Highlights of a technical brief from the Institute of Development Studies
A lack of capacity in state-provided health services severely limits Chad’s ability to fight disease. The country faces a high burden of communicable disease and an increasing burden of non-communicable disease.
Tackling deadly diseases in Africa (TDDA) works with Chad to improve health security and save lives. Integrating social science perspectives into TDDA’s technical assistance work provides important benefits. It strengthens our understanding of the contexts in which we operate and informs the support we give. It can also help to shape emergency response systems so that they are more effective, adaptive, evidence-based, and planned in consultation with affected and at-risk communities.
The Institute of Development Studies is a valued resource partner to TDDA. With our support, they have recently produced a series of technical briefs, detailing the key political, economic, cultural and social issues facing each of the countries we work with.
Here is a snapshot of their analysis for Chad.
Key considerations and recommendations in Chad – summary
Improvements to data sharing and coordination: There is a need to improve accountability mechanisms, coordination and data sharing between the health system and across sectors, especially between health and humanitarian actors. This will help support the country’s capacity and capabilities to fight disease.
Improving access to state-provided health care: State-provided health care is not free. There is a lack of both physical and economic access to government-provided clinics and a low quality of care offered. This means that those who can afford to do so, attend private clinics or alternative health providers, while poor people attend cheaper religious or NGO-run clinics, where available. State-provided health systems could be strengthened by expanding health worker capacity. To improve trust, state services could be adapted to local customs and needs, and staff and health volunteers could be recruited locally whenever possible, to improve local ownership and intercultural relations in clinic.
Targeted support to vulnerable communities: Targeting needs to occur at a local level, as vulnerability is highly determined by context. The groups that should be considered as potentially requiring extra support include: people with inadequate water, sanitation and hygiene (WASH) infrastructure, nomadic pastoralists, the urban poor, people in displacement camps, fisher folk, street children, and women.
Addressing structural causes of vulnerability to epidemics: Many drivers of disease in Chad are related to a lack of basic services (e.g. water and sanitation) and safety nets rather than to ‘risky behaviours’. Access to health services is also shaped by gendered relations, both in terms of household decision-making and in patient-staff relations in the clinic. These structural causes can be addressed by liaising with other sectors (WASH, Social Protection, Gender and Development, etc.).
Engaging alternative health providers: People in Chad rely on a diversity of health providers, including state-run and private sector services, non-profit biomedical clinics, faith healing marabouts, tradipraticiens, drug sellers and diviners. Alternative health providers could be engaged to support surveillance, risk communication, delivery of certain treatments, and referral to biomedical services. Building greater intercultural understanding would help both in the clinic and with tailoring risk communication to specific populations.
Building trust to strengthen epidemic response: Significant parts of Chad’s population feel disenfranchised. Previous epidemic responses have engaged communities in successful ways, but the impact of responses could be improved by tailoring activities and communications to local contexts. Involving trusted locals actors, like health staff, civil society organizations and local authorities, in epidemic response can lessen resistance from certain communities and bring new and valuable perspectives. Feedback loops can be used to adapt response activities and respond to communities’ queries and concerns. Communication that is modified to reflect local idioms and languages will help ensure targeting and messages do not use blame or generate stigma.
The IDS technical brief was authored by Hoinathy Remadji, Allah-Kauis Neneck, Valerio Colosio and Santiago Ripoll.
Read the full document here:
Key Considerations for Epidemic Response and Preparedness in Chad