The EAP project was born following an in-depth documentary study and interviews with various stakeholders, including the National Malaria Control Program (NMCP) , Civil Society Organizations (CSOs) , as well as experts who participated in the development of Cameroon’s funding request to the Global Fund for the 7^th grant cycle (GC7) .

This study identified major challenges that hamper the effective implementation of the national malaria control strategic plan and risk compromising the impact of GC7. Three main challenges were highlighted:

1. A lack of coordination and communication between the NMCP and civil society, making concerted and harmonized action difficult,
2. Recurring stockouts of essential malaria products in communities, linked to problems in the supply chain,
3. A lack of investment in interpersonal communication targeting vulnerable groups, hampering community mobilization during key malaria interventions.

In light of these findings, the EAP project was designed with the aim of strengthening the engagement of civil society and communities in the implementation of the national strategic plan to fight against malaria, at all levels.

Our targets:

The Equité Acces Palu project specifically targets vulnerable groups in the four health districts where project activities are implemented, namely: Maroua 3, MOKOLO, MIFI, and DOUME. These mainly include:

a. Children under 5 years old

• High vulnerability: Children under 5 years of age are the most vulnerable age group to malaria. Their immune systems are less developed, making them more likely to develop severe forms of the disease, such as seizures, severe anemia and coma.
• Mortality and morbidity: Malaria remains one of the leading causes of child mortality in sub-Saharan Africa, particularly in Cameroon, where it contributes to thousands of deaths among children under 5 years of age each year.
• Access to care: Children in this age group are often the last to benefit from interventions, including preventive treatments such as long-lasting insecticide-treated nets (LLINs) and antimalarial treatments. The project aims to improve coverage of these children through awareness-raising, community mobilization and advocacy.

b. Pregnant women

• Increased risks during pregnancy: Malaria in pregnant women is particularly dangerous because it can lead to complications such as anemia, miscarriage, premature delivery and transmission of the parasite to the child. This affects not only the mother, but also the health of the fetus.
• Limited access to specialized care: Many pregnant women, especially in rural and remote areas, do not have easy access to quality prenatal care. Malaria is an aggravating factor for maternal and child health.
• Targeted interventions: The project aims to improve the coverage of pregnant women with preventive treatments (such as sulfadoxine -pyrimethamine) and the distribution of LLINs. In addition, it will promote the care of pregnant women through prenatal consultations and awareness sessions on the risks of malaria during pregnancy.

c. Internally displaced populations (IDPs)

• Vulnerability: IDPs, particularly in the Health District (HD) of Mokolo, live in precarious conditions due to armed conflict and inter-ethnic tensions, which limits their access to health care. These populations are often isolated, with precarious hygiene and housing conditions, making it difficult to fight against malaria.
• Access to health services: Health services in areas of displacement are often insufficient or nonexistent. Displaced populations are more likely to suffer from infections, including malaria and their care is further complicated by mobility.
• Specific approaches: The project aims to strengthen access to care and health supplies (such as LLINs and rapid diagnostic tests) by setting up mobile teams and specific awareness-raising activities in IDP camps. It also aims to ensure that refugees benefit from the regular distribution of prevention tools.

d. The refugees

• Harsh living conditions: Minawao refugee camp is home to mainly Central African and Nigerian refugees, who are particularly vulnerable due to the precarious living conditions. These populations have limited access to quality health care and are exposed to the risk of malaria due to overcrowding and poor hygiene in the camps.
• Lack of health resources: Although humanitarian programs exist, they are often underfunded or poorly coordinated. Refugees need better access to malaria treatment and prevention interventions (such as LLINs).
• Intervention strategy: The project plans to implement LLIN distribution programs in camps and regroupment areas, as well as awareness sessions specifically tailored to refugees, to explain the risks of malaria and the importance of prevention.

e. Indigenous and native populations

• Geographical and cultural isolation: The Mafa (in the HD of Mokolo), Maka (in the HD of Doumé) and Baka (Pygmies) populations are often isolated in rural and forest areas, with very limited access to health care. Their nomadic lifestyle and their distance from health centers constitute a major obstacle to their health care.
• Socio-cultural barriers: These communities may also have traditional beliefs or reluctance towards modern medical care, making it difficult to accept preventive measures against malaria.
• Adapted approaches: The project focuses on community awareness, the involvement of local leaders (traditional chiefs and healers) and the adaptation of prevention messages to better reach these populations and ensure good coverage of LLINs and treatments.

f. Hard-to-reach groups

• Nomadic population: Nomadic groups and populations living in isolated areas are often beyond the reach of conventional health interventions. This includes pastoralists, migrants and seasonal workers who frequently move from one area to another.
• Geographical barriers: Difficult roads and remoteness to health centers mean that these groups do not have easy access to health services, including rapid diagnostic tests and LLIN distribution.
• Proposed solutions: The project plans to use mobile health teams and itinerant community outreach strategies to reach these groups and provide them with health services, including malaria prevention.

g. Orphans and disabled people

• Social and health exclusion: Orphans and people with disabilities are often marginalized, with limited access to health care, including for malaria. Their situation can make them even more vulnerable to infectious diseases.
• Difficulties accessing care: Orphan children are often cared for, by extended families who may have limited financial means and people with disabilities, particularly those with reduced mobility, may not be able to access health centers.
• Specific approach: The project focuses on the inclusion of these vulnerable groups by providing them with home care, preventive treatments and ensuring that they benefit from the distribution of LLINs in the communities where they reside.

Each subgroup requires a specific approach in terms of awareness raising, access to care and distribution of inputs to ensure that all these populations are well protected against malaria, regardless of their socio-economic or geographical situation.