AMRH Partnership Platform

Expression of interest to join the AMRH Partnership Platform

TYPE OF ORGANISATION

Please Note: Unless extraordinary circumstances exist, Individual companies and independent consultants are normally not eligible for Partnership Status. We recommend you first contact AMRH before further filling out this form to confirm qualification criteria.

NAME OF THE ORGANISATION

NAME OF THE NOMINATED REPRESENTATIVE IN THE ORGANISATION

POSITION OF THE NOMINATED REPRESENTATIVE

CONTACT DETAILS

PHONE

ORGANISATION PHONE

ORGANISATION EMAIL

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SELECT AREAS OF INTEREST

Activity Area	Years of Experience
Regulatory Systems	Years of Regulatory Systems
MA & Registration	Years of Experience in MA & Registration
GMP / Regulatory Inspections	Years of Experience in Regulatory Systems
Vigilance	Years of Experience in Regulatory Systems
Market Surveillance and Control/Lab Access & Testing	Years of Experience in Regulatory Systems
Clinical Trials & Oversight	Years of Experience in Regulatory Systems
Medical Devices and Diagnostics	Years of Experience in Regulatory Systems
Blood and Blood Products	Years of Experience in Regulatory Systems
IMS (Information Management System)	Years of Experience in Regulatory Systems
QMS (Quality Management System)	Years of Experience in Regulatory Systems
General Support/HR	Years of Experience in Regulatory Systems
Governance	Years of Experience in Regulatory Systems
Financing	Years of Experience in Regulatory Systems
Other (Specify and Explain)	Years of Experience in Regulatory Systems
Other - Areas of interests Title Explanation

SELECT TYPE OF SUPPORT

Other - Technical Assistance

Title for other technical assistance

Explain the type

Other - Financial Support

Title for other financial support

Explain the type

Other - Policy/Political Advocacy

Title for other policy/political advocacy

Explain the type

For Other

Title for other type of support

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SUMMARY OF PAST ACTIVITIES

YEAR THE ORGANISATION BECAME ACTIVE IN REGULATORY SYSTEM STRENGTHENING PROGRAMMES

ORGANISATION’S PROJECT EXPERIENCE

S.No	Country	Activity Area	Type Of Support	Year From	Year To

PROVIDE A SUMMARY OF HOW YOUR ORGANISATION CAN ASSIST AS PARTNER (Max 1,000 Characters)

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EXPERIENCE - 1 Organisation Past Projects & Experience COUNTRY AFRICA SADC Angola Botswana Comoros Democratic Republic of the Congo Eswatini (Swaziland) Lesotho Madagascar Malawi Mauritius Mozambique Namibia Seychelles South Africa Zambia Zimbabwe IGAD Djibouti Eritrea Ethiopia Somalia Sudan AMU / CEN-SAD Algeria Egypt Libya Mauritania Morocco Tunisia Western Sahara EAC Uganda Burundi Kenya Rwanda South Sudan Tanzania Zanzibar ECCAS / OCEAC Cameroon Central African Republic Chad Equatorial Guinea Gabon Republic of the Congo Sao Tome and Principe ECOWAS / WAHO Liberia Mali Niger Nigeria Senegal Sierra Leone Togo Guinea Guinea-Bissau Ghana Gambia Benin Burkina Faso Cape Verde Cote d'Ivoire Activity Area Regulatory Systems MA & Registration GMP / Regulatory Inspections Vigilance Market Surveillance and Control/Lab Access & Testing Clinical Trials & Oversight Medical Devices and Diagnostics Blood and Blood Products IMS (Information Management System) QMS (Quality Management System) General Support/HR Governance Financing Other (Specify and Explain) For other activity area Title Explanation SELECT TYPE OF SUPPORT Technical Assistance Additional HR (On-site) Additional HR (Remote) Coaching (On-site) Coaching (Remote) Training (On-site) Training (Remote) Twinning Other Financial Support In-Kind Other Loan Cash Policy/Political Advocacy Guideline/Specification Support Policy Briefs Policy Development Political Advocacy Other Other Other Other - Technical Assistance - project experience Title for other technical assistance Explain the type Other - Financial Support - project experience Title for other financial support Explain the type Other - Policy/Political Advocacy - project experience Title for other policy/political advocacy Explain the type For Other project experience Title for other type of support Explain the type Year From Year From: Year Year To Year To: Year Partnership Applicant Organisation Project Contact Contact Email Contact Phone Regulatory Authority Project Contact Contact Email Contact Phone Description Save
EXPERIENCE - 2 Organisation Past Projects & Experience COUNTRY AFRICA SADC Angola Botswana Comoros Democratic Republic of the Congo Eswatini (Swaziland) Lesotho Madagascar Malawi Mauritius Mozambique Namibia Seychelles South Africa Zambia Zimbabwe IGAD Djibouti Eritrea Ethiopia Somalia Sudan AMU / CEN-SAD Algeria Egypt Libya Mauritania Morocco Tunisia Western Sahara EAC Uganda Burundi Kenya Rwanda South Sudan Tanzania Zanzibar ECCAS / OCEAC Cameroon Central African Republic Chad Equatorial Guinea Gabon Republic of the Congo Sao Tome and Principe ECOWAS / WAHO Liberia Mali Niger Nigeria Senegal Sierra Leone Togo Guinea Guinea-Bissau Ghana Gambia Benin Burkina Faso Cape Verde Cote d'Ivoire Activity Area Regulatory Systems MA & Registration GMP / Regulatory Inspections Vigilance Market Surveillance and Control/Lab Access & Testing Clinical Trials & Oversight Medical Devices and Diagnostics Blood and Blood Products IMS (Information Management System) QMS (Quality Management System) General Support/HR Governance Financing Other (Specify and Explain) For other activity area Title Explanation SELECT TYPE OF SUPPORT Technical Assistance Additional HR (On-site) Additional HR (Remote) Coaching (On-site) Coaching (Remote) Training (On-site) Training (Remote) Twinning Other Financial Support In-Kind Other Loan Cash Policy/Political Advocacy Guideline/Specification Support Policy Briefs Policy Development Political Advocacy Other Other Other Other - Technical Assistance - project experience Title for other technical assistance Explain the type Other - Financial Support - project experience Title for other financial support Explain the type Other - Policy/Political Advocacy - project experience Title for other policy/political advocacy Explain the type For Other project experience Title for other type of support Explain the type Year From Year From: Year Year To Year To: Year Partnership Applicant Organisation Project Contact Contact Email Contact Phone Regulatory Authority Project Contact Contact Email Contact Phone Description Save
EXPERIENCE - 3 Organisation Past Projects & Experience COUNTRY AFRICA SADC Angola Botswana Comoros Democratic Republic of the Congo Eswatini (Swaziland) Lesotho Madagascar Malawi Mauritius Mozambique Namibia Seychelles South Africa Zambia Zimbabwe IGAD Djibouti Eritrea Ethiopia Somalia Sudan AMU / CEN-SAD Algeria Egypt Libya Mauritania Morocco Tunisia Western Sahara EAC Uganda Burundi Kenya Rwanda South Sudan Tanzania Zanzibar ECCAS / OCEAC Cameroon Central African Republic Chad Equatorial Guinea Gabon Republic of the Congo Sao Tome and Principe ECOWAS / WAHO Liberia Mali Niger Nigeria Senegal Sierra Leone Togo Guinea Guinea-Bissau Ghana Gambia Benin Burkina Faso Cape Verde Cote d'Ivoire Activity Area Regulatory Systems MA & Registration GMP / Regulatory Inspections Vigilance Market Surveillance and Control/Lab Access & Testing Clinical Trials & Oversight Medical Devices and Diagnostics Blood and Blood Products IMS (Information Management System) QMS (Quality Management System) General Support/HR Governance Financing Other (Specify and Explain) For other activity area Title Explanation SELECT TYPE OF SUPPORT Technical Assistance Additional HR (On-site) Additional HR (Remote) Coaching (On-site) Coaching (Remote) Training (On-site) Training (Remote) Twinning Other Financial Support In-Kind Other Loan Cash Policy/Political Advocacy Guideline/Specification Support Policy Briefs Policy Development Political Advocacy Other Other Other Other - Technical Assistance - project experience Title for other technical assistance Explain the type Other - Financial Support - project experience Title for other financial support Explain the type Other - Policy/Political Advocacy - project experience Title for other policy/political advocacy Explain the type For Other project experience Title for other type of support Explain the type Year From Year From: Year Year To Year To: Year Partnership Applicant Organisation Project Contact Contact Email Contact Phone Regulatory Authority Project Contact Contact Email Contact Phone Description Save
EXPERIENCE - 4 Organisation Past Projects & Experience COUNTRY AFRICA SADC Angola Botswana Comoros Democratic Republic of the Congo Eswatini (Swaziland) Lesotho Madagascar Malawi Mauritius Mozambique Namibia Seychelles South Africa Zambia Zimbabwe IGAD Djibouti Eritrea Ethiopia Somalia Sudan AMU / CEN-SAD Algeria Egypt Libya Mauritania Morocco Tunisia Western Sahara EAC Uganda Burundi Kenya Rwanda South Sudan Tanzania Zanzibar ECCAS / OCEAC Cameroon Central African Republic Chad Equatorial Guinea Gabon Republic of the Congo Sao Tome and Principe ECOWAS / WAHO Liberia Mali Niger Nigeria Senegal Sierra Leone Togo Guinea Guinea-Bissau Ghana Gambia Benin Burkina Faso Cape Verde Cote d'Ivoire Activity Area Regulatory Systems MA & Registration GMP / Regulatory Inspections Vigilance Market Surveillance and Control/Lab Access & Testing Clinical Trials & Oversight Medical Devices and Diagnostics Blood and Blood Products IMS (Information Management System) QMS (Quality Management System) General Support/HR Governance Financing Other (Specify and Explain) For other activity area Title Explanation SELECT TYPE OF SUPPORT Technical Assistance Additional HR (On-site) Additional HR (Remote) Coaching (On-site) Coaching (Remote) Training (On-site) Training (Remote) Twinning Other Financial Support In-Kind Other Loan Cash Policy/Political Advocacy Guideline/Specification Support Policy Briefs Policy Development Political Advocacy Other Other Other Other - Technical Assistance - project experience Title for other technical assistance Explain the type Other - Financial Support - project experience Title for other financial support Explain the type Other - Policy/Political Advocacy - project experience Title for other policy/political advocacy Explain the type For Other project experience Title for other type of support Explain the type Year From Year From: Year Year To Year To: Year Partnership Applicant Organisation Project Contact Contact Email Contact Phone Regulatory Authority Project Contact Contact Email Contact Phone Description Save
EXPERIENCE - 5 Organisation Past Projects & Experience COUNTRY AFRICA SADC Angola Botswana Comoros Democratic Republic of the Congo Eswatini (Swaziland) Lesotho Madagascar Malawi Mauritius Mozambique Namibia Seychelles South Africa Zambia Zimbabwe IGAD Djibouti Eritrea Ethiopia Somalia Sudan AMU / CEN-SAD Algeria Egypt Libya Mauritania Morocco Tunisia Western Sahara EAC Uganda Burundi Kenya Rwanda South Sudan Tanzania Zanzibar ECCAS / OCEAC Cameroon Central African Republic Chad Equatorial Guinea Gabon Republic of the Congo Sao Tome and Principe ECOWAS / WAHO Liberia Mali Niger Nigeria Senegal Sierra Leone Togo Guinea Guinea-Bissau Ghana Gambia Benin Burkina Faso Cape Verde Cote d'Ivoire Activity Area Regulatory Systems MA & Registration GMP / Regulatory Inspections Vigilance Market Surveillance and Control/Lab Access & Testing Clinical Trials & Oversight Medical Devices and Diagnostics Blood and Blood Products IMS (Information Management System) QMS (Quality Management System) General Support/HR Governance Financing Other (Specify and Explain) For other activity area Title Explanation SELECT TYPE OF SUPPORT Technical Assistance Additional HR (On-site) Additional HR (Remote) Coaching (On-site) Coaching (Remote) Training (On-site) Training (Remote) Twinning Other Financial Support In-Kind Other Loan Cash Policy/Political Advocacy Guideline/Specification Support Policy Briefs Policy Development Political Advocacy Other Other Other Other - Technical Assistance - project experience Title for other technical assistance Explain the type Other - Financial Support - project experience Title for other financial support Explain the type Other - Policy/Political Advocacy - project experience Title for other policy/political advocacy Explain the type For Other project experience Title for other type of support Explain the type Year From Year From: Year Year To Year To: Year Partnership Applicant Organisation Project Contact Contact Email Contact Phone Regulatory Authority Project Contact Contact Email Contact Phone Description Save

Expression of interest to join the AMRH Partnership Platform

ORGANISATION’S PROJECT EXPERIENCE

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