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ASGP APPLICATION

2015
PREPARED BY SHMGCO
The United States Ambassadors Small Grants Program
Application Form A
Programs for Community Development Projects in the larger
community
General Information
1. Date of Application
30/09/2015
2. Location of Project
(Village/LGA/State)
2, Salama Avenue, Tudun Wada, Kujama, Chikun L.G.A, Kaduna State.
Kujama is about 20minutes drive from Kaduna town(south), in Kaduna
State.
The proposed borehole is proposed to be located on the grounds of
Salama Health Centre and will serve the health centre as well as the
surrounding households in the community.
3. Type of Project
Water & sanitation
4. Total Naira Amount Requested

N1, 600,040.00
(One Million six hundred and Forty Naira Only)

5. Project Director
Jock James Ishaku
Full Name (underline surname):
Mailing Address
P.O. Box 32, Kasuwar Magani, Kaduna. State
Street Address
2, Salama Avenue, Tudun Wada, Kujama, Chikun L.G.A, Kaduna State.
Telephone: 234 81 29296797 / 234 80950 76769
Email: Saidimango42@live.com /jockjamisha@gmail.com
6. Project Committee Members (use attached list if necessary):Name
(underline surname)
Full Name
Address
Muhammed Saidi
Tundu Wada, Kujama.
Yakubu Auta
Same as above
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James Tanko
Jock J. Ishaku

Same as above
Same as above

7. Name and address of organization or community sponsoring


the project
SALAMA HEALTH MINISTRIES AND GOSPEL CRUSADE
OUTREACH. (SHMGCO)
2, Salama Avenue, Tudun Wada, Kujama, Chikun L.G.A, Kaduna State.
Kujama is 20 minutes drive from Kaduna town(south), in Kaduna State.
8.

If the community or project director has submitted other


project proposals within the past three years to the U.S
embassy, other embassies or organizations, please answer the
following (use extra pages as necessary, circle yes or no as
appropriate):
Project
Tittle

Submitte
d to

Funded?

Amount
(Naira)

Completed

Project Information
9. What is the purpose of the project
Construction of a borehole at Tudun Wada Kujama, in Chikun Local
Government Area of Kaduna State aiming at providing clean and safe
water to about 3,000 people (1,700 women, 1,300 men) community
members, and as well as to Salama Health Center run by the
implementing organization (serving about 250people weekly staff and
patients)
10.
Briefly describe the project. Include a description of how
the project will managed and who will be responsible for the
management. Where will the project get any technical advice
or assistance it may require? Who will volunteer to assist in
the project and what are their qualifications? (Attach an
additional sheet if necessary.)
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2015
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Project Description
Water is a perennially problem in the proposed project community of
Tudun Wada Kujama settlement in Chikun local government area of
Kaduna state and the clinic, the provision of a borehole will be a major
means to ease the health related issues children encounter due to nonavailability of a portable source of clean water. With the acute
shortage of water especially in dry seasons in the community, women
and children often travel long miles each day in search of clean water
from nearby locations to retrieve water for their families, a task that
adversely affects their health and prevents them from pursuing their
education and other relevant matters in life, water had therefore been
a scarce commodity to the inhabitants.
Dysentery, diarrhoea and other water-borne diseases kill many people
in the proposed project community each year, and make many others
ill. Many community members get their water from open wells,
unprotected springs, river, and ponds-often some distance from the
village, and this is usually contaminated. Many member of the
community do not make a link between poor water quality and
diseases such as diarrhoea and other water-borne diseases. This
project will help community members to get a reliable supply of safe
drinking waterSalama Health Centre Kujama, is among different programs formed by
Salama Health Ministries and Gospel Crusade Outreach aiming at
supporting vulnerable groups in the community. The Health centre has
been established at the moment and is supporting over 3,000 people
from different groups of women, children, youths and older people.
The services offered by the centre include venue for women (widows)
and youths vocational skills training, spiritual seminars and meetings
and clinic services. All these services need the availability of clean
water, at the moment the health centre only source of water supply is
from a well, which also serve the community during dry season. The
supply is not enough to the actual requirement of water due to fact
that water supply from the well is only constant during the raining
season but almost dried up in the dry season, the health centre need
to have daily water supply for drinking, toilets and sanitation.
The present source of water at the moment does not suffice the
requirement of the centre and the community. In 2011 Rotary Club
donated LifeStraw to Salama Health Ministries and Gospel Crusade
Outreach and was distributed to the community member in kujama as
means to provide the community member proper a clean source of
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drinking water, but it was only a temporary measure, providing a
borehole will give a lasting solution.
In this case, therefore request for funding from The United States
Ambassadors Small Grant Program is presented in order to construct a
borehole with a Steel tank with capacity of 20 cubic meters on a
6meter tower to minimize the gap as the present source of water is
only able to support few activities than the present plan.
Approach and Technology:
The proposed water supply from a borehole: The existing facilities
include electricity supply which runs along the proposed site. A
borehole to be drilled in the area to the depth of between 36m and
installed with PVC pipe casings after well development and pump test
target will yield great quantities of litres per hour.
A water tower of 6m to carry the 20 cubic meters steel storage tank
will be constructed. Also electricity supply to power the pumps will be
required. In addition pipe lines to carry the water from the bore hole to
the tank and distribute the water to the distribution point/consumers
points from the tank, after conducting water quality analysis at water
laboratory (see the attached pre-drilling survey report).
Management and Volunteer of the Project
The community and team of the Health Centre will be involved in all
process of project implementation from site survey, project monitoring,
forming water committee and water maintenance fund, forming Water
maintenance fund (WMF) and paying electricity bill and electricity
service line costs.(the entire project management)
Technical Advice or Assistance
The proposed work is going to be executed by an experienced drilling
company (Josig Technical Nig. Ltd) with both manual and
mechanical/electrical drilling equipment at reasonable rates.
11.
What are the social and economic benefits of this project
to the community?
The project will provides for the needs of the people by availing clean
water from secure sanitary sources to minimize their long journeys in
search of water and most importantly eradicate death and disease.
The problems that this project will address are the eradication of
prevailing diseases such as; typhoid, dysentery, black water fever and
diarrhea. These illnesses are commonly treated through clean, safe
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water and proper sanitation.
Through this project, there will be improvements in the lifestyles of
people within the community. The provision of clean drinking water will
result in better health as water borne diseases are eradicated.
The people in the community will also see a drastic change in their
lifestyle and health. Women and children will no longer have to
spending all day searching and hauling contaminated water for their
familys needs.
12.
How many people will benefit from this project?
The provision of clean and safe water will have a direct impact to about
3,000 people (1,700 women, 1,300 men) community members, and
also the Salama Health Center run by implementing organization
(serving 250people weekly staff and patients).
13.
What are the primary economic and social activities of
the community?
Peasant Farming and Micro Businesses (Petty Traders) An agrarian
community.
14. Describe all local contributions to the project, including those
of other sponsoring organizations. Do not forget to include
contributions of land, labor, materials, cash, or expertise.
N400,010.00 will be contributed by Salama Health Ministries and
Gospel Crusade Outreach representing 20% of the total project cost as
a matching grant.
Electricity Service line costs will be contributed by the community
including paying monthly electricity bills and forming Pump
maintenance fund.
The community and team of the Health Centre will be involved in all
process of project implementation from site survey, project monitoring,
forming water well committee and water maintenance fund, forming
Water maintenance fund (WMF) and paying electricity bill and
electricity service line costs.
It is planned to collect a total of N240, 000.00 for electricity service line
costs, N5,000 for monthly electricity bill and N50, 000 yearly as
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maintenance costs, all these funds will be contributed to the project by
income earned by the community from a meager fee charges paid by
Community members for fetching water, which is given an estimated
income ranging from N15,000 -20,000 per month.
15.
Has any work been completed on the project? If so, what
work has been done?
No work yet has been completed.
16. Attach a separate paper with a work plan indicating how the
project work will be done and who will be responsible for the
work. How long will the work take? When will the project be
completed? Include a timeline with the work plan. Remember
that projects should take no longer than six months to
complete
1. Mobilizing community to fully participate in project implementation.
(2weeks)
In mobilizing the community, the project will conduct meeting to the
Community of the requested water support. During these meetings the
community will be explained on how the project will be conducted and
other project condition which include community contribution,
formation of Water Maintenance Fund (WMF) and Wells Monitoring
Committees (WMC). The meetings will help to create awareness and
readiness of participating in the project implementation. In this project
the communities are required to mobile funds to support the electricity
bill payments and pump repair and maintenance.
2. Formation of Wells Monitoring Committees (WMC) which will consist
of about 10 people who will be from the village community and they
will be responsible in the borehole maintenance and repair, day to day
care of the borehole and managing the Water Maintenance Fund
(1week)
3. Formation of WMF which will be formed by the community, the fund
will be contributed by the communities to support them manage,
maintain and repair the borehole. Also (1week)
4. Purchasing and transportation of the borehole construction and
installation materials this activity will be done soon after receiving fund
(2weeks)
5. Drilling Tube Well to the Depth of 36 m. The work will be done by
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water technician (6 weeks)
6. Conducting training of the WMC on how to care and maintain the
borehole. (1day)
17. Will weather or other activities in the community, such as
holidays, harvesting, or religious ceremonies, affect the
project timeline? how?
No such activities mentioned above shall affect the project execution
and timeline as the borehole construction and installation shall be
constructed by a technical specialist with minimal assistances from the
community members.
18. Attach a detailed budget showing how much each item
necessary for the completion of the project will cost. if you
have already obtained pro-forma invoices for items as part of
your budget planning, attach them as well.
Please see the attached Proforma Invoice as submitted by Mssr, JosigTechnical Nig. Limited.
19 How will the project be sustained once the small grants
funding stops?
To make the project sustainable the following action is going to be
done.
i. The community members will be selected to form committee
consisting about 10 members (5 men and 5 women) to support
monitor the borehole progress from the beginning of the project and
after.
ii. The community members will be sensitized to form Water
Maintenance Fund (WMF) which will help to support paying electricity
bill, borehole maintenance.
iii. Participating in a training session which will be conducted to 10
people who are members of Well Monitoring Committee (WMC) on how
to manage to perform miner repair, clean, maintain the pump and
monitor any problems associated with their functioning
20 Have

village

or

community

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leaders

or

local

authorities

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approved your project? If so, who has approved it and how can
they be contacted? Please include addresses and phone
numbers where possible.
The project has been discussed with and approved by the Village Head
of Tundu Wada, Kujama, Chikun LGA, were the project is planned to be
situated his details are;
Mallam Yakubu Auta (Village Head of Tundu Wada, Kujama)
Phone Number- 0808 4777 773
21.

Using a separate sheet, please describe your monitoring plan


for the project.
AS described in item 19 above please.

21 Using a separate sheet, please describe the evaluation


indicators for the project. What information will be collected?
List the indicators of impact or change you will use to assess
the achievement of project objectives. Who will participate in
the evaluation and when? Who will be interviewed? How will
project statistics be collected? Give details of the evaluation
plan. Specifically in the case of infections averted how will
that be Measured?
EVALUATION INDICATORS FOR THE PROJECT ARE;
1. Women and children will no longer have to spending all day
searching and hauling contaminated water for the familys
needs.
2. Gaining of school time by children due closeness of clean water
sourced.
3. The provision of clean drinking water that resulted in better
health and change in lifestyle as water borne diseases are
eradicated.
4. Community accessed to a safe water source.
5. Ownership and responsibility for clean water sourced by the
community.
INFORMATION THAT WILL BE COLLECTED IN EVALUATION;

1. Monthly percentage of patient visit to the clinic for treatment of


illnesses that related to water borne diseases.
2. Daily collection of payment of water rates.
3. Percentage of numbers of people who come to fetch water.

INDICATORS OF IMPACT OR CHANGE TO BE USED TO ASSESS THE


ACHIEVEMENT OF THE PROJECT OBJECTIVES;
1. Access of Women and children to closer clean water sourced
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2. Gaining of school time by children due closeness of clean water
sourced.
3. Better health and change in lifestyle witness in the community
due to the provision of the water point.
4. Number of daily community members who fetch water from the
water sourced.
5. Community acceptance to ownership and responsibility for the
clean water sourced.
WHO
1.
2.
3.

WILL PARTICIPATE IN THE EVALUATION AND WHEN;


Community members (Monthly)
Patient at the clinic (Monthly)
Staff of the Clinic (Monthly)

WHO WILL BE INTERVIEWED?


4. Community members
5. Patient at the clinic
HOW WILL PROJECT STATISTICS BE COLLECTED?
1. Record of the clinic being operated by Salama Health Ministry
and Gospel Crusade Outreach
2. Cash book payment for rate collected
DETAILS OF THE EVALUATION PLAN
To be provided
22 Attach a list of names, addresses and telephone numbers of
individuals or organizations that can be contacted about this
project if different from those listed in items 5 and 6. also
attach a list of the names of community members supporting
or assisting in this project and their signatures.
Same as listed above Items 5 and 6
23 Attach a detailed description and a map of how to reach the
project site from the nearest state capital.
2, Salama Avenue, Tudun Wada, Kujama, Chikun L.G.A, Kaduna State.
Kujama is about 15minutes drive from Kaduna town(south), in Kaduna
State.
Please see attached map showing detailed direction to the project site
from the state capital, Kaduna.
24 Please attach any additional information you may wish to
provide, such as letters of recommendation, reports from other
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completed projects, pro forma invoices, or background
information on project participants at the end of this
application.
Please see attached APPENDIX
1.
2.
3.
4.
5.

PROFORMA INVOICE
PRE-DRILLING(GEOPHYSICAL) SURVEY REPORT.
MAP OF DETAIL DESCRIPTION TO PROJECT SITE
PICTURE OF SOURCES OF WATER IN THE COMMUNITY
CAC CERTIFICATION INCORPORATED TRUSTEES

Acknowledgement
I have reviewed the completed application n form for funding under the
U.S. Ambassadors Small Grants Program. The application is complete,
and the answers are true and correct to the best of my knowledge.
________________________________
(Signature of Project Director)

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_____________________
(Date

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