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 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
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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.
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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.
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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
Provide technical and financial assistance
to MOH for the organization,
implementation, and supervision of MDA
campaigns to control NTDs
WHO Central level
Provide technical and financial assistance
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.
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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.
ENVISION FY18 PY7 CAMEROON Work Plan
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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
ENVISION FY18 PY7 CAMEROON Work Plan
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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
Historical data and MDA
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
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(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.
ENVISION FY18 PY7 CAMEROON Work Plan
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
Historical data and MDA
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
ENVISION FY18 PY7 CAMEROON Work Plan
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.
ENVISION FY18 PY7 CAMEROON Work Plan
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.
ENVISION FY18 PY7 CAMEROON Work Plan
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
ENVISION FY18 PY7 CAMEROON Work Plan
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.
ENVISION FY18 PY7 CAMEROON Work Plan
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.
ENVISION FY18 PY7 CAMEROON Work Plan
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
ENVISION FY18 PY7 CAMEROON Work Plan
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
ENVISION FY18 PY7 CAMEROON Work Plan
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
ENVISION FY18 PY7 CAMEROON Work Plan
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
ENVISION FY18 PY7 CAMEROON Work Plan
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.
ENVISION FY18 PY7 CAMEROON Work Plan
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
ENVISION FY18 PY7 CAMEROON Work Plan
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.
ENVISION FY18 PY7 CAMEROON Work Plan
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.
ENVISION FY18 PY7 CAMEROON Work Plan
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
workshops in July and
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
workshops in July and
October 2017.
ENVISION FY18 PY7 CAMEROON Work Plan
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
workshops in July and
October 2017.
ENVISION FY18 PY7 CAMEROON Work Plan
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:
ENVISION FY18 PY7 CAMEROON Work Plan
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
ENVISION FY18 PY7 CAMEROON Work Plan
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.
ENVISION FY18 PY7 CAMEROON Work Plan
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:
ENVISION FY18 PY7 CAMEROON Work Plan
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
ENVISION FY18 PY7 CAMEROON Work Plan
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
ENVISION FY18 PY7 CAMEROON Work Plan
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
ENVISION FY18 PY7 CAMEROON Work Plan
32
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.
ENVISION FY18 PY7 CAMEROON Work Plan
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3) Maps
Figure 1. Cameroon LF, OV, SCH, STH, and Trachoma Endemicity Map
ENVISION FY18 PY7 CAMEROON Work Plan
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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
ENVISION FY18 PY7 CAMEROON Work Plan
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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
ENVISION FY18 PY7 CAMEROON Work Plan
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Figure 4. Cameroon Trachoma DSA map
ENVISION FY18 PY7 CAMEROON Work Plan
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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
ENVISION FY18 PY7 CAMEROON Work Plan
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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)
ENVISION FY18 PY7 CAMEROON Work Plan
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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
ENVISION FY18 PY7 CAMEROON Work Plan
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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
ENVISION FY18 PY7 CAMEROON Work Plan
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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
ENVISION FY18 PY7 CAMEROON Work Plan
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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
ENVISION FY18 PY7 CAMEROON Work Plan
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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
ENVISION FY18 PY7 CAMEROON Work Plan
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