ENVISION Project Overview - ENVISION | ENVISION€¦ · Web viewProvide direct technical assistance to the MoH in strategic planning and capacity building

CAMEROON Work PlanFY 2017Project Year 6

October 2016–September 2017

ENVISION FY17 PY6 CAMEROON Work Plani

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 U.S.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 U.S. United States Agency for International Development or the United States Government.

ENVISION PROJECT OVERVIEW

The U.S. Agency for International Development (USAID)’s ENVISION project (2011–2019) is designed to support the vision of the World Health Organization (WHO) and its member states by targeting the control and elimination of seven neglected tropical diseases (NTDs), including lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), three soil-transmitted helminths (STH; roundworm, whipworm, and hookworm), and trachoma. ENVISION’s goal is to strengthen NTD programming at global and country levels and support Ministries of Health (MoH) to achieve their NTD control and elimination goals.

At 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; and

NTD monitoring and evaluation (M&E).

At the country level, ENVISION provides support to national NTD programs by providing strategic technical and financial assistance for a comprehensive package of NTD interventions, including the following:

Strategic annual and multi-year planning;

Advocacy;

Social mobilization and health education;

Capacity strengthening;

Baseline disease mapping;

Preventive chemotherapy (PC) or mass drug administration (MDA);

Drug and commodity supply management and procurement;

Program supervision; and

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

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

ENVISION FY17 PY6 CAMEROON Work Planii

TABLE OF CONTENTSPage

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.....................................................................................................................................5

c) Onchocerciasis.............................................................................................................................6

d) Schistosomiasis............................................................................................................................7

e) Soil-transmitted Helminths..........................................................................................................7

3) Snapshot of NTD status in CAMEROON...........................................................................................9

1) NTD Program Capacity Strengthening...........................................................................................10

a) Strategic Capacity Strengthening Approach..............................................................................10

b) Capacity Strengthening Interventions.......................................................................................11

c) Monitoring Capacity Strengthening...........................................................................................13

2) Project Assistance..........................................................................................................................14

a) Strategic Planning......................................................................................................................14

a) NTD Secretariat..........................................................................................................................15

b) Advocacy for Building a Sustainable National NTD Program......................................................16

c) Social Mobilization to Enable NTD Program Activities...............................................................16

d) Training......................................................................................................................................20

e) Mapping.....................................................................................................................................22

f) MDA Coverage and Challenges..................................................................................................22

h) Supervision................................................................................................................................23

i) M&E...........................................................................................................................................25

3) Maps..............................................................................................................................................28

Appendix 1. FY17 Activities....................................................................................................................34

Appendix 2. Table of USAID-supported Provinces/States and Districts.................................................37

TABLE OF TABLES

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

Table 2: Snapshot of the expected status of the NTD program in Cameroon as of September 30, 2016....9

ENVISION FY17 PY6 CAMEROON Work Planiii

Table 3: Project Assistance for Capacity Strengthening.............................................................................11

Table 3a: Indicators the country will use to evaluate capacity strengthening progress............................13

Table 4: Social mobilization/communication activities and materials checklist for NTD work planning....19

Table 5: Results of coverage with USAID support in FY15/and FY17 objectives........................................23

Table 6a: Supervision for community MDA...............................................................................................24

Table 6b: Supervision activities for school-based MDA.............................................................................24

Table 6c: Supervision activities for other monitoring................................................................................24

Table 7: Planned DSAs for FY17, by disease...............................................................................................28

ENVISION FY17 PY6 CAMEROON Work Planiv

ABBREVIATIONS LIST

AE Adverse EventALB AlbendazoleAPOC African Program for Onchocerciasis ControlAZT AzithromycinCBS Calibrated Blood SpotCBTI Community-based Treatment with IVMCCU Central Coordination Unit CDC United States Centers for Disease Control and PreventionCDD Community Drug DistributorCDTI Community-Directed Treatment with IvermectinCENAME National Center for Essential Drug SupplyCMR CameroonDHIS2 District Health Information System-2DQA Data Quality AssessmentDREB Regional Directorate of Primary EducationDRES Regional Directorate of Secondary EducationDRSP Délégation Régionale de la Santé Publique (Regional Public Health Delegation)DSA Disease-Specific AssessmentsEPIRF PC Epidemiological Data Reporting FormFRPS Regional Fund for Health PromotionFTS Filariasis Test StripsFY Fiscal YearHD Health DistrictHKI Helen Keller InternationalHQ HeadquartersICT Immunochromatographic TestIEC Information, Education, and CommunicationIEF International Eye FoundationIVM IvermectinJRF Joint Reporting FormJRSM Joint Request for Selected Medicines LCIF Lions Club International FoundationLF Lymphatic FilariasisLLIN Long-lasting insecticide-insecticide treated netLOE Level of EffortM&E Monitoring and EvaluationMDA Mass Drug AdministrationMEB MebendazoleMf MicrofilaraemiaMINCOM Ministry of CommunicationMINEDUB Ministry of Primary EducationMINESEC Ministry of Secondary EducationMINISANTE Ministry of Public Health (also MOH)

ENVISION FY17 PY6 CAMEROON Work Planv

MMDP Morbidity Management and Disability Prevention ProjectMOH Ministry of Public Heath (MINISANTE)NGDO Nongovernmental Development OrganizationNTD Neglected Tropical DiseaseOV OnchocerciasisPC Preventive ChemotherapyPNLCé National Blindness Prevention ProgramPNLO National Program for the Control of OnchocerciasisPNLSHI National Program for the Control of Schistosomiasis and Intestinal HelminthiasisPZQ PraziquantelSAC School-Age ChildrenSAE Serious Adverse EventSAFE Surgery–Antibiotics–Face cleanliness–Environmental improvementsSCH SchistosomiasisSMART Specific, Measurable, Achievable, Realistic, and Time-boundSTH Soil-Transmitted HelminthsTAF Technical Assistance FacilityTAS Transmission Assessment SurveyTEO Tetracycline Eye OintmentTF Trachomatous Inflammation–FollicularTIPAC Tool for Integrated Planning and CostingTIS Trachoma Impact AssessmentsTSS Trachoma Surveillance SurveyTT Trachomatous TrichiasisUNHCR United Nations High Commission for RefugeesUNICEF United Nations Children’s FundUSAID United States Agency for International DevelopmentWHO World Health Organization

ENVISION FY17 PY6 CAMEROON Work Planvi

COUNTRY OVERVIEW

1) General Country Background

a) Administrative Structure

Cameroon is a central African country covering an area of 475,650 km². The population of Cameroon in 2017 is estimated at 23,151,178. Women comprise 54% of the total population, and 48.2% of the population resides in urban areas. Most of the country’s inhabitants are young: 16.9% of the population is between the ages of 0 and 5 years, and 26.7% is between the ages of 5 and 14 years. The annual population growth rate is 2.6%. The country has more than 230 different ethnicities, and the two official languages are French and English. Administratively, Cameroon is divided into 10 regions, 58 divisions, 360 subdivisions, 360 district councils, and 15 urban municipalities. The health system has the following structure:

10 Regional Public Health Delegations (DRSPs), each headed by a Regional Delegate, with regional hospitals and similar structures;1

189 Health Districts (HDs), all of which are operational. Each HD has a district hospital and several Integrated Health Centers, which are primary care centers run by a registered state nurse. In 2014 the Ministry of Public Health (MoH or MINISANTE) created new HDs by splitting some old HDs. It took time for new HDs to be fully operational (completed in 2015-2016). In fiscal year 2017 (FY17), there will be 189 fully operational HDs instead of 181 in FY16. This change will be reflected in the FY17 work plan and FY17 SAR-1 workbooks.

The Central Coordination Unit (CCU) of the MoH coordinates integrated control activities for the five priority neglected tropical diseases (NTDs) that can be treated with preventive chemotherapy (PC)—lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), soil-transmitted helminths (STH), and trachoma—at the national and regional level. HD management teams organize and implement the activities at the district and community levels. Community-based (for LF, STH, OV, and trachoma) and school-based (for SCH and STH) platforms are used for drug delivery by community health workers, community drug distributors (CDDs), and teachers. If necessary, the regional and district reference hospitals are in charge of the management of serious adverse events (SAEs) resulting from drugs distributed.

b) NTD Program Partners

In Cameroon, the ENVISION project is implemented by HKI under the leadership of MINISANTE. Implementation of activities is carried out in collaboration with partner nongovernmental development organizations (NGDOs). Other ministerial departments such as the Ministry of Primary Education (MINEDUB) and the Ministry of Secondary Education (MINESEC) as well as the targeted communities themselves, through the participation of the CDDs, are equally associated with the project. NTD control activities in the country’s 10 regions are organized around networks and structures that are already established—for example, the long-existing coalition of NGDOs working in OV control.

1 Private and public hospitals with technical facilities similar to those of a regional hospital.

ENVISION FY17 PY6 CAMEROON Work Plan1

HKI has signed sub-agreements with specific NGDOs, and these organizations implement mass drug administration (MDA) activities in their traditional regions of intervention: Sightsavers supports activities in the Northwest, Southwest, and West regions; International Eye Foundation (IEF) supports the South and Adamawa regions; and PersPective works in the Littoral Region. HKI directly supports the four other regions (Center, East, North, and Far North) and also provides financial and technical support to the MoH at the central level.

In addition to the funds provided by the U.S. Agency for International Development (USAID) for PC targeting of the NTDs—through the RTI-managed ENVISION project and the HKI-managed Morbidity Management and Disability Prevention (MMDP) project—the NTD program also receives financial support from the Cameroon Government and from other organizations, notably the Lions Club International Foundation (LCIF).

The following (and Table 1) provide more details on support provided for NTD activities:

The Government of Cameroon contributes to the payment of government staff salaries and other agents of the state implicated in project delivery; supports drug pick-up, transportation, and storage; is responsible for operations and various investments (building of facilities, infrastructure, and logistics); supports participation of NTD staff in international meetings and training; and manages program coordination associated with MDA and handling of LF morbidity cases (hydrocele and lymphedema) and of trachomatous trichiasis (TT) cases

Sightsavers has supported OV activities since 1996. The NGDO is contributing its own funding to the implementation of integrated LF, OV, SCH, and STH control/elimination activities in the Northwest, Southwest, and West regions. It also provides support for the elimination of trachoma in the Far North and the North regions. Sightsavers supports TT surgeries, promotion of facial cleanliness, and other hygiene and sanitation activities.

United Nations Children’s Fund (UNICEF) and HKI support bi-annual deworming of children under five years of age via the Mother and Child Health and Nutrition Action Week, during which a package of services is distributed to children under five, including mebendazole (MEB), with funding from the Canadian Government.

LCIF has supported activities for the control of OV since 1996 through a coalition of NGDOs. In 2010, LCIF started to reduce its financial support, particularly in HDs endemic for OV in the forest areas. In 2015, LCIF stopped all funding activities in the south regions (technical support is provided by IEF) and in the Littoral regions (technical support is given by PersPective). In FY17, LCIF will support, through HKI and IEF, only HDs endemic for OV in the regions of Adamawa, the Far North, and North.

World Health Organization (WHO) contributes technically and financially to the development of NTD plans, holds national planning/review meetings, and provides logistical help for the management of drug supplies.


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

PartnerLocation

(regions/states)Activities

Is USAID providing

direct financial support to this

partner?

Other donors supporting

these partners?

PersPective Littoral Region

Provide direct technical assistance to the MoH in strategic planning and capacity building

Yes (ENVISION) None

Provide technical and financial assistance to MoH for advocacy and social mobilization

Yes (ENVISION) None

Provide technical and financial assistance to MoH for the organization, implementation, and supervision of MDA campaigns to control NTDs

Yes (ENVISION) None

IEFSouth and Adamawa regions


Yes (ENVISION) LCIF


Yes (ENVISION) LCIF


Yes (ENVISION) LCIF

Sightsavers

Northwest, Southwest, and West regions


Yes (ENVISION) None


Yes (ENVISION) None


Yes (ENVISION) None

Far North RegionSupport S, F, and E components of the SAFE strategy (Surgery–Antibiotics–Face cleanliness–Environmental improvements)

Yes (MMDP Project)

None

WHO Central level

Provide technical and financial assistance to the MoH in strategic planning; WHO also offers assistance with drug supply management.

No ---

MoH Central level/all Provide government staff salaries, drug No No


PartnerLocation

(regions/states)Activities

Is USAID providing

direct financial support to this

partner?

Other donors supporting

these partners?

endemic areas

storage and transportation, construction of health facilities, infrastructure and logistics, treatment of hydrocele, and support for CDDs

HKI

Central level (Yaoundé)/all endemic areas (some supported directly: North, Far North, Center, and East regions and all other regions [6] through partner NGDOs)


Yes (ENVISION)

LCIF in OV HDs in North and Far North regions


Yes (ENVISION)LCIF in OV HD in North and Far North regions


Yes (ENVISION)

LCIF in OV HDs in North and Far North regions

Provide technical and financial assistance to MoH in disease-specific assessments (DSAs)

Yes (ENVISION) None

Far North and North regions

Management of TT cases Yes (MMDP) None

2) National NTD Program Overview

a) Lymphatic Filariasis

Cameroon started uniting vertical, disease-specific programs into an integrated NTD program in 2010 with the support of USAID through the RTI-managed NTD Control Program, with HKI as the in-country implementing partner. This support allowed the completion of NTD mapping in 2012 and the scale-up of MDA activities to bring coverage close to 100% (30 LF-endemic HDs are not covered; 6 of those are partially due to the risk of SAEs caused by co-endemicity with Loa loa). A CCU was established in 2012 to integrate the response to NTDs. This unit brings together all of the program managers from within the MoH and partners.

The goal of the LF program is to eliminate the disease as a public health problem by 2020. The strategy is ivermectin (IVM) MDA through community-directed treatment with IVM (CDTI), combined with albendazole (ALB) in endemic areas, and morbidity management of the disease. LF elimination began in 2008 with mass treatment of nine HDs in the North and Far North as part of a pilot project phase with support from WHO and the Mectizan® Donation Program. Disease mapping was completed between 2010 and 2012, using immunochromatographic test (ICT) cards, with support from USAID and the


African Program for Onchocerciasis Control (APOC; APOC supported LF mapping in 60 HDs in 2010.) The mapping revealed that LF is endemic in 158 of 181 HDs. Among the 158 districts, LF is co-endemic with both OV and L. loa in 86 HDs, co-endemic with OV alone in 14 HDs, and with L. loa only in 24 HDs. IVM and ALB MDA were extended to cover 134 of the 158 endemic HDs in 2011, 6 of which have been partially targeted due to co-endemicity with L. loa and the risk of SAEs. The remaining 24 HDs were also not treated with IVM and ALB due to co-endemicity with L. loa.

To meet the goal of eliminating LF by 2020, all endemic areas must undergo mass treatment. To reach that goal, a new strategy was attempted in 2015 in 31 HDs co-endemic with LF and L. loa where IVM had never been provided. Thirteen of these HDs in the East Region started bi-annual treatment with ALB, according to WHO guidelines. In 10 of the 13 HDs the entire district was treated, and in 3 HDs, only some areas were targeted because the others were co-endemic with OV and so had already been treated with IVM. With this strategy, the bi-annual distribution of ALB was combined with the use of long-lasting insecticide-treated nets (LLINs) provided by the National Malaria Control Program. In FY16, the original plan was to extend this strategy to 24 HDs and to some Health Areas of the 6 L. loa co-endemic HDs that did not receive IVM/ALB in order to reach 100% geographic coverage for LF in Cameroon. Unfortunately, given the conflicting baseline survey results in the East region in 2014 (using ICT cards) and with the recommendations of the Regional Program Review Group, this strategy was suspended. Previous mapping had shown prevalence of up to 20% but in 2014 (with ICT cards) the prevalence was zero. It was recommended that a mapping survey (a mini-transmission assessment survey [TAS]) be conducted in these 24 HDs to evaluate the current LF situation. These mini-TAS results will determine which HDs will require the bi-annual ALB treatment in FY17. The mini-TAS is scheduled to be completed by September 2016 (the 2 x ALB treatment is not budgeted in FY17).).

In FY16, 86 HDs conducted pre-TAS and 31 HDs TAS1. The results are still pending. In FY17, ENVISION expects to conduct pre-TAS in 12 HDs and TAS1 in 83 HDs. Preliminary results show that 30 out of 31 HDs have passed TAS-1 (one HD was not assessed due to security issues) and therefore will not need LF treatment in FY17. This is to be confirmed.

b) Trachoma

The goal of the trachoma program, coordinated by the National Blindness Prevention Program (PNLCé), is to eliminate trachoma as a blinding disease by 2020. The program uses the WHO-recommended SAFE strategy: S (surgery), A (antibiotics), F (facial cleanliness), and E (environmental improvement). The S, F, and E components are supported by other projects specifically focused on trachoma or integrated with broader water, sanitation, and hygiene-promotion projects. Sightsavers has supported TT surgeries in the Far North Region since FY14. The HKI-led MMDP project has also provided technical and financial support in terms of TT surgery in the Far North and North since FY15.

Activities to eliminate trachoma accelerated in 2010, with USAID support for mapping surveys carried out from 2010–2012. The mapping showed that trachoma is endemic in 47 HDs in the Far North, North, and Adamawa regions, with 16 HDs having a prevalence of trachomatous inflammation–follicular (TF) ≥10% and 4 HDs with a prevalence of between 5% and 9.9%. Annual administration of Pfizer-donated azithromycin (AZT) and tetracycline eye ointment (TEO) started gradually in the 20 endemic targeted HDs as soon as mapping results were available.

In 2014, trachoma impact assessments (TIS) 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 Pette) had a TF prevalence between 5% and 9.9%. After another round of MDA in FY15 in these two


HDs, TIS was planned for FY16. However, to improve coordination and planning of other PNLCé activities, the PNLCé postponed these TIS until FY17. In FY15, five HDs in the Far North (Goulfey, Guidiguis, Kousseri, Makary, and Mokolo) were to have undergone TIS. These assessments were postponed several times due to insecurity in the region and finally, the study was 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 TIS for the remaining three HDs are postponed until FY17 due to security concerns. In addition, the HD of Kolofata was not evaluated as initially planned, also due to the security situation; the Kolofata TIS is planned for FY17. Following WHO guidelines, Moutourwa, Yagoua, Guéré, and Maroua Rural, which had baseline TF prevalence rates between 5% and 9.9%, received another round of MDA in FY16 and will undergo TIS in FY17.

Three HDs in the North Region (Poli, Rey Bouba, and Tcholliré) carried out the final MDA in 2015, and TIS in these three HDs were planned for FY16, as well as in the HD of Tokombéré, which has already completed five rounds of MDA. The TIS in these four HDs were postponed to FY17.

The PNLCé plans to engage the Far North Regional Delegation of Public Health and 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 in FY17 and a possible round of MDA in the same year.

According to WHO advice, a pre-validation surveillance survey 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 be involved in a pre-validation survey in FY17, and Guidiguis and Mokolo in FY18. The MOH has expressed interest in and registered to use the WHO-led Tropical Data system to conduct its TIS and TSS.

In summary, no HD is scheduled for MDA in FY17 except the refugee camp (and only under certain conditions described above), and 14 HDs will undergo TIS. Given the unstable security situation of the Far North, the MoH will seek the support of the Ministry of Defense to oversee the planned FY17 surveys in insecure areas.

c) Onchocerciasis

History of USAID OV Support

OV is present in all 10 regions. Baseline epidemiological surveys (1993) indicated an average national prevalence of 40%, and 111 of 181 HDs are considered meso-endemic or hyper-endemic. 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 (predecessor to ENVISION) and there is a OV task force which will aid in OV elimination activities.

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

The primary strategy used is annual CDTI in the target endemic communities. IVM is given alone in 11 HDs and together with ALB in 100 HDs as part of integrated treatment for LF and OV. Out of the 111 endemic HDs that are receiving treatment with IVM, 94 are co-endemic with L. loa and thereby at risk for SAEs following IVM administration. However, after many years of treatment, the risk 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 hypo-endemic areas. 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 most of the hypo-endemic receive treatment through LF MDA.

There are no OV epidemiological surveys planned for FY17.

d) Schistosomiasis

An agreement was signed by USAID and the Ministry of Higher Education and Scientific Research in the Government of Cameroon in 1983 for the development of a pilot project for SCH control. It led to the implementation of a vast national epidemiological survey between 1985 and 1987. The survey revealed the distribution and prevalence level of different SCH species in the country. The high endemicity areas in the northern regions became the priority areas for implementation of the activities of the National Program for the Control of Schistosomiasis and Intestinal Helminthiasis (PNLSHI: created in 2003). The treatment started in 2007 as school-based deworming. The program received support from USAID through HKI in 2010.

The first MDA 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 134 HDs as being endemic (prevalence above 0%). These 134 HDs include 2 HDs (Kouoptamo and Galim in West region) which were added in 2015 by the national program due to an increase of SCH prevalence in school-aged children (SAC).

The Cameroon national SCH program plans for the elimination of SCH and has 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 the national program has targeted MDA in 80 HDs with the appropriate prevalence for treatment. The MDA for SCH are rolled out currently in 80 targeted HDs according to the following details/reasons:

In 69 HDs where the SCH prevalence is between 10% and 50%, SAC receive annual treatment. In 5 HDs where the prevalence is lower than 10% but where initial prevalence (using historical

data) was high, treatment is also annual in SAC. In 4 HDs where the SCH prevalence in SAC is ≥50%, adults are also treated. Since 2015, the PNLSHI has extended PZQ MDA to 2 new HDs (Kouoptamo and Galim in West

region) following an increase in SCH prevalence in SAC.

To date, 60% of targeted SCH-endemic HDs (according to the national strategy) have received PZQ MDA.

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 MEB MDA in schools for children aged 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.

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 aged 5–14, 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 receive a second round of deworming with ALB. For school-based deworming, SAC who are not enrolled in school are taken to the school by their parents on the day of the MDA to receive treatment. Special social mobilization efforts are conducted to target this group. Children aged 1–5 years are 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 five. Treatment for these younger children is supported by Canada’s Department of Foreign Affairs, Trade and Development through HKI and UNICEF.

Finally, if the results of the mini-TAS to be conducted in FY16 recommend using the new bi-annual ALB strategy for LF, the school-based deworming campaign with PZQ will be associated with MEB in all endemic HDs, with the exception of those that will employ the bi-annual ALB treatment strategy for LF.


3) Snapshot of NTD status in CAMEROON

Table 2: Snapshot of the expected status of the NTD program in Cameroon as of September 30, 2016

Columns C+D+E=B for each disease* d 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 MDAas of 09/30/16

No. of districts expected to be in need of MDA at any level: MDA not yet started,

or has prematurely stopped as of

09/30/16

Expected No. of districts where

criteria for stopping

district-level MDA have been

met as of 09/30/16

No. of districts requiring DSAas of 09/30/16

USAID-funded Others

LymphaticFilariasis 181 158 23 0

123a

+ 06 partial

0 24b +6 partial 5****Pre-TAS: 86TAS1: 30

Onchocerciasis 181 111 70 0 111 17c 0 0 0

Schistosomiasis 181 134d 47 0 80 0 54 0 0

Soil-transmitted helminths

181 181 0 0 181 0 0 0 0

Trachoma*** 181 21 160 0 4 0 0 7 TIS: 10

Cameroon added 8 HDs in FY16 but for the purpose of this table (and to match the work books) data from 181 HDs is presented here for FY16. a- Initially covering 134 HDs; however, 5 HDs have achieved the criteria to stop MDA in FY14.b- This concerns HDs where LF is co-endemic with L. loa. These HDs are targeted with a biannual MDA with ALB. 24 endemic HDs have received no treatment, and 6 are partially covered by IVM during the OV treatment.c- 17 HDs from the Far North (03), North (06),) and Adamawa, Adamaoua (8) receive funding from LCIF for part of the OV program. USAID funds cover the remaining needs.d- 132 HDs were found to be endemic by initial mapping but 2 HDs have been added after seeing an increase in SCH prevalence.e – 5HDs were targeted but only 4 were treated. The remaining HD has undergone a TIS following MDA in FY15. **** - Preliminary results indicate 30 HDs passed TAS-1 in August FY16. To be confirmed.


PLANNED ACTIVITIES

1) NTD Program Capacity Strengthening

a) Strategic Capacity Strengthening Approach

The technical support delivered by ENVISION in FY17 will be directed towards initiatives which can:

bring the National Program and each region to develop annual plans which set SMART (specific, measurable, achievable, realistic, and time-bound) goals, propose realistic budgets and risk mitigation plans to avoid misuse of funds,

help the National Program and each region to set and roll out mechanisms for monitoring the implementation of activities,

increase the number of staff involved in NTDs activities at each level and improve their respective skills,

raise local funding allocated to NTDs activities.

1. Planning Progress is still needed on the part of each NTD-specific program for the systematic development of annual work plans. In FY17, ENVISION will continue to provide guidance to various programs in finalizing their respective annual plans. The CCU will also benefit from ENVISION’s support for consolidation of annual plans of all the programs by coaching the regional program leaders during the preparation of the review meeting. This coaching will recommend the use of templates for drafting annual plans at the different levels of the MoH and ensure that the CCU forward the template to all programs at least one month before the annual review/planning meeting. ENVISION will also ensure that the annual program plans are available for the CCU three weeks after the annual review/planning meeting at the latest.

2. Monitoring of MDA campaigns ENVISION will conduct trainings to give central level staff and regional level staff appropriate skills to elaborate and review protocols and to prepare and submit elimination dossiers (for LF and TRA). To improve the quality of supervision done by MoH, ENVISION will use the opportunity of experience-sharing during preparatory meetings (prior to each field visit) which will be attended by NGDOs. As for the data management, ENVISION will facilitate the holding of data harmonization meetings at several levels. The aim of these meetings is to guarantee the completeness and consistency of data and to ensure that they are identical in all 3 data sets: at the HD level, the regional level and the CCU. In addition to this, ENVISION will participate in the finalization of the Tool for Integrated Planning and Costing (TIPAC; to ensure that the data is complete in terms of activities and unit costs) and provide technical and financial assistance for the operationalization of the NTD integrated database (the collection and input of historical data). In order to improve drug management, ENVISION will provide technical assistance to the MoH during the drug order process and for the setting of a drug management system all through mass drug distribution.

3. Staffing


ENVISION will use the opportunity of advocacy meetings at MoH central level to advocate for the need for sufficient, highly qualified public servants at all levels, to decrease the workload for current staffs and enable them to deliver advanced analysis of results coming from the field. ENVISION also plans routine trainings each year to reinforce the skills of newcomers to the program.

4. FundingIn FY17, ENVISION has planned field visits to Governors of the 10 regions (visits will be conducted by HKI, IEF, Sightsavers and Perspective, depending upon the regions in which each NGDO works). The NGDOs which will attend these meetings will advocate for the increase of local funding to support NTDs activities. ENVISION will also conduct the same advocacy at the MoH Central, and following this meeting (at central level) HKI will share its proposal writing experience with the CCU. This aims to assist the National NTD Program in getting new funding from other donors apart from USAID.

b) Capacity Strengthening Interventions

Table 3: Project Assistance for Capacity StrengtheningProject

assistance areaCapacity strengthening interventions/activities

How these activities will help to correct needs identified above

a. Strategic planning Experience sharing

To improve the planning and coordination of the program activities, ENVISION will continue to support the creation of the annual NTD plan. ENVISION will work with the MOH to make detailed activity timelines, set clear objectives and review progress monthly with the MoH. This will aid in planning and anticipation of problems.

ENVISION will work the MOH to ensure a final program plan is approved and accepted (this will ensure that any gaps from ENVISION support are highlighted and will allow the MoH to plan to fill these gaps).

To reinforce the capacity to monitor campaign implementation ENVISION will share experiences of how to manage regional milestones (these should be sent to the central level but often are not). Reviewing these documents together will help to transfer this responsibility to the MoH

To improve planning, ENVISION will share experience in timelines, assessing risks for projects and the creation of backup plans

To improve MDA strategic planning, ENVISION will work the MOH in the use of TIPAC

b. Program and financial management

Advocacy Co-Implementation

To reinforce the capacity of the MoH staff to improve program and financial management, ENVISION will continue to advocate for more qualified staff at the MoH by having at least one annual meeting with the Minister of Health.

To reinforce the capacity of the MoH staff to improve program and financial management, the co-implementation of the NTD integrated database with support from ENVISION will work with the MOH to increase awareness and familiarization with the database.


Project assistance area

Capacity strengthening interventions/activities

How these activities will help to correct needs identified above

c. NTD secretariat Support

To improve the planning and coordination of field activities at the central level, ENVISION will work with the CCU to improve planning.

To ensure that the CCU will be able to play an increasingly greater role, ENVISION will work with the MOH on the fundamental skills for planning and implementation and encourage the CCU to take ownership of certain activities. ENVION foresees that responsibilities in the CCU will increase each year. This step by step approach will allow for capacity building without overwhelming the CCU and staff.

d. Building advocacyfor a sustainable NTD program

Experience Sharing Partnerships Advocacy Support

In order to increase local funding and enhance local ownership, some communities have started to raise local funds for CDD incentives and this good practice will be disseminated nationwide through experience sharing

ENVISION support will enable a consultant to help the country in the development of a post-elimination plan.

To increase concrete commitments to NTDs from the MOH, ENVISION will advocate and coach, along with partners to ensure these outcomes

d. Social mobilization Support ENVISION will support the development of social mobilization

strategies and appropriate IEC materialsf. Training (please see the Training section for specific Training activities.)

g. MDA/MDA challenges Experience sharing

To help avoid low MDA coverage, ENVISION will work with the MOH to make robust coordination plans which will aid problem-solving during the MDA. This will take place during the monthly coordination meetings.

h. Drug supply management & procurement

Advocacy Technical support

ENVISION will advocate for the MOH central level to integrate PZQ and MBD in the national supply chain. To avoid drug expiration, ENVISION will also advocate for a systematic annual physical drug inventory after each MDA.To improve central level management of drug delivery, ENVISION will coach the central level MOH to improve the handling of management of fees for the timely release of drugs from customs.

i. Supervision Experience Sharing

To improve supervisors’ skills, ENVISION and the other NGOs will share their experience with the MOH during preparatory meetings (prior to each field visit) and debriefings, To improve planning of joint field visits, ENVISION will coach the MOH in providing better ToRs which will lead to improved technical assistance.Formative supervision encourages staff to engage in reflective practice and problem solve. ENVISION attends these training sessions.

k. M&E (please see the M&E section for specific M&E Capacity Strengthening activities.

Additional areas Coaching On-the-job Training

To improve M&E, ENVISION will work with the MOH to provide on the job training for the proper use of the integrated database. These tools will aid in the preparation of elimination dossiers.



c) Monitoring Capacity Strengthening

Table 3a: Indicators the country will use to evaluate capacity strengthening progress.Main categories targeted by

strategic capacity strengthening approach

Sub-categories Indicators to evaluate capacity strengthening progress

Planning N/A1-National NTD plan and annual work plan is

available2-Budget estimates are accurate

Monitoring of MDA campaigns

Conducting DSAs

1-Guidelines and protocols on DSAs are understood

2-Ability to use diagnostic tools3-DSAs and follow up actions are implemented

according to guidelines and protocols

Development of elimination dossiers

1-Guidelines for the elaboration of elimination dossiers are understood

2-Elimination dossiers are submitted

Supervision of field activities

1-Understand key elements of successful supervision

2-Number of joint supervision meetings in a year

Data management

1-Data from the field are completed, harmonized and available at the regional level two weeks before the regional annual review meeting

2-All historical data is complete in integrated database

3-Data quality assessment (DQA) is implemented, report is available, recommendations and related activities are included in annual work plan

Drug Management

1-No drug shortage is reported during the MDA campaigns

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

3-TIPAC is used to complete JAF

Staffing N/A

1-Percent of required positions (program managers, M&E staff, lab staff, finance staff) filled with persons meeting knowledge and experience requirements

2-Percent staff turnoverFunding N/A 1-Amount of money dedicated to NTD from MoH


2) Project Assistance

a) Strategic Planning

Activity 1: Annual National Review and Planning Meeting

MDA campaign activities begin each fiscal year with a national meeting to review the previous year and plan the activities for the coming year. It brings together the main stakeholders, particularly central level staff, MoH Regional Delegates, and regional NTD focal points, the representatives of the MINEDUB and MINESEC, Ministry of Water and Energy, and Ministry of Communication (MINCOM), the representatives of the communes, WHO, and the partner NGDOs. The NTD program’s PC activities are the focus of the discussions during the three-day meeting. In FY17, ENVISION will provide financial support to participants working with PC NTDs, including one day for travel. The other participants will receive support from other NGDOs and WHO.

During the meeting, participants discuss central level activity coordination, the results of activities carried out in the HDs and communities during the current year; data and drug management; the schedule of activities for each region and the various treatment strategies for each disease. The discussions also cover best practices. ENVISION provides technical assistance during the meeting by sharing the expertise and experiences of HKI and other NGDO staff implementing activities to control NTDs in Cameroon. ENVISION also shares the observations made during follow-up and monitoring activities along with recommendations for improvements.

The following specific topics will be covered in FY17: Validation of 2016 MDA data Analysis of recurrent problems HDs with recurring low performance/ coverage and approval of

strategies to improve the performance in these HDs Presentation of FY16 impact assessment results and planning for FY17 impact assessments Post-treatment monitoring strategies for HDs that have stopped their trachoma and LF MDA Discussion of the implementation of the biannual ALB distribution strategy to control LF in the

HDs which may be eligible after the mini-TAS Review of the proposed solutions to increase SCH coverage in the targeted HDs Planning activities by the regions Next steps in the development of a new NTD master plan for 2017–2021

The meeting will also provide an opportunity to share the results of NTD research. By combining coverage and assessment data with the above, the MoH will be able to formulate recommendations for the implementation of the activities included in national and regional action plans.

Activity 2: Annual Regional Review and Planning Meeting

A three-day review and planning meeting will be held in each of the 10 regions i.e., 10 meetings. The meeting attendees include the management teams of the DRSPs and of the regional delegations of the MINEDUB, MINESEC, and MINCOM; the regional representatives of the communes; representatives of HKI and other NGDOs; and representatives of CCU and of each NTD program. During the meeting, the MDA activities of the previous year (FY16) are reviewed, the problems identified during monitoring are discussed to find and validate solutions, and micro-planning is carried out for the coming year’s activities.


The CCU must ensure that consistent directives are communicated to the decentralized departments of each of the organizations involved to increase their involvement in mobilizing target populations and in activity follow-up. ENVISION provides support for CCU’s participation. The latter must ensure that the detailed micro-plans listing all of the proposed activities are defined and included in the annual regional and HD work plans. The meetings include both PC NTDs and NTD morbidity case management staff.

Activity 3: Central and Regional Coordination Meetings

The MoH holds a special one-day coordination meeting for NTDs at the central level every three months. The central-level meetings bring together the representatives of all of the NTD programs, the NGDOs working on NTDs, and WHO. The status of planned activities is reviewed and the group works to find solutions to the problems and issues encountered during implementation. The coordination meetings provide an opportunity to update the work plans. In FY17, ENVISION will provide its technical support via HKI and NGDO participation in some of the meetings. Quarterly meetings are held at the regional level. They provide an opportunity to review implementation and to coordinate the activities of all of the health programs, including the NTD programs. Outcomes from these meetings include the adjustment of timelines, the capacity strengthening of actors from areas which showed poor performances and also the increase of field supervision in these areas. The coordination meetings are entirely funded by the MoH at all levels.

Activity 4: Support for the Launch of the 2017–2021 NTD Master Plan

A first draft of the 2017–2021 Master Plan is already available. It was prepared in FY15 with the use of TIPAC. However, the current version of the tool is not final and has not been approved. ENVISION will provide technical and financial assistance for the master plan launch in Q1 FY17. The launch will take place in Yaoundé.

Activity 5: ENVISION FY18 Work Plan Development

The ENVISION project’s FY18 work plan development workshop will take place in Yaoundé in June 2017. Participants in this 3 day-activity include the heads of the CCU, the national NTD Programs, partner NGDOs, WHO, HKI, and RTI. The primary objective will be to define and plan all of the PC NTD control activities that the country program will implement in FY18. By the end of the meeting, the participants will have produced a budgeted action plan that incorporates the directives of the NTD Master Plan, WHO directives, and USAID’s priorities. RTI and USAID staff will participate in the discussions with local partners to better understand the implementation environment of the activities. Their presence will also enable a first on-site work plan review to reduce delays in feedback during the approval process.

a) NTD Secretariat

The CCU will continue to benefit from ENVISION’s technical and/or financial support for its work in FY17. The assistance will consist of:

The participation of NGDOs in the periodic coordination meetings (described in the Strategic Planning section).


Meetings to review and approve survey protocols. The meetings will also be attended by the national NTD Programs and the partner NGDOs. The meetings will not involve any additional costs.

The continuous LF monitoring plan development workshop at the central level (see the M&E section for details)

The trachoma elimination dossier development workshop for all of the HDs reaching elimination thresholds (see the M&E section for details)

Data standardization and database update meetings with all of the national NTD Program partners. These meetings will ensure that there is only one set of official data for the country and that all of the stakeholders are using the same information. Details can be found in the Monitoring section.

ENVISION will also provide technical support to the CCU and to the national NTD Programs to follow up on the implementation of key activities for the community and school campaigns. This will include training, the MDA, and regional level review/planning. To accomplish this, the NGDOs will:

Take part in joint formative supervision with MoH teams. During this activity, the supervisor does not only check-in and/control what the supervisee is doing. In such supervision, the supervisee is highly involved in identifying his weaknesses, and in finding related solutions.

b) Advocacy for Building a Sustainable National NTD Program

Activity 1: A One-day Meeting at MoH Central Level

This meeting will include the heads of Department of Pharmacy Medicines and Laboratories, Cooperation Division, Disease Control Directorate, Epidemics and Pandemics, Department of Financial Resources and Heritage program heads, and partner NGDOs. During the meetings, attendees will identify the financial resources available and the methods for drug acquisition and supply for the country’s NTD campaigns.

Activity 2: A One-day Meeting with MINEDUB and MINESEC

This central-level meeting will request greater commitment from the ministerial departments in mobilizing funds for the deworming of SAC.

Activity 3: The Regional Public Health Delegates and Regional Governors Meetings

The regional public health delegates will meet with each of the regional governors to obtain their support for a successful campaign. They will be provided with the results of the 2016 campaign, the difficulties encountered, and the 2017 activities scheduled. The governors will also be reminded how important it is that the administrative and decentralized authorities and, when necessary, police, be involved in mobilizing and supervising the population during campaigns. The issue of continued low-performing/coverage districts will also be raised during the meetings (see the M&E sections). The visits will be carried out during the first quarter of FY17 by the heads of each Regional Health Delegation, a central level manager, and NGDO staff.


c) Social Mobilization to Enable NTD Program Activities

Although there are still some problems with MDA coverage in some HDs, other HDs have maintained sufficient programmatic or epidemiological coverage and in some cases, have been able to increase coverage rates. Based on experience, the mobilization of populations for the MDA improves with strategies that use traditional channels and tools, such as town criers and radio broadcasts, which, overall, are aimed at increasing the participation of local populations. The strategies inform populations with key messages about the diseases: the campaign periods (census and distribution dates), the presence of drugs, the importance of consistent treatment, adverse events (AEs), the need for communities to select female CDDs and encourage the CDDs, as well as individual and community hygiene messages. In addition, ENVISION will assess the impact of the IEC materials during the coverage surveys planned for FY17 to determine which have the greatest impact on the population. The assessment results will enable adjustment of future materials to the target’s awareness level.

Activity 1: The Production of IEC Materials

The materials will be produced in sufficient quantities with ENVISION funding. They will consist of 16,576 posters (8176 posters printed by HKI, 1400 posters printed by PersPective, 2800 printed by IEF and 4200 posters printed by Sightsavers), 41,150 T-shirts (21,000 T-shirts are produced with Sightsavers funds), and 325 banners. The posters will be located in public places at the beginning of the MDA campaign. An average of three will be produced for each community. A T-shirt with messages about the disease and treatment will be provided to each CDD. They will wear them during the campaign to ensure that they are identified and to increase their visibility and advertise the MDA. The banners will also be produced to inform populations about the start date of the MDA campaign for SAC. There will be an average of one per district and one per regional delegation. The tools will be produced in each region.

Activity 2: Official MDA Campaign Launch Ceremony

The ceremony will be chaired by the Minister for Public Health in a district selected in advance. It will also be attended by partner ministries in NTD control such as MINEDUB, MINESEC, MINCOM, the Ministry of Water and Energy, and the Ministry for Vocational Training. 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.

Activity 3: Broadcasting of Health Messages

ENVISION will use several communication channels to reach most of the populations targeted for MDA.

Radio and television show broadcasts: Radio and television broadcast areas will be set up in each region to talk about NTDs. The messages developed by the communication department of each area, in collaboration with the staff of the support NGDO including ENVISION, will be broadcast in the official and local languages during the community and school campaigns. Before the start of each MDA campaign, the communication department of each regional health delegation will hold a meeting with journalists to review the messages to be broadcast and the suitability of the reserved time slots. Some HDs have community radio coverage that will be


used to broadcast the messages in local languages. The cost of the radio and television broadcasts will be shared with the government. The cost will be higher in regions where the biannual strategy will be implemented. In addition, ENVISION will ensure that the DRSPs use local media to broadcast messages during the SAC deworming campaign to encourage parents to permit their children to receive PZQ at their school. The messages will also emphasize the key message that children must eat before taking PZQ and that eating before treatment significantly reduces the risk of AEs.

Town criers: These are community members who report to the community head and are responsible for disseminating messages. They are also used to disseminate NTD messages, notably, about the availability of the NTD drugs in the community and the dates and places of administration. ENVISION does not provide specific support for this activity.

Places of worship: Religious places of worship are used to broadcast NTD messages. During the campaign, the messages will provide the schedule of activities (census, distribution), the dates and places of administration, the steps to take in the event of AEs, and other key messages to prevent misinformation.

Women’s group meetings: These meetings will be used to disseminate educational, awareness-raising, and informational messages about NTDs. They will also encourage women to become involved in campaign activities (by becoming CDDs, disseminate messages, provide support to the CDDs and bringing their children for deworming).

Communication in the refugee camps: The NTD awareness-raising messages that will be included in current education and health activities are prepared by the District Health Department. They are delivered by the district staff involved in sanitation servicing the camps and via other channels identified within the camp including churches, mosques, teachers, and CDDs designated by the camp residents. Due to the large variety of different people in the refugee camps, they are generally managed by the districts as special Health Areas. As a result, they will receive all IEC materials used to mobilize people including posters, flyers, T-shirts and banners.


Table 4: 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?

Participa-tion in MDA

Mectizan® and Albendazole are free+Let’s take Mectizan® and Albendazole every year to eliminate filariasis

CDDs T-shirts (back)+T-shirts (front)

The T-shirts will be provided to the CDDs during training

Once during the campaign

Number of CDDs receiving a T-shirt during the training sessions (as indicator)+ coverage survey (as mechanism)number of people participating in MDA because of messages

Let’s protect our children against schistosomiasis andintestinal worms by taking MEB andPZQ

Communities Banners

Hung in public places one month before the MDA


Number of public places in which the posters will be seen by the supervisors - during MDA monitoringnumber of people participating in MDA because of messages

Praziquantel (PZQ) poses no risk to your child’s health. Children must eat before taking PZQ. Eating before the treatment considerably reduces the risk of AEs

Parents and children

Radio/TV Local radio stations, during the two weeks preceding the school MDA+National public television during the week before the school MDA

At least one broadcast a day

Decrease in the number of PZQ refusals

Increase stakeholder participation in achieving Program objectives

Public institutions + Community members + private companies

Official MDA campaign launch ceremony

The ceremony will be held in Q2 FY17 in a HD selected during the annual national planning meeting


Increase in non-USAID contributions


d) Training

MDA Training in the Community

Given that MDA activities have taken place for several years, these refresher courses are primarily intended for Health Area nurses and the CDDs. However, if the results of the mini-TAS lead to a biannual ALB distribution strategy against LF in certain HDs, the regional implementers of the Center, East, South and Littoral regions will also receive training. The refresher courses cascade from the regional level to the community level using the training modules created. Pre-and post-training tests are given to attendees to assess their comprehension of topics covered during training. The following shortcomings were recorded during the community MDA campaign in FY16: certain CDDs had trouble filling in the registers; Health Area nurses had weak data analysis and management skills; drug management issues; and late report and data transmission. To address these shortcomings in FY17, ENVISION will provide technical and financial support for training at three different levels:

Activity 1: Nurse Training (Level 2: HD)

The second level of training will target Health Area nurses with the goal of improving their CDD training skills. Training will improve the capacities of attendees with respect to MDA preparation and implementation, monitoring, follow up and reporting. The sessions will cover CDD training techniques, follow-up of MDA campaign activities at the community level, data analysis and management, drug management, CDD training planning, and report writing. Several training sites will be set up to improve CDD training planning and ensure attendance. A CDD training plan based on training site locations and the trainers will be developed and discussed during nurse training. Case studies will be emphasized to illustrate explanations about register entries and other data collection, analysis and management tools and drug management tools. Specific topics will be covered in the Health Areas in which there will be a biannual ALB distribution. These will include the treatment plan and the differences between Health Areas which are not L. loa endemic, the management of AEs, and the importance of promoting the use of LLIN. Training will last one day, except in Health Areas with biannual ALB distribution where it will last two days. The HD management teams will do the training. Supervision will be provided by the regional level, the PNLO, the CCU and the support NGDOs.

Activity 2: CDD Training (Level 3: Health Areas)

Training will take place in the Health Areas at the training sites planned during the nurse training sessions. The training sessions will cover awareness-raising and communication techniques, the census, drug distribution, monitoring for AEs, drug management, register entries, and report writing. Several case studies and role playing will be used to ensure quality training. A pre-test and a post-test will be given to ensure that CDD knowledge improves by the end of training. While a ratio of one CDD per hundred inhabitants is recommended, in fact, the number depends on the size of the population, the extent of the area covered and accessibility. Specific topics will be covered in the Health Areas in which there will be a biannual ALB distribution. The following specific topics will be covered: the treatment plan and the population’s diligence in taking the treatment (the importance of taking ALB during each of the planned rounds to be deemed treated for LF), the management of side effects, and the importance of promoting the use of LLIN. CDD training lasts two days. The Health Area nurses will lead the training.


Formative supervision will be provided by district and regional personnel, the PNLO, the CCU, and the implementing NGDOs.

Activity 3: Training for MDA in Schools

In FY16, there were delays in sending reports and data, noncompliance with dosages by certain workers in the schools in SCH endemic areas, incomplete reports submitted, and low PZQ coverage in some HDs. To address these shortcomings, ENVISION will facilitate cascade 01-day (2 days for CDD training) from the regional level to the school level. The following topics will be covered: knowledge of the diseases (STH and SCH), activity implementation follow-up, funds management, drug and data management, report writing and data transmission, and recommendations to improve PZQ treatment coverage in the HDs with low coverage. In addition, role playing and case studies will be used during the training sessions. During group discussions, participants will stress PZQ administration, notably, the need to treat all SAC in SCH endemic HDs and to ensure that the children have eaten before receiving PZQ to reduce the risk of SAEs and limit parents’ reticence to allow their children to participate. Training will also cover how to make and consistently use dose poles in SCH endemic areas. During the trainings, ENVISION financial support will cover the per diem and transportation fees of participants, in addition to costs for stationery. Supportive supervision will be provided by the DRSP, Regional Directorate of Primary Education (DREB), Regional Directorate of Secondary Education (DRES), PNLSHI, and the implementing NGDOs during the training sessions at the departmental and arrondissement levels. A pre-test and post-test will be given to attendees to evaluate knowledge acquisition. The different training levels are as follows:

Activity 4: Regional Training

This training will be organized by the DRSP in collaboration with the MINEDUB and MINESEC, the regional representative of the United Councils and Towns of Cameroon, and other NGDOs. The DRSP will provide training with the support of trainers from the MoH central level. The list of participants will include MINESEC and MINEDUB school health inspectors, delegates from the Department of Primary School Education, delegates from the Department of Secondary School Education, and the head of HDs. Supervision will be provided by PNLSHI and support NGDOs.

Activity 5: District Training

This is a refresher course for Primary Education Arrondissement inspectors and the principals of secondary schools of Secondary Education institutions. Training will be provided by the heads of HDs, assisted by delegates of the Department of Primary Education and the Department of Secondary Education. The DRSP, PNLSHI, and the partner NGDOs will provide supervision.

Activity 6: Second Training at HD Level

This is a refresher training for primary school principals. The session will be conducted by district inspectors of Primary School Education under the supervision of the HD heads. Other supervisors are delegates from the Department of Primary Education and PNLSHI staff with NGDO support.

Activity 7: Briefing at the School Level


School principals will lead this briefing for MINEDUB teachers. ENVISION does not provide financial support for this activity but will provide technical support to the DRSPs and the HDs to ensure quality training by updating the pre-tests, post-tests, and case studies used for the training sessions

e) Mapping

No mapping is scheduled for FY17.

f) MDA Coverage and Challenges

The implementation of MDA for NTDs is based on two main strategies: The community-directed strategy in which mass drug distribution is carried out by the CDDs. The

NTDs targeted in this case are LF, OV and trachoma. Mass treatment is scheduled for February-March in the East region and April-June in the other nine regions.

The SAC deworming strategy which uses teachers as distributors. It primarily covers STH and SCH. The MDA is scheduled for the November-December period.

In both strategies, the MDA is carried out with target populations based on co-endemicity. With respect to the community-directed strategy:

For LF: IVM is combined with ALB and given to people five and older once a year. The results of the mini-TAS carried out in FY16 will condition the application of the biannual ALB distribution strategy in FY17 in L. loa co-endemic communities where IVM has never been used. Biannual ALB distribution will be combined with the use of LLINs.

For OV: IVM is given to people five and older living in endemic areas. For trachoma: AZT in pill form is given to people five years and older, and AZT syrup is given to

children between six and fifty-nine months of age. TEO is administered to children under six months old.

In areas that are OV, LF, and trachoma co-endemic, residents are given IVM, ALB, and AZT/TEO. In areas that are OV and LF co-endemic, inhabitants receive IVM and ALB.

With respect to the school strategy: PZQ is given to children aged between 5 and 14 years in SCH endemic HDs where the base

prevalence is ≥10% and to adults in HDs that have a base prevalence of at least 50%. MEB is given for STH to children aged between 5 and 14 years in all of the country’s 189 HDs. It

is combined with PZQ in SCH endemic HDs. In the specific case of STH, children aged 5 to 14 years also benefit from a second round of deworming with ALB which is distributed in the communities (combined with IVM) as part of the fight against LF.


Table 5: Results of coverage with USAID support in FY15/and FY17 objectives

NTD

No. of annual

distribution series)

Treatment objective

(FY15)No. of

Districts

No. of districts which didn’t meet

epidemiological

coverage objectives in FY15*

No. of districts which

didn’t meet the

program coverage

objective in FY15/16*

Treatment objectives

(FY15)No. of People

No. of people treated (FY15))

% of the treatment objective

met (FY15) No. of People

FY17 treatment objectives

No. of Districts

FY17 treatment objectives

No. of People

LF 1 144 3a 0 12,303,805b 11,728,871b 95.3% b 124** 12,469,652

OV 1 111 0 b 0 b 8,175,645 b 7, 754,599 b 98.6% b 113 8,523,389SCH 1 80 80 b 30 b 3,085,820 b 2,526,358 b 81.8% b 84 3,553,151STH 2 181 b 181 d 37 b 6,048,213 b 5,134,042 b 84.8% b 189 6,172,221Tr 1 6 b 1 b 1 b 847,059 b 745,983 b 88.1% b 1c 0

FY16 treatment data are not yet available. From FY14 to FY15, ENVISION recorded several HDs with recurring poor results*Epidemiological and program coverage as defined in the manuals** - 30 HDs have passed TAS1, according to preliminary reports. This is to be confirmed.(a) 8 new HDs have been created in Cameroon in 2016. These are fully functional and so FY17 data reflect this new situation. Esse, Okola and Edea were partially treated with ALB against LF in 2015.(b) 2015 data. The 2016 MDA has not occurred yet(c) Minawao refugee camp in the Mokolo HD.(d) The strategy targets SAC, but epidemiological coverage is calculated based on the total population.

g) Drug and Commodity Supply Management and Procurement

Transportation of the ALB, IVM, and Zithromax® to the HDs and the Health Areas in the regions has been part of the national supply chain circuit for essential drugs since 2004. The PZQ and the MEB used for SAC deworming have not yet been integrated in the circuit.

h) Supervision

The central level, regional level, HDs, Health Areas, and the NGDOs jointly carry out routine monitoring of the various activities. ENVISION provides technical support to the MoH and the communities to help them implement activities in compliance with programmatic standards. A monitoring grid is used for each supervision level. ENVISION will continue to provide technical assistance in FY17 to improve the quality of monitoring in the regions. Assistance will be implemented in three phases:

Activity 1: Preparation Phase

The MoH, with technical support from the NGDOs, will organize preparatory meetings. At the central level, personnel from the CCU, the national NTD Program, and NGDOs will attend the meetings. At the regional level, attendees will include the DRSP management teams and NGDO representatives. The meetings will also be attended by DREB and DRES staff for the supervision of SAC deworming activities. During the meetings, participants will develop a monitoring plan and discuss specific topics to improve the quality of activity implementation. The discussions will also include aspects related to formative supervision. TORs will be established during the meetings, and planning visits to HDs and communities experiencing problems will take priority. A checklist is updated yearly based on aspects requiring special


attention. Before traveling to the field, the supervisors must master the objectives, expected results, and monitoring tools.

Activity 2: Implementation Phase

Monitoring includes all community and school MDA, planning, and data collection activities. It also includes specific studies.

Table 6a: Supervision for community MDAActivities Supervisors

Training/refresher courses for Health Area nurses for the MDA campaigns

CCU, national NTD Program, support NGDO, DRSP staff

Training/refresher courses for CDDs CCU, national NTD Program, support NGDO, DRSP, HD staff

Drug distribution CCU, national NTD Program, support NGDO, DRSP, HD, Health Area staff

Table 6b: Supervision activities for school-based MDAActivities Supervisors

Trainer training (DREB, DRES, and district heads) PNLSHI, support NGDO staffTraining for Primary Education Arrondissement inspectors and Secondary Education institution heads

HD management team, DRSP, PNLSHI, support NGDO staff

Primary school principal training HD and Divisional Delegation for Primary Education heads, PNLSHI, support NGDO staff

Drug administration in the schools by teachers DRSP staff, HD heads, CCU, PNLSHI, support NGDO, HKI staff

Table 6c: Supervision activities for other monitoringActivities Supervisors

Community and school MDA data collection CCU, national NTD Program, DRSP, HD, Health Area, support NGDO staff

Coverage surveys CCU, support NGDO, DRSP staffPre-TAS, TAS, and TIS Support NGDO, CCU, national NTD Program (PNLO

and PNLCé) staff

Activity 3: Restitution/reporting Phase

Following each field visit, the supervisor will have a discussion with the person supervised about any problems identified and the corrective measures to be taken to improve quality. During the discussion, the supervisor must ask the supervisee to design a plan to implement the recommendations. The supervisor will keep a copy of the plan and evaluate its implementation during the following monitoring sessions. A debriefing will then be held at the DRSP. The session will be attended by all of the supervisors and the Regional Health Delegates. The supervision results will be discussed and the participants will design a plan to address any problems identified. A brief summary of the supervision report will be sent to the CCU.


i) M&E

Activity 1: Pre-TAS

Pre-TAS and TAS activities have taken place in FY16 with the help of consultants as the MOH was unable to carry out the activity as planned. In order to build capacity for FY17, we will work with the MOH and the consultants to come up with a solution which allows the MOH build capacity with respect to LF surveys.

Pre-TAS will be carried out in 12 HDs: Meiganga, Ngaoundéré-Urbain, and Tignère in the Adamawa Region Esse, Evodoula, Nanga-Eboko, Ngog-Mapubi, and Okola in the Center Region Bertoua, Bétaré-Oya, and Lomié in the East Region Akwaya in the Southwest Region

Activity 2: TAS1

TAS1 will be carried out in 83 HDs.

As planned in FY16, a pre-TAS has been carried out in 86 HDs and preliminary data show 83 among the 86 HDs are eligible for TAS-1 for FY17.

Activity 3: TIS

TIS will be carried out in the following HDs in the Far North Region: Meri, Pette, Goulfey, Makary, Kousseri, Moutourwa, Yagoua, Guéré, and Maroua-Rural., Kolofata, Poli, Tchollire, Rey-Bouba and Tokombere. All these HDs reached adequate epidemiological coverage in their respective MDA rounds.

Following the TIS in FY14, the HDs of Meri and Pette reported TF prevalence between 5% and 9.9%. They received an additional MDA round in FY15. An assessment was planned for FY16, but the PNLCé postponed it to FY17 to ensure better coordination of the activities.

The impact assessments planned for FY15 in the Goulfey, Makary, and Kousseri HDs were delayed until FY17 for security reasons. This was also the case for the Kolofata HD, which was scheduled for assessment in FY16.

Based on the new WHO guidelines, the HDs of Moutourwa, Yagoua, Guéré, and Maroua-Rural, which had a baseline TF prevalence between 5% and 9.9%, received a round of treatment in FY16. A TIS will be conducted in FY17.

Three HDs in the northern regions (Poli, Rey-Bouba and Tchollire) carried out their final MDA in FY15 and TIS were planned for FY16, along with the HD Tokombere which had already completed 5 rounds of MDA. These TIS in the 4 HDs were postponed and will be carried out in FY17.

Activity 4: Trachoma Survey in the Minawao Refugee Camp and the Kolofata HD

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 FY17 and, potentially, an MDA during the same year. The Kolofata HD will be combined with the Minawao camp for the prevalence survey.

Activity 5: Post-treatment Monitoring (after MDA has been stopped)

WHO guidelines on LF and trachoma elimination recommend to conduct post-treatment monitoring activities when HDs stop MDA. For example, for LF, these are periodic (TAS-2, TAS-3) and routine surveillance activities.

Post-treatment monitoring will cover both LF and trachoma.

For LF: The monitoring will target the 5 HDs that successfully completed the TAS in FY14 (Mokolo, Ngong, Tcholliré, Poli, and Rey Bouba) and the 31 North and Far North HDs that successfully passed the TAS1 in FY16.

For trachoma: The country will proceed with the development of the trachoma elimination dossier for all HDs that are successfully progressing towards elimination, with <5% TF.

In FY17, ENVISION will fund a workshop for the development of continuous monitoring plans (for LF and trachoma) at the central level. The meeting will require technical assistance and bring together staff from the CCU, PNLCé, PNLO, the support NGDOs (HKI, Sightsavers, PersPective, and IEF), and WHO. The plans will identify the following:

Target groups (students, soldiers, blood donors, and hospitalized patients) that will be approached for the study

The laboratories and lead hospitals that will be involved

The data collection circuit and frequency

The responsibilities of the actors (HD, regional, and central levels) involved in the monitoring process

At the regional level: ENVISION will provide technical and financial assistance for training for the managers listed below in the North and Far North regions:

The NTD focal points The blindness prevention focal points The leaders of the health care activities’ control teams The NTD data managers The members of the management teams of the HDs in question (District Medical Officers, head of

the District Health Bureau), and the district hospital directors and their laboratory assistants.

At the HD level: ENVISION will use routine Health Area nurse training sessions to add post-treatment monitoring to the curriculum (for LF and trachoma). The monitoring plans will be implemented in FY18 and will enable the MoH to identify any new transmission sources and collect data on infestation trends in the populations of the HDs targeted.


Activity 6: Coverage Survey

The priority target will be the HDs in the Southwest Region, the Center region and the Adamawa region that have recurring low coverage. Several HDs (four out of twelve HDs) in two other regions of the country that have good coverage will also be sampled. The survey will enable identification and documentation of the following:

The reasons for the below-average coverage rates and the corrective measures required

The factors that ensure good coverage rates

The survey will be carried out in Quarter 3 FY17, after the school-based and community-based MDA. RTI will provide technical assistance for creation of the protocol and implementation of field surveys.

Activity 7: Training on the Follow-up/Assessment of an LF Elimination Program

This training was planned for FY16. It could not be conducted due to trainer unavailability. It is intended to improve the capacities of the CCU and of the partners in NTD control for planning LF follow-up/assessment activities, protocol and survey report reviews, and survey monitoring. Training beneficiaries will be given the tools they need to better prepare and track the pre-TAS and TAS planned for FY17. Training will be held during the first quarter of FY17, with technical assistance from an external consultant.

Activity 8: Entry of Historical Data in the Integrated NTD Database

Given the decreasing number of HDs being treated, notably for LF and trachoma, specific actions must be planned to prepare the various elimination dossiers. This requires a single platform containing all NTD control historical data (prevalence, treatment, etc.). At this stage, ENVISION support will contribute to financing the planned activities. In FY15, a training took place in Yaoundé through ENVISION/RTI support and facilitated by a RTI consultant. Preliminary work has been done to combine all historical NTD data into a single place. The MoH has also proposed a plan for historical data entry. The MoH will require the support of an external consultant for data entry. This external consultant will work to clean and import data to the database.

Activity 9: Workshop to Design a Pilot PC NTD Data Warehouse

The MoH implemented a computerized data management system in 2014 called District Health Information System 2 (DHIS2). This electronic system enables the collection, processing, and transmission of data from HD computers to the central server located in the MoH's Health Information Unit. The indicators of the various national health programs are gradually being added to the system. A pilot PC NTD data warehouse will be implemented at HKI on DHIS2. This will require a workshop with the program managers, the NGDOs, and the Health Information Unit to create a list of key NTD indicators to be included in the data warehouse. The warehouse will improve data sharing and searches for decision-making purposes. It will be used as a data source to prepare LF and other PC NTD elimination projects. This is complementary to the integrated database as it expands the possibilities of data sharing and decision making. This will also aid the integration of NTD data and indicators into the National Health information data warehouse, increasing NTD visibility at the MOH.


Activity 10: Mid-campaign Assessment Meetings

This meeting will involve only the four regions with the largest number of HDs with recurring poor coverage rates (Center, Littoral, Southwest, and Far North). Therefore, as soon as data collection (from the school-based and community campaigns) is complete in these regions, the Regional Delegates will hold sessions to analyze results. They will identify potential bottlenecks and implement corrective actions (to be decided when problems are identified) before the regional review meeting. No cost to ENVISION.

Activity 11: M&E Training for LF and trachoma elimination

This training was scheduled for FY16 but was not completed due to the lack of availability of the trainer. As Cameroon moves towards trachoma and LF elimination targets it is important to prepare the MOH for the new challenges that this will bring: preparing and reviewing data to demonstrate elimination and prepare a dossier for and eventual submission to WHO. The training will also improve the capacity of the CCU and NTD partners in planning LF M&E activities, protocol reviews, survey implementation, survey reports and the supervision of surveys. The training will be organized during the first quarter of FY17 with the technical assistance of an external consultant.

Activity 12: Strengthening capacity of pre-TAS, TAS, TIS and coverage survey implementers

The principal investigators chosen to conduct these specific studies will lead this training before the data collection phase. The courses are designed to give investigators general knowledge on the diseases concerned in the survey and in collecting data. Practical exercises will focus on the handling of diagnostic tools (FTS) and the use of digital tools for data collection. ENVISION will ensure that the principal investigators choose regional investigators where the studies take place. For the coverage surveys, training will be organized during FY17-Q3 (after MDA) while other courses will take place during FY17-Q2.

Table 7: Planned DSAs for FY17, by disease

Disease No. of endemic districts

No. of districts planned for

DSA

Type of assessment

Diagnostic method (Indicator: Mf, FTS,

hematuria, etc.)

Lymphatic filariasis 15383 TAS FTS12 Pre-TAS FTS

Trachoma 20

14 TIS Clinical eye examination1

(Minawao refugee camp)

Rapid survey Clinical eye examination

3) Maps







Note: FY17 DSAs indicated in the map reflect all planned DSA which may include DSAs supported by other partners in addition to those supported by USAID ENVISION's project.


Note: FY17 DSAs indicated in the map reflect all planned DSA which may include DSAs supported by other partners in addition to those supported by USAID ENVISION's project.

Appendix 1. FY17 Activities


FY17 Activities

Capacity Strengthening Strategy

Project AssistanceStrategic PlanningAnnual national review and planning meetingAnnual regional review and planning meeting in the EAST regionAnnual regional review and planning meeting in the 09 other regionsCentral and regional coordination meetingsSupport for the launch of the 2017-2021 NTD Master PlanENVISION FY18 Work Plan developmentNTD Secretariat

Advocacy for Building a Sustainable National NTD ProgramA one-day meeting at MOH central levelA one-day meeting with the Ministries of Primary Education and of Secondary EducationThe Regional Public Health Delegates and Regional Governors MeetingsSocial Mobilization to Enable NTD Program ActivitiesThe production of Information, Education, and Communication (IEC) materialsOfficial MDA campaign launch ceremonyBroadcasting of health messagesTrainingMDA TRAINING IN THE COMMUNITY - Nurse training (Level 2: health district) in the East regionMDA TRAINING IN THE COMMUNITY - Nurse training (Level 2: health district) in the 09 other regionsMDA TRAINING IN THE COMMUNITY - CDD training (Level 3: health areas) in the East Region MDA TRAINING IN THE COMMUNITY - CDD training (Level 3: health areas) in the 09 other regionsTRAINING FOR MDAS IN SCHOOLS - Regional trainingTRAINING FOR MDAS IN SCHOOLS - District trainingTRAINING FOR MDAS IN SCHOOLS - Second training at HD levelTRAINING FOR MDAS IN SCHOOLS - Briefing at school levelMapping

MDASchool based MDACommunity MDA in East regionCommunity MDA in the 09 other regionsDrug Supply Management and ProcurementProcurement process (drugs and diagnostics)FY17 Drug transportation to regional level (for COMMUNITY MDA)FY17 Drug transportation to district level (for COMMUNITY MDA)FY17 Drug transportation to regional level (for SCHOOL-BASED MDA)FY17 Drug transportation to district level (for SCHOOL-BASED MDA)MonitoringSupervision of the training of nurses for the community MDA (in the East region)Supervision of the training of nurses for the community MDA (in the 09 other regions)Supervision of the training of CDDs for the community MDA (in the East region)

Appendix 2. Table of USAID-supported Provinces/States and Districts

# Region Health district Pre-TAS in FY17 TAS-1 in FY17 TIS in FY17

1 Adamaoua Bankim X 2 Adamaoua Banyo X 3 Adamaoua Djohong 4 Adamaoua Meiganga X 5 Adamaoua Ngaoundere Urbain X 6 Adamaoua Ngaoundere Rural X 7 Adamaoua Ngaoundal

8 Adamaoua Tibati (divided into 2 HDs, Tibati & Ngaoundal)9 Adamaoua Tignere X

10 Centre Akonolinga 11 Centre Awae 12 Centre Ayos 13 Centre Bafia X 14 Centre Biyemassi 15 Centre Cite-Verte 16 Centre Djoungolo 17 Centre Ebebda X 18 Centre Efoulan 19 Centre Elig-Nfomo 20 Centre Eseka 21 Centre Esse X 22 Centre Evodoula X 23 Centre Mbalmayo 24 Centre Mbandjock X 25 Centre Mbankomo 26 Centre Mfou



27 Centre Monatele X 28 Centre Nanga-Eboko X 29 Centre Ndiki X 30 Centre Ngog-Mapoubi X 31 Centre Ngoumou 32 Centre Nkolbisson 33 Centre Nkolndongo 34 Centre Ntui X 35 Centre Obala X 36 Centre Okola X 37 Centre Sa’A 38 Centre Soa 39 Centre Yoko X 40 Est Abongmbang 41 Est Batouri 42 Est Bertoua X 43 Est Betare-Oya X 44 Est Doume 45 Est Garoua Boulaye 46 Est Kete 47 Est Lomie X 48 Est Mbang 49 Est Messamena X 50 Est Mouloundou 51 Est Ndelele 52 Est Nguelemendouka 53 Est Yokadouma 54 Extreme Nord Bogo 55 Extreme Nord Bourha



56 Extreme Nord Goulfey X57 Extreme Nord Guere X58 Extreme Nord Guidiguis 59 Extreme Nord Hina 60 Extreme Nord Kaele 61 Extreme Nord Kar Hay 62 Extreme Nord Kolofata X63 Extreme Nord Kousseri X X64 Extreme Nord Koza 65 Extreme Nord Mada X 66 Extreme Nord Maga X 67 Extreme Nord Makari X68 Extreme Nord Maroua 3 (previouly called Maroua-Rural) X69 Extreme Nord Gazawa (previously part of Maroua-rural)70 Extreme Nord Maroua 1 (previously called Maroua-urbain) 71 Extreme Nord Maroua 2 (previously part of Maroua-urbain)72 Extreme Nord Meri X73 Extreme Nord Mindif 74 Extreme Nord Mogode 75 Extreme Nord Mokolo 76 Extreme Nord Mora X 77 Extreme Nord Moulvoudaye X 78 Extreme Nord Moutourwa X79 Extreme Nord Pete X80 Extreme Nord Roua 81 Extreme Nord Tokombere X X82 Extreme Nord Vele X 83 Extreme Nord Yagoua X84 Littoral Bonassama



85 Littoral Mbangué (previously part of Cite des palmiers)

86 Littoral Cite Des Palmiers (divided into 2 HDs, Mbangue &

Cite des Palmiers)87 Littoral Deido 88 Littoral Abo (previously part of Dibombari)

89 Littoral Dibombari (divided into 2 HDs, Abo & Dibombari)90 Littoral Edea X 91 Littoral Japoma (previoulsy part of Log Baba)

92 Littoral Log Baba (divided into 2 HDs, Japoma & Log Baba)93 Littoral Loum X

94 Littoral Ndjombé-penja95 Littoral Manjo X 96 Littoral Mbanga X 97 Littoral Melong 98 Littoral Manoka 99 Littoral Ndom X

100 Littoral New-Bell 101 Littoral Ngambe X 102 Littoral Nkondjock X 103 Littoral Nkongsamba X 104 Littoral Boko (previously part of Nylon)

105 Littoral Nylon (divided into 2 HDs, Boko & Nylon)106 Littoral Pouma X 107 Littoral Yabassi X 108 Nord Bibemi 109 Nord Figuil 110 Nord Garoua I 111 Nord Garoua Ii 112 Nord Gaschiga



113 Nord Golombe 114 Nord Guider 115 Nord Lagdo 116 Nord Mayo Oulo 117 Nord Ngong 118 Nord Pitoa 119 Nord Poli X120 Nord Rey-Bouba X121 Nord Tchollire X122 Nord Touboro 123 North West Ako X 124 North West Bafut X 125 North West Bali X 126 North West Bamenda X 127 North West Batibo X 128 North West Benakuma X 129 North West Fundong X 130 North West Kumbo East X 131 North West Kumbo West X 132 North West Mbengwi X 133 North West Ndop X 134 North West Ndu X 135 North West Njikwa X 136 North West Nkambe X 137 North West Nwa X 138 North West Oku X 139 North West Santa X 140 North West Tubah X 141 North West Wum X



142 South Ambam X 143 South Djoum X 144 South Ebolowa 145 South Kribi 146 South Lolodorlf 147 South Meyomessala X 148 South Mvangan 149 South Olamze X 150 South Sangmelima X 151 South Zoetele 152 South West Akwaya X 153 South West Bakassi 154 South West Bangem X 155 South West Buea X 156 South West Ekondo Titi X 157 South West Eyumojock X 158 South West Fontem X 159 South West Konye X 160 South West Kumba X 161 South West Limbe X 162 South West Mamfe X 163 South West Mbongue X 164 South West Mundemba X 165 South West Muyuka X 166 South West Nguti X 167 South West Tiko X 168 South West Tombel 169 South West Wabane 170 West Bafang X



171 West Baham X 172 West Bamendjou X 173 West Bandja X 174 West Bandjoun X 175 West Bangangte X 176 West Bangourain X 177 West Batcham X 178 West Dschang X 179 West Foumban 180 West Foumbot 181 West Galim X 182 West Kekem X 183 West Kouoptamo 184 West Malentouen X 185 West Massangam X 186 West Mbouda X 187 West Mifi X 188 West Penka Michel X 189 West Santchou




Documents

ENVISION Project Overview - ENVISION | ENVISION€¦ · Web viewProvide direct technical assistance to the MoH in strategic planning and capacity building