of malaria, with two corresponding projects (PALAT I and II) accounting for 97 percent of expenditure during the current CPD period ($97.3 million). Other projects include support to the National Council for the Fight against HIV and AIDS, initiated in previous CPDs and phasing out during the current cycle, as well as support to the procurement of medicines. Accordingly, the two outputs defined under this outcome emphasize UNDP support specifically to the response to malaria, in terms of improving access to services and governance, emphasizing institutional capacity development. Finding 17. UNDP has been an important enabler of Global Fund financing in Chad, playing a significant role in supporting the country’s health response to malaria, the leading cause of mortality in Chad. The support provided through consecutive rounds of financing has contributed to scale-up and improved access to preventive and treatment services in Chad over time, and to sustaining the national response during the country’s economic crisis. UNDP has a long-standing record of supporting the health sector in Chad through Global Fund grants. Between 2006 and 2017, UNDP supported centralized and decentralized institutional capacity of the Ministry of health and the National Council for the Fight against HIV and AIDS, through two successive projects funded with UNDP core resources. While the scale of this support has varied over this period, Global Fund grants for HIV/AIDS have been directly managed by the Ministry of Health, suggesting that institutional capacity development was successful over time. However, it should be noted that support to the health sector has been a key priority of development aid in Chad and subject to the contribution of many actors, and there is limited data available to ascertain the contribution of UNDP in this area. Since 2014, UNDP 136 137 138 139
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has also offered its health procurement capacity to the Government to respond to shortages of antiretroviral drugs and facilitate emergency acquisition, addressing bottlenecks in the acquisition and procurement process on behalf of the Government. The UNDP contribution has been significant in the fight against malaria. Malaria is endemic in Chad, and the primary cause of medical consultations and hospitalizations (41 percent), and mortality (40 percent).136 Malaria is estimated to be the leading cause of hospital death in children under five (60 percent),137 and pregnant women (12 percent). Overall, Chad accounts for 5 percent of estimated cases in the World Health Organization (WHO) Central Africa region, and 10 percent of estimated malaria deaths in the region.138 80 percent of the country’s population lives in high malaria transmission areas. In this regard, the fight against malaria is a national development priority. UNDP has been the principal recipient agent139 of the Global Fund grant for malaria in Chad since 2009, covering three successive rounds of financing, representing approximately $170 million to date.140 Through its PALAT project, UNDP has been responsible for financial management and programme activities in support of the National Programme for the Fight against Malaria (PNLP), under the leadership of the Country Coordinating Mechanism.141 The response financed through the Global Fund consists of enhancing access to preventive and treatment care at national level, notably through the implementation of mass distribution of Long Lasting Insecticidal Nets (LLIN), Intermittent preventive treatment (IPT) and Seasonal Malaria Chemoprevention (SMC) through prenatal health centres in targeted regions.142 The project also includes a component to support institutional capacity:
PNLP Annual Report 2018. Ibid. WHO (2020) World Malaria Report 2020. Since the second phase of the project in 2016, the delivery of the Global Fund grant for malaria involves several sub-recipient agents such as the PNLP and United Nations agencies, such as WFP for the distribution of LLINs and transportation to distribution sites, and UNHCR to manage distribution in refugee and IDP camps. Between 2016-2018, UNICEF was also a sub-recipient for the capacitydevelopment component of the target community-level health centres. Source: Global Fund data explorer. The Country Coordinating Mechanism is a national committee that submits funding applications to the Global Fund and oversees grants on behalf of their countries. They are a key element of the Global Fund partnership. IPT of malaria in pregnancy is a full therapeutic course of antimalarial medicine given to pregnant women at routine antenatal care visits, regardless of whether the recipient is infected with malaria. SMC involves administering monthly doses of antimalarial drugs to children aged 3-59 months during peak malaria transmission season.
CHAPTER 2: FINDINGS
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