Nrhm Scheme On Gks

National Rural Health Mission Health & Family Welfare Department, Government of Orissa

Expression of Interest NRHM, Orissa invites application from credible NGOs for undertaking capacity building programme of GKS in all the districts of Orissa. The organization must be a registered society for more than five years with fixed assets of minimum Rs. 10.00 lakhs in the form of land/building/assets with proven working experience in Health & Family Welfare activities for a minimum period of 3 years. It is mandatory that the NGO must have an office in the District and having the presence in the district at least for three years. The NGO should be willing to deposit bank guarantee of 5% of total project cost after selection. Interested NGO may apply with all relevant documents to CDMO of concerned district through speed post/registered post before 10/11/2009 in the prescribed application format and as per the guidelines available in the website www.nrhmorissa.gov.in. Incomplete applications will be rejected. Mission Director, NRHM

INFORMATION FOR NGOs APPLYING FOR GKS CAPACITY BUILDING PROGRAMME OF NRHM PROGRAMME SCOPE: All the districts of Orissa. PROPOSED ASSIGNMENT: Capacity building programme of Gaon Kalyan Samiti under NRHM.

CRITERIA FOR SELECTION OF NGO: The NGOs fulfilling the following criteria are eligible to apply for undertaking capacity building programme of GKS under NRHM. Registration: • •

NGO should be registered under Society registration Act and having more than 5 years of existence as on 1/4/2009. NGO should be registered under 12-A registration act.

Experience: •

Proven working experience for minimum of three years in Health & Family Welfare activities as on 1/4/2009 with Govt. funding support.

Asset : •

Infrastructure in form of land/building/assets amounting to Rs.10 lakhs in the name of the NGO as per the balance sheet of 31/3/2009.

District Presence: •

NGO should have office in the same District for which it is seeking funding support and the NGO should have presence in the district while carrying out different activities at least for three years.

Cancellation of application: •

The application of blacklisted NGOs by Govt./RMK/CAPART will not be considered. Further, the application of funding restriction/stopped by NRHM and poor performing MNGO/FNGO/PPP NGOs will not be considered.

Application procedure: •

The interested NGO may submit their application in the prescribed format with necessary documents to the Chief District Medical Officer of concerned district through speed post/registered post before 10/11/2009.

Jurisdiction: •

The selected NGO may be assigned the work either in one or two districts.

Documents to be submitted : 1. 2. 3. 4. 5. 6.

Copy of the Society registration certificate Copy of the 12-A registration certificate Copy of the 80 G registration certificate (if available ) Audit report for last three years (2006-07, 2007-08 & 2008-09) Annual report(2006-07, 2007-08 & 2008-09) Proof of infrastructure, land and building/equipment of minimum 10 lakhs as per balance sheet of 31/3/2009 7. Proposal for implementation of the GKS capacity building programme. 8. Bye law and memorandum 9. Experience on the health and family welfare program( with the support of Govt./donor agencies ( attach the proof ) 10. Experience in the social sector ( Attach proof) 11. Human resource details (full time, part time staffs) 12. Willingness towards submission of 5% of bank guarantee 13. Copy of PAN( if available) 14. Any other documents in support of strength of the organization

APPLICATION FORM FOR NGOS (GKS CAPACITY BUILDING PROGRAMME OF NRHM)

1

Name of the NGO

2

Registered office address with phone/fax, email

3

Contact person with telephone

4

District office address with phone

5

Whether district office located own or rented building ? Year of operation of the activities in the district ? a. Date of society registration( Attach copy) b. Act under which registered

6 7

8 9

10 11

Year of 12 A registration( Attach copy) a. Whether registered under 80 G ? b. Whether FCRA registered( Attach certificate if available) Bank details( account number and address) Pan number ( Attach photocopy)

12. Financial turn over Year Income ( Rs.) 2006-07 2007-08 2008-09 ( Attach audit report for three years)

Own/Rent

Yes/No Yes/No

Yes/No Expenditure ( Rs.)

Fixed asset as per the balance sheet( Rs.)

13. Experience in Health and Family Welfare Programme (With Govt. support ) Name of the program

Supported by

Programme duration( fromto)

Operational area

Project cost

Remark

(Attach copy of the sanction order/MOU ) 14. Experience in Health and Family Welfare Programme (With support from Non-Government agencies) Operational Project Remark Name of the Supported by Programme area cost program duration( from-to) (Attach copy of the sanction order/MOU) 15. Previous experience in community mobilization/ASHA thematic training programme /GKS programme Name of the Remark Date of Name of the Date of completion of the district program commencement of programme the programme

16. Experience in other development sector programme (With Govt. support ) Operational Project Name of the Supported by Programme area cost program duration( from-to)

Remark

( Attach copy of the proof) 17. Experience in other developmental sector (With support from Non-Govt. agencies ) Name of the Supported by Programme Operational Project Remark program duration( area cost from-to) 18. Experience in Health and Family Welfare Programme (With Govt. support ) in the respective district for which applied for grant. Name of the Supported by Programme Project cost Remark program duration( from-to) 19. Experience in Health and Family Welfare programme (with support from Non-Govt. agencies ) in the respective district for which applied for grant. Name of the Supported by Programme Project cost Remark

program

duration( fromto)

20. Experience in other development sector programme (With Govt. support ) in the respective district for which applied for grant. Operational Project Remark Name of the Supported by Programme area cost program duration( from-to) ( Attach copy of the proof) 22. Whether any training centre is available( Specify details) ? 23. List of managing committee/executive committee of NGO 24. Staff position as on 31/3/2009 Staff categories Trainers Office staffs Field staffs

Full time ( Number)

Part time ( Number )

25. Project proposal for implementation of the GKS capacity building programme in the respective district 26. Any other information

I hereby certify that I have read the rules and regulation of the programme for which I am applying for. The above facts are best to my knowledge and belief.

Signature of chief functionary with seal NB: In complete applications will be rejected and each page of the documents should be signed by the chief functionary. Documents to be submitted in the application 1. Copy of the Society registration certificate 2. Copy of the 12-A registration certificate 3. Copy of the 80 G registration certificate (if available ) 4. Audit report for last three years (2006-07, 2007-08 & 2008-09) 5. Annual report(2006-07, 2007-08 & 2008-09)

6. Proof of infrastructure, land and building of minimum 10 lakhs as per balance sheet of 31/3/2009 7. Proposal for implementation of the programme 8. Bye law and memorandum 9. Experience on the health and family welfare program( with the support of Govt./donor agencies ( attach the proof ) 10. Experience in the social sector ( Attach proof) 11. Human resource details (full time, part time staffs and available of doctors, staff nurse etc. ) 12. Copy of PAN( if available) 13. Any other documents in support of strength of the organization