UNISSAHEL in Chad
Chad faces a double burden of disease: the persistence of communicable diseases and the emergence of non-communicable diseases.
Infant mortality fell very slightly from 91 ‰ in 2005-2009 to 72 ‰ in 2010-2014. On the other hand, neonatal mortality, which represents almost half of infant mortality, has hardly decreased. These results are attributable to high-risk pregnancies (too early, too many, too close together), and to high fertility, ie 6.4 children per woman.
Maternal mortality remains particularly high compared to other countries in the sub-region: 1084 deaths per 100,000 new births in 2009, and 860 deaths per 100,000 live births in 2014. Women who received prenatal care, provided by a trained provider has increased from 43% in 2004 to 64% in 2014. This rate varies greatly depending on the environment (59% in rural areas) and (84% in urban areas). In addition, only 31% made at least the four recommended prenatal visits. This proportion is significantly higher in urban areas (51%) than in rural areas (26%).
Almost 34% of births took place with the assistance of trained health personnel and only 22% took place in a health facility; this proportion was 16% in 2010. In addition, 15% received postnatal care, in accordance with WHO recommendations. Only 6% of married women aged 15-49 and 21% of not-married women use a contraceptive method.
To combat these problems, since 2005, Chad has implemented an exemption policy for emergencies. In 2012, it was extended to health centers with the target groups of pregnant women and children aged 0 to 5. It ultimately aims to offer complete health coverage to mother-child care. However, as in many sub-Saharan countries, the strategy of extending coverage is encountering difficulties, particularly in terms of articulation with the already existing architecture of the Chadian health system - given its fragility - but also in terms of the effectiveness of free access for the target populations.