2) strengthening of the regulatory framework for the release of standard medicines and health products throughout the SNA; 3) strengthening the institutional and organizational capacity of the key institutions of the SNA; 4) strengthening of human resources to ensure the availability and traceability of quality medicines and health products in the SNA, and 5) sustainability of SNA funding of medicines and health products. These impacts are expected to make health products available at all the levels of the health pyramid through a single supply chain structured around the ONPPC and managed by the DPHMT. 162. With regard to antiretrovirals (ARVs), Niger has since 2004 introduced a free distribution policy called the Nigerien ARV Access Initiative (INARV). Thus, ARVs and other health care products are distributed free of charge to patients; this is why Niger has had a dedicated budget line for ARVs since 2011 which has now become an anti-HIV support line duly incorporated into the Appropriations Act which also ensures the procurement of reagents and other bio-medical equipment in addition to ARVs to provide medical care for HIV. ii) Legislative and administrative measures taken to ensure universal vaccination against the main infectious diseases as well as measures taken to ensure the prevention, treatment and control of epidemic and endemic diseases; 163. For universal vaccination against the main infectious diseases, reference should be made to Recommendation XXVI of Part 3 below. For measures taken to ensure the prevention, treatment and control of epidemic diseases, note should be taken of the continuation of the campaigns against cholera, meningitis, measles and poliomyelitis. Among others, measures aimed at monitoring and fighting epidemics concerned the following: - strengthening of the capacity of health facilities, disease surveillance entry points and events of public health significance; - strengthening of the capacity of personnel for the early detection and proportionate response to epidemics and other events of public health significance in accordance with the provisions of the International Health Regulations and the Integrated Disease Surveillance and Response; - regular holding of meetings of senior epidemic management staff at all levels, and - formulation and implementation of a multisectoral response plan. 164. Concerning the meningitis epidemic, a total of 3,506 cases and 232 deaths were recorded in 2018. The Neiseriea Meningidtidis C was the main germ involved. The epidemic affected the regions of Niamey, Maradi, Dosso, Tahoua and Tillabéry; the region of Zinder was affected at the end of the year when 73,000 doses of a vaccine (ICG) were administered in two villages in the health districts of Mirriah and Magaria at a cost of FCFA 104,388,996. A total of 601,725 people were vaccinated in all the health areas concerned. 165. Concerning the measles epidemic, a total of 1,500 cases and 7 deaths were recorded in 2018. A vaccination response campaign which was carried out ensured that 209,000 people were vaccinated. Several activities carried out by the State and its Technical and Financial Partners have halted these epidemics. 166. With regard to the prevention, treatment and control of epidemic diseases, note should be taken of the continuation of campaigns to screen people, distribute medicines and to treat the various diseases. Mass screening campaigns for non-transmissible diseases (high blood pressure, diabetes, sickle cell disease and cancers) were carried out in all the regions; two (2) campaigns for fistula surgery were carried out at the Mother-and-Child Centres. Operational strategies in areas which have not yet been 42