Evaluation of the feasibility and sustainability of the joint human and animal vaccination and its integration to the public health system in the Danamadji health district, Chad

Background:One Health approaches such as the Joint human and animal vaccination programmes (JHAVP) are shown to be feasible and to increase health care access to hard-to-reach communities such as mobile pastoralists. However, the financial sustainability and the integration into the public health systems at the district level of such programmes are still challenging. The main objective of the present study was to give insight to the feasibility and financial sustainability of JHAVP integrated as part of the public health system in Chad.Methods:We conducted a mixed methods study using semi-structured key informant interviews, focus group discussions and budget impact analysis. Strengths, weaknesses, opportunities, and threats were analysed regarding the feasibility and sustainability of the implementation of JHAVP in Danamadji health district in Chad. Feasibility was further analysed using three dimensions: acceptability, implementation, and adaptation. Financial sustainability of JHAVP was analysed through budget impact analysis of implementation of the programme at district level.Results:The acceptability of this approach was regularly assessed by immunization campaign teams through evalua-tion meetings which included pastoralists. The presence of authorities in the meetings and workshops of the pro-gramme had an incentive effect since they represent a mark of consideration these populations generally declared to be lacking. The coordination between the public health and veterinary services at central and decentralized level seemed to be a key element in the success of the implementation of the programme. Regarding financial sustainabil-ity, the total incremental budget impact was 27% slightly decreasing to 26% after five years, which accounts for up to one third of the total budget of the district health office. Also, given that most of the costs for each round are recur-rent costs, efficiency gains from scale effects over time are limited.Conclusion:Based on these findings, we conclude that for JHAVP to be routinely delivered at the district health level, a considerable increase in financial resources would be required. The district could benefit from joint immunization to maintain contact with mobile pastoralists to promote the use of available immunization services at district level

(De)connexions identitaires hadjeray : Les enjeux des technologies de la communication au Tchad

The recent history of Africa is characterised by the 'revolution' in information and communication technologies (ICT), specifically in the sector of mobile telephony, which reconsiders the challenges pertaining to identity in African societies. In this book, we follow the manifestation of such dynamic forces in the Hadjeray society in Guera, Tchad, a society that has suffered a history of political violence, mobility and failures. The study shows the role of the Chadian government in the implementation of ICT and explains how government logics have amplified. Through the analysis of the changes in the economic and social spheres, occurring due to mobile telephony, we discover the identity issues that are also informed by the feeling of fear, which is part of the Chadian history of violence. However, the ways in which the Hadjeray adopt this new technology also leave them with a means to escape the logic of violence and disruption. It is mostly a dynamic force that occurs amongst the youth who, by making use of mobile networks, discover another mode of identification, between the ethnic group and the more global identity, and find through it a political voice

Vaccine hesitancy among mobile pastoralists in Chad: a qualitative study

Abstract Background Demand side barriers to vaccination among rural and hard-to-reach populations in Chad are not yet well understood. Although innovative approaches such as linking human and animal vaccination increase vaccination uptake among mobile pastoralist communities, vaccination coverage in these communities is still lower than for rural settled populations. We hypothesize that mobile pastoralists’ communities in Chad face specific demand side barriers to access vaccination services. Understanding the factors that caregivers in these communities consider, explicitly or implicitly, in order to decide whether or not to vaccinate a child, in addition to understanding the provider’s perspectives, are essential elements to tailor vaccination programmes towards increasing vaccination acceptance and uptake. Methods We conducted a qualitative study in a rural health district in southern Chad in April 2016 with 12 key informant in-depth interviews and four focus group discussions (FGDs) including 35 male and female participants. Participants in the study included caregivers, traditional chiefs, local and religious leaders from mobile pastoralist communities, and health officials and staff. We conducted a content analysis using a pre-defined set of categories for vaccine hesitancy covering issues on harmful effects of vaccination, mistrust with vaccination programmes/services, issues with the health system and other issues. Results The groups of demand side barriers reported most frequently in focus group discussions were mistrust on the expanded programme on immunization (EPI) and polio vaccination outreach services (53%, n = 94), followed by health system issues (34%, n = 94), and concerns related to potential harm of vaccines (13%, n = 94). Concerns identified by caregivers, health professionals and community leaders followed a similar pattern with issues on programme mistrust being most frequently reported and issues with harm least frequently reported. None of the health professionals reported concerns about vaccinations being potentially harmful. Conclusion Mobile pastoralist communities face specific demand side barriers to vaccination. Understanding these barriers is essential to reduce vaccine hesitancy and increase vaccination uptake. Local health systems must plan for the periodic presence of pastoralist communities in their zones of responsibility and create more mutual trust