CAMEROON Work Plan FY 2018 Project Year 7

Transcription

1 CAMEROON Work Plan FY 2018 Project Year 7 October 2017 September 2018 ADD PARTNER LOGO(S) HERE ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred Hollows Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision. ENVISION is funded by the US Agency for International Development under cooperative agreement No. AID-OAA-A The period of performance for ENVISION is September 30, 2011, through September 30, The author s views expressed in this publication do not necessarily reflect the views of the US Agency for International Development or the United States Government.

2 ENVISION Project Overview The US Agency for International Development (USAID) s ENVISION project ( ) is designed to support the vision of the World Health Organization (WHO) and its member states by targeting the control and elimination of seven neglected tropical diseases (NTDs), including lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), three soil-transmitted helminths (STH; roundworm, whipworm, and hookworm), and trachoma. ENVISION s goal is to strengthen NTD programming at global and country levels and support ministries of health (MOHs) to achieve their NTD control and elimination goals. At the global level, ENVISION in coordination and collaboration with WHO, USAID, and other stakeholders contributes to several technical areas in support of global NTD control and elimination goals, including the following: Drug and diagnostics procurement, where global donation programs are unavailable Capacity strengthening Management and implementation of ENVISION s Technical Assistance Facility (TAF) Disease mapping NTD policy and technical guideline development NTD monitoring and evaluation (M&E). At the country level, ENVISION provides support to national NTD programs by providing strategic technical and financial assistance for a comprehensive package of NTD interventions, including the following: Strategic annual and multi-year planning Advocacy Social mobilization and health education Capacity strengthening Baseline disease mapping Preventive chemotherapy (PC) or mass drug administration (MDA) Drug and commodity supply management and procurement Program supervision M&E, including disease-specific assessments (DSA) and surveillance. In Cameroon, ENVISION project activities are implemented by Helen Keller International. ii

3 TABLE OF CONTENTS ENVISION Project Overview COUNTRY OVERVIEW 1 1) General Country Background... 1 a) Administrative Structure... 1 b) NTD Program Partners ) National NTD Program Overview... 4 a) Lymphatic Filariasis... 4 b) Trachoma... 6 c) Onchocerciasis... 7 d) Schistosomiasis... 9 e) Soil-transmitted Helminths ) Snapshot of NTD Status in Country PLANNED ACTIVITIES 12 1) NTD Program Capacity Strengthening a) Strategic Capacity Strengthening Approach b) Capacity Strengthening Interventions c) Monitoring Capacity Strengthening ) Project Assistance a) Strategic Planning b) Building Advocacy for a Sustainable National NTD Program c) Mapping d) MDA Coverage e) Social Mobilization to Enable NTD Program Activities f) Training g) Drug and Commodity Supply Management and Procurement h) Supervision for MDA i) M&E j) Supervision for M&E and DSAs k) Dossier Development ) Maps APPENDI 1: Work Plan Timeline 37 APPENID 2. Table of USAID-supported Regions and Districts in FY18 39 ii iii

4 TABLE OF TABLES Table 1: NTD partners working in Cameroon, donor support, and summarized activities 3 Table 2: Summary of LF endemicity status of 162 HDs 5 Table 3: Results of trachoma impact surveys completed since FY14 7 Table 4: Endemicity of OV in Cameroon 9 Table 5: List of SCH-endemic HDs to be surveyed in FY18 10 Table 6: Snapshot of the expected status of the NTD program in Cameroon as of September 30, Table 7: Project assistance for capacity strengthening 14 Table 8: Indicators the country will regularly use to evaluate capacity strengthening progress. 15 Table 9: USAID-supported districts and estimated target populations for MDA in FY18* 20 Table 10: Social Mobilization/Communication Activities and Materials Checklist for NTD Work Planning 23 Table 11: Planned Disease-specific Assessments for FY18 by Disease 31 Figure 1. Cameroon LF, OV, SCH, STH, and Trachoma Endemicity Map 33 Figure 2. Cameroon LF, OV, SCH, STH, and Trachoma Geographic Coverage Map 34 Figure 4. Cameroon Trachoma DSA map 36 iv

5 ABRREVIATIONS AE ALB APOC AZT CBTI CCO CCU CDD CDTI CENAME CVUC DQA DRSP DSA EU FEICOM FRPS FTS FY HD HKI HQ ICT IEC IEF IVM LCIF LF LOE M&E MDA MEB Mf MINCOM MINEDUB MINESEC MMDP MOH NGDO NTD OEC OV PC PNLCé Adverse Event Albendazole African Program for Onchocerciasis Control Azithromycin Community-based Treatment with IVM Cameroon Country Office Central Coordination Unit Community Drug Distributor Community-Directed Treatment with Ivermectin National Center for Essential Drug Supply Association of United Communes and Cities Data Quality Assessment Délégation Régionale de la Santé Publique (Regional Public Health Delegation) Disease-Specific Assessments Evaluation Unit Fonds Spécial d Équipement et d Intervention Intercommunale (Special Council Support Fund) Regional Fund for Health Promotion Filariasis Test Strips Fiscal Year Health District Helen Keller International Headquarters Immunochromatographic Test Information, Education, and Communication International Eye Foundation Ivermectin Lions Club International Foundation Lymphatic Filariasis Level of Effort Monitoring and Evaluation Mass Drug Administration Mebendazole Microfilaraemia Ministry of Communication Ministry of Primary Education Ministry of Secondary Education Morbidity Management and Disability Prevention Project Ministry of Public Heath (MINSANTE) Nongovernmental Development Organization Neglected Tropical Disease Onchocerciasis Elimination Committee Onchocerciasis Preventive Chemotherapy National Blindness Prevention Program v

6 PNLO PNLSHI PNLUB PZQ RPRG SAC SAE SAFE SCH STH STTA TAF TAP TAS TEO TF TIPAC TIS TOR TSS TT UNHCR UNICEF USAID WHO National Program for the Control of Onchocerciasis National Program for the Control of Schistosomiasis and Intestinal Helminthiasis National Program for the Control of Buruli Ulcers Praziquantel Regional Program Review Group School-Age Children Serious Adverse Event Surgery Antibiotics Face cleanliness Environmental improvements Schistosomiasis Soil-Transmitted Helminths Short-Term Technical Assistance Technical Assistance Facility Trachoma Action Plan Transmission Assessment Survey Tetracycline Eye Ointment Trachomatous Inflammation Follicular Tool for Integrated Planning and Costing Trachoma Impact Assessments Terms of Reference Trachoma Surveillance Survey Trachomatous Trichiasis United Nations High Commission for Refugees United Nations Children s Fund United States Agency for International Development World Health Organization vi

7 COUNTRY OVERVIEW 1) General Country Background a) Administrative Structure Cameroon is a central African country covering an area of 475,650 km². The population of Cameroon in 2018 is estimated at 24,863, Women comprise 50.5% of the total population, and 48.8% of the population resides in urban areas. Most of the country s inhabitants are young: 15.6% of the population is between the ages of 0 and 5 years, and 25.6% is between the ages of 5 and 14 years. The annual population growth rate is 2.5%. The country has more than 230 different ethnicities, and the two official languages are French and English. Administratively, Cameroon is divided into 10 regions, 58 divisions, 360 subdivisions, 360 district councils, and 15 urban municipalities. The health system has the following structure: 10 Regional Public Health Delegations (DRSPs), each headed by a Regional Delegate, with regional hospitals and similar structures; Health Districts (HDs), all of which are operational. Each HD has a district hospital and several health centers, which are primary health care centers. In 2014, the Ministry of Public Health (MOH) created new HDs by splitting some HDs. It took time for new HDs to be fully operational (completed in ). In fiscal year 2018 (FY18), there will be 189 fully operational HDs. The Central Coordination Unit (CCU) of the MOH coordinates integrated control activities for the fivepriority neglected tropical diseases (NTDs) that can be treated with preventive chemotherapy (PC) lymphatic filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), soil-transmitted helminths (STH), and trachoma at the national and regional levels. HD management teams organize and implement the activities at the district and community levels. Community-based (for LF, STH, OV, and trachoma) and school-based (for SCH and STH) platforms are used for drug delivery by community health workers, community drug distributors (CDDs), and teachers. If necessary, the regional and district referral hospitals are in charge of the management of serious adverse events (SAEs) resulting from drugs distributed. b) NTD Program Partners In Cameroon, the ENVISION project is implemented by Helen Keller International (HKI) under the leadership of MOH. Implementation of activities is carried out in collaboration with partner nongovernmental development organizations (NGDOs). Other ministerial departments such as the Ministry of Basic Education (MINEDUB), the Ministry of Secondary Education (MINESEC), the Ministry of Communication (MINCOM), the Ministry of Youth and Civic Education, the Ministry of Women s Empowerment and Family, and the Ministry of Social Affairs as well as the targeted communities themselves, through the participation of the CDDs, are associated with the project. NTD control 1 MOH, Institut National de la Statistique, United Nations Population Fund. (2016). Projections démographiques et estimation des cibles prioritaires des différents programmes et interventions de santé. (June 2016). p. 27. Available at: 2 Private and public hospitals with technical facilities similar to those of a regional hospital. 1

8 activities in the country s 10 regions are organized around networks and structures that are already established for example, the long-existing coalition of NGDOs working in OV control. HKI has signed sub-agreements with specific NGDOs, and these organizations implement mass drug administration (MDA) activities in their traditional regions of intervention: Sightsavers supports activities in the Northwest, Southwest, and West regions; International Eye Foundation (IEF) supports the South and Adamawa regions; and PersPective works in the Littoral Region. HKI directly supports the four other regions (Center, East, North, and Far North), and provides financial and technical support to the MOH at the central level. In addition to the funds provided by the U.S. Agency for International Development (USAID) for PC targeting of the NTDs through the RTI-managed ENVISION project and the HKI-managed Morbidity Management and Disability Prevention (MMDP) project the NTD program also receives financial support from the Cameroon Government and from other organizations, notably the Lions Club International Foundation (LCIF). The following list (and Table 1) provides more details on support provided for NTD activities: The Government of Cameroon contributes to the payment of government staff salaries and other agents of the state implicated in project delivery; supports drug pick-up, transportation, and storage; is responsible for operations and various investments (building of facilities, infrastructure, and logistics); supports participation of NTD staff in international meetings and training; and manages program coordination associated with MDA and handling of LF morbidity cases (hydrocele and lymphedema) and of trachomatous trichiasis (TT) cases. Sightsavers has supported OV activities since The NGDO is contributing its own funding to the implementation of integrated LF, OV, SCH, and STH control/elimination activities in the Northwest, Southwest, and West regions. It also provides support for the elimination of trachoma in the Far North and the North regions. Sightsavers supports TT surgeries, promotion of facial cleanliness, and other hygiene and sanitation activities. LCIF has supported activities for OV control since 1996 through a coalition of NGDOs. In 2010, LCIF started to reduce its financial support, particularly in HDs endemic for OV in the forest areas. In 2015, LCIF stopped all funding activities in the South Region (technical support is provided by IEF) and in the Littoral Region (technical support is provided by PersPective). In FY17, LCIF supported, through HKI and IEF, only HDs endemic for OV in the regions of Adamawa, Far North, and North; this OV-direct support will end in FY18 because LCIF will focus on nationwide comprehensive basic eye care. World Health Organization (WHO) contributes technically and financially to the development of NTD plans, holds national planning/review meetings, and provides logistical support for the management of drug supplies. MMDP project (HKI) is a five-year projected funded by USAID. The project works in northern Cameroon to provide support for training in TT and hydrocele surgery. The project will end in July

9 Table 1: NTD partners working in Cameroon, donor support, and summarized activities Partner Location (regions/states) Activities Is USAID providing direct financial support to this partner? Other donors supporting these partners? Provide direct technical assistance to the MOH in strategic planning and capacity building LCIF Adamawa Region, OV in North and Far North regions Provide technical and financial assistance to MOH for advocacy and social mobilization Provide technical and financial assistance to MOH for the organization, implementation, and supervision of MDA campaigns to control NTDs No * No WHO Central level Provide technical and financial assistance to the MOH in strategic planning; WHO also aids with drug supply management. No None MOH Central level/all endemic areas Provide government staff salaries, drug storage and transportation, construction of health facilities, infrastructure and logistics, treatment of hydrocele, and support for CDDs No Yes MMDP (HKI) Far North and North regions Provide management of TT cases Support scale up of LF morbidity management Yes None Sightsavers Northwest, Southwest, and West regions Far North and North regions Support MDA Support TT surgery, WASH activities * USAID provides support to LCIF as a sub-partner of HKI No Yes 3

10 2) National NTD Program Overview a) Lymphatic Filariasis Cameroon has made enormous progress in LF elimination countrywide. Of the 162 ever-endemic districts, to date, Cameroon has achieved the criteria to stop LF MDA in 125 districts (including preliminary results from the FY17 transmission assessment survey [TAS]), with a population of 15,466,048 no longer at risk. In FY18, 12 HDs will undergo TAS1, including 6 districts that were only treated partially with IVM+ALB. The remaining 25 districts, plus 6 partial districts, were found to not be endemic for LF based on mini-tas surveys conducted in FY16 (see Co-endemicity with L. loa section below). Cameroon is on track to reduce LF infection to a point where it is likely that transmission is no longer sustainable by the end of FY18. Cameroon started uniting vertical, disease-specific programs into an integrated NTD program in 2010 with the support of USAID through the RTI-managed NTD Control Program, with HKI as the in-country implementing partner. This support allowed the completion of NTD mapping, including LF, throughout the country from , and the scale up of MDA activities to bring coverage close to 100%. In total, using the FY17 redistricting number of 189 HDs, 162 HDs were classified as endemic. A CCU was established in 2012 to integrate the response to NTDs. This unit brings together all program managers from the MOH and partners. The goal of the LF program is to eliminate the disease as a public health problem by The strategy is ivermectin (IVM) combined with albendazole (ALB) MDA through community-directed intervention in endemic areas, and morbidity management of the disease. LF elimination began in 2008 with mass treatment of nine HDs in the North and Far North as part of a pilot project phase with support from WHO and the Mectizan Donation Program. Disease mapping was completed between 2010 and 2012, using immunochromatographic test (ICT) cards, with support from USAID and the African Program for Onchocerciasis Control (APOC); APOC s support covered 60 HDs. The mapping in revealed that LF is endemic in 162 of HDs (although later analysis revealed that 25 of these HDs were not endemic, thus the 137 in the snapshot table below). Among the 162 districts, 101 are co-endemic with OV, and 87 of these 101 HDs are also co-endemic with Loa. In 2012, IVM and ALB MDA was extended to cover 137 of the 162 endemic HDs, including 6 HDs partially targeted due to co-endemicity with L. loa and the risk of SAEs. Co-endemicity with L. loa In Cameroon, 31 HDs are co-endemic with LF and L. loa (and not with OV). Of these, 6 began partial treatment in 2011, as mentioned above. The remaining 25 were not treated prior to A baseline survey was conducted in 2014 in the East Region using ICT cards, and a new strategy was piloted in This strategy combined the bi-annual distribution of ALB with the use of long-lasting insecticidetreated nets provided by the National Malaria Control Program. Following the new WHO guidance, in the East Region 13 of these 31 co-endemic HDs started bi-annual treatment with ALB. In 10 of the 13, the entire HD received bi-annual ALB, while the remaining 3 HDs received either IVM+ALB (areas where treatment started in 2011) or bi-annual ALB (IVM-naïve areas) of 181 HDs prior to redistricting following the FY14 administrative redistricting, which became fully effective in FY17, the number of HDs increased from 181 to 189; therefore, the LF-endemic HDs grew from 158 to

11 In FY16, the national LF program planned to extend this bi-annual treatment strategy to the remaining 18 co-endemic HDs (15 treatment-naïve HDs and the other 3 partial-treatment HDs) in order to reach 100% geographic coverage for LF in Cameroon. However, a review of baseline survey results collected in the East Region in 2014 contradicted earlier mapping data. Earlier data had shown ICT prevalence of up to 20% antigenemia (Ag), but in 2014, Ag prevalence of zero was observed in the 31 HDs. After a data review by the WHO Regional Office for Africa Regional Program Review Group (RPRG), the bi-annual treatment strategy was suspended. It was recommended that a confirmatory mapping survey (a mini- TAS) be conducted in the 31 HDs in FY16 to evaluate the current LF situation using filarial test strips (FTS). Results from the mini-tas indicated that none of the FTS positive samples were positive for Wuchereria bancrofti using the thick blood smear film technique. This discrepancy may be explained by cross-reactivity with L. loa and Mansonella perstans. Testing by polymerase chain reaction has been used to confirm the positive tests. The report has been validated, and a validated copy of the report is expected to be issued in November 2017 and then will be sent to the RPRG. TASs and stopping MDA In FY14, Cameroon s first five HDs underwent and passed TAS1. In FY16, a further 33 4 HDs passed TAS1 and 87 5 HDs passed pre-tas. In FY17, the 87 HDs underwent TAS1, and results indicate all passed, although one evaluation unit (EU) reported an inadequate sample size because not enough children were present in school at the time of the survey. This EU has repeated the TAS1 with children in the community. The final report is awaiting validation and is expected to be ready in August The average number of positive cases per EU was less than 5 the critical cut-off per EU was Table 2 summarizes the current LF situation in Cameroon. Table 2: Summary of LF endemicity status of 162 HDs Survey Result # of HDs Mini-TAS (from FY16) Classified as non-endemic partial districts TAS1 in FY14 All EUs passed 5 TAS1 in FY16 All EUs passed 33 TAS1 in FY17 All EUs passed 6 87 Pre-TAS in FY17 All districts passed 12 7 (including 6 partial districts) TOTAL 162 Pre-TAS was implemented in 12 HDs in FY17. In FY18, these 12 HDs will be submitted for TAS1 if they pass pre-tas and will not require mass treatment with ENVISION support. This means that in FY18, Cameroon may be able to stop LF MDA nationwide, a remarkable achievement for the national program, the implementing partners, and the funders. In FY18, ENVISION will also support 38 TAS2 (eligible HDs are those that passed TAS1 in FY14 and FY16), post-mda surveillance activities, and preparation of the LF elimination dossier. In addition to MDA-related activities, morbidity management activities are carried out in country through the MMDP project with USAID funding and implemented by HKI since FY15. MMDP conducted a facility assessment in FY16 in 5 pilot HDs in Far North and North regions. 4 At the time of the survey, there were 31 HDs, but as a result of redistricting, there are 33 HDs. 586 HDs prior to the redistricting. 6 Final confirmation pending 7 Includes 6 HDs receiving partial treatment. 5

12 b) Trachoma Historical data and MDA The goal of the trachoma program, coordinated by the National Blindness Prevention Program (PNLCé), is to eliminate trachoma as a blinding disease by The program uses the WHO-recommended SAFE strategy: S (surgery), A (antibiotics), F (facial cleanliness), and E (environmental improvement). The S, F, and E components are supported by other projects specifically focused on trachoma or integrated with broader water, sanitation, and hygiene-promotion projects. Sightsavers has supported TT surgeries in the Far North Region since FY14. The HKI-led MMDP project has also provided technical and financial support in terms of TT surgery in the Far North and North since FY15. All 21 HDs that required antibiotic treatment have stopped MDA, and 3,137,861 people are no longer at risk for blinding trachoma. Activities to eliminate trachoma accelerated in 2010, with USAID support for mapping surveys carried out from 2010 to Of the 189 HDs, 135 were not suspected to be endemic. Mapping took place in 54 HDs in the Far North, North, and Adamawa regions; of those, 5 HDs were determined to not be endemic from trachoma (TF 0%), 33 HDs were determined, at that time, not to be to not be a public health problem, 28 HDs had TF<5%, while 5 HDs had TF 5-9.9%. The remaining 16 HDs were considerd endemic (TF 10%). Annual administration of Pfizer-donated azithromycin (AZT) and tetracycline eye ointment (TEO) started gradually, first in the 16 HDs with TF 10%, then in the 5 HDs with TF 5-9.9%. MDA was conducted in Meri and Petté in FY15. Following the new WHO guidelines, the 5 HDs with TF prevalence rates between 5% and 9.9% (Moutourwa, Yagoua, Guéré, and Maroua-Rural [now Maroua 3 and Gazawa], were now eligible for a round of MDA in FY16 and underwent trachoma impact assessments (TISs) in FY17 (see results below). No MDA was planned in FY17. One HD, Kolofata, stopped treatment in FY11 and was surveyed and declared to have reached the criteria to stop MDA by Médécins Sans Frontières. However, this HD was targeted for survey in FY17 because the HD did not receive oral AZT, and the PNLCé suspects a TF prevalence which would indicate that MDA should be started again. The security situation in Kolofata is difficult as several suicide-bombings have taken place and the survey has been postponed until FY19 in the hope that the security situation will improve. If the TF prevalence is shown to be >5%, MDA will be conducted in the HD in FY19. Surveys In 2014, TISs were conducted in seven HDs. Five HDs (Bourha, Hina, Koza, Mogode, and Roua) have met the criteria for stopping MDA (TF prevalence less than 5%), and two (Meri and Petté) had a TF prevalence between 5% and 9.9%. After another round of MDA in FY15 in these two HDs, TISs were planned for FY16. However, to improve coordination and planning of other PNLCé activities, the PNLCé postponed these TISs until FY17. In FY15, five HDs in the Far North (Goulfey, Guidiguis, Kousséri, Makary, and Mokolo) were scheduled for TIS. These assessments were postponed several times due to insecurity in the region and finally, surveys were conducted in two of the five targeted HDs (Mokolo and Guidiguis). The TF prevalence was 1.7% and 1.9% respectively, indicating that it was possible to stop MDA. The TISs for the remaining three HDs (Goulfey, Kousséri, and Makary) were postponed until FY17 due to security concerns and showed a TF prevalence <5%. Also in FY15, the HD of Kolofata was not re-evaluated as initially planned (and requested by MOH) due to the security situation. As noted above, the Kolofata confirmation prevalence survey is postponed until FY19 as the security situation has not improved 6

13 Table 3: Year Type of survey Results of trachoma impact surveys completed since FY14 HD name TF/TI result (ages 1 9 years) FY14 TIS Bourha, Hina, Koza, Mogode, Roua <5% FY14 TIS Meri, Petté 5% 9.9% FY16 TIS Mokolo, Guidiguis <5% FY17 TIS Goulfey, Kousséri, Makary, Moutourwa, Yagoua, Guéré, Maroua 3, Gazawa, Poli, Rey Bouba, Tcholliré, Tokombéré <5% FY17 2nd TIS Meri, Petté <5% Notes 1 MDA in FY15 2nd TIS postponed to FY17 Three HDs in the North Region (Poli, Rey Bouba, and Tcholliré) carried out the final round of MDA in 2015, and TISs in these three HDs were planned for FY16. TIS was also planned in FY16 in the HD of Tokombéré, which completed five rounds of MDA prior to The TISs in all four HDs were postponed to FY17. Fourteen HDs conducted TIS in FY17 using the WHO-led Tropical Data system. All 14 HDs were found to have a TF prevalence <5% in children age 1 9-years old (0% 2.5% range) and can stop MDA. Eight of these HDs have a TT prevalence above 0.2% in people age 15 years old and older, indicating a need for TT management activities. This report was shared with HKI and RTI. The HDs surveyed were Goulfey, Guéré, Moutourwa, Pété, Tokombéré, Yagoua, Poli and Rey Bouba. According to WHO guidelines, trachoma surveillance surveys (TSSs) should be carried out two years after an HD has achieved the criteria to stop MDA. The first five HDs in the Far North (Bourha, Hina, Koza, Mogode, and Roua) will undergo surveillance surveys in FY18. The PNLCé has engaged the Far North Regional Delegation of Public Health and will engage with the United Nations High Commission for Refugees (UNHCR) to understand the demographic situation and health interventions in the refugee camp in Minawao (in the HD of Mokolo). This will provide the information needed to plan for a prevalence survey of Minawao refugee camp in FY18. Note that funding for the survey has been included in the FY18 WP, but that the survey will only take place if the security situation is stable. The other refugee camps in Cameroon are not in trachoma endemic areas and there are currently no plans to implement trachoma activities in these camps. c) Onchocerciasis Historical data and MDA OV is present in all 10 regions, and baseline epidemiological surveys (1993) indicated an average national prevalence of 40% of 189 HDs are considered meso-endemic, hyper-endemic, or of mixed endemicity (Table 3a). Cameroon's primary goal is to eliminate OV by 2025, and the National Onchocerciasis Elimination Strategy is in the process of being finalized by stakeholders. The OV program has received financial and technical support from USAID since 2010 as part of the NTD Control Program 8 Previously there were 111 HDs. The increase is due to a redistricting 7

14 (predecessor to ENVISION), and there is an OV Elimination Committee (OEC), created in FY17 by the MOH, which will aid in OV elimination activities. The first meeting of the committee is expected to take place in October The first control activities began in 1987 with the mass distribution of IVM in the North Region, followed by extension of treatment to the South and Center regions between 1990 and 1992 via community-based treatment with IVM (CBTI). The National Program for the Control of Onchocerciasis (PNLO) was created in The PNLO extended control activities to five regions using the CBTI strategy and, starting in 1999, transitioned to CDTI (community-directed rather than just community-based strategy). The OV program has received financial and technical support from USAID since 2010 as part of the NTD Control Program and continues to receive support through ENVISION. The integrated NTD MDA approach in communities was built on the CDTI strategy developed for OV control In previous fiscal years, the primary strategy used was annual CDTI in the target endemic communities. IVM was given alone in 12 HDs and together with ALB in 101 HDs, where it was part of integrated treatment for LF and OV. Out of the 113 endemic HDs (redistricting added 2 HDs) that are receiving treatment with IVM, 103 are co-endemic with L. loa and LF, 87 HD are co-endemic for OV, LF and L. Loa, 16 HD for OV and L. loa only, and 10 OV only. The risk for SAEs following IVM administration, after many years of treatment, has decreased due to reduced prevalence and parasite load SAEs mainly occur in treatment-naïve individuals with a high L. loa parasite load. To achieve the elimination goal, it is necessary to extend the IVM MDA to the 71 hypoendemic HDs. This may result in an increase in the potential number of SAE cases in those areas where IVM has never been administered. For now, all meso-endemic or hyper-endemic HDs receive treatment, and until FY17, most of the hypo-endemic had received treatment through the LF MDA. Because 125 HDs have stopped LF treatment and 12 will stop in FY18, any hypo-endemic HDs that have received IVM treatment through the LF MDA will no longer do so. The MOH has no plans to either map these hypoendemic regions nor treat them because the OV program has not sought funding for OV treatment in hypo-endemic HDs. 8

15 Table 4: Endemicity of OV in Cameroon Endemicity Status # of Notes Districts Non-endemic 5 None are under treatment Hypo-endemic 71 None are under treatment Meso-endemic 15 Hyper-endemic 84 Hyper/Meso/Hypo 10 7 are mixed hyper, meso and hypo areas 3 are a mix of hyper and hypo endemic areas Meso and mixed 4 A mix of meso and hypo endemic areas Total are under treatment In FY18, ENVISION will provide support for OV MDA in 113 HDs. d) Schistosomiasis Historical data and MDA An agreement was signed by USAID and the Ministry of Higher Education and Scientific Research in the Government of Cameroon in 1983 for the development of a pilot project for SCH control. It led to the implementation of a vast national epidemiological survey between 1985 and The survey revealed the distribution and prevalence level of different SCH species in the country. The high-endemicity areas in the northern regions became the priority areas for implementation of the activities of the National Program for the Control of Schistosomiasis and Intestinal Helminthiasis (PNLSHI, created in 2003). Treatment started in 2007 as school-based deworming. The program began receiving support from USAID through the NTD Control Program, implemented by HKI, starting in The first MDA campaigns for SCH and STH in schools were launched in 2007, with support from Children Without Worms. Further campaigns have received USAID support since 2010 for mapping and MDA. The epidemiological mapping conducted in showed 140 HDs as being endemic (prevalence above 0%). These 140 HDs include 2 HDs (Kouoptamo and Galim in West Region) that were added in 2015 by the national program due to an increase of SCH prevalence in school-age children (SAC). The Cameroon national SCH program plans for the elimination of SCH by 2020 and in the past opted for a treatment frequency that does not always align with WHO in some HDs. The national program policy is to conduct yearly MDA for SAC where the prevalence is greater than 10%, and adults are treated where the prevalence in SAC is >50%. Cameroon receives praziquantel (PZQ) donations from WHO. The national strategy for SCH relies on the mapping results of (which used the Kato-Katz technique), and for FY17, the national program targeted MDA in 84 HDs (4 HDs were added due to redistricting) with the appropriate prevalence for treatment. Accordingly, in FY17, the number of HDs treated with PZQ was 84 these were treated with a mix of school-based and community-based treatment. A teachers strike in some regions prevented implementation of the school-based strategy as planned. The results of this year s MDA will be available in November SCH/STH surveys are planned in 12 HDs in FY18. This study aims to determine trends in prevalence and intensity of SCH/STH infections following at least five rounds of MDA, including twice annual ALB treatment in LF-coendemic HDs. Although USAID and ENVISION are unable to provide support for SCH/STH treatment, USAID and ENVISION will provide assistance to the the MOH in finding donors that 9

16 are able to support the school-based deworming. Following consultation with the MOH, the planned HDs for SCH/STH survey are as follows in Table 3b. Table 5: List of SCH-endemic HDs to be surveyed in FY18 Regions Health Districts SCH Prevalence STH Prevalence Adamawa Banyo Ngaoundere Rural 14.86% ( %) 11.37% ( %) 4.49% ( %) 5.39% ( %) Centre Bafia Cité Verte Efoulan Mbalmayo Mfou Nkolbisson 6.35% ( %) 25.60% ( %) 11.74% ( %) 14.77% ( %) 1.00% ( %) 25.60% 16.30% ( %) 22.30% ( %) 16.40% ( %) 36.20% ( %) 44.80% ( %) 22.30% ( %) Littoral Loum 20.99% ( %) 23.50% ( %) Nord Njombe Penja Bibemi Figuil 20.99% ( %) 13.65% ( %) 5.22% ( %) 23.50% ( %) 4.42% ( %) 0.00% e) Soil-transmitted Helminths The first STH treatments were based on data from epidemiological surveys (using the Kato-Katz technique) carried out between 1985 and Control efforts were intensified with the creation of PNLSHI in 2003 and the establishment of the national strategic plan for SCH and STH control. The STH program has received USAID support since 2010 for annual mebendazole (MEB) MDA in schools for children age 5 14 years. Data from mapping in using the same Kato-Katz slides for SCH and STH showed that the three major STH are present in all 10 regions. SAC are the most frequent sufferers, with high parasite loads and, frequently, poly-parasitic infections. Of the 189 HDs, 110 had a prevalence of 0-20%, 50 HDs were 20% and <50% and 29 HDs had a prevalence 50%. The national strategy is to provide systematic deworming in schools for all SAC regardless of whether they attend school: annual deworming in schools with MEB for children age 5 14 years, with the addition of PZQ in SCH-endemic areas. This strategy has been ongoing since the establishment of the PNLSHI. With the start of LF MDA in the country, the SAC in HDs with LF MDA also received a second round of deworming with ALB. For school-based deworming, SAC who are not enrolled in school were taken to the school by their parents on the day of the MDA to receive treatment. Special social mobilization efforts were conducted by nurses to target this group. Children age 1 5 years were also treated twice a year via the Mother and Child Health and Nutrition Action Week, during which a package of services, including MEB, is distributed to children under 5 years old. Treatment for these younger children is supported by Canada s Department of Foreign Affairs, Trade and Development through the United Nations Children s Fund (UNICEF). In FY17, all HDs in Cameroon were treated for STH, primarily with the school-based strategy (due to a teachers strike, some HDs were treated with a community-based strategy). Although USAID and ENVISION are unable to provide support for SCH/STH treatment, USAID and ENVISION will provide assistance to the the MOH in finding donors that are able to support the school-based deworming. 10

17 3) Snapshot of NTD Status in Country Table 6: Snapshot of the expected status of the NTD program in Cameroon as of September 30, 2017 Columns C+D+E=B for each Columns F+G+H=C for each disease* disease* MDA MAPPING GAP DETERMINATION MDA GAP DETERMINATION DSA NEEDS ACHIEVEMENT A B C D E F G H I No. of districts No. of districts Expected No. of expected to be in No. of No. of No. of receiving MDA districts where need of MDA at Total No. of districts districts districts as of 09/30/17 criteria for any level: MDA No. of districts stopping Disease districts in classified classified in need not yet started, requiring DSA district-level Cameroon as as nonendemic** mapping USAIDof initial or has as of 09/30/17 MDA have been endemic** Others prematurely funded met as of stopped as of 09/30/17 09/30/17 Lymphatic filariasis 137 f a b Onchocerciasis Schistosomiasis d 0 0 Soil-transmitted helminths TAS1: 12 c TAS2: e Trachoma*** TSS: 5 a) 87 HDs are currently undertaking TAS1 and are not scheduled for treatment with ENVISION support. b) This includes 38 HDs that passed TAS1 plus the 87 HDs pending TAS1 results in FY17. c) These 12 HDs will undergo pre-tas before the end of FY17 and are expected to need of TAS1 in FY18. d) Low endemic districts are not being treated twice during primary school age, as WHO guidelines recommend e) The Cameroon MOH classifies all HDs as endemic although they are not. 71 HDs have a prevalence >20% and therefore require MDA. f) 162 HDs were initially mapped as endemic for LF, however later research revealed 25 of these should have been classified as non-endemic/never-endemic. 11

18 PLANNED ACTIVITIES 1) NTD Program Capacity Strengthening AREAS FOR CAPACITY STRENGTHENING a) Strategic Capacity Strengthening Approach ENVISION will continue to work closely with the MOH to identify priority areas that will need capacity strengthening in FY18. ENVISION translated these priorities into the capacity building activities below. i) Capacity Goals and Strategy ENVISION s goals for FY18 are to increase capacity in partnership with the MOH to ensure that Cameroon is able to deliver effective MDA and surveys. To do this, ENVISION goal will be to assist he MOH s efforts to improve its strategic planning abilities, discuss with MOH to build an effective advocacy strategy, mentor MOH in developing elimination dossiers, working with MOH staff in using the data driven planning guide as a key tool in MDA implementation action plan. ii) Capacity Strengthening Objectives and Interventions Objective 1: Improved strategic planning by the MOH For effective MDA and survey implementation, planning is a vital step. ENVISION s objective is to support the MOH to more effectively plan and budget for FY18. Intervention 1: Progress is still needed on the part of each program for the systematic development of cost-effective NTD strategic documents. In FY18, ENVISION will continue to provide guidance to various programs in budgeting and finalizing their respective NTDs strategic documents. The national NTD program will also benefit from ENVISION s support for the development, validation, and implementation of its elimination plan. This support can be accomplished through coaching and experience sharing with national program leaders during their preparation for the review meeting. ENVISION will also ensure that the WHO local technical advisor in charge of NTDs is a permanent NTDs stakeholder, and also ensure that she/he attends all MOH strategic meetings. Intervention 2: ENVISION will work with the MOH on improving budgeting for activities, especially for surveys. ENVISION will also reinforce the need for more realistic budgeting and the consequences of not providing appropriate budgets (and the impact on the program). Objective 2: Advocacy for NTD activities This objective aims to improve the resources, both in quality and quantity, available from the MOH for NTD activities. Intervention 1: ENVISION will take advantage of advocacy meetings held at MOH central level to emphasize the necessity of having enough public servants who are highly qualified at all levels to decrease the 12

19 workload for current staff and enable them to deliver advanced analysis of results from the field. ENVISION also plans routine trainings each year to reinforce the skills of newcomers to the program. Intervention 2: In FY18, ENVISION will continue to provide technical support for field visits to governors of some regions of Cameroon. These visits will be extended to other local stakeholders such as economic operators who are willing to support the NTD program. The nongovernmental organizations (NGOs) that attend these meetings will advocate for the increase of local funding to support NTD activities. ENVISION will also conduct the same advocacy at the MOH central level, and following this meeting (at central level), HKI will share its proposal-writing experience with the MOH CCU. This intervention aims to help the national NTD program identify new funding from donors other than USAID ENVISION will also provide technical and financial support for a workshop during which MOH staff members from central level will be trained on fundraising. Objective 3: Preparation for the LF and trachoma elimination dossiers This objective aims to improve the readiness of the LF and trachoma programs for the eventual submission of an elimination dossier to WHO. Intervention 1: ENVISION will provide technical assistance to the MOH for the development of elimination dossiers. In this regard, ENVISION will assist the CCU in establishing LF and trachoma dossier writing committees. In addition, ENVISION will provide financial support for meetings to review the work of the dossier writing committees. External technical assistance will also be required for these meetings. Given that data are the main input for elimination dossiers, ENVISION will reinforce coaching for the MOH central-level data managers; ENVISION will also provide some on-the-job-training to these managers during the early stages of using the integrated NTD database. Objective 4: Improved drug management In the past, inaccurate drug ordering and inadequate management have led to delays and poor MDA coverage in Cameroon. ENVISION s objective is to support the MOH in improving drug management processes. Intervention 1: To improve the drug ordering process, ENVISION will attend all preparatory meetings related to a drug order, provide technical support, and help guide the MOH throughout the entire drug ordering process. In the past, not all NGOs were involved in this process, due to calendar conflicts or other barriers and the MOH preferred to move forward without partner involvement. Moving forward, ENVISION will ensure the planning meetings are well scheduled where the maximum number of NGO participants will be available to support this activity. The purpose is to make sure that decisions are made based on reliable data. For the follow-up of the drug order, ENVISION will send monthly update requests to both the CCU and the WHO CCO. 13

20 b) Capacity Strengthening Interventions Table 7: Project assistance area 1. Strategic planning 2. Building advocacy for a sustainable NTD program 3. Dossier development Project assistance for capacity strengthening Capacity strengthening interventions/activities Experience sharing Attendance at strategy meetings Advocacy Experience sharing Partnerships Advocacy Support Experience Sharing On-the-job-training How these activities will help to correct needs identified in situation above ENVISION aims to: improve the cost-effective planning of program activities. ENVISION will support the creation of the annual NTD plan. ENVISION will work with the MOH to make detailed activity timelines and set clear objectives, and will review progress monthly with the MOH. This will aid in planning and anticipation of problems. ensure that a final program plan with reasonable costs is approved and accepted (as part of forecasting, any gaps in ENVISION s support will be highlighted, which will allow the MOH to plan proactively to fill these gaps). The experience sharing aims to: Reinforce MOH capacity to monitor the campaigns. After each review of regional fixed obligation grant (FOG) deliverable documents, ENVISION will continue to share review notes with the CCU to help it in managing regional FOGs. Attending strategic meetings will help ENVISION ensure that WHO is always aware and involved in NTD decision making. ENVISION will continue to advocate for more qualified staff at the MOH by having at least one annual meeting with the Minister of Health. To increase local funding and enhance local ownership, some communities have started to raise local funds for CDD incentives; this good practice will be disseminated nationwide through experience sharing ENVISION support will enable a consultant to help the NTD program in the development of a fundraising strategy. To increase concrete commitments to NTD activities from the MOH, ENVISION, in collaboration with partners, will advocate for commitment and work with the Ministry to ensure these outcomes. ENVISION will help the MOH to improve the quality of data because data are the main input for the development of elimination dossier. An external expert will also share his/her experience and strengthen staff skills during a workshop. 14

21 Project assistance area 4. Drug supply management and procurement Capacity strengthening interventions/activities Advocacy How these activities will help to correct needs identified in situation above ENVISION will advocate for the following: Close collaboration with the WHO CCO to improve follow-up of the drug order and avoid delays in delivery. A systematic annual physical drug inventory after each MDA to ensure appropriate quantities are ordered. c) Monitoring Capacity Strengthening Table 8: Main categories targeted by strategic capacity strengthening approach Planning Building advocacy for a sustainable NTD program Dossier Development Drug supply management and procurement Indicators the country will regularly use to evaluate capacity strengthening progress. Indicators to evaluate capacity strengthening progress National NTD plan and annual work plan is available. Budget estimates are improved and closer to real situation, using previously accepted budgets as a guide. Number of strategic meetings attended by WHO CCO technical advisor to ensure implementation in accordance with guidance. Amount of increase in money dedicated to NTD from MOH. Percent staff turnover will decrease compared to previous years. Guidelines for the elaboration of elimination dossiers are understood and data collation has started in FY18. Elimination dossiers are submitted. No drug shortage is reported during the MDA campaigns. An inventory is done at the end of every campaign (for each drug). Integrated NTD database is used, along with the Tool for Integrated Planning and Costing (TIPAC), to complete the Joint Application Package. 2) Project Assistance a) Strategic Planning i) Activity 1: Annual National Review and Planning Meeting (HKI Strategic Planning) At the end of every MDA campaign, the MOH holds a national meeting in Yaoundé (two-day meeting and one travel day) to assess all the (PC) NTD activities carried out during the past year and to plan activities for the coming year. It brings together representatives from the MOH central level (8 representatives), WHO (1), partner NGDOs (15), regional delegates and MOH NTD focal points (10). This meeting provides an opportunity to review and approve the results of activities carried out by the CCU, the national programs for the prevention of NTDs, and the 10 DRSPs. The MOH also presents the results of specific studies carried out, and the attendees use them during discussions to adjust treatment strategies and areas of intervention. The discussions also include sharing best practices identified during the MDA campaign to improve implementation of activities for the upcoming campaigns. During the meeting, ENVISION provides technical assistance based on its expertise and 15

22 experience via the staff of HKI and other NGDOs that provide support to the NTD program in Cameroon. ENVISION also shares a summary of its observations collected during monitoring. The following specific topics will be covered in FY18: Approval of 2017 MDA data Inclusion of the results of the FY17 impact surveys in the NTD control strategy FY18 impact survey planning Surveillance for the HDs that have reached the criteria to stop MDA for LF and trachoma reviewing dossier submission and the steps required before submission to collate paperwork and data Possible solutions to improve and maintain coverage in HDs with recurrent poor performance. ii) Activity 2: Annual Regional Review and Planning Meetings A two-day review and planning meeting (plus two travel days) is held each year in each of the 10 regions (i.e., 10 meetings). These meetings bring together central-level MOH teams (five representatives CCU, PNLSHI, PNLO, PNLCé, National Program for the Control of Buruli Ulcers [PNLUB]); DRSP and HD management teams; and representatives of HKI, WHO, and other NGDOs. During the meeting, the activities of the previous year s MDA campaign are reviewed and the problems identified during follow-up/monitoring are presented and discussed to find and approve possible solutions. The solutions identified are included in planning for the activities of the upcoming year. As always, these meetings will focus on a review of MDA coverage, identifying areas with particular difficulties and ensuring that possible solutions are discussed, with concrete steps to implement these solutions. The meeting also enables the CCU and various national programs to share information with the regionlevel participants, including the results of specific studies carried out by central-level players as well as the program decisions taken based on these studies. During the meeting, ENVISION and the MOH central-level participants provide support to the DRSPs to develop their respective detailed micro-plans, which include the list of activities to be included in the annual work plans of the regions and HDs. iii) Activity 3: Central and Regional Coordination Meetings ENVISION will support this activity through level of effort (LOE) only. As part of its follow-up of activities, the MOH organizes quarterly one-day coordination meetings every year. At the central level, the meetings bring together representatives of all the national NTD programs, NGDOs supporting NTD control efforts, and WHO. At the regional level, the meetings bring together DRSP managers, the HD management teams, and the supporting NGDOs. The participants assess the activities planned over the previous quarter in order to update the annual work plans (redefining objectives, resetting schedules, and adjusting requirements to include the activities of the various programs). Feedback is provided to the DRSPs after each coordination meeting held at the central level. In FY18, ENVISION will take part in these meetings via its participation in the work of HKI and NGDO staff. iv) Activity 4: Workshop to Develop the ENVISION FY19 Work Plan The ENVISION project s FY19 action plan development workshop will take place in Yaoundé in June 2018 over three days. The following participants will be invited: CCU staff; the managers of the national NTD 16

23 programs; and representatives of WHO, HKI, RTI/USAID, and partner NGDOs. The workshop s primary goal will be to define and plan all the PC NTD control activities the country will implement in FY19. Next, the MOH, with the support of HKI and the NGDOs, will integrate the activities into a detailed and budgeted action plan that complies with the directives of the National Strategic Plan to Control NTDs, WHO directives, and USAID priorities. Participation in this workshop by RTI, USAID, WHO, and the local partners will enable each attendee to better understand the environment in which the activities are implemented. The presence of RTI and USAID will provide an opportunity to carry out a first local review of the draft action plan to reduce the amount of post-workshop feedback and the length of the approval process. v) Activity 5: Meetings of the Committee for the Elimination of OV and LF In FY17, the MOH created the National Committee for the Elimination of Onchocerciasis and Lymphatic Filariasis (OEC). The members of this committee include national and international experts, including from WHO, USAID, RTI, and HKI. As part of the effort to eliminate NTDs in Cameroon, this body is responsible for assessing and issuing scientific and technical opinions on the programs and projects for the prevention of OV and LF developed and implemented in the country. The committee will hold several meetings in FY18. Its reports will be shared with local players in the fight against NTDs. Sightsavers will provide financing for first rounds of these meetings. NTD Secretariat The CCU will continue to benefit from ENVISION s technical and/or financial support in FY18. The support will consist of the following: NGDO participation in periodic coordination meetings (described in the Strategic Planning section) Participation in the workshop to develop a continuous LF monitoring plan at the central level (see the M&E section for more information). In addition, ENVISION will provide support to the CCU and the national NTD programs for monitoring the implementation of community campaign activities. These activities include training, MDA, and regionallevel review/planning. To accomplish this, HKI and the NGDOs will carry out the following: Take part in the joint training supervision with the MOH teams. During this activity, the supervisor will help the persons supervised identify their weaknesses and jointly develop a plan to resolve any issues as well as a plan to follow up on how well recommendations are carried out. Everything will be recorded in the monitoring report and shared at all higher management levels. Provide the CCU with review notes for regional FOG deliverables on a regular basis. b) Building Advocacy for a Sustainable National NTD Program i) Activity 1: Advocacy Meeting at MOH Central Level This one-day meeting will bring together the heads of the NGDOs; the heads of the Directorate for the Control of Diseases, Epidemics, and Pandemics; the heads of the Directorate for Pharmacy, Medicines, and Laboratories; the heads of the Cooperation Division; and the heads of the Directorate of Financial Resources and Assets. During this meeting, participants will discuss solutions to ensure the sustainability of the national NTD program 17

24 During the meeting, the participants will carry out the following: Update the status of needs for conducting SAC deworming activities (not supported by ENVISION in FY18) and for CDD motivation Identify the financial, human, and material resources the MOH can mobilize locally to enable the country to implement additional SAC deworming activities and to motivate CDDs Review the advocacy targets and strategies to reach them Discuss the difficulties encountered in ordering and managing MDA campaign drugs and the corrective measures implemented Discuss the reasons for low FY17 MDA coverage in each district Define the measures the MOH must take to reduce staff shortages in the Health Areas, improve the delivery process for drugs and other inputs to the operational zones (notably the test kits for surveys), and design an MDA campaign waste management plan Discuss creating a post-envision strategy. ii) Activity 2: Advocacy Meeting with Other Governmental and Nongovernmental Stakeholders This one-day meeting will be organized at the central level by the MOH. It will bring together the representatives of various ministries and associations the Ministry of Social Affairs, MINCOM, Ministry of Youth and Civic Education, Ministry of Women s Empowerment and Family, MINEDUB, MINESEC, Fonds Spécial d Équipement et d Intervention Intercommunale (Special Council Support Fund [FEICOM]), Association of United Communes and Cities (CVUC an association of Cameroon mayors) as well as representatives of various media and telecommunication outlets CRTV, CAMTEL, NETTEL, MTN and Orange. During the meeting, and based on the data concerning needs and difficulties, the participants will develop strategies to accomplish the following: Mobilize local resources to motivate CDDs Mobilize internal financing for SAC deworming activities Increase the number of SAC not attending school who are treated during the deworming campaigns Increase awareness and improve communication to reduce the number of refusals during MDA in the communities. Following the advocacy meeting, the CCU will prepare a report with the commitments made by the various institutions along with the implementation deadlines. Next, the report will be shared will all the institutions represented. In order to ensure that the commitments are met, the CCU will follow up on their implementation with the authorities in question, then prepare and send out a quarterly progress report.. The meeting will be held in Q1, FY18. iii) Activity 3: Regional Advocacy Meetings The advocacy results obtained to date were presented in the introductory paragraph of this section. In addition, other mayors and governors made commitments; actions based on these commitments are currently being implemented, but the resources for the actions have not yet been mobilized. For 18

25 example, the governor of the Southwest Region instructed the mayors of his region in a letter in 2016 to contribute to motivating the CDDs. In addition, the CVUC promised a contribution from city halls to support NTD control efforts. In FY18, regional meetings will use the data provided by the central-level advocacy meeting to solicit resources for SAC deworming activities (because this will not be supported by ENVISION in FY18) and for CDD motivation. In addition, at the regional meetings, participants will assess the level of progress for implementation of commitments made in 2016, and will update commitments to reflect shifts in the field. Given the previous STH treatment in all 189 HDs, regional advocacy meetings will be held in all ten regions, funds permitting. These meetings will take their cue from previous experiences and the real needs of each region and will be held formally in several steps: First, each Regional Public Health Delegate will meet the governor of their region with the support of the NGDO that works in that region and of the MOH central level to request the involvement of administrative authorities and security forces in NTD control efforts. This involvement will increase mobilization of the population during campaigns, encourage mobilization of local resources for NTD control efforts, and provide monitoring for activities in dangerous zones. During discussions with the governor, the Regional Public Health Delegate will present the results of the 2017 campaign, the difficulties encountered, and the activities planned for The meeting will last one day. Second, the DRSP will organize a one-day work session with the regional CVUC and FEICOM representatives to solicit their support, given their proximity to local populations and as part of the three-party agreement. According to this agreement, the CVUC association has committed to mobilizing community participation via technical, logistical, and financial support and providing awareness-raising for administrative authorities about the progress of activities carried out in cooperation with the decentralized MOH department. The DRSPs will then organize a one-day meeting with a sampling of private sector parties to obtain financial or material support for NTD control efforts The last step will consist of a one-day meeting among the DRSPs; representatives of the traditional, religious, and administrative authorities; and regional delegations from ministries of Social Affairs, Communication, Youth and Civic Education, Women s Empowerment and Family, and Basic and Secondary Education. During the discussions, the DRSPs will present the list of HDs with consistently low coverage rates, and the participants will decide on the actions to be taken to improve awareness and reduce the number of refusals in these HDs. All these meetings will be held during Q1 of FY18. Following the different advocacy meetings, each DRSP will create a report of the commitments made by various authorities and the implementation deadlines. Next, the report will be shared with all the authorities who attended the meetings. To ensure that the commitments are met, the DRSPs will follow up on their implementation with the authorities in question. Lastly, the DRSPs will prepare and send out a quarterly progress report throughout the campaign. c) Mapping Mapping for all diseases is complete, and no further mapping is planned in FY18. 19

26 d) MDA Coverage Planned FY18 MDA Activities As noted at the start of this section, in FY18, ENVISION plans to support community-based MDA in all 113 OV-endemic HDs. Table 9: USAID-supported districts and estimated target populations for MDA in FY18* NTD Age groups targeted Number of rounds of distribution annually Distribution platform(s) Number of districts to be treated in FY18 Total # of eligible people to be targeted in FY18 Entire population >5 Communitybased strategy OV ,627,552 years old Communitybased strategy a 0 Trachoma Entire population 1 0 a) All the HDs have met the criteria to stop treatment for trachoma. If the survey reveals that Minawao refugee camp requires MDA, this will be planned in FY19. i) Activity 1: Community MDA The MDA campaigns for OV are organized in the communities every year during the May June period, based on the schedules established by each region. The only exception is East Region, which normally organizes the MDA from January to March. These treatment periods are generally complied with, except in the event of the unavailability of drugs or when there is a scheduling conflict. The MDA targets all members of the endemic community five years and older and is implemented by the CDDs. Prior to the start of treatment, the CDDs count all of the people living in the households of the community. Based on this count, they then receive drugs from the Health Center nurse to treat eligible persons (using the information provided to them by the nurse during the training session on drug quantity calculation). The CDDs administer IVM in OV-endemic zones based on patient size, using a dose pole. To cover all the zones targeted, they either work door-to-door or bring people together in one location. At the end of the campaign, the CDDs use their register to prepare summary reports, which they then send to the Health Center s head nurse. They keep a copy of the report for the community. The treatment data are forwarded to the MOH central level from the community, based on the Cameroon health pyramid. ii) Activity 2: Review and Production of Community Treatment Registers and Data Collection Tools The community drug distribution registers kept by the CDDs reached the end of their life cycle in 2017 and must be replaced. Printing the registers is linked to the population, e.g., despite few HDs receiving OV MDA in the Far North, there are more Health Centers and Health Areas (and CDDs) due to the large population. Registers are printed for each CDD. In addition, treatment was halted for HDs that conducted trachoma MDA, and other districts are stopping LF MDA. ENVISION will provide support for the review of the registers in The registers will be approved at a validation meeting, which will 20

27 bring together staff from the PNLO, the National NTD CCU, and partner NGDOs involved in PC NTD control efforts. Following the review meeting, ENVISION will finance the production of 27,750 community treatment registers and 10,000 data collection forms. e) Social Mobilization to Enable NTD Program Activities i) Activity 1: IEC Materials Review and Approval Workshops A coverage survey will be carried in December 2017, including questions concerning IEC materials evaluation. For this survey, a grid will be designed to evaluate IEC materials available in the field. A review and revision workshop will be held in Mbalmayo, in Q2 FY18, with workshop activities based on recommendations from the coverage survey. Heads of the NGDOs and MOH central-level managers will participate. The revised tools will be produced in FY18. ii) Activity 2: Production of IEC Materials In FY18, based on the results of the study carried out by the MMDP project, ENVISION will finance the production of posters and T-shirts as follows: 16,576 posters (8,176 printed by HKI, 1,400 printed by PersPective, 2,800 printed by IEF, and 4,200 printed by Sightsavers); 19,750 T-shirts will be produced with ENVISION funding and 21,000 T-shirts produced with funding from Sightsavers. Sightsavers, through ENVISION funding, will produce 114 banners. The IEC workshops planned in FY18 will produce redesigned materials, based on the coverage surveys carried out in Q1 FY18, making sure the most effective materials are used with the most effective messages. The posters and the T-shirts will include as many images as possible. The posters will be placed in public places at the beginning of the MDA campaign. Each community will receive an average of three posters each. During their training session, each CDD will receive a T-shirt with a message about the disease and its treatment. The Health Area heads will brief the CDDs on the content of the message printed on the T-shirts. The T-shirts will enable quick identification of the CDDs to guarantee their visibility and make their intervention in the community credible. The CDDs will also use the shirts as awareness-raising tools. Results from the coverage surveys may be used to adjust the quantities and types of IEC materials produced in FY18. Radio and television broadcasts: With ENVISION support, the communication focal points of each region will develop messages that will be broadcast in the official and local languages via radio and televisions shows during the community campaign. The messages will be based on the following topics: the diseases targeted by the mass treatments, population buy-in and diligence in following the mass treatment, the role of drug distributors and the need to welcome them warmly. Prior to the start of each MDA campaign, the communication department of each Regional Health Delegation will organize a meeting with the media to review the messages to be broadcast and determine and reserve the best air times for the broadcasts Communication in refugee camps: Cameroon has several refugee camps located primarily in the Far North, Adamawa, and East regions. The total refugee population in the country is estimated at 359, Communication for this population must continue in FY18 because the base population in the refugee camps changes continuously. ENVISION will target two refugee camps for awarenessraising messages, one in Far North and one in East Region. (These camps are already being treated for some NTDs.) Awareness-raising messages about NTDs included in the current education and 9 Eurpean Commission. (2017). Aide humanitaire et protection civile. Fiche Info Echo-Cameroun, January 2017, p

28 hygiene materials are prepared by the HD management teams and delivered both by HD staff working at the camps on sanitary issues and by the channels identified within the camp, such as churches and mosques, teachers, and CDDs designated by camp residents. With respect to the allocation and delivery of the IEC materials included in the regional FOGs, the HDs consider the refugee camps to be special Health Areas. iii) Activity 3: Official MDA Campaign Launch Ceremony (HKI Social Mobilization) The ceremony will be chaired by the Minister for Public Health in a district selected in advance. The ceremony will receive widespread media coverage resulting in broad dissemination of the messages at the national level. This will increase the involvement of stakeholders in achieving program objectives. 22

29 Category Participation Table 10: Social Mobilization/Communication Activities and Materials Checklist for NTD Work Planning Key messages Mectizan is free + Let s take Mectizan every year Mectizan is free + Let s take Mectizan every yea Population targeted CDDs IEC strategies (materials, media, activities, etc.) T-shirts (back) + T-shirts (front) Where/when will they be distributed? During the training session, each CDD will receive a T-shirt with a message about the disease and treatment. The Health Area heads will brief the CDDs on the content of the messages printed on the T-shirts. Communities Posters The posters will be hung in public places at the beginning of the MDA campaign. An average of three (3) will be required for each community. Frequency Once during the campaign Once during the campaign Is there an indicator/mechanism to track the materials or activity? If yes, which one Number of CDDs receiving a T-shirt during the training sessions (as an indicator) + coverage survey (as a mechanism). Number of people taking part in the MDA thanks to the messages. Number of public places in which the posters will be seen by the supervisors during MDA monitoring. Number of people taking part in the MDA thanks to the messages. Other comments The exact type and quantity of IEC materials will be reviewed after the workshops in July and October The exact type and quantity of IEC materials will be reviewed after the workshops in July and October In addition to the messages on the posters and T-shirts, the HD management teams will prepare awarenessraising messages about NTDs. Refugees Posters, T- shirts, education and sanitation activities The messages will be delivered by the HD staff working in the camps for sanitation purposes and by channels identified within the camps, i.e., churches, mosques, teachers, and CDDs designated by the camp populations. The T-shirts will be handed out during CDD training. The posters will be placed in the busiest places in the refugee camp. Once during the campaign Number of public places in the refugee camps where the posters will be seen by the supervisors during MDA monitoring. Number of refugees taking part in the MDA thanks to the messages. The exact type and quantity of IEC materials will be reviewed after the workshops in July and October

30 Category Key messages Increase stakeholder participation in achieving program objectives Population targeted Public powers + Community members + Private companies IEC strategies (materials, media, activities, etc.) Official MDA campaign launch ceremony Where/when will they be distributed? The ceremony will be held in Q2, FY18, in an HD selected during the annual national planning meeting. Frequency Once during the campaign Is there an indicator/mechanism to track the materials or activity? If yes, which one Increase in non-usaid contributions Other comments The exact type and quantity of IEC materials will be reviewed after the workshops in July and October

31 f) Training i) Activity 1: Nurse Training (Level 1: HD) This training is for the health care personnel of Health Areas and will be held in each HD undergoing MDA. It is intended to improve the technical capacities of participants with respect to the implementation of NTD control activities in their areas. The HD management team will develop the training program. It will take into account the results and shortcomings of the previous campaign and address them directly in the training session. The facilitators will also cover the following points: CDD training techniques, monitoring of MDA campaign activities at the community level, management of adverse events, data analysis and management, drug management, and report writing. Practical exercises will be done in groups or individually to facilitate further participants understanding of data analysis, CDD treatment register completion and data summary grids, census taking, and drug management. At the end of the training, each manager will develop an integrated MDA activities schedule to be implemented at the Health Area level and a CDD training schedule. The Health Area heads must include as many training sites as possible in the schedule to reduce the distances CDDs must travel (helping to ensure their participation). Training will last one day and will be facilitated by the HD management team. The supervisors will come from the MOH central and regional levels and from NGDOs supporting NTD control efforts. ii) Activity 2: CDD Training (Level 2: Health Areas) Training will take place at the Health Area level. The facilitators will cover the following points: awareness-raising and communication techniques, census taking, drug distribution, monitoring for adverse events, drug management, data entry in the treatment register, and CDD report writing. Several case studies and role playing will be included in the training sessions to ensure quality. While the program recommends a ratio of one (1) CDD per hundred (100) inhabitants, in reality, the number is dependent on population size, the area of the zone to be covered, and accessibility. CDD training lasts two days. It will be facilitated by the Health Area nurse(s). Training supervision will be provided by regional and HD staff, as well as staff from PNLO, CCU, and NGDOs supporting NTD control efforts. g) Drug and Commodity Supply Management and Procurement Since 2013, IVM, ALB, MEB, and PZQ orders have been planned by all stakeholders (with support from WHO) during a meeting at which the drug order form is filled in. The data used were taken from the updated 2005 national census and data collected by the HDs during previous campaigns. The volume of drugs to be ordered depends on the treatment target by disease. For trachoma, the PNLCé orders Zithromax, which is supplied by Pfizer and delivered to Cameroon via the International Trachoma Initiative. RTI supplies the TEO. For all drugs except for ZTH and the TEO, WHO serves as the delivery intermediary. HKI provides technical assistance, when required, for filling in the joint drug order forms and to ensure that the data required is complete and accurate. i) Drug transportation and delivery The NGDOs provide support for development of the distribution plans in their respective regions and districts, but the MOH provides drug transportation from the central level to the Health Areas. Several steps are required to ensure that the drugs reach the populations receiving treatment: 25

32 Step 1: The drugs arrive at the entry point to the country (port or airport). They are subjected to administrative and customs formalities before pickup. Step 2: They are then transported and warehoused at the National Center for Essential Drug Supply (CENAME). Step 3: CENAME supplies the Regional Funds for Health Promotion (FRPS) based on the distribution map created by PNLO. The FRPSs are MOH agencies responsible for managing and supplying each region with essential drugs. The problem at the FRPS level is that they often do not have a reserve stock, which makes it difficult to adjust supplies in the event of a shortage in a region. The national NTD program will supply backup stock for each FRPS to deal with this issue. Step 4: The Regional Public Health Delegate, in collaboration with the NGDO in the region that supports NTD control efforts, distributes the drugs based on the needs of each HD and sends out a copy of the distribution to the FRPS. Next, the Regional Public Health Delegate authorizes the removal of the drugs from the FRPS by a member of the management team of each HD, who then transports them to the relevant HD. There are sometimes delays in picking up the drugs because some HDs are far away from the FRPS. To deal with this problem, the regional level, with NGDO support, uses the various supervision visits to bring the drugs to the HD. Step 5: The HD supplies the Health Areas, which in turn provide the drugs to the CDDs based on the census data provided by the latter. This step also experiences delays at times due to the distance between the HDs and the Health Areas, plus the poor condition of roads and tracks. In FY18, the national NTD program will send drugs to the Health Areas at least 2 3 weeks prior to the start of CDD training. This will enable the health staff to make projections about the needs of each community based on the results of the previous campaign and to provide the CDDs with their stock at the end of their training session. At the end of each MDA campaign, the remaining stocks of drugs are collected by the Health Area nurses. They take them to the HD level, which in turn brings them to the FRPS, where they are repackaged by lot number, expiration date, and quantity. In FY18, ENVISON will use supervision visits to ensure that the return of the drugs follows the supply chain in reverse. Expired drugs are stored in the DRSPs with the FRPSs and destroyed with approval from the commission appointed for that purpose. The recurring difficulty is that the remaining drugs are not all returned. IVM and ALB are often kept by the CDDs, sometimes at the Health Area level. Tracing the drugs in the field remains a major challenge. One solution that the national NTD program will implement in FY18 will be to conduct a physical inventory at the end of the deworming campaign. The MOH will also include this issue on the agenda for the next national review meeting. Concrete actions will be discussed, and a drug return monitoring plan with recommendations will be developed, then shared at all levels. In addition to participating in drug order preparation and validation meetings, ENVISION will provide technical assistance (TA) to the Regional Delegations in developing their respective drug allocation plans. While these allocations will be done on the basis of the census from the previous year, ENVISION will assist the Regional Delegations to revise the drug loss rates downward, in order to avoid having large stocks of unused tablets. During the field supervision, ENVISION will check that all drug dispersals and returns are accompanied by a sign-off document, to ensure good tracking of medicines. ENVISION will also ensure that communities with multiple CDDs have designated one CDD to be accountable for community drug management during the MDA campaign. The designated CDD will receive the quantities of drugs allocated to the community, and will distribute them to other CDDs. To improve the return of the 26

33 remaining stocks, ENVISION will verify, during field visits, that health area personnel receive the balance of their fees for data collection only after they have submitted treatment data and remaining physical stocks of drugs. h) Supervision for MDA Activity 1: Supervision of community based MDA MDA activity implementation in the communities requires constant monitoring to ensure that the activities are carried out. Monitoring also helps to uncover problems and provides solutions to ensure the quality of results at the end of the campaign. It is for this monitoring that the stakeholders of the central, regional, HD, Health Area and NGDO jointly carry out routine monitoring during the campaign. The monitoring is for all campaign activities, from training to drug distribution in the communities. Given the extent of the departments/health Areas to be monitored, the supervisors split responsibilities to cover a considerable number of the implementation sites. ENVISION provides technical support to the MOH for the organization of monitoring in accordance with program standards, notably by participating in updating and disseminating monitoring grids specific to each activity. To ensure the quality of the community-based MDA, several supervisory visits are made in the field during the campaign: head nurses responsible for the Health Areas, members of the HD management teams, DRSP NTD staff, the MOH central level, and the NGDOs themselves. Preparation Phase The MOH will organize preparatory meetings with technical support from the NGDOs for each activity and each level. At the central level, personnel from the CCU, the national NTD programs, and the NGDOs will attend the meetings. At the regional level, DRSPs and NGDO representatives will attend. During the meetings, participants will use the strengths, weaknesses, and good practices recorded, either during previous campaigns or during the implementation of completed activities, to define the different TORs by area. Participants will develop (or update) a monitoring grid based on activity indicators and strategy. The monitoring grid and the TORs will be provided to participants to enable them to better carry out monitoring in the field. HDs with recurring low coverage during previous campaigns and HDs with new management teams will take precedence. i) Implementation Phase Supervision covers community MDA campaigns, impact surveys, training, and data collection. The TORs for the supervisors will be specific to each activity and operational level monitored. For the different supervision phases, the following actions will take place: During the training/refresher course sessions: The trainers administer pre-tests before training starts and post-tests at the end of training to assess the knowledge level of participants before and after training. For health care staff training, participants who receive a grade below 12/20 will be continuously monitored throughout the campaign by HD managers. For all activities, training supervision will be provided by district management teams and other supervisors in the zones in which health care staff who received poor grades on post-tests are working. Likewise, if a CDD receives a grade below 10/20, the community in which they distribute drugs will be considered a priority for monitoring during the MDA phase and during data collection. Because CDDs are volunteers, they are given additional supervision and coaching, but they are not prevented from going into the field. 27

34 Participants will work in groups for practical exercises, including exercises to practice using the dose pole and data collection tools, and will use role-play to simulate situations they might encounter in the field. The trainers will make IEC materials available and ensure that participants have clearly assimilated their messages in order to better transmit them. The trainers and organizers will ensure that the new registers are available in sufficient quantities for the CDDs. During the MDA: Check the availability of the drugs and their proper management to ensure early detection of any supply issues or other problems related to poor allocation and to correct the shortcomings before the end of distribution Carry out quick surveys in households to estimate the geographical and therapeutic coverage trends and take action to raise awareness and mobilize field players if the trend is weak Check that the CDDs are using the dose poles (where required) and that they are complying with dosages Check that the CDDs are correctly filling in the data collection tools Document best practices and lessons learned. For data collection: Check the presence and the correct use of data collection tools Check that the databases are filled in at all levels and correct any inconsistencies found Check that the data are archived at all levels monitored Provide feedback to the persons responsible for the level monitored, identify any problems, and suggest corrections to address any issues found in a timely fashion. Before ending monitoring in the field, the supervisor must ask the person supervised to develop an implementation plan for the recommendations. The supervisor must keep a copy of the plan and evaluate its implementation during future monitoring. ii) Debriefing, Data Validation, and Reporting The supervisors will conduct a debriefing at every level monitored to find immediate solutions to solve the problems found. They will then provide a final debriefing to the DRSP. The monitoring results will be discussed at the regional-level debriefing, which all regional and central supervisors and NGDOs taking part in the activity will attend. Attendees will discuss the problems identified in the field for which solutions were not implemented in the field during the implementation phase. The DRSP will also summarize the supervisors reports, integrating the strengths and weaknesses identified. This summary will be forwarded to the NTD CCU. In addition, and in order to guarantee the completeness and consistency of the data and ensure that they are identical throughout the transmission chain (HD, regional level, CCU), a data standardization and validation session will be held at three levels: 28

35 HD level: This session will be held during the data collection phase. The District Medical Team (DMT), regional supervisors, supervisors of NGDOs supporting NTD control efforts, and CCU supervisors will participate. They will review and correct Health Area data. ENVISION will cover only supervisor travel expenses (per diem and transportation). CDDs will file the distribution reports and CDD registers per community with the health personnel responsible for the Health Area. The health personnel will compile all the data in a summary file for the area and send it to the HD. In the event that the file is incomplete or inconsistent, the HD-level supervisors can visit the communities to correct it. Once the data have been analyzed, standardized, and approved, copies will be sent to the Health Area and the related sectors that are involved. If drugs are available and additional coverage is needed, mop-up activities are conducted immediately. If not, any remaining drugs need to be moved to other areas requiring additional support. Regional level: This session will be held for two days immediately following the annual regional NTD activities review meetings. The regional NTD focal points, the MOH central-level data managers, and the NGDO staff will attend. Central level: This session will take place following the annual national meeting to review the NTD control campaign. The national NTD CCU data manager, the coordinators of the various programs, and the NGDO data managers will attend. i) M&E i) Activity 1: TAS1 A TAS1 will be conducted in 12 HDs in February 2018, if they are found eligible after the FY17 pre-tas: Meiganga, Ngaoundéré-Urbain, and Tignère in Adamawa Region Esse, Evodoula, Nanga-Eboko, Ngog-Mapubi, and Okola in Center Region Bertoua, Bétaré-Oya, and Lomié in East Region Akwaya in Southwest Region. After the capacity building efforts in FY17, the MOH will conduct these TAS1 using a school-based survey. Team members will be MOH staff members from regional and district levels, who will be trained by MOH and NGO staff members from the central level. The survey may last two weeks and will evaluate if the HDs are eligible to stop the MDA for LF. An MOH investigator will use the WHO TAS checklists to prepare, plan, and implement the survey according to WHO guidelines for TAS1. ii) Activity 2: TAS2 In accordance with WHO guidelines on eliminating LF, it is recommended to proceed with periodic TAS two to three years after the mass treatments have been stopped. Five HDs successfully completed their TAS1 in 2014: Mokolo in Far North and Poli, Tcholliré, Ngong, and Rey-Bouba in North Region. In FY18, ENVISION will provide technical and financial support for community-based TAS2 in these 5 HDs (3 EUs) in March TAS2 will be community-based according to WHO guidelines, since the school enrollment rate is too low in the North and Far North for schoolbased surveys. An additional 33 HDs in the North and Far North regions successfully passed their TAS1 in 2016 and are eligible for TAS2 in FY18. ENVISION will provide technical and financial support for a TAS2 in all 38 HDs in 29

36 March 2018, to be arranged in 13 EUs. The results obtained will show if there has been a resurgence of LF in these HDs iii) Activity 3: Trachoma surveillance surveys Seven HDs in Far North Region successfully completed their TIS: Bourha, Roua, Koza, Hina, and Mogode in 2014 and Mokolo and Guidiguis in 2015 and stopped mass treatment for trachoma. ENVISION will provide its support in October 2017 to organize a workshop to develop an action plan for the elimination of trachoma (Trachoma Action Plan [TAP]). The plan will take into account the WHO directives for the elimination of trachoma, which recommend starting surveillance after treatment has ended. A TSS will be conducted in the seven HDs in Far North Region mentioned above. Because the MOH staff received training on the use of Tropical Data in Q2 of FY17, this methodology will be used in FY18 (after refresher training if needed). The survey s purpose will be to ensure that there has been no recrudescence of trachoma. ENVISION will provide its technical support for the implementation of this TSS, which will use the WHO Tropical Data methodology. Activity 4: Trachoma survey in Minawao refugee camp The PNLCé and the DRSP of the Far North Region, together with the support of the UNHCR, will review the status of the demographic situation and of the health care provided in the Minawao refugee camp located in the Mokolo HD (Far North Region). This will provide the data needed to plan a prevalence survey in the camp in FY18. Discussions have already begun for the planning of this prevalence survey and is planned for Q1 FY18. iv) Activity 4: Coverage survey (M&E) ENVISION will provide support for the implementation of a coverage survey which will enable identification and documentation of the following: The reasons for non-compliance (by identifying common reasons for not swallowing the drugs, the country will review the social mobilization tools/strategy prior to the next MDA round) The factors that ensure good coverage rates Posters and T-shirts will also be assessed during the coverage surveys. According to the July 2017 workshop recommendations were made to adapt both posters and T-shirts so these tools should be assessed during the coverage surveys in Q1 FY18. Due to the importance of this M&E activity, ENVISION will provide financial support to 16 people for a three-day training and 10 days of survey. These people will include an external consultant, 5 independent surveyors recruited locally, 9 staff from implementing partners, and two staff from the MOH central team, serving as observers and co-investigators. Although the independent team has ultimate responsibility for the conduct of the survey, ENVISION and partners are also obligated to ensure the survey is conducted in compliance with the protocol. In HDs targeted for survey, additional staff will be hired to serve as guides and translators. The study of the IEC materials will be added to this coverage survey, and the survey, which will cover 09 health districts, will be carried out in Quarter 1 FY18. v) Activity 5: SCH-STH impact survey (M&E) Given that USAID refocused its priorities on OV, LF, trachoma, and as part of the SCH-STH transition planning, ENVISION will provide technical and financial assistance for the implementation of a SCH-STH 30

37 impact survey which will help to measure the progress that the country made in the control of these diseases using USAID s support. This survey will be implemented in 12 health districts and it will be carried out in FY18 Q1. The study will be conducted by PNLSHI. Table 11: Disease Planned Disease-specific Assessments for FY18 by Disease No. of endemic districts No. of districts planned for DSA No. of Evaluation Units planned for DSA (if known) Type of assessment Diagnostic method (Indicator: Mf, FTS, etc) LF TAS1 FTS TAS2 FTS Trachoma TSS Clinical grading SCH/STH a Impact survey Kato Katz (a) : the impact survey targets firstly SCH. But STH will be included in the selected districts given that STH is endemic in all the 189 districts of the country. j) Supervision for M&E and DSAs i) Activity 1: Supervision of TAS1 The TAS training will be supervised by ENVISION to ensure the program s ability to carry out further assessments without external assistance. RTI will work with ENVISION staff to ensure that activities take place under the guidance and supervision of experienced staff, and therefore will design a supervision strategy to be implemented during the surveys (above). ENVISION support for the survey will also consist in ensuring that the protocol meets WHO TAS1 impact assessment directives. Therefore, support will be provided via data collection by smartphone on the platform (a platform for mobile data collection) to which the Ministry will also have access for real-time monitoring of the activity. The platform was already used by the MOH in the past to monitor administration of vitamin A as part of the Nutrition project. In May 2017, the platform was used for the real-time monitoring of TAS data collection in nine of the country s regions. Through field supervision and surveyors refresher training, the HKI team will support the MOH in implementing the survey and make sure protocol and data collection follow WHO TAS methodology. ii) Activity 2: Supervision of TAS2 ENVISION will request external technical assistance to develop and track implementation of the monitoring survey in 33 HDs these HDs will be conducting a monitoring survey two to three years after treatment. Through field supervision and surveyors refresher training, the HKI team will support the MOH in implementing the survey and make sure protocol and data collection follow WHO TAS methodology. iii) Activity 3: Supervision of trachoma surveillance surveys ENVISION will request external technical assistance to develop and track implementation of the monitoring survey in the HDs of Bourha, Roua, Koza, Hina, Mogode, Mokolo, and Guidiguis in Far North Region these HDs will be conducting a monitoring survey two to three years after treatment has 31

38 stopped. Data collection for this monitoring survey will use the Tropical Data system to ensure quality assurance and data reliability. iv) Activity 4: Supervision of prevalence survey in Minawao ENVISION provide supervision for the prevalence mapping in the refugee camp at Minawao. v) Activity 5: Supervision of SCH-STH surveys ENVISION will supervise SCH-STH surveys in the 12 HDS planned for FY18. Surveyors will be responsible for data collection (through diagnostic tools) and paper/smartphone-based recording. vi) Activity 6: supervision of the coverage survey Staff from MoH Central level and NGOs (HKI, IEF, PP and SSI) will get to the targeted districts to provide training to local surveyors. This training will include both theory and practice on the field. Following this step, these trainers will follow-up the field data collection as supervisors. This will enable to ensure that surveyors fully comply with the protocol. ENVISION will support per diem costs and travel fees for the whole team. k) Dossier Development ENVISION plans to provide support for MOH staff training in August The training will cover the development of plans to eliminate LF and trachoma. Following the training, MOH staff will be instructed on WHO directives for the preparation of elimination dossiers. During the training, an action plan will also be developed to prepare the LF and trachoma elimination dossiers. The plans must be documented to indicate roles and responsibilities for the preparation of the dossier for each disease. They must also include a schedule of actions to be executed to complete the dossier. In FY18, ENVISION support will consist in a contribution to monitoring plan implementation. i) Activity 1: Meetings to review and validate the LF and trachoma elimination dossiers progress In FY17, a workshop on preparing LF and trachoma elimination dossiers will result in the creation of two writing committees: one each for the development of the elimination dossiers for LF and trachoma. During this workshop, participants will also produce the TAP. ENVISION will provide support for two meetings to review of the work of the dossier writing committees. They will cover the progress made in terms of preparing the elimination dossiers for LF and trachoma. Technical assistance will also be required (e.g., a consultant to assist in writing), and is included in the Short Term Technical Assistance section below. 32

39 3) Maps Figure 1. Cameroon LF, OV, SCH, STH, and Trachoma Endemicity Map 33

40 Figure 2. Cameroon LF, OV, SCH, STH, and Trachoma Geographic Coverage Map The SCH and STH maps do not reflect the most recent changes to geographic coverage 34

41 Figure 3. Cameroon LF DSA map Reflects original proposal to do TAS2 in 38 districts; current FY18 plan is to do TAS2 in 5 districts 35

42 Figure 4. Cameroon Trachoma DSA map 36