CHAD | Summary

OVERVIEW | HISTORY | HEALTH & HEALTH SYSTEM | HEALTH INDICATORS & DEMOGRAPHICS 

​HISTORY

The history of Chad comes from an article by the U.S. Library of Congress.⁴ Chad has experienced conflict at the national level with multiple civil wars in the last several decades. Although the government has been unstable, efforts are being made to improve the health of citizens as well as health care delivery. Detailed information about health care in the 1980s in Chad is difficult to find or unavailable mostly due to the Chadian Civil War (1979-82). Health in Chad is mostly characterized by infectious and parasitic diseases such as outbreaks of meningitis, HIV/AIDS, and malnutrition. In the early 1960s, the government made a substantial effort to extend the country's limited health infrastructure, even in the midst of civil conflict. Chad has relied on foreign assistance and, in this time, they were able to construct new buildings and renovate existing facilities. The Chad government also started laying the groundwork for training healthcare professionals. By the early 1980s, also during civil conflicts, there were five hospitals throughout Chad and two polyclinics serving the population of the capital region. There were 18 medical centers, 20 infirmaries, 127 dispensaries, 75 private medical facilities, and 20 social centers administered to the needs of Chadians. However, the growth in health care has been very slow. Data shows that despite the increase in facilities, the number of beds only increased by 238 from 1971 to 1988. Chad experienced a shortage of trained medical personnel which has hindered providing adequate access and care. In 1983, Chad's medical system employed 920 medical staff, medical personnel, and health professionals. In addition, foreign assistance provided another 41 doctors, 103 nurses, and 2 midwives.

Access to basic health care is limited in Chad and the country has a high prevalence of malnutrition, malaria, and outbreaks of disease.⁵ The country experiences relatively subpar health indicators with few options to improve due to weak health policies and healthcare shortages. The primary causes of death in Chad include lower respiratory infections, malaria, and HIV/AIDS. The country’s HIV/AIDS prevalence rate is well above the world average but similar to that of some neighboring countries.⁶

 

Local clinics often don’t have the necessary medicines or enough trained staff and despite a national free care policy for malnourished children there are often other hidden costs that make it impossible for people in this area to afford this essential care. Cultural traditions that often clash with the need for specialized medical care. For example, according to Doctors Without Borders⁵, "mothers often prefer to take their sick child to a religious leader rather than a health clinic."Malnutrition is endemic across much of Chad, with almost half of child deaths in the country associated with the condition, which occur in the context of lack of preventive and primary health care, including maternal and child health care.⁷ The under-five children immunization coverage remains low, suggesting the health system’s inability to reduce infant mortality and morbidity from preventable diseases. On average, according to Azétsop and Ochieng in Philosophy, Ethics, and Humanities in Medicine (PEHM) journal,⁷ only 8% of children aged 12-23 months are completely vaccinated against targeted childhood diseases, while 33% have never been given a single vaccine. The health system in Chad has also not been able to reduce maternal mortality, while several countries in Sub-Saharan Africa have reduced the rate by half between 1990 and 2010.⁷ Many reasons explain this rate such as the low rate of births attended by a health professional. This rate is also aggravated by the high number of early pregnancies which often lead to complications for the adolescents.⁸  

In Chad, access to care is provided through four main mechanisms: direct payment, free access to selected services, health insurance and health mutual.⁷ The out-of-pocket payment is the most common mechanism of healthcare financing, as it represents about 50%⁷ of total health expenditure. The authors in PEHM go on to say, "Free health care concerns emergency surgery, obstetric and medical care. Financed entirely by the state with the support of its partners, this measure was introduced in hospitals in 2008 as part of the new social policy by the head of state. Other measures of gratuity are applied to selected diseases (chronic malaria, AIDS, tuberculosis, etc.) and specific population groups such people living with HIV, under-five children and pregnant women."⁷

 

Private health insurance, used by less than 2% of of the population, is provided as part of contracts by large corporations for the benefit of employees.⁷ Health mutuals, currently being implemented in the southern regions, are in experimental phase as of 2015; there is little to no information or data on them.⁷ "In spite of the efforts deployed by the state to improve health status in Chad, access to basic care remains a major challenge to most people, due to socioeconomic and geographical reasons. To access care, patients travel an average of 9 miles. Complementary strategies to provide hard-to-reach and marginalized population groups with adequate health services and infrastructures are poorly developed or non-existent," according to the article published in Philosophy, Ethics, and Humanities in Medicine.⁷

The National Health Policy, developed by the country's Ministry of Public Health, addresses health issues and implements national programs regarding health and health care. Conceptual weaknesses of policy frameworks and regulations limit its implementation.⁷ According to Azétsop and Ochieng, "A minimal essential package of health-service facilities is prescribed by the National Health Policy, which includes the Minimal Package of Activities (MPA) for integrated healthcare centers and the Complementary Package of Activities (CPA) for district hospitals. Each healthcare center is organized in areas of responsibility. The realization of MPA and CPA remains low. Out of 1,305 areas of responsibility, only 1,061 are functional.  The MPA and the CPA also play a huge role in delivering primary care through this minimal package."⁷ The go on to say, "Health worker shortages and weak HS have led to a lack of preventive and curative health care services and health promotion programs in various parts of the country, making it difficult for the country to improve health indicators."⁷ The National Health Policy recommends that the MPA and CPA should ensure integrated, comprehensive and continued care. However, such an aim is not being fully achieved because supply is very low and service delivery is incomplete, with significant differences from one district or region to another.⁷

Chad is a low income country whose health expenditures account for 4.49% of total GDP.¹ The population is approximately 16.4 million³ and is considered to have a rapid growth rate. Chad also hosts more than 450,000 refugees from Sudan, the Central African Republic, and Nigeria who represent about 4% of the country’s total population.⁸ Only 23% of Chadians live in urban areas with striking disparities for rural areas.³ The Northern region of Chad is mostly desert since it lies in the Sahara, the South, however, has the dense, green forest and vegetation. The northern people are nomadic and semi-nomadic while the southern people live lives that are more agrarian and commercial based. The south also has more resources and better living conditions than the northern regions, such as more access to healthcare.⁹ Chad’s health indicators are relatively worse than other countries in Sub-Saharan Africa due to many reasons such as civil conflict, healthcare shortages, and lack of maternal and child health. Child and Infant mortality has decreased significantly in the last few decades⁹ but numbers are still extremely high.⁸ Chad has well over 100 ethnic people groups and tribes with over 100 languages and dialects, which connect under more common languages like French, Arabic, and Sara.⁹

 

Health Indicators¹⁰

Racial/Ethnic Demographics⁹

Age Structure¹¹