Description
Introduction – Objective: The 12 years Health District Support Programme in Chad (PADS), implemented by the Swiss TPH-CSSI (Swiss Tropical and Public Health Institute - Centre de Support en Santé Internationale) consortium and funded by the Swiss Agency for Development and Cooperation (SDC), is accompanying the Chadian government in its efforts to improve governance of the health system and enable access to quality health care in two provinces, Batha and Moyen Chari. An impact study of PADS phase 2 (2018-2022) was carried out in May 2022 with the objective to assess the effects of the PADS on the management and quality of care and its perception by the community.
Methodology: A mixed-methods approach was used to collect the data. The targets for the quantitative component were service providers, while the qualitative component was reserved for community members in these provinces. On the service provider level, 78 health facilities were surveyed, including 36 in Batha province and 42 in Moyen Chari province. In the nomadic and sedentary communities, 24 focus group discussions were carried out with women, men and leaders.
Results and discussion: Analysis of the quantitative data from health facilities shows an increase in the management and quality of care for most of the indicators studied. However, the rate of use of curative care, especially for children under 11 months and women over 15, is still below expectations. Trends remain also very low in both provinces for antenatal consultations, the rate of births attended by qualified personnel, family planning and the use of contraceptive methods. This may be linked to the effects of the COVID-19 pandemic and related containment measures, since the community results showed difficulties in accessing the service during the worst moments of the COVID-19 crisis. Despite quality improvements assessed in health facilities, communities in general perceive the quality of care to be ineffective, and it is negatively associated with shortages of qualified staff and lack of equipment. The qualitative results also show that access to quality care could be improved with greater equity in terms of gender and towards the nomadic community. Involvement of both female representatives and representatives of pastoralists in the health committees of the health centers should be enforced further to enable them to play an active part in the planning of health activities.
Conclusion: The study shows significant improvements in most qualitative indicators during phase 2 of the PADS, despite the COVID-19 pandemic. However, there is a gap between the improvement in the quality of care, the population's perception of quality and the equity of access to health services.
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