The added value of a P4H Country Focal Person: the 6 years long experience of P4H Cooperation in Chad
In Chad, the government declared UHC a priority as early as 2011, and it has maintained its willingness and leadership to advance on this road ever since. In 2015, the country adopted its national UHC strategy, including an implementation roadmap. In 2016, «Ministère de la Santé publique et de la prévention» (MSP) requested technical assistance to the P4H network. A GIZ-funded health financing expert was thus deployed to support the newly set-up “Cellule interministériel de coordination de la Couverture Sanitaire Universelle» (CIC). In 2018, the expert was officially introduced as a P4H Country Focal Person. Then he was and has remained contracted by GIZ, and funded by SDC.
With support from the P4H-CFP and other development partners (DPs), the Chadian government signed a law in 2019 to set up a UHC oriented health insurance system through three schemes: the «Assurance Santé des Salariés» (ASS), the «Assurance Santé des Indépendants» (ASI), and the «Assurance Maladie des Démunis» (AMED), thus one scheme for employed workers, one for the informal sector and one for the poor. The latter group was estimated as 20% of the total population for the purpose of the UHC roll out.
The P4H-CFP has played an important role in Chad. He has been serving as an entry point for UHC-related topics, providing support to government stakeholders in advancing institutional and legal frameworks, drafting strategic documents, navigating donor procedures. He has been providing technical inputs to laws, decrees, ministerial orders and strategic documents on UHC. This includes, for example, the drafting or contribution to drafting of Terms of References for studies, the revision of legal, institutional and strategic documents, such as the health financing strategy, as well as support to the write up of texts, such as the definition of benefit packages.
The P4H-CFP is a ‹moral and technical compass› who is critical for providing orientation and advice on the process for the UHC set-up. ‹UHC was an empty space when he started his work; there was nothing for us to build on›. (Quote from key informants from government institutions)
The P4H-CFPs role in facilitating joint activities and exchange visits to other countries for learning best practices is perceived as an important catalyst to boost national stakeholders. The P4H-CFP has already facilitated three exchange visits: to Rwanda (2020), Cameroon (2022), and Mali (2023). Delegates were from the Agence nationale de régulation de la CSU, the CNAS, the «Caisse d'Assurance Maladie des Armées» (CAMA), the MSP, civil society, the CIC and Ministry of Finance and DPs.
Besides, the synergies established among key actors such as WHO, SDC, the Global Financing Facility, the World Bank, Agence Française de Développement and GIZ have led to collaborative efforts and avoided duplications, ultimately contributing to the successful development and implementation of UHC initiatives. This included the pooling of resources for supporting the functioning of the CIC, the coordinated funding and technical input to studies and reviews, and the contracting of external consultants.