To,

Juhi Gupta
CSR Head
Pepsico India Pvt. Ltd.
Level 3-6, Pioneer Square, Sec –
62, Near Golf Course Extension
Road Gurgaon, Haryana - 122002

Subject: Submission of the project proposal for financial assistance from Pepsico India
Pvt. Ltd for running 1 Mobile Health Van Unit to cover villages of Badaun &
Rampur Districts, Uttar Pradesh.”

Respected Sir,
May we have your kind attention that our organization UNITED VIKAS SAMITI is registered
Societies Registration Act, Sec-21 of 1860 bearing registration No.829 of 1995-96-dated-
o8/03/1996 and working for empowering and development of the Poor to promote development
as a liberating force for achieving social justice, economic growth and self-reliance? Our
organization wants to run one Mobile Health Van Unit to cover villages of Badaun & Rampur
Districts, Uttar Pradesh. I have read all the terms & conditions of the aforesaid scheme &
undertake to abide by the rules and regulations. I humbly request your good self for approval and
financial sanction.

Thanking you,
YoursFaithfully,
Farah Ikram
Chairperson

1
 PROJECT PROPOSAL
FOR
Running Mobile Health Van Unit
For
Villages of Badaun &
Rampur Districts of
Uttar Pradesh

SUBMITTED BY
United Vikas Samiti
Village-Midoli Mirzapur, Po-Ramzanpur, Dist-Badaun, PIN-246301,

Uttar Pradesh

CONTACT NO. : 9012884185

 ABOUT
PROJECT
1. Title of the Running one mobile health van unit in Villages
proposed project of Badaun & Rampur Districts, Uttar Pradesh.

2. Objectives of the  To provide accessibility to quality preventive and

proposed project
promote primary health care service across the target
villages
 To bring positive health seeking behavior in
community by creating awareness
 To establish convergence with stake holders in the
primary health care delivery in the villages.
Any other work assigned by the project as per local
requirement

4. Who are direct Direct beneficiaries will be the poor, local people of
beneficiaries with approx.
community living in the villages of Badaun & Rampur
number
Districts, Uttar Pradesh.
5. Project location Districts -
Badaun &
Rampur ,
State – Uttar Pradesh
6. Total Project Cost Rs. 71,88000/-
7. Support required from Rs. 71,88000/-
Pepsico India Pvt. Ltd.
8. Proposed Project Duration 12 Months

3
 ABOUT
ORGANIZATION/AGENCY
Name & registered address of UNITED VIKAS SAMITI
implementing agency:
Reg Add: Village-Midoli
Mirzapur, Po- Ramzanpur, Dist-
Badaun ,
PIN-246301, Uttar Pradesh
Legal status of agency and date of Registration Number: 829/1995-96 (Renewal
Registration N0:-R/BUD/19189/2020-21
Pan Number : AAATU2223K
Contact details (office Mob :-9012884185
no., mobile no. and e- Email :
mail)

ORGANIZATION
DETAILS

1. Brief description of the organization/ agency

United Vikas Samiti was established in 1995 by a group of Educationists

with rural background and are interested in the field of Health, Education,
Humanitarian and Rural development services. It was registered as Society under
Societies registration Act 1860. United Vikas Samiti was created to work
exclusively in the Backward and rural areas of Badaun & Rampur Districts in Uttar
Pradesh, with a

special focus to help poor and Backward communities to overcome poverty and to
get sustainability with good living standards. It has been an uphill battle for The
Society, confronting the social, economic and political realities within which the NGO
 sector is operating. However, given these limitations, United Vikas Samiti has been
attempting to explore various possibilities especially by providing Education, in
becoming more relevant to the needs of the disadvantaged poor in Badaun & Rampur
and its neighboring Districts in Uttar Pradesh.

1. Mission/Vision and Objectives of the Organization/Agency.

Mission
Train And Empower The Underserved

United Vikas Samiti is to deploy best possible methodology and technology for
achieving ideal SROI (social return on investment), to practice and promote good
governance. To link business competitiveness of the corporate with social development
initiatives; also to sensitize privileged children, youth and citizens in general to promote
Civic Driven Change.
Vision
Transforming Lives
United Vikas Samiti works with and for children, women, families and the community to
bring a permanent change in the lives of the underprivileged in terms of education, basic
hygiene and rights, with the belief that all human beings are equal and have the right to
equal opportunity.
OBJECTIVES:

Our organization is strived to raise the human and other resources to achieve the following
objectives:

-To promote the concept of National integrity, particularly the unity and integrity of all
Castes, Communities and Religions

5
 -To establish Educational and other allied institutions to impart education at all stages for the
benefit of the youngsters- The Minority communities’ in particular, in National interest. -To
establish training institutes to promote awareness through programs like Computer
education, Industrial /Vocational Training and skill development.
- To conduct health awareness programs on health and hygiene, family planning, prevention
of AIDS, Eradication of Leprosy, Tuberculosis, Hepatitis-B, Polio and other deceases.
-To establish Hospitals, Primary Health Care Centers in the Backward, Rural and Tribal areas.
-To establish shelters for children and women for the deserving poor orphaned children,
Destitute and neglected are kept in the homes for the children, widows, divorcees, untreated
parents, neglected women are kept in care centers, where they will have the vocational
training also.

-To work for the welfare of the weaker sections in general and the Schedule Castes and
Tribes in particular.
-To develop the rural villages for poorest and weaker sections, community development and
elimination of un-touch ability and support to improve culture in the backward villages.

More objects are attached in Bye laws.

1. Financial status of the organization in last 3 years

3
Year Assets & Income & Receipt & Payment
Liabilities Expenditure

2018-19
AUDIT
2019-20 ATTACHED

2020-21

1. Details of similar projects ongoing/completed by the organization/agency in previous

4
three years/ List of projects undertaken in last three years.
 SKILL DEVELOPMENT & AWARENESS PROGRAMM
 WOMEN RIGHTS, SHG & EMPOWERMENT
 INNOVATIVE DIGITAL EDUCATION PROGRAM

6
  TAILORING TRAINING PROGRAM
 ENVIRONMENT CONVERSATION PROGRAM
 MICRO-SMALL
Details & MEDIUM
of the proposed CSR project ENTERPRISES
to be undertaken by your organization
 CARE FOR AGED
UNITED VIKAS SAMITI has been in the target area for last many years. It is now felt
that community health program to be continued through local community based
1. Details of previous support received from PEPSICO INDIA PRIVATE LIMITED.
5 organizations. This will facilitate in strengthening community participation and higher
N/A
level of acceptance of basic health care services. Continuation of community health care
is the primary step towards sustainability of community health.
1. Whether affiliated to National Skill Development Corporation (NSDC)? (If
6 UNITED
yes VIKAS
the details SAMITY with the support of PEPSICO LIMITED,
thereof)
Proposes to introduce this project for providing Primary Health Care facilities by means
N/A
of operationalize 01 Mobile Wellness Unit/ Mobile Health van in Villages of Badaun &
(DOCCUMENTS ATTACHED)
Rampur Districts of Uttar Pradesh.
1. The list of current trustees / governing body members with their addresses,
7
Designation, experience and qualification.
The Mobile Wellness Units will be fabricated on a four-wheeler, customized as per the
terrain suitability; equipped with the state-of-the-art medical equipments for Point of Care
S. Name Address Designation Qualification
Tests (POCT), medicine services, audio visual equipment, one ventilator and
No.
Manned by a MBBS Doctor as Medical Officer, Pharmacist and Lab Technician.
ATTACHED IN SEARATE SHEET

8
PROJECT DETAILS
 Services that will be provided by the Mobile Wellness Unit; (i) Mobile OPD (ii)
Specialized Health Camp and (iii) Awareness on Health & Hygiene. The Mobile
Wellness Unit will reach the selected villages on a routine basis to provide free OPD
services like Consultation, conducting Point of Care Testing (POCT), Medicine
prescription and distribution.
Apart from the general OPD’s conducted through the MWU, emphasis will be given to
organize health camps as per the disease prevalence in the locality; by specialist doctors.
As an added service, in order to advice the community about prevailing health issues, its
prevention and care measures; promote healthy living habits and other health education
related videos will be screened in the villages.

2.2 Brief on Goals and objectives of the project

Providing Access to Primary Healthcare Services in villages of Badaun & Rampur

Districts
1. To operationalize Mobile Wellness Unit (MWU)/ Mobile Health Van for
better access to primary health care services.
2. To make primary healthcare services available at the doorstep; who are
deprived of such facilities; diagnosis, medication and other curative
services for common illnesses, early detection of TB, Malaria, and other
locally endemic diseases; hypertension, diabetes and cataract cases, first
aid, antenatal and postnatal care, immunization services, counseling on
HIV/AIDS, personal hygiene, environmental sanitation, nutritional
education and other health related IEC activities.
3. To organize specialized health camp on area specific endemic, general health
check-up, dermatology and gynecological issues.
4. To create awareness on Health & Hygiene; cleanliness drive.

2.3 Brief about the Location and Area of the Project.

9
 Badaun & Rampur Districts has a population of 12,193,590, roughly equal to the
nation of Latvia [14] or the US state of New Mexico. This gives it a ranking of 209th
in India (out of a total of 640). The Districts has a population density of 831
inhabitants per square kilometer (2,150/sq mi). Its population growth rate over the
decade 2001-2011 was 11.16%. Badaun & Rampur has a sex ratio of 913 females for
every 1000 males, and a literacy rate of 82.4%.

2.5 Brief about the targeted beneficiaries under proposed CSR project

The beneficiaries that would be target in this project will be the underprivileged people,
illiterate people, women, Children, and other community people living in nearby villages
of Badaun & Rampur Districts.
Special focus will also be given on providing public health information to the villages by
their own members, in their own language, in their local center, at a time where the
numbers is maximum. This will give the greatest impact of the project.

2.6 Methodology of the selection of the beneficiaries and number of beneficiaries

in detail

Beneficiaries are selected considering their access to basic health services from the
villages & Field Observation Report of United Vikas Samiti. Physical accessibility to
health facilities and vulnerability; Population of the villages who lack basic service
availability; Quality & Quantity, Villages, that are located at a distance of about 15 kms
from Block Headquarters and highly populated, Villages having Scheduled Caste
/Tribe population mostly; Villages far from health facilities; Villages where % of
prevalence of anemia & nutritional deficiencies among children & mothers have been
reported.
Preference will be given to any such specific hamlet or community having person with
disabilities, destitute women, children, small and marginal farmers, landless
labours etc. Any particular group in the village; Children below five years and their

11
 mothers. Local decision-making process shall be taken into account in consultation with
the village representatives.

2.7 Details about physical and social milestones/deliverables to be achieved

through the proposed CSR project

Milestones Strategy Outcome

Set up of Project
Office, Team
Appointment Database on socio,
 Project Office Set up
(Programme economic and health
 Baseline Survey &
 Village Health Manager, condition of the people
Profiling Report Medical Officer, in the target location.
Lab Technician, Identification of the
Pharmacist, villages, specific health
Account & needs and related
Admin Officer), expenditure, current
Training of the coping mechanism
team members, available in the villages.
Field Visit;
Establish
Rapport with the
Panchayat, SHG
Leaders, ASHA,
AWW, ANM,
PHSC
Staff &
Conducting
Baseline
Survey/Need
Assessment.

Organizing
Household
Wise Village
Health
Profiling &
blood Grouping

12
 Sharing of the
health status
respective
person
Work plan
development &
sharing

Improved access to Primary

Health Care Services in the
focused region.

Mobile OPD - 01 per day

by 01 Health van unit -
minimum 20 working
days in a month;
About 50patients per
Procurement, Procurement & day will be benefited by
Fabrication of
Fabrication of the Mobile OPDs;
Vehicle &
Operationalization Vehicle, Trial About 50 patients per day
01 Mobile Wellness Run, will be screened by the
Units Inauguration, Lab Service.
Conducting
Mobile OPD, Specialized Camp - 01
Awareness in a quarter;
Programme on  About 100 people
Health & will be benefited.
Hygiene and
Specialized
Health Camp

Awareness Camp
Community Health - 02 in
a quarter;

13
 About 100 people will
be benefited.

CHVs will be
identified; Need & demand of essential
health services in the
trained, villages are met.
equipped,
supported to take
up
Training of essential
community
health services,
10 Community enhance access
to health services
and
Health Volunteers promote people’s
trust, demand
and
(CHVs) use of Mobile
Wellness Unit
services.
CHVs will be
facilitated by the
project
through
community level
meetings.

14
2.8 Detail timeline/duration of the proposed project
Proposed Months
Activities 1 2 3 4 5 6 7 8 9 10 11 12
Baseline Survey
Setting up of Project Office &
Project Team
Recruitment
Team Formation & Orientation
Rapport Formation in the
Villages, Health
Profiling & Blood Grouping of
beneficiaries
Sharing Reports & Work Plan
Information
Information Sharing about
project with State,
Districts & Local
Officials; PHC Staff,
Village & GPU
Procurement & Fabrication of
vehicle & other
related equipment
Fixation of MWU halting spots
at villages
Finalization of root map for
MMUs functioning
Trial run of MWUs for
assessment of time &
duration
Draft SOPs for MWU
Operations & KRA of team
Functioning of MWUs covering
all the project
locations & Conducting
Mobile OPD, Awareness
Campaign/ Need Based
Specialized Health Camp
Showing films / material on
various aspects
related to water, sanitation
and personal hygiene

15
 Preparation of IEC material &
communication
strategy for information
dissemination
Identifying Community Health
Volunteers (CHVs)
Training & Involvement of
Community Health
Volunteers (CHV)
Regular follow-up with
community for assessing
behavior change
Training / Capacity Building of
Team
Quarterly Activity Report
Submission
Annual Activity Report
Submission
Impact Assessment

2.9 Budget estimate of the project with detailed budget break-up of each expenditure
head along with documents proving rate reasonability.

ANNEXURE “A”
2.10 What is the monitoring mechanism for the project as far as project activities
and benefits to the beneficiaries are concern?

- Continuous monitoring by organizing a Project Management Unit (PMU) with

stakeholder from community, United Vikas Samiti and Donor Agency;
- Project Performance & Achievement Indicators will be identified;
- MIS will be developed to collect information and generate activity reports;
- Period activity and audited utilization reports will be shared with DONOR
AGENCY;
- Corrective action on any deviation in the performance will be taken;
- Joint Field visits and inspections by DONOR AGENCY and the
Society professionals;
- Annual report with all documentation, case studies, and success stories,

16
 qualitative and quantitative output shall be compiled and shared with DONOR
AGENCY.
- Updating the progress of the project regularly on social media platform;
- Final impact evaluation can be done by an independent third party;
- Independent third-party evaluation will be set-up in consultation with DONOR
AGENCY.

2.12
How sustainability of the project is planned to be ensured?

 Establishing networks with health care providers, government, non-govt

organization and community-based organization; Follow up with DONOR
AGENCY and other such funding partners for continuation of the project;
 United Vikas Samiti may extend its support for three months with community
volunteers and other interested stakeholders of the project; formation of
community-based committees to participate actively in all relevant activities;
 Promoting the Community Health Volunteers for assuming the responsibility of
providing essential health services.

2.13 Matrix to measure the output of the Project.

Output Measurable Matrix Beneficiaries

Improved access to
Primary Health Care
# Patient attended MOPD
Services in the focused
# Patient Registered
region.
Mobile OPD - 01 per day by # Patient received Around 64496
01 Mobile Health Van Unit - Doctor Consultation people will be
minimum 20 working days benefited;
in a month;

17

About 50 patients per day
will be benefited by
the Mobile OPDs;
About 50 patients per
day will be screened by
the Lab Service.
Specialized Camp - 01 in a
quarter;
About 100 people will
be benefited.
Awareness Camp
Community Health - 02 in
a quarter;
ple will be benefited.
o
About 10 Community
Health Volunteers are
trained to satisfy the need
& demand of essential
health services.
# Patient availed Lab Service General
# Illness incidence reported # population,
Patient received Medicine Below Poverty
facilities Line,
Scheduled
# People have access to Caste, Women,
different health care Children and
interventions village wise Person with
Disabilities
# Training programmes
facilitated for Community
Health Volunteers(CHVs)
# of CHVs trained & able
to provide health services
# of people impacted and
adopting healthy
behavior
Daily/Monthly/Quarterly/Annual
Activity Report

ANNEXURE
“A” BUDGET (ESTIMATED COST BREAKDOWN)
THE FOLLOWING IS THE PROPOSED BUDGET LINE FOR
TWELVE MONTHS
S.No Description Unit UM Total Cost
.
For 12 months
Rs
1 Mobile Health Van Unit
Medicines - 4 Times in Year
1.1 4 Qtr 2,00,000
Rs.50,000 x per Qtr
1,60,000
1.2 Diagnostics & Consumables - 4 4 Qtr
Times in Year
Rs 40,000 x per Qtr

1.3 Specialized Medical Camps - 4 4 Qtr 1,20,000

18
 Times in Year
Rs 30,000 x per Qtr
1.4 Mobile OPD & Awareness Camps 12 Months 4,80,000
- 20 MOPD x 12 Months
Rs 2,000 per day
1.5 Provision for First Aid Box in 25 Village 4,50,000
Badaun & Rampur - 25
Village x Rs. 1500
per Village
1.6 Training of Community Health 10 Persons 1,20,000
Volunteer (CHVs) - 10 CHVs x
Rs
1,000 x 12 Months
1.7 Medical Officer - Rs 35,000 x 12 1 Persons 4,20,000
Months
1.8 Lab Technicians - Rs 15,000 x 12 1 Persons 1,80,000
Months
1.9 Pharmacist - Rs 18,000 x 12 1 Persons 2,16,000
Months
Accounts & Admin Officer - Rs
1.10 22,000 x 12 Months 1 Person 2,64,000
1.11 Programme Manager - Rs 25,000 x 1 Person 3,00,000
12 Months
1.12 Peon – Rs. 7,000 X 12 1 Person 84,000
1.13 Staff Nurse – Rs. 12,000 X 12 1 Person 1,44,000
1.14 One Social Worker in MOPD 1 Person
Rs. 10,000 X 12 Months 1,20,000
1.15 Health Van Unit Driver - Rs 1 Person 1,44,000
12,000 x 12 Months
1.16 Office Rent & General 1 Office 2,40,000
Maintenance at 01 Office - Rs
20,000 x 12 Months
1.17 Fuel for Mobile Van unit - Rs 1 Mobile van unit 1,20,000
10,000 x 12 Months
Printing Cost for IEC Material
/ Prescription Pad / Pathology
1.18
Reports / 1,00,000
Doctor Daily Sheet / Medicine
Availability Check List - 1 MWU
x
Rs. 1,00,000

19
1.19 Vehicle Hiring & Fuel 12 Months 30,000
Charges for Programme
Manager
1.20 Vehicle Hiring & Fuel 12 Months 3,60,000
Charges for Programme
Manager
1.21 Staff Orientation &
4 Qtr 1,20,000
Capacity Building Training
1.22 Telephone & Internet 12 Months 60,000
Medical Team
1.23 Repairs & Maintenance - Office & 4 Qtr 40,000
Mobile Health Van
Staff Insurance / Assets Insurance
1.24 Rs 60,000 x per Yr 1 Yr 60,000
2 Capital Expenditure
2.1 Mobile Wellness Unit- Vehicle 1 Mobile Health 21,50000
Cost & Fabrication Van
(FORCE AMBULANCE)
2.2 Mobile Lab & Equipment's 1 Mobile Health 1,10,000
Van
2.3 Ventilator for MWU 1 2,50000
2.4 Computer & Peripherals 1 2,00,000
2.5 Miscellaneous Expenses 2,00,000
3 Impact Assessment / Process 1,00,000
Documentation / Base line
Survey
TOTAL 71,88,000.00

TOTAL BUDGET IS RUPEES SEVENTY ONE LAKH EIGHTY

EIGHT THOUSAND ONLY

CEO,UNITED VIKAS SAMITI

 BANK DETAILS OF THE ORGANIZATION:
1 Name of Bank Indian Bank

2 Bank Branch (full address & Bhojpur ,

Telephone Number) Modinagar,Ghaziabad
Uttar Pradesh

3 Bank Account Number 899185857

4 Bank Account Name UNITED VIKAS

SAMITI

6 IFSC Code IFSC Code: IDIB000M055 (used for

RTGS and ...
MICR Code: 201019006
Branch Code: 00M055

Declaration:

I hereby declare that whatever has been stated above is true to the best of
my knowledge, correct and nothing has been concealed there from.

Place: Badaun

Date: 14/04/2022

Signatory with Common Seal