The Republic of Chad is home to nearly 650.000 refugees, asylum seekers, internally displaced people and returnees. In August 2018, it was estimated that nearly 100,000 refugees from Central African Republic were seeking refuge in Chad, most of them settling either in refugee camps or in villages along the porous Chadian southern border. With the escalation of violence in late 2017, the pressure on the already fragile Chadian services – health services in particular – was evident in southern regions of Longone Orientale, Mandoul, Moyen Chari and Salamat. Several appeals to respond to this refugee crisis were made as these running refugees were unable to get access to basic protection, food, health and drinking water. While a considerable proportion of CAR refugees settled in defined refugee camps, those with familiar and ethnic links in Chad, ended up settling in several remote and isolated villages across the border with little to no access to basic health care.
Chad ranks 186th in the Human Development Indexes among 188 countries. Life expectancy at birth is around 53 years, and nearly 130 childred from die before they turn their 5th anniversary. Diarrhoea, Lower respiratory, HIV/AIDS and malaria represent the greatest burden of disease below 5 years of age. In the southern, more tropical and forested areas of Chad, malaria is a major killer. Little to no response exists in which regards prevention (bednet distribution or indoor residual spraying) and quick access to quality care. With and increased number of so called “hot populations” arriving in the southern region, it is urgent to respond with basic preventive and curative health services.
With UNICEF and Swiss Cooperation support, MENTOR initiated a community-based project in 50 remote villages in southern Chad in Nya Pende and Monts de Lam prefectures. It is estimated that MENTOR is reaching nearly 50,000 people through a network of trained and equipped local Community Health Workers, able to provide first line treatment to simple malaria and diarrhoea cases and to support the referral of severe cases to the nearest health facility.
These CHWs are the frontline response to tackle the isolation and lack of access that local and refugee populations face, particularly in rainy season where most villages become totally isolated. It is also during this period that mosquito breeding sites increase, intensifying malaria transmission in the region. MENTOR has implemented a fully equipped network of Community Health Workers able to quickly test, diagnose and treat malaria, and to screen for and refer other patients suffering diseases or conditions such as diarrhoea, pneumonia and malnutrition.
The Way Forward
As the program evolves, further needs have been identified amongst these vulnerable populations. The evident lack of basic prevention tools and practices should be considered as a key priority. Vector control preventive tools (LLIN/IRS) are the next obvious step to ensure malaria transmission is avoided. Likewise, increasing prevention against diarrhoeal diseases is essential, particularly to decrease child mortality amongst at risk populations.