CAMEROON Work Plan
FY 2017
Project Year 6
October 2016–September 2017
ENVISION Project Overview
The U.S. Agency for International Development (USAID)’s ENVISION project (2011–2019) is designed to support the vision of the World Health Organization (WHO) and its member states by targeting the control and elimination of seven neglected tropical diseases (NTDs), including lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), three soil-transmitted helminths (STH; roundworm, whipworm, and hookworm), and trachoma. ENVISION’s goal is to strengthen NTD programming at global and country levels and support Ministries of Health (MoH) to achieve their NTD control and elimination goals.
At theglobal level, ENVISION—in coordination and collaboration with WHO, USAID, and other stakeholders—contributes to several technical areas in support of global NTD control and elimination goals, including the following:
- Drug and diagnostics procurement, where global donation programs are unavailable;
- Capacity strengthening;
- Management and implementation of ENVISION’s Technical Assistance Facility (TAF);
- Disease mapping;
- NTD policy and technical guideline development; and
- NTD monitoring and evaluation (M&E).
At the country level, ENVISION provides support to national NTD programs by providing strategic technical and financial assistance for a comprehensive package of NTD interventions, including the following:
- Strategic annual and multi-year planning;
- Advocacy;
- Social mobilization and health education;
- Capacity strengthening;
- Baseline disease mapping;
- Preventive chemotherapy (PC) or mass drug administration (MDA);
- Drug and commodity supply management and procurement;
- Program supervision; and
- M&E, including disease-specific assessments (DSA) and surveillance
In Cameroon, ENVISION project activities are implemented by Helen Keller International (HKI).
TABLE OF CONTENTS
Page
1)General Country Background
a)Administrative Structure
b)NTD Program Partners
2)National NTD Program Overview
a)Lymphatic Filariasis
b)Trachoma
c)Onchocerciasis
d)Schistosomiasis
e)Soil-transmitted Helminths
3)Snapshot of NTD status in CAMEROON
1)NTD Program Capacity Strengthening
a)Strategic Capacity Strengthening Approach
b)Capacity Strengthening Interventions
c)Monitoring Capacity Strengthening
2)Project Assistance
a)Strategic Planning
a)NTD Secretariat
b)Advocacy for Building a Sustainable National NTD Program
c)Social Mobilization to Enable NTD Program Activities
d)Training
e)Mapping
f)MDA Coverage and Challenges
h)Supervision
i)M&E
3)Maps
Appendix 1. FY17 Activities
Appendix 2. Table of USAID-supported Provinces/States and Districts
TABLE OF TABLES
Table 1: NTD partners working in Cameroon, donor support, and summarized activities
Table 2: Snapshot of the expected status of the NTD program in Cameroon as of September 30, 2016
Table 3: Project Assistance for Capacity Strengthening
Table 3a: Indicators the country will use to evaluate capacity strengthening progress.
Table 4: Social mobilization/communication activities and materials checklist for NTD work planning
Table 5: Results of coverage with USAID support in FY15/and FY17 objectives
Table 6a: Supervision for community MDA
Table 6b: Supervision activities for school-based MDA
Table 6c: Supervision activities for other monitoring
Table 7: Planned DSAs for FY17, by disease
AbbreviationsList
AEAdverse Event
ALBAlbendazole
APOCAfrican Program for Onchocerciasis Control
AZTAzithromycin
CBSCalibrated Blood Spot
CBTICommunity-based Treatment with IVM
CCUCentral Coordination Unit
CDCUnited States Centers for Disease Control and Prevention
CDDCommunity Drug Distributor
CDTICommunity-Directed Treatment with Ivermectin
CENAMENational Center for Essential Drug Supply
CMRCameroon
DHIS2District Health Information System-2
DQAData Quality Assessment
DREBRegional Directorate of Primary Education
DRESRegional Directorate of Secondary Education
DRSPDélégation Régionale de la Santé Publique (Regional Public Health Delegation)
DSADisease-Specific Assessments
EPIRFPC Epidemiological Data Reporting Form
FRPSRegional Fund for Health Promotion
FTSFilariasis Test Strips
FYFiscal Year
HDHealth District
HKIHelen Keller International
HQHeadquarters
ICTImmunochromatographic Test
IECInformation, Education, and Communication
IEFInternational Eye Foundation
IVMIvermectin
JRFJoint Reporting Form
JRSMJoint Request for Selected Medicines
LCIFLions Club International Foundation
LFLymphatic Filariasis
LLINLong-lasting insecticide-insecticide treated net
LOELevel of Effort
M&EMonitoring and Evaluation
MDAMass Drug Administration
MEBMebendazole
MfMicrofilaraemia
MINCOMMinistry of Communication
MINEDUBMinistry of Primary Education
MINESECMinistry of Secondary Education
MINISANTEMinistry of Public Health (also MOH)
MMDPMorbidity Management and Disability Prevention Project
MOHMinistry of Public Heath (MINISANTE)
NGDONongovernmental Development Organization
NTDNeglected Tropical Disease
OVOnchocerciasis
PCPreventive Chemotherapy
PNLCéNational Blindness Prevention Program
PNLONational Program for the Control of Onchocerciasis
PNLSHINational Program for the Control of Schistosomiasis and Intestinal Helminthiasis
PZQPraziquantel
SACSchool-Age Children
SAESerious Adverse Event
SAFESurgery–Antibiotics–Face cleanliness–Environmental improvements
SCHSchistosomiasis
SMARTSpecific, Measurable, Achievable, Realistic, and Time-bound
STHSoil-Transmitted Helminths
TAFTechnical Assistance Facility
TASTransmission Assessment Survey
TEOTetracycline Eye Ointment
TFTrachomatous Inflammation–Follicular
TIPACTool for Integrated Planning and Costing
TISTrachoma Impact Assessments
TSSTrachoma Surveillance Survey
TTTrachomatous Trichiasis
UNHCRUnited Nations High Commission for Refugees
UNICEFUnited Nations Children’s Fund
USAIDUnited States Agency for International Development
WHOWorld Health Organization
ENVISION FY17 PY6 CAMEROON Work Plan
1
Country Overview
1)General Country Background
a)Administrative Structure
Cameroon is a central African country covering an area of 475,650 km². The population of Cameroon in 2017 is estimated at 23,151,178. Women comprise 54% of the total population, and 48.2% of the population resides in urban areas. Most of the country’s inhabitants are young: 16.9% of the population is between the ages of 0 and 5 years, and 26.7% is between the ages of 5 and 14 years. The annual population growth rate is 2.6%. The country has more than 230 different ethnicities, and the two official languages are French and English. Administratively, Cameroon is divided into 10 regions, 58 divisions, 360 subdivisions, 360 district councils, and 15 urban municipalities. The health system has the following structure:
- 10 Regional Public Health Delegations (DRSPs), each headed by a Regional Delegate, with regional hospitals and similar structures;[1]
- 189 Health Districts (HDs), all of whichare operational. Each HD has a district hospital and several Integrated Health Centers, which are primary care centers run by a registered state nurse. In 2014 the Ministry of Public Health (MoH or MINISANTE) created new HDs by splitting some old HDs. It took time for new HDs to be fully operational (completed in 2015-2016). In fiscal year 2017 (FY17), there will be 189 fully operational HDs instead of 181 in FY16. This change will be reflected in the FY17 work plan and FY17 SAR-1 workbooks.
The Central Coordination Unit(CCU) of the MoH coordinates integrated control activities for the five priority neglected tropical diseases (NTDs) that can be treated with preventive chemotherapy (PC)—lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), soil-transmitted helminths (STH), and trachoma—at the national and regional level. HD management teams organize and implement the activities at the district and community levels. Community-based (for LF, STH, OV, and trachoma) and school-based (for SCH and STH) platforms are used for drug delivery by community health workers, community drug distributors (CDDs), and teachers. If necessary, the regional and district reference hospitals are in charge of the management of serious adverse events (SAEs) resulting from drugs distributed.
b)NTD Program Partners
In Cameroon, the ENVISION project is implemented by HKI under the leadership of MINISANTE. Implementation of activities is carried out in collaboration with partner nongovernmental development organizations (NGDOs). Other ministerial departments such as the Ministry of Primary Education (MINEDUB) and the Ministry of Secondary Education (MINESEC) as well as the targeted communities themselves, through the participation of the CDDs, are equally associated with the project. NTD control activities in the country’s 10 regions are organized around networks and structures that are already established—for example, the long-existing coalition of NGDOs working in OV control.
HKI has signed sub-agreements with specific NGDOs, and these organizations implement mass drug administration (MDA) activities in their traditional regions of intervention: Sightsavers supports activities in the Northwest, Southwest, and West regions; International Eye Foundation (IEF) supports the South and Adamawa regions; and PersPective works in the Littoral Region. HKI directly supports the four other regions (Center, East, North, and Far North) and also provides financial and technical support to the MoH at the central level.
In addition to the funds provided by the U.S. Agency for International Development (USAID) for PC targeting of the NTDs—through the RTI-managed ENVISION project and the HKI-managed Morbidity Management and Disability Prevention (MMDP) project—the NTD program also receives financial support from the Cameroon Government and from other organizations, notably the Lions Club International Foundation (LCIF).
The following (and Table 1) provide more details on support provided for NTD activities:
- The Government of Cameroon contributes to the payment of government staff salaries and other agents of the state implicated in project delivery; supports drug pick-up, transportation, and storage; is responsible for operations and various investments (building of facilities, infrastructure, and logistics); supports participation of NTD staff in international meetings and training; and manages program coordination associated with MDA and handling of LF morbidity cases (hydrocele and lymphedema) and of trachomatous trichiasis (TT) cases
- Sightsavers has supported OV activities since 1996. The NGDO is contributing its own funding to the implementation of integrated LF, OV, SCH, and STH control/elimination activities in the Northwest, Southwest, and West regions. It also provides support for the elimination of trachoma in the Far North and the North regions. Sightsavers supports TT surgeries, promotion of facial cleanliness, and other hygiene and sanitation activities.
- United Nations Children’s Fund (UNICEF) and HKI support bi-annual deworming of children under five years of age via the Mother and Child Health and Nutrition Action Week, during which a package of services is distributed to children under five, including mebendazole (MEB), with funding from the Canadian Government.
- LCIF has supported activities for the control of OV since 1996 through a coalition of NGDOs. In 2010, LCIF started to reduce its financial support, particularly in HDs endemic for OV in the forest areas. In 2015, LCIF stopped all funding activities in the south regions (technical support is provided by IEF) and in the Littoral regions (technical support is given by PersPective). In FY17, LCIF will support, through HKI and IEF, only HDs endemic for OV in the regions of Adamawa, the Far North, and North.
- World Health Organization (WHO)contributes technically and financially to the development of NTD plans, holds national planning/review meetings, and provides logistical help for the management of drug supplies.
Table 1: NTD partners working in Cameroon, donor support, and summarized activities
Partner / Location (regions/states) / Activities / Is USAID providing direct financial support to this partner? / Other donors supporting these partners?PersPective / Littoral Region / Provide direct technical assistance to the MoH in strategic planning and capacity building / Yes (ENVISION) / None
Provide technical and financial assistance to MoH for advocacy and social mobilization / Yes (ENVISION) / None
Provide technical and financial assistance to MoH for the organization, implementation, and supervision of MDA campaigns to control NTDs / Yes (ENVISION) / None
IEF / South and Adamawa regions / Provide direct technical assistance to the MoH in strategic planning and capacity building / Yes (ENVISION) / LCIF
Provide technical and financial assistance to MoH for advocacy and social mobilization / Yes (ENVISION) / LCIF
Provide technical and financial assistance to MoH for the organization, implementation, and supervision of MDA campaigns to control NTDs / Yes(ENVISION) / LCIF
Sightsavers / Northwest, Southwest, and West regions / Provide direct technical assistance to the MoH in strategic planning and capacity building / Yes(ENVISION) / None
Provide technical and financial assistance to MoH for advocacy and social mobilization / Yes(ENVISION) / None
Provide technical and financial assistance to MoH for the organization, implementation, and supervision of MDA campaigns to control NTDs / Yes(ENVISION) / None
Far North Region / Support S,F, and E components of the SAFE strategy (Surgery–Antibiotics–Face cleanliness–Environmental improvements) / Yes(MMDP Project) / None
WHO / Centrallevel / Provide technical and financial assistance to the MoH in strategic planning; WHO also offers assistance with drug supply management. / No / ---
MoH / Central level/all endemic areas / Provide government staff salaries, drug storage and transportation, construction of health facilities, infrastructure and logistics, treatment of hydrocele, and support for CDDs / No / No
HKI / Central level (Yaoundé)/all endemic areas (some supported directly: North, Far North, Center, and East regions and all other regions [6] through partner NGDOs) / Provide direct technical assistance to the MoH in strategic planning and capacity building / Yes (ENVISION) / LCIF in OV HDs in North and Far North regions
Provide technical and financial assistance to MoH for advocacy and social mobilization / Yes (ENVISION) / LCIF in OV HD in North and Far North regions
Provide technical and financial assistance to MoH for the organization, implementation, and supervision of MDA campaigns to control NTDs / Yes (ENVISION) / LCIF in OV HDs in North and Far North regions
Provide technical and financial assistance to MoH in disease-specific assessments (DSAs) / Yes (ENVISION) / None
Far North and North regions / Management of TT cases / Yes (MMDP) / None
2)National NTD Program Overview
a)Lymphatic Filariasis
Cameroon started uniting vertical, disease-specific programs into an integrated NTD program in 2010 with the support of USAID through the RTI-managed NTD Control Program, with HKI as the in-country implementing partner. This support allowed the completion of NTD mapping in 2012 and the scale-up of MDA activities to bring coverage close to 100% (30 LF-endemic HDs are not covered; 6 of those are partially due to the risk of SAEscaused by co-endemicity with Loa loa). A CCU was established in 2012 to integrate the response to NTDs. This unit brings together all of the program managers from within the MoH and partners.
The goal of the LF program is to eliminate the disease as a public health problem by 2020. The strategy is ivermectin (IVM) MDA through community-directed treatment with IVM (CDTI), combined with albendazole (ALB) in endemic areas, and morbidity management of the disease. LF elimination began in 2008 with mass treatment of nine HDs in the North and Far North as part of a pilot project phase with support from WHO and the Mectizan® Donation Program. Disease mapping was completed between 2010 and 2012, using immunochromatographic test (ICT) cards, with support from USAID and the African Program for Onchocerciasis Control (APOC;APOC supported LF mapping in 60 HDs in 2010.) The mapping revealed that LF is endemic in 158 of 181 HDs. Among the 158 districts, LF is co-endemic with both OV and L. loain 86 HDs, co-endemic with OV alone in 14 HDs, and with L. loa only in 24 HDs. IVM and ALB MDA were extended to cover 134 of the 158 endemic HDs in 2011, 6 of which have been partially targeted due to co-endemicity withL. loa and the risk of SAEs. The remaining 24 HDs were also not treated with IVM and ALB due to co-endemicity with L. loa.
To meet the goal of eliminating LF by 2020, all endemic areas must undergo mass treatment. To reach that goal, a new strategy was attempted in 2015 in 31 HDs co-endemic with LF and L. loawhere IVM had never been provided. Thirteen of these HDs in the East Region started bi-annual treatment with ALB, according to WHO guidelines. In 10 of the 13 HDs the entire district was treated, and in 3 HDs, only some areas were targeted because the others were co-endemic with OV and so had already been treated with IVM. With this strategy, the bi-annual distribution of ALB was combined with the use of long-lasting insecticide-treated nets (LLINs) provided by the National Malaria Control Program. In FY16,the original plan was to extend this strategy to 24 HDs and to some Health Areas of the 6 L. loa co-endemic HDs that did not receive IVM/ALB in order to reach 100% geographic coverage for LF in Cameroon. Unfortunately, given the conflicting baseline survey results in the East region in 2014 (using ICT cards) and with the recommendations of the Regional Program Review Group, this strategy was suspended. Previous mapping had shown prevalence of up to 20% but in 2014 (with ICT cards) the prevalence was zero. It was recommended that a mapping survey (a mini-transmission assessment survey [TAS]) be conducted in these 24 HDs to evaluate the current LF situation. These mini-TAS results will determine which HDs will require the bi-annual ALB treatment in FY17. The mini-TAS is scheduled to be completed by September 2016 (the 2 x ALB treatment is not budgeted in FY17).).
In FY16, 86 HDs conducted pre-TAS and 31 HDs TAS1. The results are still pending. In FY17,ENVISION expects to conduct pre-TAS in 12 HDs and TAS1 in 83 HDs. Preliminary results show that 30 out of 31 HDs have passed TAS-1 (one HD was not assessed due to security issues) and therefore will not need LF treatment in FY17. This is to be confirmed.
b)Trachoma
The goal of the trachoma program, coordinated by the National Blindness Prevention Program (PNLCé), is to eliminate trachoma as a blinding disease by 2020. The program uses the WHO-recommended SAFE strategy: S (surgery), A (antibiotics), F (facial cleanliness), and E (environmental improvement). The S, F, and E components are supported by other projects specifically focused on trachoma or integrated with broader water, sanitation, and hygiene-promotion projects. Sightsavers has supported TT surgeries in the Far North Region since FY14. The HKI-led MMDP project has also provided technical and financial support in terms of TT surgery in the Far North and North since FY15.
Activities to eliminate trachoma accelerated in 2010, with USAID support for mapping surveys carried out from 2010–2012. The mapping showed that trachoma is endemic in 47 HDs in the Far North, North, and Adamawa regions, with 16 HDs having a prevalence of trachomatous inflammation–follicular (TF) ≥10% and 4 HDs with a prevalence of between 5% and 9.9%. Annual administration of Pfizer-donated azithromycin (AZT) and tetracycline eye ointment (TEO) started gradually in the 20 endemic targeted HDs as soon as mapping results were available.