NHSRC CHECKLIST To accompany proposals submitted to the Committee for approval Before submitting your study proposal to the Committee, complete the following checklist by ticking each item you have included. Do not send the proposal in unless you can tick all the boxes, or provide a reason for the absence of any item. TITLE OF PROPOSAL: PRINCIPAL INVESTIGATOR: The following are included in or with this proposal 1. The NHSRC Checklist [ ] 2. Cover letter of introduction from the Principal Investigator (PI) [ ] 3. The NHSRC Application Form 101 [ ] 4. Proposal Summary (refer to the Application Form 101 [ ] 5. Main proposal [ ] To include: - Cover page [ ] Abstract [ ] Background, Problem Statement and Justification [ ] Main and Specific Objectives [ ] Hypothesis/Research Questions if any Literature review [ ] Methodology • design of study [ ] • place of study [ ] • target population • sampling techniques and tools [ ] • sample size determination [ ] • data collection techniques and tools • data analysis • dissemination of results • Ethical considerations • personnel roles and Institution • work plan • budget (with 10% contribution fee indicated) and justification [ ] References [ ] 1. Informed consent in both English and Chichewa (or appropriate local language) [ ] 2. Data collection instruments in both English & Chichewa or other appropriate Local language [ ] 3. Letter of approval from foreign ethics committee (for all students studying in Foreign universities) [ ] 4. Letter(s) of support from affiliating and institutions where the study will be done 5. Copy of Receipt of the Application fee (U$ 150) or K5000 for Malawian Students 6. Proof of funding from the Sponsor/Funder (where applicable) 7. Curriculum vitae (CVs) for all the investigators [ ] IF ANY ITEM IS NOT TICKED, EXPLAIN WHY THIS IS NOT INCLUDED WITH THE SUBMISSION SIGNATURE: NAME (PRINT) DATE: Promoting Scientific and Ethical Conduct of Health Research in Malawi Executive Committee: Dr M. Joshua (Chairperson), Dr F. Sinyiza (Vice-Chairperson) IRB Number 00003905 FWA00005976 Registered with the USA Office for Human Research Protections (OHRP) as an International IRB Email: research@health.gov.mw/mohdoccentre@gmail
