Final UNICEF Newsletter On

POLIO-FREE CHAD UNICEF QUARTERLY ON THE POLIO ERADICATION INITIATIVE IN CHAD

October 2013 A Year Without WPV How to dismantle a hard-hitting enemy

Frontline Focus Working with nomads along migration routes & photo essay

Keeping cVDPV

in-check Intensifying mop-up campaigns

1 © UNICEF NYHQ/2012/Holt

A Year Without WPV WITH THE CONTRIBUTION OF Eradicating WPV is an ambitious BRUNO MAES Representative endeavour. In a country where MARCEL S. OUATTARA the public health system is still in Salamat Forum Deputy Representative need of a major push, this result A regional forum in the district GIANLUCA FLAMIGNI Chief, Polio is of significant importance, and of Am-Tinam brought together LALAINA FATRATRA ANDRIAMASINORO gives hope for making a polio- political, administrative, Chief of Communication free world a reality. traditional and religious leaders DJINGRI OUOBA in aims of establishing a network C4D Specialist (Polio) of partnerships between BOUREIMA KONATÉ Page 4 C4D Specialist (Polio) stakeholders, and to design an JUSTIN MASRADAYE action plan to improve health C4D Consultant (Polio) and vaccination performance in BAKOLY RABENARIVO Frontline Focus the region. Regional C4D Specialist (Polio) Reaching previously hard NADIM BOUGHANMI Communication Officer -to-reach communities has Page 22 FACT CHECKING been emphasized this year. THOMAS MORBAN Working closely with different M&E Specialist (Polio) government entities as well as UNDER THE SUPERVISION OF LALAINA FATRATRA ANDRIAMASINORO local and traditional leaders, Keeping cVDPV in-check Chief of Communication such communities can now Globally and in Chad,the cVDPV GIANLUCA FLAMIGNI also benefit from life-saving situation is becoming a source Chief, Polio vaccinations. of concern. Heavy campaigning WRITING / REPORTING combined with missed children NADIM BOUGHANMI Communications Officer Page 8 could have an effect on the LALAINA FATRATRA ANDRIAMASINORO incidence of the derived virus. Chief of Communication High quality campaigns are key. LAYOUT AND DESIGN NADIM BOUGHANMI Communications Officer Missed Children Page 24 PHOTOGRAPHY “Why curing the world from NADIM BOUGHANMI polio is not just a two drop affair” Read Also: Communications Officer examines the issue of missed children in the Chadian context Engaging Communities Through and implications on community Radio Game Shows Page 21 mobilization efforts. Reaching A Crucial Milestone Page 25 Page 19 CONTENTS

© United Nations Children’s Fund (UNICEF) Chad Country Office This newsletter has been prepared to provide periodic information updates on the Polio eradication Initiative in Chad.The findings, interpretations and conclusions expressed in this newsletter are those of the author(s) and do not necessarily reflect the policies or views of UNICEF. The text has not been edited to official publication standards and UNICEF accepts no responsibility for errors. EDITORIAL NOTE

olio eradica- including UNICEF and to-reach beneficiaries sonal migration routes tion efforts WHO would not have such as nomadic groups across the southern in Chad been able to put in and refugees, to the borders with the Central have yielded place the structures and recent implementation African Republic. excellent implement the strate- of the Reaching Every results over gies that helped enable District (RED) strategy, Communication for the past 15 months. By such a promising result. and the revitalization of Development in the P Chadian context, and the end of 2012, the the country’s immuniza- total number of new In Chad, and despite tion programme, efforts being one of UNICEF’s infections had dropped sizable challenges (dis- were not spared. flagship disciplines, is by more than 95%, and persed populations, dif- also featured in this edi- this year, there have ficult terrain, insufficient Notwithstanding this tion of Polio-Free-Chad, been no new cases of knowledge on good promising result, the alongside a number of WPV to date. family practices, frail cVDPV situation in Chad human interest stories cold chain system and remains a source of and a photo gallery that The engagement of the lack of qualified health concern. Five cases have we hope will give you a Chadian Government, workers just to name a been confirmed this feel for our work on the whose president de- few), real progress was year, prompting a dense ground here. clared an all-out war on made, and the country schedule of localized the virus back in 2009, is now on its way to mop-up campaigns. We hope this newsletter has played a key role becoming polio-free. will serve you well as a in reaching a crucial In this new edition of tool to obtain periodic milestone on June 14th Efforts were intensi- Polio–Free Chad, and information updates of this year, after 12 con- fied across all facets of as we celebrate the and generally as a secutive months with- the Eradication Initia- important eradication channel for improved out a new case of WPV. tive, from the complete milestone that has been interaction between overhaul of the coun- reached in June 2013, partners. Support from partners try’s cold chain system we try to shed the light such as the Bill and to the deployment of on working with tradi- Melinda Gates Founda- more than 45 national tionally hard-to-reach Bruno Maes tion, the Government communication staff communities of nomad- Representative of Japan, USAID, CDC to increase community ic tribes, along their sea- Atlanta and Rotary awareness trough work- International has been ing with community decisive, and without and religious leaders, to which operating agen- special campaigns tar- cies on the ground geting previously hard-

How to dismantle a hard-hitting enemy

Eradicating polio has been a top public health priority in Chad since the re-establishment of Wild Poliovirus (WPV) circulation back in 2009. A little over three years later, and despite sizable challenges, Chadian government and global partners including UNICEF and WHO have recently achieved a crucial eradication milestone: 12 consecutive months of interrupted WPV transmission – a fundamental criterion needed to declare a polio-free state.

Although Chad is not the only re-established transmission country in the region to achieve this milestone (An- gola and DR Congo reported their last cases in July and December 2012, re- spectively), progress attained here over the past 15 months is nothing short of outstanding: the 95% drop in new WPV cases in 2012 is not only a tangible result, but it was also obtained in a country still grappling with the after- math of never ending political instabil- ity, coupled with the some of harshest environmental factors on the planet. till ranking in had a catastrophic impact on the bottom four polio eradication efforts, and countries (184/187) so could have the measurable in the world on the influxes of IDPs and refugees UN Human Devel- following recent political opment Index, (in turmoil in neighbouring Scontrast, Angola and Nigeria countries. are ranked 148 and 153, re- spectively), and with a surface Instead, this result is rather spanning 1.284 million km2, reflective of meticulous Chad is not the easiest of bat- strategic planning, rigorous tlefronts. implementation and tight monitoring. Added is the abil- Defective or inexistent ity to quickly and effectively infrastructure, notably in mobilize and operationalize terms of transportation and the eradication apparatus, communication, low levels of which involves many actors education (nearly half of the at international and national population is illiterate), a weak levels, multiple government public health system plagued agencies and partners, and with a serious lack of human the deployment of enormous and financial resources (for human and financial resourc- example, Chad has the lowest es in order to reach the entire number of medical doctors target population. A particular per capita in the world), a vast focus was placed on reaching territory complete with plenty hard-to-reach groups such as of difficult terrain - whether nomadic communities, IDPs it is remoteness or accessibil- and refugees, and on deliver- ity, and a near-constant state ing swift and effective mop- of humanitarian emergency ups when needed. (floods in 2012 displaced more than 70,000 people in The last two cases of WPV in Chad), are all factors that polio Chad were reported from the eradication actors at all levels Lake Chad region back in June must deal with on a daily 2012 and were responded to basis. with a four-round mop-up campaign, which reached Aside form what such an more than 300,000 children in achievement means for the the span of eight weeks. Global Polio Eradication Initia- tive, especially at a time of re- Meanwhile, the endemic in kindled hope at the prospect neighbouring Nigeria was of achieving global eradica- flaring up, and the porous tion - with a new scientifically borders became a source of backed global deadline set for concern, prompting multi- 2018 and many talking about lateral regional coordination the last 0.1% as opposed to activities centred on the the last 1% - a fundamental prevention of cross-border lesson learned here is that transmission. Campaigns when efforts are well planned, were synchronized across coordinated and implement- borders. Recently, a new case ed, eradication of the elusive of WPV has been confirmed in polio virus is possible, even on western Cameroon. toughest of terrains. More recently, and to respond to the five confirmed cVDPV cases notified to date in the If it can be done in Chad regions of Salamat, Batha, Kanem and Ennedi, several Progress in Chad over the Mop-up rounds have been past few months is not the conducted this year, or are result of random environ- currently underway, in order mental factors. If anything, to increase vaccination cover- last year’s floods could have age and contain the virus. 6 Working the frontlines Partners and strategy

Major strides achieved in so- Evidently, continued support cial mobilization make up for from donors was a key factor. yet another deciding factor Past eradication shortcom- in the recent progress made ings in several parts of the towards polio eradication in world have been traced back, Chad. For instance, over the amongst other factors, to past 15 months, more than funding shortfalls or delays. 45 national communication In Chad, donor support over professionals have been de- the past few years has been ployed by UNICEF in all parts decisive. UN member states of the country with a focus such as Japan, and the United on priority at risk districts, States, as well as global organ- to, amongst other expected izations such as the Bill and outcomes, catalyse social Melinda Gates Foundation, mobilization efforts. GAVI alliance, the CDC and the Rotary Club have maintained This strategy proved to be past and future financial a game changer, because commitments to the efforts in it enabled better and more Chad, enabling organizations successful engagement of on the ground such as UNICEF influential community lead- and WHO to effectively carry- ers such as village chiefs and out the work. religious leaders, as well the implementation of better and Perhaps one of the most more effective information remarkable strategic moves sharing mechanisms with the made during this past year’s population, especially parents swift descent towards the and caregivers. magic number zero, and in-line with the global GPEI In addition, this network strategy, was the decision to successfully helped bridge see opportunity in adversity: gaps between the central and One of the main challenges regional levels, and facilitated crippling the health system is implementation of many ac- the weakness of its Expanded tivities on the ground, such the Programme of Immuniza- recruitment, training and su- tion (EPI). By shifting focus to pervision of community relays, include the routine immuniza- vaccinators and other health tion programme in the scope and community workers. of GPEI in Chad, not only will vaccination campaigns In urban hubs, mass media and improve in quality, but the public events were utilized on entire EPI system will also and off-campaign time. Chad- be revitalized in the process, ian music celebrities joined which will in turn make for forces with UNICEF to educate sustainable and more effec- parents and caregivers. Open tive subsequent campaigns in air free-admission concerts the future. were held in N’Djamena, Moundou, and even in Bol, in Eradicating polio is serious the remote Lake Chad region. business. When polio hits, it hits hard. A single new case Songs about polio were espe- of polio is a major setback to cially created and performed the Initiative. While there are to engage the public. Chad- many lessons to be learned ian artists went door-to-door from the experience in Chad, with vaccination teams to the perhaps the most valuable “difficult” neighbourhoods lesson retained, is that, given at campaign time to talk to an adequate political climate, parents. They appeared on the ultimate goal of a polio- FM and AM radio shows and free future is absolutely feasi- advocated tirelessly for the ble, even when faced with the polio eradication cause. most difficult of conditions. N.B. 7

Frontline Focus Working with nomads along migrations routes

special vaccina- to reach and serve vulnerable been working with them for are practically no vaccination tion campaign populations in the country. years on vaccinating their refusal issues when it comes to targeting cattle. working with nomadic groups. nomadic Targeted preventable illnesses The difficulty, however, lies populations has include all diseases covered “It is important for us to try mainly in the logistical aspect recently been by the routine vaccination everything we can to reach of the campaigns. Aconcluded in the Moyen Chari schedule such as the measles, nomadic groups,” explained region of Southern Chad, near tuberculosis, diphtheria, and UNICEF communication for As group movements are the border with the Central polio, in addition to meningitis development worker Justin directly influenced and condi- African Republic. An estimated and yellow fever. Pregnant Masradaye, who has been tioned by rainfall – or the lack 6,000 children under five mothers were also vaccinated working closely working with thereof – campaign organizer and 2,500 pregnant mothers against tetanus. the region’s tribes since the must be flexible and capa- received life-saving vaccina- beginning of the campaign. ble of adapting to changing tions during this campaign The campaign’s service schedules, as projected pas- which runs parallel to the package also included “They are difficult to reach and sage dates and location often seasonal cattle immunization deworming treatment, are therefore more vulnerable. change last minute. campaign, in which thousands vitamin A supplementation, They often have low or very of domestic animals and malnutrition screening and little vaccination coverage. In Later this year, as nomadic livestock are periodically im- malaria prevention through terms of polio eradication in tribes begin their decent munized. the distribution and use of Chad, working with such com- back southward looking for mosquito nets. munities is key,” he added. rain water and feed for their This type of specialized vac- cattle, they will benefit from cination campaigns is a part of Although nomadic groups This familiarity with the another round of vaccinations, several public health initiatives are generally uneducated, principle (and the impor- to increase immunization ef- by Chadian government and they are very familiar with tance) of vaccination creates a fectiveness. its development partners such the concept of vaccination, good environment for service as UNCIEF and WHO, designed as local authorities have demand and delivery. There Due to their particular lifestyle, nomadic tribes in Chad and throughout the region have chronically had low or no access to basic health services such as routine immunization. Endeavours such as this special vaccination campaign in the Moyen Chari help bridge the gaps in service delivery, and Eight-year-old Miriam eyes cau- ensure that these populations, tiously the needle on the syringe who are already vulnerable, do as a health worker prepares the injection (full page left), a few not fall victim to marginaliza- minutes before bravely receiving tion. the shot (top right). It is her first time to ever receive a vaccina- It is estimated that the nomad tion, her mother tells us. Below, population in Chad represents several tribe members sit with between 3.5 and 4% of the to- vaccination teams and health tal population, which accounts workers who gather information for an overall population of such as age and past vaccination roughly 350,000. Nomadic history, before filling it into the populations in Chad remain vaccination booklets some of the most vulnerable, to be handed out. as they are often difficult to Photos UNICEF©2013/Boughanmi track and to reach with social and health services. N.B.

9 Frontline Focus photo essay

Nomadic tribes have traditionally been under-served by public health and social services, due to their lifestyle centred around traditional cattle breeding and migratory movements over long distances. In an effort to reach nomadic groups, collaboration within several government departments made it possible to organize special campaigns along seasonal passage corridors. Photos UNICEF©2013/Boughanmi 11 Nomad mother receives a supply of deworming tablets and is instructed on how to use them by health worker. She is holding her ten month-old baby who received immuni- zations for the first time. The mother is also informed that her child will need further rounds of vaccinations, provided at no cost at health centers along their routes, or during proximity campaigns such as this one. Photo UNICEF©2013/Boughanmi

Nomad boy coura- geously receives his vaccine shot during the campaign which deliv- ered all vaccinations covered by the Chadian EPI, including deworming treatment and vitamin A supplementation - measures that have been proven to dramatically increase children’s resistance to preventable illnesses.

Nomad communities in Chad are estimated to comprise 3.5 to 4 percent of the total population. In addition to their unique lifestyle based on traditional cattle breeding, nomads capture the interest and the fascination of many, in part because of unique traditions involving complex hairstyles, dis- tinctive jewellery and colourful clothing.

14 Due to their lifestyle, nomadic communities have historically been under-reached by public health and social services. Many nomadic children have never received any vaccinations, and are today being provided services for the first time.

15 Coordination with government departments in charge of livestock, which periodically run cattle vaccination campaigns, enabled the feasibility, in terms of logistics and communication, of con- ducting parallel polio and routine EPI vaccination campaigns.

Recent approaches adopted by the government and its partners include working directly with nomad community leaders, as well as traditional and religious leaders, in order to use their communication chan- nels to inform tribes on upcoming campaigns, and to advocate on the importance of vaccination.

16 A nomad mother and her two youngsters after receiving, aside from the necessary vaccinations, a basic care kit, containing water purification tablets, mosquito nets to help prevent malaria as well as deworming and vitamin A tablets.

Missed Children WHY CURING THE WORLD FROM POLIO IS NOT JUST A TWO DROP AFFAIR

ecent results in settings, is most likely to be polio eradication food security – and not the TRENDS efforts worldwide vaccination schedule of her have created a children. Missed Children buzz of excite- ment in the pro- With livelihoods often lim- Rfessional circles. The world is ited to subsistence farming The proportion of missed children has shown a slightly closer today than it has ever and small scale trading, it is, decreasing trend in the last four rounds of national been to achieving polio’s unfortunately, more vital for long coveted eradication, children to be productive immunization campaigns in Chad: 7% in October 2012, as scientists and profes- by helping parents on the 6% in December 2012, 6% in February 2013 and 5% in sionals from across several fields or with the cattle, and March 2013. However, thousands of children continue disciplines are now putting for the mother to rush to the to be missed during campaigns. According to the latest fourth serious claims that, market – baby strapped on UNICEF social data analysis, Wadi Fira Region has the given no funding shortfalls, her back – in order to secure highest percentage of missed children (11%) followed polio will be wiped out by the day’s meal for her family. 2018. by Dar Sila (10%) and N’Djamena (8%) in March. Child Due to the harsh environ- absent remains the main reason for missed children, As the final battle for the last ment coupled with poor accounting for over 59% of the total number of missed 1 % rages on in several polio living standards, often children at national level. battlefronts, with some deprived of the most basic experts even beginning to needs (such as access to This proportion of child absence is particularly high in talk about the last 0.1 %, the clean water or to basic problem of “absent” children health services), many chil- Mandoul (99%), in Kanem (80%) and in Moyen Chari – in particular “true” absenc- dren in Chad do not make (79%). Children who are absent when vaccination es and not “soft” refusals – is it to adulthood (approxi- teams visit are usually at playgrounds, which are usu- becoming the object of seri- mately one out of every five ally not far from their homes. Other times, they may be ous reflection, and concern. children in Chad won’t make at social events, which often take place in or near the it to the age of five.) household. Why are so many children not present at home at cam- Polio does not thrive in paign time, even though healthy environments Some pockets of non-compliance as a reason for parents or caretakers were missed children during campaigns have also been fully aware of the campaign, It is estimated that a single reported in some parts of Chad. In Logone Orientale, and were not inherently OPV dose received by a refusals account for over 9% of the total of missed against vaccinating their child in a “normal” or “good” children, 7% in Moyen Kebbi Est and 7% in N’Djamena. children? environment could provide up to 75% immunity against However, caregivers’ refusals to vaccinate their children In other words, why do polio. A recent report stipu- account for only 3% of the total number of missed some parents remain so pas- lated that the same single children nationally. L.F.A. sive when it comes to a sim- dose administered to the ple, yet life saving measure, average Chadian child, will provided to the doorstep, not provide more than 35% free of charge? protection.

A matter of priorities Although vaccination laria, malnutrition, respirato- Due to a lifestyle centred against polio remains effec- ry infections and diarrhoea, on traditional cattle breed- A part of the answer lies tive, evidence now suggests preventive measures such as ing, nomadic communities within the bounding princi- that its effect is accentuated vaccination are unfortunate- are regularly on the move, ples of priority. by better living conditions, ly much less effective. seasonally, as they search and vise-versa. for food and water for their In Chad the number one Nomadic communities in animals. The nomad’s living priority for the average When the child’s health is Chad are a prime example environment is often a harsh mother, especially in rural chronically crippled by ma- of this. one. Scarce access to water, 19 constant exposure to the By applying such a holistic elements, little or inexistent approach, a favourable en- Engaging communities basic health services, and vironment for child survival chronically low education and development is created, through radio game shows levels are typical aspects setting the ground for the of the living conditions of needed shift in attitude nomadic communities. and perception, as parents’ views on the importance of hanks to an These conditions combined the wellbeing of the child initiative of with the inherent difficulty change. the National of reaching these communi- Office of Radio ties with health and social A healthier, safer environ- and Televi- services does not play in ment for children, combined sion of Chad, favour of these communi- with a shift of attitudes of and with the ties’ children. parents on the importance support of UNICEF, about of the wellbeing of their fortyT producers and radio Increasing service de- children, creates an envi- broadcasters covering forty mand, and a holistic ronment where the elusive health districts have received delivery Poliovirus, for example, can- training on the design and not thrive. production of public radio Holistic approaches such the games and programming one currently adopted by While thorough vaccination from 10th to 15th June UNICEF in Chad may prove coverage is key, experi- 2013. The objective of the to be the missing piece of ence has shown that, polio, workshop was to strengthen the puzzle. similarly to many other capacity to produce radio infectious diseases targeted programs, directly engaging By investing in a service for containment or eradica- communities and educating delivery that provides tion, thrives in poverty and them on the importance of comprehensive care while at mediocre human condition. vaccination. The session was the same time creating the By addressing and respond- preceded by a training-of- needed shift in the per- ing to the root causes that trainers held in N’Djamena ceived value of the child’s stand in the way of hu- from 28th May to 2nd June. wellbeing, remaining gaps man development and the can be closed. improvement of the human “Public radio show games condition, polio eradication conducted in local lan- In Chad, UNICEF provides efforts have higher suc- guages for the communities mosquito nets, basic family cess rates, as well as a more by the communities is the hygiene kits, water puri- tangible and sustainable approach likely to promote fication kits, malnutrition impact. N.B. lasting change and to screening with in-patient or support communication ac- outpatient treatment with tivities in immunization and referral system, routine vac- polio eradication . Such pro- cinations, vitamin A supple- grammes increase participa- mentation, and deworming tion, community ownership, treatment. and allows to offer solutions to a given problem,“ said These is coupled with a like us on facebook_ Bruno Maes, UNICEF Repre- dense communication sentative in Chad. and social mobilization agenda, which includes Public radio show games An important part of the the involvement of local have already been proven initiative to eradicate polio in community leaders and effective in several African Chad, radio remains one of religious leaders, and the countries. Developed by the main sources of informa- use of an increasing number experts on community/local tion parents – after public of community relays from radio stations, programmes street announcers behind - within target communities, are designed to provide a on immunization. During the in order to promote essen- variety of public games of last national immunization tial family practices for the edutainment activities to be campaign against polio in survival and development of broadcast at Community level. the month of March, about the child, such as exclusive Following this training, radio a quarter of parents (23%) breast feeding, vaccination, show hosts and producers are were informed of the vacci- or good personal and family Stop Polio Chad ✓ expected to be able plan and nation campaign through ra- hygiene practices. to produce their program for dio. This proportion is of 51% the rest of the year. in the area of N’Djamena, 55% in the Kanem region, formation on immunization,” with local radio stations ers and 3,300 community and 45% in the region of continues Bruno Maes. spread over the entire ter- volunteers. Tandjilé. ritory. Nearly 40 stations The external review of the are currently disseminating “In this final phase of the “Radio in Chad remains by expanded program on im- awareness messages and eradication program, UNICEF far the most used media in munization in Chad (2012) producing entertainment programs specifically Chad, before watching televi- reported that 49% of missed and educational programs designed to reach children sion and using print media. It children have not been vac- in local communities, both in the most disadvantaged is a communication channel cinated for reasons other during and between immu- and vulnerable populations, that should be exploited to than the lack of information nization campaigns. At the including nomads, who are the maximum. A large major- of parents about the routine national level, UNICEF also most likely to be missed. ity of parents do not vacci- immunization program. supports a vast network of “These groups hold the key nate their children because communication and social the eradication of polio in they are not aware of, or In Chad, UNICEF has estab- mobilizers, which includes Chad,“ concludes Bruno do not have the necessary in- lished a formal partnership some 3,500 public announc- Maes. L.F.A. Salamat advocacy forum

Concerted action plan to strengthen both demand and service

he Govern- any dose of vaccine that ment, with protects them against teta- the support nus. “Parents did not get of UNICEF and their children vaccinated WHO held a because they ignore the regional forum immunization schedule,” re- inT the district of Am-Tinam, veals the latest behavioural bringing together political, KAP study. administrative, traditional and religious leaders. This “This forum will lay the forum aims at establish- groundwork for a con- ing a strong network of certed action plan in the partnership between those region to strengthen both stakeholders and designing the demand and the ser- an action plan to improve vices. Based on this new health and vaccination per- framework, everyone has formance in the region. to bring its own contribu- tions,” continued Dr. Jean “The Salamat Region, Marie Vianny Yameogo, with its worrying health WHO Representative in indicators, is among the Chad. regions where vaccination coverage is extremely low. It is important to men- The fact that this strain has “UNICEF will increase its Several villages are inac- tion that the first case of circulated in the region support in this region by cessible mainly during the circulated vaccine-derived shows that routine immu- strengthening the cold rainy season,” said Mahadi poliovirus this year was nization coverage is still chain, human resources Brahim Adam, General Sec- discovered in the district low, increasing therefore and communication and retary of the Region. of Aboudeia, in the region the threat of the spread of social mobilization ac- of Salamat, in February. poliovirus at any time. tivities. Every child has the According to the latest In response to this case right to grow up healthy, immunization coverage detected among nomadic There have been four more wherever and whatever survey, only four children populations, the Govern- cases to date, with the most their living conditions. Im- out of ten are fully immu- ment carried out intensive recent case confirmed in the proving equity is the right nized in Salamat and two mop-up campaigns in the Ennedi region, and which and smart thing to do for never received any dose of region in April and May, prompted a large scale mop- sustainable development,” vaccine. Nearly half of the which was followed by a up targeting the vast north- said Bruno Maes, UNICEF mothers did not receive national campaign in June. ern parts of the territory. Representative in Chad. 22 Chad has made tremen- nearly half of children did demand for the benefits of coverage estimates, Chad dous progress towards not receive any vaccines immunization is an essen- remains at risk for new polio polio eradication. The num- before their first birthday. tial component of an active outbreaks at any time. This ber of new cases of wild immunization programme,” is a vital time for the polio poliovirus has decreased “Chad is very close to eradi- stated Ahmat Djidda Has- eradication programme in from 132 in 2011 to only 5 cating polio. Everybody san, Ministry of Public Chad. Its high level of com- cases in 2012. needs to work together. Health in Chad, during the mitment and drive cannot be Now is the chance to opening ceremony of the let up,” concluded Mr. Maes. However, the country make Chad polio-free. To forum. L.F.A. has to overcome several succeed,everyone needs challenges. The level of to be committed. Commu- “Continuing to build im- immunization coverage nity participation is a key munization coverage and is extremely low in Chad. factor in raising immuniza- surveillance is the best pos- Only one in three children tion coverage. Creating sible insurance policy. With is fully immunized and awareness of and public low routine immunization 23 Keeping cVDPV in-check Three localised interventions to boost vaccination coverage

hree mop-up As Chad has recently districts of Mao and Mondo In an effort to build on campaigns reached the long-coveted in the Kanem Region, while recent hard-won gains in targeting ten 12 consecutive months-free the remaining two mop- the battle against polio- regions of the of Wild Polio Virus (WPV) ups will target the regions myelitis, this year’s polio Chadian terri- milestone, efforts are now of Borokou, Tibesti, Enn- vaccination schedule has tory have been being intensified to increase edi, Bhar El Gazal, Batha, been relentless. To date, a addedT to this year’s busy vaccination coverage all Ouaddai, Lake Chad, and total of seven campaigns polio vaccination schedule. over the territory, with a Hadjer Lamis, as well as have been deployed in the particular focus on reach- districts from the Kanem country, including two NIDs, The campaigns run from ing populations chronically region on 23rd August, and and five mop-ups, which 26th July to 29th Sep- missed during campaigns, again on 27th of September. seven targeted nine regions tember, and will reach an due to remoteness and dif- estimated total of 650,000 ficult accessibility. children under five. “Some of areas we are going These localized interven- to this time are deep in the tions are designed to desert – in the north – Popu- increase coverage in regions lations we will find there still reporting lower vaccina- have probably never seen tion levels and to contain any vaccination teams in any possible propagation of the past,” explains Gianluca vaccine-derived poliovirus, Flamigni, Polio Unit Chief of (cVDPV) which has already UNICEF in Chad. manifested itself on five occasions this year – with The Lac Chad region on the last case confirmed in the other hand, which May in Fada, in the Ennedi comprises a large number Region. of inhabited small islands only accessible by water on While the number of cVDPV small boats, has tradition- cases to date this year is still ally been under-vaccinated below last year’s total of in the past. The region is of 12 cases, the issue remains added importance due to its a source of concern, as it geographical location near denotes that some children the Nigerian border. are still being missed during campaigns. Vaccination activities along trans-border passage cor- The problem is not con- ridors will be the focus of fined to Chad. Several other upcoming campaigns in this countries, whether endemic region, in order to prevent or not, who also witnessed any possible importation heavy campaigning over of WPV form Nigeria, which the past year and a half, are has been grappled by polio also reporting incidences of in recent years. cVDPV. Last year, there have been 70 cases globally. This Following the pattern of year to date, there have only incidence of cVDPV, the been 16 cases recorded. first mop-up targeted the

24 Reaching a crucial milestone

in the east, south- east and n June 14th WPV paralysis cases as of Recently, a new 2018 global southern parts of the coun- 2013, Chad August 2013. eradication deadline has been try, including the regions of reached an put fourth, in a declaration Batha, Guera, Salamat, Sila, important Government and partners backed by more than 400 Ouaddai and Wadi Fira. N.B. milestone in are capitalizing on efforts scientists and global health its on-going deployed since 2009, after experts. The six-year plan pre- Obattle for polio eradication: the personal engagement of sented on the Global Vaccine 12 consecutive months of the Chadian president, who Summit in Abu Dhabi last no newly reported cases of declared an all out “War” April is estimated to cost USD paralysis caused by the wild against the virus. 5.5 Billion. Poliovirus, and an important gain towards attaining a More frequent and high In 2012, a total of 12 vac- polio-free status. quality campaigns played a cination campaigns were major role in reaching this deployed over the Chad- Chad is one of three coun- milestone and largely ben- ian territory. They included tries in the region with efitted from increased efforts Supplementary National and so called “re-established in social mobilization, which Regional Immunization Days, transmission”, alongside ranged from creating part- as well as several rounds of Angola and the Democratic nerships with national Radio Mop-Up campaigns. Three Republic of Congo, who last and Television, community national campaigns have reported WPV cases respec- radio as well as working with already been conducted in tively in June and December engaged public political fig- 2013, and at least another of 2012. ures and influential commu- two are planned for later in nity, traditional and religious the year. Nigeria on the other hand leaders. continues to experience an There have been four endemic polio situation. Partnerships with local instances of Circulating NGOs also paved the way for Vaccine Derived Polio Virus The situation in Nigeria is a increased public awareness during the last 12-month pe- source of particular concern and social mobilization. riod, including the recently due to the risk of cross-bor- confirmed case in the Ennedi der transmission. Regional Strategic planning such region. A total of five mop- coordination mechanisms as revitalizing the health up campaigns have been so have been put in place and sector’s Expanded Immu- far scheduled in 2013, target- several cross-border activi- nization Program is helping the entire territory since ties have been conducted ing to improve important April with several rounds since 2012 and are currently infrastructures such as the planned over a six-month underway. cold chain, and by increasing period. N.B. human resource capacity in This milestone is a seri- the sector. ous achievement for Chad. Despite last year’s floods, Funding in Chad has been the ensuing nutrition crisis decisive. Global partners such and the influx of refugees Japan, the United States, and IDPs, polio was success- The Bill and Melinda Gates fully kept in check, with the Foundation, GAVI alliance, the overall number of new cases Rotary Club and the CDC have dropping from 132 in 2011 provided vital financial and to 5 in 2012 - a 95% reduc- technical support to sustain tion - and no reported new eradication efforts.

Eradicating Poliomyelitis is a global public health effort which necessitates substantial resources.

To combat polio in Chad, Unicef and WHO have the support of the following partners: • The Bill & Melinda gates Foundation • The Government of Japan • The Government of Saoudi Arabia • Rotary International • CDC ATLANTA • USAID • GAVI Alliance FOR MORE INFORMATION POLIO-FREE CHAD

BRUNO MAES Representative +235 66 29 60 60 [email protected] UNICEF Chad Country Office

LALAINA FATRATRA ANDRIAMASINORO Chief of Communication +235 60 84 01 20 www.poliofreechad.org [email protected] UNICEF Chad Country Office

GIANLUCA FLAMIGNI Chief, Polio +235 66 23 15 83 [email protected] UNICEF Chad Country Office

Nadim Boughanmi Communication Officer (Polio) +235 62 30 58 43 [email protected] UNICEF Chad Country Office