Chad 2024. Community Health System Maturity Assessment and Inventory of Foundational Elements
With ICHESS technical assistance under the Global Fund–funded BIRCH project, Chad’s Ministry of Public Health (Directorate of Community Health) carried out the 2024 community health system maturity assessment in August 2024, together with an inventory of the foundational elements of community health. It is the third annual assessment since 2022, and its conclusions fed into the preparation of the National Forum on Community Health.
Why it matters. Chad has some of the world’s highest maternal and child mortality (860 maternal deaths per 100,000 live births; child mortality of 133 per 1,000, DHS-MICS 2014–2015), and 78% of the population lives in rural areas. The national strategy relies on community-based interventions to close this gap.
Method. Mixed methods: review of national policies and strategic plans, inventory of foundational elements, and systematic scoring of program domains with the community health maturity matrix, with the Ministry, technical and financial partners, civil society and community representatives.
Key findings
| Domain | 2024 status | Key finding |
|---|---|---|
| Community engagement | Functional | Good community mobilization, although village health committees remain weak |
| Governance and leadership | Partially functional | Guidelines exist but are outdated; weak coordination between actors |
| Financing | Partially functional | No dedicated budget line for community health |
| Information systems | Partially functional | Gaps in collecting and transmitting community data and in integrating it into DHIS2 |
| Supply chain | Partially functional | Frequent stock-outs; no guidelines for procuring and managing CHW supplies |
| Service delivery | Partially functional | Protocol implementation and service coverage need improvement |
| Human resources | Non-functional | Staff shortages and no legal framework for community health workers |
Overall, the system is partially functional, with 44% of foundational elements available.
Priority actions
- Update and disseminate the community health policy and strengthen the technical consultation framework and steering committee
- Create a dedicated budget line and hold a resource-mobilization round table
- Propose a legal framework recognizing CHWs and include them in HR planning
- Integrate community indicators into DHIS2 and train actors on data tools
- Develop guidelines for procuring and managing supplies
- Involve communities more in planning and build village health committee capacity
- Revise the CHW package and improve quality through continuous training