Cameroon_RFI_SEMBE I_signed.pdf

Please Note: THIS IS A REQUEST FOR INFORMATION ONLY (RFI). THIS NOTICE DOES NOT CONSTITUTE A FUNDING OPPORTUNITY ANNOUNCEMENT. This RFI is issued solely for information gathering and planning purposes. This RFI does NOT represent any commitment to issue a solicitation, nor does it obligate the United States government to pay for costs incurred in the preparation and submission of any response to the RFI questions. The RFI is not accepting applications for financial assistance and USAID will not accept applications prior to issuance of a notice of funding opportunity. Interested parties are advised to monitor the USAID Business Forecast website (https://www.usaid.gov/business-forecast) for updates on this potential funding opportunity.

Subject:

Activity Name:

Date of Issuance:

Feedback Deadline:

Anticipated timeframe:

Anticipated total budget:

Eligible Applicants:

Request for Information (RFI) Systems to End the Malaria Burden through Meaningful Engagement-I

(SEMBE I)

September 1, 2022 September 15, 2022 Five (5) years $20-30 million Exclusively for Cameroon Local Organization/partners, defined as organizations which are registered or legally organized under the laws of, and have its principal place of operations in Cameroon; is majority owned by citizens or lawful permanent residents of Cameroon; and is managed by a governing body the majority of who are citizens or lawfully permanent residents of Cameroon.

To All Interested Respondents/Parties:

The United States Agency for International Development as represented by USAID/West Africa is in the process of designing a new five-year health activity and seeks to collect feedback through this Request for Information (RFI) from local entities interested in the attached draft Program Description marked (Attachment A).

“Local entity” refers to an individual or organization that:

1. Is legally organized under the laws of Cameroon,

2. Has as its principal place of business or operations in Cameroon,

3. Is majority-owned by individuals who are citizens or lawful permanent residents of Cameroon, and

4. Is managed by a governing body, the majority of whom are citizens or lawful permanent residents of

Cameroon.

This is NOT a Request for Proposals/Applications and is NOT to be construed as a commitment by the U.S.

Government to issue any Notice of Funding Opportunity (NOFO), Request for Proposal (RFP), or to pay for any cost incurred in the preparation and submission of comments/answers on this RFI.

Responding to or providing input in response to this RFI will not give any advantage to an organization in any subsequent procurement action. Likewise, not responding to this RFI does not preclude any local organization from applying in response to the future solicitation, should USAID/West Africa decide to issue one. USAID/West Africa will not provide feedback on submissions or answers to any questions submitted in response to this RFI.

Phone inquiries will not be entertained.

The information provided will be used to help guide future planning decisions. The requested information will not be shared publicly.

USAID/West Africa will retain all responses to this RFI. They will not be returned. USAID/West Africa may elect to use the information submitted at its discretion. Organizations should not submit any proprietary or otherwise sensitive information. This RFI does not restrict the USG's approach on a future solicitation, and USAID/West Africa reserves the right to modify the details of the planned activities. Similarly, USAID/West Africs is not obligated to modify its planned approach or otherwise incorporate input that organizations offer.

INSTRUCTIONS:

USAID/West Africa welcomes all local Cameroon organizations to respond. Interested organizations may choose to respond to either or all parts of this notice following the instructions included below. - Attachment A - Draft Program Description (PD), which serves as the basis for this RFI.

Kindly submit responses no later than the date noted above, via email to Mohammad Badder, A&A Specialist at mbaddar@usaid.gov, and Contracting/Agreement Officer, Nathan Strand at nstrand@usaid.gov, with a copy to the undersigned at tbaldwin@usaid.gov. The email subject line must include the RFI number and the name of the submitting organization, i.e., “RFI-SEMBE1 – [Organization name].”

Submissions should be written in English. USAID/West Africa is not seeking technical or cost proposals at this time. Do not submit any proposal/application in response to this RFI.

Each response should contain:

1. Cover Page:

All submissions must include a cover page (one page) that includes the following information:

a. Organization name and address

b. Organization points of contact name, mailing address, UEI (Unique Entity Identifier) number (if applicable), telephone number, and email address

c. Organization type, i.e., commercial, public sector, educational institution, NGO, etc.

2. Response to RFI:

To inform our on-going design process, USAID/West Africa is seeking input on the prospective activity.

Please carefully review the attached draft Program Description (Attachment A) and respond to the following questions (please limit this section to no more than five pages):

mailto:mbaddar@usaid.gov

1. How might the activity objectives be made clearer?

2. What other objectives might be necessary for the achievement of the activity purpose?

3. What other important considerations/approaches/interventions should be included in the activity design?

4. Considering the context of the geographic area targeted and your understanding of malaria service delivery activities, what do you see as the highest priority to implementation needs and constraints in the next 5 years, and how might you propose to address them?

5. How can USAID better partner with local governments, research institutions, private sector, and other local entities, to strengthen malaria service delivery and organizational capacity?

6. What models of activity implementation would you propose to consider that could result in an increased country-led, managed, and owned malaria service delivery implementation that is more sustainable and achieves high quality implementation?

7. What key results should USAID target with malaria service delivery activities and how would we measure them, collect, and ensure quality?

Reponses are due to the email addresses above by the date listed above. Respondents may provide responses through the email message platform, or through attachments to email in Microsoft Word compatible format or Adobe Acrobat formats.

3. Organizational Capability Statement

In addition to input in response to the RFI, USAID/West Africa is seeking brief organizational capability statements from organizations who believe they can perform the activity described in the attached Program Description. We are therefore requesting that you provide the following information (please limit this section to no more than two pages):

a. A brief discussion of your organization’s demonstrated ability to manage health information systems.

b. A brief discussion of your organization’s demonstrated ability to develop and implement an activity with a behavior change interventions.

For more information about working with USAID, WorkwithUSAID.org is a free, USAID-funded resource hub that empowers partners with the knowledge and networks to navigate how to work with USAID. By visiting the website, current and prospective partners will gain access to a variety of innovative services and curated resources, all designed to improve organizational readiness, connect partners to peers and experts, and prepare prospective partners to pursue USAID funding.

USAID appreciates any feedback provided. Thank you for your time and interest in USAID’s activities

NOTE:

USAID plans to hold an Industry PMI Pre-Solicitation Conference on Thursday, September 15, 2022. Exact logistics, timing, and location are yet to be determined, and will be communicated properly at a later date.

Sincerely, Taniece Baldwin Owusu Supervisory Regional Agreement Officer (acting)

ATTACHMENT A

Systems to End the Malaria Burden Through Meaningful Engagement - I (SEMBE I)

Program Description

9/1/2022

Table of Contents

ACRONYMS LIST 7

1. INTRODUCTION 8

2. PROGRAM DESCRIPTION 8

2.1 Problem statement and justification for activity 8

2.2 Country response 10

2.3 U.S. government response 11

2.4 Technical approach 14

2.4.1 Goal and intermediate results 15

2.4.2 Geographic focus 15

2.4.3 Beneficiaries 15

2.4.4 Development Hypothesis and Results framework 14

2.4.5 Activity Description 16

2.4.6 Relationship to U.S. government strategy 23

2.5 Strategic Considerations 23

2.5.1 Gender 23

2.5.2 Environment compliance 24

2.5.3 Climate Risk 24

2.6 Collaborating, Learning, and Adapting (CLA) 24

2.7 Monitoring and Evaluation (M&E) 25

3. MANAGEMENT PLAN 25

ACRONYMS

ANC Antenatal care AS/AQ Artesunate-amodiaquine AOR Agreement Officer Representative CHW Community health worker CLA Collaborating, Learning, and Adapting CSO Civil society organization DQA Data Quality Assessment EMMP Environmental Mitigation and Monitoring Plan EPI Expanded program for immunization FETP Field Epidemiology Training Program FY Fiscal year GRC Government of the Republic of Cameroon Global Fund Global Fund to Fight AIDS, Tuberculosis and Malaria HMIS Health Management Information System HSS Health System Strengthening IEE Initial Environmental Examination IPTi Intermittent preventive treatment for infants IPTp Intermittent preventive treatment for pregnant women IR Intermediate Result ITN Insecticide-treated mosquito net M&E Monitoring and Evaluation MIP Malaria in pregnancy MRDQA Malaria rapid data quality assessment NMCP National Malaria Control Program NSP National Strategic Plan PMI U.S. President’s Malaria Initiative PMP Performance Monitoring Plan QA/QC Quality assurance/Quality control RDT Rapid diagnostic test SBC Social and behavior change SEMBE Systems to End the Malaria Burden through Meaningful Engagement SMC Seasonal Malaria Chemoprevention SM&E Surveillance, monitoring, and evaluation SOP Standard Operating Procedure SP Sulfadoxine-pyrimethamine SPAQ Sulfadoxine-pyrimethamine and amodiaquine UNICEF United Nations Children’s Fund U.S. United States USAID United States Agency for International Development WHO World Health Organization

1. INTRODUCTION

The ‘Systems to End the Malaria Burden through Meaningful Engagement - I’ (SEMBE I) activity seeks to strengthen the capacity of the Cameroonian government and local stakeholders to lead and promote local solutions to the fight against malaria. SEMBE means Strength in Fufulde, one of the major local languages in the Far North. The SEMBE I recipient will work closely with Cameroon’s National Malaria Control Program (NMCP) and regional and district-level entities to achieve the delivery of malaria-related services to beneficiaries over the next five years. This program description outlines USAID’s expectations for the SEMBE I activity – a $20 - 30 million acrivity issued to a local entity (as defined in series 303.6 of USAID’s Automated Directives System (ADS) to lead malaria prevention, control, and elimination challenges in the Far North Region of Cameroon. USAID will mobilize funds primarily through the President’s Malaria Initiative (PMI) to finance SEMBE I activities.

The SEMBE I project will contribute to key priorities outlined in Cameroon’s National Strategic Plan (NSP) for Malaria Control for the period covering 2019 through 2023:

● Reduce malaria morbidity and mortality by 60 percent from 2015 levels by 2023.

● Reduce malaria incidence from 2015 levels by 60 percent by 2023.

● Reduce malaria transmission to a very low level (pre-elimination threshold) in some health districts in the Sahelian zone of the country by 2023.

2. SYSTEMS TO END THE MALARIA BURDEN THROUGH MEANINGFUL

ENGAGEMENT-I (SEMBE I)

2. 1 Problem statement and justification for activity

Dramatic progress over the past two decades has prevented 1.5 billion malaria infections and saved 7.6 million lives. PMI has been a key driver, providing approximately $8 billion to expand access to malaria-fighting tools, support frontline and community health workers, and strengthen health systems across Sub-Saharan Africa and Southeast Asia.

However, efforts to achieve ambitious global targets to dramatically reduce malaria have fallen short. The unmet need in global malaria funding has slowed progress and threatens to reverse gains. In the past decade, global funding for malaria has plateaued despite increasing U.S.

government investments, and the resource gap grows each year. The World Health Organization (WHO) estimates there were 241 million new malaria cases and 627,000 deaths worldwide in 2020 — figures that have stopped declining since 2015.

The devastating impacts of global health emergencies such as COVID-19 on communities, the health workforce, supply chains, and health systems have set malaria progress back by years.

Increasing drug and insecticide resistance, unpredictable effects of climate change, and growing conflict and violence in malaria-affected communities all pose major challenges. A reversal in progress against malaria will have dire consequences, resulting in hundreds of thousands of additional deaths, increasing the risk of outbreaks and drug resistance, undermining economies, increasing poverty, and weakening global health security.

Yet, unprecedented opportunities offer hope. The world’s first malaria vaccine paired with existing proven interventions could dramatically reduce cases and severe disease and ultimately reduce malaria deaths. Strategic investments in community health systems and surveillance can fight malaria, extend care to the unreached, and strengthen pandemic preparedness and response.

Innovations to combat insecticide and drug resistance and improvements in data and supply systems mean that optimal interventions can be deployed where they are needed most. Strong global partnerships can ensure a healthy, resilient market for lifesaving prevention and treatment products.

Malaria in Cameroon:

Cameroon is among 11 countries that account for approximately 70 percent (%) of the global burden of malaria and is implementing the “High Burden to High Impact'' approach - a country-led response (supported by the WHO and Roll-Back Malaria Partnership) to reignite the pace of progress in the global malaria fight. Malaria is the most widespread endemic disease in Cameroon, responsible for greater than two million reported cases, and absenteeism from school and work annually.

The malaria burden has been on a steady rise since 2017, with children under five years and pregnant women most affected. Plasmodium falciparum is the predominant species of mosquito responsible for transmission, with Anopheles gambiae s.l., the primary vector. At the national level, the number of cases recorded in health facilities, stagnant since 2011, has shown an increasing trend since 2017. The number of deaths, after a downward trend over several years, has gone upward since 2017. In response to this increasing burden, preventing and controlling malaria is a national health priority as highlighted in the Cameroonian government’s Health Sector Strategy (2016-2027).

The coverage of key interventions such as preventive treatment of malaria in pregnancy and community case management remains low partly due to lack of adherence to the country’s free treatment policy which ensures children under five have access to effective antimalarial treatment free of charge – recent data show only 21% of children under five years old are receiving free treatment. Vector insecticide resistance and limited access to quality health services in many parts of the country are also contributing to the malaria burden, in addition to limited multisectoral collaboration. Overdiagnosis of severe malaria and irrational use of injectable artesunate are a recognized ongoing problem in Cameroon.

Malaria in the Far North Region

While the malaria parasite transmission is seasonal in the Far North region and prone to frequent eruptions of epidemics, mortality is highest in this geographic area due to a number of factors:

The Far North region is comparatively the most deprived, with dire health indicators. All-cause under-five mortality has declined from 186/1,000 in 2004 to 102/1,000 in 2018 in the Far North region – compared to 80/1,000 national average. Malaria prevalence as measured during household surveys via rapid diagnostic tests (RDT) declined from 27% in 2011 to 22% in 2018 in the Far North – compared to 24% national average. Household ownership of at least one insecticide treated net (ITN) has increased from 27% in 2011 to 87% in 2018 in the Far North Region – compared to 73.4% national average.1

The Far North Region, specifically, is severely affected by deadly attacks on civilians in towns and villages carried out by Boko Haram/Islamic State’s West Africa Province, which severely impedes access to critical health services. Over 30 health areas in the Far North are located in conflict-affected zones.

1 Demographic and Health Survey, 2018

2.2 Country Response

Cameroon’s National Strategic Plan (NSP) for malaria, 2019-2023, articulates a vision of a malaria-free Cameroon. The stated mission is to ensure universal access to effective and affordable malaria prevention and treatment interventions for all Cameroonians, especially the most vulnerable and marginalized. The strategic focus is to accelerate intervention scale-up to reach universal coverage of key interventions and achieve a lasting impact on malaria morbidity and mortality. In addition to prioritizing the most vulnerable, interventions will be targeted to zones with high population density, high endemicity, and intense seasonal transmission.

The goal of the 2019-2023 NSP is to contribute to improving the health of Cameroonians by reducing the health and socioeconomic burden of malaria. The objectives are to reduce malaria morbidity and mortality by 60% from 2015 levels; reduce malaria incidence from 2015 levels by 60 percent; and reduce malaria transmission to a very low level (pre-elimination threshold) in some health districts in the Sahelian zone of the country (i.e., Far North region) by the end of 2023.

The NSP outlines specific interventions and activities that fall under six strategic areas. These activities are summarized below along with their associated objectives:

I. Prevention: includes ITN distribution via mass campaigns and routine channels, promotion of ITN use, intermittent preventive treatment for pregnant women (IPTp), seasonal malaria chemoprevention (SMC) for children aged 3-59 months in the North and Far North regions, and indoor residual spraying in 15 districts. The routine ITN distribution strategy will expand beyond distribution to pregnant women through antenatal care (ANC) to include the Expanded Program for Immunization (EPI) platform for children and introduction of Piperonyl butoxide ITNs in regions with evidence of vector metabolic resistance to insecticides and low efficacy of currently used ITNs. Larval source management in urban settings such as Yaoundé and Douala is also part of the prevention strategy, with pilot activities to be undertaken to obtain preliminary data on effectiveness.

II. Case Management: includes universal diagnostic confirmation of suspect cases, treatment of confirmed cases at health facility and community level according to national guidelines, use of artemether-lumefantrine rather than artesunate-amodiaquine (AS/AQ) as the first-line artemisinin-based combination therapy in the North and Far North regions due to SMC implementation, pretreatment of severe malaria and referral with rectal artesunate at the community level, scale up of integrated community case management, pharmacovigilance, and supply chain strengthening. A quality assurance/quality control (QA/QC) system will ensure strengthened diagnostics throughout the country.

III. Communication: includes advocacy; behavior change interventions; social mobilization;

social marketing and private partnership; and training of health agents, community actors, and journalists.

IV. Training and Research: include training and creation of a critical mass of researchers (epidemiologists, entomologists) and the organization of working sessions on universal health coverage at all levels of the health pyramid.

V. Surveillance, Monitoring, Evaluation and Epidemic Response: includes monitoring and evaluation (M&E) system strengthening, implementation of M&E, epidemiologic surveillance system strengthening, and epidemic response. The NMCP is elaborating a sentinel surveillance model that will focus on ensuring high-quality data from a purposefully selected group of health facilities throughout the country. These sites will also serve as research platforms for therapeutic efficacy studies and other operational research questions prioritized by the NMCP.

VI. Program Management: includes mobilization of funds, financial management, governance, planning, and partnership coordination. PMI works closely with the NMCP and other partners to coordinate support for activities to best support the National Strategy for malaria control. PMI and the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) provide most of the malaria funding to Cameroon. Other development assistance for malaria comes from WHO, United Nations Children’s Fund (UNICEF) and United Nations Population Fund. Aside from some central-level activities, the bulk of PMI funding supports NMCP activities in the North and Far North regions of the country, while the Global Fund focus is in the other eight regions.

2.3 U.S. Government Response

Cameroon was selected as a PMI focus country in FY 2017. PMI is a critical funding source for malaria-related interventions in Cameroon. The annual budget ranges between $20 million and $23.5 million. For further information, please visit: https://www.pmi.gov/where-we-work/cameroon/. Since partnering with PMI, child death rates have fallen from 122 per 1,000 to 80 per 1,0002 due to increased access to lifesaving interventions such as distribution of mosquito nets, seasonal preventive treatments, increased availability of rapid diagnostic tests, and fast acting malaria medicines.

2 Demographic and Health Survey 2018 https://www.pmi.gov/where-we-work/cameroon/ https://www.pmi.gov/where-we-work/cameroon/

Figure 1. PMI Intervention Support Map

PMI works closely with the NMCP and other partners such as the Global Fund, WHO, and UNICEF, to coordinate activities and provide complementary support to achieve the malaria NSP.

Alongside PMI activities, the Global Fund, WHO and UNICEF support activities including nationwide campaigns for the distribution of bed nets, health management information systems strengthening, and co-funding of malaria surveys (e.g., Demographic and Health Survey, Malaria Indicator Survey and Malaria Behavior Survey), training and supporting community health workers, and entomological surveillance. In the eight non-PMI regions, other donors also provide routine ITN distribution, malaria health products supply, facility and community case management, intermittent preventive treatment of infants (IPTi) and IPTp, training and support to community health workers, and entomological surveillance.

Lessons Learned

PMI’s past and current investments in improving malaria service delivery in the North and Far North regions have included assessments of the current coverage and quality of services. One important focus is health worker competency in diagnosing and treating malaria cases. Results from three rounds of supportive supervision showed low health worker competency to manage uncomplicated malaria – only between 5-11% of health workers scored above 90% on the outpatient department checklist. Some reasons identified were failure to welcome the patients;

insufficient clinical assessment; and failure to properly counsel patients. Turnover among trained staff was another challenge contributing to overall performance far below the 40% target set by the NMCP. Health worker performance was better for proper classification of malaria (case versus. non case). Despite the investments being made in training hospital staff to identify and manage severe malaria, performance as measured by chart review, is very low. Adherence to negative test results also improved and remained high. Competency in diagnosing malaria using malaria rapid diagnostic tests also improved greatly in PMI-target regions in the past four years.

Competencies in preventing and managing malaria in pregnant women remain low in Cameroon.

Some reasons identified based on analysis of the data, include providers' failure to welcome pregnant women; lack of directly observed therapy administration of Sulfadoxine-pyrimethamine (SP); and failure to provide appropriate counseling.

PMI also supports integrated community case management of malaria cases, gradually expanding its footprint to cover the costs of training, supervision, materials and transportation stipends for Community Health Workers (CHW) to provide services in 20 out of 47 health districts in the North and Far North regions. Some of the challenges faced are stockouts of commodities, difficulty procuring non-malaria commodities, and differential support packages across donors.

Limited geographical coverage of the health districts by supportive supervision has a profound effect on the quality of malaria services both in the health facilities and in the community.

Irregularity of data review meetings has impacted the quality of data and its use for decision making as well as monitoring of malaria interventions and supply chain management.

PMI supports SMC in all of the eligible 47 districts of the North and Far North and has learned many lessons over the past few years of implementation. Cost-saving implementation approaches are important as available resources need to cover an ever-increasing population; however it remains important to maintain high coverage and adherence to the medication regimen. Some of the improvements that have been achieved with PMI funding include, payment of SMC actors using mobile money with agreements with telecommunications companies, using leaders in the communities to help promote and monitor adherence to day 2 and day 3 of treatments, establishing a ‘mobidi’ workforce in which the same individuals act as community mobilizers and as distributors, to increase ownership and responsibility.

Way Forward

Globally, PMI recently released its third Strategic Plan, 2021-20263 outlining three strategic objectives:

1. Reduce malaria mortality by 33 percent from 2015 levels in high-burden PMI partner countries, achieving a greater than 80 percent reduction from 2000.

2. Reduce malaria morbidity by 40 percent from 2015 levels in PMI partner countries with high and moderate malaria burden.

3. Bring at least ten PMI partner countries toward national or subnational elimination and assist at least one country in the Greater Mekong Subregion to eliminate malaria.

To achieve these objectives, PMI will take a strategic to:

● Reach the unreached: Achieve, sustain, and tailor deployment and uptake of high-quality, proven interventions with a focus on hard-to-reach populations.

3 PMI’s 2021 - 2026 Strategic Plan: “END MALARIA FASTER” https://d1u4sg1s9ptc4z.cloudfront.net/uploads/2021/10/10.04Final_USAID_PMI_Report_50851.pdf

● Strengthen community health systems: Transform and extend community and frontline health systems to end malaria.

● Keep malaria services resilient: Adapt malaria services to increase resilience against shocks, including COVID-19 and emerging biological threats, conflict, and climate change.

● Invest locally: Partner with countries and communities to lead, implement, and fund malaria programs.

● Innovate and lead: Leverage new tools, optimize existing tools, and shape global priorities to end malaria faster. Reaching the unreached by malaria services.

Through the SEMBE I activity, USAID/West Africa seeks to align interventions with PMI’s 2021-2026 Strategic Plan and increase local ownership of PMI programming. The SEMBE I activity involves partnering with a local entity to positively respond to and lead malaria prevention, control, and elimination interventions in the Far North Cameroon.

2.4 Technical Approach

2.4.1 Goal and Intermediate Results (IR)

Goal: Reduce malaria-related morbidity and mortality by improving the capacity of the National Malaria Control Program and other local entities to lead the prevention, control, and elimination of malaria in Cameroon

IR 1: Increased access to and utilization of quality malaria diagnosis and drug-based prevention and treatment services at the facility and community level

IR 2: Increased adoption of malaria prevention and treatment behaviors

IR 3: Increased access to and utilization of quality malaria data

IR 4: Health systems strengthened to optimize the use of malaria resources and implement high quality malaria interventions

Case Management. PMI currently provides central support for NMCP case management activities and through support in the North and Far North regions for training and supervision of health providers at the facility and community levels. The SEMBE I activity will continue to improve access to and use of timely, quality, and well-documented malaria testing and treatment services by providing facility- and community-based health workers with training, supervision, and malaria commodities to provide quality, effective care.

Prevention of malaria in pregnancy (MIP). PMI currently supports the national strategy for MIP, which includes provision of ITNs at the first ANC visit, a minimum of three doses of IPTp in malaria endemic areas starting at 13 weeks gestational age, and effective case management of malaria per WHO guidelines. PMI and the NMCP are working together to address the serious ANC access gap and improve IPTp uptake. Priorities include training and supportive supervision aimed at building capacity at health facilities for malaria case management during pregnancy and provision of IPTp and ITNs. PMI support to CHW integrated training and supervision also contributes to improving household sensitization of pregnant women on early and frequent ANC attendance, IPTp uptake, and use of ITNs. The SEMBE I activity will continue interventions focused on improving IPTp uptake in the Far North Region.

SMC. Cameroon introduced SMC in 2016 with sulfadoxine-pyrimethamine and amodiaquine (SPAQ) targeting children 3 to 59 months of age living in all health districts of the North and Far North region. SMC consists of a monthly administration of SPAQ using a door-to-door strategy during the peak malaria transmission period (July to November). Based on some meteorological and geographical factors the period of administration has been prolonged to December in a few health districts in the Far North Region. The SEMBE I activity will continue to use CHWs to administer SPAQ within the framework of their routine activities and also support all aspects of the SMC campaign (i.e., distribution and administration of SPAQ, training, supervision, and payment of actors, etc.).

2.4.2 Geographic focus

The SEMBE I activity will focus service delivery and health systems strengthening activities exclusively in the Far North Region of Cameroon.

2.4.3 Beneficiaries

The SEMBE I activity will offer general services to people living in the Far North Region including host population, refugees, and internally displaced persons. In addition, SEMBE I will prioritize service packages for populations most vulnerable to malaria – children under five and pregnant women with specific packages –, while working to expand health care to the most hard-to-reach populations.

2.4.4 Development Hypothesis and Results Framework

The goal of the SEMBE I activity is to “reduce malaria-related morbidity and mortality by improving the capacity of the National Malaria Control Program and other local entities to lead the prevention, control, and elimination of malaria in Cameroon.” In order to contribute to this goal, SEMBE I is driven by the following developmental hypothesis:

If (i) country capacity (managerial, financial and leadership) is enhanced; (ii) stakeholder collaboration with each other and with government is strengthened; AND (iii) evidence-based best practices in malaria prevention and control are applied in an enabling environment, Then there will be strong capacity and commitment of the Government of the Republic of Cameroon (GRC) and local communities to lead the fight against malaria in Cameroon and influence innovative solutions to adapt to the local context.

Leading to increased provision of quality malaria preventive and treatment services and improved local capacity to lead the national malaria program at all levels of the health system, AND, Contributing to a reduction of malaria-related mortality and morbidity; and accelerating Cameroon’s path towards malaria elimination.

SEMBE I’s results framework outlined in Table 1 below provides a detailed overview of the intended results. Each IR is supported with a list of illustrative approaches and indicators provided. SEMBE I applicants are highly encouraged to propose new and innovative approaches and indicators that may contribute to the achievement of the IRs, as appropriate.

Goal: Reduce malaria-related morbidity and mortality by improving the capacity of the National Malaria Control Program and other local entities to lead the prevention, control, and elimination of malaria in Cameroon

IR 1: Increased access to and utilization of quality malaria diagnosis and drug-based prevention and treatment services at the facility and community level

IR 2: Increased adoption of malaria prevention and treatment behaviors

IR 3: Increased access to and utilization of quality malaria data

IR 4: Health systems strengthened to optimize the use of malaria resources and implement high quality malaria interventions

1.1 Malaria Case

management strengthened at the facility and community level

2.1 Implementation of

community-level evidence-based malaria social and behavior change (SBC) interventions increased

3.1 Improved health

management information systems, data analysis, data use and malaria surveillance, monitoring, and evaluation activities coordination at the country-level

4.1 Strengthened

relationship between community health workers and the formal health system, including touchpoints of supply chain, supervision, reporting, and referral

1.2 Prevention of malaria

in pregnant women and young children improved through high quality delivery of IPTp, and routine distribution of ITN during ANC and EPI

2.2 Implementation of

evidence-based malaria SBC interventions at service delivery points increased (i.e., by facility, and community-based health workers)

3.2 Increased availability

of local scientific evidence to support decision making

4.2 Capacity to

effectively design, implement, and monitor the national malaria program improved at all levels of the health system

1.3 Implementation of

SMC strengthened

2.3 SBC packages

continuously monitored and refined

3.3 Malaria data

collection, review, analysis, use, and coordination strengthened at the region, districts, and health area levels

4.3 Capacity of non-

government local actors to manage and implement malaria programs strengthened

1.4 Training, supportive

supervision, and quality assurance improved

2.4 Improved

coordination with other service delivery, vector control, and other technical working groups and implementers

3.4 Improved detection, reporting and monitoring of malaria data at the community level

4.4 Quality of

malaria services in the private sector improved

*Drug-base prevention may include RTS,S (malaria vaccine) or other immunizations developed for the prevention of malaria.

2.4.5 Activity Description

Intermediate Result (IR) 1: Increased access to and utilization of quality malaria diagnosis and drug-based prevention and treatment services at the facility and community level

The SEMBE I applicant will design, implement, and monitor innovative, evidence based, high quality interventions which will support the prevention, diagnosis, and treatment of malaria at regional and district levels in collaboration with GRC, partners, and other relevant stakeholders.

This will be accomplished through technical assistance and/or implementation of malaria case management, and drug-based prevention interventions at the public health facility level and in the community. Planned interventions must be carried out in close alignment with PMI and Cameroon’s strategic objectives and goals and should be guided by the approved country malaria strategic plan. Planned interventions should also be carried out in coordination with USAID-supported vector control, SBC, and supply chain management programs and consider the deployment of interventions by other key partners such as UNICEF and Global Fund.

Quality malaria service delivery requires:

● Prompt diagnosis by improving and maintaining high quality RDTs and microscopies in all facilities and improving adherence to diagnostic results. This requires QA/QC and provision of supportive supervision to health workers to improve parasite-based diagnosis at all levels of the health system and in both public and private facilities. Uncomplicated and severe cases should be accurately differentiated based on the patient’s symptoms.

● Prompt diagnosis by improving and maintaining high quality RDTs in households and improving adherence to diagnostic results at the community level.

● Appropriate treatment of uncomplicated and severe malaria at the facility level and appropriate treatment of uncomplicated malaria and referral of severe malaria cases in the community.

● Uninterrupted availability of all antimalarial commodities at health facility and community level.

● Adoption of good health supply chain practices at health facility and community level.

● Provision of drug-based preventive medicines for IPTp, and SMC as well as SBC messages to pregnant women and caregivers of children under five years of age.

● Exhaustive and accurate notification of all cases and deaths due to malaria in health facilities in the public and private sector as well as in the community.

● Strong and efficient linkage and integration of community and health facility-based activities and health workers.

● Support of community-led monitoring to ensure access to free malaria services by vulnerable groups (children below 5 years and pregnant women).

● SBC efforts that complement service delivery and ensure uptake of services

● Supportive efforts for eventual malaria vaccine roll out, including supervision and SBC.

● Continuous capacity building of facility-based health care providers and community health workers.

Illustrative approaches may include:

● Organize in-service training and supportive supervision for malaria service delivery activities at the health facility level. Activities include verification of commodity availability while integrating district focal points for supply chain management.

● Organize capacity building workshops and mentoring on inventory management.

● Organize training for midwives and ANC health facility staff, and supportive supervision at public and non-profit health facilities to effectively deliver IPTp and routine case management services for pregnant women. This training can be integrated with the case management training and supervision package.

● Organize initial training and periodic supportive supervision packages for CHWs in the Far North Region to effectively deliver routine case management and MIP services to hard-to-reach populations in collaboration with Civil Society Organizations (CSOs). MIP activities include encouraging early and frequent ANC attendance, use of ITNs, and IPTp.

● Plan and implement SMC in all health districts, covering four or more rounds, from July to October and beyond. An innovative model of this SMC will be implemented through CHW programs where they will be used to mobilize and distribute SPAQ to eligible children in the catchment area under the supervision of the district health team.

● Implement a comprehensive QA/QC plan for malaria diagnostics including RDTs and microscopy. Organize supportive outreach supervision of public and non-profit laboratories to reinforce training.

● Carryout audits on malaria-related deaths in health facilities.

● Pursue the implementation of activities identified as priority for private sector engagement.

● Procure and distribute tools and materials to CHWs to perform their work based on needs.

Illustrative Indicators:

● Number of health staff trained (CHWs, Health Facility staff, laboratory technicians) by technical area (integrated community case management (iCCM), malaria diagnosis, mRDT, microscopy, malaria treatment, implementing IPTp)

● SMC coverage and adherence to second and third doses

● Proportion of uncomplicated malaria vs severe malaria cases

● Proportion of pregnant women attending at least 4 ANC visits

● Proportion of pregnant women receiving at least 3 doses of IPTp

● Proportion of health workers involved with malaria services supervised

● Proportion of priority health facilities supervised

● Percentage of health facilities with stock cards available and updated

● Proportion of health facilities with stock out of malaria commodities

IR 2: Increased adoption of malaria prevention and treatment behaviors

PMI has identified six essential components of malaria SBC implementation that should be integrated throughout PMI-supported SBC interventions:

● Formative assessments on barriers and facilitators to behavior uptake;

● A theory-informed, strategic conceptual model;

● Audience profiles and segmentation into homogenous subgroups;

● Tailored interventions that utilize a mix of communication channels;

● Actionable, audience-specific, pre-tested messages; and

● Well-timed, programmatically useful monitoring and evaluation.

The SEMBE I recipient will implement SBC activities in the Far North Region to promote uptake of malaria prevention and treatment behaviors. The recipient will coordinate closely with another USAID-funded central SBC mechanism to ensure high-quality SBC implementation in coordination with the NMCP and other SBC stakeholders. While SEMBE I will be responsible for direct SBC implementation at community and service delivery levels, the central mechanism will coordinate and lead SBC planning and design for both campaigns and ongoing SBC. The central mechanism will be responsible for providing technical assistance to develop SBC strategies and activities that integrate the six components of high-quality SBC listed above and SEMBE I will then implement those activities at scale. The central mechanism will develop M&E frameworks for SBC, including M&E tools and approaches. SEMBE I will use the M&E frameworks developed by the central mechanism to conduct robust monitoring of SBC implementation. It may also support formative research, OR or program evaluation data collection efforts.

The central mechanism will lead national and regional SBC coordination efforts, such as coordinating SBC Technical Working Groups and support NMCP focal points to engage in global SBC coordination networks (e.g., Roll Back Malaria - RBM - SBC Working Group). It will also support NMCP participation in training activities and implement SBC training/workshops for stakeholders in-country. SEMBE I will participate in these national and regional SBC coordination efforts and participate in relevant training and workshop activities.

For both community-based and service delivery-based SBC, implementation should leverage existing platforms to deliver and amplify health messaging and encourage uptake of target behaviors. Use of existing platforms is not only a cost-efficient way to extend reach of SBC, but it utilizes trusted community messengers that are often familiar to target audiences.

Illustrative approaches:

● Implement localized community-based SBC through platforms such as community health workers, women’s network, schools, religious organizations, and markets. May include use of community radio (building on ongoing campaigns) and national radio where appropriate.

● Implement SBC targeted to service providers (facility-based and community-based) to address health promotion and client-provider relationships.

● Implement SBC in support of periodic campaign-based interventions including ITN distribution and SMC campaigns.

● Conduct robust monitoring of SBC activities and refine approaches based on monitoring results as needed.

● Participate in national and regional SBC technical working groups in coordination with other PMI partners and stakeholders, including civil society organizations.

● Implement SBC for novel interventions (e.g., malaria vaccine, Perennial Malaria Chemoprevention) to address behaviors such as vaccine hesitancy/acceptance and maintenance of more “traditional” behaviors if new interventions are rolled out.

● Organizing continuous capacity building workshops for service providers, community-based organizations, journalists, school authorities, faith based organizations and others.

● Number of materials produced and distributed (by type of material, target audience)

● Number and type of media broadcast (by station, topic area)

● Number of people reached with media broadcast (by station, topic area)

● Number of community sensitization discussions facilitated (by platform, topic area, target audience)

● Number of people reached with community sensitization (by platform, topic area, target audience)

● Number of health facility-based providers trained in service communication and building patient/client trust

● Number of home visits conducted by the community health workers

● Number of educative talks provided by health care providers

● Number of rapid surveys conducted for audience monitoring

IR 3: Increased access to and utilization of quality malaria data

Building on previous achievements of the USAID-funded PMI Measure Malaria mechanism and other partners, SEMBE I will provide technical support to the NMCP at the regional, district, health facility and community levels.

At the central level, a recent assessment of the surveillance, monitoring and evaluation system highlighted the need to reinforce capacities, harmonize and disseminate updated tools as well as maintaining an updated health management information system (HMIS). Following recent trends in the malaria data reported, the region and district levels are currently facing challenges including over-reporting of severe malaria cases, and evidence of abusive use of injectable artesunate. This suggests a focus on data quality improvement in general and regular detailed data analysis, assessment, review, and validation to help clean the data and inform stakeholders for follow-up and capacity reinforcement. Tracking the work being done at the community level will be essential for interpretation of malaria data.

Additionally, few malaria operational research studies were conducted locally in recent years to inform decision making on updated and efficient best practices. To date, PMI has identified research priorities that could be customized and complemented locally using a variety of methodologies and study designs, including qualitative, quantitative, experimental and/or non-experimental. The research priorities include, but are not limited to prevention, chemoprevention, case management, surveillance, monitoring and evaluation, or cross-cutting topics.

Illustrative approaches to be implemented at regional level:

● Identify malaria surveillance, monitoring, and evaluation (SM&E) capacity gaps and develop capacity-strengthening plans to address them.

● Carryout regular data review and validation meetings at regional and district level.

● Develop and implement protocols for strengthening practices in malaria data quality assurance.

● Identify service delivery gaps through regular analysis and use of malaria data.

● Strengthen health facilities to produce high-quality malaria data.

● Support the development and dissemination of guidelines and tools for data collection.

● Train district teams to use the malaria rapid data quality assessment (M-RDQA) tool and support them to conduct regular M-RDQAs in targeted health facilities.

● Support the NMCP to implement the M&E activities of mass campaigns.

● Support the NMCP to conduct the SMC external data quality review monitoring and data quality assessment.

● Support the NMCP to coordinate malaria SM&E at the regional level.

● Strengthen the Ministry of Public Health to implement field epidemiology training program (FETP) for frontline health workers to increase local SM&E capacity.

● Improve country-level ability to manage health information systems to serve malaria needs.

● Support the training and coordination of community health workers on the use of electronic reporting tools.

● Support the NMCP to produce monthly regional bulletins and quarterly national bulletins.

● Support to therapeutic efficacy studies as per WHO recommendations to evaluate efficacy of antimalarial drugs included in the NSP.

● % of health facilities submitting HMIS reports (reporting rate) (# reports submitted/# reports expected)

● % of health facilities conducting data quality assessments (DQA) with available reports

● % of HMIS reports submitted on a timely basis (# submitted on time/# submitted)

● Accuracy of malaria elements in HMIS (based on DQA, matching reports in HMIS and in health facility registers)

● Percentage of CHW submitting their report in District Health Information System 2 platform (# submitted/#expected)

● % of health areas with least one person trained in FETP

IR 4: Health systems strengthened to optimize the use of malaria resources and implement high quality malaria interventions

SEMBE I will build on ongoing efforts to strengthen cross-cutting aspects of the Cameroon health system to reach the unreached, achieve, sustain, and tailor deployment and uptake of high-quality, proven interventions.