round 9 – hiv - The Global Fund to Fight AIDS, Tuberculosis and

advertisement
PROPOSAL FORM – ROUND 9
(SINGLE COUNTRY APPLICANTS)
Applicant Name
CCM
Country
CAMEROON
Income Level
(Refer to list of income levels
by economy in Annex 1 to the
Round 9 Guidelines)
Applicant Type
LOWER INTERMEDIATE
CCM
X
Sub-CCM
Non-CCM
Round 9 Proposal Element(s):
Disease
1
Title
Does this disease include
cross-cutting Health
Systems Strengthening
interventions in part 4B?
(include in one disease only)
Is this a 're-submit'
of the same disease
proposal not
recommended in
Round 8?
HIV 1
STENGTHENING THE
NATIONAL RESPONSE TO HIV
AND AIDS BY MEANS OF
PREVENTION AND SCALED
TRANSITION OF CARE
NO
Tuberculosis1
SUSTAINING TUBERCULOSIS
CONTROL AND EMPOWERING
AFFECTED POPULATIONS
AND COMMUNITIES IN
CAMEROON
NO
Malaria
SCALING UP MALARIA
CONTROL FOR IMPACT IN
CAMEROON
NO
Different HIV and tuberculosis activities are recommended for different epidemiological situations. For further
information: see the ‘WHO Interim policy on collaborative TB/HIV activities’ available at:
http://www.who.int/tb/publications/tbhiv_interim_policy/en/
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG1/15
If this is a Round 8 proposal being re-submitted, have the TRP Review Form comments
been clearly addressed in s.4.5.2?
Are there major new objectives compared to the Round 8 proposal that is being resubmitted? If yes, please provide a summary of the changes in the box below by each disease
re-submission and section number.
Yes
No
Yes
No
INSERT TEXT – maximum one page
Currency
USD
Deadline for submission of proposals:
or
X
EURO
12 noon, Local Geneva Time,
Monday 1 June 2009
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG2/15
INDEX OF SECTIONS and KEY ATTACHMENTS FOR PROPOSALS
'+' = A key attachment to the proposal. These documents must be submitted with the completed Proposal
Form. Other documents may also be attached by an applicant to support their program strategy (or
strategies if more than one disease is applied for) and funding requests. Applicants identify these in
the 'Checklists' at the end of s.2 and s.5.
1.
Funding Summary and Contact Details
2.
Applicant Summary (including eligibility)
Attachment C: Membership details of CCMs or Sub-CCMs
+
Complete the following sections for each disease included in Round 9:
3.
Proposal Summary
4.
Program Description
4B.
HSS cross-cutting interventions strategy **
5.
Funding Request
5B.
HSS cross-cutting funding details **
** Only to be included in one disease in Round 9. Refer to the Round 9 Guidelines for detailed
information.
+ Attachment A: 'Performance Framework' (Indicators and targets)
+ Attachment B: 'Preliminary List of Pharmaceutical and Health Products'
+ Detailed Work Plan: Quarterly for years 1 - 2, and annual details for years 3, 4 and 5
+ Detailed Budget: Quarterly for years 1 - 2, and annual details for years 3, 4 and 5
IMPORTANT NOTE:
Applicants are strongly encouraged to read the Round 9 Guidelines fully before completing a
Round 9 proposal. Applicants should continually refer to these Guidelines as they answer
each section in the proposal form. All other Round 9 Documents are available here.
A number of recent Global Fund Board decisions have been reflected in the Proposal Form. The Round 9
Guidelines explain these decisions in the order they apply to this Proposal Form. Information on these
decisions is available at:
http://www.theglobalfund.org/documents/board/16/GF-BM16-Decisions_en.pdf.
Since Round 7, efforts have been made to simplify the structure and remove duplication in the Proposal
Form. The Round 9 Guidelines therefore contain the majority of instructions and examples that will assist in
the completion of the form.
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG3/15
1.
FUNDING SUMMARY AND CONTACT DETAILS
Clarified section 1.1
1.1.
Funding summary
Total funds requested over proposal term
Disease
HIV
Tuberculosis
Malaria
Year 1
Year 2
Year 3
19,635,129
21,701,203
23,630,906
3,942,658
2,880,353
67,793,574
9,998,422
Year 4
Year 5
Total
26,331,590
29,957,084
121,255,912
3,767,464
2,753,535
2,078,463
15,422,473
14,674,613
10,806,113
10,710,615
113,983,337
HSS crosscutting
interventions
section 4B
and 5B
within [insert
name of the
one disease
which
includes
s.4B. and
s.5B. only if
relevant]
Total Round 9 Funding Request
1.2.
:
250,661,722
Contact details
Primary contact
Secondary contact
Name
Dr Nfetam Elat
Dr Ephraim Toh Nyonga
Title
Permanent Secretary
Medical Advisor
Organization
National HIV/AIDS Control
Committee
CAMEROON PLAN
Mailing address
BP 7784 Yaoundé
BP 25236 Yaoundé
Telephone
(+237) 96 98 40 02/ 22 22 57 58/
99 92 19 65/ 77 11 34 82
(+237) 99 28 91 75
Fax
(+ 237) 22 22 57 58/ 22 23 62 30/
22 21 51 87
(+237) 22 21 54 57
E-mail address
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
Alternate e-mail address
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG4/15
1.3.
List of Abbreviations and Acronyms used by the Applicant
Acronym/
Abbreviation
Meaning
[use “Tab” key to add extra rows if needed]
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG5/15
2.
APPLICANT SUMMARY (including eligibility)
CCM applicants: Only complete section 2.1. and 2.2. and DELETE sections 2.3. and 2.4.
Sub-CCM applicants: Complete sections 2.1. and 2.2. and 2.3. and DELETE section 2.4.
Non-CCM applicants: Only complete section 2.4. and DELETE sections 2.1. and 2.2. and 2.3.
IMPORTANT NOTE:
Different from Round 7, ′income level′ eligibility is set out in s.4.5.1 (focus on poor and key
affected populations depending on income level), and in s.5.1. (cost sharing).
2.1.
Members and operations
Clarified section 2.1.1
2.1.1. Membership summary
Sector Representation
Number of members
Academic/educational sector
20
X
Government
X
Non-government organizations (NGOs)/community-based organizations
X
People living with the diseases
X
People representing key affected populations 2
X
Private sector
X
Faith-based organizations
X
Multilateral and bilateral development partners in country
05
04
02
04
03
10
Other (please specify):
X
Observers
• Representative from the World Bank
• Representative from UNAIDS Cameroon
Dr Mamadou Lamine Sakho
• Dean of the Faculty of Medicine and Biomedical Sciences
Yaoundé:
2
Please use the Round 9 Guidelines definition of key affected populations.
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG6/15
0
Prof. Ekoue Tetanye
• Representative from the Medical Research and Medicinal Plant
Studies Development Institute:
Prof. Jean-Louis Essame Oyono
• Representative from the Research and Development Institue
(IRD)
Dr Laurent Vidal
Rapporteurs sur les Programmes en cours
• Permanent Secretary for the GTC/CNLS
• Permanent Secretary for the GTC/RBM
• Permanent Secretary for the GTC/PNLT
• Main Recipient Technical Secretariat (Government)
• CARE Cameroon: Main Recipient (Civil Society)
• Technical Secretariat CCM
Total Number of Members:
(Number must equal number of members in 'Attachment C'' 3 )
48
2.1.2. Broad and inclusive membership
Since the last time you applied to the Global Fund (and were determined compliant with the minimum
requirements):
(a)
(b)
Have non-government sector members (including any new members
since the last application) continued to be transparently selected by their
own sector; and
X
Is there continuing active membership of people living with and/or
affected by the diseases.
Yes
No
X
No
Yes
3
Attachment C is where the CCM (or Sub-CCM) lists the names and other details of all current members. This
document
is
a
mandatory
attachment
to
an
applicant's
proposal.
It
is
available
at:
http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_AttachmentC_en.xls
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG7/15
2.1.3. Member knowledge and experience in cross-cutting issues
Health Systems Strengthening
The Global Fund recognizes that weaknesses in the health system can constrain efforts to respond to the
three diseases. We therefore encourage members to involve people (from both the government and nongovernment) who have a focus on the health system in the work of the CCM or Sub-CCM.
(a)
Describe the capacity and experience of the CCM (or Sub-CCM) to consider how health system
issues impact programs and outcomes for the three diseases.
The presence of the Public Health and Finance Ministries as well as that of Development partners such
as the WHO and NGO and Associations for people living with diseases, confers to the CCM the capacity
to assess the impact of Cameroon’s Health System’s problems regarding caring for diseases.
Some of these members are involved in the implementation of the Sector Wide Approach (SWAP) which
the Cameroon government has been engaged in since 2005, after the Declaration of Paris on the efficacy
of aid for Development. In order to consolidate the existing National Health Development Plans for
Districts, the Multiannual Health Development Plan 2009-2012 is being drafted as a fundamental part of
the Health SWAP.
Therefore, the situational analysis that led to the review of the Health Sector Strategy will be shared with
members of the CCM who will also be informed about the strategy of Strengthening the Health System on
all levels which are being withheld as an implementation strategy for the Cameroon’s Health Sector
Strategy.
Gender awareness
The Global Fund recognizes that inequality between males and females, and the situation of sexual
minorities are important drivers of epidemics, and that experience in programming requires knowledge
and skills in:
•
•
(b)
methodologies to assess gender differentials in disease burdens and their consequences
(including differences between men and women, boys and girls), and in access to and the
utilization of prevention, treatment, care and support programs; and
the factors that make women and girls and sexual minorities vulnerable.
Describe the capacity and experience of the CCM (or Sub-CCM) in gender issues including the
number of members with requisite knowledge and skills.
The presence within the CCM of the Ministries of Justice, the Advancement of Women and the Family
and Social Affairs, whose partners include the UNDP and the UNFPA and national NGO heavily involved
in Reproductive Health and the Gender approach, such as CAMNAFAW, enables the CCM to be
informed of the imperative need to correct imbalances and inequalities of access to care within the
population as soon as possible. Therefore this proposal, submitted to the Global Fund, pays special
attention is to Gender issues.
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG8/15
Multi-sectoral planning
The Global Fund recognizes that multi-sectoral planning is important to expanding country capacity to
respond to the three diseases.
(c)
Describe the capacity and experience of the CCM (or Sub-CCM) in multi-sectoral program design.
Several members of the CCM are focal points for controlling AIDS in their corresponding Sectors and
have actively participated in the drafting of the National Strategic Plan to control AIDS 2006-2010 and the
operational plan to control AIDS 2006-2008. This means they have a lot of experience on the matter of
drafting multi-sector projects. Besides which, some of them have participated in the integration of the
fight against disease in the Strategic Reduction in Poverty Document and the drafting of documents such
as the National Youth Policy, the National Population Policy, the National Securing of Contraceptives and
essential drugs Program, the National Reproduction Health Policy and the National Health Development
Program.
Participation by CCM members in finalizing the proposals for rounds 5,6, 7 and 8, as well as this round,
means they also have a lot of experience in planning multi-sector programs and projects.
2.2.
Eligibility
2.2.1. Application history
'Check' one box in the table below and then follow the further instructions for that box in the right hand column.
X
Applied for funding in Round 7 and/or Round 8 and was
determined as having met the minimum eligibility requirements.
Last time applied for funding was before Round 7 or was
determined non-compliant with the minimum eligibility
requirements when last applied.
Complete all of sections 2.2.2
to 2.2.8 below.
First, go to ′Attachment D′
and complete.
Then also complete sections
2.2.5 to 2.2.8 below (Do not
complete sections 2.2.2 to 2.2.4)
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG9/15
2.2.2. Transparent proposal development processes
Refer to the document 'Clarifications on CCM Minimum Requirements' when completing these questions.
Documents supporting the information provided below must be submitted with the proposal as clearly named
and numbered annexes. Refer to the ′Checklist′ after s.2.
(a)
Describe the process(es) used to invite submissions for possible integration into the proposal from
a broad range of stakeholders including civil society and the private sector, and at the national,
sub-national and community levels. (If a different process was used for each disease, explain each
process.)
In accordance with its procedures, a call for proposals was launched in the official newspaper the
Cameroun Tribune on Wednesday 22 October 2008. This procedure enabled the CCM Cameroon to
keep the Government Sector, the Civil Society and the National Private Sector informed on the launch
of Round 9 of the Global Fund and therefore submit their proposals within the deadline set out in the
application tender. This deadline was set at Friday 6 march 2009.
The Technical Secretariat of the CCM recorded eleven (11) proposals, of which 7 were related to
HIV/AIDS, two (2) to Tuberculosis and two (2) to Malaria.
The two Malaria proposals were submitted by the following organizations: ASSADEMIR (NGO) and the
National Malaria Control Program/ Civil Society.
The two Tuberculosis proposals were submitted by: LEDUCANET (NGO), National Tuberculosis
Control Program / Civil Society.
The HIV proposals were submitted by: Care-Help Cameroun (NGO), Higher Institute of Applied Medical
Sciences (02 proposals), AFRICASO (sub-regional proposal), National Association for Education and
Development (NGO), National Committee against HIV/AIDS/Civil Society, UGEPAD (NGO).
(b)
Describe the process(es) used to transparently review the submissions received for possible
integration into this proposal. (If a different process was used for each disease, explain each process.)
As of Tuesday 10 March 2009, the Technical Secretariat of the CCM sent several emails to the different
members of the CCM and to non-members to elicit their voluntary enrolment in the three working groups
(Malaria, HIV, and Tuberculosis) before reviewing all the proposals received.
After the Cameroon CCM meeting on Thursday 26 March 2009 during which an assessment table for
the proposals was suggested and approved in the plenary, the working groups formed immediately
started work on pre-reviewing the proposals. This work was performed by the Technical Secretariat of the
CCM for the ‘HIV/AIDS group’ and the National Malaria Control Group for the ‘Malaria group’ and the
National Tuberculosis Control Group for the ‘Tuberculosis group’, respectively.
During the meeting on Tuesday 14 April 2009 the CCM working groups gave feedback for Cameroon's
choice of proposal for the three components, HIV, Tuberculosis and Malaria.
Out of the 7 HIV/AIDS proposals received, only 2 were selected, namely:
The joint Government/Civil Society proposal entitled: “Increased care for people infected and affected
by mobilization and the need to increase the supply of services" and the sub-regional proposal from
AFRICASO: “Reducing vulnerability of key affected populations to HIV infection, stigma and
discrimination”.
Out of the two Tuberculosis proposals received and examined from top to bottom, only the following was
deemed acceptable: “Sustaining Tuberculosis control and empowering affected populations and
communities in Cameroon” submitted by the Government/Civil Society.
The two Malaria proposals received were examined (“Scaling up malaria control in Cameroon for
impact” from the PNLP [National Malaria Control Program]/Civil Society coalition and “Promoting the
fight against malaria in vulnerable pockets of rural areas in central, South and East Cameroon” by
ASADEMIR) were deemed complementary and will therefore be consolidated into one proposal.
In accordance with its drafting strategy for Cameroon’s proposal, at its meeting on Tuesday 19 May 2009
the CCM implemented a finalization team responsible for, among other things, merging all the CCM
approved proposals into one coherent single document, and translating or arranging for the translation of
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG10/15
the final document into English.
(c)
Describe the process(es) used to ensure the input of people and stakeholders other than CCM (or
Sub-CCM) members in the proposal development process. (If a different process was used for each
disease, explain each process.)
During the proposals drafting period, huge consultations took place between NGO, the Private Sector
and the Principal Recipients of Rounds in progress. The drafting teams also called on experts and
consultants (UNAIDS, Clinton Foundation, WHO, UNFPA, UNICEF, the American Embassy,
Coopération française and UNESCO) for the HIV/AIDS proposal, (STOP TB Partnership, WHO …) for
the Tuberculosis proposal and (UNICEF, WHO, RBM) for the Malaria proposal to support them in the
drafting of this proposal. The different proposal drafting teams took part in re-reading workshops with
peers and experts at Ouagadougou in Burkina Faso for the HIV and Tuberculosis components, and in
Nairobi in Kenya for the Malaria component. Furthermore, the HIV proposal was sent to the re-reading
by experts committee in Dakar. All these exercises enabled the involvement of people and
stakeholders other than members of the CCM. Advice, suggestions and recommendations received
during the workshops contributed to considerably improving the proposals.
After the CCM selected the proposals, the working groups were split into two groups (restricted drafting
committee and a broader re-reading committee) which worked according to the calendars which they
themselves created. This strategy enabled the preparation of Cameroon’s proposal to be extended to
non-CCM members, some of whom sent their contributions via
e-mail. It is worth noting that these
groups comprised CCM members and experts from both the Civil Society and the Public and Private
Sector.
(d)
Attach a signed and dated version of the minutes of the meeting(s) at
which the members decided on the elements to be included in the proposal
for all diseases applied for.
Annexes : 4, 5,
6,17
2.2.3. Processes to oversee program implementation
(a)
Describe the process(es) used by the CCM (or Sub-CCM) to oversee program implementation.
For more adequate supervision of the implementation of the Program submitted to the Global Fund
Cameroon CCM underwent significant internal restructuring.
During the workshop on 25 September 2008, in the presence of an International Consultant, the
internal rules determining Cameroon CCM’s regulations implemented by Decision No.
0363/D/MPS/CAD of 9/08/2002 and amended on 12 March 200, was revised and adopted. This
amendment to the institutional framework will enable Cameroon CCM to ensure compliance with the
Global Fund’s directives.
Moreover, during this meeting, the new office of the CCM was elected whose composition was
reviewed transparently with the election of members from sectors other than the public sector.
The setting up of a Technical Secretariat by the Ministry of Public Health will certainly enable a
procedures manual to be prepared for supervising and implementing proposals and other missions
allocated by the CCM. However, in the framework of its supervisory role, Cameroon CCM will take part
n the Steering Committee for existing programs, analyze reports on activities and PR audits, approve
annual action plans and ensure their dissemination to facilitators.
(b)
Describe the process(es) used to ensure the input of stakeholders other than CCM (or Sub-CCM)
members in the ongoing oversight of program implementation.
Supervision will be conducted according to a methodology which will be implemented by the CCM.
Actions and supervisions will be conducted on account of the CCM with the participation of its
members, both on a central and peripheral level. Skills beyond the CCM’s scope will therefore be
sought out and engaged.
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG11/15
2.2.4. Processes to select Principal Recipients
The Global Fund recommends that applicants select both government and non-government sector Principal
Refer to the Round 9 Guidelines for further explanation of the
Recipients to manage program implementation.
principles. .
(a)
Describe the process used to make a transparent and documented selection of each of the
Principal Recipient(s) nominated in this proposal. (If a different process was used for each
disease, explain each process.)
Having arrived at this crucial point in the agenda of the meeting of 26 May 2009, the bidders present
were invited to enter the meeting room:
Methods adopted:
(b)
•
CCM members were first of all split into three groups; 1,2 and 3 according to their
installation order, each group contained about 7 members;
•
The names of the 3 domains (HIV, Tuberculosis and Malaria) were marked on three
sheets, then a random selection of files led to each group of members being assigned a
batch of files to review;
•
Members of group 1 reviewed the files on Malaria, group 2 assessed bids from the
domain of Tuberculosis and group 3 was entrusted the HIV files.
•
It is worth noting that CCM members applying for the posts of PRs and SRs were
excluded from the working groups, to prevent any conflicts of interest arising.
•
Then the groups were formed and the work began under the leadership of the three
Permanent Secretaries for the programs.
•
These groups then had the task of reviewing all the files received in detail according to
an evaluation table duly made available to them. Then they had to shortlist the
candidates that they deemed competent.
•
The CCM met on 27 May 2009 for the official announcement of the results of the bids for
PRs and SRs.
Attach the signed and dated minutes of the meeting(s) at which the
members decided on the Principal Recipient(s) for each disease.
Annexes: 7, 17,
8, 9, 10, 11, 12,
13, 14
2.2.5. Principal Recipient(s)
Name
Disease
Sector**
Ministry of Public Health
HIV
Government
CARE Cameroun
HIV
Non-governmental organization
(NGO)
Ministry of Public Health
Malaria
Government
PLAN Cameroun
Malaria
Non-governmental organization
(NGO)
Tuberculosis
Government
Ministry of Public Health
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG12/15
** Choose a 'sector' from the possible options that are included in this Proposal Form at s.2.1.1.
2.2.6. Non-implementation of dual track financing
Provide an explanation below if at least one government sector and one non-government sector Principal
Recipient have not been nominated for each disease in this proposal.
The option for dual track financing was not chosen by the working group responsible for the Principal
Recipients selection due to the fact that the NGO, BCH Africa, which applied for this post, only fitted in
communication and social mobilization, whose budget is very small. The proposal’s budget is about 15
million euros; the amount allocated to communication is therefore not enough to support a Principal
Recipient. Besides hospital workers are needed for the activities, which BCH is not capable of
implementing. The group therefore suggested reclassifying this NGO as a sub-beneficiary.
ONE PAGE MAXIMUM
2.2.7. Managing conflicts of interest
(a)
Are the Chair and/or Vice-Chair of the CCM (or Sub-CCM) from the
same entity as any of the nominated Principal Recipient(s) for any of
the diseases in this proposal?
Yes
provide details below
X
No
go to s.2.2.8.
(b)
If yes, attach the plan for the management of actual and potential
conflicts of interest.
Yes
[Insert Annex
Number]
2.2.8. Proposal endorsement by members
Attachment C – Membership
information and Signatures
Has 'Attachment C' been completed with the signatures
of all members of the CCM (or Sub-CCM)?
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG13/15
X
Yes
Proposal checklist - Section 1 and 2
List Annex Name
and Number
Section 2: Eligibility
CCM and Sub-CCM applicants
2.2.2(a)
Comprehensive documentation on processes used to
invite submissions for possible integration into the
proposal (if different processes used for each disease,
attach as separate annexes).
1, 2,3
2.2.2(b)
Comprehensive documentation on processes used to
review submissions for possible integration into the
proposal (if different processes used for each disease,
attach as separate annexes).
4, 5, 6,17
2.2.2(c)
Comprehensive documentation on processes used to
ensure the input of a broad range of stakeholders in
the proposal development process
18, 19, 20, 21,22
2.2.3(a)
Comprehensive documentation on processes to
oversee grant implementation by the CCM (or SubCCM).
XXXXXXXXX
2.2.3(b)
Comprehensive documentation on processes used to
ensure the input of a broad range of stakeholders in
grant oversight process.
XXXXXXXXX
2.2.4(a)
Comprehensive documentation on processes used to
select and nominate the Principal Recipient (such as
the minutes of the CCM meeting at which the PR(s)
was/were nominated). If different processes used for
each disease, then explain.
7, 17, 8, 9, 10, 11, 12,
13,14
2.2.7
Documented procedures for the management of
potential Conflicts of Interest between the Principal
Recipient(s) and the Chair or Vice Chair of the
Coordinating Mechanism
XXXXXXXX
2.2.8
Minutes of the meeting at which the proposal was
developed and CCM (or Sub-CCM) endorsed.
11,17
2.2.8
Endorsement of the proposal by all CCM (or SubCCM) members.
Attachment C to the
Proposal Form
Sub-CCM applicants only
2.3.3
(CCM Endorsement)
Documented evidence (including minutes of the CCM
meetings) that the CCM in the country reviewed and
endorsed the proposal (as relevant).
2.3.4
Documented evidence justifying the Sub-CCM’s right
to operate without guidance from the CCM.
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG14/15
Proposal checklist - Section 1 and 2
Non-CCM applicants only
2.4.1
Documentation describing the organization such as
statutes and by-laws (official registration papers) or
other governance documents, documents evidencing
the key governance arrangements of the organization,
a summary of the organization, including background
and history, scope of work, past and current activities,
and a summary of the main sources and amounts of
funding.
2.4.2(a)
Documentary evidence justifying the one of the three
exceptional circumstances for submitting a non-CCM
proposal
2.4.2(b)
Documentary evidence of any attempts to include the
proposal in the relevant CCM’s final approved country
proposal and any response from the CCM.
Other documents relevant to sections 1 and 2 attached by applicant:
(add extra rows to this section of the table as required to ensure that documents directly relevant are attached)
R9_CCM_CMR_HTM_PF_s1-2_4Aug09_ENG15/15
HIV PROPOSAL OF CAMEROON - SERIES 9
Strengthening the national response to HIV/AIDS
through prevention and scaling up of care.
CCM – CAMEROON
May 09
ROUND 9 – HIV
Map of Cameroon
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
2/89
ROUND 9 – HIV
INDEX OF SECTIONS and KEY ATTACHMENTS FOR PROPOSALS
'+' = A key attachment to the proposal. These documents must be submitted with the completed Proposal
Form. Other documents may also be attached by an applicant to support their program strategy (or
strategies if more than one disease is applied for) and funding requests. Applicants identify these in
the 'Checklists' at the end of s.2 and s.5.
1.
Funding Summary and Contact Details
2.
+
Applicant Summary (including eligibility)
Attachment C: Membership details of CCMs or Sub-CCMs
Complete the following sections for each disease included in Round 8:
3.
Proposal Summary
4.
Program Description
4B.
HSS cross-cutting interventions strategy **
5.
Funding Request
5B.
HSS cross-cutting funding details **
** Only to be included in one disease in Round 9. Refer to the Round 9 Guidelines for
detailed information.
+ Attachment A: 'Performance Framework' (Indicators and targets)
+ Attachment B: 'Preliminary List of Pharmaceutical and Health Products'
+ Detailed Work Plan: Quarterly for years 1 – 2, and annual details for years 3, 4 and 5
+ Detailed Budget: Quarterly for years 1 – 2, and annual details for years 3, 4 and 5
IMPORTANT NOTE:
Applicants are strongly encouraged to read the Round 9 Guidelines fully before completing a Round 8 proposal.
Applicants should continually refer to these Guidelines as they answer each section in the proposal form. All other
Round 8 Documents are available here.
A number of recent Global Fund Board decisions have been reflected in the Round 8 Proposal Form. The
Round 9 Guidelines explain these decisions in the order they apply to this Proposal Form. Information on
these decisions is available at:
http://www.theglobalfund.org/en/files/boardmeeting16/GF-BM16-Decisions.pdf.
Since Round 7, efforts have been made to simplify the structure and remove duplication in the Round 8
Proposal Form. The Round 9 Guidelines therefore contain the majority of instructions and examples that
will assist in the completion of the form.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
3/89
ROUND 9 – HIV
List of abbreviations and acronyms used by the applicant
Acronym/Abbreviation
Signification
Canadian International Development Agency
CIDA
ACMS
Cameroon Association of Social Marketing (Association Camerounaise de
Marketing Social)
ADC
AFFTC
Aéroports du Cameroun – Cameroon Airports Company
AFRICASO
African Council of Aids Services Organisations
RGA
ALUCAM
Revenue Generating Activities
CLA/ARC
Community Liaison Agent(Agent de Relais Communautaire)
ARV
Antiretroviral
ASECNA
Agency for the Safety of Air Navigation in Africa and Madagascar (Agence pour
la sécurité de la navigation aérienne en Afrique et à Madagascar)
UA
Universal Access
AWARE
Action for West Africa Region
ILO
International Labour Organisation
WB
World Bank
BSR-AC
Central Africa Sub-Regional Office (Bureau Sous Régional pour l’Afrique
Centrale)
C2D
Debt Development Contract (Contrat de Désendettement et Développement)
NAF
National Amortisation Fund (Caisse Autonome d’Amortissement)
CAMNAFAW
Cameroon National Association for Familly Welfare
RPSC
Regional Pharmaceutical Supply Centre (Centrale d’Approvisionnement Régional
en Produits Pharmaceutiques)
BCC
Behaviour Change Communication
CCA Sida
Cameroon Coalition to Combat AIDS and Malaria
CCAA
Cameroon Civil Aeronautic Authority
CCA-SIDA
Coalition of Community Affairs Against AIDS, Tuberculosis and Malaria (Coalition
de la communauté des Affaires Contre le Sida la tuberculose et le paludisme)
BCC
Behaviour Change Communication
CCM
Country Coordinating Mechanism
CD4
Closter Designation 4
CDC
Centre for Disease Control
CE
Causerie Educative (Educational Discussion)
CENAME
National Office of Procurement of Essential Drugs(Centrale Nationale
d’Approvisionnement en Médicaments et Consommables Médicaux Essentiels)
Affiliated Treatment Centre
Aluminium du Cameroun
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
4/89
ROUND 9 – HIV
CHART
Artisans Association (Chambre des Artisants)
HMPC
Humanitarian Medical-Pharmaceutical Centre (Centrale Humanitaire MédicoPharmaceutique)
CHP
Care and Health Programme
ICEL
Information Centre for Education and Listening
CIFM
Mindourou Industrial and Forestry Centre (Centre Industriel et Forestier de
Mindourou )
CIRCB
Chantal Biya International Research Centre (Centre International de Recherche
Chantal Biya)
NCCA
National Committee to Combat AIDS (Comité National de Lutte contre le Sida)
COMINSUD
PCCA
Community Association for Sustainable Development
PNC
Prenatal Consultation
CR
Compte Rendu
CRETES
Economic and Socio-Behavioural Research and Study Centre(Centre de
Recherche et d’Etudes Economiques et Socio-comportementales)
CRIS
Country Response Information System
CRS
Catholic Relief Services
CSSD
District Health Services Chief (Chef du Service de Santé de District)
CSTC
Cameroon Confederation of Workers Unions (Confédération Syndicats des
Travailleurs du Cameroun)
CTC
Certified Treatment Centre (Centre de Traitement Agrée)
CTX
Cotrimoxazole
DBS
Dry Blood Spot
DHC
District Health Committee
DHP
Department of Health Promotion
DHS
Demographic Health Survey
DLM
Department of Fight Against Disease (Direction de la Lutte contre la Maladie)
DLM
Department of Fight Against Disease (Direction de la Lutte contre la Maladie)
DMT
District Management Team
DOD
Department Of Defense
SDA
Service Delivery Area (Domain de Prestation de Service)
SDA
Service Delivery Area (Domain de Prestation de Service)
SDPR
Strategy Document for Poverty Reduction
DTC
Diagnosis and Treatment Centre
ECAM
Cameroon Survey of Households (Enquête de Camerounaise Auprès des
Ménages)
EDS
Demographic Health Survey (Enquête Démographique de Santé)
EPP Spectrum
Estimation Projection Package – Spectrum
EVF/EMP/VIH
Family Life Education/On Population and HIV (Education à la Vie Familiale/En
Matière de Population et de VIH)
Provincial Committee to Combat AIDS (Comité Provincial de Lutte contre le Sida)
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
5/89
ROUND 9 – HIV
FCFA
African Financial Community Francs (Francs Communauté Financière Africaine)
GF
Global Funds (Fonds Mondial)
FOCAP
Cameroon Psychology Forum (Forum Camerounais de Psychologie)
Frs
Francs
SE
Sanitation Education
TSG
Technical Support Group (Groupe d’Appui Technique)
PCOG
Partner's Coordination Group (Groupe de Coordination des Partenaires )
GFATM
Global Fund to Fight Aids Tuberculosis and Malaria
Groupement de la Filière Bois du Cameroun
GIP ESTHER
Public Initiative Group – Hospital Treatment Support Network (Groupement
d’Initiative Public Ensemble pour la Solidarité Thérapeutique Hospitalière En
Réseaux)
CTG/NCCA
Central Technical Group/National Committee to Combat AIDS (Groupe
Technique Centrale/Comité National de Lutte contre le Sida)
TCG/RBM
Technical Coordination Group/Roll Back Malaria (Groupe Technique de
Coordination/Roll Back Malaria)
RTG
Regional Technical Group (Groupe Technique Régional)
GTZ
German Cooperation (Coopération Allemande)
HCR
High Commissioner for Refugees
DH
District Hospital
HIPC
Heavily Indebted Poor Countries
HIV
Human Immunodeficiency Virus
HRH
Men having Relations with Men (Homme ayant des Relations avec des Hommes)
HSH
Men having Sex with Men (Hommes ayant des rapports Sexuels avec les
Hommes)
HSS
Health Sector Strategy
EWI
Early Warning Indicators
IDA
International Development Agency
IEC
Information Education Communication
IMMP
Institute of Medicine and Medicinal Plants (Institue Médicale et des Plantes
Médicinales)
INS
National Statistics Institute (Institut National de statistique)
OI
Opportunistic Infection
STI
Sexually transmissible infection
KfW
Kreditanstalt für Wiederaufbau
LANACOM
National Laboratory for Analysis and Quality Control of Essential Drugs
(Laboratoire National d’Analyse et de Contrôle qualité des Médicaments et
Consommables Médicaux Essentiels)
LANSPEX
National Laboratory of Public Health and of Expertise
LEDUCANET
LFA
Language Education Network
Local Fund Agent
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
6/89
ROUND 9 – HIV
LME
List of Essential Drugs (Liste des Médicaments Essentiels)
M&E
Monitoring and Evaluation
M&E
Monitoring and Evaluation
MDGs
Millennium Development Goals
MESDINE
Meeting SRH Diversity Needs
MINAS
Ministry of Social Affairs (Ministère des Affaires Sociales)
MINEDUB
Ministry of Basic Education (Ministère de l’Education de Base)
MINIFI
Ministry of Finance
MINJEUN
Ministry of Youth (Ministère de la Jeunesse)
MINSANTE
Ministry of Health (Ministère de la Santé)
MINSEC
Ministry of Secondary Education (Ministère des Enseignements secondaires)
MOI
Medicines for opportunistic infections
MOH
Ministry of Public Health
MSM
Men having Sex with Men
MTN
Mobile Telephone Network
NACP
National AIDS Control Programme
NASA
National AIDS Spending Assessment
ND
Non-determined
BCC
Blood Cell Count (Numération Formule Sanguine)
NGO
Non-governmental Organisation
NOWECA
UN
North West Craft Association
CBO
Community Based Organisation
OCEAC
Organisation to Coordinate the Fight against Central African Endemics
OVC
Orphans and Vulnerable Children (Orphelins et Enfants Vulnérables)
ILO
International Labour Organisation
ILO/US-DOL
MDG
International Labour Organisation/United State Department of Labour
NGO
Non-Government Organisation
UNAIDS
Joint United Nations Program on HIV and AIDS
CSO
Civil Society Organisation
PSO
Private Sector Organisation
WFP
World Food Program
PC
Peer Counsellors
PCGE
Cameroonian Business Coucil (Plate forme de Coordination Groupe des
Entreprises du Cameroun)
IPC
Interpersonal Communication
IMCD
Integrated Management of Childhood Diseases (Prise en Charge Intégrée des
Maladies de l’Enfant)
United Nations
Millennium Development Goals
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
7/89
ROUND 9 – HIV
PCR
Polymerase Chain Reaction
PAA
POS
Partner Against AIDS (Partenaire Contre le SIDA)
Pair éducateur
Peer educator
PEC
Prise en charge
CS
Community Support
PEDC
Paediatric Care
PEPFAR
Presidential Emergency Programme for Aids Relief
PHP
PIM
Upper Penja Plantations (Plantations du Haut Penja)
SME/SMI
Small and Medium Enterprises/Small and Medium Industries
PNLS
National Programme to Combat AIDS (Programme National de Lutte contre le
Sida)
PP
Page
PPP
Public-Private Partnership
APPCA
AIDS Prevention Project in Central Africa (Projet de Prévention du Sida en
Afrique Centrale)
APPCA
AIDS Prevention Project in Central Africa (Projet de Prévention du Sida en
Afrique Centrale)
HIPC
Highly Indebted Poor Countries (Pays Pauvres Très Endettés)
PR
Principal Recipient
PRSTDA
Prevention of STD and AIDS
PRSP
Poverty Reduction Strategy Paper
PSI
Population Service International
NSP
National Strategic Plan
PMCT
Prevention of Mother and Child Transmission of HIV (Prévention de la
Transmission Mère et Enfant du VIH )
PLWHA
Persons Living with HIV
R 3 ,4, 5
Round 3 ,4 and 5
CAR
Central African Republic
RECAP+
Cameroonian Network of Persons Living with HIV (Réseau Camerounais de
Personnes vivant avec le VIH)
RGPH
General Census of Population and Housing (Recensement Général de la
Population et de l’Habitat)
SBR
Social and Business Responsibility
M/E
Monitoring and Evaluation
CS
Civil Society
SCTB
Cameroonian Wood Transformation Company (Société Camerounaise de
Transformation de Bois)
SIDA-COOP
MIS
Swedish International Development Agency
Point of Sale (Point de vente)
Purchasing and Inventory Management
Management Information System
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
8/89
ROUND 9 – HIV
PS
Permanent Secretary
SR
Sub Recipient
HRH
Human Reproductive Health
SSR
Sub-Sub Recipient
STRACOM
SWAP
Cameroon Transport Company (Société des Transports du Cameroon)
SYNAME
National System of Procurement of Essential Drugs (Système National
d’Approvisionnement en Médicaments et consommables Médicaux Essentiels)
ARVT
Antiretroviral Treatment
TB
Tuberculosis
TORs
Terms of Reference
MW
Migrant Workers
TRP
Technical Review Panel
SW
Sex Worker
UAFC
Universal Access to Female Condom
UDS
Dja and Lobo Département Trade Union (Union Départementale Syndicale du
Dja et Lobo)
MU
Mobile Unit
UNFPA
United Nations Fund for Population Agency
UNGASS
United Nation General Assembly Special Session on AIDS
UNICEF
United Nations Children's Fund
UNITAID
Unit Aid
CU
Care Unit
USAID
United Nations Aid for International Development
USD
US Dollar
USDOL
United States Department of Labor
HOV
Home Visit
CVOL
Community Volunteer
VCTC:
Voluntary Counselling and Testing Centre
HIV
Human Immunodeficiency Virus
VSO
Voluntary Services Overseas
WHO
World Health Organisation
Sector Wide Approach
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
9/89
ROUND 9 – HIV
3. PROPOSAL SUMMARY
3.1. Duration of Proposal
Planned Start Date
To
2010
2014
Month and year:
(up to 5 years)
3.2. Consolidation of grants
Yes
(go first to (b) below)
(a)
Does the CCM (or Sub-CCM) wish to consolidate any existing HIV Global
Fund grant(s) with the Round 9 HIV proposal?
X
No
(go to s.3.3. below)
‘Consolidation’ refers to the situation where multiple grants can be combined to form one grant. Under Global Fund
policy, this is possible if the same Principal Recipient (‘PR’) is already managing at least one grant for the same
disease. A proposal with more than one nominated PR may seek to consolidate part of the Round 9 proposal.
Î More detailed information on grant consolidation (including analysis of some of the benefits and areas to consider
is available at:
http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_FAQ_GrantConsolidation_en.pdf
(b)
If yes, which grants are planned to be consolidated with the
Round 9 proposal after Board approval?
(List the relevant grant number(s))
3.3.
Clarified section 3.3
Alignment of planning and fiscal cycles
Describe how the start date:
(a)
contributes to alignment with the national planning, budgeting and fiscal cycle; and/or
(b)
in grant consolidation cases, increases alignment of planning, implementation and reporting efforts.
The fiscal year in Cameroon runs from 1st January to 31st December. The National AIDS Control
Committee develops annual action plans which are attuned to the fiscal year. This programme should
preferably be launched on 1st January 2010 to ensure the integration and complementarity of
Government's HIV/AIDS control activities for better harmonization with the national action plan.
3.4.
Program-based approach for HIV
3.4.1. Does planning and funding for the country's
response to HIV occur through a program-based
approach?
Yes. Answer s.3.4.2
X
3.4.2. If yes, does this proposal plan for some or all of the
requested funding to be paid into a commonfunding mechanism to support that approach?
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
No. Î Go to s.3.5.
Yes Î Complete s.5.5 as an
additional section to explain the
financial operations of the common
10/89
ROUND 9 – HIV
funding mechanism.
X
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
No. Do not complete s.5.5
11/89
ROUND 9 – HIV
3.5.
Summary of Round 9 HIV Proposal
Provide a summary of the HIV proposal described in detail in section 4.
Prepare after completing s.4.
With a prevalence of 5.1%, Cameroon, being a low income country, is found in the context of a
generalised epidemic. HIV is the leading cause of death among adolescents and adults in Cameroon. In
response to this situation, Cameroon has developed a National Strategic Plan for Combating AIDS 20062010 (NSP) based on a multi-sectoral and decentralised approach.
Interventions included in this proposal are consistent with the NSP orientations and aim for prevention
among at risk and vulnerable groups, taking overall responsibility for PLWHA and care of OVC (pages
22, 39 and 42). Priority target groups are represented by persons having risky behaviours (truckers, men
in uniform, sex workers, prison inmates), vulnerable persons (youths, women and pregnant women),
infected (PLWHA) and affect (OVC) persons. In addition to these groups which are clearly identified in
the National Strategic Plan (NSP) for the Combat against AIDS 2006-2010 (Attachment 1), projected
activities intend to aid complementary populations which are at risk and/or vulnerable, particularly MSM,
handicapped persons and Marginal Populations: Pygmies and Mbororos.
This proposal is developed in the context of completion of Rounds 3 and 4 funding to December 31,
2009. To respond to the major risk of interruption of ARV treatments, this submission will continue the
interventions of Round 3 in the area of care, treatment and support, while capitalising on the experiences
of Rounds 3 and 4 from Global Funds involving Civil Society participants.
The goals of this submission are: (i) To contribute to reducing new infections in at risk and/or vulnerable
target groups by intensifying prevention activities and (ii) to contribute to reducing morbidity, mortality and
the negative impact related to HIV and AIDS from 2010 to 2014. Following an extensive evaluation of
current and anticipated shortcomings, this submission has identified five objectives which are:
To assure the prevention of HIV within 6 at risk and/or vulnerable target groups through close CBC,
(i)
(ii)
(iii)
(iv)
(v)
distribution of condoms, and voluntary Counselling and testing;
To increase from 50% to 80% from 2012 to 2014 the proportion of pregnant women with access to HIV
counselling and testing
To provide medical care to 165,061 PLWHA adults and children by 2014;
To ensure the availability of a continuum of care to all patients on ARV treatment and support
for 30,000 OVC per year from 2010 to 2014;
To strengthen the favourable environment for implementing prevention activities, medical,
psychosocial and support care in 166 Health Districts (HD) from 2010 to 2014.
This proposal is a major challenge, due to an active file of patients on ARV estimated to be 74,710
(including 3,110 children) at the end of 2009. As a result of the decentralisation policy, institution of free
ARV, and subsidy of biological assessment, this result exceeds the objectives set at Round 3. The
objective up to 2014 is 165,061 patients treated with ARV. Support for this demanding file requires
mobilisation of significant financial resources. The Government undertakes to take responsibility for 50%
of these patients.
The innovation in this submission is in the financing of two channels selected by the Cameroon CCM so
that civil society and the private sector on the one hand and the Government on the other hand
coordinate, assume and assure, each for their own area, concurrent activities towards a common goal.
This proposal is based on four fields of activity:
Prevention :
In the field of prevention, in addition to the group of PLWHA which benefit from a holistic care including
positive prevention, 6 at risk and vulnerable groups have been targeted. These groups are poorly covered
by other programs. They are uneducated youths, truckers, sex workers, handicapped persons, men who
have sex with men, marginal populations (Mbororos, pygmies). In addition, the provision of PMCT
services for pregnant women will be strengthened as part of scaling up activities of Round 5.
Interventions for prevention will lead all these targets to testing and care where there is a diagnosis of HIV
infection.
Activities implemented in this submission will enable the distribution of 4,107,225 supports for
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
12/89
ROUND 9 – HIV
Communication for Behaviour Change, facilitating access to testing for 1,365,910 persons, and to
distribute 33,313,255 condoms (male and female) and lubricant gel.
Expected results from the activities developed in this component are (i) enabling 975,270 out-of-school
youths, 40,000 truckers, 10,300 SW, 378,000 sensorially handicapped persons, 7,500 MS, 36,666
Pygmies, 50,000 Mbororos and 2,288,893 pregnant women to know their serological status from 2010 to
2014 , and (ii) to increase the use of condoms in these groups, especially MS (1,039,500 condoms
distributed) and Truckers (400,000 condoms distributed).
Medical Care:
The main activities implemented in this field include supply and distribution of medicines to PLWHA,
establishment of 34 new support units to reach 166 operational Units by 2014, the training/retraining or
390 personnel responsible for care, improvement of the biological reference laboratory for viral
examinations. Under this proposal, the Global Fund will be requested to make up the 50% contribution of the
Government for ARV, or 82,530 patients.
Expected results from activities developed in this component are to put onto ARV, 165,061 PLWHA
eligible for ARVT by 2014.
Care and support:
The objective of the submission is to ensure the continuum of care for 165, 061 PLWHA under ARVT and
a support to OVC at 30,000 per year.
These activities are based on positive prevention, psychological and social monitoring including
assistance with therapeutic adherence, locating persons lost track of, and referral-reference by mediation
of PLWHA. Within this objective, 1,680 community volunteers (CVOL) and 736 Community liaison agents
(CLA) will be trained/retrained. Food support will be established for the benefit of the needy.
The expected results are that )i) 65 care operating organizations (CTC/CU) representing 85% of patients)
have an operational community arrangement ensuring a continuum of quality care and (ii) 2/3 of persons
lost track of are reintegrated into the care system.
Regarding support for OVC, the submission proposes to continue the holistic care of OVC by capitalising
on their achievements and experiences from Rounds 3 and 4, and strengthening community involvement
in this care. It is planned to support 30,000 OVC annually (taking into account their degree of
vulnerability) in the form of 30,000 support packages, including education, nutritional, psychological and
social, health and legal sections.
Creation of a favourable environment for development of activities in 166 Health Districts:
The aim is to improve the capacity of 317 CSOs and 100 Private Sector Organisations in the
management, coordination and implementation of activities for prevention, continuing care and support
for OVC.
In parallel, strengthening the public sector institutional capacities will be developed particularly in its
capacity to manage and coordinate the program including a platform for partners.
Based on a national and regional coordination around the health district, regular meetings are scheduled
between the participants at all levels of the operational chain. Among activities of the monitoringevaluation and research components, studies and surveys will be implemented (mapping of
interventions, biennial bio-behavioural studies, ARV resistance studies, sentinel surveillance among
pregnant women, etc.).
Results expected are (i) to strengthen the intervention abilities of all actors (public sectors, civil society
and private sector) and (ii) to improve the scope of operational activities through well-coordinated
programs.
In conclusion, this submission for the 9th Round of appeal to the Global Fund will complete the
Government's contribution (50%) in order to consolidate and extend the holistic care of persons living with
HIV whose expected number in 2014 is 165,601. This will also ensure quality activities for the benefit of
vulnerable and/or marginal populations, both in prevention and in terms of support for the continuum of
care and support for OVC. Finally, it intends to pursue PMCT activities after completion of Round 5 in
December 2011.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
13/89
ROUND 9 – HIV
With funding in two ways, this proposal of an amount of 120,288,049 Euros will provide the means to
obtain positive results. It is therefore an innovative opportunity for Cameroon to continue the path towards
universal access and achievement of the Millennium Development Goals.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
14/89
ROUND 9 – HIV
4.
PROGRAM DESCRIPTION
4.1.
National prevention, treatment, care, and support strategies
(a)
ƒ
ƒ
Briefly summarize:
the current HIV national prevention, treatment, and care and support strategies;
how these strategies respond comprehensively to current epidemiological situation in the country;
and
ƒ
the improved HIV outcomes expected from implementation of these strategies.
HIV infection is a real public health problem in Cameroon and a brake on development. In the context of a
generalized epidemic, HIV prevalence is estimated at 5.1% among adults aged 15 to 49 years. According
to the report on the Global AIDS Epidemic 2008 UNAIDS (Attachment 4), youth and women are most
affected.
Cameroon has developed a National Strategic Plan to Combat AIDS 2006-2010. This Plane outlines 6
Strategic directions:
1. Universal access to prevention for priority target groups such as youth, women and groups
with at risk behaviours (men in uniform, truckers, prison populations and sex workers)
•
Strengthening of prevention among youth and women by promoting less risky behaviour, and the
strengthening of the screening at health facilities and mobile units are the foundation of
prevention interventions in this area.
•
In health care facilities, strengthening of blood safety, prevention of accidents involving exposure
to body fluids, prevention of mother to child transmission, prevention and adequate care for STIs,
are also interventions in response to the need for prevention in the population.
•
Associated with this overall prevention program is promotion of male and female condoms.
•
To enable young people to improve their knowledge of HIV, interventions to strengthen
information about HIV and AIDS in the education sector and vocational schools have also been
undertaken.
These interventions are implemented through the contribution of the GFATM (Rounds 3, 4 and 5), the
Government and other partners. This proposal aims to strengthen these gains, but also to develop broad
and innovative interventions for and with key populations (at high risk to STD / HIV), which have not yet
been reflected in prevention priorities.
2. Universal access to treatment and care for children and adults living with HIV / AIDS
•
This area includes health care capacity building, strengthening the prevention and treatment of
Opportunistic Infections (OIs), and increasing access to ARV treatment, which, in Cameroon,
constitute major interventions.
•
In this context, the development of outpatient services and home care, the development of
nutritional care, strengthening of biological, medico-technical and clinical services, strengthening
the supply system (medicines, ARVs, reagents, consumables and equipment) and the
organization of assistance to treatment adherence are the structural supports for medical
response.
•
These basic health services rely on the public health sector and the voluntary and community
sector, whose involvement helps develop a continuum of care for the benefit of those infected
and affected by HIV.
Funding obtained to date have also helped to develop the medical and community response, which will
be scaled up in 166 health districts with this proposal, in the interests of improving and ensuring the
sustainability of service quality.
3. Protection and support for OVC
•
This priority aims to strengthen institutional capacity for protection and holistic care of OVCs,
supporting community initiatives for the care and maintenance of OVC in their communities and
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
15/89
ROUND 9 – HIV
the establishment of a dynamic database on OVC.
•
Some interventions (psychosocial support, nutritional, educational, health and legal) have been
initiated towards this vulnerable group.
4. Appropriation of the combat by participants
•
To achieve the targets set by the NSP (Attachment 1), the involvement of all key players
(PLWHAs, Communities, religious organizations, opinion leaders, media) is required through
grouping in structured Networks (PLWHA Associations), building their capacities, advocacy,
contracting for the implementation of activities.
•
Different funding has enabled the creation of Local Committees to Combat AIDS, Committees for
the combat in enterprises and public sectors, the Municipal Committees (IDA financing),
mobilization and strengthening of all the Civil Society Associations (Financing Round 4).
These interventions have led to increased operational involvement of associations and representation of
PLWHA and Associations and Networks at various levels of the fight against the pandemic (CNLS, CCM,
etc.).
3. Promotion of research and epidemiological surveillance
•
The promotion of operational research and strengthening of surveillance at sentinel sites are the
main interventions for this priority.
To allow for consolidation of implementing the national system for monitoring and evaluation and
operational research, this proposal will develop a coherent cycle of interventions that will allow better
monitoring of the dynamics of the epidemic in Cameroon and to measure the impact of interventions.
6. Strengthening coordination, partner management and evaluation monitoring.
•
Capacity development of organisations and institutional structures involved in combating HIV and
STIs (public sector, community and voluntary sector, national and international NGOs) has
received support from the GFATM grants under Rounds 3, 4 and 5.
•
In addition, strengthening of multi-sectoral coordination of actors and partners combating HIV
and STIs has been initiated. This coordination will be strengthened as part of this proposal, given
the weakness of the institutional response observed in the regions and districts.
•
In terms of regional and international cooperation, civil society has developed a variety of
bilateral and multilateral partnerships both North and South. The SP-CNLS of Cameroon
assumed responsibility as the Principal Recipient of GFATM for Cameroon CCM.
•
With regards to mobilisation of resources, substantial efforts have been undertaken. However,
there are weakness in this area which have resulted in performances below projections.
This proposal takes into account all the financial shortfalls and the need to address them, through a
strengthened partnership between all participants in the national response, including the private sector,
hitherto insufficiently involved in the operative part of the fight.
Thanks to the implementation of these strategies, and despite the weaknesses noted, significant results
have been achieved, which need to be further strengthened and expanded, given the demand for
prevention and care, growing unceasingly.
In terms of results to the national response, there is significant improvement since 2006:
•
Counselling and testing is performed following two strategies: the strategy for health training and
the advanced strategy through Mobile Units (MU) for testing. Between 2006 and 2008, 1,253,250
persons were tested for HIV through the development and extension of these two strategies. The
average rate of test acceptance among counselled persons was on average 97% and more than
97% received their results.
•
With regard to the Prevention of Mother to Child Transmission (PMCT), more than 2,000 health
facilities offer the package of PMCT services across the 10 regions of the country. In 2008,
almost 281,204 pregnant women were tested for HIV, bringing the number to 582,833 pregnant
women tested since 2006. This figure is steadily increasing as the number of pregnant women
tested in ANC increased from 90,238 in 2006 to 209,319 in 2007 In 2008 to early diagnosis of
PCR began at 47 sites, and enabled testing 5,136 children born to mothers infected by DBS.
5.7% of these children were found to be positive. In total, approximately 18.0% of HIV positive
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
16/89
ROUND 9 – HIV
pregnant women have fully benefited from PMCT services.
•
Increased use of condoms is noticeable. Since 2006, 96,836,059 condoms were distributed
(354,587 female and 96,481,488 male) going from 33,373,152 in 2006,130,264 female and
33,242,888 male) to 33,629,358 (143,593 female and 33,485,765 male) in 2008, through the
commercial network mainly based in urban areas. With regard to seroprevalence, condom
distribution is low, because the rate is 32% compared to the theoretical needs in 2008. In 2006,
among women aged 15-24 who have had unsafe sex, about six in ten (62%) used a condom at
last sex with an unmarried or non-cohabiting partner (CNLS 2007 Report). The introduction of the
community based strategy for condom distribution in 2008 will extend coverage to rural areas.
•
In terms of care for PLWHA, a total of 24 Certified Treatment Centres (CTC) and 108 Care Units
(CU) covering the 10 regions are currently operational. The support of PLWHA is global. The
active file of patients on ARVs increased from 17,156 in 2005 to 59,960 to 31 December 2008
(39% of those eligible). This is a part of extending the geographical coverage of the care
structures that went from 84 in 2005 to 132 in late 2008 of which 27% are private and religious
health facilities, and also free antiretroviral treatment from 1 May 2007 throughout the territory,
and subsidy of biological tests.
•
The mobilization of civil society through the round 4 has allowed the institutional strengthening of
220 CSOs which gave 39,807 PLWHA support on the psychosocial level. In addition, 7500
PLWHA have received material support in terms of financial support for the costs of nonsubsidised examinations, OI treatment, nutritional packages and AGR. Also in Round 3, Civil
Society contributed through 508 community agents in health care facilities by providing patients
with psychosocial support, help with compliance and adherence to treatment. PLWHAs were a
valuable contribution to improving of the active file through their open testimonies and their
service in the care structures.
Nonetheless, there are significant challenges to overcome:
•
Difficulties in reaching highly exposed key populations (often isolated from the health, social,
public and community systems, victims of stigma and discrimination), led to the focus in this
proposal on interventions toward these populations that are based on innovative and participatory
approaches .
•
The provision of mobile and advanced screening strategies, reaching people who do not
normally have access to these services (removal of fixed testing sites, fear of stigma and
discrimination, etc.).
•
The mobilisation of the greatest number of pregnant women and their partners to use PMCT
services (CPN, screening, retrieving results, prophylactic treatment, etc..), particularly women
with the highest risk of exposure;
•
An ARV treatment coverage which remains low compared to estimated population needs
(especially in children) and PEC medical services requiring quality improvement;
•
Insufficient consideration of the needs of the private sector, with the result being low involvement.
•
The availability and low quality of laboratory services; reduced access to preventive and care
services for the most vulnerable populations.
The Round 9 proposal will take into account all the problems listed above, focusing on strengthening the
response capacity of both the public sector, civil society and the private sector, whose dynamism
contributed significantly to the results observed in recent years.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
17/89
ROUND 9 – HIV
(b)
From the list below, attach* only those documents that are directly relevant to the focus of this
proposal (or, *identify the specific Attachment number from a Round 7 or Round 8 proposal when
the document was last submitted, and the Global Fund will obtain this document from our files).
Also identify the specific page(s) (in these documents) that support the descriptions in s.4.1. above.
Document
X
National Health Sector Development/Strategic Plan
Proposal
Attachment
Number
Page References
Attachment nº 1
R 8, Attachment 1
Page 12
Attachment nº16
Page 28
Attachment nº5
R8, Attachment 3
Page 26
Attachment nº6
Page 19
Attachment 12
Page 19
Attachment nº13
R8, Attachment 7
Page 25
Attachment 14
Page 27
Attachment nº 15
Page 26
Attachment nº 23
R8, Attachment 7
Page 56
National HIV Control Strategy or Plan
X
X
X
Important sub-sector policies that are relevant to the
proposal
(e.g., national or sub-national human resources policy, or
norms and standards)
Most recent self-evaluation reports/technical advisory
reviews, including any Epidemiology report directly
relevant to the proposal
National Monitoring and Evaluation Plan (health sector,
disease specific or other)
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 of services
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
18/89
ROUND 9 – HIV
4.2.
Epidemiological Background
4.2.1. Geographic reach of this proposal
(a)
Do the activities target:
X
Whole country
Specific Region(s)
**If so, insert a map to
Specific population groups
**If so, insert a map to show where
show where
these groups are if they are in a specific
area of the country
A/ National epidemiological data
The UNAIDS 2008 report estimated the average prevalence of HIV infection in the adult population of
Cameroon at 5.1% [3.9-6.2] at the end of 2007 (EPP and Spectrum estimate (Attachment 12)). According to
these estimates, 540,000 people [430,000-640,000] live with HIV in Cameroon, including 45,000 children and
300,000 women. In 2007, 39,000 deaths were linked to AIDS and 300,000 children were orphaned by AIDS
(UNAIDS - Epidemiological Fact sheet Cameroon - September 2008 (Attachment 6)).
In 2008, out of 276,177 pregnant women screened in CPN, 6.5% were positive for HIV. This rate varies
geographically from 3.2% in the Far North region to 8.6% in the Southwest (CNLS - Annual Report 2008).
The third Demographic and Health Survey of Cameroon (EDSC-III (Attachment 10)) of 2004 was the first
investigation to perform an HIV test in the general population of Cameroon. This bio-behavioural survey
revealed disparities in the population and target groups both in terms of HIV prevalence and of risk factors. In
addition:
- Women are more affected than men in the 15 to 49 year age group(6.8% versus 4.1%); the peak of
infection is in the 20-29 year age group among women (10.3%) and in the range of 35-39 years for
men (8.6%);
- Men and women from urban areas are much more affected than rural areas: The prevalence
reached 6.7% in urban areas against 4.0% in rural areas; the HIV epidemic does not uniformly affect
the different regions of Cameroon.
- The number of PLWHA (adults and children) needing antiretroviral treatment (ART) is estimated at
179,083 in 2010, 200,190 in 2012 and 220,081 in 2014 (see Table 1).
Table 1: Estimated Number of PLWHA needing ART therapy from 2010 to 2014
Year
Adults
Children
2010
168,579
10,504
2011
178,324
12,224
2012
185,695
14,495
2013
193 066
16766
2014
201,228
18,853
Estimates taken from Spectrum (January 2008)
B/ Prevalence data in the proposal target groups
The articulation of this proposal (prevention, care, care and support, coordination) aims to consolidate and
extend the holistic care of persons infected and affected while ensuring the populations most vulnerable to
infection are offered preventive services and care. The populations identified in this submission are the outof-school youths, truckers, sex workers (SW), the sensorially handicapped, men who have sex with men
(MSM), marginal populations (Pygmies and Mbororos) and pregnant women. In addition to these populations
at high risk of infection and/or vulnerable, OVCs and PLWHAs will be taken into account in the provision of
care and support services.
Knowledge of the risk and vulnerability factors to HIV infection for these populations can better tailor the
response and the provision of services that will be proposed.
•
populations at high risk of HIV exposure: these populations whose level of infection is higher than
the general population are characterised both by their high risk of exposure (children borne to HIV
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
19/89
ROUND 9 – HIV
positive mothers) and/or the fact that they may play a role in disseminating the infection to the
general population: truckers, SW, MSM;
•
populations in situations of social and/or economic vulnerability: with relatively low prevalence levels,
some population groups nevertheless have a particular vulnerability to HIV, due to their socioeconomic situation (lack of family protection, economic dependency, gender inequality, etc..) out-ofschool youths, sensorial handicapped persons, marginal populations (Pygmies, Mbororos, OVC).
3
2
2
11
3
Roads used by truck drivers with the following stop points shown: Douala, Edéa, Kribi, Puma, Sombo, Boumnyebel,
Mbankomo, Yaoundé, Mbalmayo, Ebolowa, Ambam, Ayos, Bertoua, Bélabo, Batouri, Kentzou, Garoua Boulai,
N’Gaoundéré, Garoua, Maroua, Kousseri, Limbe, Bonaberi, Bafoussam, Foumban, Banyo
Sex workers: only the largest 23 SW sites are shown here, out of 188, for reasons of legibility. The number of sits in
cities are specified in the symbol.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
20/89
ROUND 9 – HIV
Pygmies
Mbororos
MSM Groups - Douala, Yaoundé, Bafoussam, Limbe, Kribi, Garoua, N’Gaoundéré
Target populations of the proposal
Out-of-school youths:
According to the EDSC-III survey (Attachment 10), the average prevalence of HIV among young people aged 15-24 is
3.3% with a female / male ratio of 3.4 (4.8% versus 1.4 %). HIV prevalence among young people rose from 1.4% on
average among the 15-19 years to 5.5% among 20-24 year olds (7.9% among girls). And this is up to 5 times higher
among women 23-24 years old compared to men (11.8% versus 2.2%).
The vulnerability of this population is double because of the vulnerability of youth and its development in an environment
offering few opportunities to acquire and/or maintain protective behaviours of life relative to HIV infection.
This vulnerability of young people can be illustrated by the percentage of women and men 18 to 49 years, having heard
of AIDS, who believe that condoms should be taught to youths 12 to 14 years old. Overall, only 59% of women think this
should be done compared to 73% of men. Wide regional disparities exist because only 33% of women and 50.5% of men
in the Far North region believe that teaching should take place against respectively 84.4% and 83.8% in the South .
The risks of infection are marked in this population since among 15-19 year olds, 54.7% of girls and 43% of boys report
having already had sexual intercourse at least once, and 4.6% of girls in this age group have already had a year ago or
more (EDS III-C).
Among 15 to 24 year olds, multiple partners are also an HIV vulnerability factor. In fact, 4 percent of HIV-positive youths
aged 15 to 24 had at least 2 sexual partners at high risk during the last 12 months with a higher vulnerability in women
(9.3% versus 2.2%). Similarly, the prevalence is higher among young women aged 15 to 24 who did not use a condom
than among those who did, either during their last sexual intercourse or during their last intercourse in the 12 months
preceding the survey EDS III-C.
Contamination is higher in these age groups. Despite prevention programs conducted up to 2007 (IDA
funding - World Bank) the messages were generic and not directed specifically at young people. Round 4,
which targeted young people was more focused on the public school. This situation is therefore of greater
concern for young people not in school due to non-relevance of the messages and weakness or even
absence of intervention for those living in rural areas. If we consider that from 2005 to 2009, prevention was
strongly reduced due to frequent stopping of funding and only a few large-scale campaigns have been
carried out, none of which were related to female condoms, it is more than urgent to target this group. This
project intends to focus on young people not in school, with additional attention for those living in rural areas,
in that out-of-school youth in urban areas are already exposed to preventive actions issued in the cities.
Thus girls, who constitute the majority of young people in rural areas (since boys leave the countryside to
find work in the cities) will be the most affected.
This population of young people (girls and boys) not in school estimated at 2,244,260, will be the subject of a
series of actions to prevent HIV/STIs and access to services (including the availability of condoms), through
approaches to education by peers and acquiring the life skills. The epidemiological particularities in terms of
gender and regional vulnerability will be taken into account for interventions.
Truckers:
Truckers (including under this generic name, heavy truck and public transport drivers, apprentices, touts and
taxi drivers) constitute in Cameroon a population both at the highest risk of exposure and a group likely to
encourage the spread of infection. Their number is estimated to be 186,000 in Cameroon (Office of the
General Land freight).
The submission targets this group because of the high seroprevalence rate of 16.3% observed in 2004
(Seroepidemiologic and behavioural report on HIV and AIDS in specific groups - 2004 (Attachment 9)) and
the impact that may have on other people to maintain (or even increase) prevalence in this population.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
21/89
ROUND 9 – HIV
Under this proposal the term trucker covers heavy truck drivers and their assistants.
Sex workers:
The Sex Worker is a man or woman who becomes a prostitute. In Cameroon, the actors who engage in this
activity are called "free woman" for women prostitutes; the phenomenon does not have a name for men. Sex
Workers constitute a high risk group. Their vulnerability is primarily due to multiple sexual partners that
characterizes them and is accentuated by the non use of condoms.
The number of SW in 447 sites surveyed is over 18,000 people (Cartographic Report of Sex Workers, 2008
(Attachment 24)).
In 2004 (DHS III-C), a small proportion of men (3%) reported having had sex with a prostitute. If this
proportion is low (although higher at 6% among men with broken unions), only 64% of these men reported
using a condom during the last sexual intercourse.
The exact number of SW activity is not known in Cameroon, but the 2008 report on universal access
estimated 20,145 in 2006 (Vanderpite, Sex Transm Infect 2006). The average number of clients per SW per
week ranged from 9 to 19 in Yérélon Project studies (2001) and AIDS 3 (2005).
In parallel, the rate of seroprevalence among sex workers is evaluated at 26.4% (NAC / CRETES report
2004).
This proposal will develop interventions for prevention and care tailored to the specific needs of this key
population (access to services tailored to support STI / HIV, the availability of male and female condoms).
Sensorial handicapped persons:
According to Ministry of Social Affairs in 2008, an estimated 10% the population of Cameroon, or 1,839,771 persons, are
disabled, of which 30% are blind and visually impaired, and 20% deaf and mute. Sensory disabilities represent 10%
of all disabilities. Despite their demographic significance, sensorially disabled persons are not covered by
any intervention.
Although no prevalence figure is currently available for this group, the vulnerability to HIV of this group is
increased, due to several factors including low education and training, poor access to information and health
services, and the stigma that they may be victims.
This submission will propose offering appropriate services to persons with disabilities. Presented as
vulnerable populations for which specific initiatives should be developed, interventions for this group will take
into account the particularities of disabilities (visual, auditory, etc.) especially as regards to access to
information and services.
Men having Relations with Men (MSM):
Despite the limited data available on the population of MSM in Cameroon, this group is well identified although not
officially and culturally recognized, which makes it difficult to deal with this issue. A study in Douala and Yaounde
between 2000 and 2002 with 81 MSM who agreed to interviews revealed that 58% of them declared themselves as
"pure homosexual". Nevertheless, among this subgroup 28.6% had had a sexual relationship with the opposite sex
(Gueboguo C., 2007 (Attachment 8)).
MSM constitute a group of the highest risk of exposure to HIV which can be both a population at high risk of
infection but also constitute a group for dissemination to other subgroups.
Interventions to this population will constituted of both peer education, offers of help line (green line) and
benefits (access to condoms and lubricants, access to screening).
Marginal populations (Pygmies – Mbororos):
The Pygmies are a minority considered to be indigenous to Cameroon. They represent one of the poorest
communities living in isolated locales, often with difficult access. They are considered as little advanced and
suffer from discrimination and sociocultural marginalization from the surrounding populations that dominate
and exploit them.
The Mbororos constitute one of the marginal populations of Central Africa (Indigenious and Tribal People
and Poverty Reduction Strategy in Cameroon, 2005 (Attachmente 11)). They are subject to marginalisation,
prejudices and have limited access to basic social services. They practice transhumance and are victims of
social exclusion by sedentary populations: their lifestyle and rights are not recognized.
Common vulnerabilities to HIV for Pygmies and Mbororos are:
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
22/89
ROUND 9 – HIV
•
•
They have limited access to infrastructure and basic social services like education and health.
When these services exist, they are not adapted to their lifestyle;
They have limited access to information and knowledge about HIV and AIDS;
Similarly, specific preventive approaches to Pygmyies and Mbororos are very underdeveloped. Screening
(FONDAF Report 2005/HIV and STI prevention project along the Chad - Cameroon pipeline corridor
(Attachment 7)) conducted in area exclusively of Pygmies indicate a seropositivity of 2.5%. This
seropositivity is especially problematic when the size of this population sub-group is considered. In addition
Mbororos women fall more often into contact with surrounding populations because they sell dairy products
in homes. This proposal therefore targets these marginal populations.
Orphans and Vulnerable Children
According to the report on the global epidemic of AIDS in 2008 (Attachment 4), there are in Cameroon
300,000 orphans due to AIDS. The OVC is a person below the age of 18 who has lost at least one parent or
legal guardian, exposed to dangers of all kinds and who does not have a satisfactory family or community
structure.
PLWHA
With the development of methods for estimating EPP and Spectrum projections at the global level,
requirements were revised for Cameroon (Appendix 12). The number of PLWHA eligible for treatment in
2014 is estimated to be 220,081. The active file of patients on ARVs is estimated at end 2009 to be 74,710
(including about 3,110 children).
According to these estimates and considering the objective of the NSP 2006-2010 (Attachment 1), the
number of patients to be put on ARV therapy by the end 2014 is 165,061.
Pregnant women
Pregnant women account for 5% of the general population. HIV prevalence among pregnant women is 7.3%
(EDS III). The number of pregnant women having access to counselling and screening for HIV in 2008 was
283,204, or 30.7% of pregnant women. Coverage of ARV prophylaxis was 56.3% of pregnant women
testing seropositive and 18.4% of those estimated.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
23/89
ROUND 9 – HIV
(b)
Size of population group(s)
(If national data is disaggregated differently then type over the categories proposed)
Population Groups
Population Size
Source of Data
Year of Estimate
Total country population (all ages)
18,397,712
Institut National de la Statistique
2007
Women > 25 years
3,363,421
Institut National de la Statistique
2007
Women 19 – 24 years
902,436
Institut National de la Statistique
2007
Women 15 – 18 years
1,026,279
Institut National de la Statistique
2007
Men > 25 years
3,164,587
Institut National de la Statistique
2007
Men 19 – 24 years
749,134
Institut National de la Statistique
2007
Men 15 – 18 years
986,693
Institut National de la Statistique
2007
Girls 0 – 14 years
3,866,820
Institut National de la Statistique
2007
Boys 0 – 14 years
3,825,483
Institut National de la Statistique
2007
OVC
300,000
UNAIDS Annual Report
2008
Truckers
186,000
Bureau Général des Frets
Terrestres
2008
Sex Workers
18 900
Cartographic Report of Sex
Workers
2008
(Attachment 24)
Youth Plan
Out-of-school Youths
2,244,260
Ministère de la Jeunesse
2009
(Attachment 3)
PYGMIES
73,332
MBOROROS
Sensorially handicapped
Indigenious and Tribal People
and Poverty Reduction Strategy
in Cameroon (Attachment 11)
2005
Politique Nationale de protection
des Handicapés, MINAS
(Attachment 2)
2008
ND
945,000
MSM
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
ND
24/89
ROUND 9 – HIV
4.2.2. HIV epidemiology of target population(s)
(If national data is disaggregated differently then type other the categories suggested)
Estimated
Number
Source of Data
Year of Estimate
Number of people living with HIV
(all ages)
543,294
(includes 44,800
children < 15
years)
UNGASS Progress Report No. 3
Cameroon(Attachment 13)
2007
Women living with HIV > 25 years
171,534
UNAIDS
2007
Women living with HIV 19 – 24
years
38,804
UNAIDS
2007
Women living with HIV 15 – 18
years
44,130
UNAIDS
2007
Pregnant women living with HIV
62,439
CNLS Report 2007
2007
161,693
UNAIDS
2004
Men living with HIV 19 – 24 years
8,989
UNAIDS
2004
Men living with HIV 15 – 18 years
11,840
UNAIDS
2004
Girls (0 – 14 years) living with HIV
22 848
Boys (0 – 14 years) living with HIV
21,952
Population Groups
Men living with HIV > 25 years
OVC
UNGASS Progress Report No. 3
Cameroon(Attachment 13)
UNGASS Progress Report No. 3
Cameroon(Attachment 13)
2007
2007
ND
29,800
CNLS/CRETES Report
(Attachment 9)
2004
Sex Workers infected with HIV
4,990
CNLS/CRETES Report
(Attachment 9)
2004
Out-of-school youths infected with
HIV
71,800
EDS III
2004
PYGMIES infected with HIV
1,833
FONDAF Report (Attachment
7)
2005
EDS III
2004
Truckers infected with HIV
MBOROROS infected with HIV
ND
Sensorial handicapped infected
with HIV
48,195
MSM infected with HIV
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
ND
25/89
ROUND 9 – HIV
4.3.
Major constraints and gaps
(For the questions below, consider government, non-government and community level weaknesses and gaps, and also
any key affected populations 1 who may have disproportionately low access to HIV prevention, treatment, and care and
support services, including women, girls, and sexual minorities.)
4.3.1. HIV program
Describe:
•
the main weaknesses in the implementation of current HIV strategies;
•
how these weaknesses affect achievement of planned national HIV outcomes; and
•
existing gaps in the delivery of services to target populations.
Despite progress and worthwhile results, implementation strategies against AIDS in Cameroon still show
many weaknesses in the areas of prevention, care and therapeutic support, community mobilization as
well as coordination, monitoring and evaluation.
Main weaknesses
• Prevention
- Low utilization of counselling and screening that has meant only 1,322,596 people between 2006
and 2008, or 15.6% of the population aged 15 and over (Annual GTC / CNLS and 2007,2008
(Attachment 5)), were counselled and screened, which is below the 75% that the NSP targets for
2010 (Attachment 1). This is due to:
o weak community mobilisation which does not enable people to know the full range of
services available interest them to use them;
o The low supply of screening outreach services in some areas and towards specific
groups of people defined in the NSP (Attachment 1). In addition, the rural populations
have less access to the various interventions of the Communication for Behavioural
Change, which are developed more in cities than in rural areas.
- Low coverage of rural areas and lack of condom promotion and availability (male and female) in
these areas;
- Low coverage of interventions towards specific groups (SW, MSM and Marginalized Populations)
•
•
•
1
Treatment
The active file of patients on ARVs by end 2008 is 59,960 (2,450 children and 57,710 adults),
representing 39.1% of PLWHA eligible for treatment. This low coverage may be explained by
different causes described below: (i) Inadequate geographic coverage of PEC structures,
estimated at 52% of health districts in 2008 (NAC Report 2008);
(ii) Insufficient quality and quantity of human resources involved in the medical PEC, and
psychosocial and community support for a good treatment adherence and the promotion of good
practice in secondary prevention and nutrition;
(iii) Poor access to biological assessments by PLWHA, making it difficult to provide adequate
care for patients on ART: the experience of Round 3 has shown that despite the biological test
subsidies, only 35% of people on ARVs have had biological monitoring assessments.
(iv) the percentage of patients lost track of from the active therapeutic file is estimated at 30%
(Evaluation report of EWI in March 2009 (Attachment 14)), particularly because of the weakness
of mediation tutors and assistance to for treatment adherence.
Care and support:
Low involvement by community participants in the continuum of care;
Inadequate support of OVC: only 20.2% of OVC benefit from support (GTC/CNLS Annual report
2008 (Attachment 15))
Insufficient involvement of business in prevention and care of their employees, families and
surrounding communities in their settlement area;
Community system
Low organisational and logistic capacity in civil society;
Please refer back to the definition in s.2 and found in the Round 9 Guidelines.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
26/89
ROUND 9 – HIV
-
Low integration of participants in the health system.
•
Coordination/Monitoring and Evaluation
Despite the existence of program coordination structures at all levels (central, regional and municipal),
shortcomings in coordination between different participants and partners in the combat against HIV /
AIDS are noted, and a lack of mapping of interventions throughout the country. There is a lack of
coordination of interventions by Civil Society participants;
Although the program has developed and implemented a national strategy for M & E, the monitoring and
data collection system is still inadequate in terms of human resources, logistics and finance. To be
specific the latest surveys of HIV prevalence among pregnant women date from 2002. The lack of data on
the prevalence of HIV in this group does not allow proper assessment HIV epidemic trends in recent
years.
Consequences of weaknesses
These weaknesses undermine the results anticipated in the fight against AIDS, in effect:
-
the target of 75% of the population 15 years old and above to know their status is far from being
achieved, the current performance of the counselling-screening is 15.6%.
- Low use of condoms as the distribution rate is 32% compared to the theoretical needs in 2008;
- PLWHA eligible for treatment are not all on ART treatment.
- The retention rate of patients 12 months after the start of TAR is less than or equal to 70% in
50% of sites surveyed in 2008;
- A very low coverage of the OVC target group: 61,670 OVCs have been supported in 2008 or
20.2% of OVC estimated;
- Employees of Businesses, their families and surrounding populations do not all have access to
care and prevention services;
- A low monitoring of community activities and their inclusion in the information management and
monitoring and evaluation systems of interventions in the fight against AIDS;
- Weakness in data collection, transmission and processing;
- Difficulties in accurately assessing the quality and coverage of services for the fight against AIDS;
- Lack of data on HIV prevalence among pregnant women since 2002.
Deficiencies/Gaps
Deficiencies and gaps in services to target populations are the following:
- Poor access for populations including the out-of-school youths (especially girls), the sensorially
disabled and marginal populations (Pygmies and Mbororos) to services for voluntary testing. The
same is true of other vulnerable populations such as truckers, SW and MSM. This latter group
suffers from the stigma in the provision of services.
- Lack of preventive interventions directed at out-of-school youths in rural areas, marginal
populations (Pygmies and Mbororos), the sensorially disabled and MSM;
- Insufficient coverage for prevention directed at SW and Truckers;
- In 2008, 60.85% of patients eligible for treatment were not put on ARV, representing 93,213
patients out of 153,185;
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
27/89
ROUND 9 – HIV
4.3.2.
Health System
Describe the main weaknesses of and/or gaps in the health system that affect HIV outcomes.
The description can include discussion of:
•
issues that are common to HIV, tuberculosis and malaria programming and service delivery; and
•
issues that are relevant to the health system and HIV outcomes (e.g.: PMTCT services), but
perhaps not also malaria and tuberculosis programming and service delivery.
The national health system in Cameroon is organised on three levels of which each has administrative
structures, health facilities and dialogue structures relating to specific functions; the health pyramid gives
to the central level a role of design and coordination fro implementing intervention strategies, at the
intermediate level provincial support and coordination, and peripherally responsibility for operational
implementation.
1.
Weaknesses of the health system affecting planning and delivery of services relating to HIV,
tuberculosis and malaria.
Common problems in planning and delivery of services relating to HIV, tuberculosis and malaria are
illustrated at all points of the 6 building blocks of the health system functions, namely:
Governance:
• Low staff capacity for project management.
Human resources
• Qualitative and quantitative insufficiency in Human Resources;
• Personnel instability at all levels;
• Lack of a personnel motivation and retention system.
Information:
•
Weakness of the SIS for formal health information;
•
Weakness of human resources (quantity and quality) and funding;
•
Lack of statistical unit for data management within the SE.
Funding:
•
Three quarters of health expenditures are borne directly by households, the heaviest burden being on the
poorest households and in rural areas. In fact, 50.6% of the Cameroonian population lives below the
poverty line (ECAM III (Attachment 17)). Therefore, the majority of the population do not have
access to services offered by the three programs;
•
Financing the health sector has never exceeded 5% of the national budget between 2001 and 2006
(Evaluation Report of the Implementation of the Sector Strategy in 2006 (Attachment 16));
•
There is a gap on the flow of funds into the health system in general and particularly in the fight against HIV /
AIDS.
Medicines, vaccines and technologies:
•
Inadequacy in the logistics management of medicines and related products especially at the decentralized
level (inadequate estimates of needs, inappropriate storage conditions, low knowledge of standards and
standardized tools for harmonized management of medicines at health facilities, inadequate logistics for
transport). The result is the frequent breakdown of stocks of medicines at health facilities.
Service delivery:
•
50% of the population do not have physical access to a health facility. 154/174 DS district hospitals
functional (Strategy of Health Sector (Attachment 16));
•
Implementation of programs showed a lack of program benefit coordination at the DS level following the low
integration of their activities in the minimum package of activities offered by operational level.
2.
Weaknesses of the health system affecting HIV results
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
28/89
ROUND 9 – HIV
The main current weaknesses of the health system that could have a satisfactory response in
implementing the Cameroon proposition Round 9 may be summarised as follows:
•
Decentralisation remains inadequate; it does not allow universal access to secluded populations to
prevention, care, treatment and support: inadequate territorial coverage in health structures offering PMCT
and screening services and PLWHA care units.
•
The lack of qualified personnel and low motivation of health workers in the public sector, aggravated by
excessive mobility;
•
Data management which has little logic relating to monitoring of patients in treatment, such as multiplicity of
records, records poorly suited to the volume of the active file, and lack of software to harmonise data
management on PLWHA under ARV.
•
The inadequacy of information on HIV infection trends among certain specific groups (sex workers, pregnant
women, truckers, sexual minorities, etc.).
•
The current vehicle fleet of NCCA consists of vehicles acquired in 2001 under IDA funding; maintenance of
these vehicles is increasingly costly given their advanced age.
Weaknesses of the community system affecting HIV results
The system meets NGOs/associations/PLWHA groups, faith-based organizations and the private sector. The state of
community response can be summarised as:
•
Weak financial and logistical capacity which marks certain organisations with a "high logistical vulnerability"
(no rolling stock, no data processing equipment, and no awareness materials).
•
Weakness in human resources and regularity of activity which translates into a deficiency in
expert manpower, a non-permanent functioning which cycles with the rhythm of funding obtained
from partners.
•
Weakness in strategic approach: The strategic anticipation of a massive upsurge in risky
behaviours in order to direct interventions is inadequate.
•
Weak involvement of the private sector in the national response to the combat against HIV and
AIDS.
The absence of a global data processing system, to summarise individual's data for CBO's for their use in
reports and for monitoring all activities by civil society organisations. Lack of a credible CSO coordination
structure
4.3.3. Efforts to resolve health system weaknesses and gaps
Describe what is being done, and by whom, to respond to health system weaknesses and gaps that
affect HIV outcomes.
Measures have been taken to respond to these weaknesses and gaps affecting results of the combat
against HIV, namely:
• Construction and renovation of District Hospitals and Health Centres by the Government with
support of partners (IDB, C2D, BAD);
• Training of pharmacy management trainers for supporting UNICEF/UNITAID in implementing
PMCT, based on developed and adopted training modules.
• Establishment of a National System for the Supply of Essential Drugs and Related Products
(SYNAME); National Central Supply of Essential Medicines and Related Products (CENAME)
and Regional Pharmaceutical Supply Centres (RPSC) are established and are operational. RPSC
personnel have been trained in pharmacy management by FNUAP.
• Recruitment by the Civil Service of 3,000 paramedical personnel in 2008, with HIPC and C2D
funds. Recruitment of 2797 personnel is in process for 2009.
•
Personnel training (medical, paramedical and community) for HIV infection management.
• Conducting a comparative study in collaboration with the WHO to find out if PMCT data may be
used for HIV sero-surveillance among pregnant women, in order to overcome the lack of sentinel
surveillance investigation. conducting of a study on the threshold of resistance to treatment
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
29/89
ROUND 9 – HIV
among newly treated patients, by the Ministry of Public Health in collaboration with the WHO and
OCEAC.
• Establishing a CU tutoring Policy by CUs (Attachment 19), by the Ministry of Public Health in
collaboration with the WHO, ESTHER and the Coopération Française (C2D).
• Establishing a national system of quality assurance in HIV diagnosis in collaboration with the
CDC Atlanta and the WHO'
• Establishing a collection system of early warning indicators of resistance to ARV in 10 pilot sites,
in collaboration with the WHO;
• Recruiting 508 community liaison agents (ARC) in community based organisations such as
Associations of persons living with HIV and put into health training as part of Round 3.
• Capacity building of 52 NGOs and associations working in the care of OVC between 2006 and
2008.
• Erection of certain Treatment Centre Enterprises (CU): CCP, HEVECAM, ALUCAM, PHP.
By overcoming the major constraints it faced through the approaches outlined above, the health system
could significantly improve its performance, accessibility, use and the quality of its services. The
implementation of the different program components of the combat against HIV would be more efficient
and faster.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
30/89
ROUND 9 – HIV
4.4.
Round 9 Priorities
Complete the tables below on a program coverage basis (and not financial data) for three to six areas identified by the applicant as priority interventions for this proposal.
Ensure that the choice of priorities is consistent with the current HIV epidemiology and identified weaknesses and gaps from s.4.2.2 and s.4.3.
Note: All health systems strengthening needs that are most effectively responded to on an HIV disease program basis, and which are important areas of work in this
proposal, should also be included here.
Priority No: 1
Universal access to treatment and
care for PLWHA
Indicator
name
Number of adults and children under
ARV treatment
Historical
Current
Country targets
2007
2008
2009
2010
2011
2012
2013
2014
A: Country target (from annual plans where these exist)
55,665
66,213
76,533
79,484
99,075
119,353
141,196
165,061
B: Extent of need already planned to be met under
other programs
45,605
59,960
74,710
39,742
49,538
59,677
70,598
82,530
C: Expected annual gap in achieving plans
10,060
6,253
1,823
39,742
49,538
59,677
70,598
82,530
39,742
49,538
59,677
70,598
82,530
D: Round 9 proposal contribution to total need
Priority No: 2
Care of OVC
Indicator
name
Number of OVC under care
(e.g., can be equal to or less than full gap)
Historical
Current
Country targets
2007
2008
2009
2010
2011
2012
2013
2014
A: Country target (from annual plans where these exist)
61,000
73,200
85,400
97,600
109,800
122,000
134,200
146,400
B: Extent of need already planned to be met under
other programs
45,186
60,925
52,000
9,000
11,000
3,000
3,000
3,000
15,814
12,275
33,400
88,600
98,800
119,000
131,200
143,400
C: Expected annual gap in achieving plans
D: Round 9 proposal contribution to total need
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
(e.g., can be equal to or less than full gap)
30,000
30,000
30,000
30,000
30,000
31/89
ROUND 9 – HIV
Priority No: 3
Promotion of less risky sexual
practices for target populations
Indicator
name
Number of condoms distributed
Historical
2007
2008
Current
2009
Country targets
2010
2011
2012
2013
2014
A: Country target (from annual plans where these exist)
45,600,000
50 650,000
55 000,000
60 000,000
65 250,000
70,250,000
75 500,000
80 000,000
B: Extent of need already planned to be met under
other programs
29 833,550
33 629,360
33 600,000
36 300,000
42 500,000
46,000,000
50 000,000
54,000,000
C: Expected annual gap in achieving plans
D: Round 9 proposal contribution to total need
15 766,450
17 200,640
21 400,000
(e.g., can be equal to or less than full gap)
23 700,000
22 750,000
24 250,000
25 500,000
26 000,000
3 313,255
7 500,000
7 500,000
7 500,000
7 500,000
* total needs of the country in terms of condoms
** The Global Fund assures the needs of condoms by the 6 priority target groups of this proposal.
Priority No: 4
Counselling and screening
Indicator
name
Number of persons receiving CS
with records of results
Historical
2007
2008
Current
Country targets
2009
2010
2011
2012
2013
2014
A: Country target (from annual plans where these exist)
750,000
750,000
1,000,000
1 100,000
1 200,000
1 300,000
1 400,000
1 500,000
B: Extent of need already planned to be met under
other programs
573,897
590 325
640,325
680,325
730,325
755,325
805,325
855,325
159,675
359,675
419,675
469,675
544,675
594 675
644,675
185,000
293,000
294,910
C: Expected annual gap in achieving plans
D: Round 9 proposal contribution to total need
176,103
(i.e., can be equal to or less than full gap)
295,500
297,500
A : Country target (of annual plan, if applicable): Country screening needs, including pregnant women
B : Extent to which needs are covered by other programs: These covered needs take into account screening of pregnant women in health
facilities offering PMCT.
C : Annual gaps/shortfalls anticipated for implementing plans: These gaps relate to screening in the general population including at risk and/or
vulnerable target groups.
D : Contribution of the Round 9 proposal to total needs: The Global Fund assures the purchase of reagents intended to test populations in the 6 at
risk and/or vulnerable target groups. Screening of pregnant women is assured by the Government through the HIPC relief financing initiative and
the support of UNICEF.
Î If there are six priority areas, copy the table above once more.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
32/89
ROUND 9 – HIV
4.5.
Implementation strategy
4.5.1. Round 9 interventions
Explain: (i) who will be undertaking each area of activity (which Principal Recipient, which Sub-Recipient
or other implementer); and (ii) the targeted population(s). Ensure that the explanation follows the order of
each objective, service delivery area (SDA), activities and indicator in the 'Performance Framework'
(Attachment A). The Global Fund recommends that the work plan and budget follow this same order.
Where there are planned activities that benefit the health system that can easily be included in the HIV
program description (because they predominantly contribute to HIV outcomes), include them in this
section only of the Round 9 proposal.
Note: If there are other activities that benefit, together, HIV, tuberculosis and malaria outcomes (and health outcomes
beyond the three diseases), and these are not easily included in a 'disease program' strategy, they can be included in
s.4B in one disease proposal in Round 9. The applicant will need to decide which disease to include s.4B (but only
once). Î Refer to the Round 9 Guidelines (s.4.5.1.) for information on this choice.
The Cameroon submission consists of 2 goals, 5 objectives and 12 SDA.
This proposal aims to ensure continuity of care interventions, treatment and support for those infected
and affected by HIV supported by funding from Rounds 3, 4 which is coming to an end in late 2009 and
Round 5 at the end of 2011. In addition, prevention actions towards at risk and vulnerable targets will be
carried out.
GOAL 1: To help reduce new infections in the targeted groups by intensification of prevention
activities
PREVENTION (RP : Civil Society)
Objective 1: To ensure the prevention of HIV within 6 at risk and/or vulnerable target groups through
close BCC, distribution of condoms, and voluntary Counselling and testing;
SDA 1.1: Community liaison in the target groups: This intervention targets high risk and vulnerable
groups which are: out-of-school youths, sex workers, truckers (truck drivers and their helpers) and the
populations bordering main roads, sites of production and processing enterprises, sensorially
handicapped, marginal populations (Pygmies and Mbororos) and MSM. It will reach 2,205,661 people
from these different target groups throughout the project. On the ground implementation of activities will
be ensured by 138 CBOs, Business and private sector organizations distributed as follows: Out-of-school
youths: 168; SW: 29; MSM: 11; Truckers: 21; Sensorial handicapped persons: 39 and the Marginal
populations: 60 encampments: The SSR will be recruited on the basis of criteria defined beforehand by
the CCM. They are distributed as follows: Youths: 10; SW: 1; MSM: 1; MBOROROS : 1 and Pygmies: 1.
These 14 Sub-Sub Recipients (SSR) will follow the CBO, businesses and private sector organizations in
their activities. 4 Sub Recipients (SR) including 1 SR from the private sector have been selected for
implementation in out-of-school youth groups, truckers and sensorially handicapped; as regards the other
three groups (SW, MSM and marginal populations), implementation is entrusted to the Principal Recipient
(PR).
It is for the SRs to first train the trainers identified in the SSRs, CBOs, private sector organizations and
companies who in turn will train Peer Educators (PE); these are responsible for organizing educational
sessions in all target groups. During these educational sessions, peer educators will be promoting
services (screening, use of condoms and reproductive health). For marginal populations, given their
socio-cultural specificities, educational sessions will put an particular emphasis on screening and
knowledge of serological status.
In addition campaigns will be organised aimed at awareness of abstinence, fidelity and condom use, and
activation of HIV screening directed at youths.
The SW and MSM target groups will be reached in meeting places (bars, restaurants, nightclubs) during
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
33/89
ROUND 9 – HIV
the evenings through informal exchanges or with small groups in these places. They will then be brought
into contact with peer support groups. Another strategy is the use of the free telephone line "green line"
that enables circumventing stigma and discrimination. The listening hours for the green line will be
expanded and tailored to the needs of target populations. It will be manned by listening Counsellors who
receive training in the specific care of these groups. Peer educators visits will be in pairs for safety
reasons due to the late hours of these groups at their living, leisure and work places.
The operational unit for implementing prevention activities among out-of-school youth is the Commune.
This will be organized through use of appropriate channels (mobile caravans, AIDS-free holiday
operations , community radio, etc.). Out-of-school youths will be enlisted by Youth Associations, private
sector organizations and the companies that employ them. This will be organized in each of the 320
Communes, 3 campaigns during the project period, for a total of 960 campaigns.
Regarding "AIDS-free holiday operations", these are held during school holidays because there is a
blend of students and non students. These tend to develop risky behaviours that make them more
vulnerable to HIV infection. This operation has so far covered only young vacationers in urban areas
(main towns of the ten Regions). The submission aims to extend the operation to rural areas.
Out-ofschool
youths
Truckers
Sex
workers
Sensorial
ly
handicap
ped
Target
size
Target
to
reach
Number
of sites
Number of
educational
sessions
Number
of PE
trained
Number of
awareness
campaigns
Awarenes
s kits
produced
and
distributed
Condoms
(male and
female)
Number
of
persons
screened
2,244,260
1683,195
169
145 880
1,351
960
1 683,195
29175,425
975,270
186,000
40,000
26
6,000
157
48
40,000
400,000
24,000
18,900
10,300
29
1,560
116
-
10,300
1 039,500
6,240
945,000
378 000
39
37 800
467
12
378 000
1,890,000
302,400
7 500
11
1,125
126
-
7 500
125,000
6,000
60*
13,000
241
433,330
52,000
ND
MSM
Mbororos
Pygmies
ND
73,332
50,000
36,666
50 000
16
36,666
3 467,492
2205,661
334
205,365
2,458
1036
2 205,661
33 313,255
1 365,910
TOTAL
* Encampments
Principal activities related to SDA 1.1:
1.1.1. Recruiting 138 CBOs, private sector organizations and enterprises in the 6 target groups and 14
SSRs to cover the 334 sites and 14 SSRs to ensure monitoring of the CBOs, private sector
organizations and enterprises.
1.1.2. Train 40 trainers in 02 sessions of 20 persons;
1.1.3. Train 2,458 Peer Educators (40 PE/4 day session) in the 6 target groups by trainers, in the first
year;
1.1.4. Organise 205,365 educational sessions with demonstration of wearing condoms in the target
groups with peer educators on their sites of activity throughout the period;
1.1.5. Equip 2,458 PE communication kits and other necessary aids for their activities (anatomical
models and condoms for demonstration, picture boxes, etc.).
1.1.6. Produce awareness materials (leaflets 50%, stickers 15%, sunshades 10% and posters 25%);
1.1.7. Organise 1,036 mass awareness campaigns for 4 target groups through appropriate channels
(mobile caravans, AIDS-free holiday operations , community radio, brochures, etc.).
1.1.8. Extend the green line listening hours.
Target populations: 1,683,195 out-of-school youths, 40,000 truckers, 10,300 SW, 378,000 sensorially
handicapped, 7,500 MSM, 50,000 Mbororos and 36,666 Pygmies.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
34/89
ROUND 9 – HIV
Indicators:
- Number of persons affected by BCC activities.
SDA 1.2: Condoms: The supply of condoms will be provided by ACMS which has the logistical capacity.
Distribution of condoms in the 6 groups will be provided by the SR and SSR through peer educators (on
the principle of social marketing at the living and work places of these groups through outlets located for
this purpose). To do this, a stock of 33,313,255 condoms with 10% representing female condoms will be
available to them. Condoms distributed to CBOs will be sold by them to the target groups. Profits from the
sale of these condoms will be used to strengthen the functioning of CBOs.
Principal activities related to SDA 1.2:
1.2.1. purchase 29,981,929 male condoms throughout the proposal duration;
1.2.2. purchase 3,331,326 female condoms throughout the proposal duration;
1.2.3. distribute 33,313,255 male and female condoms throughout the proposal duration;
1.2.4. Support MSM with lubricants.
Target populations: 6 at risk and vulnerable groups: out-of-school youths, truckers with roadside
populations, sex workers, sensorially handicapped (Deaf and dumb, blind and visually impaired),
Marginal populations (Pygmies and Mbororos), and MSM.
Indicators:
- Number of male and female condoms distributed
SDA 1.3: Counselling and Screening in the target groups (SR):
Screening sessions will be
organized through mobile units in partnership with CSOs, businesses and organizations from the private
sector (SSR). A timetable of on the ground mobile unit visits will be developed between the Regional
Technical Group for the Fight against AIDS (Mobile Units Manager) in collaboration with peer educators
and Enterprises as applicable, who have previously enlisted the target groups. 50% of tests and
consumables will be provided by the National Committee for the Fight against AIDS with funding from
debt relief (HIPC initiative (Appendix 18) and 50% by this proposal. Persons testing positive will be
directed to the care and support structures (CU, CTC). ARCs from the CA and CTC will accompany
Mobile unit visits to facilitate reference to the care structures. A reference system using coupons will be
set up to trace and track people referred.
Principal activities related to SDA 1.3:
1.3.1. In the first year, train 60 Counsellors in counselling in 3 sessions of 20 participants each;
1.3.2. Ensure the provision of pre and post quality counselling in mobile units;
1.3.3. Over five years organise 1,036 screening campaigns by 12 mobile units, an average of 60
campaigns per quarter;
1.3.4. Ensuring the supply of reagents for screening;
1.3.5. Purchase equipment for 12 mobile units for undertaking campaigns mass screening.
Target populations: 1,365,910 members of target groups
Indicator(s):
- Number of persons receiving CS with records of results
Objective 2: To increase from 50% to 80% between 2012 and 2014 the proportion of pregnant women
with access to HIV counselling and testing
SDA 2.1: PMCT
In the NSP 2006-2010 (Attachment 1), from now to 2010, in urban and rural areas, an increase
respectively from 12% and 4% to 70% and 60% is projected for pregnant women who receive counselling
and HIV testing during prenatal visits. With the funding of Round 5, which aimed to increase from 10% to
50% the proportion of pregnant women having access to HIV counselling and screening by 2011,
283,204 pregnant women were screened for HIV in 2008 or 30.7% of pregnant women expected.
Coverage of ARV prophylaxis was 56.3% of pregnant women testing seropositive and 18.4% of those
estimated. This proposal intends to continue to scale up interventions being implemented in Round 5 for
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
35/89
ROUND 9 – HIV
the period from 2012 to 2014. In addition, this submission will strengthen early diagnosis by PCR for
children born to seropositive mothers, ARV prophylaxis and prevention of opportunistic infections. All
tests and consumables will be provided by the National Committee for the Fight against AIDS with
Funding from debt relief (HIPC initiative (Appendix 18)). UNICEF provides assistance for the purchase of
2 PCR devices for early diagnosis and this submission procures reagents.
Implementation of PMCT in Cameroon is done using a district approach. A health district is operational in
the PMCT field if (i) at least 80% of the health areas are functional, (ii) the district hospital is fulfilling its
role of reference, (iii) the Coordination mechanism for district PMCT is in place and functional. This
mechanism must be integrated into the existing general coordination mechanism. In 2008, 163 HD out of
178 HD were already offering PMCT services in over 1800 health facilities.
Sampling for PCR early diagnosis of children born to infected mothers is done at 47 health facilities using
absorbent paper (DBS method). These samples are transported to 2 reference laboratories which are the
Chantal Biya International Research Agency (CICB) and CDC Mutenguéné (local representative of CDC
Atlanta).
Main DPS 2.1 activities:
2.1.1. Training / retraining 900 staff on PMCT in 30 sessions of 30 people, from 2012;
2.1.2.
Train 500 laboratory technicians in DBS sampling techniques in 2 day sessions for 40
participants;
2.1.3. Provide supplies for PMCT and PEDC (ARV, MIO prophylactics) to health facilities;
2.1.4. Supply reference laboratories with PCR reagents;
2.1.5. Organise biannual central coordination meetings;
2.1.6.
Produce management tools (training manuals, clinical guides, examination requisition sheet
booklets, shipping and record document booklets)
2.1.7. Ensure DBS transport from health facilities to reference laboratories.
Target populations: 2,288,893 pregnant women and 95,826 children exposed to HIV.
Indicator(s):
- Number of health institutions performing DBS sampling and sample despatch.
- Number and percentage of infants born to mothers living with HIV who received a virological test
for HIV diagnosis within two months after birth;
- Number and percentage of pregnant women receiving ARV prophylaxis;
- Number and percentage of children born to seropositive mothers who received ARV prophylaxis;
GOAL 2: To help reduce the morbidity, mortality and the negative impact associated with HIV and
AIDS from 2010 to 2014
Medical care has three complementary components: antiretroviral treatment and monitoring of ARV,
treatment of OIs and the continuum of community care.
TREATMENT (RP: Government)
Objective 3: To provide medical care to 165,061 PLWHA adults and children by 2014;
SDA 3.1.: Treatment and monitoring: The NSP 2006-2010 (Attachment 1) sets as an objective to make
ARV treatment available to at least 75% of adults and 100% of eligible children. In developing the NSP
the number of patients in need of ARVs were estimated on the basis of 15-20% of PLWHA becoming
eligible. With the development of methods for estimating EPP and Spectrum projections at the global
level, requirements were revised for Cameroon (Appendix 12). The number of PLWHA eligible for
treatment in 2014 is estimated to be 220,081.
Round 3 enabled 59,960 PLWHA to be placed on ARV treatment by late December 2008 (Annual Report
GTC / CNLS 2008, PP 23 (Attachment 15)). The active file of patients on ARVs is estimated at end 2009
to be 74,710 (including about 3,110 children).
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
36/89
ROUND 9 – HIV
According to these estimates and considering the objective of the NSP 2006-2010 (Attachment 1), the
number of patients to be put on ARV therapy by the end 2014 is 165,061. 50% of the needs will be
financed by the State budget (HIPC (Attachment 18), Public Investment Budget) with the support of other
partners. Under this proposal, the Global Fund will be requested to bear the remaining 50%, or 82,530
patients,
The operational unit for ARV management is the Health District (HD). Placing on ARV therapy takes
place in specialized organisations including Care Units (CU) in public, church and private hospitals, and
Certified Treatment Centres (CTC) at central and regional, and private enterprise hospitals of the country.
The supervision of CUs caring for patients on ARV treatment is done by a guidance system developed
since 2004 with the decentralization of care (Appendix 19). The CTCs, being organisations with efficient
staff and technical platforms, serve as reference organisations. They oversee the quality assurance of
services offered by their subsidiaries, as part of comprehensive care of PLWHA, through on-site training,
facilitating supervision, networking, agents internships in CUs in the CTCs.
Cameroon envisages, under this proposal, increasing from 132 functional Care organisations to 166 by
the end of 2014 in 134 HD, or a 75% coverage of Health Districts which offer care services bay ARV for
adults and children. The extension of care units will be done gradually, with priority given to districts high
prevalence or high risk areas (the border area, main roads, areas of population convergence ) and TB
care organisations.
Technical documents will be revised and produced: Training sessions on the themes of medical care,
paediatric care, dispensing of ARVs, training of laboratory technicians and agents responsible for HIV
data collection will be organized to start.
st
nd
According to projections, the ARVs (1 , 2 lines) and the MOI will be acquired through the National
Central Supply of Essential Medicines and Related Products (CENAME) which will ensure procurement,
stocking and distribution of medicines to the CTCs and CUs through the Regional Pharmaceutical Supply
Centres (RPSC). These medicines will be distributed free of charge to patients in the SE according to
protocols and rules in force.
Before placing on ARV therapy, an orientation assessment (CD4) and pre-therapeutic assessment (NFS
Transaminases, Glycaemia and pregnancy test if necessary) are done. Once the patient is being
treatment, a semi-annual review of monitoring will be done, including: CD4, BCC, Transaminase,
Glycaemia and pregnancy test, if necessary. An viral load assessment is recommended once a year for
each patient on ARV (Guide for the care of PLWHA on ARV). Also required is improving the technical
level of 34 new care organisations and replace defective equipment in 33 old care organisations; as well
as supplying reagents and laboratory consumables to care organisations.
Main DPS 3.1 activities:
3.1.1.
Set up 34 new care units (CU) including in businesses having a significant labour force: office,
chairs, counters, etc.
3.1.2. Revise, produce and distribute (1st and 3rd year) the following technical documents: (i) 1105
National Care Guideline Documents for adults and adolescents, (ii) 1105 Support documents for
ARV and MOIs, (iii) 2045 Documents on counselling and screening, (iv) 2045 Documents on
nutritional care, (v) 2045 Documents on Assistance for therapeutic adherence, and (vi)
Documents on eliciting EWIs.
3.1.3. Train/retrain 390 personnel, in 10 sessions of 40 persons from public, private and confessional
CTCs and CUs, in multi-disciplinary teams consisting of: initial training, (i) 78 doctors, (ii) 117
nurses, (iii) 78 laboratory technicians, (iv) 78 data collection agents, and (v) 39 ARV dispensing
staff;
3.1.4. Supply of ARV throughout the period
3.1.5. Distribute ARVs to care organisations throughout the period;
3.1.6.
Supply and distribute reagents for CD4, haematological and biochemical examinations
throughout the period;
3.1.7. Equip 60 health facility pharmacies with storage furniture (cabinets) for medicines;
3.1.8. Train 200 pharmacy technicians in 8 sessions of 25 participants on management of
pharmaceutical stocks;
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
37/89
ROUND 9 – HIV
3.1.9. Ensure biological monitoring of persons living with HIV;
3.1.10. Ensure the equipment technical level of 34 care organisations buying equipment (centrifuges,
spectrophotometers, and haematology automation) and replace defective equipment (centrifuges,
spectrophotometer, automatic biochemistry, haematology machines and automated CD4 Meters)
in 33 old care organisations; CD4 devices are supported by the HIPC funds (Attachment 18).
3.1.11. Strengthen molecular biology reference laboratories to ensure viral load examinations: 01 viral
load determination machines, 01 refrigerated centrifuges, 02 hoods, 02 hot plates and
accessories, 01 micro-centrifuges and 02 mixers.
3.1.12. Ensure maintenance of old and new equipment in 166 care organisations (CTC and CUs) by
signing an annual maintenance contract.
3.1.13 Supporting health facilities to purchase consumables.
.
Target populations: 165,061 Persons Living with HIV on ARV
Indicator(s):
- Number of adults and children under ARV treatment
SDA 3.2: Prophylaxis and treatment of opportunistic infections: The national policy for PLWHA care
allows free patient access to curative and prophylactic treatment of major opportunistic infections
including tuberculosis through the program dedicated to this disease, toxoplasmosis, pneumocystosis,
cryptococcosis and buco-esophageal candidiasis.
This proposal will continue the free care of opportunistic infections initiated by the R3 conforming to the in
the table below.
2010
38,152
2011
47,556
2012
57,289
2013
67,774
2014
79,229
Cotrimoxazole 48%
Cryptococcosi
1%
795
991
1,194
1,412
1,651
s
Toxoplasmosi
3%
2,385
2 9 88
3,581
4,236
4,952
s
15%
11,923
14,861
17,903
21,179
24,759
Mycosis
The needs for each molecule are estimated as follows: (i) 48% of patients are under CXT (extensions on
ARV'S in Attachment); (ii) Cerebral cryptococcosis: 1% (Fluconazole or amphotericin 30% of estimated
needs); (iii) Toxoplasmosis: 3% (sulfadiazine, pyrimethamine, lederfoldine ; 0,5% clindamycine); (iv)
fungal infectoins15% (nystatin tablet estimate at 70% and 30% estimated on fluconazole).
Main DPS 3.2 activities:
3.2.1. Procurement of medicines for Opportunistic Infections;
3.2.2. Distribution of medicines for Opportunistic Infections.
Target populations: 165,061 Persons Living with HIV on ARV
Indicator(s):
Number of adults and children under OI treatment
CARE AND SUPPORT:
Objective 4: To ensure the availability of a continuum of care to all patients on ARV treatment and
support for 30,000 OVC per year from 2010 to 2014;
SDA 4.1: Care and support for the chronically ill: The continuum of care is an essential component for
overall care of PLWHA.
It ensures the continuity of monitoring of infected and affected persons in the community and businesses
making use of care organisations and it is based on collaboration and complementarity between the
organisations for support of the health system and community organizations. The main participants of this
component are: (i) community liaison agents (CLA) based in care structures and (ii) community
volunteers (CVOL) within the community preferably recruited from associations of PLWHA and faith
based organisations.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
38/89
ROUND 9 – HIV
CLAs serve as an interface between care organisations and the community. They are responsible for
counselling patients (whether under treatment or not), therapeutic education of patients in these
organisations and technical assistance to CVOL in performing their activities.
The CVOLs, members of the community in which they live, are the main participants in community care.
They are responsible for conducting psychosocial activities through home visits, adherence support,
nutrition education, positive prevention education, research for persons lost track of, referring and guiding
PLWHA towards care organisations and mobilization of pregnant women to use PMCT services. The
CVOL will evolve in men and women pairs taking into account certain socio-cultural aspects in certain
communities.
Interventions for PLWHA continuum of care are: (i) the psychosocial care of PLWHA (whether on ARV
therapy or not including seropositive pregnant women) by the ARC in the care organisations, by the
CVOL at the community level through home visits and the Green Line; (ii) support for treatment
adherence through therapeutic education and counselling in health facilities and communities through
associations of PLWHA for all PLWHA on ARV therapy; (iii) research and the reinstatement of persons
lost track of in the active file of health facilities; (iv) facilitation of discussion sessions.
The CLAs will be present in 166 care sites (24 CTCs and 142 CUs at the rate of 07 CLAs per CTC and 04
CLAs per CU).CVOL activities will be provided as a priority by the 175 CBO (associations of PLWHA and
associate organizations of the target groups) around the 65 treatment sites having an active file at least
500 patients by 2014, representing 85% of patients ARVs in Cameroon. Health facilities have an average
rate of losing track of patients of 30% in 2008. These 65 sites will be targeted with the aim of reintegrating
into care approximately 65% of those lost track of to reach a rate of persons lost track of around 10% in
2014. Supervision of all these activities will be ensured by the PR supported by 1 SR (training of
participants and strengthening of organisational capacities) and 175 SSR (CBO) from which the CVOL
are drawn.
Main DPS 4.1 activities:
4.1.1. Update and make available 2000 copies of standards documents (5), with 400 copies on the
community approach theme;
4.1.2. Train/retrain 72 community supervisors (3 training sessions for trainers of 30 persons each)
drawn from CSOs and the private sector at the beginning of the project;
4.1.3. Train/retrain 736 Community Liaison Agents (CLA) in 20 sessions of 40 agents. Based on
analysis of past performance, the CLAs from Round 3 will be returned to those duties;
4.1.4. Ensure ongoing psychosocial support and positive life education (to aid adherence, nutritional
advice, positive prevention, etc.). in all the CTC/CUs by the CLAs.
4.1.5. Making information booklets available to 165,061 ARV therapy PLWHAs participating in
treatment education sessions over five years;
4.1.6. Train/retrain 1,680 Community Volunteers (CVOL) in 40 sessions of 40 volunteers;
4.1.7. Equip the 1,680 CVOLs with volunteer Kits during the 1st year, renewed for the 3rd year;
4.1.8. Undertake 1,019,770 home visits to 140,302 PLWHA by Community Volunteers over five years
(about 85% of PLWHA on ARV);
4.1.9.
Provide food support by means of a package of food commodities (cereals, proteins, lipids) at a
cost of 11,000 FCFA per semester to 7015 bedridden, indigent and abandoned PLWHAs;
Target populations: 165,061 Persons Living with HIV on ARV
Indicator(s):
- Number of adults and children under ARV treatment monitored at home
SDA 4.2: Support of orphans and vulnerable children (OVC) PR: CNLS/MINSANTE : The OVC is a
person below the age of 18 who has lost at least one parent or legal guardian, exposed to dangers of all
kinds and who does not have a satisfactory family or community structure. Cameroon proposes as part of
Round 9, further care of OVCs by capitalizing on the achievements and experiences of Round 3,
following a methodology based on: (i) division of the country into 70 intervention sites; (ii) strengthening
OVC capacities, private sector partner organisations for holistic care of OVC; (iii) physical identification of
OVC and their specific needs; (iv) enrolment of new OVC into care each yar; (v) community involvement
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
39/89
ROUND 9 – HIV
in the care of OVC.
At the Commune level, the Ministry of Social Affairs (MINAS) will provide technical support through
Community Centres and Social Action Services who will monitor the access of OVC to services offered by
institutions, education, training and justice institutions.
The different degrees of vulnerability:
OVCs are divided into three categories according to their vulnerability: (i) OVC in extreme vulnerability
(having lost 2 parents and whose protective and providing environment is irreversibly destructured), (ii)
OVC in medium vulnerability: (a) OVC with a deceased parent, the living parent has chronic illness, care
resources are affected; (b) OVC supported by a host family with fewer than 6 children, and (iii) OVC with
simple vulnerability (parents living with a chronic illness and lessening productivity, reduced family
resources and allocated to care, stigma). The project supports the first two categories of OVC.
OVC support includes: (i) The common basic support package for all OVC cared for in this project.
According to the defined enrolment mechanism (see Table below), a support package is provided for
30,000 OVC each year which includes: educational support, nutritional support, psychosocial support,
health support and legal support; (ii) the supplementary support package provided to OVC in situations of
extreme vulnerability consists of: intensified psychosocial support; enhanced and enriched nutritional
support if the OVC is seropositive; parental education support; reference; (iii) complementary
interventions: sponsorship; work placement or vocational training; special monitoring measures to prevent
exposure to abuse, exploitation and trafficking; the community mobilisation for involvement in the care of
OVC. This mobilisation will be done through parent education, advocacy for the establishment of
"solidarity funds" for the care of OVC by host communities. This ensures ownership of OVC care and
thereby ensure the sustainability of this action in the host communities. These interventions are
conducted with the collaboration of competent social services.
Each OVC in a situation of extreme vulnerability will benefit per year by a support package consisting of
basic common support and additional support throughout the project. Each OVC in a medium vulnerability
situation will receive a support package consisting of common basic support, and complementary
interventions for one year and referred to their communities through complementary mechanisms, for the
remainder of their care. This allows enrolling each year a large number of new OVC into care. The
recruitment of OVC will be as follows over the implementation of the proposal:
Year
Year 1
Year 2
Year 3
Year 4
Year 5
Extremely vulnerable
New
Old
6,000
4,800
6,000
3,840
10,800
3 0 88
14,640
2,458
17,712
Medium
vulnerability
24,000
19,200
15,360
12 2 88
9,830
TOTAL
30,000
30,000
30,000
30,000
30,000
Over the project, 150,000 support packages will be provided to OVC, according to their degree of
vulnerability, or 30,000 support per year.
Main SDA 4.2 activities:
4.2.1.
Update and produce background documents (250 operation handbooks, 250 monitoring
handbooks and 250 Social Worker handbooks);
4.2.2 Train 10 social worker and NGO member trainers;
4.2.3. Train 210 civil society partner organisation members and social assistants in OVC holistic care,
trained in the 1st year and retrained in the 3rd year in 3 training pools of two 6 day sessions.
4.2.4.
Provide care to 30,000 OVC per year, distributed between extremely vulnerable and medium
vulnerable according to the table above;
4.2.5. Mobilise communities and private sector organisations for community care of OVC;
4.2.6. Compensate 140 social workers (2 Social workers per site);
4.2.7. Identify at the beginning of each year new OVC by site and update databases.
Target populations: 30,000 Orphans and Vulnerable Children per year over five years
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
40/89
ROUND 9 – HIV
Indicator(s):
- Number of OVC supported per year.
PROGRAM COORDINATION AND MANAGEMENT
Objective 5: To strengthen the favourable environment for implementing prevention activities, medical,
psychosocial and support care in 5 Health Districts (HD) from 2010 to 2014.
SDA 5.1. Strengthen civil society and institutional capacities
For this submission, priority has been given to strengthening institutional capacity of basic participants of
civil society. This plays a part in the Global Fund's two track funding recommendation which is to
designate one Principal Recipient (or more) from the government sector and one beneficiary (or more)
from non-government sectors;
Main SDA 5.1 activities:
5.1.1.
Train/retrain 494 Persons in charge of SR, SSR and CBO in basic competencies
(planning, resource mobilisation, supervision, M&E, etc.:
a) Train/retrain 100 persons in charge of 5 SR (2 SR for the prevention component, 1 SR for
continuum of care, and 1 for the OVC or 3 persons per SR) in the first year and retrain in the
3rd year;
b) Train/retrain 70 persons in charge of 50 SSR (14 SSR for prevention, 36 for continuum of
care and 4 regional representatives of OVC or 2 persons per SSR) in the first year and retrain
in the 3rd year, or 4 sessions of 31 participants each;
c) Train/retrain 384 persons in charge of 192 CBO (2 persons per CBO) in the first year and
retrain in the 3rd year, or 13 sessions of 40 participants each;
5.1.2. Train/retrain 70 persons in charge of CSO OVC in basic competencies (planning, resource
mobilisation, supervision, M&E, etc.:
5.1.3.
Provide coordination of 5 SR (Private sector SSR will be provided with their own funds
excluding the position of mobilisation of Business), 50 SSR, 70 OVC sites and 192 CBO in
equipment and materials in the first year;
5.1.4. Provide coordination of 70 CSO OVC for equipment and materials in the first year.
5.1.5.
Support operation of 5 SR, 54 SSR, 70 OVC sites and 192 partner Community Based
Organisations (CBO) for the duration of the project;
5.1.6. Support the operation of 70 CSO OVC partners for the duration of the project
5.1.7. Cost of management and administration of the Civil Society PR in material and logistics
5.1.8. Cost of management and administration of Civil Society PR in human resources and operations.
5.1.9. involve 6 organisations per year (2 PR, 2 SR, 1 SSR, 1 CBO) in short courses and workshops.
5.1.10. Ensure an external audit of the PR and 5 SR each year
Target populations: persons in charge of Civil Society Organisations responsible for coordinating and
supervising CBO activities.
Indicator(s):
- Number of NGO and Associations working in planning, budgeting, monitoring and evaluation of
activities related to HIV.
SDA 5.2. Public Private Partnership (PPP) Development
To be effective, national responses require a strong partnership between the Government and Private
Sector and this submission strengthens the Public Private Partnership with technical support of the ILO
through their respective commitment to adoption of programs. The Ministry of Public Health has become
aware and consultations are underway with the ILO and other partners to develop innovative strategies in
view of institutionalising and expanding the response in the framework of a Public Private Partnership. A
workshop will be arranged to agree on the objectives to be achieved along with a roadmap. A limited
structure will be established to ensure monitoring and effectiveness of this consensual roadmap for
achieving the results. The involvement of the private sector is highly strategic not only to contain the
evolution of the epidemic but also to increase opportunities for care and support (PLWHA, OVC).
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
41/89
ROUND 9 – HIV
Main SDA 5.2 activities:
5.2.1. Organise 06 meetings of 02 days to lobby Business Directors (Year 1: 02 meetings x 50
participants, Year 2: 02 meetings x 50 participants, Year 3: 02 meetings x 50 participants);
5.2.2. Produce 1000 lobbying kits for PPP (500 in the 1st year and 500 in the 2nd year) and ensure their
distribution;
5.2.3. Train 300 business Directors in the Social Responsibility of Business in 04 workshops ( 2
workshops in year 1, 2 workshops in year 2) of three days;
5.2.4. Organise two Monitoring committee meetings (25 members representing the Private sector,
Public sector, Civil Society and Bi/Multi-lateral Partners);
5.2.5. Train 100 focal points on the integration of AIDS into Business Plans (Year 1: 4 workshops of 25
persons x five days). Year three 4 updating workshops of 3 days;
5.2.6. ;Organise two annual forums to share experiences and to distribute information on the PPPs. 2
dyas/forum/50 participants each.
5.2.7. Conduct a study on the scheme for program sustainability to develop the institutional framework,
incentives encouraging the PPPs, mechanisms for evaluation and improvement;
5.2.8. Organise joint missions (GTC-ILO-CARE-Private sector organisations) for monitoring and
supervision of implementing the PPPs.
Target populations: 300 Company leaders and 100 focal points
Indicator(s):
- Number of Company Leaders and Focal Points trained.
SDA 5.3 Cost of management and administration of the public sector program: Strengthening the
human resources of the program consists of: (i) recruiting support personnel, internal
accountants/auditors and data collection agents in the care organisations, which will be progressively
integrated into the public service, and (ii) providing compensation to staff personnel in charge of technical
and financial management of the program. 20 program managers will be trained and/or retrained in M&E
and management through workshops and participation in international conferences.
Main SDA 5.3 activities:
5.3.1 Recruit an office for selecting agents;
5.3.2 Recruit support personnel: 15 secretaries (05 central and 1 per RTG), 14 drivers (4 central, 1 per
RTG) and 15 support and maintenance staff (5 central and 1 per RTG);
5.3.3. Recruit 15 accountants (5 central and 1 per RTG) and 2 internal auditors (central);
5.3.4. Ensure payment of 226 agents (2 per CTC and 1 per CU) charged with data collection in the
care organisations;
5.3.5. Ensure payment of allowances to 44 program managers (3 per RTG and 12 central) and 12
Focal Points in charge of technical management of the PMCT program from 2012 (02 central
PMCT Focal points and 10 regional);
5.3.6.
Enlist 3 agents per year in short internships (average 15 days), workshops and international
conferences;
5.3.7. Purchase 10 all terrain double cabin vehicles for central and the RTG;
5.3.8 Purchase 05 portable computers;
5.3.9. Produce the various documents and annual reports (500 UNGASS every second, 500 Universal
Access Progress Reports annually, 500 evaluation monitoring guides, and 500 training modules
on evaluation monitoring);
5.3.10 Ensure automobile fleet operation for the TCG and RTG;
5.3.11 Ensure security for goods and facilities;
5.3.12
Ensure day-to-day operation (Internet, telephone, office furniture, computer and office
equipment maintenance, etc.)
5.3.13. Ensure an annual external audit
Target populations: NCCA staff
Indicator(s):
- Number of staff recruited
SDA 5.4. Monitoring-Evaluation and operational research: These include: (i) promoting a better
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
42/89
ROUND 9 – HIV
understanding of target groups, (ii) monitoring and evaluating project progress, (iii) evaluate project
impact and (iv) reinforce the capacity of actors involved in the M&E.
To ensure the management and coordination of the Round 9 subsidy, the following will be organised: (i)
semi-annual coordination meetings between principal beneficiaries and all implementing partners, (ii)
quarterly coordination meetings between the RTG and all regional implementation partners, (iii) quarterly
meeting of the project steering committee from the CCM.
Main SDA 5.4 activities:
5.4.1
Organise semi-annual supervisory missions from the central to Regional levels and quarterly
from the regional level (under the guidance of the CTC (Attachment 19)) to the operational level
(implementation sites), management of medicines at the RPSC and CTC/CU;
5.4.2 Conduct a CAP survey coupled with serology for each of the 6 target group in implementation of
the project, during the first phase and at the end of the project.
5.4.3 organise a study on resistance to ARV each year:
- monitoring of early warning indicators (EWI) of HIV pharmacoresistance;
- monitoring HIV drug resistance among patients on ARV during the first 12 months;
- monitoring the prevalence of resistance transmitted among patients new to ARV;
5.4.4 Conduct sentinel surveillance among pregnant women in 66 sentinel sites each year;
5.4.5
In the first year, prepare cartography of interventions, interveners and partners in the national
territory to ensure good visibility and legibility of interventions in the fight against HIV and AIDS;
5.4.6 Ensure training of 32 national trainers on monitoring and evaluation in 1 session;
5.4.7
Ensure training of 232 agents (6 sessions of 40 agents) involved in monitoring and evaluation
on the guide and CRIS;
5.4.8
Produce each year: (i) 178 pre-ART registers, (ii) 178 ART registers; (iii) 200 data collection
guides;
5.4.9
Implement harmonised software for data management of PLWHA on ARV with training of 300
agents;
5.4.10 Organise quarterly regional and central meetings for data quality assurance;
st
5.4.11 Evaluate the M&E system at the beginning of the 1 phase;
5.4.12 Conduct an annual NASA survey;
5.4.13 Conduct operational research into the impact of the continuum of care on the quality of life and
survival of PLWHA;
5.4.14 Produce the final review of the National Strategic Plan (Attachment 1);
5.4.15
Ensure quarterly supervision of field activities of regional and peripheral civil society
participants;
5.4.16
Ensure semi-annual supervision of field activities of civil society participants involved in PVC
care;
5.4.17 Annual meeting to assess OVC interventions;
5.4.18 Implement a Documentation centre for Civil Society in the fight against AIDS;
5.4.19 Organise an annual forum to share experience and distribute information on best practices for
CBO throughout the term of the proposal;
5.4.20 Organise semi-annual and quarterly coordination meetings.
Target populations: SR, SSR, and all monitoring and implementation participants in activities related to
HIV.
Indicator(s):
- Number of activity reports produced
4.5.2. Re-submission of Round 8 (or Round 7) proposal not recommended by the TRP
If relevant, describe adjustments made to the implementation plans and activities to take into account
each of the 'weaknesses' identified in the 'TRP Review Form' in Round 8 (or, Round 7, if that was the last
application applied for and not recommended for funding).
The current proposal is not a resubmission of Round 8 (or 7); but a relative critique on preventive aspects
directed at children/youths in schools and universities, excluding out-of-school youths, sex workers,
sexual minorities, the current proposal corrects this weakness by developing activities directed at out-of-
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
43/89
ROUND 9 – HIV
school youths, sex workers, men having sex with men (MSM), sensorially handicapped (Blind and poor
sighted and Deaf-mutes) and marginal populations (Pygmies and Mbororos).
In response to the main weaknesses identified by the TRP on community interventions in Round 7 and 8,
the various adjustments are presented below:
1. As a lower-middle income country, Cameroon should have predominantly focused on the
most vulnerable population groups (Round 7 Guidelines for Proposals, pg 4-5). However:
(a) The major prevention interventions are focused on children and youth in
schools/universities, with no focus on those not enrolled (with those not enrolled more
vulnerable than those with access to education).
(b) There is no mention of other key and known vulnerable groups within Cameroon such as,
for example, sex workers and men OMS have sex with men and how these groups are
being reached.
this gap has been corrected in this Round which focuses on the most exposed target groups: outof-school youths, truckers, sex workers and MSM, Marginal populations (Pygmies and Mbororos),
and sensorially handicapped (Deaf and dumb, blind and visually impaired).
2. Although one of the objectives is strengthening and extending communication strategies for
youth, there is no clear link with the Round 4 grant which focuses on prevention, including
mass media communication targeting youth
In Round 4 interventions targeting youth contributed to improved knowledge by youths and increased
condom use But these interventions do not sufficiently reach rural youth, especially those not in
school, who have a lower level of knowledge. Experience gained in Round 4 regarding design of
messages and supports for mass BCC destined for youths will be used in this proposal for design and
production adapted to BCC for the same target group. In addition, funding available for these
intervention stops in 2009. Thus, the proposal of Round 9 will take over from this approach.
3. There is no demonstrated progressive absorption of human resources (including training) by
the government during the 5 years of implementation (the government counterpart funding is
fix throughout the years)
The Government has resumed recruitment of staff since 2006 to reach 30,000 agents in 2014, or
14,000 recruits. Staff recruited under this proposal will be progressively integrated into the public
service, as is already with 15% of the agents recruited for Round 3.
4. There are some discrepancies between the information on how ART will be financed (4.4.1
and pg 70) and in the numbers of people under ARVs
5. This remark applies to the proposal of Round 7; the funding mechanism for ARV in this proposal has
been reorganised as follows: Following estimates, the number of patients to be place on ARV
treatment by the end of 2014 is 165,061 PLWHA. 50% of the needs will be financed by the State
budget (HIPC (Attachment 18), Public Investment Budget) with the support of other partners. Under
this proposal, the Global Fund will be requested to bear the remaining 50%, or 82,530 patients, In the
tables under Programmatic Needs Assessment (4.4.1), a considerable number of baselines are
“0” including the number of people benefiting from prevention activities and number of
condoms distributed. This does not appear realistic given the targeted population groups,
and the existing Global Fund and other resources contributing to interventions in these areas
Attachment A of the Round 9 proposal takes into account the 2008 data for prevention (number of
condoms distributed, number of annual screenings) and for medical care (active file on ARV)
6. Most of the indicators are output indicators, rather than outcome or impact indicators
This remark has been followed and the proposal has helped capture the impact of different
interventions on the targets of the proposal through different impact indicators proposed per target.
On the other hand, surveys projected in this proposal will measure the impact of the different
interventions.
7. There are inconsistencies between the planned interventions and the intended impact of the
proposal on HIV. For example, the first impact indicator is related to HIV prevalence among
men and women, but the baseline is a survey among pregnant women (Attachment A, Targets
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
44/89
ROUND 9 – HIV
and Indicators Table). Additionally, it is not addressed in the monitoring and evaluation
section, and there is no evidence on how it will be measured throughout the implementation
period. The same occurs with the assessment of the achievement of Goal 1.
Prevalence remains an impact indicator of Goal 1, and to measure it we will use: results of the EDS
2010 and 2014 for youths, results of CAP studies coupled with serology planned at the end of the 1st
phase and at the end of the project for specific groups.
8. Although the program targets the rural youth and sexual minorities, the implementation of this
is not adequately addressed in the text, the budget, nor the M&E framework
The same targets are again priorities in Round 9, and the implementation strategy is described in the
SDA 1 as well as in section 4.5.5. In short, it provides for operations for young people who are not in
school with a emphasis on rural areas through educational sessions by PE and mass campaigns
culminating in voluntary screening. Intervention times will be adjusted for targets having late hours
and the free telephone line service to reach the most stigmatised populations.
9. Inadequate explanation of program implementation. For example, 20 million € are allocated to
strengthening the Principal Recipients, the Sub-recipients (only one identified to date) and 250
CSOs (to be identified) with little explanation on the various roles to be taken at the different
levels. The money is allocated towards human resources, infrastructure, equipment, and
running costs. At the same time there is substantial allocation for training and equipping peer
counsellors, community counsellors, supervisors and volunteers and a supervision system.
How the CSO strengthening and the counsellor/ supervisor/volunteer system will interlink to
reach the targeted groups is not clearly explained.
This proposal also relies on all Sub-Recipients (SR: 6), Sub-Sub-Recipients (SSR: 62) and
CSO/Businesses/Encampments (138) to implement BCC at proximity, distribution of condoms,
mobilisation for screening and improvement of treatment monitoring by community continuum of care.
BCC: 3 nationwide SR have been selected for quantitavely significant targets or representing a large
number of sites, either for youths, handicapped or truckers. For youths, in addition, each of the 10
regions will be covered by one SSR which will liaise the SR with the CBO. For the SW, MSM, Pygmy
and Mbororo target groups, 1 SSR per group will liaise with the PR for interventions for these specific
target groups. All CBO/Businesses/Encampments will have 2,458 Peer Educators specifically
covering each of the 6 target groups. In some of these groups strengthened for BCC, some
Community Volunteers will be identified for the listening and counselling capacities to make the link
between screening where there are positive results) and care organisations by offering subsequent
visits/encounters to people who tested positive and the opportunity to accompany them to nearby CU
and CTC.
Continuum of care: 1 A nationwide SR will provide enhanced technical and operational support to
SSRs and CBOs (APLHIV and Faith Based Organisations essentially). 36 SSRs able to cover 65
CT/CTC, the largest hosting the CLA (Community Liaison Agents) who serve as an interface between
the CU/CTC and communities. They are responsible for counselling patients (whether under
treatment or not), for therapeutic education in care organisations and business healthcare
departments and for technical assistance to Community Volunteers (CVOL) in performing their
activities. They will be present during screening campaigns to facilitate referrals to healthcare. The
CVOL, member of the community in which he lives and from a CBO, is responsible for conducting
psychosocial monitoring activities through home visits and at PLWHA living places, to assist with
adherence, nutritional education, positive prevention education, research of persons lost track of, and
referrals/directing PLWHA towards care organisations. Many organisations identified whose
capacities were strengthened during Round 4 already serve in this role combining CLA and CVOL
monitored by a community supervisor. This proposal will allow close to 85% of patients under ARV to
be systematised for these capital support services to improve adherence.
Coordination Scheme
10. The complementarity and additionality with the Round 4 proposal is not adequately
demonstrated.
This proposal will take place at the completion of Round 4 set for December 31, 2009; it will expand
and complete activities of Round 4 in the field of prevention: Round 4 developed Mass Media BCC for
youths, mostly in school, while Round 9 will develop BCC towards groups which are physically less
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
45/89
ROUND 9 – HIV
accessible: out-of-school youths, sensorially handicapped, SW, MSM, Mbororos, Pygmies.
It builds on the achievements of Round 4 in the field of continuum of care by reinforcing the
integration of CBOs and their community volunteers in the health system through liaison with the
CLAs. For the achievements of Round 4, see section 4.6.1.
11. 18 million € are allocated for support to people living with HIV SIDA and orphans and
vulnerable children without a clear indication of how this will happen. For example, 1.6 million
€ is allocated for vocational training support with no details. People living with HIV SIDA and
orphans and vulnerable children are categorized into 6 grades (each). The reason for this is
not clear. Also, if there are packages of care, how these will be allocated to different people is
not clear.
Regarding material assistance to PLWHA, the proposal gives priority to nutritional support by semiannual distribution of staple food packages to indigent PLWHA. Regarding material assistance to
OVCF as described in SDA 3.2, this is an annual support package distributed as follows: The
common basic support package (at a cost of 45.7 Euros) consists of: educational support; nutritional
support, psychosocial support; medical support and legal support; (ii) the supplementary support
package (at a cost of 30.49 Euros) consists of: intensified psychosocial support; enhanced and
enriched nutritional support if the OVC is seropositive; parental education support; reference; The
package includes educational support integrating vocational training for older OVC to insert them into
active life and permit them to generate the resources necessary for their survival.
12. Round 7 weaknesses cited by the are not adequately addressed, including. fixed government
contribution, how the vulnerable groups will be targeted, building on Round 4 and the M&E
framework.
See responses to questions 1, 2, and 3 relating to the question of the Round 7 TRP.
13. The M&E framework has some weaknesses such as outcome indicators have no targets,
output indicators are not focused on the vulnerable groups, and indicators in the proposal are
not aligned with those in the Performance Framework (Attachment A).
The output indicators in this proposal are directed towards the vulnerable groups: number of condoms
distributed to truckers and SW, number of PPR screened and knowing their result.
There are 3 indicators of effect and 2 indicators of impact in the proposal:
-
2 indicators of effect (rate of current school attendance by orphans and non-orphans and
percentage of sex workers reporting having used a condom with their last client) are provided by
a bas value and expected target,
-
2 impact indicators (percentage of babies born to mothers infected with HIV and themselves
carrying the virus, and percentage of young men and women aged 15 to 24 who are infected with
HIV) are indicated for base values and expected values
1 indicator of effect (percentage of men declaring having used a condom the last time they had anal sex
with another man) remains to by indicated by CAP surveys planned for the end of the 1st phase and the
end of the proposal.
4.5.3. Lessons learned from implementation experience
How do the implementation plans and activities described in 4.5.1 above draw on lessons learned from
program implementation (whether Global Fund grants or otherwise)?
Multi-sectoral Program for the Fight against AIDS (PMLS): With IDA funding, there was much
community involvement in the fight against HIV and AIDS through the mobilisation of people among
Communes, Businesses and Religious Denominations for prevention (BCC, screening, promotion of the
use of condoms). This mobilisation was done through a participatory process carried out with the support
of civil society organisations. In addition, 7,530 base communities, 180 associations and PLWHA
association networks, 21 Public sectors, 128 religious organisations, 104 enterprises and unions, 116
NGO/Associations, etc., were mobilised. This proposal will build on the existing CSOs to reach the target
groups. The capacities of these CSOs will be strengthened with regards to planning, management and
funding research. This strategy avoid stopping activities when funding ends (sustainability).
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
46/89
ROUND 9 – HIV
In addition, the strategy put forward for counselling and screening through Mobile Units purchased with
IDA funding has enabled reaching people poorly covered by health services or who do not spontaneously
request screening services. This proposal will continue this experience during the campaigns especially
towards the target groups. In order to ensure monitoring of persons who have tested positive, a
community liaison agent will be a part of the mobile unit team when in the field to steer these people to
care centres (CTC/CU).
Global Fund Round 3: The policy of free ARV and the MOI and subsidies of biological assessments
implemented through GF Round 3 Funding has enabled the active file of persons under ARVT to be
considerably increased. This policy will continue under this proposal and the experience of
decentralisation of care through a network of CTC/CU in 75% of health districts.
The experience of care through psychosocial support of patients by the CLAs will increase with the
continuum of care at the community level which will be implemented by community volunteers from the
CBOs. This community component will reduce those lost track of.
The system of monitoring and evaluation which was a weakness, will be reinforced by bio-behavioural
studies which will enable evaluating the impact of interventions, by operational research, as by improving
the data collection and analysis system in the CTC/CU and the RTGs.
The identification and support of OVCs through associations will be pursued. Under this proposal, the
intervention capability of Associations for efficient care of OVC will be strengthened, all while adopting an
approach which allows the enrolment of a large number of OVCs into support, as a function of their
vulnerability.
The tender procurement commission will be revitalized to resolve problems (slowness) observed in
awarding tenders. This commission will be personally followed and supervised by the Minister of Public
Health to assure its proper functioning.
The experience of Round 4 showed the usefulness of a communications strategy inciting behaviour
change adapted to the specificities of the "youth" target group. However, it also demonstrated the limits of
mass media in the coverage of certain targets (ex. rural youths, MSM, etc.) for prevention information.
The proposal aims to capitalise on local expertise in the development of appropriate communication
messages and tools, and production infrastructures reinforced with Global Fund funding and the
experiences of various partners of Rounds 3, 4, and 5 in community mobilisation through mass
awareness and proximity to specific target groups.
Global Fund Round 5:
The reinforcement of gateways for screening to achieve the objective of universal access to treatment
and care developed in Round 5 has allowed the number of people being treated with ARV to be
increased. This screening will be pursued among other high risk target populations with elevated
prevalence in order to allow them to benefit from treatment and monitoring. Beginning in the third year,
PMCT activities developed in Round 5 will be scaled up.
Other programs
1) "Free Girls" project implemented by the Cameroon Red Cross affecting both Free Girls and
PLWHA. It has yielded the following lessons:
-
Interventions involving SW improve their knowledge, aptitudes and practices in HIV
prevention and allow them to not only protect their clients but also to adopt personal risk
reduction strategies.
-
The SW and PLWHA are more likely to penetrate this closed environment, to propose
solutions to various problems submitted by their peers.
2) Project AWARE implemented by CHP: The main lessons learned were the increased attendance
of health facilities by SW and their clients related to the creation of a multidisciplinary exchange
forum: between the providers of health facilities, community workers and other interveners such
as security, social affairs, territorial administration, civil society. These discussions have created a
synergy which has enhanced the credibility and use of this health facility by SW in the city of
Yaoundé.
3) Project PRISIDA (2005 to 2009) targeted Truckers and roadside populations, with financing of the
Canadian International Development Agency (CIDA), demonstrating that:
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
47/89
ROUND 9 – HIV
-
Community BCC culminating by awareness and screening campaigns at truck stops leads to
the adoption of lower risk behaviours. 699,000 male and 2,300 female condoms distributed.
Rate of condom use during sex with a casual partner increased from 65% to 92% from 2005
to 2008 for the target;
Project MESDINE (Attachment 21) proposes activities directed at the MSM target group. This submission
capitalises on pilot experiences already conducted in Yaoundé, namely: 117 MSM brought to screening
by CAMNAFAW/RECAP+/association partnerships in Yaoundé. As with SW, the MSM and PLWHA peers
are more likely to penetrate this closed environment, to propose solutions to various problems submitted
by their peers, because of their own experience of the phenomena of stigma and discrimination.
4.5.4. Enhancing social and gender equality
Explain how the overall strategy of this proposal will contribute to achieving equality in your country in
respect of the provision of access to high quality, affordable and locally available HIV prevention,
treatment and/or care and support services.
(If certain population groups face barriers to access, such as women and girls, adolescents, sexual
minorities and other key affected populations, ensure that your explanation disaggregates the
response between these key population groups).
The overall strategy of this proposal against HIV will contribute to equality of access to services according
to different methods of intervention
Prevention
• BCC in youths
A specific approach will be developed to address, during discussions with young rural girls, the situations
the can put them especially at risk in order to help them reduce their potential exposure to HIV. BCC
activities and tools focus on the analysis with this target group of the causes of precocious sexual
relations and their possible postponement for these young girls (the average age of the first sexual
relationship is 15.8 years among young rural girls, or 1 year younger than young urban girls and 3 years
younger than rural boys) and on reproductive health. Also, the issue of transactional sexual relationships,
will be developed in all rural sites where males having financial means are regularly present, and the
motivations leading to it and alternative possibilities. Members of the Réseau des tantines (young girls
mother) - GTZ - will be heavily involved as peer educators.
• BCC in Pygmy environments
Pygmy women are particularly vulnerable to non-consensual sexual relations with non-Pygmy populations
in the vicinity of encampments. Approaches to reducing HIV risk take into account this reality and peer
support groups will be encouraged to mobilize them to know their status, share with their partner and get
treatment if necessary.
• BCC in Mbororos environments
Mbororos populations are characterized by annual festive events or large gatherings of farmers where
sexual relations are greatly facilitated. Women are particularly targeted by the BCC due to their greater
physiological vulnerability to HIV transmission. Reflection on the reduction of use of condoms in these
specific circumstances will be conducted with peers among women and men Mbororos. The use of
condoms and knowledge of serostatus will be encouraged on these occasions.
• BCC among truckers and roadside populations
Transactional sexuality is particularly developed in the roadside female population in truck stop areas.
The links between risky behaviour and dependency will be discussed during talks with the peers. The
Réseau des tantines - GTZ - may again be mobilized to seek an alternative group for girls and women to
have access to income. Also the promotion of female as well as male condoms will be done.
• BCC in MSM and SW environments
Because of legislation that condemns homosexual practices and prostitution (the latter being tolerated,
however), approach to these targets is subject to a very high barrier of repression. Peer approaches to
SW or MSM and PLWHA are included in the proposal as the best suited to enter this closed environment,
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
48/89
ROUND 9 – HIV
to propose solutions to various problems submitted by their peers because of their own experience of the
phenomena of stigma and discrimination.
• Access to screening and treatment
In a situation of women's dependency on her spouse, the discovery of seropositivity often leads to not
sharing the results with the spouse to avoid risking rejection or rupture. This situation constantly
handicaps women from taking treatments that must be concealed. For women who are better educated
and financially less dependent, it should also be noted that these have a higher HIV prevalence and that
the survey on violence against women (EDSIII) showed that they are more likely to be victims of violence
of all categories (conjugal, other, …). Sharing the result will be equally problematic and dangerous.
Screening counsellors and CLA will be specially trained for the approach of sharing results between
spouses in order to facilitate communications between the couple on this subject and to make
interventions in the family environment prior to sharing results if desired by the PLWHA.
Care and Treatment
In this proposal which aims to increase the number of eligible PLWHA on ARV, the proportion of target
men and women is in correlation to our epidemiological profile. Care for PLWHA in Cameroon is on the
principle of universal access to treatment and care by fee ARV and subsidies for biological tests. In our
active files of PLWHA under treatment, women represent 67.3% of patients on ARV in December 2008 or
40,357 women on ARV against 19,603 men. This percentage is higher than 57% in all regions of the
country. The decentralisation of care enables offering enclosed populations equal access to quality care
and treatment. These rural organisations, which represent nearly half of the care and treatment supply,
will be equipped similarly to those in easily accessible urban areas.
All CU care organisations are accompanied by a policy of coaching in place in Cameroon since 2004 by
CTC in health training which ensures quality guarantees for care (Attachment 19). The decentralisation of
care is is done in prison environments with equipment and supervision of these centres; they are provided
with ARV and medicines against opportunistic infections as well as other care organisations.
Continuum of care:
Particular attention is paid to training of community volunteers in the orientation of pregnant women
visited during antenatal consultations in order to benefit from PMCT services as well as on sexuality and
the desire for children in seropositive or discordant couples. They will also have available tools for
information and education on breastfeeding for postnatal group discussions.
Care of OVC
On their own, OVC constitute a social stratum vulnerable to HIV. Care for them in this project is based on
social equity.
The database on OVC includes 47% female OVC and 53% male OVC. However, in the context of
implementing the project, OVC will be assumed to be equal boy/girl according to their degree of
vulnerability.
4.5.5
Strategy to mitigate initial unintended consequences
If this proposal (in s.4.5.1.) includes activities that provide a disease-specific response to health system
weaknesses that have an impact on outcomes for the disease, explain:
ƒ
the factors considered when deciding to proceed with the request on a disease specific basis;
and
ƒ
the country's proposed strategy for mitigating any potentially disruptive consequences from a
disease-specific approach.
An unintended consequence of preferential targeting of girls in the prevention-BCC could be their
designation as the main carriers of the virus, lead to stigmatisation / misperceptions. This is why proximity
BCC will be used to strongly target young girls while screening campaigns and "AIDS-free vacations"
operations more massive and publicised will focus on youths in general in order to recall the need to
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
49/89
ROUND 9 – HIV
include boys as well as girls in relation to behavioural change.
Screening counsellors will be particularly trained in screening incentives for both partners of the couple
and sharing results with the spouse.
Community interventions can lead to fear of stigmatisation from accompanying recipients. To counter this
effect, community volunteers are mostly from community associations, whose community presence is
common and does not give rise to special attention (visitors from confessional organisations that regularly
visit families for reasons other than health, women's groups from the area having habitual activities for
women and children in families). PLWHA groups propose visits/meetings with recipients outside the home
so that their contacts may be made with all discretion. The whole community (volunteers, counsellors,
liaison agents) receive training modules on confidentiality to facilitate teaching of good reflexes in the
matter.
Because of the law and sociocultural environment which condemns homosexual practices and
prostitution (even is the latter is tolerated), approach to targets is delicate. Use of the green line and
approaches by SW or MSM and PLWHA peers are included in the proposal as the best suited to enter
this closed environment, to propose solutions to various problems submitted by their peers because of
their own experience of the phenomena of stigma and discrimination.
4.6.
Links to other interventions and programs
4.6.1. Other Global Fund grant(s)
Describe any link between the focus of this proposal and the activities under any existing Global Fund
grant. (e.g., this proposal requests support for a scale up of ARV treatment and an existing grant
provides support for service delivery initiatives to ensure that the treatment can be delivered).
Proposals should clearly explain if this proposal requests support for the same interventions that are already planned
under an existing grant or approved Round 7 or Round 8 proposal, and how there is no duplication. Also, it is
important to comment on the reason for implementation delays in existing Global Fund grants, and what is being
done to resolve these issues so that they do not also affect implementation of this proposal.
The links between the orientations of this proposal and other activities already undertaken through the
Global Fund grants are numerous, and this proposal aims to strengthen the value of previous effects of
subsidies on the one hand and to supplement them on the other.
Prevention :
In the Round 5 proposal, improving availability of PMCT services together with prevention and
management of STIs and HIV screening in the sectors of Defense, Security, Prison Administration,
Higher and Secondary Education, were components covered by this funding. This proposal increases the
scale of service for PMCT for the 2012 –2014 period.
The Proposal of Round 4 implemented by Care Cameroon was oriented towards the mobilisation of civil
society; 4,500 peer educators have been trained in community settings of which 2,458 will be retrained in
the context of this proposal for prevention activities in within the 6 target groups.
Treatment:
Implementation of Round 3 in 2004 enabled Cameroon to increase the number of patients under
treatment from 14,523 in February 2005 to 59,960 by the end of December 2008 (source: progress report
Nº 10 and 2008 annual report GTC/NCCA (Attachment 15)). It is to note that such results would not have
been achieved without the financial support of several partners, especially the Global Fund (GF) Rounds
3, 4, and 5.
Continuum of Care:
The decentralisation of care for PLWHA with the funding of Round 3 has enabled an accessibility by
populations of rural areas to ARV and a significant recruitment of eligible PLWHA. The funding of Round
4 has allowed the strengthening of community structures around care through financial and technical
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
50/89
ROUND 9 – HIV
support of CBO offering services of continuum of care to PLWHA at the community level. In certain sites,
the funding of Round 4 assures the continuity of therapeutic counselling services and IEC educators in
the CU (Nylon, New Bell, Ndogpassi III and Soboum) since 2008 after the withdrawal of Doctors without
Borders (DWB). The extension of these activities in 10 other sites with large active files of patients on
ARVs is scheduled for 2009. At the community level, a series of training of community actors - including
a number of CLA from Round 3 – for psychosocial monitoring and support for PLWHA was conducted as
part of Round 4. This experience enables assurance of immediate on the ground availability of 1,680
persons able to ensure the role of community volunteer as envisaged in this proposal.
OVC:
The submission proposes to continue the PEC of OVC initiated by Round 3 and Round 4. To do this,
principles acquired in this rounds will be capitalised on, namely: (i) providing support to targets identified
and listed in the dynamic database on OVC set up in Round 3; (ii) build on the experience acquired by
NGZO/partner Associations in the implementation of Round 3 and Round 4.
Monitoring:
In addition, there currently exist in the care units, agents for completing the monitoring registers for
patients under ARV, with funding from the Global Fund. These registers are essential, even if
computerisation of the system has yet to be implemented. These records agents have led to regular data
collection, which has allowed visibility of the active file of patients on ARVs.
4.6.2. Links to non-Global Fund sourced support
Describe any link between this proposal and the activities that are supported through non-Global Fund
sources (summarizing the main achievements planned from that funding over the same term as this
proposal).
Proposals should clearly explain if this proposal requests support for interventions that are new and/or complement
existing interventions already planned through other funding sources.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
51/89
ROUND 9 – HIV
There are many links between this proposal and activities supported by other resources than the Global
Fund.
PREVENTION :
HIPC Funds (Attachment 18) will enable of reagents for screening in the general population and pregnant
women (PMCT). Under this proposal, these funds will cover 50% of the reagents and consumables for
screening of target groups through 12 Mobile Units, acquired with financing from the World Bank since
2006.
BAD/ : This is 2006-2009 funding of 1,759,600 € granted by the African Development Bank under the
project supporting the national reproductive health program implemented by UNESCO to enable 4,170
teachers at the primary, secondary, and normal levels who reach 119,000 students for
EVF/EMP/HIV/AIDS education.
The AIDS prevention program, for the trucker and roadside community components in Cameroon, is
financed by the Canadian International Development Agency (CIDA), implemented by CARE-Cameroon,
while prevention in cross-border populations (Chad-Cameroon, CAR-Cameroon and CameroonEquatorial Guinea and Gabon borders) is financed by German-Cameroon cooperation through the
AIDS/HIV Prevention Program in Central Africa (APPCA). These two projects mobilise the targets through
behaviour change activities, including voluntary screening which will be reinforced by the mobile strategy.
Out-of-school youths are supervised by the Ministry of Youth with the support of UNICEF under the
"Children and HIV/AIDS" program with a youth component represented in 33 Information Centres for
Education and Listening (ICEL) in 6 of the 10 regions. The out-of-school target is also supported by
ACMS in its YELLO Réglo program, financed with the support of the MTN Foundation in the cities of
Douala, Yaoundé, Bamenda, Garoua and Maroua. Sex workers and sexual minorities (gays, lesbians,
bisexuals and transsexuals) are respectively supervised by the Red Cross and CAMNAFAW through a
pilot project Meeting SRH Diversity Needs (MESDINE (Attachment 21)) in the cities of Yaoundé and
Douala. All these projects mobilise the targets through behaviour change activities, including voluntary
screening which will be reinforced by the mobile strategy. UNICEF also accompanies PMCT through a
project which covers 56 Health Districts up to 2012. Fields of intervention are screening of pregnant
women, ARV prophylaxis for mothers and children, and paediatric care.
SUPPORT
The WB will ensure supply of ARV in 2010 for a residual amount of USD $600,000. The HIPC funds will
ensure the supply of ARV, Medicines for Opportunistic Infections, screening tests and strengthening of
technical platforms (8 PCR and 60 CD4 equipment) from 2008 to 2012.
OVC:
UNICEF, the CRS and HIPC projects of MINAS provide support to strengthening care of OVC (legal
assistance, referral to basic services, psychosocial support, nutritional support, health support, school
support and RGA).
Contributions of various participants to support of OVC in Cameroon
2005
Bi Multi
Integral Project of the fight against
UNICEF
HIV and AIDS (OVC Component)
Total UNICEF
CARE Cameroon (GFATM 4)
Catholic Relief Services (CRS)
35,133
2,424
TOTAL
37,557
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
2006
2007
3,000
2008
7000
0
612
45,519
6,030
3,000
16,762
5,780
7,612
19,543
4,229
51,549
25,542
31,384
52/89
ROUND 9 – HIV
Clarified section 4.6.3
4.6.3. Partnerships with the private sector
(a)
The private sector may be co-investing in the activities in this proposal, or participating in a way
that contributes to outcomes (even if not a specific activity), if so, summarize the main contributions
anticipated over the proposal term, and how these contributions are important to the achievement
of the planned outcomes and outputs.
(Refer to the Round 9 Guidelines for a definition of Private Sector and some examples of the types of financial and
non-financial contributions from the Private Sector in the framework of a co-investment partnership.)
Cameroon opted a few years ago to involve the private sector in the HIV/AIDS control
response. Thus, some enterprise health facilities were upgraded to management units (MU), in
particular: CDC, HEVECAM, ALUCAM and PHP. Health facilities of the private sector currently
provide 27% of care. In addition, the private sector supports the operating costs of these
structures and the personnel who work there. With regard to support, some facilities
(orphanages, children’s homes and foster families) in the private sector provide support to
OVC.
This proposal aims to strengthen the institutionalization of public-private partnerships to
enhance the contribution of the private sector in care and support for infected/affected persons.
To this end, the programme proposes to fund activities for the private sector including the
organization of advocacy meetings that will breathe new life into private sector involvement.
Several scenarios from operational research to be conducted at the beginning of the
programme will be proposed to the public and private stakeholders to ensure the structural and
financial sustainability of the partnership. The various contribution options could take into
account:
•
Contribution to the purchase of ARVs for the treatment of workers, their families and
adjoining communities
•
The constitution of a solidarity fund to support OVC and members
•
Provision of support packages to OVC and PLWHA
•
Building the capacity of adjoining and vulnerable populations (PLWHA), and families
taking care of OVC, the development of income-generating micro- projects, and
provision of employment opportunities within enterprises or elsewhere
•
Provision of opportunities for learning/training/employability for OVC and PLWHA
•
Carrying out HIV and AIDS control activities for staff, dependents and surrounding
populations in synergy with the Health Districts and MU
•
Access to Enterprise health facilities for adjoining populations and PLWHAs for the
management of STI and OI, etc.
The private sector will participate in the implementation of activities in the various areas of this
proposal (prevention, care and support to OVCs) through these various structures: large
enterprises, SME/SMI, associations and coalitions of small businesses and of the informal
sector, decentralized and central organizations of employers and employees. The stakeholders
concerned are companies and partner organizations that employ out-of-school youths,
agricultural cooperatives that massively employ young seasonal workers, enterprises having
mobile staff and employing or using truck drivers, companies with worksites employing or near
marginal pygmy and Mbororo populations. These enterprises that are the partners of this
proposal shall carry out educational talks and testing campaigns and promote the accessibility
of condoms to their staff and surrounding communities. This means that they will make available
focal points for training and preparation, their staff at events and make available facilities,
logistics and needed communication channels.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
53/89
ROUND 9 – HIV
(b)
Identify in the table below the annual amount of the anticipated contribution from this private sector
partnership. (For non-financial contributions, please attempt to provide a monetary value if possible, and at
a minimum, a description of that contribution.)
Population relevant to Private Sector co-investment
(All or part, and which part, of proposal's
targeted population group(s)?) Î
Part of BCC target groups of this
proposal : truck Divers, out-of-school
youths, pygmies.
Care and complementary support to
PLWHA and to enterprises
neighbourhood population.
Contribution Value (in USD or EURO)
Refer to the Round 9 Guidelines for examples
Organization
Name
Platform for
the
Coordinatio
n of Groups
of
Enterprises
in
Cameroon
Contribution
Description
(in words)
Year 1
Year 2
Year 3
402 000
248 035
248 035
128 206
128 206
128 206
11 891
11 891
Year 4
Year 5
Total
248 035
248 035
1 394 140
euros
128 206
128 206
641 030
euros
Contribution
to the
payment of
biological
test of
workers,
their
families
Constitution
to a
solidarity
fund to
support
OVC within
the
enterprises
Provision of
support
packages to
workers
who are
infected
Cameroon
Wood
Sector
Group]
Payment of
salaries of
health
personnel
working in
health
facilities of
the
enterprises
Small and
Medium
Enterprises
/Small and
Medium
Industries
Health
insurance to
workers and
their family
members
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
23 782
euros
54/89
ROUND 9 – HIV
4.7.
Program Sustainability
4.7.1. Strengthening capacity and processes to achieve improved HIV outcomes
The Global Fund recognizes that the relative capacity of government and non-government sector
organizations (including community-based organizations), can be a significant constraint on the ability to
reach and provide services to people (e.g., home-based care, outreach prevention, orphan care, etc.).
Describe how this 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.
Î Refer to country evaluation reviews, if available.
The proposal contributes to improving the public sector, civil society and the private sector by focusing on
capacity building, strengthening usual partnerships with CBOs (NGOs and Associations)
and
establishment of Public Private Partnerships. The areas of this strengthening are:
•
Decentralisation in progress by the progressive establishment of CUs in health districts aimed at
closer access to the populace to services, especially vulnerable and high risk groups.
•
Improvement in management of essential medicines and related products in health
organisations through training of pharmacy clerks and pharmacy equipment such as storage
cabinets.
•
Continuing the access strategy to prevention and treatment services through Community
Liaison Agents (CLA) and Community Volunteers acting as an interface between the community
and health participants.
•
Promotion the use of health services by mobilising and sensitising the neighbouring
community, through strengthening of partnerships with civil society organisations (NGOs and
Associations)
•
Strengthening the capacity of community organisations, mainly those for PLWHA and priority
vulnerable groups. This aims to help 192 organisations to cope with the operation and equipping
of their organisation.
•
Integration of the private sector into the health system through implementation of Public
Private Partnerships.
•
Strengthening of consultation and coordination of interventions including sharing lessons
learned. A certain number of activities will be organised during Round 9.
o An annual forum to share experience and distribute information on best practices of
CBOs;
•
o
Consultation meetings at the provincial, regional and national levels;
o
The participation of actors in different regional and international meetings;
o
To ensure the most sustainable interventions of civil society, in addition to the
development plan for human resources, a resource centre for civil society will be set up
and made operational.
Strengthening of NCCA: the coordination of the NCCA is essential for the implementation of the
"Three Ones" and the harmonisation of the support of other partners across the private sector
and reinforced civil society.
Sustainability of achievements of each of the priority interventions of this request requires a participatory
approach to which all partners will bring their experience and comparative advantages.
4.7.2. Alignment with broader developmental frameworks
Describe how this proposal’s strategy integrates within 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 other important initiatives,
such as the 'Global Plan to Stop Tuberculosis 2006-2015' for HIV/TB collaborative activities.
•
Cameroon endorses the Millennium Development Goals particularly for Targets 6, 8 and 12,
relating to reversing the trends of priority diseases by 2015 and access to financial opportunities
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
55/89
ROUND 9 – HIV
for the purchase of necessary inputs. Planning exercises such as the Poverty Reduction Strategy
Plan (PRSP and the National Strategic Plan for the fight against AIDS (NSP), fully integrates
these objectives (Attachment 1).
•
The Cameroon Poverty Reduction Strategy Plan considers HIV infection as a factor aggravating
poverty in that it affects a young fringe of the population, considered as the most productive.
Financing interventions is eligible for HIPC debt reduction. Cameroon has benefited since 2002
from resources of this initiative in the field of the fight against AIDS (see analysis table of financial
gaps, section 5).
•
The NCCA based its guidelines on the multi-sectoral and decentralised approach, health for all
and taking into account the gender dimension in the fight against HIV.
•
This proposal falls within the approach based on human rights and is in line with the respect and
support of implementing the Human Rights conventions ratified by Cameroon as the Rights and
Freedoms of Minorities and the Rights of the Disabled.
Finally, this proposal also subscribes to the principles of the Ottawa Charter which confers upon
communities the right to take control of their own health and to improve it.
4.8.
Measuring impact
4.8.1. Impact Measurement Systems
Describe the strengths and weaknesses of in-country systems used to track or monitor achievements
towards national HIV outcomes and measuring impact.
Where one exists, refer to a recent national or external evaluation of the IMS in your description.
The M&E system in the program of the fight against HIV and AIDS in Cameroon is multi-sectoral and is
coordinated by the planning, monitoring and evaluation section of the GTC/NCCA.
Strengths of the national monitoring and evaluation system:
•
Existence of data collection tools;
•
Existence of a national guide for monitoring and evaluation in the 2006-2010 National Strategic
Plan of the fight against AIDS (Attachment 23), describing all the indicators to be collected at the
national level;
•
Existence of a multi-year plan for monitoring and evaluation 2008-2010;
•
Existence of a Working Group for M&E with regular meetings;
•
Existence of a National Strategic Plan for the fight against AIDS (Attachment 1);
•
Existence of a section responsible for ME at the central level (GTC/CNLS) and a ME unit at the
regional level (GTR/CRLS);
•
Existence of a data collection circuit in various sectors (public, private and confessional);
• Regular production of progress and annual reports (support for PLWHA, PMCT, use of condoms)
Weaknesses of the national monitoring and evaluation system:
•
Weakness of sectoral ME systems, especially the health system that provides 60% of the
information for development of the 60 PNLS at the national level;
•
Poor alignment of partners for data collection and transmission;
•
Insufficient human resources available to M&E units;
•
Low motivation of M&E providers, particularly in sectoral systems;
•
Inadequacy of information tools within M&E units;
•
Irregularity in data transmission by sectoral ME systems in the ME section of PNLS;
•
Weak capacity of M&E organisations from the human and infrastructural points of view, in quality
and quantity;
•
Weak coordination of different interventions in the ME chain;
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
56/89
ROUND 9 – HIV
•
Absence of appropriate software for data management;
• Poor allocation of funds for financing ME activities.
Absence of a reliable system of monitoring and evaluation for civil society activities.
4.8.2. Avoiding parallel reporting
To what extent do the monitoring and evaluation ('M&E') arrangements in this proposal (at the PR, SubRecipient, and community implementation levels) use existing reporting frameworks and systems
(including reporting channels and cycles, and/or indicator selection)?
Activities carried out by sub-recipients will be the subject of periodic reports from data collected on
existing tools which will be revised to incorporate new indicators (eg, monitoring of ARV resistance).
ME modalities of this proposal are based on the ME system of the multi-sectoral national response to the
fight against AIDS, as described in the National Guide for SE from BSP 200—2010, adopted in 2007
(Attachment 23), with a multi-year ME plan fro 2008-2010.
Data produced by all the participants on the ground in the carrying out of their activities are recorded on
standardised data collection sheets, such as shown in the ME guide (Attachment 23). These sheets date
back each month on two circuits:
•
the first circuit is from the peripheral level to the central level of national guardianship institutions,
for production of sectoral reports
•
the second circuit is from the peripheral level to the regional level where the data from the
sectoral circuit is centralised, analysed by the GTP which produces monthly and quarterly
reports, which are sent with the same frequency to the GTC/NCCA for compilation.
At all levels of the system there is feedback.
National, quarterly, semi-annual and annual reports are produced by the GTC/NCCA to reflect the level of
activity implementation and the use of funds.
4.8.3. Strengthening monitoring and evaluation systems
What improvements to the M&E systems in the country (including those of the Principal Recipients and
Sub-Recipients) are included in this proposal to overcome gaps and/or strengthen reporting into the
national impact measurement systems framework?
Î The Global Fund recommends that 5% to 10% of a proposal's total budget is allocated to M&E activities, in order
to strengthen existing M&E systems.
Improvements to the national M&E system are grouped into five areas which are:
1. institutional reinforcement;
The fight against HIV/AIDS being multi-sectoral, it involves a growing number of players. To be more
efficient, the organisation of the information chain must be strengthened in order to understand the effects
of all the projects/programs both on individuals and on communities to understand the extent and
dynamics of the pandemic.
To enable the PME section of fully and correctly play its roles of coordination, monitoring and support at
the operational level to make the information circuit more efficient and operational, it will carry out
monitoring and supervision missions. For this it will make available mobile equipment for perform its
coordination activities, monitoring missions and specific joint supervision.
This section will also by provided with notebook computers identical to the regional ME units. Regional
and departmental services from different sectors will also be equipped with computer equipment as
needed. To do this, an analysis of the existing computer situation will be performed at all levels within the
technical organisations (TCG, the PTG, health training at central, regional and district levels).
2. strengthening capacity of agents responsible for monitoring and evaluation;
The availability of human resources competent in the domain is essential for implementation of a reliable
and operational system of monitoring and evaluation. One of the areas for improvement highlighted in
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
57/89
ROUND 9 – HIV
the evaluation of the 2000-2005 strategic plan was to strengthen the capacities of all agents involved in
monitoring and evaluation. Although statistical engineers are recruited in all GTP for monitoring and
evaluation at the regional level, these and all M&E players in all sectors need to strengthen their capacity
for data management.
A pool of 32 national trainers will be put together for all sectors at the rate of 2 representatives per sector.
These national trainers will in turn provide training to 200 regional trainers with at least one representative
per sector, or 20 trainers per region from the sectors concerned. Training content will include the ME
system, completing and transmission of data components and mastering of the information circuit.
3. Coordination ;
Conforming to the guidelines on implementing the three main principles, the establishment of a
coordination of activities is essential in a context which is multi-sectoral and with multiple interventions.
Monitoring and evaluation activities are no exception to this rule.
The objectives of the plan aim at revitalising the coordination bodies at different levels, through the
organisation of quarterly meetings of the Technical Group on ME and semi-annual meetings of the PCCA.
4. Studies and research
These allow the country to be situated in relation to the epidemic by its evolution, its characteristics in the
general population and the strata or sections most affected. The information or results of these studies
provide arguments for policy in the fight against the epidemic and clarify decision-making. As part of the
implementation of the M&E system, certain studies are priority.
These are to carry out periodic surveys of HIV prevalence among pregnant women and two specific
surveys of populations at risk.
Two surveys of resistance of various STI germs to antibiotics will also be done and a monitoring survey of
HIV resistance to ARV.
This will be in the final evaluation of the 2006-2010 NSP (Attachment 1).
4.9.
Implementation capacity
4.9.1 Principal Recipient(s)
Describe the respective technical, managerial and financial capacities of each Principal Recipient to
manage and oversee implementation of the program (or their proportion, as relevant).
In the description, discuss any anticipated barriers to strong performance, referring to any pre-existing assessments
of the Principal Recipient(s) other than 'Global Fund Grant Performance Reports'. Plans to address capacity
needs should be described in s.4.9.6 below, and included (as relevant) in the work plan and budget.
PR 1
Ministère de la Santé Publique
Address
B.P. 14,386 Yaoundé, Rue de Croix Rouge
The Ministry of Public Health [Ministère de la Santé Publique] has established a Technical Secretariat
responsible for coordination and monitoring of Global Funds Programs of which it is the Principal
Recipient. This Secretariat consists of a Coordinator, a monitoring agent, a financial expert and support
personnel (driver, secretaries)
The Minister of Public Health implements the fight against HIV and AIDS through:
9 The National Committee of the fight against AIDS (NCCA) chaired by the Minister of Public
Health, is the body for design and direction of strategies and activities to implement each year. It
holds semi-annual meetings.
9 The permanent secretariat of the National Committee of the fight against AIDS (NCCA), body for
management and monitoring of implementation of activities. It includes the Technical
Coordination Group (TCG) at the central level and the Regional Technical Groups (RTG) at the
Regional level.
The Permanent Secretariat has 52 staff:
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
58/89
ROUND 9 – HIV
ƒ
22 at the central level: (Permanent Secretary, Deputy Permanent Secretary, 7
Section Chiefs, 4 TCG Unit Chiefs, 9 TCG Senior Designers);
ƒ 30 at the Regional level: 10 RTG coordinators, 10 Monitoring Unit Chiefs, 10
Local Response Unit Chiefs).
Implementation of regional level activities:
9 Regional coordinators are responsible for supervision and monitoring of implementation of
activities in collaboration with the Regional Delegates of Public Health.
Implementation of district level activities:
9 At the operational level, activities of the fight against HIV are implemented in an integral manner
with health organisations (district hospitals, integral health centres).
Under the medical care for PLWHA, specialised CU/CTC organisations exist within central regional and
certain district hospitals.
Within the Ministry of Public Health there is the Directorate for the Fight against Disease (MLD) which is
responsible for coordination of programs in the fight against disease (Malaria, Tuberculosis, HIV and
AIDS, Cancer, Blindness, Onchocerciasis, Leprosy, Burili ulcer, etc.). The HIV/AIDS, Malaria,
Tuberculosis programs have Focal Points which assure an interface between these programs and the
MLD.
Financial management and Procurement
Financial Management
The Program has a proven expertise in management and implementation of projects financed externally
with evidential results. Since 2001, numerous funds (World Bank for 50 million USD dollars, Global Fund
through Rounds 3 and 5 respectively for 55,500517 USD and 9,060,883 Euros) have been managed and
audited conforming to international standards.
Financial management of the Program is done under the OHADA accounting system and a computerised
system using TOMPRO Software. The Principal Recipient has opted for the National Amortisation Fund
[Caisse Autonome d’Amortissement] (NAF) which is the gateway for the Government to all external
funding, to initiate and manage key accounts receiving Program funds. These funds are managed
following procedures established by both the donor and those in the State Financial Regime and the Law
of Finances.
Procurement
Contracts are awarded in conformity with the Code of Public Tenders of September 14, 2004. A Special
Committee for Procurement for Global Fund Contracts exists within the Principal Recipient. Under this
Proposal, this Commission will be reinforced to improve delays in Tender awards.
Acquisition of medicines is through the CENAME which is a specialised and experienced organisation in
this area fir the Tender Awards Commission created by the tender authority in this independent
organisation.
Audits
Two auditors have been recruited by the Program whose principal mission is the verification, application
and improvement of procedures in order to ensure the integrity of the heritage and good use of funds.
Each year, an independent audit firm hired by competitive tender will conduct external audit procedures.
PR 2
CARE International au Cameroun
1071 Winston Churchill avenue, Hippodrome district BP 422 Yaoundé. Cameroun
[email protected] [email protected]
CARE Cameroon is one of the country offices of the International CARE network. The International CARE
network consists of 12 Members: CARE France, Great Britain, Denmark, Germany, Austria, Norway,
Japan, United States, Australia, Canada, Thailand and Netherlands. CARE International has offices in
nearly 70 countries around the world (Africa, Asia, Latin America, Eastern Europe), and has an average
annual budget of over 600 million Euros, from both private and institutional resources.
Address
The mission of CARE is to serve individuals and families in the poorest communities in the world. Our
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
59/89
ROUND 9 – HIV
program principles include: promotion of strengthening, working with partners, accountability, nondiscrimination, promotion of non-violent resolution of conflicts, and Research of sustainable results.
CARE has intervened in Cameroon since 1978 and conducts activities throughout the national territory.
Below is a list of recent projects conducted by CARE Cameroon.
1. The Potable Water and Community Health Project in the province of Adamaoua (March 2002 to June
2006) which aimed to reduce water-borne diseases through improving access to potable water. Funding:
CIDA. Budget: 2,439 million Euros.
2. STI/HIV/AIDS Prevention and Road Safety Project along the N'Gaoundéré-Touboro-Moundou roadway
(December 2004 – November 2006). Funding: European Union. Budget: 152,449 Euros.
3. Rural Development Project in the provinces of Adamaoua and the East which aimed at improving
maternal and infant nutrition by increasing agricultural production (January 2005 to January 2008).
Funding: USDA. Budget: 2,591 million Euros.
4. STI/HIV/AIDS Prevention Project among truckers and roadside populations along Cameroon roadways
(December 2004 to June 2009). Funding: CIDA. Budget: 3,048 million Euros.
5. Project to mobilise Civil Society for the fight against HIV/AIDS (January 2005- December 2009).
Funding: Global Funds Round 4. Budget: 12.348 million Euros.
6. The project to provide integrated community care for persons infected and affected by
HIV/AIDS/Tuberculosis in the province of the extreme North (January 2005 – December 2007), Funding:
European Union. Budget: 2,5 million Euros.
7. The project to support orphans and vulnerable children in 4 sites of the North and Extreme North.
(2008). Funding: Global Funds Round 3. Budget: 135,434 Euros
8. The Program for Malaria Prevention in the Lagdo zone of North Cameroon. (July 2005 to June 2007).
Funding: SANOFI AVENTIS. Budget: 132,000 Euros
9. The Project for Assistance of Central African Refugees in Cameroon (January 2007 to December
2007). Funding: United Nations High Commissioner for Refugees. Budget: 698,216 Euros
10. The Urban Health Project (Malaria, Reproductive Health) of Garoua (January 2009 – June 2011).
Funding: European Union. Budget: 700,000 Euros.
In all these projects, CARE co-contracts with partners who are thematic specialists or
geographically/sociologically close to target populations – more than 220 sub-contracts over the last 5
years –all projects combined.
Previous analysis of CARE projects allows CARE Cameroon to identify obstacles and possible risks to
the achievement of results. These include lo level of ownership of accountability by civil society
organisations and the mismatch between available human resources in terms of quantity and tasks to be
accomplished.
CARE has strengthened, during Round 4, the community base of its work and links with national and
international institutions and organisations: Ministry of Public Health, of Social Affairs, of Labour, of
Transport, of the Promotion of Women and the Family, of Planning and Improvement of the Territory, of
Agriculture and Rural Development, VSO, PNUD, CRS, WFP, HCR.
CARE Cameroon has qualified, competent and motivated human resources for implementation,
monitoring and evaluation of programs and projects. The professional activities of CARE Cameroon
employees is supervised by recently revised administrative and financial procedures which have recently
been further tightened.
Serving the project, in addition to those working directly with specific programs, CARE Cameroon has a
Director, an Internal Audit Service, an Administrative and Financial Coordinator assisted by a Chief of
Accounting and Finances, a Manager of Administration and logistics, and a Human Resources Manager,
several accountants, logisticians and 5 support personnel.
In addition, since April 2008, CARE Cameroon is supervised within the CARE network by CARE France
which makes it eligible for the assistance of a Management Comptroller, two auditors, a program
manager, a health reference, a communications specialist.
CARE Cameroon has a regularly monitored accounting system and is equipped with SAGA software
used by many development NGOs allowing:
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
60/89
ROUND 9 – HIV
•
•
•
•
•
•
•
Declare assets and liabilities to third parties.
Respect the double entry rule.
Respect the rule of reciprocity of accounts.
Establish a general ledger and trial balance.
Establish an operating statement
Establish a balance sheet
Monitor the budget
CARE Cameroon also uses a cash system for monitoring separate project/donor financial transactions,
tools for bank and cash reconciliation and periodic inspection of cash movements.
The CARE Cameroon accounting system allows funds to be disbursed to sub-recipients and suppliers in
a transparent and justifiable manner. Following current procedures:
ƒ
The maximum delay of payment to suppliers is 15 days after filing and approval of the invoice.
ƒ
The delay is 21 days for sub-recipients, after filing of the financial report and validation of
supporting expense documents by internal audit.
ƒ
The presence of offices in areas of the program facilitates the provision of funds to suppliers.
ƒ
For provision of funds to sub-recipients, CARE Cameroon has established a system of direct
deposit to the accounts of organisations which guarantees greater speed and security.
The internal audit service of CARE Cameroon, called for by the Global Fund at the beginning of Round 4,
now has all the tools for monitoring and control of sub-contracts, approved quarterly by the LFA.
Î Copy and paste tables above if more than three Principal Recipients
4.9.2 Sub-Recipients
(a)
Will sub-recipients
implementation?
be
involved
in
program
X
Yes
No
(b)
If no, why not?
X
1–6
7 – 20
(c)
If yes, how many sub-recipients will be involved?
21 – 50
more than 50
(d)
Are the sub-recipients already identified?
(If yes, attach a list of sub-recipients, including details of the
'sector' they represent, and the primary area(s) of their work
over the proposal term.)
(e)
X
Yes
[Insert Attachment Number for list]
No
Answer s.4.9.4. to explain
If yes, comment on the relative proportion of work to be undertaken by the various sub-recipients.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
61/89
ROUND 9 – HIV
If the private sector and/or civil society are not involved, or substantially involved, in program
delivery at the sub-recipient level, please explain why.
The Cameroon proposal will be implemented by two PR: The Minister of Public Health as Public Sector
PR, and CARE for Civil Society and the Private Sector. This decision of the CCM demonstrates a
willingness to involve Civil Society and the Private Sector in the fight against AIDS. Civil Society, through
associations, is broadly involved in implementation of the program at the Sub-Recipient level.
The Minister of Public Health: Public Sector PR
The experience of MINSANTE in financial management, human resource management, planning, activity
implementation, partnerships, evaluation monitoring, management of grants and contracts in the "make
do" context, have the competencies and technical capacities required to efficiently perform any project in
the field of health and population. In addition, the MINSANTE provides direction in administrative and
financial aspects and on monitoring evaluation. The process of mobilisation aims to engage state
organisations and civil society in order to receive subsidies intended for implementation of projects and
activities within the framework of the proposal.
The NGO CARE: Civil Society and Private Sector PR
Sub-Recipients are NGOs/Partner Associations of CARE as part of a contract for implementation of HIV
prevention acitivities with target groups. Sub-Recipients previously identified sign a service contract with
them to carry out vicinity BCC activities as part of the basic community strategy developed in the
proposal. Sub-Recipients and Sub-Sub-Recipients have contracted with CARE, identifying them as
persons who are trained as trainers and peer educators in the activities of sensitisation, and as
Community Liaison Agents and Community Volunteers in activities of the continuum of care.
•
•
Establishment of a community base in response to HIV, in a decentralised management of the
fight, requires a significant involvement of civil society if it is to succeed. The continuum of care is
generally entrusted to community organisations grouping PLWHA or not, as well as support for
OVC which uses the CBO and the community.
Involvement of businesses in the national response to HIV/AIDS is evident and needs to be
strengthened. Also, the Sub-Recipient of the Private Sector, which is the ILO, will be responsible
for training and advocacy with business leaders to ensure the mobilisation of businesses in the
fight against HIV and AIDS in the workplace.
DOMAIN
PRINCIPAL
RECIPIENT
Prevention
CARE
Treatment
MINSANTE
Care
and
Support
Coordination
and
Management
MINSANTE
SDA
SUB-RECIPIENT
SDA 1: BCC
SDA 2: Condoms
SDA 3: Screening
SDA 4: PMCT
SDA 1: Medical Treatment
and Monitoring
SDA 2: Prophylaxis and
treatment of MOI
SDA 1: Care and support for
chronic diseases
SDA 2: Support for OVC
SDA 1: Strengthening of Civil
Society
and
institutional
capacities
SDA 2: Development of the
Public Private Partnership
SDA 3: Costs of public
sector management and
administration
SDA
4:
MonitoringEvaluation and operational
research:
ACMS, CHP, CAMNAFAW
ACMS, CHP, CAMNAFAW
CNLS/MINSANTE
CNLS/MINSANTE
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
CNLS/MINSANTE
CNLS/MINSANTE
CARE
CNLS/MINSANTE
CARE
ILO
CNLS/MINSANTE
CNLS/MINSANTE
62/89
ROUND 9 – HIV
NB : The vicinity BCC in the out-of-school youth environment is ensured by the CHP, among Truckers by
the ACMS and among MSM and SW by CANAFAW. BCC among sensorially handicapped and marginal
populations is ensured by the PR (CARE).
Each of the actors in the different target groups will assure distribution of condoms.
4.9.3.
Pre-identified sub-recipients
Describe the past implementation experience of key sub-recipients. Also identify any challenges for
sub-recipients that could affect performance, and what is planned to mitigate these challenges.
The Cameroon Association for Social Marketing (CASM), which is part of the Population Services
International (PSI) network, is an association of Cameroon law created in 1996. Its mission is to
contribute to improving the social well-being of vulnerable and low-income populations. It contributes
along with other participants in the health sector in the design and implementation of strategies of social
marketing, including research, communications for behaviour change and distribution of quality public
health products at affordable costs. Its areas of competence are:
• Prevention of HIV/AIDS;
• Family planning;
•
Integrated Management of Childhood Diseases (PCIME);
• The fight against Malaria;
• The Fight against diarrheic and water-borne diseases.
Not limited in the implementation of projects, the CASM has a significant portfolio of projects which mainly
revolve around:
1. The fight against AIDS across these projects:
• Prevention of HIV in Central Africa (PPSAC), which target vulnerable populations such as MSM,
fishermen, pygmies, SW, Truckers, youths, women and the general population. This project,
financed by the KFW at a cost of 4.7 million Euros in its first phase and 11.5 million Euros in its
second phase, has been implemented by the CASM since 2005 and has as its goal to facilitate
accessibility and availability of condoms, improving behaviour regarding HIV prevention and
reducing stigmatisation and discrimination against PLWHA.
• 100%Jeune which is a Reproductive Health project directed at youth, 100%Jeune, through mass
media communications (the magazine 100%Jeune in monthly French and English editions, the
website www.reglo.org, interactive and twice weekly radio broadcasts on 5 stations in French and
English, TV and radio spots on HIV prevention), interpersonal communication (100 clubs for
youths in school and not in school which hold weekly discussion groups on the basis of a monthly
discussion guide), promotion of voluntary screening (free and voluntary screening campaigns are
held on a regular basis in the school and non-school environment). This project, in place since
2000 and whose annual cost of around 305,000 Euros is mainly funded by the KFW and donors
such as the Bill Gates Foundation, the MTN Foundation, Art Venture, the West American
Ambassador's Fund, PSI.
• Prevention of STI/HIV on major roadways and around Roadside populations (PRISIDA) is
financed by the CIDA for an overall amount of 1,407,878 Canadian Dollars and in place since
2005. This project targets truckers and their partners, and neighbouring populations along main
roads and truck parks. It was established on 18 truck parks and includes a community component
implemented by ACMS, which consists of Behaviour Change Communications, social marketing
of condoms and community mobilisation.
• Prevention of HIV among the armed forces which consists of advocating for involvement and
adoption of HIV prevention activities by the military High Commission, sensitisation of men in
uniform, social marketing of condoms and promotion of screening. This project, implemented by
the ACMS since the beginning of 2009 with financing from the American Department of Defence
(DOD) has a budget of 825,127 American Dollars.
• The Universal Access to Female Condom Project which is increasing its scale in Cameroon in
terms of training, awareness, advocacy and distribution of the female condom. This project,
valued at 2,129,882 Euros is financed by the Universal Access to Female Condom (UAFC) which
brings together the Netherlands I+Solutions, the Ministry of Foreign Affairs, Oxfam Novib and
WPF. This project has been implemented by the ACMS since the beginning of 2009.
2. Family Health through the projects:
• Distribution of oral rehydration salt "Orasel";
• Distribution of sodium hypochlorite solution called "Sur'Eau/Waterguard" for home water
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
63/89
ROUND 9 – HIV
treatment.
Promotion and distribution of long term impregnated mosquito nets/reimpregnation kits and free
distribution of ACT.
• Promotion of family planning in projects such as: Family Protection (ProFam) at 25 private health
centres in the city of Yaoundé and social marketing of hormonal contraceptives, progestin and
estrogen-progestin.
• Child survival through observation of children under 5 years incompliance with standard for the
integrated management of childhood diseases (IMCD) in 25 ProFam project trainings.
In the field of procurement and supply, ACMS uses national and international public tenders in order to
guarantee transparency and impartiality of the procurement process for each order. If necessary, ACMS
uses the services of its partner PSI which has competitive international experience in supply of health
products from internationally qualified and credible suppliers. In 2007, supplies for a total value of
$1,222,946 USD were made for products and sponsors who were:
-Male condoms at a value of $984,262 USD (KfW)
-Mosquito netting and Insecticide at a value of $232,234 USD (Own funds)
-Safe Water Solution for an amount of $6,450 USD (Discretionary funds)
Moreover, the ACMS has a service contract with the National Laboratory for Essential Medicines
(LANACOME) to confirm the quality of products supplied and their conformity with technical specifications
in force before being placed on the market. The ACMS manages logistics relating to product distribution,
ranging from planning purchases, through orders with suppliers, transport, customs procedures and
warehousing. The ACMS currently has three warehouses: The main warehouse is the packaging unit in
Yaoundé. Regional warehouses are operational in the cities of Douala and Garoua. A warehouse is being
renovated in Bamenda.
For distribution, the ACMS network is based on three distinct and complementary networks:
pharmaceutical (04 pharmaceutical wholesalers covering nearly 200 pharmacies), commercial (20,000
points of sale) and voluntary (57 Community Based Organisations). This network last year distributed
28,702,109 male condoms and 143,593 female condoms. To energize this network, the ACMS makes us
of qualified staff, regularly trained in product distribution techniques, and a pharmaceutical logistician
responsible for monitoring stocks to international standards.
The ACMS has remarkable experience as an actor and partner of other associations of Civil Society and
as such has significant experience in managing contracts with partner organisations. In this capacity,
since 2004 it has contracted with:
• 180 associations to support implementation of the Pincez Déroulez campaign
• 210 associations to support implementation of the Trusted Partner campaign
• 29 associations to support implementation of the Pincez Déroulez campaign towards women
It is also preparing to contract in 2009 with 40 organisations to support the campaign to raise awareness
of the female condom.
•
It should be noted however that acquisition of condom stocks implies a storage volume increase of 15%.
Therefore, this funding request proposes acquisition of a new store in Yaoundé and support for
renovation of the store at Bamenda in order to store female condom units.
To optimise project implementation, the ACMS also provides for strengthening of logistical, human and
computer resources.
IRSDC
The Institute for Research, Socio-economic Development and Communication (IRSDC) is a non-profit
Non-Governmental Organisation created in 1993. Its mission is to contribute to the improvement, in a
measurable and sustainable way, of living conditions of African populations, by the promotion and
conduct of research and community development initiatives at the national and regional level. It has its
head office at Yaoundé, and regional representatives in several cities of Cameroon.
In its 2007-2011 strategic plan, IRSDC identifies the fight against HIV as being the major thrust of its
intervention for future years.
To carry out its activities, IRSDC has a multidisciplinary team, who have a demonstrated and proven
ability in operational research, monitoring and evaluation of health programs, design and implementation
of human development projects, social marketing and behaviour change communication. It consists of
social science specialists (sociologists, anthropologists, demographists and health economists), health
professionals (public health, RS) and experts in information and communications sciences. In addition,
IRSDC has a permanent pool of consulting experts whose profiles and expertise covers the areas of
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
64/89
ROUND 9 – HIV
intervention. The field of IRSDC intervention extends beyond the borders of Cameroon and reaches
several sub-Saharan African countries including but not limited to Rwanda, Madagascar, Gambia and
Senegal. IRDSC is a partner of the Ministry of Health and of the National Committee for the Fight against
AIDS in Cameroon. It also works closely with other government departments including the Ministry of
Youth and those in charge of education (Ministry of Basic Education, Ministry of Secondary Education,
Ministry of Higher Education). Similarly, an active partnership with several NGOs and associations and
community-based organisations in all regions of the country facilitates a good control of IRSDC activities
across the country.
IRSDC developed and implemented several projects which have had a significant impact on the life of
many in Cameroon as has been shown by evaluations of these projects. Since 1993, IRSDC has led
dozens of projects and programs, including operational research aiming to improve the impact of health
programs, programs to promote less risky HIV behaviour, which have benefitted several population
groups including youths, SW, MSM and drug users. Challenges such as HIV and AIDS prevention,
access to primary health care, water and sanitation are at the core of IRSDC activities. Notable
achievement in the field of HIV/AIDS are its contribution to exposing nearly three quarters of Cameroon,
aged 15-24, to information on HIV prevention through the mass media and interpersonal communication,
through the Entre Nous Jeunes (ENAJ) program from 2005 to 2009. By targeting as a priority persons
living in rural areas, IRSDC has contributed to reducing the information deficit for rural populations
regarding HIV in Cameroon.
CARE AND HEALTH PROGRAM
Care and Health Program (CHP) is a Non-Governmental Organisation (NGO) created in 1996 and based
in Cameroon. For over 12 years, CHP has been involved in the area of prevention activities including
research into STI/HIV/AIDS and family planning activities, not only in Cameroon but also in Central Africa
and the West.
CHP also is greatly involved in implementing several projects related to STI/HIV/AODS/FP in the public,
private and community sectors. Targets groups covered by CHP include, among others, the uniformed
bodies (public order forces, police, prison administration staff), out-of-school youths, students (secondary
and university), truckers, SW, inmates, women, minorities, etc., in six (10) provinces of Cameroon. In
addition, CHP has also had to provide technical assistance to several partners such as NCCA, RECAP+,
AFASO, SUNAIDS, SWAA, women's associations, the Ministry of Defense, police, etc., in the
implementation, management, training and monitoring of projects.
CHP also has a long experience of collaboration with national and international organisations in the subregion. There is nearly ten years of collaboration with UNAIDS, USAID, WHO, JHU, CCP, Global Funds,
KFW, World Bank, etc. As part of the FHA/SFPS project, CHP was instrumental in contributing to
developing skills to control activities for STI and HIV/AIDS in the sub-region from 1998 to 2003. From
October 2003 to July 2008, CHP worked as an associate partner responsible for the counselling and
screening component of the AWARE HIV/AIDS project which is a Regional Project financed by USAID
covering 18 countries (including 15 CEDEAO countries plus Cameroon, Chad and Mauritania). Sice
2006, CHP has been a sub-Recipient of the Ministry of Public Health, Principal Recipient, in
implementation of the activities of Round 5 of the Global Fund Fight against Malaria, AIDS and
Tuberculosis care component of STI as a gateway to the treatment of PLWHA by ARVs. It should be
noted that CHP has an international standard accounting system which is regularly audited by
internationally recognized audit firms such as Ernest & Young, Bekolo & Partners, Price House Coopers.
CHP is currently in the process of acquiring TOMPRO accounting software which will help us to make our
management system more competitive.
Projects performed by the bidder (in relation to the selected field):
With the confidence gained by CHP from donors, we have managed several projects including:
a. Project Nº1: Strengthening diagnosis and care of STI among 100,000 patients in the
vulnerable target groups: MIDEF, MINESUP, MINESEC, Prison Administration, DGSN
i. Budget: 4,315,144 Euros or 2,830,734 FCFA………
ii. Sources of Funding: Global Fund…………
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
65/89
ROUND 9 – HIV
iii. Period: August 06 – July 2011 …………………………
iv. Targets: pupils, students, uniformed men, inmates, PLWHA
v. Implementing partners: CNLS/MINESANTE, MINDEF, MINESEC, MINESUP,
DGSN, MINJUSTICE, associations and clubs
Coverage area: 10 regions of Cameroon
b. Project Nº2: Improving access to HIV screening and quality of service in Central Africa
and the West
i. Budget: 523,833,487 FCFA
ii. Sources of Funding: Family Health International
iii. Period: October 2003 – June 2008
iv. Targets: Truckers, SW, roadside populations, youths, PLWHA
v. Implementing partners: CNLS/MINESANTE – Ministry of Transport – Secondary
education – Higher education of the countries concerned
Coverage area: 15 African countries of the CEDEAO plus Cameroon, Chad and
Mauritania
c.
Project Nº3: DHAPP
i. Budget: 1,500,000,000 FCFA
ii. Sources of Funding: US MILITARY DEPT OF RESEARCH
iii. Period: 2003 - 2008
iv. Targets: Military, PLWHA
v. Implementing partners: MINDEF - MOH
Coverage area: Cameroon, Chad, Gabon, Congo, Equatorial Guinea, Sao Tome, CAR
SB 4: International Labour Organisation (ILO)
The ILO is a United Nations Specialist Agency that deals with the world of work. As a co-partner of
UNAIDS, the ILO is the UN organisation responsible for integration of HIV issues in employment. The
response of ILO to AIDS was defined according to the recommendations of the "Division of Tasks" of the
UNAIDS, which assigns specific responsibilities to each of the 10 co-sponsoring organisations, in
accordance with their mandates and comparative advantages. From its knowledge of social partners
(groups of businesses and labour organisations), the ILO is well placed to accompany the strengthening
of the Public Private Partnership in Cameroon and to ensure skills transfer to the national section.
The Sub-Regional Office of the ILO for Central Africa (ILO SRO –CA) manages a major n=budget to
execute projects in 11 countries of the sub-region. For the two years 2008-2009, the SRO-CA managed
a budget of over 6 million. A network resource management tool (FISEXT) with the Regional Offices and
the Head Office enables a transparency and monitoring of expenses. An external audit is performed
annually. The SRO-CA has technical capabilities and experience in project management. It uses its
expertise to implement projects funded by various support agencies and multilateral and bilateral
cooperation including: workplace projects in the fight against HIV, or the fight against child labour
(American Department of Labour); the Fight against HIV in Cooperatives and the informal sector
(Swedish Cooperation), Promotion of decent employment and the fight against poverty (French
Cooperation); project of the fight against child labour and trafficking (Dutch Cooperation)).
In its multi-sectoral approach, HIV/AIDS is integrated into the agenda for ILO Decent Labour which
encourages an integrated approach to respect of rights, promotion of international labour standards
including gender, employment/productivity, extending social protection to the most vulnerable groups
such as women and PLWHA through a new dynamic of social dialogue that promotes responsibility to
players in the world of work and sustainability of programs.
SB5 : Cameroonian National Association for Family Welfare (CAMNAFAW)
CAMNAFAW is a Non Governmental Organisation which works in the field of sexual and reproductive
health. It is a member of the International Planned Parenthood Federation (IPPF) which has been its main
donor since its creation in 1987.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
66/89
ROUND 9 – HIV
The mission of CAMNAFAW is to "Contribute, alongside the Cameroonian Government, to ensure to the
greatest number of people access to quality SR services through:
⊥ Improvement and extension of quality integrated SR service offerings;
⊥ Mobilisation and involvement of adolescents/youths;
⊥ Comprehensive care of HIV infection;
⊥ Advocacy to remove sociocultural and legal barriers;
Care problems of SMI, including post-abortum care.
Personnel
The CAMNAFAW has a large network of volunteers distributed throughout the national territory. To date,
its national staff counts for around 200 persons with various skills. Apart from activities aimed at outreach
strategies, CAMNAFAW is involved through supervisory organisations, which are Youth Centres and
Health Care Centres. CAMNAFAW has regional representations in 7 of the 10 Cameroon provinces.
Fields of intervention
The main fields of CAMNAFAW intervention are the following:
1. Sexual and Reproductive Health
2. Harmful and violent sexual practices against women
3. Sexual Rights and Rights in Reproductive Health
Experience with CBOs
The main beneficiaries of the CAMNAFAW programs are the following:
1. In-school and out-of-school youths
2. The LGBTI community
3. Men and women of childbearing age and persons
4. SW and migrant workers
5. PLWHA across several projects such as:
The annual budget of CAMNAFAW is around 385,000 Euros, audited annually by the international firm
Deloitte
Strengths of the organisation
-Full member of an international federation (IPPF) recognised worldwide and subject to quality and
performance criteria
-Located in seven of ten provinces of the country in which it conducts regular field activities
-Founding member of the national NGO/Health Associations network (ROSACAM)
-Solid base of committed volunteers with a variety of skills
-Organisation in compliance with national legislation regarding labour and taxation
-Modern financial management procedures, conforming to the OHADA accounting plan and the
requirements of donors, regularly reviewed and audited annually since 1989 by an international firm of
accounting expertise
-Recognised as a partner by the MINSANTE (cooperation agreement and hire service contract)
Use of an integrated management system of computerised data software
-Well trained, competent and motivated personnel
Leader in the field of SR in Cameroon
Weak points, to be strengthened
-
Insufficient staff
Non availability of long term real estate
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
67/89
ROUND 9 – HIV
4.9.4. Sub-recipients to be identified
Explain why some or all of the sub-recipients are not already identified. Also explain the transparent,
time-bound process that the Principal Recipient(s) will use to select sub-recipients so as not to delay
program performance.
Sub-Recipients of the Ministry of Public Health (MINSANTE) and CARE are already identified and have
legal status and the capacity to carry out activities at the strategic and program level. Indeed, MINSANTE
and CARE as PRs have 5 years of management experience with the Global Fund. They have in the past
contracted with the institutions selected for implementing activities. These have signed agreements
setting out terms of grants received by the Principal Recipient under the proposals, in Rounds 3, 4, and 5
for HIV/AIDS. They depend on Sub-Recipients in their allocation of activity packages to achieve.
MINSANTE and CARE depend on the Sub-Recipients and depend on their capacity to mobilise their
decentralised network.
MINSANTE and CARE have not yet identified all their Sub-Recipients. The Sub-Recipients will work with
Sub-Sub-Recipients and the CBOs. Sub-Recipients will be recruited on the basis of a well established
procedure by common agreement with the CCM following precise criteria.
To guarantee the integrity and coherence of an open and transparent process, selection of new Sub
Recipients will be done after a call for submission of nominations to be published in newspapers and on
the radio. A selection committee will be established and mandated to prepare the evaluation. Those
selected are those who meet the required criteria, such as: technical competence., management
capabilities (performance), dynamism in the field, previous experience in the areas mentioned in the
candidate's datasheet.
4.9.5. Coordination between implementers
Describe how coordination will occur between multiple Principal Recipients, and then between the
Principal Recipient(s) and key sub-recipients to ensure timely and transparent program performance.
Comment on factors such as:
•
How Principal Recipients will interact where their work is linked (e.g., a government Principal
Recipient is responsible for procurement of pharmaceutical and/or health products, and a nongovernment Principal Recipient is responsible for service delivery to, for example, hard to reach
groups through non-public systems); and
•
The extent to which partners will support program implementation (e.g., by providing
management or technical assistance in addition to any assistance requested to be funded through
this proposal, if relevant).
NCCA and CARE will work in partnership under the direction of CCM-Cameroon where all the sectors of
Cameroonian society are represented.
Skills transfer at the Sub-Recipient level is indispensable to obtain the same strictness in management.
For example, it is important that at the level of sub-recipients there should be a small procedure manual
for improving management of activities. Training of Sub-Recipients on Global Fund procedures is a key
element for success of activities and achieving objectives. This requires recruitment of management and
technical staff both at NCCA and CARE.
For smooth operation of the program in a timely and transparent manner, coordination between the
principal recipients will be made through a joint work program to enable them to:
•
Regularly evaluate the contribution of each in the implementation of activities;
•
Periodically evaluate the results obtained and the timing decided;
•
Identify potential bottlenecks and constraints to be addressed.
Coordination of the activities of Sub-Recipients will by overseen by the Principal Recipient. It will hold
quarterly meetings with persons concerned in order to monitor the progress of activities being carried out
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
68/89
ROUND 9 – HIV
and to help them in preparing the different reports that are required. As Principal Recipient, it will identify
training and/or technical support needs by sub-recipients for which adequate solutions will be made,
either through training or by experts who will be identified for this purpose.
4.9.6. Strengthening implementation capacity
The Global Fund encourages in-country efforts to strengthen government, non-government and
community-based implementation capacity.
If this proposal is requesting funding for management and/ or technical assistance to ensure strong
program performance, summarize:
(a)
the assistance that is planned;**
(b)
the process used to identify needs within the various sectors;
(c)
how the assistance will be obtained on competitive, transparent terms; and
(d)
the process that will be used to evaluate the effectiveness of that assistance, and make
adjustments to maintain a high standard of support.
** (e.g., where the applicant has nominated a second Principal Recipient which requires capacity development to
fulfill its role; or where community systems strengthening is identified as a "gap" in achieving national targets, and
organizational/management assistance is required to support increased service delivery.)
As part of national efforts to strengthen the capacity for implementation, the need for Technical
Assistance for the estimated annual requirements for medicines (ARV and MOI) is identified.
This Technical Assistance could be needed once per year to determine national estimates for medicines
(ARV and MOI). At the time there will be an ability for skills transfer. His estimated stay will be 10 days.
This assistance is anticipated in the first two years of implementing the proposal.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
69/89
ROUND 9 – HIV
4.10.
Management of pharmaceutical and health products
4.10.1. Scope of Round 9 proposal
No
Does this proposal seek funding
pharmaceutical and/or health products?
for
any
Î Go to s.4B if relevant, or direct to s.5.
X
Yes
Î Continue on to answer s.4.10.2.
4.10.2. Table of roles and responsibilities
Provide as complete details as possible. (e.g., the Ministry of Health may be the organization responsible for the
‘Coordination’ activity, and their ‘role’ is Principal Recipient in this proposal). If a function will be outsourced, identify
this in the second column and provide the name of the planned outsourced provider.
Activity
Procurement policies &
systems
Which organizations and/or
departments are responsible for
this function?
(Identify if Ministry of Health, or
Department of Disease Control,
or Ministry of Finance, or nongovernmental partner, or
technical partner.)
In this proposal what is the role
of the organization responsible
for this function?
(Identify if Principal Recipient,
sub-recipient, Procurement
Agent, Storage Agent, Supply
Management Agent, etc.)
CENAME, MOH,
Procurement agent
Does this
proposal
request
funding for
additional
staff or
technical
assistance
Yes
X
Intellectual property rights
MINCOMMERCE, MOH
OAPI, TRIPS
Yes
PR
X
Quality assurance and quality
control
CENAME, MOH
Management and coordination
More details required in
s.4.10.3.
Ministry of Public Health
Product selection
MOH, Partners
X
X
Forecasting
RP, Procurement Agent
NACC, CENAME
RP, Procurement Agent
No
Yes
PR
DEP (NHMIS), CENAME,
CAPRs SE/ RP/FM, NACC,
DPM
No
Yes
PR
X
Management Information
Systems (MIS)
No
Yes
Procurement agent
LANACOME
No
No
Yes
X
No
X
Yes
No
Procurement and planning
CENAME
Yes
Procurement agent
X
Storage and inventory
management
More details required in
CENAME
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
Procurement agent
No
Yes
70/89
ROUND 9 – HIV
s.4.10.4
X
Distribution to other stores and
end-users
More details required in
s.4.10.4
CENAME, CARPs, Health
centers
Ensuring rational use and
patient safety
(pharmacovigilance)
CENAME, NACC, CARPs
Yes
Procurement agent
X
PR, Procurement
No
No
Yes
agent
X
No
4.10.3. Past management experience
What is the past experience of each organization that will manage the process of procuring, storing and overseeing
distribution of pharmaceutical and health products?
Organization Name
CENAME
PR, subrecipient, or
agent?
(Same currency as on cover of proposal)
Agent
22,622,550 Euros
Total value procured during
last financial year
[use the "Tab" key to add extra rows if more
than four organizations will be involved in the
management of this work]
4.10.4. Alignment with existing systems
Describe the extent to which this proposal uses existing country systems for the management of the
additional pharmaceutical and health product activities that are planned, including pharmacovigilance
systems. If existing systems are not used, explain why.
Purchasing, storage, quality control, distribution of medicines and medical consumables are done through
the SYNAME which includes the National Central Purchasing of Medicines and Essential Medical
Consumables (CENAME) and 10 Regional Procurement Supply Centres (RPSC) located at regional
headquarters. In addition, CENAME has a depot at Ngaoundéré to ensure supply of RPSC in the
Northern Regions of the country. CENAME ensures purchasing of medicines and storage at the central
level. Quality control is assured by the National Quality Control Laboratory for medicines and expertise
(LANACOME, YAOUNDE-CAMEROON), the National Public Health and Expertise Laboratory (LANSPEX
Niamey – Niger) and the Medico-Pharmaceutical Humanitarian Central (CHMP, Clermont Ferrand
France) for counter expertise.
CENAME then ensures distribution to the RPSC. The RPSCs are responsible for distribution within the
health facilities.
Under this proposal, the process of purchasing, storage and distribution will be done with the existing
SYNAME.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
71/89
ROUND 9 – HIV
4.10.5. Storage and distribution systems
X
(a)
Which organization(s) have
primary responsibility to
provide
storage
and
distribution services under
this proposal?
National medical stores or equivalent
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 this 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 RPSCs currently have very good storage capacity. CENAME has a central storage
capacity of about 6,800 m² in Yaoundé with a Ngaoundéré Attachment of about 1,100 m². The RPSCs
have a storage capacity which varies from 600 to 1000 m². This capacity permits storage of ARV acquired
under Round3 from the Global Fund without difficulty.
(c)
For distribution partners, what is each organization's current distribution capacity for
pharmaceutical and health products? If this 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 Vans and 02 pickups which ensure pharmaceutical product distribution in
the 7 Souther Regions of the country. For the Northern Regions, transport is assured by the CAMRAIL
which is the National Railway Company [Compagnie Nationale des Chemins de Fer] up to the depot at
Ngaoundéré. At this depot, distribution of products within the RPSCs is done by rented trucks and 1
pickup.
Each RPSC has 3 to 5 cars (PICK-UP) for distribution at health facilities.
This proposal will not significantly increase the volume of products to be distributed.
4.10.6. Pharmaceutical and health products for initial two years
Complete 'Attachment B-HIV' to this Proposal Form, to list all of the pharmaceutical and health
products that are requested to be funded through this proposal.
Also include the expected costs per unit, and information on the existing 'Standard Treatment Guidelines
('STGs'). However, if the pharmaceutical products included in ‘Attachment B-HIV’ are not included in the
current national, institutional or World Health Organization STGs, or Essential Medicines Lists ('EMLs'),
describe below the STGs that are planned to be utilized, and the rationale for their use.
Not applicable
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
72/89
ROUND 9 – HIV
4.10.7. Multi-drug-resistant tuberculosis
Yes
Is the provision of treatment of multi-drugresistant tuberculosis included in this HIV
proposal as part of HIV/TB collaborative
activities?
In the budget, include USD 50,000 per year over the full
proposal term to contribute to the costs of Green Light
Committee Secretariat support services.
X
No
Do not include these costs
4B.
PROGRAM DESCRIPTION – HSS CROSS-CUTTING INTERVENTIONS
Optional section for applicants
SECTION 4B CAN ONLY BE INCLUDED IN ONE DISEASE IN ROUND 9 and only if:
ƒ
The applicant has identified gaps and constraints in the health system that have an impact
on HIV, tuberculosis and malaria outcomes;
ƒ
The interventions required to respond to these gaps and constraints are 'cross-cutting' and
benefit more than one of the three diseases (and perhaps also benefit other health
outcomes); and
ƒ
Section 4B is not also included in the tuberculosis or malaria proposal
Read the Round
interventions.
9
Guidelines
to
consider
including
HSS
cross-cutting
'Section 4B' can be downloaded from the Global Fund's website here if the applicant
intends to apply for 'Health systems strengthening cross-cutting interventions' ('HSS crosscutting interventions').
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
73/89
ROUND 9 – HIV
5.
FUNDING REQUEST
5.1.
Financial gap analysis - HIV
Î Summary Information provided in the table below should be explained further in sections 5.1.1 – 5.1.3 below.
Financial gap analysis (same currency as identified on proposal coversheet)
Note Î Adjust headings (as necessary) in tables from calendar years to financial years (e.g., FY ending 2008 etc.) to align with national planning and fiscal periods
Actual
2007
Planned
2008
2009
Estimated
2010
2011
2012
2013
2014
HIV program funding needs to deliver comprehensive prevention, treatment and care and support services to target populations
Line A Î Provide annual amounts
57,219,424
61,498,509
65,910,838
Line A.1 Î Total need over length of Round 9 Funding Request
70,435,866
73,957,659
77,655,542
81,538,319
85,615,235
389,202 622
(combined total need over Round 9 proposal
term)
Current and future resources to meet financial need
Domestic source B1: Loans and debt
relief (provide name of source )
1,524,390
1,524,390
914,634
6,551,210
6,730,326
7,656,393
7,637,338
8,410,966
Domestic source B2
National funding resources
3,926,829
4,868,739
3,496,788
3,495,426
3,495,426
3,495,426
3,495,426
3,495,426
542,097
388,132
376,241
376,241
376,241
Domestic source B3
Private Sector contributions (national)
Total of Line B entries Î Total
current & planned DOMESTIC
(including debt relief) resources:
External resource C 1
(ADB-UNESCO)
5,451,219
6,393,129
4,411,422
10,588,733
10,613,884
11,528,060
11,509,005
12,282,633
707,649
435,357
145,119
145,119
145,119
145,119
145,119
145,119
762,195
1,143,293
2,439,024
2,439,024
2,667,683
1,600,610
0
0
External source C2
(UNICEF)
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
74/89
ROUND 9 – HIV
Financial gap analysis (same currency as identified on proposal coversheet)
Note Î Adjust headings (as necessary) in tables from calendar years to financial years (e.g., FY ending 2008 etc.) to align with national planning and fiscal periods
Actual
Planned
Estimated
2007
2008
2009
2010
2011
2012
2013
2014
265,000
270,000
270,000
335,000
335,000
360,000
360,000
385,000
809,756
579,314
579,314
579,314
579,314
579,314
579,314
579,314
186,078
378,213
115,808
26,677
22,866
22,866
22,866
22,866
99,051
146,322
92,546
30,488
30,488
30,488
30,488
30,488
75,000
105,000
200,000
200,000
200,000
200,000
200,000
200,000
1,713,710
1,873,496
2,973,171
2,973,171
2,881,707
2 881707
106,707
106,707
533,537
533,537
1,143,293
1,143,293
0
0
0
0
1,756,954
1,040,822
1,227,459
1,848,565
0
0
0
0
NA
NA
NA
NA
NA
9,720,651
6,862,177
2,938,397
1,444,494
1,469,494
External source C3
(WHO)
External source C4
(WORLD BANK)
External source C5
(ILO)
External source C6
(UNDP)
External source C7
(UNAIDS)
External source C8
(GTZ KFW – German Cooperation)
External source C9
(American Government)
External source C10
(Clinton Foundation)
External source C3
Private Sector Contributions
(International)
Total of Line C entries Î
Total of EXTERNAL resources
(Global Funds subsidies excluded)
current and projected:
6,908,930
6,505,354
9,185,734
In line D below, insert additional separate lines for each separate Global Fund grant. This will ensure that you show information on different Global
Fund grants.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
75/89
ROUND 9 – HIV
Financial gap analysis (same currency as identified on proposal coversheet)
Note Î Adjust headings (as necessary) in tables from calendar years to financial years (e.g., FY ending 2008 etc.) to align with national planning and fiscal periods
Actual
Planned
2007
2008
2009
13,093,212
12,096,743
8,192,207
Round 4
2,131,087
3,171,847
220,866
Round 5
1,500,277
379,577
Total line D
16,724,576
Line E Î Total current and planned
resources (i.e. Line E = Line B total
+
29,084,725
Line D: Annual value of all existing
Global Fund grants for same
disease: Include unsigned ‘Phase 2’
amounts as “planned” amounts in
relevant years
Estimated
2010
2011
2,065,051
2,045,391
2,251,203
15,648,167
10,478,124
2,045,391
2,251,203
28,546,650
24,075,280
22,354,775
19,727,264
2012
2013
2014
14,466,457
12,953,499
13,752,127
Round 3
Line C total + Lind D Total)
Calculation of gap in financial resources and summary of total funding requested in Round 9 (to be supported by detailed budget)
Line F Î Total funding gap
(i.e. Line F = Line A – Line E)
28,134,699
41,835,558
48,081,091
54,230,395
63,189,085
68,584,820
71,863,108
Line G = Round 9 HIV funding request
(same amount as requested in table 5.3 for this disease)
19,635,129
21,701,203
23,630,906
26,331,590
29,957,084
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
32,951,859
76/89
ROUND 9 – HIV
Part H – 'Cost Sharing' calculation for Lower-middle income and Upper-middle income applicants
In Round 9, 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 reaching 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 reaching not more than 35% of
the national disease program funding needs over the proposal term.
Line H Î Cost Sharing calculation as a percentage (%) of overall funding from Global Fund
Cost sharing =
(Total of Line D entries over 2010-2014 period + Line G Total) X 100
31%
Line A.1
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
77/89
ROUND 9 – HIV
5.1.1. Explanation of financial needs – LINE A in table 5.1
Explain how the annual amounts were:
•
developed (e.g., through costed national strategies, a Medium Term Expenditure Framework
[MTEF], or other basis); and
•
budgeted in a way that ensures that government, non-government and community needs were
included to ensure fully implementation of country's HIV program strategies.
The National Strategic Framework for the Fight against STI/HIV/AIDS covers the period 2006-2010.
The financial needs for its implementation have been estimated from the planning of central and
regional sectoral activities. These financial needs are estimated at 301,131,104 Euros for the 20062010 period.
The period estimated for implementing the proposal exceeds 4 years, the period covered by the
National Strategic Framework for the Fight against STI/HIV/AIDS. For this purpose, an estimate of
needs was made for 2011 and 2014 taking into account expected costs for 2010, increased by 5%
annually for the cost of inflation. It is also based on costing for national strategies and epidemiological
projections. Needs for 2010-2014 are estimated at 389,202,622 Euros.
5.1.2. Domestic funding – 'LINE B' entries in table 5.1
Explain the processes used in country to:
•
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
•
ensure that domestic resources are utilized efficiently, transparently and equitably, to help
implement treatment, prevention, care and support strategies at the national, sub-national and
community levels.
The national financial contribution for the fight against HIV/AIDS comes from the direct Government
budget, funds from debt relief (HIPC Resources).
Regarding HIPC resources, a project document has been prepared taking into account national needs
(Attachment 18). The project is submitted to the Advisory and Monitoring Committee for HIPC
Resources, presided over by the Ministry of Finance. This committee reviews the project and
near to approval of the project, a sectoral panel defines the fields to be financed. The
selection criteria are mainly the complementarity with existing financing and the priority with
the actions which directly affect patients. Under the HIPC 2009-2012 project, priority was
given to supply of medicines, acquisition of screening tests and medical equipment
(Attachment 18).
The direct Government budget is mobilised as the counterpart of external funding (Global Funds,
World Bank), salaries for staff responsible for implementing activities, operations,
renovations, equipment for organisations that monitor and care for patients.
5.1.3. External funding excluding Global Fund – 'LINE C' entries in table 5.1
Explain any changes in contributions anticipated over the proposal term (and the reason for any
identified reductions in external resources over time). Any current delays in accessing the external
funding identified in table 5.1 should be explained (including the reason for the delay, and plans to
resolve the issue(s)).
Contributions of partners for the 2010-2014 period have been supplied by them for reference. No
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
78/89
ROUND 9 – HIV
change in external financial contribution has yet been identified.
5.2.
Detailed Budget
Suggested steps in budget completion:
1.
Submit a detailed proposal budget in Microsoft Excel format as a clearly numbered
Attachment. Wherever possible, use the same numbering for budget line items as the program
description.
•
FOR GUIDANCE ON THE LEVEL OF DETAIL REQUIRED (or to use a template if there is
no existing in-country detailed budgeting framework) refer to the budget information
available at the following link: http://www.theglobalfund.org/en/rounds/9/single/#budget
2.
Ensure the detailed budget is consistent with the detailed workplan of program activities.
3.
From that detailed budget, prepare a 'Summary by Objective and Service Delivery Area'
(s.5.3.)
4.
From the same detailed budget, prepare a 'Summary by Cost Category' (s.5.4.)
5.
Do not include any CCM or Sub-CCM operating costs in Round 9. This support is now available
through a separate application for funding made direct to the Global Fund (and not funded
through grant funds). The application is available at: http://www.theglobalfund.org/en/ccm/
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
79/89
ROUND 9 – HIV
Clarified section 5.3
5.3.
Summary of detailed budget by objective and service delivery area
Service delivery area
Objective
Number
(Use the same numbering as
in program description in
s.4.5.1.)
Year 1
ART and follow-up
Building of civil society
and institutional capacity
Support for orphans and
vulnerable children
Cost of programme
management and
administration
Care and support for the
chronically ill
7 771 453
10 697 798
11 662 517
14 223 006
17 067 140
61 421 914
3 197 161
2 350 395
2 047 860
2 047 860
2 047 860
11 691 136
2 065 986
2 090 502
2 253 225
2 291 765
2 363 335
11 064 813
2 208 171
1 921 948
1 986 433
2 002 898
2 002 898
10 122 348
1 467 575
1 289 277
1 502 307
1 425 942
1 396 308
7 081 409
91 165
735 813
1 711 671
1 883 379
2 330 074
6 752 102
1 227 049
1 149 887
905 898
940 485
1 151 376
5 374 695
708 977
466 967
505 339
438 154
438 154
2 557 591
269 065
335 383
404 026
477 969
558 755
2 045 198
Testing and counselling
218 635
311 363
318 099
312 677
313 729
1 474 503
Condoms
Development of Publicprivate sector partnership
230 897
230 897
230 897
230 897
230 897
1 154 485
178 995
120 973
102 634
56 558
56 558
515 718
19 635 129
21 701 203
23 630 906
26 331 590
29 957 084
121 255 912
PMTCT
Monitoring/evaluation and
operational research
CCC – community relay
workers and schools
Prophylaxis and treatment
of OIs
Round 9 HIV funding request:
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
Year 2
Year 3
Year 4
Year 5
Total
80/89
ROUND 9 – HIV
5.4.
Summary of detailed budget by cost category (Summary information in this table should be further explained in sections 5.4.1 – 5.4.3 below.)
Avoid using the "other" category unless
necessary – read the Round 9 Guidelines.
Human resources
Technical and Management Assistance
Training
Health products and health equipment
Pharmaceutical products (medicines)
Procurement and supply management costs
Infrastructure and other equipment
Communication Materials
Monitoring & Evaluation
Living Support to Clients/Target
Populations
Planning and administration
Overheads
(same currency as on cover sheet of Proposal Form)
Year 1
Year 2
Year 3
Year 4
Year 5
Total
2,226,983
2,701,309
2,765,794
2,782,259
2,782,259
13,258,604
218,160
57,327
0
0
0
275,487
1,211,978
183,395
486,578
39,607
0
1,921,558
2,467,503
3,433,401
2,510,041
2,958,532
3,479,059
14,848,536
5,065,974
7,422,027
9,734,499
11,988,853
14,532,968
48,744,321
859,485
1,273,595
1,643,450
2,010,712
2,432,692
8,219,934
2,053,506
108,594
88,105
88,105
46,395
2,384,705
565,820
493,310
526,414
455,014
451,641
2,492,199
945,243
915,674
776,073
777,849
956,102
4,370,941
3,032,461
3,974,636
3,917,374
4,019,512
4,064,821
19,008,804
467,799
578,020
622,663
651,232
651,232
2,970,946
520,217
559,915
559,915
559,915
559,915
2,759,877
0
0
0
0
0
0
19,635,129
21,701,203
23,630,906
26,331,590
29,957,084
121,255,912
Other: (Use to meet national budget planning
categories, if required)
Round 9 HIV funding request
(Should be the same annual totals as table 5.2)
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
81/89
ROUND 9 – HIV
5.4.1. Overall budget context
Briefly explain any significant variations in cost categories by year, or significant five year totals for
those categories.
The end of Round 3 funding and high risks of associated stock shortage are reflected by the importance
of the Pharmaceutical (medicines) Products category, which represents over 50% of the overall budget of
the proposal. The number of persons under ARV treatment, estimated to be 165,061 by the end of 2014,
has the effect on the supply of ARV of constituting only 41%, or € 49 M, of overall expenses.
Pharmaceutical (medicines) Products: The great significance of the active file in Cameroon and its
estimated growth (increase of 100% in the period 2010-2014) combined with the cessation of other
sources of financing, especially by UNITAID regarding second line ARV (cost four times higher than a
first-line treatment), causes the supply of ARVs to increase from € 5M in 2010 to € 13M in 2014.
Infrastructure and other training equipment: Investment in these categories will be almost exclusively
made in year 1, with the progressive establishment of new care units and increasing the scale of PMCT
from 2012, the date when the Global Funds Rounds 5 comes to an end. Support of equipment of
participants involved at all levels of the "Strengthening of Civil Society and Institutional Capacities" (about
45% of the Infrastructure category) and training of peer educators and community volunteer will only be
done in the first year and will allow putting in place the needed environment for smooth running of the
program.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
82/89
ROUND 9 – HIV
5.4.2. Human resources
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.
(Useful information to support the assumptions to be set out in the detailed budget includes: a list of the proposed
positions that is consistent with assumptions on hours, salary etc included in the detailed budget; and the proportion
(in percentage terms) of time that will be allocated to the work under this proposal.
Î Attach supporting information as a clearly named and numbered Attachment
The cost of human resources in this proposal represents 10.8% of the overall budget and consists first of
all of the compensation for government staff (central and regional) and, secondly, salaries for civil society
participants.
Monthly compensation (social security and taxes excluded) of government staff:
Permanent Secretary (NCCA Program Chief)
Deputy Permanent Secretary
Section Heads
Unit Heads
€ 1,220
€ 1,067
€ 610
€ 534
Monthly salaries (social security and taxes excluded) for civil society:
Principal Recipient:
Project Manager
Deputy Project Manager
Regional Project Manager
Deputy Regional Project Manager
€ 2,159
€ 1,653
€ 1,357
€ 503
Sub-Recipients:
Project Manager
Administrative and Financial Manager
CS activity manager
M&E Manager
Driver
€ 915
€ 686
€ 457
€ 457
€ 229
Supporting Civil Society will enable it to take on its role well in the various SDA described above. Most of
these organisations do not have their own funding and can only operate with the support of external
donors.
5.4.3. Other large expenditure items
If other 'cost categories' represent important amounts in the summary in table 5.4, (i) explain the basis for
the budget calculation of those amounts.
Also explain how this contribution is important to
implementation of the national HIV program.
Î Attach supporting information as a clearly named and numbered Attachment
Pharmaceutical (medicines) Products: Quantification of ARV needs is based on protocols currently
used and progress towards new protocols following changes to the care guide. More details on the basis
of calculating ARV needs, as well as reagents and laboratory consumables can be found under "GAS
Plan".
Humane support of patients/target populations:
(1) Care for OVC includes provision of several supports: educational, health and legal. OVCs identified
as extremely vulnerable will benefit from additional nutritional support.
The provision of psychosocial support will be assured by Community Liaison Agents, who will benefit from
monthly compensation of € 99.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
83/89
ROUND 9 – HIV
5.5.
Funding requests in the context of a common funding mechanism
In this section, common funding mechanism refers to situations where all funding is contributed into a
common fund for distribution to implementing partners.
Do not complete this section if the country pools, for example, procurement efforts, but all other
funding is managed separately.
5.5.1. Operational status of common funding mechanism
Briefly summarize the main features of the common funding mechanism, including the fund's name,
objectives, governance structure and key partners.
Î Attach, as clearly named and numbered Attachmentes to your proposal, the memorandum of understanding, joint
Monitoring and Evaluation procedures, the latest annual review, accountability procedures, list of key partners, etc.
No common operating funding mechanism exists.
5.5.2. Measuring performance
How often is program performance measured by the common funding mechanism? Explain whether
program performance influences financial contributions to the common fund.
Not applicable
5.5.3
Additionality of Global Fund request
Explain how the funding requested in this proposal (if approved) will contribute to the achievement of
outputs and outcomes that would not otherwise have been supported by resources currently or planned
to be available to the common funding mechanism.
If the focus of the common fund is broader than the HIV program, applicants must explain the process by which they
will ensure that funds requested will contribute towards achieving impact on HIV outcomes during the proposal term.
Not applicable
5B.
FUNDING REQUEST – HSS CROSS-CUTTING INTERVENTIONS
Applying for funding for HSS cross-cutting interventions is optional in Round 9
SECTION 5B CAN ONLY BE INCLUDED IN ONE DISEASE IN ROUND 9 and only if this
disease includes the applicant's programmatic description of HSS cross-cutting interventions
in s.4B.
Read the Round 9 Guidelines to consider including HSS cross-cutting
interventions
Download 'Section 5B' from the Global Fund website here if the applicant intends to
apply for 'Health systems strengthening cross-cutting interventions' ('HSS crosscutting interventions') in Round 9 and has completed section 4B and included that
section in the HIV proposal sections.
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
84/89
Proposal checklist – Section 3 to 5 HIV
Section 3 and 4: Program Description
List Attachment
Name and Number
4.1
Supporting documentation for National Strategy
National Strategic
Plan for the Fight
against AIDS 20062010
Attachment 1
4.2.1
Map if proposal targets specific region/population group
Target group
localisation map
4.3.2
Any recent report on health system weaknesses and gaps
that impact outcomes for the three diseases (and beyond if it
exists).
- Report of estimate
program gaps and
funding needs for
PNLS
Attachment
22
- Report of evaluation
of Health Sector
Strategy
implementation, 2006
Attachment
16
4.4
Document(s) that explain basis for coverage targets
4.5.1
A completed 'Performance Framework' by disease
Refer to the M&E Toolkit for help in completing this table.
Attachment A
4.5.1
A detailed component Work Plan (quarterly information for
the first two years and annual information for years 3, 4 and 5)
by disease.
Work plan
4.5.2
A copy of the Technical Review Panel (TRP) Review Form
for unapproved Round 7 or Round 8 proposals (only if
relevant).
4.8.1
A recent evaluation of the ‘Impact Measurement Systems’
as relevant to the proposal (if one exists)
4.9.1
A recent assessment of the Principal Recipient capacities
(other than Global Fund Grant Performance Report).
4.9.1
Document describing the organization such as: official
registration papers, summary of recent history of
organization, management team information
(for non-CCM
applicants)
4.9.2
Tables of Proposal
Objectives
- ECAM III
Attachment 17
List of sub-recipients already identified (including name,
sector they represent, and SDA(s) most relevant to their
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
85/89
Proposal checklist – Section 3 to 5 HIV
activities during the proposal term)
4.10.6
A completed ‘List of Pharmaceutical and Health Products’
by disease (if applicable).
Section 4B: HSS Cross-cutting (once only in whole country proposal)
4B.2
4B.2
Attachment A
A detailed separate HSS cross-cutting Work Plan (or add
a separate “worksheet” to the disease Work Plan under
which s. 4B is submitted) (quarterly information for the first
two years and annual information for years 3, 4 and 5).
Work plan
5.2
A ‘detailed budget’ (quarterly information for the first two
years, and annual information for years 3, 4 and 5)
5.4.2
Information on basis for budget calculation and diagram
and/or list of planned human resources funded by proposal
(only if relevant)
5.4.3
Information on basis of costing for ‘large cost category’ items
5.5.1
Documentation describing the functioning of the common
funding mechanism
5.5.2
(if common
funding
mechanism)
5B.4.2
List Attachment
Name and Number
Detailed Budget
Most recent assessment of the performance of the common
funding mechanism
Section 5B: HSS Cross-cutting financial information
5B.1
List Attachment
Name and Number
A completed separate HSS cross-cutting 'Performance
Framework' (or add a separate “worksheet” to the
disease ‘Performance Framework’ under which s. 4B is
submitted)
Refer to the M&E Toolkit for help in completing this table.
Section 5: Financial Information
(if common
funding
mechanism)
Attachment B
A separate HSS cross-cutting ‘detailed budget’ (or add a
separate “worksheet” to the disease ‘detailed budget’
under which s. 4B is submitted). Quarterly information for
the first two years, and annual information for years 3, 4
and 5).
List Attachment
Name and Number
Detailed Budget
Information on basis for budget calculation and diagram
and/or list of planned human resources funded by proposal
(only if relevant)
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
86/89
Proposal checklist – Section 3 to 5 HIV
5B.4.3
Information on basis of costing for ‘large cost category’ items
Other documents relevant to sections 3, 4 and 5 attached by Applicant:
3.5.
Information on priority target groups of the strategic plan
Available in Proposal R8, Attachment 1
List Attachment
Name and Number
National Strategic
Plan for the Fight
against AIDS 20062010
Attachment 1
4.1.
Information on the disabled population in Cameroon
National Policy for
Protection of the
Disabled
Attachment 2
4.1.
Information on the youth population
Youth Plan, 2009
Attachment 4
4.1.
Information on seroprevalence among youths and women
Report on the World
AIDS Epidemic,
UNAIDS
Attachment 4
4.1.6.
Information on condom use among women
Report of CNLS
activities, 2007
Attachment 5
Available in Proposal R8, Attachment 3
4.2.1
Information on average prevalence among the general population
UNAIDSEpidemiological Fact
Sheet CameroonSeptember 2008
Attachment 6
4.2.1.
Information on seropositivity in the Pygmy environment
Report of FONDAP
activities on screening
in the Pygmy
environment
Attachment 7
4.2.1.
Information on sexual practices of MSM
The homosexual
question in Africa, the
case of Cameroon,
Gueboguo C., 2007
Attachment 8
4.2.1.
Information on seroprevalence in groups at risk
Report of the
seroepidemiological
and HIV and AIDS
behaviours survey
conducted on specific
groups, 2004
Attachment 9
4.2.1.
Information on seroprevalence by gender and population age group
EDSC III, 2004
Attachment
10
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
87/89
Proposal checklist – Section 3 to 5 HIV
4.2.1
Information on indigenous peoples in Cameroon
Indigenous and Tribal
People and Poverty
Reduction Strategy in
Cameroon, 2005
Attachment 11
4.2.1.
Information on estimated numbers of PLWHA
EEP Spectrum
Attachment 12
4.2.2.
Information on seroprevalnce of HIV
Progress Report of
UNGASS nº 3
Cameroon
Attachment
13
Available in Proposal R8, Attachment 7
4.3.1.
Information on the percentage of patients lost track of.
Report of IAP
evaluation and
pharmacovigilance
Attachment
14
4.3.1.
Information on pregnant women tested in CPH; on utilisation of
screening services
2008 Annual Report
of CNLS activities
Attachment
15
4.3.2.
Information on funding of the Health Sector
Report of sectoral
strategy
implementation
evaluation, 2006
Attachment
16
4.3.2
Information on poverty in Cameroon
ECAM III Report
Attachment
17
4.5.1.
Information on the IPC Project required to finance 50% of ARV
purchases
IPC Project Document
Attachment
17
4.5.1.
Information on the CU mentoring system in Cameroon
National Mentoring
Guide for PLWHA
Care Units in
Cameroon
Attachment
19
4.5.1.
Information on national AIDS expenses
NASA Report 2008
Attachment
20
4.6.2.
Information on MSM
Project MESDINE
Activity Report
Attachment
21
4.7.2.
Information on program and financial gaps for PNLS
Report of Program
Gaps and Funding
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
88/89
Proposal checklist – Section 3 to 5 HIV
Needs Attachment
22
4.8.1.
Directives for PNLS monitoring and evaluation
Available in Proposal R8, Attachment 7
6.1.1.
National Guide for
Monitoring of the
National Strategic
Plan 2006-2010
Attachment
23
Information on sex workers
Cartographical report
of sex workers
Attachment
24
Information on project target groups
Target Group
Description Document
Attachment
25
Information on the fight against HIV and AIDS in the workplace
Final Report of the
HIV/AIDS Workplace
Education Program
(SHARE) for
Cameroon
Attachment 26
Information on the fight against AIDS in the workplace
Final Progress Report
of Multi and Bilateral
ILO Technical
Cooperation
Attachment
27
R9_CCM_CMR_H_PF_s3-5_4Aug09_En
89/89
Download
Related flashcards
Surgery

42 Cards

Orthopedics

21 Cards

Traumatology

37 Cards

Hygiene

25 Cards

Create flashcards