i o n a l f u n d i n g u n d e r t h i s s u p p l e m e n t w i l l c o n t r i b u t e t o H I ' S b r o a d e n e d t r a i n i n g p r o g r a m .

H a n d i c a p I n t e r n a t i o n a l h a s a l s o worked c l o s e l y w i t h a n e w l y e s t a b l i s h e d i n d i g e n o u s PVO c o n c e r n e d w i t h t h e d i s a b l e d i n Mozambique . T h i s o r g a n i z a t i o n , A s s o c i a c a o d o s D e f i c i e n t e s M o z a m b i c a n o s (QDEMO), is a c t i v e l y m o b i l i z i n g t h e d i s a b l e d t o i n i t i a t e e d u c a t i o n a n d i n f o r m a t i o n c a m p a i g n s on d i s a b i l i t y , t o s t a r t i n c o m e - g e n e r a t i n g p r o j e c t s Tor d i s a b l e d M o z a m b i c a n s , a n d t o p r o m o t e l e g i s l a t i o n r e l a t e d t o d i s a b i l i t y i n Mozambique . M h i l e ADEMO h a s n o t y e t d i r e c t l y p a r t i c i p a t e d i n t h e P r o j e c t , f u n d i n g u n d e r t h i s PP s u p p l e m e n t , t h r o u g h a s u b g r a n t w i t h H I , w i l l p r o v i d e ADEMO w i t h s u p p o r t f o r v o c a t i o n a l t r a i n i n g a n d i n c o m e g e n e r a t i n g a c t i v i t i e s .

USAID A c t i v i t i e s u n d e r t h e P r o j e c t i n c l u d e t h e f u n d i n g o f a p r o j e c t c o o r d i n a t o r , a n e e d s a s s e s s m e n t , e v a l u a t i o n s / a u d i t , a n d c o n t i n g e n c y . T h e n e e d s a s s e s s m e n t w a s p l a n n e d d u r i n g t h e f i r s t 6 m o n t h s o f p r o j e c t i m p l e m e n t a t i o n w i t h s u p p o r t f r o m a U S A i D - r e c r u i t e d c o n s u l t a n t . E a r l y i n p r o j e c t i m p l e m e n t a t i o n , h o w e v e r , i t w a s d e c i d e d t h a t t h e a s s e s s m e n t wou ld b e c o n d u c t e d i n t e r n a l l y w i t h t h e e f f o r t s o f t h e F i e l d C o o r d i n a t o r a n d o t h e r l o c a l l y b a s e d i m p l e m e n t i n g a g e n c i e s who had a b e t t e r u n d e r s t a n d i n g o f b o t h t h e m a g n i t u d e o f t h e p r o b l e m n a t i o n w i d e a n d t h e g a p s o r d i s c r e p a n c i e s i n e x i s t i n g d a t a . The n e e d s a s s e s s m e n t s h o u l d b e c o m p l e t e d b e f o r e J a n u a r y 1941. A l t h o u g h a f u l l - t i m e p r o j e c t c o o r d i n a t o r w a s i n i t i a l l y a n t i c i p a t e d f o r p r o j e c t managemen t r e q u i r e m e n t s , t h e MOH a n d USAID j o i n t l y

. d e c i d e d t o e s t a b l i s h a h a l f - t i m e f i e l d c o o r d i n a t o r , b a s e d a t t h e WOH, a n d . a n o t h e r h a l f - t i m e USAID-based a d m i n i s t r a t i v e ) a s s i s t a n t t o m e e t p r o j e c t managemen t n e e d s . I n December ' 1 4 8 9 , t h e MOH-based F i e l d C o o r d i n a t o r w a s r e c r u i t e d . A USAID-based a s s i s t a n t w i l l b e h i r e d i n t h e n e a r f u t u r e .

I n summary, c o n s t r u c t i o n a c t i v i t i e s f o r h o s t e l s a n d p r o s t h e t i c w o r k s h o p s h a v e b e g u n u n d e r t h e a u s p i c e s o f ICRC a n d SCF; t r a i n i n g a c t i v i t i e s a t b a s i c , i n t e r m e d i a t e , a n d a d v a n c e d l e v e l a re b e i n g i n i t i a t e d w i t h t h e a s s i s t a n c e o f ICRC, HVO, a n d H I ; t e c h n i c a l a s s i s t a n c e ' i s b e i n g f u n d e d t h r o u g h HVO a n d H I ; and a n e e d s a s s e s s m e n t is b e i n g d e v e l o p e d .

1 1 . PROJECT DESCRIPTION

A . GOAL A N D PURPOSE

T h e q o a l o f t h e P r o s t h e t i c s A s s i s t a n c e P r o j e c t , a s s t a t e d i n t h e o r i g i n a l P P , is t o e s t a b l i s h t he c a p a c i t y f o r Mozambique t o t r ea t a n d p h y s i c a l l y r e h a b i l i t a t e a l l of t h e e m e r g e n c y - r e l a t e d c i v i l i a n d i s a b l e d , a n d t o a s s i s t them t o l e a d n o r m a l l i v e s . T h i s g o a l c o n t i n u e s t o b e r e l e v a n t w i t h i n t h i s PP s u p p l e m e n t .

The p r o j e c t purpose, as s t a t e d i n t he o r i g i n a l PP, i s t o i nc rease t he c a p a c i t y o f governmental and non-governmental e n t i t i e s t o address t he unmet and growing needs o f men, women, and c h i l d r e n d i s a b l e d by long-s tand ing c i v i l c o n f l i c t o r s u f f e r i n g from o t h e r c r i p p l i n g m o b i l i t y d i s o r d e r s . Th i s purpose remains r e l e v a n t w i t h i n t h i s supplement.

The o r i g i n a l PP noted f i v e key program c o n s t r a i n t s around which t h e p r o j e c t i n t e r v e n t i o n s were p'lanned:

1. The need f o r ( a ) more p rec i se es t imates o f c u r r e n t need and ( b ) a longer range n a t i o n a l r e h a b i l i t a t i o n p l an and s t r a t e g y ;

2. A shor tage o f c a p a c i t y to .manufacture and f i t prostheses and othoses;

3. Poor o v e r a l l s tandards o f o r t hoped i c su rgery f o r amputees and o t h e r d isab led , i n c l u d i n g an inadequate fo l l ow-up program and inadequate prostheses maintenance program ;

4. T h e . c r i t i c a l . s h o r t a g e o f t r a i n e d o r t hoped i c surgeons, p r o s t h e t i s t s , o r t h o t i s t s , and p h y s i c a l t h e r a p i s t s ; and

W W $ W W @

5. The need t o p rov ide b e t t e r access f o r r u r a l Mozambicans t o p r o s t h e t i c se rv i ces .

A d d i t i o n a l fund ing f o r e x i s t i n g and new i n t e r v e n t i o n s p rov ided under t h i s PP supplement w i l l con t inue t o address the goa l , purpose, and c o n s t r a i n t s descr ibed above which a r e r e l e v a n t w i t h i n t h i s PP supplement.

B. Requirements f o r .Amendment

I nc reas ing c o n s t r u c t i o n c o s t s and t h e need f o r l a r g e r accommodation c a p a c i t y i n the t r a n s i t cen te r s n e c e s s i t a t e t h a t t h e g r e a t e s t p r o p o r t i o n o f supplemental fund ing be prov ided t o Save the C h i l d r e n Federa t ion (SCF) f o r c o n s t r u c t i o n o f the f o u r h o s t e l s p resc r i bed i n the P r o j e c t Paper. E x t r a fund ing w i l l a l s o b e g iven t o Handicapped I n t e r n a t i o n a l f o r a d d i t i o n a l t r a i n i n g a c t i v i t i e s and a subgrant t o ADEMO; t o extend the c o n t r a c t o f the F i e l d Coord inator ; and t o add t o U S A I D e v a l u a t i o n s / a u d i t and cont ingency. These a r e discussed more f u l l y below. A breakdown o f supplemental funds i s p rov ided i n Table I .

( 1 ) CONSTRUCTSON O F HOSTELS ( T R A N S I T CENTERS)

P r o j e c t fund ing f o r h o s t e l c o n s t r u c t i o n w a s i n s u f f i c i e n t to meet t he l e v e l o f e f f o r t p re5cr ibed i n t h e P r o j e c t Paper. Four

hostels in four provincial capitals were to be constructed for $150,000, using, to the maximum extent, local materials to economize on project expenditures. The PP also stipulated that these structures should be built as close as possible to the ICRC workshops in each locale.

Rudimentary hostels, each accommodating 15-20 people, were to be constructed from local materials (such as cane, mud, wattle, thatched roofs, and including kitchen and bathrooms), for an estimated cost of approximately 825,000 in each of three provincial capitals and 845,000 in Maputo. This approach was prescribed based on Handicap International's fairly successful experience in Inhambane in constructing workshops and hostels out of local materials. The HI model was expected to be followed with the four project-funded hostels constructed by SCF . As suggested in the PP, an assessment team composed of Government representatives, SCF, HI, ICRC, and USAID visited three of the four proposed hostel sites (Beira, Ouelimane, and

~b-m+a Nampula). During these visits, HI reported their difficulties and rising costs in constructing hostels from local materials. Because costs of procuring and transporting local materials from remote rural areas to urban centers increased so dramatically over the last 1 8 months, HI now builds hostels in cement block using "modern" designs. Furthermore, zoning laws in the provincial capitals prohibit construction with local materials in those areas accessible to the ICRC prosthetic workshops. The MOH has also articulated the need to increase the accommodation capacity of the hostels over that planned in the original PF. Instead of accommodating only 15-20 patients in Beira and Nampula, the MOH requires capacity for 35-40,patients

.' in each city. ' This is due to: a) higher demand 'for prosthet~c ' services in the northern provinces resulting from greater political stability and access to patients; b ) enhanced production capacity of the ICRC and HI workshops in Nampula and Beira to meet increased demand; and cj the regional responsibilities of both the Beira and Nampula prosthetic and orthotic workshops. (Nampula serves all the prosthetic and orthotic needs in Niassa, Cabo Delgado, and Nampula provinces, while Beira serves Sofala and Manica Provinces, as well as acting as a referral point for Nampuia patients.)

Based an HI'S shift in approach and the necessity to build close to ICRC workshops within the three cities, the assessment team concluded that construction from cement block was more realistic and sustainable than building hostels i n local materials. The assessment team also determined that larger hostels to accommodate the increased needs of the MOH were warranted . Houses and vacant land in Beira and Nampula w e r e identified a5 options for rehabilitation and/or construction o f transit

P a g e 7

c e n t r r c . C o s t estimates o f r e h a b i l i t a t i n g e x i s t i n g b u i l d i n g s r e v e a l e d n o d i f f e r e n c e f r o m t h e cos t s o f c o n s t r u c t i n g new c e n t e r s or i n s t a l l i n g p r e f a b r i c a t e d s t r u c t u r e s . T h i s i s d u e t o t h e h i g h i n c r e a s e s i n ma t e r i a l a n d t r a n s p o r t c o s t s o v e r t h e l a s t IS m o n t h s , a n d t h e s p e c i a l d e s i g n n e e d s f o r l a r g e r b a t h r o o m f a c i l i t i e s a n d w i d e r d o o r w a y s t h r o u g h o u t t h e f a c i l i t y t o accommoda te c r u t c h e s , w a l k e r s , a n d w h r e l c h a i r s . R e h a b i l i t a t i o n o f e x i s t i n g h o u s e s wou ld n e c e s s i t a t e major s t r u c t u r a l work t o m e e t t h e s e r r q c ~ i r e m e n t s a n d c o s t s a v i n g s wol-rld n o t b e r e a l i z e d . F u r t h e r m o r e , f e w s i n g l e s t o r y h o u s e s e x i z t f o r r e h a b i l i t a t i o n a n d t w o - . s t o r y h o u s i n g is i n a p p r o p r i a t e f o r d i s a b l e d i n d i v i d l - t a i c , .

V a c a n t l a n d c i o s e l y s i t u a t e d t o ICRC worb:.shops a n d h a s p i t a i s i n b o t h c i t i e s is a v a i l a b l e a n d h a s b e ~ n a l l u c a t e d t o t h e M i r i i c t r y o f H e a l t h f o r i ts u s e . T h e MPH h a s i n t u r n , d e s i g n a t e d t h e s e a reas f o r c o n c , t r u c t i o n o f h o s t e l f a c i l i t i e s u n d e r t h i s p r o j e c t . conceptual a r c h i t e c t u r a l d e s i g n s f o r t h e t r a n s i t c e n t e r s h a v e b e e n p r e p a r e d w i t h i n c r e a s e d r a p a c i t y a n d t h e n e e d f o r s p e c i a l b a t h r o o m f a c i l i t i e s a n d w i d e r d o o r w a y s i n m i n d . Ba5ed on t h e s e d e s i g n s , t h e c o s t o f c o n s t r u c t i n g a n d equipping a new f a c i l i t y o r i n s t a l l i n g a n d e q u i u p i n g a p r e f a b r i c a t e d s t r u c t . - [ r e is e c , t i m a t e d a t 820i3. !:)(:>!) p e r u n i t i n e a c h c i t y . c r $.Fi,:)l::j.(:ii:ii'' t o f d i f o r f o u r t r a n s i t c e n t e r 5 ( i n c l u d i n g S a v e t h e C h i i d r e n o v e r h e a d cas t s ) . An a d d i t i o n a l 525.OC1Ci is a l s o r e o u i r e d f o r o n - s i t e i o n c . t r u c t i o n ~ n o n i t o r i n g a n d s c ! p e r v i s i o n bi/ S a v e t h e C h i l d r e n . A c c o r d i n g 1 y , $5675, c l r f i . ~ ':":"" i n s u p p l e m e n t a l f u n d s w i l l b e a d d e d to t h e S C F g r a n t f o r c o n t r u c t i n g a n d e q u i p p i n g t h e i a u r t r a n s i t c e n t e r s a5 d e z c r i b e d a b o v e .

To e n s u r e t h a t s u f f i c i e n t r e s o u r c e s are a v a i l a b l e f o r u p k e e p a n d m a i n t e n a n c e . a n d t h a t t h e h o s t e l s w i l l b e u t i i l z e d a s l n t e n d e d o n c e c o n s t r a c t e d . t h e F ' r o ~ e c t I n c l u d e s a c o n d l t l o r : p r e c e d e n t t o t h e P r o j e c t A g r e e m e n t amendment ( p r l o r t o d l c b u r c e - m e n t o f c c t n s t r i - r c t i o n f u n d s t o S C F ) w h i c h r e q u i r e s r a i f i c i e n t e v i d e n c e o i e - ; - i s ' k i n g f i n a n c i a l arid human resocir-ctss f o r h o c t e i n p e r a t ~ o n a n d m a i n t e n a n c e . The M i n l s t r v o f H e a l i f ; 15 i - e ~ p o n s - t ? l r f o r o p e r a t i n g arld m a i n t a i n i r r ~ t h e h o z t e l c ; ~ n c i ~ t d ~ r - ~ ~ ; : ti-lose e : . :penses r e l a t e d t o s t a f f ( h o s t e l s u p e r v i ~ . r r s / ' d i r e c t o ~ - 5 . j , f o o d , t r a r - i s p o r - t . a n d u t i l i t i e s . P v e r a l i a d m ' i n i s t r a t i v e s u p p n r t f o r h o s t e l o p e r a t i o n w i l l be a s s u m e d by t h e p r o v l n c l a l h e a l t h d - r e c t o r - a t c s wha h a u e r e s p c j n ~ i b ~ l i t y f o r h c s p i t 3 l s a n d o+l~!-- . r- t:eci tl? f a c r 1 1 tiee: I n l-ho%e c i i : i e s . However , b e c : s ~ i s e . t t 7 p hac,ti-.!.~ a r e new i a c ~ l l t ~ e s , i:helr- ruc! . . i r t - sn t C L ~ S ~ S b * J e r @ cot i n c i ~ ! d @ d LIT

th r - i.lr3t.l ' 5 F't'1.77i3 arid F Y 1591. bctdqe-k e t ~ d -3r.!p~lemen t ~ . r , ~ ~ G@Pl . , b~-tcigetar-y re5.3t-ti-ces a r e n o t a . , a * . ~ a b l e f ' n r these f l . ;cai x,.,+z:::--z,

l - l i c ts . GUM r e s o l - r r c e s n e c r s t z a r v t o rl-!n t h e h a s t e l z c o m p l e t e d r n 1 . Y c 7 i rlc n o t c t - r r r -en t lv e:-;rst and w i l l r i ~ t e i : l r - t w jen tl:e ~CF~:C?IE-- at-E c c ~ ~ ~ ! s j . e t e d . T I - - - I+;.< f . l i n i s t r v has i n d i c a t e d i ts l a t e n t i f i n t a -?,.rid t o ~ . t s r - e c c l i - r e n t bcidqet b < z q ~ n n i r - ~ g I n F\: I??" t o a c c o r i i r ~ d a t e tt-ie a d c l ~ t i c ? n a ! c=osi:.s of irhec-e new f a r i l i t i e s . I n t h e lrl tel-iiii

( 2 ) TRAINING

As e a r l i e r descr ibed, t r a i n i n g i n o r t h o t i c s and p r o s t h e t i c s i s be ing supported by t h e p r o j e c t a t advanced, in te rmed ia te , and bas i c l e v e l s . Pro jec t - funded t e c h n i c a l ass i s t ance from HVO w i l l a s s i s t t h e medica l school i n upgrad ing t h e o r thoped ic su rgery s k i l l s and se rv i ces o f medica l s t uden ts and doc to rs . The M i n i s t r y o f Hea l th , w i t h p ro jec t - funded t e c h n i c a l ass i s t ance f rom ICRC, i s conduc t ing a pre-serv ice, i n t e r m e d i a t e - l e v e l t r a i n i n g course i n o r t ho -p ros the t i c technology f o r 30 s tuden ts i n Be i ra . Bas i c - l eve l t r a i n i n g i n t h i s same a rea i s be ing developed by t h e M i n i s t r y o f Hea l t h w i t h ass i s t ance from Handicap I n t e r n a t i o n a l (descr ibed be low) .

When t h e c u r r i c u l u m f o r the p ro jec t - funded p h y s i c a l therapy course was be ing developed by H I and t he MOH, a d d i t i o n a l t r a i n i n g needs were i d e n t i f i e d i n b a s i c - l e v e l o r t h o p r o s t h e t i c

1 technology f o r t echn i c i ans working w i t h i n t h e p r o s t h e t i c

:P workshops, many o f whom have no fo rma l t r a i n i n g t o p e r m i t them

$ i t o con t i nue meet ing t h e p r o s t h e t i c and o r t h o t i c p roduc t i on needs o f t he c o u n t r y f o l l o w i n g t he t e r m i n a t i o n o f donor suppor t . The MOH has requested i n s e r v i c e t r a i n i n g f o r these t e c h n i c i a n s t o enhance t h e i r s k i l l s over t h e long-term. Based on these newly de f i ned needs, H I has developed c u r r i c u l a f o r a p h y s i c a l therapy and an o r t h o p r o s t h e t i c technology course:

A. In termedia te-Leve l Phys i ca l Therapy: 3 1 /2 year p re -serv ice course f o r 30 p h y s i c a l therapy s tuden ts w i t h completed secondary school q u a l i f i c a t i o n s .

8 . Basic-Level O r thop ros the t i c Technoloqy: A 2 1 /2 year,, i n s e r v i c e caurse f o r approx imate ly 15 employees i r

p r o s t h e t i c workshop5 throughout the coun t ry . H a l f t h e course i s t o be he ld i n t he c lassroom and the remainder w i l l be on-the- job p r a c t i c a l t r a i n i n g .

Under supplemental p r o j e c t fund ing, the P r o j e c t w i l l p r o v i d e H I w i t h an a d d i t i o n a l 6125,000 ( o r 6275,000 t o t a l ) f o r implement ing b o t h courses. Whi le the t o t a l c o s t f o r b o t h courses i s es t imated a t 3400,000 over t h ree years ( 1 9 9 1 - 9 3 ) , H I a n t i c i p a t e s t h a t the fund ing gap w i l l be met through o t h e r donors o r through t h e i r own o r g a n i z a t i o n a l resources.

( 3 ) SUBGRANT TO ADEMO

As mentioned e a r l i e r , Handicap I n t e r n a t i o n a l has been work ing c l o s e l y w i t h t h e Associacao dos D e f i c i e n t e s Mocambicanos ( A D E M O ) , a l o c a l NGO es tab l i shed t o legislatively and economica l ly promote handicapped Mozambicans. While ADEMO has n o t y e t p a r t i c i p a t e d d i r e c t l y i n the p r o j e c t , t h e i r invo lvement under t h i s PP supplement w i l l b r i d g e the e f f o r t s between s e r v i c e d e l i v e r y and the d i sab led themselves. The p r o j e c t proposes t o fund voca t i ona l t r a i n i n g a c t i v i t i e s i n ADEMO . , I I , 4 . , I T

H a n d i c a p I n t e r n a t i o n a l and GDEMO w i l l i d e n t i f y d i s c r e t e p r o j e c t a c t i v i t i e s , s u c h as c h i c k e n p r o d u c t i o n . w o o d w o r k i n g , s h o e m a k i n g , o r p a r t i c p a t i o n i n h o s t e l m a n a g e m e n t . F u n d i n g t o GDEMO w i l l b e p r o v i d e d f o r management t r a i n i n g , s t a r t - u p c a p i t a l , a n d c o n t i n g e n c y costs . H1 w i l l b e r e s p o n s i b l e f o r m a n a g i n g t h e s u p p o r t t o ADEMO a n d i n d e f i n i n g p r o j e c t s w i t h t h e g r e a t e s t c h a n c e f a r s u s t a i n a b i l i t y i n t h e a b s e n c e o f f u t u r e d o n o r c,c!ppor-t .

j OTHER ACTIVITIES

P r o j e c t f u n d i n g f o r p r o j e c t managemen t a c t i v i t i e s w a s i n s u f f i c i e n t t o c o v e r t h e c o s t s ' o f t h e f i e l d c o o r d i n a t o r a n d t h e USGID-based a d m i n i s t r a t i v e a s s i s t a n t over t h e l i f e o f t h e p r o j e c t , p a r t i c u l a r l y i n v i e w o f t h e e x t e n s i o n o f t h e F'ACD. S u p p l e m e n t a l f u n d i n g is t h u s p r o v i d e d f o r p r o j e c t managemen t s t a f f t h r o u g h l i f e o f t h e p r o j e c t . F u r t h e r m o r e , a d d i t i o n a l f u n d i n g is p r o v i d e d f o r t h e t w o e x t e r n a l e v a l u a t i o n s w h i c h w e r e a l s o u n d e r f u n d e d i n t h e o r i g i n a l F'F. T h e r e m a i n i n g s u p p l e m e n t a l f u n d s w i l l b e r e t a i n e d by USGIE f o r c o n t i n g e n c y a c t i v i t i e s .

C. ADDITIONhL OUTPUTS AND INPUTS

T h e f i v e ciutpc!ts l i s t e d i n t h e o r i g i n a l PP c o n t i n u e t o b e r e l e v a n t t o t h e p r o j e c t . A r i x t h a d d i t i o n a l o u t p u t is a d d e d f o r t h e new ADEMO c o m p o n e n t :

1. An a c c u r a t e a s s e s s m e n t o f e m e r q e n r y r e l s . t e d p h y s i c a i r e h a b i l l t a t i o n n e e d s a g r e e d t o by t h e GPRM a n d d o n o r c w i : i S e r v e a s a b a s i c , f o r p l a n n i n g . A n a i r l o n a i ~n \~ , c ; . 1ca . l r13,hatli i i t s t i o n p i a n w i 1 1 b e d e v e i o p e d . .. sic, . A n $i-icrea.c,e t h e number o f p r o s t h e s i s tha t are m r ~ d f i t a n d i n e I n 1933. 675 new p t - ~ s t h e s i r w e r e F i t t e d . B y 1992, t h e new p r o s t h e s i s f i T t e d c h c u l d t o t a l 13iI)i:1.

l e imrj_rovement5 i 1 - i t he c l c ~ . a l . i t \ ~ o f f_?rrtIfc!c:~:~L1-gEE.- c l . il-licai case inanaciecnent. T h e c ; ~ i n c i u d c e s t a b i i c h 1 1 - 1 ~ p r o f e r r i n r i a l .consul t a t - i o n b e t w e e n s u t - q e o n c and r c h a b i 11 t a t i o n c- taf f as s t a n d a r d p r a c t i c e cr- i a r ti:, surgery. e s t a b l i s h i n g a n e f f e c t i v e c l i n r c a l f o l l n w - u p p r o g r a m f o r a r n p u t e e r , a n d a " c 1 Len t - r e s p o n s i v ~ " pra.~.-!..i~e.rr=;s mar in t ena~nce pr-ogr-am,

~ i ! i . r ~ i . n & cOL\rr:5.F-'C- C i ~ ~ ~ k r n ~ d and cc~r~d!-\!_. 1n CC!ITi.pOriFi7~.5- 4 . i re I- a L 1 1. . , t h e se 5 e roaL-1~ ti o n . Ou.a l i - i i ied a r ' t t i n p e d i c s u r g e o n s w i i l i n c r e z r e f r c m one to l:i-tl.-ee. Qi!a!. if:!.prj p r . o ~ t : h e t 1 5 i i ~ r t h ~ t i 5 . t ~ ~i 1 I. i r i c r e ~ ~ e

0 . from one to 20. Qualified physical therapists will increase from 27 to 50. Qualified basic-level orthoprosthetic technicians will increase by 15. At least 80 percent of the newly trained prosthetists/ orthotists will be posted to rural areas.

5. Four hostels constructed and equipped to establish a national network of clinical rehabilitation centers for prosthetic patients from the outlying rural areas. The four hostels will accommodate up to 120 individuals awaiting or receiving treatment. In addition, better transport will be made available, both inter- and intra-province travel for patient care.

6. Disabled Mozambicans actiyelv ensaqed in productive economic activities, through food production at the hostels and small income-generating projects in two or three other sites.

To achieve the outputs, the Project will finance the following inputs:

1 Needs As5essment and Strategy Development , Inc-reased Prosthetic Production

@M@*w Improved Quality-of Orthopedic Care

Training Improved Qccess to Care Vocational Training for the Disabled Project Administrative Support Evaluation/Audit Contingency

TOTAL $ 3,530,000

. I . REVISED IMPLEMENTATION RESPONSIBILITIES AND PhQN

The Ministry of Health provides policy leadership to the project and to the private voluntary organizations who have received grants for project implementation. The MOH also serves as the coordinator of project components and provldes local currency support necessary to ensure project sustainabillty le.g. personnel, operating costs of hostels, etc 1 .

The Field Coordinator, with the participation of the MOH and other implementing agencies, is responsible for completing the Needs essessment and the national strategy based on the assessment. The Field Coordinator is also responsible for organizing Project Steering Committee,meetings and preparing quarterly progress reports summarizing achievement of project outputs.

Each o f t he PVOs a r e respons ib l e f o r implement ing t h e i r s p e c i f i c component o f t he p r o j e c t , and p a r t i c i p a t i n g i n t h e P r o j e c t S t e e r i n g Committee, a mechanism e s t a b l i s h e d t o enhance c o o r d i n a t i o n among agencies.

S p e c i f i c implementat ion steps, de l i nea ted by ou tpu t . f o l l o w . A c t i v i t i e s a l r eady completed (such as execu t ion o f i n d i v i d u a l g r a n t s n o t a f f e c t e d by t h i s supplemental PP) a r e n o t l i s t e d . I n parentheses, a r e v i s e d t a r g e t da te f o r a c t i v i t y comp le t ion i s suggested.

Output Number 1 - Needs Assessment and S t r a t e q i c Plan:

- F i e l d Coord ina to r , w i t h involvement o f o t h e r

o r g a n i z a t i o n s and the MOH, prepares needs assessment (December 1990).

- Resu l t s a r e reviewed and approved by MOH and P r o j e c t

S t e e r i n g Committee (January 1991).

- Data i s used t o fo rmu la te a long-term r e h a b i l i t a t i o n

s t r a t e g i c p l an f o r d issemina t ion t o GPRM e n t i t i e s , o t h e r donors, and NGOs ( A p r i l 1991).

Output Number 2 - P r o s t h e t i c / O r t h o t i c Produc t ion and F i t t i n q

- ICRC and H I e s t a b l i s h annual and q u a r t e r l y p roduc t i on

and t rea tment goa ls as w e l l as annual workplans (December 1990, 1991, 1992).

- ICRC and H I submi t semi-annual progress r e p o r t s and

f i n a n c i a l r e p o r t s t o USAID and P r o j e c t S t e e r i n g Committee ( J u l y and January o f 1990, 1991, 1972).

Output Number 3 - Q u a l i t y o f Treatment

- HVO submi ts a workplan f o r meet ing component g o a l s and

o b j e c t i v e s (September 1990).

- Workplan i s approved by MOH, P r o j e c t S t e e r i n g Committee

and UShID (October 1990).

- H V O r e c r u i t s and f i e l d s shor t - term TA as de f i ned i n annual workplans (ongo ing ) .

Output Number 4 - T r a i n i n q

Course #1 - I C R C In termedia te-Leve l O r thop ros the t i c Technoloqy:

- Classrooms completed and mater ia ls /equ ipment procured

and i n s t a l l e d (October 1990).

P a g e 12

- C o u r s e c o n t i n u e s u n t i l c o m p l e t i o n ( J u l y 1 9 9 3 ) .

- S e m i - a n n u a l p r o g r e s s r e p o r t s s u b m i t t e d b y ICRC t o USAID a n d P r o j e c t S t e e r i n g C o m m i t t e e ( t w i c e y e a r l y t h r o u g h 1 9 9 3 ) .

C o u r s e #2 - HI I n t e r m e d i a t e - L e v e l P h y s i c a l T h e r a p y

- C u r r i c u l u m c o m p l e t e d ( i n c l u d i n g b u d g e t , a n d n e c e s s a r y

r e s o u r c e s i d e n t i f i e d ) a n d a p p r o v e d by MOH a n d USAID ( O c t o b e r 1 9 9 0 ) .

- R e v i s i o n t o H I g r a n t f o r a d d i t i o n a l f u n d i n g (Wovember

1 9 9 0 ) .

- S t u d e n t s a n d f a c u l t y s e l e c t e d a n d r e c r u i t e d by H I a n d

MOH ( D e c e m b e r 1 9 9 0 ) .

- C o u r s e b e g i n s a n d c o n t i n u e s f o r 3 1 / 2 y e a r s ( F e b r u a r y

1 9 9 1 o n w a r d s ) .

C o u r s e #3 - HI B a s i c - L e v e l O r t h o p r o s t h e t i c T e c h n o l o q v

- C u r r i c u l u m c o m p l e t e d ( i n c l u d i n g b u d g e t , a n d n e c e s s a r y

r e s o u r c e s i d e n t i f i e d ) a n d a p p r o v e d by MOH a n d USAID ( O c t o b e r 1 9 9 0 ) .

0 - R e v i s i o n t o H I g r a n t f o r a d d i t i o n a l f u n d i n g (November

1 9 9 0 ) .

- S t u d e n t s a n d f a c u l t y s e l e c t e d a n d r e c r u i t e d by HI a n d

MOH ( D e c e m b e r 1 9 9 0 ) .

- C o u r s e b e g i n s a n d c o n t i n u e s f o r 2 1 / 2 y e a r s ( F e b r u a r y

1 9 9 1 o n w a r d s l'. .

O t h e r T r a i n i n q - HVO C o n t i n u i n q E d u c a t i o n f o r M e d i c a l S t u d e n t s . R e s i d e n t s , S u r q e o n s

- T r a i n i n g P l a n is d e v e l o p e d a n d a p p r o v e d a s p a r t o f

o v e r a l l HVO w o r k p l a n ( O c t o b e r 1 9 9 0 ) .

- F a c i l i t i e s and e d u c a t i o n a l m a t e r i a l s a r e p r e p a r e d ( D e c e m e b e r 1 9 9 0 ) .

- C o u r s e s u n d e r w a y by J a n u a r y 1990 ( o n g m i n g ) .

- S e m i - a n n u a l r e p o r t s s u b m i t t e d t o MOH, USAID, a n d

S t e e r i n g C o m m i t t e e ( J u l y a n d J a n u a r y 1 9 9 1 , 1 9 9 2 , a n d 1 9 9 3 ) .

Output Number 5 - Hos te l Cons t ruc t i on and Improved Access t o C a r e

- Cons t ruc t i on P lan ( w i t h budget and p lans f o r equ ipp ing

h a s t e l s ) developed by SCF f o r approva l by MOH and USAID, i n c l u d i n g rev iew by REDS0 Engineer (September 1990) .

- P lans approved by USAID and MOH (October 1990) .

- MOH submi ts p l an f o r maintenance and upkeep o f h o s t e l s

f October 1990 1.

- USAID approves p l a n f o r maintenance (November 1990) .

- Amendment t o SCF Grant (November 1990 ) .

- B i d s ob ta ined f rom c o n s t r u c t i o n f i r m s i n each l o c a l e

(November 1990)

- S e l e c t i o n o f c o n s t r u c t i o n f i r m (December 1990)

- Cons t ruc t i on beg ins and i s completed accord ing t o

. Y schedule (January 1990 onwards)

- SCF submi ts semi-annual progress r e p o r t s t o USAID and

P r o j e c t S t e e r i n g Committee (January and J u l y 1991, 1992, 1993) .

Output Number 6 - Disab led Enqaqed i n Economic A c t i v i t i e s

- H I and ADMED i d e n t i f y p r o j e c t s a t p r o v i n c i a l o r d i s t r i c t

l e v e l and s e l e c t those most app rop r i a te f o r P r o j e c t suppor t (November 1 9 9 0 ) .

- 6 i s t . a n d p r ~ ~ p o s a l s o f ADEMO a c t i v i t i e s submi t ted t o

bSGID f o r approva l (November 1990 ) .

- Grants executed by H I w i t h ADEMO (December 1990) .

- P r o j e c t implementat ion beg ins (January 1990 onwards).

- Ademo submi ts semi annual progress r e p o r t s t o H I f o r

fo rward ing t o USAID ( J u l y and January 1991, 1992, 1 9 9 3 ) .

Other A c t i v i t i e s

- M id -p ro j ec t e v a l u a t i o n conducted by e x t e r n a l e v a l u a t i o n

team ( J u l y 1991)

- Fknal e v a l u a t i o n conducted by e x t e r n a l eva lua t i on team

(June 1993)

- Audit conducted by non-governmental (U.S. ) a u d i t team ( J u l y 1 9 9 3 ) .

Faae 14

E. PROCUREMENT PLAN AND METHODS OF FINANCING

Procurement under t h i s p r o j e c t w i l l be through A.I.D. g r a n t s t o PVOs and i n t e r n a t i o n a l o rgan iza t ions , and d i r e c t a.1.D. c o n t r a c t s f o r t e c h n i c a l ass is tance, eva lua t i on and a u d i t . Such g r a n t s and c o n t r a c t s w i l l be handled d i r e c t l y by A.I.D., e i t h e r by USAID/tlozambique, t h e Regional Cont rac ts O f f i c e r i n USAID/Swaziland, o r fhID/Washington i n t h e case o f work o r d e r s under e x i s t i n g IQCs.

(I) S o ~ t r c e / O r i a i n / N a t i o n a l i t y I s s u r s

No source/origin/nationality waivers w i l l be r e q u i r e d as A.I.D. Geographic Code 935 i s t he au thor i zed proc i~rement code f o r t h i s p r o j e c t . However, goods and se rv i ces w i l l be procured f rom the U.S. t o t he maximum e x t e n t poss ib le .

Wi th respec t t o procurement under i n d i v i d u a l grants , t h e o r d e r o f pre ference o f f i r s t Code (300, then t h e hos t coun t ry , then Code 941, then Code 935 w i l l app ly , regard less o f t h e amount o f t h e procurement, i n keeping w i t h Spec ia l Procurement F ' o l l c ~ Rules governing t he Development Fund f o r A f r i c a (BFG). Wi th

, *. . . , r espec t t o ocean sh ipp ing o f commodltles p roc~ r red by g ran tees , .. and a i r t r a v e l and t r a n s p o r t a t i o n , t he s tandard g r a n t p r o v i s i o n s 'l

regard ing these ma t te r s w i l l app ly . However, as p rov ided i n t h e b lanke t t r a n s p o r t a t i o n source waiver f o r Mozambique approved i n January 1989, and rev i sed i n January 1990, no U.S. f l a g source i s a v a i l a b l e from non-U.S. p o r t s t o p o r t s i n Mozambique, and thus grantees may need t o o b t a i n a de te rmina t ion o f non- a ~ . / a i l a b i l i t y f rom I"IS/@F'/TFiGMS f o r any shipments o f commodit ies t o Mozambique from nan-U.S. po r t s .

Wi th r e r p e c t t o A . I .D . d i r e c t procurement, the f o l l o w i n g r e s t r i c t i o n s apply . Long term managerial ass is tance w i l l g e n e r a l l y be f rom Mozambique o r t he U.S.. Shor t term t e c h n i c a l assis<$&nc& c - $ 1 1 f %genera l l y - ' be from U.S. sources. G l l G . I . D. f inanced a i r t ran 'spor t 'a t ion and t r a v e l i rom the Un i ted S ta tec w i l l be l i m i t e d t o U.S. f l a g c a r r i e r s , s ~ t b j e r t t o documented except ions. which w i l l be made spa r i ng l y . No U.S. f l a g c a r r i e r s i l y i n t o Mozambique, so U.S. f l a g c a r r i e r s w i l l be used t o t he neares t pa in - t on c!sctal l y t r a v e l l e d rotrter-. U.S. rnanufactcrred v e h i c l e s cannot meet the needs o f the p r o j e c t . because o f r e q u i r e d s p e c i f l c a t i o n s , i n c lctding t he need f o r r i g h t hand d r i v e v e h i c l e s n o t a v a i l a b l e from t h e U . S . . and

. _ spare p a r t s and maintenanre capabilities w i t h i n Mozambique.

Therefore, non-U.S. v e h i c l e s from Code.935 countries w l l i be procured .

(2) Grants t o PVDs and I n t e r n a t i c ~ r i a l Orqar-1i.zation5~

Sclec t i o n .. - -- .. . - .. . : Dc.lring t h e F ' rn jec t d & ~ i u n , t h ree F'VOs (SCF. t-iVO, and H I ) and one international or-ganizat ion ( I C E C ) , were se lec ted as i i r iplementing agencies by t he desian team, t he MCiH and USAID. T- i iey were .;elected dclp t o their clngoing invcl lvement

August 1990 FIGURE A

ILLUSTRATIVE LIST OF SUPPLIES AtiD SERVICES FOR THE NOZAflaIQUE PROSTHETIC PROJECT (656-0215) i.

\

A n t i c i p a t e d A n t i c i p a t e d A n t i c i p a t e d Value Source O r i q i n ------------ -------------- --------------

Procurement Of i i c e

1. Cons t ruc t i on R a t e r i a i s 750,000 Rozambique and Geographic and Se rv i ces South A f r i c a Code 935 (cesent, lumber, g lass , s t e e l , sand, p i p i n q , grave l , etc.; l abo r1

AID Grantees (Save the C h i l d r e n Fede ra t i on and ICRC v i a subcon t rac t1

2. A r c h i t e c t l E n q i n e e r i n g 30,000 Geographic Geoqraqhic Serv ices Code 735 Code 935

AID Grantees , (Save the ~ h i l i r e n Fede ra t i on v i a subcontrac t I ICRC)

3. T r a i n i n g H a t e r i a l s 75,000 1 books, r ode i s , teach ing aids, paper supp l i es , e t c l

&ograph ic Code 935

Geographic AID Grantees Code 935 (Handicap I n t e r n a t i o n a l

and ICRC)

4. Two r i g h t hand d r i v e v e h i c l e s

South A f r i c a Geographic GiU Grantees Code 955 (Save the C h i l d r e n

Fede ra t i on 1

5. P ros thes i s nanu fac tu r i ng i i 0 ,3 i i 0 i q u i o s e n t i l a r i a a t o r s , j igsaws, d r i l l s , g r i nde rs , e tc .

6eographic Code 93:

Geographic AID Grantees Code i35 - 1 ICRC)

6. Operat inq Room E q u i p ~ e n t ii5,OiiO and or thopeaic s u p p l i e s i o r t hopeo i c i n s t r u a e n t sets, autoclave, i ~ ~ i a n t manuiac tur - i n q equipment, o t h e r s u o ~ l i e s !

U.S. AID Grantees { H e a l t h Vo lunteers Gverseas)

Geographic Code 935

Geoqraphic AID Grantee E o d ~ 735 (HI J

8. T e c h n ~ c a l Ass is tance 1,300,000 (Hea l t h Vo iunteers Overseas)

U.S. U.S. AID Grantee (HVO)

9, Eva lua t i on and A u d i t 115,900 Services

Geograpnlc Code 935

Geoqraohic USAlD/tlozaab~que Code 935

TOTAL VALVE OF SEWICES 3,204,000 AND COEflOGIiiiS

- C o n n o d i t i ~ s P o r t i o n 1,359,300 - Serv ices P o r t i o n 1 ,a50,000

Auqurt 1990 FIGURE 0

Rozambique Prosthetics Project (656-02151 .................... HETHUDS OF FINANCING --------------------

Entity Type of Contract Hethod of Payrent Paying Office -------- --------------- ---------------- -------------

1 ) International Connittee Grant o i the Red Crass

Letter of Credit hIDiWasbinqton

2 ) Save the Children Grant Letter of Credit ~IIOIWashington Federation

31 Handicap International Grant Direct Reiaburseaent USBIDltlozaabique

4 ) Health Voiunteers Overseas Grant Direct Reirburserent USfiiDlflozaabique

5 ) iechnical Asjlstance for IOC throuqh PIOIT to Direct fleiaburseaent USdIDltlozambique .+ , Needs As5esscenr AIDIYashing ton

6 ) Adainistraiive Support Local Personal Ser- Direct 'Relahurseeent USdIDlHozamb~que to Project vices Contract r l t h

US4iDltlozaablque

i ; iva!uation ieaa IQC through PIOii to Direct Reimbursetent USfiiDlRozawbisue AIDIYashinqton

8) Hon-governmen t Audl t Direct Contract with J i r ec t Relwburserent USAiDlfiozambique RIGiNairobl w l t h local acredited f i r s

A, '<.

5

w i t h t h e MOH i n t he area o f p r o s t h e t i c s ass is tance , o r , i n t h e case o f HVO, on i t s a b i l i t y t o f u l f i l l a p a r t i c u l a r need. Grants were made t o SCF, HVQ, and H I i n accordance w i t h Handbook 13 r e g u l a t i o n s f o r g r a n t s t o PVOs. A g r a n t was made t o I C R C i n accordance w i t h Handbook 13 r e g u l a t i o n s pe r t a i nsng ta i n t e r n a t i o n a l o rgan i za t i ans . .

Procurement o f Goods and Serv ices under I n d i v i d u a l Grants: The i nd i v i dc ta l PVOs a r e respons ib l e f o r a1 1 procurement r e q u i r e d f o r implemznt ing t h e i r s p e c i f i c p r o j e c t components i n accordance w i t h t h e i r e s t a b l i s h e d procurement procedures, p rov ided t h a t such procedures a r e i n accordance w i t h t h e s tandard p r o v i s i o n s a t tached t o each g ran t . F o r each o r g a n i z a t i o n , as descr ibed i n ( 1 ) above, procurement o f a l l goods and s e r v i c e s s h a l l have t h e i r source and o r i g i n i n c o u n t r i e s i nc l uded i n A I D Geographic Code 935 (Spec ia l Free Wor ld j , b u t t o t he maximum e x t e n t p r a c t i c a l , procurement o f goods and s e r v i c e s s h a l l occur i n t he Un i t ed States. Each g ran tee i s r espons ib l e f o r d e f i n i n g the goods and s e r v i c e s r e q u i r e d t o c a r r y o u t p r o j e c t a c t i v i t i e s . The f o l l o w i n g a r e i l l u s t r a t i v e o f t h e types o f commodit ies and s e r v i c e s which w i l l be procured w i t h p r o j e c t funds. I n a d d i t i o n , F i g u r e A c o n t a i n s an i l l u s t r a t i v e l i s t and est imated c o s t o f these procurements.

Pracurement o f c o n s t r u c t i o n c e r v i c e s w i l l be c o m p e t i t i v e l y awarded by SCF and I C R C i n accordance w i t h g r a n t p r o v i s i o n s and i n keeping w i t h GRM c o n t r a c t i n g r e g u l a t i o n s . P r i o r t o d isburse- ment o f funds t a SCF f o r h o s t e l c o n s t r u c t i o n , c o n s t r u c t i o n p lans w i l l be reviewed and approved by bo th t h e cognizant GRM t e c h n i c a l a u t h o r i t i e s and t h e USAID FiEGSO Engineer. I t w i l l be t he r e s p o n r i b i l i t y o f I C R C and SCF t o ensure t h a t c o n s t r u c t i o n m a t e r i a l s a r e ob t z i ned i n a manner which ensures the lowes t pn -s r l b l e p r i c e 5 a r e pa id f o r h i g h q u a l i t y m a t e r i a l s . Glso pr?-at- t n disbctt-sement o f fund+ t o SCF f o r h ~ s t e l const rc tc t ion. t h e NOH w t l l prepare a p l an f o r h o 3 t e i maintenance and upi,.eep wnic", w i l l be submi t ted t o USAiD f o r approva l . Baced on USAlP's

.c !nderstanding o f t h e source a+ l o c a l m a t e r i a i , coming l ing w i l l n o t be an i s r u e .

T r a i n i n g -.- ma-keria.1~ (books, models, teaching a i d s , e t c j w11i bc procored it-om Code $35 (ma in l y Europe o r couthern ACrlcd -.. ,octrces f o r t h e pctt-poses o f r t anda t - i l za t i c l n ) thr-octgh ICF,,C and

7.. ti1 adm in l . = t r a t i ve o f f i c e s . I he i r - f a m i l i a r i t y w:~i:h p r - o s t h r t ~ c s / c r - tho t i c5 teach ing materials and 1angu.ai;e t-eqct.1 rements i n Mazambique jets-ti fie.: pr-ncc!t-ement from t h e c ; e soccr-.:lz-s.

I : : : ' r r _ : r ~ \ r ~ + r n ~ ~ r ; t m f pr..c!tha:;:.ec- man(..!-? ac.t~-!r ina pact1 pment , -- s c ~ ~ p l i e s L-.-:?!L~ ~ , t h e r ~,!~LgLfI12.~1.-1:-1:&L1:..t7~ ~ 1 . 1 1 have t h e i r probable a t - ig ln and ~=,ELI~-ce I n code C--C , . - . , I coi.!n t r i e s (the U.S. , Ec ! rop~ , Japan, o r s o c t t h ~ r n

A-fr - lca) i n accor-d,-.rlce wltl-I ICRC:, H I , and, HL'C1 normal pr-ocLtrr.menk

F'age 16

p r a c t i c e s . A c t u a l e q u i p m e n t n e e d s w i l l b e d e f i n e d b y t h e g r a n t e e s d u r i n g p r o j e c t i m p l e m e n t a t i o n , b u t F i g u r e A c o n t a i n s a n i l l u s t r a t i v e l ist o f t h e t y p e o f e q u i p m e n t w h i c h is l i k e l y t a be p u r c h a s e d .

A d m i n i s t r a t i v e s u p p o r t t o t h e p r o j e c t w i l l b e c o m p e t i t i v e l y p r o c u r e d by USAID. L o c a l p e r s o n n e l w i l l b e h i r e d u n d e r local p e r s o n a l s e r v i c e s c o n t r a c t s w i t h t h e M i s s i o n . T h e s e w i l l b e c o m p e t e d a n d a w a r d e d i n a c c o r d a n c e w i t h AID r e g u l a t i o n s b y USAID/Morambique. A d d i t i o n a l s h o r t - t e r m TA w i l l b e o b t a i n e d . a s r ~ q u i r e d ~ u s i n g I E C s , PSCs. or p u r c h a s e o r d e r s . F'SCs a n d p u r c h a s e o r d e r s f o r s e r v i c e s w i l l b e c o m p e t e d a n d e x e c u t e d i n a c c o r d a n c e w i t h A I D r e g u l a t i o n s . IGC w o r k o r d e r s w i l l b e e x e c u t e d by A I D / W a s h i n g t o n .

Evalua t - ic !n s e r v i c ~ s w i l l b e p r o c u r e d th roc rgh work o r d e r s i t n d e r e x i s t i n g I Q C s i n A I D / W a s h i n g t o n , o r by c o m p e t i t i o n a n d a w a r d o f c o n t r a c t s .

A1 1 g r a n t e e s a re r ~ q u i r e d t o c o n d u c t a n n u a l a u d i t s o f t h e i r o v e r a l l o p e r a t i o n s . i n c l u d i n g f u n d s p r o v i d e d b y A I D . Any s e r v i c e s r e q u i r e d f o r n o n - f e d e r a l a u d i t of t h e p r o j e c t w i l l b e o b t a i n e d t h r o u g h IBCs e x e c u t e d b y R I G / N a i r o b i . B e c a u s e o f t h e s p e c i a l i z e d n a t u r e o f t h e se rv ices r e q u i r e d u n d e r t h i s p r o j e c t , 8 ( a ) f i r m s a re n o t i n c l u d e d as p r i m a r y r e c i p i e n t s o f AID f u n d s . However , p e r s o n s a n d / o r o r g a n i z a t i o n c c o n t r a c t e d t o p r o v i d e s h o r t - t e r m t e c h n i c a l a s s i s t a n c e t h r o u g h h'VO o r f o r e v a l u a t i o n / a u d i t s e r v i c e s may c a n f o r m t o G r a y Amendment r e q u i r e m e n t s . E v e r y e f f o r t w i l l b e made t o identify d i s a d v a n t a g e d e n t e r p r i s e s wha c a n h a n d l e t h e s e a c t i v i t i e s .

M e t h o d s o f F i n a n c i n g f o r t h e a b o v e z e r v i c e s a re d e s c r i b e d i n

F. REVISED FINANCIAL FLAN A N D SUMMARY OF FINANCIAL ANALYSIS

F u n d i n g p r n v i d e d u n d e r t h e c ~ r i g i n a l PP (82.53 million) w a s f u . l l v m b l l q a t r d i n 1989 t h r o c q h a F 3 r o i e c t A g r e e m e n t w i t h t h e

. , . -Piozambiqcre M i n i s t r y of H e a l . t h . A d d l t i c j n a l ' S u n d i n g t..tncfcr t h i c . , r ~ i p p l e m e n t i S ; l ; i : j m l l l l o n ! . w i l l be c i b i i g a t e d thr@*-!gi? a r l . ,

amendmen t t o t h e P r o j e c t Aqt-ee~nent . G r a n t s to e a c h o r - g a n i z a t l o n e a r m a r k s u p p o r t f o r t h e s p e c i f i c p r o j e c t a c t i v i t i e s outlined i n t h e o r i q l n a l F ' r o j e c t F ' a p e r . Amendments t o t h e H I a n d SCF- g r - - a n t s w i . l l earmark i u n d i n q f o r t h o s ~ s . c : l - - i v l thes d e s c r i b e d i n ~ . e c t i o n ti o f t h i s docc!inen+ . e n t i t l e d "Rea!.il.reme~i-lzr f o r Amendment" . A l:jrr?al..dowrr o f t t - 1 2 t o t a l F ' r o j e c t bucigpir 0%; o r g a n i z a t i o n a n d a c t i v i t y is p r o v i i j e d i n Tab1.e I . TI.~ese c o c t s a rp e l a b o r a t e d uI:mn b e 1 . 0 ~ ar-icj 2.r) r - r v i ~ ~ d Financial firial..,sFz fat-!rid i n t h e Anne:-:.

P a g e 17 '

S a v e t h e C h i l d r e n F e d e r a t i o n w i l l r e c e i v e .i;1,241,8Ci0 f o r c o n t r u c t i n g a n d e q u i p p i n g f o u r t r a n s i t c e n t e r s i n f o u r P r o v i n c e s o f Mozambique (8825.000) b e g i n n i n g i n t h e s e c o n d y e a r o f i m p l e m e n t a t i o n ; a n d f o r a d m i n i s t r a t i v e s u p p o r t t o l o n g - t e r m a n d s h o r t - t e r m HVO p e r s o n n e l ! 8416,800).

H a n d i c a p I n t e r n a t i o n a l wi l l r e c e i v e tS5CiS,i?(:1Ci f o r si:.: p e r s o n - y e a r c o f t e c h n i c a l a s s i s t a n c e I4180,96(3 j : t h e o r t h o p r o s t h e t i c a n d p h y s i c a l t h e r a p y t r a i n i n g p r o g r a m s ($275,0(:)(3 j w h i c h w i 1 1 b e i m p l e m e n t e d bey i n n i n g 1991 : a n d a s u b g r a n t t o ADEMO i 850,(30U ) . T h e I n t e r n a t i o n a l C o m m i t t e e o f t h e Red C r o s s r e c e i v e s %45(3,0i)Ci f o r a n a r t h o p r o e t h e t i c t r a i n i n q c o u r s e (830, Cs(?i:)) ; p u r c h a s i n g a n d i n s t a l l i n g o r t h o p e d i c e q u i p m e n t ($254,0i:)0): r e h a b i l i t a t i o n a n d c o n s t r ~ t c t i o n o f w o r k s h o p s a n d l i v i n g q u a r t e r s (8125 ,C)i:j0 j ; a n d c o n t i n g e n c y (841,00(33. ICRC p l a n s t o e x p e n d m o s t o f t h e i r f u n d i n g w i t h i n t h e f i r s t t w o y e a r s o f p r o j e c t i m p l e m e n t a t i o n .

H e a l t h V o l u n t e e r s O v e r s e a s w i l l r e c e i v e s 8583,200 f o r l o n g - a n d s h o t - t - t e r m - t e c h n i c a l a s s i s t t \ . n c e (8668, i33i:j j a n d e q u i p m e n t / s u p p l i e s ($215,200 3 .

F i n a l l y , USAID w i l i r e t a i n 845rjp000 f o r a d m i n i s t r a t i v e s u p p o r t t o t h e p r o j e c t 18195,t:jO(:jj f o r t h e HOH-based i i e l d C o o r - d i n s t o r a n d t h e USAID-based a d m i n i s t r a t i v e a s s i s t a n t : t w o e v a l u a t i o n s a n d o n e a u d i t (5115. i:ji:ii:)) : s u p p o r t f o r t h e n e e d s a s s e s s m e n t (855 ,(:iOi3 j a n d f ' r o j e c t c o n t i n g e n c y (055,i:j(3i:i) . T a b l e i I p r o v i d e s a b reakdown o f a n t i c i p a t e d p r o j e c t e x p e n d i - t u r e s by y e a r o f p r ~ j e c t i m p l e m e n t a t i o n . Years 2 a n d 3 e x h i b i t t h e m o s t a c t i v i t y w h i c h relates t o d i c b u r s e m e n t o f p r o j e c t f unci l q g .

( 2 ) G o v e r n m e n t o f flozarnblc?r_t~ C o r ~ t ~ - 1 bct t l -ex

T h e GEM c o n t r i b u t i o n t o t h e p r o j e c t is c a l c u l a t e d a t 8236,357 or 6.3% o f t h e t o t a l p r o j e c t c o s t o f 83,766.337 i n c l u d i n g t h e GF;M 1 c o n t : r i b ~ l t l o n . T h i s a m o u n t is s l i ~ i - ~ t l v l e n s t h a n t h e Giqtl c c ~ n k r - l b c t t i o n l n d l c a t e d i n t h e a r i q i n a l F.F' ($242,4iL!iI!! d u e t o ael a ~ s i n p r o J Er t lmplemen t a t i o n a n d t h u s p o s t p o n e m e n t c f t h e

.. . n e e d f o r G E M s u p p o r t f o r hnstels u n t i l l a t e r i n t h e o r o j e c t . . . . .

. , . * T a b l e L:J found r n t h e R e v x s e d F i n a n c i a l A n a l y s i s . i n a n n e x C a t t h l s FF s u p p l e m e n t p r o v i d e s a b reakdown o f GRM c o n t r i b u t i p n e x p r e s s e d i n U. 5. d o 1 l a r s . 5162,lSCi i n r a l a r y s u p p o t - - t f o r work .shop a n d h o s t e l p e r s o n n e l is c a l c ~ 1 . 1 a t e d c v e r t h e i i i e - o f - pr-o j ec t (LGF) . War-Crsliap arid l i o c t e l m a i n t e n a n c e F E c a l : i ! l + t ~ d a t S 3 1 , 2 2 1 m o s t o f w h i c h w i l l a c c r u e d u r i n g t h e l a s t h a l f o f p ro jec t i m p l e ! n e n t a t l . o n when h c l c t ~ l c o n s t r u c t i o n is c o m p l e t e d and patient^. . t - E cjccctpyinq t h e c e n t e r s . S t u d e n t s t i p e n d s foi-

t h ~ t h r e e t r a i n i n g c o ~ ~ r c - e c , i s f-c. t imateci atS815.5Z7 o v e r t he L[!p. Fi1-i~:. 1.y. p~.r . .diem and t r a v e l e ; : p F n s e s f o r 2i:i pel--,onz. t~ a t t e n t i 6-week.. s e m l n a t - c on o r t t i o p e d i c s u r u c r y a n d care is

c a l c u l a t e d e a c h y e a r f o r a t o t a l c o s t @f %37,39(:). A l t h o u g h t h e GRM c o n t r i b u t i o n i n t h i s document is n o t e d i n U.S. d o l l a r s , t h e MOH w i l l pay t h e 5 e casts i n l o c a l c u r r e n c y ( N e t i c a i s j a t a n e s t i m a t e d v a l u e o f M224,520,150.

......................................................... T A B L E I

I L L U S T R A T I V E PKOJECT BUDGET

BY COLLABORATING I N S T I T U T I O N AND A C T I V I T Y

I n s t i t u t i o n Prev ious S u p p l e m e n t a l T o t a l F c r n d i n q Level F c t n d l n a , Fundina

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( 2 ) H A N D I C A P I N T E R N A T I O N f i f - T e c h n i c a l G s ~ . i s t a n c e

( b Fer~.on years f o r f i e l d P r o g r a m s 1 1st:) , i:iOi> -{I)- 1 8i:i , Oi:)i:) j - T r a i n i n g F ' t - og ram 1 zi:) , i2i2i3 1 2 :, i)i2 (1) 275 , i:ii>i:j

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$ R I C K C i u n d i n q e l e m e n t s and b u d g ~ t % a r e those l i s t e d i n t he g r a n t r -a ther tiiar; t h c ~ z e l l c - l r c ? d i n t h e o r r i q l n a l p 1 " i 7 - j ~ 3 ~ + ~a(:7er-.

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......................................................... T A B L E I 1

I L L U S T R A T I V E PROJECT BUDGET

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- H o s t e l and T r a n s p o r t -0- i : i i i : .2i:ii>,O(>O 125,~:i(:!i> - S u p p a r t t o HVO 5(>,c?C;i] 125,fic:ji:i lSi:S,(:ii:iC:i 91,Eii3O

i 2 ! HAND I CAP I NTERNAT ' L - T e c h n i c a l A s s i s t a n c e 3 5 , (11 (3 i:i 63 , i>Oi> &5,i>i:10 15,i3i]i) - T r a i n i n g P r o g r a m -0- 120,Qr:ii:i l i i>,Q(](] 45,i>i>i> - S u b g r a n t t o GDEMO -0- 1 5 , i]i3 iIi 2 5 , Ci 0 i:i 1 i3 , i:i (33

( 3 ) I N T E R N A T I O N A L RED CROSS COMMfTTEE

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Auqust 1990 A .. REVISE0 LOGICRL FRRREYORK

Prosthet ics Ass~stance Project lb56-0215)

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l o Increase the capacity o f : - Rehab i l i t a t ion strategy completed : - Plans and minutes o f meeting I - ROH can r e t a i n t ra ined qovernnental and non-qovern- : and i n use I - N60 and NOH records and : s t a f f mentri organizations to : - Increase I n numbers of prosthesis : follow-UQ surveys : - Prostheses production not address the unmet and qrowlng I produced, f i t t e d , and i n use : - Expert review 01 orthopedic I inpalred by inadequate

needs af c i v i l i a n s d i n b l e d : - laprovrd qua l i t y of ortnopadic I practice i I F C C E I t R f9U lBIPlli16 by lonqstandinq c1v11 c o n f l i c t : care : - nOH and NGO c l i n i c a l records : - Access to casual t ies not or su t fe r inq from other : - Increased number of disabled : - Hostel records : reduced by secur i ty c r lpp l ieq mobr i i t y disorders. : c r v l l i a n s t reated and I - C l r n i c a l rccords

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r e h a b l l l t a t l o n s t a f f working : : throughout the country ' 9

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I 1 Arsessment of emerqency - I - one assessbent and plan : - Pro jec t reports. NGO records : - ROH ran h l r e and r e t a ~ n s t a f f re la ted ohvslcal r e h a b l l i - : - 675 new prostheses f ~ t t e d I n : - NOH c l i n i c a l records : i n current economic clrmate ta t lon needs I 1988; 1300 t o t a l by 1992 I - F i e l d s i t e v i s i t s I - Proused donor funds t o

1 ) increased productive : - 152 amputations fo l law technical : - Expert r ra lua t ion o f : supplement AID contr ibut ion capacity fo r producing, and : consul tat ion between surqeons I c l i n l c a l o n c t i c e : continues to be avai lable I l t ! rnq prosther ls I and rehab i l r ta t ron 5 t a f f : - UOH and NGU personnel : - Securlty s i tua t ion does not

31 l ~ o r o v e d qua l i t y of or tho- : - Rehabi l i tated uorrshoos : records : preclude iaplementatlon o f pedic c l i n l c a i case : serve 500 p a t ~ e n t s by 1972 I I t ra ln lnq and continuing nanaqement I - 2 orthopedic surgeons, 1'1 : education programs

44 Tralnlnq courses dcvelooed : intermediate- level orthopros- : : - Haateis are secure from var lous leve ls tn physical I t h r t i c techntclans, 23 phvsrcal : : attach5 r e h a b i l i t a t ~ o n and pros- : therapists, and 15 baslc- level : : - &OEM0 and other disabled these5 production. : o r t h o p r o i t h e t ~ c technicuns I I organizations continue to

51 Four t r a n s ~ t centers I trarned. : r o b l l ~ z e amputees t o ut111ze constructed and equrpped : - Hostel capacity fo r 110 persons : : services

to es tab l i sh a nat ional : constructed; 801 I n use network of c l i n r c a l : - Contlnulnq education belnq : r e h a b i l i t a t i o n centers : conducted for heal th and ledkcal I

bI D~sabled flata~bicans ! s t a f f i n p r o v ~ n t e s : ac t i ve ly enqaqed I n produc- : - I r o income qeneratinq orolects : tkve economic a c t i v l t l e s : established fo r disabled persons; :

: dlsabled lnvolred i n treatment 1 I and care l o r aroutees and hostei I : patients.

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inputs : Funding Targets ------ I _- _ _ - _ - _ - - _ - - - _ - Needs Rssessaent and Stra- : - One Long-Term 13b months1 : - HGO l inanc ia i repor ts : - Q u a l i l l e d e rap t r ia tcs can

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ANNEX C

REVISED FINANCIAL ANALYSIS

P r o j e c t C o s t s

T a b l e s I a n d 1 1 i n t h e P r o j e c t G e s c r i p t i o n p r o v i d e a summary o f t o t a l p r o j e c t co s t s a n d p r o j e c t b u d g e t by y e a r o f i m p l e m e n t a t i o n . T a b l e 1 1 1 i n t h i s s e c t i o n p r o v i d e s a summary o f p r o j e c t costs bv i n p u t a n d o u t p u t and i n c l u d e s estimates o f t h e G o v e r n m e n t o f t h e Fiepctbl ic o f Mozambique c o n t r i b u t i o n t a w a r d a c h i e v i n g t h e s e o u t p u t s .

T h e b a s i s f o r t h e o v e r a l l p r o j e c t b u d g e t as a l l o c a t e d to e a c h i m p l e m e n t i n g a g e n c y f o l l o w s :

S a v e t h e C h i l d r e n F e d e r a t i o n ( S C F ) is e x p e c t e d t o s p e n d a p p r o x i m a t e 1 y $200,000 p e r h o s t e l or $ 8 U 0 , 0 0 0 t o t a l o n c o n s t r u c t i n g t h e f a c i l i t a t i e s a n d e q u i p p i n g t h e m w i t h f u r n i t u r e a n d b a s i c a p p l i a n c e s . E a c h h o s t e l is e x p e c t e d t a a c c o m m o d a t e a p p r o x i m a t e l y 35-40 p e r s o n s . ( T h e r a t i o n a l f o r t h e i n c r e a s e i n ac ' commoda t ion c a p a c i t y is p r o v i d e d i n t h e P r o j e c t D e s c r i p t i o n . ) T o t a l c o n s t r u c t i o n c o s t s . i n c l u d i n g f o u n d a t i o n , w a t e r a n d e l e c t r i c i t y hooku 'ps , s e w a g e s y s t e m i n s t a l l a t i o n , k i t c h e n a p p l i a n c e s ( s t o v e , r e f r i g e r a t o r s f , a n d i n s t a l l a t i o n o f l i g h t s is e s t i m a t e d a t $I5i3,i:ji:>!> p e r h o s t e l . SCF o v e r h e a d (27%) f o r e a c h h o s t e l is c a l c u l a t e d a t 84i:). 500. I n e x p e n s i v e eqckipment f o r t h e h o s t e l s , i n c l u d i n g t a b l e s , c h a i r s , b e d s , l i n e n s . d i s h e s , e t c , w i l l h e p u r c h a s e d f a r a n e s t i m a t e d B?.SQ!S. T h i s b r i n g s t h e t o t a l cclst o f c o n s t r u c t i n g o n e f a c i l i t y to $2i:ii3,i:iOl:3.

S C F a l so p r o v i d e s l o g i s t i c a l s u p p o r t t o t h e HVO o r t h o p e d i c s u r g e o n a n d HVO c o n s u l t a n t s . T h i s i n c l u d e s h a u s i n g (9172.OCi0 - c o n ~ u l t a n t s are e : : p e c t e d t o s t a y i n t h e s u r g e o n ' s h o u s e , b u t w h e r e , ' h o t e l a c c o m m ~ d a t i a n is n e c e s s a r y , t h i s a m o u n t w l i l c o v e r

. , . I ' . ' t

t h e s e c o s t s j ; cc tard s e r v i c e (3122,5i:)0); a d r i v e r ( $ 9 , 1 : ? f : : i i : ! ) : a p r o j e c t . c o o r d i n a t o r f o r H V O ~ t a f f i $45,185) : a v e h i c l e arid m a i n t e n a n c e ($32,475) ; i n - c o u n t r y t r a v e l ($15,0i:lO) : a n d o f f i ce r e n t a l a n d t e l e c o m m u n i c a t i o n s c u p p o r t i 831.44-i:i) . T h e s e f i g u r e s a re bcrdqeted o v e r t h e t h r e e y e a r LOP, G r i n q i n g t h e t o t a l t o 841&.8i:)0, i n c l i t d i n g t h e 27% SCF o v e r h e a d ( w h i c h rs c a l c u l a t e d a t 5-8'3.26i:) for HVO s u p p o r t o v e r t h e LOP>.

H a n d i c a p I n t e r n a t l a i c - 1 ( H I ) f u n d s t h e c a s t s o f r e c r ~ t i t i n g . f i e l d i n g and s u p p o t - t i n 9 Z p e r s o n s p e r yeat- o v e r t he L O P . t>ccmrd inq t o H I . each p e r s o n cnsizs i ipprc?: . : rmately S.?l>,?:~iIii-i p e r y e a r i n c l u d i n g H I a d m l n i c - t r a t i v e s u p p a r t a n d technlca i f o l l o w - u p . F r o j e c t - f u n d e d TA p r a v l d e d bv HI i s t h e r e f o r e c a l c u l a t e d a c c o r d ~ n g l y .

1.41's t w o t t -air-11nq p r o g r a m s a re e s t ~ m a t e d t o c o s t a r o u n d $4i:,i:i, CI?:!~) ba-;cd or, a pl-pl i m i n a r y bu .dae t s c ! b m i t t c a t o USGIG. These c o s t 5 a r e f o r m a t ~ r l a 1 . s . e q u i p m e n t . t e a c h e r s ' s a l a r i e s ,

Annex C , F i n a n c i a l A n a l y s i s P a g e 2

'.

a d m i n i s t r a t i v e s u p p o r t , e t c . , o v e r t h e t h r e e y e a r s o f t r a i n i n g . T h e p r o j e c t w i l l c o n t r i b u t e o n l y 8275,000 t o w a r d t h e cost o f i m p l e m e n t i n g t h e t r a i n i n g p r o g r a m s , a s s u m i n g t h a t t h e r e m a i n i n g casts w i l l b e b o r n e by HI o r by o t h e r d o n o r s . P r o j e c t f u n d i n g w i l l m o s t l i k e l y ' b e u s e d f o r t e a c h e r ' s sa lar ies , a v e h i c l e , some t e a c h i n g s u p p l i e s a n d e q u i p m e n t .

I n t e r n a t i o n a l Red C r o s s C o m m i t t e e ( ICRC) t o t a l costs a re b a s e d o n p r o c u r e m e n t o f t o o l s , m a c h i n e s . a n d materials f o r t h e t r a i n i n g c o u r s e i n B e i r a ( 8 6 4 , 0 0 0 3 ; r e h a b i l i t a t i n g a n d e x p a n d i n g t h e w o r k s h o p i n Mapu to ( B 1 0 , 0 6 0 ) ; o n g o i n g p r o d u c t i o n a c t i v i t i e s

I i n f o u r ICRC o r t h o p e d i c c e n t e r s i n Mozambique (818 i : ) , 0C j i : , ) : r e h a b i l i t a t i o n a n d c o n s t r u c t i o n a c t i v i t i e s (8125.0003 f o r t h e M a p u t o w o r k s h o p , s t u d e n t a n d a m p u t e e q u a r t e r s i n F e i r a , t h e classroom i n F e i r a , a n d a m p u t e e q u a r t e r s i n Nampula ; a n d t r a i n i n g s u p p o r t f o r s t u d e n t s I.$30,013i:i j , i n c l u d i n g b o o k s a n d s u p p l i e s , t e a c h i n g s a l a r y s u p p o r t , a n d t r a v e l e x p e n s e s f o r t h e t r a i n e e s .

H e a l t h V o l c t n t e e r s C!verses.s ( H V O ) u t i l i z e s 889,16(:j p e r y e a r [ 8 2 6 7 , 4 8 0 o v e r t h e LOP) f o r t h e s a l a r y a n d p o s t d i f f e r e n t i a l o f t h e t h e O r t h o p e d i c s u r g e o n : $62,000 f o r a l l o w a n c e s f o r t h e o p r t h o p e d i c s u r q e e n (HHE s h i p m e n t , UAB, c o n s u m a b l e 5 , e t c ) : 311,00t3 f u r s h o r t - t e r m , v o l u n t e e r s t i p e n d s f o r 22 p e r s o n - m o n t h s o f v o l u n t e e r a s s i s t a n c e ; 8 8 0 , ~ ? ~ ) t > for 'HVO/Washington s u p p o r t : i n t e r n ? . t i , o n a l t r a v e l ( K T ~ ~ ~ - ~ o z a r n b i ~ c [ e ) a n d p e r d i e m is c a l c u l a t e d a t $ 9 4 , 0 G 0 o v e r t h e LOP f o r the o r t h o p e d i c s u r g e o n ( o n e t r i p p e r y e a r ) , HVO c o n s u l t a n t s (22 t r i p s ) , a n d HVO/ W a s h i n g t o n m o n i t o r i n g v i s i t s ( 2 t r i p s p e r y e a r ) . S u p p l i e s a n d E q u i p m e n t f o r t h e h o a p i t a l ~ p ~ r a t i n g r o o m s (8180, Gi30) a n d t r a ~ r r i n g m a t e r i a l s (835,5i:)Oj w i l l b e f u n d e d by t h e p r o j e c t . F i n a l 1 y HVO c o n t i n g e n c y ( $ 7 2 , 0 8 4 ) a n d o v e r h e a d (880,3601 is i n c l c t d e d i n t o t h e t n t s l HVO bcidget o f 88€33,2i70.

USiilG. c a s t s i n c l i t d e t h e s a l a r y a n d i n - c o u n t r y t r a v e l cos t s o f s. p a r t - t i m e f i e l d c o o r d i n a t o r i$3(3,i:ji:jO p e r y e a r o v e r 4 y e a r s ) : a USG'IID:'' ~ d m i n F ' s t r a t i v e A s s i s t a n t 1%25,~:jOCI p e r y e a r . o v e r :, , v e a r s ; : t w o e v a l u a t i o n s e s t i m a t e d ' a t 825,000 p e r ' p e r s o n m o n t h . ( 2 . 2 p e r s o n - m o n t h s f o r t h e mid - t e rm e v a l u a t i o n a n d 2.4 p e r s o n - m o n t h s f o r t h e f i n a l e v a l u a t i o n ) ; %55,00Ci f o r a two p e r s o n - m o n t h c o n s u l t a n c y f o r t h e n e e d s a s s e s s m e n t ; a n d 8 8 5 , 0 0 0 f o r p r o j e c t c o n t i n q e n c v .

G o v e r n m e n t of t-ic~za.mbiac~e C o n t r i h c ~ t i o n : 0 .I ,.

. T h e Gmvernmen t o f Mozambique c o n t r i t i L c t l o n 'i~.. cal tit iated ,an -the h a s i s o f i n - k i n d ~ u a p o r t t o t h e p r o j e c t . s u c h a s s a l a r i e s of NOH p e r s o n n e l d i r e c t l y i n v o l v e d i n p r o j e c t i m p l e m e n t a t i o n , w o r k s h u p a n d h o s t e l m a i n t e n a n c e ? s t i p e n d s f o r s t u d e n t s , a n d t r a v e l f a r NOH p e r s o n n e l t o c o n t i n u i n g e d u c a t i o n s e m l n a r s a r r a n ~ e d by t h & o r t h o p e d i c s i i t -gei i~-I . f h e ~ ~ j c o s t s a r e r io t d i f f e r e n t t h a n t h n c e p r o p o z e d 3.n t h e o r i g i n a l PP e x c e p t f o r b ~ o s t c l m a i n t e n a n c e w h l c l i h a s i n c r e a s e d f r a m M 3 , C i C l C ! p e r mon th t o

Annex C, F i n a n c i a l A n a l y s i s F a g e 3

\I

Mi2(3,0Cl(3 p e r m o n t h t o a c c o m m o d a t e t h e i n c r e a s e d u t i l i t y c o s t s a s s o c i a t e d w i t h m o r e modern c o n s t r u c t i o n . T a b l e I V lists t h e GRM c o n t r i b u t i o n i n d o l l a r s , a l t h o u g h t h e a c t u a l c o s t s i n c u r r e d by t h e G o v e r n m e n t w i l l b e p a y a b l e i n Meticais. N o a d j u s t m e n t is made f o r i n f l a t i o n . B a s e d o n t h e c u r r e n t e x c h a n g e rate o f M 9 5 0 = $1.00, t h e t o t a l GRM c o n t r i b u t i o n is $236,337 or 6.3% o f t h e t o t a l p r o j e c t c o s t o f $3,766,337.

A s i n d i c a t e d i n t h e o r i g i n a l PF', sa l a r i e s are a c c o u n t e d f o r w o r k s h o p l a b o r e r s , h o s t e l socia l w o r k e r s , a n d h o s t e l p h y s i c a l t h e r a p i s t s a s p a r t o f t h e GKM c o n t r i b u t i o n . Salaries are c a l c u l a t e d f o r a l l e m p l o y e e s f o r a l l y e a r s o f p r o j e c t i m p l e m e n t a t i o n .

Workshap a n d h o s t e l u p k e e p (water , e l e c t r i c i t y ) is c a l c ~ t l a t e d a t M 1 2 0 , 0 0 0 p e r m o n t h p e r u n i t . H o s t e l m a i n t e n a n c e is c a l c u l a t e d f o r 2 h o s t e l s b e g i n n i n g t h e t h i r d y e a r o f p r o j e c t i m p l e m e n t a t i o n a n d f o u r h o s t e l s i n t h e f o u r t h y e a r o f i m p l e m e n t a t i c n . T h i s is b a s e d o n t h e a s s u m p t i o n t h a t c o n s t r u c t i o n o f t h e f i r s t t w o h o s t e l s w i l l n o t b e c o m p l e t e d u n t i l mid-1991 w h i c h is t h e b e g i n n i n g o f t h e t h i r d y e a r o f i m p l e m e n t a t i o n . L i k e w i s e t h e f i n a l t w o h o s t e l s w i l l p r o b a b l v n o t be c o m p l e t e d u n t i l mid -1992 , t h e b e g i n n i n g o f t h e f o u r t h y e a r o i p r o j e c t i m p l e m e n t a t i o n .

S t u d e n t s t i p e n d s are c a l c u l a t e d a t t l b , 0 0 0 p e r m o n t h p e r s t u d e n t . The E e i r a c o u r s e b e g a n i n t h e m i d d l e o f t h e f i r s t y e a r o T p r o j e c t i m p l e m e n t a t i o n a n d w i l l f i n i s h i n t h e m i d d l e o f t h e f o u r t h y e a r o f p r o j e c t i m p l e m e n t a t i o n . C a l c u l a t i o n s h a v e b e e n made a c c o r d i n g l y . T h e c o u r s e s f o r p h y s i c a l t h e r a p y a n d o r t h o p r o s t h e t i c t e c h n o l o g y w i l l n o t b e g i n u n t i l t h e m i d d l e o f t h e s e c o n d y e a r o f p r o j e c t i m p l e m e n t a t i o n . T h u s p e r d i e m ra tes h a v e h e e n a d j u s t e d f o r t h i s y e a r , a n d are n o t e d i n f u l l f o r s u b s e q u e n t y e a r s .

T r a ~ e l a n d p e r d l e m ra tes a r e b a s e d on c o n t l n u l n q z d u c a t l o n c e c - s i a n s f a r Z15 p e r s o n s f o r L w e e k s e a c h p e r y e a r . T h e s e s e s c l c t n s w l l l b e f t l n d c t r l n g veat- 2 af t h e p r o j e c t . d u e t o t h e l a t e a r r l v a l o f t h e o r t h o a e d l c c u r g e o n a t t h e e n d o f y e a r 1. T h u s , n o c o s t s a re n o t e d f o r v e a r 1 o f p r o j e c t I m p l e m e n t a t l o n .

1 . A s n o t e d i n t h e o r i g i n a l PF. t h e MUH c a n n o t s u s t a i n a

. , p r c r s t h e t i c s p r a q r a m w i t h o i c t c o n t i n u e d h i g h l e v e l s of d o n o r a s s i c t a n r e . D o n o r s are c u r r e n t l y s p e n d i n g a n e s t i m a t e d 82.0 m i 1 l i o n a n n u a l l y f o r t h e SF:f! 's p r o s t h e t i c s s e r v i c e s . G i v e n t h e MC3H's o t h e r p r i o r i t i e s . i t i c . c t n l i k . e l v t h a t t h e y wocild u t i l i z e t h e i r own l i m i t e d r e s o u r c e s f o r t h i s p r o g r a m . I f t h e e m e r g e n c y c o n t i n u e s , t h e n d o n o r f i n a n r i n g w i l l b e e v e n more e s s e n t i a l t o a c o n t i n u e d proeraan . On t h e o t h e r t iand , i f t h e e m e r g e n c y ~ u b s l d e s a n d peace is a t t a i n e d . t h e s v e r a l l rez .out -ce n e e d s f o r t h i s p r o g r a m w i l l b e s u b s t a n t i a l 1.; le%r;s. U n t i l p e a c e come.;, c o n t i n u e d d o n o r s u p p o r t i s i m p e r a t i v e t o m e e t t h e p r c z t h e t i c a n d o r - t h o t i c n e e d s o i t h o s e c i v i l i a n s a f f e c t e d by war.

C

TABLE 111 WQZ6ilBIQUE PROSiHETICS ASSISTANCE PROJECT

PROJECT COSTS OF INPUTS BY OUTPUTS

PROJECT OUTPUTS ,-----------;-----------I------------'- -----------:-----------I

I No. 1 1 N o . 2 1 No.3 . I No.( : N o . 5 I No.6 1 Other :TOTAL FEOJECT INPUTS ---------------------------~-----------I-----------;-----------~-----------~-----------'-----------*-----------l------------- - AID Appropriated I I t

I I I I I I I I

----------------- I , I 1 I , I

- Needs Assessment : 55,000 I -0- I -0- -0- ; -0- : -0- 1 - 0 - ' ' 5 5 , 0 0 0 ; - P r o s t h e t i c s P r o d u c t n . 1 -0- 1 555,000 I -0- ; -0- -0- -0- 1 -0- I 555,000 ;

- I ~ p r o v e d f l u a i i t y , , a

o f Care I -0- : -0- 1 1,300,000 : -0- 1 -0- : -0- 1 -0- : 1,300,000 ; - T ra in ing : -0- -0- I -0- 1 350,000 1 -0- ' -0- 1 -0- 1 350,000 - Iaproved access : -0- -0- -0- -0- I 8 2 5 , 0 0 0 : -0- I -0- I 825,000 1 - Vocat ional Tra in ing I -0- 1 -0- I -0- -0- -0- 1 50,000 : -0- ' a 5 0 , 0 0 0 . - Tft P r o j e c t ilanagenent -0- 1 -0- I -0- I -0- I -0- I -0- : 195,000 I 195,050 -

- Eva iua t ion lAud i t ; -0- -0- -0- I -0- ' r -0- ; -0- 1 115,000 1 115,000 . - Contingency -0- -0- -0- -0- -0- ; -0- I 8 5 , 0 0 0 : 8 5 , 0 0 0 :

I I I t , , ,

4 I I Host Country I I I

. ---- ------ -- C I I I I

- Tra in ing ; -0- , -0-. -0- 15,537 : - 0 - ; . . I -0- -0- ' , 15,537 - improved dcce.5 %!?%@@ 1 -0- : -0- I -0- : -0- : 31,632 I -0- : -0- ' , 3 i .3:i - ?#proved Quai L cy o i ; I

I

Car? I -0- I i51,579 1 37,369 : -0- : -0- : -.j- ; -0- ' , 168,968 I

I I

I t

+ 8

TOTAL : 55,300 : 706,5i9 : 1,3Si,38? : 365,537 : 656,632 1 50,000 : 395,000 : 3,766,357 I ,

----_-------------_--------~-----------,-----------4-----------3-----------.-----------~-----------S-----------,------------- -

BEST AVAILABLE COPY

I Auqust 1990

TABLE IV ROZAH8 iOUE PROSTHETICS ASSISTANCE PROJECT 6OVERHnEHT OF fiOZAnBI~UE CONTRIBUTION

(in U.S. dollars1 . : -

I TER I YEAR I YEAR 2 I YEAR 3 : YEBR 4 : TOTAL : ;-----------I-----------'---------- ;----------I-

Salaries I I , I I I I , I

-------- , 1 I

. - Workshop Laborers , 1 I I I I I I 4

(100 x H30,0001ao = I , I , I I , I I I I

H36 rillionlyear) : 37,895 I 37,895 : 37,895 : 37,895 : 151,579 I I , I I I 0 I

- Hostel Social Workers I , I I , , 6 1 I I I

I4 x 35,0001ro = I 1 I , I I

fill6~0,000Iyearl. : 1,760: 1,760: 1,768: 1,768: 7,074: I I I

- Hostel Phys. Therapists I a , I 2 x X35,000/year = I I , , I , I

Ha40,000/year) , I 084 : 064 I 684 I 8 0 4 : 3,537: I .

8 I t 1 I

WorkshoplHostel Upkeep I I I , I I I , , I I I 1 I 9 I

- 4 hostels at Rl20,OOO I I a I I t

per ronth = H1,140,000 : , I

per hoste!lyear 1 -0- -0- , 1 3,032 I b,Ob5 I 9,075 I - 2 workshops a t n120,ooo 1 I , per aonth = nl,440,000 : i

1 t , 1 - , . > : per worksnopiyear I 3,032 : 3,032 : 3,052 : 3,032 I 12,120 :

1 , I ' I

Student Stipends , I ------------- a I t

- 30 students (Beirai f I

x R6,300/ao for 3 yrs I I

= n2,160,000/year I 1,137 : 2,274 : 2,274 : 1,137 I 6,6ii : t

I

- 30 students tpnys. therapy) x n6,000/ro : , x 3 yeirs = n2,160,00O/year I -0- I l l i 2,274: 2 , 2 7 4 : 5 , b 6 4 :

. 8

- 20 students (orthopros: I

techn.)xfi6,OOOlmo : x 2 years = n1,440,0001year -0- I 758 : 1,516 I 758 I 3,03i :

iraveilFer Dies --------------- - 20 per5ons traveilyr :

z RaS,OOO/RT t r l o 3 -9- : 1,353 : 1,653 : 1,653 : 5,555

- 20 persons per dien : x n12,000lniqht x 42 : niqhtsiyear = nlOIP63,G00/ye~r : -0- I 10,bli I 10,hli : 10,611 : 31,832 :

TOTAL GRn CONTRIEUT. : 44,716 I b0,Zll 1 65,137 : 66,274 : 236,337 :

~ ~ ~ _ _ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ _ ~ ~ ~ ~ ~ _~______-____'.____------s-----------'---------_-'-----------:-

KITE: Exchanqe rate based on H150 = $!.so

agency for international oevelopment …pdf.usaid.gov/pdf_docs/pdabp477.pdfi f- 1 i prosthetics...

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