proposal form – round 9 - (single country applicants)

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)

LOWER INTERMEDIATE

Applicant Type CCMX Sub-CCM

Non-CCM

Round 9 Proposal Element(s):

Disease 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?

HIV1

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

1 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

http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_Guidelines_Single_en.pdf

http://www.who.int/tb/publications/tbhiv_interim_policy/en/

If this is a Round 8 proposal being re-submitted, have the TRP Review Form comments been clearly addressed in s.4.5.2?

Yes

No

Are there major new objectives compared to the Round 8 proposal that is being re-submitted? If yes, please provide a summary of the changes in the box below by each disease

re-submission and section number.

Yes

No

INSERT TEXT – maximum one page

Currency USD or X EURO

Deadline for submission of proposals: 12 noon, Local Geneva Time, Monday 1 June 2009



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.



http://www.theglobalfund.org/en/rounds/9/



http://www.theglobalfund.org/documents/board/16/GF-BM16-Decisions_en.pdf


1. FUNDING SUMMARY AND CONTACT DETAILS Clarified section 1.1 1.1. Funding summary

Disease Total funds requested over proposal term

Year 1 Year 2 Year 3 Year 4 Year 5 Total

HIV 19,635,129 21,701,203 23,630,906 26,331,590 29,957,084 121,255,912

Tuberculosis 3,942,658 2,880,353 3,767,464 2,753,535 2,078,463 15,422,473

Malaria 67,793,574 9,998,422 14,674,613 10,806,113 10,710,615 113,983,337

HSS cross-cutting 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 : 250,661,722

1.2. 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]

Alternate e-mail address [email protected]

[email protected]

[email protected]

[email protected]


mailto:[email protected]






1.3. List of Abbreviations and Acronyms used by the Applicant

Acronym/ Abbreviation

Meaning

[use “Tab” key to add extra rows if needed]


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

X Government 20

X Non-government organizations (NGOs)/community-based organizations 05

X People living with the diseases 04

X People representing key affected populations2 02

X Private sector 04

X Faith-based organizations 03

X Multilateral and bilateral development partners in country 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:

0

2 Please use the Round 9 Guidelines definition of key affected populations.



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) Have non-government sector members (including any new members since the last application) continued to be transparently selected by their own sector; and

X No

Yes

(b) Is there continuing active membership of people living with and/or affected by the diseases. No

X 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


http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_AttachmentC_en.xls

http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_AttachmentC_en.xls

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 non-government) 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:

• 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.

(b) 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.


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.

Complete all of sections 2.2.2 to 2.2.8 below.

Last time applied for funding was before Round 7 or was determined non-compliant with the minimum eligibility requirements when last applied.

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)


http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_PForm_AttachmentD_en.doc

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


http://www.theglobalfund.org/documents/ccm/Clarifications_CCM_Requirements_en.pdf

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.


2.2.4. Processes to select Principal Recipients

The Global Fund recommends that applicants select both government and non-government sector Principal Recipients to manage program implementation. Refer to the Round 9 Guidelines for further explanation of the 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:

• 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.

(b) 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)

Ministry of Public Health Tuberculosis Government



** 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)? X Yes


Proposal checklist - Section 1 and 2

Section 2: Eligibility List Annex Name and Number

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 Sub-CCM).

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 Sub-CCM) 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.


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)

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.

http://www.theglobalfund.org/en/apply/call8/single/#guidelines

http://www.theglobalfund.org/en/rounds/9/single/#guidelines

http://www.theglobalfund.org/en/rounds/9/


http://www.theglobalfund.org/en/files/boardmeeting16/GF-BM16-Decisions.pdf


ROUND 9 – HIV


List of abbreviations and acronyms used by the applicant

Acronym/Abbreviation Signification

CIDA Canadian International Development Agency

ACMS Cameroon Association of Social Marketing (Association Camerounaise de Marketing Social)

ADC Aéroports du Cameroun – Cameroon Airports Company AFFTC Affiliated Treatment Centre

AFRICASO African Council of Aids Services Organisations

RGA Revenue Generating Activities ALUCAM Aluminium du Cameroun 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)

ROUND 9 – HIV


CHART Artisans Association (Chambre des Artisants) HMPC Humanitarian Medical-Pharmaceutical Centre (Centrale Humanitaire Médico-

Pharmaceutique) 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 Community Association for Sustainable Development PCCA Provincial Committee to Combat AIDS (Comité Provincial de Lutte contre le Sida) 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)

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 Language Education Network LFA Local Fund Agent

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 North West Craft Association UN United Nations 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 International Labour Organisation/United State Department of Labour MDG Millennium Development Goals 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)

ROUND 9 – HIV


PCR Polymerase Chain Reaction

PAA Partner Against AIDS (Partenaire Contre le SIDA) POS Point of Sale (Point de vente) Pair éducateur Peer educator PEC Prise en charge CS Community Support PEDC Paediatric Care PEPFAR Presidential Emergency Programme for Aids Relief

PHP Upper Penja Plantations (Plantations du Haut Penja) PIM Purchasing and Inventory Management 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 Swedish International Development Agency MIS Management Information System

ROUND 9 – HIV


PS Permanent Secretary SR Sub Recipient HRH Human Reproductive Health SSR Sub-Sub Recipient

STRACOM Cameroon Transport Company (Société des Transports du Cameroon) SWAP Sector Wide Approach 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

ROUND 9 – HIV 3. PROPOSAL SUMMARY

Planned Start Date To 3.1. Duration of Proposal

Month and year: (up to 5 years)

2010 2014

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.

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))

Clarified section 3.3

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 No. Go to s.3.5.

3.4.2. If yes, does this proposal plan for some or all of the requested funding to be paid into a common-funding mechanism to support that approach?

Yes Complete s.5.5 as an additional section to explain the financial operations of the common


http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_FAQ_GrantConsolidation_en.pdf

ROUND 9 – HIV funding mechanism.

X No. Do not complete s.5.5


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 2006-2010 (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:

(i) To assure the prevention of HIV within 6 at risk and/or vulnerable target groups through close CBC, distribution of condoms, and voluntary Counselling and testing;

(ii) To increase from 50% to 80% from 2012 to 2014 the proportion of pregnant women with access to HIV counselling and testing

(iii) To provide medical care to 165,061 PLWHA adults and children by 2014; (iv) 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; (v) 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


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 monitoring-evaluation 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.


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.

ROUND 9 – HIV 4. PROGRAM DESCRIPTION

4.1. National prevention, treatment, care, and support strategies

(a) 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 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


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


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 non-subsidised 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.


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.

Proposal Attachment

Number Page References Document

Attachment nº 1 R 8, Attachment 1 Page 12 X National Health Sector Development/Strategic Plan

National HIV Control Strategy or Plan

X Important sub-sector policies that are relevant to the proposal (e.g., national or sub-national human resources policy, or norms and standards)

Attachment nº16 Page 28

Attachment nº5 R8, Attachment 3 Attachment nº6 Attachment 12 Attachment nº13 R8, Attachment 7 Attachment 14 Attachment nº 15

Page 26 Page 19 Page 19 Page 25 Page 27 Page 26

X Most recent self-evaluation reports/technical advisory reviews, including any Epidemiology report directly relevant to the proposal

X National Monitoring and Evaluation Plan (health sector, disease specific or other)

Attachment nº 23 R8, Attachment 7 Page 56

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


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 show where

Specific population groups **If so, insert a map to 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 2010 2011 2012 2013 2014 Adults 168,579 178,324 185,695 193 066 201,228 Children 10,504 12,224 14,495 16766 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 out-of-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


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 socio-economic situation (lack of family protection, economic dependency, gender inequality, etc..) out-of-school youths, sensorial handicapped persons, marginal populations (Pygmies, Mbororos, OVC).

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.

3

2

3

2

11


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.


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:


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.


ROUND 9 – HIV

(b) Size of population group(s) (If national data is disaggregated differently then type over the categories proposed)

Population Size Source of Data Year of Estimate Population Groups

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

18 900 Cartographic Report of Sex

Workers

(Attachment 24) 2008 Sex Workers

2,244,260

Youth Plan

Ministère de la Jeunesse

(Attachment 3)

2009 Out-of-school Youths

PYGMIES 73,332 Indigenious and Tribal People

and Poverty Reduction Strategy in Cameroon (Attachment 11)

2005

MBOROROS ND

945,000 Politique Nationale de protection des Handicapés, MINAS (Attachment 2)

2008 Sensorially handicapped

MSM ND


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 Population Groups

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 > 25 years

8,989 UNAIDS 2004 Men living with HIV 19 – 24 years

11,840 UNAIDS 2004 Men living with HIV 15 – 18 years

22 848 UNGASS Progress Report No. 3

Cameroon(Attachment 13) 2007 Girls (0 – 14 years) living with HIV

21,952 UNGASS Progress Report No. 3

Cameroon(Attachment 13) 2007 Boys (0 – 14 years) living with HIV

ND

OVC

29,800 CNLS/CRETES Report (Attachment 9) 2004 Truckers infected with HIV

4,990 CNLS/CRETES Report (Attachment 9) 2004 Sex Workers infected with HIV

Out-of-school youths infected with HIV 71,800 EDS III 2004

1,833 FONDAF Report (Attachment 7) 2005 PYGMIES infected with HIV

ND MBOROROS infected with HIV

Sensorial handicapped infected with HIV 48,195 EDS III 2004

ND MSM infected with HIV


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 populations1 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)

• 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;

1 Please refer back to the definition in s.2 and found in the Round 9 Guidelines.



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;


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


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


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.

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.

Universal access to treatment and care for PLWHA Historical Current Country targets Priority No: 1

Number of adults and children under ARV treatment 2007 2008 2009 2010 2011 2012 2013 2014 Indicator

name

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

D: Round 9 proposal contribution to total need (e.g., can be equal to or less than full gap) 39,742 49,538 59,677 70,598 82,530

Care of OVC Historical Current Country targets Priority No: 2

Number of OVC under care 2007 2008 2009 2010 2011 2012 2013 2014 Indicator name

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 (e.g., can be equal to or less than full gap) 30,000 30,000 30,000 30,000 30,000


ROUND 9 – HIV


Priority No: 3 Promotion of less risky sexual practices for target populations Historical Current Country targets

Indicator name Number of condoms distributed 2007 2008 2009 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 15 766,450 17 200,640 21 400,000 23 700,000 22 750,000 24 250,000 25 500,000 26 000,000

D: Round 9 proposal contribution to total need (e.g., can be equal to or less than full gap) 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 Historical Current Country targets

Indicator name

Number of persons receiving CS with records of results 2007 2008 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

C: Expected annual gap in achieving plans 176,103 159,675 359,675 419,675 469,675 544,675 594 675 644,675

D: Round 9 proposal contribution to total need (i.e., can be equal to or less than full gap) 185,000 293,000 294,910 295,500 297,500

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.

If there are six priority areas, copy the table above once more.

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). 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



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.

Target size

Target to reach

Number of sites

Number of educational sessions

Number of PE trained

Number of awareness campaigns

Awareness kits produced and distributed

Condoms (male and female)

Number of persons screened

Out-of-school youths

2,244,260 1683,195 169 145 880 1,351 960 1 683,195 29175,425 975,270

Truckers 186,000 40,000 26 6,000 157 48 40,000 400,000 24,000

Sex workers 18,900 10,300 29 1,560 116 - 10,300 1 039,500 6,240

Sensorially handicapped

945,000 378 000 39 37 800 467 12 378 000 1,890,000 302,400

MSM

ND 7 500 11 1,125 126 - 7 500 125,000 6,000

Mbororos ND 50,000 60*

13,000

241

16 50 000

36,666

433,330 52,000 Pygmies 73,332 36,666

TOTAL 3 467,492 2205,661 334 205,365 2,458 1036 2 205,661 33 313,255 1 365,910

* 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.


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


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).


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. According to projections, the ARVs (1st, 2nd 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;


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 2011 2012 2013 2014 Cotrimoxazole 48% 38,152 47,556 57,289 67,774 79,229 Cryptococcosis 1% 795 991 1,194 1,412 1,651

Toxoplasmosis 3% 2,385 2 9 88 3,581 4,236 4,952

Mycosis 15% 11,923 14,861 17,903 21,179 24,759 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.


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


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 Extremely vulnerable Medium vulnerability

TOTAL New Old

Year 1 6,000 24,000 30,000 Year 2 4,800 6,000 19,200 30,000 Year 3 3,840 10,800 15,360 30,000 Year 4 3 0 88 14,640 12 2 88 30,000 Year 5 2,458 17,712 9,830 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


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).


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


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; 5.4.11 Evaluate the M&E system at the beginning of the 1st 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-


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: out-of-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


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


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 semi-annual 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).


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:


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,


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:

the factors considered when deciding to proceed with the request on a disease specific basis; and

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


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


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.


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 Cameroon-Equatorial 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 2006 2007 2008

UNICEF

Bi Multi 3,000 7000 Integral Project of the fight against HIV and AIDS (OVC Component)

0 612

Total UNICEF 3,000 7,612 CARE Cameroon (GFATM 4) 35,133 45,519 16,762 19,543 Catholic Relief Services (CRS) 2,424 6,030 5,780 4,229

T O T A L 37,557 51,549 25,542 31,384


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.



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.)

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.

Population relevant to Private Sector co-investment (All or part, and which part, of proposal's

targeted population group(s)?)

Contribution Value (in USD or EURO) Refer to the Round 9 Guidelines for examples

Contribution Description (in words)

Year 1 Year 2 Year 3 Year 4 Year 5 Total Organization Name

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

402 000 248 035 248 035 248 035 248 035 1 394 140 euros

Platform for the Coordination of Groups of Enterprises in Cameroon

Payment of salaries of health personnel working in health facilities of the enterprises

128 206 128 206 128 206 128 206 128 206 641 030 euros

Cameroon Wood Sector Group]

Small and Medium Enterprises/Small and Medium Industries

Health insurance to workers and their family members

11 891 11 891 23 782 euros



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.

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


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;


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, Sub-Recipient, 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?

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


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

B.P. 14,386 Yaoundé, Rue de Croix Rouge Address

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:

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.

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:


ROUND 9 – HIV 22 at the central level: (Permanent Secretary, Deputy Permanent Secretary, 7

Section Chiefs, 4 TCG Unit Chiefs, 9 TCG Senior Designers); 30 at the Regional level: 10 RTG coordinators, 10 Monitoring Unit Chiefs, 10

Local Response Unit Chiefs). Implementation of regional level activities:

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: 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.

CARE International au Cameroun PR 2

1071 Winston Churchill avenue, Hippodrome district BP 422 Yaoundé. Cameroun [email protected] [email protected]

Address

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. The mission of CARE is to serve individuals and families in the poorest communities in the world. Our




ROUND 9 – HIV program principles include: promotion of strengthening, working with partners, accountability, non-discrimination, 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:


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: The maximum delay of payment to suppliers is 15 days after filing and approval of the invoice. The delay is 21 days for sub-recipients, after filing of the financial report and validation of

supporting expense documents by internal audit. The presence of offices in areas of the program facilitates the provision of funds to suppliers. 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.

Copy and paste tables above if more than three Principal Recipients

4.9.2 Sub-Recipients

(a) Will sub-recipients be involved in program implementation?

X Yes

No

(b) If no, why not?

X 1 – 6

(c) If yes, how many sub-recipients will be involved? 7 – 20

21 – 50

more than 50

X Yes [Insert Attachment Number for list] (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.) No

Answer s.4.9.4. to explain

(e) If yes, comment on the relative proportion of work to be undertaken by the various sub-recipients.


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 SDA SUB-RECIPIENT

Prevention CARE

SDA 1: BCC ACMS, CHP, CAMNAFAW SDA 2: Condoms ACMS, CHP, CAMNAFAW SDA 3: Screening CNLS/MINSANTE SDA 4: PMCT CNLS/MINSANTE

Treatment MINSANTE

SDA 1: Medical Treatment and Monitoring CNLS/MINSANTE

SDA 2: Prophylaxis and treatment of MOI CNLS/MINSANTE

Care and Support MINSANTE

SDA 1: Care and support for chronic diseases CARE

SDA 2: Support for OVC CNLS/MINSANTE

Coordination and Management

SDA 1: Strengthening of Civil Society and institutional capacities

CARE

SDA 2: Development of the Public Private Partnership ILO

SDA 3: Costs of public sector management and administration

CNLS/MINSANTE

SDA 4: Monitoring-Evaluation and operational research:

CNLS/MINSANTE


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


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


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 sub-region. 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…………


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.


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


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 non-government 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


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.


ROUND 9 – HIV

4.10. Management of pharmaceutical and health products

4.10.1. Scope of Round 9 proposal

Does this proposal seek funding for any pharmaceutical and/or health products?

No Go to s.4B if relevant, or direct to s.5.

X Yes 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.

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 non-governmental 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.)

Does this proposal request funding for additional staff or technical assistance

Activity

CENAME, MOH, Procurement agent Yes

X No

Procurement policies & systems

MINCOMMERCE, MOH OAPI, TRIPS PR Yes

X No

Intellectual property rights

CENAME, MOH

LANACOME Procurement agent Yes

X No

Quality assurance and quality control

Ministry of Public Health PR Yes

X No

Management and coordination More details required in s.4.10.3.

MOH, Partners PR Yes

X No

Product selection

DEP (NHMIS), CENAME, CAPRs SE/ RP/FM, NACC, DPM

RP, Procurement Agent Yes

X No

Management Information Systems (MIS)

NACC, CENAME RP, Procurement Agent X Yes

No

Forecasting

CENAME Procurement agent Yes

X No

Procurement and planning

Storage and inventory management More details required in

CENAME Procurement agent Yes


ROUND 9 – HIV s.4.10.4

X No

CENAME, CARPs, Health centers

Procurement agent Yes

X No

Distribution to other stores and end-users More details required in s.4.10.4

CENAME, NACC, CARPs PR, Procurement agent Yes

X No

Ensuring rational use and patient safety (pharmacovigilance)

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?

PR, sub-recipient, or

agent?

Total value procured during last financial year

(Same currency as on cover of proposal) Organization Name

CENAME Agent 22,622,550 Euros

[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.


ROUND 9 – HIV 4.10.5. Storage and distribution systems

X National medical stores or equivalent

(a) Which organization(s) have primary responsibility to provide storage and distribution services under this proposal?

Sub-contracted national organization(s) (specify)

Sub-contracted international organization(s) (specify)

Other: (specify)

(b) For storage partners, what is each organization's current storage capacity for pharmaceutical and health products? If 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


ROUND 9 – HIV 4.10.7. Multi-drug-resistant tuberculosis

Yes 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.

Is the provision of treatment of multi-drug-resistant tuberculosis included in this HIV proposal as part of HIV/TB collaborative activities?

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:

The applicant has identified gaps and constraints in the health system that have an impact on HIV, tuberculosis and malaria outcomes;

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

Section 4B is not also included in the tuberculosis or malaria proposal Read the Round 9 Guidelines to consider including HSS cross-cutting interventions. '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 cross-cutting interventions').



http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_PForm_HSS_4B_Single_en.doc

ROUND 9 – HIV 5. FUNDING REQUEST 5.1. Financial gap analysis - HIV

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 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

HIV program funding needs to deliver comprehensive prevention, treatment and care and support services to target populations

57,219,424 61,498,509 65,910,838 70,435,866 73,957,659 77,655,542 81,538,319 85,615,235 Line A Provide annual amounts

(combined total need over Round 9 proposal term)

389,202 622

Line A.1 Total need over length of Round 9 Funding Request

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 Total current & planned DOMESTIC

(including debt relief) resources: 5,451,219 6,393,129 4,411,422 10,588,733 10,613,884 11,528,060 11,509,005 12,282,633

External resource C 1 (ADB-UNESCO) 707,649 435,357 145,119 145,119 145,119 145,119 145,119 145,119

External source C2 (UNICEF)

762,195 1,143,293 2,439,024 2,439,024 2,667,683 1,600,610 0 0


ROUND 9 – HIV Financial gap analysis (same currency as identified on proposal coversheet)

Note 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


2007 2008 2009 2010 2011 2012 2013 2014

External source C3 (WHO)

265,000 270,000 270,000 335,000 335,000 360,000 360,000 385,000

External source C4 (WORLD BANK)

809,756 579,314 579,314 579,314 579,314 579,314 579,314 579,314

External source C5 (ILO)

186,078 378,213 115,808 26,677 22,866 22,866 22,866 22,866

External source C6 (UNDP)

99,051 146,322 92,546 30,488 30,488 30,488 30,488 30,488

External source C7 (UNAIDS)

75,000 105,000 200,000 200,000 200,000 200,000 200,000 200,000

External source C8 (GTZ KFW – German Cooperation) 1,713,710 1,873,496 2,973,171 2,973,171 2,881,707 2 881707 106,707 106,707

External source C9

(American Government) 533,537 533,537 1,143,293 1,143,293 0 0 0 0

External source C10 (Clinton Foundation) 1,756,954 1,040,822 1,227,459 1,848,565 0 0 0 0

External source C3 Private Sector Contributions

(International) NA NA NA NA NA

Total of Line C entries Total of EXTERNAL resources

(Global Funds subsidies excluded) current and projected:

6,908,930 6,505,354 9,185,734 9,720,651 6,862,177 2,938,397 1,444,494 1,469,494

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.


ROUND 9 – HIV Financial gap analysis (same currency as identified on proposal coversheet)

Note 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


2007 2008 2009 2010 2011 2012 2013 2014

Line D: Annual value of all existing Global Fund grants for same

disease: Include unsigned ‘Phase 2’ amounts as “planned” amounts in

relevant years Round 3

13,093,212 12,096,743 8,192,207

2,131,087 3,171,847 220,866 Round 4

1,500,277 379,577 2,065,051 2,045,391 2,251,203 Round 5

16,724,576 15,648,167 10,478,124 2,045,391 2,251,203 Total line D

Line E Total current and planned resources (i.e. Line E = Line B total

+ Line C total + Lind D Total)

29,084,725 28,546,650 24,075,280 22,354,775 19,727,264 14,466,457 12,953,499 13,752,127

Calculation of gap in financial resources and summary of total funding requested in Round 9 (to be supported by detailed budget)

Line F Total funding gap (i.e. Line F = Line A – Line E) 28,134,699 32,951,859 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


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.

Cost sharing = (Total of Line D entries over 2010-2014 period + Line G Total) X 100 Line A.1

31%

Line H Cost Sharing calculation as a percentage (%) of overall funding from Global Fund

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 2006-2010 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


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/

http://www.theglobalfund.org/en/rounds/9/single/#budget

http://www.theglobalfund.org/en/ccm/

ROUND 9 – HIV Clarified section 5.3 5.3. Summary of detailed budget by objective and service delivery area

Service delivery area (Use the same numbering as

in program description in s.4.5.1.)

Year 1 Year 2 Year 3 Year 4 Year 5 Total Objective Number

ART and follow-up 7 771 453 10 697 798 11 662 517 14 223 006 17 067 140 61 421 914 Building of civil society and institutional capacity 3 197 161 2 350 395 2 047 860 2 047 860 2 047 860 11 691 136

Support for orphans and vulnerable children 2 065 986 2 090 502 2 253 225 2 291 765 2 363 335 11 064 813

Cost of programme management and administration 2 208 171 1 921 948 1 986 433 2 002 898 2 002 898 10 122 348

Care and support for the chronically ill 1 467 575 1 289 277 1 502 307 1 425 942 1 396 308 7 081 409

PMTCT 91 165 735 813 1 711 671 1 883 379 2 330 074 6 752 102 Monitoring/evaluation and operational research 1 227 049 1 149 887 905 898 940 485 1 151 376 5 374 695

CCC – community relay workers and schools 708 977 466 967 505 339 438 154 438 154 2 557 591

Prophylaxis and treatment of OIs 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 230 897 230 897 230 897 230 897 230 897 1 154 485 Development of Public-private sector partnership 178 995 120 973 102 634 56 558 56 558 515 718

Round 9 HIV funding request: 19 635 129 21 701 203 23 630 906 26 331 590 29 957 084 121 255 912


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.)

(same currency as on cover sheet of Proposal Form) Avoid using the "other" category unless

necessary – read the Round 9 Guidelines. Year 1 Year 2 Year 3 Year 4 Year 5 Total

Human resources 2,226,983 2,701,309 2,765,794 2,782,259 2,782,259 13,258,604 Technical and Management Assistance 218,160 57,327 0 0 0 275,487 Training 1,211,978 183,395 486,578 39,607 0 1,921,558 Health products and health equipment 2,467,503 3,433,401 2,510,041 2,958,532 3,479,059 14,848,536 Pharmaceutical products (medicines) 5,065,974 7,422,027 9,734,499 11,988,853 14,532,968 48,744,321 Procurement and supply management costs 859,485 1,273,595 1,643,450 2,010,712 2,432,692 8,219,934 Infrastructure and other equipment 2,053,506 108,594 88,105 88,105 46,395 2,384,705 Communication Materials 565,820 493,310 526,414 455,014 451,641 2,492,199 Monitoring & Evaluation 945,243 915,674 776,073 777,849 956,102 4,370,941 Living Support to Clients/Target Populations 3,032,461 3,974,636 3,917,374 4,019,512 4,064,821 19,008,804 Planning and administration 467,799 578,020 622,663 651,232 651,232 2,970,946 Overheads 520,217 559,915 559,915 559,915 559,915 2,759,877 Other: (Use to meet national budget planning categories, if required) 0 0 0 0 0 0

Round 9 HIV funding request (Should be the same annual totals as table 5.2) 19,635,129 21,701,203 23,630,906 26,331,590 29,957,084 121,255,912



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.


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.

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) € 1,220 Deputy Permanent Secretary € 1,067 Section Heads € 610 Unit Heads € 534

Monthly salaries (social security and taxes excluded) for civil society:

Principal Recipient:

Project Manager € 2,159 Deputy Project Manager € 1,653 Regional Project Manager € 1,357 Deputy Regional Project Manager € 503

Sub-Recipients:

Project Manager € 915 Administrative and Financial Manager € 686 CS activity manager € 457 M&E Manager € 457 Driver € 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.

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.


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.

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 cross-cutting interventions') in Round 9 and has completed section 4B and included that section in the HIV proposal sections.



http://www.theglobalfund.org/documents/rounds/9/CP_Pol_R9_PForm_HSS_5B_Single_en.doc

Proposal checklist – Section 3 to 5 HIV

List Attachment Name and Number Section 3 and 4: Program Description

4.1 Supporting documentation for National Strategy National Strategic Plan for the Fight against AIDS 2006-2010 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 Tables of Proposal Objectives

4.5.1 A completed 'Performance Framework' by disease Refer to the M&E Toolkit for help in completing this table. Attachment A

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 4.5.1

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)

- ECAM III Attachment 17

4.9.1 A recent assessment of the Principal Recipient capacities (other than Global Fund Grant Performance Report).

4.9.1

(for non-CCM applicants)

Document describing the organization such as: official registration papers, summary of recent history of organization, management team information

4.9.2

List of sub-recipients already identified (including name, sector they represent, and SDA(s) most relevant to their


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). Attachment B

List Attachment Name and Number Section 4B: HSS Cross-cutting (once only in whole country proposal)

4B.2 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.

Attachment A

4B.2 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

List Attachment Name and Number Section 5: Financial Information

5.2 A ‘detailed budget’ (quarterly information for the first two years, and annual information for years 3, 4 and 5) Detailed Budget

5.4.2

Information on basis for budget calculation and diagram and/or list of planned human resources funded by proposal (only if relevant)

Information on basis of costing for ‘large cost category’ items 5.4.3

5.5.1 (if common funding mechanism)

Documentation describing the functioning of the common funding mechanism

5.5.2 (if common funding mechanism)

Most recent assessment of the performance of the common funding mechanism

List Attachment Name and Number Section 5B: HSS Cross-cutting financial information

5B.1 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).

Detailed Budget

5B.4.2

Information on basis for budget calculation and diagram and/or list of planned human resources funded by proposal (only if relevant)


Proposal checklist – Section 3 to 5 HIV Information on basis of costing for ‘large cost category’ items 5B.4.3

List Attachment Name and Number 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

National Strategic Plan for the Fight against AIDS 2006-2010 Attachment 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.

Information on condom use among women


Report of CNLS activities, 2007 Attachment 5

4.1.6.

Information on average prevalence among the general population UNAIDS-Epidemiological Fact Sheet Cameroon-September 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.

4.2.1. Information on seroprevalence by gender and population age group EDSC III, 2004 Attachment 10


Proposal checklist – Section 3 to 5 HIV 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

4.2.1.

Information on seroprevalnce of HIV


Progress Report of UNGASS nº 3 Cameroon Attachment 13

4.2.2.

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

4.3.1.

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

4.3.2

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

4.5.1.

Information on MSM Project MESDINE Activity Report Attachment 21

4.6.2.

4.7.2. Information on program and financial gaps for PNLS Report of Program Gaps and Funding


Proposal checklist – Section 3 to 5 HIV


Needs Attachment 22

4.8.1. Directives for PNLS monitoring and evaluation


National Guide for Monitoring of the National Strategic Plan 2006-2010 Attachment 23

6.1.1. 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

proposal form – round 9 - (single country applicants)

Documents

Transcript of proposal form – round 9 - (single country applicants)