Call for Proposals: Better tools for integrated management of childhood fever

Context

In 2016 an estimated 5.6 million children died before their fifth birthday. Pneumonia (24%), diarrhoea (15%), and malaria (9%) remain the leading causes of death in children ages 1 – 59 months, and malnutrition is an underlying factor associated with nearly half of under-five deaths. Both pneumonia and malaria are febrile illnesses, and common causes of diarrhoea in children (e.g. rotavirus, Escherichia coli) can also include fever. While all are treatable, the effectiveness of key medicines is currently at risk: resistance to artemisinin-based combination therapies (ACTs) is spreading in South-East Asia and antibiotic resistance is a growing global concern. Efforts to improve child survival and preserve essential medicines currently threatened by resistance require a more effective, integrated response to childhood fever.

Over three-quarters of children seeking care at facilities and in the community in low- and middle-income countries (LMICs) present with fever. The recent scale-up of malaria rapid diagnostic tests, together with decreasing malaria incidence, have resulted in an increasing number of fevers being diagnosed as malaria-negative. Evidence suggests that many non-malarial fevers are not appropriately managed due in part to a lack of diagnostic tools, leading to: inappropriate treatment including overuse and wastage of both malaria medicines and antibiotics; increased spread of antibiotic resistance; and high costs related to the management of drug-resistant patients. Moreover, missed opportunities to effectively treat sick children can result in severe disease (including severe malaria), which is often overlooked and contributes directly to increased child mortality.

Hypoxaemia, or low oxygen saturation in the blood, is a key indicator of severe disease that requires onwards referral and treatment, including oxygen therapy. While screening for hypoxaemia with pulse oximetry is currently recommended at primary health care and is included in the Integrated Management of Childhood Illness (IMCI) guidelines, this is rarely implemented due in large part to a lack of tools adapted for use in these settings in LMICs.

Promising, new pulse oximeters have recently entered the market that are better adapted for primary care use in children in LMIC. Pilot implementation of these devices is now needed in early-adopter countries to lay the foundation for standard use in primary healthcare facilities and to prepare for their widespread scale-up. In addition, multimodal handheld devices which can detect hypoxaemia as well as other vital signs including respiratory rate, non-invasive haemoglobin and temperature are currently being developed and have the potential to improve integrated care at the frontline. If a sustainable market for these tools is established, they also have the ability to support wider connectivity with other health services.

Call scope

Under this Call, Unitaid is soliciting proposals for the following interventions aimed at accelerating the availability, adoption and scale-up of improved tools to identify severe disease including:

  • Pilot implementation of pulse oximeters adapted for point-of-care use in children in primary health care settings in LMICs

Pilots should demonstrate proof of concept in early adopter countries and focus on scale-up preparatory activities including evaluation of the impact, cost-effectiveness and operational feasibility of implementing adapted pulse oximeters at the primary healthcare level, in uncontrolled settings. Pilots should aim to catalyse demand, adoption and scale-up of adapted pulse oximeters for primary healthcare use in children in LMIC. This includes the generation of evidence to support operational guidance, including practical guidance to support primary healthcare workers in integrating pulse oximeters into their daily work. Additionally, innovative procurement and supply chain approaches for pulse oximeters in highly-fragmented LMIC markets such as: improving distribution methods to ensure the availability of replacement probes, batteries and devices; coordinated ordering; and price sharing forums etc. could be considered as relevant activities. Activities should also include Identifying and collaborating with key partners to ensure that widespread scale-up of pulse oximeters is supported.

  • Large-scale field evaluations, market entry and market access activities, for multimodal devices, namely large-scale field evaluation and validation studies in LMIC settings

Market entry/access preparatory activities include the development of a business plan and should consider market sizing, market sustainability, device prices, and potential use cases, as well as an analysis of demand- and supply- side barriers to introduction (e.g. health worked acceptability assessments), regulatory and distribution pathways, cost effectiveness/willingness-to-pay studies, etc. Evidence generated through large-scale field evaluations should support a broader set of policy-making activities such as work to establish priorities of new tools for severe disease and the development of a Target Product Profile for multimodal devices.

To ensure that tools to improve the identification of severe disease are adopted and used, promising digital technologies such as electronic decision-support applications that could both improve adherence to clinical algorithms and collect real-time data on fever, could be incorporated as part of proposed projects to introduce new tools for severe disease.

In order to have impact, activities to accelerate access to tools for severe disease must be closely coordinated with efforts to increase access to dispersible amoxicillin and other key medicines for childhood fever, particularly where large access barriers exist, as well as efforts to improve referral systems and access to oxygen therapy.

For this Call for Proposals, multimodal handheld devices are tools that can detect hypoxaemia as well as at least one other vital sign including respiratory rate, non-invasive haemoglobin and temperature.

Data generated through all activities should be suitable for assessment through World Health Organization product registration and policy pathways and should demonstrate the public health impact of the new product. Given that grants awarded under this Call are likely to begin in early-2019, proponents should demonstrate the potential for field evaluations and pilot implementation of the product to begin in this timeframe.

Topics which are out of scope for this Call include: basic and early-stage research, including small-scale field evaluations and product adaptions/modifications i.e. products that are yet to be design-locked.

Proposals submitted should clearly demonstrate the fit with the objectives set out above, the expected impact and value for money as well as the complementarity and added value to similar projects.

Process for proposal submission

When developing a proposal, please note the following resources:

  • Answers to frequently asked questions relevant to proposal development (this document is regularly updated), please [click here PDF, 40 KB];
  • Unitaid’s Fever Diagnostic Technology Landscape, please [click here 460 KB].

Unitaid works through market-based interventions to achieve global market and public health impact. Proposals should clearly demonstrate the use of innovative and sustainable approaches to accelerating access to better tools for integrated management of childhood fever. Demonstrated articulation with national programmes or other scale-up partners will therefore be key. Unitaid notes that this call may share some common elements or activities with other recent calls or ongoing Unitaid grants, and welcomes approaches that outline a coherent, integrated approach.

Applicants should be clear about the underlying assumptions made in their proposed approach, and should highlight any major risks or other factors that may affect the delivery of results. Finally, proposals are expected to outline a lean, concrete and clear pathway to results and impact.

Important dates

01 June 2018

If you intend to submit a proposal, please complete and send the [intention to submit (ISP) form PDF, 70 KB] to proposalsUnitaid@who.int by 01 June 2018.

17 August 2018

The closing date for receipt of full proposals is 17 August 2018, at 12:00 noon Geneva (Switzerland) time. Applications received past the indicated deadline will not be considered.

N.B. A proposal is considered submitted only once you receive an e-mail message of confirmation of receipt from Unitaid.

Submission and format of proposals

Proposals, including all annexes, should be submitted electronically to proposalsUnitaid@who.int. A full proposal consists of the following documents:

  • Proposal form with scanned version of signed Front page [template DOC, 105 KB]
  • Annex 1: Log frame [template XLS, 50 KB]
  • Annex 2: Timeline GANTT chart [template XLS, 35 KB]
  • Annex 3: Budget details [template XLS, 23 KB]
  • Annex 4: Organizational details and CVs of key team members [no template]
  • Annex 5: Support Letters (not mandatory) [no template]
  • Annex 6: Declaration of relevant interest  [no template]
  • Annex 7: Applicable ethics, anti-discrimination and environmental policies [no template]
  • Annex 8: Declaration regarding tobacco entities [no template]
  • Guidance on Impact Assessment [PDF, 450 KB]
  • Financial Guidelines for Unitaid Grantees [PDF, 1,2 MB]

Please note that our email system accepts messages up to 8 MB in size. For submissions exceeding this size, please consider splitting attachments in several messages.

Your proposal and potential queries receive personal attention: submitting your application at least a day before the deadline allows providing feedback on its completeness. You will receive answers to your queries at any one stage of the application review process. Please send your queries to Grant Application Manager at proposalsUnitaid@who.int.

After assessment of the proposals and endorsement by the Unitaid Board all applicants will be officially notified as to whether they will be invited to develop a full grant agreement for Unitaid funding.

You will find further guidance in the Unitaid proposal process document [PDF, 100 KB].

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