07 December 2018
The Global Fund has classified Chad as a Challenging Operating Environment and put in place measures to minimize risks and achieve program objectives under its Additional Safeguard Policy. As a result, the Chad portfolio receives extra attention from the Global Fund, including additional flexibility in implementing grant programs. Chad has also received Global Fund investments in building country capacity through initiatives such as technical assistance, training and support for the establishment of a project management unit within the Ministry of Health.
Additional safeguard measures, including a Fiscal Agent, limited cash policy, a procurement agent and capacity building support have helped to reduce, but not sufficiently mitigate, significant financial and programmatic risks. The overall grant performance indicators are not improving, raising questions about the effectiveness of these measures.
Despite the challenging environment, Global Fund programs in Chad have increased their capacity to absorb the allocated funds and are piloting the integration of community health workers for malaria and the use of a District Health Information System for tuberculosis.
HIV and TB grant performance is stagnant: neither grant has been rated above B1 (adequate) since 2013, while the malaria grant rating improved from inadequate (B2) in 2016 to meeting expectations (A2) at the end of 2017. The quality of services and of data – specifically for HIV/AIDS program – remains a concern, and HIV program achievements are limited. One third of patients receiving retroviral treatment are lost to follow-up after one year on treatment. Monitoring of HIV patients under treatment is also weak.
The weaknesses in service quality and data stem from the limited capacity of the Principal Recipient (FOSAP) to oversee program implementation, from overall shortcomings in the supply chain and from a lack of authority from Principal Recipients and National Programs over health districts and regions. The split of regions between the Global Fund and the government has resulted in intervention gaps between Global Fund-led regions and government-led ones.