The Ministry of Public Health is committed to improving the health status of the population in Chad through the implementation of sectorial policies including the National Health Policy 2016-2030 and several important reforms with the support of technical and financial partners.
Switzerland‘s cooperation policy takes a systemic approach to addressing the causes of fragility in the sector, at different levels (local, regional and national) and through various categories of actors including the State. In this context, the Republic of Chad and the Swiss Confederation have signed a project agreement and the Swiss Development Cooperation (SDC) commissioned the consortium consisting of Swiss TPH and the Centre de Support en Santé Internationale (CSSI) to implement the PADS project (Projet d'appui aux districts sanitaires du Tchad - Yao et Danamadi) for its first phase from 2014 to 2018.
Objectives and Aims
The objective of PADS is to contribute to reducing mortality and morbidity in the SDC's intervention regions through better and more accessible services. In addition, the project aims to improve the performance of the health system as well as people's access to preventive and curative services in the supported health districts, with a strong emphasis on the quality of the minimum package of activities (PMA), particularly maternal and child health.
Its expected outcomes are:
- Outcome 1: Healthcare is improved both in quantity and quality in the two supported districts
- Outcome 2: The demand for mother and child health and their effective utilisation are increased in the two supported districts
- Outcome 3: The strengthening of health administration at district, regional and national levels progressively contributes to transparent, efficient, participative and accountable management of the health sector.
Swiss TPH and CSSI joined forces in a consortium to implement the project. PADS mainly works in proximity and systemic support at the level of the two health districts of Yao and Danamadji, where multidisciplinary teams are integrated into the two district management teams (EDC) and work with the regional level.
The project is led by a coordination team based in N'Djamena and implements its multi-level approach by bringing experiences from the peripheral to the central level, including innovations that could be replicated at national level or at least ignite national dialogue.
The project conducted a baseline survey that will be replicated at the end of the current phase to measure the effects and results achieved. The implementation of an inclusive monitoring system in the health information system makes it possible to regularly produce indicators, notably through the DHIS2 software. In addition, the Ministry of Public Health is taking advantage of the PADS experience to extend DHIS2 to the national level.
Many contributions have been made by the project, particularly at the end of the second year, to make progress in terms of supply and demand for care and better governance in health administration at all levels. These include capacity building in human resources, infrastructure, equipment, the establishment of performance based contracts, health information system strengthening, drug management, community participation and social mobilization, Onehealth approaches with mixed campaigns (information and vaccination in human and animal health), and operational research activities.
The final evaluation assessed that the program has a coherent structure, effectiveness and efficiency, and produces significant effects. Nevertheless, the following recommendations were made: strategic reorientations to be made to ensure sustainability; greater use of community-based strategies; capacity building of field actors; and addressing institutional weaknesses (including the availability of quality human resources and leadership from the Ministry of Public Health).
The main beneficiaries of the project are mainly the populations of the two health districts and mainly the most vulnerable: women, children, the poor and nomadic populations. There are 519,583 inhabitants (2018 DSIS projection), including 223,361 inhabitants in Yao district (and Alifa district created from Yao) and 296,222 inhabitants in Danamadji district (and Maro and Koumogo districts created from Danamadji).
Communities, administrative and health officials at all levels of the health pyramid and health personnel in both districts benefit from this project in terms of capacity building. Local NGOs also benefit from the project through performance based contracts (ADRB, APDI, ATEV) and the coordinated approach at the health district level should benefit other development actors including livestock agents, NGOs and the community based health insurance in Danamadji called Borsah (“mutuelle de santé”).
Based on the achievements and lessons learned, the partners are actively preparing for Phase 2 of the PADS, which is scheduled to begin on November 1, 2018.
Centre de Support en Santé Internationale CSSI
Le Ministère de la Santé Publique de la République du Tchad
Swiss Agency for Development and Cooperation (SDC)