CAMEROON Work Plan - ENVISION · CAMEROON Work Plan FY 2018 Project Year 7 October 2017–September...

CAMEROON Work Plan FY 2018

Project Year 7

October 2017–September 2018

ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred Hollows

Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision. ENVISION is funded by

the US Agency for International Development under cooperative agreement No. AID-OAA-A-11-00048. The period of performance

for ENVISION is September 30, 2011, through September 30, 2019.

The author’s views expressed in this publication do not necessarily reflect the views of the US Agency for International Development

or the United States Government.

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ENVISION FY18 PY7 CAMEROON Work Plan

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ENVISION Project Overview

The US 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 (MOHs) to achieve their NTD control and

elimination goals.

At the global 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

• 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

• M&E, including disease-specific assessments (DSA) and surveillance.

In Cameroon, ENVISION project activities are implemented by Helen Keller International.


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TABLE OF CONTENTS

ENVISION Project Overview ii

COUNTRY OVERVIEW 1

1) General Country Background ............................................................................................................ 1

a) Administrative Structure ............................................................................................................... 1

b) NTD Program Partners .................................................................................................................. 1

2) National NTD Program Overview ...................................................................................................... 4

a) Lymphatic Filariasis ....................................................................................................................... 4

b) Trachoma ...................................................................................................................................... 6

c) Onchocerciasis .............................................................................................................................. 7

d) Schistosomiasis ............................................................................................................................. 9

e) Soil-transmitted Helminths ......................................................................................................... 10

3) Snapshot of NTD Status in Country ................................................................................................. 11

PLANNED ACTIVITIES 12

1) NTD Program Capacity Strengthening ............................................................................................ 12

a) Strategic Capacity Strengthening Approach ............................................................................... 12

b) Capacity Strengthening Interventions ........................................................................................ 14

c) Monitoring Capacity Strengthening ............................................................................................ 15

2) Project Assistance ........................................................................................................................... 15

a) Strategic Planning ....................................................................................................................... 15

b) Building Advocacy for a Sustainable National NTD Program ...................................................... 17

c) Mapping ...................................................................................................................................... 19

d) MDA Coverage ............................................................................................................................ 20

e) Social Mobilization to Enable NTD Program Activities ............................................................... 21

f) Training ....................................................................................................................................... 25

g) Drug and Commodity Supply Management and Procurement .................................................. 25

h) Supervision for MDA ................................................................................................................... 27

i) M&E ............................................................................................................................................ 29

j) Supervision for M&E and DSAs ................................................................................................... 31

k) Dossier Development .................................................................................................................. 32

3) Maps................................................................................................................................................ 33

APPENDIX 1: Work Plan Timeline 37

APPENIDX 2. Table of USAID-supported Regions and Districts in FY18 39


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TABLE OF TABLES

Table 1: NTD partners working in Cameroon, donor support, and summarized activities 3

Table 2: Summary of LF endemicity status of 162 HDs 5

Table 3: Results of trachoma impact surveys completed since FY14 7

Table 4: Endemicity of OV in Cameroon 9

Table 5: List of SCH-endemic HDs to be surveyed in FY18 10

Table 6: Snapshot of the expected status of the NTD program in Cameroon as of September 30, 2017

11

Table 7: Project assistance for capacity strengthening 14

Table 8: Indicators the country will regularly use to evaluate capacity strengthening progress. 15

Table 9: USAID-supported districts and estimated target populations for MDA in FY18* 20

Table 10: Social Mobilization/Communication Activities and Materials Checklist for NTD Work

Planning 23

Table 11: Planned Disease-specific Assessments for FY18 by Disease 31

Figure 1. Cameroon LF, OV, SCH, STH, and Trachoma Endemicity Map 33

Figure 2. Cameroon LF, OV, SCH, STH, and Trachoma Geographic Coverage Map 34

Figure 4. Cameroon Trachoma DSA map 36


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ABRREVIATIONS

AE Adverse Event

ALB Albendazole

APOC African Program for Onchocerciasis Control

AZT Azithromycin

CBTI Community-based Treatment with IVM

CCO Cameroon Country Office

CCU Central Coordination Unit

CDD Community Drug Distributor

CDTI Community-Directed Treatment with Ivermectin

CENAME National Center for Essential Drug Supply

CVUC Association of United Communes and Cities

DQA Data Quality Assessment

DRSP Délégation Régionale de la Santé Publique (Regional Public Health Delegation)

DSA Disease-Specific Assessments

EU Evaluation Unit

FEICOM Fonds Spécial d’Équipement et d’Intervention Intercommunale (Special Council

Support Fund)

FRPS Regional Fund for Health Promotion

FTS Filariasis Test Strips

FY Fiscal Year

HD Health District

HKI Helen Keller International

HQ Headquarters

ICT Immunochromatographic Test

IEC Information, Education, and Communication

IEF International Eye Foundation

IVM Ivermectin

LCIF Lions Club International Foundation

LF Lymphatic Filariasis

LOE Level of Effort

M&E Monitoring and Evaluation

MDA Mass Drug Administration

MEB Mebendazole

Mf Microfilaraemia

MINCOM Ministry of Communication

MINEDUB Ministry of Primary Education

MINESEC Ministry of Secondary Education

MMDP Morbidity Management and Disability Prevention Project

MOH Ministry of Public Heath (MINSANTE)

NGDO Nongovernmental Development Organization

NTD Neglected Tropical Disease

OEC Onchocerciasis Elimination Committee

OV Onchocerciasis

PC Preventive Chemotherapy

PNLCé National Blindness Prevention Program


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PNLO National Program for the Control of Onchocerciasis

PNLSHI National Program for the Control of Schistosomiasis and Intestinal Helminthiasis

PNLUB National Program for the Control of Buruli Ulcers

PZQ Praziquantel

RPRG Regional Program Review Group

SAC School-Age Children

SAE Serious Adverse Event

SAFE Surgery–Antibiotics–Face cleanliness–Environmental improvements

SCH Schistosomiasis

STH Soil-Transmitted Helminths

STTA Short-Term Technical Assistance

TAF Technical Assistance Facility

TAP Trachoma Action Plan

TAS Transmission Assessment Survey

TEO Tetracycline Eye Ointment

TF Trachomatous Inflammation–Follicular

TIPAC Tool for Integrated Planning and Costing

TIS Trachoma Impact Assessments

TOR Terms of Reference

TSS Trachoma Surveillance Survey

TT Trachomatous Trichiasis

UNHCR United Nations High Commission for Refugees

UNICEF United Nations Children’s Fund

USAID United States Agency for International Development

WHO World Health Organization


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

2018 is estimated at 24,863,337.1 Women comprise 50.5% of the total population, and 48.8% of the

population resides in urban areas. Most of the country’s inhabitants are young: 15.6% of the population

is between the ages of 0 and 5 years, and 25.6% is between the ages of 5 and 14 years. The annual

population growth rate is 2.5%. 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;2

• 189 Health Districts (HDs), all of which are operational. Each HD has a district hospital and

several health centers, which are primary health care centers. In 2014, the Ministry of Public

Health (MOH) created new HDs by splitting some HDs. It took time for new HDs to be fully

operational (completed in 2015–2016). In fiscal year 2018 (FY18), there will be 189 fully

operational HDs.

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 levels. 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 referral

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 Helen Keller International (HKI) under the

leadership of MOH. Implementation of activities is carried out in collaboration with partner

nongovernmental development organizations (NGDOs). Other ministerial departments—such as the

Ministry of Basic Education (MINEDUB), the Ministry of Secondary Education (MINESEC), the Ministry of

Communication (MINCOM), the Ministry of Youth and Civic Education, the Ministry of Women’s

Empowerment and Family, and the Ministry of Social Affairs—as well as the targeted communities

themselves, through the participation of the CDDs, are associated with the project. NTD control

1 MOH, Institut National de la Statistique, United Nations Population Fund. (2016). Projections démographiques et estimation des cibles prioritaires des différents programmes et interventions de santé. (June 2016). p. 27.

Available at: http://slmp-550-

104.slc.westdc.net/~stat54/downloads/2016/Rapport_etude_estimations_populations_cibles_MINSANTE.pdf 2 Private and public hospitals with technical facilities similar to those of a regional hospital.


2

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 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 list (and Table 1) provides 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.

• LCIF has supported activities for OV control 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 Region (technical support is

provided by IEF) and in the Littoral Region (technical support is provided by PersPective). In

FY17, LCIF supported, through HKI and IEF, only HDs endemic for OV in the regions of Adamawa,

Far North, and North; this OV-direct support will end in FY18 because LCIF will focus on

nationwide comprehensive basic eye care.

• World Health Organization (WHO) contributes technically and financially to the development of

NTD plans, holds national planning/review meetings, and provides logistical support for the

management of drug supplies.

• MMDP project (HKI) is a five-year projected funded by USAID. The project works in northern

Cameroon to provide support for training in TT and hydrocele surgery. The project will end in

July 2019.


3

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?

LCIF

Adamawa Region,

OV in North and

Far North regions

Provide direct technical assistance to the

MOH in strategic planning and capacity

building

No* No

Provide technical and financial assistance

to MOH for advocacy and social

mobilization


to MOH for the organization,

implementation, and supervision of MDA

campaigns to control NTDs

WHO Central level


to the MOH in strategic planning; WHO

also aids with drug supply management.

No None

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 Yes

MMDP (HKI) Far North and

North regions

Provide management of TT cases

Support scale up of LF morbidity

management

Yes None

Sightsavers

Northwest,

Southwest, and

West regions

Far North and

North regions

Support MDA

Support TT surgery, WASH activities

No Yes

*USAID provides support to LCIF as a sub-partner of HKI


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2) National NTD Program Overview

a) Lymphatic Filariasis

Cameroon has made enormous progress in LF elimination countrywide. Of the 162 ever-endemic

districts, to date, Cameroon has achieved the criteria to stop LF MDA in 125 districts (including

preliminary results from the FY17 transmission assessment survey [TAS]), with a population of

15,466,048 no longer at risk. In FY18, 12 HDs will undergo TAS1, including 6 districts that were only

treated partially with IVM+ALB. The remaining 25 districts, plus 6 partial districts, were found to not be

endemic for LF based on mini-TAS surveys conducted in FY16 (see Co-endemicity with L. loa section

below).

Cameroon is on track to reduce LF infection to a point where it is likely that transmission is no longer

sustainable by the end of FY18.

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, including LF, throughout

the country from 2010-2012, and the scale up of MDA activities to bring coverage close to 100%. In

total, using the FY17 redistricting number of 189 HDs, 162 HDs were classified as endemic. A CCU was

established in 2012 to integrate the response to NTDs. This unit brings together all program managers

from 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) combined with albendazole (ALB) MDA through community-directed intervention 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’s support covered 60 HDs. The mapping in 2010-2012 revealed

that LF is endemic in 162 of 1893 HDs (although later analysis revealed that 25 of these HDs were not

endemic, thus the 137 in the snapshot table below). Among the 162 districts, 101 are co-endemic with

OV, and 87 of these 101 HDs are also co-endemic with Loa. In 2012, IVM and ALB MDA was extended to

cover 137 of the 162 endemic HDs, including 6 HDs partially targeted due to co-endemicity with L. loa

and the risk of SAEs.

Co-endemicity with L. loa

In Cameroon, 31 HDs are co-endemic with LF and L. loa (and not with OV). Of these, 6 began partial

treatment in 2011, as mentioned above. The remaining 25 were not treated prior to 2015. A baseline

survey was conducted in 2014 in the East Region using ICT cards, and a new strategy was piloted in

2015. This strategy combined the bi-annual distribution of ALB with the use of long-lasting insecticide-

treated nets provided by the National Malaria Control Program. Following the new WHO guidance, in

the East Region 13 of these 31 co-endemic HDs started bi-annual treatment with ALB. In 10 of the 13,

the entire HD received bi-annual ALB, while the remaining 3 HDs received either IVM+ALB (areas where

treatment started in 2011) or bi-annual ALB (IVM-naïve areas).

3 158 of 181 HDs prior to redistricting—following the FY14 administrative redistricting, which became fully

effective in FY17, the number of HDs increased from 181 to 189; therefore, the LF-endemic HDs grew from 158 to

162.


5

In FY16, the national LF program planned to extend this bi-annual treatment strategy to the remaining

18 co-endemic HDs (15 treatment-naïve HDs and the other 3 partial-treatment HDs) in order to reach

100% geographic coverage for LF in Cameroon. However, a review of baseline survey results collected in

the East Region in 2014 contradicted earlier mapping data. Earlier data had shown ICT prevalence of up

to 20% antigenemia (Ag), but in 2014, Ag prevalence of zero was observed in the 31 HDs. After a data

review by the WHO Regional Office for Africa Regional Program Review Group (RPRG), the bi-annual

treatment strategy was suspended. It was recommended that a confirmatory mapping survey (a mini-

TAS) be conducted in the 31 HDs in FY16 to evaluate the current LF situation using filarial test strips

(FTS). Results from the mini-TAS indicated that none of the FTS positive samples were positive for

Wuchereria bancrofti using the thick blood smear film technique. This discrepancy may be explained by

cross-reactivity with L. loa and Mansonella perstans. Testing by polymerase chain reaction has been

used to confirm the positive tests. The report has been validated, and a validated copy of the report is

expected to be issued in November 2017 and then will be sent to the RPRG.

TASs and stopping MDA

In FY14, Cameroon’s first five HDs underwent and passed TAS1. In FY16, a further 334 HDs passed TAS1

and 875 HDs passed pre-TAS. In FY17, the 87 HDs underwent TAS1, and results indicate all passed,

although one evaluation unit (EU) reported an inadequate sample size because not enough children

were present in school at the time of the survey. This EU has repeated the TAS1 with children in the

community. The final report is awaiting validation and is expected to be ready in August 2017. The

average number of positive cases per EU was less than 5—the critical cut-off per EU was 18–20. Table 2

summarizes the current LF situation in Cameroon.

Table 2: Summary of LF endemicity status of 162 HDs

Survey Result # of HDs

Mini-TAS (from FY16) Classified as non-endemic 25 + 6 partial districts

TAS1 in FY14 All EUs passed 5

TAS1 in FY16 All EUs passed 33

TAS1 in FY17 All EUs passed6 87

Pre-TAS in FY17 All districts passed 127 (including 6 partial districts)

TOTAL 162

Pre-TAS was implemented in 12 HDs in FY17. In FY18, these 12 HDs will be submitted for TAS1 if they

pass pre-TAS and will not require mass treatment with ENVISION support. This means that in FY18,

Cameroon may be able to stop LF MDA nationwide, a remarkable achievement for the national program,

the implementing partners, and the funders. In FY18, ENVISION will also support 38 TAS2 (eligible HDs

are those that passed TAS1 in FY14 and FY16), post-MDA surveillance activities, and preparation of the

LF elimination dossier.

In addition to MDA-related activities, morbidity management activities are carried out in country

through the MMDP project—with USAID funding and implemented by HKI—since FY15. MMDP

conducted a facility assessment in FY16 in 5 pilot HDs in Far North and North regions.

4 At the time of the survey, there were 31 HDs, but as a result of redistricting, there are 33 HDs. 5 86 HDs prior to the redistricting. 6 Final confirmation pending 7 Includes 6 HDs receiving partial treatment.


6

b) Trachoma

Historical data and MDA

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. All 21 HDs that required antibiotic

treatment have stopped MDA, and 3,137,861 people are no longer at risk for blinding trachoma.

Activities to eliminate trachoma accelerated in 2010, with USAID support for mapping surveys carried

out from 2010 to 2012. Of the 189 HDs, 135 were not suspected to be endemic. Mapping took place in

54 HDs in the Far North, North, and Adamawa regions; of those, 5 HDs were determined to not be

endemic from trachoma (TF 0%), 33 HDs were determined, at that time, not to be to not be a public

health problem, 28 HDs had TF<5%, while 5 HDs had TF 5-9.9%. The remaining 16 HDs were considerd

endemic (TF ≥10%). Annual administration of Pfizer-donated azithromycin (AZT) and tetracycline eye

ointment (TEO) started gradually, first in the 16 HDs with TF ≥10%, then in the 5 HDs with TF 5-9.9%.

MDA was conducted in Meri and Petté in FY15. Following the new WHO guidelines, the 5 HDs with TF

prevalence rates between 5% and 9.9% (Moutourwa, Yagoua, Guéré, and Maroua-Rural [now Maroua 3

and Gazawa], were now eligible for a round of MDA in FY16 and underwent trachoma impact

assessments (TISs) in FY17 (see results below).

No MDA was planned in FY17. One HD, Kolofata, stopped treatment in FY11 and was surveyed and

declared to have reached the criteria to stop MDA by Médécins Sans Frontières. However, this HD was

targeted for survey in FY17 because the HD did not receive oral AZT, and the PNLCé suspects a TF

prevalence which would indicate that MDA should be started again. The security situation in Kolofata is

difficult as several suicide-bombings have taken place and the survey has been postponed until FY19 in

the hope that the security situation will improve. If the TF prevalence is shown to be >5%, MDA will be

conducted in the HD in FY19.

Surveys

In 2014, TISs were conducted in seven HDs. Five HDs (Bourha, Hina, Koza, Mogode, and Roua) have met

the criteria for stopping MDA (TF prevalence less than 5%), and two (Meri and Petté) had a TF

prevalence between 5% and 9.9%. After another round of MDA in FY15 in these two HDs, TISs were

planned for FY16. However, to improve coordination and planning of other PNLCé activities, the PNLCé

postponed these TISs until FY17.

In FY15, five HDs in the Far North (Goulfey, Guidiguis, Kousséri, Makary, and Mokolo) were scheduled

for TIS. These assessments were postponed several times due to insecurity in the region and finally,

surveys were conducted in two of the five targeted HDs (Mokolo and Guidiguis). The TF prevalence was

1.7% and 1.9% respectively, indicating that it was possible to stop MDA. The TISs for the remaining three

HDs (Goulfey, Kousséri, and Makary) were postponed until FY17 due to security concerns and showed a

TF prevalence <5%. Also in FY15, the HD of Kolofata was not re-evaluated as initially planned (and

requested by MOH) due to the security situation. As noted above, the Kolofata confirmation prevalence

survey is postponed until FY19 as the security situation has not improved


7

Table 3: Results of trachoma impact surveys completed since FY14

Year Type of

survey HD name

TF/TI result

(ages 1–9

years)

Notes

FY14 TIS Bourha, Hina, Koza, Mogode, Roua <5%

FY14 TIS Meri, Petté 5%–9.9%

1 MDA in FY15

2nd TIS postponed to

FY17

FY16 TIS Mokolo, Guidiguis <5%

FY17 TIS

Goulfey, Kousséri, Makary,

Moutourwa, Yagoua, Guéré,

Maroua 3, Gazawa, Poli, Rey

Bouba, Tcholliré, Tokombéré

<5%

FY17 2nd TIS Meri, Petté <5%

Three HDs in the North Region (Poli, Rey Bouba, and Tcholliré) carried out the final round of MDA in

2015, and TISs in these three HDs were planned for FY16. TIS was also planned in FY16 in the HD of

Tokombéré, which completed five rounds of MDA prior to 2015. The TISs in all four HDs were postponed

to FY17.

Fourteen HDs conducted TIS in FY17 using the WHO-led Tropical Data system. All 14 HDs were found to

have a TF prevalence <5% in children age 1–9-years old (0%–2.5% range) and can stop MDA. Eight of

these HDs have a TT prevalence above 0.2% in people age 15 years old and older, indicating a need for

TT management activities. This report was shared with HKI and RTI. The HDs surveyed were Goulfey,

Guéré, Moutourwa, Pété, Tokombéré, Yagoua, Poli and Rey Bouba.

According to WHO guidelines, trachoma surveillance surveys (TSSs) should be carried out two years after

an HD has achieved the criteria to stop MDA. The first five HDs in the Far North (Bourha, Hina, Koza,

Mogode, and Roua) will undergo surveillance surveys in FY18.

The PNLCé has engaged the Far North Regional Delegation of Public Health and will engage with the

United Nations High Commission for Refugees (UNHCR) to understand the demographic situation and

health interventions in the refugee camp in Minawao (in the HD of Mokolo). This will provide the

information needed to plan for a prevalence survey of Minawao refugee camp in FY18. Note that

funding for the survey has been included in the FY18 WP, but that the survey will only take place if the

security situation is stable. The other refugee camps in Cameroon are not in trachoma endemic areas

and there are currently no plans to implement trachoma activities in these camps.

c) Onchocerciasis


OV is present in all 10 regions, and baseline epidemiological surveys (1993) indicated an average national

prevalence of 40%—1138 of 189 HDs are considered meso-endemic, hyper-endemic, or of mixed

endemicity (Table 3a). Cameroon's primary goal is to eliminate OV by 2025, and the National

Onchocerciasis Elimination Strategy is in the process of being finalized by stakeholders. The OV program

has received financial and technical support from USAID since 2010 as part of the NTD Control Program

8 Previously there were 111 HDs. The increase is due to a redistricting


8

(predecessor to ENVISION), and there is an OV Elimination Committee (OEC), created in FY17 by the MOH,

which will aid in OV elimination activities. The first meeting of the committee is expected to take place in

October 2017.

The first control activities began in 1987 with the mass distribution of IVM in the North Region, followed

by extension of treatment to the South and Center regions between 1990 and 1992 via community-based

treatment with IVM (CBTI). The National Program for the Control of Onchocerciasis (PNLO) was created

in 1993. The PNLO extended control activities to five regions using the CBTI strategy and, starting in 1999,

transitioned to CDTI (community-directed rather than just community-based strategy). The OV program

has received financial and technical support from USAID since 2010 as part of the NTD Control Program

and continues to receive support through ENVISION. The integrated NTD MDA approach in communities

was built on the CDTI strategy developed for OV control

In previous fiscal years, the primary strategy used was annual CDTI in the target endemic communities.

IVM was given alone in 12 HDs and together with ALB in 101 HDs, where it was part of integrated

treatment for LF and OV. Out of the 113 endemic HDs (redistricting added 2 HDs) that are receiving

treatment with IVM, 103 are co-endemic with L. loa and LF, 87 HD are co-endemic for OV, LF and L. Loa,

16 HD for OV and L. loa only, and 10 OV only.

The risk for SAEs following IVM administration, after many years of treatment, has decreased due to

reduced prevalence and parasite load—SAEs mainly occur in treatment-naïve individuals with a high L. loa parasite load. To achieve the elimination goal, it is necessary to extend the IVM MDA to the 71 hypo-

endemic HDs. This may result in an increase in the potential number of SAE cases in those areas where

IVM has never been administered. For now, all meso-endemic or hyper-endemic HDs receive treatment,

and until FY17, most of the hypo-endemic had received treatment through the LF MDA. Because 125

HDs have stopped LF treatment and 12 will stop in FY18, any hypo-endemic HDs that have received IVM

treatment through the LF MDA will no longer do so. The MOH has no plans to either map these hypo-

endemic regions nor treat them because the OV program has not sought funding for OV treatment in

hypo-endemic HDs.


9

Table 4: Endemicity of OV in Cameroon

Endemicity Status # of

Districts Notes

Non-endemic 5 None are under treatment

Hypo-endemic 71 None are under treatment

Meso-endemic 15

Hyper-endemic 84

Hyper/Meso/Hypo 10 7 are mixed hyper, meso and hypo areas

3 are a mix of hyper and hypo endemic areas

Meso and mixed 4 A mix of meso and hypo endemic areas

Total 189 113 are under treatment

In FY18, ENVISION will provide support for OV MDA in 113 HDs.

d) Schistosomiasis


An agreement was signed by USAID and the Ministry of Higher Education and Scientific Research in the

Government of Cameroon in 1983 for the development of a pilot project for SCH control. It led to the

implementation of a vast national epidemiological survey between 1985 and 1987. The survey revealed

the distribution and prevalence level of different SCH species in the country. The high-endemicity areas

in the northern regions became the priority areas for implementation of the activities of the National

Program for the Control of Schistosomiasis and Intestinal Helminthiasis (PNLSHI, created in 2003).

Treatment started in 2007 as school-based deworming. The program began receiving support from

USAID through the NTD Control Program, implemented by HKI, starting in 2010.

The first MDA campaigns for SCH and STH in schools were launched in 2007, with support from Children

Without Worms. Further campaigns have received USAID support since 2010 for mapping and MDA. The

epidemiological mapping conducted in 2010–2012 showed 140 HDs as being endemic (prevalence above

0%). These 140 HDs include 2 HDs (Kouoptamo and Galim in West Region) that were added in 2015 by

the national program due to an increase of SCH prevalence in school-age children (SAC).

The Cameroon national SCH program plans for the elimination of SCH by 2020 and in the past opted for

a treatment frequency that does not always align with WHO in some HDs. The national program policy is

to conduct yearly MDA for SAC where the prevalence is greater than 10%, and adults are treated where

the prevalence in SAC is >50%. Cameroon receives praziquantel (PZQ) donations from WHO. The

national strategy for SCH relies on the mapping results of 2010–2012 (which used the Kato-Katz

technique), and for FY17, the national program targeted MDA in 84 HDs (4 HDs were added due to

redistricting) with the appropriate prevalence for treatment.

Accordingly, in FY17, the number of HDs treated with PZQ was 84—these were treated with a mix of

school-based and community-based treatment. A teachers’ strike in some regions prevented

implementation of the school-based strategy as planned. The results of this year’s MDA will be available

in November 2017.

SCH/STH surveys are planned in 12 HDs in FY18. This study aims to determine trends in prevalence and

intensity of SCH/STH infections following at least five rounds of MDA, including twice annual ALB

treatment in LF-coendemic HDs. Although USAID and ENVISION are unable to provide support for

SCH/STH treatment, USAID and ENVISION will provide assistance to the the MOH in finding donors that


10

are able to support the school-based deworming. Following consultation with the MOH, the planned

HDs for SCH/STH survey are as follows in Table 3b.

Table 5: List of SCH-endemic HDs to be surveyed in FY18

Regions Health Districts SCH Prevalence STH Prevalence

Adamawa Banyo

Ngaoundere Rural

14.86% (0.00-63.70%)

11.37% (0.00-24.49%)

4.49% (2.08-10.00%)

5.39% (0.00-12.00%)

Centre Bafia

Cité Verte

Efoulan

Mbalmayo

Mfou

Nkolbisson

6.35% (0.00-52.80%)

25.60% (9.60-40.60%)

11.74% (5.00-25.30%)

14.77% (0.00-73.80%)

1.00% (0.00-2.00%)

25.60%

16.30% (5.80-44.90%)

22.30% (14.90-29.30%)

16.40% (11.00-17.20%)

36.20% (8.00-57.10%)

44.80% (32.70-61.20%)

22.30% (14.90-29.30%)

Littoral Loum

Njombe Penja

20.99% (3.40-39.20%)

20.99% (3.40-39.20%)

23.50% (20.00-30.00%)

23.50% (20.00-30.00%)

Nord Bibemi

Figuil

13.65% (0.00-51.02%)

5.22% (0.00-10.00%)

4.42% (0.00-14.00%)

0.00%

e) Soil-transmitted Helminths

The first STH treatments were based on data from epidemiological surveys (using the Kato-Katz

technique) carried out between 1985 and 1987. Control efforts were intensified with the creation of

PNLSHI in 2003 and the establishment of the national strategic plan 2005–2010 for SCH and STH control.

The STH program has received USAID support since 2010 for annual mebendazole (MEB) MDA in schools

for children age 5–14 years. Data from mapping in 2010–2012 using the same Kato-Katz slides for SCH

and STH showed that the three major STH are present in all 10 regions. SAC are the most frequent

sufferers, with high parasite loads and, frequently, poly-parasitic infections. Of the 189 HDs, 110 had a

prevalence of 0-20%, 50 HDs were ≥20% and <50% and 29 HDs had a prevalence ≥50%.

The national strategy is to provide systematic deworming in schools for all SAC regardless of whether

they attend school: annual deworming in schools with MEB for children age 5–14 years, with the

addition of PZQ in SCH-endemic areas. This strategy has been ongoing since the establishment of the

PNLSHI. With the start of LF MDA in the country, the SAC in HDs with LF MDA also received a second

round of deworming with ALB. For school-based deworming, SAC who are not enrolled in school were

taken to the school by their parents on the day of the MDA to receive treatment. Special social

mobilization efforts were conducted by nurses to target this group. Children age 1–5 years were also

treated twice a year via the Mother and Child Health and Nutrition Action Week, during which a package

of services, including MEB, is distributed to children under 5 years old. Treatment for these younger

children is supported by Canada’s Department of Foreign Affairs, Trade and Development through the

United Nations Children’s Fund (UNICEF).

In FY17, all HDs in Cameroon were treated for STH, primarily with the school-based strategy (due to a

teachers’ strike, some HDs were treated with a community-based strategy). Although USAID and

ENVISION are unable to provide support for SCH/STH treatment, USAID and ENVISION will provide

assistance to the the MOH in finding donors that are able to support the school-based deworming.


11

3) Snapshot of NTD Status in Country

Table 6: Snapshot of the expected status of the NTD program in Cameroon as of

September 30, 2017

Columns C+D+E=B for each

disease* Columns F+G+H=C for each disease*

MAPPING GAP DETERMINATION MDA GAP DETERMINATION MDA

ACHIEVEMENT DSA NEEDS

A B C D E F G H I

Disease

Total No. of

districts in

Cameroon

No. of

districts

classified

as

endemic**

No. of

districts

classified

as non-

endemic**

No. of

districts

in need

of initial

mapping

No. of districts

receiving MDA

as of 09/30/17

No. of districts

expected to be in

need of MDA at

any level: MDA

not yet started,

or has

prematurely

stopped as of

09/30/17

Expected No. of

districts where

criteria for

stopping

district-level

MDA have been

met as of

09/30/17

No. of districts

requiring DSA

as of 09/30/17 USAID-

funded Others

Lymphatic

filariasis

189

137f 52 0 12a 0 12 125b TAS1: 12c

TAS2: 38

Onchocerciasis 113 76 0 113 0 0 0 0

Schistosomiasis 140 49 0 84 0 56d 0 0

Soil-transmitted

helminths 189e 0 0 189 0 0 0 0

Trachoma*** 21 168 0 0 0 0 21 TSS: 5

a) 87 HDs are currently undertaking TAS1 and are not scheduled for treatment with ENVISION support.

b) This includes 38 HDs that passed TAS1 plus the 87 HDs pending TAS1 results in FY17.

c) These 12 HDs will undergo pre-TAS before the end of FY17 and are expected to need of TAS1 in FY18.

d) Low endemic districts are not being treated twice during primary school age, as WHO guidelines recommend

e) The Cameroon MOH classifies all HDs as endemic although they are not. 71 HDs have a prevalence >20% and therefore

require MDA.

f) 162 HDs were initially mapped as endemic for LF, however later research revealed 25 of these should have been classified as

non-endemic/never-endemic.


12

PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

AREAS FOR CAPACITY STRENGTHENING

a) Strategic Capacity Strengthening Approach

ENVISION will continue to work closely with the MOH to identify priority areas that will need capacity

strengthening in FY18. ENVISION translated these priorities into the capacity building activities below.

i) Capacity Goals and Strategy

ENVISION’s goals for FY18 are to increase capacity in partnership with the MOH to ensure that

Cameroon is able to deliver effective MDA and surveys. To do this, ENVISION goal will be to assist he

MOH’s efforts to improve its strategic planning abilities, discuss with MOH to build an effective advocacy

strategy, mentor MOH in developing elimination dossiers, working with MOH staff in using the data

driven planning guide as a key tool in MDA implementation action plan.

ii) Capacity Strengthening Objectives and Interventions

Objective 1: Improved strategic planning by the MOH

For effective MDA and survey implementation, planning is a vital step. ENVISION’s objective is to

support the MOH to more effectively plan and budget for FY18.

Intervention 1:

Progress is still needed on the part of each program for the systematic development of cost-effective

NTD strategic documents. In FY18, ENVISION will continue to provide guidance to various programs in

budgeting and finalizing their respective NTDs strategic documents. The national NTD program will also

benefit from ENVISION’s support for the development, validation, and implementation of its elimination

plan. This support can be accomplished through coaching and experience sharing with national program

leaders during their preparation for the review meeting. ENVISION will also ensure that the WHO local

technical advisor in charge of NTDs is a permanent NTDs stakeholder, and also ensure that she/he

attends all MOH strategic meetings.

Intervention 2:

ENVISION will work with the MOH on improving budgeting for activities, especially for surveys.

ENVISION will also reinforce the need for more realistic budgeting and the consequences of not

providing appropriate budgets (and the impact on the program).

Objective 2: Advocacy for NTD activities

This objective aims to improve the resources, both in quality and quantity, available from the MOH for

NTD activities.

Intervention 1:

ENVISION will take advantage of advocacy meetings held at MOH central level to emphasize the

necessity of having enough public servants—who are highly qualified—at all levels to decrease the


13

workload for current staff and enable them to deliver advanced analysis of results from the field.

ENVISION also plans routine trainings each year to reinforce the skills of newcomers to the program.

Intervention 2:

In FY18, ENVISION will continue to provide technical support for field visits to governors of some regions

of Cameroon. These visits will be extended to other local stakeholders such as economic operators who

are willing to support the NTD program. The nongovernmental organizations (NGOs) that attend these

meetings will advocate for the increase of local funding to support NTD activities. ENVISION will also

conduct the same advocacy at the MOH central level, and following this meeting (at central level), HKI

will share its proposal-writing experience with the MOH CCU. This intervention aims to help the national

NTD program identify new funding from donors other than USAID—ENVISION will also provide technical

and financial support for a workshop during which MOH staff members from central level will be trained

on fundraising.

Objective 3: Preparation for the LF and trachoma elimination dossiers

This objective aims to improve the readiness of the LF and trachoma programs for the eventual

submission of an elimination dossier to WHO.

Intervention 1:

ENVISION will provide technical assistance to the MOH for the development of elimination dossiers. In

this regard, ENVISION will assist the CCU in establishing LF and trachoma dossier writing committees. In

addition, ENVISION will provide financial support for meetings to review the work of the dossier writing

committees. External technical assistance will also be required for these meetings. Given that data are

the main input for elimination dossiers, ENVISION will reinforce coaching for the MOH central-level data

managers; ENVISION will also provide some on-the-job-training to these managers during the early

stages of using the integrated NTD database.

Objective 4: Improved drug management

In the past, inaccurate drug ordering and inadequate management have led to delays and poor MDA

coverage in Cameroon. ENVISION’s objective is to support the MOH in improving drug management

processes.

Intervention 1:

To improve the drug ordering process, ENVISION will attend all preparatory meetings related to a drug

order, provide technical support, and help guide the MOH throughout the entire drug ordering process.

In the past, not all NGOs were involved in this process, due to calendar conflicts or other barriers and

the MOH preferred to move forward without partner involvement. Moving forward, ENVISION will

ensure the planning meetings are well scheduled where the maximum number of NGO participants will

be available to support this activity. The purpose is to make sure that decisions are made based on

reliable data. For the follow-up of the drug order, ENVISION will send monthly update requests to both

the CCU and the WHO CCO.


14

b) Capacity Strengthening Interventions

Table 7: Project assistance for capacity strengthening

Project

assistance area

Capacity strengthening

interventions/activities

How these activities will help to correct needs

identified in situation above

1. Strategic

planning

• Experience sharing

• Attendance at strategy

meetings

• Advocacy

ENVISION aims to:

• improve the cost-effective planning of program

activities. ENVISION will support the creation of the

annual NTD plan. ENVISION will work with the MOH to

make detailed activity timelines and set clear

objectives, and will review progress monthly with the

MOH. This will aid in planning and anticipation of

problems.

• ensure that a final program plan with reasonable costs

is approved and accepted (as part of forecasting, any

gaps in ENVISION’s support will be highlighted, which

will allow the MOH to plan proactively to fill these

gaps).

The experience sharing aims to:

• Reinforce MOH capacity to monitor the campaigns.

After each review of regional fixed obligation grant

(FOG) deliverable documents, ENVISION will continue

to share review notes with the CCU to help it in

managing regional FOGs.

• Attending strategic meetings will help ENVISION

ensure that WHO is always aware and involved in NTD

decision making.

• ENVISION will continue to advocate for more qualified

staff at the MOH by having at least one annual

meeting with the Minister of Health.

2. Building

advocacy for a

sustainable

NTD program

• Experience sharing

• Partnerships

• Advocacy

• Support

• To increase local funding and enhance local

ownership, some communities have started to raise

local funds for CDD incentives; this good practice will

be disseminated nationwide through experience sharing

• ENVISION support will enable a consultant to help the

NTD program in the development of a fundraising

strategy.

• To increase concrete commitments to NTD activities

from the MOH, ENVISION, in collaboration with

partners, will advocate for commitment and work with

the Ministry to ensure these outcomes.

3. Dossier

development

• Experience Sharing

• On-the-job-training

• ENVISION will help the MOH to improve the quality of

data because data are the main input for the

development of elimination dossier.

• An external expert will also share his/her experience

and strengthen staff skills during a workshop.


15

Project

assistance area

Capacity strengthening

interventions/activities

How these activities will help to correct needs

identified in situation above

4. Drug supply

management

and

procurement

• Advocacy

ENVISION will advocate for the following:

• Close collaboration with the WHO CCO to improve

follow-up of the drug order and avoid delays in

delivery.

• A systematic annual physical drug inventory after each

MDA to ensure appropriate quantities are ordered.

c) Monitoring Capacity Strengthening

Table 8: Indicators the country will regularly use to evaluate capacity strengthening

progress.

Main categories targeted by

strategic capacity

strengthening approach

Indicators to evaluate capacity strengthening progress

Planning

National NTD plan and annual work plan is available.

Budget estimates are improved and closer to real situation, using previously

accepted budgets as a guide.

Number of strategic meetings attended by WHO CCO technical advisor to

ensure implementation in accordance with guidance.

Building advocacy for a

sustainable NTD program

Amount of increase in money dedicated to NTD from MOH.

Percent staff turnover will decrease compared to previous years.

Dossier Development

Guidelines for the elaboration of elimination dossiers are understood and

data collation has started in FY18.

Elimination dossiers are submitted.

Drug supply management and

procurement

No drug shortage is reported during the MDA campaigns.

An inventory is done at the end of every campaign (for each drug).

Integrated NTD database is used, along with the Tool for Integrated Planning

and Costing (TIPAC), to complete the Joint Application Package.

2) Project Assistance

a) Strategic Planning

i) Activity 1: Annual National Review and Planning Meeting (HKI Strategic Planning)

At the end of every MDA campaign, the MOH holds a national meeting in Yaoundé (two-day meeting

and one travel day) to assess all the (PC) NTD activities carried out during the past year and to plan

activities for the coming year. It brings together representatives from the MOH central level (8

representatives), WHO (1), partner NGDOs (15), regional delegates and MOH NTD focal points (10).

This meeting provides an opportunity to review and approve the results of activities carried out by the

CCU, the national programs for the prevention of NTDs, and the 10 DRSPs. The MOH also presents the

results of specific studies carried out, and the attendees use them during discussions to adjust

treatment strategies and areas of intervention. The discussions also include sharing best practices

identified during the MDA campaign to improve implementation of activities for the upcoming

campaigns. During the meeting, ENVISION provides technical assistance based on its expertise and


16

experience via the staff of HKI and other NGDOs that provide support to the NTD program in Cameroon.

ENVISION also shares a summary of its observations collected during monitoring.

The following specific topics will be covered in FY18:

• Approval of 2017 MDA data

• Inclusion of the results of the FY17 impact surveys in the NTD control strategy

• FY18 impact survey planning

• Surveillance for the HDs that have reached the criteria to stop MDA for LF and trachoma—

reviewing dossier submission and the steps required before submission to collate paperwork

and data

• Possible solutions to improve and maintain coverage in HDs with recurrent poor performance.

ii) Activity 2: Annual Regional Review and Planning Meetings

A two-day review and planning meeting (plus two travel days) is held each year in each of the 10 regions

(i.e., 10 meetings). These meetings bring together central-level MOH teams (five representatives—CCU,

PNLSHI, PNLO, PNLCé, National Program for the Control of Buruli Ulcers [PNLUB]); DRSP and HD

management teams; and representatives of HKI, WHO, and other NGDOs.

During the meeting, the activities of the previous year’s MDA campaign are reviewed and the problems

identified during follow-up/monitoring are presented and discussed to find and approve possible

solutions. The solutions identified are included in planning for the activities of the upcoming year. As

always, these meetings will focus on a review of MDA coverage, identifying areas with particular

difficulties and ensuring that possible solutions are discussed, with concrete steps to implement these

solutions.

The meeting also enables the CCU and various national programs to share information with the region-

level participants, including the results of specific studies carried out by central-level players as well as

the program decisions taken based on these studies. During the meeting, ENVISION and the MOH

central-level participants provide support to the DRSPs to develop their respective detailed micro-plans,

which include the list of activities to be included in the annual work plans of the regions and HDs.

iii) Activity 3: Central and Regional Coordination Meetings

ENVISION will support this activity through level of effort (LOE) only. As part of its follow-up of activities,

the MOH organizes quarterly one-day coordination meetings every year. At the central level, the

meetings bring together representatives of all the national NTD programs, NGDOs supporting NTD

control efforts, and WHO. At the regional level, the meetings bring together DRSP managers, the HD

management teams, and the supporting NGDOs. The participants assess the activities planned over the

previous quarter in order to update the annual work plans (redefining objectives, resetting schedules,

and adjusting requirements to include the activities of the various programs). Feedback is provided to

the DRSPs after each coordination meeting held at the central level. In FY18, ENVISION will take part in

these meetings via its participation in the work of HKI and NGDO staff.

iv) Activity 4: Workshop to Develop the ENVISION FY19 Work Plan

The ENVISION project’s FY19 action plan development workshop will take place in Yaoundé in June 2018

over three days. The following participants will be invited: CCU staff; the managers of the national NTD


17

programs; and representatives of WHO, HKI, RTI/USAID, and partner NGDOs. The workshop’s primary

goal will be to define and plan all the PC NTD control activities the country will implement in FY19. Next,

the MOH, with the support of HKI and the NGDOs, will integrate the activities into a detailed and

budgeted action plan that complies with the directives of the National Strategic Plan to Control NTDs,

WHO directives, and USAID priorities. Participation in this workshop by RTI, USAID, WHO, and the local

partners will enable each attendee to better understand the environment in which the activities are

implemented. The presence of RTI and USAID will provide an opportunity to carry out a first local review

of the draft action plan to reduce the amount of post-workshop feedback and the length of the approval

process.

v) Activity 5: Meetings of the Committee for the Elimination of OV and LF

In FY17, the MOH created the National Committee for the Elimination of Onchocerciasis and Lymphatic

Filariasis (OEC). The members of this committee include national and international experts, including

from WHO, USAID, RTI, and HKI. As part of the effort to eliminate NTDs in Cameroon, this body is

responsible for assessing and issuing scientific and technical opinions on the programs and projects for

the prevention of OV and LF developed and implemented in the country. The committee will hold

several meetings in FY18. Its reports will be shared with local players in the fight against NTDs.

Sightsavers will provide financing for first rounds of these meetings. NTD Secretariat

The CCU will continue to benefit from ENVISION’s technical and/or financial support in FY18. The

support will consist of the following:

• NGDO participation in periodic coordination meetings (described in the Strategic Planning

section)

• Participation in the workshop to develop a continuous LF monitoring plan at the central level

(see the M&E section for more information).

In addition, ENVISION will provide support to the CCU and the national NTD programs for monitoring the

implementation of community campaign activities. These activities include training, MDA, and regional-

level review/planning. To accomplish this, HKI and the NGDOs will carry out the following:

• Take part in the joint training supervision with the MOH teams. During this activity, the

supervisor will help the persons supervised identify their weaknesses and jointly develop a plan

to resolve any issues as well as a plan to follow up on how well recommendations are carried

out. Everything will be recorded in the monitoring report and shared at all higher management

levels.

• Provide the CCU with review notes for regional FOG deliverables on a regular basis.

b) Building Advocacy for a Sustainable National NTD Program

i) Activity 1: Advocacy Meeting at MOH Central Level

This one-day meeting will bring together the heads of the NGDOs; the heads of the Directorate for the

Control of Diseases, Epidemics, and Pandemics; the heads of the Directorate for Pharmacy, Medicines,

and Laboratories; the heads of the Cooperation Division; and the heads of the Directorate of Financial

Resources and Assets. During this meeting, participants will discuss solutions to ensure the sustainability

of the national NTD program


18

During the meeting, the participants will carry out the following:

• Update the status of needs for conducting SAC deworming activities (not supported by

ENVISION in FY18) and for CDD motivation

• Identify the financial, human, and material resources the MOH can mobilize locally to enable the

country to implement additional SAC deworming activities and to motivate CDDs

• Review the advocacy targets and strategies to reach them

• Discuss the difficulties encountered in ordering and managing MDA campaign drugs and the

corrective measures implemented

• Discuss the reasons for low FY17 MDA coverage in each district

• Define the measures the MOH must take to reduce staff shortages in the Health Areas, improve

the delivery process for drugs and other inputs to the operational zones (notably the test kits for

surveys), and design an MDA campaign waste management plan

• Discuss creating a post-ENVISION strategy.

ii) Activity 2: Advocacy Meeting with Other Governmental and Nongovernmental Stakeholders

This one-day meeting will be organized at the central level by the MOH. It will bring together the

representatives of various ministries and associations—the Ministry of Social Affairs, MINCOM, Ministry

of Youth and Civic Education, Ministry of Women’s Empowerment and Family, MINEDUB, MINESEC,

Fonds Spécial d’Équipement et d’Intervention Intercommunale (Special Council Support Fund [FEICOM]),

Association of United Communes and Cities (CVUC—an association of Cameroon mayors)—as well as

representatives of various media and telecommunication outlets—CRTV, CAMTEL, NEXTTEL, MTN and

Orange.

During the meeting, and based on the data concerning needs and difficulties, the participants will

develop strategies to accomplish the following:

• Mobilize local resources to motivate CDDs

• Mobilize internal financing for SAC deworming activities

• Increase the number of SAC not attending school who are treated during the deworming

campaigns

• Increase awareness and improve communication to reduce the number of refusals during MDA

in the communities.

Following the advocacy meeting, the CCU will prepare a report with the commitments made by the

various institutions along with the implementation deadlines. Next, the report will be shared will all the

institutions represented. In order to ensure that the commitments are met, the CCU will follow up on

their implementation with the authorities in question, then prepare and send out a quarterly progress

report..

The meeting will be held in Q1, FY18.

iii) Activity 3: Regional Advocacy Meetings

The advocacy results obtained to date were presented in the introductory paragraph of this section. In

addition, other mayors and governors made commitments; actions based on these commitments are

currently being implemented, but the resources for the actions have not yet been mobilized. For


19

example, the governor of the Southwest Region instructed the mayors of his region in a letter in 2016 to

contribute to motivating the CDDs. In addition, the CVUC promised a contribution from city halls to

support NTD control efforts.

In FY18, regional meetings will use the data provided by the central-level advocacy meeting to solicit

resources for SAC deworming activities (because this will not be supported by ENVISION in FY18) and for

CDD motivation. In addition, at the regional meetings, participants will assess the level of progress for

implementation of commitments made in 2016, and will update commitments to reflect shifts in the

field. Given the previous STH treatment in all 189 HDs, regional advocacy meetings will be held in all ten

regions, funds permitting.

These meetings will take their cue from previous experiences and the real needs of each region and will

be held formally in several steps:

• First, each Regional Public Health Delegate will meet the governor of their region with the

support of the NGDO that works in that region and of the MOH central level to request the

involvement of administrative authorities and security forces in NTD control efforts. This

involvement will increase mobilization of the population during campaigns, encourage

mobilization of local resources for NTD control efforts, and provide monitoring for activities in

dangerous zones. During discussions with the governor, the Regional Public Health Delegate will

present the results of the 2017 campaign, the difficulties encountered, and the activities

planned for 2018. The meeting will last one day.

• Second, the DRSP will organize a one-day work session with the regional CVUC and FEICOM

representatives to solicit their support, given their proximity to local populations and as part of

the three-party agreement. According to this agreement, the CVUC association has committed

to mobilizing community participation via technical, logistical, and financial support and

providing awareness-raising for administrative authorities about the progress of activities

carried out in cooperation with the decentralized MOH department.

• The DRSPs will then organize a one-day meeting with a sampling of private sector parties to

obtain financial or material support for NTD control efforts

• The last step will consist of a one-day meeting among the DRSPs; representatives of the

traditional, religious, and administrative authorities; and regional delegations from ministries of

Social Affairs, Communication, Youth and Civic Education, Women’s Empowerment and Family,

and Basic and Secondary Education. During the discussions, the DRSPs will present the list of

HDs with consistently low coverage rates, and the participants will decide on the actions to be

taken to improve awareness and reduce the number of refusals in these HDs.

All these meetings will be held during Q1 of FY18.

Following the different advocacy meetings, each DRSP will create a report of the commitments made by

various authorities and the implementation deadlines. Next, the report will be shared with all the

authorities who attended the meetings. To ensure that the commitments are met, the DRSPs will follow

up on their implementation with the authorities in question. Lastly, the DRSPs will prepare and send out

a quarterly progress report throughout the campaign.

c) Mapping

Mapping for all diseases is complete, and no further mapping is planned in FY18.


20

d) MDA Coverage

Planned FY18 MDA Activities

As noted at the start of this section, in FY18, ENVISION plans to support community-based MDA in all

113 OV-endemic HDs.

Table 9: USAID-supported districts and estimated target populations for MDA in FY18*

NTD Age groups targeted

Number of

rounds of

distribution

annually

Distribution

platform(s)

Number of

districts to

be treated

in FY18

Total # of

eligible

people to be

targeted

in FY18

OV Entire population >5

years old 1

Community-

based strategy 113 8,627,552

Trachoma Entire population 1 Community-

based strategy 0a 0

a) All the HDs have met the criteria to stop treatment for trachoma. If the survey reveals that Minawao refugee camp requires

MDA, this will be planned in FY19.

i) Activity 1: Community MDA

The MDA campaigns for OV are organized in the communities every year during the May–June period,

based on the schedules established by each region. The only exception is East Region, which normally

organizes the MDA from January to March. These treatment periods are generally complied with, except

in the event of the unavailability of drugs or when there is a scheduling conflict. The MDA targets all

members of the endemic community five years and older and is implemented by the CDDs.

Prior to the start of treatment, the CDDs count all of the people living in the households of the

community. Based on this count, they then receive drugs from the Health Center nurse to treat eligible

persons (using the information provided to them by the nurse during the training session on drug

quantity calculation). The CDDs administer IVM in OV-endemic zones based on patient size, using a dose

pole. To cover all the zones targeted, they either work door-to-door or bring people together in one

location.

At the end of the campaign, the CDDs use their register to prepare summary reports, which they then

send to the Health Center’s head nurse. They keep a copy of the report for the community. The

treatment data are forwarded to the MOH central level from the community, based on the Cameroon

health pyramid.

ii) Activity 2: Review and Production of Community Treatment Registers and Data Collection Tools

The community drug distribution registers kept by the CDDs reached the end of their life cycle in 2017

and must be replaced. Printing the registers is linked to the population, e.g., despite few HDs receiving

OV MDA in the Far North, there are more Health Centers and Health Areas (and CDDs) due to the large

population. Registers are printed for each CDD. In addition, treatment was halted for HDs that

conducted trachoma MDA, and other districts are stopping LF MDA. ENVISION will provide support for

the review of the registers in 2018. The registers will be approved at a validation meeting, which will


21

bring together staff from the PNLO, the National NTD CCU, and partner NGDOs involved in PC NTD

control efforts. Following the review meeting, ENVISION will finance the production of 27,750

community treatment registers and 10,000 data collection forms.

e) Social Mobilization to Enable NTD Program Activities

i) Activity 1: IEC Materials Review and Approval Workshops

A coverage survey will be carried in December 2017, including questions concerning IEC materials

evaluation. For this survey, a grid will be designed to evaluate IEC materials available in the field. A

review and revision workshop will be held in Mbalmayo, in Q2 FY18, with workshop activities based on

recommendations from the coverage survey. Heads of the NGDOs and MOH central-level managers will

participate. The revised tools will be produced in FY18.

ii) Activity 2: Production of IEC Materials

In FY18, based on the results of the study carried out by the MMDP project, ENVISION will finance the

production of posters and T-shirts as follows: 16,576 posters (8,176 printed by HKI, 1,400 printed by

PersPective, 2,800 printed by IEF, and 4,200 printed by Sightsavers); 19,750 T-shirts will be produced

with ENVISION funding and 21,000 T-shirts produced with funding from Sightsavers. Sightsavers,

through ENVISION funding, will produce 114 banners. The IEC workshops planned in FY18 will produce

redesigned materials, based on the coverage surveys carried out in Q1 FY18, making sure the most

effective materials are used with the most effective messages. The posters and the T-shirts will include

as many images as possible. The posters will be placed in public places at the beginning of the MDA

campaign. Each community will receive an average of three posters each. During their training session,

each CDD will receive a T-shirt with a message about the disease and its treatment. The Health Area

heads will brief the CDDs on the content of the message printed on the T-shirts. The T-shirts will enable

quick identification of the CDDs to guarantee their visibility and make their intervention in the

community credible. The CDDs will also use the shirts as awareness-raising tools.

Results from the coverage surveys may be used to adjust the quantities and types of IEC materials

produced in FY18.

• Radio and television broadcasts: With ENVISION support, the communication focal points of each

region will develop messages that will be broadcast in the official and local languages via radio and

televisions shows during the community campaign. The messages will be based on the following

topics: the diseases targeted by the mass treatments, population buy-in and diligence in following

the mass treatment, the role of drug distributors and the need to welcome them warmly. Prior to

the start of each MDA campaign, the communication department of each Regional Health

Delegation will organize a meeting with the media to review the messages to be broadcast and

determine and reserve the best air times for the broadcasts

• Communication in refugee camps: Cameroon has several refugee camps located primarily in the Far

North, Adamawa, and East regions. The total refugee population in the country is estimated at

359,000.9 Communication for this population must continue in FY18 because the base population in

the refugee camps changes continuously. ENVISION will target two refugee camps for awareness-

raising messages, one in Far North and one in East Region. (These camps are already being treated

for some NTDs.) Awareness-raising messages about NTDs included in the current education and

9 Eurpean Commission. (2017). Aide humanitaire et protection civile. Fiche Info Echo-Cameroun, January 2017, p. 1.


22

hygiene materials are prepared by the HD management teams and delivered both by HD staff

working at the camps on sanitary issues and by the channels identified within the camp, such as

churches and mosques, teachers, and CDDs designated by camp residents. With respect to the

allocation and delivery of the IEC materials included in the regional FOGs, the HDs consider the

refugee camps to be special Health Areas.

iii) Activity 3: Official MDA Campaign Launch Ceremony (HKI Social Mobilization)

The ceremony will be chaired by the Minister for Public Health in a district selected in advance. The

ceremony will receive widespread media coverage resulting in broad dissemination of the messages at

the national level. This will increase the involvement of stakeholders in achieving program objectives.


23

Table 10: Social Mobilization/Communication Activities and Materials Checklist for NTD Work Planning

Category Key messages Population

targeted

IEC strategies

(materials,

media,

activities,

etc.)

Where/when will they be

distributed? Frequency

Is there an

indicator/mechanism to

track the materials or

activity? If yes, which one

Other comments

Participation Mectizan® is free

+

Let’s take Mectizan® every

year

CDDs T-shirts (back)

+

T-shirts (front)

During the training

session, each CDD will

receive a T-shirt with a

message about the

disease and treatment.

The Health Area heads

will brief the CDDs on the

content of the messages

printed on the T-shirts.

Once during

the campaign

Number of CDDs receiving a

T-shirt during the training

sessions (as an indicator) +

coverage survey (as a

mechanism).

Number of people taking part

in the MDA thanks to the

messages.

The exact type and

quantity of IEC

materials will be

reviewed after the

workshops in July and

October 2017.

Mectizan® is free

+

Let’s take Mectizan® every

yea

Communities Posters The posters will be hung

in public places at the

beginning of the MDA

campaign. An average of

three (3) will be required

for each community.

Once during

the campaign

Number of public places in

which the posters will be

seen by the supervisors

during MDA monitoring.

Number of people taking part

in the MDA thanks to the

messages.

The exact type and

quantity of IEC

materials will be

reviewed after the


October 2017.

In addition to the messages

on the posters and T-shirts,

the HD management teams

will prepare awareness-

raising messages about NTDs.

Refugees Posters, T-

shirts,

education and

sanitation

activities

The messages will be

delivered by the HD staff

working in the camps for

sanitation purposes and

by channels identified

within the camps, i.e.,

churches, mosques,

teachers, and CDDs

designated by the camp

populations. The T-shirts

will be handed out during

CDD training. The posters

will be placed in the

busiest places in the

refugee camp.

Once during

the campaign

Number of public places in

the refugee camps where the

posters will be seen by the

supervisors during MDA

monitoring.

Number of refugees taking

part in the MDA thanks to the

messages.

The exact type and

quantity of IEC

materials will be

reviewed after the


October 2017.


24

Category Key messages Population

targeted

IEC strategies

(materials,

media,

activities,

etc.)

Where/when will they be

distributed? Frequency

Is there an

indicator/mechanism to

track the materials or

activity? If yes, which one

Other comments

Increase stakeholder

participation in achieving

program objectives

Public powers

+ Community

members +

Private

companies

Official MDA

campaign

launch

ceremony

The ceremony will be held

in Q2, FY18, in an HD

selected during the

annual national planning

meeting.

Once during

the campaign

Increase in non-USAID

contributions

The exact type and

quantity of IEC

materials will be

reviewed after the


October 2017.


25

f) Training

i) Activity 1: Nurse Training (Level 1: HD)

This training is for the health care personnel of Health Areas and will be held in each HD undergoing

MDA. It is intended to improve the technical capacities of participants with respect to the

implementation of NTD control activities in their areas. The HD management team will develop the

training program. It will take into account the results and shortcomings of the previous campaign and

address them directly in the training session. The facilitators will also cover the following points: CDD

training techniques, monitoring of MDA campaign activities at the community level, management of

adverse events, data analysis and management, drug management, and report writing. Practical

exercises will be done in groups or individually to facilitate further participants’ understanding of data

analysis, CDD treatment register completion and data summary grids, census taking, and drug

management. At the end of the training, each manager will develop an integrated MDA activities

schedule to be implemented at the Health Area level and a CDD training schedule. The Health Area

heads must include as many training sites as possible in the schedule to reduce the distances CDDs must

travel (helping to ensure their participation). Training will last one day and will be facilitated by the HD

management team. The supervisors will come from the MOH central and regional levels and from

NGDOs supporting NTD control efforts.

ii) Activity 2: CDD Training (Level 2: Health Areas)

Training will take place at the Health Area level. The facilitators will cover the following points:

awareness-raising and communication techniques, census taking, drug distribution, monitoring for

adverse events, drug management, data entry in the treatment register, and CDD report writing. Several

case studies and role playing will be included in the training sessions to ensure quality. While the

program recommends a ratio of one (1) CDD per hundred (100) inhabitants, in reality, the number is

dependent on population size, the area of the zone to be covered, and accessibility. CDD training lasts

two days. It will be facilitated by the Health Area nurse(s). Training supervision will be provided by

regional and HD staff, as well as staff from PNLO, CCU, and NGDOs supporting NTD control efforts.

g) Drug and Commodity Supply Management and Procurement

Since 2013, IVM, ALB, MEB, and PZQ orders have been planned by all stakeholders (with support from

WHO) during a meeting at which the drug order form is filled in. The data used were taken from the

updated 2005 national census and data collected by the HDs during previous campaigns. The volume of

drugs to be ordered depends on the treatment target by disease. For trachoma, the PNLCé orders

Zithromax®, which is supplied by Pfizer and delivered to Cameroon via the International Trachoma

Initiative. RTI supplies the TEO. For all drugs except for ZTH and the TEO, WHO serves as the delivery

intermediary. HKI provides technical assistance, when required, for filling in the joint drug order forms

and to ensure that the data required is complete and accurate.

i) Drug transportation and delivery

The NGDOs provide support for development of the distribution plans in their respective regions and

districts, but the MOH provides drug transportation from the central level to the Health Areas.

Several steps are required to ensure that the drugs reach the populations receiving treatment:


26

• Step 1: The drugs arrive at the entry point to the country (port or airport). They are subjected to

administrative and customs formalities before pickup.

• Step 2: They are then transported and warehoused at the National Center for Essential Drug Supply

(CENAME).

• Step 3: CENAME supplies the Regional Funds for Health Promotion (FRPS) based on the distribution

map created by PNLO. The FRPSs are MOH agencies responsible for managing and supplying each

region with essential drugs. The problem at the FRPS level is that they often do not have a reserve

stock, which makes it difficult to adjust supplies in the event of a shortage in a region. The national

NTD program will supply backup stock for each FRPS to deal with this issue.

• Step 4: The Regional Public Health Delegate, in collaboration with the NGDO in the region that

supports NTD control efforts, distributes the drugs based on the needs of each HD and sends out a

copy of the distribution to the FRPS. Next, the Regional Public Health Delegate authorizes the

removal of the drugs from the FRPS by a member of the management team of each HD, who then

transports them to the relevant HD. There are sometimes delays in picking up the drugs because

some HDs are far away from the FRPS. To deal with this problem, the regional level, with NGDO

support, uses the various supervision visits to bring the drugs to the HD.

• Step 5: The HD supplies the Health Areas, which in turn provide the drugs to the CDDs based on the

census data provided by the latter. This step also experiences delays at times due to the distance

between the HDs and the Health Areas, plus the poor condition of roads and tracks. In FY18, the

national NTD program will send drugs to the Health Areas at least 2–3 weeks prior to the start of

CDD training. This will enable the health staff to make projections about the needs of each

community based on the results of the previous campaign and to provide the CDDs with their stock

at the end of their training session.

At the end of each MDA campaign, the remaining stocks of drugs are collected by the Health Area

nurses. They take them to the HD level, which in turn brings them to the FRPS, where they are

repackaged by lot number, expiration date, and quantity. In FY18, ENVISON will use supervision visits to

ensure that the return of the drugs follows the supply chain in reverse.

Expired drugs are stored in the DRSPs with the FRPSs and destroyed with approval from the commission

appointed for that purpose. The recurring difficulty is that the remaining drugs are not all returned. IVM

and ALB are often kept by the CDDs, sometimes at the Health Area level. Tracing the drugs in the field

remains a major challenge. One solution that the national NTD program will implement in FY18 will be to

conduct a physical inventory at the end of the deworming campaign. The MOH will also include this

issue on the agenda for the next national review meeting. Concrete actions will be discussed, and a drug

return monitoring plan with recommendations will be developed, then shared at all levels.

In addition to participating in drug order preparation and validation meetings, ENVISION will provide

technical assistance (TA) to the Regional Delegations in developing their respective drug allocation

plans. While these allocations will be done on the basis of the census from the previous year, ENVISION

will assist the Regional Delegations to revise the drug loss rates downward, in order to avoid having

large stocks of unused tablets.

During the field supervision, ENVISION will check that all drug dispersals and returns are accompanied

by a sign-off document, to ensure good tracking of medicines. ENVISION will also ensure that

communities with multiple CDDs have designated one CDD to be accountable for community drug

management during the MDA campaign. The designated CDD will receive the quantities of drugs

allocated to the community, and will distribute them to other CDDs. To improve the return of the


27

remaining stocks, ENVISION will verify, during field visits, that health area personnel receive the balance

of their fees for data collection only after they have submitted treatment data and remaining physical

stocks of drugs.

h) Supervision for MDA

Activity 1: Supervision of community based MDA

MDA activity implementation in the communities requires constant monitoring to ensure that the

activities are carried out. Monitoring also helps to uncover problems and provides solutions to ensure

the quality of results at the end of the campaign. It is for this monitoring that the stakeholders of the

central, regional, HD, Health Area and NGDO jointly carry out routine monitoring during the campaign.

The monitoring is for all campaign activities, from training to drug distribution in the communities. Given

the extent of the departments/Health Areas to be monitored, the supervisors split responsibilities to

cover a considerable number of the implementation sites. ENVISION provides technical support to the

MOH for the organization of monitoring in accordance with program standards, notably by participating

in updating and disseminating monitoring grids specific to each activity. To ensure the quality of the

community-based MDA, several supervisory visits are made in the field during the campaign: head

nurses responsible for the Health Areas, members of the HD management teams, DRSP NTD staff, the

MOH central level, and the NGDOs themselves. Preparation Phase

The MOH will organize preparatory meetings with technical support from the NGDOs for each activity

and each level. At the central level, personnel from the CCU, the national NTD programs, and the NGDOs

will attend the meetings. At the regional level, DRSPs and NGDO representatives will attend. During the

meetings, participants will use the strengths, weaknesses, and good practices recorded, either during

previous campaigns or during the implementation of completed activities, to define the different TORs

by area. Participants will develop (or update) a monitoring grid based on activity indicators and strategy.

The monitoring grid and the TORs will be provided to participants to enable them to better carry out

monitoring in the field. HDs with recurring low coverage during previous campaigns and HDs with new

management teams will take precedence.

i) Implementation Phase

Supervision covers community MDA campaigns, impact surveys, training, and data collection. The TORs

for the supervisors will be specific to each activity and operational level monitored.

For the different supervision phases, the following actions will take place:

During the training/refresher course sessions:

• The trainers administer pre-tests before training starts and post-tests at the end of training to

assess the knowledge level of participants before and after training. For health care staff

training, participants who receive a grade below 12/20 will be continuously monitored

throughout the campaign by HD managers. For all activities, training supervision will be

provided by district management teams and other supervisors in the zones in which health care

staff who received poor grades on post-tests are working. Likewise, if a CDD receives a grade

below 10/20, the community in which they distribute drugs will be considered a priority for

monitoring during the MDA phase and during data collection. Because CDDs are volunteers,

they are given additional supervision and coaching, but they are not prevented from going into

the field.


28

• Participants will work in groups for practical exercises, including exercises to practice using the

dose pole and data collection tools, and will use role-play to simulate situations they might

encounter in the field.

• The trainers will make IEC materials available and ensure that participants have clearly

assimilated their messages in order to better transmit them.

• The trainers and organizers will ensure that the new registers are available in sufficient

quantities for the CDDs.

During the MDA:

• Check the availability of the drugs and their proper management to ensure early detection of

any supply issues or other problems related to poor allocation and to correct the shortcomings

before the end of distribution

• Carry out quick surveys in households to estimate the geographical and therapeutic coverage

trends and take action to raise awareness and mobilize field players if the trend is weak

• Check that the CDDs are using the dose poles (where required) and that they are complying with

dosages

• Check that the CDDs are correctly filling in the data collection tools

• Document best practices and lessons learned.

For data collection:

• Check the presence and the correct use of data collection tools

• Check that the databases are filled in at all levels and correct any inconsistencies found

• Check that the data are archived at all levels monitored

• Provide feedback to the persons responsible for the level monitored, identify any problems, and

suggest corrections to address any issues found in a timely fashion.

Before ending monitoring in the field, the supervisor must ask the person supervised to develop an

implementation plan for the recommendations. The supervisor must keep a copy of the plan and

evaluate its implementation during future monitoring.

ii) Debriefing, Data Validation, and Reporting

The supervisors will conduct a debriefing at every level monitored to find immediate solutions to solve

the problems found. They will then provide a final debriefing to the DRSP. The monitoring results will be

discussed at the regional-level debriefing, which all regional and central supervisors and NGDOs taking

part in the activity will attend. Attendees will discuss the problems identified in the field for which

solutions were not implemented in the field during the implementation phase. The DRSP will also

summarize the supervisors’ reports, integrating the strengths and weaknesses identified. This summary

will be forwarded to the NTD CCU.

In addition, and in order to guarantee the completeness and consistency of the data and ensure that

they are identical throughout the transmission chain (HD, regional level, CCU), a data standardization

and validation session will be held at three levels:


29

• HD level: This session will be held during the data collection phase. The District Medical Team

(DMT), regional supervisors, supervisors of NGDOs supporting NTD control efforts, and CCU

supervisors will participate. They will review and correct Health Area data. ENVISION will cover

only supervisor travel expenses (per diem and transportation). CDDs will file the distribution

reports and CDD registers per community with the health personnel responsible for the Health

Area. The health personnel will compile all the data in a summary file for the area and send it to

the HD. In the event that the file is incomplete or inconsistent, the HD-level supervisors can visit

the communities to correct it. Once the data have been analyzed, standardized, and approved,

copies will be sent to the Health Area and the related sectors that are involved. If drugs are

available and additional coverage is needed, mop-up activities are conducted immediately. If

not, any remaining drugs need to be moved to other areas requiring additional support.

• Regional level: This session will be held for two days immediately following the annual regional

NTD activities review meetings. The regional NTD focal points, the MOH central-level data

managers, and the NGDO staff will attend.

• Central level: This session will take place following the annual national meeting to review the

NTD control campaign. The national NTD CCU data manager, the coordinators of the various

programs, and the NGDO data managers will attend.

i) M&E

i) Activity 1: TAS1

A TAS1 will be conducted in 12 HDs in February 2018, if they are found eligible after the FY17 pre-TAS:

• Meiganga, Ngaoundéré-Urbain, and Tignère in Adamawa Region

• Esse, Evodoula, Nanga-Eboko, Ngog-Mapubi, and Okola in Center Region

• Bertoua, Bétaré-Oya, and Lomié in East Region

• Akwaya in Southwest Region.

After the capacity building efforts in FY17, the MOH will conduct these TAS1 using a school-based

survey. Team members will be MOH staff members from regional and district levels, who will be trained

by MOH and NGO staff members from the central level. The survey may last two weeks and will

evaluate if the HDs are eligible to stop the MDA for LF. An MOH investigator will use the WHO TAS

checklists to prepare, plan, and implement the survey according to WHO guidelines for TAS1.

ii) Activity 2: TAS2

In accordance with WHO guidelines on eliminating LF, it is recommended to proceed with periodic TAS

two to three years after the mass treatments have been stopped.

Five HDs successfully completed their TAS1 in 2014: Mokolo in Far North and Poli, Tcholliré, Ngong, and

Rey-Bouba in North Region. In FY18, ENVISION will provide technical and financial support for

community-based TAS2 in these 5 HDs (3 EUs) in March 2018. TAS2 will be community-based according

to WHO guidelines, since the school enrollment rate is too low in the North and Far North for school-

based surveys.

An additional 33 HDs in the North and Far North regions successfully passed their TAS1 in 2016 and are

eligible for TAS2 in FY18. ENVISION will provide technical and financial support for a TAS2 in all 38 HDs in


30

March 2018, to be arranged in 13 EUs. The results obtained will show if there has been a resurgence of LF

in these HDs

iii) Activity 3: Trachoma surveillance surveys

Seven HDs in Far North Region successfully completed their TIS: Bourha, Roua, Koza, Hina, and Mogode

in 2014 and Mokolo and Guidiguis in 2015 and stopped mass treatment for trachoma. ENVISION will

provide its support in October 2017 to organize a workshop to develop an action plan for the

elimination of trachoma (Trachoma Action Plan [TAP]). The plan will take into account the WHO

directives for the elimination of trachoma, which recommend starting surveillance after treatment has

ended. A TSS will be conducted in the seven HDs in Far North Region mentioned above. Because the

MOH staff received training on the use of Tropical Data in Q2 of FY17, this methodology will be used in

FY18 (after refresher training if needed). The survey’s purpose will be to ensure that there has been no

recrudescence of trachoma. ENVISION will provide its technical support for the implementation of this

TSS, which will use the WHO Tropical Data methodology. Activity 4: Trachoma survey in Minawao

refugee camp

The PNLCé and the DRSP of the Far North Region, together with the support of the UNHCR, will review

the status of the demographic situation and of the health care provided in the Minawao refugee camp

located in the Mokolo HD (Far North Region). This will provide the data needed to plan a prevalence

survey in the camp in FY18. Discussions have already begun for the planning of this prevalence survey

and is planned for Q1 FY18.

iv) Activity 4: Coverage survey (M&E)

ENVISION will provide support for the implementation of a coverage survey which will enable

identification and documentation of the following:

• The reasons for non-compliance (by identifying common reasons for not swallowing the drugs,

the country will review the social mobilization tools/strategy prior to the next MDA round)

• The factors that ensure good coverage rates

• Posters and T-shirts will also be assessed during the coverage surveys. According to the July

2017 workshop recommendations were made to adapt both posters and T-shirts so these tools

should be assessed during the coverage surveys in Q1 FY18.

Due to the importance of this M&E activity, ENVISION will provide financial support to 16 people for a

three-day training and 10 days of survey. These people will include an external consultant, 5

independent surveyors recruited locally, 9 staff from implementing partners, and two staff from the

MOH central team, serving as observers and co-investigators. Although the independent team has

ultimate responsibility for the conduct of the survey, ENVISION and partners are also obligated to

ensure the survey is conducted in compliance with the protocol. In HDs targeted for survey, additional

staff will be hired to serve as guides and translators. The study of the IEC materials will be added to this

coverage survey, and the survey, which will cover 09 health districts, will be carried out in Quarter 1

FY18.

v) Activity 5: SCH-STH impact survey (M&E)

Given that USAID refocused its priorities on OV, LF, trachoma, and as part of the SCH-STH transition

planning, ENVISION will provide technical and financial assistance for the implementation of a SCH-STH


31

impact survey which will help to measure the progress that the country made in the control of these

diseases using USAID’s support. This survey will be implemented in 12 health districts and it will be

carried out in FY18 Q1. The study will be conducted by PNLSHI.

Table 11: Planned Disease-specific Assessments for FY18 by Disease

Disease

No. of

endemic

districts

No. of districts

planned for

DSA

No. of

Evaluation

Units

planned for

DSA (if

known)

Type of

assessment

Diagnostic method

(Indicator: Mf, FTS, etc)

LF 12 12 4 TAS1 FTS

33 16 TAS2 FTS

Trachoma 0 7 7 TSS Clinical grading

SCH/STHa 84 12 Impact survey Kato Katz

(a): the impact survey targets firstly SCH. But STH will be included in the selected districts given that STH is endemic in all the 189

districts of the country.

j) Supervision for M&E and DSAs

i) Activity 1: Supervision of TAS1

The TAS training will be supervised by ENVISION to ensure the program’s ability to carry out further

assessments without external assistance. RTI will work with ENVISION staff to ensure that activities take

place under the guidance and supervision of experienced staff, and therefore will design a supervision

strategy to be implemented during the surveys (above).

ENVISION support for the survey will also consist in ensuring that the protocol meets WHO TAS1 impact

assessment directives. Therefore, support will be provided via data collection by smartphone on the

www.ONA.io platform (a platform for mobile data collection) to which the Ministry will also have access

for real-time monitoring of the activity. The platform was already used by the MOH in the past to

monitor administration of vitamin A as part of the Nutrition project. In May 2017, the platform was used

for the real-time monitoring of TAS data collection in nine of the country’s regions. Through field

supervision and surveyors’ refresher training, the HKI team will support the MOH in implementing the

survey and make sure protocol and data collection follow WHO TAS methodology.

ii) Activity 2: Supervision of TAS2

ENVISION will request external technical assistance to develop and track implementation of the

monitoring survey in 33 HDs—these HDs will be conducting a monitoring survey two to three years after

treatment. Through field supervision and surveyors’’ refresher training, the HKI team will support the

MOH in implementing the survey and make sure protocol and data collection follow WHO TAS

methodology.

iii) Activity 3: Supervision of trachoma surveillance surveys

ENVISION will request external technical assistance to develop and track implementation of the

monitoring survey in the HDs of Bourha, Roua, Koza, Hina, Mogode, Mokolo, and Guidiguis in Far North

Region—these HDs will be conducting a monitoring survey two to three years after treatment has


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stopped. Data collection for this monitoring survey will use the Tropical Data system to ensure quality

assurance and data reliability.

iv) Activity 4: Supervision of prevalence survey in Minawao

ENVISION provide supervision for the prevalence mapping in the refugee camp at Minawao.

v) Activity 5: Supervision of SCH-STH surveys

ENVISION will supervise SCH-STH surveys in the 12 HDS planned for FY18. Surveyors will be responsible

for data collection (through diagnostic tools) and paper/smartphone-based recording.

vi) Activity 6: supervision of the coverage survey

Staff from MoH Central level and NGOs (HKI, IEF, PP and SSI) will get to the targeted districts to provide

training to local surveyors. This training will include both theory and practice on the field. Following this

step, these trainers will follow-up the field data collection as supervisors. This will enable to ensure that

surveyors fully comply with the protocol. ENVISION will support per diem costs and travel fees for the

whole team.

k) Dossier Development

ENVISION plans to provide support for MOH staff training in August 2017. The training will cover the

development of plans to eliminate LF and trachoma. Following the training, MOH staff will be instructed

on WHO directives for the preparation of elimination dossiers. During the training, an action plan will also

be developed to prepare the LF and trachoma elimination dossiers. The plans must be documented to

indicate roles and responsibilities for the preparation of the dossier for each disease. They must also

include a schedule of actions to be executed to complete the dossier. In FY18, ENVISION support will

consist in a contribution to monitoring plan implementation.

i) Activity 1: Meetings to review and validate the LF and trachoma elimination dossiers progress

In FY17, a workshop on preparing LF and trachoma elimination dossiers will result in the creation of two

writing committees: one each for the development of the elimination dossiers for LF and trachoma. During

this workshop, participants will also produce the TAP.

ENVISION will provide support for two meetings to review of the work of the dossier writing committees.

They will cover the progress made in terms of preparing the elimination dossiers for LF and trachoma.

Technical assistance will also be required (e.g., a consultant to assist in writing), and is included in the

Short Term Technical Assistance section below.


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3) Maps

Figure 1. Cameroon LF, OV, SCH, STH, and Trachoma Endemicity Map


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Figure 2. Cameroon LF, OV, SCH, STH, and Trachoma Geographic Coverage Map10

10 The SCH and STH maps do not reflect the most recent changes to geographic coverage


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Figure 3. Cameroon LF DSA map11

11 Reflects original proposal to do TAS2 in 38 districts; current FY18 plan is to do TAS2 in 5 districts


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Figure 4. Cameroon Trachoma DSA map


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APPENDIX 1: Work Plan Timeline

FY18 Activities

Management Support

Project Assistance

Strategic Planning

Annual National Review and Planning Meeting

Annual Regional Review and Planning Meeting

Central and Regional Coordination Meetings

Workshop to Develop the ENVISION FY19 Work Plan

Meetings of the Committee for the Elimination of OV and LF

NTD Secretariat

Support to CCU

Building Advocacy for Sustainable National NTD Program

Advocacy Meeting at MOH Central Level

Advocacy Meeting with Other Governmental and Nongovernmental Stakeholders

Regional Advocacy Meetings

Mapping

N/A

MDA Coverage

Community Census

Community MDA

Review and Production of Community Treatment Registers and Data Collection Tools

Social Mobilization to Enable NTD Program Activities

IEC Materials Review and Approval Workshops

Production of IEC Materials

Official MDA Campaign Launch Ceremony

Training

Nurse Training (Level 1: HD)

CDD Training (Level 2: Health Areas)

Drug Supply Management and Procurement

Drug transportation from the entry point of the country (port /airport) to the Central level

Drug transportation from the Central level to regions

FY17 Drug transportation to regional level (for SCHOOL-BASED MDA)

FY17 Drug transportation to district level (for SCHOOL-BASED MDA)

Drug transportation from regions to health districts

Supervision for MDA

Supervision of the training of nurses for the community MDA

Supervision of the training of CDDs for the community MDA

Supervision of the community Mass Drug Distribution

Supervision of the regional training (TRAINING FOR MDAS IN SCHOOLS)

Supervision of data collection

Monitoring and Evaluations

TAS1

TAS2

Prevalence mapping in Minawao refugee camp

Post-MDA TSS


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FY18 Activities

Supervision for Monitoring and Evaluation

Supervision of TAS1

Supervision of TAS2

Supervision of Post-MDA TSS

Dossier Development

Assessment Meeting for Implementation of the Action Plan to Develop LF and Trachoma Elimination

Dossiers

STTA

Assistance to develop LF and trachoma elimination dossiers TIS/TSS refresher training (Tropical Data)


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APPENIDX 2. Table of USAID-supported Regions and Districts in FY18

Region Health Districts

Baseline

sentinel sites

(list disease(s)

MDA DSA

(List type : TAS 2, TSS, etc.)

LF OV SCH STH TRA LF OV SCH STH TRA

Adamaoua

Bankim X

Banyo X

Djohong X

Meiganga X TAS I

Ngaoundere Urbain X TAS I

Ngaoundere Rural X

Ngaoundal X

Tibati X

Tiger X TAS I

Centre

Knolling

Awake

Ayes

Baafi X

Biemans

Cite-Vertex

Dongola

Ebbed X

Foulant

Eigenform X

Seka X

Essen X TAS I

Evo doula X TAS I

Mbalmayo

Brandjack X

Mankato

Mafoo

Mona tele X

Nanga-eBooks X TAS I

Niki X

Ngog-Mapoubi X TAS I


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Ngoumou

Nkolbisson

Nkolndongo

Ntui X

Obala X

Okola X TAS I

Sa’A X

Soa

Yoko X

Est

Abongmbang

Batouri

Bertoua X TAS I

Betare-Oya X TAS I

Doume

Garoua Boulaye

Kete

Lomie X TAS I

Mbang

Messamena X

Mouloundou

Ndelele

Nguelemendouka

Yokadouma

Extreme

Nord

Bogo TAS II

Bourha TAS II TSS

Goulfey TAS II

Guere TAS II

Guidiguis TAS II TSS

Hina TAS II TSS

Kaele TAS II

Kar Hay TAS II

Kolofata TAS II

Kousseri

Koza X TAS II TSS

Mada

Maga

Makari TAS II

Gazawa TAS II


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Maroua 3 TAS II

Maroua 2 TAS II

Maroua 1 TAS II

Meri TAS II

Mindif TAS II

Mogode TAS II TSS

Mokolo X TAS II TSS

Mora

Moulvoudaye

Moutourwa TAS II

Pete TAS II

Roua X TAS II TSS

Tokombere

Vele

Yagoua TAS II

Littoral

Bonassama

Mbangue

Cite Des Palmiers

Deido

Abo

Dibombari

Edea X

Japoma

Log Baba

Loum X

Njombe Penja X

Manjo X

Mbanga X

Melong X

Manoka

Ndom X

New-Bell

Ngambe X

Nkondjock X

Nkongsamba X

Boko

Nylon

Pouma X


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Yabassi X

Nord

Bibemi TAS II

Figuil TAS II

Garoua I TAS II

Garoua Ii TAS II

Gaschiga TAS II

Golombe TAS II

Guider TAS II

Lagdo X TAS II

Mayo Oulo TAS II

Ngong X TAS II

Pitoa TAS II

Poli X TAS II

Rey-Bouba X TAS II

Tchollire X TAS II

Touboro X TAS II

North

West

Ako X

Bafut X

Bali X

Bamenda X

Batibo X

Benakuma X

Fundong X

Kumbo East X

Kumbo West X

Mbengwi X

Ndop X

Ndu X

Njikwa X

Nkambe X

Nwa X

Oku X

Santa X

Tubah X

Wum X

South

Ambam X

Djoum X

Ebolowa


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Kribi

Lolodorlf

Meyomessala X

Mvangan

Olamze X

Sangmelima X

Zoetele X

South

West

Akwaya X TAS I

Bakassi X

Bangem X

Buea X

Ekondo Titi X

Eyumojock X

Fontem X

Konye X

Kumba X

Limbe X

Mamfe X

Mbongue X

Mundemba X

Muyuka X

Nguti X

Tiko X

Tombel X

Wabane X

West

Bafang X

Baham X

Bamendjou X

Bandja X

Bandjoun X

Bangangte X

Bangourain X

Batcham X

Dschang X

Foumban X

Foumbot X

Galim X

Kekem X


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Kouoptamo X

Malentouen X

Massangam X

Mbouda X

Mifi X

Penka Michel X

Santchou X

TOTAL 189 0 0 113 0 0 0 50 0 0 0 7


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CAMEROON Work Plan - ENVISION · CAMEROON Work Plan FY 2018 Project Year 7 October 2017–September...

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