ArticleThe Pan African medical journal2013
Perceptions of the usefulness of external support to immunization coverage in Chad: an analysis of the GAVI-Alliance cash-based support.
Article in The Pan African medical journal, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.
- Health services uptake among nomadic pastoralist populations in Africa: A systematic review of the literature.PLoS neglected tropical diseases · 2020Pooled it
- Digital payments of health workers within vaccination campaigns: a mixed-methods study in Chad.BMJ global health · 2026Article
- Molecular characteristics of hepatitis B virus among students and pregnant women in Chad.BMC infectious diseases · 2025Article
- Prevalence of hepatitis B virus infection and its associated factors among students in N'Djamena, Chad.PloS one · 2024Article
- [Determinants of vaccine acceptance in Makokou, Gabon].The Pan African medical journal · 2024Article
- The Governance of Childhood Vaccination Services in Crisis Settings: A Scoping Review.Vaccines · 2023Article
- Challenges to implementing Gavi's health system strengthening support in Chad and Cameroon: results from a mixed-methods evaluation.Globalization and health · 2017Article
- Global health initiatives in Africa - governance, priorities, harmonisation and alignment.BMC health services research · 2016Review
- Exploring the influence of the Global Fund and the GAVI Alliance on health systems in conflict-affected countries.Conflict and health · 2015Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionChad is one of the countries supported by the GAVI-Alliance that remains with unsatisfactory vaccination coverage. This paper tries to understand the main barriers to better coverage.
methodsThese barriers were categorised as up or downstream against the health system building blocks as proposed by WHO and compared with barriers and activities identified by the country in its health system's strengthening grant proposal as approved by the GAVI Alliance in 2007. Data were collected using a modified Delphi system and by analysis of grant and annual report documents.
resultsMost of the activities anticipated under the GAVI health system's strengthening proposal are activities targeting downstream barriers (the neglect of upstream issues is of major importance in a decentralised state like Chad) and aligned with, not complementary to, immunization services strengthening activities. Further, both set of cash grants are blind to important recommendations such as the need to address barriers at the level of leadership and governance and at the level of the financing system and also about initiatives to promote community demand of vaccination services.
conclusionIN CHAD SLOW VACCINATION PROGRESS IS AGGRAVATED BY SEVERAL CONTEXTUAL BARRIERS: the size of the country, the low population density, the nomadic nature of a significant part of its peoples, the recent civil war, associated with civil unrest and political instability and its geographical localization. In this situation it would be important to sustain downstream operations (the major focus of the ISS grant) while taking a long term view of the needs of the health system. The GAVI effectively supports downstream operations, but neglects the long term view.
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