Health in Chad

The Government of Chad, through the Ministry of Health and Prevention (MoH), envisions an inclusive national health system where refugees and host communities have equitable access to quality health and nutrition services. 

This vision is reflected in Chad’s National Health Development Plan 2018-2030 (Plan National de Développement Sanitaire, PNDS) and is aligned with commitments made under the Global Compact on Refugees and the 1951 Refugee Convention. 

• Short-term vision: Deliver life-saving health and nutrition services in refugee-hosting areas by leveraging existing health services through mobile clinics, temporary health posts, and coordinated outreach campaigns. Focus on acute needs following mass arrivals in the east and promote early adoption of integrated service delivery models benefiting both refugees and host populations.  Ensure all interventions are guided by conflict sensitivity analysis to foster social cohesion, peaceful coexistence  and minimize tensions. 
• Medium-term vision: Integrate refugee services into district health plans, expand infrastructure, equipment and workforce capacity both in quantity and quality in a health system strengthening approach.
• Long-term vision: Achieve full inclusion of refugees and displaced people in the national health policies and interventions that guarantee equitable access to health facilities for refugees, displaced people and host communities for social cohesion. This includes sustainable financing and governance arrangements in which refugee populations are accounted in national, provincial, and district-level planning, budgeting, and oversight mechanisms, ensuring shared accountability and system-wide coherence. Integration will be advanced gradually across provinces, based on the capacity of local health systems, including infrastructure, staffing, and coordination mechanisms, and guided by an area-based approach and shared service delivery in refugee-hosting regions, recognizing that health system maturity varies by location. Focus on refugees’ vulnerability and an inclusion in free care policy.

Chad has demonstrated a strong political commitment to inclusion through several legal and policy frameworks: 

• Law No. 021/PR/2020 grants refugees access to public services, including health care.
• The National Health Development Plan (PNDS) 2018–2030 promotes decentralized, equity-oriented health services, with a specific focus on fragile and border regions. 
• The Memorandum of Understanding (May 2024) signed between the Ministry of Health and UNHCR outlines a progressive integration plan for refugee health services in the east. 
• At the Global Refugee Forums (2019 and 2023), Chad pledged to enhance refugee inclusion in national systems, including the health sector. 
• The National Nutrition and Food Policy (2014–2025) aims to ensure the delivery of a comprehensive package of high-quality, integrated nutrition services and the appropriate management of acute malnutrition among children under five, as well as pregnant and lactating women, across all health facilities in the country.
• The Governance and Coordination Framework for Food and Nutrition includes the National Council for Nutrition and Food (CNNA), the Permanent Technical Committee for Nutrition and Food (CTPNA), and the Provincial Committees for Nutrition and Food, which collectively oversee strategic planning and implementation.
• Chad has adopted a WASH in Nutrition strategy, which guides water, sanitation, and hygiene interventions both within malnutrition treatment units and at the community level.

The National Health Development Plan (PNDS) and health sector guidelines define several key service delivery benchmarks in Chad: 

• Health posts should be available for every 5,000 people and provide basic outpatient care, vaccinations, and health promotion activities.
• Health centers should serve around 10,000 to 15,000 people, offering primary health care services, including maternal and child health care, minor procedures, and basic diagnostics.
• District hospitals function as referral facilities for several health centers, delivering secondary health care services including inpatient care, emergency services, and broader diagnostic and treatment options.
• Regional/provincial hospitals offer tertiary-level care, including specialist consultations, surgical services, and advanced diagnostics, typically for entire provinces.

In addition to this structure, national standards aim to:

• Achieve at least 90% coverage rate of Penta3 and Measles vaccine (diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b) among children under one year, which is a key indicators of routine immunization performance.
• Reach the WHO-recommended threshold of one qualified health worker (doctor, nurse, or midwife) per 1,000 people; a target Chad remains significantly below.
• Deliver services in line with the Minimum Package of Activities (PMA) for health centers and the Complementary Package of Activities (PCA) for hospitals, which outline required services, staffing, and equipment by facility level.
• Achieve the Sphere standards for nutrition aim for a recovery rate above 75%, a mortality rate below 10%, and a default rate below 15%.

Data source: Ajala Platform. The Ajala Platform is a humanitarian coordination platform that collects comprehensive data for the response in Eastern Chad.

Progress toward the inclusion of refugees in Chad’s national health system can be monitored through a set of indicators that reflect both service access and systems-level integration: 

• Number of refugee-hosting health facilities integrated into MoH systems (e.g., staffing, supervision, supplies).
• Percentage of refugee and host community births attended by skilled health personnel.
• Penta 3 and MCV vaccination coverage among children under one (refugee and host community).
• Number of mental health consultations delivered. 
• Nutrition indicators, including Global Acute Malnutrition (GAM) rates and the number of children treated for severe or moderate acute malnutrition. 
• Share of refugee caseloads included in district health plans and budgets. 
• Availability of essential medicines and equipment in refugee-hosting health facilities. 
• Staffing ratios, including the deployment of MoH personnel and integration of qualified refugee health workers. 

Monitoring is conducted through multiple systems, including national and partner-led systems such as the Ajala platform, UNHCR’s Integrated Refugee Health Information System (iRHIS), WHO/MoH’s Early Warning, Alert, and Response System (EWARS),  and targeted surveys like the Standardized Expanded Nutrition Survey (SENS). The national District Health Information Software 2 (DHIS2) system also plays a central role; however, refugee-specific data is not yet systematically disaggregated. As monitoring systems continue to evolve, progress varies by region and remains dependent on sustained investment, particularly in underserved eastern provinces.

Even before the Sudan crisis that erupted in April 2023, Chad’s health system faced longstanding challenges linked to limited infrastructure, workforce shortages, and resource constraints. The large-scale arrival of Sudanese refugees has significantly increased pressure on already stretched services, particularly in eastern districts.

The Ministry of Health, with support from humanitarian and development partners, is actively working to expand service coverage and strengthen national systems. However, additional investment is urgently needed to sustain emergency response efforts while advancing longer-term goals of integration, resilience, and equitable access.

Refugee-hosting districts continue to face systemic constraints that hinder the delivery of quality care for both displaced and host populations. These include shortages of qualified personnel, limited ambulance and referral capacity, and constrained access to treatment for chronic conditions. Long distances to referral facilities and the lack of reliable transport create serious barriers to timely care, particularly for women with pregnancy-related complications and other high-risk patients, inadequate access to potable water and poor hygiene condition. 

To deliver on the vision of inclusive and sustainable health care, investments are needed across several key areas: 

• Human resources: Strengthening the health workforce remains a top priority, including training, recruitment and retention of qualified Ministry of Health staff in underserved areas, as well as the accreditation and inclusion of skilled refugee health workers. Additional support is needed to create enabling conditions that attract and retain personnel, particularly in remote or high-need settings.
• Infrastructure: Many health facilities in the east continue to operate from temporary structures that lack reliable water, energy, and staff accommodation. Upgrading infrastructure is essential to improve service continuity and quality.
• Mental health and psychosocial support (MHPSS): Services remain limited despite growing needs. Scaling up MHPSS involves implementing a stepped-care model, where support ranges from community-based psychosocial interventions to more specialized mental health services depending on the level of need. Integrating these services into primary health care is critical to address trauma and longer-term psychological impacts.
• Nutrition: Funding shortfalls risk disrupting life-saving treatment for thousands of children affected by acute malnutrition. Sustained investment in nutrition services is needed, particularly for children under five and pregnant or lactating women.
• Supplies and referral systems: Persistent shortages of essential medicines, cold chain equipment, and ambulances continue to hinder timely care, especially for emergency cases such as obstetric referrals.
• Health governance and financing: Support is needed to ensure refugee caseloads are fully integrated into district health planning, budgeting, and supervision, enabling a coordinated and nationally led response. In some locations, communities continue to rely on temporary health facilities where services are provided free of charge, while nearby public structures remain underused due to cost barriers. Over time, there is a need to support the gradual transition toward strengthened, inclusive public health services that are sustainably financed and accessible to all.

The health and nutrition response in Chad plays a vital role in addressing the impacts of the Sudan crisis, particularly in the eastern regions where the health system has been overwhelmed by the scale of new arrivals. While humanitarian actors continue to meet urgent needs, the transition to a more sustainable, inclusive model requires long-term engagement and investment from development partners.

Development actors can play a critical role by: 

• Supporting health workforce development, including training, deployment, and incentives for Ministry of Health personnel, as well as accreditation pathways for qualified refugee health professionals. Newly arrived refugees include trained health workers, who represent a valuable resource that can strengthen local systems if effectively integrated.
• Reinforcing district health budgets to ensure equitable service delivery for both refugees and host communities. This is particularly important in areas where new refugee settlements have been established with economic and service expansion potential, providing a strong foundation for scalable, area-based integration.
• Financing infrastructure upgrades in health posts, health centers, and district hospitals, particularly in remote and underserved areas, including provision of water, energy, and basic equipment. In many sites, camp-based clinics are already being integrated into the national system under Ministry of Health leadership, creating opportunities to shift toward more sustainable public service delivery.
• Integrating refugee health services and data into national planning, budgeting, and health information systems, supporting harmonization, efficiency, and joint accountability.
• Partnering on area-based programming for mental health and nutrition services, in alignment with national strategies and local district health plans.

Last updated: October 2025