Cameroon: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

Cameroon has a national action plan for antimicrobial resistance (AMR) that addresses the surveillance, detection, and reporting of priority AMR pathogens.

The Joint External Evaluation of Cameroon, published in 2017, noted that the country did not possess a national plan for the laboratory detection of antimicrobial-resistant pathogens (p. 11). ¹

However, Cameroon has since developed and adopted the National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR). This comprehensive, multi-sectoral document lists "Strengthen knowledge and evidence through surveillance and research" as a key strategic objective (p. 11, 36). ² The plan outlines various activities to achieve this, including strengthening capacities for Standard Operating Procedures (SOPs) related to the surveillance of infections caused by antimicrobial-resistant pathogens across human, animal, plant, and environmental health sectors (p. 44). It also specifies the development of SOPs for AMR surveillance in environmental and plant health, and the revision of the National Guide for AMR Integrated Surveillance (p. 45-46). For reporting, the plan mandates the production of biannual AMR surveillance reports and annual reports for the Global Antimicrobial Resistance Surveillance System (GLASS) (p. 47). ³ The most recently available update on the GLASS webpage is from 2023. ⁴

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 100

Cameroon possesses a national laboratory system capable of testing for priority antimicrobial resistance (AMR) pathogens.

The Joint External Evaluation of Cameroon, published in 2017, explicitly states that the country's national laboratory system has the capacity to detect priority pathogens and confirm them in both human and animal health sectors using recommended tests (p. 24-25). Specifically, the Centre Pasteur du Cameroun (CPC) and the Laboratoire National de Santé Publique (LNSP) have been designated as national reference laboratories (p. 11). Moreover, Cameroon has 12 laboratories with level 4 capacity (p. 11). ⁵

Using the FAO/ATLASS (Assessment Tools Laboratories Antimicrobial Surveillance System) tool, an assessment conducted in December 2021 for the National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR) further confirmed that various laboratories, including the National Public Health Laboratory (NPHL), National Laboratory for the Diagnostic Analysis of Agricultural Products and Inputs (LNAD), National Laboratory for Quality Control of Medicines and Expertise (LANACOME), CPC, and National Veterinary Laboratory (LANAVET), demonstrate bacteriological and AMR detection capacity. Some of these, like the CPC, are classified at Level III, indicating strong bacteriological and AMR detection capabilities and regular participation in external quality assurance (p. 31). The CPC also holds ISO 15189 and 17025 accreditation (p. 32). The new NAP-AMR includes an objective to "Designate a national reference laboratory for AMR" (p. 49). ⁶

Regarding the specific priority pathogens covered, annual surveillance reports from AMR sentinel sites in Cameroon indicate that the most isolated pathogens of priority in human health for 2021, 2022, and 2023 include Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus (p. 20). For sustainable development objective indicators on blood infections, Escherichia coli isolates showed high resistance to Aminopenicillins + Betalactamase inhibitors (Amoxicillin + clavulanic acid), fluoroquinolones (Ciprofloxacin, Levofloxacin), and third-generation cephalosporins (Ceftazidine, Ceftriaxone) (p. 20). Other pathogens frequently identified in surveillance reports include Acinetobacter baumannii, Pseudomonas aeruginosas, and Salmonella spp. (p. 20). Furthermore, studies referenced in the plan detail multidrug resistance (MDR) rates for Escherichia coli, Klebsiella pneumoniae, and Staphylococcus spp. in human health, Salmonella spp. in animal studies, and Staphylococcus spp. in environmental studies (p. 21). Multi-resistant species observed across human, animal, and environmental health sectors include Staphylococcus spp., Proteus spp., and Citrobacter spp., with additional mentions of Serratia fonticola, Aeromonas hydrophila, and Kluyvera spp. in aquaculture (p. 21). Specific fish skin isolates from aquaculture included S. aureus, Enterobacter sakazakii, Citrobacter freundii, Serratia fonticola, Klebsiella oxytoca, Proteus spp., Aeromonas hydrophila, Kluyvera spp., Moraxella spp., Pasteurella multocida, and Pseudomonas fluorescens, many of which were multi-drug resistant (p. 22). ⁷

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

The government's active environmental detection or surveillance activities specifically for antimicrobial residues or AMR organisms are not widely documented as routine. While public health laboratories conduct environmental surveillance more broadly, the 2017 Joint External Evaluation of Cameroon indicated a lack of specific elaboration on environmental surveillance activities or tests for AMR organisms (p. 5). ⁸

The National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR) highlights the acknowledgment that antimicrobials and their residues are present in the environment (waterways, soils, and basements), increasing the risk of resistant microbial strains (p. 17). The Ministry of Environment, Nature Protection and Sustainable Development (MINEPDED) conducts environmental inspections and controls in classified institutions, focusing on waste management and environmental compliance (p. 27). However, the plan also identifies "insufficient programming of inspections and environmental control of agricultural producing institutions, fisheries, aquaculture, livestock and health facilities whose activities are potential sources for the emergence and spread of AMR in the environment" as a remaining challenge (p. 27-28). ⁹

Furthermore, the 2024-2028 NAP-AMR explicitly includes future objectives such as conducting a "national assessment of the risks of exposure to and spread of AMR in the environment by residues of antimicrobial compounds and resistant microorganisms" in 2025 (p. 55). It also plans to "produce and disseminate standards for antimicrobial pollution in the environment" (p. 55). ¹⁰

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

Cameroon possesses national legislation or regulation effectively requiring prescriptions for antibiotic use in humans. However, the effective enforcement and implementation of these regulations face significant challenges, leading to widespread issues such as illicit sales and inappropriate use.

The foundational Framework Law No. 96/03 of April 4, 1996 relating to public health explicitly addresses pharmaceutical regulations, with Articles 50-60 outlining prescription requirements for various medicines, including antibiotics. ¹¹ Furthermore, Cameroon adheres to the CEMAC Regulation on Harmonized Pharmaceutical Policy, a common medicine policy adopted by member states to standardize pharmaceutical practices across the region. This regional policy mandates prescriptions for List A/B drugs, encompassing antibiotics, as highlighted in "Strengthening medicines regulation in Central Africa" news, which notes that CEMAC Member States resolved to work together to ensure regulatory consistency and that a common medicine policy was adopted in 2013 to standardize institutional and legal frameworks. ¹² The existence of these laws is corroborated by the 2021 TrACSS Country Report on the Implementation of National Action Plan on Antimicrobial Resistance (AMR) for Cameroon, which explicitly states that the "Country has laws/regulations on prescription/sale of antimicrobials for human use," and further on page 3, confirms "Y" (yes) for the query "Country has laws on prescription and sale of antimicrobials, for human use" in 2021. ¹³

Despite this clear legal framework, the effective enforcement and implementation of these regulations remain a significant challenge, leading to concerns about illicit sales and inappropriate use of antibiotics. The National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR) acknowledges that while legal instruments broadly cover pharmaceutical practices, there are "no specific regulations relative to the fight against AMR" in the human health sector, indicating a gap in targeted AMR legislation (p. 23). The NAP-AMR further details that the General Inspection of Pharmaceutical Services and Laboratories' role in controlling sales practices is performed sporadically due to resource limitations, contributing to widespread antimicrobial misuse, "inappropriate prescriptions" in hospitals, and "illicit drug distribution circuits… which exacerbates the phenomenon of self-medication" (p. 23). ¹⁴ This sentiment is echoed in the 2017 Joint External Evaluation of Cameroon, which, despite referencing laws governing the pharmacy profession, underscores the urgent need for public and professional awareness regarding the judicious use of antimicrobials (p. 12). ¹⁵ Even an older 2011 WHO report noted that while regulations existed, antibiotics were still sometimes sold without a prescription (p. 66). ¹⁶

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 50

There is national legislation in place requiring prescriptions for antibiotic use for animals, but there are gaps in enforcement.

The National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR) indicates that "There is equally a compendium of texts governing livestock farming, fishiries and animal industries" (p. 25). It references Law No. 2000/018 of December 19, 2000, which regulates veterinary pharmacy and covers aspects such as marketing authorization, importation, manufacturing, wholesale, and retail distribution (p. 25). ¹⁷ This law states that veterinary medications can only be distributed by veterinarians or authorized groups of livestock farmers, who operate under the supervision of a designated veterinarian. "Veterinary pharmacy," as defined by Law No. 2000/018, does indeed include antibiotics. Article 2 (1)(a) of the law defines veterinary medication as "Any substance or preparation presented as having preventive or curative properties against animal diseases, as well as any product that can be administered to animals to restore, modify or correct their organic functions, to diagnose animal diseases, to provoke physiological modifications in animals" (p. 1). Antibiotics, being substances with curative properties against bacterial diseases in animals, fall squarely within this broad definition. ¹⁸

However, despite this framework, the NAP-AMR acknowledges that "the situation remains critical since prescriptions in most veterinary clinics are essentially made on the basis of symptomatic diagnosis" (p. 29). It also states that "there is no specific regulatory framework to prevent the use of antimicrobials of critical importance" (p. 26). ¹⁹ The 2017 Joint External Evaluation of Cameroon did not explicitly mention prescription regulations for animals (p. 12). ²⁰ The NAP-AMR's strategic objective to "Optimise the use of existing antimicrobials in human, animal and plant health" includes actions to improve the regulatory framework for antimicrobials (p. 36). ²¹

1.2.1a Laws/plans on zoonotic disease

Score: 100

Cameroon has national legislation, plans, and strategy documents that cover the prioritization, detection, and reporting of zoonotic diseases.

According to the 2017 Joint External Evaluation (JEE), the country has established the National Program for the Prevention and Fight Against Emerging and Re-Emerging Zoonoses (NPPCERZ) through Decree N° 28/CAB/PM of 04 April 2014, which promotes a multi-sectoral "One Health" approach to address these threats (p. 15). ²² Furthermore, "Law No. 2001-6 on the nomenclature and zoo-sanitary regulations of livestock diseases deemed legally contagious and subject to compulsory notification" of 16 April 2001 identifies a list of notifiable livestock diseases, establishing a legal basis for animal disease surveillance. ²³

For prioritization, Cameroon has identified five key zoonoses: rabies, anthrax, avian influenza, Ebola/Marburg, and bovine tuberculosis. Action plans for surveillance and contingency are being developed for these priority diseases, aligning with the "One Health" strategy (p. 14). ²⁴

In terms of detection, a surveillance network with a well-defined organizational structure is in place (p. 14). Several laboratories, including the National Veterinary Laboratory (LANAVET), the Centre Pasteur du Cameroun (CPC), and the Military Health Research Centre (CRESAR), are actively involved in zoonotic disease surveillance, including specific efforts for wildlife surveillance (p. 14). ²⁵ The National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR) also acknowledges the increasing interest in zoonoses in Cameroon, which can lead to higher antimicrobial use (p. 21). ²⁶

Regarding reporting, a legal requirement exists for livestock owners to report notifiable disease outbreaks to local administrative and veterinary authorities, with mechanisms in place for subsequent reporting to central public veterinary services. ²⁷ Additionally, the Ministry of Livestock, Fisheries and Animal Industries is responsible for notifying the World Organisation for Animal Health (WOAH) and the Food and Agriculture Organization (FAO) about animal-origin events (p. 31). ²⁸ However, the JEE noted that insufficient collaboration between the National Focal Point for International Health Regulations (RSI) and the OIE contact point has sometimes led to delays in notification (p. 31). ²⁹

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 100

Cameroon has national legislation, plans, and equivalent strategy documents that include measures for risk identification and reduction for zoonotic disease spillover events from animals to humans, with a strong emphasis on the "One Health" approach.

The National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR) centrally incorporates this approach for combating antimicrobial resistance, which inherently involves addressing the human-animal-ecosystem interface where zoonotic spillover events occur (p. 17). Within its Strategic Objective II, "Strengthen knowledge and evidence through surveillance and research," the NAP-AMR mandates specific activities for risk identification, such as "Carry out 2 risk assessments for the emergence of AMR cases at the human-animal-environment interface" (p. 48). This directly targets identifying risks at the critical intersection for zoonotic events. Furthermore, under Strategic Objective III, "Reduce the incidence of infections by implementing effective sanitation, hygiene and infection prevention measures," the plan includes developing and disseminating a multisectoral national action plan for Infection Prevention and Control and developing national biosafety guides for both plant and animal health (p. 51, p. 54). These measures aim to reduce the likelihood of pathogen transmission. The NAP-AMR also specifies building the capacities of fish farmers in biosafety measures to mitigate spillover risks from aquaculture (p. 54). ³⁰

These recent efforts build upon earlier foundational documents. The Decree N° 28/CAB/PM of 04 April 2014 established the National Program for the Prevention and Fight Against Emerging and Re-Emerging Zoonoses (NPPCERZ). This program is designed to promote a "One Health" approach and explicitly aims to mitigate the risk of transmission of zoonoses between humans and animals. Its mission includes "to ensure health surveillance, investigation, and response against emerging and re-emerging zoonoses" and "to promote and adopt the "One Health" concept through a multisectoral and multi-actor approach" (p. 1). These missions directly involve continuous monitoring for potential threats, investigating identified cases, and implementing coordinated actions across sectors to prevent and control outbreaks, thereby reducing spillover risk. ³¹

The 2017 Joint External Evaluation of Cameroon confirmed that this program was in place and supported this objective (p. 14). The JEE also highlighted the existence of "Contingency, surveillance, control, and prevention plans for certain zoonoses like Ebola, Avian Flu" and "Pilot initiatives for surveillance of wild fauna health for Ebola, Filovirus, etc." (p. 16), which are concrete measures for risk identification and reduction. Despite these efforts, the 2017 JEE noted challenges such as insufficient surveillance of wild fauna and a lack of standardized procedures for multidisciplinary teams hindering timely and effective response to zoonoses (p. 14). ³² The NAP-AMR also notes challenges like limited financial and technical support for implementing certain aspects, including insufficient integrated plans to reduce transmission of priority zoonoses to humans (p. 15). ³³

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

Cameroon possesses national legislation, plans, and guidelines that account for the surveillance and control of multiple zoonotic pathogens of public health concern.

The 2017 Joint External Evaluation of Cameroon confirms that action plans for surveillance and response to zoonotic diseases are under development with multi-sector collaboration, emphasizing the "One Health" approach (p. 14). ³⁴ It notes the establishment of the National Program for the Prevention and Fight Against Emerging and Re-Emerging Zoonoses via Decree N° 28/CAB/PM of 04 April 2014, which promotes this multi-sectoral approach. ³⁵³⁶ According to Article 3 of Decree N° 28/CAB/PM, the Program’s missions include promoting and adopting the “One Health” concept through a multisectoral and multi-stakeholder approach, as well as contributing to the development and implementation of national policies on training and capacity building for stakeholders involved in combating zoonoses (p. 2). ³⁷ This program specifically identifies and prioritizes five zoonoses: rabies, anthrax, avian influenza, Ebola/Marburg, and bovine tuberculosis, with action plans for surveillance and contingency in progress for these diseases (p. 14). ³⁸

While the decree itself was passed over 10 years ago, more recent strategic documents explicitly refer to it as an active and contributing entity. The National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR), which was published in March 2024, mentions the "Zoonosis Programme" as one of the national organizations involved in the fight against AMR (p. 12). This inclusion in a very current national plan indicates its continued relevance and active role in addressing health threats at the human-animal-environment interface. ³⁹

"Law No. 2001-6 on the nomenclature and zoo-sanitary regulations of livestock diseases deemed legally contagious and subject to compulsory notification" of 16 April 2001, which outlines nomenclature and zoosanitary regulations, identifies notifiable animal diseases under Article 3, including zoonoses such as tuberculosis and anthrax, thereby providing a legal framework for their control (p. 1-2). ⁴⁰

The 2024–2028 NAP-AMR further underscores the importance of addressing zoonoses, recognizing their role in the increased use of antimicrobials and the emergence of resistance (p. 21). This plan proposes developing and implementing national directives for the surveillance of emerging zoonoses under the "One Health" approach, and integrating training on field epidemiology and zoonotic disease control into the curricula for human, animal, and environmental health personnel (p. 42). ⁴¹

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 100

Cameroon has a multi-sectoral coordinating mechanism dedicated to zoonotic diseases that functions across ministries.

The National Program for the Prevention and Fight Against Emerging and Re-Emerging Zoonoses (NPPCERZ) was established by Decree N° 28/CAB/PM of 04 April 2014, and it operates under a "One Health" approach, fostering collaboration between various stakeholders (p. 15). The 2017 Joint External Evaluation (JEE) of Cameroon explicitly references the National Program for the Prevention and Fight Against Emerging and Re-Emerging Zoonoses (NPPCERZ) as a joint entity for cross-sectoral coordination. Under the "Zoonoses" section of the JEE report, it mentions the "Establishment of the national program for the prevention and control of emerging and re-emerging zoonoses by Decree N°28/CAB/PM of 04 April 2014 creating, organizing and operating said program which ensures the promotion or appropriation of the 'One Health' concept through a multisectoral and multi-actor approach" (p. 15). This directly confirms the NPPCERZ's role in promoting cross-sectoral coordination under the "One Health" framework. ⁴²

It operates under the direct oversight of the Prime Minister and is explicitly mandated to prevent and control zoonoses through a comprehensive One Health approach, highlighting its central role in inter-ministerial collaboration (p. 70-71). Its hierarchical structure facilitates this coordination, beginning with the Strategic Orientation Committee (COS), which serves as the top-level supervisory and guiding body. This committee is notably chaired by the Secretary General of the Prime Minister's Services and includes a broad representation of ministers from key sectors such as Public Health, Livestock, Fisheries, and Animal Industries; Environment, Nature Protection, and Sustainable Development; Scientific Research and Innovation; Forests and Wildlife; Agriculture and Rural Development; Higher Education; Communication; and Defense, ensuring a wide-ranging, cross-ministerial commitment (p. 72). Below the COS, the Technical Committee (CT) provides technical oversight and monitoring, co-chaired by a senior official from the Prime Minister's Services, alongside the Director of Disease, Epidemic, and Pandemic Control from the Ministry of Public Health and the Director of Veterinary Services from the Ministry of Livestock, Fisheries, and Animal Industries (p. 73). Finally, the Permanent Secretariat (SP) acts as the executive arm, managing the planning, coordination, and implementation of One Health activities, with its membership drawn from multiple ministries to ensure integrated and actionable approaches (p. 74). ⁴³

1.2.1e Presence of One Health strategic plan

Score: 100

Cameroon has its One Health Action Plan 2024-2028 which is built around five strategic areas: (1) strengthening the institutional framework of the approach; (2) improving the capacity of stakeholders; (3) supporting the development of research on emerging and re-emerging diseases; (4) strengthening surveillance, investigation and response systems; and (5) promoting communication and awareness on the One Health concept and its areas of action.⁴⁴

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 100

Cameroon has a national mechanism, which is legally mandated, for owners of livestock to report on disease surveillance to a central government agency. This comprehensive framework is further supported by dedicated guidelines ensuring the safe and secure handling of associated pathogens at the laboratory level, reinforcing the overall integrity of the disease surveillance and response system.

Law No. 2001-6 on the nomenclature and zoo-sanitary regulations of livestock diseases deemed legally contagious and subject to compulsory notification of 16 April 2001 specifies a list of legally contagious and notifiable livestock diseases under Article 3 (p. 1-2). This law requires animal owners to provide a written report of these notifiable diseases to local administrative and veterinary authorities under Article 5 (p. 3). Furthermore, veterinary technicians tasked with inspecting animals suffering from these legally contagious diseases are required to report their findings in writing to their administrative and line managers. Article 5 also obligates them to promptly inform the territorially competent technical services of the Ministry of Public Health in all cases of contagious diseases transmissible to both humans and domestic animals (p. 3). ⁴⁵

Complementing this field-level reporting, the National Guide to Laboratory Biosafety and Biosecurity in Cameroon provides regulatory oversight for the subsequent laboratory processing of these reported cases. As highlighted in its preface, this guide serves as a fundamental reference for laboratory practitioners, outlining the necessary precautions for "handling, transporting or storing pathogens, toxins and radioactive agents in Cameroon" (Preface, p. v). It is described as "the first document Cameroon has developed to regulate activities involving the handling of pathogens, toxins, and radioactive agents" (Preface, p. v). This guide ensures that both existing and new laboratories comply with essential "physical standards on containment, operating standards and those relating to verification and performance test" (Preface, p. v). ⁴⁶

The 2017 Joint External Evaluation of Cameroon also confirms the existence of an animal health surveillance system, which includes a network whose organizational structure is well-established (p. 14). ⁴⁷

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no publicly available evidence of specific legislation or regulations in Cameroon that explicitly safeguard the confidentiality of information generated through surveillance activities for animals, particularly for livestock owners.

The 2017 Joint External Evaluation of Cameroon does not mention any provisions for confidentiality within the animal health surveillance system, despite noting the existence of the National Program for the Prevention and Fight Against Emerging and Re-Emerging Zoonoses (NPPCERZ) (p. 31). ⁴⁸ Information from the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA) and the NPPCERZ itself also lacks details on confidentiality safeguards for surveillance data. ⁴⁹⁵⁰ While "Law No. 2001-6 on the nomenclature and zoo-sanitary regulations of livestock diseases deemed legally contagious and subject to compulsory notification" of 16 April 2001 mandates the reporting of notifiable livestock diseases, it does not address the confidentiality of the information collected from owners. ⁵¹

More broadly, while Cameroon has laws related to electronic communications and cybersecurity, these do not appear to specifically cover or guarantee the confidentiality of animal disease surveillance data. The United Nations Conference on Trade and Development (UNCTAD)'s database on data protection and cybersecurity does not list any laws on data protection and privacy in Cameroon that are relevant to this specific context. ⁵²

1.2.2c Wildlife zoonotic disease surveillance

Score: 100

Cameroon conducts surveillance of zoonotic disease across wildlife, poultry, and livestock.

For wildlife, the Military Health Research Centre (CRESAR) plays a role in this surveillance. The 2017 Joint External Evaluation of Cameroon notes that CRESAR conducts surveillance for zoonoses in wildlife and has led pilot initiatives concerning diseases like Ebola and Filovirus (p. 14-16). While these efforts are noted, the JEE also stated that wildlife surveillance, despite progress, was still considered "insufficient" (p. 15). ⁵³

For poultry and livestock, systematic surveillance is carried out. The Ministry of Livestock, Fisheries and Animal Industries (MINEPIA) oversees this. Cameroon has identified five priority zoonoses, including avian influenza (relevant to poultry) and anthrax and bovine tuberculosis (relevant to livestock) (p. 14). ⁵⁴ The National Veterinary Laboratory (LANAVET) is actively involved in these surveillance efforts. ⁵⁵ Furthermore, "Law No. 2001-6 on the nomenclature and zoo-sanitary regulations of livestock diseases deemed legally contagious and subject to compulsory notification" of 16 April 2001 mandates the reporting of notifiable livestock diseases under Article 5, establishing a legal framework for surveillance activities in this sector (p.3). ⁵⁶ The National Program for the Prevention and Fight Against Emerging and Re-Emerging Zoonoses (NPPCERZ) is designed to improve control and prevention of these diseases. ⁵⁷

The National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR) also reports on specific surveillance activities in animal health, noting that an integrated sentinel surveillance system for priority antimicrobial agents has been set up, and data on the use of antimicrobials in livestock (e.g., poultry farms) has been collected (p. 29). ⁵⁸

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

Cameroon has a mechanism for reporting notifiable diseases to the World Organisation for Animal Health (WOAH), and evidence of this mechanism is publicly available through WOAH's reporting platforms.

The Ministry of Livestock, Fisheries and Animal Industries (MINEPIA) is responsible for notifying WOAH (formerly OIE) of events of animal origin. The Veterinary Health Directorate (Direction de la Santé Vétérinaire) within L16MINEPIA serves as the operational WOAH contact point in Cameroon as per Camerooon's Joint External Evaluation report from 2017 (p. 31). ⁵⁹

Publicly available reports on the WOAH World Animal Health Information System (WAHIS) demonstrate that Cameroon actively reports animal disease outbreaks. For instance, Cameroon reported a highly pathogenic avian influenza outbreak in 2017, and this report was publicly accessible on WOAH's WAHIS database. ⁶⁰

1.2.4a Number of veterinarians per 100,000 people

Score: 0

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 0

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

Cameroon's national plans and strategies related to zoonotic diseases do include mechanisms for working with the private sector in controlling or responding to zoonoses; however, public documentation of specific detailed mechanisms are limited.

The National One Health Action Plan emphasizes the importance of collaboration with various stakeholders, including civil society organizations and technical and financial partners, in addressing health challenges. The foreword states that the plan is the result of a "collaborative effort between various ministries, civil society organizations and technical and financial partners" (p. 1). More concretely, the plan outlines the composition of its technical and editorial committees, which include representatives from various ministries, but also mentions Civil Society Organization (ROOHCAM) and Technical and Financial Partners (PTF) as contributors and members in various coordinating bodies (p. 7). Specifically, the "Coordination with other stakeholders" section details engagement with Civil Society Organizations and technical and financial partners, stating that "The activities implemented by the PTFs must respond to the country's priorities and be coordinated by the national bodies established at all levels" (p. 75). ⁶¹

The National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR), developed under the One Health concept, also explicitly recognizes the private sector's role. It notes weaknesses in the current system, such as the "Insufficient control of the distribution circuit of medicines and products for veterinary use" and the "Existence of places of storage and sale of unapproved antimicrobials and pesticide," (p. 87). Critically, the NAP-AMR includes a strategic objective to "Optimise the use of existing antimicrobials in human, animal and plant health," and under this, it plans to "Build the capacities for routine data collection on the use of antimicrobials in the human, animal, plant and environmental health sectors" (p. 59). Furthermore, it details activities such as conducting pilot studies on data related to the quantities of antimicrobials sold in the human health (importers/wholesalers and pharmacists), animal health (importers/wholesalers, retail pharmacists), and agricultural (pesticide importers and distributors) sectors (p. 60). ⁶²

The 2017 Joint External Evaluation (JEE) report, while not a strategic document itself, provides context by stating that "mechanisms exist for intersectoral collaboration for the detection and response to public health events, especially zoonoses" (p. 2). However, it highlights a need to "reinforce the functioning of exchange platforms between the different sectors for a better implementation of the RSI (2005)" (p. 10). The JEE also recommends elaborating and diffusing standardized operating procedures for the National Focal Point, with the participation of all relevant sectors (p. 9). ⁶³

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

While Cameroon's national laboratories maintain internal registers of pathogenic agents, publicly available evidence does not indicate the existence of a comprehensive central government record, updated within the past five years, of all facilities where especially dangerous pathogens and toxins are stored or processed, including detailed inventories and inventory management systems for these facilities.

It has been noted in Cameroon's Joint External Evaluation from 2017 that individual reference laboratories, such as the Cameroon Pasteur Centre (CPC), the Military Health Research Centre (CRESAR), and the National Veterinary Laboratory (LANAVET), have implemented registers for pathogenic agents along with measures for their conservation and access (p. 19). ⁶⁴

However, the "Joint external evaluation of IHR core capacities of Cameroon: Mission report 25-29 September 2017" highlighted a lack of a global, integrated system for managing the biosecurity and biosafety of pathogens across all laboratories in the country. There is also an absence of specific standards and guidelines pertaining to the use, inventory, storage, and disposal of pathogenic agents in laboratories on a national scale (p. 19). Furthermore, no official classification system for laboratories based on their biological containment levels is publicly evidenced (p. 20). ⁶⁵

Law No. 2025/006 governing biosecurity in Cameroon, enacted on 25 April 2025, serves as the overarching legal instrument governing biosecurity in Cameroon. Section 12 mentions maintaining a list of invasive species and LMOs, but does not mention any provisions related to a centralised record. ⁶⁶

While a national law on biosafety and biosecurity has been under development, publicly accessible information does not confirm its enactment or its provisions for a centralized, regularly updated inventory system for dangerous pathogens and toxins across all relevant facilities. ⁶⁷⁶⁸

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 50

Cameroon has enacted foundational legislation and developed comprehensive guidelines to address biosecurity requirements, including physical containment, operational practices, and mechanisms for reporting within facilities handling dangerous biological materials. However, it does not offer specific details on cybersecurity requirements or integrated failure reporting systems within this framework.

Law No. 2025/006 governing biosecurity in Cameroon, enacted on 25 April 2025, serves as the overarching legal instrument governing biosecurity in Cameroon. This law broadly applies to any person or entity engaged in activities posing a biosecurity threat within the national territory or abroad, and to various vectors, means of transport, points of entry, and facilities, including "any laboratory, institute or centre, engaged, in the research and analysis of invasive alien species, living modified organisms or their derivatives, including through the use of biotechnology" (Section 2(1), p. 2). It establishes key biosecurity principles such as State responsibility, prevention, precaution, participation, and collaboration (Section 3(1), p. 2). The law specifically mandates the State to carry out biosecurity risk analysis for regulated sectors, species, and products, including identification, assessment, and reporting of risks based on scientific data and expert opinion (Section 5, p. 5). It also requires the State to compile and update a list of invasive alien species and living modified organisms, which may be subject to import bans, restrictions, or official control (Section 12, p. 6). The law further details biosecurity threat response measures, including internal biosecurity investigations and controls, where the State may declare areas as biosecurity control areas and restrict movement or seize property posing a risk (Sections 16-19, p. 7). Penalties are prescribed for various biosecurity offenses, including failure to declare, obstructing officers, forging documents, and unlawful importation or possession of regulated products (Sections 41-47, p. 11-12). ⁶⁹

Complementing this legal mandate, the National Guide to Laboratory Biosafety and Biosecurity in Cameroon, published in 2019, provides the essential operational and technical guidance for laboratories. This Guide serves as a fundamental reference for laboratory practitioners, outlining the "precautions to take when handling, transporting or storing pathogens, toxins and radioactive agents in Cameroon" (Preface, p. v). It explicitly states its purpose to enable both existing and new laboratories "to comply with physical standards on containment, operating standards and those relating to verification and performance test" (Preface, p. v). The Guide's preface highlights its significance as "the first document Cameroon has developed to regulate activities involving the handling of pathogens, toxins, and radioactive agents" (Preface, p. v). It meticulously details risk assessment processes (Section 3.1, p. 5), classification of microorganisms by risk group (Section 3.1.1, p. 5), classification of laboratories by biosafety level (Section 3.2, p. 8), and essential biosafety and biosecurity measures, including design requirements for facilities (Section 3.3.1, p. 9) and specific rules for different biosafety levels (NSB1 to NSB4) with corresponding physical and operational controls (Sections 3.4-3.6, p. 10-21). The Guide also covers management and responsibility within laboratories, including the role of a Biosafety Officer and a Biosafety Committee (Section 16, p. 44-45), and mechanisms for incident/accident management, requiring documentation and corrective actions (Section 11, p. 36). ⁷⁰

According to the 2017 Joint External Evaluation (JEE), a national law on biosafety and biosecurity was indeed "under development" at that time, coordinated by the Ministry of Environment, Nature Protection and Sustainable Development (MINEPDED) (p. 19). ⁷¹ The enactment of Law No. 2025/006 signifies the fulfillment of this development, providing the legal backbone for the biosecurity framework. ⁷² However, while the Guide details management of incidents and accidents, the documents do not explicitly outline comprehensive failure reporting systems or specific cybersecurity requirements for facilities handling dangerous pathogens and toxins, beyond general data security for health information systems (Section 10, p. 35). ⁷³ Furthermore, the National Action Plan for the Fight Against Antimicrobial Resistance 2024–2028 still indicates a perceived need to "Develop, validate and disseminate two national biosafety guides (for plant health and animal health)" (p. 54), suggesting that while robust frameworks exist for human health laboratories, cross-sectoral harmonization or dedicated guides for other domains are still considered a priority. ⁷⁴

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

Cameroon has established a legally mandated framework and operational guidelines for biosecurity, clearly distinguishing it from biosafety, and has designated agencies responsible for enforcing these regulations. This framework addresses critical aspects of preventing unauthorized access, theft, misuse, diversion, or intentional release of dangerous pathogens and toxins, including those considered especially dangerous.

The foundational legal instrument for biosecurity is Law No. 2025/006, enacted on 25 April 2025, which explicitly governs biosecurity in Cameroon. This law defines "biosecurity" comprehensively as a "strategic and integrated approach, including policies and regulatory frameworks for the analysis, and management of risks to food safety, animal life and health, plant life and health and related environmental risks; legal and technical measures governing (i) the introduction of plant pests, animal parasites, diseases and zoonoses; (ii) the introduction and release of genetically modified organisms and their derivatives; and (iii) the introduction and management of invasive alien species and genotypes" (Section 4, p. 3). It explicitly mandates the State with responsibility for "coordinating and ensuring the effectiveness of measures to prevent, manage and control biosecurity risks" (Section 3(2), p. 2) and establishes "Biosecurity officers" as sworn personnel responsible for carrying out biosecurity duties (Section 4, p. 3). Furthermore, the law outlines "Biosecurity Preventive Measures" (Chapter II, p. 5) and "Biosecurity Threat Response Measures," including internal biosecurity investigations and the declaration of "biosecurity control areas" (Chapter III, p. 7), demonstrating mechanisms for enforcement and management of biosecurity threats. Penalties are also stipulated for various "biosecurity offences" (Chapter VI, p. 9). ⁷⁵

Complementing this legal mandate, the National Guide to Laboratory Biosafety and Biosecurity in Cameroon, published in 2019, provides specific operational guidance for laboratories. This Guide explicitly defines biosecurity as "the set of principles, technologies, and operational practices related to containment that are implemented to prevent deliberate exposure to pathogenic agents or toxins. Biosecurity, therefore, refers to security measures aimed at preventing the loss, theft, malicious use, diversion, and intentional release of infectious materials or toxins" (Section 2, p. 3). This definition directly addresses the core aspects of biosecurity, especially concerning dangerous pathogens. The Guide details the role of a Biosafety Officer responsible for ensuring compliance with safety and security regulations and acting as a technical resource (Section 16.2, p. 44). It also mandates the establishment of a Biosafety Committee, responsible for defining the institution's biosafety and biosecurity policy, reviewing research protocols involving infectious agents, and evaluating risks (Section 16.3, p. 45). ⁷⁶

At the national level, the National Biosafety Committee (NBC), established in 2012 under the Ministry of Environment, Nature Protection and Sustainable Development (MINEPDED), serves as a key agency. While its primary focus, as detailed by the FAO GM Foods Platform, is on biosafety concerning genetically modified organisms (GMOs) – managing risks associated with biotechnology to prevent accidental harm, ⁷⁷ its mandate also extends to the broader regulatory framework which, as per Law 2025, encompasses both biosafety and biosecurity aspects for GMOs and their derivatives (Section 4, p. 3). ⁷⁸ The National Biosafety Committee (NBC) is not designated as the sole or central agency responsible for coordinating and executing the entirety of Law No. 2025/006. Law No. 2025/006 explicitly states that the State is responsible for "coordinating and ensuring the effectiveness of measures to prevent, manage and control biosecurity risks" (Section 3(2), p. 2). This indicates a broader, governmental responsibility rather than assigning it to a single committee. ⁷⁹

In the human health sector, the National Public Health Laboratory (LNSP), within the Ministry of Public Health, coordinates quality and risk policies in human health laboratories. The 2017 Joint External Evaluation (JEE) report explicitly confirms that the LNSP plays a crucial role in the "One Health mechanism, for the coordination of policies on quality and risks (biosafety/biosecurity) in human and animal health laboratories" (p. 19). The JEE further notes that this coordination "covers especially dangerous human and animal pathogens and biological toxins" (p. 19), indicating a clear mandate for the LNSP to enforce both biosafety and biosecurity for the most critical biological threats. ⁸⁰

For animal health, the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA) holds oversight responsibilities. While the National Action Plan for the Fight Against Antimicrobial Resistance 2024–2028 indicates that the Department of Veterinary Services (DSV) within MINEPIA conducts control activities (p. 26), which contribute to overall animal health safety and disease control (biosafety), the plan does not explicitly detail comprehensive biosecurity measures specifically aimed at preventing the deliberate misuse, diversion, or intentional release of dangerous animal pathogens. ⁸¹ However, the overarching Law No. 2025/006 applies to "animal life and health" and the management of "animal parasites" (Section 4, p. 3), thereby providing the legal basis for MINEPIA's biosecurity enforcement. ⁸²

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

Based on the publicly available evidence, while Cameroon has established a robust legal and operational framework for the management, control, and secure storage of dangerous pathogens and toxins, there is no explicit indication in national documents that the country has taken action to strategically consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities. The focus appears to be on regulating and securing existing storage sites and their contents.

The Law No. 2025/006, enacted on 25 April 2025, comprehensively governs biosecurity in Cameroon, applying to any premises containing regulated products, including "any warehouse, store, silo, enclosure, farmland or other premises within the national territory containing regulated products, invasive alien species, living modified organisms or their derivatives" (Section 2(1), p. 2). This law mandates the State to "compile and update a list of invasive alien species, living modified organisms and their derivatives" (Section 12(1), p. 6) and to "designate points of entry…and border holding areas" (Section 11(1), p. 6), as well as "storage areas" (Section 11(1), p. 6; Section 15, p. 7). It also grants the State authority for measures such as quarantine and the "seizure, confiscation or destruction of property that poses a proven biosecurity risk" (Section 19, p. 8). These provisions provide a strong legal basis for control and regulation over where such materials are kept and how they are managed and inventoried. However, they do not explicitly outline a policy objective or action plan to reduce the number of authorized facilities or consolidate existing inventories into fewer sites. ⁸³

The National Guide to Laboratory Biosafety and Biosecurity in Cameroon, published in 2019, provides detailed operational directives for the secure handling and storage of biological materials within laboratories. It emphasizes that "Biological material (microorganisms, spores, toxins and derivatives) must be stored and secured in order to avoid use for bioterrorism" (Section 8, p. 34). The Guide mandates "correct storage of samples and isolates of micro-organisms with the corresponding level of access control and maintenance of stocks" (Section 3.4.4, p. 12), and instructs laboratories to "provide spaces for long-term storage, which should be conveniently located, away from work areas" (Section 3.4.6, p. 13). It also requires an "updated inventory of stored samples and isolates" as part of monitoring and evaluation activities (Section 17, p. 46). While these guidelines ensure stringent internal management and inventory practices, they are primarily focused on how materials are stored and accounted for within individual facilities, rather than on a national strategy for reducing the overall number of storage sites. ⁸⁴

The 2017 Joint External Evaluation (JEE) earlier noted that while national reference laboratories (including the Cameroon Pasteur Centre, Military Health Research Centre, and National Veterinary Laboratory) had established internal registers for pathogenic agents and implemented some storage and access measures, there was a recognized absence of a "comprehensive national system for managing these inventories" (p. 19). The JEE specifically highlighted "a lack of national standards and guidelines for the use, inventory, and storage of such agents" (⁸⁵, p. 19). While Law No. 2025/006 and the National Guide to Laboratory Biosafety and Biosecurity address many of these identified gaps by providing legal mandates and comprehensive guidelines for inventory management and secure storage within facilities, they do not explicitly detail mechanisms or policies aimed at the consolidation of inventories into a minimum number of facilities. The JEE's recommendation to establish an official classification system for laboratories based on their biological containment capacities (p. 20) supports the establishment of controlled environments, which is addressed by the Guide, but does not equate to a policy for national-level physical consolidation of collections. ⁸⁶

Existing supplementary legislation, such as Law no. 2016/015 on arms and munitions, prohibits the acquisition, development, or storage of biological agents not intended for peaceful purposes. While this law addresses illicit activities, it does not establish mechanisms for consolidating legitimate, authorized biological inventories into a minimized number of facilities. ⁸⁷

No other relevant evidence was found on the websites of the Ministry of Public Health and the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA). ⁸⁸⁸⁹

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 100

There is public evidence of in-country capacity in Cameroon to conduct Polymerase Chain Reaction (PCR)–based diagnostic testing for anthrax and Ebola, which would allow for testing without necessarily culturing a live pathogen.

For anthrax, the Cameroon Pasteur Centre (CPC), which serves as the national reference laboratory, reported in May 2018 that its staff, along with personnel from the National Public Health Laboratory (LNSP) and the Military Health Research Centre (CRESAR), received training on real-time PCR diagnosis for anthrax. This training made PCR-based testing for anthrax available in the country, a capability that did not exist previously. ⁹⁰

For Ebola, the CPC has also indicated its capacity for molecular diagnostic tests. While the documentation does not explicitly state "PCR" for Ebola, it refers to "rapid molecular diagnostic tests" and mentions having a biosafety-level 3 laboratory for this purpose. Molecular tests, by their nature, generally rely on PCR or similar nucleic acid amplification techniques, which would preclude the need for culturing a live pathogen for diagnosis. ⁹¹⁹²

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

Based on publicly available evidence, Cameroon does not currently require biosecurity training, using a standardized, required approach (such as a common curriculum or a train-the-trainer program), for all personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

The 2017 Joint External Evaluation (JEE) report specifically noted the absence of a national biosecurity regime and a comprehensive biosecurity training program (p. 21). It recommended the development and implementation of a national training program on biological safety and security for laboratory personnel and all those handling biological agents. While the report acknowledged that training procedures existed for personnel in BSL-2+ and BSL-3 laboratories (like the Cameroon Pasteur Centre, National Veterinary Laboratory, and Military Health Research Centre), it did not specify if this training was government-mandated for all relevant personnel or if it covered all "especially dangerous pathogens" with a standardized curriculum. ⁹³

More recently, the National Action Plan for the Fight Against Antimicrobial Resistance (NAP-AMR) mentions the adoption of a "National Guide for biosafety and biosecurity in laboratories in Cameroon" in June 2019. This guide aims to align laboratory practices with WHO and OIE standards and provides information on the safe handling, transport, and elimination of biological risks (p. 25). However, the "guide" provides recommendations and information and does not constitute or present any evidence of a required training program. ⁹⁴

In Cameroon, several training initiatives are available, including a 6-month program led by the University of Dschang and the University of Buea, in collaboration with the African Field Epidemiology Network (AFROHUN), which promotes a "One Health" approach for professionals in human, animal, and environmental health. Another example is the Quality and WArning System (QWArS) Project, a 7-month continuing education program on antimicrobial resistance (AMR) surveillance across human and animal sectors. However, these programs are considered general capacity-building efforts (p. 33) ⁹⁵ and do not represent specific, mandatory biosecurity training based on a standardized framework for personnel working with especially dangerous pathogens.

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 33.33

Based on the available information, regulations or licensing conditions in Cameroon require health background and medical fitness checks for personnel in high-level biosafety laboratories, but do not explicitly specify that all security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to drug testing or general security background checks.

The 2017 Joint External Evaluation (JEE) report indicates that a national law on biosafety and biosecurity was under development (p. 19). However, there is no public confirmation that this law has been enacted or that it includes such specific personnel vetting requirements. The JEE and other documents focus more on the absence of a comprehensive, integrated biosecurity system and the need for standardized practices, rather than detailed personnel screening mandates (p. 20-21). ⁹⁶

The "National Guide to Biosafety and Biosecurity in Laboratories in Cameroon" (June 2019) mandates health background checks for personnel recruited into specific laboratories, such as BSL-3 facilities (p. 21). It also requires mandatory medical visits for BSL-3 personnel, including a physical examination and review of medical history, to confirm medical fitness for professional activity (p. 19). Furthermore, the guide emphasizes an occupational health program that supports the physical, mental, and social well-being of laboratory staff (p. 35). However, the guide does not explicitly outline requirements for drug testing or general security background checks for personnel with access to dangerous biological materials. ⁹⁷

While Law no. 2016/015 on arms and munitions prohibits the acquisition, development, or storage of biological agents not intended for peaceful purposes, it does not outline specific personnel vetting for those handling legitimate biological materials. ⁹⁸

The National Action Plan for the Fight Against Antimicrobial Resistance (2024–2028 NAP-AMR) emphasizes capacity building, training, and improved governance, but it does not detail specific vetting requirements for personnel with access to dangerous biological materials (p. 36-37). ⁹⁹

There is no publicly available regulatory or licensing documentation that mandates drug testing, background checks, and psychological or mental fitness checks for personnel with access to especially dangerous pathogens or toxins across the country. ¹⁰⁰¹⁰¹

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

Cameroon does not have publicly available, comprehensive national regulations specifically detailing the safe and secure transport of infectious substances, including Categories A and B, in a consolidated and easily accessible format.

The 2017 Joint External Evaluation (JEE) report mentions that national guidance exists for the shipment of dangerous pathogens and that training for technicians and logisticians on the international shipping of infectious substances is conducted in accordance with WHO-IATA (World Health Organization – International Air Transport Association) regulations. However, the JEE explicitly states that there is "no reference to Categories A and B" in this national guidance (p. 26). The report also notes an internal document from the Military Health Research Centre (CRESAR) on "Special pathogen sample management," but this document is not publicly available (p. 26). ¹⁰²

While Cameroon has general regulations concerning the transport of dangerous goods, such as Order No. 735/MINT of June 7, 2005, on air transport of dangerous goods, these regulations typically refer to international standards (like ICAO's technical instructions) rather than providing detailed national provisions specific to Categories A and B infectious substances. ¹⁰³

The National Action Plan for the Fight Against Antimicrobial Resistance (NAP-AMR), while discussing biosafety and biosecurity, focuses on laboratory practices and waste management rather than the transport of infectious substances (p. 25, 54). ¹⁰⁴

The National Guide to Biosafety and Biosecurity in Laboratories in Cameroon, issue in 2019 by the Ministry of Public Health, does no contain any reference to Categories A and B. ¹⁰⁵

No relevant evidence was found on the websites of the Ministry of Public Health or the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA). ¹⁰⁶¹⁰⁷

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no publicly available evidence of legislation or regulations in Cameroon explicitly focused on overseeing the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential.

The 2017 Joint External Evaluation (JEE) report indicates that a national law on biosafety and biosecurity was under development, coordinated by the Ministry of Environment, Nature Protection and Sustainable Development (MINEPDED) (p. 19). However, there is no public evidence to confirm the enactment of this law or that it specifically addresses the cross-border transfer and end-user screening of such dangerous biological materials. The JEE noted that Cameroon lacked a national, integrated biosecurity system for pathogens in laboratories and comprehensive standards/guidelines for their use, inventory, and storage (p. 19). ¹⁰⁸ While a "National Guide to Biosafety and Biosecurity in Laboratories in Cameroon" was issued by the Ministry of Public Health in June 2019, it focuses on internal laboratory practices and safe handling, not specifically on the mechanisms for cross-border transfer or end-user screening of biological materials. ¹⁰⁹

Two Cameroonian laws govern the cross-border transfer and control of pathogens and related biological materials: one for phytosanitary protection and another for modern biotechnology safety. There is no specific mention of "end-user screening," but the regulations establish a framework for risk assessment and prior consent for transfers. Law No. 2003/003 on Phytosanitary Protection focuses on controlling organisms harmful to plants and plant products, which includes pathogenic agents. The key provisions for cross-border transfers are found in Chapter II: Phytosanitary Protection of the Territory. Article 8 prohibits the introduction, possession, or transportation of "quarantine organisms," including pathogenic agents, on national territory. Exceptions may be granted for research, experimentation, or training purposes. Article 9 prohibits the import or export of plants, soils, or culture media contaminated with harmful organisms. Imports and exports require a phytosanitary certificate, and a specific import permit is necessary for regulated biological control agents. However, neither law cites pandemic potential. ¹¹⁰

Cameroon is a member of and has adopted the Cartagena Protocol, which addresses the transboundary movement of living modified organisms (LMOs) resulting from modern biotechnology. ¹¹¹ However, the Protocol primarily focuses on environmental and health risks associated with genetically modified organisms and does not specifically regulate the cross-border transfer or implement end-user screening for especially dangerous pathogens and toxins.

No further relevant evidence was found on the websites of the Ministry of Public Health or the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA). ¹¹²¹¹³

1.4.1a Biosafety laws/regulations

Score: 100

Cameroon has enacted comprehensive national legislation and developed detailed operational guidelines that broadly cover both biosecurity and biosafety aspects, establishing a robust framework for managing risks associated with biological agents and materials.

Law No. 2025/006, enacted on 25 April 2025, governs biosecurity in Cameroon. This legislation defines "biosecurity" as a comprehensive and integrated approach, encompassing policies and regulatory frameworks for the analysis and management of risks to food safety, animal life and health, plant life and health, and related environmental risks. It specifically includes "legal and technical measures governing (i) the introduction of plant pests, animal parasites, diseases and zoonoses; (ii) the introduction and release of genetically modified organisms and their derivatives; and (iii) the introduction and management of invasive alien species and genotypes" (Section 4, p. 3). This broad scope means the law effectively consolidates legal instruments relevant to both biosecurity (preventing intentional misuse) and biosafety (preventing accidental harm) for a wide array of biological agents and organisms, including especially dangerous pandemic pathogens, as they fall under "biosecurity risk" or "biosecurity threat" definitions (Section 4, p. 3). The law notably applies to "any laboratory, institute or centre, engaged, in the research and analysis of invasive alien species, living modified organisms or their derivatives" (Section 2(1), p. 2). ¹¹⁴

Complementing this legal framework, the National Guide to Laboratory Biosafety and Biosecurity in Cameroon, published in 2019 by the Ministry of Public Health, provides operational standards. This Guide serves as a key reference document for laboratory personnel, meticulously detailing "precautions to take when handling, transporting or storing pathogens, toxins and radioactive agents in Cameroon" (Preface, p. v). It explicitly distinguishes between biosafety and biosecurity, defining biosafety as "all measures aimed at preventing and countering the dangers related to the handling and use of biological materials in diagnostic, teaching, industrial and research laboratories" and biosecurity as "the set of principles, technologies, and operational practices related to containment that are implemented to prevent deliberate exposure to pathogenic agents or toxins… referring to security measures aimed at preventing the loss, theft, malicious use, diversion, and intentional release of infectious materials or toxins" (Section 2, p. 3). The Guide allows laboratories to comply with "physical standards on containment, operating standards and those relating to verification and performance test" (Preface, p. v), and provides information on safe handling, transport, and disposal of biological risks, and harmonizing laboratory practices nationally (p. 1-2). It further outlines the classification of microorganisms by risk group, laboratory biosafety levels (NSB1-NSB4), and management protocols for incidents and accidents (Section 3.1.1, p. 5; Section 3.2, p. 8; Section 11, p. 36). ¹¹⁵

The enactment of Law No. 2025/006 fulfills a long-standing objective, as the 2017 Joint External Evaluation (JEE) report had indicated that a national law on biosafety and biosecurity was "under development," coordinated by the Ministry of Environment, Nature Protection and Sustainable Development (MINEPDED) (p. 19). ¹¹⁶ Older legal instruments, such as Law No. 006/2003 on safety regulations governing modern biotechnology, which primarily focused on GMOs and their impact, including recombinant-DNA vaccines and other pharmaceutical products manufactured through genetic modification, are now subsumed and complemented by the more comprehensive Law No. 2025/006. ¹¹⁷¹¹⁸ Similarly, references to a 1993 Biosafety Law and Policy concerning GMOs are integrated into this expanded legal and operational framework. ¹¹⁹ Therefore, while previous legislation had a narrower focus, Law No. 2025/006, together with the National Guide, provides a broad and comprehensive national biosafety and biosecurity regulatory and operational landscape.

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 100

Cameroon has established agencies that are responsible for the enforcement of biosafety legislation and regulations, although the comprehensiveness and specific focus on especially dangerous pathogens are still evolving areas.

According to the FAO GM Foods Platform, the primary agency is the National Biosafety Committee (NBC). This committee was created in 2012 and is responsible for managing risks associated with biotechnology in Cameroon. It works in collaboration with several ministries, and it operates under the Ministry of Environment, Nature Protection and Sustainable Development (MINEPDED). While its initial focus was heavily on genetically modified organisms (GMOs), its existence demonstrates a national body mandated with biosafety oversight. ¹²⁰

The NBC is responsible for coordinating and executing the specific provisions of Law No. 2025/006 that relate to genetically modified organisms and their derivatives. The law itself is comprehensive, covering a wide range of biosecurity risks including food safety, animal and plant health, zoonoses, and invasive alien species, in addition to GMOs. Other agencies, such as the National Public Health Laboratory (LNSP) for human health and MINEPIA for animal health, also have roles in enforcing biosecurity legislation within their respective domains, as outlined by the overarching Law No. 2025/006. ¹²¹

Within the Ministry of Public Health, the National Public Health Laboratory (LNSP) is responsible for coordinating quality and risk policies in laboratories (p. 19). ¹²² This includes aspects related to biosafety and biosecurity in human health laboratories, further detailed by the National Guide to Biosafety and Biosecurity in Laboratories in Cameroon, which provides specific guidelines for laboratory practices. ¹²³

For animal health, the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA) has oversight responsibilities. The National Action Plan for the Fight Against Antimicrobial Resistance 2024–2028 states that the Department of Veterinary Services (DSV) within MINEPIA conducts control activities (p. 26). ¹²⁴

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no evidence that Cameroon mandates a standardized, required approach for biosafety training, such as through a common curriculum or a train-the-trainer program, for all personnel who work with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

The 2017 Joint External Evaluation (JEE) identified this as a gap, noting the absence of a national biosecurity regime and a comprehensive biosecurity training program. Although the JEE acknowledged that certain training procedures were in place for personnel in specific high-level biosafety laboratories (BSL-2+ and BSL-3), it did not confirm whether this training was a government-wide requirement for all relevant personnel or if it adhered to a standardized curriculum across various facilities handling dangerous pathogens. ¹²⁵

While the National Guide to Biosafety and Biosecurity in Laboratories in Cameroon was developed in 2019, this document primarily serves as a set of recommendations and information for best practices. ¹²⁶ Current training initiatives—such as the 6-month program offered by the University of Dschang and the University of Buea in partnership with the African Field Epidemiology Network (AFROHUN), which applies a "One Health" approach for human, animal, and environmental health professionals, and the Quality and WArning System (QWArS) Project, a 7-month continuing education program on antimicrobial resistance (AMR) surveillance in human and animal sectors—contribute to general capacity building. However, as per the National Action Plan for the Fight Against Antimicrobial Resistance 2024–2028, they are not structured as universally required, standardized biosecurity training programs specifically designed for personnel handling high-risk biological agents (p. 33). ¹²⁷

1.5.1a Evidence of national assessment of dual-use research

Score: 0

While Cameroon has established a comprehensive legal and operational framework that mandates and provides mechanisms for the assessment of research activities to identify and manage those involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research, there is limited evidence that such assessment has been conducted in Cameroon.

The overarching legal framework, Law No. 2025/006, enacted on 25 April 2025, explicitly applies to "any laboratory, institute or centre, engaged, in the research and analysis of invasive alien species, living modified organisms or their derivatives, including through the use of biotechnology" (Section 2(1), p. 2). This law mandates the State to "carry out a risk analysis for regulated sectors, species and products" which includes "the identification, assessment and reporting of risks" based on scientific data and expert opinion (Section 5, p. 5). Furthermore, the law directly addresses the inherent dangers of biological materials by prohibiting "any form of use of biological materials, organisms or substances…with the intention of committing criminal or terrorist acts" (Section 29(1), p. 9), thereby providing a legal basis to regulate dual-use concerns. ¹²⁸

Complementing this legal mandate, the National Guide to Laboratory Biosafety and Biosecurity in Cameroon, published in 2019, provides specific operational requirements for such assessments within research settings. It mandates that laboratory activities involving pathogenic microorganisms or toxins be subjected to a risk assessment (Section 3.1, p. 5). The Guide details the classification of microorganisms by risk group, categorizing them from Group 1 (low/no risk) to Group 4 (high risk for individuals and community) based on pathogenicity, transmission, and availability of treatment/prevention (Section 3.1.1, p. 5). This classification is a direct assessment tool for determining the dangerous potential of pathogens in research. ¹²⁹

Crucially, the Guide dedicates sections specifically to research activities. Firstly, Safety and DNA Recombination Technologies explicitly states that "Due to the potential risks posed by these manipulations, genetic engineering work must be carried out under good safety conditions, which requires a correct risk assessment and sufficient safety measures" (Section 13.1, p. 37). This directly addresses the assessment of genetically modified organisms and technologies with dual-use implications. Secondly, Biosecurity, Bioethics and Research further mandates that "research involving laboratory analyses and the use of animal and plant models must comply with biosafety and biosecurity standards." It requires that "the protocol must include in the methodology a point on the biosafety and biosecurity measures that will be applied… for work using new experiments, a thorough analysis of the benefits… of the potential risks and the quality of the proposed mitigation measures… will determine whether or not ethical clearance should be granted. The risk analysis will be based on the criteria developed in the previous paragraphs" (Section 15, p. 43). Thirdly, the Guide also establishes the Biosafety Committee, whose role includes examining "research protocols involving the manipulation of infectious agents, the use of animals, the implementation of DNA recombination techniques or the use of genetically modified organisms" (Section 16.3, p. 45). This committee serves as the formal body for assessing research activities for biosafety and biosecurity risks, including those related to dangerous pathogens and dual-use concerns. ¹³⁰

While the 2017 Joint External Evaluation (JEE) report noted at that time a lack of an "overarching national, integrated biosecurity system for pathogens" and did not mention specific national assessments for dual-use research (p. 19), ¹³¹ the subsequent enactment of Law No. 2025/006 and the detailed provisions of the 2019 National Guide to Laboratory Biosafety and Biosecurity demonstrate that Cameroon has since implemented a robust framework that mandates and facilitates these specific assessments for research involving dangerous pathogens and potential dual-use concerns. Law no. 2016/015, which bans the acquisition, development, or storage of biological agents for non-peaceful purposes, further reinforces the intent to prevent misuse, with the new legal and guidance documents establishing the mechanisms for oversight. ¹³²

Beyond these framework provisions for individual research assessments, Cameroon provides concrete, publicly available evidence of national-level assessments actively being conducted on dangerous pathogens through its annual surveillance reports. The Antimicrobial Resistance Report 2022 – Cameroon (hereafter referred to as "Rapport RAM 2022") serves as a prime example of such an assessment. This comprehensive report details the results of the 2022 Antimicrobial Resistance (RAM) surveillance in Cameroon, covering both human and animal health sectors. It describes a rigorous, transversal, and comparative methodology for collecting and analyzing data from eight sentinel sites across Cameroon, six in human health and two in animal health (Section III.3, p. 13; Section III.3.1, p. 15). This involved collecting monthly data using WHONET software, centralized and processed by the National Public Health Laboratory (LNSP). ¹³³

The entire report is dedicated to assessing the prevalence and resistance profiles of high-priority pathogens that pose significant threats due to their antimicrobial resistance. For instance, in human health, the report specifically identifies and analyzes Escherichia coli (53.28%), Klebsiella pneumoniae (18.89%), and Staphylococcus aureus (15.43%) as the most frequently isolated pathogens (Summary, p. 9; Section IV.1.1, p. 17). Similarly, in animal health, Escherichia coli (60%) and Staphylococcus aureus (31%) were the primary pathogens assessed (Summary, p. 9; Section IV.2.1, p. 30). These pathogens, particularly when multi-drug resistant, qualify as "especially dangerous pathogens" due to their potential to cause severe infections with limited treatment options. ¹³⁴

The report doesn't merely present static data; it includes comparative analyses of resistance profiles and pathogen distribution between 2021 and 2022, illustrating the continuous nature of these assessments (Section IV.1.3.2, p. 25; Section IV.2.3, p. 33). This ongoing surveillance directly contributes to determining "whether ongoing research is occurring on especially dangerous pathogens" as it is the ongoing research and assessment activity itself. ¹³⁵

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no publicly available evidence of national legislation or regulation in Cameroon that specifically requires oversight of research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research.

The Joint External Evaluation (JEE) report from 2017 notes that a national law on biosafety and biosecurity was under development, coordinated by the Ministry of Environment (MINEPDED), but it does not indicate that this law would cover oversight of dual-use research (p. 19). The report also highlights a general lack of a national biosecurity regime and specific training in this area (p. 19). ¹³⁶

While the National One Health Action Plan mentions supporting the development of research on emerging and re-emerging diseases and threats as a strategic objective, it does not detail specific legislation or regulation for oversight of dangerous pathogens or dual-use research (p. 66-67, Section III.6.2 & III.7.3). The National Strategic Plan for Community Health 2021-2025 (p. 26-39) and the National Action Plan For The Fight Against Antimicrobial Resistance (2024-2028) (p. 35-37) primarily focus on health system strengthening, disease control, and AMR management, without specifying regulatory oversight for dual-use research or especially dangerous pathogens. No evidence of such a regulation or legislation was found in these documents. ^137138139

Cameroon's national implementation data submitted under the Biological Weapons Convention (BWC) states that "No information on the oversight of dual-use research in the life sciences has been received". ¹⁴⁰

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no publicly available evidence of an agency in Cameroon specifically responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research.

The Joint External Evaluation (JEE) report from 2017 notes that national reference laboratories, such as the Cameroon Pasteur Centre (CPC), Military Health Research Centre (CRESAR), and National Veterinary Laboratory (LANAVET), evaluate biosecurity risks and have a register of pathogens, along with storage and access measures (p. 19). However, the JEE also states that Cameroon lacks a national, integrated biosecurity system for pathogens in laboratories and that a national law on biosafety and biosecurity was under development at the time (p. 19). This report does not identify a dedicated agency for the oversight of dual-use research or research involving dangerous pathogens. ¹⁴¹

The National One Health Action Plan mentions supporting the development of research on emerging and re-emerging diseases and threats, with the National Program for the Prevention and Fight Against Emerging and Re-Emerging Zoonoses (NPPCERZ) contributing to scientific knowledge on zoonoses, but it does not specify an oversight agency for the research itself (p. 66, 67, 71). ¹⁴²

Similarly, the National Action Plan For The Fight Against Antimicrobial Resistance 2024-2028 (p. 36) and the National Strategic Plan for Community Health 2021-2025 (p. 36) outline strategic objectives related to surveillance, research, and health system strengthening, but they do not designate an agency for the oversight of dangerous pathogen or dual-use research. ¹⁴³¹⁴⁴

No relevant evidence was found on the websites of the Ministry of Public Health or the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA). ¹⁴⁵¹⁴⁶

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no publicly available evidence of legislation or regulation in Cameroon that specifically requires the screening of synthesized DNA (deoxyribonucleic acid) against lists of known pathogens and toxins before it is sold.

The Joint External Evaluation (JEE) report from 2017 mentions that a national law on biosafety and biosecurity was under development, coordinated by the Ministry of Environment (MINEPDED) (p. 19). However, the report does not indicate whether this law would include provisions for screening synthesized DNA. ¹⁴⁷

While Law No. 2003/006 of April 21, 2003 on safety regulations governing modern biotechnology in Cameroon addresses genetically modified organisms (GMOs) and requires risk assessment for their use, transfer, import/export, and marketing, it does not explicitly mandate the screening of synthesized DNA sequences against lists of known pathogens or toxins before commercial sale (p. 25). ¹⁴⁸

No relevant evidence was found on the websites of the Ministry of Public Health or the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA). ¹⁴⁹¹⁵⁰

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 0

Based on the information available through the World Organisation for Animal Health (formely OIE) database for Cameroon, there is no publicly available vaccination data specifically for Foot-and-Mouth Disease for livestock. The dashboard shows control measures, but current vaccination figures are not displayed for FMD in Cameroon's profile within this database. ¹⁵¹

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Cameroon maintains a comprehensive national immunization strategy that meets the outlined criteria, encompassing a national plan, equitable distribution mechanisms, and specific strategies to address socioeconomic, geographic, and cultural barriers.

Firstly, a robust national immunization strategy is in place. Cameroon's national vaccination policy is aligned with international and regional frameworks, including the Global Vaccine Action Plan and the Regional Strategic Plan for Vaccination. Nationally, the Expanded Program on Immunization (PEV) operates under a multi-year vaccination plan (PPAC) that defines intervention areas, vaccine supply, logistics, epidemiological surveillance, and communication. This framework is further supported by a national communication strategic plan, a national logistics plan, and a strategic plan for data quality improvement. The country also has specific strategic plans for the elimination or eradication of diseases such as poliomyelitis, measles, tetanus, and yellow fever, and the vaccination policy is underpinned by a national framework law on health. ¹⁵²

Secondly, the national immunization strategy includes a plan to ensure equitable distribution. This is evident through the "Reach Every District" approach, which aims to improve vaccination coverage by focusing on resource management, achieving all targets, engaging with communities, conducting formative supervision, and utilizing data for action. This strategy employs both fixed vaccination points within health facilities for nearby populations and advanced strategies for those living further away or in harder-to-reach areas. ¹⁵³

Thirdly, the strategy incorporates specific measures to overcome socioeconomic, geographic, and cultural barriers. Socioeconomic inequalities are addressed by offering routine PEV vaccines free of charge to children aged 12 to 59 months who are unvaccinated or have not completed their vaccination schedule, as part of the Integrated Management of Childhood Illnesses (PCIME). Geographical barriers are mitigated by advanced strategies where health personnel travel to specific locations in villages or neighborhoods, including "hit and run" tactics for populations in insecure zones, and door-to-door vaccination, fixed, and temporary fixed posts for widespread campaigns. Cultural and linguistic considerations are integrated through community engagement and by establishing vaccination schedules in common agreement with local communities, indicating an adaptive approach to local contexts. ¹⁵⁴

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 0

The national immunization strategy and plan for Cameroon does not include measures aimed at addressing vaccine hesitancy and building public trust in vaccines.

The Expanded Program on Immunization (PEV)’s framework includes the "Reach Every District" approach, which is central to Cameroon's routine vaccination, explicitly includes "engagement with communities" as one of its five core strategies. ¹⁵⁵

However, no specific information on building public trust and addressing potential hesitancy was found. ¹⁵⁶ No relevant evidence was found on the websites of the Ministry of Public Health. ¹⁵⁷

1.6.1e National advisory group for immunization strategy/plan

Score: 100

There is a national advisory group in Cameroon that provides technical guidance and advice on the immunization strategy and plan to the government.

This body is known as the National Consultative Technical Group for Vaccination (GTCNV). The GTCNV serves as an advisory body within the Expanded Program on Immunization (PEV) structure, specifically mandated to guide health authorities in the domain of vaccines and vaccination. The organization and functioning of this group are formally defined by a decision issued by the Minister of Public Health (MSP), confirming its official status and mandate within the national health system. ¹⁵⁸

The GTCNV is a multi-sectoral and multidisciplinary body. A multidisciplinary body, it is composed of a president, a vice-president, a rapporteur, eleven ex officio members, eight auxiliary members and four liaison members. The President and Vice-President are appointed by decision of the Minister of Public Health. The ex-officio members are national experts, recruited in the following disciplines or fields: pediatrics; infectious diseases; epidemiology; bacteriology-virology; internal medicine; public health; health economics; communication for development (C4D); pharmacy; health systems research; social sciences-anthropology. The ex-officio members vote on the recommendations. The auxiliary members are made up of ex-officio members and liaison members. The ex-officio members are representatives of the Ministry of Public Health, partner administrations, professional orders and learned societies involved in the implementation and monitoring of vaccination activities and the liaison members are representatives of national and international organizations or institutions that provide support in the implementation of vaccination activities (WHO, UNICEF, CHAI, PROVARESCC). The members of the GTCNV are appointed by the administrations and organizations to which they belong. ¹⁵⁹

1.6.1f Presence of an immunization programme for influenza

Score: 100

Cameroon has an immunization program that includes influenza.

The Expanded Program on Immunization (PEV) in Cameroon offers 14 vaccines to prevent major infectious diseases and premature mortality in children, and among the new vaccines introduced since 2005 is the vaccine against influenza (grippe). ¹⁶⁰

In terms of availability of seasonal flu vaccines, Cameroon has not introduced seasonal influenza vaccine in the national immunization programme, according to the WHO. ¹⁶¹

The immunization calendar was not available in the website of the Expanded Program on Immunization (PEV). ¹⁶²

1.7.1a Strategy/plan for resilience of health system

Score: 0

There is evidence that Cameroon has integrated climate change considerations into its national development strategies, including those related to health, but a specific, comprehensive plan for a climate-resilient health system that thoroughly addresses infectious disease threats linked to changing weather patterns does not exist.

The National One Health Action Plan 2024-2028 highlights climate change and its enormous repercussions, noting that many risk factors for infectious diseases and other public health events are not solely within the health sector's usual domain (p. 17). It emphasizes the need for an integrated approach to balance and optimize human, animal, and ecosystem health, including taking measures against climate change and protecting the environment (p. 15). The document also mentions the National Development Strategy 2030 (SND30) and the environment sector's strategy, which aim to strengthen adaptation and mitigation measures for climate change effects to ensure sustainable economic and social development (p. 37). However, it notes that the analysis of the political, strategic, and legal framework shows weak consideration of health security in this context (p. 37). ¹⁶³

The National Strategic Plan for Community Health 2021-2025 does not specifically address climate change or its impact on the health system's resilience or infectious diseases. ¹⁶⁴ The National Action Plan For The Fight Against Antimicrobial Resistance (2024-2028) mentions Cameroon's ranking on the global climate risk index and its susceptibility to flooding and droughts (p. 14). ¹⁶⁵

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 100

Cameroon's national laboratory system has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests.

The National Public Health Laboratory (LNSP) of Cameroon was established by Ministerial Order No. 2964/MINSANTE of October 9, 2013, establishing the creation, organization, and operation of the National Public Health Laboratory by the Minister of Public Health. The LNSP is coordinated by the Directorate of Pharmacy, Medicines, and Laboratories (DPML). ¹⁶⁶

The Joint External Evaluation (JEE) report from 2017 states that Cameroon's national laboratory network, coordinated by the National Public Health Laboratory (LNSP), includes public, animal health, private, and research laboratories. The report specifically indicates that the country's national laboratory system is capable of detecting priority pathogens that can cause epidemics or epizootics (p. 24). The Cameroon Pasteur Centre (CPC), identified as a central reference laboratory, is noted for its capacity to conduct diagnostic tests for influenza and polio (p. 38). The JEE also mentions the laboratory network's capacity to perform rapid diagnostic tests for malaria and that the CPC is the national reference laboratory for tuberculosis (p. 38). Additionally, the virology laboratory at the Centre for Research on Emerging and Re-emerging Diseases and Nuclear Medicine (IMPM) conducts serology testing for HIV (p. 38). These capacities demonstrate the ability to conduct diagnostic tests for at least five WHO-defined core tests (polio, HIV, tuberculosis, malaria, and influenza). ¹⁶⁷

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no publicly available evidence of a national plan, strategy, or similar document in Cameroon specifically for conducting testing during a public health emergency that explicitly includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing.

The Joint External Evaluation (JEE) report from 2017 highlights the need for a mechanism for real-time collection of laboratory data by the surveillance system (p. 47). While it details the existing laboratory network and its capabilities for detecting priority diseases (p. 24), it does not describe a comprehensive plan for handling novel pathogens or scaling testing capacity during emergencies. ¹⁶⁸

The National One Health Action Plan emphasizes strengthening systems for surveillance, investigation, and response for human, animal, and environmental health, as well as supporting research on emerging and re-emerging diseases (p. 66, 67). It also mentions the importance of early detection (p. 15). However, this document does not outline a specific national strategy for laboratory testing for novel pathogens or how capacity would be scaled in an emergency. ¹⁶⁹

The National Action Plan For The Fight Against Antimicrobial Resistance (2024-2028) focuses on improving knowledge and detection capacity for antimicrobial resistance cases but does not detail a broader emergency testing strategy for all public health emergencies (p. 44). ¹⁷⁰

The National Strategic Plan for Community Health 2021-2025 also concentrates on community health and does not provide such a specific testing strategy (p. 31). ¹⁷¹

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 100

There is a national laboratory that serves as a reference facility which is accredited.

The National Action Plan For The Fight Against Antimicrobial Resistance (2024-2028) mentions that the Centre Pasteur Cameroon (CPC), a public health institution serving as a national reference laboratory, holds ISO 15189 and 17025 accreditation (p. 32) ¹⁷²¹⁷³ The Joint External Evaluation (JEE) report from 2017 further states that the CPC participates in the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) framework and received a high score in a 2017 review (p. 41). ¹⁷⁴

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

There is a national laboratory that serves as a reference facility and is subject to external quality assurance review.

The Centre Pasteur Cameroon (CPC), a public health institution serving as a national reference laboratory, undergoes external quality review. The CPC Medical Analysis Laboratory (LAM) is aligned with the quality management system. It has been accredited since 2019 according to the international standard ISO 15189. In 2017, the LAM obtained WHO Expert accreditation for the microscopic diagnosis of malaria. ¹⁷⁵ The National Action Plan For The Fight Against Antimicrobial Resistance (2024-2028) mentions that the CPC, among other laboratories, participates in external quality assurance programs like EILAS, even though it does not indicate what the abbreviation means (p. 31). ¹⁷⁶ The Joint External Evaluation (JEE) report from 2017 further states that the CPC is subject to external quality assurance reviews for its WHO reference laboratories (p. 42). ¹⁷⁷

Adding to this, the National Public Health Laboratory (NPHL) was established in Cameroon, inaugurated in 2018 with support from the U.S. Centers for Disease Control and Prevention (CDC). This NPHL now provides leadership and guidance to subnational laboratories across the country, solidifying its role as a central reference facility (p. 5, p. 11). This support has significantly bolstered Cameroon's overall laboratory capacity, leading to five laboratories achieving ISO 15189 accreditation, an internationally recognized standard for laboratory quality management (p. 6, p. 11). This accreditation itself signifies their subjection to rigorous external quality assurance. Furthermore, the CDC facilitated the establishment of a national external quality assurance (EQA) program for HIV testing. This program actively uses domestically produced proficiency testing panels to continuously monitor and ensure the sustained competency of laboratory personnel across more than 1,300 sites throughout all ten regions of Cameroon (p. 11). This EQA program serves as direct evidence of a comprehensive system for external quality review for critical diagnostic services. Additionally, an accredited blood transfusion center of excellence, the first of its kind in Central Africa, was also established with CDC's support, further strengthening the network of externally quality-assured reference facilities (p. 11). ¹⁷⁸

2.2.1a Nationwide specimen transport system

Score: 100

Cameroon is implementing a unified, nationwide specimen transport system designed to standardize and improve the collection and movement of biological samples across all 10 regions.

While the Joint External Evaluation (JEE) report from 2017 noted that documented transport systems for specimens existed only in certain specific cases—such as for suspected Ebola cases, diseases under the Expanded Programme on Immunisation (polio, measles, yellow fever), and for vertical disease programs (HIV and tuberculosis) (p. 43)—the JEE explicitly stated that the overall specimen transport system in Cameroon was insufficient at that time. It recommended putting in place a harmonized and secure system for specimen transport/transfer at all laboratory levels with standard operating procedures (p. 43). ¹⁷⁹

Addressing these earlier gaps, the US Centers for Disease Control and Prevention (CDC) is supporting the introduction of a unified transport system in Cameroon, beginning in October 2024. This system is designed to transform how biological samples are sent from health facilities to laboratories across all 10 regions of the country, integrating existing laboratory sample referral and transport systems for HIV, TB, and emerging public health concerns. This initiative is expected to strengthen national capacity for transportation and referral of samples for laboratory testing services and the return of results for HIV, TB, and emerging infectious diseases (p. 11). ¹⁸⁰ No more recent evidence was found regarding the implementation of this transport system.

Other national documents, such as The National Strategic Plan for Community Health 2021-2025, mention the national supply chain for essential medicines and medical consumables but do not describe a comprehensive nationwide specimen transport system (p. 41). ¹⁸¹ Similarly, the National Action Plan For The Fight Against Antimicrobial Resistance 2024-2028 (p. 29-30) and the National One Health Action Plan (p. 66) do not provide details on a nationwide specimen transport system. ¹⁸²¹⁸³

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

While Cameroon has demonstrated a robust capability to rapidly scale up its national laboratory system during specific public health emergencies, there is no explicit evidence in the national documents of a formal, pre-existing plan specifically detailing a rapid authorization or licensing process for laboratories to supplement national capacity during any outbreak as a standing readiness step. Instead, the evidence points to a responsive expansion of existing infrastructure and coordination mechanisms during actual crises.

The 2022-2023 Biennial Report mentions that, during the COVID-19 pandemic, the country underwent a significant expansion of its molecular biology laboratory capacities at the national level. Cameroon "passed from 2 to 45 laboratories (19 public and 26 private) equipped with the means and skills for the RT-PCR diagnosis of Covid-19 and other pathogens" (Section 2.2.1, p. 49). The accompanying "Mapping of Covid-19 diagnostic laboratories in Cameroon" (p. 50) lists these laboratories. Furthermore, in response to the cholera epidemic, Cameroon successfully expanded its reference laboratory capacities, "allowing the country to pass from 2 to 7 reference laboratories capable of confirming cholera cases by culture" (Section 2.2.5, p. 61). ¹⁸⁴ This demonstrates a proven ability to reactively integrate and equip laboratories during an emergency.

The National Public Health Laboratory (LNSP), as the central reference laboratory, inherently plays a coordinating role in the national laboratory network. While its public website does not detail a "rapid authorization plan," its mission typically involves ensuring quality, standardization, and the integration of laboratory services across the country, which would be central to any emergency scale-up efforts. ¹⁸⁵ The Roadmap for implementing the Quality Management System in Cameroon's laboratory network outlines important aspects of Cameroon's national laboratory system, it does not directly provide evidence for a plan to rapidly authorize or license new laboratories to supplement capacity during an outbreak. The document details the LNSP's role in strengthening and supporting the national laboratory network, particularly through the implementation of Quality Management Systems (QMS) and preparation for accreditation/certification (Table 4.1.2.1, p. 14). Moreover, the roadmap's objectives revolve around improving the quality, reliability, and technical capacities of laboratories already part of, or designated for, the national network (Sections 3 & 4). However, The QMS roadmap primarily focuses on systematic, long-term quality improvement and accreditation processes. No provisions related to rapid authorization were identified. ¹⁸⁶ Therefore, while Cameroon has successfully scaled its laboratory capacity in past emergencies, the documentation does not explicitly describe a formalized plan or readiness step for the rapid authorization or licensing of laboratories specifically for this purpose across any potential outbreak.

The 2017 Joint External Evaluation (JEE) report noted the need to strengthen overall laboratory capacity and establish real-time data collection mechanisms (p. 25, 47). While the JEE did not explicitly mention a plan for rapid authorization of laboratories, the subsequent actions detailed in the 2022-2023 Biennial Report demonstrate that such a functional capacity exists. ¹⁸⁷¹⁸⁸ Other national plans, such as the National One Health Action Plan (p. 66, 67) and the National Action Plan For The Fight Against Antimicrobial Resistance (2024-2028) (p. 48-50), focus on strengthening surveillance, investigation, and general laboratory capacities, but do not outline a specific mechanism for rapid authorization or licensing of additional facilities during an outbreak. ¹⁸⁹¹⁹⁰

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

Cameroon has significantly strengthened its surveillance capabilities, moving towards more comprehensive and ongoing event-based surveillance and analysis for both notifiable and novel infectious diseases, building upon its established indicator-based system.

According to the Joint External Evaluation (JEE) report from 2017, Cameroon has an Integrated Disease Surveillance and Response (SIMR) system in place for mandatory indicator-based surveillance. This system uses standardized forms for data collection at both national and sub-national levels, leveraging software like DHIS2 for human health and ARIS2 for animal health (p. 28). While the 2017 JEE noted that event-based surveillance activities had been implemented only in pilot settings (e.g., in nine health facilities in Yaoundé from May 2017 to January 2018) and that there was "no evidence to suggest that this is an ongoing process" nationwide at the time (p. 44, 29), more recent evidence demonstrates significant progress in establishing continuous event-based and community-based surveillance. ¹⁹¹

The WHO 2022-2023 Biennial Report for Cameroon provides concrete evidence of expanded event-based surveillance efforts. Under "Mise en œuvre du RSI" (Implementation of IHR), the report states that "the training of 368 community health workers/key informants as well as district (19) and health area managers strengthened the implementation of event-based surveillance" (Section 2.1.2, p. 44). The report also highlights the "Reinforcement of the surveillance of vaccine-preventable diseases (VPD) by the deployment of 50 epidemiologists who supported the regions and districts, with the realization in 2023 of 12,641/33,462 active surveillance site visits" (Section 1.4.5, p. 34). Efforts in "Communication de Risque et Engagement Communautaire" (Risk Communication and Community Engagement) further support event-based surveillance by strengthening the capacity of 100 volunteers in risk communication, surveillance, and community engagement (Section 2.4, p. 70), enabling bottom-up reporting of unusual events. ¹⁹²

The Ministry of Public Health (MINSANTE) actively promotes and enhances surveillance capabilities, particularly in response to multiple ongoing epidemics. As reported in a MINSANTE article from May 2022, the Minister of Public Health, Dr. MANAOUDA Malachie, announced at a press briefing that Covid-19, cholera, yellow fever, measles, and polio were under special surveillance. He outlined measures taken for these diseases, including "strengthening surveillance in all regions of the country," "activating the incident management system," and "increasing in-depth investigations of cases". ¹⁹³

Furthermore, for novel infectious diseases and those with pandemic potential, Cameroon has demonstrated advanced surveillance capabilities through specialized institutions. The Pasteur Center of Cameroon (CPC) plays a pivotal role in monitoring and early warning, as evidenced by its robust response to the SARS-CoV-2 virus during the COVID-19 pandemic. As a designated COVID-19 reference laboratory, the CPC spearheaded the establishment and decentralization of molecular diagnostics (RT-PCR) for SARS-CoV-2 across 17 laboratories in 9 of the country's 10 regions. Beyond initial diagnostics, the CPC actively engaged in genomic surveillance, introducing this capability in January 2021 and sequencing numerous SARS-CoV-2 genomes and partial sequences to identify the circulation of variants like Alpha, Beta, Delta, and Omicron. The CPC also participates in collaborative research programs such as REPAIR (International Pasteurian Research Program in Response to Coronavirus in Africa) and AFROSCREEN, which aim to strengthen genomic sequencing capabilities and share data across African institutions. Additionally, the CPC is involved in pioneering alternative epidemiological approaches, such as monitoring SARS-CoV-2 in wastewater, indicating a capacity to detect and analyze emerging threats and provide early warning signals beyond traditional human-based indicator systems. ¹⁹⁴ The analysis of event-based data for these threats is inherently continuous in its monitoring for signals; once an event is detected or a signal reported, analysis becomes immediate and rapid, focusing on in-depth investigations and early warning to characterize and respond to the specific event. Therefore, while there isn't a fixed periodic schedule for analyzing all event-based data, the system is designed for continuous vigilance and prompt analysis triggered by the detection of any unusual event or signal.

Regarding data analysis capacity, which the 2017 JEE found weak (p. 29), the WHO 2022-2023 Biennial Report shows progress. It mentions that "the capacities of 26 Ministry of Public Health personnel were strengthened in the development of knowledge products… to increase the availability and use of health data" (Section 4.1, p. 82). ¹⁹⁵¹⁹⁶

The National One Health Action Plan includes a strategic objective to strengthen surveillance, investigation, and response systems for environmental, animal, and human health (p. 66), and references efforts to implement community-based and pilot event-based surveillance (p. 42). ¹⁹⁷

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

There is publicly available evidence of a mechanism for reporting notifiable diseases to the World Health Organization (WHO) in Cameroon, specifically through an operational International Health Regulations (IHR) National Focal Point (NFP). However, the evidence also indicates challenges in consistently meeting the set timelines for reporting.

According to the Joint External Evaluation (JEE) report from 2017, Cameroon has an "operational IHR NFP consisting of five structures, including the National Public Health Observatory (ONSP) which coordinates the implementation of IHR capacities and notifies WHO of any event that may constitute a Public Health Emergency of International Concern (PHEIC)" (p. 31). The report further notes that most sectors relevant to the IHR play a role in this notification process (p. 31). ¹⁹⁸

Despite this established mechanism, the JEE report also identifies areas for improvement regarding timely reporting. It explicitly recommends strengthening the capacities of the IHR NFP to improve its performance, "particularly notification to WHO within 24 hours" (p. 31), which suggests that this 24-hour timeline is not consistently met. Furthermore, the report points out the "absence of Standard Operating Procedures (SOPs) for the approval and notification to WHO of a potential PHEIC" (p. 32), which is crucial for ensuring consistent and timely reporting. ¹⁹⁹

While the country has submitted its annual IHR reports to the WHO, this refers to periodic compliance rather than the immediate notification required for public health emergencies. The National One Health Action Plan mentions ongoing efforts, such as the IHR-PVS National Bridging Workshops, aimed at exploring commonalities and facilitating coordinated actions, which implies a continuous commitment to improving surveillance and reporting (p. 32). ²⁰⁰ The "IHR-PVS National Bridging Workshop in Cameroon" conducted in 2023 with representatives from the ministry of health, WHO, and ONSP provides clear evidence of a mechanism for reporting diseases to the World Health Organization (WHO) through the International Health Regulations (IHR) National Focal Point, and that the mechanism is active and operational. A key outcome of the workshop was a joint road map aimed at enhancing multisectoral collaboration. The paper notes that joint activities in the area of surveillance will establish the foundation for "coordinated multisectoral surveillance and information sharing for zoonotic diseases to enable early detection of health threats and timely routine data sharing among sectors". ²⁰¹

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

The government of Cameroon operates electronic reporting surveillance systems at both the national and sub-national levels within the human and animal health sectors.

According to the Joint External Evaluation (JEE) report from 2017, the District Health Information System (DHIS2) software is installed in all health districts for the collection and transmission of human health surveillance data. For animal health, the ARIS2 software is installed in departmental (regional) offices of the Ministry of Livestock to collect data on zoonoses under surveillance (p. 46). These systems facilitate data collection at sub-national levels and its aggregation for national-level surveillance. ²⁰²

The National Strategic Plan for Digital Health 2020-2024 further confirms that DHIS2 is the national aggregated health data collection system, implemented by the Health Information Unit. This system is "scaled up in all districts, approximately 6,000 facilities," enabling the compilation and analysis of health indicators at district, regional, and country levels (p. 20, p. 72, Table 26). This includes its use for general health indicators (DHIS2-CIS) and specific programs like HIV (DHIS2-NACC), operating across all levels of the health pyramid. ²⁰³

The Technical Guide for Integrated Disease Surveillance and Response in Cameroon, updated in 2020, explicitly designates DHIS2 as the chosen national electronic platform for the collection and transmission of health data within the framework of electronic Integrated Disease Surveillance and Response (e-SIMR) (Section 9.1, p. 374). This e-SIMR system leverages DHIS2 to produce "validated data in real time for public health surveillance, investigations and rapid response to epidemics" (Section 9, p. 373), enhancing promptness and completeness of reporting (Section 9.4.2, p. 378). ²⁰⁴

The overarching strategic direction for this digital infrastructure is articulated in the National Guide To The Management Of Epidemiological Surveillance Data, which outlines the comprehensive principles and procedures for health data management within the Ministry of Public Health. This guide describes the National Health Information System (SNIS) as the framework for data collection, processing, analysis, dissemination, storage, and archiving (Section 2.1, p. 4-5). It formalizes the entire data lifecycle, from initial collection at health facilities and by community health workers, through various electronic tools (DHIS2, Kobbocollect, EWARS, DAMA, EMR, LMIS) to advanced analysis and reporting (Section 2.2.1, p. 6; Section 3.1.1.2, p. 22; Section 3.3.1, p. 27). ²⁰⁵

Recent communications from the Ministry of Public Health (MINSANTE) in late 2023 underline the continued progress and strategic importance of digital health initiatives, including the "urbanization of health information systems" to ensure data interoperability and security. MINSANTE is actively pursuing the digitalization of health registers in facilities to improve the collection, management, and reliability of health data, as part of its ongoing efforts to build a national data aggregation platform and integrated health information system. ^206207208

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 100

Cameroon's electronic reporting surveillance system currently collects ongoing and real-time laboratory data, which can be disaggregated and analyzed by age, ethnicity, and other categories.

While the Joint External Evaluation (JEE) report from 2017 explicitly stated that a mechanism for real-time collection of laboratory data by the surveillance system needed to be established (p. 46), subsequent national guidance emphasizes real-time data flow. ²⁰⁹ The Technical Guide for Integrated Disease Surveillance and Response in Cameroon defines electronic Integrated Disease Surveillance and Response (e-SIMR) as being based on the "rapid and real-time collection, analysis, notification and use of data on diseases or events" for appropriate public health action (Section 7, p. 14). It further specifies that e-SIMR enables "real-time notification" for both indicator-based and event-based surveillance (Section 9.7, p. 388). ²¹⁰

The National Guide To The Management Of Epidemiological Surveillance Data reinforces this by stating that the transmission of laboratory analysis results and sample summaries is done "immediately and weekly" from all levels (Section 3.3.2, p. 28). This clearly indicates that ongoing (weekly) and real-time (immediate) laboratory data collection and transmission are current procedural requirements across all levels of the health system. The guide details the process from detection sites (community, FOSA, PSF) to central reference laboratories, outlining that laboratory focal points receive, verify, analyze, and transmit results and summaries immediately and weekly to relevant hierarchical levels (p. 27-28). ²¹¹ While the 2017 JEE highlighted a gap in real-time laboratory data integration, ²¹² and the National Action Plan For The Fight Against Antimicrobial Resistance (NAP-AMR) (2024-2028) mentions monthly data transmission from sentinel sites (p. 29), these newer national guidelines articulate a clear strategic intent and procedural requirement for real-time or immediate laboratory data flow into the surveillance system. ²¹³ The support from the US Centers for Disease Control and Prevention (CDC) for laboratory testing and genomic surveillance, and the rollout of Data Manager (DAMA) and electronic medical record (EMR) systems for "near real-time" reporting for HIV and HIV-associated Tuberculosis (TB) (p. 12), further contribute to this evolving real-time data landscape. ²¹⁴ Recent communications from the Ministry of Public Health (MINSANTE) discussing the "urbanization of health information systems" and the digitalization of health registers also aim to improve data collection and management, directly supporting enhanced real-time capabilities. ^215216217

Regarding data disaggregation and analysis, the electronic reporting surveillance systems, including DHIS2 for human health and ARIS2 for animal health, are designed to collect surveillance data at national and sub-national levels (p. 46). ²¹⁸ The National Strategic Plan for Digital Health 2020-2024 confirms DHIS2 is scaled up across all districts and approximately 6,000 facilities, enabling the compilation and analysis of health indicators at district, regional, and national levels, facilitating informed decision-making across the health pyramid (p. 19, 23, 72). ²¹⁹ The National Guide To The Management Of Epidemiological Surveillance Data explicitly states that data analysis is to be done "according to time, place, and people" (T-L-P), which involves descriptive analysis, spatial analysis (using GIS tools), and explanatory analysis (Section 2.2.4, p. 10). The figure illustrating the data flow within DHIS2 also supports the system's capacity for granular disaggregation (Figure 19, p. 390). Data from DHIS2 and other programmatic systems can be disaggregated by administrative regions (p. 13) and various demographic categories. ²²⁰ For example, the National Strategic Plan for Community Health 2021-2025 includes indicators and data disaggregated by age groups such as "children aged 5", "pregnant women," and "children aged 12 to 23" (p. 17). ²²¹ Furthermore, the National One Health Action Plan aims to strengthen the collection and communication of disaggregated data on endemic zoonotic, neglected tropical, and vector-borne diseases (p. 130). ²²²

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of ongoing sub-national/local wastewater and environmental surveillance for poliovirus in Cameroon. Cameroon began ES in Africa in 2014.²²³ Wastewater/sewage sampling is conducted at designated sites (e.g., in Yaoundé and Douala areas). Cameroon has been part of the African Region's ES network with active sites for detecting poliovirus circulation. This complements AFP surveillance and has been used for cVDPV2 detection and optimization efforts. While not a fully scaled national multi-pathogen wastewater programme, the polio ES is ongoing at the sub-national level.²²⁴²²⁵ Further, in 2016, under the Polio Environmental Surveillance Expansion Plan (PESEP), the GPEI began initiating ES implementation in six new countries (Burkina Faso, Cameroon, Chad, Guinea, Madagascar and Niger).²²⁶ Moreover, the WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 17 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.²²⁷

2.4.1a Common usage of electronic health records

Score: 0

While electronic health records (EHRs) are not yet universally implemented across all health facilities in Cameroon, the evidence indicates that the country is actively transitioning towards the use of electronic health information systems within its broader national health information system, laying the groundwork for the eventual widespread use of EHRs.

Earlier assessments, such as the Health Sector Strategy 2016-2027, noted a "very low computerized environment at all levels" within the national health information system (p. 92). ²²⁸ However, more recent strategic guidance and implementation efforts demonstrate a clear shift. The National Guide To The Management Of Epidemiological Surveillance Data, published in 2021, explicitly states that Cameroon has made progress by introducing "electronic platforms for managing surveillance data, among others: District Health Information Software 2 (DHIS2), Data Management (DAMA), Electronic Medical Record (EMR), Laboratory Management Information System (LMIS), etc." (Section 1.1, p. 1). This guide further outlines principles for data governance, including patient rights to consult their electronic medical record, indicating a policy framework for such records (Section 2.3.1, p. 13). ²²⁹

The Technical Guide for Integrated Disease Surveillance and Response in Cameroon, updated in 2020, reinforces this strategic direction. It defines electronic Integrated Disease Surveillance and Response (e-SIMR) as a component of the National Health Information System (SNIS) that draws data not only from aggregated reports but also from "registers of external consultations, laboratory registers, hospitalization registers and medical records" (Section 9.1, p. 374). While DHIS2 is confirmed as the national platform for aggregated data , the Technical Guide also highlights the planned implementation of specific EHR systems, noting "EMR (Electronic Medical Records)" in "planning for 10 more sites" (Section 9.6.3, p. 387). Additionally, other patient-level data management systems are already operational, such as "DAMA (Patient Data Management)" which is "functional in the PEPFAR zone, 154 sites" for electronic health registers (Section 9.6.3, p. 387). ²³⁰ The National Guide To The Management Of Epidemiological Surveillance Data further details the collection of individual-level clinical, laboratory, and outcome data for various programs, including Maternal, Perinatal Death Surveillance and Response (SDMPR) and general case management, utilizing both physical and electronic tools like individual notification forms and linear lists (Section 3.2.1, p. 25; Section 3.4.1, p. 29). ²³¹

Despite these advancements, challenges persist. The National Guide To The Management Of Epidemiological Surveillance Data acknowledges that while platforms are introduced, issues such as a lack of formal training for 55% of data managers, 50% of health facilities lacking data verification tools, and low data utilization rates (87.5% of facilities not using their own data) remain (Section 1.1, p. 2). The evidence demonstrates that Cameroon is implementing electronic health information systems rather than achieving widespread use of fully functioning EHRs nationwide. These systems are operational within targeted contexts and reflect a strategic commitment to digital health transformation, but the capacity for universal EHR use is still under development.

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no evidence that the national public health system in Cameroon commonly have access to electronic health records of individuals across the country.

The "Health Sector Strategy 2016-2027" explicitly notes a "very low computerized environment at all levels" within the health information system, indicating a significant lack of digital infrastructure for comprehensive individual patient records (p. 92). ²³² While the District Health Information System (DHIS2) is in use for the collection and transmission of aggregated surveillance data for diseases and zoonoses, this pertains to public health monitoring and not widespread individual patient electronic health records in clinical settings (p. 28). ²³³ Furthermore, previous efforts to strengthen the National Health Information System (NHIS) "has not been effective" (p. 92), suggesting that a robust system for widespread individual electronic health records and national-level access is not yet in place. ²³⁴

Indeed, the same National Guide To The Management Of Epidemiological Surveillance Data highlights significant system weaknesses, stating that "the requirements to ensure interoperability between the different electronic platforms are not yet assured," and noting a "multiplicity of data collection tools" (p. 2). ²³⁵ This lack of interoperability and fragmentation of tools impedes the widespread, unified access to individual electronic health records across the country. Furthermore, the Technical Guide for Integrated Disease Surveillance and Response in Cameroon emphasizes that its electronic SIMR (e-SIMR) platform is designed to "improve real-time surveillance" and facilitate public health actions related to "diseases or events" (p. 14), reinforcing its focus on aggregated surveillance data rather than comprehensive individual patient clinical records accessible to clinicians nationwide. ²³⁶

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no evidence to suggest that comprehensive data standards, such as ISO standards, are commonly in use to ensure data comparability across Cameroon's national public health system, particularly for electronic health records.

The Health Sector Strategy 2016-2027 explicitly highlights that the national health information system operates in a "very low computerized environment at all levels" and is characterized by a "multiplicity of information sub-systems and data collection tools" (p. 92). ²³⁷ This fragmentation is further underscored by the National Guide To The Management Of Epidemiological Surveillance Data, which states that "the requirements to ensure interoperability between the different electronic platforms are not yet assured" despite the development of some intermediate software components (p. 2). This directly confirms that a cohesive system with established overarching data standards for comparability is not yet prevalent. ²³⁸

While the Technical Guide for Integrated Disease Surveillance and Response in Cameroon emphasizes harmonization of different methods, software, data collection forms, standards and case definitions to avoid inconsistencies (p. 7) for Integrated Disease Surveillance and Response (SIMR) data, and notes that electronic SIMR (e-SIMR) is "based on: standardized, interoperable and interconnected information systems" (p. 14) to "facilitate comparison between different health facilities" (p. 378), these statements reflect strategic objectives and principles for surveillance data harmonization rather than confirming the widespread implementation of comprehensive data standards (such as ISO for EHRs) across the entire national public health system for broader data comparability. ²³⁹ The aforementioned National Guide To The Management Of Epidemiological Surveillance Data reinforces this by reporting ongoing "difficulties in producing quality data" and persistent issues with "interoperability between the different electronic platforms" (p. 2), even within the broader health data management context. ²⁴⁰

Similarly, while the Health Sector StrategY identifies a future objective to "harmonize tools for data collection, getting a consensus of the optimal number of indicators to document for an effective HSS monitoring" and prioritizes "standardization of data collection tools" (p. 172), this indicates a recognized need for such standards, not their current widespread implementation. ²⁴¹ Similarly, the National Strategic Plan for Community Health 2021-2025 mentions the review and harmonization of tools developed for data management for community health interventions (p. 36), further confirming that efforts are underway to address data consistency, rather than reflecting established, overarching standards. ²⁴²

Although the Joint External Evaluation (JEE) mentions that certain laboratories are accredited to ISO 15189:2012 standards (p. 24), this refers specifically to laboratory quality management and diagnostic testing, not to data comparability standards for electronic health records within the broader national public health system. ²⁴³

2.4.2a Data sharing mechanisms

Score: 0

While there are strategic initiatives within Cameroon's national public health system designed to facilitate data sharing among relevant ministries responsible for animal, human, and wildlife surveillance, there is insufficent evidence of established mechanisms.

The primary overarching mechanism is the National Program for the Prevention and Fight Against Emerging and Re-Emerging Zoonoses (NPPCERZ). Established in 2014, the NPPCERZ serves as a multisectoral and multidisciplinary coordinating body under the direct supervision of the Prime Minister. One of its explicit functions is to "ensure the availability, reliability, and communication of information on threats falling within the domains of the One Health approach" (p. 70). Its structure, including the Strategic Orientation Committee, Technical Committee, and Permanent Secretariat, brings together representatives from ministries overseeing public health (MINSANTE), animal health (MINEPIA), forests and wildlife (MINFOF), and environment (MINEPDED), among others, thereby creating a framework for inter-ministerial dialogue and data flow (p. 72-74). ²⁴⁴

Furthermore, the National One Health Action Plan 2024-2028 outlines specific strategic objectives and activities aimed at strengthening data sharing systems. Notably, under Strategic Axis 4, "Strengthening surveillance, investigation, and response systems for Environment, Animal Health, and Human Health," an expected result is the establishment of a "multisectoral and interoperable surveillance system for threats" (p. 69). Specific activities include recruiting consultants to "operationalize the interoperable data sharing system" (p. 132) and establishing "an interconnected and interoperable tool/software for data sharing between different sectors" (p. 132). This is explicitly outlined as a planned activity within the National One Health Action Plan 2024-2028, rather than an already completed and operational system. ²⁴⁵

The Technical Guide for Integrated Disease Surveillance and Response in Cameroon strongly supports this multisectoral commitment, stating that effective SIMR "requires improved communication, coordination and collaboration across all sectors, for the implementation of an effective framework for the 'One Health' approach" (p. 12). It further emphasizes that the electronic SIMR (e-SIMR) "is based on: standardized, interoperable and interconnected information systems, administered in the national context" (p. 14). This commitment to interoperability is underscored by the mention of formalizing agreements between MINSANTE, MINAGRI, MINEPIA, MINFOF, and MINEPDED for platforms such as the Health Information System (SIS), SIMR, Maternal, Perinatal Death Surveillance and Response (SDMPR), laboratory networks, and the Cameroon Animal Disease Surveillance Network (RESCAM) (p. 115-116). ²⁴⁶

However, while these mechanisms and plans are established, the National Guide To The Management Of Epidemiological Surveillance Data provides nuance regarding their current operationalization. It acknowledges that despite efforts in harmonization and integration, the system "still encounters difficulties in producing quality data necessary for decision-making" and that "the requirements to ensure interoperability between the different electronic platforms are not yet assured" (p. 2). For instance, the guide's table on laboratory networks indicates varying degrees of interoperability with DHIS2, with some key laboratory networks showing "Non" (not interoperable) status (p. 28, Table 3.1). ²⁴⁷

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 0

There is no direct evidence indicating that Cameroon makes de-identified health surveillance data on infectious diseases publicly available via reports or other formats on government websites, such as those of the Ministry of Health or Ministry of Livestock, Fisheries and Animal Industries (MINEPIA).

Several documents mention the production and dissemination of "epidemiological bulletins", such as the National Action Plan for the Prevention and Control of Infection in Human Health 2021-2024 (p. 15), the Joint External Evaluation (p. 28), the Health Sector Strategy 2016-2027 (p. 172), and the National Strategic Plan for Community Health 2021-2025 (p. 36). ^248249250251

The Technical Guide for Integrated Disease Surveillance and Response in Cameroon further reinforces the commitment to public communication and transparency within the health system. It emphasizes that "effective SIMR requires improved communication, coordination and collaboration across all sectors" and states the importance of disseminating information quickly and transparently at the national level (p. 12, p. 31). The document details that "epidemiological bulletins" and "situation reports (SITREP)" are produced for a "wider public than the health staff" including "administrative authorities, parliamentarians and other decision-makers" and "technical and financial partners and donors" (p. 296). It notes that these reports are "generally brief (2 to 8 pages)" (p. 296). While "all citizens have the right to receive… information on risks or threats to their health" (p. 289), the specific form of "de-identified health surveillance data" (e.g., downloadable datasets) is not confirmed as being part of this public dissemination. ²⁵²

In fact, despite these communication channels and expressed objectives, the National Guide To The Management Of Epidemiological Surveillance Data still highlights "difficulties in producing quality data" and persistent issues with "interoperability between the different electronic platforms" (p. 2), which could hinder the systematic public release of such data. ²⁵³ Furthermore, the Joint External Evaluation (JEE) report, while predating some of these specific documents, notes "limited modes of communication and information for the public" (p. 29) regarding electronic notification systems, which while distinct from direct data publication, points to broader challenges in electronic public communication. ²⁵⁴

Based on available evidence, while mechanisms for general public health communication and reporting to partners exist, and government websites are identified as communication channels, there is no direct evidence found that Cameroon systematically makes de-identified health surveillance data on infectious diseases publicly available in detailed formats on these government websites. No relevant evidence for such direct data access was found on the websites of the Ministry of Public Health or the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA) for the general public. ²⁵⁵²⁵⁶

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 0

There is no data protection legislation in Cameroon. The main applicable tool is the Guide to Good Practices for the Creation, Organization and Operation of Ethics Committees for Human Health in Cameroun. However, this is not binding.²⁵⁷

Cameroon's national public health system does have separate provisions that address data confidentiality, security, and patient privacy, particularly in the context of health data management and surveillance activities.

The National Guide To The Management Of Epidemiological Surveillance Data, from June 2024, outlines core Guiding Principles of Data Governance which directly pertain to the protection of health information. These principles include transparency (ensuring all data actions are traceable), data minimization (collecting only relevant data), accuracy, and crucially, security and integrity (implementing technical and organizational measures for data protection) (p. 12-13). It explicitly states that "the patient has the right to respect for the confidentiality of their personal data" and details rights related to accessing, rectifying, erasing, and portability of their electronic medical records (p. 13). Furthermore, it mandates that those involved in electronic data processing "must sign a confidentiality clause and undertake to implement all mechanisms to protect collected personal data," and refers to Article 310 of the Cameroonian Penal Code (2016) which penalizes the "violation of professional secrecy" (p. 13). ²⁵⁸

Complementing this, the Technical Guide for Integrated Disease Surveillance and Response in Cameroon, from 2020, explicitly recognizes the sensitivity of personal health data within surveillance activities. It states that "The Public Health community recognizes that the use of names in data notification could pose risks to the preservation of the privacy of individuals and communities" (p. 134). To mitigate this, it mandates the "use of unique identifiers such as numbers instead of names" to "avoid inadvertent disclosure of identities" and specifies that "identifiable patient data should be kept where public health interventions are implemented, such as in health facilities (FOSA)" (p. 134). The guide also directs that "Health Districts (DS) must have directives on privacy and confidentiality of health data, which should be inspired by national directives" (p. 134). Moreover, within the key principles for establishing electronic SIMR (e-SIMR), "Data security" is listed as essential, ensuring that "only authorized persons… have access to information" and emphasizing the "ethical dimension in data manipulation" and the need to "ensure that processes are put in place to protect patients' privacy" (p. 380). ²⁵⁹

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

Cameroon's national public health system operates explicitly addresses cybersecurity, data confidentiality, and patient privacy through a combination of general laws, established principles, and specific technical guidelines. However, there is no data protection legislation in the country that protects identifiable health information for individual.

The National Guide To The Management Of Epidemiological Surveillance Data, from June 2024, incorporates national legal instruments, citing Law N°2010/012 of December 21, 2010, on Cybersecurity and Cybercriminality as foundational to the health data management framework (p. 5). Furthermore, it defines cybersecurity as a "set of prevention, protection, and deterrence measures… to achieve security objectives through electronic communication networks, information systems, and for the protection of individuals' privacy" (p. 11). The guide mandates "security and integrity" as guiding principles for data governance, ensuring data is collected and processed "to guarantee their security through the implementation of technical and organizational mechanisms" (p. 13). Crucially, it specifically addresses the confidentiality and non-disclosure of data, requiring personnel to "sign a confidentiality clause and undertake to implement all mechanisms to protect collected personal data (encoding, encryption, access restriction, security audit, etc.)" (p. 13). Direct protections against data loss and unauthorized access, relevant to ransomware, are explicitly detailed under Some data security principles, including the requirement for "strong authentication systems," "VPN connections," "centralized logging systems," "technology and security monitoring systems," and critically, an "off-site backup system" (p. 15-16). These measures directly mitigate the impact of cyberattacks. ²⁶⁰²⁶¹

The Technical Guide for Integrated Disease Surveillance and Response in Cameroon, from 2020, highlights data protection within surveillance. It acknowledges "risks for the preservation of privacy" and mandates "the use of unique identifiers such as numbers instead of names" to prevent inadvertent disclosure, stipulating that "identifiable patient data should be kept where public health interventions are implemented" and that "Health Districts (DS) must have directives on privacy and confidentiality of health data, which should be inspired by national directives" (p. 134). The e-SIMR section reiterates Data security as an essential principle, emphasizing information protection, controlled access, and ethical data manipulation to protect patient privacy (p. 380). It also lists Data security policies and user agreement on rules as a key element (p. 386). ²⁶²

While earlier assessments, such as the "Health Sector Strategy 2016-2027" (p. 100) and the 2017 Joint External Evaluation (JEE) (p. 7), noted "gaps and contradictions" or "obsolete" legal instruments in the broader legal framework governing health interventions, and the 2020-2024 National Digital Health Strategic Plan identified "legal loopholes" regarding confidentiality and privacy (p. 13), the more recent operational guides demonstrate that specific measures and mandates, drawing upon general cybersecurity laws, have been established to safeguard identifiable health information. ^{263264265266267268269}

2.4.5a Cooperative commitments or agreements within regions

Score: 100

The government of Cameroon has made commitments to share surveillance data during a public health emergency with other countries. This commitment is evidenced through its adherence to international regulations, national strategic planning documents, and cooperative agreements.

Cameroon is a State Party to the International Health Regulations (IHR 2005), which establishes obligations for member states to detect and respond to public health events and to report annually to the World Health Assembly on their implementation progress (p. 1). The Joint External Evaluation (JEE) report, a 2017 assessment of Cameroon's IHR core capacities, explicitly states the country's target for "accurate and timely notification of diseases, in accordance with WHO requirements, and systematic coordination with FAO and OIE" (p. 31). The JEE confirms that Cameroon possesses an operational IHR National Focal Point (NFP) that fulfills notification duties to the World Health Organization, and the Ministry of Livestock, Fisheries, and Animal Industries likewise notifies the WOAH (World Organisation for Animal Health) and FAO regarding events of animal origin (p. 31). While the JEE did identify some internal procedural weaknesses leading to notification delays, this indicates an existing commitment to international reporting rather than an absence of such an obligation (p. 31). Furthermore, the JEE provides direct evidence of cooperative agreements, noting the establishment of "bilateral and multilateral agreements for transborder surveillance collaboration between Cameroon and its neighboring countries" (p. 31, D.3.1). However, the JEE mentions the establishment of these agreements generally but does not specify the names of these bilateral and multilateral agreements or explicitly list the neighboring countries involved. ²⁷⁰

National policy documents reinforce this commitment. The National One Health Action Plan 2024-2028 emphasizes that the One Health approach strengthens the implementation of the IHR (2005) and promotes global health security, inherently involving international collaboration and data exchange (p. 31). It also references Cameroon's participation in IHR-PVS National Bridging Workshops (NBW), which aim to facilitate coordination and joint actions between human and animal health sectors for global health security (p. 31). ²⁷¹

Cameroon has also invested in robust data management infrastructure and guidelines to support its surveillance and reporting obligations. The National Guide To The Management Of Epidemiological Surveillance Data is a foundational document that outlines the country's approach to data quality and information flow. This guide explicitly discusses "data transmission," stating that "in emergency situations, a rapid data exchange system should be established in accordance with IHR (2005) recommended timelines" (Section 2.2.3). This directly addresses the need for timely international reporting during crises. The same guide details "data utilization and dissemination," including the use of internet sites and emails for sharing results, implying a commitment to making information accessible, which is vital for international partners (Section 2.2.5 & 2.2.8). ²⁷²

Furthermore, this Guide lays out principles for data governance, emphasizing "interoperability," where "data exchange with existing systems (DHIS2, CSU, telemedicine, etc.) must be effective and secure" (Section 2.3.1). This internal interoperability within Cameroon's health information system (including its Digital Health Architecture, Figure 2.5) facilitates the eventual sharing of harmonized and reliable data with external entities, including international bodies. Specifically, for border health posts, the guide reiterates that "in emergencies, and in accordance with IHR 2005, data can simultaneously be sent through the normal circuit and to the national level (IHR National Focal Point) to facilitate notification within prescribed deadlines" (Section 3.5). This targeted instruction for points of entry is crucial for global health security, as these are often the first lines of defense against international disease spread. ²⁷³

The country's increasing adoption of electronic IDSR (e-IDSR) platforms further streamlines its data sharing capabilities. The Technical Guide for Integrated Disease Surveillance and Response in Cameroon notes that e-IDSR "offers new opportunities to accelerate the achievement of IHR (2005) core capacities" and aims to "ensure systematic information sharing between different levels of the health pyramid and sectors" (Section 7). The operationalization of tools like DHIS2 for data collection and analysis, as referenced in the National Guide To The Management Of Epidemiological Surveillance Data, supports more rapid and standardized data transmission, which is essential for fulfilling international reporting obligations. ²⁷⁴²⁷⁵

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 50

Cameroon has a comprehensive national system in place to provide support at the sub-national level for critical public health emergency activities, including contact tracing. This system operates through a multi-layered approach involving various ministries, a dedicated One Health platform, and robust training and rapid response mechanisms.

According to the National One Health Action Plan 2024-2028, the overarching framework is provided by the National Program for the Prevention and Fight Against Emerging and Re-Emerging Zoonoses (NPPCERZ), which is mandated to strengthen surveillance, investigation, and response systems for human, animal, and environmental health (p. 66). This platform facilitates multisectoral coordination and collaboration, essential for a comprehensive emergency response that would inherently include contact tracing. ²⁷⁶ Complementing this, the National Strategic Plan for Community Health (PSNSC) 2021-2025 aims to enhance the community's role in health interventions, explicitly detailing mechanisms for early signal detection and reporting, which are precursors to effective contact tracing (p. 27). ²⁷⁷

Support at the sub-national level is provided through various mechanisms. In terms of training and capacity building, the 2017 Joint External Evaluation (JEE) report highlights the presence of a "Field Epidemiology Training Program (FETP)" designed to develop human resources capable of fulfilling International Health Regulations (IHR) requirements, including epidemiological investigation (p. 33). ²⁷⁸ The NPPCERZ further aims to "strengthen the capacities of stakeholders on the principles and domains of the One Health approach" through training and simulation exercises (p. 66). ²⁷⁹ The PSNSC, in particular, focuses on training Community Health Workers (ASC) in "community-based surveillance" and "essential family practices," extending this to include gender approaches and human rights in crisis contexts (p. 30-33, 39). ²⁸⁰

Regarding metrics standardization and tools, the JEE mentions the use of "standardized forms for data collection" and "Standard Operating Procedures (POS)" for data validation and quality assurance within the Integrated Disease Surveillance and Response (SIMR) system, which operates down to the sub-national level (p. 28). ²⁸¹ The PSNSC explicitly plans the "conception/production of SBC tools and their provision to all ASCs in health areas" and aims for "100% of complete and quality reports on community health interventions by 2025" (p. 33, 36). A significant step towards standardization is also the use of the "DHIS2" software for reporting community health data, which allows for better monitoring and evaluation (p. 36). ²⁸²

For operational and financial resources, the Health Sector Strategy (HSS) 2016-2027 indicates that Rapid Intervention Teams (EIRs) are trained and equipped and are present at both central and regional levels, providing a key human resource for outbreak response (p. 37). ²⁸³ The PSNSC details substantial budgetary allocations for its implementation, with 90% of the budget directed to the operational level (Community and District), covering costs for ASC remuneration, operational expenses, and logistics (p. 45). This includes funding for "capacity building of Community Health Workers," "supply of inputs," and "supervision" (p. 44). Furthermore, there is a commitment to strengthen the supply chain for essential inputs and medicines down to the "last mile" in vulnerable contexts (p. 39). ²⁸⁴ The NPPCERZ also outlines activities to mobilize financial resources for One Health actions, including zoonoses surveillance and response (p. 84). ²⁸⁵

Based on the 2021 Public Health Emergency Operations Center COUSP Manual, the Public Health Emergency Operations Centre (COUSP) serves as a central hub for coordinating preparation, response, and recovery during public health emergencies, ensuring multisectoral and multidisciplinary coordination, especially through the Incident Management System (IMS) at district and provincial levels (p. 7, 23). This includes the coordination of information from communities, incident sites, and health facilities across district, regional, and national levels (cousp.pdf, p. 25-26). The COUSP also develops and implements training programs and simulation exercises for both permanent and mobilized staff to maintain essential skills (p. 31). Rapid Response Teams (Équipes d’intervention rapide – EIRs/RRTs) are also a key component, comprising multidisciplinary groups trained to provide support to regional, local, and district health authorities, ready for deployment to conduct investigations and support interventions at the tactical (field) level during emergencies (p. 23). ²⁸⁶

Taken together, while Cameroon’s public health framework demonstrates strong multisectoral coordination, structured capacity building, and comprehensive surveillance mechanisms, the specific integration of contact tracing within simulation training and broader community health initiatives remains limited, indicating an opportunity to more explicitly align these components with the country’s overall emergency preparedness and response system.

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

While Cameroon provides some wraparound services, particularly regarding free medical attention during public health emergencies, there is currently no explicit or extensively detailed evidence of direct government-provided economic support (such as paychecks or job security) designed to enable individuals to self-isolate or quarantine as recommended.

During public health emergencies or epidemics, the management of epidemic-prone diseases is generally provided free of charge in health structures and at the community level. This indicates that infected individuals can expect to receive medical attention without direct financial burden during an outbreak (p. 56). ²⁸⁷ The National Strategic Plan for Community Health 2021-2025 also outlines efforts to improve health coverage for "key and vulnerable populations" by providing them with promotional, preventive, and curative services through community-directed interventions (p. 38-39). This includes the establishment of a "local/associative socio-sanitary protection mechanism for vulnerable groups" (p. 39), although further details are unavailable. ²⁸⁸

However, specific government-provided economic support in the form of paychecks, job security, or direct financial compensation to enable self-isolation or quarantine is not explicitly mentioned in published documents. While the National Strategic Plan for Community Health 2021-2025 aims to "Empower vulnerable groups," this primarily refers to strengthening their capacities and supporting "community initiatives related to income-generating activities (AGR)" (p. 39). This focus on livelihood empowerment is more about long-term economic resilience for vulnerable populations rather than direct, temporary economic assistance for individuals mandated to isolate or quarantine due to public health directives. ²⁸⁹ The broader health financing context in Cameroon, with a significant reliance on out-of-pocket payments and low health insurance coverage, also suggests that a comprehensive social safety net for such economic support may not be widely in place (p. 74). ²⁹⁰

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is insufficient evidence to confirm a comprehensive and concrete joint plan or cooperative agreement explicitly detailing how the public health system and border control authorities jointly identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of a public health emergency.

While there are indications of collaboration and public health activities at Points of Entry (PoEs), the specific details of a formalized, explicit joint plan covering all aspects of the user's query are not present. The 2017 Joint External Evaluation (JEE) report mentions "joint actions" and "exercises have been carried out" at international airports (p. 40, R.3.1). This suggests a degree of cooperation, but it does not provide the concrete details of a standing, documented agreement on how border control authorities work with public health to manage all aspects of international travelers during an emergency, particularly for tracing and quarantining contacts. ²⁹¹

The JEE also notes that certain PoEs, such as Douala International Airport, have health services capable of detecting, evaluating, and notifying Public Health Events of International Concern (PHEICs), and that there is a "system for transferring patients to hospitals" (p. 47). The "Order No. 1745/A/MINSANTE of June 27, 2006" formalizes the existence of health posts at borders (p. 48). These points confirm the presence and functions of public health personnel and infrastructure at borders for initial identification and transfer of suspected cases. However, they do not explicitly detail a joint operational plan or cooperative agreement with border control authorities (such as immigration or customs) for the broader processes of identifying potential cases, and subsequently, the specific roles and procedures for tracing and quarantining their contacts by border authorities in coordination with public health, beyond merely transferring a symptomatic individual. ²⁹²

The Public Health Emergency Operations Centre (COUSP) is responsible for coordinating the national emergency response and facilitating multidisciplinary coordination, integrating information from PoEs (p. 7, 23, 25-26, 31). While the COUSP would undoubtedly play a central role in managing an emergency, the request is specifically for a joint plan or cooperative agreement between the public health system AND border control authorities detailing the on-the-ground procedures at PoEs for travelers and their contacts. ²⁹³ The JEE's "areas for strengthening/challenges" for PoEs include "Optimizing the capacity to detect, assess, and report public health events at Points of Entry" and the need for "Developing and implementing a simulation exercise plan" (p. 49, PoE.2), which suggests that while some actions occur, a fully optimized and explicitly documented joint plan covering all aspects of contact management and quarantine involving both public health and border control authorities is not clearly established. ²⁹⁴

While the U.S. Centers for Disease Control and Prevention (CDC) actively partners with Cameroon to strengthen public health preparedness and response, including implementing Global Health Security Agenda efforts at Points of Entry (PoEs) to build workforce capabilities, this partnership focuses on enhancing capabilities and training rather than explicitly confirming the existence of a formal, documented joint plan or cooperative agreement between Cameroonian public health and border control authorities for the comprehensive management of international travelers and their contacts, particularly concerning tracing and quarantine. ²⁹⁵²⁹⁶

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

Cameroon meets one of the criteria: an applied epidemiology training program (FETP) is available in the country.

The 2017 Joint External Evaluation of Cameroon confirms the existence of a Field Epidemiology Training Programme (FETP) operating under the Ministry of Health and Higher Education (p. 33, D.4.2). This program, known as the Cameroon Field Epidemiology Training Programme (CAFETP), was established in 2011 with support from the US Centers for Disease Control and Prevention (CDC) and the Defense Threat Reduction Agency (DTRA). It offers both basic and advanced programs and is accredited by the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET). Candidates for the CAFETP must be civil servants employed by either the Ministry of Health or the Ministry of Livestock (p. 34). ²⁹⁷

While the CAFETP exists within the country, there is no evidence to suggest that the government provides resources to send citizens to another country specifically for applied epidemiology training programs. No relevant evidence was found on the websites of the Ministry of Public Health or the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA). ²⁹⁸²⁹⁹

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

Field epidemiology training programs in Cameroon are explicitly inclusive of animal health professionals.

The Cameroon Field Epidemiology Training Programme (CAFETP) is inclusive of animal health professionals. The 2017 Joint External Evaluation of Cameroon notes that the FETP, operating under the Ministry of Health and Higher Education, includes veterinarians as candidates. The report specifies that the cohort at the time of the assessment included three veterinarians (p. 14). ³⁰⁰

Additionally, beyond CAFETP, there is a specific program focused on animal health professionals. In 2018, the Food and Agriculture Organization (FAO) and the Institute for Infectious Animal Diseases (IIAD) at Texas A&M AgriLife Research launched the In-Service Applied Veterinary Epidemiology (ISAVET) program in 14 countries, including Cameroon. This four-month frontline field epidemiology program is designed to train veterinary field epidemiologists. ³⁰¹ The training program was designed to combine both theoretical and practical learning. The theoretical component, delivered over three weeks by a team of trainers, focused on building participants’ foundational knowledge and technical understanding of the subject matter. This was followed by a practical phase lasting one week, during which participants applied what they had learned under the guidance of experienced mentors. The practical training emphasized hands-on skills, particularly in ensuring compliance with biosafety standards at the farm level and in mastering the correct procedures for collecting, packaging, and transporting samples to the laboratory. ³⁰²

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 0

There is not public evidence to confirm Cameroon has at least one trained field epidemiologist per 200,000 people, though the country has trained over 1,700 graduates from its Field Epidemiology Training Program (FETP) since its establishment in 2010. While Cameroon is a regional leader in field epidemiology training with support from partners like the CDC and WHO, the exact ratio of trained epidemiologists to the population isn't specified in the provided public information. ^303304305

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 100

Cameroon has an overarching national public health emergency response plan in place that explicitly addresses planning for multiple communicable diseases with epidemic or pandemic potential. This comprehensive framework is detailed in the National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024 (PNMPR). Furthermore, the plan includes clear evidence of its funding strategy and budgetary allocation.

The PNMPR serves as an "essential tool for anticipating priority health risks" and was developed using a multisectoral approach (p. 25). It was created to fill a previous gap, as Cameroon historically had specific contingency plans (e.g., for Ebola, Polio, Cholera) but "does not have a multi-risk preparedness and response plan for public health emergencies" (p. 32). This document, covering the period 2022-2024, is explicitly designed to address this need by encompassing a wide range of threats. ³⁰⁶

The plan takes into account the results of a "Threat Hazard Identification Risk Assessment" (THIRA) exercise, revised in April 2021, which prioritized sixteen (16) major events for the country (p. 25, 32). Among these prioritized risks are numerous communicable diseases with epidemic or pandemic potential, including: Human influenza due to a new subtype (COVID-19); Cholera; Monkeypox; Measles epidemics; Rabies; Avian influenza; Viral hemorrhagic fevers (Ebola). These diseases are specifically identified and ranked based on their probability and impact (p. 42). The document further states that "epidemics constitute major risks in the country," citing past outbreaks of cholera, measles, yellow fever, meningitis, and Monkey Pox (Chapter 1.2, p. 42). ³⁰⁷

The overall objective of the PNMPR is to "strengthen the national management of multisectoral preparedness and response to priority public health emergencies to rapidly and effectively assist affected populations in Cameroon, for the period 2022-2024" (Chapter 2.1, p. 55). This includes specific objectives such as strengthening the capacity of the multisectoral surveillance system to detect all public health emergencies and disasters within required timelines, and reinforcing rapid intervention mechanisms (Chapter 2.2, p. 55). The PNMPR's comprehensive nature and explicit focus on multiple identified communicable disease threats confirm its status as an overarching national plan for epidemic and pandemic preparedness. ³⁰⁸

Furthermore, the PNMPR includes a detailed budgetary allocation and a clear funding strategy. Its implementation is planned for the triennium 2022-2024, with a provisional budget of 24,210,017,000 FCFA (approximately 44,018,213 USD at the exchange rate used in the document) (p. 25, 74). The plan explicitly states that "Financing is essential and indispensable for the implementation of this plan" (p. 67). The mobilization of these resources is designated to be carried out by the State with the support of Technical and Financial Partners (PTF) (p. 25, 78). The document provides extensive tables detailing the triennial budget by objective, program, and activity, for each year of the plan (2022, 2023, 2024) (Tables 4, 5, 6, 7 on pp. 68-74). The success of the planned activities is explicitly tied to "The consideration of the related budget lines in the Medium-Term Expenditure Framework (CDMT) of the Ministry of Public Health and other sectoral ministries," as well as "The integration of planned activities into the future work plans of our traditional Technical and Financial Partners (PTF)" (p. 78). This demonstrates a clear commitment to funding and a defined strategy for resource mobilization for the plan's execution. ³⁰⁹

3.1.1b National public health emergency response plan published in past 3 years

Score: 100

The overarching national public health emergency response plan for Cameroon, the National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon, has been updated within the last three years.

The document itself is titled with the period it covers: "National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024". This indicates that the plan was designed and implemented to be valid for the years 2022, 2023, and 2024. The preface further confirms this, stating, "Designed for the period 2022-2024, the National Plan for Multi-Risk Preparedness and Response to Public Health Emergencies in Cameroon…" (Préface, p. 9). The summary also reiterates that "The plan will cover a period of three (3) years from 2022-2024" (p. 27). ³¹⁰

In terms of what is covered under this plan, it presents a comprehensive framework for multi-risk preparedness and response to public health emergencies in Cameroon. The plan’s overarching goal is to strengthen national management of multisectoral preparedness and response to priority public health emergencies to rapidly and effectively assist affected populations in Cameroon (Chapter 2.1, p. 55). To achieve this, the plan sets out four specific objectives: to reinforce managerial processes and governance (OS1), to enhance the capacity of the multisectoral surveillance system for detection (OS2), to strengthen intervention mechanisms (OS3), and to develop post-emergency rehabilitation mechanisms (OS4), all to be achieved by 2024 (Chapter 2.2, p. 55). ³¹¹

The strategies for intervention include strengthening coordination (Strategy 1), evaluating the preparedness and response system (Strategy 2), reinforcing the epidemiological surveillance system (Strategy 3), implementing emergency interventions such as the deployment of Rapid Investigation and Intervention Teams (EIIR) (Strategy 4), enhancing infrastructural, material, and logistical capacities (Strategy 5), implementing risk communication and community engagement (Strategy 6), and developing rapid recovery mechanisms (Strategy 7) (Chapter 2.3, p. 55). The plan also details a situational analysis, identifying major risks such as floods, road accidents, COVID-19, and cholera, and assesses existing response capacities (Chapter 1.1, p. 39; Chapter 1.2, p. 41; Table 1, p. 42). It includes a comprehensive logical framework outlining specific activities under each objective and strategy, ranging from analyzing risks and capacities to implementing inter-operable data collection systems, reinforcing laboratory technical platforms, and operationalizing emergency operation centers (Table 2, p. 59-62). The document emphasizes a multisectoral approach, involving various public, private, and civil society actors, and highlights the importance of financial and technical partners in its execution (Préface, p. 8; Chapter 1.4.1, p. 49).

3.1.1c One health principles by covering multiple threat types

Score: 100

The overarching national public health emergency response plan in Cameroon, the National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024 (PNMPR), explicitly follows One Health principles by covering multiple threat types, including zoonotic disease spillover, antimicrobial resistance, and other biological risks, potentially including deliberate acts.

The PNMPR emphasizes a multisectoral and "One Health" approach as fundamental to addressing various public health emergencies. As stated in the preface, "The multi-sectoral dimension and even more so the “One Health” approach, essential for dealing with various public health emergencies, highlight the need to improve our coordination mechanisms both between the different sectors and between the different levels of management of public health events" (p. 8). This clearly establishes the plan's foundation on One Health principles, recognizing the interconnectedness of human, animal, and environmental health. The summary further confirms that the plan was developed according to a multi-sectoral approach (p. 25). ³¹²

The plan's "multi-risk" nature is central to its design, intended to serve as a common roadmap for all concerned administrations (public, private, and civil society) in preparing for and responding to priority public health events (p. 8). It incorporates findings from a "Threat Hazard Identification Risk Assessment" (THIRA) exercise, revised in April 2021, which identified and prioritized sixteen major events (p. 25, p. 32). This broad identification of threats demonstrates its adherence to addressing diverse risks. ³¹³

Specifically, the PNMPR addresses various threat types. The prioritized risks listed include several diseases with strong zoonotic components or potential for spillover, such as "Human influenza due to a new subtype (COVID-19)," "Monkeypox," "Rabies," "Avian influenza," and "Viral hemorrhagic fevers (Ebola)" (p. 42). The involvement of the Ministry of Livestock, Fisheries, and Animal Industries (MINEPIA) and the Ministry of Forests and Wildlife (MINFOF) in the plan's technical committee and supervision further highlights the integration of animal and wildlife health, critical for addressing zoonoses (p. 2-5). The plan also mentions a Permanent Secretary of the National Program for the Prevention and Control of Emerging Re-emerging Zoonoses (PNPLZR) as a member of the drafting committee (p. 3). Moreover, the list of acronyms and abbreviations within the document explicitly includes antimicrobial resistance (p. 17). While the provided excerpt does not detail specific strategies for AMR, its inclusion as a recognized term within the plan's foundational elements signifies its consideration within the broader public health emergency landscape.Furthermore, the glossary's definition of "preparedness" specifies that relevant public health emergency response plans should cover biological, chemical, radiological, nuclear and other risks (p. 22). The historical context in the introduction also cites terrorist attacks as past challenges Cameroon has faced (p. 8). ³¹⁴

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 100

Cameroon's overarching plan meets both criteria.

Cameroon's overarching national public health emergency response plan, the National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024 (PNMPR), explicitly follows One Health principles by covering a multitude of threat types. The plan underscores the "multisectoral dimension and even more the 'One Health' approach" as essential for addressing various public health emergencies, stating that this approach is "de rigueur for effective management of Public Health events" (p. 8, 49). The PNMPR's development was based on a comprehensive risk assessment that prioritized sixteen major events, many of which are communicable diseases with epidemic or pandemic potential. These include human influenza (such as COVID-19), cholera, and several zoonotic diseases like Monkeypox, rabies, avian influenza, and viral hemorrhagic fevers (e.g., Ebola) (p. 42). Furthermore, the plan defines "preparedness" as encompassing "biological, chemical, radiological, nuclear and other risks," thereby covering potential biological accidents or deliberate acts (p. 22). While specific strategies for Antimicrobial Resistance (AMR) are not extensively detailed in the provided sections, the inclusion of it in the list of abbreviations suggests its recognition as a relevant concern within the plan's broader scope of public health threats (p. 17). ³¹⁵

The PNMPR includes a consideration of health equity and mechanisms for identifying the needs of vulnerable populations. The plan's preface highlights the importance of pooling interventions based on "epidemiological, socioeconomic and political context" to enhance the resilience of the health system, demonstrating an awareness of diverse societal factors (p. 9). The PNMPR acknowledges the varied demographics of the Cameroonian population, providing statistics on gender and age groups, such as the proportion of women, youth under 20, and individuals over 65 (p. 33). A core guiding principle of the plan is that "the community is the main beneficiary" and constitutes a "major stakeholder." Consequently, "particular emphasis will be placed on its full participation" in risk communication, community engagement, decentralization, and empowerment for managing public health emergencies (p. 36). The situational analysis identifies "low involvement of communities in major risk mitigation" and "low empowerment of communities in organizing first aid" as existing weaknesses (p. 51). The overall objective also emphasizes assisting "affected populations," underscoring a focus on those impacted by emergencies (p. 55). ³¹⁶

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 100

Cameroon's National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024 (PNMPR) includes specific mechanisms for engaging with the private sector in outbreak emergency preparedness and response.

The plan explicitly positions itself as a common roadmap for “all administrations (public, private, and civil society) concerned with the implementation of preparedness and response activities for priority public health events” (p. 8). This foundational statement already frames the private sector as an integral part of the overall preparedness strategy, indicating that their participation in planning and activity implementation is expected. Furthermore, the PNMPR’s analysis of stakeholders, under the section “Identification of stakeholders), explicitly lists “Public and private administrations" as key actors involved in managing emergencies (Chapter 1.4.1, p. 50). This formal recognition underscores the private sector's mandated involvement. ³¹⁷

Regarding the role of private sector actors and how they would be engaged, the plan provides several indications. For preparedness, the private sector is expected to align its activities with the PNMPR's common roadmap, contributing to a unified approach to public health event readiness (p. 8). For response, the document is more specific, especially concerning healthcare provision. Within the section detailing “Hospital services in public health emergency contexts", it specifies that “in addition to the services of public health facilities, the military, parapublic, private, and confessional sub-sectors contribute to maintaining continuity of care in public health emergency situations while strengthening the referral and counter-referral system" (Chapter 1.3.6, p. 46). This clearly defines a role for the private health sector in active response efforts, particularly in service delivery, maintaining the flow of patients, and ensuring ongoing medical support during crises. The inclusion of private administrations among key stakeholders (p. 50) implies their engagement in broader coordination efforts to facilitate this continuity of care and the effective deployment of resources. Thus, the plan envisions the private sector as an active participant both in strategic preparedness alignment and in the practical delivery of health services during emergencies.

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 100

Cameroon has policies, plans, and guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic.

The National Plan for Prevention and Infection Control (PCI) in Human Health 2021-2024 directly outlines strategies for infection prevention and control (IPC), a key NPI, during epidemics and pandemics. This plan aims to establish a functional IPC program nationally and within healthcare facilities, and to improve IPC through community interventions by 2024 (p. 8, 21). It emphasizes multimodal strategies, including system changes, education, monitoring, and communication, to reduce healthcare-associated infections and combat antimicrobial resistance (p. 15). ³¹⁸

The National One Health Action Plan references a "Covid-19 resurgence plan" and a "multi-risk plan of the Ministry of Public Health" (Table 2). ³¹⁹ Additionally, the National Strategic Plan for Community Health 2021-2025 emphasizes communication for development, social mobilization, and behavior change strategies (p. 34-35). ³²⁰

The National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024 (PNMPR) serves as the overarching framework, explicitly covering multiple threat types with epidemic or pandemic potential (p. 25). A key strategy of the PNMPR focuses on Risk Communication and Community Engagement – RCCE, which is a fundamental NPI aimed at influencing public behavior to prevent disease transmission ( p. 55). Additionally, the plan emphasizes the deployment of multisectoral Rapid Investigation and Intervention Teams (EIIRs), whose activities are crucial for implementing NPIs on the ground (p. 61). ³²¹ A specific and critical activity outlined in the plan is to operationalize multisectoral extra-hospital, pre-hospital, and community management of public health emergencies) (p. 61). This directly covers interventions that occur outside traditional healthcare settings, heavily relying on NPIs such as public health messaging, community education, and local containment measures. The overarching goal to strengthen intervention mechanisms in public health emergencies and disasters in Cameroon by 2024 ensures a comprehensive approach that includes NPIs as a core component of the response strategy (p. 55). ³²²

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 100

Cameroon meets both criteria, demonstrating recent activity in public health emergency preparedness and response.

Cameroon has activated its national emergency response plan for an infectious disease outbreak within the past year. On October 28, 2024, the Ministry of Public Health in Cameroon declared a measles outbreak in Mayo-Oulo village. This declaration triggered a rapid, coordinated response involving local health authorities, the Cameroon Red Cross Society, and UNICEF. Actions included immediate mass vaccination campaigns, active case finding, and community mobilization, with volunteers providing education on measles symptoms and prevention. This swift activation of resources and implementation of interventions successfully contained the outbreak, preventing further cases in the affected area. ³²³

Cameroon has completed a national-level biological threat-focused exercise in the past year. From April 22 to 23, 2025, the United Nations Office for Disarmament Affairs (UNODA) and Cameroon's Ministry of External Relations co-organized a national workshop in Yaoundé. The workshop aimed to strengthen the implementation of the Biological Weapons Convention (BWC) within the country. It focused on raising awareness among national stakeholders, training participants on reporting requirements (Confidence-Building Measures), and identifying steps to amend relevant legislation for BWC implementation. This event clearly served as a national-level exercise to enhance preparedness and response capabilities against biological threats. ³²⁴

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 100

Cameroon has identified a list of gaps and best practices in its response capabilities and developed plans for improvement within the past year.

In response to the Marburg Virus Disease (MVD) outbreak declared by Equatorial Guinea on February 13, 2023, Cameroon's Ministry of Public Health (MOH) activated its National Public Health Emergency Operations Center (EOC). During this response, "Cameroon worked with CDC and the World Health Organization to update their Viral Hemorrhagic Fever Response plan to identify gaps and develop strategies to address them," as detailed in the US Embassy in Cameroon article from July 11, 2023. ³²⁵

Further evidence comes from the paer titled "Assessing the state of infection prevention and control in Cameroon", published in October 2024, which evaluates the period from January 2017 to December 2023. This assessment describes a national workshop held in December 2023 where "experts and key stakeholders involved in IPC in Cameroon evaluated the implementation of infection prevention and control… to identify gaps to be addressed" (p. 2-3). The workshop revealed that Cameroon's IPC program was "still far from the norms and standards laid out by the WHO," and the findings were intended "to contribute to improve policies and strategies towards an effective IPC programme" (p. 2). A "conceptual framework for the development of an IPC programme in Cameroon" was subsequently designed, outlining barriers, enablers, and potential interventions to improve IPC at various levels (p. 6). ³²⁶

Additionally, the Bulletin COVID-19 Infos – No. 005, while documenting activities from 2022, highlights a continuous process of review. It outlines "Lessons Learned And Best Practices Identified" through an Intra-Action Review (IAR) of the COVID-19 response and an After Action Review (AAR) of the AFCON 2021 Health Coverage (p. 13). These reviews identified specific challenges, such as "irregular data reporting" and "low acceptance of the vaccination," and led to recommendations for "updating the national response plan for COVID-19" and "develop[ing] an operational action plan to correct the shortcomings and consolidate the achievements" (p. 13-14). ³²⁷

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 100

There is evidence that Cameroon has undergone a national-level public health emergency exercise that included private sector representatives in the past year.

This is detailed in the IOM Regional Office for West and Central Africa's news article titled "Cameroon Steps Up Preparedness for Public Health Emergencies," published on 08 August 2025. The article describes the "Public Health Emergency Management Month," an initiative launched by the Ministry of Public Health. This event spanned "over four weeks" and brought together "health professionals, government officials, humanitarian workers and experts for workshops, conferences and simulation exercises". While the article specifically mentions a "large-scale flood simulation" as a highlight, the broader context of "Public Health Emergency Management Month" and discussions around "disease outbreaks" and "complex health challenges" inherently encompass planning for biological threats with epidemic or pandemic potential. ³²⁸

Crucially, the participation of private sector representatives is explicitly documented. The photo caption accompanying the article, showing "Authorities launching the 5th International Forum on Emergency and Public Health Event Management in Cameroon," identifies the "CEO of ADDAX Petroleum" as one of the key figures present at the launch. ADDAX Petroleum is a private energy company, and its CEO's involvement in launching this national forum and related activities clearly indicates private sector participation in a national-level public health emergency exercise and preparedness initiative. ³²⁹

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

The country has an Emergency Operations Center (EOC) in place.

Cameroon possesses a functional Public Health Emergency Operations Center (COUSP). This center was operational and had already been activated at the time of the 2017 Joint External Evaluation, even though its formal regulatory creation was still pending (p. 37). The report explicitly notes the "Existence of a functional COUSP already activated despite its lack of regulatory existence" (p. 38). ³³⁰

The formal establishment and regulatory backing for the COUSP were solidified on May 12, 2020, through Decree No. 051/PM, issued by the Prime Minister. This decree officially created the Public Health Emergency Operations Coordination Center, providing a comprehensive legal framework for its existence, missions, organization, and functioning. This formalization ensures the COUSP's mandate to coordinate emergency operations, manage information, mobilize resources, and facilitate strategic decision-making during public health crises. ³³¹

Further enhancing its capabilities, the COUSP was inaugurated in 2018 with significant support from the U.S. Centers for Disease Control and Prevention (CDC) and the Defense Threat Reduction Agency. This partnership has been instrumental in building Cameroon's core public health capacities, particularly in emergency management. The EOC's mandate extends to coordinating emergency response activities for both human and animal health threats, thereby fostering more robust responses by improving multisector collaboration, data sharing, and decision-making (p. 9). ³³²

The center's effectiveness is evidenced by its proven rapid activation capacity, capable of being activated in less than 24 hours. This was notably demonstrated during the early 2023 Marburg Virus Disease alert at Cameroon’s southern border. The COUSP has been activated on numerous occasions—at least 15 times—to address various emergencies, including outbreaks of cholera, measles, and mpox. Beyond disease outbreaks, its versatility has been shown through activations for events like a train accident and even as a preemptive measure for a large international soccer competition (p. 9). ³³³

The CDC's long-standing Public Health Emergency Management Program in Cameroon has played a crucial role in developing the EOC's human resources. Through extensive training and certification of Ministry of Health (MOH) staff in emergency management, this program has also supported efforts to establish similar subnational programs, aiming to create a pool of well-trained EOC managers for both human and animal health sectors at regional and district levels (p. 9). This capacity building, alongside extensive technical assistance for developing disease-specific surveillance and incident management plans, ensures a coordinated and effective response infrastructure from national to local levels (p. 9). ³³⁴

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 100

There is substantial evidence that Cameroon's Emergency Operations Center (EOC) and related national structures conduct drills and exercises for public health emergency scenarios at least once per year, with several instances occurring within the past year.

The National One Health Action Plan explicitly outlines a commitment to regular simulation exercises under "Strategic Axis 2: Strengthening Stakeholder Capacities," with an action to "Conduct simulation exercises to strengthen One Health System (USS) skills" (p. 69). Specifically, the plan aims to "Conduct 04 SIMEX [Simulation Exercises] per year" (p. 92), a framework that has been effective since 2021, indicating a sustained commitment to such drills ³³⁵.

Supporting these efforts, the U.S. Centers for Disease Control and Prevention (CDC) has provided significant assistance to Cameroon's emergency management capabilities. The Public Health Emergency Operations Center (EOC) was inaugurated in 2018 with CDC support, enhancing the coordination of multisectoral responses to health threats (p. 9). ³³⁶ CDC's emergency management trainings since 2016, combined with the network of CAFETP graduates, have contributed to Cameroon's capacity to rapidly activate and respond to health threats. Furthermore, CDC supported a cholera response simulation during 2016-2018, which effectively demonstrated multisectoral outbreak management (p. 9). ³³⁷ These activities highlight a foundation for regular testing of capacities through "simulations/tabletop exercises," (p. 7) as mentioned in the World Bank's Stakeholder Mobilization Plan (PMPP). This project is a direct response to the critical gaps identified in the 2017 JEE, aiming to improve regional coordination and strengthen the prevention, detection, and response to health emergencies in the country (p. 3). ³³⁸

More recently, the Ministry of Public Health has been actively involved in strengthening incident management systems. A workshop organized by MINSANTE focused on "Incident Management System: Strengthening the capacities of regional actors in the East of Cameroon," which included practical exercises and simulations to enhance response planning, coordination, logistics, and risk communication, aiming for improved operational effectiveness. ³³⁹

Within the past year (from September 2024 to September 2025), Cameroon has actively engaged in multiple activities that include or directly support the conduct of drills and exercises. From September 1 to 3, 2025, Cameroon conducted its first functional exercise dedicated to managing arbovirus epidemics, specifically a dengue outbreak scenario. Organized by the Ministry of Public Health (MINSANTE) and involving numerous multidisciplinary and multisectoral stakeholders, this exercise explicitly aimed to "test and strengthen the capacities" of professionals in detection, notification, investigation, and response to arbovirus epidemics. This directly fulfills the criterion of a national-level drill for a public health emergency scenario. ³⁴⁰ In 2024, Cameroon adhered to the SURGE (Strengthening and Utilization of Response Groups for Emergencies) initiative. The initial phase involved training a pool of 40 personnel from the health and other sectors, commencing November 25, 2024, and concluding February 14, 2025 (p. 16).

Moreover, according to the Annual Epidemiological Bulletin of Cameroon for the Year 2024, a workshop held from December 9 to 13, 2024, focused on finalizing the national strategic plan for meningitis elimination. One of its general objectives was to establish "a reinforced and integrated surveillance system" to rapidly detect cases, monitor epidemic trends, and trigger "appropriate and real-time responses" (p. 16). From November 18 to 29, 2024, formative supervision of SIMR, including influenza sentinel sites, was carried out across 10 regions, 40 health districts, and 101 health facilities. This activity aimed to evaluate and improve surveillance performance, a critical component of preparedness that feeds into effective drills (epidemiologique.pdf, p. 16). Finally, the Incident Management System was activated on September 11, 2024 (p. 18). ³⁴¹

Finally, the commitment to regular simulation exercises is further exemplified by the country's participation in a regional functional simulation exercise in December 2022, which tested the functionality of Public Health Emergency Operations Centers (PHEOCs) in the African Region using an Ebola virus disease outbreak scenario (p. 353). The exercise, involving over 1,000 representatives from 36 member states, highlighted the importance of conducting such functional exercises at least once a year at both regional and national levels (p. 353). ³⁴²

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no public evidence to show that Cameroon's Emergency Operations Center (EOC) has conducted within the last year a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency or scenario.

The 2017 Joint External Evaluation (JEE) noted a challenge in the "Availability of a single contact point 24 hours a day, 7 days a week, organized and sustainable" (p. 38), which implies a lack of rapid activation capacity. ³⁴³ While the U.S. Centers for Disease Control and Prevention (CDC) has significantly supported the establishment and strengthening of Cameroon's EOC, indicating efforts to improve response capabilities, publicly available evidence does not confirm activation within a 120-minute timeframe within the last year ³⁴⁴.

According to the CDC in Cameroon – 20 Years of Public Health Impact report, the Public Health Emergency Operations Center (EOC) was inaugurated in 2018 with support from the CDC and the Defense Threat Reduction Agency. This EOC coordinates emergency response activities for human and animal health threats, and with CDC's emergency management trainings since 2016, Cameroon has developed "the capacity to rapidly activate and respond to health threats" (p. 9). ³⁴⁵ The report states that "The EOC can be activated in less than 24 hours," citing the early 2023 Marburg Virus Disease alert as an example of its activation (p. 9). ³⁴⁶ The EOC has been activated 15 times for various emergencies, including cholera, measles, and mpox, and was also activated for a train accident and a large international soccer competition (p. 9). ³⁴⁷ Additionally, CDC supported a cholera response simulation during 2016-2018, which demonstrated multisectoral management of an outbreak (p. 9). ³⁴⁸ While these activities highlight ongoing efforts and successful activations for real events and simulations, the documented activation timeframe of "less than 24 hours" does not meet the specified criterion of 120 minutes.

While the Emergency Appeal Operation Update, issued by the nternational Federation of Red Cross and Red Crescent Societies (IFRC) in 27 January 2025, details a coordinated humanitarian response to severe flooding that began in August 2024, involving the Cameroon Red Cross and other partners, the document does not specify the EOC's initial activation time for this event. ³⁴⁹

More broadly, an article from the U.S. Centers for Disease Control and Prevention (CDC) titled "CDC’s collaborative approach", from 28 February 2023, notes that "Cameroon's PHEOC… can be activated within six hours to respond to disease outbreaks or other emergencies." This timeframe, while commendable and indicating strong functional capacity (360 minutes), still exceeds the 120-minute criterion. ³⁵⁰

Although the National One Health Action Plan outlines a commitment to conducting "04 SIMEX [Simulation Exercises] per year" (p. 92), this document does not provide details on the activation speed for these planned exercises or for actual responses. ³⁵¹

No relevant evidence was found on the websites of the Ministry of Public Health or the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA). ³⁵²³⁵³

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no publicly available evidence that Cameroon has carried out an exercise specifically to respond to a potential deliberate biological event (bioterrorism attack) in the past year, nor are there publicly available formal agreements (SOPs, MOUs) explicitly between all the specified authorities to respond to such an event.

The 2017 Joint External Evaluation (JEE) report mentions that Cameroon's aim is to be capable of responding to events of "natural or deliberate origin." It notes that "joint actions" involving public health and security authorities, including "exercises," have been carried out at points of entry (p. 40). Furthermore, the JEE identified gaps, stating that Cameroon "has not drafted a memorandum of understanding" and recommended "developing and implementing a memorandum of understanding between public health and security authorities" (p. 40). It also noted the absence of a "formal framework for collaboration and information sharing between institutions involved in emergency management" (p. 40). ³⁵⁴

The 2021 National One Health Action Plan emphasizes multisectoral collaboration but, in its SWOT analysis, still lists absence of joint procedures for the implementation of "One Health" interventions as a weakness (p. 39). While this document acknowledges the threat of "terrorist attacks" in its contextual analysis (p. 41), it does not provide evidence of specific exercises or publicly available formal agreements for responding to deliberate biological events that include the private sector or delineate roles for national security authorities beyond general emergency management. ³⁵⁵

The National Plan for Prevention and Control of Infection in Human Health 2021-2024 and the National Strategic Plan for Community Health 2021-2025 focus on general public health interventions, infection control, and community engagement, without specific mention of deliberate biological event response exercises or formal agreements involving national security and the private sector. ³⁵⁶³⁵⁷

To address biological threats more broadly, a Training Manual on Contingency Planning Process and Emergency Response for Biological Invasions in Cameroon was developed in 2017 as part of the Cameroon Biosecurity Project. This manual assists in formulating "generic emergency response exercises for biological invasions," particularly those involving Living Modified Organisms (LMOs) and Invasive Alien Species (IAS) (Module 4A). This indicates a structured approach to contingency planning for certain biological threats; however, its scope is focused on ecological and agricultural biosecurity, rather than explicitly addressing exercises or formal agreements for deliberate biological events (bioterrorism attacks) involving national security and the private sector. ³⁵⁸

No relevant evidence was found on the websites of the Ministry of Public Health or the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA). ³⁵⁹³⁶⁰

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 100

Cameroon does have in place a section detailing a risk communication plan specifically intended for use during a public health emergency, primarily within its National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024 (PNMPR) and further elaborated in the dedicated National Risk Communication and Community Engagement Strategy (CREC).

The PNMPR itself is explicitly valid for the period 2022-2024, as indicated in its title and confirmed in the preface, which states, "Designed for the period 2022-2024, the National Plan for Multi-Risk Preparedness and Response to Public Health Emergencies in Cameroon…" (Préface, p. 9), and in the summary, "The plan will cover a period of three (3) years from 2022-2024" (p. 27). ³⁶¹

While the situational analysis section within the PNMPR previously noted a gap, stating, "The absence of a national multisectoral communication strategy related to public health emergencies is regrettable. Furthermore, emergency communication procedures are not available" (p. 47), the PNMPR directly addresses this by outlining "Risk Communication and Community Engagement" as one of its seven key intervention strategies (p. 55). Under this strategy, the PNMPR details specific activities aimed at establishing and operationalizing a robust risk communication framework, such as "Establish a multisectoral risk/crisis communication system" and "Establish the multisectoral framework for consultation and harmonization of risk/crisis communication strategies in emergency situations for key IHR capacities" (p. 61). ³⁶²

Complementing the PNMPR, the National Strategy for Risk Communication and Community Engagement (CREC) under the One Health Approach provides a dedicated and more detailed framework for risk communication and community engagement. This CREC strategy explicitly states its implementation period as the quinquennium 2023-2027 (p. v). This document was developed to align with the recommendations of the Joint External Evaluation regarding International Health Regulations (p. v), and it directly supports the PNMPR's strategic objective related to risk communication. The CREC strategy outlines objectives to improve community knowledge, engage decision-makers, mobilize resources, ensure stakeholder involvement, manage rumors and misinformation, and strengthen coordination and information sharing (p. v). ³⁶³

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

While Cameroon's National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024 (PNMPR) emphasizes the importance of risk communication and community engagement, it explicitly acknowledges the current absence of a fully detailed national strategy for reaching populations with diverse communication needs.

The plan clearly commits to a decentralized and community-oriented approach for risk communication and community engagement (RCCE). It states that "the community is the main beneficiary… and particular emphasis will be placed on its full participation during the implementation of risk communication activities, community engagement, decentralization and empowerment for the management of public health emergencies" (p. 36). This commitment to decentralization and community empowerment inherently suggests an intention to tailor messages to local contexts, which would implicitly address varying linguistic, geographic, and socio-cultural needs. The document also notes that "risk communication and community engagement strategies are currently implemented in 59 districts out of 190" (p. 46), indicating an ongoing effort to reach local populations. ³⁶⁴

However, the PNMPR simultaneously identifies a significant gap: "The absence of a national multisectoral communication strategy related to public health emergencies is regrettable. Furthermore, emergency communication procedures are not available" (p. 47). It also points to a lack of "synergy in sensitization and local partnership with civil society organizations" as a weakness (p. 47). To address this, the plan includes activities under "Strategy 6: Risk Communication and Community Engagement" to establish a multisectoral risk/crisis communication system and establish the multisectoral framework for consultation and harmonization of risk/crisis communication strategies (p. 61). ³⁶⁵

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

While Cameroon's National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024 (PNMPR) aims to establish a robust risk communication system, it does not explicitly designate a specific position within the government to serve as the primary spokesperson to the public during a public health emergency.

The PNMPR acknowledges that, as of its publication, there was an "absence of a national multisectoral communication strategy related to public health emergencies" and that "emergency communication procedures are not available" (p. 47). This indicates that the detailed operational aspects of public communication, including the designation of a primary spokesperson, were still in development. The plan does outline Risk Communication and Community Engagement and includes activities to "Establish a multisectoral risk/crisis communication system" and "Establish the multisectoral framework for consultation and harmonization of risk/crisis communication strategies" (p. 61). These actions are aimed at creating the necessary structures and procedures for emergency communication. While officials from the Ministry of Communication (MINCOM) and the communication unit of the Ministry of Public Health (MINSANTE) are listed as members of the technical drafting committee (p. 3, 5), the document does not explicitly assign the role of primary public spokesperson to any specific position or individual for public health emergencies. The focus is on building the framework and procedures rather than naming a designated public face. ³⁶⁶

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

There is evidence that Cameroon's public health system has actively shared messages via online media platforms, such as its website and social media, to inform the public about ongoing public health concerns and to dispel rumors or misinformation.

The Ministry of Public Health (MINSANTE) utilizes its official website as a central hub for disseminating critical health information. This includes regular updates on public health issues, preventive measures, and responses to health emergencies. ³⁶⁷ Beyond its official site, MINSANTE maintains a significant presence on social media platforms to reach a broader audience and enhance communication. As of November 2023, MINSANTE is among the 30 out of 37 Cameroonian ministries actively using Facebook to share information and engage with citizens. ³⁶⁸ Furthermore, MINSANTE also maintains an active account on Twitter (now known as X), participating in the 20 ministries that leverage this platform for real-time communication. ³⁶⁹

In recent years, Cameroonian institutions, including those within the public health sector, have increasingly adopted WhatsApp as a communication tool due to its widespread adoption and ease of use among the population. ³⁷⁰ These WhatsApp channels are utilized to disseminate important information directly to citizens. ³⁷¹

A significant aspect of this online engagement is dedicated to clarifying facts and dispelling rumors or false claims that circulate within communities. For example, during the COVID-19 pandemic, MINSANTE actively used its platforms to provide accurate information and directly counter false claims about treatments and preventive measures. In a notable instance in February 2021, the Ministry addressed a false message circulating on WhatsApp that purported to offer a home treatment plan for COVID-19 symptoms, clarifying that the information was a hoax and providing correct guidance. ³⁷²

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no evidence to suggest that senior leaders, such as the President or Ministers, have shared misinformation or disinformation on infectious diseases within the past two years.

On the contrary, the information indicates a clear awareness of and active effort by these leaders and the public health system to combat misinformation and disinformation. For instance, the Minister of Public Health, Dr. Malachie MANAOUDA, explicitly acknowledged "the resurgence of misinformation" as a challenge in the fight against HIV/AIDS in April 2025. ³⁷³

Furthermore, in January 2024, the Expanded Program on Immunization (PEV), with UNICEF's support, proactively organized a training of trainers specifically aimed at "social listening and misinformation management," a direct response to a "flood of information" on social media intended to manipulate public opinion and create vaccine hesitancy regarding the malaria vaccine. ³⁷⁴

3.6.1a Percentage of households with Internet

Score: 50.5

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 52.18

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 80

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 79.17

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There are no public records or reports of Cameroon implementing restrictions on the export or import of medical goods in the past year due to an infectious disease outbreak, nor are there indications of such an intervention being based on international recommendations or a structured decision mechanism involving scientific evidence, expert input, or guidelines/policies.

Reviews of public health announcements and national news outlets within the last year do not show a change in this stance or the implementation of new trade restrictions on medical goods. ^{375376377378379380}

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There are no reports of Cameroon implementing widespread restrictions on non-medical goods exports or imports in the past year due to an infectious disease outbreak.

Subsequent checks of public announcements and national news within the last year do not show indication of such restrictions being implemented. ^{381382383384385386}

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There were no widespread travel restrictions implemented by Cameroon in the past year (September 2024 – September 2025) for infectious disease outbreaks, as there were no major outbreaks that necessitated such measures or international calls for them. The country did not report implementing new inbound or outbound travel restrictions for public health reasons during this period.

Recent official communications from the Ministry of Health and news outlets do not show international travel bans linked to infectious diseases. ^{387388389390391392}

3.7.2b Risk-based approach to international travel-related measures

Score: 0

While Cameroon publicly commits to adhering to International Health Regulations (IHR 2005) principles, which advocate for risk-based measures in international travel, evidence suggests that the country's actual implementation of a comprehensive risk-based approach at its points of entry is significantly limited.

The 2017 Joint External Evaluation (JEE) of Cameroon, a critical assessment of the country's IHR core capacities, scored "Points of Entry" (PoE.1 and PoE.2) as severely deficient, indicating "No capacity or limited capacity." Specific challenges identified in the JEE mention the inadequate provision of medical services at many of the 35 designated points of entry, hampering rapid diagnosis and management of sick travelers. Furthermore, a crucial lack of integrated electronic data systems (such as DHIS2) between points of entry and relevant ministries impedes the real-time data exchange essential for effective risk assessment. The absence of comprehensive hygiene and sanitation programs, vector control initiatives, and standardized operational procedures for transport inspection further underscores the limitations. ³⁹³

While other documents, such as the National One Health Action Plan and the National Plan for Prevention and Infection Control in Human Health, discuss broader surveillance and infection control within the country, they do not detail a specific risk-based approach to international travel-related measures. ³⁹⁴³⁹⁵

4.1.1a Doctors per 100,000 people

Score: 1.49

4.1.1b Nurses and midwives per 100,000 people

Score: 7.54

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

Cameroon has an overarching national health workforce strategy, updated within the past five years, that identifies insufficient workforce fields across the entire health system and outlines strategies to address these shortcomings.

This is detailed in the National Health Development Plan (NHDP) 2021-2025, which is explicitly stated as the "first operational plan of the revised Health Sector Strategy (HSS) 2020-2030" (p. 11). This document serves as the country's current strategic framework for health development, covering the period up to 2025. The NHDP dedicates a specific section to "Human Resources in Health" (p. 80), where it comprehensively analyzes the current situation and identified needs. The document clearly states: "the need for qualified human resources remains quite high," citing an "insufficient number of qualified staff… precarious situation and without a contract," and "poor distribution of health personnel throughout the national territory" (p. 80). It provides concrete data on identified gaps, including "Estimated human resource needs by level of the health pyramid for 2020" (p. 82), breaking down needs by categories such as specialists, general practitioners, pharmacists, nurses, and medical laboratory technicians. Moreover, it acknowledges a "poor match between the initial training of health personnel and the needs of health facilities" and that "continuous training is insufficient for all categories of staff" (p. 83). Furthermore, it highlights issues in personnel management, such as "underutilization," "mismatch between profiles and workstations," and "insufficient staff retention mechanisms" (p. 84). ³⁹⁶

Under Strategic Axis 4, Strengthening the Health System, the National Health Development Plan (NHDP) establishes a specific objective focused on human resources: “Increase, according to prioritized needs, the availability of HRH” (p. 144). To reach this objective, the plan outlines measurable targets, including improving the proportion of health structures equipped with at least 50% of the required human resources from 52% to 60%, increasing the ratio of medical doctors to one per 10,000 inhabitants, and raising the number of students trained annually in both human and animal health fields from 4,400 to 5,000 (p. 103,144). Complementing these targets, the plan specifies interventions such as developing mechanisms to strengthen the managerial and technical capacities of health sector managers, recruiting HRH in priority areas like midwifery, psychiatry, emergency medicine, and mortuary services, and creating strategies to motivate and retain health professionals (p. 132–133). These measures reflect a comprehensive approach to addressing HRH challenges by balancing workforce expansion, capacity-building, and retention strategies. ³⁹⁷

4.1.1d Health system capacity for essential health services

Score: 0

Cameroon's health system, despite ongoing efforts and the implementation of various strategic plans, continues to grapple with insufficient capacity for delivering essential health services across its entire population.

One significant challenge lies in human resources for health, where, despite the availability of personnel, both their quantity and quality remain limited, contributing to notable regional disparities. For instance, according to the Health Sector Strategy (HSS) 2016 – 2027, the ratio of medical doctors, midwives, and nurses to the population (1.07 per 1,000 inhabitants) falls below the World Health Organization's recommended standard of 2.3 per 1,000, as documented in the HSS (p. 89). ³⁹⁸ This concern is echoed in the National Action Plan for the Prevention and Control of Infection in Human Health 2021-2024, which specifically outlines objectives to strengthen human resource capacities, underscoring existing gaps (p. 8). ³⁹⁹ Similarly, the National Strategic Plan for Community Health 2021-2025 explicitly points to a "deficit in human resources" as a barrier to effective service delivery (p. 11). ⁴⁰⁰

Many health facilities are hindered by inadequate quality and quantity of technical equipment, frequently deteriorated due to a lack of proper maintenance. A significant geographical imbalance persists, with some populations residing more than 20 kilometers from a health facility, as noted in the HSS (p. 82). While governmental efforts are directed towards constructing and rehabilitating facilities, weaknesses in follow-up and the consistent provision of essential equipment often render some newly built or renovated structures non-functional (p. 81). ⁴⁰¹ The National Action Plan for the Prevention and Control of Infection in Human Health further substantiates this by reporting that most healthcare facilities demonstrate only a "basic" to "inadequate" level of infection prevention and control infrastructure (p. 7). ⁴⁰²

The HSS identifies "unsatisfactory case management in health facilities as well as in the community" and highlights a "high rate of preventable morbidity and mortality" (p. 106). The efficiency of referral and counter-referral systems is deemed poor, which negatively affects the continuity of patient care (p. 83). ⁴⁰³ The Joint External Evaluation (JEE) further corroborates these challenges by scoring the country a 1, the lowest score possible, on this measure and by noting limitations in laboratory capacities, including crucial aspects such as sample transport and the implementation of robust quality systems (p. 26). ⁴⁰⁴

4.1.1e Essential health services continuity plan for public health emergencies

Score: 100

Cameroon's National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024 (PNMPR) is designed to strengthen the nation's capacity to manage public health emergencies, and a core component of this is ensuring the continuity of essential health services.

The plan explicitly addresses this through Specific Objective 4 (OS4): "By 2024, develop post-emergency rehabilitation mechanisms in Cameroon" (p. 55). Under this objective, the PNMPR includes a direct and critical activity: "Implement a system for the continuity of essential services" (p. 62). This activity is underpinned by Strategy 7: "Development of rapid recovery mechanisms" (p. 55). ⁴⁰⁵

Beyond this explicit activity, several other strategies and objectives within the PNMPR indirectly or directly contribute to ensuring service continuity. Specific Objective 3 (OS3) focuses on reinforcing intervention mechanisms. This includes "Strengthen the capacity of priority health facilities to manage public health emergencies and mass casualties" (p. 61). This ensures that healthcare infrastructure remains functional and capable of handling increased demands during crises. OS3 also addresses the logistical aspects crucial for maintaining services. Activities like "Prepare the logistics chain for responding to identified risks" and "Logistical support for case management" (p. 61) are vital to prevent stockouts of essential medicines and equipment, a weakness identified in the situational analysis (p. 45). Moreover, the plan aims to "Operationalize multisectoral out-of-hospital management (pre-hospital, community) of public health emergencies" (p. 61). Futhermore, the situational analysis highlighted challenges such as a "non-homogeneous distribution of qualified human resources in health facilities" and "inequality in the distribution of technical platforms" (p. 46). ⁴⁰⁶

4.1.2a Hospital beds per 100,000 people

Score: 69.83

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 100

Cameroon possesses the capacity to isolate patients afflicted with highly communicable diseases within its health system.

According to the Joint External Evaluation (JEE) report from September 2017, isolation and treatment centers specifically designed for the management of certain diseases, particularly Ebola virus disease, have been established within the country (p. 56). ⁴⁰⁷

This capacity is further supported by broader efforts to enhance healthcare infrastructure and infection prevention and control measures. The National Plan for Prevention and Control of Infection in Human Health 2021-2024 includes objectives to improve infrastructure and the built environment within healthcare facilities to facilitate infection control practices (p. 19). ⁴⁰⁸ The Health Sector Strategy 2016-2027 also outlines plans for the construction and equipping of regional hospitals and the rehabilitation of major general and university teaching hospitals (p. 29, 164), which could house or develop advanced isolation units. ⁴⁰⁹

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

Cameroon has developed a plan to improve and expand capacity for infection control, which inherently includes isolation capabilities, within the specified timeframe. However, there is no specific evidence that the country has developed, updated, or tested a plan to expand isolation capacity in response to an infectious disease outbreak within the past two years, nor evidence of demonstrated capacity to expand isolation infrastructure during an outbreak.

The National Plan for Prevention and Control of Infection in Human Health 2021-2024 explicitly outlines strategic objectives and actions aimed at reinforcing infrastructure and the built environment in healthcare facilities by 2024. This plan's objective is to "Improve infrastructure and the built environment and ensure the continuous availability of essential materials and equipment necessary in 60% of FOSA [health facilities], including biomedical waste management by 2024" (p. 19). Specific actions under this objective include "Improving WASH [Water, Sanitation, and Hygiene] activity in health facilities from 1st to 4th category" and "Arranging a space for disinfection and decontamination of medical equipment" (page 19). While these objectives are relevant to strengthening IPC measures broadly, they do not explicitly address increasing isolation capacity for managing surges in infectious disease outbreaks. ⁴¹⁰

No relevant evidence was found on the website of the Ministry of Public Health. ⁴¹¹

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 50

Cameroon’s Ministry of Public Health uses a national procurement protocol managed by the National Central Supply of Essential Medicines and Medical Consumables (CENAME) for essential medical supplies, but not specifically for laboratory items, and no unified framework linking the Ministries of Public Health and Agriculture exists for such procurement.

According to the "Strategic Plan for Strengthening the Public Supply Chain for Health Products in Cameroon 2022–2026" (Section 1.9), the public supply chain for health products in Cameroon is centralized under the Ministry of Public Health, with CENAME playing a crucial role. Purchases of health products are made from approved suppliers, and orders for essential medicines and medical consumables are placed by CENAME following Cameroon's public procurement code (Section 1.9). This indicates the existence of a regulated national procurement process for medical supplies within the health sector. The 2017 Joint External Evaluation (JEE) report also noted the existence of a national central purchasing unit for essential materials, including laboratory reagents (p. 25). ⁴¹²⁴¹³

Despite CENAME's role and the application of the public procurement code, the system still faces challenges. The strategic plan highlights "cumbersome administrative procedures that do not facilitate the speed of purchases" and mentions the "suppression of the special status in public procurement previously granted to CENAME," which had allowed for shorter tender deadlines (Section 1.14). These issues suggest operational difficulties within the existing framework. ⁴¹⁴

Furthermore, while CENAME handles "essential medicines and medical consumables," the extent to which it comprehensively covers all "laboratory supplies" across the entire Ministry of Health (e.g., specialized reagents for advanced diagnostics) and, more importantly, for the Ministry of Agriculture, is not explicitly defined within a unified, stated protocol. Other documents like the National Strategic Plan for Community Health 2021-2025 mention that funding for community health interventions, and by extension their supplies, relies heavily on external funding (p. 22, 31). ⁴¹⁵ Similarly, the National Action Plan for the Prevention and Control of Infection in Human Health 2021-2024 points to challenges in the availability of essential infection prevention and control materials, emphasizing a need for improved infrastructure and continuous supply, without detailing a comprehensive procurement protocol for these items (p. 19). ⁴¹⁶

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 33.33

Cameroon's capacity regarding stockpiles for public health emergencies and equitable distribution during such events is complex, as it operates without a single overarching national public health emergency response plan.

The 2017 Joint External Evaluation (JEE) report indicates the "pre-positioning of medical supply stocks at central and intermediate levels" (p. 42), confirming the existence of a national stockpile. However, the same report also highlighted "insufficient emergency stocks for response at all levels" (p. 42), suggesting a need for expansion. It also pointed out a "lack of knowledge of mechanisms for constituting and mobilizing emergency stocks" and the "absence of decision-making procedures for sending and receiving medical supplies and personnel in an emergency" (p. 42). To address these shortcomings, the JEE recommended finalizing, validating, simulating, and implementing a national medical supply chain plan that integrates procedures for sending and receiving medical supplies during emergencies (p. 42). ⁴¹⁷

The Strategic plan for strengthening the public supply chain for health products in Cameroon 2022-2026 directly addresses these dysfunctions. It highlights "poor logistical management (stock-outs, overstocks, expired products) and low availability of quality data" (Executive Summary, p. 1). CENAME, the primary supplier, faces "structural difficulties" in ensuring continuous product availability (Executive Summary, p. 1-2). The Chaine plan aims to strengthen the "emergency supply management plan" for "flexibility… for rapid distribution of vaccines and other health products in emergency situations" (Strategic Intervention 2.2, p. 28). Key weaknesses impacting emergency response include "insufficient storage and warehousing facilities" and non-compliance with WHO standards (Section 1.16, p. 33-34). Distribution suffers from "insufficient or poor condition of rolling stock" and "regular delays in deliveries" due to poor roads and inadequate vehicle capacity (Section 1.15, p. 30-31). This can lead to reliance on private wholesalers during shortages (Section 1.8, p. 16). ⁴¹⁸

More recent documents, particularly the National Strategic Plan for Community Health (PSNSC) 2021-2025, elaborate on the country's plan for supply and equitable distribution. The PSNSC includes an objective to "make available in at least 80% of health facilities quality inputs/medicines including for Community Health Workers" by 2025 (p. 32). It details the "Strengthening the supply, resupply, and monitoring system for the use of inputs/medicines to the last mile" (p. 32). This plan explicitly covers distribution "in vulnerable contexts" by 2022, with activities such as "appropriate quantification of the needs of vulnerable groups by zone /region" and "involving/contracting local, humanitarian actors for the distribution of inputs/service offerings in hard-to-reach areas" (p. 39). ⁴¹⁹

The National Plan for Prevention and Control of Infection in Human Health 2021-2024 further supports the continuous availability of essential materials and equipment in health facilities (p. 19), which would contribute to preparedness for public health emergencies. While an "overarching national public health emergency response plan" defining these emergencies is not explicitly detailed as a single document in the provided materials, various strategic plans, such as the PCI and PSNSC, address responses to epidemics and public health threats. ⁴²⁰⁴²¹

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

Cameroon is actively working to strengthen the supply and management of laboratory supplies, but there is no explicit mention or factual evidence of a dedicated national stockpile of laboratory reagents and media specifically designated for use during a public health emergency.

The 2017 Joint External Evaluation (JEE) report, while noting "pre-positioning of medical supply stocks at central and intermediate levels" (p. 42), simultaneously indicated "insufficient emergency stocks for response at all levels" (p. 42). This suggests that any existing general medical supply reserves were inadequate for emergencies at that time. More specifically for laboratories, the JEE recommended the "Establishment of a regular supply system for laboratories in reagents and consumables" (p. 25), indicating a need to improve routine supply rather than explicitly establishing an emergency stockpile. ⁴²²

The Strategic plan for strengthening the public supply chain for health products in Cameroon 2022-2026 further details systemic weaknesses in the overall health product supply chain that would impact laboratory reagents. It notes "poor logistical management (stock-outs, overstocks, expired products) and low availability of quality data necessary for decision-making" (Executive Summary, p. 1). CENAME, the national supply center, faces "structural difficulties" in ensuring continuous availability (Executive Summary, p. 1-2). Challenges include "insufficient storage and warehousing facilities" and non-compliance with WHO standards for health products (Section 1.16, p. 33-34), which would extend to laboratory consumables. Despite efforts to strengthen laboratories like LANACOME, its current facilities "do not comply with WHO requirements" (Section 1.17, p. 40), indicating broader infrastructure issues affecting reliable supply management. ⁴²³

Other strategic plans, such as the National One Health Action Plan 2024-2028 and the National Plan for Prevention and Control of Infection in Human Health 2021-2024, focus on general improvements to laboratory capacity and supply chain management. The National One Health Action Plan includes objectives for the "Acquisition of consumables and equipment to strengthen the technical platform of accredited laboratories" (p. 114) and generally for laboratories to "Acquire laboratory equipment and materials" (p. 142). The National Plan for Prevention and Control of Infection aims to "ensure the continuous availability of essential materials and equipment necessary in 60% of FOSA [health facilities]" and mentions the "Installation of stock management software" (p. 19, 20). ⁴²⁴⁴²⁵

No relevant evidence was found on the website of the Ministry of Public Health. ⁴²⁶

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no explicit evidence indicating that Cameroon conducts or requires an annual review of a national stockpile to specifically ensure its sufficiency for a public health emergency.

While the 2017 Joint External Evaluation (JEE) report highlights the "pre-positioning of medical supply stocks at central and intermediate levels" (p. 42) and identify "insufficient emergency stocks for response at all levels" (p. 42), it does not detail a formalized annual review process for assessing the sufficiency of these stocks for emergencies. The JEE recommended improvements in supply chain planning and mechanisms for constituting emergency stocks (p. 42), but not specifically an annual review for sufficiency. ⁴²⁷

The Strategic plan for strengthening the public supply chain for health products in Cameroon 2022-2026 reveals systemic weaknesses in the overall supply chain that would impede such a comprehensive review. While "periodic physical inventory (monthly, quarterly, and annual) of products in storage points" is mentioned (Section 1.16, p. 33), the document highlights that "stock data for essential medicines at the downstream level are rarely sent upstream… to improve decision-making" (Section 1.16, p. 34). Furthermore, there is an "absence of a communication platform to coordinate relations between the different stakeholders… to prevent stock-outs and overstocking" (Section 1.16, p. 34), which would be crucial for a national emergency stock assessment. These issues, alongside a "low rate of completeness in reporting logistical information at all levels" (Section 1.19, p. 54), suggest that while inventories occur, a dedicated, comprehensive annual review of national emergency stockpile sufficiency is not effectively in place. ⁴²⁸

The National Plan for Prevention and Control of Infection in Human Health 2021-2024 mentions "quarterly control of IPC stocks in collaboration with districts" (P. 20). ⁴²⁹ However, this refers to a quarterly check of infection prevention and control (IPC) supplies, which is not equivalent to an annual review of a comprehensive national emergency stockpile, nor is its stated purpose specifically to ensure sufficiency for all public health emergencies. Other strategic documents, such as the National Strategic Plan for Community Health 2021-2025 and the Health Sector Strategy 2016-2027, focus on general supply chain strengthening and resource mobilization, but do not provide details on annual reviews of emergency stockpiles. ⁴³⁰⁴³¹

No relevant evidence was found on the website of the Ministry of Public Health. ⁴³²

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 100

Cameroon meets the criterion of having a plan or mechanism to procure medical supplies for national use during a public health emergency.

Regarding the first criterion, concerning a plan or agreement to leverage domestic public and/or private sector manufacturing capacity for medical supplies during a public health emergency, explicit evidence for such a plan is not readily available. While the Strategic Plan for Strengthening the Public Supply Chain for Health Products in Cameroon 2022-2026 acknowledges that "local medicine production remains embryonic and non-competitive," covering "less than 5% of national needs" (Section 1.8, p. 13), and the Health Sector Strategy 2016-2027 expresses an intent to develop local pharmaceutical industries (p. 170), neither document explicitly outlines a specific plan to rapidly scale up or leverage this limited existing capacity for emergency production. ⁴³³⁴³⁴

However, concerning the second criterion, there is clear evidence of a plan and mechanisms to procure medical supplies for national use during a public health emergency. The Strategic Plan for Strengthening the Public Supply Chain for Health Products in Cameroon 2022-2026 explicitly details Strategic Intervention 2.2, aimed at strengthening the emergency supply management plan (p. 28). This plan's objective is to "ensure the flexibility of the supply chain for rapid distribution of vaccines and other health products in emergency situations," outlining activities such as "Elaborate operating procedures for the emergency supply chain" and "Train SYNAME actors in emergency supply management" (p. 29). ⁴³⁵ Furthermore, the National Strategic Plan for Community Health 2021-2025 reinforces this commitment by detailing efforts to "Strengthen the supply, resupply, and monitoring system for the use of inputs/medicines to the last mile" (p. 39), particularly emphasizing its application in "vulnerable contexts," which inherently includes emergency situations (p. 40). This involves actions like the "appropriate quantification of the needs of vulnerable groups by zone /region" and "involving/contracting local, humanitarian actors for the distribution of inputs/service offerings in hard-to-reach areas" (p. 40). ⁴³⁶

Finally, concerning the third criterion, which addresses plans or mechanisms to expedite medical supplies through points of entry during a public health emergency, specific expediting mechanisms beyond general customs exemptions are not explicitly detailed. Although "customs duty exemptions exist for donated medicines" (p. 27), the Strategic Plan 2022-2026 indicates that requiring Marketing Authorization (AMM) for purchases can "take time, thus extending supply delays" (p. 28). This suggests that while some facilitative measures exist for donations, a dedicated, expedited mechanism for all types of critical medical supplies during an emergency, designed to circumvent typical regulatory processes beyond existing exemptions, is not explicitly detailed in the provided documentation. ⁴³⁷

No further evidence was found on the website of the Ministry of Public Health. ⁴³⁸

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 100

Cameroon meets one of these criteria. There is evidence of a plan/mechanism in place to procure medical supplies, including laboratory supplies, for national use during a public health emergency.

Firstly, concerning a plan or agreement to leverage domestic public and/or private sector manufacturing capacity to produce laboratory supplies for national use during a public health emergency, there is no clear evidence of such a broad strategy. The Strategic Plan for Strengthening the Public Supply Chain for Health Products in Cameroon 2022-2026 explicitly states that "local medicine production remains embryonic and non-competitive", covering "less than 5% of national needs" (p. 13). ⁴³⁹ This position is reinforced by the Joint External Evaluation (JEE) report from September 2017, which identifies "low local production capacity of medical supplies" as a current challenge (p. 43). ⁴⁴⁰ While the National Action Plan for the Prevention and Control of Infection in Human Health 2021-2024 mentions an action to "provide a locally produced alcohol-based hand sanitizer" (p. 20), this is identified as a specific item and does not signify a comprehensive strategy for domestic manufacturing across the full spectrum of laboratory or medical supplies. ⁴⁴¹

Secondly, Cameroon does have evidence of a plan and mechanisms in place to procure laboratory supplies for national use during a public health emergency. The Strategic Plan for Strengthening the Public Supply Chain for Health Products in Cameroon 2022-2026 clearly outlines Strategic Intervention 2.2, focused on strengthening the emergency supply management plan (p. 28). The objective of this intervention is to "ensure the flexibility of the supply chain for rapid distribution of vaccines and other health products in emergency situations", with planned activities including "Elaborate operating procedures for the emergency supply chain" and "Train SYNAME actors in emergency supply management" (p. 29). The Strategic Plan further designates the Central National Supply of Essential Medicines and Medical Consumables (CENAME) as the "public structure responsible for supply in the regions" and the primary authorized supplier for the public health system, tasked with ensuring the availability of "essential medicines and essential medical consumables" (p. 1-2, p. 13). ⁴⁴² In the context of health supply chains, "medical consumables" typically encompass a wide range of items, including laboratory reagents, test kits, and other disposables critical for diagnostic testing, particularly during public health emergencies. The National Action Plan for the Prevention and Control of Infection in Human Health 2021-2024 further supports this by budgeting for activities like "providing health facilities with Infection Prevention and Control consumables and equipment", indicating planned procurement of such items that are essential for laboratory and diagnostic work in emergency settings (p. 20). ⁴⁴³

Thirdly, there is no explicit plan or mechanism detailed to specifically expedite laboratory supplies through points of entry during a public health emergency. The Strategic Plan for Strengthening the Public Supply Chain for Health Products in Cameroon 2022-2026 indicates that requiring Marketing Authorization (AMM) for purchases can "take time, thus extending supply delays" (p. 28), implying that standard procedures may impede rapid entry. While "customs duty exemptions exist for donated medicines" (p. 27), this measure is specific to donations and does not constitute a general expediting mechanism for all procured laboratory supplies. Furthermore, the regulatory framework for importing health products is still under development, with a strategic intervention identified to establish a framework for health product importation jointly with the General Directorate of Customs (p. 62). ⁴⁴⁴ The JEE report reinforces this area as needing improvement, noting that the "absence of intervention plans and SOPs" (standard operating procedures) at points of entry hinders effective "simulation exercises" (p. 48). ⁴⁴⁵

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

Cameroon has initiatives and ongoing efforts aimed at establishing and strengthening systems for emergency logistics and supply chain management at national and subnational levels, but the evidence indicates that these systems are still under development or facing significant challenges in full operationalization.

Firstly, regarding a system or mechanism for national and subnational levels for emergency logistics and supply chain management, the 2017 Joint External Evaluation (JEE) report mentions the "Elaboration and evaluation of a national supply chain plan for medical supplies" and the "Constitution of a working group to elaborate the national supply plan for medical supplies for USP [public health emergency] response" (p. 42). This indicates that, as of 2017, the country was in the process of developing such a plan and constituting the necessary working group, rather than having a fully established and operational system. The report explicitly highlights a critical gap: "absence of decision-making procedures for sending and receiving medical supplies and personnel in an emergency" (p. 42), which is fundamental for an operational emergency logistics system. ⁴⁴⁶ While the Health Sector Strategy (HSS) 2016-2027 describes the "National Essential Drugs and Medical Supplies Procurement System (SYNAME)" as functional for routine supply (p. 84), it does not detail its specific adaptation or demonstrated capacity for emergency logistics. ⁴⁴⁷ The National Strategic Plan for Community Health (PSNSC) 2021-2025 states an objective to "Strengthening the supply, resupply, and monitoring system for the use of inputs/medicines to the last mile" (p. 31), particularly for "vulnerable contexts" (p. 39). ⁴⁴⁸ The Strategic plan for strengthening the public supply chain for health products in Cameroon 2022-2026 details Strategic Intervention 2.2: Strengthen the emergency supply management plan (p. 28). The objective is to "ensure the flexibility of the supply chain for rapid distribution of vaccines and other health products in emergency situations" (p. 28). This plan involves elaborating operating procedures and training actors, indicating active development rather than a fully mature system. The Strategic plan acknowledges "poor logistical management (stock-outs, overstocks, expired products) and low availability of quality data" (Executive Summary, p. 1), which hinders effective emergency response. ⁴⁴⁹

Secondly, concerning whether the system is exercised, reviewed, evaluated, and updated on a regular basis, the JEE report itself was an external evaluation highlighting "weaknesses" in the supply chain and recommending that the national plan be "finalized, validated, simulated, diffused and implemented" (p. 42). ⁴⁵⁰ This indicates that the system, as of 2017, was neither fully exercised nor regularly updated based on prior evaluations. The existence of later plans (e.g., PSNSC 2021-2025) suggests that reviews and updates are occurring at a strategic level to address identified weaknesses, but direct evidence of regular operational exercises or a defined schedule for such activities is not provided. The "quarterly control of IPC stocks" mentioned in the National Plan for Prevention and Control of Infection in Human Health 2021-2024 (p. 20) is a routine stock check for specific items, not a comprehensive exercise or evaluation of the entire emergency logistics and supply chain management system. ⁴⁵¹ The Strategic plan's activities like "Elaborate operating procedures for the emergency supply chain" and "Train SYNAME actors in emergency supply management" (p. 29) suggest future implementation of such processes. However, the document also indicates existing challenges with data reliability and utilization, such as "low rate of completeness in reporting logistical information at all levels" and "insufficient analysis/review of data quality and their sharing" (Section 1.19, p. 54), which would impede effective evaluation and updating. ⁴⁵²

Thirdly, regarding specific considerations like cold chain management for vaccines, the HSS acknowledges challenges with "insufficient availability and curative maintenance of cold chain equipment" and "limited supply of electricity" (p. 22, 53). ⁴⁵³ Likewise, the Strategic plan explicitly identifies "Difficulties in maintaining the cold chain at all levels" and "lack of consistency between available vehicle types, capacity, and actual delivery needs: there is insufficient optimal cold chain conditions and trucks for last-mile deliveries" (Section 1.15, p. 31). It also notes a "low level of control over storage conditions… particularly for temperature and humidity" (Section 1.16, p. 35). ⁴⁵⁴ No recent evidence was found on the website of the Ministry of Public Health regarding cold chain management. ⁴⁵⁵

Finally, concerning coverage of public and private sectors, SYNAME does involve both public and private entities in routine supply (p. 84). ⁴⁵⁶ The PSNSC mentions "involving/contracting local, humanitarian actors" for distribution in difficult areas (p. 39), which could include private actors. ⁴⁵⁷ However, the extent and formalization of private sector integration into emergency-specific logistics and supply chain management is not detailed. The HSS mentions a general "partnership strategy aimed at strengthening the concerns of the private sector in service delivery" (p. 99), which is broad and not specific to emergency supply chains. ⁴⁵⁸ The Strategic plan's Strategic Intervention 3.2 aims to "Strengthen the distribution of health products to the last mile taking into account the experience of private sector operators" and includes an activity to "Define a regulatory framework governing partnership with the private sector for last-mile distribution support (FRPS – FOSA) (3PL)" (p. 31-32). This indicates a plan to formalize private sector integration, but also that such a formalized system is still being developed. The existing public supply chain (SYNAME) already involves the Central National Supply of Essential Medicines and Medical Consumables (CENAME) and Regional Funds for Health Promotion (FRPS) at national and subnational levels, but its operational dysfunctions affect all levels, public and private, particularly in emergency situations. ⁴⁵⁹

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 100

Cameroon has plans, programs, or guidelines in place for dispensing medical countermeasures (MCMs) for national use during a public health emergency.

The Strategic Plan for Strengthening the Public Supply Chain for Health Products in Cameroon 2022–2026 outlines the country's vision to "ensure uninterrupted and financially accessible good quality health products at all levels of the health pyramid" by 2025 (Introduction, p. 3). This plan includes Strategic Intervention 2.2, aimed at strengthening the emergency supply management plan, with the explicit objective to "ensure the flexibility of the supply chain for rapid distribution of vaccines and other health products in emergency situations" (p. 28). This directly addresses the dispensing of a key MCM category. Furthermore, this strategic plan outlines established policies for free or subsidized access to specific therapeutics, stating that "Anti-tuberculosis drugs and antiretroviral drugs are free for everyone. Anti-malarial drugs are heavily subsidized for everyone and free for children under 5 years old; intermittent preventive treatment for malaria is free for pregnant women and infants from 0 to 11 months." (Section 1.18, p. 48). These are direct mentions of specific therapeutics—antibiotics (antituberculeux), antivirals (ARVs), and antimalarials—and their dispensing, often free or subsidized, which is critical during public health scenarios. ⁴⁶⁰

The 2017 Joint External Evaluation (JEE) report indicates that "During epidemics, case management is free of charge" and that this management is "done in all health structures in the country" and "also done at the community level for some cases of epidemic-prone diseases" (p. 56). This establishes a policy and operational framework for dispensing therapeutics and diagnostics during public health emergencies, extending to the community level. The report also notes the existence of disseminated case management directives and standard operating procedures for case management and transport of potentially infectious patients (p. 39). In the context of diagnostics, the JEE report specifically mentions the "detection of antimicrobial resistance" and the presence of national diagnostic and research laboratories, including reference centers (CPC, LNSP), capable of "detecting priority pathogens" (P.3.1, p. 12). ⁴⁶¹

The National Strategic Plan for Community Health (PSNSC) 2021-2025 reinforces and expands upon these mechanisms by outlining a detailed plan for the provision and distribution of medical inputs. It sets an objective to "make available in at least 80% of health facilities quality inputs/medicines including for Community Health Workers" by 2025 (p. 32). The plan includes specific interventions for "Strengthening the supply, resupply, and monitoring system for the use of inputs/medicines to the last mile" and "involving/contracting local, humanitarian actors for the distribution of inputs/service offerings in hard-to-reach areas" in "vulnerable contexts" (p. 39), which encompasses public health emergencies. The performance indicators within the PSNSC explicitly track the dispensing of both diagnostics and therapeutics at the community level, including "Proportion of suspected malaria cases submitted to a parasitological test in the community" (N°12, p. 66) and "Proportion of confirmed simple malaria cases who received first-line antimalarial treatment in the community" (N°13, p. 66). These examples demonstrate clear guidelines for the dispensing of specific therapeutics (antimalarials) and diagnostics for national use, particularly in emergency and vulnerable settings. ⁴⁶²

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 100

Cameroon has a public plan or mechanism in place specifically designed to facilitate workforce surge in an emergency.

While the 2017 Joint External Evaluation (JEE) report previously identified a significant gap, stating that "Cameroon does not have a national plan for the transfer of medical supplies and deployment of health personnel in the event of an International Public Health Emergency" (p. 42) and recommending to "Develop a plan for sending and receiving health personnel during a public health emergency" (p. 42), more recent developments indicate the establishment of such mechanisms ⁴⁶³.

The manual for Cameroon's Public Health Emergency Operations Center (COUSP) explicitly details a mechanism for workforce augmentation. It maintains a list of mobilizable supplementary personnel, comprising multi-disciplinary and multi-sectoral experts. These individuals can be activated to reinforce the center's staff during a health crisis, with provisions for regular training and simulation exercises to ensure their readiness for deployment (p. 49). ⁴⁶⁴

This strategic direction is further supported by the Health Sector Strategy 2020–2030 (HSS 2020-2030), which sets a key strategic objective to "increase, according to prioritized needs, the availability of Human Resources for Health in at least 80% of Health Districts" ⁴⁶⁵. The National Health Development Plan 2021–2025 (PNDS 2021-2025) serves as the operational framework for the HSS, and the National Community Health Strategic Plan 2021–2025 (PSNSC 2021-2025) was developed to address health system weaknesses, "particularly linked to the deficit in human resources". ⁴⁶⁶⁴⁶⁷ Further evidence of developing surge capacity includes Cameroon forming its first African Volunteer Health Corps (AVOHC) surge team, aimed at strengthening health emergency response. ⁴⁶⁸

While there are mentions of training programs for health professionals and discussions about managing existing personnel during an influx of patients (e.g., SOPs for staff assignment during a massive influx in the National Action Plan for the Prevention and Control of Infection in Human Health, p. 18), these are now part of a broader, evolving strategy for workforce augmentation. ⁴⁶⁹

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

Cameroon does not have a public plan in place to receive health personnel from other countries to respond to a public health emergency.

The 2017 Joint External Evaluation (JEE) report explicitly states this as a gap. Under the section Medical supplies and personnel deployment, it notes: "Cameroon does not have a national plan related to the transfer of medical supplies and the deployment of health personnel in case of an International Public Health Emergency". It further clarifies that "However, such a plan does not exist for sending and receiving health personnel during an IPHE". The recommendation immediately following this observation is to "Develop a plan for sending and receiving health personnel during a public health emergency" (p. 42). ⁴⁷⁰

Later documents, such as the National One Health Action Plan 2024-2028 or the National Strategic Plan for Community Health 2021-2025, mention general international cooperation or support from partners, but they do not provide evidence that a specific, public national plan for receiving health personnel from other countries for emergency response, as recommended by the 2017 JEE, has been developed or implemented. ⁴⁷¹⁴⁷²

No relevant evidence was found on the website of the Ministry of Public Health. ⁴⁷³

4.3.2c Plan to redeploy existing health personnel within the country

Score: 100

There is evidence of some planning for the redeployment of existing health personnel within health facilities, particularly concerning role redeployment during specific situations, and a national plan is being developed to address broader geographical redeployment.

The National Action Plan for the Prevention and Control of Infection in Human Health 2021-2024 mentions the development of Standard Operating Procedures (SOPs) related to personnel assignment within health facilities. Under "Workload, staffing and bed occupancy," an activity is to "Develop SOPs on the assignment of care personnel and the management of visits in health facilities during a massive influx of patients." These SOPs are also to be validated, produced, and disseminated to regions, districts, and health facilities (p. 18). This suggests a mechanism for managing and potentially redeploying existing staff within health facilities to handle increased patient loads, which could involve role adjustments ⁴⁷⁴.

While the 2017 Joint External Evaluation (JEE) report previously indicated a broader lack of a national deployment plan for health personnel during public health emergencies, stating that "Cameroon does not have a national plan for the transfer of medical supplies and deployment of health personnel in the event of an International Public Health Emergency (PHEIC)" (p. 42) and recommending developing such a plan (p. 42) ⁴⁷⁵, more recent initiatives are directly addressing this gap.

Cameroon is taking steps to revitalize its emergency medical services (EMS), including the development of a national EMS plan and training programs. This effort is aimed at improving the capacity to manage medical emergencies and involves the creation of structured teams and protocols that would facilitate the redeployment of health personnel across the country during public health emergencies ⁴⁷⁶.

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 0

The Constitution of the Republic of Cameroon does not explicitly guarantee citizens' right to medical care.

Instead, its provisions are more aspirational or subject to progressive realization. The Preamble of the Constitution makes broad reference to sacred and inalienable human rights, incorporating fundamental freedoms enunciated in international human rights instruments, but it stops short of explicitly stating a direct, guaranteed right to medical care. Furthermore, Article 34 establishes a Social Council tasked with advising various government bodies on matters relating to economic, social, and cultural development, which would encompass health. However, this advisory role does not translate into a direct constitutional guarantee of medical care for all citizens. ⁴⁷⁷

Supporting this interpretation, the Cameroon 2021 Human Rights Report indicates that while the constitution "prescribes equal rights for all citizens," the law does not explicitly prohibit discrimination against certain groups "in access to government services such as health care" (p. 53). If the constitution explicitly guaranteed the right to medical care, it would logically follow that discrimination in accessing this care would be prohibited constitutionally or by explicit law. ⁴⁷⁸

Similarly, the research paper on Universal Health Coverage (UHC) in Souza-Cameroon notes the Cameroonian government's "strategic vision to guarantee equitable access to quality healthcare for Cameroonians" and its initiation of a process "aimed at eventually providing the country with universal health coverage" (p. 2). The phrasing "strategic vision" and "aimed at eventually providing" suggests that universal access to healthcare is a goal or an ongoing process of progressive realization, rather than an already established and explicitly guaranteed constitutional right. The paper also mentions that "access to healthcare is perceived not only as a right, but also as an accessible reality" (p. 7), distinguishing between perception and explicit guarantee. ⁴⁷⁹

4.4.1b Access to skilled birth attendants (% of population)

Score: 54.41

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 80.89

4.4.1d Coverage of essential health services through universal health coverage

Score: 35.42

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 70.65

4.4.1f Rate of mortality amenable to health care

Score: 74.67

4.4.2a Guaranteed paid sick leave

Score: 66.67

In Cameroon, workers are guaranteed paid sick leave, although this entitlement is conditional upon their seniority. An employee is eligible for unpaid sick leave during their first six months of service, after which they are entitled to paid sick leave. The level of compensation can reach up to 100% of the employee's income for a maximum of six months, with the specific amount and duration depending on factors like seniority, employment sector, and the individual contract. This compensation is typically shared between the employer and the National Social Security Fund (CNPS), and collective agreements often provide more detailed terms. To take sick leave, the employee must provide a valid medical certificate from a recognized health professional. This duly recorded illness allows for the suspension of the employment contract for the leave period. ⁴⁸⁰⁴⁸¹

Regarding the availability of sick leave for mental health, Cameroon's Labor Code 92/007 of August 14th 1992 does not explicitly differentiate between mental and physical health conditions. The legal text refers generally to "illness" or "injury" that is validated by a doctor. ⁴⁸²

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available legislation, policy, or explicit public statement from the government of Cameroon specifically committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency.

Existing protocols and training efforts underscore the importance of healthcare worker safety. For instance, the Joint External Evaluation (JEE) report notes the existence of protocols for the protection of health personnel in the context of disease management (p. 12). It also highlights training efforts, stating that more than 1000 laboratory personnel and health professionals have been trained in biosafety and biosecurity in preparation for the Ebola pandemic (p. 19) ⁴⁸³. Further illustrating these protective measures, during the COVID-19 pandemic, the Cameroonian government, with support from the World Health Organization (WHO), facilitated nationwide training for healthcare professionals. A key goal of this training was the "protection of healthcare workers" by educating them on infection prevention and control (IPC), early detection of cases, and proper precautions when handling suspected or confirmed cases ⁴⁸⁴.

The National Strategic Plan for Community Health 2021-2025 acknowledges the risk of healthcare workers (ASC) abandoning their posts if not adequately remunerated or supported, stating that it will be necessary to mobilize sufficient resources, train and remunerate ASC well to retain them (p. 47). This speaks to retention strategies and motivation but does not directly address prioritized healthcare for illness contracted during emergency response. ⁴⁸⁵

No relevant evidence was found on the websites of the Ministry of Public Health or the Ministry of Livestock, Fisheries and Animal Industries (MINEPIA). ⁴⁸⁶⁴⁸⁷

4.5.1a Existence of system for communication during a public health emergency

Score: 100

There is a system in place for public health officials and healthcare workers to communicate during a public health emergency, and the recently developed National Risk Communication and Community Engagement (CREC) Strategy aims to strengthen and improve these mechanisms, particularly in areas identified for improvement.

The Joint External Evaluation (JEE) report highlights the existence of a Public Health Emergency Operations Centre (COUSP), which is described as a "central site for coordinating information and operational resources for the strategic management of public health emergencies and emergency simulation exercises" (p. 37). It is also noted that the COUSP functions on a surveillance principle and has a system for detecting events and notification (p. 37). While the regulatory text for its creation and operation was not yet adopted at the time of the JEE report (2017), it was functional and had been activated multiple times for health emergencies (p. 38). ⁴⁸⁸

The JEE also mentions that communication with local and intermediate levels, as well as partners, is done by phone or email, and weekly presentations are made at the central level. During crises, there is a "punctual communication mechanism" (p. 28). However, the JEE identified areas for improvement, including the need to "Finalize and disseminate the regulatory texts governing the creation, missions, operation and activation of the COUSP, specifying the modalities of communication with local and regional levels as well as national partners (information and feedback)" (p. 38). It also pointed out the need for a 24/7 single point of contact (p. 38) and highlighted a current limitation in "limited modes of communication and information for the public" (p. 29). ⁴⁸⁹

The National Risk Communication and Community Engagement (CREC) Strategy 2023-2027 was initiated with the establishment of the One Health CREC Task Force in 2020, following recommendations from the Joint External Evaluation (JEE) regarding the implementation of International Health Regulations (RSI 2005) requirements (p. xix). It emphasizes the critical need for an effective communication system during public health events. The strategy highlights that a successful response requires "active interaction with communities through bidirectional communication to ensure access to updated, accurate, reliable, and adequate information" (Preface, p. ii). This strategy serves as a guiding instrument for all stakeholders, proposing a set of tools based on multisectoral collaboration to engage communities before, during, and after a crisis (Preface, p. ii). It focuses on six strategic axes, including education for health, advocacy, partnership, community engagement, management of rumors and disinformation, and coordination (Executive Summary, p. v). ⁴⁹⁰

The National Strategic Plan for Community Health 2021-2025 also refers to various communication tools and practices. It mentions the "Circuit of information/data on the implementation of ISC activities" which includes reporting from community health workers (ASC) up through the health pyramid (Area, District, Regional, Central) and the use of DHIS2 (District Health Information System 2) for data collection and transmission (p. 41, 42). This system facilitates the flow of information that would be crucial during an emergency. The plan also includes an axis for "Communication for development" to increase community demand for health services and mobilize various authorities and partners (p. 34) ⁴⁹¹. The CREC strategy further reinforces this by including an objective to "improve the monitoring and management of rumors on digital platforms by involving the community more in risk communication interventions" (Executive Summary, p. v). ⁴⁹²

Complementing this, the National Multi-risk Preparedness and Response Plan for Public Health Emergencies in Cameroon 2022-2024 (PNMPR) outlines broader coordination efforts. The PNMPR mentions the creation of the National Center for Health Emergency Operations (CNOUS) in 2020 and states that "a Concept of Emergency Operations (CONOPS) as well as Standardized Operational Procedures (SOPs) for the CNOUS have been developed to facilitate a common understanding of the responsibilities of the various stakeholders during public health emergency preparedness and response" (p. 39). These CONOPS and SOPs would guide communication among officials. Moreover, while acknowledging that a "clearly defined coordination and collaboration mechanism between the different stakeholders" was lacking at the operational level (p. 44), the PNMPR aims to address this by implementing a "multisectoral risk/crisis communication system" and a "multisectoral framework for consultation and harmonization of risk/crisis communication strategies" (p. 61). ⁴⁹³

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

While the strategic intent to include the private sector in communication mechanisms during public health emergencies is evident, it is not fully clear whether the operational system for public health officials and healthcare workers currently encompasses both public and private sector healthcare workers through integrated communication channels.

The 2017 Joint External Evaluation (JEE) report explicitly identified a critical gap: an "absence of communication coordination mechanism between stakeholders (public sector, civil society, private sector, hospitals) in emergency situations" (p. 45) ⁴⁹⁴.

However, the recently adopted National Strategy for Risk Communication and Community Engagement (CREC) according to the "One Health" approach, explicitly recognizes the private sector as a key stakeholder. The CREC document identifies the "private sector" as one of the "Parties prenantes" (stakeholders) (p. 50). Furthermore, it includes "intermediate social bodies (private companies, NGOs, health sector organizations, civil society)" as a tertiary target for the strategy (p. 30). The strategy outlines a need to map all stakeholders (p. 23) and to strengthen coordination and information sharing between different actors at all levels (p. v, p. 34). This demonstrates a clear strategic intent and a plan within the CREC to integrate the private sector into the overall communication framework for public health emergencies. ⁴⁹⁵

Operationally, organizations like the U.S. Centers for Disease Control and Prevention (CDC), through their extensive support for health systems in Cameroon, implicitly contribute to communication networks that span across various healthcare providers. For instance, CDC has expanded HIV clinical services to 347 sites across all ten regions, serving a vast majority of people living with HIV through PEPFAR-funded partners (p. 7). This widespread engagement with numerous "health facilities" and "implementing partners" (p. 7, 10), including those that may be private or non-governmental, necessitates and fosters operational communication and coordination for service delivery, laboratory testing, and emergency response activities, as seen during the COVID-19 pandemic (p. 10-11). While not explicitly detailing a formal emergency communication protocol between public and private sector healthcare workers, the scale and nature of CDC's collaborative efforts suggest an operational network that extends beyond purely governmental entities ⁴⁹⁶.

Despite these operational realities and strategic intents, specific evidence detailing the full operationalization and effectiveness of integrated emergency communication channels specifically designed between public and private sector healthcare workers (as opposed to general coordination or service delivery communication) is not yet fully articulated in the provided documents. Subsequent strategic documents, such as the National One Health Action Plan, emphasize broader multisectoral collaboration and improved communication, aligning with the CREC's objectives to bridge such gaps ⁴⁹⁷.

No relevant evidence was found on the website of the Ministry of Public Health. ⁴⁹⁸

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no evidence that Cameroon's national public health system is currently monitoring for and tracking the number of healthcare associated infections (HCAI) in healthcare facilities in a robust or comprehensive manner.

An assessment of infection prevention and control (IPC) programs in some health facilities in Cameroon explicitly found that HCAI surveillance was the weakest of the eight IPC core components. It reported that most (89.2%) of the surveyed health facilities did not include HCAI surveillance in their IPC programs (p. 1, 5). The study further noted that the median IPCAF score for health facilities was 275 out of 800, with 86% having either an inadequate or basic IPC status, and none achieving advanced status (p. 1). These findings highlight a significant deficit in the implementation of HCAI surveillance. ⁴⁹⁹

The National Action Plan for the Prevention and Control of Infection in Human Health 2021-2024 explicitly states the existing reality: "There is very little national data…" regarding healthcare-associated infections (IAS) (p. 6). A 2019 evaluation found "a zero score for IPC at the national level and an inadequate to basic IPC level in all visited health facilities. This evaluation also explicitly stated "no surveillance of healthcare-associated infections…) (p. 7, 8). Furthermore, the document outlines a future objective to address this gap: "Establish an IAS surveillance system from the national level to all health facilities of 1st to 4th category by 2024" (p. 7). The section on "6.3 Surveillance des IAS" notes that a 2019 evaluation revealed a "zero or low" score for this component (p. 14). ⁵⁰⁰ Similarly, the 2017 Joint External Evaluation (JEE) assigned a score of 1 (the lowest capacity) to "P.3.3 Program for the prevention and control of nosocomial infections" (p. 12), indicating very limited or no capacity in this area at that time. ⁵⁰¹

No relevant evidence was found on the website of the Ministry of Public Health. ⁵⁰²

4.6.1b Infection prevention and control programme

Score: 100

There is evidence of an infection prevention and control (IPC) program in place nationally, but the national documents also highlight that it has significant weaknesses and is largely in its early stages of development and implementation.

The National Action Plan for Infection Prevention and Control in Human Health 2021-2024 explicitly addresses this. It states that the IPC program is a priority and highlights findings from evaluations conducted in 2019: "For all six components of the IPCAT2 tool (existence of a national IPC program, existence of IPC guidelines, lack of continuous training in IPC, lack of surveillance of healthcare-associated infections, lack of multimodal strategy for behavior change, lack of monitoring/evaluation of IPC activities at national level), the score is zero" (p. 8). Also, it mentions that "There is no national action plan or national guidelines for IPC" (p. 8). "However, Cameroon developed and validated the guide to good hygiene practices in hospitals in 2017, but this guide has not been disseminated to healthcare facilities" (p. 8). ⁵⁰³

Despite these significant identified gaps, this Plan itself serves as a foundational step towards establishing a functional national IPC program. Its main objective is to "prevent, reduce and control healthcare-associated infections (HAIs) and the development and spread of Antimicrobial Resistance (AMR), in order to improve patient health and safety" (p. 8). ⁵⁰⁴

The plan outlines specific actions to operationalize a national IPC program, including: organizing workshops to evaluate and update the national legal framework for IPC, and producing/disseminating legal frameworks (p. 11); organizing advocacy meetings for the creation of a national IPC Program with its branches and IPC committees at healthcare facility levels, designating members, elaborating terms of reference, validating creation texts, and establishing funding mechanisms (p. 11); and disseminating existing guidelines and developing/validating prioritized Standard Operating Procedures (SOPs) for IPC ( p. 12).

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

There is evidence of a plan to ensure a safe environment in health facilities nationally, though the documents indicate this is an area requiring continued strengthening and implementation.

The National Action Plan for Infection Prevention and Control in Human Health directly addresses the safe environment within health facilities. One of its key objectives is to "Improve infrastructure and the built environment and ensure the continuous availability of essential materials and equipment necessary in 60% of FOSA [health facilities] including biomedical waste management by 2024" (p. 19). ⁵⁰⁵

The plan details several actions under the "Built environment, material and equipment for IPC at the facility level" axis. WASH (Water, Sanitation, and Hygiene) Improvement includes conducting evaluations of current WASH programs in health facilities, training WASH teams, assessing risks, and developing/implementing improvement plans (p. 20). Hand Hygiene Practices involve providing soap, disposable paper towels, trash cans, locally produced alcohol-based hand sanitizer, and functional hand hygiene stations in health facilities (p. 20). Water Quality measures consist of performing annual chemical and microbiological analyses of water in health facilities to ensure its potability, as well as providing water storage tanks and cisterns (p. 20). ⁵⁰⁶

Equipment and Energy Provision actions include assessing the needs for cleaning equipment and consumables, equipping health facilities with IPC consumables and equipment, installing stock management software, training staff on its use, controlling stock levels, installing solar panels for constant energy supply, and maintaining energy supply facilities (p. 20-21). Environmental Health Management System efforts focus on developing tools for cleaning evaluation and monitoring, preparing standardized cleaning schedules, evaluating cleaning practices, reporting results to IPC committees, establishing disinfection and decontamination areas for medical equipment, and developing a preventive maintenance plan for equipment (p. 21). Finally, Medical Waste Management includes implementing systems for quantifying and sorting different types of waste, providing incinerators or autoclaves for waste destruction in higher-category hospitals, and establishing a safe transport system for healthcare waste from production to disposal points (p. 21). ⁵⁰⁷

The Joint External Evaluation (JEE) report from 2017 further supports this, noting that "In the context of biosafety and biosecurity in Cameroon, a number of actions have been taken, particularly at the level of reference laboratories (CPC, CRESAR, LANAVET) which assess biosafety and biosecurity risks…" (p. 19). However, it also points out the need for a comprehensive, integrated biosafety and biosecurity management system and effective waste management across the country (p. 19). ⁵⁰⁸ The National Action Plan for Infection Prevention and Control in Human Health directly addresses these identified shortcomings.

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is a mandatory national requirement for an ethical review by an ethics committee or Institutional Review Board (IRB) before any clinical trial involving human subjects can begin in Cameroon. This requirement is legally mandated by Law No. 2022/008 of April 27, 2022 relative to medical research involving human subjects in Cameroon. ⁵⁰⁹

The ethical review process is further detailed in the government-published Guide of Good Practices for the Creation, Organization, and Functioning of Research Ethics Committees for Human Health, issued in September 2016. This guide establishes the framework for ethical oversight of research. As per this guide, a Research Ethics Committee (CERSH) is formally designated to review, approve, and monitor research protocols involving human subjects. Its primary purpose is to ensure that these protocols adhere to ethical rules, thereby protecting the rights and well-being of participants (p. 10). The guide explicitly states that the researcher must obtain written and dated approval/favorable opinion from an Ethics Committee before undertaking the study (p. 20). ⁵¹⁰

The missions of these committees include evaluating the ethical, scientific, and social aspects pertinent to research projects involving human beings and ensuring the ethical follow-up of approved research protocols (p. 11). The functions also involve assessing potential risks and benefits, evaluating informed consent procedures and documentation, and reviewing participant recruitment methods (p. 12). Furthermore, the guide specifies three types of ethics committees in Cameroon: the National Ethics Committee for Research on Human Health (CNERSH), Regional Ethics Committees (CRERSH), and Institutional Ethics Committees (CEIRSH), each with defined competencies based on geographical area and type of project, including clinical trials (p. 10, 16-17). The CNERSH, for instance, is competent for clinical trials and research involving international cooperation (p. 17). ⁵¹¹

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

While Cameroon has significantly strengthened its regulatory framework for clinical trials, public evidence explicitly detailing an expedited process for approving clinical trials for unregistered medical countermeasures (MCMs) or the mutual recognition of clinical trial results from other countries specifically in the context of ongoing pandemics or epidemics is not readily available.

Cameroon has reinforced its regulatory framework for clinical trials through a decree signed in 2023 by the Minister of Public Health. This decree concerns the National Technical Commission for Clinical Trials (CTNEC), which is responsible for the scientific, technical, and methodological evaluation of clinical trials. The aim is to make procedures more efficient, transparent, and adapted to national and international standards, thereby reducing delays and attracting more clinical research while ensuring participant protection. ⁵¹² This regulatory reinforcement complements the existing mandatory ethical review process, as established by Law No. 2022/008 of April 27, 2022, on medical research involving human subjects, and detailed in the 2016 Guide of Good Practices for the Creation, Organization, and Functioning of Research Ethics Committees for Human Health) (p. 10, 20). ⁵¹³⁵¹⁴

Despite this emphasis on efficiency and adherence to international standards, specific public documentation outlining expedited pathways for unregistered MCMs during emergencies or mechanisms for mutual recognition of trials from other countries is not explicitly detailed within the provided documents. The 2017 Joint External Evaluation (JEE) report discusses national commissions that approve marketing authorizations for drugs (p. 11), but this primarily refers to market access rather than the specific, expedited clinical trial approval process for novel interventions in emergency situations. ⁵¹⁵ Similarly, other national plans, such as the National Action Plan for the Prevention and Control of Infection in Human Health 2021-2024 and the National One Health Action Plan 2024-2028, while focusing on infection prevention, control, surveillance, and broader research development, do not elaborate on these particular regulatory pathways for clinical trials in public health crises. ⁵¹⁶⁵¹⁷

No relevant evidence was found on the website of the Ministry of Public Health. ⁵¹⁸

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

There is a government agency responsible for approving new medical countermeasures (MCMs) for humans, overseeing both their clinical evaluation and market authorization.

The FDA Cameroon also plays a role in the oversight of clinical trials. It maintains a dedicated Clinical Trials Department responsible for ensuring the safety and ethical conduct of clinical investigations of drugs, biologics, and medical devices intended for human use. This department, which works in collaboration with other regulatory bodies, aims to protect the rights, safety, and welfare of human subjects involved in clinical research and to ensure the integrity of clinical trial data. ⁵¹⁹

The 2017 Joint External Evaluation (JEE) report further indicates the existence of National Drug Commissions, which are responsible for approving Marketing Authorizations for drugs in human and animal health (p. 11). This highlights a separate but equally vital government function: ensuring that once an MCM has successfully completed clinical trials and demonstrated efficacy and safety, it can be legally placed on the market. While the specific agency name is not explicitly mentioned in the JEE, its function clearly points to a government body with the authority to grant market access for medical products. ⁵²⁰

Additionally, the National One Health Action Plan mentions "a national laboratory responsible for evaluating all imported medicines before they are placed on the market" and "a national laboratory for drug quality control and expertise (LANACOME)" (p. 11). These entities reinforce the comprehensive oversight by regulatory bodies involved in ensuring the quality and approval of medical products throughout their lifecycle, from clinical evaluation to market entry and post-market surveillance. ⁵²¹

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is no explicit mention of an expedited process for approving medical countermeasures (MCMs) for human use, or a mechanism for mutual recognition of approval decisions made elsewhere, specifically during public health emergencies.

The 2017 Joint External Evaluation (JEE) report, under the section Antimicrobial Resistance, states the existence of National Drug Commissions which approve Marketing Authorizations for drugs in human and animal health (p. 11). While the document does not explicitly name the specific agency, it indicates the existence of National Drug Commissions with the authority to grant marketing authorizations for human health medicines, which would include new medical countermeasures. This implies that such a commission or a related government body is responsible for this approval process. ⁵²²

However, the existence of National Drug Commissions which approve Marketing Authorizations for drugs in human and animal health refers to the standard regulatory process for market entry. There is no information detailing special or accelerated procedures for emergency situations, nor any mention of recognizing approvals granted by other countries or international bodies in the context of pandemics or epidemics.

No relevant evidence was found on the website of the Ministry of Public Health. ⁵²³

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Cameroon has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁵²⁴

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 0

Epidemics and pandemics are acknowledged within the national disaster risk reduction (DRR) discourse in Cameroon, but there is no evidence of a fully integrated, comprehensive national DRR strategy that prioritizes or fully incorporates epidemic and pandemic threats. Instead, planning for health emergencies is primarily addressed in sectoral or adjunct plans, such as the National Contingency Plan (2011), which includes a public health emergency component, but fails to prioritize epidemics within an overarching risk reduction framework.

According to the 2017 Joint External Evaluation (JEE) report, Cameroon’s public health emergency preparedness is covered under the ‘National Contingency Plan’ (2011), a general disaster risk reduction framework. This contingency plan addresses health risks, including epidemics of meningitis, yellow fever, and cholera, as well as animal diseases. It includes elements such as public awareness-raising, improved surveillance mechanisms, and the development of targeted response plans. However, the JEE noted that this health-related component was “underdeveloped” and recommended the creation of a multi-hazard, multisectoral national plan that integrates existing risk maps and emergency response plans into a cohesive national strategy (p. 35). ⁵²⁵ This highlights that while health risks are acknowledged, their integration into disaster risk reduction planning remains insufficient.

In April 2025, Cameroon updated its National Disaster Risk Financing Strategy. This strategy provides a framework for mobilizing resources to respond to various disasters while maintaining budgetary balance. Its introduction acknowledges Cameroon's exposure to multiple risks, including floods, droughts, landslides, and epidemics. However, the operational scope of this financing strategy primarily covers natural disasters such as floods, landslides, and droughts, which are identified as the main threats causing significant human and economic losses. Epidemics are mentioned within the broader risk context but are not prioritized within the financing instruments for disaster response. ⁵²⁶

Therefore, while various plans and strategies, such as the National One Health Action Plan, emphasize strengthening collaboration and coordination for health risks including epidemics (p. 16), these efforts currently exist alongside, rather than within, a fully integrated overarching national disaster risk reduction strategy that comprehensively incorporates and prioritizes all epidemic and pandemic threats, particularly in terms of financial planning. ⁵²⁷

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 100

Cameroon has established bilateral and multilateral agreements for transboundary surveillance collaboration with its neighboring countries, specifically concerning public health emergencies. These agreements were in place at the time of the Joint External Evaluation in September 2017.

The evaluation report states, in the section on notification indicators and scores, that there is an "Establishment of bilateral and multilateral agreements on collaboration for cross-border surveillance between Cameroon and its neighboring countries" (p. 31). This indicates that formal arrangements exist to facilitate cooperation on cross-border public health surveillance. The Public Health Emergency Operations Center (COUSP) has also been activated on several occasions for health emergencies, such as the avian influenza epidemic, demonstrating practical application of response mechanisms (p. 37). ⁵²⁸

Furthermore, the National One Health Action Plan underscores the importance of addressing transboundary threats and mentions that infectious agents "know no borders" or know no borders, reinforcing the necessity for cross-border cooperation (p. 15). The "One Health" approach itself, adopted by Cameroon, emphasizes collaborative, multisectoral efforts across human, animal, and environmental health, which inherently supports regional and international cooperation in managing health threats (p. 15). ⁵²⁹

More recent evidence showcases specific active partnerships demonstrating this ongoing commitment: in May 2025, Cameroon, alongside Niger and Nigeria, endorsed a "Call for Action" to strengthen cross-border collaboration for Neglected Tropical Disease (NTD) elimination, including the development of a joint Memorandum of Understanding (MoU) to harmonize these efforts. ⁵³⁰ Cameroon is also an integral part of the Lake Chad Basin cross-border coordination plan for polio eradication, which involves Nigeria, Niger, Chad, and the Central African Republic, focusing on synchronizing vaccination campaigns, sharing data, and implementing interventions for mobile and cross-border populations. ⁵³¹ Polio retains its status as a Public Health Emergency of International Concern (PHEIC) as of November 2025.⁵³² Additionally, Cameroon actively participates in initiatives to strengthen cross-border surveillance and information sharing in Africa, such as those supported by the World Bank, which has backed regional disease surveillance programs involving Cameroon to reinforce disease surveillance and response systems across borders (p. 3), ⁵³³ and frameworks from Africa CDC designed to enhance cross-border surveillance and information exchange mechanisms across the continent (p. 7-8). ⁵³⁴ These examples collectively demonstrate a sustained commitment and active participation in various agreements and plans for transboundary surveillance collaboration.

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

Cameroon has established bilateral and multilateral agreements for transboundary surveillance collaboration with its neighboring countries, with regards to animal health emergencies, but there is evidence of gaps in their implementation.

The 2017 Joint External Evaluation (JEE) states, in the section on notification indicators and scores, that there is an "Establishment of bilateral and multilateral agreements on collaboration for cross-border surveillance between Cameroon and its neighboring countries" (p. 31). This indicates that formal arrangements exist to facilitate cooperation on cross-border public health surveillance. The Public Health Emergency Operations Center (COUSP) has also been activated on several occasions for health emergencies, such as the avian influenza epidemic, demonstrating practical application of response mechanisms (p. 37). ⁵³⁵

Furthermore, the National One Health Action Plan underscores the importance of addressing transboundary threats and mentions that infectious agents "know no borders" or know no borders, reinforcing the necessity for cross-border cooperation (p. 15). The "One Health" approach itself, adopted by Cameroon, emphasizes collaborative, multisectoral efforts across human, animal, and environmental health, which inherently supports regional and international cooperation in managing health threats (p. 15). ⁵³⁶ This is further solidified by the existence of a National Program for the Prevention and Control of Zoonoses, which includes a component for strengthening sub-regional and international cooperation on zoonoses with neighboring countries and international organizations (p. 17). ⁵³⁷

More recent evidence showcases specific active partnerships and initiatives demonstrating this ongoing commitment to transboundary animal health collaboration. Cameroon actively engages in multi-country initiatives, such as training courses for rabies control in Central Africa, emphasizing a One Health approach in collaboration with organizations like the WHO. This highlights direct cooperation on specific zoonotic diseases that cross borders. ⁵³⁸

Moreover, a robust veterinary workforce is crucial for animal health surveillance and emergency response, particularly for zoonotic and transboundary animal diseases (TADs). Cameroon's efforts, supported by organizations like Africa One Health University Network (AFROHUN), focus on developing this workforce to ensure early detection and rapid response to such threats (p. 6). ⁵³⁹ Finally, the Food and Agriculture Organization (FAO) has successfully piloted an animal health emergency operations manual in Cameroon. It states that the experience gained by Cameroon in piloting the animal health emergency operations manual "may also be used in the regional context and is set to become a source of knowledge and recommendations". This phrasing suggests that while Cameroon's capacity is being built and shared, the comprehensive, immediate leveraging of this for active regional responses to all animal health emergencies is a future prospect rather than a fully established, operationalized system. ⁵⁴⁰

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Cameroon is fully a State Party to the Biological Weapons Convention (BWC) with the same legal effect as ratification. ⁵⁴¹

Signing the BWC was only possible before its entry into force on March 26, 1975. Cameroon did not sign before that date. It therefore acceded (which has the same legal effect as ratification for states that didn't originally sign the treaty) on January 18, 2013. ⁵⁴²

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 100

Cameroon has made a CBM submission in 2024. ⁵⁴³

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Cameroon submitted a national report to the UNSC Resolution 1540 Committee in 2008. ⁵⁴⁴

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Cameroon is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP), the Australia Group (AG), nor the Proliferation Security Initiative (PSI). ^545546547

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

Cameroon completed a Joint External Evaluation (JEE) in 2017 and released a comprehensive report. No subsequent evaluations have been published since then. ⁵⁴⁸

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

Cameroon has not completed and published a Performance of Veterinary Services (PVS) assessment in the last five years. ⁵⁴⁹

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

Cameroon has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years. ⁵⁵⁰

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 100

Cameroon has allocated national funds to improve its capacity to address pandemic or epidemic threats within the past three years, primarily through its national strategic plans for health. These plans outline specific activities and associated budgets for key areas related to public health emergencies and infection control for the period covering 2022, 2023, and 2024.

For instance, the National Strategic Plan for Community Health 2021-2025 details estimated costs for strategic interventions aimed at strengthening the health system and community health, both of which are integral to epidemic and pandemic response. Specifically, for "Improving the provision of quality community health services" (Strategic Axis No. 2), the plan allocated 1,743,282,491 FCFA (approximately US$3,143,881) in 2022, 3,599,069,844 FCFA (approximately US$6,490,657) in 2023, and 3,584,374,973 FCFA (approximately US$6,464,156) in 2024. For "Monitoring and evaluation and operational research on community health interventions" (Strategic Axis No. 4), allocations were 356,459,577 FCFA (approximately US$642,848) in 2022, 273,102,327 FCFA (approximately US$492,519) in 2023, and 203,967,942 FCFA (approximately US$367,841) in 2024. Additionally, "Access of vulnerable populations and key populations to quality health care including community health care and consideration of gender and human rights" (Strategic Axis No. 5) had allocations of 260,867,770 FCFA (approximately US$470,455) in 2022, 478,875,209 FCFA (approximately US$863,616) in 2023, and 453,885,325 FCFA (approximately US$818,548) in 2024 (p. 44). These budget lines, part of a national strategic document, represent a commitment of national funds, even though the plan also acknowledges a significant funding gap and a reliance on external partners for its overall implementation (p. 46). ⁵⁵¹

Furthermore, the National Action Plan for the Prevention and Control of Infection in Human Health 2021-2024 outlines budgeted activities specifically for infection prevention and control, which is a critical component of preparing for and responding to infectious disease outbreaks. For instance, activities related to strengthening the legal and institutional framework for infection prevention and control (Action 1) have allocated funds for the period, such as 16,370,000 FCFA (approximately US$29,522) for evaluating the national legal framework (p. 24). This document, a national action plan, further supports the evidence of national fund allocation for capacities addressing epidemic threats. ⁵⁵²

While the National One Health Action Plan highlights an "insufficient national funding of One Health activities by sectors" (p. 38), the existence of detailed national plans with specific budget lines for activities spanning the past three years demonstrates that funds have indeed been allocated by the government of Cameroon for improving its health security capabilities against epidemics and pandemics. ⁵⁵³

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 100

The Joint External Evaluation (JEE) report and subsequent national action plans for health security in Cameroon describe and allocate specific funding from the national budget to address identified gaps.

The JEE report from September 2017 identified gaps in Cameroon's health security capacities, noting, for example, a low capacity in Infection Prevention and Control (PCI) with a score of 1 (p. 4). The JEE also advocated for increased and sustainable funding for public health emergency preparedness (p. 35). ⁵⁵⁴

Following these assessments, the National Action Plan for the Prevention and Control of Infection in Human Health 2021-2024 was developed with the explicit aim of strengthening PCI activities at national and health facility levels to address the identified weaknesses (p. 8). This plan includes detailed budget allocations in FCFA for specific activities. For instance, under "Strengthening the legal and institutional framework of the PCI," it allocates 16,370,000 FCFA for evaluating the national legal framework for PCI (p. 24). ⁵⁵⁵

Similarly, the National Strategic Plan for Community Health 2021-2025 aims to improve health indicators by addressing health system weaknesses, including a reliance on external funding (p. 11). This plan details estimated national budget allocations for its strategic axes covering the period 2021-2025. For example, for "Improving the provision of quality community health services" (Strategic Axis No. 2), it allocated 1,830,633,362 FCFA in 2021, and continuing through 2025 (p. 44). ⁵⁵⁶

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

Cameroon has not completed and published a Performance of Veterinary Services (PVS) assessment or gap analysis in the last five years. ⁵⁵⁷

5.5.3a Emergency public financing during a public health emergency

Score: 100

There is publicly identified special emergency public financing mechanism/dedicated national reserve fund that Cameroon can readily access in the face of a public health emergency.

Cameroon has the Health Solidarity Fund (Fonds de Solidarité pour la Santé), which was established by Law No. 93/006 of April 22, 1993. ⁵⁵⁸ The text of the law was not found available online. This fund is intended to finance health programs and activities within the country, and as such, it can potentially be leveraged during health emergencies. However, its effectiveness and transparency, particularly in the context of recent crises, have faced scrutiny. During the COVID-19 pandemic, concerns were raised regarding the management and utilization of funds, including potentially those from the Health Solidarity Fund, impacting its perception as a consistently reliable and readily accessible emergency mechanism. ⁵⁵⁹ The Ministry of Finance's Synthesis Report on the Management of Funds Allocated to the Response Against the COVID-19 Pandemic also details various funding sources, including state budget allocations and external partner contributions, but highlights the creation of a "Compte d'Affectation Spéciale" (Special Purpose Account) for COVID-19, indicating reliance on ad-hoc measures and external support in addition to existing structures (p. 11-13). ⁵⁶⁰

Furthermore, Cameroon has demonstrated access to significant international financing mechanisms during health crises. The country is eligible for financing from the World Bank's Pandemic Fund, which is designed to provide a dedicated, long-term stream of funding for pandemic preparedness and response. During the COVID-19 crisis, Cameroon was a recipient of funds from the World Bank's Pandemic Emergency Financing Facility (PEF). ⁵⁶¹ Additionally, the country launched an Emergency Cash Transfer Program as an integral component of the World Bank-financed Social Safety Net Project, aiming to mitigate the severe economic impact of the pandemic on vulnerable urban households. ⁵⁶²

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 0

There is limited evidence that senior leaders in Cameroon (the president or ministers) have made explicit public commitments to provide financing or capacity support to other countries for pandemic or epidemic threats.

In October 2024, the Minister of Public Health, Dr. Manaouda Malachie, publicly presided over a high-level meeting to announce the adoption of two significant strategic plans: The National Strategic Plan for Integrated Disease Surveillance and Response (IDSR) 2024–2030 and The National Multi-risk Preparedness and Response Plan for Public Health Emergencies 2024–2026. During this event, the Minister explicitly stated that these plans represent a decisive measure to strengthen Cameroon's health system against recurrent epidemics. He underscored the primary goals of these initiatives, which include enhancing early detection capabilities, fortifying response coordination mechanisms, and developing a robust surveillance system. The meeting saw participation from both national experts and international partners, notably the World Health Organization (WHO), signaling a collaborative approach to capacity building. While the adoption of these strategies and the involvement of international partners demonstrate intent to bolster internal capacity, no specific financial assurances or detailed funding allocations were publicly announced during this event. ⁵⁶³

In March 2024, senior leaders, including Cameroon's health officials, participated in a regional declaration alongside other African nations during a high-level meeting in Yaoundé. The declaration included commitments to coordinated health actions in the fight against malaria, with a significant emphasis on enhancing data-sharing capabilities and increasing domestic investment in epidemic preparedness. However, this commitment, while publicly announced, primarily targeted regional cooperation for specific diseases (like malaria), rather than pandemic preparedness broadly. ⁵⁶⁴

In December 2024, President Paul Biya, speaking at the Economic and Monetary Community of Central Africa (CEMAC), raised concerns about financial stability in Central Africa, warning of the potential for “disastrous consequences” if regional reserve deficits were not addressed. While this reflects his broader engagement in regional economic stability, it did not directly address pandemic preparedness nor reflect commitments to financing other countries’ capacities. ⁵⁶⁵

No direct or explicit commitment was found demonstrating that Cameroonian senior leaders have pledged financial support or capacity-building directly for other countries in the context of addressing pandemic or epidemic preparedness. No other relevant evidence was found on the websites of the Ministry of Public Health or the Minsitry of Foreign Relations. ⁵⁶⁶⁵⁶⁷

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that Cameroon invested finances from donors to improve its own domestic capacity to address epidemic threats in the past three years, but there is no evidence that it has provided other countries with the same support.

According to the Global Health Security Tracking Dashboard, Cameroon received US$2 billion in aid between 2014 and 2022. For IHR Core Capacities, the largest funds were for the national laboratory system, immunization, and workforce development. The three largest donors were The Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States, and the United Nations (UN). ⁵⁶⁸

Further demonstrating this collaborative effort, the U.S. Centers for Disease Control and Prevention (CDC) actively supports Cameroon’s public health infrastructure. For instance, the CDC has played a pivotal role in strengthening laboratory capacity and systems, supporting the establishment of the National Public Health Laboratory and helping five laboratories achieve ISO 15189 accreditation (p. 11). The CDC also significantly contributes to enhancing disease surveillance and data systems, supporting electronic reporting platforms and the Early Warning, Alert, and Response System (p. 12). Moreover, it aids in preventing, detecting, and responding to health emergencies by supporting the Public Health Emergency Operations Center and training field epidemiologists (p. 9). These efforts directly bolster the country's capacity to detect and respond to health threats, as outlined in their 20th-anniversary report (p. 5-6). ⁵⁶⁹

There is no evidence that Cameroon has supported other countries to improve capacity to address epidemic threats by providing financing or in-kind support in the past three years. The only data of Cameroon being a funder in the Global Health Security Tracking Dashboard is for the World Health Organization (WHO). ⁵⁷⁰ No evidence was found on the website of the Ministry of Public Health. ⁵⁷¹ No evidence was found on the website of the Ministry of Foreign Relations. ⁵⁷²

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

Cameroon’s assessed contribution record with the World Health Organization shows mixed performance over the past two years. For 2023, the country was assessed USD 62,200 with due date in 1 January 2023, which was eventually settled in full on 9 June 2025. Although the payment was delayed, the obligation for that year has been met entirely. Similarly, for 2024, Cameroon was assessed USD 74,650 with due date in 1 January 2024, which was also paid in full on 9 June 2025. ⁵⁷³ For the current year, 2025, the assessed contribution amounts to USD 74,640, of which only USD 517 has been paid as of mid-year. This leaves an outstanding balance of USD 74,123, indicating that Cameroon has not yet fulfilled its obligation for 2025. ⁵⁷⁴

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 100

Cameroon has established some policy mechanisms for data sharing, particularly within the context of genomic research and ethical review, which extend beyond influenza. A publicly available policy specifically for systematic, international sharing of genetic data, clinical specimens, and isolated biological materials, along with associated epidemiological data, for general public health purposes, is evident.

For instance, Cameroon demonstrates active engagement in international reporting obligations under the International Health Regulations (IHR 2005). The National Guide To The Management Of Epidemiological Surveillance Data details that in emergency situations, data from border health posts can be sent simultaneously through the normal national reporting circuit and directly to the National Focal Point RSI to ensure timely international notification (Section 3.5.2.2, p. 32). This mechanism for rapid data exchange is in conformity with RSI (2005) deadlines for emergencies (Section 2.2.3, p. 9), suggesting a structured approach to international epidemiological data sharing for public health threats. ⁵⁷⁵

In the realm of laboratory surveillance, Cameroon has defined operational procedures for the international exchange of biological materials. The Standard Operating Procedures (SOP) for epidemiological surveillance data management in laboratories explicitly outlines a task for the Central Level (National Reference Laboratory – LNR) to summarize and transmit samples sent to international reference laboratories (p. 78). This indicates a formal and systematic process for sharing biological specimens internationally, particularly for epidemic-prone diseases and priority affections (MAPE and AP), where specialized diagnostic or characterization capabilities at a national level may necessitate external collaboration. The ational Guide To The Management Of Epidemiological Surveillance Data also lists platforms like WHONET, which are often used for international antimicrobial resistance (AMR) surveillance data exchange, as interoperable with DHIS2 for specific laboratory data (p. 28). ⁵⁷⁶

Beyond emergency and laboratory-specific exchanges, Cameroon's broader Digital Health Architecture aims for a "durable, integrated, computerized, accessible by all actors, performant at all levels, allowing information sharing and producing quality health information" (Section 2.3.6.1, p. 19). This architecture, coupled with guiding principles of data governance that emphasize interoperability (Section 2.3.1, p. 12; Section 2.3.6, p. 18) and secure data exchange, provides the foundational framework for enabling systematic data flow, which can be extended to international partners. The SOP on infomration diffusion further specifies procedures for secure sharing and dissemination with Technical and Financial Partners (PTFs), requiring written authorization and informed consent for personal data, thus formalizing aspects of international information exchange (p. 87-91).

In the specific context of genomic research, Cameroon's ethics guidelines notably require a data sharing agreement as part of the ethics application process for research, with all secondary studies using such data subject to review by an ethics committee (p. 8). This policy mechanism for governing the sharing of research-generated genetic data is applicable beyond influenza, providing ethical oversight for research data sharing. While this mechanism is within the specialized domain of research ethics, it demonstrates a sophisticated understanding and regulation of genetic data exchange. ⁵⁷⁷

The Joint External Evaluation (JEE) report from September 2017 noted existing collaborations with external institutions for the diagnosis of unusual pathogens (p. 24), which hints at international cooperation involving the exchange of specimens for confirmation. ⁵⁷⁸ This aligns with and is further formalized by the operational details provided in the National Guide To The Management Of Epidemiological Surveillance Data regarding international reference laboratories. While the National One Health Action Plan promotes national information sharing and collaboration (p. 66), and the National Action Plan for the Prevention and Control of Infection in Human Health focuses domestically, the National Guide To The Management Of Epidemiological Surveillance Data provides explicit evidence of structured international data and biological material exchange beyond these broader policy statements. ⁵⁷⁹⁵⁸⁰

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

Publicly available evidence indicating that Cameroon has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) Framework in the past two years is not readily available.

A review of general public health reports from Cameroon and WHO communications does not reveal any explicit public statements or reports of non-compliance by Cameroon regarding sample sharing under the PIP Framework in the specified timeframe. ⁵⁸¹

No other relevant evidence was found in the website of the Ministry of Public Health. ⁵⁸²

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

Publicly available evidence indicating that Cameroon has not shared pandemic pathogen samples during an outbreak in the past two years is not apparent through general public health reporting.

There is no public information or reports suggesting that Cameroon has failed to share pandemic pathogen samples during an outbreak within the last two years. ⁵⁸³

No other relevant evidence was found in the website of the Ministry of Public Health. ⁵⁸⁴

6.1.1a Policy formation

Score: 75

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 0

6.1.1d Vested interests/cronyism

Score: 0

6.1.1e Corruption

Score: 26

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 25

6.1.2a Orderly transfers of power

Score: 0

6.1.3a Risk of social unrest

Score: 25

6.1.4a Risk of terrorism

Score: 25

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 25

6.1.5a Presence or risk of armed conflict

Score: 25

6.1.6a Government territorial control

Score: 0

6.1.7a International tensions

Score: 25

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 76.88

6.2.2a UNDP Gender Inequality Index score

Score: 27.11

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 69.4

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 33.33

6.2.4a Public confidence in government

Score: 0

6.2.5a Robust, open, diverse local media and reporting

Score: 50

6.2.6a Gini coefficient

Score: 57.8

6.3.1a Adequacy of road network

Score: 25

6.3.2a Adequacy of airports

Score: 50

6.3.3a Adequacy of power network

Score: 0

6.4.1a Urban population (% of total population)

Score: 41.26

6.4.2a Change in forest area (percentage points)

Score: 62.33

6.4.3a Natural disaster risk

Score: 25

6.5.1a Total life expectancy (years)

Score: 41.9

6.5.1b NCD mortality rate

Score: 58.91

6.5.1c Population aged 65+

Score: 92.68

6.5.1d Tobacco use (% of adults)

Score: 75.97

6.5.1e Level of adult obesity (%)

Score: 75.5

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 83.06

6.5.2a Access to potable water

Score: 70.96

6.5.2b Access to at least basic sanitation facilities

Score: 46.93

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 77.08

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 2.38

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50