In Chad, the nutritional situation remains worrying. In August-September 2019, the national prevalence of acute malnutrition was 12.9%, above the 10% alert threshold set by the WHO. As displayed in Tandjilé, one of Tchad’s provinces, numerous cases of children and infants aged 0-59 months, were found suffering from physical and intellectual low growth development due to acute malnutrition. This is often the result, as in the case of the Lai Health District of Tandjilé, of under-equipped health clinics, insufficient numbers of locally trained and skilled staff; low community access to drinking water; low levels of women’s participation in weak health communities’ infrastructures; and a lack of healthy practices from local communities.

Expected Results

Result 1: Quality and equitable health care and services are provided to the population of the Lai district in accordance with the Minimum Package of Activities (MPA).

Result 2: The capacity of health care providers in the Lai Health District is strengthened by the end of the project.

Result 3: Community health service delivery structures are established/strengthened and a network is established at the most peripheral level of the health system.

Result 4: Target populations (men, women, girls, and boys) have adopted appropriate behaviours, attitudes and practices (Water, Sanitation and Hygiene (WASH), nutrition) to prevent malnutrition.

Main Activities

• Diagnosis of health structures in relation to MPA
• Support to health structures in terms of essential drugs, consumables, equipment, rehabilitation, women professional service providers and women community health workers
• Health care management, including in advanced strategy and support for the referral and cross-referral system for children aged 6 to 59 months and pregnant and breastfeeding women
• Support for the management of cases of Gender Based Violence (GBV) and people living with HIV
• Support and reinforcement of vertical programmes (vaccination), to ensure optimal coverage of the population with the MPA
• Support for strengthening the surveillance of diseases, including malnutrition
• Conducting a client/ staff satisfaction survey
• District health centre excellence competition
• Assessment of attitudes and skills of service providers in Lai Health District
• Training and retraining of providers on national standards for health care delivery (Integrated Management of Acute Malnutrition, management of childhood diseases, Performance Improvement in Healthcare, Basic Emergency Obstetric and Neonatal Care, Adolescent and Youth Reproductive Health, Infant and Young Child Feeding, Family Planning/After Abortion Care), and in drug management, the health information system and counselling
• Support to the Lai Health District in the temporary recruitment of key staff for the implementation and/or scaling up of the MPA as required
• Establishment of a system of regular clinical mentoring and formative supervision of all health facilities
• Support to the implementation/revitalisation of Health Committee, Management Committee, community health workers, Community Liaison Officer
• Implementation of the Home for Learning and Nutritional Rehabilitation, Infant and Young Child Feeding, and Mother Blood Pressure monitoring
• Training of community leaders, matrons, healers, traditional healers on the prevention and community management of malnutrition
• Development of Village Savings and Loan Associations (VSLAs) for the promotion of prevention and community-based management of malnutrition
• Support for the networking of community structures: training on networking, organisation of periodic network meetings, formative supervision, communication (fleet)
• Carrying out studies on the local causes of malnutrition, eating habits, diversification, food taboos and measuring improvements and results
• Carrying out a gender analysis (initial, mid-term and final) and a „social analysis and action“ in Lai district
• Carrying out Community Action Plan studies (at the beginning and end of the project) of communities which are regarded to have good hygiene practices, nutrition, breastfeeding, and prevention of child illnesses
• Implementation of Information, Education, Communication campaigns for behaviour change on good hygiene, food and nutrition practices via the WASH In Nut approach
• Implementation of the Community Led Total Sanitation Approach
• Implementation of the Infant and Young Child Feeding Strategy and culinary demonstration
• Support for the establishment/revitalisation of community structures (women’s groups, youth groups, girl-mother groups, etc.) for behaviour change