22 February 2023
The Global Fund has classified Chad as a challenging operating environment with high political instability and security issues. This resulted in the Global Fund applying an Additional Safeguard Policy in 2009. Despite these difficulties, progress has been made in fighting HIV, tuberculosis (TB) and malaria in Chad, and at the regional level. But many challenges remain, particularly in the areas of procurement and supply chains.
Over the last 10 years Chad progressed in the fight against the three diseases reducing both new infections and deaths. There are, however, key programmatic interventions for HIV and malaria that require attention to sustain impact. For HIV, the rate of viral load suppression was low. Likewise, the number of newborns from HIV positive mothers that are tested for HIV and put on treatment is low. Coverage for prevention of key affected populations (KAPs) is below grant targets. For malaria, community interventions were delayed, undermining coverage for this disease. As a result, the adequacy and effectiveness of key HIV interventions and community programs for malaria are rated as partially effective.
The distribution of Global Fund medicines using the in-country mechanism through the central medical store and 23 provincial medical stores is commendable. Yet, problems with quantification, ordering and distribution mechanisms have lead to frequent stock-outs and expiry of health commodities, impacting service delivery to beneficiaries. Furthermore, medicines distributed at peripheral levels have limited traceability and lack accountability. Efforts to improve the in-country supply chain with a transformation plan stagnated due to lack of funding and low government commitment. Therefore, the adequacy and effectiveness of the in-country supply chain arrangements to ensure the continuous availability of commodities and accountability at all levels needs significant improvement.
Overall, Chad is making improvements on grant management through the Secretariat and in-country oversight bodies. While the Project Management Unit and the Fiduciary Agents have significantly contributed to this progress, several issues are impacting their effectiveness. Therefore, the adequacy and effectiveness of grant implementation, as well as the oversight and assurance arrangements to address emerging risks – including monitoring and capacity-building activities – needs significant improvement.