WHO contribution to the performance of the vaccination program in Chad
Since the creation of the Chad Expanded Programme on Immunization (EPI) in 1984 until 2018, vacination coverage (VC) of the third dose of vaccine protecting against diphtheria, tetanus, and pertussis (DPT3) has never reached 50% according to WUENIC data. In 2019, Chad achieved a DTC3 CV of 50%, 52% in 2020, 58% in 2021, 60% in 2022 and 67% in 2023 according to WUENIC data.
These performances correspond to periods when Chad was facing the COVID -19 pandemic but also and above all various crises such as political instability, the massive influx of at least 1.2 million refugees from Sudan, 258,000 displaced and 150,000 returned. It should be noted that Chad is one of the rare countries in Africa to record an increase in CV during the COVID pandemic. Strengthening the achievements of the last 3 years made it possible to vaccinate 199,804 children with DTP3 from January to April 2024 versus 178,911 children during the same period in 2023.
A quick analysis shows that the improvement in these performances is mainly due to the improvement of the management of the EPI with the involvement of the Minister of Health, the strengthening of the WHO, Unicef, Gavi partnership and the continuous technical support of the WHO since 2020 and other partners focused on the sub-national level (provinces, districts and areas of responsibility).
Thanks to funding from GAVI, WHO contributed to achieving these performances, through:
- Support for the development of operational action plans (POA) from 2020 to 2024 of the EPI which have been approved by the CCIA with a detailed timetable of activities;
- Remarkable technical support to the working groups (technical, logistics, finance and communication) and to the Technical Support Committee (CTA) of the CCIA responsible for monitoring the implementation of the annual work plan to identify problems, prioritize them and identify corrective actions. WHO, Gavi and Unicef meet every 14 days to coordinate actions for efficient interventions in the implementation of POAs;
- The deployment of consultants in low-performing provinces and districts to provide technical and programmatic support mainly in the development of micro plans in health districts, their implementation and monitoring. At the end of March 2024, for example, at least 80% of health districts had microplans available in the provinces supported by the consultants;
- Monitoring the implementation of fixed, advanced and mobile strategies to reach hard-to-reach children such as nomads, displaced people, refugees and returnees. At least 80% of advanced strategies have been completed from January to April 2024
- Supportive supervision of health district management teams and vaccination teams during vaccination sessions. At least 80% of supervisions were carried out compared to the supervisions planned from January to April 2024
- The organization of EPI performance monitoring meetings focused on the CV, the number of zero-dose and insufficiently vaccinated children and the corrective actions to be taken based on identified weaknesses
- Strengthening the capacities of CS teams in calculating indicators, their interpretation, monitoring abandonments and corrective actions
However, the progress observed in vaccination performance has a limited impact in reducing mortality, morbidity and disability due to vaccine-preventable diseases, hence the need to improve them. In this sense, several challenges remain to be met:
- Mobilization of resources to expand EPI consultants to other provinces;
- Insufficiency of qualified personnel at the sub-national level forcing WHO to provide programmatic support in provinces, districts and areas of responsibility;
- The continued influx of refugees from Sudan requiring continuous updating of micro plans in the 3 border provinces to take into account additional needs;
- A strong dependence of the EPI on external resources in a context where there is a reduction in external resources and no increase in national resources.
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Author: Paluku Gilson Kipese, Medical Officer, WHO Chad,
Photo: Sensibilization of the community on vaccination by a WHO consultant deployed on the terrain in the health district of Amleyouna. Credit: WHO/Chad.