Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

Challenges

<h2>THE OPPORTUNITY</h2>At the Bill &amp; Melinda Gates Foundation, we believe that malaria eradication within a generation is possible. We recognize that in order to achieve this, National Malaria Control Programs (NMCPs) must be empowered to use timely, high-quality data to inform their malaria strategic planning, decision-making, program implementation, and evaluation. As we work to sustain the decline in incidence rates that have marked the last fifteen years of malaria control, this concept of data-to-action has never been more important.Our vision for data-to-action, recently endorsed by WHO’s Malaria Policy Advisory Committee (MPAC), is one of stratification and sub-national tailoring. In the first step, multiple data sources – from geospatial to epidemiological data – are used to define district-level strata within a country. Next, additional data types are used as the input to mathematical models that output the optimal package of interventions that result in maximum malaria burden reduction within a given resource envelope. The success of stratification and sub-national tailoring is highly dependent on the underlying data, which may not always be complete, high-quality, and / or timely. We are therefore exploring new data streams that might improve our understanding of factors driving changes in malaria epidemiology or be used to optimize the choice of interventions modelled. One of these new data streams is serological, genetic, and / or genomic data which arises from malaria molecular surveillance.Malaria Molecular Surveillance (MMS) is an umbrella term which describes the use of molecular biology approaches – from serology to genotyping to whole genome sequencing (WGS) – to interrogate parasite and / or vector populations in order to derive epidemiologically actionable information. MMS does not include research-oriented genetic and genomic investigations, such as studies using genomics to investigate parasite or mosquito biology. Rather, the emphasis is on analyses that can directly influence malaria control policy and practice. In addition to the laboratory techniques used, MMS also includes the bioinformatics tools and resources necessary to process, interpret, and share the resulting data.<h2>THE CHALLENGE</h2>Initial work in the MMS space focused on methods development and proof-of-concept pilot studies. Now, the tools and analyses are maturing, the infrastructure is in place, and the time-to-result is much shorter, meaning that MMS is beginning to influence program planning and execution. In elimination settings, genetics has been deployed in focused investigations of malaria importations. In higher-burden settings, MMS is being used to visualize the spatio-temporal spread of antimalarial drug resistance markers, influencing treatment guidelines, and to track the effect of different interventions on parasite genetic diversity as a surrogate measure of transmission intensity.In June 2019, a WHO Technical Consultation on the role of parasite and vector genetic and genomic data in malaria surveillance (<a href="https://www.who.int/docs/default-source/malaria/mpac-documentation/mpac-october2019-session7-report-consultation-on-genomics.pdf" target="_blank">workshop report</a>), stakeholders from MMS community – both on the research and programmatic sides – gathered with the goal of identifying those MMS use cases for which sufficient evidence exists to recommend routine use for malaria control and elimination, and those for which more upstream research is needed in order to generate a broader evidence base for future recommendations.The list of use cases that are ready or near ready (marked with an asterisk*) for programmatic deployment includes:<ul><li>Detect drug resistance: monitor the prevalence/frequency of molecular markers of drug resistance to inform intervention selection, treatment guidelines, and surveillance</li><li>Detect hrp2/3 deletions: monitor the prevalence/frequency of hrp2/3 deletion affecting RDT efficacy to inform diagnostic selection</li><li>Assess drug resistance gene flow: determine the origins of drug resistance markers and monitor their spread within/among regions and parasite populations to inform containment strategies and regional policies around intervention selection, treatment guidelines, and surveillance*</li><li>Predict emerging resistance: detect signatures of positive selection suggesting emerging resistance to inform intervention selection, treatment guidelines, and surveillance*</li><li>Identify local transmission: identify focal areas of high transmission and clusters of infections to inform resource deployment*</li><li>Distinguish local and imported cases: in elimination settings, classify cases as imported or otherwise for case investigation and elimination certification*</li><li>Reconstruct transmission chains: elucidate contributing factors (e.g. seasonality, migrants, asymptomatic cases, and highly infectious individuals) to ongoing transmission patterns to inform intervention selection, resource deployment, surveillance, and case investigation*</li><li>Determine connectivity of parasite populations: assess degree to which transmission is linked among regions due to linked parasite populations to inform program planning and resource deployment*</li><li>Survey for allelic variation in target sites for gene drive: determine whether SNPs that would prevent CRISPR site recognition exist in wild populations to optimize gene drive release planning*</li></ul>As MMS transitions from proof-of-concept work in academic institutions to operational reality in NMCPs, Ministries of Health, and National Public Health Institutes, the challenge lies in conducting the work in a way that engages country programs and malaria decision-makers and that empowers them to understand and use their data actively for programmatic decision-making.The purpose of this call is therefore to identify new and innovative approaches to integrating malaria molecular surveillance into malaria surveillance and programmatic decision-making in malaria endemic countries.What we are looking for:We are looking for innovative proposals that will use MMS data to enable NMCPs to inform their national and sub-national surveillance efforts, national strategic planning, and/or intervention implementation. These may include proposals that: create or expand laboratory, bioinformatics, and data interpretation capacity within NMCPs or at institutions closely affiliated with an NMCP; create or implement tools for communicating and sharing parasite and/or vector molecular surveillance data; and/or build relationships between groups with MMS capacity and NMCP partners. Proposals should target the use cases identified above that are ready or near-to-ready for programmatic deployment. We do not want respondents to be generating MMS data for research purposes; rather, the intent of this call is to support the application of MMS approaches to routine malaria surveillance and planning within NMCPs, Ministries of Health, or similar organizations.While we welcome respondents from around the world, we are particularly interested in proposals from respondents working in high-burden malaria settings. All proposals must include a principal investigator or co-investigator from a malaria-endemic country.Winning proposals should:<ul><li>Explain the rationale for and potential benefits of using MMS data in their setting</li><li>Address one or more of the use cases outlined in the Challenge section above</li><li>Include representation from the NMCP, Ministry of Health (MOH) representation, government agency or healthcare provider responsible for malaria control in the country / region</li><li>Describe how MMS information arising from the project will be shared with the NMCP, MOH and other key stakeholders</li></ul>A few examples of work that would be considered for funding:<ul><li>Implementing or scaling-up a laboratory assay for hrp2/3 deletion and / or antimalarial drug resistance marker surveillance in partnership with an NMCP</li><li>Developing a web interface or reporting tool for communicating molecular data to stakeholders who do not have genomics / bioinformatics experience</li><li>Creating a bioinformatics workflow for MMS data that goes from fastq file to a readable report summarizing the analysis results in a user-friendly way</li><li>Developing and implementing a training program to familiarize NMCP staff with the use and interpretation of MMS data</li></ul>We will not consider funding for:<ul><li>Proposals that do not include an investigator from a malaria-endemic country</li><li>Proposals that do not include an explicit partnership with the NMCP, MOH or other authority responsible for malaria surveillance and control in the country / region</li><li>Proposals that do not demonstrate how the results will immediately influence malaria decision-making by the relevant NMCP, MOH or other authority</li></ul>

Grand Challenges Explorations

New Approaches to Integrating Molecular Surveillance into Malaria Control Programs (Round 26)

<h2>THE OPPORTUNITY</h2>
At the Bill &amp; Melinda Gates Foundation, we believe that malaria eradication within a generation is possible. We recognize that in order to achieve this, National Malaria Control Programs (NMCPs) must be empowered to use timely, high-quality data to inform their malaria strategic planning, decision-making, program implementation, and evaluation. As we work to sustain the decline in incidence rates that have marked the last fifteen years of malaria control, this concept of data-to-action has never been more important.
Our vision for data-to-action, recently endorsed by WHO’s Malaria Policy Advisory Committee (MPAC), is one of stratification and sub-national tailoring. In the first step, multiple data sources – from geospatial to epidemiological data – are used to define district-level strata within a country. Next, additional data types are used as the input to mathematical models that output the optimal package of interventions that result in maximum malaria burden reduction within a given resource envelope. The success of stratification and sub-national tailoring is highly dependent on the underlying data, which may not always be complete, high-quality, and / or timely. We are therefore exploring new data streams that might improve our understanding of factors driving changes in malaria epidemiology or be used to optimize the choice of interventions modelled. One of these new data streams is serological, genetic, and / or genomic data which arises from malaria molecular surveillance.
Malaria Molecular Surveillance (MMS) is an umbrella term which describes the use of molecular biology approaches – from serology to genotyping to whole genome sequencing (WGS) – to interrogate parasite and / or vector populations in order to derive epidemiologically actionable information. MMS does not include research-oriented genetic and genomic investigations, such as studies using genomics to investigate parasite or mosquito biology. Rather, the emphasis is on analyses that can directly influence malaria control policy and practice. In addition to the laboratory techniques used, MMS also includes the bioinformatics tools and resources necessary to process, interpret, and share the resulting data.
<h2>THE CHALLENGE</h2>
Initial work in the MMS space focused on methods development and proof-of-concept pilot studies. Now, the tools and analyses are maturing, the infrastructure is in place, and the time-to-result is much shorter, meaning that MMS is beginning to influence program planning and execution. In elimination settings, genetics has been deployed in focused investigations of malaria importations. In higher-burden settings, MMS is being used to visualize the spatio-temporal spread of antimalarial drug resistance markers, influencing treatment guidelines, and to track the effect of different interventions on parasite genetic diversity as a surrogate measure of transmission intensity.
In June 2019, a WHO Technical Consultation on the role of parasite and vector genetic and genomic data in malaria surveillance (<a href="https://www.who.int/malaria/mpac/mpac-october2019-session7-report-consultation-on-genomics.pdf" target="_blank" rel="noopener noreferrer">workshop report</a>), stakeholders from MMS community – both on the research and programmatic sides – gathered with the goal of identifying those MMS use cases for which sufficient evidence exists to recommend routine use for malaria control and elimination, and those for which more upstream research is needed in order to generate a broader evidence base for future recommendations.
The list of use cases that are ready or near ready (marked with an asterisk*) for programmatic deployment includes:
<ul>
<li>Detect drug resistance: monitor the prevalence/frequency of molecular markers of drug resistance to inform intervention selection, treatment guidelines, and surveillance</li>
<li>Detect hrp2/3 deletions: monitor the prevalence/frequency of hrp2/3 deletion affecting RDT efficacy to inform diagnostic selection</li>
<li>Assess drug resistance gene flow: determine the origins of drug resistance markers and monitor their spread within/among regions and parasite populations to inform containment strategies and regional policies around intervention selection, treatment guidelines, and surveillance*</li>
<li>Predict emerging resistance: detect signatures of positive selection suggesting emerging resistance to inform intervention selection, treatment guidelines, and surveillance*</li>
<li>Identify local transmission: identify focal areas of high transmission and clusters of infections to inform resource deployment*</li>
<li>Distinguish local and imported cases: in elimination settings, classify cases as imported or otherwise for case investigation and elimination certification*</li>
<li>Reconstruct transmission chains: elucidate contributing factors (e.g. seasonality, migrants, asymptomatic cases, and highly infectious individuals) to ongoing transmission patterns to inform intervention selection, resource deployment, surveillance, and case investigation*</li>
<li>Determine connectivity of parasite populations: assess degree to which transmission is linked among regions due to linked parasite populations to inform program planning and resource deployment*</li>
<li>Survey for allelic variation in target sites for gene drive: determine whether SNPs that would prevent CRISPR site recognition exist in wild populations to optimize gene drive release planning*</li>
</ul>
As MMS transitions from proof-of-concept work in academic institutions to operational reality in NMCPs, Ministries of Health, and National Public Health Institutes, the challenge lies in conducting the work in a way that engages country programs and malaria decision-makers and that empowers them to understand and use their data actively for programmatic decision-making.
The purpose of this call is therefore to identify new and innovative approaches to integrating malaria molecular surveillance into malaria surveillance and programmatic decision-making in malaria endemic countries.
What we are looking for:
We are looking for innovative proposals that will use MMS data to enable NMCPs to inform their national and sub-national surveillance efforts, national strategic planning, and/or intervention implementation. These may include proposals that: create or expand laboratory, bioinformatics, and data interpretation capacity within NMCPs or at institutions closely affiliated with an NMCP; create or implement tools for communicating and sharing parasite and/or vector molecular surveillance data; and/or build relationships between groups with MMS capacity and NMCP partners. Proposals should target the use cases identified above that are ready or near-to-ready for programmatic deployment. We do not want respondents to be generating MMS data for research purposes; rather, the intent of this call is to support the application of MMS approaches to routine malaria surveillance and planning within NMCPs, Ministries of Health, or similar organizations.
While we welcome respondents from around the world, we are particularly interested in proposals from respondents working in high-burden malaria settings. All proposals must include a principal investigator or co-investigator from a malaria-endemic country.
Winning proposals should:
<ul>
<li>Explain the rationale for and potential benefits of using MMS data in their setting</li>
<li>Address one or more of the use cases outlined in the Challenge section above</li>
<li>Include representation from the NMCP, Ministry of Health (MOH) representation, government agency or healthcare provider responsible for malaria control in the country / region</li>
<li>Describe how MMS information arising from the project will be shared with the NMCP, MOH and other key stakeholders</li>
</ul>
A few examples of work that would be considered for funding:
<ul>
<li>Implementing or scaling-up a laboratory assay for hrp2/3 deletion and / or antimalarial drug resistance marker surveillance in partnership with an NMCP</li>
<li>Developing a web interface or reporting tool for communicating molecular data to stakeholders who do not have genomics / bioinformatics experience</li>
<li>Creating a bioinformatics workflow for MMS data that goes from fastq file to a readable report summarizing the analysis results in a user-friendly way</li>
<li>Developing and implementing a training program to familiarize NMCP staff with the use and interpretation of MMS data</li>
</ul>
We will not consider funding for:
<ul>
<li>Proposals that do not include an investigator from a malaria-endemic country</li>
<li>Proposals that do not include an explicit partnership with the NMCP, MOH or other authority responsible for malaria surveillance and control in the country / region</li>
<li>Proposals that do not demonstrate how the results will immediately influence malaria decision-making by the relevant NMCP, MOH or other authority</li>
</ul>

Grand Challenges Explorations seeks new and innovative approaches to integrating molecular surveillance into malaria surveillance and programmatic decision-making in malaria endemic countries. Malaria molecular surveillance encompasses the use of molecular biology approaches to interrogate parasite or vector populations to derive epidemiologically actionable information.

<h2>THE OPPORTUNITY</h2>Fundamental changes in menstrual health and hygiene (MHH) products are needed to meet the needs of women and girls in low and middle income countries (LMIC) who face challenges with regard to their overall menstrual health and to managing their menstrual periods with dignity. Women and girls in LMIC face significant challenges barriers related to MHH from menarche to menopause. Current literature, while limited, shows an association between inadequate access to MHH products and poorer physical and mental health outcomes.<a href="#_ftn1" title="" id="_ftnref1" name="_ftnref1">[1]</a> <a href="#_ftn2" title="" id="_ftnref2" name="_ftnref2">[2]</a> In Ethiopia, for example, only 28% of women and girls reported having "everything they need" to manage their menstruation. Globally, based on data collected from 8 countries in PMA2020 (Performance Monitoring for Action, 2020), it is estimated that 528 million women and girls are lacking what they need for basic MHH care. Challenges can range from social stigma, lack of clean water for basic hygiene, and ineffective, inadequate, or expensive products.<a href="#_ftn3" title="" id="_ftnref3" name="_ftnref3">[3]</a> For example, many women and girls face limited economic resources to purchase supplies that best meet their needs. In addition, girls face inadequate or poor water and sanitation facilities at school, lack of privacy and lengthy travel to and from schools, which increases the likelihood of leaks/stains. Lack of access to MHH products that are context-appropriate, affordable and sustainable can have tangible biological and social impact. Additionally, limited access to MHH products leads to diminished dignity and respect and increased discrimination and stigma for many women and girls in LMIC across their reproductive life.Key characteristics of MHH products for women and girls include effectiveness, safety, discretion, sustainability, and affordability. Currently available products (e.g., disposable pads, reusable pads, tampons, and menstrual cups) all involve trade-offs among one or more of these desired characteristics and attributes. For example, menstrual cups are discreet but expensive and difficult to use; disposable pads are discreet but create a lot of waste that is particularly problematic in LMICs. Additionally, lack of access to clean water limits the utility of reusable products (e.g., menstrual cups) for many women. As a result, some women and girls turn to inadequate and potentially harmful homemade alternatives such as goatskin, cow patties, or cloths in many settings. In India for example, 88% of women and girls use homemade alternative products to manage MHH.While a multi-pronged approach to address dignified menstrual health is broadly necessary, one key need is innovation in materials science and transformative product development to better meet user needs. This Grand Challenge opportunity is focused exclusively on the product innovation domain. To date, changes in this field have been largely incremental - often focusing on increasing access through pricing or making current products with biodegradable materials. Disruptive innovation in this space has the potential to shift the current market structure and thus improve reach to poor and vulnerable populations. To be most impactful, significant changes in science and technology require mitigation of environmental impact with the aspirational goal to create zero waste and move toward a circular economy (defined as an economic system aimed at eliminating waste and the reuse, sharing, repair, refurbishment, remanufacturing, and recycling of resources).<h2>THE CHALLENGE</h2>We seek fundamentally transformative and innovative ideas to support the design and development of new MHH products that meet key criteria of being responsive to user needs - particularly in LMIC context; with priority focus on safety, unobtrusiveness, effectiveness (no leaking), cultural acceptability, and sustainability. While there are a number of challenges related to access to current products, reducing stigma, and shifting social norms, this opportunity is specifically focused on driving transformative innovation in the product development domain. We are particularly seeking new technologies, including those potentially used in adjacent fields such as materials science, that could be adapted to innovative MHH products. We fully recognize that technology alone does not automatically improve people's lives. Thus, these creative solutions must be contextually grounded and designed in response to the needs and preferences of women and girls living in LMIC and designed particularly with the future in mind.Proposals should include how they will address the following criteria:<ul><li>Innovation: We are seeking radical transformation of existing MHH products, including leveraging materials science and other product innovations.</li><li>Discretion: The ability to use a product without it being detected is of high importance to women and girls, specifically during: wear (e.g., no blood leaking and staining clothes), cleaning (e.g., for reusable products, washing product can be kept discreet and is feasible in the absence of clean water supply), and disposal (e.g., for disposable products, does not leave conspicuous waste). Other considerations include safety (e.g., obviating the need to access public sanitation facilities at night). Finally, functionality over the life course depends upon adaptability to times of irregular and sometimes heavy bleeding, including perimenarche, postpartum, and perimenopause.</li><li>Sustainability: Current MHH products either require access to clean water to clean (e.g., menstrual cup) or result in waste (e.g., disposable pad). A transformative product would neither require neither clean water nor result in waste.</li></ul>Note: Given the foundation's target geographies and populations, a MHH product needs to be affordable for a woman throughout her reproductive years. This criterion will need to be weighed carefully against the prior criteria. While striving for a low cost of goods sold (COGS), we also recognize that affordability can be addressed through multiple levers including market dynamics and scaled production.The following will not be considered for funding:<ul><li>Basic research in materials science or product design that does not address the criteria as outlined above</li><li>Proposals only focusing on innovative new materials science without a clear path toward developing an MHH prototype manufacturing process</li><li>Proposals where there is no clear path forward to scale</li><li>Proposals focused on current MHH product delivery and education, as opposed to a technological solution for innovations in new products</li><li>Proposals that focus on incremental change of existing products</li><li>Proposals focused on other aspects of MHH, including infrastructure/systems for addressing access to existing products, water and sanitation improvements or shifting social norms around stigmatization.</li></ul>_____________________________<a href="#_ftnref1" title="" id="_ftn1" name="_ftn1">[1]</a>&nbsp;<a href="https://www.unfpa.org/news/menstruation-not-girls-or-womens-issue-%E2%80%93-its-human-rights-issue" title="https://www.unfpa.org/news/menstruation-not-girls-or-womens-issue-its-human-rights-issue">https://www.unfpa.org/news/menstruation-not-girls-or-womens-issue-its-human-rights-issue</a><a href="#_ftnref2" title="" id="_ftn2" name="_ftn2">[2]</a> Hennegan J, et al. Women’s and girls‘ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PloS Med. 2019; 16:e1002803.<a href="#_ftnref3" title="" id="_ftn3" name="_ftn3">[3]</a> Kuhlmann AS, Henry K, Wall LL. Menstrual Hygiene Management in Resource-Poor Countries. Obstet Gynecol Surv. 2017;72:356-76.

Innovations in Materials Science for a Transformative Menstrual Health and Hygiene Product (Round 25)

<h2>THE OPPORTUNITY</h2>
Fundamental changes in menstrual health and hygiene (MHH) products are needed to meet the needs of women and girls in low and middle income countries (LMIC) who face challenges with regard to their overall menstrual health and to managing their menstrual periods with dignity. Women and girls in LMIC face significant challenges barriers related to MHH from menarche to menopause. Current literature, while limited, shows an association between inadequate access to MHH products and poorer physical and mental health outcomes.<a href="#Note1">1, </a><a href="#Note2">2</a> In Ethiopia, for example, only 28% of women and girls reported having "everything they need" to manage their menstruation. Globally, based on data collected from 8 countries in PMA2020 (Performance Monitoring for Action, 2020), it is estimated that 528 million women and girls are lacking what they need for basic MHH care. Challenges can range from social stigma, lack of clean water for basic hygiene, and ineffective, inadequate, or expensive products.<a href="#Note3">3</a> For example, many women and girls face limited economic resources to purchase supplies that best meet their needs. In addition, girls face inadequate or poor water and sanitation facilities at school, lack of privacy and lengthy travel to and from schools, which increases the likelihood of leaks/stains. Lack of access to MHH products that are context-appropriate, affordable and sustainable can have tangible biological and social impact. Additionally, limited access to MHH products leads to diminished dignity and respect and increased discrimination and stigma for many women and girls in LMIC across their reproductive life.
Key characteristics of MHH products for women and girls include effectiveness, safety, discretion, sustainability, and affordability. Currently available products (e.g., disposable pads, reusable pads, tampons, and menstrual cups) all involve trade-offs among one or more of these desired characteristics and attributes. For example, menstrual cups are discreet but expensive and difficult to use; disposable pads are discreet but create a lot of waste that is particularly problematic in LMICs. Additionally, lack of access to clean water limits the utility of reusable products (e.g., menstrual cups) for many women. As a result, some women and girls turn to inadequate and potentially harmful homemade alternatives such as goatskin, cow patties, or cloths in many settings. In India for example, 88% of women and girls use homemade alternative products to manage MHH.
While a multi-pronged approach to address dignified menstrual health is broadly necessary, one key need is innovation in materials science and transformative product development to better meet user needs. This Grand Challenge opportunity is focused exclusively on the product innovation domain. To date, changes in this field have been largely incremental - often focusing on increasing access through pricing or making current products with biodegradable materials. Disruptive innovation in this space has the potential to shift the current market structure and thus improve reach to poor and vulnerable populations. To be most impactful, significant changes in science and technology require mitigation of environmental impact with the aspirational goal to create zero waste and move toward a circular economy (defined as an economic system aimed at eliminating waste and the reuse, sharing, repair, refurbishment, remanufacturing, and recycling of resources).
<h2>THE CHALLENGE</h2>
We seek fundamentally transformative and innovative ideas to support the design and development of new MHH products that meet key criteria of being responsive to user needs - particularly in LMIC context; with priority focus on safety, unobtrusiveness, effectiveness (no leaking), cultural acceptability, and sustainability. While there are a number of challenges related to access to current products, reducing stigma, and shifting social norms, this opportunity is specifically focused on driving transformative innovation in the product development domain. We are particularly seeking new technologies, including those potentially used in adjacent fields such as materials science, that could be adapted to innovative MHH products. We fully recognize that technology alone does not automatically improve people's lives. Thus, these creative solutions must be contextually grounded and designed in response to the needs and preferences of women and girls living in LMIC and designed particularly with the future in mind.
Proposals should include how they will address the following criteria:
<ul>
<li>Innovation: We are seeking radical transformation of existing MHH products, including leveraging materials science and other product innovations.</li>
<li>Discretion: The ability to use a product without it being detected is of high importance to women and girls, specifically during: wear (e.g., no blood leaking and staining clothes), cleaning (e.g., for reusable products, washing product can be kept discreet and is feasible in the absence of clean water supply), and disposal (e.g., for disposable products, does not leave conspicuous waste). Other considerations include safety (e.g., obviating the need to access public sanitation facilities at night). Finally, functionality over the life course depends upon adaptability to times of irregular and sometimes heavy bleeding, including perimenarche, postpartum, and perimenopause.</li>
<li>Sustainability: Current MHH products either require access to clean water to clean (e.g., menstrual cup) or result in waste (e.g., disposable pad). A transformative product would neither require neither clean water nor result in waste.</li>
</ul>
Note: Given the foundation's target geographies and populations, a MHH product needs to be affordable for a woman throughout her reproductive years. This criterion will need to be weighed carefully against the prior criteria. While striving for a low cost of goods sold (COGS), we also recognize that affordability can be addressed through multiple levers including market dynamics and scaled production.
The following will not be considered for funding:
<ul>
<li>Basic research in materials science or product design that does not address the criteria as outlined above</li>
<li>Proposals only focusing on innovative new materials science without a clear path toward developing an MHH prototype manufacturing process</li>
<li>Proposals where there is no clear path forward to scale</li>
<li>Proposals focused on current MHH product delivery and education, as opposed to a technological solution for innovations in new products</li>
<li>Proposals that focus on incremental change of existing products</li>
<li>Proposals focused on other aspects of MHH, including infrastructure/systems for addressing access to existing products, water and sanitation improvements or shifting social norms around stigmatization.</li>
</ul>
_____________________________
<a>1</a><a href="https://www.unfpa.org/news/menstruation-not-girls-or-womens-issue-%E2%80%93-its-human-rights-issue#" target="_blank" rel="noopener noreferrer"> https://www.unfpa.org/news/menstruation-not-girls-or-womens-issue-%E2%80%93-its-human-rights-issue#</a>
<a>2</a>Hennegan J, et al. Women’s and girls‘ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PloS Med. 2019; 16:e1002803.
<a>3</a>Kuhlmann AS, Henry K, Wall LL. Menstrual Hygiene Management in Resource-Poor Countries. Obstet Gynecol Surv. 2017;72:356-76.

Grand Challenges Explorations seeks transformative and innovative ideas to support the design and development of a new menstrual health and hygiene product that meets key criteria of being responsive to user needs, focusing on discreetness, affordability, and sustainability. Truly disruptive technologies harnessing materials science will be prioritized. Solutions must be designed in response to the needs and preferences of women and girls living in low- and middle-income countries and designed particularly with the future in mind.

<h2>THE OPPORTUNITY</h2>Countries rely on both routine health systems and campaign-based delivery to extend the reach of important health products. Many programs, including immunization, neglected tropical diseases, nutrition, malaria, and polio regularly rely on such campaigns to support accelerated disease control, make progress towards elimination/eradication goals, and achieve large scale health impact.Campaign-based delivery of health interventions is typically time-limited, intermittent, and implemented at-scale. All countries utilize health campaigns in some capacity - such as for outbreak response - and campaigns have been shown to be an effective way of driving health impact. For example, Vitamin A supplementation is estimated to reduce risk of all-cause child mortality by 12%. <a href="#_ftn1" title="" id="_ftnref1" name="_ftnref1">[1]</a> Measles campaigns are estimated to reach 66% of "zero-dose" children who are not otherwise immunized by routine health systems. <a href="#_ftn2" title="" id="_ftnref2" name="_ftnref2">[2]</a>Still, the performance of campaigns is variable, and campaigns often do not realize their potential impact. For example, only 47% of the measles campaigns and 38% of vitamin A campaigns reached their intended coverage targets.<a href="#_ftn3" title="" id="_ftnref3" name="_ftnref3">[3]</a>&nbsp;Campaign evaluations may also show they consistently miss a subset of populations - most often the most vulnerable - resulting in reduced equity of the health intervention. Although many campaigns experiment with or implement innovations to increase effectiveness, these innovations are rarely systematically evaluated, iterated upon, and disseminated.Quality planning is a key enabler of effective campaign implementation and is critical to support campaign performance. More specifically, microplanning, which specifically addresses the detailed, delivery-level planning required to reach intended populations with a health intervention, is recognized as a critical driver of campaign success. Planning and microplanning can be used as a tool to identify and reach the most vulnerable populations (e.g., high-risk and unreached populations).We believe there is opportunity to dramatically&nbsp;improve the way health campaigns that deliver health products or services realize impact, including through improved planning/microplanning. These campaigns will achieve higher coverage of target populations, better identify and reach high-risk/unreached populations, and efficiently use campaign resources.<h2>THE CHALLENGE</h2>We are seeking innovative solutions that accelerate the improvement of coverage, reach, efficiency, and effectiveness of mass health campaigns that deliver health products or services in low-and middle-income countries, specifically through improved planning/microplanning and focus on unreached populations.Specifically, we are looking for innovations in approaches, practices, or tools that dramatically improve the&nbsp;planning/microplanning that will lead to improved effectiveness of campaigns. We are also looking for innovative tools and technologies to more effectively identify and reach the most vulnerable populations when countries are designing and implementing mass campaigns.In order to contribute to the development and spread of campaign "best practices", a solution should be applicable to campaigns beyond the context in which it is originally tested (e.g., applicable in&nbsp;multiple&nbsp;lower- to middle-incomes countries and/or applicable&nbsp;across multiple types of health campaigns&nbsp;such as immunization, NTDs, malaria, or nutrition).We are especially interested in novel approaches that draw on innovation from large-scale delivery models outside of the health sector, which may include interventions used in the private sector.Successful proposals should consider the following:Planning and microplanning: This includes the planning processes - led by governments and often supported by partners - at the national, sub-national, facility, or community levels. Overall planning supports the mobilization of information and resources needed to conduct the campaign, and <a href="https://www.unicef.org/innovation/reports/innovation-children-urbanizing-world" target="_blank">microplanning</a> specifically addresses the detailed, delivery-level planning required to reach intended populations with the health intervention. Innovations might include/consider:<ul><li>Interactive or adaptive microplans that better incorporate past or real-time data (e.g. based on prior campaign performance or operational monitoring data) to guide planning and implementation.</li><li>Increased automation of microplans (e.g. updating, adapting microplans for other platforms).</li><li>Modeling and analytics to test, identify, and recommend more effective implementation approaches (e.g. modeling to identify optimal location of campaign fixed sites and outreach posts in order to improve community access).</li><li>Novel or nontraditional information or data sources to improve the accuracy of planning (e.g. geospatial data to improve population estimation or location and more accurately plan for and target campaign delivery).</li><li>Technologies for developing and using community maps or populations that can help campaigns to better reach their intended age groups or sub-populations.</li><li>Novel approaches to understanding the effectiveness of campaign planning and implementation while campaigns are ongoing or during post-campaign evaluations.</li></ul>Identifying and reaching high-risk or unreached populations: This includes innovative approaches to better understand, identify, and reach un/underserved communities and unreached or "zero-dose" children. This wil likely include novel tools, technologies, and methodologies to more effectively identify and reach high-risk or unreached populations at a subnational level (e.g. approaches to leverage data, maps, or other information to support campaign planning, appropriate use of targeted or sub-national campaigns, and post-campaign assessments).Criteria for success include solutions that:<ul><li>Are transformative, novel, or innovative. These interventions will significantly change the way in which campaigns are planned, conducted, or evaluated by proposing new ways of working, leveraging lessons from other sectors, or increasing transparency and effectiveness.</li><li>Could be used by various health campaigns beyond the campaign in which the innovation is originally conceptualized or tested, such as for immunization (measles, yellow fever, meningitis, etc.), neglected tropical diseases (trachoma, onchocerciasis, schistosomiasis etc.), nutrition (vitamin A, deworming), malaria (bed net distribution, seasonal malaria chemoprophylaxis), and polio.</li><li>Could be used in various low- and middle-income countries beyond the country in which the innovation is originally conceptualized or tested.</li><li>Can be designed, tested, and scaled as a "best practice".</li><li>Can be applied in low- and middle-income countries.</li><li>Are cost effective.</li></ul>We will not consider funding for:<ul><li>Proposals that are not innovative; proposals that only offer incremental / non-transformative improvements (e.g., use of mobile data collection instead of paper-based collection) with no clear link to dramatically improved campaign effectiveness; proposals that repeat conventional approaches without novel application.</li><li>Proposals addressing one specific health need/campaign platform, rather than an innovation that would improve health campaigns in general.</li><li>Proposals focused on educational campaigns or are not specifically focused on campaign-based delivery of health goods and services. Interventions that are better classified as technical assistance or campaign implementation (e.g., focused on the delivery or improvement of a single campaign).</li><li>Proposals focused on improving access to existing tools or technologies or seeking to apply existing tools in ways that do not transform the current practices used for campaign-based delivery.</li><li>Proposals where the solution is to leverage one health campaign for co-delivery of other goods or services (e.g., using a NTD campaign to deliver vaccine reminders).</li><li>Approaches not directly relevant to low-income settings and that do not clearly consider the local context of available financial systems and infrastructure for resource poor health settings (e.g., using expensive devices; require government issued IDs where few people have them; require hospital deliveries in settings where this is not the norm).</li><li>Secondary analysis of existing studies or systematic reviews unless there is a clear way in which the analysis can be scaled and will fundamentally change practice.</li><li>Approaches that circumvent the public sector completely.</li><li>Approaches which would require a donor’s long-term financial support to sustain.</li><li>Approaches that are clinic based.</li></ul>_________________________<a href="#_ftnref1" title="" id="_ftn1" name="_ftn1">[1]</a>Imdad et al. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database of Systematic Reviews, 2017.<a href="#_ftnref2" title="" id="_ftn2" name="_ftn2">[2]</a>Portnoy et al. Impact of measles supplementary immunization activities on reaching children missed by routine programs. Vaccine, 2018; In this use, "zero-dose" refers to children with no prior dose of measles vaccine. “Zero-dose” can also refer to children who have not received their first dose of other key vaccines.<a href="#_ftnref3" title="" id="_ftn3" name="_ftn3">[3]</a>Internal analysis of WHO PCT Databank and GHO data (accessed September 2019).

Innovations for Improving the Impact of Health Campaigns (Round 25)

<h2>THE OPPORTUNITY</h2>
Countries rely on both routine health systems and campaign-based delivery to extend the reach of important health products. Many programs, including immunization, neglected tropical diseases, nutrition, malaria, and polio regularly rely on such campaigns to support accelerated disease control, make progress towards elimination/eradication goals, and achieve large scale health impact.
Campaign-based delivery of health interventions is typically time-limited, intermittent, and implemented at-scale. All countries utilize health campaigns in some capacity - such as for outbreak response - and campaigns have been shown to be an effective way of driving health impact. For example, Vitamin A supplementation is estimated to reduce risk of all-cause child mortality by 12%.<a href="#Note1">1</a>&nbsp;Measles campaigns are estimated to reach 66% of "zero-dose" children who are not otherwise immunized by routine health systems.<a href="#Note2">2</a>
Still, the performance of campaigns is variable, and campaigns often do not realize their potential impact. For example, only 47% of the measles campaigns and 38% of vitamin A campaigns reached their intended coverage targets.<a href="#Note3">3</a> Campaign evaluations may also show they consistently miss a subset of populations - most often the most vulnerable - resulting in reduced equity of the health intervention. Although many campaigns experiment with or implement innovations to increase effectiveness, these innovations are rarely systematically evaluated, iterated upon, and disseminated.
Quality planning is a key enabler of effective campaign implementation and is critical to support campaign performance. More specifically, microplanning, which specifically addresses the detailed, delivery-level planning required to reach intended populations with a health intervention, is recognized as a critical driver of campaign success. Planning and microplanning can be used as a tool to identify and reach the most vulnerable populations (e.g., high-risk and unreached populations).
We believe there is opportunity to dramatically&nbsp;improve the way health campaigns that deliver health products or services realize impact, including through improved planning/microplanning. These campaigns will achieve higher coverage of target populations, better identify and reach high-risk/unreached populations, and efficiently use campaign resources.
<h2>THE CHALLENGE</h2>
We are seeking innovative solutions that accelerate the improvement of coverage, reach, efficiency, and effectiveness of mass health campaigns that deliver health products or services in low-and middle-income countries, specifically through improved planning/microplanning and focus on unreached populations.
Specifically, we are looking for innovations in approaches, practices, or tools that dramatically improve the&nbsp;planning/microplanning that will lead to improved effectiveness of campaigns. We are also looking for innovative tools and technologies to more effectively identify and reach the most vulnerable populations when countries are designing and implementing mass campaigns.
In order to contribute to the development and spread of campaign "best practices", a solution should be applicable to campaigns beyond the context in which it is originally tested (e.g., applicable in&nbsp;multiple&nbsp;lower- to middle-incomes countries and/or applicable&nbsp;across multiple types of health campaigns&nbsp;such as immunization, NTDs, malaria, or nutrition).
We are especially interested in novel approaches that draw on innovation from large-scale delivery models outside of the health sector, which may include interventions used in the private sector.
Successful proposals should consider the following:
Planning and microplanning: This includes the planning processes - led by governments and often supported by partners - at the national, sub-national, facility, or community levels. Overall planning supports the mobilization of information and resources needed to conduct the campaign, and&nbsp;<a href="https://www.who.int/polio-transition/documents-resources/best-practices-microplanning.pdf?ua=1" target="_blank" rel="noopener noreferrer">microplanning</a>&nbsp;specifically addresses the detailed, delivery-level planning required to reach intended populations with the health intervention. Innovations might include/consider:
<ul>
<li>Interactive or adaptive microplans that better incorporate past or real-time data (e.g. based on prior campaign performance or operational monitoring data) to guide planning and implementation.</li>
<li>Increased automation of microplans (e.g. updating, adapting microplans for other platforms).</li>
<li>Modeling and analytics to test, identify, and recommend more effective implementation approaches (e.g. modeling to identify optimal location of campaign fixed sites and outreach posts in order to improve community access).</li>
<li>Novel or nontraditional information or data sources to improve the accuracy of planning (e.g. geospatial data to improve population estimation or location and more accurately plan for and target campaign delivery).</li>
<li>Technologies for developing and using community maps or populations that can help campaigns to better reach their intended age groups or sub-populations.</li>
<li>Novel approaches to understanding the effectiveness of campaign planning and implementation while campaigns are ongoing or during post-campaign evaluations.</li>
</ul>
Identifying and reaching high-risk or unreached populations: This includes innovative approaches to better understand, identify, and reach un/underserved communities and unreached or "zero-dose" children. This wil likely include novel tools, technologies, and methodologies to more effectively identify and reach high-risk or unreached populations at a subnational level (e.g. approaches to leverage data, maps, or other information to support campaign planning, appropriate use of targeted or sub-national campaigns, and post-campaign assessments).
Criteria for success include solutions that:
<ul>
<li>Are transformative, novel, or innovative. These interventions will significantly change the way in which campaigns are planned, conducted, or evaluated by proposing new ways of working, leveraging lessons from other sectors, or increasing transparency and effectiveness.</li>
<li>Could be used by various health campaigns beyond the campaign in which the innovation is originally conceptualized or tested, such as for immunization (measles, yellow fever, meningitis, etc.), neglected tropical diseases (trachoma, onchocerciasis, schistosomiasis etc.), nutrition (vitamin A, deworming), malaria (bed net distribution, seasonal malaria chemoprophylaxis), and polio.</li>
<li>Could be used in various low- and middle-income countries beyond the country in which the innovation is originally conceptualized or tested.</li>
<li>Can be designed, tested, and scaled as a "best practice".</li>
<li>Can be applied in low- and middle-income countries.</li>
<li>Are cost effective.</li>
</ul>
We will not consider funding for:
<ul>
<li>Proposals that are not innovative; proposals that only offer incremental / non-transformative improvements (e.g., use of mobile data collection instead of paper-based collection) with no clear link to dramatically improved campaign effectiveness; proposals that repeat conventional approaches without novel application.</li>
<li>Proposals addressing one specific health need/campaign platform, rather than an innovation that would improve health campaigns in general.</li>
<li>Proposals focused on educational campaigns or are not specifically focused on campaign-based delivery of health goods and services. Interventions that are better classified as technical assistance or campaign implementation (e.g., focused on the delivery or improvement of a single campaign).</li>
<li>Proposals focused on improving access to existing tools or technologies or seeking to apply existing tools in ways that do not transform the current practices used for campaign-based delivery.</li>
<li>Proposals where the solution is to leverage one health campaign for co-delivery of other goods or services (e.g., using a NTD campaign to deliver vaccine reminders).</li>
<li>Approaches not directly relevant to low-income settings and that do not clearly consider the local context of available financial systems and infrastructure for resource poor health settings (e.g., using expensive devices; require government issued IDs where few people have them; require hospital deliveries in settings where this is not the norm).</li>
<li>Secondary analysis of existing studies or systematic reviews unless there is a clear way in which the analysis can be scaled and will fundamentally change practice.</li>
<li>Approaches that circumvent the public sector completely.</li>
<li>Approaches which would require a donor’s long-term financial support to sustain.</li>
<li>Approaches that are clinic based.</li>
</ul>
_________________________
<a name="#Note1" id="#Note1">1</a>Imdad et al. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database of Systematic Reviews, 2017.
<a name="#Note2" id="#Note2">2</a>Portnoy et al. Impact of measles supplementary immunization activities on reaching children missed by routine programs. Vaccine, 2018; In this use, "zero-dose" refers to children with no prior dose of measles vaccine. “Zero-dose” can also refer to children who have not received their first dose of other key vaccines.
<a name="#Note3" id="#Note3">3</a>Internal analysis of WHO PCT Databank and GHO data (accessed September 2019).

Grand Challenges Explorations seeks innovative solutions that accelerate the improvement of coverage, reach, efficiency, and effectiveness of campaign-based delivery of health interventions.

<h2>THE OPPORTUNITY</h2>Countries rely on both routine health systems and campaign-based delivery to extend the reach of important health interventions such as accelerated disease control and delivery of life-saving health products and services. Many programs, including immunization, neglected tropical diseases, nutrition, malaria, and polio regularly rely on such campaigns to manage the spread of disease and achieve large scale health impact.Campaign-based delivery of health interventions is typically time-limited, targeted, and implemented at-scale. All countries utilize health campaigns in some capacity – such as outbreak response – and campaigns have shown to be an effective way of driving health impact. For example, Vitamin A supplementation is estimated to reduce risk of all-cause child mortality by 12%.<a href="#_ftn1" title="" id="_ftnref1">[1]</a> Measles campaigns are estimated to reach 66% of "zero-dose" children who are not otherwise immunized by routine health systems.<a href="#_ftn2" title="" id="_ftnref2">[2]</a>Still, the performance of campaigns is variable, and campaigns often do not realize their potential impact. For example, only 44% of the measles campaigns and 31% of mass drug administration for NTDs conducted in 2017 reached their intended coverage targets.<a href="#_ftn3" title="" id="_ftnref3">[3]</a> Campaign evaluations may also show they consistently miss a subset of populations, resulting in reduced equity and coverage of the health intervention.Although many campaigns experiment with or implement innovations to increase effectiveness, these innovations are rarely systematically evaluated, iterated upon, and disseminated.We believe there is opportunity to dramatically improve the way health campaigns realize impact - including achieving higher coverage of health interventions, better identifying and reaching the highest risk populations, and improving efficiency of campaign resources.<h2>THE CHALLENGE</h2>We are seeking innovative solutions that accelerate the improvement of coverage, reach, efficiency, and effectiveness of health campaigns.Specifically, we are looking for innovations in approaches, practices, or tools that dramatically improve the planning and microplanning, implementation / operations, and monitoring and evaluation that will lead to improved effectiveness of campaigns.In order to contribute to the development and spread of campaign "best practices", a solution should be applicable to campaigns beyond the context in which it is originally tested (e.g. applicable in multiple lower- to middle-incomes countries and/or applicable across multiple types of health campaigns such as immunization, NTDs, malaria, or nutrition).We are especially interested in novel approaches that draw on innovation from large-scale delivery models outside of the health sector, which may include interventions used in the private sector.Successful proposals should consider the following phases of campaign delivery:<ul><li>Planning and microplanning,: This includes the planning processes - led by governments and often supported by partners - at the national, sub-national, facility, or community levels. Overall planning supports the mobilization of information and resources needed to conduct the campaign, and <a href="https://www.who.int/health-topics/cholera/poliomyelitis#tab=tab_1" target="_blank">microplanning</a> specifically addresses the detailed, delivery-level planning required to reach intended populations with the health intervention. Innovations might include/consider:<ul><li>Modeling and analytics to test, identify, and recommend more effective implementation approaches (e.g. modeling to identify optimal location of campaign fixed sites and outreach posts in order to improve community access).</li><li>Novel or nontraditional information or data sources to improve the accuracy of planning (e.g. geospatial data to improve population estimation or location and more accurately plan for and target campaign delivery).</li><li>Technologies for developing and using community maps or populations that can help campaigns to better reach their intended age groups or sub-populations.</li><li>Interactive or adaptive microplans that better incorporate past or real-time data (e.g. based on prior campaign performance or operational monitoring data) to guide planning and implementation.</li><li>Increased automation of microplans (e.g. updating, adapting microplans for other platforms).</li></ul></li><li>Implementation / operations: Improvement in this area may encompass all aspects of campaign operations, ranging from logistics management, identification and reach of target populations, delivery of interventions, management of human resources (including payments, incentives, and training), data collection &amp; analysis, and supervision. Innovations might include/consider:<ul><li>Novel approaches to leverage data, maps, or other information or data to better identify and reach high-risk or unreached (e.g. "zero dose") populations.</li><li>Approaches to delivering campaigns in a way that prioritize high-risk or vulnerable populations.</li><li>Leveraging of novel partnerships such as linking with other disease control programs, community initiatives, or religious or traditional structure that may improve campaign outcomes.</li><li>Use of innovative technologies to support logistics management, campaign supervision, data collection and use.</li></ul></li><li>Monitoring and evaluation: Campaigns rely on monitoring and evaluation both during and after the campaign to understand campaign performance, identify populations that require post-campaign mop-up or targeting, to inform post-campaign improvement activities and routine system strengthening and identify lessons learned. Additionally, although M&amp;E has not been used to systematically test and identify promising or best practices that may be replicated across geographies or campaign types, there is an opportunity to improve the use of iterative testing or operations research to identify best practices. Innovations might include/consider:<ul><li>Novel approaches to understanding the effectiveness of campaign planning and implementation while campaigns are ongoing or during post-campaign evaluations.</li><li>Approaches for measuring and incorporating real time process, quality, and coverage improvement during campaigns.</li><li>Methods of identifying, testing, and disseminating lessons learned and promising or best practices.</li></ul></li></ul>Criteria for success include solutions that:<ul><li>Are transformative, novel, or innovative. These interventions will significantly change the way in which campaigns are planned, conducted, or evaluated by proposing new ways of working, leveraging lessons from other sectors, or increasing transparency and effectiveness.</li><li>Could be used by various health campaigns beyond the campaign in which the innovation is originally conceptualized or tested, such as for immunization (measles, yellow fever, meningitis, etc.), neglected tropical diseases (trachoma, onchocerciasis, schistosomiasis etc.), nutrition (vitamin A, deworming), malaria (bed net distribution, seasonal malaria chemoprophylaxis), and polio.</li><li>Could be used in various low- and middle-income countries beyond the country in which the innovation is originally conceptualized or tested.</li><li>Can be designed, tested, and scaled as a "best practice".</li><li>Can be applied in low- and middle-income countries.</li><li>Are cost effective.</li></ul>We will not consider funding for:<ul><li>Proposals not presenting clear innovation for improving the planning, implementation, or evaluation of health campaigns.</li><li>Interventions that are better classified as technical assistance or campaign implementation (e.g. focused on the delivery or improvement of a single campaign).</li><li>Proposals seeking to apply existing tools in ways that do not transform the current practices used for campaign-based delivery.</li><li>Proposals where the solution is to leverage one health campaign for co-delivery of other goods or services (e.g. using a NTD campaign to deliver vaccine reminders).</li><li>Incremental improvements or small, non-transformative operational improvements (e.g. use of mobile data collection instead of paper-based collection) with no clear link to dramatically improved campaign effectiveness.</li><li>Proposals focused on improving access to existing tools or technologies.</li><li>Innovative ideas without a clearly-articulated and testable approach.</li><li>Approaches not directly relevant to low-income settings.</li><li>Approaches for which proof of concept cannot be demonstrated within the scope of the GCE Phase 1 award ($100,000 over 18 months).</li><li>Secondary analysis of existing studies or systematic reviews unless there is a clear way in which the analysis can be scaled and will fundamentally change practice.</li><li>Proof of concept studies that do not clearly consider the current context of available financial systems and infrastructure for resource poor health settings. For example, ideas that are tested using expensive devices or require government-issued IDs in a country where few people have them, or to populations which require hospital deliveries in settings where this is not the norm.</li><li>Approaches that circumvent the public sector completely.</li><li>Approaches which would require a donor’s long-term financial support to sustain.</li><li>Innovative ideas that repeat conventional approaches without novel application.</li></ul>_________________________<a href="#_ftnref1" title="" id="_ftn1">[1]</a>Imdad et al. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database of Systematic Reviews, 2017.<a href="#_ftnref2" title="" id="_ftn2">[2]</a>Portnoy et al. Impact of measles supplementary immunization activities on reaching children missed by routine programs. Vaccine, 2018.<a href="#_ftnref3" title="" id="_ftn3">[3]</a>Internal analysis of WHO PCT Databank and GHO data (accessed September 2019).

Innovations for Improving the Impact of Health Campaigns (Round 24)

<h2>THE OPPORTUNITY</h2>
Countries rely on both routine health systems and campaign-based delivery to extend the reach of important health interventions such as accelerated disease control and delivery of life-saving health products and services. Many programs, including immunization, neglected tropical diseases, nutrition, malaria, and polio regularly rely on such campaigns to manage the spread of disease and achieve large scale health impact.
Campaign-based delivery of health interventions is typically time-limited, targeted, and implemented at-scale. All countries utilize health campaigns in some capacity – such as outbreak response – and campaigns have shown to be an effective way of driving health impact. For example, Vitamin A supplementation is estimated to reduce risk of all-cause child mortality by 12%.1 Measles campaigns are estimated to reach 66% of "zero-dose" children who are not otherwise immunized by routine health systems.2
Still, the performance of campaigns is variable, and campaigns often do not realize their potential impact. For example, only 44% of the measles campaigns and 31% of mass drug administration for NTDs conducted in 2017 reached their intended coverage targets.3 Campaign evaluations may also show they consistently miss a subset of populations, resulting in reduced equity and coverage of the health intervention.
Although many campaigns experiment with or implement innovations to increase effectiveness, these innovations are rarely systematically evaluated, iterated upon, and disseminated.
We believe there is opportunity to dramatically improve the way health campaigns realize impact - including achieving higher coverage of health interventions, better identifying and reaching the highest risk populations, and improving efficiency of campaign resources.
<h2>THE CHALLENGE</h2>
We are seeking innovative solutions that accelerate the improvement of coverage, reach, efficiency, and effectiveness of health campaigns.
Specifically, we are looking for innovations in approaches, practices, or tools that dramatically improve the planning and microplanning, implementation / operations, and monitoring and evaluation that will lead to improved effectiveness of campaigns.
In order to contribute to the development and spread of campaign "best practices", a solution should be applicable to campaigns beyond the context in which it is originally tested (e.g. applicable in multiple lower- to middle-incomes countries and/or applicable across multiple types of health campaigns such as immunization, NTDs, malaria, or nutrition).
We are especially interested in novel approaches that draw on innovation from large-scale delivery models outside of the health sector, which may include interventions used in the private sector.
Successful proposals should consider the following phases of campaign delivery:
<ul>
<li>Planning and microplanning,: This includes the planning processes - led by governments and often supported by partners - at the national, sub-national, facility, or community levels. Overall planning supports the mobilization of information and resources needed to conduct the campaign, and <a href="https://www.who.int/polio-transition/documents-resources/best-practices-microplanning.pdf?ua=1" target="_blank" rel="noopener noreferrer">microplanning</a> specifically addresses the detailed, delivery-level planning required to reach intended populations with the health intervention. Innovations might include/consider:
<ul>
<li>Modeling and analytics to test, identify, and recommend more effective implementation approaches (e.g. modeling to identify optimal location of campaign fixed sites and outreach posts in order to improve community access).</li>
<li>Novel or nontraditional information or data sources to improve the accuracy of planning (e.g. geospatial data to improve population estimation or location and more accurately plan for and target campaign delivery).</li>
<li>Technologies for developing and using community maps or populations that can help campaigns to better reach their intended age groups or sub-populations.</li>
<li>Interactive or adaptive microplans that better incorporate past or real-time data (e.g. based on prior campaign performance or operational monitoring data) to guide planning and implementation.</li>
<li>Increased automation of microplans (e.g. updating, adapting microplans for other platforms).</li>
</ul>
</li>
<li>Implementation / operations: Improvement in this area may encompass all aspects of campaign operations, ranging from logistics management, identification and reach of target populations, delivery of interventions, management of human resources (including payments, incentives, and training), data collection &amp; analysis, and supervision. Innovations might include/consider:
<ul>
<li>Novel approaches to leverage data, maps, or other information or data to better identify and reach high-risk or unreached (e.g. "zero dose") populations.</li>
<li>Approaches to delivering campaigns in a way that prioritize high-risk or vulnerable populations.</li>
<li>Leveraging of novel partnerships such as linking with other disease control programs, community initiatives, or religious or traditional structure that may improve campaign outcomes.</li>
<li>Use of innovative technologies to support logistics management, campaign supervision, data collection and use.</li>
</ul>
</li>
<li>Monitoring and evaluation: Campaigns rely on monitoring and evaluation both during and after the campaign to understand campaign performance, identify populations that require post-campaign mop-up or targeting, to inform post-campaign improvement activities and routine system strengthening and identify lessons learned. Additionally, although M&amp;E has not been used to systematically test and identify promising or best practices that may be replicated across geographies or campaign types, there is an opportunity to improve the use of iterative testing or operations research to identify best practices. Innovations might include/consider:
<ul>
<li>Novel approaches to understanding the effectiveness of campaign planning and implementation while campaigns are ongoing or during post-campaign evaluations.</li>
<li>Approaches for measuring and incorporating real time process, quality, and coverage improvement during campaigns.</li>
<li>Methods of identifying, testing, and disseminating lessons learned and promising or best practices.</li>
</ul>
</li>
</ul>
Criteria for success include solutions that:
<ul>
<li>Are transformative, novel, or innovative. These interventions will significantly change the way in which campaigns are planned, conducted, or evaluated by proposing new ways of working, leveraging lessons from other sectors, or increasing transparency and effectiveness.</li>
<li>Could be used by various health campaigns beyond the campaign in which the innovation is originally conceptualized or tested, such as for immunization (measles, yellow fever, meningitis, etc.), neglected tropical diseases (trachoma, onchocerciasis, schistosomiasis etc.), nutrition (vitamin A, deworming), malaria (bed net distribution, seasonal malaria chemoprophylaxis), and polio.</li>
<li>Could be used in various low- and middle-income countries beyond the country in which the innovation is originally conceptualized or tested.</li>
<li>Can be designed, tested, and scaled as a "best practice".</li>
<li>Can be applied in low- and middle-income countries.</li>
<li>Are cost effective.</li>
</ul>
We will not consider funding for:
<ul>
<li>Proposals not presenting clear innovation for improving the planning, implementation, or evaluation of health campaigns.</li>
<li>Interventions that are better classified as technical assistance or campaign implementation (e.g. focused on the delivery or improvement of a single campaign).</li>
<li>Proposals seeking to apply existing tools in ways that do not transform the current practices used for campaign-based delivery.</li>
<li>Proposals where the solution is to leverage one health campaign for co-delivery of other goods or services (e.g. using a NTD campaign to deliver vaccine reminders).</li>
<li>Incremental improvements or small, non-transformative operational improvements (e.g. use of mobile data collection instead of paper-based collection) with no clear link to dramatically improved campaign effectiveness.</li>
<li>Proposals focused on improving access to existing tools or technologies.</li>
<li>Innovative ideas without a clearly-articulated and testable approach.</li>
<li>Approaches not directly relevant to low-income settings.</li>
<li>Approaches for which proof of concept cannot be demonstrated within the scope of the GCE Phase 1 award ($100,000 over 18 months).</li>
<li>Secondary analysis of existing studies or systematic reviews unless there is a clear way in which the analysis can be scaled and will fundamentally change practice.</li>
<li>Proof of concept studies that do not clearly consider the current context of available financial systems and infrastructure for resource poor health settings. For example, ideas that are tested using expensive devices or require government-issued IDs in a country where few people have them, or to populations which require hospital deliveries in settings where this is not the norm.</li>
<li>Approaches that circumvent the public sector completely.</li>
<li>Approaches which would require a donor’s long-term financial support to sustain.</li>
<li>Innovative ideas that repeat conventional approaches without novel application.</li>
</ul>
_________________________
1 Imdad et al. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database of Systematic Reviews, 2017.
2 Portnoy et al. Impact of measles supplementary immunization activities on reaching children missed by routine programs. Vaccine, 2018.
3 Internal analysis of WHO PCT Databank and GHO data (accessed September 2019).

Innovations for Improving the Impact of Health Campaigns seeks innovative solutions that accelerate the improvement of coverage, reach, efficiency, and effectiveness of campaign-based delivery of health interventions.

<h2>THE OPPORTUNITY</h2>

A set of rapidly-evolving technologies is changing the world and expanding the realm of the possible. These emerging technologies include – but are not limited to – artificial intelligence, materials science, wearable sensors, synthetic biology, nanotechnology, microscopy, augmented and virtual reality, geospatial mapping, robotics, and DNA sequencing. The capabilities of some of these technologies are increasing at an exponential rate, and their potential for impact is becoming apparent in an increasingly diverse set of areas. There is now an opportunity to build on these advances and explore new applications of these technologies – singly or in combination – to provide new ways of solving the key challenges in global health.

<h2>THE CHALLENGE</h2>

We seek proposals that apply an emerging technology – or a combination of emerging technologies – for new and potentially transformative solutions in global health priority areas. For background on the priority areas funded by the Bill &amp; Melinda Gates foundation, please read the summaries of the strategies being employed by the teams within the global health division at the Gates foundation: <a href="https://www.gatesfoundation.org/What-We-Do/Global-Health/Discovery-and-Translational-Sciences" target="_blank">Discovery &amp; Translational Sciences</a>; <a href="https://www.gatesfoundation.org/What-We-Do/Global-Health/Enteric-and-Diarrheal-Diseases" target="_blank">Enteric and Diarrheal Diseases</a>; <a href="https://www.gatesfoundation.org/What-We-Do/Global-Health/HIV" target="_blank">HIV</a>; <a href="https://www.gatesfoundation.org/What-We-Do/Global-Health/Malaria" target="_blank">Malaria</a>; <a href="https://www.gatesfoundation.org/What-We-Do/Global-Health/Maternal-Newborn-and-Child-Health-Discovery-and-Tools" target="_blank">Maternal, Newborn, and Child Health Discovery &amp; Tools</a>; <a href="https://www.gatesfoundation.org/What-We-Do/Global-Health/Neglected-Tropical-Diseases" target="_blank">Neglected Tropical Diseases</a>, <a href="https://www.gatesfoundation.org/What-We-Do/Global-Health/Pneumonia" target="_blank">Pneumonia</a>, <a href="https://www.gatesfoundation.org/What-We-Do/Global-Health/Tuberculosis" target="_blank">Tuberculosis</a>, and <a href="https://www.gatesfoundation.org/What-We-Do/Global-Health/Vaccine-Development-and-Surveillance" target="_blank">Vaccine Development and Surveillance</a>. These priority areas encompass infectious disease outcomes, pregnancy and birth outcomes, child growth and development outcomes, disease surveillance, and research for the development of new vaccines, drugs (including non-hormonal contraceptives), and diagnostics.

Below are examples of the types of applications of emerging technologies that we would consider – but note that these are meant only as illustrative examples, and other applications not listed would be considered as would other emerging technologies not listed. The goal of this challenge is to foster and support impact in global health through innovative uses of emerging technologies.

A few of the many options we will consider include (but are not limited to):

<ul>
	<li>Artificial intelligence for image analysis of human patients (e.g., fetal ultrasound, infant optical neuroimaging, or infant video data) or human biosamples (e.g., tissue sample microscopy or placental morphology) to reveal predictive biomarkers of adverse health outcomes or correlates of resilience</li>
	<li>Materials science for the design of laboratory model systems enabling investigation of new aspects of disease mechanisms (including pathogen persistence) or response to therapy, or enabling high-throughput screening assays (including culture systems to recapitulate complex biological systems)</li>
	<li>Wearable sensors to provide early indicators of treatment response, to identify causal factors underlying adverse pregnancy and birth outcomes, or to continuously monitor systemic metabolites to understand baselines and temporal fluctuation for biomarkers of health and disease</li>
	<li>Synthetic biology approaches to develop highly sensitive diagnostics (e.g., infectious disease diagnostics based on CRISPR technology)</li>
	<li>Nanotechnology for the creation of sensitive and specific biosensors</li>
	<li>Microscopy for intravital imaging of organ systems to reveal actionable mechanisms to prevent infectious disease pathogenesis or foster robust immune response</li>
	<li>Augmented reality to improve the quality of patient care through interactive guidance for diagnostic procedures</li>
	<li>Virtual reality to simulate host-pathogen interactions for insights into the design of agents to protect against infectious disease</li>
	<li>Geospatial mapping to understand and predict temporal changes in disease burden and design geographically-targeted interventions</li>
	<li>Robotics to enable new drug screening systems</li>
	<li>DNA sequencing combined with data analytical methods to facilitate a transkingdom view of the microbiota across body sites, including potential microbiota-mediated interactions between body sites</li>
</ul>

We will give highest priority to approaches that:

<ul>
	<li>Represent potentially transformative approaches that would not have been funded by mechanisms focusing on individual technologies or subject areas</li>
	<li>Represent new perspectives on the problem being targeted, including applying insights from fields outside the priority global health areas that are the subject of this challenge</li>
	<li>Leverage existing data or biosamples from human cohorts or biorepositories of proven value</li>
</ul>

We will not consider funding approaches that:

<ul>
	<li>Are not aligned with the Gates foundation's priority areas and strategies</li>
	<li>Are not directly relevant to developing countries</li>
	<li>Lack a clearly-articulated and testable hypothesis</li>
	<li>Lack a compelling plan for achieving proof of principle</li>
	<li>Lack a relevant indicator of success that can be demonstrated within the scope of the GCE Phase 1 award (USD $100,000 over 18 months)</li>
	<li>Represent incremental improvements to conventional solutions</li>
	<li>Represent basic research without clear relevance to the goals of this challenge</li>
	<li>Present unacceptable safety risks</li>
	<li>Detract from or interfere with beneficial practices</li>
</ul>

Emerging Technologies for New Solutions in Global Health Priority Areas (Round 23)

<h2>THE OPPORTUNITY</h2>

Salmonella enterica ssp. enterica serovar Typhi (S. Typhi) caused an estimated 10 million typhoid cases and 117,000 deaths in 2017 (Global Burden of Disease 2017). S. Typhi strains that are resistant to multiple antibiotics have emerged (Klemm et al. 2018) and are stretching health systems in multiple low- and middle-income settings (Andrews et al. 2018). Humans are believed to be the only natural host of S. Typhi (Wain et al. 2002). Infections result when contaminated food or water is consumed, and transmission by the fecal-oral route requires the organism to survive in the environment in between human infections. This has implications for the interventions necessary to eliminate typhoid as a public health problem—if environmental niches exist that sustain the survival and promote transmission of S. Typhi, improvements in water and sanitation and accessible vaccines are likely both necessary to halt transmission and eliminate disease. Additionally, we know little about the selection pressures on S. Typhi in the environment, and it is possible that exposure to antibiotics, both in the clinic and in the environment, is driving the development of antibiotic resistant S. Typhi strains. Though typhoid has been eliminated from various geographies, it is unclear if the low-income settings where typhoid persists today harbor environmental niches conducive to longer-term survival of the typhoid bacterium.

Evidence suggests that S. Typhi survival in the environment is enhanced in the presence of protozoans such as Acanthamoeba castellani (Frédéri Douesnard-Malo and Daigle 2011). Salmonella Typhimurium survives within Acanthamoeba polyphaga; whereas this survival is dependent on genes in the Salmonella Pathogenicity Island 2 (which have been shown to be necessary for virulence and invasion of macrophages), we might ask if the original function of these genes was to enhance environmental survival (Bleasdale et al. 2009). S. Dublin also exists within an amoeba, Acanthamoeba rhysodes (Tezcan-Merdol et al. 2004), and whether S. Typhi similarly can survive within a protozoan or other aquatic species is unknown. Shellfish have been shown to be a source of S. Typhi infection among humans, but the duration of S. Typhi survival in shellfish, especially in warm, tropical waters, is unknown (Jordan 1925). Other niches may exist in the soil and in water. S. Typhi DNA has been detected in drinking water from Kathmandu, Nepal, and in Dhaka, Bangladesh, but whether this represents a viable, pathogenic organism remains unknown (Karkey et al. 2016; Saha et al. 2019). In this grand challenge, we are interested in learning if environmental niches exist in which S. Typhi can survive, and whether (and how much) such niches contribute to transmission of disease in humans.

Additionally, these environmental niches may play a role in the development of antibiotic resistance in pathogens (Forsberg et al. 2012). We are interested in understanding whether S. Typhi survival in the environment is impacted by antibiotics and their residuals, and whether environmental exposure to antibiotics impacts the development of antibiotic resistance and the transmissibility of S. Typhi.

<h2>THE CHALLENGE</h2>

In this new grand challenge, we solicit proposals to examine the environmental niches of S. Typhi. We are interested in understanding:

<ol>
	<li>Survival of S. Typhi in the context of the soil and water microbiomes. S. Typhi survives for 3 weeks in the presence of A. castellani, but for no more than 10 days by itself (Frédéric Douesnard-Malo and Daigle 2011). Do interactions with other organisms impact survival of S. Typhi? How do they impact transmissibility of the bacterium?</li>
	<li>Survival of S. Typhi within other organisms. Similar to V. cholerae, which thrives within zooplankton (Lipp, Huq, and Colwell 2002), does S. Typhi interact with aquatic multicellular organisms? If yes, how does this impact the transmission and epidemiology of typhoid?</li>
	<li>Impact of environmental niches on the development of antibiotic resistance in S. Typhi. What is the relative amount of time S. Typhi spends in the environment compared to in infected individuals? How does this impact its exposure to antibiotics, and the development of antibiotic resistance in S. Typhi strains?</li>
</ol>

What we are interested in funding:

<ul>
	<li>Studies of S. Typhi in the context of soil and water microbiomes, with clear implications for survival, virulence, or antibiotic resistance.</li>
	<li>Examining survival of S. Typhi within or in the presence of free-living protozoans</li>
	<li>Examining the role of the environment (soil, water, residual antibiotics) in the development of AMR in S. Typhi</li>
	<li>Transcriptome analysis and mutagenesis of S. Typhi to identify genes associated with particular environmental niches.</li>
</ul>

In all cases, the relevance of findings to the epidemiology of typhoid must be clear.

What we will not fund:

<ul>
	<li>Studies of only other Salmonella enterica serovars, without a focus on S. Typhi</li>
	<li>Clinical studies of typhoid with no environmental focus</li>
	<li>Solely lab-based mutagenesis studies of S. Typhi with no data to link findings to environmental samples or typhoid epidemiology</li>
</ul>

References

Andrews, Jason R., Farah N. Qamar, Richelle C. Charles, and Edward T. Ryan. 2018. "Extensively Drug-Resistant Typhoid — Are Conjugate Vaccines Arriving Just in Time?" New England Journal of Medicine 379 (16): 1493–95. <a href="https://doi.org/10.1056/NEJMp1803926" target="_blank">https://doi.org/10.1056/NEJMp1803926</a>.

Bleasdale, Benjamin, Penelope J Lott, Aparna Jagannathan, Mark P Stevens, Richard J Birtles, and Paul Wigley. 2009. "The Salmonella Pathogenicity Island 2-Encoded Type III Secretion System Is Essential for the Survival of Salmonella Enterica Serovar Typhimurium in Free-Living Amoebae." Applied and Environmental Microbiology 75 (6): 1793–95. <a href="https://doi.org/10.1128/AEM.02033-08" target="_blank">https://doi.org/10.1128/AEM.02033-08</a>.

Douesnard-Malo, Frédéri, and France Daigle. 2011. "Increased Persistence of Salmonella Enterica Serovar Typhi in the Presence of Acanthamoeba Castellanii." Applied and Environmental Microbiology 77 (21): 7640–46. <a href="https://doi.org/10.1128/AEM.00699-11" target="_blank">https://doi.org/10.1128/AEM.00699-11</a>.

Douesnard-Malo, Frédéric, and France Daigle. 2011. "Increased Persistence of Salmonella Enterica Serovar Typhi in the Presence of Acanthamoeba Castellanii." Applied and Environmental Microbiology 77 (21): 7640–46. <a href="https://doi.org/10.1128/AEM.00699-11" target="_blank">https://doi.org/10.1128/AEM.00699-11</a>.

Forsberg, Kevin J., Alejandro Reyes, Bin Wang, Elizabeth M. Selleck, Morten O.A. Sommer, and Gautam Dantas. 2012. "The Shared Antibiotic Resistome of Soil Bacteria and Human Pathogens." Science 337 (6098): 1107–11. <a href="https://doi.org/10.1126/science.1220761" target="_blank">https://doi.org/10.1126/science.1220761</a>.

Global Burden of Disease. 2017. "GBD Results Tool | GHDx". <a href="http://ghdx.healthdata.org/gbd-results-tool" target="_blank">http://ghdx.healthdata.org/gbd-results-tool</a>.

Jordan, Edwin O. 1925. "THE VIABILITY OF TYPHOID BACILLI IN SHELL OYSTERS." JAMA: The Journal of the American Medical Association 84 (19): 1402. <a href="https://doi.org/10.1001/jama.1925.02660450010006" target="_blank">https://doi.org/10.1001/jama.1925.02660450010006</a>.

Karkey, Abhilasha, Thibaut Jombart, Alan W. Walker, Corinne N. Thompson, Andres Torres, Sabina Dongol, Nga Tran Vu Thieu, et al. 2016. "The Ecological Dynamics of Fecal Contamination and Salmonella Typhi and Salmonella Paratyphi A in Municipal Kathmandu Drinking Water." PLoS Neglected Tropical Diseases 10 (1): 1–18. <a href="https://doi.org/10.1371/journal.pntd.0004346" target="_blank">https://doi.org/10.1371/journal.pntd.0004346</a>.

Klemm, Elizabeth J, Sadia Shakoor, Andrew J Page, Farah Naz Qamar, Kim Judge, Dania K Saeed, Vanessa K Wong, et al. 2018. "Emergence of an Extensively Drug-Resistant Salmonella Enterica Serovar Typhi Clone Harboring a Promiscuous Plasmid Encoding Resistance to Fluoroquinolones and Third-Generation Cephalosporins" <a href="https://mbio.asm.org/content/9/1/e00105-18" target="_blank">https://mbio.asm.org/content/9/1/e00105-18</a>.

Lipp, Erin K, Anwar Huq, and Rita R Colwell. 2002. "Effects of Global Climate on Infectious Disease: The Cholera Model." Clinical Microbiology Reviews 15 (4): 757–70. <a href="https://doi.org/10.1128/CMR.15.4.757-770.2002" target="_blank">https://doi.org/10.1128/CMR.15.4.757-770.2002</a>.

Saha, Senjuti, Arif M. Tanmoy, Jason R. Andrews, Mohammad S. I. Sajib, Alexander T. Yu, Stephen Baker, Stephen P. Luby, and Samir K. Saha. 2019. "Evaluating PCR-Based Detection of Salmonella Typhi and Paratyphi A in the Environment as an Enteric Fever Surveillance Tool." The American Journal of Tropical Medicine and Hygiene 100 (1): 43–46. <a href="https://doi.org/10.4269/ajtmh.18-0428" target="_blank">https://doi.org/10.4269/ajtmh.18-0428</a>.

Tezcan-Merdol, Dilek, Marianne Ljungström, Jadwiga Winiecka-Krusnell, Ewert Linder, Lars Engstrand, and Mikael Rhen. 2004. "Uptake and Replication of Salmonella Enterica in Acanthamoeba Rhysodes." Applied and Environmental Microbiology 70 (6): 3706–14. <a href="https://doi.org/10.1128/AEM.70.6.3706-3714.2004" target="_blank">https://doi.org/10.1128/AEM.70.6.3706-3714.2004</a>.

Wain, John, Deborah House, Julian Parkhill, Christopher Parry, and Gordon Dougan. 2002. "Unlocking the Genome of the Human Typhoid Bacillus." The Lancet. Infectious Diseases 2 (3): 163–70. <a href="http://doi.org/10.1016/S1473-3099(02)00225-6" target="_blank">https://doi.org/10.1016/S1473-3099(02)00225-6</a>.

Environmental niches of Salmonella Typhi (Round 23)

Environmental niches of Salmonella Typhi (Round 23)

<h2>The Opportunity</h2>

Immunization represents one of public health's most valuable and cost-effective interventions, and delivers positive health, social, and economic benefits. Globally, an estimated 2-3 million child deaths and 600,000 adult deaths are prevented by vaccination on an annual basis. Vaccination has been shown to contribute to improved childhood physical development, higher educational outcomes, reduced poverty and household spending, and enhances equity (Deogaonkar et al. 2015; Verguet et al 2013). Furthermore, the return on investment (ROI) of money invested in immunization programs is significant: recent research has demonstrated that every USD $1 invested in immunization results in at least USD $16 in net health and economic benefits; when accounting for the economic benefits of living longer, healthier lives, this figure increases to $44 of net benefit (Ozawa, et al, 2016). Despite these successes, considerable gaps remain in our ability to fully vaccinate all children. As health care systems - and immunization systems in particular - evolve, we see an increasing opportunity to take lessons learned from other sectors to improve the efficiency and effectiveness of vaccination systems.

Despite the documented benefits of vaccines and immunization, global immunization coverage continues to stagnate, and we are off-track to reach the 2020 targets for coverage and equity articulated by both the Global Vaccine Action Plan, as well as the Gavi Alliance. We believe that "demand-side" factors have an increasingly important role to play in helping accelerate progress.

<h2>The Challenge</h2>

Within this call to increase demand for vaccination services, and thus increase the number of children vaccinated globally, we are looking for innovative ideas in the following specific areas (please specify whether your concept applies to the first, or second challenge, or both):

<table>
	<tbody>
		<tr>
			<td>(1) Novel approaches for providing practical knowledge about vaccines and vaccination services to caregivers, which may include:

			<ul>
				<li>Familiarizing caregivers with information on where and when routine and/or campaign services are provided</li>
				<li>Educating caregivers about how many times a child should be vaccinated and the importance of timely vaccination. Please explain how a proposed intervention would very tactically increase the knowledge of when a child needs to be brought in for his or her first, subsequent, or campaign-related vaccination. (Suggestions may include helping caregivers plan for completing subsequent visits.)</li>
				<li>Addressing common concerns (multiple injections, post-vaccination discomfort) that may result in missed opportunities for vaccination</li>
				<li>Empowering caregivers to ask for full vaccination services</li>
			</ul>
			</td>
			<td>(2) Novel ideas for improving the convenience and/or caregiver seeking of vaccination services; these may focus on:
			<ul>
				<li>Approaches that use human-centered design to improve the convenience of accessing services from a caregiver perspective</li>
				<li>Approaches that minimize wait time for caregivers, such as scheduling appointments, providing information as to wait times, and/or providing information regarding stock availability (may be linked to electronic registries)</li>
				<li>Approaches that reduce the "cost" of seeking services (i.e., time, lost wages, transport cost, discordance with social norms, etc.) while increasing the "benefit" (appreciation of vaccines, integrated services.) (Please exclude direct monetary incentives)</li>
				<li>Approaches that provide an innovative "nudge" for seeking vaccination services and translating intention into action. (Please do not submit proposals based on SMS reminders given their current emphasis/on-going support in operational research.)</li>
			</ul>
			</td>
		</tr>
	</tbody>
</table>

 
What we are looking for:

Successful proposals will include:

<ul>
	<li>A clear hypothesis underlying the proposed approach to improve immunization programs and/or improving the user experience of beneficiaries;</li>
	<li>Details on the design and pilot testing of the approach in their application, including proposed pilot location.</li>
	<li>A plan for evaluating the effectiveness of the approach for improved measurement of the immunization program and/or improving the user experience of beneficiaries;</li>
	<li>Outline of the design of the proposed approach/intervention; and,</li>
	<li>Innovations that involve building on, disrupting, or adapting existing systems. Successful proposals will describe how their approach would work within existing health systems or what change would need to occur within health systems for their approach to be effective.</li>
</ul>

Additionally, we will consider proposals in low-income countries that:

<ul>
	<li>Are based on human-centered design principles</li>
	<li>Utilize latest thinking in social, economic, and behavioral research</li>
	<li>Do not increase burden upon frontline health workers</li>
	<li>Minimize perverse incentives (including incentives for falsification)</li>
	<li>Are relevant in multiple developing country settings</li>
	<li>Constitute transformative rather than incremental improvements and are deliverable and scalable in low-income countries</li>
</ul>

We will not consider funding for:

<ul>
	<li>Innovative ideas without a clearly-articulated and testable approach;</li>
	<li>Approaches not directly relevant to low-income settings;</li>
	<li>Approaches reliant upon financial incentives;</li>
	<li>Solutions focused solely on SMS reminders;</li>
	<li>Approaches that rely on traditional information, education, communication approaches;</li>
	<li>Approaches that rely on traditional social mobilization approaches;</li>
	<li>Approaches for which proof-of-concept cannot be demonstrated within the scope of the GCE Phase 1 award ($100,000 over 18 months);</li>
	<li>Applications that can only be applied in a single country that are not broadly applicable in multiple countries;</li>
	<li>Approaches that present significant data safety risks (for mobile solutions, these risks must not be greater than the relative risk inherent in developed world mobile payment systems);</li>
	<li>Approaches which would require a donor's long-term financial support to sustain.</li>
</ul>

Increasing Demand for Vaccination Services (Round 23)

**NOTE: Although this challenge topic’s open date (October 15th) and close date (December 5th) differ from the other Round 22 GCE Grant Opportunities, grantees will still be a part of this round’s cohort.<h2>The Opportunity</h2>In order to identify and treat existing and emergent infectious disease efficiently, clinicians and the global health community must have access to accurate and timely estimates of disease burden and distribution. Traditionally, summaries of these data have been manually reported by national health ministries from regional clinical data, aggregated from local health centers. Local institutions, however, face multiple challenges to accurately assess the emerging needs of their community with current toolsets. For example, most clinical tests are based on common or easily detectable pathogens previously identified, which can miss occult and/or emerging pathogens. In addition, curation of large-scale pathogen data across multiple locations/platforms is time consuming and expensive, preventing facile integration of individual patient-level diagnostic data into a larger pathogen landscape on the regional and national level.Recent breakthroughs in pathogen sequencing technology - both at the hardware and software level - enable the combination of rapid deep sequencing of patient samples with subsequent sequence mapping to a custom, continuously updated reference database to provide near-real-time pathogen detection. Yet, these advancements alone have not been sufficient to provide metagenomic sequencing to patients in low- and middle-resource settings that could benefit the most, largely due to limitations in access or availability of the following essential components: a) expensive equipment/reagents, b) specialized biochemical training, c) accurate reference pathogen sequence databases, d) and advanced computational analytics.<h2>The Challenge</h2>Recognizing barriers for adoption of next-generation sequencing in global health, the Bill &amp; Melinda Gates Foundation has partnered with the Chan Zuckerberg Biohub and the Chan Zuckerberg Initiative to enable patients in low- and middle-resource settings to benefit from cutting-edge pathogen detection and discovery. This partnership will provide highly specialized training in biosample preparation and sequencing to technical staff from awardee global health centers. Trainees will learn to use the open-source, open-access <a href="http://www.idseq.net/" target="_blank">IDseq</a> software developed by CZ-Biohub for the global health community to upload and analyze patient sequencing data. The BMGF-CZ-Biohub partnership will therefore aim to provide selected applicants the benefits of onsite next generation sequencing and rapid pathogen detection to better understand their local pathogen landscape. We are specifically seeking projects that endeavor to build upon their initial locally-focused effort to contribute to future data-informed decision-making at the population level via data sharing and pathogen data comparison across sites.Through this GCE award, BMGF will support travel and accommodation of grantees for pilot analysis of samples from their home region during hands-on, intensive mentoring provided by the CZ-Biohub in San Francisco. This 2-week instructional period will include both biochemical sample preparation for sequencing and bioinformatic analysis using the IDseq software platform. Specifically, the hands-on training for bench scientists will include best practices and standards for sample processing, DNA &amp; RNA extraction, library preparation and data analysis on the Global IDseq software platform. Upon completion of training at CZ-Biohub, laboratory teams are expected to use the remaining GCE award primarily on the following items: 1) a sequencer<a href="#_ftn1" title="" id="_ftnref1" name="_ftnref1">[1]</a>,<a href="#_ftn2" title="" id="_ftnref2" name="_ftnref2">[2]</a> suitable for the global health environment, 2) a dedicated sequencing technician, and 3) sequencing reagents for the duration of the award. The combination of intensive training with molecular, capital equipment, reagent, and personnel support is intended to maximize the potential for sustainable, prospective, onsite analysis of patient samples upon return to the home site. A list of compatible sequencers appropriate for global health use is listed <a href="https://d1rjb0mbpus5s2.cloudfront.net/GCE+Compatible+Sequencers.pdf" target="_blank">here</a>.Molecular data generated at individual global sites is intended to be linked and automatically aggregated into IDseq for referencing by all participating clinics and associated sites. This method of local sequence analysis coupled with cross-site comparison could serve as a model for a process that would eventually lead to a network of pathogen detection nodes that could provide increased global transparency into regional pathogen distribution in an accurate and timely manner.Examples of insights could include:<ol><li>Deciphering unknown medical cases</li><li>Identification of new pathogens</li><li>Detection of local outbreaks</li><li>Characterization of the local pathogen landscape, including vector-borne diseases</li><li>Detection and classification of AMR Markers, with potential for insight into antibiotic treatment discordance</li><li>Data-informed healthcare and resource allocation</li></ol>We are specifically looking for sites that believe in collaborative approaches and data sharing. Grantees will be expected to partner closely with scientists and engineers and provide feedback to help guide the cloud computing software’s development. Sites will also be expected to share data and collaborate with other labs in the network.We will consider sites that:<ul><li>Provide a clearly scoped initial project that demonstrates why this technology will provide insights that are not currently possible.</li><li>Have space and capacity to run samples on a basic, globally rugged sequencer once provided with training, reagents, sequencer, and a dedicated computer.</li><li>Have consistent access to electricity and the ability to upload data via internet to a designated cloud server at least once a day.</li><li>Are willing to give product feedback and collaborate with an engineering team through scheduled video calls, email, or other messaging service.</li><li>Are committed to open science, preprints, and data sharing.</li><li>Already have, or can rapidly acquire, necessary IRB approval for pathogen DNA and RNA sequence sharing from patients.</li><li>Include neonatal and infant patients as a substantial fraction of overall sampling</li><li>Are representative of larger geographic regions</li></ul>We will not consider sites that:<ul><li>Do not articulate how they will leverage the value of next generation sequencing to impact health outcomes.</li><li>Are interested exclusively in Whole Genome Sequencing</li><li>Do not plan to share their pathogen data and discoveries.</li><li>Have extremely limited internet access.</li><li>Are limited to previously stored samples, without substantial potential for prospective sample collection.</li></ul>_____________________________________________<a href="#_ftnref1" title="" id="_ftn1" name="_ftn1">[1]</a> Recognizing that shipping costs and tariffs for the sequencer could significantly impair the intended impact of projects, grantees will be allowed to submit invoices for these costs to the foundation for reimbursement.<a href="#_ftnref2" title="" id="_ftn2" name="_ftn2">[2]</a> To ensure the sequencer continues to be used for purposes consistent with the foundation’s charitable objectives, we may request that funded applicants other than charities, universities, and similar organizations donate any sequencer purchased with grant funds to a charity or university, after the 18-month term of the project.

Application of Metagenomic Next Generation Sequencing to Detect and Identify Pathogens (Round 22)

<h2>The Opportunity</h2>

Immunization represents one of public health's most valuable and cost-effective interventions, and delivers positive health, social, and economic benefits. Globally, an estimated 2-3 million child deaths and 600,000 adult deaths are prevented by vaccination on an annual basis. Vaccination has been shown to contribute to improved childhood physical development, higher educational outcomes, reduced poverty and household spending, and enhances equity (Deogaonkar et al. 2015; Verguet et al 2013). Furthermore, the return on investment (ROI) of money invested in immunization programs is significant: recent research has demonstrated that every USD $1 invested in immunization results in at least USD $16 in net health and economic benefits; when accounting for the economic benefits of living longer, healthier lives, this figure increases to $44 of net benefit (Ozawa, et al, 2016). Despite these successes, considerable gaps remain in our ability to fully vaccinate all children. As health care systems - and immunization systems in particular - evolve, we see an increasing opportunity to take lessons learned from other sectors to improve the efficiency and effectiveness of vaccination systems.

Despite the documented benefits of vaccines and immunization, global immunization coverage continues to stagnate, and we are off-track to reach the 2020 targets for coverage and equity articulated by both the Global Vaccine Action Plan, as well as the Gavi Alliance. We believe that "demand-side" factors have an increasingly important role to play in helping accelerate progress.

<h2>The Challenge</h2>

Within this call to increase demand for vaccination services, and thus increase the number of children vaccinated globally, we are looking for innovative ideas in the following specific areas (please specify whether your concept applies to the first, or second challenge, or both):

<table>
	<tbody>
		<tr>
			<td>(1) Novel approaches for providing practical knowledge about vaccines and vaccination services to caregivers, which may include:

			<ul>
				<li>Familiarizing caregivers with information on where and when routine and/or campaign services are provided</li>
				<li>Educating caregivers about how many times a child should be vaccinated and the importance of timely vaccination. Please explain how a proposed intervention would very tactically increase the knowledge of when a child needs to be brought in for his or her first, subsequent, or campaign-related vaccination. (Suggestions may include helping caregivers plan for completing subsequent visits.)</li>
				<li>Addressing common concerns (multiple injections, post-vaccination discomfort) that may result in missed opportunities for vaccination</li>
				<li>Empowering caregivers to ask for full vaccination services</li>
			</ul>
			</td>
			<td>(2) Novel ideas for improving the convenience and/or caregiver seeking of vaccination services; these may focus on:
			<ul>
				<li>Approaches that use human-centered design to improve the convenience of accessing services from a caregiver perspective</li>
				<li>Approaches that minimize wait time for caregivers, such as scheduling appointments, providing information as to wait times, and/or providing information regarding stock availability (may be linked to electronic registries)</li>
				<li>Approaches that reduce the "cost" of seeking services (i.e., time, lost wages, transport cost, discordance with social norms, etc.) while increasing the "benefit" (appreciation of vaccines, integrated services.) (Please exclude direct monetary incentives)</li>
				<li>Approaches that provide a "nudge" for seeking vaccination services and translating intention into action. (Please do not submit proposals based on SMS reminders given their current emphasis/on-going support in operational research.)</li>
			</ul>
			</td>
		</tr>
	</tbody>
</table>

 
What we are looking for:

Successful proposals will include:

<ul>
	<li>A clear hypothesis underlying the proposed approach to improve immunization programs and/or improving the user experience of beneficiaries;</li>
	<li>Details on the design and pilot testing of the approach in their application;</li>
	<li>A plan for evaluating the effectiveness of the approach for improved measurement of the immunization program and/or improving the user experience of beneficiaries;</li>
	<li>Outline of the design of the proposed approach/intervention; and,</li>
	<li>Innovations that involve building on, disrupting, or adapting existing systems. Successful proposals will describe how their approach would work within existing health systems or what change would need to occur within health systems for their approach to be effective.</li>
</ul>

Additionally, we will consider proposals in low-income countries that:

<ul>
	<li>Are based on human-centered design principles</li>
	<li>Utilize latest thinking in social, economic, and behavioral research</li>
	<li>Do not increase burden upon frontline health workers</li>
	<li>Minimize perverse incentives (including incentives for falsification)</li>
	<li>Are relevant in multiple developing country settings</li>
	<li>Constitute transformative rather than incremental improvements and are deliverable and scalable in low-income countries</li>
</ul>

We will not consider funding for:

<ul>
	<li>Innovative ideas without a clearly-articulated and testable approach;</li>
	<li>Approaches not directly relevant to low-income settings;</li>
	<li>Approaches reliant upon financial incentives;</li>
	<li>Solutions focused on SMS reminders;</li>
	<li>Approaches that rely on traditional information, education, communication approaches;</li>
	<li>Approaches that rely on traditional social mobilization approaches;</li>
	<li>Approaches for which proof-of-concept cannot be demonstrated within the scope of the GCE Phase 1 award ($100,000 over 18 months);</li>
	<li>Applications that can only be applied in a single country that are not broadly applicable in multiple countries;</li>
	<li>Approaches that present significant data safety risks (for mobile solutions, these risks must not be greater than the relative risk inherent in developed world mobile payment systems);</li>
	<li>Approaches which would require a donor's long-term financial support to sustain.</li>
</ul>

Increasing Demand for Vaccination Services (Round 22)

This request for proposals represents a partnership between the Bill &amp; Melinda Gates Foundation, <a href="https://www.unicef.org/innovation/" target="_blank">UNICEF</a>, <a href="http://www.arm.com" target="_blank">Arm</a>, and <a href="https://aasciences.africa/" target="_blank">The African Academy of Sciences (AAS)</a>.&nbsp;African entrants located in African organizations should apply through the <a href="https://aasciences.africa/Funding" target="_blank">Grand Challenges Africa (a program of The AAS) portal</a>; entrants located throughout the rest of the world should apply through the Bill &amp; Melinda Gates Foundation portal. At The AAS, this request for proposals is funded in partnership with the <a href="https://www.sida.se/en" target="_blank">Swedish International Development Agency (SIDA)</a>.<h2>THE OPPORTUNITY</h2>While there are several dimensions of rapid urbanization that demand innovative solutions, we see the main area of need emerging in Water, Sanitation and Hygiene (WASH). Billions of people worldwide living in densely populated informal and/or low income urban settlements suffer from inadequate sanitation; 4.5 billion people lack access to sanitation altogether, with as many as one billion people worldwide defecating in the open, and an additional three billion using toilets from which the waste is not safely managed – meaning that either it is not safely contained or, once emptied, is not safely treated. Over sixty percent of the human waste that is collected in the developing world is discharged untreated into the environment.Clearly, there is a dire and pervasive need for awareness and information around: incidents of contamination, threats to delivery (e.g., from drought, heat waves, power outages), alternative approaches, emergency protocols, and overall monitoring of effectiveness and cost-effectiveness of the delivered service. Many solutions and delivery models already exist, and there is great opportunity to scale and redesign them to be effective in challenging urban contexts. Digital technology-based solutions can help bridge gaps and open doors – both online and on the ground – providing greater access to information, faster and more affordable communication, and expanded choices. For example, sensors placed strategically at different points in the value chain can collect and notify us of this type of information, whereas mapping platforms and ICT technologies can get that information to the right places for response and action.When deployed in the right way, emerging and existing technologies can be critical in shaping cities to be centers of liveability, productivity, opportunity, and growth for children and their communities. We know that cities are hubs of diversity, growth, and innovation, and they should provide boundless opportunities for young people to survive, thrive, learn, participate, integrate, and reach their full potential.<h2>THE CHALLENGE</h2>How can we find solutions to make it easier to access safe, clean water and sanitation services for the urban poor?We seek digital technology-based solutions that promote access to essential resources and services (clean water, sanitation) and can make a difference in reducing morbidity and mortality to promote healthy, safe, and productive lives. We know that technology does not automatically or inevitably improve people's lives; creative solutions must be contextually grounded and designed in response to on-the-ground needs of women, children, and families living in challenging urban environments.What We Are Looking For:Ideal solutions may target individuals, families, communities, urban planners, service providers, or WASH/ food infrastructure, networks, and systems. Solutions may include but are not limited to: services, models, or tools intended to improve overall access to WASH services and that apply a deeper understanding of our users' (customers/providers) needs when designing programs, services, and products/interventions. &nbsp;We seek solutions that are interactive, contextual, scalable, and relevant to WASH systems strengthening. We are specifically interested in work targeting: clean drinking water, household sanitation and hygiene, and urban pollution.Criteria for success include solutions that:<ul><li>Provide data/evidence for effective solutions that 1) reduce the barrier to entry, 2) verify performance of municipal water or sanitation utilities, and 3) improve service delivery</li><li>Broaden the toolkit of local solutions for urban areas to encourage municipalities, utility companies, and entrepreneurs to participate in creating and expanding access to services</li><li>Develop a system that integrates with monitoring systems (i.e., community health, water quality, etc.)</li><li>Have the potential to build on existing Public-Private or Public-Academic Partnerships, which will be essential to achieve results at scale</li><li>Are cost effective</li></ul>Potential solutions may respond to questions around how we might:<ul><li>Monitor the level of environmental contamination, bacteriological contamination, or service failure across urban contexts and map trends in real-time</li><li>Create new ways to collect, recycle, and dispose of domestic human waste and improve access to adequate services that ultimately lead to safely treated waste</li><li>Connect low-income urban settlement populations with reliable and affordable sanitation service delivery models, including monitoring systems</li><li>Set up remote operation and maintenance of existing urban WASH assets</li><li>Establish awareness programming to improve understanding of sanitation-related risks amongst dwellers in low income urban settlements</li><li>Integrate hygiene promotion programs with urban activities (such as marketplaces, schools, etc.)</li><li>Monitor sanitation infrastructure construction and conditions (latrines, wells, treatment systems, etc.)</li><li>Design monitoring and incentive models to increase compliance with regulatory requirements within decentralized or distributed treat/pre-treatment systems</li><li>Conduct groundwater mapping in affected drought areas</li><li>Fill the data gap on measuring the proportion of waste emptied from pits and septic tanks and taken to treatment, including:<ul><li>Tracking service providers (e.g., vacuum trucks, hand carts) from household to disposal site</li><li>Measuring sludge volumes delivered to treatment sites</li><li>Quantifying solids contents of sludge delivered to treatment plants</li><li>Quantifying treatment efficiency of fecal sludge treatment plants ("effective treatment")</li></ul></li></ul>Examples of types of solutions we want:<ul><li>Technologies that help improve or strengthen WASH quality, accessibility, delivery, distribution, and awareness and will support the most vulnerable children living in cities</li><li>Tools/platforms that connect urban communities with the tools, services, and relationships they need to measure, alert, organize, and respond to specific urban concerns</li><li>Tech-enabled tools that expand urban planning and policy processes (specifically those related to WASH concerns) to include vulnerable populations, especially youth</li><li>Generative data collection + analysis methodologies to improve our sense of what specific WASH problems exist where and for whom</li><li>Solutions may involve deepening understanding (moving towards proof of concept), and/or experimentation, and/or evaluating promising ongoing programs</li><li>New solutions for influencing people to behave differently in relationship to their hygiene (preventative and treatment seeking)</li><li>Solutions may target gaps in knowledge, gaps in delivery systems to meet demand for care, or bottlenecks blocking those with knowledge and demand from seeking services (access, cost, stigma, taboos, distance, etc.)</li></ul>We hope to see work that recognizes contextual constraints:<table><tbody><tr><td>Social/Cultural Constraints</td><td>High linguistic diversity Low digital and basic literacy rates Low involvement of vulnerable populations in planning and design processes</td></tr><tr><td>Political Constraints</td><td>Possibility of prohibitive security concerns Complexity of political systems can be hard to manage; need adequately designed policy frameworks</td></tr><tr><td>Economic Constraints</td><td>Unequal and limited access to financial and banking systems Budget uncertainty (for sustained operations) can be high when costs per person need to be low</td></tr><tr><td>Environmental Constraints</td><td>Harsh environmental conditions are the norm in many vulnerable urban areas (e.g., earthquake risk, extreme heat and wind, highly polluted/toxic conditions) Higher intensity and frequency of natural hazards</td></tr><tr><td>Infrastructural and Technical Constraints</td><td>Brittle mobile cellular networks <a href="http://reports.weforum.org/global-risks-2015/part-2-risks-in-focus/2-3-city-limits-the-risks-of-rapid-and-unplanned-urbanization-in-developing-countries/" target="_blank">(WEF Global Risks Report</a>) Insufficient ICT infrastructure, systems, platforms, and standards Low prevalence of mobile data plans</td></tr></tbody></table>&nbsp;For more details please read the constraints section in the use case handbook UNICEF's Office of innovation developed on <a href="https://www.unicef.org/innovation/urbanization" target="_blank">Innovating for children in an urbanizing world.</a>Priority consideration will be given to solutions that:<ul><li>Address current inequities in access to WASH needs</li><li>Prioritize marginalized populations, considering specifically those marginalized by their physical/intellectual disability, economic status, race, ethnicity, religion, age, marital status, gender, caste, sexuality, profession, location, literacy or lack thereof, and access to media and communications</li><li>Address a diverse geographic range of urban environments (we hope to select solutions from different regions)</li><li>Consider UNICEF Office of Innovation's Design Principles:<ul><li>Design with the User</li><li>Understand the existing ecosystem</li><li>Design for scale</li><li>Build for sustainability</li><li>Be data driven</li><li>Use open standards, open data, open source, open innovation (*if/where possible)</li><li>Reuse and improve</li><li>Do no harm</li><li>Be collaborative</li></ul></li></ul>To be considered, ideas must constitute transformative rather than incremental improvements in urban water and sanitation solutions and be low cost. We define low cost as interventions targeted for populations with individuals living on less than $1 per day, deliverable, and scalable in low- and middle-income countries. Proposals must (i) have a testable hypothesis, (ii) include an associated plan for how the idea would be tested or validated, and (iii) yield interpretable and unambiguous data in Phase I, in order to be considered for Phase II funding.Geographic considerations:We will prioritize selection of ideas that addresses WASH challenges in urban environments where all partners supporting this call actively work.&nbsp;This includes prioritizing WASH interventions in countries with high burden of open defecation and areas of substantial momentum in sanitation service delivery.&nbsp;For urban WASH, focus areas should support low income urban settlements, small towns, cities under protracted conflict, and cholera hotspots.We will not consider funding for:<ul><li>Ideas that are not directly relevant to low and middle-income countries</li><li>Projects that don't clearly consider the current context of available services/systems</li><li>Ideas that simply translate traditional approaches to an ICT platform (mobile, tablet, or web-based tools and aids)</li><li>Interventions that require our long-term financial support</li><li>Educational programs or campaigns without clearly articulated, measurable behavior outcomes or the ability to be taken to scale</li><li>Ideas for which proof of concept cannot be demonstrated within the scope of the Phase 1 award ($100k over 18 months)</li><li>Approaches that repeat conventional solutions without novel application</li><li>Basic research not directly linked to Urban WASH or measurable outcomes and focused purely on research tools for researchers and implementers</li><li>Ideas that do not address at least one of these specific areas: infrastructure interventions, education, campaigns, and models and tools to improve overall access to WASH needs that also apply a deeper understanding of our users' (customers/providers) needs when designing programs, services, and products/interventions</li><li>Approaches that present unacceptable ethical or safety risks</li><li>Projects earmarking foundation funds for lobbying activity (e.g., attempts to influence legislation or legislative action) or efforts to influence political campaigns for public office</li></ul>