A KEY INSTRUMENT FOR DECENTRALISATION ESTHER PARTNERSHIPS: A KEY INSTRUMENT FOR DECENTRALISATION OF HIV CARE AND HSS IN CAMEROON Jules Motto, ESTHER coordinator in Cameroon Caroline Comiti, program manager

Content CONTEXT & JUSTIFICATION ESTHER LOGIC OF INTERVENTION SOME KEY RESULTS CONCLUSION & RECOMMENDATIONS

1 - Context & Justification Cameroon : ≈ 20 M inhabitants (projections census 2007) 4,3 % seroprevalence HIV (HDS 2011) Nb de PLHIV: 560 306 (8,5% are children) Need of ART : 260 000 PLHIV Coverage of global ART: ≈ 106 000 (with 49% are followed within sites supported by ESTHER) 24 National / Regional Hospitals (ATC, 13 are tutors) & 178 HD

PLWHIV A way forward to Institutionnal Twinning Partnerships LEVEL OF INTERVENTION OF ESTHER IN CAMEROON MOH DLM, DPM, DROST Reg Lev RHD, CAPR ATC Partnership HCU/DH DH HCU PLWHIV CBO’S A way forward to Institutionnal Twinning Partnerships

2 - ESTHER logic of intervention Access to care and treatment (Paediatric, STI, OI, E-MTCT, ...) Health system strengthening (training of HRH and equipments ) Monitoring and evaluation (support to Health information System : ESOPE) Strategic support and project management : central and intermediate level of the MoH (DDC,RHD) Support to key populations

C2D/ESTHER: DECENTRALIZATION THROUGH THE TUTORING traditional twinning National / regional Hospital Health District Hospital 1st generation Tutoring Northern Hospital 2nd generation tutoring Other ANC EPI units CRN/CTN counsellor/ Community

ESTHER TWINNING IN CAMEROON IMPLEMENTATION ESTHER TWINNING IN CAMEROON Since 2002 Expertise recognized by MoH Today the whole country is covered : central, regional et peripheral levels 13 tutor hospitals (national/regional: ATC in the 10 regions 10 northern hospitals (8 in France & 2 in Germany) Intervention nationale sur V1 et déclinaison du projet sur V1,V2 et V3 sur les 4 régions cibles TOGO

3 - KEY RESULTS Scaling up of Decentralization through tutoring of care of HIV/AIDS project

DISTRIBUTION OF TRAINED HR WITHIN ESTHER SITES The whole package

4 - Conclusion & recommendations THE WAY FOWARD … UNIVERSAL ACCESS B. ART Coverage through ATC & tutored HD & tutored health units (80%) A. ART Coverage through ATC & tutored HD (49%) DEMAND OF THE MOH DH/CU Cov 49% DH/CU Cov 49% MC Cov 10% HC Cov 5% ATC twinning Northern Hospital HC Cov 3% HC Cov 16%

THANKS SO MUCH to You and to our partners & donors The hospitals partners CAMEROUN FRANCE Région de l’Adamaoua : HR Ngaoundéré Région du Centre HCY- HGY -CH ESSOS Région de l’Est : HR Bertoua Région de l’Extrême Nord : HR Maroua Région Littoral : H G. Douala Région Littoral : H Laquintinie Douala Région Nord : HR Garoua Région Ouest : HR Bafoussam Région Sud : HR Ebolowa Hospices civils de Lyon CHU Montpellier CHU Creil CHU Dijon APHP Tenon HU Strasbourg CHU Nancy CHIC Créteil Région Sud Ouest : HR Limbe Région Nord Ouest : HR Bamenda HU Rostock ESTHER Allemagne HU Hambourg MINSANTE CBO’s inCameroon