Normes et Standards en SR/PF au Cameroun

Objectives

Cameroon’s 2018 sexual and reproductive health norms and standards provide a national quality framework for integrated, rights-based services across the health system. They support the Health Sector Strategy 2016–2027 and Sustainable Development Goals on health and gender equality by defining minimum acceptable performance, required inputs and service standards for each component of care.[1]The framework seeks to promote physical, mental and social sexual and reproductive well-being, informed and voluntary fertility decisions, and access to safe, effective, affordable and acceptable family-planning methods within the law.[2]

• Improve maternal, perinatal, neonatal, infant and child outcomes through family planning, pregnancy surveillance, safe childbirth, post-partum care, emergency obstetric and neonatal care, and maternal, perinatal and neonatal death surveillance and response.[3][4][5][6]
• Ensure equitable, client-centred services for women, children, adolescents and young people, men, older people, persons with disabilities, refugees, displaced people and other key populations.[7]
• Protect client rights to information, access, informed choice, safety, privacy, confidentiality, dignity, comfort, non-discrimination and continuity of care.[8][9][10][11]
• Provide voluntary family planning, including postpartum care, to prevent high-risk, unintended and closely spaced pregnancies, while supporting infertility assessment, treatment and psychosocial care for couples seeking children.[3][12][13]
• Deliver a broad reproductive-health package covering post-abortion care, therapeutic abortion within the stated legal framework, obstetric fistula prevention and treatment, adolescent and youth services, sexually transmitted infections and HIV, female genital mutilation, sexual violence, genital cancers and prevention of mother-to-child transmission of HIV.[14][15][16][17][18][19][20]
• Strengthen newborn survival through essential and emergency neonatal care, care for premature and low-birth-weight newborns, Kangaroo Mother Care, breastfeeding support, vaccination, prevention of mother-to-child transmission and management of newborn complications.[21][22][23][24]
• Eliminate preventable maternal, perinatal and neonatal deaths by identifying every death, determining causes and contributing factors, and using findings to implement preventive action in facilities and communities.[6]
• Promote healthy practices and demand for services through communication for behaviour change, social mobilisation, counselling, advocacy, community dialogue and partnership.[25][26][27]

Implementation

Implementation uses an integrated, decentralised model across community, primary, district, regional and central levels of Cameroon’s health pyramid. Standards specify service activities, authorised provider categories, training and competency requirements, minimum infrastructure, equipment, medicines, consumables, information tools, referral arrangements and supervision.[1][14][28]Services are intended to operate through public, private secular and faith-based facilities, social-security and enterprise facilities, armed-forces, police and prison facilities, and community settings.[14][7]

• Organise care through multidisciplinary teams of community health workers, peer educators, nurses, midwives, doctors, pharmacists, laboratory staff, social workers and relevant specialists, with responsibilities assigned by intervention and facility level.[7][29][30]
• Apply referral and counter-referral across the health pyramid, including transfer documentation, communication, clinical stabilisation before transfer and continuity between referring and receiving facilities.[31][22][32]
• Maintain continuous availability for emergency obstetric, neonatal and sexual-violence care, supported by trained staff, functional equipment, supplies, transport and communication systems.[5][22][33][34]
• Integrate priority services at common entry points, including antenatal, delivery, postnatal, vaccination, infant surveillance, family-planning, HIV and post-abortion services; prevention of mother-to-child transmission is specifically organised as a linked or “one-stop” model where possible.[35][36][20][37]
• Strengthen provider capacity through pre-service integration of sexual and reproductive health curricula, competency-based continuing training, workplace practice, post-training follow-up, multidisciplinary teamwork and formative integrated supervision.[38][39]
• Engage communities through locally selected and supported community health workers, household visits, health promotion, community distribution of selected contraceptives, tracing of people lost to follow-up, referral support and community-led interventions.[40][41][42]
• Coordinate policy and regulation centrally through the Ministry of Public Health, while regional and district structures provide technical support and programme implementation; the Family Health Directorate and decentralised services coordinate specified reproductive-health activities.[28][43]
• Work with professional bodies, training institutions, other ministries, local authorities, civil society, development partners, schools, media, religious and traditional leaders, and private-sector actors.[44][17][27]
• Use routine records, client files, registers, health-information systems, supervision checklists and facility quality assessments to monitor services. Specified mechanisms include monthly activity reporting, periodic self-assessment and supervision, quarterly monitoring of emergency obstetric and neonatal care, and defined reporting deadlines for prevention of mother-to-child transmission data.[39][45][46]
• Operate maternal, perinatal and neonatal death surveillance as a cycle of identification, notification, review, analysis and response, with notification within 24 hours for facility deaths and 48 hours for community deaths.[47]
• Mobilise resources for community-directed interventions through pooled contributions from communities, decentralised local authorities, Government, technical and financial partners and the private sector, alongside financial and non-financial motivation for community health workers.[48]

Monitoring & Evaluation

The guideline establishes a broad monitoring, supervision and quality-assurance architecture for sexual, reproductive, maternal, newborn, child and adolescent health. It combines routine health-information reporting, service records, formative supervision, facility quality assessments, logistics monitoring, death surveillance and response, and community-level data collection.[39][46][49][50]

• Maintain routine records for family planning, antenatal, delivery, postnatal, referral, newborn, abortion-care, laboratory and hospitalisation services, including client files, registers, partographs and referral forms.[51][52][53][54][55]
• Produce monthly reproductive-health activity reports and transmit them to the district health service.[39]Submit prevention of mother-to-child transmission of HIV programme data monthly, with sites reporting to districts by the fifth day of the following month, districts reporting to regional delegations by the tenth, and regions reporting to the Family Health Department by the fifteenth.[46]
• Conduct multidisciplinary self-assessments at least every three months, consult clients, prepare action plans assigning problems, solutions, responsible persons and deadlines, implement corrective measures and assess results.[39]
• Undertake formative integrated supervision monthly for integrated health centres and medicalised health centres, every three months at district level, and every six months at regional-delegation level.[56]Supervision covers infrastructure, management tools, provider competence, client satisfaction, medicines logistics and analysis of service statistics.[56]
• Measure family-planning availability, accessibility, utilisation and coverage, including contraceptive prevalence, and transmit these indicators through the activity-reporting chain.[35][12]
• Collect emergency obstetric and neonatal care indicators on availability, utilisation and quality at all relevant service levels, and conduct quarterly monitoring.[45]Monitor antenatal, delivery and post-partum service indicators, including availability, accessibility, utilisation, coverage, first and sixth contacts, the 84-contact measure, assisted delivery and postnatal care.[5]
• Track HIV and sexually transmitted infection services through indicators on condom distribution and sales, service points, treatment, trained providers, antenatal syphilis screening, testing, treatment, opportunistic-infection prophylaxis, treatment continuity and mortality.[57][58]
• Monitor obstetric-fistula services through the number and proportion of women detected, managed and successfully treated, and record each repair in the operating-theatre register.[43]
• Operate maternal, perinatal and neonatal death surveillance and response as a continuous cycle of identification, notification, review, analysis and corrective response.[6][47]Notify health-facility deaths within 24 hours and community deaths within 48 hours; analyse community deaths through verbal autopsy.[47]
• Collect community information on household deliveries, health events, maternal, neonatal and infant deaths, diseases and health commodities, and conduct community surveillance of epidemic-prone diseases and maternal, perinatal and neonatal deaths.[41][59][42]
• Use daily integrated registers for community-directed activities, compile and analyse data monthly, and transmit information to the Area of Health by the 25th, district by the fifth and region by the tenth of the following month.[48]
• Assess facility quality through scored protocol-compliance checklists covering governance, clinical services, records, hygiene, medicines, equipment, laboratory services, hospitalisation, vaccination and financial management.[60][61][62]The overall facility-assessment synthesis has a maximum of 270 points, or 257 points when tuberculosis is not applicable.[63]
• Verify service quality through document review, inspection, direct observation, equipment checks, record sampling and client or staff interviews.[64][65][62]
• Monitor medicine logistics through data accuracy, storage compliance, stock-outs, product availability, order-processing time, order-satisfaction rate, losses, damage, expiry, stock turnover and delivery time.[66][67]

Accountability is principally operational: facilities and supervisors use action plans, checklists, quality scores, review findings, financial records and corrective recommendations.[39][60][68]Some services also require specific documentation, such as multidisciplinary therapeutic-abortion decisions, signed consent, forensic records for sexual violence and operative reports for fistula repair.[69][19][43]The extracts do not provide a single document-wide set of evaluation methods, reporting formats, sanctions or named accountability bodies.[49][63][67]

Costing & Financing

The guideline largely specifies resource requirements rather than priced budgets. It identifies equipment, medicines, consumables, infrastructure, staffing, transport, communications and logistics needed for service delivery, but does not provide an overall programme budget, costing methodology, funding-gap estimate or economic assumptions.[1][70][50]

• Provide minimum equipment, essential medicines, consumables, reagents and infrastructure according to provider category and level of the health-system pyramid.[1]
• Maintain supplies, equipment and logistics to prevent stock-outs and surpluses, including storage practices for reproductive-health commodities.[71][72][73]
• Support referral and counter-referral with transport, communications and financing mechanisms for patient transfers, although no funding source or amount is specified.[22][32]
• Mobilise community resources for emergency transport, referral financing, tracing people lost to follow-up and local health activities.[74][42]
• Pool contributions from communities, decentralised local authorities, Government, technical and financial partners and the private sector to finance community activities and incentives for community health workers.[48]
• Maintain facility financial records, including cash and bank journals, revenue registers, monthly treasury reports, invoices and expenditure reports.[75][76]
• Calculate the facility performance-bonus envelope as monthly revenue or receipts minus operating expenditure.[76][77]Operating expenditure includes base pay, medicines and equipment, subcontracting, operations, community relays, maintenance and rehabilitation.[76][77]
• Limit base and performance bonuses, together with applicable staff salaries, to no more than half of total facility revenue in one assessment framework and no more than 60% of total facility receipts in another.[78][77]

Cost-recovery tariffs and family-planning service prices are expected to be displayed to clients, but no tariff amounts are supplied.[64][79]The numerical values elsewhere in the quality-assessment sections are generally compliance scores, not financial allocations.[80][61]