PROPOSITIONVIHDUCAMEROUN-SERIE 10 Accès Universel pour

Transcription

PROPOSITION VIH DU CAMEROUN‐ SERIE 10
Accès Universel pour la PTME, la prise en charge globale des
PVVIH et la prévention du VIH auprès des populations les plus
exposées au Cameroun
CCM – CAMEROUN
Rubriques 1-2
R10_CCM_CMR_H_PF_s1-2_20Aug10_Fr
1/23
FORMULAIRE DE PROPOSITION – SERIE 10
CANDIDAT PAYS SEUL
RUBRIQUES 1- 2
Nom du candidat
CCM
Pays
CAMEROUN
Niveau de revenu
INTERMEDIAIRE INFERIEUR
Type de candidat
x CCM (Instance
de coordination
nationale)
Si votre pays participe
également à une
proposition multi-pays
pour la Série 10, indiquer
sur quelle(s) maladie(s)
porte cette proposition
multi-pays
Monnaie
VIH
Non-CCM
Tuberculose
Paludisme
Dollar américain
Maladie
Titre
x Ordinaire
Réserve
pour les
populations
les plus
exposées au
risque
VIH
Sous-CCM
« Accès
Universel pour la
PTME, la prise en
charge globale
des PVVIH et la
prévention du
VIH auprès des
populations les
plus exposées au
Cameroun».
x Euro
La proposition inclut-elle
des interventions
transversales de
Renforcement des Systèmes
de Santé dans la partie 4B ?
NON
S’agit-il d’une
proposition
maladie
consolidée ?
NON
Tuberculose
Paludisme
2/23
INDEX DES RUBRIQUES DE LA PROPOSITION
REMARQUE IMPORTANTE :
Nous recommandons vivement aux candidats de se référer aux informations ci-dessous lorsqu’ils
remplissent le Formulaire de proposition et autres documents relatifs à leur candidature. Il est
important de lire attentivement chaque section des Directives de la Série 10 en remplissant la
proposition et autres documents de candidature, afin de soumettre une candidature complète.
Tous les autres documents de la Série 10 sont disponibles sur le site Internet du Fonds mondial.
RUBRIQUES OBLIGATOIRES DU FORMULAIRE DE PROPOSITION :
A) Remplir les rubriques 1 - 2 une seule fois par candidat1
Rubrique 1
Résumé du financement et interlocuteurs
Rubrique 2
Résumé du candidat et recevabilité
o
o
Renseignements sur les membres (du CCM ou sous-CCM)
Formulaire de recevabilité (le cas échéant)
B) Remplir les rubriques 3 - 5 une fois pour chaque proposition maladie2
Rubrique 3
Résumé de la proposition
Rubrique 4
Description du programme
Cadre de performance ou Cadre de performance consolidé
Liste des produits pharmaceutiques et sanitaires (le cas échéant)
Plan de travail
Rubrique 5
Demande de financement
Budget détaillé
RUBRIQUES OPTIONNELLES DU FORMULAIRE DE PROPOSITION :
Si cela est pertinent, remplir les rubriques 4B et 5B une seule fois par candidat et inclure ces
rubriques dans une seule proposition maladie
1
2
Rubrique 4B
Interventions transversales de renforcement des systèmes de santé
Rubrique 5B
Financement des interventions transversales de renforcement des systèmes de
santé
Le candidat doit soumettre les rubriques 1 - 2 une seule fois, même si sa demande porte sur plusieurs maladies.
Le candidat doit soumettre les rubriques 3 - 5 pour chaque proposition maladie.
3/23
RUBRIQUE 1 : RESUME DU FINANCEMENT ET INTERLOCUTEURS
1.1
Résumé du financement
Demande de financement – Série 10
Maladie
Année 1
VIH
15.177.355
Année 2
Année 3
Année 4
Année 5
15.023.185
21.311.396
22.104.138
23.795.868
Total
97.411.943
Tuberculose
Paludisme
Interventions
transversales
de RSS
 Insérer le
nom de la
maladie
Financement total demandé pour la Série 10
1.2
Interlocuteurs
Interlocuteur principal
Interlocuteur secondaire
Nom
Dr ELAT NFETAM
NGAPPE NGANGUE Emmanuel
Fonction
Secrétaire Permanent
Directeur Exécutif
Organisation
Comité National de Lutte contre le
VIH/Sida (CNLS)
Cameroon National Association for
Familly Welfare (CAMNAFAW)
Adresse postale
BP 1459 Yaoundé
BP : 11994 Yaoundé
Téléphone
(+237) 96 98 40 02/ 77 77 73 00/
22 22 57 58/
(+237) 22 23 62 30
Fax
(+ 237) 22 23 34 39
(+237) 22 20 36 99
Adresses de courrier
électronique
jbelat@yahoo.fr/
st_ccm_cam@yahoo.fr
camnafaw@ippf.org
camnafaw@yahoo.fr
4/23
1.3
Liste des abréviations et acronymes utilisés par le candidat
Acronyme/
Abréviation
Signification
ACMS
Association Camerounaise de Marketing Social
AFASO
Association des Femmes Actives et Solidaires
AG
Assemblée Générale
ALUCAM
Aluminium Cameroun
ARC
Agent de Relais Communautaire
ARV
Antirétroviral
BIT
Bureau International du Travail
C2D
Contrat de Désendettement et Développement
CAMNAFAW
Cameroon National Association for Family Welfare
CCA
Caisse Autonome d’Amortissement
CCA-SIDA
Coalition Camerounaise de Lutte Contre le Sida, et le Paludisme
CCC
Communication pour le Changement de Comportement
CCM
Country Coordinating Mechanism
CDC
Cameroon Development Coorporation
CDC
Centre for Disease Control
CDT
Centre de Diagnostic et de Traitement
CD4
Closter Designation 4
CENAME
Centrale Nationale d’Approvisionnement en Médicaments et Consommables
Médicaux Essentiels
CHP
Care and Health Programme
CIMENCAM
Cimenterie du Cameroun
CIP
Causerie interpersonnelle
CIRCB
Centre International de Recherche Chantal Biya
CMA
Centre Médical d’Arrondissement
CNLS
Comité National de Lutte contre le Sida
CPN
Consultation Prénatale
CSI
Centre de Santé Intégré
CTA
Centre de Traitement Agrée
CTX
Cotrimoxazole
DBS
Dry Blood Spot
DCIP
Dépistage Conseil Initié par le Prestataire
DIU
Diplôme Interuniversitaire
DPS
Domaine de Prestation de Service
DS
District de Santé
DSCE
Document de Stratégie pour l'Emploi et la Croissance
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ECAM
Enquête de consommation auprès des Ménages
EDS
Enquête Démographique de Santé
ESTHER
Ensemble pour la Solidarité Thérapeutique Hospitalière En Réseaux
FM
Fonds Mondial
GAP
Global AIDS Programme
GCOP
Groupe de Coordination des Partenaires
GFBC
Groupement de la Filière Bois du Cameroun
GIC
Groupement d'Initiative Commune
GICAM
Groupement Inter Patronal du Cameroun
GMS
Grant Management Solution
GTC
Groupe Technique Central
GTZ
Coopération Technique Allemande
HD
Hôpital de District
HEVECAM
Hévéa Cameroun
IAP
Indicateurs d’Alerte Précoce
IDA
International Development Agency
IEC
Information Education Communication
IO
Infection opportuniste
Institut pour la Recherche, le Développement Socio-économique et la
Communication
IRESCO
IST
Infection sexuellement transmissible
JURTA
Join Regional Team on Aids
LFA
Local Fund Agent
LGBTI
Lesbiennes Gay Bisexuels Transgenres Intersexués
MARPs
Most at Risk Populations
MBP
Mother Baby Pack
MESDINE
Meeting SRH Diversity Needs
MINAS
Ministère des Affaires Sociales
MINSANTE
Ministère de la Santé Publique
MIO
Médicaments pour les infections opportunistes
MS
Médiateur de Santé
MSM
Men who have sex whith men
NA
Non applicable
NFS
Numération formule sanguine
OBC
Organisation à base communautaire
OCEAC
Organisation de Coordination pour la lutte contre les Endémies en Afrique
Centrale
OEV
Orphelins et Enfants Vulnérables
OMD
Objectifs du Millénaire pour le Développement
6/23
OMS
Organisation Mondiale de la Santé
ONG
Organisation Non Gouvernementale
ONUSIDA
Programme Commun des Nations Unis sur le VIH et Sida
OSC
Organisation de la Société Civile
PCR
Polymerase Chain Reaction
PEC
Prise en Charge
PEPFAR
Presidential Emergency Programme for Aids Relief
PF
Planning Familial
PHP
Plantation du Haut Pénja
PME/PMI
Petite et Moyenne Entreprise/Petite et Moyenne Industrie
PNLT
Programme National de Lutte contre la Tuberculose
PNUD
Programme des Nations Unies pour le Développement
PPP
Partenariat Public-Privé
PPSAC
Projet de Prévention du Sida en Afrique Centrale
PR
Principal Recipient
PCR
Polymerase Chain Reaction
PSN
Plan stratégique National
PTF
Partenaires Techniques Financiers
PTME
Prévention de la Transmission Mère et Enfant du VIH
PUDR
Progress Update Disbursment Report
PV
Procès Verbal
PVVIH
Personnes Vivant avec le VIH
RBM
Roll Back Malaria
RECAP+
Réseau Camerounais de Personnes vivant avec le VIH
RGPH
Recensement Général de la Population et de l’Habitat
RSC
Renforcement du système communautaire
RSS
Renforcement du système de santé
SIDA
Syndrome d'Immunodéficience Acquise
SMI
Santé Maternelle et Infantile
SOSUCAM
Société Sucrière du Cameroun
SONEU
Soins Obstétricaux et Néonataux d'Urgence
SR
Santé de la Reproduction
SR
Sous Récipiendaire
ST
Secrétaire Technique
SWAP
Sector Wide Approach
SYNAME
Système National d’Approvisionnement en Médicaments et consommables
Médicaux Essentiels
TAR/TARV
Traitement AntiRétroViral
TB
Tuberculose
7/23
TIC
Technique de l'Information et de la Communication
TME
Transmission mère et enfant
TPI
Traitement Préventif Intermittent
TS
Travailleur du Sexe
TRP
Technical Revue Panel
UE
Union Européenne
UNDAF
United Nation Assistance Development Framework
UNESCO
Organisation des Nations pour la Science et la Culture
UNFPA
United Nations Fund for Population Agency
UNGASS
United Nation General Assemble Sur le Sida
UNICEF
United Nations Children's Fund
UNIFEM
Fonds de Développement des Nations Unies pour la Femme
UPEC
Unité de Prise En Charge
USAID
United Nations Aid for International Development
VC
Volontaire Communautaire
VIH
Virus de l’Immunodéficience Humaine
 Utiliser la touche « Tabulation » pour ajouter des lignes si nécessaire
8/23
RUBRIQUE 2 : RESUME ET RECEVABILITE DU CANDIDAT
Candidats CCM
Candidats sous-CCM
Candidats Non-CCM
 Remplir les rubriques 2.1 et 2.2
 Supprimer les rubriques 2.3 et 2.4
 Remplir les rubriques 2.1, 2.2 et 2.3
 Supprimer la rubrique 2.4
 Remplir la rubrique 2.4
 Supprimer les rubriques 2.1, 2.2 et 2.3
2.1
Membres et mode de fonctionnement
2.1.1 Résumé de la composition  Cocher la case appropriée
Secteur représenté
Nombre de membres
Secteur universitaire / éducatif
x
Gouvernement
20
x
Organisations non gouvernementales (ONG) /organisations
communautaires
06
x
Personnes vivant avec les maladies
04
x
Personnes représentant les populations clés3
02
x
Secteur privé
03
x
Organisations confessionnelles
02
x
Partenaires de développement nationaux, bilatéraux et
multilatéraux
10
x
Autres (préciser)
Autres :
Observateurs
 Représentant de la Banque Mondiale: Mme Mary BARTONDOCK
 Doyen de la Faculté de Médecine des sciences biomédicales
Yaoundé : Pr TETANYE EKOUE
 Représentant de l’Institut de Recherche Médicales et d’Etudes
des Plantes Médicinales : Pr ESSAME OYONO Jean-Louis
 Représentant Institut de Recherche sur le Développement (IRD)
Dr VIDAL Laurent
 Représentant de l’Ambassade d’Italie : Mr Raffaele FESTA, 1er
Secrétaire
3
Voir définition de « populations clés » dans les Directives de la Série 10.
9/23
Secrétariat Technique du CCM
 Dr. Caroline MEDOUANE, Secrétaire Technique CCM
Rapporteurs pour les programmes financés par le Fonds Mondial
 Dr ELAT NFETAM : Secrétaire Permanent du GTC/CNLS
 Dr NDONG A BESSONG : Secrétaire Permanent du GTC/RBM
 Dr GOTINGAR André : Secrétaire Permanent du GTC/PNLT
Nombre total de membres :
 Ce nombre doit être égal à celui indiqué dans le formulaire « Renseignements sur
47
les membres»
10/23
2.1.2 Composition large et inclusive
Depuis votre dernière demande recevable effectuée auprès du Fonds Mondial :
(a) Y a-t-il eu des changements dans la composition depuis
la dernière fois que le CCM (ou sous-CCM) a été déclaré
recevable ?
Non
x
Oui
(b) Si vous avez sélectionné « Oui » à la question (a), veuillez décrire dans l’espace ci-dessous la
façon dont les nouveaux membres ont été sélectionnés
Monsieur Isaac BISSALA, Président de l’Union Générale des Travailleurs du Cameroun (UGTC), représentant des syndicats a
été désigné par son secteur pour le Représenter au CCM (Annexes 1 et 2 :). Lors de sa session ordinaire du 22 Mars 2010, le
CCM a approuvé à l’unanimité la désignation de Monsieur BISSALA (Annexe 3).
Deux (02) membres du CCM sont décédés. Il s’agit de Monsieur BOOH Jean (Secteur Privé, par ailleurs Vice Président du
CCM) et Dr MBESSI Robert (Secteur confessionnel catholique). Ces deux membres décédés seront remplacés par d’autres
venant de leurs secteurs respectif.
Monsieur John ESSOBE (secteur confessionnel protestant) a été remplacé par le Révérend NGANDO MBENDE Paul du même
secteur (Annexe 4).
Pr. Louis ABOLO du Ministère du Travail et de la Sécurité Sociale, admis à faire valoir ses droits à la retraite a été remplacé par
Dr. EYOUM Bruno du même ministère (Annexe 5).
(c) Y a-t-il une représentation continue et active de
personnes vivant avec et/ou touchées par les maladies ?
(d) Y a-t-il autant d’hommes que de femmes parmi les
membres actifs et/ou une amélioration de l’équilibre
hommes/femmes parmi les membres ?
Non
x
Oui
Non
x
Oui
11/23
2.1.3 Connaissances et expériences des membres en matière de questions transversales
(a) Renforcement des systèmes de santé : Décrire la capacité et l’expérience du CCM (ou sous-CCM) en
matière de renforcement des systèmes de santé
Le CCM est un organisme multisectoriel dont une frange importante de ses membres jouit d’une expérience avérée
en matière de système de santé. Il s’agit principalement des représentants du gouvernement (Ministère de la Santé
Publique), la société civile, du secteur privé et des partenaires. La plupart des membres ont participé activement à
l’élaboration de plusieurs documents liés au système de santé parmi lesquels : le plan national de développement
sanitaire, la stratégie sectorielle santé, les plans stratégiques nationaux de lutte contre le VIH/sida, la Tuberculose et
le Paludisme, l’Approche Sectorielle Santé (SWAP), le Plan de développement des ressources humaines.
Le CCM bénéficie régulièrement de l’appui technique de personnes ressources des programmes nationaux de lutte
contre le Sida, Paludisme et Tuberculose dans la définition des priorités nationales et l’amélioration de leurs
connaissances en matière de renforcement des systèmes de santé.
(b) Genre : Décrire la capacité et l’expérience du CCM (ou sous-CCM) en ce qui concerne les questions
de genre et les questions liées à l’orientation sexuelle et aux identités sexuelles.

Compétences et connaissances des méthodologies d'évaluation des différences liées au genre en
matière d’impact des maladies et de leurs conséquences (y compris les différences
hommes/femmes et garçons/filles), ainsi que des moyens requis pour accéder à et utiliser les
programmes de prévention, de traitement, de soins et de soutien ; et
 Connaissance globale des facteurs qui rendent vulnérables les femmes et les jeunes filles, ainsi
que les minorités sexuelles, telle que les normes, les comportements, les attitudes et les
pratiques néfastes qui sous-tendent les différences dans la propagation du VIH (par exemple :
violence liée au genre, discrimination et stigmatisation, mutilation génitale féminine, mariage
précoce, masculinité, etc.)
Le CCM Cameroun accorde une grande importance sur les questions de genre dans l'élaboration et la mise en
œuvre des programmes. La composition du CCM favorise l'équilibre entre les sexes. Les femmes représentent
36,7% du CCM, la vice-présidence du CCM est assurée par une femme (représentante des malades) et le
secrétaire technique est également une femme. Le CCM a mis en place un Comité Ad-hoc chargé d’appuyer le
secrétariat technique dans toutes ses missions. Ce Comité est composé de 10 membres actifs dont 6 femmes et 4
hommes.
Le CCM ne pratique pas de discrimination liée à l’orientation sexuelle et aux identités sexuelles. Le CCM œuvre pour
la promotion du genre et la prise en compte des questions liées à l’orientation sexuelle et aux identités sexuelles.
Des organisations telles que CAMNAFAW et AFASO qui travaillent principalement dans les secteurs de la santé
sexuelle et génésique et la mobilisation des femmes dans la lutte contre le VIH sont des membres clés qui assurent
une perspective genre au sein du CCM. CAMNAFAW a également une expérience considérable en matière de santé
sexuelle et reproductive chez les MSM et les LGBTI. Le Ministère de la Promotion de la Femme et de la Famille
(MINPROFF), est membre du CCM, et veille régulièrement à la prise en compte de l’approche genre et de la lutte
contre les violences sexospécifiques.
Deux membres du CCM ont participé à l’atelier de consultation régionale en Afrique occidentale et centrale sur
l’opérationnalisation des stratégies sur l’égalité de genre du Fonds Mondial et de l’ONUSIDA à Dakar (Sénégal) du
26 au 28 Janvier 2010.
Le CCM bénéficie régulièrement de l’appui technique de personnes ressources des autres secteurs de la société
civile non membres du CCM, notamment les MSM. Par exemple, le processus d’élaboration de la proposition du
Round 10 a fait l’objet d’une large consultation y compris des associations des MSM et des TS.
Le Plan stratégique national de lutte contre le Sida élaboré avec la contribution du CCM prend en compte la
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dimension genre dans le contexte du VIH ainsi que les minorités sexuelles.
En 2009, plusieurs membres du CCM ont contribué à la réalisation d’une étude nationale sur le genre et le VIH
réalisée par le Ministère de la santé publique avec l’appui de l'ONUSIDA, l’UNIFEM et le PNUD.
(c) Combien de membres du CCM (ou sous-CCM)
disposent de compétences importantes dans l’un
ou dans les deux domaines décrits dans la
rubrique 2.1.3 (b) ?
 15 (Renforcement des systèmes de santé), 10
(genre)
(d) Planification multisectorielle : Décrire la capacité et l’expérience du CCM (ou sous-CCM) dans
l'élaboration de programmes multisectoriels.
Plusieurs départements ministériels y compris les partenaires au développement sont représentés au CCM par de
hauts responsables qui ont en charge l’élaboration des programmes multisectoriels. A titre d’exemple, le MINEPAT
(Ministère de l’Economie, de la Planification et de l’Aménagement du Territoire), membre du CCM, a la charge de
l’élaboration et de la mise en œuvre de la politique économique de la nation ainsi que de l’aménagement du
territoire. Pareillement, le Ministère de la Jeunesse élabore les politiques en matière de jeunesse, le Ministère de
l’Agriculture et du Développement Rural, les politiques agricoles, le Ministère de la Recherche Scientifique et de
l’Innovation élabore les politiques de recherche, etc.
Toutes ces institutions ont joué un rôle fondamental dans l’élaboration des principaux documents stratégiques
nationaux tels que le document de vision 2035 du Cameroun, Document de Stratégie pour la Croissance et l’Emploi
(DSCE 2010-2020), les Plans stratégiques nationaux de lutte contre le Sida, Paludisme, Tuberculose.
Plusieurs membres du CCM jouent le rôle de leadership dans la planification multisectorielle, et apportent une
expérience et une expertise considérables dans ce domaine. Le CCM comporte en son sein des experts-consultants
au niveau international dans l’élaboration des programmes.
13/23
2.2
Recevabilité
2.2.1 Historique de la candidature
x
Demande de financement récente effectuée dans le cadre de
la Série 8, de la Série 9, ou des Processus de reconduction des
subventions 5 - 8, et déclarée recevable.
 Remplir les rubriques 2.2.2 à 2.2.7
 Compléter le formulaire de
recevabilité
Dernière demande effectuée avant la Série 8 ou avant le
Processus de reconduction des subventions 5.
 Ne pas remplir les rubriques 2.2.2 à
2.2.4
 Compléter le formulaire de
recevabilité
Dernière demande déclarée non recevable.
 Ne pas remplir les rubriques 2.2.2 à
2.2.4
2.2.2 Processus d’élaboration de la proposition
(a) Décrire le processus suivi pour solliciter les contributions - en vue d’une intégration éventuelle à la
proposition - d'un large éventail d’acteurs, de la société civile comme du secteur privé, sur les plans
national, infranational et communautaire, ainsi que des principales populations affectées, si cela est
pertinent.  Expliquer le processus pour chaque proposition maladie incluse dans la candidature
À la suite de l'appel à propositions du Fonds mondial le 20 mai 2010, le CCM a tenu une réunion le 03 Juin 2010, où
il a été décidé de soumettre une proposition au Round 10. Les membres du CCM ont unanimement décidé
d’accorder la priorité à la proposition pour la composante VIH étant donné d’une part, que le Cameroun bénéficie de
la subvention du Fonds Mondial dans le cadre du Round 9 Paludisme et Tuberculose, et que d’autre part les Round
3 et 4 sont terminés depuis décembre 2009 et font l’objet d’une continuité des services (CoS) qui se termine en
décembre 2011(Annexe 6). Suite à cette réunion, le CCM a lancé un appel à propositions pour la Série 10, publié
dans le quotidien national, Cameroun Tribune. (Annexe 7). A travers ce processus le CCM Cameroun a permis à
l’opinion publique nationale et internationale d’être informé du lancement du Round 10 du Fonds Mondial et donc de
soumettre éventuellement leurs propositions dans des délais prescrits par l’appel à candidature. Ce délai étant fixé
au Vendredi 16 juillet 2010 à 15 heures précises.
Des entretiens qualitatifs et des visites de terrain ont été organisés avec les MARPS (TS, MSM) pour solliciter leurs
contributions en vue d’une intégration dans la proposition nationale (Annexe 7bis).
Le CCM a enregistré au niveau de son Secrétariat Technique, les dix (10) sous-propositions issues des institutions
suivantes : MINSANTE (associant ACMS, IRESCO, CAMNAFAW, BIT, CHP), Care Cameroun, Institut de Recherche
pour le Développement (IRD), Coalition d’OBC, association Presse Jeune, Catholic Relief Services, Cameroon
Baptist Convention, Forum Camerounais de psychologie, Centre International de Recherche sur le VIH/sida
(CIRCB), Care Help.
(b) Décrire le processus suivi pour examiner de façon transparente les contributions reçues en vue d’une
intégration éventuelle à cette proposition.  Expliquer le processus pour chaque proposition maladie incluse dans
la candidature
L’ensemble des sous-propositions reçues au secrétariat du CCM a été transmis à tous les membres. Ces souspropositions ont été également remises à l’ONUSIDA mandaté par le CCM pour assurer la coordination technique
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du processus d’élaboration de la proposition nationale au Round 10 (Annexe 6). L’ONUSIDA a constitué à cet effet,
un groupe d’experts indépendants pour l’analyse des 10 sous-propositions. Le résultat de l’analyse des experts a été
présenté lors de la réunion du CCM du 27 juillet 2010 (Annexe 8). Après délibération, aucune proposition n’a été
entièrement rejetée. Le CCM a opté pour l’intégration de toutes les propositions suivant le cadre prioritaire retenu
pour la proposition nationale (Annexe 9).
Les membres du CCM qui ont signalé leur volonté de participer à la finalisation de la proposition nationale ont été
invités à une séance de travail le 28 juillet 2010 (Annexe 10). Les travaux de finalisation de la proposition nationale
se sont déroulés à l’ONUSIDA du 28 juillet au 19 août 2010.
Une session de restitution des membres du CCM s’est tenue le 06 août 2010. Au cours de cette session, le projet de
proposition nationale a été présenté en détail aux membres du CCM.
Cette proposition nationale a été transmise à tous les membres du CCM en préparation de la réunion du 13 août
2010.
Lors de sa session du 13 août 2010, le CCM a procédé à l’adoption de la proposition nationale (Annexe 11)
(c) Décrire le processus suivi pour assurer l'implication d’acteurs autres que les membres du CCM (ou
sous-CCM) dans le processus d'élaboration de la proposition.  Expliquer le processus pour chaque
proposition maladie incluse dans la candidature
Dès le début du processus d'élaboration de la proposition, des consultations ont eu lieu avec des groupes les plus
exposés au VIH (PVVIH, TS, MSM, MARPs). Les MARPs ont identifié leurs priorités et stratégies d’interventions à
l’issue de réunions avec les experts nationaux et consultants internationaux de l’ONUSIDA. Des réunions séparées
ont eu lieu avec un groupe du Sud-ouest et les groupes MSM à Douala et Yaoundé (Alternative, Douala et Projet
Mesdine, Yaoundé) (Annexe 7bis).
Des séances de travail ont également eu lieu avec les cliniciens impliqués dans les Traitements Antirétroviraux ainsi
qu’avec les professionnels impliqués dans la gestion des achats et la chaîne d'approvisionnement afin de valider le
processus de quantification des ARV et des médicaments des infections opportunistes (Annexe 12).
Le CCM a mis en place un Comité d’élaboration de la proposition nationale sous la coordination technique de
l’ONUSIDA. Le Comité était composé des membres du CCM et des experts nationaux et consultants internationaux
constituant ainsi une équipe multisectorielle et pluridisciplinaire. Les personnes non-membres du CCM, mais
disposant d’une expertise dans l’un des domaines de la proposition ont apporté leur contribution à la rédaction. Les
non-membres du CCM ont pris part aux sessions de restitution de la proposition nationale les 06 et 13 août 2010.
Une délégation de 06 experts nationaux conduite par le Ministre de la Santé a participé à la réunion de Nairobi sur
le passage à l’échelle des programmes de PTME pour l’élimination virtuelle de la TME du VIH du 26 au 28 mai 2010.
Une délégation de 06 experts nationaux a participé à l’atelier Régional de lecture croisée des propositions pays pour
une revue par les pairs qui s’est tenue à Ouagadougou du 29 juin au 02 juillet 2010.
Ces réunions ont permis de mieux orienter les priorités nationales dans le cadre du Round 10.
Le projet de proposition du Cameroun a été soumis au comité régional JURTA de relecture qui s’est tenu à Dakar du
26 juillet au 04 août 2010. Une délégation de 03 membres du comité de rédaction de la proposition nationale a
échangé avec les membres du comité JURTA pour une meilleure intégration de commentaires.
Les drafts des propositions ont fait l’objet de relecture par les personnes ressources identifiées dans le secteur
universitaire et de la société civile (Annexe 13).
(d) Joindre le compte-rendu daté et signé de la réunion (ou des réunions) au
cours de laquelle le CCM (ou sous-CCM) a décidé des éléments à inclure dans
chaque proposition maladie.
Annexes 6 et 9
15/23
2.2.3 Processus de supervision de la mise en œuvre des programmes
(a)
Décrire le processus suivi pour assurer l'implication d’acteurs autres que les membres du CCM (ou
sous-CCM) pendant la supervision continue de la mise en œuvre des programmes
Avec l’appui de Grant Management Solution (GMS), des documents cadres régissant le fonctionnement du CCM :
statut, Manuel de procédure, un règlement intérieur, plan de gestion des conflits d’intérêts (Annexe 14, 15, 16, 17)
ont été élaborés. Ces documents ont été adoptés par le CCM en sa session du 13 août 2010 (Annexe 11).
Le Manuel de procédure prévoit la mise en place d’un Comité de supervision. Le mandat de ce comité est d’assurer
le suivi du programme au moins une fois par trimestre. La supervision de ce programme implique la mobilisation
d’une grande expertise y compris des non-membres du CCM.
Dans le cadre du présent programme, l’approche mission conjointe de supervision avec les autres Partenaires
Techniques et Financiers (PTF) et les représentants des populations cibles, non membres du CCM sera privilégiée
et planifiée en concertation avec ces derniers.
Les rapports et documents des différents acteurs de la lutte contre la maladie seront largement exploités.
Les personnes morales et physiques non membres du CCM, reconnues pour leur expertise seront officiellement
invitées du Président du CCM pour critiquer les rapports de supervision du Comité. Les rapports de mission seront
discutés avec les PRs, les PTF, le Gouvernement et la société civile. Le Comité de supervision, avant de faire son
rapport à l’Assemblée Générale du CCM pourra demander des clarifications aux PRs.
Cette supervision ne concerne pas seulement le VIH, elle couvrira également les programmes Paludisme et la
Tuberculose qui bénéficient déjà du financement du Fonds Mondial dans le cadre du Round 9.
(b)
Décrire le processus suivi par le CCM (ou sous-CCM) pour superviser la mise en œuvre des
programmes.
Le Manuel de procédure du CCM récemment adopté décrit le processus de supervision de la mise en œuvre du
Programme avec un comité de supervision et un calendrier annuel de supervision. Le suivi et évaluation des
programmes prévoit deux aspects : la gestion et les finances d’une part et les aspects programmatiques d’autre
part. Le comité de supervision est composé de personnes relevant des secteurs gouvernemental, non
gouvernemental, des partenaires au développement et des représentants des personnes vivant ou affectées par les
trois maladies ayant une expérience en matière de suivi-évaluation des programmes.
Dans le cadre de ses missions, ce comité aura accès à toute information nécessaire : demandes de décaissement,
rapports trimestriels, budgets annuels, plans de travail, plans de suivi et d’évaluation, rapports d’audit.
Dans son rapport à l’AG et/ou au Bureau du CCM, le Comité de supervision fera le point sur les performances, les
contraintes, les difficultés, les succès et les leçons apprises du programme.
A la fin de chaque année, le Comité de supervision évaluera son fonctionnement. Il consultera le CCM à travers l’AG
ou son Bureau exécutif ainsi que les Bénéficiaires. Le Comité pourra aussi consulter les membres des
administrations, les ONG, les leaders communautaires et les partenaires au développement et le secteur privé.
2.2.4 Processus de sélection du ou des Récipiendaire(s) principal (aux)
(a)
Décrire le processus suivi pour sélectionner de façon transparente et documentée chaque
Récipiendaire principal désigné dans cette proposition.
 Expliquer le processus pour chaque Récipiendaire Principal pour chaque maladie
Le CCM a lancé un appel à candidature pour la sélection des PRs et SRs publié le 22 juillet 2010 dans le quotidien
national Cameroun Tribune (Annexe 18). A l’issue de l’appel, le CCM a reçu 4 candidatures aux fonctions de PR et
23 candidatures aux fonctions de SRs (Annexe 19).
16/23
Le CCM a tenu une session le 06 août 2010 dont l’un des points à l’ordre du jour était la sélection des
Récipiendaires Principaux et des Sous-Récipiendaires. La session a été ouverte au public, non membres du CCM
notamment les représentants des différents soumissionnaires (Annexe 19). Lors de cette session, le CCM a mis en
place 4 groupes de travail pour examiner la recevabilité des dossiers conformément aux critères contenus dans
l’appel d’offre. Après examen, chaque groupe a présenté son rapport en séance plénière, en présence des
représentants des soumissionnaires (Annexe 19). A l’issue de cette phase, une liste restreinte de candidats dont les
dossiers ont été jugés recevables a été validée par le CCM (Annexe 19). Les candidats aux postes de PR et sous
PR qui sont membres du CCM, n’ont pas pris part aux délibérations conformément aux dispositions du plan de
gestion des conflits d’intérêts. L’examen technique des documents a été confié à un groupe de partenaires technique
et financier membres du CCM sous la coordination de l’ONUSIDA ouvert à d’autres membres du CCM non candidat
aux postes de PR et SR. Le CCM a mandé le groupe d’élaborer, valider et utilisé une grille d’évaluation appropriée
des différentes offres.
Le Rapport de sélection des candidats aux fonctions de principal récipiendaire et Sous récipiendaire a été présenté
et adopté au CCM à la réunion du CCM du 13 août 2010 en présence des représentants des soumissionnaires
(Annexe 20). Ce rapport a été discuté et adopté à l’unanimité par le CCM.
(b)
Joindre une version datée et signée du compte-rendu de la ou des
réunion(s) pendant laquelle/lesquelles le CCM (ou sous-CCM) a désigné
le Récipiendaire principal (ou les Récipiendaires principaux) pour
chaque maladie.
Annexe 11
2.2.5 Absence de mise en œuvre d'un financement à deux voies
Le financement à deux voies implique qu’au moins un Récipiendaire principal du secteur
gouvernemental et un Récipiendaire principal du secteur non-gouvernemental soient désignés pour
chaque maladie dans la proposition. Le cas échéant, fournir ci-dessous une explication pour justifier
l’absence de mise en œuvre d’un financement à deux voies dans une ou plusieurs des propositions
maladies de la candidature
N /A
2.2.6 Gestion des conflits d’intérêts
(a)
(b)
Le Président et/ou le Vice-président du CCM (ou sous-CCM)
appartiennent-ils à la même entité que l'un des Récipiendaires
principaux désignés dans cette proposition - quelle que soit la
maladie ?
Oui
x Non
Si oui, joindre le plan de gestion des conflits d'intérêt réels et
potentiels.
2.2.7 Approbation de la proposition par les membres
Le formulaire « Renseignements sur les membres » a été signé par tous les
membres du CCM (ou sous-CCM)
x
X
17/23
2.3
Précisions concernant le sous-CCM
2.3.1
Statut du sous-CCM
(a)
Le sous-CCM opère-t-il sous l'autorité d’un CCM afin de concentrer son
action sur une région ou question particulière ?
Oui
Le sous-CCM se déclare-t-il indépendant pour opérer sans la supervision du
CCM ?
Oui
(b)
2.3.2 Justification
Pourquoi une approche basée sur un sous-CCM est-elle considérée efficace dans le cas de votre pays ?
2.3.3. Approbation par le CCM
(a)
Joindre une version datée et signée du compte-rendu de la réunion du
CCM pendant laquelle celui-ci a convenu d'approuver la proposition du
sous-CCM.
(b)
Joindre une lettre du Président ou du Vice-président du CCM confirmant
l’approbation de la proposition du sous-CCM par le CCM
2.3.4. Justification de l'indépendance du sous-CCM
Expliquer dans quelle mesure le sous-CCM a le droit d'opérer sans l’approbation du CCM.
18/23
2.4
Candidats non-CCM
2.4.1 Secteur d’activité
Secteur universitaire / éducatif
Gouvernement
Organisations non gouvernementales (ONG) / Organisations communautaires
Personnes vivant avec les maladies
Personnes représentant les populations clés4
Secteur privé
Organisations confessionnelles
Autre : 
préciser
2.4.2 Justification d’une proposition non-CCM
(a)
Donner la principale justification pour la soumission d’une proposition non-CCM
(i)
Pays en conflit, confronté à une catastrophe naturelle ou en
situation d'urgence complexe
(ii)
Pays qui supprime ou qui ne dispose pas de partenariats
établis avec la société civile et les organisations non
gouvernementales, qui peuvent inclure, notamment, les
populations clés
(iii)
(b)
Etat sans gouvernement légitime, et qui n'est pas
administré par une administration intérimaire reconnue
Oui
Oui
Oui
Si (ii) s’applique :
Décrire, dans l'ordre chronologique, toutes les tentatives du non-CCM visant à communiquer avec le
CCM concernant l’inclusion des activités de la proposition non-CCM dans la proposition plus large du
CCM.
(c) Décrire comment le candidat non-CCM sera en mesure de mettre en œuvre la proposition et
d'aboutir à des réalisations/résultats alors que le CCM n'a pas soutenu la proposition.
4
Voir définition de « principales populations affectées » dans les Directives de la Série 10.
19/23
2.4.3 Bénéfices anticipés de la proposition
Décrire comment cette proposition répond aux lacunes identifiées dans les efforts nationaux existants
(pour le VIH, la tuberculose et/ou le paludisme, suivant le cas).
2.4.4
Connaissance et expérience des non-CCM en matière de questions transversales
(a) Renforcement des systèmes de santé
Décrire la capacité et l’expérience du non-CCM en matière de renforcement des systèmes de santé.
(b) Genre : Décrire la capacité et l’expérience du non-CCM en ce qui concerne les questions de genre
et les questions liées à l’orientation sexuelle et aux identités sexuelles.
Le Fonds mondial reconnait que l'inégalité entre les hommes et les femmes, ainsi que la situation des
minorités sexuelles, sont des facteurs importants de diffusion des épidémies, et que l'élaboration de
programmes efficaces nécessite :


Des compétences et connaissances des méthodologies d'évaluation des différences liées au genre
en matière d’impact des maladies et de leurs conséquences (y compris les différences
hommes/femmes et garçons/filles), ainsi que des moyens requis pour accéder à et utiliser les
programmes de prévention, de traitement, de soins et de soutien ; et
Des connaissances globales des facteurs qui rendent vulnérables les femmes et les jeunes filles,
ainsi que les minorités sexuelles, telle que les normes, les comportements, les attitudes et les
pratiques néfastes qui sous-tendent les différences dans la propagation du VIH (par exemple :
violence liée au genre, discrimination et stigmatisation, mutilation génitale féminine, mariage
précoce, masculinité, etc.)
(c) Combien de membres du candidat non-CCM ]
disposent de compétences importantes dans l’un
ou dans les deux domaines décrits dans la
rubrique 2.4.4 (b) ?
(d) Planification multisectorielle : Décrire la capacité et l’expérience du non-CCM dans l’élaboration
de programmes multisectoriels.
2.4.5 Absence de mise en œuvre d'un financement à deux voies
Le financement à deux voies implique qu’au moins un Récipiendaire principal du secteur
gouvernemental et un Récipiendaire principal du secteur non-gouvernemental soient désignés pour
chaque maladie dans la proposition. Fournir, ci-dessous, une explication pour justifier l’absence de
mise en œuvre d’un financement à deux voies dans une ou plusieurs des propositions maladies de la
candidature.
20/23
2.4.6 Signature des représentants agréés du candidat non-CCM
Fonction
Nom complet en majuscule
Signature
21/23
LISTE DE CONTROLE DE LA PROPOSITION : RUBRIQUES 1 ET 2
Indiquer le nom et le
numéro de l’Annexe
Rubrique 2 : Recevabilité
Candidats CCM et sous-CCM uniquement
2.2.2(a)
Processus suivi pour solliciter les contributions en
vue de leur intégration éventuelle dans chaque
proposition maladie
Annexes (7, 7bis)
2.2.2(b)
Processus suivi pour examiner les contributions
reçues, en vue de leur intégration éventuelle dans
chaque proposition maladie
Annexe 8
2.2.2(c)
Processus suivi pour assurer l’implication d'un large
éventail d’acteurs dans le processus d’élaboration de
la proposition
Annexes (8, 12, 13)
2.2.3(a)
Processus de supervision de la mise en œuvre des
subventions par le CCM (ou sous-CCM)
Annexe 15
2.2.3(b)
Processus suivi pour assurer la contribution d'un large
éventail d'acteurs dans le processus de supervision
de la subvention
Annexe 15
2.2.4(a)
Processus suivi pour sélectionner et désigner le (ou
les) Récipiendaire(s) principal (aux) pour chaque
proposition maladie
Annexes (11,19, 20)
2.2.6
Politique sur les conflits d’intérêt
Annexe 17
2.2.7
Compte-rendu de la réunion au cours de laquelle la
proposition a été finalisée et approuvée par le CCM
(ou sous-CCM)
Annexe 11
2.2.7
Approbation de la proposition par tous les membres
du CCM (ou sous-CCM)
Annexe 21
Candidats sous-CCM uniquement
2.3.3
Approbation du CCM
2.3.4
Processus démontrant que le CCM a examiné et
approuvé la proposition
Documents justifiant le droit du sous-CCM à opérer
indépendamment du CCM.
Candidats non-CCM uniquement
2.4.1
Document(s) décrivant l’organisation et les
principales dispositions de gouvernance, et résumé
des principales sources de financement et montant
des subventions
2.4.2(a)
Documents
décrivant
les
circonstances
22/23
exceptionnelles justifiant une proposition non-CCM
2.4.2(b)
Documents prouvant les contacts établis avec le CCM
en vue d’un examen de la proposition
Autres documents relatifs aux rubriques 1 et 2 joints par le candidat :
Ajouter des lignes supplémentaires à ce tableau si besoin, pour s’assurer que les documents directement nécessaires sont
annexés
Correspondance n° 057/10/MSP/CCM/PRES/ST du 23
mars 2010 du Président du CCM au Secrétaire Général du
Ministère du Travail et de la Sécurité Sociale, Greffier des
Syndicats
Correspondance N° 02015/MINTS/SG/CS du Ministre du
Travail et de la Sécurité Sociale, au Président du CCM
portant désignation du représentant des travailleurs au
CCM Cameroun
Compte-rendu de la réunion du CCM du 22 mars 2010
correspondance du 06 août 2010, de Monsieur le Chef de
service Administratif et Financier du Conseil des Eglises
Protestantes du Cameroun au Président du CCM
Cameroun
Correspondance du MINTSS N° du 0693 portant
désignation du Dr EYOUM BRUNO comme, représentant
du MINTSS au CCM en remplacement du Pr. Louis
ABOLO admis à faire valoir ses droits à la retraite
Compte-rendu de la réunion du CCM du 03 juin 2010
Compte-rendu de la réunion du CCM du 27 juillet 2010
Annexe 1
Annexe 2
Annexe 3
Annexe 4
Annexe 5
Annexe 6
Annexe 9
message-porté N° 080/10/MSP/ST/CCM du 29 juillet 2010
du Secrétaire Technique du CCM
Annexe 10
Statut du CCM
Annexe 14
Règlement intérieur du CCM
Annexe 16
Cameroon Tribune N° 9646/5647 du 22 juillet 2010 Page 26
Annexe 18
23/23
ROUND 10 – HIV
PROPOSAL FORM – ROUND 10
SINGLE COUNTRY APPLICANT
SECTIONS 3-5: HIV
3. PROPOSAL SUMMARY
Clarified 3.1 (a)
Option 1: Transition to a single stream of funding by submitting
a consolidated disease proposal
 go to section 3.1 (b)
Relevant sections are marked in RED throughout the
proposal form
3.1 Transition to a single
stream of funding
(a) Select only one of the three
options:
Option 2: Transition to a single stream of funding during grant
negotiation
 go to section 3.1 (b)
proposal form
10
Option 3: No transition to a single stream of funding in Round
proposal form
(b) For options 1 or 2, list the
grant numbers.
 insert relevant grant numbers
3.2 Duration of Proposal
Month and year:
Planned Start Date
To
1st July 2011
30 June 2016
3.3 Alignment to in-country cycles
Describe:
(a) how the proposal duration was selected in section 3.2 and how it contributes to alignment with the
national fiscal cycle(s), programmatic reporting, or in-country program reviews; and
(b) the systems in place for regular national program reviews and evaluations (including Operations and
Implementation research).
(a) The fiscal year in Cameroon is established between 1st January and 31 December. The National
R10_CCM_CMR_H_PF_s3-5_4Oct10
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ROUND 10 – HIV
Committee for the Fight Against Aids develops actions plans that align with the fiscal year. The
launch of Round 10 corresponds to the 2nd quarter of the national fiscal cycle for 2011. The last
quarter of the implementation of the proposal will correspond to the 1st quarter of the fiscal
year for the year 2016.
The routine data (programmatic and financial) for the monitoring of PSN 2011-2015 are produced
monthly (district), quarterly (region), biannually and annually (central). The reporting for the proposal
which will start in July 2011 will be secured with the national reporting. As well, the evaluations in
year 2 (end of phase 1) and year 5 of the implementation of this proposal will provide useful
information for the mid-way and final evaluations of the national strategic plan planned during the
period.
(b) This proposal will align on one hand, with the surveys programmed into the framework of the
regular evaluation of the national programs, in particular the sentinel monitoring of HIV among
pregnant women, the bio-behavioural surveys in specific groups (SW and their customers, truck
drivers, MSM). On the other hand, the cycle for this proposal will correspond with the carrying
out of the EDS 2011 and 2015.
3.4 Summary of Round 10 Proposal
Provide a summary of the HIV proposal.
“Universal access for the PMTCT, the global care of PLWHA and the prevention of HIV among the
most exposed populations in Cameroon”.
Cameroon is faced with a generalized epidemic with a prevalence of 5.1% in the general population. It
is estimated that there are approximately 560,000 PLWHA in 2010 of which 58% are women, and 37.5
are young people less than 24 years old. The strategies developed have allowed 76,228 PLWHA to be
placed under treatment, or 30.6% of the eligible patients (at the end of 2009) with a survival rate of 5
years after the beginning of the treatment among the highest in the region, which shows the
importance of following these efforts (Appendix 1).
The analysis of the national response and the recent review of the National Strategic Plan (NSP)
2006-10 showed that these strategies did not sufficiently target the marginalized populations, the
most exposed and the most vulnerable (prevalence varying according to the regions from 28.5 to 48%
among the SW, 35% seropositivity among a group of MSM having had recourse to voluntary screening;
prevalence of 16.2% among truck drivers). As well, the new NSP 2011-15 places a particular
emphasis on these populations’ MARPs who are the motors of the epidemic while reinforcing the
gains of the national program. This will contribute to a reduction in morbidity and the mortality
related to HIV thanks to a decrease in new infections in the MARPs and in the general population and
an improvement of the quality of care for the PLWHA.
The NSP 2011-15 calls for universal access to the prevention, care, treatment and support; and
contributes to the attaining of OMD 4, 5 and 6 by way of the main following results:

The prevalence of HIV in the general population is stabilized and has started to reverse thanks
to the combined efforts to reduce the rate of MCT to less than 5% and the reduction by 50% of
the new infections in high risk groups.

The number of eligible adult and child patients placed on ARV treatment increased from 92,500
end December 2010 to 226,338 (80% of the eligible patients) by the end of 2015
Cameroon has benefitted from three Global Fund grants on HIV which have contributed to the
implementation of NSP 2006-2010. In addition to the commitments by the government and partners,
this proposal will contribute in a significant way, by way of 04 synergetic and additional goals, to the
implementation of the main priorities of NSP 2011-15 to attain the following results in 2015:

Prevalence is controlled in the general population and decreased among the MARPs;

The proportion of pregnant women who benefit from at least one PNC including the HIV test by
2015 has increased from 35 to 80% (from 333,386 to 859,655 pregnant women, or 70% of the
NSP target);

The proportion of seropositive pregnant women and their children who receive an ARV regime
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ROUND 10 – HIV
to prevent MCT has increased respectively from 19% to 70% and from 16% to 70% in 2015
(57,167 HIV+ pregnant women and 57,167 newborns born of seropositive mothers in 2015, or
70% of the NSP target);

14,240 MSM, 39,440 SW and 148,800 truck drivers (or 80% of the NSP target) know their
serological status in 2015;

The proportion of adult and child PLWHA eligible for treatment has increased from 30.6% to
80% by 2015 (210,264 adults, of whom 22,868 are pregnant women, and 16,074 children);

20,000 orphans and vulnerable children per year have received at least the appropriate support
(or 25% of the NSP target).
Within the framework of this proposal, Cameroon has taken into account the TRP comments of Round 9
and programmatic and financial deficiency of the national strategic plan 2011-2015. Considering the
issues related to decentralization, and the gender and human rights dimension, this proposal revolves
around 04 goals and 07 objectives:
Goal 1: Reduce the new HIV infections among newborns by the prevention of the mother-child
transmission
Objective 1.1: Increase from 35 to 80%, the proportion of pregnant women who benefit from at
least one PNC including HIV screening by 2015.
Objective 1.2: Increase from 19% to 70%, the proportion of seropositive pregnant women and their
children who receive ARVs to prevent TME.
Objective 1.3: Increase from 16 to 70%, the proportion of exposed children tested for HIV (PCR) at
6 weeks by 2015.
The attaining of this goal will rely on the tight collaboration between the health system and the
community system, which together increase the social mobilization for access to services.
All of the seropositive HIV pregnant women received in PNC will be counselled and accompanied during
the pregnancy and childbirth, for the early diagnosis of the child, the observance of the taking of ARV
and cotrimoxazole. These women as well as the children born infected will receive ARV treatment and
will benefit from the counting of CD4 lymphocytes. This proposal aims to reinforce the technical
plateau of the laboratories and alleviates the deficiency in ARC and other inputs related to the
adoption of the PMTCT 2009 recommendations, with the application of option A, associated with a
Mother Baby Pack treatment. All of the HIV+ pregnant women having need of ARV treatment for their
own health will be oriented within the framework of the global care of adults.
Goal 2: Reduce the new HIV infections among SW and MSM and their partners
Objective 2.1: Ensure access to prevention services and the reduction of discrimination to 14,240
MSM, 39,440 SW and 148,800 truck drivers in the 10 regions by 2015.
Goal 2 and the attached objectives aims to reduce the new infections by HIV among the populations
the most exposed to risk particularly the SW, the MSM and the truck drivers by offering a package of
coherent and integrated interventions including: (i) the BCC, (ii) the promotion and the supply of
condoms and lubricating gels, (ii) the screening and syndromic care of STIs, (iv) counselling and HIV
screening, the care with ARV, (v) access to care and pyschosocial support as well as (vi) the fight
against stigma and discrimination. The interventions targeting the MARPs (mostly young population)
benefit indirectly an important fringe of young people.
The community actors for the reference centres for the SW and MSM and truck drivers will be trained
on the counselling and screening to accompany the populations the most exposed to risk in their steps
towards knowledge of serological status. The supply of HIV tests will allow the screening of these
populations via a set strategy in the partner health centres and an advanced strategy by the mobile
units in the locations where the targeted group lives and socializes.
Goal 3: Reduce the morbidity and mortality related to HIV as well as the socio-economic impact by
reinforcing the global care of adult and child PLWHA and the support to OVC by 2015
Objective 3.1: Ensure overall quality care to 80% of the eligible adult and child PLWHA by 2015
Objective 3.2: Reduce the impact of HIV/Aids among the OVC and the stigma and discrimination of
HIV
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A total of 210,264 adults (of whom 22,868 are seropositive pregnant women) and 16,074 children will
benefit from 1st and 2nd line treatment in accordance with the national directive by 2015 in the 240
care structures (public, private, faith-based). The support for the observance by patients by way of
the continuity of care for the PLWHA in the community by civil society organizations.
This proposal intends to ensure the pre-therapeutic check-up for all people newly screened with a
dosage of CD4 lymphocytes and a monitoring check-up for the PLWHA on ARV. This Round 10 will
continue the integration efforts of the TB/HIV programs by contributing to the training of health
personnel, and reinforcing the coordination between the two programs.
As well, it will follow the global CM of the OVC by capitalizing on the acquisitions and experiences of
Round 3, by ensuring a complete package of services: psychosocial and legal support, school support,
medical support and a nutritional support involving the community-based associations.
Actions to reduce the stigma and discrimination related to HIV will be carried out at several locations
including business, health, public service and community locations.
Goal 4: Strengthen the coordination, monitoring evaluation and the partnership with civil society
in the context of the implementation of the proposal
Objective 4.1: Strengthen the coordination and monitoring evaluation system
In order to produce strategic information for better decision-making, studies on the mapping, biobehavioural surveys among the SW, MSM and truck drivers; as well as monitoring surveys among the
pregnant women, resistance to ARV, and studies on TB/HIV coinfection will be carried out.
The personnel in charge of monitoring and evaluation at the most peripheral level of the central
system will be strengthened in their numbers and capacities. Supervision activities will be carried out
regularly by way of planning and appropriate human and material resources.
This will also reinforce the capacities of actors in civil society and the private sector in the realization
of the objectives defined in this proposal. A particular emphasis will be placed on the institutional
reinforcement of instances of national coordination for an efficient partnership with all sectors.
This proposal will be implemented by two main recipients: the Ministry of Health for the public sector,
and CAMNAFAW for civil society.
The amount of this HIV proposal for Cameroon in Round 10 is estimated at 97,411,943 Euros and
represents 24.16% of all of the financial needs of NSP 2011-2015. In addition to the other costs
attached to the fight against HIV, the government contribution covers 50% to 60% of the costs of
the ARV.
4. PROGRAM DESCRIPTION
4.1 National program
Describe:
(a) current HIV national prevention, treatment, and care and support strategies;
(b) how these strategies respond comprehensively to current epidemiological situation in the country;
and
(c) the improved HIV outcomes expected from implementation of these strategies.
(a) With a prevalence of 5.1%, Cameroon, a country with lower average revenue, finds itself in a
context of a generalized epidemic. The total number of persons living with HIV (PLWHA) is
estimated in 2010 to be 560,300 of which 249,341 are eligible for treatment. This epidemic is
characterized by its feminization (58.2% are women vs 41.8% men). As well the young women
of 15-25 are more affected compared to young men (4.3% vs 1.2%). The impact of HIV is
significant: there are approximately 304,210 orphans and vulnerable children due to Aids
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(Appendix 1.)
In response to this situation, the Government of Cameroon has made the fight against this scourge one
of its priorities in terms of development. This commitment has allowed within the framework of the
NSP 2006-2010 the placing on treatment of 76,228 PLWHA in December 2009 and increased the PMTCT
coverage to 99% of the Health Districts. This commitment is reinforced by the adoption of the
Strategic National Plan (SNP) for the fight against Aids 2011-2015, based on a multisectoral and
decentralized approach (Appendix 2). The R10 proposal arises out of this plan and is organized around
08 strategic axes based on results:
 Axis 1: Reinforcement of the prevention of the transmission of HIV and STIs
The interventions are based among others on the reinforcement of (i) the Prevention of the
Transmission of HIV from the Mother to the Child (PMTCT) with the view to virtually eliminate this
transmission, (ii) the prevention of HIV/Aids and the care of STIs in high risk groups (SW and their
customers, MS, Truck Drivers, etc.), (iii) the reinforcing of the counselling and screening for HIV, (iv)
reinforcement of the links between HIV services and sexual and reproductive health. The
implementation of the interventions combined with prevention will be made around the concept of
offering a “package of services” accessible in an equitable manner. As well, themes related to
reproductive health, violence towards women are taken into account in a way to reinforce the
efficiency of the prevention programs. In the context of the R10 proposal, the groups targeted for the
prevention are pregnant women and their infants, the populations the most exposed to risk (SW, MSM
and Truck Drivers) who have a seroprevalance at least 3 times higher than the prevalence in the
general population.
 Axis 2: Reinforcement of the access to care and treatments
In the context of the passage to the scale of the interventions, this axis aims to pursue the process of
decentralization of the offer of quality care and treatments by way of the operational implementation
of new structures and reinforcement of the existing ones for a global care for People Living with HIV
(PLWHA) in all of the health districts. This will allow on the one hand, an increase in the national
coverage and offer outreach services and other the other hand, to aim to attain the Millenium
Development Goals (MDG). The R10 will allow the offering of treatment and care to pregnant women
eligible for ART, children and infants, and adults with a therapeutic indication for ARV.
 Axis 3: Reinforcement of the support and protection of PLWHA, the OVC and persons
affected
The interventions aim especially to reduce the negative impact of HIV on these vulnerable groups and
to guarantee them equitable access to health, education and citizenship. For the PLWHA, this means
promoting their rights and obligations including in the workplace, and facilitating their access to other
services all while fighting against stigma and discrimination. Taking into account the weight of the
epidemic on the OVC, the R10 proposal will provide annual support to the OVC.
 Axis 4: Appropriation of the fight against HIV, Aids and the STIs by all actors
The efforts aim at effective implementation for a better appropriation of the fight by the different
actors. The strengthening of the capacities of the actors, the improvement of the provision of
coordination and monitoring of the sectoral interventions, as well as the reinforcement of the publicprivate partnership (PPP) will allow all of the actors to be involved (pubic, private and civil society).
 Axis 5: Reinforcement of the health system
The health system will be reinforced to support the efforts in favour of universal access to prevention,
to care/treatment and case management by improving the availability and quality of services. The
accent will be placed on the reinforcement of human resources capacities, the continuity of care, the
offer of palliative care for the PLWHA, from the national medication supply system and HIV inputs,
monitoring-evaluation, leadership and governance in the health sector. The R10 will allow the
reinforcement of the health system by the improvement of the provision of services by way of the
supply of equipment, the training of personnel, the extension of the service offering, supply of
medications and other inputs, etc.
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 Axis 6 : Reinforcement of the community system
This strategic axis places the emphasis on the development of the capacities of community actors,
advocacy and civil society leadership, planning and the monitoring evaluation of community
interventions, governance and the partnership. The community system will be reinforced to ensure the
complementarity with the health system in order to guarantee the effectiveness and effectiveness of
the interventions. The reinforcement of the community system in the context of this R10 proposal will
allow implication of the community system and the private sector in the provision of the activities of
prevention, care and support.
 Axis 7: Strategic information
The Strategic Plan aims to reinforce the actual device which will allow the efficient production of
quality strategic information, in order to: (i) take account of the unrolling of the programmed
interventions by the different actors and of the mobilization and use of resources; (ii) orient the
decisions founded on a functional system of monitoring-evaluation, sentinel surveillance and
operational research, (iii) document the results obtained as far as the use and the quality of the
services offered and,(iv) document the effects and the impacts of the interventions on the general
population and the target groups of the program. To do this, this proposal will allow the carrying out
of surveys and studies, the reinforcement of the system of monitoring-evaluation and the production of
strategic information.
 Axis 8: Coordination, partnership and management
This axis aims to reinforce the partnership between the public, the private and civil society, with the
goal to ensure the complementarity of the interventions. A particular emphasis will be placed on the
mobilization of national resources by way of the implementation of innovative mechanisms for the
mobilization of financing following the example of the partnership with the private sector and mutual
health insurance companies. In matters of management, the principles of good governance and
management based on the results will be applied in order to rationalize the cost of the interventions
and will lead to the effective and efficient use of the resources.
(b) These strategies will allow by way of the reinforcement of the public-private partnership,
the health systems and the community to make accessible and available the prevention
services, the care and the support for all of the population in urban and rural zones. The
targeting of the interventions towards vulnerable persons and the persons most exposed to risk
will encourage the changing of behaviours, for example the delaying of the age of the first
sexual relationship among young people, the systematic use of condoms, lubricating gel by the
SW and their customers, as well as the MSM. As well, these strategies will allow on one hand
the increase in the use of screening services and care of cases of HIV and STI and on the other
hand, the frequentation of Prenatal Consultation (PNC) services including maternal and infant
health. The offer of PMTCT service will allow reinforcement of the prevention of new
infections among women of procreating age, to provide the prophylaxis ARC to seropositive
pregnant women and their infants in order to reduce the risks of transmission from mother to
child of HIV. The reduction of violence towards women (rapes, sororat and levirate..), of the
discrimination and stigma towards people infected and affected as well as the taking into
account of the gender and human rights aspects encouraging the improvement of equitable
access to services. The comprehensive PMTCT will have an impact not only on the feminization
but also on the juvenilization of the epidemic; it will contribute to the reduction of maternal
and infantile mortality related to HIV/Aids.
The treatment will decrease morbidity and mortality especially maternal and infantile related
to HIV/Aids and contribute also to the protection of the general population and to an increase
in productivity.
The support to OVC and persons affected will allow the impact of the infection to be reduced
and will lessen the vulnerability related to HIV.
Making strategic information available will allow the progress made to be evaluated, the impact of the
interventions on the recipients and will facilitate also decision-making in order to ensure a quality of
services and a complete coverage of national needs.
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(c) Improvement of the expected results by the implementation of the national strategy
In terms of the implementation of the national strategic plan 2011-2015, the following main results will
be attained:
Prevention:
 The prevalence of HIV in the general population is stabilized and starts to reverse thanks to the
combined effect of the virtual elimination of MCT to less than 5% and the reduction by 50% of
the new infections in the high risk groups.
- The proportion of persons having carried out their screening test for HIV (men and women)
goes from 13% to 60% between 2011 and 2015.
- The proportion of SW who know their HIV serological status goes from 64.1% to 90%.
- 75% of the MSM have correct knowledge of HIV and the STI and SSR
- The rate of use of condoms during their last risky sexual relationship among young women and
men aged 15-24 years of age goes to 80%
- 90% of the MSM state they used a condom during their last risky sexual relationship.
Overall care:
- The number of eligible adults and children placed on ARV treatment increases from 92,500 at the
end of December 2010 to 226,338 (80%) of the patients by the end of 2015.
- 80% of the PLWHA (adults and children) and 55% of the OVC have a better quality of life because of
the increase in their access to care services, treatments and support.
Within the specific context of the R10 proposal, the results attained are:
 The proportion of pregnant women who benefit from at least one CPN including the HIV test by
2015 increases from 35 to 80%;
 The proportion of seropositive pregnant women and their children who receive ARC
medications to prevent MCT goes respectively from 19% to 70% and from 16% to 70% in 2015.;
 The overall quality care for the adult and child PLWHA with therapeutic indication goes from
30.6% to 80% by 2015. Round 10 will provide 50% of the financing for the costs of the ARV, the
other half being taking into account by the Government of Cameroon.
 14,240 MSM, 39,440 SW and 148,800 truck drivers (or 80% of the target) know their serological
status by 2015;
All of these results will contribute to the reduction of the morbidity and mortality related to HIV
thanks to the decrease in new infections in the population and an improvement of access to prevention
services, care and support.
Clarified 4.2 (b)
4.2 Epidemiological profile of target populations
(a) Describe the current epidemiological profile of the target populations, and how this profile is changing
with respect to HIV.
As much as the epidemic has generalized, there are very exposed populations in Cameroon and at very
high prevalence who because of their sexual behaviour and practices, play a large role in the progression
of the epidemic. In relation to the epidemiological data, particularly the prevalence of HIV which is very
high, the persistence of the exposure to risks and the vulnerability factors, the following populations have
been targeted in this proposal. This is the case for the SW, MSM, and truck drivers with the respective
prevalence of HIV at 36%, 35% (rate of seropositivity), and 16.2%. Because of the fact that the epidemic
affects particularly the young, they are not specifically targeted, because they benefit indirectly from
the interventions in the direction of the SW, MSM, Truck drivers, pregnant women, etc… Because of their
increased vulnerability, pregnant women and infants, the PLWHA and the OVC are also targeted in this
proposal.
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Pregnant women and infants:
In Cameroon, the health indicators for mother and infant indicate that the synthetic rate of fertility is 5.0
children per woman and the gross birth rate is 37.8 for 1000 individuals (EDS III, 2004; pp 66 and 62;
Appendix 3); the rates of infant and juvenile mortality are respectively 87 per 1000 and 149 per 1 00 live
births. Maternal mortality is 1000 for 100,000 live births (Sectoral Health Strategy 2001-2015, Appendix
4) and the neonatal mortality is 30 per 1,000 live births. The proportion of pregnant women who state
having consulted a health agent during pregnancy is 82%. The routine program data reveals that at the
end of 2009, 35% of the pregnant women were received in PNC in the health facilities offering PMTCT.
According to MICS III, 2007, 98.1% of the women breastfed their newborns; however the exclusive rate of
material breastfeeding of infants of 0-5 months is 21%, and 35% of infants aged 0-11 months are
adequately fed following recommendations (Appendix 5).
In 2010, PLWHA are estimated at 560,306 of which 58.2% (326,278) are women; 12% (73,750) of these are
pregnant women (Appendix 1). At the end of 2009, the prevalence of HIV among pregnant women aged
15 to 49 years of age was 7.6%; in the age categories, 15 to 19 years of age and 20-24 years of age, there
were respectively 5.1% and 7.8%. This seroprevalance is not uniformly distributed in the 10 regions of the
country, and between the rural and urban zones. The seroprevalance of Syphilis among pregnant women
is 0.5%. Twenty-three percent of the women surveyed stated having used a modern contraceptive
method before the actual pregnancy and 85% stated that they were favourable for the participation in the
PMTCT program (VIH Sentinel Surveillance Report Among Pregnant Women, 2009; Appendix 6). AIDS is
one of the major causes of mortality and of maternal morbidity and also represents the first cause of
mortality among adults (women or men) in the country. The targeting of pregnant women will allow the
young girls in this group to be reach and to influence the feminization but all the juvenilization of the
epidemic; it will contribute to the reduction of the maternal and infant mortality related to HIV/Aids.
The number of new infection of HIV is estimated at 7349 for children less than one year old. These
infants contract the infection mainly by mother-child transmission and represent 91.9% of the new
infections estimated in the country among those younger than 05 years (NAC. Profile Estimate Reports
2010-2010; Appendix 1).
The reduction of new infections among women and the risk of transmission of HIV from the mother to the
infant will contribute to the reaching of the ODM 4, 5 and 6 in the country. As well all of the
interventions which will take place during this Round 10 in the areas of PMTCT and paediatric care will
definitely have an impact on the overall improvement of maternal and infant health.
Sex workers (SW)
The Sew Workers are a priority group for this Round 10 proposal, with respect to the particularly high
prevalence in this group. In effect, the mapping of the 447 sites distributed around the country is
characterized by a strong mobility of the sex workers (Mapping Report of Sex Workers, Appendix 7). This
group is mainly young; 45.2% of the SW surveyed were between 15-24 years old. This prevalence reaches
72.8% for the section from 15-29 years of age. Those of the young aged 20-24 years was 33% for a survey
of 994 TS. The rate of seroprevalance in this groups went from 26.5% in 2004 (NAC Enquiry Report on
specific groups, 2004, Appendix 8) to 36% in 2010 (Sero-epidemiological and behaviour enquiry report on
HIV and syphilis among SW, John Hopkins, Appendix 9). This prevalence varies from 28.5% (in the central
region) to 48% ( in the region of Adamaoua).
The rate of seroprevalance of HIV in relation to the age bands reveals a juvenilization of the infecting in
this group. As well, in the band 15-19 years, this rate was 18.8%, 29.7% in the band 20-24 years and
39.5% in that of 25-29 years. The seroprevalance of syphilis is 18%. The same survey reveals that during
the last three months preceding the study, 63.3% of the SW did not take part in an awareness session;
18.1% had never done a screening test for HIV and 52.2% only had systematically used the condom with
their paying sexual partners, regular or occasional. In the case of STI, 18.8 of the SW questioned stated
having recourse to a public or private health centre, and 14.5 to self medication. The targeting of this
group will reach a fringe of young people whose clients are also found among the young.
Men having sexual relations with men (MSM)
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MSM are an emerging phenomenon in Cameroon and which remains essentially urban and concentrated in
certain cities such as Yaoundé, Douala, Kribi, Limbè, Bafoussan, Garoua and Ngaoundéré. The study
carried out on the factors associated with unprotected anal relations among 168 MSM in Daoula,
Cameroon indicate that the stigmatism, penalization and the reject of this group are the main factors
that prevent them from accessing and receiving essential prevention and care services for HIV (E. Henry,
F. Marcelin, Y. Yomb et al. Factors associated with unprotected anal intercourse among men who have
sex with men in Douala, Cameroon 2009, appendix 10). On the other hand, the lack of prevention
interventions combining information, social and legal support, support for strengthening self esteem,
prevention and the care of STI is enough of a context to increase their risk of exposure to HIV.
The same study showed that close to half of the members had had bisexual relationships in the six (06)
months preceding the study. It remains that 65% of the MSM reported having had at least 02 different
sexual partners during the last 06 months. It also remains that 45% do not know their serological status,
57.7% declared having already been beneficiaries and/or actors of HIV/AIDS prevention actions. The
median age of this group is 23 years old and the first anal sexual contact occurs at the age of 16-19. In
2009, the activity report of the NGO CAMNAFAW revealed that of 133 MSM tested for HIV, 35% were
seropositive. The discussions with the intervening actors with this group reveal the importance of the use
of communication information and technologies (CIT) as main tools of communication and exchange
between the members. This population with a high risk of exposure also makes up one of the priorities of
the Round 10 proposal by way of integrated prevention programs.
The Truck Drivers:
Epidemiological data for 2004 reveals a rate of prevalence of HIV of 16.2% in this group (NAC, 2004,
Appendix 8). As far as prior Sexually Transmitted Infections (STI), 17.7 of truck drivers state having had
an STI during the last twelve months prior to the survey (CARE Cameroon, 2005; Appendix 11). The
survey carried out in 2008 by OCEAC/PPSAC with the same groups reveals that only 28% of truck drivers
have a complete knowledge of HIV/Aids and 50% don’t consider themselves to be at risk of contracting
HIV. On the other hand, only 45% have done the HIV screening test and received results during the last 12
months preceding the survey. During the same period, the average number of sexual partners was 2.27
among truck drivers and 4.47 among their occasional sexual partners made up of primarily the SW. 40%
of the truck drivers and 73% of their partners had had risky sexual relations, but only 22% of the truck
drivers and 23.4 of their partners declared having used a condom on that occasion (OCEAC/PPSAC,
Enquiry report on the evaluation of PPSAC project indicators, 2008, Appendix 12).
Persons living with HIV
With a prevalence of 5.1% in the general population, the number of PLWHA is estimated at 560,300 in
Cameroon in 2010 of whom 58% are women, 18.2 are young people aged 15-24 years of age and 19.3%
aged less than 15 years of age (Appendix 1). This population is also a priority retained in the Round 10
framework.
Based on the recent eligibility criteria for ARV defined by the WHO (CD4˂350), 249,341 PLWHA are
eligible for treatment in 2010, or 44.5% of all of the estimated PLWHA. However, only 76,228 PLWHA, or
30.6% of the eligible patients were put on ARV treatment at the end of 2009 (NAC, Annual Report 2009,
Appendix 13). The profile of patients on ARV indicated that 67% are women and 33% are men. On the
other hand, 4% of the PLWHA on ARV are infants.
Tuberculosis is the main cause of mortality among the PLWHA. In 2008, 217 functional CDT allowed the
screening of 16,144 people ill with tuberculosis or 45% of the 35,000 estimated tuberculosis patients.
Among these, 6,515 were screened positive for HIV and cared for with ARV in the UPEC/CTA. This
corresponds to a coinfection TV/HIV of 40.4% (Appendix 14).
Orphans and vulnerable Children:
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In 2010, the number of deaths related to HIV is estimated at 34,478 and 33,737 in 2015. This mortality
weighs down considerably the burden of the epidemic which also leads to an increase in the number of
OVC. In effect, the estimates show that the number of children infected or affected by HIV and Aids
increases from one year to the next. According to the estimates, this number will go from 304,210 (25.3%
of all of the orphans for all causes together) in 2010 to 350,644 (27.2%) in 2015 (Appendix 1).
(b) Do the activities in the proposal target:
Whole country
Specific geographic region(s)
Specific population group(s)
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(c) Size of target population(s)
Population Groups
Population Size
Source of Data
Year of Estimate
Total country population (all
ages)
19,406.100
3rd RGPH Report Cameroon
2010
Females > 25 years
3,560,256
2010
Males > 25
3,373,146
2010
Females 20-24
981,955
2010
Males 20-24
855,334
2010
Females 15-19
1,101,526
2010
Males 15-19
1,068,509
2010
Females 10 – 14 years
1,167,201
2010
Males 10 – 14 years
1,227,470
2010
Females 5-9 years
1,370,992
2010
Males 5-9
1,412,467
2010
Females 0-4
1,624,936
2010
Males 0-4
1,662,298
2010
970,305
NAC. Profile Report Estimates
2010-2020
2010
1,203,918
NAC: Profile Report Estimates
2010-2029
2010
Truck Drivers
186,000
General Office of Terrestrial
Freight
Sex workers
49,303
NAC: Profile Estimate Reports
2010-2020
2010
Men having sexual relations with
Men
17,763
NAC: Profile Estimate Reports
2010-2020
2010
Pregnant women
Number of Orphans
(d) HIV epidemiology of target population(s)
Population Groups
Estimated Number
Source of Data
Year of Estimate
Number of people living with HIV
(all ages)
560,306
Report on the profile of estimates
and projections for HIV and Aids:
2010-2020, NAC- Cameroon
2010
Females living with HIV > 25 years
229,662
2010
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Males living with HIV > 25 years
180,264
2010
Females living with HIV 20 – 24
years
50,556
2010
Males living with HIV 20 – 24 years
21,107
2010
Females living with HIV 15 – 19
years
21,902
2010
Males living with HIV 15 – 19 years
8,079
2010
Pregnant females living with HIV
>25 years
34,659
2010
20-24 years
22,123
2010
15-19 years
16,961
2010
Females 10–14 years living with
HIV
5,288
2010
Males 10-14 years living with HIV
5,373
2010
Females 5-9 years living with HIV
8,333
2010
8,463
2010
Females 0–4 years living with HIV
10,537
2010
10,742
2010
Seropositive pregnant women
73,743
2010
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AIDS orphans
304,210
2010
Sex workers
17,749
2010
Truck drivers infected with HIV
31,132
General Office of Terrestrial
Freight
2010
Men having sexual relations with
Men
6,217
2010
4.3
Major constraints and gaps in disease, health, and community systems
4.3.1 HIV program
Describe:
(a) the main weaknesses in the implementation of current HIV strategies;
(b) existing gaps and inequities in the delivery of services to target populations; and
(c) how these weaknesses affect achievement of planned national HIV outcomes.
Despite the advances and considerable results, the implementation of strategies in the fight against
aids in Cameroon, evaluated during the Strategic National Plan (SNP) for the fight against Aids 20062011 (Appendix 5), allowed us to place the emphasis on the weaknesses in the areas of prevention,
therapeutic care and support, of the community mobilization as well as in terms of coordination nod
monitoring/evaluation. These main weaknesses in the implementation of actual strategies which were
at the base of the elaboration of the new SNP 2011-2015, are presented as follows:
In terms of Prevention of new infections:
(a)
Main weaknesses
- Weakness in the targeting of interventions, more particularly in so far as concerns the groups the
most exposed to the risk of HIV (SW, MSM, Truck drivers). Effectively, these groups are difficult to
reach because of the fact of the socio-cultural context in the country. On the other hand, the
working standards towards these groups are not yet harmonized as well as much as the
capitalization of the interventions are not efficient. Thus, numerous interventions were mainly
destined for the general population, leaving behind some of the groups the most at risk such as the
SW, MSM, Truck drivers, etc. The fact that the majority of the interventions concerns the general
population, the populations the most exposed to risk have not be subject of studies allowing
strategic information to be generated to orient specific actions.
- Weak use of counselling and screening services which has only allowed testing of 1.8 million
people between 2006 and 2009, or 13.6% of the population aged 15 and older (Report on the review
of the National Strategic Plan for the Fight Against AIDS 2006-2010. Appendix 16), which is far
from the objective of 75% set for 2010;
- Weakness in the CPN coverage: the non harmonized and high costs of the CPN services (going
from 1.5 to 15 Euros), birthing in some health facilities as much public, private as faith-based could
be a brake to the accessibilities of CPN services. This situation is accentuated by a lack of
information within the communities which translates into an under utilization of the services both
for pregnant women and their spouses;
- Qualitative and quantitative insufficiency of services in the health system and the community
system: only 57% of women seen in PMTCT benefit from ARV prophylactics of whom a high number
are lost sight of in PMTCT;
-Weak implementation of the strategy for screening counselling on the initiative on the initiative of
the services provider (DCIP) has had the consequence of a weak integration of the screen services
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in the health facilities (SR/PMTCT, SMI);
- Weakness in the offer of screening services in the advanced strategy inherent to insufficiencies in
human resources and a lack of logistical means in certain zones and in the direction of the groups
of the population most exposed to risk.
(b) Disparities and inequities
- The urban locations benefit from more interventions and offers of services than the rural areas
(weak offer of services for counselling and screening in the rural locations, weak quality of care for
TARV, weak access to male and female condoms,)(Review of the Strategic National Plan for the
Fight Against AIDS 2006-2010. Appendix 16).
- 21% of the health facilities recognized don’t offer PMTCT.
- The delay in the delivery of blood samples (taken on blotting paper) to the reference
laboratories, the resulting output and the placing on treatment of infants remains very long (34 to
55 days). The delay of the output results of the screening is long with an average of 2 days in some
sites
Table 1: Stream of PMTCT indicators in Cameron, 2009 (source: GTC/NAC. NSP Evaluation Report
2006-2010)
PMTCT Indicators
Level of
Coverage (in %)
FS Coverage in PMTCT
79
Frequentation of FP site by women
Coverage screening program for
pregnant women in CPN1
Coverage assisted birthing program
for HIV+ women
Coverage pop TARV for HIV+ children
40
35
61
11
PMTCT Indicators
Coverage pop ARV prophylactics
among HIV+ pregnant women
Coverage pop ARV prophylactic among
exposed children
Coverage pop in CTX among exposed
children
Coverage pop in PCR among exposed
children
% partners of HIV+ pregnant women
Level of
coverage (in %)
19
16
23
17
2
c) Consequences
- Because of the fact that the populations the most exposed to HIV have not been sufficiently targeted
for the prevention and care, this has had the consequence a rate of seropositivity and prevalence very
high representing one of the motors of the epidemic in Cameroon. Thus the strategy choice has been
made in the strategic national plan 2011-2015 and in this proposal showing the important that the
country gives to the reduction of new infections (know your epidemic).
- Only 19% of seropositive pregnant women expecting and 16% of the infants born of seropositive
mothers benefited from a prophylactic regime in 2009;
- Only 57% of those who are followed by the PMTCT program receive ARV prophylactics.
- The coverage of early diagnosis of children born to seropositive mothers is weak at 17% in only 92
health facilities out of 2569 representing a geographical coverage of 4.5% (NAC Annual Report, 2009.
Appendix 13).
In the area of treatment, care and support.
(a)

Main weaknesses
The active file for patients on ARV at the end of 2009 is 76,228 (3114 children and
73114 adults) representing 49.5% of the PLWHA eligible for treatment (NAC. Activity Report
2009, Appendix 13). By taking into account the new WHO recommendations of December 2009,
this figure indicates a coverage of 30.6% of the eligible persons. This weak coverage can be
explained by the following elements: (i) Only 56% of the health districts (100/178) had a
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structure for care of the PLWHA at the end of 2009 (NAC. Activity Report 2009, Appendix 13);
(ii) the insufficient number of biomedical equipment, (iii) the qualitative and quantitative
insufficiency of human resources involved in the PEC medical, the psychological and social
accompaniment aiming for proper observance of treatment and the promotion of good
nutritional practices and secondary prevention, (iv) Weak accessibility to biological statements
by the PLWHA, making adequate care for patients on ARV: the experience of Round 3 showed
that despite the subsidization of biological examinations, only 48% of the persons on ARV had
done biological monitoring tests. (v) the embryonic state of the care continuum between the
health structures and the community, (vi) the insufficiency of the TB diagnostics among HIV
patients related to the diagnostic difficulties due to a deficit in capacities at the appropriate
technical level, (vii) weakness of the implementation of the UPEC tutorat by the ACT;

Weaknesses related to care and support are significant, the weak implication of
community actors in the continuum of care, insufficiency of the support for OVC (only 25% of
the OVC benefited from support (Strategic National Plan 2011-2015, Appendix 2);

Insufficient involvement of the private sector in prevention and the care of their
employees, families and surrounding communities in their zone of implantation.
(b)
Disparities and inequities
- The overall offering of services of care for the PLWHA is more developed in the urban
environment than in the rural environment
-Patients have difficulties with respect to geographical access in certain care structures in the rural
zone, which increases the number of those lost from sight
- The care for HIV infection among children has been initiated late which has had the consequence
of insufficiency of access to care for children living with HIV.
(c)
Consequences
- As much has Cameroon has a significant active file of patients on ARV at the end of 2009 for
76,228 (3114 children and 73114 adults) which represents 49.5% of the PLWHA eligible for
treatment (NAC. Activity Report 2009, Appendix 13). The taking into account of WHO
recommendations will bring this coverage to 30.6% of the eligible persons which indicates the
importance of the efforts remaining to be carried out. It is the same for the biological monitoring
which indicates that 48% of the PLWHA on ARV benefitted from biological monitoring test.
- Those lost from sight are estimated to be between 10 to 40% of the active files. This translates
the fact that the continuum of care is insufficiently ensured in terms of quality and of geographical
coverage. There is also a weakness of community relay agents (APC) who intervene as an interface
between the care structures and the communities.
- As far as the OVC, the stated weaknesses have had the consequence of an insufficiency of the
taking into account of the issues specific to OVC: school, medical and psychological, nutritional
support etc…
Concerning strategic information and the coordination of interventions
(a)
Main weaknesses
- The unavailability of quality data and information which is due notably to non-appropriate
planning, irregular supervision and the inadequacy of data collection. The personnel not being
trained enough and motivated to ensure a regular collection of data.
- The weakness in the implementation of epidemiological surveillance, surveillance of resistance,
research on HIV and insufficient use of the resulting in decision-making and planning;
- Monitoring/evaluation and coordination: the weak level of control and the monitoring of the
implementation, despite the existence of program coordination structures at all levels (central,
regional and communal) is also due to weak planning and an absence of financial resources
allocated to this aspect. Also added to this are deficiencies in coordination between the different
actors of the community and health systems.
- Weakness in the information system: the lack of functionality of the information system between
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the services explains the weak traceability of data concerning women and children coming from
PMTCT and placed under TARV. As well, these difficulties are also found in the community
structures offering the activities of CPN/PMTCT and the activities of the groups most exposed to
risk.
(b) Disparities and inequities
The insufficiency in the collection and analysis of strategic data does not allow the taking into
account on the one hand of the most vulnerable populations for the ones the most exposed to risk,
and on the other hand their needs or specific expectations. This constitutes an inequity in the
management of information and decision-making.
c) Consequences
Planning and budgeting suffer from a lack of information based on tangible facts, which does not allow
pertain decisions to be taken vis-à-vis the populations the most exposed to risk, the PLWHA, the
pregnant women, etc. with regards to their context.
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4.3.2
Health Systems
Describe the main weaknesses of and/or gaps in health systems that affect HIV outcomes.
The national health system in Cameroon is organized on three levels. Each level has administrative and
technical structures with specific functions. The central level has the role of elaborating policies and
strategies, coordination and regulation; the intermediate or regional level ensures technical support to
the health districts; the peripheral or operation level has the responsibility for the implementation of
programs. The health system has 178 health districts, 1600 health zones distributed among 10 Regions
in which there are 2569 health structures of which 76% are public, 17% private secular and 7% private
faith-based. The HIV program has 140 structures (23 ACT and 117 UPEC) which ensure the overall care
of the PLWHA.
Weakness of the health system which affect the results in terms of HIV are found at the level of 6
areas:
Provision of services: In Cameroon, close to 14% of the health districts don’t have operational district
hospitals. The territorial coverage in health structures offering PMTCT, screening and structures
certified for care of the PLWHA do not allow universal access of the enclaved populations to
prevention, care, treatment and support. This last insufficiency is accentuated by the weak
involvement of the private sector and civil society in the national response to HIV.
Medications, vaccinations and technologies: the insufficient logistical management of medications
and related products is noted at the decentralized level, more particularly in the regions of the East
(Bertoua) the Extreme North (Maroua) because of the difficulties of road access (inadequate estimates
of the needs, storage and distribution conditions…)
The absence of qualified personnel (pharmacist) at the central level (CNLS) for the coordination of
management activities (forecasting, quantification) for medications and inputs and the absence of
capacity strengthening for the actors involved in the management chain for medications exposed to
risks of rupture of inventories at all levels of the SYNAME. As well, there is also insufficiency and
antiquity of the equipment in the health facilities, particularly the care structures, accentuated by the
absence of a system of maintenance.
Health Information: the health information system is characterized by the weak capacity of the units
to manage the data within the health structures leading to a weak promptitude and completeness of
routine data. There is also an irregularity in the collection of information on the HIV infection
tendencies among certain specific groups (sex workers, mean having sexual relations with men) and a
weak coordination of the research, hindering the use of all of the data generated. There is not reliable
information on the cost/benefits reports on the programs for the fight against HIV/Aids. The weak use
of the strategic information available does note facilitate strategic decision-making adapted to the
epidemiological context.
Human resources: in the context of the care of PLWHA, the workload expressed in the form of a
health personnel ratio in the population is very high: doctors: 1/13 468, medical-health personnel: 1/3
094, surgeons dentists: 1/105 882 (Sectoral Strategy for Health, Appendix 4). The personnel of the
different sectors are weakly prepared to offer HIV services (prevention and overall care), this area not
being integrated into the curricula of the initial training.
In addition, ongoing training does not cover all of the needs, particularly for the PMTCT and the care of
PLWHA including paediatric CM. This explains the implementation of the concept of guardianship. The
weakness of the motivation of the personnel aggravates this quantitative and qualitative deficit which
is more marked in the rural locations. This situation influences the quality of the offering of the
preventions services, treatment, care nod support and leads inevitably to a “burn out”.
Financing: more than three quarters of the expenses in health are supported directly by households
(Sectoral Health Strategy Appendix 4). 50.6% of the Cameroon population lives belong the poverty
level (ECAM III Appendix 17) and as a consequence the majority of the population does not access the
offerings of health services including HIV. As well, the financing of the health sector in Cameroon
remains below 15% of the national budget between 2001 and 2006 (PSN Evaluation 2006-2010 Appendix
16). As far as financing for the fight against aids, there is involvement of the Government in the
financing of ARV costs (50%). However, it remains strongly dependent on external support.
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4.3.3
Community Systems
Describe the main weaknesses of and/or gaps in community systems that affect HIV outcomes.
The participation of the community system is based on a collaboration and a complementarily between
the structures of the health system and the organisms of the community system (NGO, the Associations
or Community Groups, the faith-based organizations, the private sector, etc…) The main actors in this
area are: (i) the CHW attached to CM structures and (ii) the VS, Peer Educators (PE) or health
mediators attached to the OBC the activities of the OBC are focussed on promotion,
information/counselling and the mobilization for the use of the health services. The CHW lead the
following activities: (i) psychological and social monitoring of the PLWHA (under ARV treatment or
not); (ii) assistance for treatment observance by way of therapeutic education and counselling in the
health facilities; (ii) research and reintegration of those lost from view in the active file of the health
facilities; (iv) running discussion groups, (v) nutritional education. A mechanism for monitoring
interventions and for collecting data allows information from the community system to be captured.
However, weaknesses exist at different levels:
Weakness in the enabling environment and advocacy
Advocacy is not sufficiently taken into account in the implementation of interventions by Communitybased organizations and Organizations of Civil Society. This is due to an insufficiency of skills of some
actors, insufficiency of the documentation for interventions and the deficit in leadership. There is also
a weakness of consultation and of coordination noted between the organizations and the civil society
actors.
Efforts carried out in matters of the protection of the rights associated with HIV remain insufficient.
Stigmatization and discrimination are recurrent and are an obstacle for the prevention of new
infections, access to care services and support for the ill (PPSAC report 2008).
Weaknesses in Community coordination, networks, links and partnerships
The absence of a formal coordination structure for the CHO leads to overlap in the implementation
and non rational use of the available resources, which as a consequence the insufficiency of the
coverage of needs of the national response.
The weak involvement of the private sector (formal and informal) in the national response to the
fight against HIV has as a consequence an insufficiency of coordination between the public, private and
community sectors. Despite the efforts deployed by the Government, coalitions of businesses and
certain partners in the in the promotion of the public-private partnership, the results remain below the
potentialities of the sector, because of the absence of operational mechanisms to ensure the
implementation of the partnership.
Weaknesses in Resources and capacities
The weaknesses of organizational capacities. The organizational insufficiency of certain associations
has had as a consequence the weak involvement of the CHO in the development of policies and
strategies as well as in the implementation of interventions.
Weakness in the strategic approach. The interventions implemented by these organizations are not
specific enough and put the accent on the project approach to the detriment of a program approach
which is part of the strategic plan.
The Weakness in mobilization, administrative and financial management. The CHO don’t always
have a real strategy for the mobilisation of resources. There are no procedure manuals and
administrative management tools, financial management and rendering of accounts. This leads to an
inadequacy of the allocation of resources with respect to needs. This also influences their capability to
implement interventions for the PLWHA, care and protection of the MARPs (Appendix 11).
Weakness in logistics. Some organization lack logistical resources (operating equipment, computer
equipment, etc.)
Weakness in human resources is observed in the context of the offering of prevention, care and
support services for the PLWHA and the groups most exposed to risk and vulnerable. This translates
into insufficient numbers of people, leading to a full time use of volunteers with limited technical skills
(Appendix 11).
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Weakness in the diversification of the offer of prevention, care and support services
We observe little specialization in the targeted interventions; on the other hand the package of
interventions delivered for a given target is often incomplete and the programmed interventions are
not often based on real analysis of the situation. As well, these interventions remain general and don’t
specifically address the preoccupations of these targets in terms of legal assistance for issues of
stigmatization and discrimination related to these groups (Appendix 18). This would also allow this
populations to have access to targeted prevention interventions, to know their serological status and
they have available equitable access to care and treatment.
Weaknesses of Monitoring evaluation and planning
The weak capacity of the community system to report and analyze data does not allow decision-making
based on evidence. The insufficiency of the supervisions of the organization of Civil Society in the
implementation of the interventions limits the performance of their actors and the capitalization of
acquisitions (Appendix 11).
4.3.4 Efforts to resolve weaknesses and gaps
Describe what is being done, and by whom, to respond to health and community system weaknesses
and gaps that affect HIV outcomes, as outlined in sections 4.3.2 and 4.3.3.
To respond to these weaknesses and deficiencies affecting the results in the matter of the fight against
HIV, measures have been taken, as follows:
(i)
Concerning the health system
The operational unit for the care of the ARV and the Health District (HD). The placement on ARV
treatment is carried out in specialized structures, notably the Care Units (UPEC) in the public, faithbased and private hospitals, and the Accredited Treatment Centres (CTA) at the level of the central,
regional and Company private hospitals of the country. The framing of the UPEC in the care of patients
on ARC is carried out by tutelage system developed since 2004 with the decentralization of care. The
CTA which are structures with personal and a high performance technical platform serve as reference
structures. They ensure the assurance/quality of the services offered by their subsidiaries, in the
context of the overall care of the PLWHA, by way of training on site, supervision, the establishment in
networks, internships for the UPEC agents in the CTA.
Health system:
1.
Provision of services

The government by way of the Ministry of health has always maintained its contribution for
the financing of ARC, medications for opportunistic infections, equipment and reagents for
the biological examinations, as well as a good use of the PPTE funds oriented towards the
sector of public health.

The construction and rehabilitation of the District Hospitals and the Health Centres by the
Government with support of the Partners (Islamic Development Bank, Development
Disindebtedness Contract (C2D(Health), African Development Bank), which has allowed
among other things to bring the PMTCT, prevention and CM services to the populations.

The start-up of support activities in the health facilities for the implementation of an
internal quality assurance system for HIV diagnosis in collaboration with CDC/GAP (Global
AIDS Program) and WHO to improve the quality of screening;

The implementation of a national quality assurance system for HIV diagnosis in
collaboration with CDC/GAP (Global AIDS Program) and WHO to improve the quality of
screening.

The TB/HIV activities in the prison setting by GTZ in the context of prevention and
treatment interventions for tuberculosis and screening for HIV.

The implementation of Round 3, 4 and 5 interventions on HIV, Round 3 and 9 on
Tuberculosis as well as 3, 5 and 9 for malaria have allowed and/or will allow important
realizations in these areas: reinforcement of the health system (care and laboratories),
reinforcement of capacities and rehabilitation of the CDT. This has led to the obtaining of
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significant progress in the areas of PMTCT, SMI, care of PLWHA, the reduction of morbidity
and mortality related to the three diseases.
2.
Human Resources

The recruitment by the Ministry of Health and the making available of health facilities of
4421 health personnel of all categories on PPTE funds and C2D (France) to improve the
health services offering including those related to HIV. The recruitment of 508 community
health workers (CHW) in the community-based organizations such as the Associations of
Persons Living with HIV and the making available of health facilities in the context of
Round 3 and 1500 community volunteers by Round 4 to ensure the continuum of care.

The establishment by the Ministry of Public Health in collaboration with OMS, ESTHER and
the French Cooperation (C2D) of a Policy of guardianship of the UPEC by the CTA since
2007, allowing to train, in complementarity with Round 10, the newly recruited personnel,
actualize knowledge and accompany the new structures in the operationalization of
services and programs.

The progressive training by the Ministry of Health of 3625 health agents (medical,
paramedical) and 1371 community agents on the aspects of prevention and care for HIV
infection including the management of medications.

The signing of an agreement between the Ministry of Health and the Ministry of Secondary
Education for the training of maintenance agents for health equipment including CD4 and
PCR devices.
3.
Medications, vaccinations and technology

4.
A technical coordination cell for the supply of HIV inputs which brings together the CNLS,
the Pharmaceutical Product Branch, the Department for the fight Against the Disease, the
Clinton Foundation, CENAME, ESTHER, WHO, UNICEF and USAID, has been put in place to
ensure the planning of medication needs.
Health information

5.
The establishment with OMS since 2007 of the surveillance program for resistances to ARV
allowing useful information for the choice of therapeutic protocols to be available
Financing

A system of mutualisation is in process of experimentation in the northern regions intends
to cover the health expenses related to PNC, birth and Caesareans with the assistance of
the French Cooperation.

The development of the public private partnership has led with the support of BIT to the
establishments of care services for PLWHA in companies (CDC, HEVECAM, ALUCAM, PHP,
SOCUCAM, CIMENCAM etc.) expanded to the surrounding communities. This partnership is
reinforced by the signing in March 2010 of an agreement framework between the Ministry
of Health and the employers’ association (GICAM) in order to promote co-investment in the
fight against HIV\aids.
Community system
1.
2.
The enabling environments and advocacy

Enabling environments and advocacy. The actions put in place consist of (i) the
restructuring of the network of associations of PLWHA since 2008 and the establishment in
2009 of a Taskforce of actors of Civil Society involved in AIDS who mandate is to put in
place “The Coalition of Civil Society of Cameroon against HIV/Aids” with the support of
UNAIDS and PNUD; and (ii) the establishment of sectoral networks: private sector
platforms (CCA-AIDS, CFBC), Alliance of Mayors and Municipal Authorities for the fight
against HIV/aids, the Coordination group section Operational Partners (GCOP).

Community experience aiming to involve men in the frequentation of SR/PMTCT services
“men as partners” has been led in the North-West with support from UNICEF.
Community coordination, networks, links and partnerships
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
3.
Resources and capacities

As far as resources and capacities, several initiative were put in place to reinforce the
capacities of the actors of the community systems in the form of logistical support for the
operating of RECAP+ and of the Alliance of Mayors against HIV.

Several initiatives were put in place to reinforce the capacities of the actors of the
community system in the form of (i) support for the operating of RECAP+ and other
associations of PLWHA by ACMS, UNAIDS and CAMNAFAW, (ii) logical and technical support
for associations of youths and unwed mothers by CAMNAFAW, GTZ, ACMS, IRESCO, UNFPA,
UNESCO, UNICEF, and (iii) technical support for actors of the private sector by BIT and
GTZ.

The strengthening of capacities of 52 NGO/Associations working in the care of OVC
between 2006 and 2009 in the context of Round 3. Support for the development of
governance of the OSC by UE by way of the Support Programs for the Stucturalization of
Civil Society Organizations (PASOC). Sixty five (65) companies GICAM, 9 companies from
the BOIS subsidiary, 5 companies from the transport sector and 25 PME/PMI from Douala
(CCA/Aids) benefited from capacity strengthening for their employers and works by BIT, as
well as the development of policy and action plans for the fight against Aids in companies
and the establishment of fight committees.
4.
4.4
The problems of coordination of the community response, find the beginnings of a solution
in: the network of associations for the PLWHA, the employers’ associations, community,
faith-based organizations and the Youth Network. The involvement of the private sector is
reinforced by the promotion of the Public Private Partnership (PPP) (MINHEALTH – Private
Sector) with the technical support of the International Work Office (BIT). The
establishment by MINHEALTH of an ad hoc committee for monitoring the fight against
HIV/Aids by civil society.
Diversification of the offer of prevention, care and support services

The service offers are more and more diversified towards the groups the most exposed to
risk notably the MSM (by way of CAMNAFW and Alternative), incarcerated men, the SW,
the truck drivers (ADMS, CHP by way of AWARE/USAID). Otherwise the private sector is
involved by the designation of some medical services of companies as treatment centres
and care centres for the PLWHA: Cameroon Development Cooperation (CDC), HEVECAM,
ALUCAM, PHP.

On the other hand, NGO diversify more and more their offer of service by orienting their
interventions in the direction of SW, MSM and Truck drivers. This is the case with
CARE/USAID by way of the Male as Partner project.
Proposal strategy
Complete this version of section 4.4.1 if the applicant selected option 2 or 3 in section 3.1 of
the Proposal Form
Option 2 = Transition to a single stream of funding during grant negotiation
Option 3 = No transition to a single stream of funding in Round 10
4.4.1 Interventions
Describe the objectives, service delivery areas (SDA), and activities of the proposal. The description
must be organized in that exact order and the numbering system must match the Performance
Framework, detailed budget and work plan.
The description must reference:
(a) who will implement each area of activity (e.g. Principal Recipient, Sub-recipient or other
implementer); and
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(b) the targeted population(s).
Goal 1: Reduce new HIV infections of new born through PMTCT
Cameroon has opted for virtual elimination of TME. It is as such that strategic axis 1 of the NSP 20112015 aims to cover 90% of the seropositive pregnant women and 100% of the infants exposed to HIV.
This proposal focuses on 70% of the needs and the rest will be covered by the Government and the
other partners.
The proposal contributes to the needs of pregnant women and infants by way of interventions relative
to pillars 3 and 4 of the prevention of HIV in this group. This requires the establishment of strategies
aiming to increase access and use of PNC services by pregnant women as well as the improvement of
the services offered including PMTCT. The 1st pillar, centred on the primary prevention of infection
among women of procreating age, especially young girls of 15-24 years of age will be taken into
account by the government and its other partners. These last will support also the aspects of the 2nd
pillar which is the prevention of unwanted pregnancies amongst seropositive women. The strategies of
notification of partners, comprehensive PMTCT, the CM of infants allowing improvement of the
frequentation of partners of pregnant women in the PMTCT services. The interventions of community
mobilization aim for both the pregnant women and their partner in order to increase the use of health
services.
Objective 1.1: Increase from 35% to 80% the proportion of pregnant women who benefit from at
least one CPN including screening for HIV by 2015
These interventions aim to improve the access to screening counselling from 333,386 to 859,655
pregnant women seen in PNC from 2011 to 2015 in the 178 health districts.
The coordination will be ensured by the PR governmental and a sub recipient coming from civil society.
The implementation will be ensure by the health personnel (in the health facilities) and civil society (in
the community).
SDA 1.1.1: RSC: Advocacy, communication and social mobilization
The civil society organizations and the community volunteers coming from various organizations will
organize the actions of continuous and permanent social mobilization and the awareness outreach in
the neighbourhoods and villages with a view to increase the frequentation of health services
(SMI/SR/FP/PMTCT/HIV) by pregnant women and their spouses as well as a direct support to HIV
seropositives. The activities of the CV will be ensured by 1600 OBC (the mother providers, HIV+
mothers, Women’s associations, support groups, PLWHA associations, religious confessions…). These
activities of the OBC will allow research for those lost sight of and their effective mobilization for the
PNC services. The proposal will contribute to the development and the multiplication of promotion
tools for the interventions. As well, it will support the radio broadcast communication by contracting
with 75 community radios who will broadcast messages appropriate for the local cultural context on
the SMI/SR/FP/PMTCT/HIV. The advocacy actions supported by the Government and Round 10 will be
organized in the direction of women’s associations, opinion leaders, traditional authorities, religious
authorities and decision makers at all levels in order to promote PNC and PMTCT.
The coordination will be ensured by the PR governmental: MINHEALTH and the implementation will be
ensure an SR coming from civil society: CARE and other SR from civil society.
Targets: pregnant women, partners of pregnant women, community leaders
The main activities of this SDA are:
1.1.1.1
Train 3200 CV (women and men) coming from 1600 OBC in the 178 health districts on
communication and social mobilization techniques (for the PMTCT, care)
1.1.1.2
Organize bi-monthly sessions of community dialogue (CIP, home visits, research for lost from
sight) by the CV for the mobilization of pregnant women and their spouse for years 1, 2, 3
1.1.1.3
Design communication tools to promote access to the PNC and SSR in the community setting
for the mobilization of women (especially those lost from sight) and their partners
1.1.1.4
Produce interpersonal communications tools in the community setting for the mobilization of
women and their partners for PMTCT
1.1.1.5
Contract with 75 community radios and training the facilitators for the broadcasting of
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communications messages adapted to the local context for the mobilization of women and
their partners for PMTCT
1.1.1.6
Organize 02 national days of social mobilization for PMTCT and SR (caravans broadcasting
messages, moving cinema, theatre) in the large gathering places of neighbourhoods and
villages
1.1.1.7
Organize 05 advocacy sessions at the level of the health districts at the place for presidents
of female associations, religious leaders, village chiefs and access to PMTCT/SR in years 1 and
2
1.1.1.8
Organize 02 advocacy sessions/training sessions in each FS to improve the reception of
patients (pregnant women, partners, PLWHA, etc…) in the different services in years 1 and 2
1.1.1.9
Organize integrated activities for awareness outreach for parents, community volunteers,
women’s associations, association of seropositive mothers and the other community actors.
1.1.1.10 Provide the 05 SR with office and computer equipment for the monitoring and reporting of
PMTCT and CM community activities and prevention in the direction of groups of risk
1.1.1.11 Acquire 06 4x4 vehicles for the supervision of the implementation of PMTCT activities,
community CM and prevention in the groups at risk by the NGO and OBC.
SDA 1.1.2 HSS (Health system strengthening): Health professionals
SDA Description: This SDA will allow strengthening of the capacities of health professions in order to
respond in the long term in the improvement of services of maternal and infant health. The
MINHEALTH will ensure the application and the monitoring of decisions relative to the harmonization of
PNC costs and the births in all of the health facilities. They will develop the integrated DCIP
(Screening Counselling Initiated by the Provider) training documents, SONEU (Obstetrical and Neonatal
Emergency Care), SR (Reproductive Health), Nutrition in the HIV context, early screening, FP (Family
Planning). The country has 102 trainers available. This proposal thus aims to train 254 trainers of
health providers. These trainings would take place as a cascade, starting from the central level to the
operational level for a coverage of all of the health structures in trained personnel. The post training
monitoring will be carried out during the joint supervisions carried out by the DS team. This capacity
strengthening strategy for providers adds to training in counselling screening of 1052 providers initiated
in years 1 and 2 in the context of Round 5. Round 10 will also support the carrying out of supervision.
The Government ensures, under C2D financing from 2011, the strengthening of capacities of personnel
with 901 health trainings in SONEU including PMTCT. As well, the development partners (UNICEF, OMS,
UNFPA) will support the development of the modules.
The coordination and the implementation of the activities will be done by the PR governmental:
MINHEALTH
Targets: health providers of the FS
1.1.2.1
Produce and disseminate the SMI training modules: PMTCT/Reproductive Health/SONEU
(Obstetrical and Neonatal Emergency Care)
1.1.2.2
Train 254 trainers of health providers of the health system and of the community system
on the maternal and infant health package (SMI)
1.1.2.3
Train/retrain 3336 health providers (02 per FS among 1668 FS out of 2569) in
PMTCT/SONEU
1.1.2.4
Organize training sessions of 10 working days for 1500 health personnel in the PMTCT
reference centres (post-training session)
1.1.2.5
Organize post-training supervision missions (2nd level tutelage)
SDA 1.1.3 Testing and counselling
SDA Description: The screening of pregnant women will be done according to the “opt out” approach
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in fixed strategy (by promoting screening at the initiative of the provider) in the FS and the community
care structures; in advanced strategy by the health centre managers during their descents into the
community for health interventions (TPI, vaccination, mosquito nets). The pregnant women will be
tested on the finger by the health personnel with provision of the results the same day. At the level of
the community, the CHW (community health worker, trained and competent) in collaboration with the
health personnel will proceed with pre and post counselling. The CHW will work in tight collaboration
with the community volunteers to identify pregnant women needing the screening test.
This proposal will ensure the purchase of reagents for the screening of pregnant women at the rate of
20% of the needs of the proposal, the rest being ensured by MINHEALTH as part of the funding for PPTE
and the other partners. The CHW (508 former and 100 new) will be provided with screening kits and
trained on the counselling and technique of screening using the finger.
The coordination and the implementation of the activities will be done by the PR governmental:
MINHEALTH
Targets: pregnant women seen in PNC
1.1.3.1
Acquire for a national supply of reagents and consumables for the screening counselling in
PNC/PTME (routine screening, sentinel PMTCT sites, operational research)
1.1.3.2
Train 608 CHW community health workers on the counselling and technique of rapid
screening
1.1.3.3
Provide the 608 CHW (508 former and 100 new) with integrated counselling kits (box,
jacket, tools for IEC, book for data management).
Objective1.2: Increase from 19% to 70% the proportion of seropositive pregnant women and their
infants who receive ARV to prevent MCT by 2015
This will require covering by 2015, 57,167 HIV+ pregnant women and 57,167 newborns born of
seropositive mothers in the 178 health districts
SDA 1.2.1: PMTCT
SDA Description: This SDA will ensure the passage from the scale of the offer of PMTCT services to the
pregnant women. All of the HIV+ pregnant women received in PNC will be consulted on nutritional
practices for the child and observance of the taking of the ARV and cotrimoxazole. These HIV+ women
will benefit from the lymphocyte counting CD4. Those needing ARV treatment for their own health
(CD4˂350) will be oriented in the context of the overall care for adults. The others (CD4˃350) will
receive the ARV for prophylaxis according to the recommendation of WHO 2009 following option A
adopted by Cameroon (Appendix 19). These women will receive the ARV treatments (in the form of a
single treatment package Mother Baby Pack (MBP). This proposal will support the actions aiming to
combine the needs in ARV and other inputs relative to PMTCT. As well, it will contributed up to 70% in
2015 of the target PMTCT of the NSP 2011-2015 and the 10% remaining will be covered by the
Government and its partners. The interventions of social mobilization aiming to increase the
frequentation of PNC services by pregnant women and the coverage in ARC of HIV+ pregnant women
are already described in SDA 1.1.1 and 1.1.2 for objective 1.1, and will contribute to the attaining of
objective 1.2.
The coordination will be ensured by the PR governmental: MINHEALTH and the implementation of the
activities ensured by the MINHEALTH in collaboration with the SR of civil society: CBC
Targets: seropositive pregnant women seen in PNC and their infants
1.2.1.1
Provide 128,761 single packets (MBP) of APV medications (ARV, cotrimoxazole) necessary
for the seropositive pregnant women and the infant for prophylaxis
1.2.1.2
Acquire 184 kits for nutritional rehabilitation (Image boxes, scale, height measure, tape
measure WHO table of growth standards) for 23 CTA for nutritional rehabilitation
1.2.1.3
Equip 120 of the community care structures in tools for monitoring evaluation (registers,
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summary sheets) and consumables for the PNC/PMTCT
Objective 1.3: Increase from 16 to 70% the proportion of exposed infants tested for HIV (PCR) at 6
weeks by 2015
The access to early diagnosis will be offered to 57,167 exposed infants in 2015 in the 10 Regions.
SDA 1.3.1: HSS (Health System Strengthening): Health professionals
SDA Description: This SDA aims to strengthen the capacities of providers in view of the extension of
the national network for collection, shipping of all of the samples (DBS) from the FS to the reference
laboratories and the return of results. The proposal will ensure the training of 06 doctors and or
biology technicians specialized in DIU of molecular biology The laboratories of the regional structures
will be trained in the collection of samples on blotting paper, the management of inputs,
communication and the transmission of data.
The coordination and the implementation of the activities will be done by the PR Governmental:
MINHEALTH
Targets: Health professionals
1.3.1.1
Train/retrain 18 regional laboratory and national reference (CIRCB and CDC) personnel on
the early diagnosis of HIV among children born to seropositive mothers;
1.3.1.2
Train at the DIU (international course) 06 doctors/technicians as national reference people
in molecular biology
1.3.1.3
Train the providers of the PMTCT sites on the collection of samples of DBS (taken into
account in SDA 1.1.2)
SDA 1.3.2: HSS (Health System Strengthening): Provision of services
SDA Description:
The PCR devices of the reference laboratories are used for early diagnosis. The functioning of these
laboratories will be reinforced by the training of 06 doctors and/or technicians specialists in biology,
the acquisition of additional equipment and a maintenance contract for the said equipment. These
laboratories will be supplied with PCR reagents and the health facilities will be provided with kits for
sampling and monitoring tools. A network centred on the district and assimilated hospitals will
facilitate the regrouping and shipping of all of the DBS sampled in the health facilities offering PMTCT
in each Health District and the return of the early diagnosis results.
The coordination will be ensured by the PR Governmental: MINHEALTH and the implementation of the
activities ensured by the MINHEALTH in collaboration with the SR of civil society: CBC
Targets: reference laboratories, FS in the HD
1.3.2.1
1.3.2.2
1.3.2.3
Contract with a transport agency for the samples between the collecting centre and the
reference laboratory for the return in real time of the results of early diagnosis
Supply the 02 reference laboratories with inputs for early diagnosis
Produce the management tools (book of sheets for examination request, books of shipping
sheets)
Goal 2: Reduce the new infection by HIV among the SW, MSM, Truck Drivers and their partners
Goal 2 of this proposal aims to reduce the new infections by HIV among the populations the most
exposed to risk (SW, MSM and truck drivers) and their partners by way of offering a package of
interventions that are coherent and integrated including: BCC, the promotion and supply of condoms,,
the syndromic care of STIs, counselling and HIV screening, as well as the fight against stigmatization
and discrimination. The overall care (ARV, OI) in favour of these groups is taken into account in the
interventions of SDA 3.1.2 of Goal 3.
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Objective 2.1: Ensure the access to prevention services and the reduction of discrimination to
14240 MSM, 39,440 SW and 148,800 Truck Drivers in the 10 regions by 2015
SDA 2.1.1 BCC – Community truck stops and schools
The proposal aims to organize meetings and educational discussions in order to bring the groups the
most exposed to risk to use the prevention services. These meetings and discussion sessions will take
place in the activity zones of the different groups (bars/cabarets, meeting places, truck parks,
companies). Prevention kits will be acquired and available from peer educators for the SW and Truck
Drivers, and health mediators for the MSM for demonstrations. The training will be ensured by the
peer educators (PE) and health mediators (HM) coming from the OBC working with the different
targets. Also the BCC manuals (brochures, flyers, posters etc.) specific to each group will be produced
and distributed.
The coordination will be ensured by the PR of civil society: CAMNAFAW, and the implementation by the
SR involved in these groups: CHP, Presse Jeune
Target: 148,800 Truck Drivers, 39,440 SW, 14,240 MSM and their partners
2.1.1.1
Organize training for the managers of the 120 OBC working with the target groups and
their partners on the questions related to the access to integrated prevention services and
the care of the populations the most exposed to HIV risk (MARPs)
2.1.1.2
Train and retrain the supervisors coming from the 12f0 OBC on the questions related to
rights, access to integrated prevention and care
2.1.1.3
Design/multiply and disseminate 3500 copies of the reference guide for peer education ion
all of the MARP locations
2.1.1.4
Train and retain 11584 peer educators in the SW group on the techniques of peer
education, life skills and reproductive health
2.1.1.5
Train and retrain 535 health mediator in the MSM group on the techniques of peer
education, life skills and reproductive health, sexo-specificity related to gender,
promotion and correct use of the condom
2.1.1.6
Design and produce integrated prevention supports and for the promotion of access to care
adapted to each group most exposed to risk (SW, MSM and Truck Drivers)
2.1.1.7
Acquire 2119 tools and IEC/BCC materials for the peer educators (1584) and health
mediators (535)
2.1.1.8
Organize 136,764 educational discussion groups with the SW, MSM, Truck Drivers for the
reinforcement of the prevention of STI\HIV and access to care
2.1.1.9
Organize 05 regional experience exchange meetings between the peer educators and
supervisors
2.1.1.10
Organize 02 biannual supervision missions of the SR towards the OBC and 04 quarterly
supervision missions (OBC) towards the PE and MS.
SDA 2.1.2: RSD Development of linkages, collaboration and community coordination
Description of SDA: This requires updating the mapping of public, private and community health
structures offering or able to offer services to these populations in respect of their specificities and
their needs.
Quarterly meetings will be organized at the level of each region between the FS and OBC to evaluate
the quality of the services offered to each group.

For the MSM, the identified community centres will be established (life community centre) in
order to improve access to information and prevention in this group. The tools (registers and
sheets, vouchers) of reference will be produced and made available to the FS and the OBC

For the SW, MSM and truck drivers, the identified health centre offering prevention and care
services for STI and for counselling screening of HIV.
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The coordination will be ensured by the PR of civil society: CAMNAFAW, and the implantation by the SR
involved in these groups: CHP, Presse Jeune
Targets: SW, MSM and Truck Drivers
2.1.2.1
Update the mapping for the health structures to receive and offer prevention services to
the SW, MSM and Truck Drivers and their customers/partners;
2.1.2.2
Design, produce and disseminate the tools: 15,000 sheets to allow the reference and
counter reference of the targeted persons between the health system and the community
system;
2.1.2.3
Organize 04 meetings per year for discussion and advocacy at the regional level between
the associated community actors and the health actors for access to prevention and care
of the MARPs;
2.1.2.4
Establish and equip 30 health structures offering information and prevention spaces for the
SW and Truck Drivers;
2.1.2.5
Equip 10 community life centres in STI/HIV/aids information and awareness Kits (TV, DVD
or LCD), prevention and care for the MSM.
SDA 2.1.3: Condoms
SDA Description: This requires acquiring and supplying condoms (male and female) to the different
target groups and their partners. The overall needs in condoms are estimated at 132,554,349 male and
8,129,931 female. The proposal takes into account 25% of the needs. These condoms will be
distributed freely to the SW, MSM, truck drivers and their partners during demonstration sessions on
the correct use of condoms.
The social marketing sellers of condoms will be trained in the different techniques of distribution
without stigmatization (friendly) and the demonstration of the correct use of the condom. Monthly
supervisions will also be carried out by the SR personnel in charge of the activity with the aim to
strengthen the capacities of these vendors and enlarging the distribution network.
The coordination will be ensured with the PR Governmental: MINHEALTH and the implementation by an
civil society organization.
Targets: 148,800 Truck Drivers, 39,440 SW, 14, 240 MSM and their partners.
2.1.3.1
Acquire 33,138,587 male condoms for the Truck Driver and MSM populations
2.1.3.2
Acquire 202,748 female condoms for the SW populations
2.1.3.3
Acquire 3,590,240 lubricating gels for the SW, truck drivers and MSM
2.1.3.4
Train the social marketing sellers
2.1.3.5
Ensure the delivery of the condoms to the recipient distribution sites
SDA 2.1.4: Diagnosis and treatment of STI (Sexually Transmitted Infections)
SDA Description: 240 providers from the 120 health facilities (public, private and faith-based)
identified in the intervention zones will be trained on the care of STI following the syndromic
approach. The health facilities will be supplied in medication in the form of CM syndromic kits for the
STI.
The care will take place in advanced strategy (campaign in the activity and socialization sites in the
target groups, invention coupled with HIV monitoring) and fixed (in the friendly health centres or in
relationship or belonging to the OBC-GIC, NGO, Association, etc – working with the targets). The
actions will also concern the targets as well as their customers or partners. The health facilities will
be supplied with equipment for the storage of the kits and other CM consumables, audio visual
equipment for the awareness, as well as data collection tools. These health facilities will be
supervised quarterly by the sub beneficiary.
The coordination will be ensure by the PR for civil society: CAMNAFAW, and the implementation by the
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Targets: 148,800 Truck Drivers, 39,440 SW, 14,240 MSM and their partners
2.1.4.1
Retrain 240 health care providers in 120 health facilities offering prevention and care to
the SW, MSM, and Truck drivers on the diagnosis and syndromic CM of STIs as well as the
screening for HIV;
2.1.4.2
Produce training manuals for care providers on integrated prevention, care of STI and
access to care;
2.1.4.3
Supply the 120 public and private health facilities with kits of medications for syndromic
CN of STI;
2.1.4.4
Ensure the quarterly supervision in collaboration with the MINHEALTH of 120 health
facilities on the prevention, care of STI and to care for the SW, MSM and truck drivers
2.1.4.5
Establishment of a continuous quality evaluation system of the care of STI and access to
care by the TS, MSM and truck drivers
SDA 2.1.5: Testing and counselling
SDA Description: This SDA aims to ensure the screening of HIV in the target groups (TS, MSM, truck
drivers) in order to offer correct care. The screening will take place in advanced strategy by way of
mobile units (information and awareness campaigns in the activity sites and in the community life
centres, screening for HIV, promotion of the correct use of condoms and notification of partners) and
fixed strategy (in the classic CS and “friendly” health centres for these groups). The 12 mobile units
involved in the advanced strategy are already available
The coordination will be ensure by the PR of civil society: CAMNAFAW in collaboration with the
MINHEALTH
Target: SW, MSM and Truck Drivers
The main activities of the SDA are:
2.1.5.1
Support the operations of 12 mobile screening units for the carrying out of screening
campaigns for HIV in the intervention zones for the target groups, their partners and
riverside populations;
2.1.5.2
Organize the activities of promotion of HIV screening in collaboration with the
NGO/associations of the target groups (SW, MSM, Truck Drivers)
SDA 2.1.6: Reduction of the stigmatization in all contexts
SDA Description: In this SDA, this requires reducing the discrimination and stigma among some care
providers in the health facilities, by developing a better understanding of the life context for the MSM,
SW and truck drivers. This will be done by way of learning sessions aiming for the acquisition of the
aptitudes and skills for the welcoming and CM of these populations in the respect of gender, their
rights and their dignities. These quarterly sessions will take place within the health facilities which
have established partnerships with the OB and the NGO working for the health of these populations.
The necessary tools for the training of health mediators and peer educators will be developed,
multiplied and distributed with the support of the proposal. Legal consultations will be made available
for these groups to strengthen their knowledge in the area of stigmatization and discrimination.
The coordination will be ensured by the PR of civil society: CAMNAFAW, and the implementation by the
Target: SW, MSM and Truck Drivers
2.1.6.1
Organize quarterly meetings between the OBC/associations/NGO representing the SW,
MSM, truck drivers and the managers of health facilities in order to improve the offer of
care;
2.1.6.2
Organize advocacy session for the health personnel for the reduction of stigmatization and
discrimination in the health services for the groups at risk;
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2.1.6.3
Organize 04 annual meetings for the legal education and the protection of rights towards
the SW, MSM
2.1.6.4
Training the OSC managers in the framing of the OBC offering the intervention package in
matters of prevention, SR, violence towards women and access to care among SW, MSM
and Truck Drivers;
2.1.6.5
Organize legal sessions for the protection of the rights of the SW and MSM
Goal 3: Reduce the morbidity and mortality related to HIV as well as the socio economic impact by
way of the strengthening of the overall care for the adult and child PLWHA and the support to OVC
by 2015
Objective 3.1: Ensure overall quality care to 80% of the adult and child PLWHA eligible by 2015
This involves offering ARV treatment to 226,338 eligible patients (210,264 adults and 16,074 children)
in the whole country according to the national directives adopted in 2010. These patients also benefit
from psychological and social care in the context of a continuum of care. Round 10 will supply 50% of
the financing for the costs of the ARV, the other half being taken care of by the Government of
Cameroon.
SDA 3.1.1: HSS (health system strengthening): Health professionals
SDA Description: the main activities in this SDA aim to strengthen the capacities and skills of the
caring personnel the strategy of guardianship (overall care of PLWHA, identification and the reference
of exposed children towards the appropriate screening and/or care services and the management of
ARV and OI medications.
The training/retraining targeting the medical and paramedical personnel of the 140 existing care
structures and the 100 new ones which will be created to cover all of the operational district hospitals
to ensure the implementation of the new WHO 2009 recommendations in PMTCT (pregnant women
eligible for TAR). Formations targeting the 140 existing CM structures will be ensured by the C2D
financing by way of the strategy of tutelage of the UPEC by the CTA (first level tutelage). The
personnel of the 100 new structures created (UPEC) will be trained in overall care in the form of 20
structures per year (10 HD, 5 CMA, 5 CSI). The implementation of the activities of these 100 new
structures will be supervised by the 140 former ones according to the 2nd level tutelage strategy with is
taken into account by this proposal. This 2nd level tutelage strategy will be implemented from the 6th
week during the training session. A practice session of 3 days will be cared out in the site of the
“tutor” structure by 2 personnel of the tutored site every 3 months during the course of year 1 of the
activity start-up.
Guides for care, training modules and modules for the strengthening of provider capacities on
assistance with observance, nutritional and therapeutic educational counselling will be ensured by the
UNITAID financing. The integrated training tools on the different aspect of overall CM of adults,
pregnant women eligible for TAR and children will be developed and produced with the support of the
development partners.
The coordination and the implementation will be ensured by the PR governmental: MINHEALTH
Targets: Health personnel
3.1.1.1
Train 960 paramedical personnel (4 per UPEC) on the overall CM of adults, children and
seropositive pregnant women
3.1.1.2
Train 480 doctors on the overall CM of adults, children and seropositive pregnant women
3.1.1.3
Ensure the supervision of the 100 new CM structures (1st and 2nd level tutelage)
3.1.1.4
Ensures for 5 years the practice sessions (10 days/session) for 800 personnel from the 100
new structures created.
SDA 3.1.2: Antiretroviral (ARV) treatment and monitoring
SDA Description: the provision of antiretrovirals for eligible children and adults, the carrying out of
monitoring exams and support for observance of patients are the main activities in this SDA and have
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been implemented from Round 3 and under the financing of the continuity of services until December
2011. A total of 21,264 adults (of whom 22,868 are eligible seropositive pregnant women) and 16,074
children will be covered in treatment of 1st and 2nd line in accordance with the national directive by
the end of 2015 in the 240 CM structures. The new therapeutic combinations excluding stavudine will
be progressively introduced in this Round 10.
To attain these targets, all of the opportunities offering health care for adults and children (workplace
medicine, PEV, growth monitoring, malnutrition, paediatric consultation, TC etc) will be used to offer
HIV screening to patients presenting symptoms evocative of HIV infraction. This means also ensures
the carrying out of monitoring examinations and viral load (for children).
This proposal intends to ensure the pre-therapeutic exam (NFS, glycaemia on an empty stomach, etc…)
to all people newly screened HIV+ with a dosage of CD4 lymphocytes. A monitoring exam (Appendix
19) for the PLWHA not eligible for ARV with the dosage of CD4 lymphocytes two times per year will also
be taken into account in the context of this proposal. The exam of PLWHA on ARC is constituted of 021
dosages of CD4 lymphocytes.
The contributions of the Government and its development partners (between 2007 and 2009) allowed
the coverage in ARV among adults and children to 30.6% (76,228). Round 10 will support 50% of the
financing for the attaining of 80% coverage. The other half (50%) of the costs of ARV treatment already
being taken into account by the Government.
The coordination and the implementation will be ensured by the PR Governmental: MINHEALTH
Target: PLWHA
3.1.2.1
Acquire first and second line ARV medications for the adults
3.1.2.2
Acquire first and 2nd line paediatric ARV medications
3.1.2.3
Acquire reagents and consumables for the orientation exam (CD4) pre-therapeutic (NFS,
glycaemia, transaminase) and for monitoring of the PLWHA
SDA 3.1.3 HSS (health system strengthening): Provision of services
SDA Description: The activities of this SDA aim to improve the decentralization of the offer of service
in the 240 care structures of which there are 100 new ones. Among the 140 already existing, the needs
in equipment for the biological monitoring of patients are 39 spectrophotometers, 38 haematology
automats and 73 centrifuges. As well, among the 100 new structures to be made operational, 50
require reinforcement in equipment. Within the context of the decentralization strategy and the
overall care, 42 CD4 counting devices are available and functional. The addition need to cover all of
the care structures is 40, these will be acquired by the Government of Cameroon with PPTE fund
(Appendix 20).
Within the framework of this proposal, a pharmacist will be recruited to establish an appropriate
forecasting system and for the management of inventory procurement as well as the quality assurance
system for medications and inputs. The maintenance of the bio-medical equipment above will be
ensured by the government and the other partners.
The coordination and the implementation will be ensured by the PR governmental: MINHEALTH
Targets: PLWHA
3.1.3.1
Acquire 88 haematology automats and 89 biochemistry spectrophotometers and 123
centrifuges for the 140 former structures (CTA/UPEC) and 50 of the 100 new structures
and 02 PRC devices.
3.1.3.2
Acquire consumables and small equipment for the 2 molecular biology reference
laboratories to ensure early diagnosis
3.1.3.3
Ensure the maintenance of biomedical equipment in the CM structures (CD4, viral load,
automats, PCR, etc)
3.1.3.4
Ensure the quality control of the laboratories responsible for the biological exams related
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to HIV (CD4, viral load and HIV screening)
3.1.3.5
Ensure the quality of care services for the PLWHA in UPEC and CTA
3.1.3.6
Ensure the indemnisation of 10 regional focal points for the implementation and
monitoring of the implementation of the PMTCT activities and the overall care in the 10
regions
3.1.3.7
Ensure the indemnisation of a pharmacist specialized in forecasting and planning the needs
in medications and reagents at the level of GTC/NAC
SDA 3.1.4: Prophylaxis and treatment for opportunist infections
The national policy for the care of PLWHA allow free access for patients to prophylactic and curative
treatments for major opportunistic infections such as tuberculosis by way of the program dedicated to
this disease, toxoplasmosis, pneumocystose, cryptococcose and buco-oesophagan candida).
This proposal intends to continue the free care of opportunist infections started by R3 and the
financing over the therapeutic continuity of Round 3 until December 2011. As for the ARV, the other
half (50%) of the costs of MIO treatment will be taken into account by the Government.
The implementation and the coordination of these activities will be ensured by the PR governmental:
MINHEALTH
Targets: PLWHA
3.1.4.1
Acquire cotrimoxazole for the prophylaxis of OI in adults
3.1.4.2
Acquire cotrimoxazole for the prophylaxis of OI in children
3.1.4.3
Acquire medications for Cerebral Crytococcose for adults and children
3.1.4.4
Acquire medications for toxoplasmosis for adults and children
3.1.4.5
Acquired medications for fungal infections, for adults and children
3.1.4.6
Distribute the mediation for Opportunistic Infections
SDA 3.1.5: Tuberculosis/HIV
SDA Description: The Round 9 tuberculosis component already contributes to the training of care and
diagnostics providers for HIV among TB patients, and to integrate the counselling and screening for HIV
in the treatment centres for tuberculosis (CDT). This Round 10 will continue the policy of integration of
TB/HIV programs. It will ensure the training of health personnel in the 100 new UPEC and to retrain
those of the 140 others on the care of the coinfection TB/HIV which also constitutes a training module
in the overall CM of the adult, including the pregnant woman the children eligible for TAR. This
proposal will also support the evaluation of the prevention interventions for tuberculosis in HIV+
patients initiated within the framework of Round 5 in 10 CM structures for PLWHA. The TB/HIV
working group bringing together the different actors will be strengthened for a better coordination and
monitoring of TB/HIV interventions.
This activity will be coordinated by the PR government: MINHEALTH
Targets: health personnel
3.1.5.1
Train/retrain the providers of the 100 UPEC/CTA (02 per structure) on the prevention and
care of TB/HIV coinfection
3.1.5.2
Support the operations of the working group on HIV/TB
3.1.5.3
Carry out an evaluation of the prevention interventions for TB among HIV patients
(prophylaxis with INH).
3.1.5.4
Organize annual meetings on the coordination, joint planning and monitoring of TB/HIV
activities
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SDA 3.1.6: Care and support: care and support for the chronically ill
SDA Description: This SDA allows insurance of the continuity of care for persons infected and affected
at the level of the community and companies with care structures. This strategy is based on a
collaboration and complementarity between the care structures of the health system and the
community system organisms. The main actors of this section are: (i) the ARC attached to the CM
structures and (ii) the OSC and the OBC involved in the communities: mother providers, HIV+ mothers,
male as Partner, support groups. The existing networks of the religious organizations and the
associations of PLWHA will be enhanced to potentialize the supply of care and support to the
chronically ill. In order to facilitate the implementation of the activities, each Health District will be
placed under the responsibility of an OBS/OSC (SSR) who will work with the other OBC/OSC for its zone
of intervention.
The continuum of care interventions to be implemented will be set out in a national guide for the care
of PLWHA in the community setting. This will be elaborated by the MINHEALTH and its other partners.
These community actors will implement the following activities: (i) the psychological and social
monitoring of the PLWHA (under ARV treatment or not including seropositive pregnant women and
TB/HIV patients) by way of among other things home visits or use of a green line; (ii) assistance in the
observance of ARV treatment including TB by way of therapeutic education and counselling in the
health facilities and in the communities; (iii) the research and reintegration of those lost from sight in
the active file of the health facilities; (iv) running of information and education sessions on HIV and TB;
(v) the implementation of finger screening (vi) nutritional education, (vi) social mobilization for the
frequentation of the health services (vii) the referencing and counter referencing with the CM
structures, (viii) the reporting on community activities.
The community actors will cover all of the communities in relation with the health zones and the 240
CM ARV sites. The establishment of 100 new UPEC will require 400 new ARC which will be mobilized as
needed from the site extensions.
The coordination will be ensured by the PR Governmental: MINHEALTH and the implementation by the
SR of civil society: CARE
Targets: PLWHA
3.1.6.1
Revise the national CM community guide for PLWHA including TB
3.1.6.2
Produce and disseminate 360 national community PLWHA guides (03 per OBC)
3.1.6.3
Pursue indemnisation of 908 (508 former and 400 new) CHW involved within the
associations, in the context of the mobilization for PMTCT, integrated prevention and the
continuum of care
3.1.6.4
Train/retrain 908 CHW by 2015 involved within the associations, in the context of the
mobilization for PMTCT, integrated prevention, the continuum of care and education
3.1.6.5
Revise and produce didactic tools for assistance with observance of ARV treatment of adult
and child PLWHA (908 image boxes and 100,000 flyers)
3.1.6.6
Support the OSC and OBC for the monitoring/supervision of activities of community
volunteers
3.1.6.7
Support the implementation of home visits by the CV including the awareness of the
observance of TB and ARV treatment
3.1.6.8
Revise and reproduce 1200 TAR registries and Pre-TAR registries (05 per care structure for
05 years) for reporting
Objective 3.2: Reduce the impact of HIV/Aids among the OVC and the stigmatization and
discrimination related to HIV
This will involve making available 100,000 support packages to the OVC in the form of 20,000/year by
2015, and to lead activities aimed to reduce the stigma and discrimination associated with HIV
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SDA 3.2.1: Support for orphans and vulnerable children
SDA Description: Cameroon proposed to continue the CM of the OVC by capitalizing on the acquisitions
and experiences of Round 3, following a methodology based on: (i) the dividing of the country into 82
intervention sites; (ii) the assignment of 01 Social Worker per intervention site for social surveys of the
OVC; the psychosocial support and home monitoring of the OVC with a maximum monitoring load of
250 OVC; (ii) the renewal of the data base by the physical identification of the OVC; (iv) the targeting
of interventions by age bands, sex and degree of vulnerability; (v) the strengthening of the OSC
capacities by way of one OSC per site, organizations of the private partner sector for the holistic CM of
the OVC; (vi) the identification of the specific needs of the OVC to be supported and the enrolment of
new OVC in the CM each year; (vii) the implication of families and communities in the CM of the OVC.
This proposal aims to consolidate and strengthen these acquisitions of Rounds 3 and 4.
At the level of the Communes, the Ministry of Social Affairs (MINAS) will provide technical support to
the Social and Social Action Services Centres which will ensure the monitoring of the access of the OVC
to the services offered by the health institutions, education and training and justice.
For the duration of the proposal, 100,000 individual support packages will be provided to the OVC,
according to their degree of vulnerability, or 20,000 supports per year.
The coordination will be ensured by the PR governmental: MINHEALTH, and the implementation by CRS
Targets: OVC
3.2.1.1
Revise, produce and distribute basis documents (250 execution manuals, 250 monitoring
manuals and 250 Social Worker manuals)
3.2.1.2
Train 10 trainers of social workers and members of the NGO
3.2.1.3
Train/retrain in 02 sessions of 05 days, 164 providers (82 members of civil society partner
organizations as 01 per site, 82 Social Workers or 01 per site) on the holistic care of OVC in
years 1 and 3
3.2.1.4
Mobilize the communities and private sector organizations for the community care of the
OVC
3.2.1.5
Care for 20,000 OVC per year (nutritional support, educational, pyschosocial, health and
legal protection)
3.2.1.6
Indemnify 82 Social Workers (01 Social worker per intervention site) for the framing of the
OVC
3.2.1.7
Organize the supervision of the NGO/Associations by the PR civil society
3.2.1.8
Identify each year new OVC and the specific needs of the OVC to support in the year, in
order to update the database and provide targeted support
3.2.1.9
Support the operations of 82 support Associations for the OVC
SDA 3.2.2 Reduction of the stigma in all contexts
SDA Description: The environments identified as the most affected by the stigma and discrimination
associated with HIV/Aids are in order: the workplace (companies, care environments, public services),
the community life areas (family, neighbourhood) (Appendix 12). This proposal aims to reduce the
amplitude of this phenomenon by targeted actions in the different environments. A evaluation of the
index of stigmatization and discrimination based on the tools developed by NGP+ and ONUSDA will be
carried out at the being and at the end of the interventions. This will require leading actions for
strengthening the capacities, advocacy, and communication on stigmatization and discrimination.
A pool of 20 trainers (02 per region) coming from the community and work setting will be enabled. At
the community level, these trainers will ensure the integration of the stigmatization and
discrimination related to Aids in the facilities and the activities of the CHW, VC, NGO/Associations
involved in the mobilization of populations for PMTCT, the continuum of care, support for the OVC (SDA
1.1.1, 1.1.3, 3.2.1)
As far as concerns the health setting, a specific module on stigmatization and the management of
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confidentiality will be integrated in the training of targeted health providers in this proposal (SDA
1.1.2, 3.1.1).
With respect to public services this requires training the focal points of the 18 ministerial departments
having an action plan for the fight against HIV on the issues of stigmatization and discrimination. As
well, 20 Inspectors and 2 workplace Judges will be trained to ensure the accompaniment of PLWHA
victims of stigmatization in the exercise of their rights.
As the company level, workshops will be organized for 312 focal point coming from 104 companies who
have implemented the HIV/Aids interventions. The advocacy towards the 104 Managers on the
reduction of stigmatization and discrimination will provide an occasion to sensitize them on the
importance of coinvestment, and the implementation of the CIGAM-MINHEALTH agreement.
The coordination will be ensured with the PR Governmental (MINHEALTH) and the implementation in
collaboration with a private sector organization.
Targets: PLWHA
3.2.2.1
Organize a validation forum for a national policy for the fight against aids in the workplace
in order to improve the protection of the PLWHA rights, access to care for the PLWHA
3.2.2.2
Produce and distribute 1000 copies of the document on the national policy for the fight
against aids in the workplace
3.2.2.3
Train and establish a pool of 20 trainers (02/region) for the fight against discriminationstigmatization
3.2.2.4
Retrain the company focal points (312) targeted on the integration of HIV/Aids in the
development plan for the company including the fight against stigmatization and
discrimination, monitoring and reporting
3.2.2.5
Train 18 Focal points of the Ministerial Departments, 20 Work inspectors and 20 workplace
Judges on the reinforcement of questions of PLWHA rights, stigmatization and the legal
accompaniment of the PLWHA victims of violations of their right in the workplace
3.2.2.6
Develop and produce supports for the promotion of PLWHA rights (1,219,500 flyers, 11,200
plaques, 22,400 posters) in the community sites and workplaces (public, health, company
and community)
3.2.2.7
Organize an annual meeting of 104 company Managers for the protection of rights and
mobilisation of financing for CM and the support of PLWHA
3.2.2.8
Implementation and monitoring of interventions for reduction of stigmatization and
discrimination in the workplace (companies, health structures) and the community
3.2.2.9
Support the carrying out of missions for monitoring and supervision of the implementation
of the activities retained
Goal 4: Strengthen the coordination, monitoring evaluation in the context of the implementation
of the proposal
Objective 4.1: Strengthen the coordination and monitoring evaluation system
SDA 4.1.1: RSC – monitoring and evaluation, generation of information based on tangible facts
SDA Description: The activities in this SDA aim for the production of strategic information in the
community section of the proposal. This requires ensuring a better knowledge of the target groups by
way of carrying out bio-behavioural survey including mapping among the TS, MSM and Truck drivers.
This SDA will allow monitoring, evaluation of the progress made by the interventions.
The coordination by the PR of civil society: CAMANFAW ad the implementation by the SR of civil
society: CHP, Press Jeune
Targets: SW, MSM, Truck Drivers, PLWHA and OVC
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4.1.1.1
Carry out 02 bio-behavioural studies including mapping among the MSM, SW and Truck
drivers
4.1.1.2
Develop, produce and distribute the tools (15000 data collection sheets and 240
registers) for monitoring evaluation of the interventions in the 03 target groups
4.1.1.3
Organize 02 missions per year of supervision and data quality control by the PR and 04
mission per year for the 05 SR of civil society
4.1.1.4
Establish a system for collection and report of data from the community system
SDA 4.1.2: HSS (health system strengthening): Information system
SDA Description: the SDA aims to generate strategic information in relation to the progress made in
the implementation of interventions of the health system. It is necessary to carry out sentinel
surveillance surveys of HIV among the pregnant women, a study on the methods of transmission of HIV,
surveillance of the resistance to treatments, evaluation of the quality of CM of HIV patients. 140
agents for filling out the registers (data managers) have been recruited in the context of round 3 and
financing for the continuity of services (CoS) and it ensures the regular collection of data. The
proposal will continue the remuneration of these agents in order to guarantee the regularity and the
promptitude of site data. Other register filling agents will be mobilized for the 100 new care
structures for a total of 240 data managers (for the 240 CM structures). In order to ensure
sustainability, these agents will be progressively contracted by the Government following the
development plan for human resources of the Ministry of Health.
The coordination and implementation will be ensure by the PR governmental: MINHEALTH
Targets: health personnel, PLWHA
Studies and research
4.1.2.1
Carry out mapping of the interventions in the fight against HIV/aids in the workplace
4.1.2.2
Carry out every two years a survey of HIV sentinel surveillance and syphilis among
pregnant women
4.1.2.3
Carry out a study on the methods of transmission of HIV in Cameroon
4.1.2.4
Carry out 05 surveys (1 per year) on the estimation of the flow of resources and the
expenses incurred in the fight against aids (NASA)
4.1.2.5
Carry out evaluation studies of the resistance to ARV treatment (01 survey on the IAP per
year, 01 survey for monitoring resistance in 01 site per and 01 survey on primary resistance
in 02 sites every 02 years)
4.1.2.6
Carry out a study on the following of nutritional practices among seropositive mothers
after birth
4.1.2.7
Carry out an evaluative study of the quality of services in the areas of PMTCT and the care
of PLWHA including the determinants of the weak frequentation of the reproductive health
services
4.1.2.8
Lead a comparative study on the psychological impact of the method of delivering results
on the adhesion to PMTCT program
4.1.2.9
Carry out a cohort study on the evaluation of the survival of patients on ARV treatments at
12, 24 and 36 months
4.1.2.10
Carry out 02 evaluations of the index of stigmatization and discrimination related to HIV
4.1.2.11
Carry out a study on the cost/benefit status of interventions in the fight against HIV/aids
in year 4 of the implementation
4.1.2.12
Strengthen the capacities of the structures for case to ensure the quality of programmatic
data and strategic information
Supervision
4.1.2.13
Organize supervision and data quality control missions (including an audit of the quality of
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ROUND 10 – HIV
data) by the PR (biannual) and the 02 SR (biannual) of the Government
4.1.2.14
Organize integrated biannual supervision missions at the central level towards the regional
level (CTA, UPEC, CARP and PMTCT sites) in 06 regions out of 10, the other regions being
supported by the government and its partners
4.1.2.15
Organise biannual supervision missions of the regional level towards the district level for
the supervision of the implementation of PMTCT activities and care
4.1.2.16
Organize a development workshop for the operational plan for the implementation of the
public private partnership
4.1.2.17
Organize a biannual supervision meeting between the NAC, the PR and the SR for the
monitoring and evaluation of the program and the consolidation of the data at the central
and regional level
Coordination/monitoring
4.1.2.18
Organize programmatic annual reviews (annual forum of the state of interventions by the
different actors and the fight against HIV/Aids)
4.1.2.19
Organize 02 central meetings and 04 meetings at the regional level for the strengthening
of the national coordination and the partnership with civil society and the private sector
(NAC)
4.1.2.20
Organize a quarterly meeting between the NAC, the PR and the SR for the monitoring and
evaluation of the program and the consolidation of the data at the central and regional
level
Support personnel
4.1.2.21
Make available and indemnify a monitoring evaluation assistant for the strengthening of
the monitoring evaluation Unit of the PR Governmental
4.1.2.22
Recruit an informaticien developer of data bases for the reinforcement of the monitoring
evaluation Unit of the PR Governmental
4.1.2.23
Ensure indemnification of 240 data managers on the monitoring of CM of the PLWHA in the
CM sites
4.1.2.24
Train 240 data managers for the 240 CM structures (140 former and 100 new) on the
monitoring of CM of the PLWHA
Documentation
4.1.2.25
Organize 02 national scientific day involving all of the partners for the sharing of
experience and dissemination of results of the studies and research on HIV and Aids
4.1.2.26
Document and disseminate best practices in the implementation of the different
component of the proposal
4.1.2.27
Organize a half point evaluation and final evaluation of the implementation of round 10
(years 2 and 5)
4.1.2.28
Organize a half point and final review of the Strategic Plan 2011-2015 (years 3 and 5)
4.1.2.29
Ensure the establishment of a national database on HIV/aids oriented to the web
4.1.2.30
Develop the communication plan on the implementation of the HIV/aids program
4.1.2.31
Develop the national technical assistance plan for the implementation of NSP 2011-20115
SDA: 4.1.3: Management and administration costs for the program
SDA Description: This SDA aims to ensure the functioning at all levels of the PR and SR involved in the
implementation of the Round 10 activities. Audit missions at all levels will be organized for the
monitoring and execution of the program.
The coordination and the implementation will be ensured by the PR Governmental: MINHEALTH
and PR civil society: CAMNAFAW
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ROUND 10 – HIV
4.1.3.1
Support the operations of 02 PR and 05 SR
4.1.3.2
Ensure the logistics for the 02 PR and 05 SR (Vehicles, computers etc.)
4.1.3.3
Support the operations of the partners for the duration of the project
4.1.3.4
Management and administration cost for the PR Government
4.1.3.5
Management and administration cost for the PR Civil Society
4.1.3.6
Have health professionals as well as community actors participate in international and
regional meetings
4.1.3.7
Train/retrain 25 managers (from the central and regional level) accountants on the use of
the accounting software
4.1.3.8
Carry out annual external audits of the SR and PR
4.1.3.9
Technical assistance for PR and SR in the implementation of interventions, the production
of reports and documentation
4.1.3.10
Technical assistance for capacity strengthening of the PR and SR on the aspects of
management and administration of the program
Complete this version of section 4.4.1(a) (b) and (c) if the applicant selected option 1 in
section 3.1 of the Proposal Form
Option 1 = Transition to a single stream of funding by submitting a consolidated disease proposal
4.4.1 Interventions
(a) Overview of programmatic activities
Describe the objectives, service delivery areas (SDA), and activities of the consolidated disease
application. The description must be organized in that exact order and the numbering system must
match the Consolidated Performance Framework, detailed budget and work plan.
The narrative description of the Round 10 interventions should reflect all objectives, service delivery
areas (SDAs), and activities in the Round 10 consolidated disease proposal, but distinguish between
what programming is being continued from existing grants versus new programming for Round 10.
The description must identify:
(1) who will implement each area of activity (e.g. Principal Recipient, Sub-recipient or other
implementer);
(2) the targeted population(s);
(3) what changes in implementation and/or the targeted population(s) have occurred, if any, for
those elements which are from existing grants and continuing in this consolidated disease
proposal;
(4) any links between the existing grant activities to be continued in the consolidated disease
proposal, as these activities previously existed in separate grants;
(5) any links between the proposed activities and existing Global Fund grants for other diseases or
HSS; and
(6) how duplication will be avoided if there are linkages identified in points (4) and (5) above.
NA
(b) Changes to existing SDAs, programmatic activities, indicators and targets
In the table below, list the SDAs and activities of existing grants consolidated within the Round 10
consolidated disease proposal. Explain whether each SDA and activity from an existing grant will be
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ROUND 10 – HIV
included in the Round 10 consolidated disease proposal by indicating an increase in scale, decrease in
scale, continuation without change, or discontinuation. Provide justification for any proposed changes
or discontinuation.
Round #
Service
Delivery Area
(SDA)
Activity
Proposed change
Justification for change
NA
 use “Tab”
key to add
extra rows
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ROUND 10 – HIV
(c) Changes to existing impact or outcome indicators and targets
Describe any major changes in indicators and targets that may have occurred due to the programming
described above in sections (a) and (b) and that is supported by the Consolidated Performance
Framework. In particular, if there has been discontinuation or change in indicators or if targets have
been changed between previous grants and the Round 10 proposal, describe why this has occurred.
NA
4.4.2 Addressing weaknesses from a previous category 3 proposal
If relevant describe how the weaknesses identified in the TRP Review Form of a previous category 3
proposal have been addressed.
TRP Comment R9
Response
Major weaknesses

The approach of the most at
risk populations identified is not
focused. It includes broad activities
without dealing with their
specificities and factors that
determine their vulnerability (e.g.,
dealing with the disabled who have
lower HIV prevalence than general
population).

Tuberculosis/HIV
coinfection is barely mentioned (as an
Opportunistic Infection (OI)) and
there is no demonstration of the
existence of a plan to address coinfection in any of the directions
(HIV prevention, screening and
treatment among tuberculosis
patients and tuberculosis screening,
prevention and treatment among
HIV patients).

The prevention of mother-tochild transmission (PMTCT) targets
are underestimated for an intervention
that is simple and which can have a
very important impact. There is no
mention of PMTCT guidelines to be
followed and infant feeding.

Although there is a whole
section on PMTCT, no impact or
outcome indicators are presented in
the performance framework to
measure the progress of the
program in the country.
The Round 10 proposal has taken into account the observations of TRP
concerning the populations most exposed to HIV risk and relies on:
 The epidemiological situation in Cameroon which shows an elevated
prevalence in the populations most exposed (seroprevalance of 36%
among sex workers and 16.4 among truck drivers), rate of
seropositivity of 35% in a group of MSM tested..
 On the specific needs of the MARPs identified during land visits and
meetings with the SW and the MSM in Yaoundé and Douala.
This proposal has taken into consideration this observation. The TB/HIV
coinfection is integrated in Round 9 of the TB proposal (accepted) and in
HIV Round 5 in so far as concerns the HIV screening of those with
tuberculosis.
So that the monitoring and care of TB-HIV coinfection is sustainable over
time, Round 10 will reply on the mechanisms of technical coordination for
the HIV and TB program at all levels.
The training of providers on TB/HIV coinfection will be organized in the
PLWHA care structures.
This Round 10 proposal makes PMTCT a major axis (Goal 1), which is part
of the national and international perspective for the virtual elimination of the
transmission of HIV from mother to child in the 5 coming years (based on
option « A » of the new WHO 2009 directives on the PMTCT and the
feeding of young children).
The increase in coverage of the services for mother and child, their use
and improvement of the quality are the main activities of the PMTCT.
The community mobilisation must allow increased access to this basic
service and significant reduction of the mother to child transmission of HIV.
The targets in matters of PMTCT have been reviewed and the objectives
defined with the view to the virtual elimination of MCT. This proposal aims
to cover 80% of pregnant women by 2015.
This Round 10 proposal making PMTCT a major axis (Goal 1) has
integrated the indicators of the effects and impact of which some are taken
up again in the context of performance, such as :
 The percentage of pregnant women received in PNC and knowing
their serological status
 The percentage of HIV+ pregnant women receiving a complete ARV
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ROUND 10 – HIV
regime to reduce the transmission of HIV from mother to child
The percentage of children born of HIV+ mothers receiving an ARV
prophylaxis
 The percentage of infants born to HIV+ mothers benefiting from a PCR
(early diagnosis) at 06 weeks
 The percentage of infants infected by HIV born of HIV+ mothers
This proposal gives an inventory of the situation and a mapping of the
existing laboratory equipment (NAC : Report on the state of laboratory
equipment, Appendix 20).
It is based on an analysis of the deficiencies and the needs in the area of
diagnostics and biological monitoring of patients.
The analysis has allowed the carrying out of an inventory of what is
available in terms of laboratory equipment (complementarity with previous
Rounds) and an estimation of needs. These last are a function of the
passage to the scale of the TAR and the PMTCT (early diagnosis of
newborns, CD4 counts for pregnant women) in the context of the virtual
elimination of the mother child transmission and the universal access for
the 2015 horizon
In so far as concerns genotyping see the response to question 7 below.
This HIV Round 10 proposal relies on the analysis of financial and
programmatic deficiencies.
This proposal aims for universal access, however the national financing
and financial support of development partners has not allows this objective
to be obtained. The Round 10 financing will thus be in complement to the
Government financing and the financing of its partners in development. As
well in the section 4.4.7 the analysis has allowed it to be show that Round
10 will have no overlap with Rounds 3, 4 and 5 in so far as the moment
that R10 starts, the previous Rounds will be closed.
In this proposal, interventions are planned for ::
1- preventing the occurrence of resistance to ART by:
 The respect of ART treatment protocols
 Reinforcement of observance by therapeutic education, the active
research of those lost from sight by way of the intervention of CHW
(Community Health Workers)/CV (Community Volunteers)
 Reinforcement of the Procurement Supply Management (PSM) to
avoid ruptures in inventory at all levels.
2- Genotyping will assist in the surveillance of the emergence of primary
resistance and acquired to optimize the efficiency of the first and second
line therapeutic protocols.


The country is requesting a
grant for the purchase of
equipments and reagents for viral
load, CD4, PCR and genotyping
without a clear map and description
of what is already in place

Non Global Fund funds are
listed but there is no
comprehensive
additional/complementary
description in relation to the present
proposal.

The proposal previews
several studies on ART resistance
(including primary resistance) but
there is no indication of strategies
to deal with the problem that will
certainly be created.

The OVC component targets
166 districts out of 174 districts.
(http://www.unicef.org/wcaro/wcaro
_CAM_factsheet_HEALTH.pdf).
Objective 5, on the other hand, will
focus on 5 health districts (page
41/89). There is no information on
the geographical or epidemiological
criteria used to exclude or include
the districts in each of the cases.
In this Round 10 proposal, the choice of Orphans and Vulnerable Children
(OVC) is not in relation to the health districts. It aims more all of the OVC
who have lost 1 or 2 parents following HIV infection and so the protective
environment is very destructured. This Round continues the CM of OVC in
84 intervention sites which cover all of the country.

The monitoring and
evaluation system for ARV patients
is inadequately described.
Since 2002, Cameroon has been committed to an ambitious program
aiming to facilitate the access to treatment for PLWHA with therapeutic
indication. The national active file was 76,228 PLWHA at the end of
December 2009, the Ministry of Health has adopted the WHO
recommendations (December 2009) and treatments have been
standardized to facilitate patient monitoring. The monitoring registries for
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ROUND 10 – HIV
patients on ARV are available in the care sites within the framework of the
monitoring/evaluation system and there are responsible personnel. The
data on the TAR are collected and sent monthly to the health facilities in
the Region. The TARV information for the regions is sent quarterly to the
central level. These last are subject to a compilation and quarterly
publications (progress reports). The traceability of HIV+ patients on TARV
is done by way of a unique indentifying number which is anonymous and
which is recorded in all of the site registries (pre-ART registries, ART,
pharmacy, etc.
The ESOPE software made available by GIP-ESTHER serves to receive
the data for individual monitoring or the active file of patients on ARV. It
will be progressively extended to all CTA tutors and the tutored UPC which
will then be equipped with a database. The managers (operators) look
after the database and will document the information obtained. As well,
the PMTCT monitoring and paediatric care will use the “paediatric” version
of ESOP will should be available at the end of 2010. The Esope system
allows the centralization of indicators for which the regular analysis
(biannual) will provide information on the evolution of the access program
for ARV.
 The weaknesses identified by the
TRP in Round 7 and Round 8 have
been discussed in the relevant
sections of the proposal but have
not all been fully addressed.
The commentaries of Round 7 and Round 8 were based around the
problematic of the most exposed populations, the supply of ARV, the basic
data and the importance of indicators of effect and impact which were
elaborated in the proposal for Series 7 and 8 of the Global Fund. To this
effect, this Round 10 proposal has considered as a priority axis the
populations the most exposed to risk (Goal 2) and the availability of ARV
(Goal 3). The round 10 proposal has defined a performance plan based
on the impact and effect indicators related to the different interventions and
to the instruction of the Global Fund Round 10.
The commentaries of Round 7 and 8 established the state of the
interventions and the expected impacts, and the organization of the SR
and PR for the implementation of programmed activities within the
framework of these rounds. This Round 10 proposal presents an
organizational schema with two avenues of financing: a PR Governmental
(Ministry of Health) and a PR Civil Society (CAMNAFAW).
In so far as concerns the monitoring evaluation system, this Round 10
proposal has done an analysis based on the 12 components of UNAIDS
and considers the evaluation monitoring as a priority and strategic axis for
the implementation of the proposal (Goal 4). Finally, in recognition of the
Rounds 7 and 8 commentaries, a summary is submitted as an appendix
(Appendix 21)
Minor Weaknesses
 Regarding the budget: some
budget items seem to be
inappropriately costed (actual
budget costs/more realistic unit
costs). For instance, male
condoms: €0.0823/ €0.025;
desktops: €1,143/ €750; vehicles:
€30,490/ € 20,000.
This Round 10 proposal relies on the national consolidated unit costs with
the LFA from the proposals of Rounds 3, 4 and 5 by taking into account the
national procurement procedures.
Some unit costs are aligned with those of Rounds 9 on tuberculosis and
malaria which are already accepted.
The CCM Cameroon drafting committee will oversee the avoidance of
errors in the logic of the budgetary framework.
 Further clarifications are needed
on, for instance, training of PMTCT
staff, training of laboratory
The aspects of training for laboratories and providers in PMTCT are
adapted to the activities defined in each of the components and sub
components. This proposals provides detailed information on the training
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ROUND 10 – HIV
technicians.
 Pharmaceutical budget costs and
Attachment B need to be
reconciled. For instance, supply
health units in PTME and PECP
inputs (ARV, OI prophylactics).
as well as on the strategies and the associated budgets.
Budgetary coherence and consolidation of the costs in the PSM form.
4.4.3 Lessons learned from implementation experience
How do the implementation plans and activities described in 4.4.1 above draw on lessons learned from
program implementation (from either Global Fund financed or non-Global Fund financed programs)?
The activities described in section 4.4.1 draw from and rely on the lessons learned from the
implementation of NSP 2006-2010.
These teachings can be situated at several levels:

Access to prevention in favour of the priority groups
Thanks to IDA financing, there has been a large community implication in the fight against HIV and Aids
by way of the mobilization of populations at the level of the Communes, Businesses and Religious
Confessions for the prevention (BCC, screening, promotion of the use of condoms). This mobilization
was realized with the support of the civil society organizations. As well, 7,530 base communities, 180
associations and networks of association for PLWHA, 21 public sector, 128 religious organizations, 104
companies and unions, 116 NGO/Associations etc were mobilized.
The effective implication of the local decentralized collectivities and their leadership in the actions of
NSP 2011-2015 will allow development of mechanisms of appropriation and sustainability of the
interventions by community actors. Within the context of this proposal the capacities of the OSC will
be reinforced in terms of planning, management and search for funding in order to avoid stopping the
activities as soon as the funding ends (sustainability).
The experience of Round 4 and the interventions sustained by the other partners has shown the use of
mass medias as means of communications adapted to incite a change in behaviour among the young.
However these media have shown they are limited in the capturing of some groups, such as the SW and
MSM.
The Round 10 proposal aims to capitalize on the existing OSC to attain the target groups by way of
outreach communication.
- The counselling and voluntary screening in advanced strategy implemented by way of the Mobile Units
acquired with IDA financing allowing populations to be reached that were not well covered by health
services or those not having spontaneously screening services. The mobilization of personnel of the
local health facilities facilitated the orientation of people diagnosed HIV+ towards the care structures.
This proposal will continue this experience in the direction of the targeted groups (SW, MSM, Truck
Drivers) with the involvement of the OSC in order to ensure the continuum of care among people
tested positive.
- The distribution of condoms based on the community-based strategies has shown its effectiveness on
the availability and use of condoms. At the same time the involvement of men increases the
acceptance and use of the female condom The implementation of this proposal strengthens this
strategy, contributing also to the reduction of the incidence of HIV in the general population and in the
high risk groups in particular.
-The involvement of beneficiaries in the development of strategies aimed for the groups the most
exposed to risk as well as the PLWHA, will be done in more depth and systematized in order to extend
the access to services and the consolidation of acquisitions.
- The creation of an exchange space, for dialogue and meeting between providers of the health
facilities, community works and others involved (security,, social affairs, territorial administration and
civil society) has allowed an increase in the credibility and frequentation of the FS by the SW for the
city of Yaoundé. This best practice will be capitalized on within the framework of this proposal to
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ROUND 10 – HIV
improve the interventions for this group.
Experiences on PMTCT
The PMTCT activities developed in Round 5 allowed for an improvement in coverage and access to PNC
services (35% of the pregnant women expected benefited from HIV screening in PNC in 2009) and the
ARV prophylaxis for seropositive pregnant women. However, the weak involvement of the community
actors and the rarity of mobilization interventions for the pregnant women were a brake to the efforts
deployed for the improvement of accessibility, use of PMTCT services. This proposal will place
particular emphasis on the community mobilization of pregnant women and their partners in order to
increase the coverage of screening in PNC to 80%.

Access to treatment and care in favour of the eligible adult and children PLMHA
- The policy of free ARV and the MIO associated with the subsidy for biological examination has allowed
an increase in the active file of people on ART going from 36,033 in June 2007 to 73,114 adults in
December 2009. This policy will be pursued within the framework of this proposal as well as the
experience of decentralization of the care by way of a network of CTA/UPC covering all of the county
towns and health districts.
- the establishment of early diagnosis per PCR from the 6th week par the use of DBS and the
implementation of the ministerial decision on the paediatric care by ARV has allowed the number of
infants on ARV to be doubled in two years going from 1700 in 2007 to 3114 in 2009.

Coordination and monitoring evaluation of the program
- The lessons drawn from the implementation of monitoring evaluation indicating the necessity of
harmonizing the indicators of monitoring evaluation at different levels: harmonization of the national
indicator in relation with SNIS, between the different PR and SR, with the community sector.
- The irregularity of coordination and discussion meetings between the different people involved, the
deficit in communication and the difficulty of managing the financial flow at different level between
the different backers, the insufficiency in human resources are also factors which weaken
coordination. This last will be strengthened with the aim for a complementarity of actions and an
improvement in geographical coverage of the people involved and the targets.
- The lessons drawn in the area of human resources have show that their weak number (quantitative
and qualitative) is a limiting factor for the data collection system (promptitude and completeness).
This has been partially corrected by the recruitment of register filling agents within the framework of
COS of Round 3 and will be reinforced by the Round 10 proposal including the strengthening of their
capacities.
4.4.4 Enhancing TB/HIV collaborative activities
Describe:
(a)
(b)
how the proposal will contribute to strengthening TB/HIV collaborative activities; and
the collaboration between the National TB program and the HIV services of your country.
Cameroon has just benefited from a Round 9 Global Fund subsidy for the Tuberculosis component.
This subsidy has the objective of (i) improving the quality of services in the CDT, (ii) controlling the
coinfection of TB/HIV and bringing from 60% to 90% the HIV screening of tuberculosis patients, (iii)
sustaining the populations affected by TB and (iv) promoting operational research via the conducting of
national studies on the resistance to anti-tuberculins and on the study of the transmission of TB.
The HIV Round 5 proposal integration the actions with lead to the reduction of the impact of
Tuberculosis among HIV+ patients by way of diagnosis and prevention of tuberculosis among HIV+
patients (prevent with Isoniazide). The implementation of the interventions is carried out in 10 of the
140 functional care structures for PLWHA and has allowing the placement on preventative treatment of
Isoniazide (TIP) of 806 patients HIV+ out of 1017 planned between 2006 and April 2010. The evaluation
of these interventions will allow the collection of evidence on the effectiveness of this prevention in
the Cameroon context with an aim to take it to scale.
The integration of HIV screening among tuberculosis patients in the 216 existing Diagnostic and
Treatment Centres for Tuberculosis (CDT) has allowed improvement of the care of HIV/Aids among
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ROUND 10 – HIV
tuberculosis patients. This proposal aims to consolidate this acquisition by way of the pursuit of the
making available of cotrimozazole and the antiretrovirals in the CDT centres as well as the training of
providers in the care of HIV/TB coinfection. In this Round, the contribution of Civil Society (association
of PLWHA) and the community actors will allow improvement of the community care of tuberculosis
among HIV+ patients as described in SDA 3.1.6. At the same time, this proposal, by contributing to the
training and retraining of providers in the ARV treatment centres on the care of TB/HIV coinfection will
assist with the integration of the TB activities in the services responsible exclusively for the care of the
PLWHA.
A formal and operational reference and counter reference framework exists between the HIB and TB
programs. The working group on TB/HIV coinfection, made of different actors, including civil society
and the beneficiaries ensures the joint planning, monitoring evaluation and harmonization of
interventions for TB/HIV coinfection and also contributes to the quality of care for patients.
4.4.5 Enhancing social and gender equality
Using specific references to objectives, SDAs, and activities included in section 4.4.1, explain how the
Round 10 interventions address issues related to social and gender equality and confirm that these
items have been properly costed in the budget.
Problems related to Gender and to Human Rights are elaborated throughout the interventions in the
different parts of the proposal:

Equality of access to PMTCT services:
The efforts of the PMTCT are centred on women and their specific needs to encourage their adhesion
to this program. However, the PMTCT program treats mainly women as mothers and looks to involve
the father and siblings of the newborn. In addition, the involvement of men should increase the
numbers of women frequenting maternal and infant health services including PNC1. In effect, the
lessons acquired from the experiences of “males as partners” shows this. The interventions for access
to services of the PMTCT are also aimed at young girls of 15-24 years because of the prevalence of HIV
in this age bracket. As well, because of the fact that the heads of family influence the access of
women to health care and they have financial control, their involvement is thus primordial to attain
the objectives for PMTCT services.
The overall strategy for this “HIV” strategy will contribute to the respect of the equality of gender in
the access to services according to different types of interventions. Several actions of advocacy,
social mobilization and community mobilization are based on the responsibilization of women,
women’s associations, HIV+ mothers, “mother providers” as much in the rural environment as in the
urban. Goal 3 targets women and mention during advocacy/social mobilization campaigns with the
aim to increase the frequentation of PNC services. Goal 3 integrates particularly pregnant women
eligible for antiretroviral therapy.

Taking into account the MARPs (SW, MSM and Truck Drivers) and equitable access to health
and treatment services
The predominance of the target young within the MARPs (SW, MSM, truck drivers) is a reality which
constitutes a preoccupation in the priority interventions of this proposal. The community approach
and the strengthening of the collaboration with the health system will allow populations the most
exposed to HIV risk to have equitable access to the interventions of prevention,, treatment, care and
support, by reducing the stigmatization and the discrimination in the respect of their specificities and
their rights (goal 2, objective 2.1).
The interventions on the issue of violence based on gender is taken into account in the strengthening
of the capacities of health mediators and peer educators in SDA 2.1.1 and SDA 2.1.2.

Equality of access to screening and treatment services (ARV, MIO)
In the policy of access to care structures, there is no discrimination or limitation related to sex.
However there are sociocultural factors which have had an impact on the access to these services.
The proposal will implement interventions to alleviate these limits (SDA 2.1.6 and SDA 3.2.2). In a
situation of dependence vis-à-vis her spouse, the seropositive woman often has difficulties in sharing
her results with the former by fear of a rejection or rupture. This situation which exposes the spouse
to HIV infection is also the cause of inobservance of treatments with its corollaries. A higher level of
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ROUND 10 – HIV
education and financial dependence do not protect women from violence related to gender either.
The survey carried out in Cameroon in 2009 by GTZ on the violence towards women revealed that they
are often victims of violence related to gender (Appendix 22). The screening counsellors and the ARC
are especially trained under the framework of SDA 1.1.3 on the approach to HIV screening and the
sharing of results between spouses or partners.
Gender sensitive care and treatment

The care of PLWHA in Cameroon is based on the principles of universality and equity of access to
treatment, care and support by way of free ARV and the subsidization of biological exams. The
strategy of decentralization of care in all of the 178 health districts allows the offering to populations
that are enclaved an equitable access to quality treatment and care. This proposal aims to increase
the number of eligible PLWHA placed on ARV, by way of interventions plan in goal 3, objective 3.1 and
the SDA that apply. The proportion of women and men targeted for TAR is in correlation with the
epidemiological profile of the country. In December 2009, 67% of the PLWHA on TAR were women or
51,032 women versus 25,196 men. The care structures situated in rural zones, which represent close
to half of the offers in care in treatment, are equipped the same as the urban zones, in order to
guarantee equity and geographical accessibility. The reinforcement of the “tutoring” strategy for the
health facilities by the structures having a higher technical level (UPEC by the CTA; CSI/CMA by UPEC)
will guarantee the quality of the care at all levels. As well, the collection tools for the monitoring of
the active file produced will allow a disaggregation of the data as a function of sex and of age.
Continuum of care

The selection and training of Community Health Workers and community volunteers will take into
account the equilibrium of the sexes including the pedagogic content of these trainings. Home visits
will be carried out in binomially and will target both women and men, girls and boys, both in the urban
setting as in the rural setting. They will also have information and animation tools relative to this for
the interpersonal communication sessions and for social mobilization in the community. (goal 1,
objective 1.1, SDA 1.1.1.; Goal 3, Objective 3.1, SDA 3.1.6). The OVC by the fact of their vulnerability
present generally unequal access to education, particularly for the young girls. The interventions of
this proposal for the OVC take into account the situation of the young girl and the content of the
interventions is a function of the age bracket.
4.4.6
Partnerships with the private sector
Describe how contributions related to: (i) co-investment from the private sector, and (ii) donated goods
or services, will add value to the planned outcomes of the proposal. Make specific reference to the
associated objectives, SDAs, or activities to which they are linked.
The private sector is one of the actors for the development and implementation of this submission and
it is involved in most of the areas of the provision of services. 27% o the care offering for the PLWHA is
actually ensured by private sector health facilities. The involvement of new private structures in the
implementation of this proposal will allow an increase of the extension of the offer of services in the
perspective of the universal access to PMTCT services, care and treatment of HIV/Aids. The private
sector will also benefit from the same facilities as the public (supply of reagents, ARV, technical
support, support for advocacy). In return, these companies make available their personnel, their
premises and their logistics for the capacity strengthening sessions, the realization of prevention
activities for HIV/Aids. As well, they will support the operational costs of their structures and the
salaries for their employees assigned within the context of the implementation of this proposal.
Within the context of activities for the reduction of new infections (Goals 1 and 2), some companies
(wood industry, Agro-industry, construction worksites, etc…) are retained as sites to deliver services to
their employees who are clients of the SW, because their activities create favourable conditions for the
development of sex work. The companies who employ truck drivers are also targeted to lead
prevention actions in order to reduce risky behaviours within this category of workers. All of these
companies will carry out educational discussions sessions, screening campaigns, orient/refer and
promote access to services to their employees and to the SW in the immediate environment of their
production sites. In effect, the companies (ALUCAM, CDC, AES Sonel, SOSUCAM, HEVECAM, CAMRAIL
etc) who have health structures offer screening services for HIV, PMTCT, diagnosis and treatment of STI
as well as the care of PLWHA.
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ROUND 10 – HIV
This proposal grants particular attention to the development of the public-private partnership in order
to operationalize the co-investment. The MINHEALTH signed on March 31, 2010 a agreement with the
Groupement Interpatronal de Cameroon (Appendix 23) of which one of the objectives is the mobilization
of private companies for the financing of ARV and medications for OI, in return for the support of the
MINHEALTH in the reinforcement of the capacities of the companies in the fight against HIV/Aids. The
activities retained in SDA 4.1.3 are developed in a way to implement the GICAM MINHEALTH agreement
and to ensure the monitoring and evaluation as well as the promotion of the private-public partnership.
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ROUND 10 – HIV
Only complete section 4.4.7 if the applicant selected Option 2 or 3 in section 3.1 of the
Proposal Form, DO NOT COMPLETE section 4.4.7 if the applicant selected Option 1 in section
3.1 of the Proposal Form
4.4.7 Links to other Global Fund resources
Describe in the table below the linkages between this Round 10 proposal and existing
Global Fund resources. It is important to list the SDAs and activities as outlined in the
current proposal in the left hand column, add a description as to how they relate to
previous grants in the middle two columns, and then outline how the Round 10 proposal
specifically addresses this in the right-hand column.
Existing grants
Key SDA and activity as proposed
in the Round 10 proposal
Round 3 (CoS
until December
2011)
Round 4 (closed
in December
2009)
Round 5
(closed in
June 2011)
Round 10 Proposal
SDA 1.1.1: RSC: Advocacy, communication and social mobilization
The main activities of this SDA
concern the social mobilization
in order to increase access to
services for populations,
particularly in so far as concerns
PLWHA, care…
No link
The social
mobilization
was initiated in
Round 4 but on
a weak scale
No link
Extension of the
actions of social
mobilization in order
to increase the
frequentation of
health services
(SMI/SR/FP/PMTCT/HIV)
SDA 1.1.2 HSS (Health system strengthening): Health professionals
This SDA aims to develop the
training activities and
pedagogical modules to
strengthen activities in the SMI:
PMTCT/reproductive
health/SONEU (Obstetrical and
Neonatal Emergency Care)
No link
No link
Training in CD
in PMTCT which
doesn’t cover
all of the needs
Strengthening of the
capacities of health
professionals for the
improvement of
maternal and infantile
health services
No link
No link
Acquisition of
test that don’t
integrate the
MARPs
Enlarge and diversify
the offer of screening,
ensure the screening
for HIV among target
groups (SW, MSM,
truck drivers) in order
to offer correct care
No link
No link
Prophylaxis for
the PMTCT not
in the form of
package
Ensure the passage to
the level of the offer
of PMTCT services to
pregnant women
Only the
activities of the
Community
Health Workers
The OBC who
are not
concerned with
the
No link
Extension of the
“outreach” activities
with the groups most
exposed to HIV risk
SDA 1.1.3: Testing and counselling
Acquisition of screening test as
part of national supply and
support for the operating of
mobile screening units (PMTCT,
MARPs, Counselling centre and
screening)
SDA 1.2.1: PMTCT
Provide 128,761 single packages
(MBP) of medications (ARV,
cotrimoxazole) necessary for the
seropositive HIV+ pregnant
women and to the child for
prophylaxis
SDA 2.1.1 BCC – Community relays
concern the strengthening of the
competencies of the OBC who
are involved with the (MARPs)
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ROUND 10 – HIV
PMTCT/reproductive
health/SONEU (Obstetrical and
Neonatal Emergency Care)
(CHW) for the
care of the
PLWHA
intervention of
the MARPs
SDA 2.1.2: RSC Development of linkages, collaboration and community coordination
aim to map the health structures
to receive and offer prevention
services to the SW, MSM and
Truck Drivers and their
customers/partners.
Organize discussion and advocacy
meetings at the regional level
between associated community
actors and the health actors for
access to the prevention and
care of the MARPs
No link
No link for
mapping
No link
Yes for the
advocacy
meeting with
the OBC not
acting in the
direction of
the MARPs
Yes for the
advocacy
meeting with
the OBC not
acting in the
direction of the
MARPs
National supply
National supply
Continuation of the
acquisition of male
and female condoms
which takes into
account the actions
towards the MARPs
Link for the
prophylaxis.
The action will be
developed and
amplified to attain the
targets as well as their
customers or partners
Mapping of the health
structures and the
people involved to
reinforce and enlarge
the offer of prevention
and care
SDA 2.1.3 Condoms
Acquire male condoms for the
populations of truck drivers and
MSM.
Acquire female condoms for the
SW populations.
Acquire lubricating gels for the
SW, truck drivers and MSM
National supply
SDA 2.1.4: Diagnosis and treatment of STI (Sexually transmitted infections)
Establishment of an continuous
evaluation system for the quality
of care of STI and access to care
for SW, MSM and truck drivers.
Retraining and training of
providers of health care in the
health facilities offering
prevention services and care to
SW, MSM and truck drivers on the
diagnosis and syndromic CM of
STI as well on HIV screening
No link
No link
The STI only in
the prison,
school and
university
setting
SDA 2.1.6: Reduction of stigma in all contexts
The main activities consist of
organization the activities of
quarterly meetings between the
OBC/associations/NGO, with the
participation of populations (SW,
MSM, truck drivers) as well as the
advocacy sessions in the
direction of health personnel
No specific
program but
indirect links
No specific
program but
indirect links
No specific
program but
indirect links
Enlargement of the
actions to reduce
discrimination and
stigmatization vis-à-vis
the PLWHA
Continuity only
for the
prophylaxis in
PMTCT
Enlargement of the
therapeutic care with
ARV to attain universal
access
SDA 3.1.2: Antiretroviral (ARV) treatment and monitoring
Acquire a national supply of first
and second line ARV medications
for the adults.
Acquire first and second line
paediatric ARV medications.
Acquire reagents and
consumables for the pretherapeutic orientation exam
(CD4) (NFS, glycaemia,
transaminases) and for
monitoring of the PLWHA
Continuity
No ARV in
Round 4
SDA 3.1.4: Prophylaxis and treatment for opportunistic infections
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ROUND 10 – HIV
Acquisition of Treatments for
opportunistic infections
This proposal
intends to
continue the
taking care
freely of
opportunistic
infections
started by R3
and the
financing on the
therapeutic
continuity of
Round 3 until
December 2011
No link
No link
Continuation and
extension of the care
of opportunistic
infections started by
R3 and the financing
on the therapeutic
continuity of Round 3
until December 2011.
As for the ARV, the
other half (50%) of the
costs for MIO
treatments will be
taken into account by
the Government
No link
No link
Yes training,
supervision and
prophylaxis
with INH
Extension of the
training of health
personnel in the 100
new UPEC and the
retraining of those in
the 140 others on the
care of TB/HIV
coinfection
Pursuit of
needs in the
continuum of
care
Pursuit of needs
in the
continuum of
care with
involvement of
the
communities
Ensure the continuity
of care of the PLWHA
with extension of
services. Action based
on a collaboration a
complementarity
between the
community system and
the health system
No link
No link
Pursue the CM of the
OVC by capitalizing on
the acquisitions and
experiences of Round
3 and targeting of the
most vulnerable
Continuation of
the
interventions
initiated in
Round 3 and
revision of the
data collection
tools
Manage the strategic
information with
respect to the progress
made in the
implementation
(studies, monitoring
evaluation, half way
evaluation, … etc)
Operational
costs for the PR
and SR
Ensure the functioning
of 02 PR and SR
involved in the
implementation of
Round 10 activities
SDA 3.1.5: Tuberculosis/HIV
The activities aiming to
Train/retrain providers on the
prevention and care of
coinfection
TB/HIV; and Support for the
operations of the working group
on HIV/TB
SDA 3.1.6: Care and support: care and support for the chronically ill
The social psychological support,
positive prevention for PLWHA
and their families in the care site
and in the community (continuity
of care)
Initiation of
activities in the
continuum of
care
SDA.3.2.1: Support for orphans and vulnerable children
Overall support activities for the
OVC
Round where
the OVC occupy
an important
place
SDA 4.1.2: HSS (health system strengthening): Information system
Support activities for the system
of monitoring evaluation,
reinforcement of capacities and
human resources;
Support for the activities of biobehavioural studies and situation
analysis
Initiation of a
support of the
monitoring
evaluation
system (training
and
indemnification
of data
managers)
Uniquely on
the aspects of
supervision
SDA 4.1.3: Management and administration costs for the program
Operational support (human
resources and organizational
resources in the two PR and the
SR, for coordination)
Operational
costs of the PR
and SR
Operational
costs for the
PR and SR
Link with Round 9 TB component in process of execution: The integration of HIV screening among
tuberculosis patients in the existing 216 Diagnostic and Treatment Centres for Tuberculosis (CDT) allows
improvement of care of HIV/Aids among tuberculosis patients. This proposal aims to consolidate the
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ROUND 10 – HIV
acquisitions by way of the continuation of the availability of reagents for HIV screening, cotrimoxazole
and the antiretrovirals in the CDT centres as well as the training of providers by the HIV program.
In this Round, the contribution of civil society (PLWHA associations) and the community actors will allow
improvement of the community care of tuberculosis in HIV+ patients as described in SDA 3.1.6. At the
same time, this proposal, by contributing to the training and retraining of providers in the ARV treatment
centres on the care of TB/HIV coinfection will help to integrate the TB activities in the services
responsible exclusively for the care of PLWHA.
A formal and operational framework of reference and counter reference exists with the HIV and TB
programs. The working group on TB/HIV coinfection made up of different actors including civil society
and the beneficiaries ensures the joint planning, monitoring evaluation and harmonization of the
interventions for HIV/TB coinfection and contributes as well to the quality of care for patients.
4.4.8
Links to non-Global Fund resources
Describe whether the Round 10 interventions (e.g. goals, objectives, SDAs, and activities) listed in section
4.4.1 have linkages to programs financed through non-Global Fund resources. If such linkages exist, list
the non-Global Fund financed programs and their activities, and explain how the proposal complements
those programs and activities. In addition, explain how the Round 10 interventions do not duplicate
existing programs and activities supported by non-Global Fund resources.
Areas of
intervention
Round 10
Other partners
Goal 1 : Reduce the new HIV infections among newborns by the prevention of mother-child transmissions
Goal 2: Reduce the new HIV infections among the SW, MSM, Truck Drivers and their partners
Prevention
Objective 1.1 : Increase from 35 to
80% the proportion of pregnant
women who benefit from at least one
CPN including HIV screening by 2015
ADB: The African Development Bank within the
framework of the support project for the national
reproductive health program implemented by UNESCO,
which allowed for the training of 4170 teachers of primary,
secondary and teaching schools which for their part
reached 119,000 students on the teaching of
EVF/EMP/HIV and aids (financing of 1 759 600 €
between 2006-2009)
KFW : The program for the Preventions of HIV/Aids in
Central Africa (PPSAC) by way of the funding from the
KFW going until the year 2014, mobilizes the targets by
way of activates to change behaviours, including the
screening, supply of condoms. The distribution of female
condoms and male conducts was done by ACMS for the
general population. Unfortunately, the distribution did not
take into account the specificities of the at risk groups
(SW, MSM, truck drivers) in the rest of the country.
UNFPA : Within the framework of their 5th cooperation
program, they are involved in 11 Health Districts of 03
Regions (North, Extreme north, East.). The contribution of
the UNFPA concerns the prevention in the youth
environment by way of the training of peer educators and
volunteers of community-based services. They ensure
the supply of female and male condoms (less than 5% of
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ROUND 10 – HIV
the national needs) which are distributed by SYNAME and
’ACMS until 2012.
PMTCT
Objective 1.2 : Increase from 19% to
70% the proportion of seropositive
pregnant women and their infants who
receive ARV to prevent MCT by 2015
The Government by way of PMTCT funds implements
the activities of pillar 1 of the PMTCT. As well, with the
C2D health financing, it also contributes to the PMTCT
from January 2011 for the integrated training of personnel
of 901 health facilities in SONEU including the PMTCT in
4 Regions.
R10 doesn’t take into account Pillar 1
of the PMTCT.
It will contribute up to 70% in 2015 of the
PMTCT target of NSP
UNICEF : The contribution of UNICEF in the component
Children, HIV Aids (EVS) aims for the primary prevention
(pillar 1 of the PMTCT) among children and adolescents
as well as their parents. Within the framework of pillars
2,3 and 4 of the PMTCT and PECP, it contributes by way
of UNITAID financing and on capital funds of a part of the
screening activities for HIV among pregnant women, the
ARV prophylaxis, early diagnosis and the care of
paediatric HIV until 2012.
UNFPA : contributes to the improvement of the offer and
quality of services for PMTCT until 2012 by way of
strengthening of the capacities of providers thanks to
training in SONEU and the reinforcement of the technical
level of some health facilities in 11 Health Districts of 03
Regions (North, Extreme North, East). It ensures that
availability of contraceptives in all of the health facilities in
the whole country contribution as such to pillars of
PMTCT.
CDC/PEPFAR will ensure the mapping of PMTCT sites
Early diagnosis Objective 1.3 : Increase from 16 to
per PCR
705 the proportion of exposed
children tested for HIV (PCR) at 6
weeks by 2015
The Government and the other partners will contribute to
the reaching of at least 10% of the PMTCT objective until
2015.
US Government (CDC) : it contributes since 2008 to the
offer of early diagnosis by PCR from the 6th week and the
reinforcement of capacities of the reference laboratories
in collaboration with the International Research Centre
(CIRCB). It relies on the establishment of a quality
assurance system for the screening of HIV.
The Clinton Foundation will contribute until 2011 to the
supply of reagents for the early diagnosis of HIV.
UNICEF : It has provided since 2007, 2 PCR devices
Government of Cameroon (PPTE) has acquired in 2009
two PCR devices
Prevention of
new infections
among
the
MARPs
Objective 2.1 : Ensure access to
prevention services and reduction of
discrimination to 14,240 MSM, 39 440
SW and 148 800 Truck drivers in the
10 regions by 2015
Civil society : NGO Red-Cross, CAMNAFAW,
Alternative- Cameroun. The sex workers and the sexual
minorities (gays, lesbians, bisexuals and transgenders)
are part of the framework of a pilot project « Meeting
SRH Diversity Needs (MESDINE) » in the cities of
Yaoundé and Douala. The NGO « Alternative »
undertakes prevention actions and care of the MSM in the
city of Douala.
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ROUND 10 – HIV
All of these projects mobilise the target groups through
activities for changing behaviour, including the screening
of STI and HIV but cover only 02 areas of Cameroon and
a part of their needs.
UNHCR: It plans to establish prevention interventions for
HIV and STI among refugees (financing of 20 334€) but
without specifically targeting the SW, MSM or truck
drivers.
USAID: It supports the prevention actions for high risk
groups for the period of 2010 to January 2012 for an
amount of 400,000 € per year in the regions of the East,
North-west and the city of Douala.
Goal 3 : Reduce the morbidity and mortality related to HIV as well as the socio-economic impact by way of strengthening
of the overall care of adult and child PLWHA and support for OVC by 2015
The Government as a counter part to COS of Round 3,
Overall care
Objective 3.1 : Ensure overall
contributes to the amount of 50% of the purchase of ARV.
quality care to 80% of the adult
Within the framework of this proposal, the Government will
and child PLWHA eligible by 2015
continue to ensure its contribution for a threshold 50%.
Objective 3.2: Reduce the impact
of HIV/Aids among the OVC and
the stigmatization and
discrimination of HIV
The Government as a counter part to COS of Round 3,
ARV treatment
Objective 3.1 : Ensure overall
contributes up to 50% of the purchase of ARV. Within the
quality care for 80% of the adult
framework of this proposal, the Government will continue
and child PLWHA eligible by 2015
to ensure its contribution for a threshold of 50%.
Objective 3.2: Reduce the impact
Clinton Foundation (CHAI) by way of UNITAID funding,
supplies paediatric ARV (line 1 and 2, adult ARV (line 2),
inputs for the early diagnosis of paediatric HIV until 2011.
R10 will ensure 50% of the costs of
ESTHER (by their own financing and by way of C2D
ARV to attain 80% coverage (NSP
health) accompanies 140 certified facilities (tutelage
target)
strategy) in the areas of training for therapeutic care of the
PLWHA, cohort monitoring and therapeutic education.
UNICEF (with UNITAID and their own funds) ensures the
supply of cotrimoxazole for the prevention of OI in the
mother child couple, and support for the development of
normative documents.
TB/HIV
SDA:3.1.5. Tuberculosis/HIV
Laboratory and
medical
equipment
SDA: 3.1.3. HSS (health system
strengthening) Provision of
services
The total needs estimated at 82 CD4
devices, Gap of 40.
No CD4 devices will be acquired in
R10
SDA: 3.1.4. Prophylaxis and
Opportunistic
WHO has established a resistance surveillance program of
HIV to ARV in 2009 and supports the development of
normative documents.
GTZ: prevention and treatment interventions in the prison
environment for tuberculosis Aare the priority areas for an
annual amount of 397,893 €.
The Government thanks to PMTCT and C2D financing
will ensure the acquisition of 40 CD4 devices and the
rehabilitation of the infrastructures capable of holding the
CD4 devices for the UPEC/CTA
Clinton Foundation (CHAI) will support the supply in
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ROUND 10 – HIV
infections
OVC support
treatment for opportunistic
infections
SDA: 3.2.1. Support for orphans
and vulnerable children
MIIO for the prevention of opportunistic infections among
children until December 2011.
The Government and UNICEF in the cooperation
program Cameroon-UNICEF which ends in 2012 support
10000 OVC in the areas of schooling, legal, safety in
particular in the convergence zone (Adamaoua).
Catholic Relief Service (CRS) in collaboration with the
diocesan coordination for health provides support in 4
Dioceses out of 24, for the reinforcement of care for the
OVC (legal assistance, referral to basic service,
psychosocial support, nutritional support, school support
and the AGR).
Involvement of Objective 1.1 : Increase from 35 to
the communities 805 the proportion of pregnant
and civil society
women who benefit from at least
one CPN including HIV screening
by 2015
Objective 2.1 : Ensure access to
preventions services and
reduction of discrimination to 14
240 MSM, 39 440 SW and 148 800
Truck drivers in the 10 regions by
2015
Objective 3.2 : Reduce the impact
Objective 4.1 : Reinforce the
coordination and monitoring
evaluation system
Development of Objective 4.2 : Reinforce the
the public-private system of coordination and
partnership
monitoring evaluation
GTZ: It is involved in the prevention of HIV among unwed
mothers by way of the network of «aunties” at the level of
the Health Districts and studies on the risk factors among
young girls.
UNDP: the mobilization of the local collectivities by way of
the program « Alliance of Mayors » contributes to the
reinforcement of the appropriation of the fight against
HIV/Aids by community leaders.
UNICEF through the program Child HIV/Aids supports the
involvement of community support groups in favour of the
use of health services and psycho-social-economic
framework for seropositive women in 62 Health Districts.
UNAIDS support the process of establishment of the
platform of organizations of civil society including the
PLWHA networks.
UNFPA : Within the framework of the 5th cooperation
program, it ensure the strengthening of capacities of the
OBC and other community actors in 24 Health Districts
until 2012.
UNESCO-BAD : Within the framework of the support
program for reproductive help which goes until April 2011,
UNESCO supports the reinforcement of capacities in 17
community radios out of the 40 existing.
Catholic Relief Service (CRS) contributes to the
reinforcement of capacities of 500 community volunteers in
the regions of the North, North-west and South-west and
108 OBC in the Regions of the East and North-west for the
carrying out of home visits.
The Groupement Inter patronal (GICAM) with the support
of BIT will ensure the implementation of the agreement
signed with the MINHEALTH in March 2010 to accompany
the Government in the mobilization of domestic funding.
Goal 4: Reinforce the coordination, monitoring evaluation within the framework of the implementation of the proposal
MonitoringObjective 4.1 : Reinforce the
UNAIDS. Supports the reinforcement of the national
system of coordination and
evaluation
system of monitoring evaluation for the response to HIV
and Aids, particularly the development and actualization of
guides and tools for the collection of data.
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4.4.9 Strategy to mitigate unintended consequences of additional program support on health
systems
Describe:
(a) the potential risks and unintended consequences on health systems that may result from the
implementation of the proposal; and
(b) the proposed strategy for mitigating these potentially disruptive consequences.
STIGMATIZATION AND DISCRIMINATION
The interventions which target in particular certain populations can lead to a risk of stigmatization by
making this population visible. In order to attenuate this risk, the proposal implements concrete
measures following the example of a better involvement of the CHW coming from setting or the
targeted populations to prevent this risk by actions of intra-community mediation and discussions with
health professionals.
To avoid stigmatization within the context of PMTCT which could be engendered by the distribution of
Mother Baby Pack among pregnant women, the proposal implements a transverse and integrated
approach. This would solicit the participation of community actors, SMI services in order to attain a
better acceptance of the PMTCT interventions.
According to the needs the PLWHA Associations will offer visits/meetings with beneficiaries in locations
outside of the residence so that their contacts occur in complete discretion. The community actors
(ARC, volunteers, counsellor, health agents) will receive training on confidentiality.
The attention placed on pregnant women within the context of the PMTCT program could increase
their visibility by the knowledge of the HIV serological status and lead to a stigmatization within their
family. The outreach communication towards pregnant women, their partners and all of the
community could limit this discrimination/stigmatization.
CARE AND TREATMENT
This proposal places the accent on the continuation of the free ARV and medications for OI. This could
lead to an incomprehension on the part of the patients who suffer from other chronic and serious
illnesses. In order to attenuate these effects, the NSP 2011-2015 plans to establish mechanisms of
community solidarity and health mutuals, a reinforcement of the health system which will benefit all
diseases.
HUMAN RESOURCES
The ARC involved in the research for those lost from sight, the counselling, the screening will benefit
from an indemnity within the framework of this proposal. This situation could be at the origin of a
miscomprehension between the health personnel and these community actors from the fact they have
the same health training. The solution is to accelerate the revision of the career profile for the
personnel in the State health facilities as envisaged in the development plan for human resources for
the MINHEALTH.
Within the context of the intensification of the overall care of persons infected by HIV, the proposal
plans for the extension of training/retraining to personnel of all of the health structures of the country
and to provide the logistics support applying to this passage of scale. Frustrations and demotivation
could arise among personnel of services who don’ benefit from the same advantages. As well, these
last could be tempted to desert the said services. The extension of training to other medical services
and medical specialists and the interaction between the different entry point related to HIV could
attenuate this risk.
Burn out: The growth in the number of PLWHA cared for will lead inevitably to an increase in the
workload or “burn out” among the concerned providers, this could lead to a large mobility of personnel
towards positions or services that are less demanding. The valorisation of their work and their support
through their training, in-service training, scholarships and the participation in international
conferences are some of the measures envisaged in this round to attenuate this risk.
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ROUND 10 – HIV
4.5
Program Sustainability
4.5.1 Strengthening capacity and processes in HIV service delivery to achieve improved health
and social outcomes
Describe how the proposal contributes to overall strengthening and/or further development of public,
private and community institutions and systems to ensure improved HIV service delivery and outcomes.
The proposal contributes to the improvement of the public sector, civil society and the private sector
by promoting the reinforcement of capacities, the reinforcement of the usual partnerships with the
OSC (NGO and Associations) and the establishment of a Public-Private Partnership.
 By ensuring 50 to 60% of the financing for antiretroviral treatments and supplies of medications
for opportunistic infections, the Government shows a continued commitment and support for
the sustainability of activities in the fight against HIV.
 By supporting the actions of decentralization of the care of PLWHA, the proposal aims to make
progressively operational the UPEC in the health districts in order to encourage the bringing
together of services for recipients including the vulnerable groups or the most exposed groups.
 The reinforcement of SYNAME capacities, CENAME, the CAPR and the health districts on the
management of medications and related products and quality control allows the proper
estimation of needs, to make available for the ill products of quality and to avoid ruptures.
 The involvement and reinforcement of capacities of actors of the community system will allow,
in the short term (i) increase in the frequentation of sexual and reproductive health services
and CPN by pregnant women and their partners, (ii) increase the percentage of people
knowing their serological status, (iii) improvement in the observance of treatment among
patients; (iv) reduction in the rate of those lost from sight; and in the long term (i) reduction
in the number of new infections; (ii) reduction in maternal mortality and infantile; and (iii)
improvement in the survival of patients under treatment and life conditions for the OVC.
 The strengthening of capacities of the community organizations through training, institutional
and organizations support will allow optimization of their capacities of intervention and
mobilisation of resources, reduction of the stigmatization and the discrimination towards SW,
MSM and the PLWHA, contribution as such to the creation of a favourable environment for the
fight.
 Involvement of the private health sector in the provision of protection and care allowing the
efforts of the government to be completed in matters of the mobilization of resources, ranting
as such the continuity and sustainability of the offer of services and actions in all sector of
development.
 The proposal plans several activities for the strengthening of meeting and coordination of the
interventions including the sharing of information and best practices at the national, regional
and operational level.
This will permit the guarantee of complementarity and the
sustainability of the interventions of the actors, in addition to the development of human
resources and the improvement of management.
 The strengthening of institutional and operational capacities of the NA through the recruitment
of new personnel, the supply of equipment and technologies adapted and made available with
technical assistance with allow this structure to play its role fully of coordination and
monitoring evaluation of the interventions.
4.5.2 Alignment with broader developmental frameworks
Describe how the proposal’s strategy aligns with broader developmental frameworks such as:
 Poverty Reduction Strategies;
 The Highly-Indebted Poor Country (HIPC) initiative;
 The Millennium Development Goals;
 An existing national health sector development plan; and
 Any other important initiatives.
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ROUND 10 – HIV
The present proposal is construed within the implementation of the National Strategic Plan (NSP), 20112015 on the fight against HIV/AIDS, which is the national policy and strategic guidance document
pertaining to the fight against STDs, HIV and AIDS. This document is aligned on national and
international basis as shown in the table below. The goal of this proposal is to achieve a generation
without HIV/AIDS through the improvement of maternal and child health and through ensuring an better
quality of life for PLWHA.
Documents/National
initiatives
Document « Cameroun Vision
2035 »
Description of links with the proposal
The «Vision 2035 » aims among others to increase the life expectancy for the
populations by reducing the maternal and infant mortality of which one of the
causes is HIV/AIDS. The proposal is part of this objective though the PMTCT
interventions and the care for persons infected and affected.
Strategy Document for Growth
and Employment (DSCE)
It considers HIV infection as a national priority with respect to its tragic impact
on human development. The interventions defined in the proposal will
contribute to the reduction of this impact.
The Initiative of Very Indebted
Poor Countries (PPTE)
Since 2002 Cameroon benefits from the resources of this initiative for the fight
against AIDS. The governmental counterpart for the implementation of this
proposal, notably the purchase of ARV, MEO and screening tests will be
ensured by the resources coming from this initiative.
Sectoral Strategy Documents
(Health, rural development,
social development…)
These documents consider HIV infection as a factor which affects health
aggravates poverty in so far as it touches a young fringe of the population,
considered as most productive. By targeting the reduction of new infections,
this proposal contributes to the alleviation of the burden of the epidemic in this
sector of the population.
This proposal is part of the operational framework of the SNP 2011-2015. It
rests on the strategies of this plan by search for complementary funding for
the identified priorities.
Strategic National Plan (SNP) ,
2011-2015, for the fight against
AIDS which is aligned with the
Sectoral Health Strategy (SHS)
2001-2015.
Strategic national plan for the
integral development of the
young child (PNDIJE)
The taking into account of the fundamental needs of the OVC as a function of
sex and the age bracket as defined in this proposal integrates perfectly with
the orientations of the PNDIJE.
Orientations on «the
multisectoral and decentralized
approach » of health for all.
Documents/International
initiatives
Objectives of the
United Nations Millennium
Development Goals
(MDG)
This proposal is based on the orientations of the mutisectoral and
decentralized approach of interventions, whose objective is the health for all
and the taking into account of the gender dimension in the fight against HIV.
Description des liens avec la proposition
Cameroon has subscribed to the Objectives of the United Nations Millennium
Development Goals (MDG) in particular for objectives 4,5 and 6, relative to the
inversion of tendencies of the priority diseases by 2015. These MDG
constitute the priority orientations from which the operational strategies relative
to the fight against AIDS/HIV are derived..
Framework Plan of the United The UNDAF 2008-2012 for Cameroon is centred on 04 large components:
Nations in Cameroon (UNDAF The problematic of the care of the PLWHA, the social protection of the PLWHA
and the target groups , the OVC are taken into account in the sectors of health,
2008-2012)
education and social protection of this plan. The joint program of the United
Nations on HIV/Aids 2008-2012 framework with the strategic priority axes of
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ROUND 10 – HIV
the NSP 2006-2010. The annual plans of the UNDAF and the joint plan of the
United National will be centred and aligned on the NSP 2011-2015.
Declaration of the United The proposal contributes to the attaining of the objectives of Universal Access
Nations on HIV/Aids (UNGASS) to prevention, care and treatment of HIV/Aids.
At the end of 2009, Cameroon adhered to this initiative within the framework of
International Health Partnership the development of the new plan perennial plan for development of health and
(iHP+)
the integration of HIV/Aids in the minimum package of activities in the health
sector. Its implementation is in progress.
Initiative of the Lake Tchad Round 10 took into account the complementarities in matters of prevention,
Basin for the reduction of the care and support.
vulnerability
and
risks
associated with HIV/Aids
Conventions on Human Rights
This proposal enters into the approach based on human rights and goes in
the direction of the respect and support for the implementation of agreements
for Human Rights ratified by Cameroon as the rights of freedoms of minorities
to health.
Declaration of the Heads of
state and Government of the
African Union (UA) in Abuja
Round 10 is within the framework of the implementation of the declaration of
the Heads of State, Governments of the African Union to make on the fight
against HIV, tuberculosis and malaria a priority.
Paris declaration on the
effectiveness of development
assistance;
The proposal aims to reinforce the appropriation of the interventions by the
actors, alignment of the national priorities and harmonization, management
based on results and mutual responsibility.
15th Summit of African Chiefs in
Kampala (27 July 2010)Declaration of the First Ladies
on the virtual elimination of the
Transmission of HIV from
Mother to Child
The proposal has integrated PMTCT and objectives 4,5 and 6 of the WHO, it
aims overall to improve by 2015 the health of the mother and child in
accordance with the declaration of the First Ladies.
The principle of the « Three
Ones"
The proposal also aims to reinforce the national mechanisms of coordination
and monitoring evaluation of interventions, as well as the development of
partnership to attain results.
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ROUND 10 – HIV
4.5.3 Improving value for money
Explain how the program that the proposal contributes to represents good value for money.
Specifically, given the context of the epidemic in the country and the definition of value for money
provided in the Guidelines, describe how the key interventions in the proposal represent the best
balance of costs and effectiveness, with consideration to the desired achievement of both short and
long term impacts.
The interventions retained in this proposal are those for which scientific evidence exists and which are
recommended at the international level for their effectiveness in the reduction of new infections or
improvement of the quality of life of infected persons.
In the context of a generalized epidemic and that of countries with limited resources, the targeting of
population at high risk (SW and MS) and PMTCT are actions which have proven their effectiveness. The
combined strategies available of condoms, treatment of STIs, the outreach awareness with peer
educators and health mediators, the fight against stigma and discrimination, towards the SW, MSM,
Truck drivers and their partners will have an impact on the expansion of the epidemic in the general
population.
With a view to reduce new paediatric infections, the proposal is oriented towards the virtual
elimination of the mother child transmission of HIV. The strategies adopted aim as such to contribute
the attaining of WHO 4, 5, 6 by 2015. It is in this context that for the PMTCT, the choice of option A
relies on the analysis of costs/benefits carried out with the contribution of the WHO and the Clinton
Foundation. The result of this is that the effectiveness of Options A and B were comparable when we
take into account the number of infections avoided. However, the cost of Option B being clearly
greater than of Option A, the country has made its choice of option A. As well, its establishment
presents the best cost/effectiveness rapport.
A study carried out by Goldie S. et al Cost/effectiveness of HIV treatment in poor settings – the case of
the Côte d’Ivoire, New England Journal of Medicine, 2006, 355, 1141-53. Retrieved on August 11, 2010
from http//www.pistes.fr/transcriptase/131_570.htm reveals that the strategies associating TAR and
prophylaxis for opportunist infections had a better cost/effectiveness rapport than those not using
ARV. In addition, the use of a antiretroviral treatment is based on clinical and1or immunological
criteria (CD4 counting) leading to an additional gain of 10.7 on the life expectancy for a surcharge of
590 dollars/year of life gained is a public health investment which is economically attractive in the
context of weak resources. This scientific demonstration comforts us in the choice of Goal 3 of this
proposal which puts the emphasis on the offering of services for CD$ to determine the appropriate
time to initiate treatment, the supply of ARV treatments and medications for opportunistic infections.
Cameroon has revised the national directives in accordance with the WHO (2009) recommendations.
The choice of therapeutic protocols, the MBP device, the taking into account of the TB/HIV dimension
constitute as well the strategies which must allow in the long term the reduction of the costs and
expenses related to HIV.
Studies on the cost/benefit rapport of interventions related to the health system are not sufficiently
documented in Cameroon. However, the use of data on the methods of transmission of HIV (Know Your
Epidemic) coupled with the in-depth use of NASA (Know the Financial Side of Your Epidemic) data could
allow estimation of the cost/effectiveness rapport in the management of the program. This proposal,
has the ambition of leading a study to better determine the cost benefit ratio for the patients.
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SERIE 10 – VIH
Monitoring and Evaluation System
4.6
4.6.1 Impact and outcome measurement systems
Describe the impact and outcome measurement systems, including strengths and weaknesses, used to measure achievements of the national disease
program at impact and outcome level.
The system of M&E of the program for the fight against HIV and aids in Cameroon is multisectoral and it is based on the 12 standard components of
UNAIDS. It is coordinated by the planning, monitoring and evaluation section of GTC/NAC.
In Cameroon the national system for monitoring evaluations has a function section for monitoring evaluation positioned at the level of the structure of
coordination at the central level GTC/NAC, and at the level of each region of a Unit of M&E at the GTR/NAC. This national system has available a
mutisectoral national plan, actually in process of revision because of the fact that the planning exercise NSP 2011-2015 has just finished. There exists
as well tools for collection as well as a circuit for reviewing the data which takes into account the different stakeholders of the programs (public,
private, faith-based and community). The Monitoring evaluation section participates in the integrated supervision with partners of the different
sectors, as well as in the studies whose results are contained in the quarterly and annual reports are used within the context of strategic information for
decision-making.
However, despite the existence of this monitoring-evaluation sections, some difficulties, notably structural and organizational hinder the proper
functioning of this provision. There is a qualitative and quantitative insufficiency of human resources, due to the lack of perfection and motivation.
Beyond this situation, the insufficiency of the financial means is also an obstacle to seat the mechanisms of coordination and reinforcement of
leadership in the area of monitoring-evaluation. Under these conditions, the monitoring evaluation section suffers from the absence of coordination
with the other sectors, health information systems, information systems for the community sector which do not allow this section to fully play its role.
This translates into an insufficiency in the control of the quality of data, the weak completeness and the difficulties of managing, storing the data. It
also leads to under production and under use of strategic information, the absence of an efficient strategy of retro-information, dissemination and
promotion of the use of the available data.
No.
1
M&E
components
Organizational
structures
Strengths
Weaknesses
Existence of a functional sector for
monitoring evaluation at the level of the
coordination structures (GTC/NAC at the
central level, GTS/NAC at the regional level)
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SERIE 10 – VIH
2
3
4
5
6
7
8
Human capacity
Availability of the technical supports of
partners as a function of the needs identified,
Existence of training modules in M&E
formation en S&E
Qualitative and quantitative insufficiency of the human resources in
the units for M&E of the sectors and structures at the operational
level, strong mobility of personnel in charge of the surveillance of
HIV, lack of plan for career development and career profile
Partnership
Existence of M&E Working Group
Weakness of coordination mechanisms, non coordination of the
research on HIV and weakness in leadership and communications
National
mutlisectoral M&E
plan
Availability of a national multisector M&E
plan for the fight against aids NSP 20112015 related to NSP 2011-2015. This M&E
plan was elaborated in a participative
manner based on the evaluation of NSP
2006-2010.
National work plan
numbers
The process of development of the
monitoring and evaluation operational plan
2011-2015 is in progress.
Advocacy,
communication and
culture
Existence of an advocacy tool based on HIV Absence of a communication plan on HIV including M&E,
data intended for leaders and deciders at the insufficiency of allocation of financial resources for the financing of
national level.
ME activities
Availability of data collection tools, the
existence of a data collection circuit at the
Systematic program
level of the different sectors (public, private
monitoring
and faith-based)
Survey and
surveillance
Existence of protocols for all surveys in
relation with the international standards,
existence of a system of biological and
behavioural surveillance.
Weakness of the health information system, weakness in the
mechanisms of transmission,, feedback and collaboration between
the actors involved, weakness of the sectoral systems of ME,
absence of tools for the collection of data and the monitoring
evaluation of interventions in the community and sectoral setting.
Irregularity of studies. Lack of a system to monitor epidemiological
tendencies, microbiological and parastiological of opportunist
infections
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SERIE 10 – VIH
9
10
11
12
National and
regional database
Supervision and
control of data
quality
Evaluation of HIV
and research
agenda of
Dissemination and
use of data
Absence of a data base, weak availability of quality data, absence
of software appropriate for the management of data
Existence of supervision for M&E activities
Weakness in supervision and control of data quality, absence of
tools for the supervision and control of quality
Inventory of evaluation studies and research
on HIV in progress, existence of an ethics
Absence of inventories of institutes and research capacities on
committee and administration clearance for
HIV/Aids
research on HIV/aids, use of results of
research in planning and strategies in the
fight against HIV.
 Absence of a plan for the identification of needs in view of
developing a plan for the use of data
 Insufficiency of data quality control, weak completeness and
Regular production of quarterly and annual
difficulties of management, difficulties in the storage of data
reports
 Under production and under use of strategic information.
Absence of an effective strategy of retro-information,
dissemination and promotion of the use of available data
4.6.2 Impact and outcome measurement
(a) Has impact and/or outcome
data been collected in the last 2
years?
Yes
No
(b) What was the source(s) of
the measurement?
HIV and syphilis seroprevalence
among pregnant women in 2009 and
sero-epidemiologic and behavioural
study among sex workers
(c) It is important to guarantee that there are systems in place to measure all impact and outcome indicators in the performance framework. In order
to do this, fill in the table below, fully describing all planned surveys, surveillance activities and routine data collection in country used to measure
impact and outcome indicators relevant to the proposal. Add rows as needed.
Years of Implementation
Data Source
Funding
2011
2012
2013
2014
2015
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Impact/Outcome Indicators
relevant to the proposal to be
measured by data source
SERIE 10 – VIH
Carry out every two years a
survey of sentinel
surveillance of HIV and
syphilis among pregnant
women
Carry out an evaluative
study on the quality of
services the areas of PMTT
and the care of PLWHA
Carry out a cohort study on
the evaluation of the
survival of patients on ARV
treatment at 12, 24 and 36
months
Carry out 02 evaluations of the index of
stigmatization and discrimination
related to HIV
Carry out 02 bio-behavioural studies
among the SW, MSM and truck drivers
Carry out a demographic survey of
Health IV
Total cost
Secured funding amount and funding source
Funding gap
147.225
0
147.225
Round 10 funding request for Source 1
147.225
Total cost
Funding gap
Total cost
Funding gap
20 912
0
20 912
20 912
9147
0
9147
20 912
0
20 912
20 912
9147
0
9147
20 912
0
20 912
20 912
9147
0
9147
20 912
0
20 912
20 912
9147
0
9147
20 912
0
20 912
20 912
9147
0
9147
9147
9147
9147
9147
9147
147.225
0
147.225
147.225
0
147.225
147.225
147.225
Total cost
Funding gap
Total cost
Funding gap
17 348
0
17 348
17 348
55 287
0
55 287
17 348
0
17 348
17 348
55 287
0
55 287
55 287
55 287
Total cost
1 541 000
1 541 000
Funding gap
0
0
Percentage of babies born to
mothers carrying HIV and
themselves carriers of the virus
Percentage of babies born to
mothers carrying HIV and
themselves carrying the virus
Percentage of adults and children
affected by HIV who we know they
have been treated for 12 months
before the beginning of
antiretroviral therapy
Percentage of women and men of 15 to
49 years having a behaviour of
acceptance towards persons with HIV
Percentage of population the most
exposed to risks (sex professionals) and
carriers of HIV
Percentage of the population the most
exposed to risk (men having sexual
relations with men) and carriers of HIV
Percentage of women and men 15 to 49
years of age having had at least one
sexual partner during the last 12 months
and declaring having used a condom
during their last sexual relationship
Percentage of men aged 15 to 49 having
declared using a condom the last time
they had a sexual relationship with a sex
professional
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Clarified 4.6.3 (b)
4.6.3 Links with the National M&E System
(a) Describe how the monitoring and evaluation (M&E) arrangements in the proposal (at the Principal
Recipient, Sub-recipient, and other levels) use existing national indicators, data collection tools and
reporting systems including reporting channels and cycles.
The methods of monitoring-evaluation (ME) for this proposal rely on the orientation of the ME system for the
multisectoral response in the fight against Aids such as defined in the new NSP 2011-2015 and the monitoring
evaluation 2011-2015.
In this proposal, the national performance indicators and effect used come from the national strategic plan and are
harmonized with the indicators for universal access and UNGAAS. The data will be collected by using the existing
tools of which certain of them will be revised in order to manage the reliable information in the context of the national
program. To this effect, the community actors and the health personnel in charge of monitoring evaluation will
benefit from a strengthening of their capacities. The effectiveness of this system rests on its integration in the
national system for which the functioning is described below.
The activities implemented by the recipients (PR, SR and providers will be the subject of quarterly reports based on
the data collected. The existing collection tools will be adapted to facilitate the collection of data on the interventions
led by the OSC in the groups of SW, MSM and Truck drivers, and by the health system in accordance with the
national indicators. To allow this provision to function and manage the expected information, this proposal must in
place several trainings at different levels (training of data managers in the CTA and UPEC, training of actors of the
community system and health system. The data produced by the ground actors will e recorded on standardized
collection sheets.
At the regional level, the evaluation monitoring and planning unit compiles the data sent by the actors of the different
sectors including civil society. For its turn, the Regional Technical Group (RTG) sends the aggregated data to the
central level to the Planning Monitoring-Evaluation Section of the Central Technical Group (CTG) who compile the
data for all of the Regions. Quarterly reports, biannual and annual reports are produced by the CTG/NAC to take
into account the realizations, from the level of the implementation of activities , the use of allocated resources, the
gaps identified and the measured planned to correct them.
Within the same framework, the data coming from the health facilities of the Ministry of Health (PMTCT and the care
of PLWHA), are transmitted from the operational level via the Health services of the Health District to the Regional
Delegation for public Health (DRSP). These data, compiled by the DRSP, are sent to the CTG and to the Director
for Fight Against the Disease. After analysis, these data are sent to CTG by the RTG.
The system of monitoring evaluation for this proposal is clearly part of the national system of ME. Thus, the two PR
coordinate the receipt of the data with the respective SR and the NAC. The consolidation of the data coming from
the SR will be done by the PR. At the regional and operational level, the implementation structures transmit
simultaneously to PR and to RTG who after compilation and analysis sends it to CTG\NAC for use and strategic
decision-making.
There will be no overlap of reports coming from the PR and the SR, because most of the MINHEALTH partners have
adopted the same plan and the same report model. In addition, the data on the indicators envisaged by the proposal
can be easily received by means of existing systems and approaches by all of those responsible for the
implementation with the strengthening of their capacities.
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(b) Are all of the M&E arrangements planned for the proposal
using the national M&E system?
Yes
No
(c) If no, explain why not and list any service delivery areas (SDAs) and/or activities that will not be
monitored through the national M&E system.
NA
4.6.4 Strengthening monitoring and evaluation systems
(a) Has a multi-stakeholder national M&E assessment been
recently conducted (in last 2 years)?
Yes
No
(b) If yes, has a costed M&E action plan been developed or
updated to include identified M&E strengthening measures?
Yes
No
(c) Describe whether the proposal is requesting funding for any M&E strengthening measures. These
strengthening measures may have been identified through a national M&E assessment or any other
relevant evaluation or review process.
The review of NSP 2006-2010 and the development of the new strategic plan revealed a certain number of gaps
and measures that this proposal takes into account.
1.
Institutional strengthening
In order to allow the Planning Monitoring Evaluation (PME) section of GTC/NAC to fully play their role, it revolving
material will be made available for the carrying out of the activities of coordination, specific monitoring and
supervision missions and joint (SDA 4.1.3). The section of PSE and the units of SE regional will be provided with
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computer equipment.
2.
The strengthening of the capacities of agents responsible for monitoring evaluation
The availability of competent human resources in the area is incontestable for the implementation of a system of
monitoring evaluation which is reliable and functional. This proposal will contribute the strengthening of
capacities of the personnel (qualitative and quantitative) in SE of the PR and SR involved in the monitoring and
evaluation. As much as engineers statisticians are recruited in all of the SE units of the GTR within the context of
monitoring and evaluation at the regional level, these last all of the actors of SE for all of the sectors concerned
by the proposal need a strengthening of their capacities in the matter of data management.
The proposal will contribute to the strengthening of capacities of 240 registry filling agents in the care structures,
the informaticien responsible for developing a database and the assistant for monitoring evaluation.
3.
Coordination
The objectives of the M&E plan aim for the redynamisation of instances of coordination at the different level, and
this by way of the organization of the quarterly meeting of the Technical Group on SE and the biannual meetings
of the CPLS.
4.
Studies and research
The information coming from these studies gives arguments in the context of the orientation of policies in matters
of the fight against the epidemic and clarifies decision making. In the context of the implementation of the
system of SE, some studies are to be made priorities. This will mean carrying out:

Periodic surveys on the prevalence of HIV among pregnant women and two specific surveys among the SW
and MSM.

Valorisation of all of the studies will be carried out in partnership with the CIRCB, IRD and ANRS on
PMTCT, paediatric care, resistances, etc.

Periodic studies of the prevalence of HIV among pregnant women and two specific surveys of the groups
the most exposed to risk

Two surveillance surveys for resistance of HIV to ARV will also be carried out

Annual estimation surveys for the flow of resources and expenses incurred in the fight against Aids

Evaluation study of the survival of patients on ARV at 12, 24 and 36 months

Evaluative studies of the indexes of stigmatization and discrimination related to HIV

Evaluation at the halfway point and a final evaluation of the implementation of the R10 proposal

An evaluation halfway and a final evaluation of NSP 2011-2015 at the end of 2015.
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Implementation Capacity
4.7
4.7.1 Principal Recipient(s)
Describe the technical, managerial and financial capacities of each Principal Recipient (PR) to manage
and oversee implementation. Include any anticipated limitations to strong performance and refer to
any existing assessments of the PR, other than Global Fund reporting mechanisms.
PR 1 Name
Ministry of Health
Sector
Street Address
Rue de Crois-Rouge PO: 1459 Yaoundé
Governmental
The Ministry of Public Health has established a Technical Secretariat responsible for the coordination and
monitoring of Global Fund Programs of which it is the Principal Recipient. This Secretariat includes a Coordinator,
a person responsible for monitoring, a financial expert and support personnel (Chauffeur, secretaries)
The Public Ministry of Health implements the fight against HIV and Aids through:
The National Committee for the fight against AIDS (CNLS) presided by the Ministry of Public Health, organ
for the design, orientation of strategies and activities to be implemented each years. It holds biannual
meetings.
 The Permanent Secretariat of the National Committee for the Fight Against AIDS (CNLS), management and
monitoring organ for the implementation of activities. It include the Central Technical Group (CTG) at
the central level and the Regional Technical Groups (RTG) at the Regional level.
The Permanent Secretariat has 52 personnel:

22 at the central level (Permanent Secretary, Permanent Assistant Secretary, 7 Section Heads, 4 CTG Unit
Chiefs, 9 CTG design officers);

30 at the Regional level: 10 RTG coordinators, 10 monitoring Unit Chiefs, 10 Local Response Unit Chiefs)
Implementation of activities at the regional level:
 The regional coordinators are responsible for the supervision and monitoring of the implementation of
activities in collaboration with the Regional Delegates for Public Health
Implementation of activities at the level of the districts
 At the operational level, the activities for the fight against HIV are implemented in an integrated fashion
at the level of the health facilities (district hospitals, integrated health centres).
In the context of the medical care of PLWHA, the specialized UPEC/CTA structures exist in the central, regional
hospitals and some district hospitals.

There exists at the level of the Ministry of Public Health, the direction for the fight against Diseases (DLM) which is
in charge of the coordination of programs in the fight against the diseases (Malaria, Tuberculosis, HIV an Aids,
Cancer leading to blindness, Onchocerose, Leprosy, Mbasu etc). The HIV/Aids, Malaria, Tuberculosis Aare the
Focal Points which ensures the interface between these programs and DLM.
Financial management and Procurement
Financial management
The program has a pointed expertise in the management and implementation of projects with external funding
with probing results. Since 2001, numerous funding (World Bank for 50 million USD, the Global Fund through
Rounds 3 and 5 respectively of 55,500,517 USD and 9,060,883 Euros have been managed and audited in
accordance with international standards.
The Financial management of the Program is done within the framework of an OHADA accounting system and in a
computerized system using the TOMPRO software. The Principal Recipient has opted for the Autonomous
Amortization Fund (RET), which is the window for all of the external funding, opening and managing main accounts
receiving the funding for the Program. These funds are managed following the procedures dictated both by the
provider of the funds and those contained in the Financial Regime for the State and the Law on Finances.
Procurement
Contracts are issued in accordance with the Code on Public Contracts of 14 September 2004. There is a Special
Commission for the Issuing of Global Fund Contracts among the Principal Beneficiary. With the framework of this
proposal, this Commission will be strengthened to improve the time frames for the issuing of Contracts.
The acquisition of medications is done through CENAME which is a special and experienced structure in the matter
through the Commission for the Issuing of Contracts created by the authority for contracts within this independent
structure.
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Audits
Two auditors have been recruited by the Program whose first mission if the verification, application and
improvement of procedures in order to guarantee the integrity of fund and a good use of the funds.
Each year, an independent audit firm recruited by a competitive offer carries out the diligences of an external
audit.
PR 2 Name
Cameroonian National
Association for Family
Welfare (CAMNAFAW)
Sector
Civil Society
PO : 11994 Yaoundé
Telephone : (+237) 22 23 62 30 ;
Street Address
Fax : (+237) 22 20 36 99
Email : camnafaw@ippf.org
camnafaw@yahoo.fr
Cameroonian National Association for Family Welfare (CAMNAFAW)
CAMNAFAW is a Non-governmental Organization that works in the area of sexual and reproductive
health. They are a member of the International Planned Parenthood Federation (IPPF) which is their
main provider of funds since their creation in 1987.
The mission of CAMNAFAW is to “Contribute at the side of the Cameroon Government to ensure to the
greatest number of people, access to quality RH services through:

Improvement and extension of the offer of integrated quality RH services;

The mobilization and implication of adolescents/young people;

The overall care of HIV infection;

Advocacy for the lifting of sociocultural and legal barriers

The care of SMI problems, including post-abortion care
Personnel
CAMNAFAW has a large network of volunteers disseminated in all the national territory. To date, its
national file includes approximately 200 people with various skills. Outside of the activities led in
advanced strategy, CAMNAFAW intervenes through framework structures which are the Youth centre
and care and Health centres. CAMNAFAW has regional representation in 7 of the ten provinces of
Cameroon.
Areas of Intervention
The main areas of intervention of CAMNAFAW are the following:
1.
Sexual and Reproductive Health
2.
Harmful type sexual practices and violence towards women
3.
Sexual Rights and Rights in Reproductive Health
Experience with CBO
The main recipient groups of CAMNAFAW programs are the following:
1.
Youth in and out of school
2.
The LGBTI community
3.
Men women at the age of procreation and persons
4.
SW and migrant workers
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5.
PLWHA through various projects such as:
The annual budget for CAMNAFAW revolves around 385000 euros, funds audited annually by the
international office of Deloitte
Organization strengths
- Full member of an international federation (IPPPF) recognized on the world scale and subject to
quality and performance criteria
-Implanted in seven of the ten provinces in which it regularly leads activities on the ground
- Founding member of a national network of NGO/Health Associations (ROSACAM)
- solid base of volunteers engaged and with various skills
- Organization in line with national legislation in matters of work and taxes
- Modern procedures of financial management, in accordance with the OHADA accounting plan and the
requirement of funders regularly reviewed and audited annually since 1989 by an international office
of expert accounts
- Recognized as a partner by the MINHEALTH (collaboration agreement and service rental contract)
- Use of an integrated management system: computerized program data
- Well trained personnel, competent and motivated
- Leader in the area of RH in Cameroon
Weak points, to be strengthened
- Insufficiency of personnel
- Non availability of long term real estate assets
Clarified 4.7.2 (a) (d) (f)
4.7.2 Sub-recipients
Yes
(a) Will Sub-recipients be involved in implementation?
No
(b) If no, why not?
HALF PAGE MAXIMUM
(c) If yes, how many Sub-recipients will be involved?
(d) Are all Sub-recipients already identified?
1-6
Yes
7-20
21-50
50+
No
(e) List the identified Sub-recipients and describe:
 The work to be undertaken by each Sub-recipient;
 Past implementation experience of each Sub-recipient;
 Any challenges that could affect performance of each Sub-recipient as well as a mitigation
strategy to address this.
ORGANIZATION OF WORK FOR THE PR AND SR
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DOMAINE
PMTCT
PRs
MINHEALTH
Prevention of
HIV among CAMNAFAW
MARPs
Treatment
and Care
MINHEALTH
Reduction of
the impact of MINHEALTH
stigmatisation
Coordination
and
Monitoring
Evaluation
CAMNAFAW
MINHEALTH
MINHEALTH,
CAMNAFAW
SDA
SDA 1.1.1 : Communication and
social mobilisation
SDA 1.1.2 : Health professionals
SDA 1.1.3 : Screening
SDA 1.2.1 : PMTCT
SDA 1.3.1 Health professionals
SDA 1.3.2 Provision of services
SDA 2.1.1 : BCC- community
relays
SDA 2.1.2 Development of links,
SDA 2.1.3 Condoms
SDA 2.1.4 STI
SDA 2.1.5 Screening
SDA
2.1.6 Reduction of
stigmatisation
SDA 3.1.1 Health professionals
SDA 3.1.2 : Treatment and
monitoring
SDA 3.1.3 Provision of service
SDA 3.1.4 Prophylaxis and
treatment of MIO
SDA 3.1.5 : TB/HIV
SDA 3.1.6: Care and support for
chronically ill
SDA 3.2.1 : Support for OVC
SDA
3.2.2
Reduction
of
stigmatisation
SDA 4.1.1 : Information based on
tangible facts
SDA 4.1.2 : Information system
SDA 4.1.3 : Management and
administration costs
SOUS RECIPIENDAIRE
2
CARE,
MINHEALTH
MINHEALTH
MINSANE, CBCHB
MINHEALTH
MINHEALTH
CHP, Presse Jeune
CHP,
MINHEALTH
CHP,
MINHEALTH
CHP, Presse Jeune
MINHEALTH
MINHEALTH
MINHEALTH
MINHEALTH
MINHEALTH
CARE
CRS
MINHEALTH
CAMNAFAW, CHP, Presse
Jeune,
MINHEALTH
MINHEALTH, CAMNAFAW
NB: The BCC outreach in the Truck Drivers locations will be ensured by CHP and with the MSM and SW
by CANAFAW. Each of the actors of these different target groups will ensure the distribution of
condoms, diagnosis and treatment of STI. The messages on the community radios will be coordinated
by Presse Jeune.
SR EXPERIENCE
1. CARE Cameroon
Care Cameroon is one of the country offices of CARE International. The CARE International network is
made up of 12 members: CARE France, Great Britain, Denmark, Germany, Austria, Norway, Japan,
United States, Australia, Canada, Thailand and the Netherlands. CARE International has representative
offices in close to 70 countries around the world (Africa, Asia, Latin America, Eastern Europe) and also
had an average annual budget of close to 600 Million Euros, coming both from private resources and
institutional.
The mission of CARE is to serve individuals and families within the poorest communities of the world.
Their programming principles include: the promotion of reinforcement, work with partners,
accountability, non discrimination, the promotion of the non violent resolution of conflicts and the
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search for sustainable results.
CARE has been involved in Cameroon since 1978 and conducts its activities in the whole of the national
territory. Below is a list of the recent projects conducted by CARE Cameroon.
1. The Potable Water project and community health in the province of Adamaoua (March 2002 to June
2006) which aimed for the reduction hydric diseases by the improvement of access to potable water.
Financing: ACDI. Budget: 2,439 million Euros.
2. The project for the prevention of STI/HIV/AIDS and road security along the axe of the N’GaoundéréToubor-Moundou road (December 2004 to November 2006) Financing: European Union. Budget:
152,449 Euros.
3. The rural development project in the provinces of Adamaoua and the East which aimed to improve
the maternal and infant nutrition by the increase of agricultural production (January 2005 to January
2008). Financing: USDA. Budget: 2,591 million Euros.
4. The project for the prevention of STI/HIV/AIDS among truck drivers and the surrounding populations
of road axes of Cameroon (December 2004 to June 2009). Financing: ACDI. Budget: 3,048 million
Euros.
5. The project for the mobilization of civil society for the Fight Against HIV/AIDS (January 2005 to
December 2009). Financing: Global Fund Round 4. Budget: 12,348 million Euros.
6. The project for the promotion of the integrated community care for persons infected and affected
by HIV/AIDS/Tuberculosis in the province of the extreme North (January 2005-December 2007).
Financing: European Union. Budget: 2.5 million Euros.
7. The support project for orphans and vulnerable children in 4 site of the North and Extreme North
(Year 2008) Financing: Global Fund Round 3. Budget: 135,434 Euros.
8. The project for the prevention of malaria in the zone of Lagdo in North Cameroon (July 2005 to June
2007). Financing: SANOFI AVENTIS. Budget: 132,000 Euros
9. The assistance project for Central African Refugees in Cameroon (January 2007 to December 2007).
Financing: High Commissariat of the United Nations for Refugees. Budget: 698,216 Euros
10. The project for Urban Health (Malaria, Reproductive Health) of Garoua (January 2009 – June 2011).
Financing: European Union. Budget: 700,000 Euros.
In all of its projects CARE co-contracts with specialized thematic partners or
geographically/sociologically close to target populations – more than 220 sub-contracts over the course
of the 5 last years – all projects together.
The prior evaluation of projects allows CARE Cameroon to identify the obstacles and possible risks to
attain results. There is notably a weak level of appropriation of the obligation to be accountable by
the organizations of civil society and inadequate human resources available in terms of quantity and
the tasks to be accomplished.
CARE has reinforced over the course of the Round 4 project the community seating of its work as well
as the links with the national institutions and organizations: Ministry of Public Health, Social Affairs,
Work, Transport and the Promotion of Women and the Family, Planning and the Organization of the
Territory, Agriculture and Rural Development, VSO, PNUD, CRS, PAM, HCR.
CARE Cameroon has qualified human resources, competent and motivated for the implementation,
monitoring and evaluation of programs and projects. The professional activity of CARE Cameroon
employees is framed by recently revised administrative and financial procedures in the sense of a
rigour which is even more reinforced.
In the service of the project, in addition to specific direct collaborators for the program, CARE
Cameroon has available a Director, an internal audit services, an Administrative and Financial
Coordinator assisted by an Accounting and Financial Manager, an Administration/Logistics Manager and
a Human Resource Manager, several accountants, logisticiens and 5 support persons.
In addition, since April 2008, CARE Cameroon is supervised with the CARE network by CARE France who
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a makes available the assistance of a Management Controller, two auditors, one a program manager,
one a reference in health matters, one a specialist in communications.
CARE Cameroon possesses a regularly controlled accounting system and has available SAGA software
used by numerous development NGOs allowing them to:
 Certify liabilities and debts of third parties.
 Respect the rule of the double entry
 Respect the rule of the reciprocity of accounts
 Establish a general ledger and a general account balance
 Establish an operating account
 Establish a balance sheet
 Do budgetary monitoring.
CARE Cameroon also uses a cash system which allows a distinct monitoring of financial transactions by
project/provider, tools for bank reconciliation and cash and periodic control of cash movements.
CARE Cameroon’s accounting system allows for the payment of funds to sub-beneficiaries and to
suppliers in a transparent and justifiable manner. According to current procedures:
 The maximum time period for payment of suppliers is 15 days after deposit and approval of the
invoice
 The time period is 21 days for the sub-beneficiaries, after deposit of the financial report and
validation of the justifications of expenses by internal audit
 The presence of an office in the zones of intervention of the program facilitates the available of
funds for suppliers
 For the availability of funds to sub-beneficiaries CARE Cameroon has establish a system of direct
transfer into the account of the organizations which guarantees the swiftness and security.
The internal audit service of CARE Cameroon, desired by the Global Fund at the start-up of Round 4,
has available today all of the monitoring tools and control tools for sub-contracts, validated by LFA
quarterly.
2. CARE AND HEALTH PROGRAM
Care and Health Program (CHP) is a NGO (Non governmental organization) created in 1996 and based in
Cameron. For more than 12 years, CHP has been involved in the area of the activities related to
prevention including research in matters of STI/HIV/AIDS and the activities of family planning; non only
in Cameroon but also in Central and West Africa.
CHP has also been strongly involved in the implementation of several projects relative to
STI/HIV/AIDS/FP in the public, private and community sectors. The targets aimed at by CHP include
the among others, the authoritative forces (security forces, police, penitentiary administration
personnel), youth out of school, youth in school (secondary and university), the truck drivers, the sex
workers, prisoners, women, sexual minorities..., in six (10) provinces of Cameroon. As well, CHP has
also provided technical assistance to several partners such NAC, RECAP+, AFASO, SUNAIDS, SWASS, the
women’s associations, the Ministry of Defence, the police,.. in the implementation, management,
training and monitoring of these projects.
As well, CHP has a long experience of collaboration with national and international organizations in the
sub-region. They have also had close to ten years of collaboration with UNAIDS, USAID, WHO, JHU,
CDC, Global Fund, KFW, the World Bank, ... Being part of the FHA/SFPS project, CHP contributed
strongly to the development of skills for control activities for STI and HIV/AIDS in the sub-region
between 1009 to the year 2003. Since October 2003 to July 2008, CHP has worked as an associate
partner in charge of the counselling and screening part for the AWARE HIV/AIDS project which is a
Regional Project financed by USAID covering 18 countries (of which 15 are ECOWAS countries plus
Cameroon Tchad and Mauritania). Since 2006 CHP has been a sub-beneficiary of the Ministry of Public
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Health, Principal Beneficiary, in the implementation of Round 5 activities of the Global Fund for the
Fight Against Malaria, Aids and Tuberculosis, care of STI section as an entry point for the care of
PLWHA by the ARV. It should also be noted that CHP has an standard international accounting system
which is regularly audited by renowned audit firms such as Ernest & Young, Bekolo & Partners, Price
House Coopers. CHP is currently in the process of acquiring the TOMPRO accounting software which we
will allow them to make their management system more competitive.
Projects carried out by the bidder (in relation to the chosen domain)
Thanks to the confidence gained in CHP by fund providers, they have managed several project, among
others:
a. Project No. 1: Strengthening of the diagnosis and care of STI among 100,000 patients in the
vulnerable target groups: MIDEF, MINESUP, MINESEC, Penitentiary Administration, DGSN.
i. Budget: 4,315,144 Euros of which 2,830,734,464 FCFA
ii. Source of financing: Global Fund
iii. Period: August 06 to July 2011
iv. Targets: Students in and out of school, men in detention, prisoner, PLWHA
v. Project Partners: NAC/MINHEALTH, MINDEF, MINESEC, MINEWUP, DGSN, MINJUSTICE, associations
and clubs
Zone of coverage: 10 regions of Cameroon
b. Project No. 2: Improvement of the access to screening for HIV as well as the quality of service in
Central and West Africa
i) Budget: 523,833,487 FCFA
ii) Source of financing: Family Health International
iii) Period: October 2003 – June 2008
iv) Targets: Truck drivers, sex workers, peripheral populations, young people, PLWHA
v) Project partners: NA/MINHEALTH – Ministry of Transportation – Secondary teaching – higher
education of the concerned countries
c. c. Project No. 3: DHAPP
i) Budget: 1,500,000,000 FCFA
ii) Source of funding: US MILITARY DEPT OF RESEARCH
iii) Period: 2003-2008
iv) Targets: Military, PLWHA
v) Project partners: MINDEF- MOH
Coverage zone: Cameroon, Tchad, Gabon, Congo, Equatorial Guinea, Sao Tome, RCA
3. Catholic Relief Services (CRS www.crs.org )
Catholic Relief Services (CRS) has been involved in the fight against HIV and AIDS in Africa, Asia and in
Latin America since 1986. CRS is currently in charge of more than 250 projects on HIV and AIDS and
directly reaches close to four million people in 52 countries. For the 2007 period alone, CRS spend 119
million dollars on HIV and AIDS.
CRS has managed Global Fund resources since 2002. CRS has already benefited from more than 85
million dollars to support 28 projects (16 on HIV, 10 on malaria, 2 on TB) in 19 countries for seven of
the eight regions covered by the Global fund. Currently 17 projects (10 HIV, 6 malaria, 1 TB) are
implemented in 12 countries for a program evaluated t close to 80 million dollars.
CRS works in partnership with faith-based health care institutions and secular community-based
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institutions as well as with institutions for community mobilization. CRS enjoys a long and unique
partnership with preferential access to thousands of health establishments in the catholic health
network. CRS and its partners work jointly at promoting innovative and effective community programs
which are overall effective in attenuating the effects of HIV and AIDS, working on the underlying
causes, and helping to reduce the propagation of HIV.
The organizational and technical capacity of CRS in matters of HIV-AIDS can be expressed in terms of
seven permanent HIV-AIDS professionals based at the head office, eight regional technical counsellors
based in Africa, in Asia and in Latin America, numerous program officers in more than 40 countries all
equipped with a large experience in the management of HIV and AIDS programs.
CRS has pointed expertise in home care (HBC), the support and care of orphans and vulnerable children
(OVC), life skills education, antiretroviral treatments (ART), the Prevention of Mother-child
Transmission PTME), food safety and nutrition, Counselling and Voluntary Screening, the improvement
of policy on HIV and AIDS and advocacy for economic strengthening
With respect to the care and support for orphans and vulnerable children (OVC), the CRS programs
have improved the quality of life of 56,700 OVC affected by HIV and AIDS in six countries. The 12
million dollars of the PEPFAR program financing the increase in capacities of 10,220 families to be able
to efficiently meet the needs of the orphans and vulnerable children through the training of 15,422
care personnel and the increase in the institutional capacities of 760 faith-based and community
partners in order to offer durable and high quality interventions to OVC.
CRS started to work in Cameroon in 1961 and has adapted its programs to the changing needs of the
country. The organization started to support HIV and AIDS projects in 2003 and since that time, CRS
has provided its support to community care and support interventions targeting the OVC, the PLWHA
and their families in the North-west, South-west, Centre and East to reach more than 3,000 OVC and
1,500 PLWHA with a network made up of 500 community volunteers and 108 community-based
organizations (OBC).
4. Presse Jeune
Created in 1997, Presse Jeune is a Non-governmental Organization (NG0) for advocacy, community
mobilization and technical support. Presse Jeune has in its active file the implementation of several
project directed at children, young people, women and the media. The organization has worked with
several partners in development including the Government, PASOC, CIDA, the European Union,
CONFEJES, la Francophonie, UNESCO, UNAIDS, PNUD, UNICEF, the World Bank, UNFPA, CEA, the
Embassy of the United States, the Coopération Française, the Netherlands, etc. Presse is a member of
several networks and national and international working groups. Presse Jeune conducts their activities
in the whole of the national territory.
Areas of competence: Prevention of HIV/Aids and promotion of SR, Communication for Development,
public policy, gender and human rights, community system strengthening.
Below is a list of some recent projects carried out by Press Jeune:
 Young people media project and HIV/AIDS supported by Unesco, Unicef, NA and la Francophonie
 Project for the promotion of the leadership of young girls and women in the fight against
HIV/AIDS and the promotion of SRA support by la Francophonie, the Embassy of the United
States, GTZ and MINREX
 HIV/Aids and the rights of man project: the youth mobilize supported by UNESCO, NAC, IFMSA,
GTZ



Community radio project and HIV/Aids supported by CIDA, UNICEF, UNESCO, and NAC
Behavioural analysis combining risk and vulnerability mapping and life skills and establishment of an Centre
for information, education and listening for Young people within the framework of PDA and EVS supported
by UNICEF, MINYOUTH, MINESEC
Communication for the change in behaviours : production and diffusion of BCC information such as
magazines (Rebondir Magazine, Le Journal des Enfants, Lycées et Collègues, AGIR), brochures, flyers,
posters guides etc. Capacity building for journalists on the treatment of information on HIV/Aid with support
from UNCEF, NAC, Unesco, CIDA.
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




Regional capacity building workshop for young people on gender, HIV and maternal and neonatal mortality
supported by SRO/UNFPA
Advocacy and community mobilization activities for the access to services
Positioning project for Civil Society in CCM support by Care within the framework of Round 4 of the GF and
PASOC of the European Union
Advocacy for the positioning on the agenda of young people in the local collectivities with the support of
PASOC, MINATD and the National Assembly
Establishment of a civil society working group on the partnership with the private sector
5. Cameroon Baptist Convention Health Board (CBCHB)
The CBCHB is a faith-based health organization which has been operational in Cameroon since 1949.
This organization has five hospitals (of which 02 are equipped with 250 beds each), 24 integrated
health centres, 43 primary care centres, one pharmaceutical production and distribution centre, as
well as a training school for health personnel. http//www.cbchealthservices.org/ ).
Technical capacity and partnership
The CHCHB has developed and worked in partnership with several governmental and non-governmental
organizations in Africa, Europe and in North America, among whom in particular are USAID, UNISEF,
Columbia University, CIDA, Elizabeth Glaser Pediatric Foundation, UNICEF and the Ministry of Health of
Cameroon. In 1999 in response to the HIV epidemic, the CHCHB established a Community Education
Program, which has developed into a program for care and prevention of HIV. The program includes 5
HIV care centres, PMTCT centres and support groups to target approximately 3000 PLWHA.
The CBCHB is equipped with a good capacity of human resources with 46 doctors, 423 nurses and midwives, 428 care aids, 223 paramedical , 15 administrators, 176 administrative personnel to which 47
spiritual counsellors and social workers can be added. This personnel is spread out in the health
facilities which deliver integrated services in complementarity/continuity with the other public and
private health structures. It also contributes to the increased access for populations to health care.
Financial management
CBCHB has a credible financial structures with a lot of experience in the management of external
resources especially funds coming from the American government. The personnel involved in financial
management is made up of three people (01 Director of Finance, and 03 certified accountants). The
external financial audits are regularly carried out. In their last externally audited report, KPMG (An
international audit institution) congratulated CHCHB for their financial management judged to be in
agreement with contemporary norms.
Experience in PMTCT
CBCHB has been involved in PMTCT since February 2000 with a significant financing from the Elizabeth
Glazer Foundation (EGPAF) and USAID. This financing allowed CBCHB to develop and to offer PMTCT
services in certain localities of the country especially in the regions of the South-west and North-west.
In 2004, USAID, Africa West Program (USAID/WARP) though the AWARE program provided financial
support to CBCHB to reinforce its PMTCT activities.
CBCHB has established a Regional Training Centre which has training providers of PMTCT services
coming from 15 countries of the sub-region, and provides technical support to five of these countries in
the implementation of PMTCT services. With the support of the AWARE project, CBCHB has established
the project Men-As-Partners (MAP) in 5 PMTCT sites. The originality of this project is that it
implements an approach which encourages the male sexual partners of PMTCT service clients to
participate in the PNC visits, to solicit the screening for HIV. As well, it contributes to the reduction
and prevention of domestic violence.
CBCHB collaborated in the PEARL research project (PMTCT Effectiveness in Africa: Research and
Linkages to Care) financed by the CDC Atlanta and EGPAF. In 2008, with financing from EGPAF, CBCHB
implemented the CORE research project (Continuum of Care Operations Research) which aimed to
compared the two approaches of passages to the scale of ARV prophylactics more effective for women
and their children.
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(f) If the private sector and/or civil society are not involved as Sub-recipients in implementation, or
only involved in a limited way, explain why.
Six (6) civil society organizations are involved in the implementation, including CAMNAFAW as principal
recipient, CARE-Cameron, Care and Health Program (CHP), Catholic Relief Services (CRS), Cameroon
Baptist Convention Health Board (CBCHB) and Press Jeune as sub-recipients.
Clarified 4.7.3
4.7.3 Sub-recipients to be identified
Describe:
(a) why some or all of the Sub-recipients are not already identified; and
(b) the transparent, time-bound process that the Principal Recipient(s) will use to select Subrecipients and not delay program performance.
N/A
4.7.4 Coordination between or among implementers
Describe:
(a) how coordination will occur between multiple Principal Recipients if there is more than one
nominated Principal Recipient for the proposal; and
(b) how coordination will occur between each nominated Principal Recipient and its respective Subrecipient to ensure timely and transparent program performance.
The coordination between the PR, the PR and the SR, will be ensured by two PR (MINHEALTH and
CAMNAFAW) through the organization of regular meeting on one hand between the two PR, and other
the hand, between the PR and the SR to ensure respect of the execution of the program according to
the role predefined for each actor and thus guaranteeing the proper functioning of the program by
correspondence exchanges and work documents.
To this effect, a first national discussion meeting on the implementation of the Round 10 proposal will
be organized with all the stakeholders, then a permanent meeting framework between the two BP in
particular with the presence of the coordinators, financial managers and those responsible for
Coordination meetings will be organized each quarter and each time there is a need to harmonize the
implementation of related or common activities.
Each PR will hold quarterly review meetings for the program and for validation of programmatic and
financial data with the SR under their responsibility.
When the PR interventions are linked, the two PR will strengthen their meeting on the state of the
implementation area by area.
The two PR, after having consolidated the programmatic and financial data will regularly report to the
CCM Cameroon.
Finally the partners in development and the agencies of the System of Nations joint team on HIV,
UNAIDS, UNICEF, WHO, UNFPA, PAM, PNUD, UNESCO, BIT and DAT UNAIDS, will provide their technical
support for the implementation of Round 10.
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4.7.5 Strengthening implementation capacity
(a) The applicant is encouraged to include a funding request for management and/or technical assistance to achieve strengthened capacity and high quality
services, supported by a summary of a technical assistance (TA) plan based on the indicative percentage range in the Guidelines. In the table below provide a
summary of the TA plan.
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Management
and/or technical
assistance need
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
Management and/or technical assistance activity
Recruit a national consultant to design the communication tools to promote access to PNC
and PMTCT in the community setting for the mobilisation of women and their partners (Goal
1; SDA 1.1.1, Activity 1.1.1.3)
Recruit national consultants for the development of promotion and strengthening tools for the
integrated offer of prevention and access to adapted care for the setting of the MARPs (Goal
2 ; SDA 2.1.1, Activities 2.1.1.3 and 2.1.1.6)
Recruit national and international consultants to carry out bio-behavioural surveys including
mapping among the MARPs (MSM, SW and truck drivers) in the workplace (Goal 2 ; SDA
2.1.2, Activity 2.1.2.1, SDA 2.1.2, Activities 2.1.2.1 et 2.1.2.2) Goal 4; SDA 4.1.2. Activity
4.1.2.1)
Contract with a technical agency for the establishment and monitoring of a continuous
evaluation system for the quality of care services for STI among the at risk populations (SW,
MSM, Truck Drivers) (Goal2; SDA 2.1.4, Activity 2.1.4.5)
Contract with a technical agency to ensure the quality control of biological exams (CD4, viral
load, HIV screening) carried out by the laboratories involved in the care of PLWHA (Goal 3;
SDA 3.1.3, Activity 3.1.3.5)
Contract with a technical agency for the strengthening of capacities and the monitoring of
quality of care services for the PLWHA in the UPEC (Goal 3; SDA 3.1.1; 3.1.2., 3.1.3, 3.1.4,
3.1.5, 3.1.6), Activity 3.1.3.6.
Contract with a technical agency to carry out an evaluation of the TB prevention
interventions among HIV patients (prophylaxis with INH) (Goal 3, SDA 1.5, Activity
3.1.5.3)
Contract with a technical agency for the implementation and monitoring of interventions to
reduce stigmatization and discrimination in the workplace (companies, care structures) and
the (Goal 3; SDA 3.2.2, Activity 3.2.2.8)
Contract with a technical agency to strengthen the collection system and ensure the quality
Intended
beneficiary
of
management
and/or
technical
assistance
Estimated
timeline
Estimated
cost
SR and
beneficiaries
Yr1
8 881
SR, OBC
and
beneficiaries
PR, SR and
OBC
Yr1
17 762
Yr1 and
Yr5
125 663
SR, OBC
and
beneficiaries
PLWHA care
structures
Yr1 to
Yr5
68 602
Yr1 and
Yr5
265 795
PR, SR and
PLWHA care
structures
PR, SR and
PLWHA care
structures
PR, SR, CM
structures,
companies
and
recipients
PR, SR and
Yr1 and
Yr5
282 983
An 1 et
An 2
50 461
Yr1 and
Yr5
188 656
Yr1 and
94 328
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SERIE 10 – VIH
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
Technical
assistance
of programmatic data (routine) and studies/research carried out in the community setting and
in care structures for PLWHA (UPEC and CTA) (Goal 4; SDA 4.1.1 and SDA 4.1.2,
Activity 4.1.1.4)
Contract with a technical institutions to carryout surveys on sentinel surveillance of HIV and
syphilis among pregnant women (Goal 4; SDA 4.1.2, Activity 4.1.2.2).
Contract with a technical institution to carry out a studies on the methods of transmission of
HIV in Cameroon (Goal 4; SDA 4.1.2. Activity 4.1.2.3).
Contract with (a)carry out evaluation studies of the resistance to ARV treatments and the
survival of patients on ARV at 12, 24 and 36 (Goal 4; SDA 4.1.2. Activities 4.1.2.5
and4.1.2.10)
Contract with (a) technical institution(s) to carry out studies contributing to the strengthening
of the offer of quality PMCTC services (Goal 4, SDA 4.1.2, Activities 4.1.2.6 ; 4.1.2.7,
4.1.2.8, 4.1.2.9)
Recruit national and international consultants to carry out an evaluation study of the
cost/benefit rapport of interventions in the fight against HIV/Aids in year 5 of the
implementation of the proposal (Goal 4; SDA 4.1.2. Activity 4.1.2.12).
Recruit a national consultant to strengthen the capacity of care structures to ensure the
quality of routine data and strategic information (Goal 4, SDA 4.1.2, Activity 4.1.2.13)
Recruit national and international consultants for half-way reviews (year 2) and final (year 5)
of the implementation of the Round 10 proposal (Goal 4; SDA 4.1.2. Activity 4.1.2.24)
Recruit national and international consultants for the half-way reviews (year 3) and final
(year 5) of the implementation of strategic plan (Goal 4; SDA 4.1.2. Activity 4.1.2.25)
Recruit a national consultant to put in place a national database on HIV/AIDS (Goal 4; SDA
4.1.2. Activity 4.1.2.26).
Recruit national consultants to develop a communications plan and reinforce the capacities
of the PR and SR in terms of leadership, advocacy and the production of report and
documentation on the implementation of the HIV/AIDS program (Goal 4; SDA 4.1.2.
Activity 4.1.2.27 ).
Recruit a national consultant for the development of the Technical Assistance Plan for the
implementation of the proposal and NSP 2011-2015 ((Goal 4; SDA 4.1.2. Activity 4.1.2.28)
OBC and
care
structures
PR, SR and
OBC
PR, SR and
OBC
PR, SR,
care
structures
and
recipients
PR, SR and
OBC
An 5
Yr1, Yr 3
and Yr5
Yr 3
226 387
36 398
Yr1 and
Yr5
140 063
Yr1 and
Yr3
314 219
PR, SR
Yr 1, 3
and 5
65 401
PR, SR,
care
structures
and
recipients
PR, SR
Yr1 and
Yr5
91 469
43 600
PR and SR
Yr 2 and
Yr5
Yr3 and
Yr5
Yr 1
42 381
PR and SR
Yr 1
4 573
PR and SR
Yr 1
4 573
PR, SR
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SERIE 10 – VIH
Management
assistance
Technical
assistance
Technical
assistance
Recruit national consultants to carry out annual external audits of the PR and SR (Goal 4;
SDA 4.1.3. Activity 4.1.3.9).
Recruit two international technical assistants to support the PR and SR governmental and
Civil Society in the implementation of interventions, the production of reports and
documentation (Goal 4; SDA 4.1.3. Activities 4.1.3.10 and 4.1.3.11)
Recruit a national consultant and an international consultant for the organization and support
of the implementation of the Round 10 proposal by the Civil Society involved in the fight
against aids (Goal 4, SDA 4.1.3, Activity 4.1.3.12)
PR and SR
PR, SR and
OSC
SR and OSC
Yr 1 to
Yr5
Yr 1 to
Yr5
Yr 1 and
Yr 2
Total
137 204
1 080 000
210 989
3 578 442
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SERIE 10 – VIH
(d) Describe the process used to identify the assistance needs listed in the above table.
Continuous and sustained technical assistance is essential in Cameroon to strengthen the technical capacities of the
recipients, sub-recipients and beneficiaries in order to ensure the implementation of interventions, guarantee
performance and ensure the quality of interventions developed in the proposal.
The needs in technical assistance within the framework of this Round 10 proposal arise on the one hand, from the
evaluation of the implementation of the strategic plan 2006-2010 and on the other hand the participatory exchanges
carried out by the revision team for the proposal and the other actors. The evaluation of NSP identified different
weaknesses that affect the national response, notably: (i) the health system, (ii) the collection, analysis and the
dissemination of strategic information on the situation of the epidemic and the national response, the coordination of
the interventions, (iii) the monitoring of patients on ARV treatment, (iv) the implementation of the HIV/TB collaboration
activities, (iv) the insufficiency of the performance of the PMTCT services and reproductive health, (v) the qualitative
insufficiency of the care of sexually transmitted infection, (vi) the implementation of the interventions towards the
MARPs, (vii) interventions aiming to make the environment favourable to improve the demand for care services and
the overall care.
The specific needs among those identified in the NSP, and judged to be pertinent and coherent with respect to this
proposal have been validated and retained with the different actors involved in the drafting of the proposal, and are
coherent with the planned activities, available human resources and the period for implementation.
These weakness are taken into account in the new strategic national plan 2011-2015 and can be minimized by the
strengthening of national capacities through national and/or international technical assistance in the implementation of
the grants for this Round 10 from the Global Fund. The related budget is based on the locally applied costs (national
consultant, national technical assistant) at the international level (average cost applied by the United National
System). This technical assistance will contribute to the strengthening of existing national capacities in the delivery of
the planned serves in accordance with the requirements of the Global Fund and the needs of the beneficiaries.
(c) If no request for management and/or technical assistance is included in the proposal, provide a
justification below. Or, if the funding request is outside the indicative percentage range, provide a
justification below.
4.8
Pharmaceutical and Other Health Products
Clarified 4.8.1
4.8.1
Scope of Round 10 proposal
Does the proposal seek funding for any
pharmaceutical and/or health products?
Yes
No
4.8.2
Table of roles and responsibilities
80/101
SERIE 10 – VIH
Function
Procurement policies,
systems, and planning
Name of the organization(s)
responsible for this function
CENAME, MOH,
Role of the organization(s)
responsible for this function
Does the
proposal request
funding for
additional staff
or technical
assistance?
 indicate Yes
or No
Procurement agent
No
RP
No
Procurement agent
No
Quality assurance and
quality control
MINCOMMERCE, MOH
OAPI, TRIPS
CENAME, MOH
LANACOME
Management and
coordination
Ministry of Public Health
RP
No
Product selection (e.g.
PMTCT and paediatric HIV
care)
MOH, Partners
RP,
No
Intellectual property
regulations
RP, Procurement Agent
No
Forecasting
DEP (NHMIS), CENAME,
CAPRs SE/ RP/FM, NACC,
DPM
NACC, CENAME
RP, Procurement Agent
No
Storage and inventory
management
CENAME
Procurement agent
No
Distribution to other stores
and end-users
CENAME, CARPs, Health
centres
Procurement agent
No
Ensuring rational use and
patient safety
CENAME, NACC, CARPs
RP, Procurement agent
No
Pharmacovigilance
CENAME, MOH
LANACOME
Procurement agent
No
Drug resistance
Surveillance
NACC, OMS
RP
No
Management Information
Systems (MIS)
4.8.3 Past management experience
Describe the past experience of each organization that will be involved in managing pharmaceutical
and other health products.
Organization name
CENAME
Short description of management experience
CENAME has a storage capacity available at
the central level of approximately 6,800 m2
in Yaoundé with an annex at the level of
Ngaoundéré of approximately 1,100m2. At
the decentralized level, they work with CARP
(Centrale d’Approvisionnement Régionale des
produits Pharmaceutiques) who each have a
storage capacity which varies between 600
and 1000 m2. This capacity has allowed the
management without difficulty of the storage
of ARV acquired within the framework of
Round 3 of the Global Fund
Total value procured
during
last financial year
22,622,550 Euro
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4.8.4 Alignment with existing systems
Describe how the proposal uses existing country systems for the management of the additional
pharmaceutical and health product activities that are planned, including pharmacovigilance and drug
resistance surveillance systems. If existing systems are not used, explain why.
The purchase, storage, quality control, distribution of medications and medical consumable is done through
SYNAME which includes the National Centre for the Purchase of Medications and Essential Medical Consumables
(CENAME) and the 10 Regional Procurement Centres for Pharmaceutical Products (CARP) located at the level of
the county towns of the Regions. As well, CENAME has a depot available at Ngaoundéré to ensure the supply of the
CARP of the northern Regions of the country. CENAME ensure the purchase of medications and their storage at the
central level. The quality control is ensured by the National Laboratory for the Quality Control of Medications and
Expertise (LANACOME, YAOUNDE-CAMEROUN), the National Laboratory of Public Health and Expertise
(LANSPEX Niamey – Niger) and the Centrale Humanitaire Médico-Pharmaceutique (CHMP, Clermont Ferrand
France) for their expertise.
CENAME then ensures the distribution in the CARP. The CARP are responsible for the distribution in the health
facilities.
Within the framework of this proposal, the process of procurement, storage and distribution will be done using the
existing SYNAME.
Clarified 4.8.5 (a)
4.8.5
Storage and distribution systems
 National medical stores or equivalent
 specify
(a)
Which organization(s) have
primary responsibility to
provide storage and
distribution services under
the proposal?
Sub-contracted national organization(s)
 specify
Sub-contracted international organization(s)
 specify
Other:
 specify
(b)
For storage partners, what is each organization's current storage capacity for pharmaceutical and
health products? If the proposal represents a significant change in the volume of products to be
stored, estimate the relative change in percent, and explain what plans are in place to ensure
increased capacity.
CENAME and the CARP currently have a very good storage capacity. CENAME has a storage capacity available at
the central level of approximately 6 800 m2 in Yaoundé with an annex at the level of Ngaoundéré of approximately
1 100 m2. The CAPR have a storage capacity which varies from around 600 et 1000 m2. This capacity allow the
management without difficulty of the ARV acquired within the framework of Round 3 of the Global Fund
(c)
For distribution partners, what is each organization's current distribution capacity for
pharmaceutical and health products? If the proposal represents a significant change in the
volume of products to be distributed or the area(s) where distribution will occur, estimate the
relative change in percent, and explain what plans are in place to ensure increased capacity.
CENAME has 02 Trucks, 01 van and 02 pickups which ensure the distribution of pharmaceutical products in the 7
southern regions of the country. For the northern regions, the transport is ensured by CAMRAIL with is the national
railway company up to the depot at Ngaoundéré. At the level of this depot, the destruction of the products in the
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SERIE 10 – VIH
CARP is done by rented trucks and 01 pickup.
Each CART has 3 to 5 (PICK-UP) cares available to ensure the distribution in the health facilities.
This proposal will not increase significantly the volume of products to be distributed.
Clarified 4.8.6
4.8.6
Pharmaceutical and health products for initial two years
Complete the Pharmaceutical and Health Products List and list all of the products that are requested
to be funded through the proposal.
If the pharmaceutical products included in the Pharmaceutical and Health Products List are not
included in the current national, institutional or World Health Organization Standard Treatment
Guidelines (STGs), or Essential Medicines Lists (EMLs), describe below the STGs that are planned to be
utilized, and the rationale for their use.
Applicants are invited to justify the prices based on either the guidance provided in the Unit Costs for
Selected Key Health Products information note or with another published international reference
source. If the provided price is out of range, provide justification. Also, if local legislation is preventing
access to low cost prices through local manufacturers or similar mandates, clarification should be
provided as well as a plan for addressing such barriers over the life of the proposal.
All pharmaceutical products included in the proposal form submitted by CCM Cameroon within Round
10 are mentioned on the national list of essential medicines. Regarding Stavudine, national guidelines
plan a progressive withdrawal over a 3-year period following the start of the implementation of the
proposal.
Medicine’s prices are based on a price list provided in the note on the prices of the main sanitary
products.
Clarified 4.8.7
4.8.7
Multi-drug resistant tuberculosis
Is the provision of treatment of multi-drug
resistant tuberculosis included in this HIV
proposal?
Yes
No
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ROUND 10 – HIV
5. FUNDING REQUEST
The Round 10 Guidelines contain different guidance for sections 5.1 and 5.2 depending on whether the applicant selected Option 1, 2 or 3
in section 3.1 of the Proposal Form
5.1
Financial Gap Analysis
Section D and H of the Gap Analysis table below must be completed differently depending on whether applicant selected Option 1, 2 or 3
(see above)
Clarified 5.1
Financial gap analysis
Actual
2008
Planned
2009
Estimated
2010
2011
2012
2013
2014
2015
70 435 866
77 197 459
84 880 890
88 086 979
92 049 455
101 159 884
SECTION A: Funding needs for the full national HIV program
LINE A
61 498 509
65 910 838
LINE A.1
443 374 666
SECTIONS B, C AND D: Current and planned resources to meet the funding needs of the full national HIV program
Section B: Domestic
Domestic source B1:
Loans and debt relief
1 524 390
914 634
7 283 079
6 730 326
7 656 393
7 637 338
 provide name of source here
84/101
8 410 966
9 252 063
ROUND 10 – HIV
Actual
Domestic source B2
National funding resources
 Total of Section B entries
Estimated
2009
2010
2011
2012
2013
2014
2015
4 868 739
3 496 788
3 844 970
4 229 466
4 652 413
5 117 654
5 629 420
6 192 362
0
542 097
388 132
376 241
376 241
376 241
376 241
4411422
11670146
11347924
12685047
13131233
14416627
15820666
385481.59
325 710
385 000
385 000
385 000
385 000
385 000
385 000
114 236
410 714
410 714
410 714
410 714
410 714
410 714
410 714
193 223
531 300
531 300
531 300
531 300
531 300
531 300
531 300
1 005 350
1 172 231
287165.34
1 065 680
757 680
1 142 343
1 142 343
1 142 343
15 000
20 000
50 000
50 000
50 000
50 000
50 000
50 000
265 440
679 677
360 955
360 955
360 955
360 955
360 955
0
51 529
51 529
51 529
51 529
51 529
51 529
51 529
1 040 822
1 410 431
1 410 431
1 551 474
0
0
0
0
534
489 285
489 285
417 857
417 857
417 857
417 857
417 857
Domestic source B3
Private sector contributions
(national)
LINE B: Total current & planned
DOMESTIC resources
Planned
2008
6393129
Section C: External (non-Global Fund)
External source C1
 UNAIDS
External source C2
 UNESCO
C3
WHO
C4
UNICEF
C5
UNIFEM
C6
UNFPA
C6
UNHCR
C6
Clinton Foundation
C8
US Government (USAID)
85/101
ROUND 10 – HIV
Actual
US Government (Peace Corps)
External source C3
Private sector contributions
(International)
LINE C: Total current & planned
EXTERNAL (non-Global Fund)
resources
Estimated
2009
2010
2011
2012
2013
2014
2015
35 700
35 700
53 571
53 571
53 571
53 571
53 571
53 571
116 780
116 780
116 780
116 780
116 780
116 780
116 780
0
250 000
250 000
250 000
250 000
250 000
C9
French Government (Esther)
C10
World Bank
C11 International Work
Organisation Ilo
C12 UNDP
C13 World Food Program
C14 ADB/UNESCO
C15 GTZ KFW
C16 American Government
PEPFAR
C17 CDC (Early Diagnosis)
C14 ADB/UNESCO
C15 GTZ KFW
Planned
2008
0
378 213
115 808
26 677
22 866
22 866
22 866
22 866
22 866
146 322
N/A
N/A
1 873 496
92 546
N/A
N/A
2 973 171
30 488
N/A
N/A
2 973 171
30 488
N/A
N/A
2 881 707
30 488
N/A
N/A
2 881707
30 488
N/A
N/A
106 707
30 488
N/A
N/A
106 707
30 488
N/A
N/A
0
0
0
583 333
583 333
583 333
583 333
583 333
1 150 000
1 150 000
1 150 000
1 150 000
1 150 000
1 150 000
Grant D1
Grant D2
 Global Fund R4
1 150 000
1 873 496
2 973 171
2 973 171
2 881 707
2 881707
106 707
106 707
0
0
0
0
0
0
0
0
6 338 378
9160645
8 645 788
9913254
8 053 780
5663443
5663443
5556736
Complete this version of Section D if the applicant selected Option 2 or 3 in section 3.1 of the Proposal Form:
Section D: External (Global Fund)
Global Fund R3
1 150 000
12 096 743
8 192 207
3 171 847
220 866
6 097 561
6 097 561
86/101
ROUND 10 – HIV
Actual
Grant D3
Global Fund Round 5
Planned
Estimated
2008
2009
2010
2011
379 577
2 065 064
684 809
3 611 372
2012
2013
2014
2015
0
0
LINE D: Total current & planned
EXTERNAL (Global Fund) resources
 Total of Section D entries
Complete this version of Section D if the applicant selected Option 1 in section 3.1 of the Proposal Form:
Section D: External (Global Fund)
Section D1: Grants not included in
consolidated disease proposal
Grant D1-A
 provide grant number here
Grant D1-B
Section D2: Grants included in
consolidated disease proposal and
listed in section 3.1(b)
Grant D2-A
Grant D2-B
LINE D: Total current & planned
EXTERNAL (Global Fund) resources
 Total of Section D entries
LINE E : Total current and planned
resources
 Line E = Line B + Line C + Line D
15 648 167
28379674
10 478 137
24050204
6 782 370
27098304
9 708 933
30970111
0
20738827
0
18794676
20080070
21377402
71969385
79782482
Calculation of gap in financial resources and summary of total funding requested in Round 10  must be supported by detailed budget
LINE F: Total funding gap
Line F = Line A – Line E
33118 835
41860634
43 337 562
46227348
64142063
69292303
87/101
ROUND 10 – HIV
Actual
2008
Planned
2009
2010
LINE G: Round 10 HIV funding request
Estimated
2011
15177355
2012
15023185
2013
2014
21311396
22104138
2015
23795868
Part H – Cost Sharing calculation for Lower-middle income and Upper-middle income applicants
In Round 10, the total maximum funding request for HIV in Line G is:
(a)
For Lower-Middle income countries, an amount that results in the Global Fund's overall contribution (all grants) to the national program being not more than 65% of
the national disease program funding needs over the proposal term; and
(b)
For Upper-Middle income countries, an amount that results in the Global Fund overall contribution (all grants) to the national program being not more than 35% of
the national disease program funding needs over the proposal term.
Line H = Cost Sharing calculation as a percentage (%) of overall funding from Global Fund
Complete this cost sharing calculation if the applicant selected Option 2 or 3 in
section 3.1 of the Proposal Form:
Cost sharing =
(Total of Line D amounts for proposal period + Total of Line G amounts) X
100
Line A.1
24,16 %
Complete this cost sharing calculation if the applicant selected Option 1 in
section 3.1 of the Proposal Form:
Cost sharing =
(Total of Line D1 amounts for proposal period + Total of Line G amounts) X 100
Line A.1
88/101
ROUND 10 – HIV
5.1.1 Explanation of financial needs and additional needs for Global Fund financing
Describe how the annual amounts were:
(a) developed;
(b) budgeted in a way that ensures that government, non-government and community needs were
included to reflect implementation of the country's malaria program strategies; and
(c) developed in a way that demonstrates the funding requested in the proposal will contribute to
the achievement of outputs and outcomes that would not be supported by currently available
or planned domestic resources.
(a) The new Strategic National Plan for the fight against STD/HIV/AIDS which covers the period
2011-2015 has been developed based on the existing programmatic data and the EPP-spectrum
projections.
The objectives were set under the optic of universal access, in coherence with the objectives of the
document on the Strategy for Growth and Employment (DSCE 2010-2010)(Appendix 24) and the
sectoral health strategy 2001-2015. This strategic plan takes into account the interventions to be
carried out by all sectors (governmental, non-governmental and community).
(b) The financial needs for its implementation have been developed based on figures calculated for
the strategic axes of NSP 2011-2015 by using the “Resource Needs Model (RNM)” model with the
standard unit costs applicable to Cameroon.
This budget also takes into account the needs of all of the sectors as described.
(c) The actual or planned amounts for all sources of financing have been identified and collected by
axis or area of intervention as described in PSN 2011-2015. The financing requested in the
framework of this proposal covers in part the programmatic gaps identified and will contribute to
the realization of the results and effect not financed by other sources. The financing for Round 10
(2011-2015) represents close to one quarter of the needs in total financing for the fight for the
same period. The financing requested within the framework of this proposal represents 24.16% of
the total needs and will allow the gap to be reduced. This last is complementary to all of the
existing financing.
5.1.2 Domestic funding
Describe the processes used in country to:
(a) prioritize domestic financial contributions to the national HIV program including HIPC [Heavily
Indebted Poor Country] and other debt relief, and grant or loan funds that are contributed
through the national budget; and
(b) ensure that domestic resources are used efficiently, transparently and equitably, to help
implement treatment, prevention, care and support strategies at the national, sub-national and
community levels.
(a) The national financial contribution for the fight against HIV/AIDS comes directly from the State
budget, the funds coming from the repaying of the debt (PPTE Resources).
Concerning the PPTE resources, a project document has been elaborated taking into account the
national needs (Appendix 25). The project has been submitted to the Consultative and PPTE
resource monitoring committee presided over by the Ministry of Finance. The said committee
examines the project and after approval, a sectoral panel defines the areas to be financed. The
criteria for choosing are mainly the complementarity with existing financing and the priority for
actions which directly affect the ill. Within the framework of the PPTE 2008-2012 project, the
priority has been given to the supply of medications, the acquisition of medical screening tests
(Appendix 25).
The direct State budget is mobilized in the context of the counter part of external financing (Global
89/101
ROUND 10 – HIV
Fund, World Bank), the salaries of the personnel in charge of the implementation of the activities,
the operations, the rehabilitation, equipment for the monitor and care structures for the ill.
(b) In Cameroon there exists the Caisse Autonome d’Amortissement (CAA), which is under the
tutelage of the Ministry of Finance and which receives financing from the partners and the
countering funds from the State. These different funds are subject to the same control and
management procedures.
5.1.3 External funding
Describe:
(a) any changes in contributions anticipated over the proposal term and the reason for any
identified reductions in external resources over time; and
(b) any current delays in accessing the external funding identified in Table 5.1 that should be
explained, including the reason for the delay, and plans to resolve the issue(s).
Information on the partner contributions for the period 2011-2015 have been supplied following
meetings with these last. No modification in the external financial contribution has been
notified to date.
The management mechanisms and the availability of the funds varies according to the partners.
There is still no common mechanism for financing and for management of external
resources. To this effect, the principles of the “Three ones” will be reinforced at all
levels.
5.2
Detailed Budget
Instructions for completion of the detailed budget:
1.
2.
3.
4.
5.
Submit a detailed budget in Microsoft Excel format.
Ensure that this detailed budget is consistent in numbering with the Round 10 interventions in
section 4.4.1 of the Proposal Form, the Performance Framework, and the detailed work plan.
From the detailed budget, prepare table 5.3, the summary by objective and service delivery
area.
From the detailed budget, prepare table 5.4, the summary by cost category.
Do not include a request for CCM or Sub-CCM funding in this Round 10 proposal. Requests for
funding are available through a separate application. The application is available at:
http://www.theglobalfund.org/en/ccm/
90/101
ROUND 10 – HIV
5.3
Summary of Detailed Budget by Objective and Service Delivery Area
Objective
number
1.1 ; 2.1
2.1
1.1 ; 2.1
1.2
2.1
3.1
3.1
3.1
3.2
3.1
2.1 ; 3.2
1.3 ; 3.1
1.1 ; 1.3 ;
3.1
Service delivery area
Year 1
Year 2
Year 3
Year 4
Year 5
Total
BCC – Community relays
and schools
Condoms
258.260
194.061
376.690
311.675
374.349
1.515.034
255.298
312.293
367.338
430.115
491.150
1.856.194
213.428
191.116
302.490
292.554
348.954
1.348.542
900.852
1.279.389
1.795.572
2.415.543
2.974.675
9.366.031
105.437
88.160
156.508
142.719
170.515
663.339
3.246.221
6.788.790
9.881.752
11.811.939
11.816.864
43.545.566
154.902
278.210
343.516
437.150
511.807
1.725.585
1.041.929
1.010.353
1.296.719
1.113.510
1.113.510
5.576.022
943.488
880.576
930.058
880.576
880.576
4.515.274
84.430
31.706
59.200
15.091
15.091
205.518
294.068
151.670
293.475
151.670
255.102
1.145.984
2.475.952
787.139
992.385
1.279.479
1.494.047
7.029.002
1.070.921
81.661
1.092.025
81.661
81.661
2.407.930
Tests and counselling
PMTCT
Diagnosis and treatment of
STI (sexually transmitted
infection
Antiretroviral (ARV) treatment
and monitoring
Prophylaxis and treatment for
opportunist infections
Care and support for critically
ill
Support of orphans and
vulnerable children
Tuberculosis / HIV
Reduction of stigmatism in all
contexts
HSS (health system
strengthening) Provision of
services
HSS (health system
strengthening) Health
professionals
91/101
ROUND 10 – HIV
Objective
number
4.1
1.1
2.1
4.1
4.1
Service delivery area
HSS (health system
strengthening) : Information
system
RSC: Advocacy,
communication and social
mobilization
RSC: Development of
linkages, collaboration and
community coordination
RSC: Monitoring and
evaluation, generation of
information based on tangible
facts
Management and
administration costs for the
program
Round 10 funding request:
Year 1
Year 2
Year 3
Year 4
Year 5
Total
815.798
622.866
822.676
630.239
962.426
3.854.004
877.577
445.278
730.599
408.407
408.407
2.870.268
118.974
92.596
37.406
19.984
20.629
289.590
292.782
53.873
201.097
53.873
248.152
849.776
2.027.039
1.733.448
1.631.891
1.627.953
1.627.953
8.648.285
15.177.355
15.023.185
21.311.396
22.104.138
23.795.868
97.411.943
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ROUND 10 – HIV
5.4
Summary of Detailed Budget by Cost Category
Cost Category
Year 1
Year 2
Year 3
Year 4
Year 5
Total
1.816.094
1.969.305
2.108.796
2.143.097
2.177.398
10.214.691
962.945
670.166
703.029
490.732
751.570
3.578.442
Training
2.110.563
550.706
2.252.773
545.501
584.437
6.043.980
Health products and health equipment
2.860.489
1.471.810
2.000.207
2.494.575
2.918.433
11.745.515
Pharmaceutical products (medicines)
3.432.017
6.752.455
9.733.698
11.922.228
13.911.295
45.751.693
Procurement and supply management costs
550.414
1.073.518
1.546.755
1.884.344
419.783
5.474.814
Infrastructure and other equipment
654.491
127.057
63.126
52.052
52.052
948.777
Communication materials
431.795
226.403
492.012
275.487
396.747
1.822.445
Monitoring & Evaluation
773.999
563.265
746.200
575.714
813.595
3.472.773
Living support to clients/target populations
801.400
835.353
881.652
937.260
987.411
4.443.077
Planning and administration
139.964
139.964
139.964
139.964
139.964
699.818
Overheads
643.184
643.184
643.184
643.184
643.184
3.215.920
15.177.355
15.023.185
21.311.396
22.104.138
23.795.868
97.411.943
Human resources
Technical and management assistance
Other (specify):
Round 10 HIV funding request:
93/101
ROUND 10 – HIV
5.4.1 Overall budget context
Describe any significant variations in cost categories by year, or significant five year totals
for those categories.
The end of CoS funding, the elevated risks of the rupture of associated stock and the
number of people on ARV treatment estimated at 226,338 at the end of 2015 shows the
importance of the category Pharmaceutical Products (medications) which represents 46.96%
of the overall budget for the proposal, or € 45,751,693.
Pharmaceutical Products (medications): The size of the active file in Cameroon and its
exponential progression (197% in the period 2009-2015) combined with the stopping of other
sources of funding, particularly that of UNITAI used for the purchase of 2nd line protocols for
st
which the cost is approximately 4 times that of the 1 line protocols. Due to this fact, the
estimated cost to supply the protocols goes from € 3,43 million in 2011 to €13.9 million in
2015.
5.4.2 Human resources
(a) Describe how the proposed financing of salaries, compensation, volunteer stipends, or
top-ups will be consistent with agreed in-country salary frameworks, such as national salary
or inter-agency frameworks.
The cost of human resources in this proposal represents 10.5% of the overall budget. It is
made up of:

indemnification for the community relay agents and social workers whose role is
primordial in the mobilization of women with the aim to have them adhere to the
PMTCT program and in the monitoring of the PLWHA within the context of the
continuum of care which are key actions for the attaining of the objectives of this
proposal.

In the public sector, the indemnities for operating personnel (Appendix 26) and the
salaries for contractual workers (Accounts, Chauffeurs, Secretaries)

In civil society, the salaries of some agents involved in the implementation of the
project, remunerations for community volunteers.
These budgetary allocations are calculated based on national standards and the contracts
entered into during the course of the previous rounds (3, 4, 5) and ratified by ministerial
decisions (Appendix 26).
The support in remuneration of the OBC of civil society will allow ensure they can well fill
their role described in the various SDA described above. Most of these organizations do not
have sufficient financing and must rely in part on external resources to attain the
programmatic results.
(b) In cases where human resources represents an important share of the budget,
summarize: (i) the basis for the budget calculation over the initial two years; (ii) the
method of calculating the anticipated costs over years three to five; and (iii) to what
extent human resources spending will strengthen service delivery.
NA
(c) As well, in cases where the human resources will represent a significant portion of the
budget, summarize : (i) the basis for calculation of the budget for the first period of two
years ; (ii) the method of calculating anticipates costs for the years 3 to 5 ; and (iii) explain
how the expenses in human resources will reinforce the supply of services
The human resources, estimated at 10.5%, do not represent a significant portion of the
total budget of the request.
94/101
ROUND 10 – HIV
5.4.3 Other areas representing significant expenses.
If other “cost categories” represent significant amounts in the summary in table 5.4, (i)
explain what is the basis of calculation for these amounts. Also explain the importance of
this contribution for the implementation of the national program in the fight against HIV.
All of the other cost categories take up less than 10.5% of the total budget for the
proposal, except the heading Health products and health equipment which represents
12.06% of the budget for the proposal. Based on unit costs practised at the international
level by standard suppliers (Appendix B).
5.4.4 Measuring service unit cost and cost effectiveness
Provide the following:
(a) where available, estimates of recent average service delivery unit costs at the
program-level for key services with an explanation of how the estimates were
developed;
(b) estimates of the expected average service delivery unit costs for key services that are
included in the proposal; and
(c) a description of how key service delivery unit costs will be measured at the programlevel, over time throughout the lifecycle of the grant.
At the national level, the unit costs for the provision of services are part of the logic of
the continuity of costs applied in the implementation of the previous rounds (HIV,
Malaria and Tuberculosis). However, at all levels of the supply of essential services
described in this proposal (PMTCT, ARV) we have unitary costs for the main activities
entering into the supply of the said services.
Within the context of the supply of ARV treatments, the unitary costs for the essential
activities have been applied:

Training of a provider, calculated on the basis of the local cost of the workshop
applied to the number of participant (example: approximately 50 Euros for a
man/day of training)

Reagents for screening and biological monitoring, supply of OI medications,
ARV, condoms, equipment (cost on the international market)

Supervision at all levels (regional, district), calculated based on the local costs
and the duration (example: 65 Euros per day of supervision at the central level)
5.5 Funding Requests in the Context of a Common Funding Mechanism
Clarified 5.5.1
5.5.1 Common funding mechanism
If the country’s response to HIV is through a program-based
approach, does the proposal plan for some or all of the
requested funding to be paid into a common-funding
mechanism to support that approach?
Yes
No
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ROUND 10 – HIV
5.5.2 Operational status of common funding mechanism
Describe the main features of the common funding mechanism, including the fund's name,
objectives, governance structure and key partners.
NA
5.5.3 Measuring performance
Describe how program performance helps determine financial contributions to the common
fund.
NA
5.5.4 Additionality of Global Fund request
Describe how the funding requested in the proposal will contribute to the achievement of
outputs and outcomes that would not be supported by current or planned resources available
to the common funding mechanism.
NA
5B. CROSS CUTTING HSS – FUNDING REQUEST
Read the Round 10 Guidelines to consider including
optional cross-cutting HSS interventions
SECTION 5B can only be included in the Round 10 HIV proposal if:

the applicant submitted section 4B with HIV.
Section 5B can be downloaded from the Global Fund's website if the applicant intends to
apply for cross-cutting HSS interventions.
96/101
PROPOSAL CHECKLIST: SECTIONS 3-5 HIV
Section 3 and 4: Proposal Summary and Program Description
Document
attached?
List
document
name and
number
4.1
National Health Sector Development / Strategic Plan
X
Sectoral
Health
Strategy,
MINHEALTH
2001-2005
(Appendix 4)
4.1
National HIV Control Strategy and/ or Costed
Implementation Plan
X
National
Strategic Plan
for the Fight
against HIV,
Aids and STI
for the period
2011-2015
(Appendix 2)
X
National
Directives for
the care of
PLWHA
(Appendix 19)
4.1
Sub-sector policies that are relevant to the proposal (e.g.
national or sub-national human resources policy, norms
and standards, gender policies/strategies and plans,
policies on community or CSO partnerships with
government health or other systems)
MINHEALTH/G
ICAM
Agreement
(Appendix 23)
4.1
Most recent self-evaluation reports/technical advisory
reviews, including any epidemiology report directly
relevant to the proposal
X
Profile
estimation
report NAC,
2010-2020
(Appendix 1)
4.1
National Monitoring and Evaluation Plan (e.g. health
sector, disease-specific, or other)
X
Plan for the
monitoring
evaluation of
NSP 20112015 (Draft)
(Appendix 27
4.1
National policies to achieve gender equality in regard to
the provision of HIV prevention, treatment, and care and
support services to all people in need.
4.1
Most recent bio-behavioural surveillance of key
population(s)
NA
X
Report on HIV
sentinel
surveillance
among
pregnant
women, NAC,
2009
97/101
(Appendix 6)
4.1
National report on gender specific operational research
and any gender analysis/assessments that might have
been undertaken of the HIV response
4.1
National pharmacovigilance policy
X
-Report of the
seroepidemiologic
al survey on
HIV and
syphilis
among the
SW, John
Hopkins, 2010
(Appendix 9)
X
-Report
survey on the
evaluation of
PPSAC project
indications,
OCEAC, 2008
(Appendix 12)
4.2 (b)
Map if proposal targets specific region/population group
X
Mapping of
target MSM,
SW, Truck
drivers (page
11, section
3.5 form
4.3.2
Any recent report on health system weaknesses and gaps
that impact outcomes for the three diseases (and beyond
if it exists)
X
Sectoral
Health
strategy
document
2001-2015
(Appendix 4)
Document(s) that explain basis for coverage targets
X
Coverage
Table of
targets
(Appendix
28)
4.4
4.4.1
A completed Performance Framework (mandatory)
Performance
Framework
4.4.1
A detailed work plan (mandatory)
work plan
4.4.2
A copy of the Technical Review Panel (TRP) Review Form
from Round 8 or 9, if relevant
4.6.1
A recent evaluation of the Impact Measurement Systems
as relevant to the proposal (if one exists)
x
TRP response
to Rounds 7
and 8
(Appendix 21)
98/101
4.7.1
A recent assessment of the Principal Recipient capacities
(other than Global Fund Grant Performance Report)
X
NAC audit
report
(MINHEALTH)
(Appendix 29)
CAMNAFAW
audit report
(Appendix 30)
4.7.1
Documents describing the organization, such as official
registration papers, summary of recent history of
organization, management team information
NA
4.7.2
List of Sub-recipients already identified (including name,
sector they represent, and SDA(s) most relevant to their
activities during the proposal term)
List of the PR
and SR
(Appendix 31)
4.8.6
A completed HIV Pharmaceutical and Health Products
List
Lists of
pharmaceutic
al products
(Appendix 32)
Section 4B: Cross-cutting HSS (only one per country’s application)
Document
attached?
List
document
name and
number
4B.2
A completed separate cross-cutting HSS Performance
Framework (mandatory, if applicable)
X
Performance
Framework
(Appendix
33)
4B.2
A detailed separate cross-cutting HSS work plan
(mandatory, if applicable)
X
work plan
(Appendix
34)
Section 5: Funding Request
5.2
Document
attached?
List
document
name and
number
X
detailed
budget
(Appendix
34)
A detailed budget (mandatory)
5.4.2
Information on basis for budget calculation and diagram
and/or list of planned human resources funded by
proposal
X
Detailed
budget
(Appendix
34)
5.4.3
Information on basis of costing for ‘other’ cost category
items
X
Detailed
budget
(Appendix 34)
5.5.1
Documentation describing the functioning of the common
funding mechanism
NA
99/101
5.5.2
Most recent assessment of the performance of the
common funding mechanism
Section 5B: Cross-cutting HSS Funding Request
5B.1
NA
Document
attached?
List
document
name and
number
A separate cross-cutting HSS detailed budget
(mandatory, if applicable)
detailed
budget
5B.4.2
Information on basis for budget calculation and diagram
and/or list of planned human resources funded by
proposal (only if relevant)
Detailed
budget
5B.4.3
Information on basis of costing for ‘other’ cost category
items
Detailed
budget
Other documents relevant to sections 3, 4 and 5
attached by applicant
Document
attached?
List
document
name and
number
X
EDS III, NAC,
2004 ; pp 66
and 62 ;
Appendix 3
X
Mapping report
on Sex
workers, NAC,
2009, Appendix
7
X
Survey report
with specific
groups, NAC,
2004, Appendix
8
X
Factors
associated with
unprotected
anal
intercourse
among men
who have sex
with men in
Douala,
Cameroon, E.
Henry, F.
Marcelin, Y.
Yomb et al.,
2009, Appendix
100/101
10
X
Report on
activities,
NAC,2009,
Appendix 13
X
CARE
Cameroun,200
5 Appendix 11
Report ECAM
III, MINEPAT,
year, Appendix
17
X
Evaluation
report of NSP
2006-2010,
NAC, 2009,
Appendix 16
X
Report on the
state of
laboratory
equipment,
NAC, 2010,
Appendix 20
101/101
PROPOSAL FORM – ROUND 10
SINGLE AND MULTI-COUNTRY APPLICANT
Performance Framework: Indicators, Targets and Periods Covered
HIV
Program Details
Country:
Disease:
Proposal ID:
Cameroon
HIV
Round 10
Program Goals, impact and outcome indicators
Goals:
1
Reduce new infections by HIV for new-born babies by preventing mother-child transmission
2
3
Reduce new infections by HIV among TSs, MSMs, Lorry Drivers and their partners
Reduce morbidity and mortality connected with HIV as well as the socio-economic impact by reinforcing the overall cover provided for PWIH adults and children and supporting the OEVs until 2015
4
Reinforce coordination and moitoring/assessment within the framework of implementing the proposal
Baseline
Impact
indicator
number
1
2
Impact indicator formulation
Percentage of babies born to mothers with HIV and with HIV themselves.
Percentage of the population most exposed to risks (sex professionals) and HIV positive.
value
9.7%
36%
Year
Source
2009
Reports (2009 annual of the
national fight against HIV/AIDS
programme
2009
Year 1
Report due
date
Percentage of the population most exposed to risks (men having sexual intercourse with men) and HIV
positive.
35%
2009
Report from the "Mesdine"
project implemented by
Camnafaw
4
Percentage of adults and children affected by HIV who are known to have been treated for 12 months
after the start of the antiretroviral therapy
65%
2009
Survey into health organisations
value
Year
9.0%
15/05/2012
8.0%
30.0%
Outcome indicator formulation
15/05/2013
Year 3
7.0%
15/05/2013
28.0%
15/05/2013
70.0%
15/05/2012
75.0%
15/05/2013
Year 1
Report due
date
Year 2
Report due
date
Year 4
Year 5
Comments*
6.0%
5.0%
This concerns serpositivity databases. Reducing
new infections could have an impact on prevalence
for TSs. Bio-behaviourial studies and MOT studies
will make it possible to provide information
concerning HIV seroprevalence amongst TSs.
20.0%
This concerns serpositivity databases. Reducing
new infections could have an impact on prevalence
for MSMs. Bio-behaviourial studies and MOT
studies will make it possible to provide information
concerning HIV seroprevalence amongst MSMs.
20.0%
80.0%
85.0%
90.0%
Year 3
Year 4
Year 5
The objective concerning access for everybody to
care and treatment must be achieved by 2015
Targets
Baseline
Outcome
indicator
number
Targets
Report due
date
The objectives of the virtual elimination of PTME
must be achieved by end 2015
Seroepidemiological and
behavioural survey concerning
HIV and syphillis among SWs
3
Year 2
Source
Comments*
the data will be provided by the EDS 2011 and in
2015
1
2
Percentage of sex professionals stating that they used a contraceptive with their last customer
Percentage of men stating that they used a contraceptive the last time they had anal sex with another
man
72,7%
43.7%
2009
Report concerning
Seroepidemiological and
behavioural survey concerning
HIV and syphillis among TSs au
Cameroun
2008
Results of the "Identity, at-risk
sexual behaviour in terms of
HIV/AIDS amongst men having
sexual intercourse with other
men in the city of Douala" study
2006
MICS (enquête par survey by
multiple-indicator bunches)
85%
95%
the data will be provided by the EDS 2011 and in
2015
75%
90%
Current school attendance rate of orphans and non-orphans
3
4
89.0%
Percentage of women and men aged between 15 and 49 having an attitude of acceptance towards
people who are HIV positive
NA
Veuillez sélectionner…
the data will be collected during the course of the
MICS surveys in year 2(2012) and year 4 (2014)
91%
50%
15/12/2012
92%
85%
the data will be collected during the surveys based
on the stigma index in year 1 (2011) and year 5
(2015)
* please specify source of measurement for indicator in case different to baseline source.
Program Objectives, Service Delivery Areas and Indicators
Objective
Number
Objectives:
1
Increase from 35% to 80%, the proportion of pregnant women benefiting from at least one CPN including HIV screening by 2015
2
Increase from 19% to 70% the proportion of serpositive pregnant women and their children who are treated with ARV in order to prevent TME.
3
4
Increase from 16% à 70%, the proportion of exposed children tested for HIV (PCR) from the age of 6 weeks by 2015
5
Ensuring access to prevention services and reducing discrimination for 14,240 MSMs, 39,440 TSs and 148,800 Lorry Drivers in the 10 regions by 2015
Provide high-quality medical care for 80% of adult and child PVVIH subject to therapeutic indication by 2015
6
Reduce the impact of HIV/AIDS amongst OEV and stigmatisation and discrimination linked to HIV by 2015
R10_CCM_CMR_H_PerfWF_20Aug10_En.xls
Performance Framework
1/2
Baseline (if applicable)
Indicator
Number
1
2
Objective
Number
1.1
1.2
Service Delivery Area
PTMC
Tied to
Number of pregnant women having undergone an
HIV test and who know the results
Number of seropositive pregnant women who have
been given antiretrovirals to reduce the risk of TME
278,332
10,322
3
1.3
RSS (reinforcing health
systems) : Provision of
services
Number of babies born from seropositive mothers
having undergone an HIV test by PCR six weeks
after birth
9314
4
2.1
Condoms
Number of contraceptives distributed to sex
workers, men having sexual intercourse with men
(MSM) and lorry drivers
5
2.1
Test and advice
Number of sex workers having undergone the HIV
test and who know the results
Supporting orphans and
vulnerable children
Number of orphans and vulnerable children having
benefited from free basic support (nutrition,
education, legal help, psychosocial)
R10_CCM_CMR_H_PerfWF_20Aug10_En.xls
859,655
Subvention
actuelle
O – cumulatives par
année
N
Top 10
MINSANTE
13,807
17,293
20,779
24,571
34,496
46,416
57,167
Subvention
actuelle
année
N
Top 10
GFATM contribution (round 10). The data will be
collected on a six-monthly basis through the
PTME progress report.
MINSANTE
NA
2,865,367
5,730,733
3,114,529
6,229,058
6,602,801
7,101,126
7,474,869
Subvention
actuelle
année
N
Top 10
MINSANTE
NA
6,790
13,580
9,858
19,715
26,076
32,655
39,440
Subvention
actuelle
année
N
Top 10
CAMNAFAW
76228
3114
NA
2009
2009
2009 annual
report of the
activities of
the National
Fight Against
AIDS
Program
2009
2009 annual
report of the
activities of
the National
Fight Against
AIDS
Program
GFATM (round 10) contribution 35% of
requirements in screening tests for this target.
The data will be collected on a six-monthly basis
through the PTME progress report.
MINSANTE
Equivalent Top
10
2009 annual
report of the
activities of
the Mesdine
Project
Comments
GFATM contribution (round 10). The data will be
collected on a six-monthly basis through the
PTME progress report.
N
NA
3.2
723,940
Year 5
année
Number of lorry drivers having undergone the HIV
test and who know the results
10
593,158
Year 4
Subvention
actuelle
Test and advice
Number of children infected with advanced HIV
being treated with antiretroviral therapy (HAART)
467,276
Year 3
57,167
2.1
Antiretroviral treatment
(ARV) and monitoring
233,638
24 months
46,416
7
3.1
2009
2009 annual
report of the
activities of
the National
Fight Against
AIDS
Program
346,253
18 months
34,496
133
9
2009
2009 annual
report of the
activities of
the National
Fight Against
AIDS
Program
173,127
12 months
DTF: Name of PR
responsible for
implementation of the
corresponding activity
24,571
Number of MSMs having undergone the HIV test
and who know the results
Number of adults infected with advanced HIV being
treated with antiretroviral therapy (HAART)
2009
2009 annual
report of the
activities of
the National
Fight Against
AIDS
Program
6 months
Top 10 indicator
20,779
Test and advice
Antiretroviral treatment
(ARV) and monitoring
Source
Baselines
included in
targets (Y/N)
17,293
2.1
3.1
Year
Targets cumulative
Y-over program term
Y-cumulative annually
N-not cumulative
13,303
6
8
Annual targets for years 3, 4, and 5
Indicator formulation
Value
Test and advice
Targets for years 1 and 2
The contribution from the Cameroon Government
from 2011 to 2015 is 65% of the overall
contraceptive requirement. The data will be
collected half-yearly through the progress report
The data will be collected half-yearly through the
progress report of interventens amongst MARPs
447
1,340
4,021
8,041
10,934
13,412
14,420
Subvention
actuelle
année
N
Top 10
CAMNAFAW
9,300
18,600
25,575
51,150
83,700
116,250
148,800
Subvention
actuelle
année
N
Top 10
CAMNAFAW
MINSANTE
Contribution du Gouvernement du Cameroun qui
passera de 50% en 2011 à 60% en 2015. Les
données seront collectées semestriellement à
travers le rapport de progrès Accès Universel
97,684
106,702
116,962
127,222
150,226
175,714
210,264
4,482
5,130
6,066
7,002
9,450
12,474
16,074
10,000
20,000
10,000
20,000
20,000
20,000
20,000
Performance Framework
Programme
National
Programme
National
O – sur la durée du
programme
O
Top 10
O – sur la durée du
programme
O
Top 10
MINSANTE
N – non cumulatives
N
Non Top 10
MINSANTE
Contribution from the Clinton Foundation and
GFATM (round 10). The data will be collected
half-yearly through the Access for Everybody
progress report.
Round 10 provides 100000 support packages for
the duration of the proposal to 20 000 OVCs per
year. The data will be collected twice a year
through the Universal Access progress report.
2/2

PROPOSITIONVIHDUCAMEROUN-SERIE 10 Accès Universel pour

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