Child health, immunization and polio eradication
Recent socioeconomic crises and conflicts undermined the already fragile health system and contributed to the increasing deprivations for the most vulnerable groups, including women, children and adolescents despite efforts from the Government and its health partners. Persistent communicable diseases, inappropriate family practices and poor access to basic social services are main factors keeping vulnerable groups deprived. Chad counts a large number of nomadic and island populations that because of their mobility have very limited access to preventive and curative health services.
In its most recent report, the UN Inter-Agency Group for Child Mortality Estimation (IGME) estimated the under-five child mortality in Chad at 119 children per 1000 live births for the year 2018 and the neonatal mortality at 33 per 1000 live births. The latest MICS survey (2014-15) reported a maternal mortality ratio of 856 deaths per 100,000 live births. At the current annual reduction of mortality rates, objectives set in the Sustainable Development Goals will not be achieved.
Only 34 per cent of births are assisted by qualified personnel and other high-impact interventions to reduce neonatal mortality are still at a low level of coverage. Vaccination coverage is low: the 2017 vaccination coverage survey indicated that only 22 per cent of children aged 12 to 23 months were fully vaccinated. The low vaccination coverage combined with the precarious situation of the health system exposes Chad to recurrent outbreaks of measles, cholera, meningitis, hepatitis A and recently also circulating Vaccine Derived Polio Virus (cVDPV). The recent measles epidemic that started in 2018 and which has been ongoing throughout 2019 affected 122 out of 126 districts (97 per cent). In total almost 30,000 suspected cases were reported, and 336 deaths recorded since the onset of the epidemic in April 2018.
Specific documents and guidelines on neonatal health and a national policy to improve quality of maternal care are lacking. As for infrastructure and equipment, the 2019 Emergency Obstetric and Neonatal Care (EmONC) mapping exercise, shows that only 18 per cent(29/158) of the hospitals offer EmONC services of which 25 provide Comprehensive EmONC and 4 Basic EmONC. A slight improvement from 2011 where this stood at 20 and 3 respectively. Furthermore, there are frequent stock outs of essential commodities and data collection is poor.
Between 2013 and 2016, household spending on health care doubled. Children in Chad continue to suffer from multiple deprivations affecting their health, survival and development, which are further aggravated by recurrent health emergencies and conflicts.
Monthly advocacy meetings with the President have proven to be a powerful channel for the renewal of State commitments to improve vaccination coverage and maternal neonatal and child health.
In partnership with the Bill & Melinda Gates Foundation and KfW, UNICEF is implementing two community-based approaches: to support community engagement and improve demand for routine immunization services in the Lake region, and to promote integrated health, nutrition and WASH services at community level in Western Logone province while also linking up with the education, child protection, C4D and social protection sectors.
UNICEF continues to support the government to improve routine immunization services. In response to the measles outbreaks, a Task force led by the Ministry of Health was set up. UNICEF supported the Ministry of Health with the purchase of vaccines, covered operational costs, and provided technical assistance to curb the epidemic. Similar support is provided for the recent cVDPV outbreak.
Maternal, Neonatal and Child Health
Solutions to address these challenges comprise the supporting the government in the development of a national strategic plan or action plan focusing on the newborn including the development of clear guidelines, standards, and protocols on the prevention and management of newborn cases at all levels of the health pyramid; an effective implementation of the free care policy and the availability of medicines; equitable distribution of health personnel throughout the country; and an improved health information system (availability of data collection tools, data analysis and interpretation). In addition, UNICEF, with the Mentor Initiative, is implementing an Integrated Community Case Management approach in 3 districts of Eastern Logone province, which will be extended to Guera province.