It costs more to vaccinate a child in Chad against polio - almost 70 US cents per child - than any other country in the world at risk of an outbreak, according to the World Health Organization (WHO).
It costs half as much to vaccinate a child in violence-wracked Afghanistan, Sudan or Somalia.
WHO polio coordinator Mohammed Mohammedi, who was kidnapped in Somalia in 2001 by militias and held hostage for four days, is now working in Chari Baguirmi, the Chad region with the second highest number of reported polio cases in 2009 after the capital, N'Djamena.
He told IRIN the main reason Chad had not been able to wipe out an outbreak after almost two years was lack of money and corruption. "Not enough of the money intended for polio campaigns makes it to the population in Chad. This money disappears in the capital and never makes it to health centres." He reckoned only 60 percent of the funds for polio vaccination campaigns were used to fight polio.
In 2010 donors have been called on to raise US$10 million for polio eradication in Chad.
Speaking to IRIN last December, Oliver Rosenbauer, spokesman for the multi-agency Global Polio Eradication Initiative (GPEI), said corruption boosts polio costs in Chad. "Less than half the children who need vaccinations are being reached in the capital, the most affected area. Campaigns have been poorly run and managed. There is poor financial tracking and almost non-existent management. "
The government's coordinator for polio vaccinations, Sylvain Djimrangar, told IRIN it had been a "challenge" to trace polio spending from the national level to health centres.
Chad's WHO representative Youssouf Gamatié told IRIN that while it is difficult to know how much money is misdirected, his team frequently reports that during campaigns there are no cars to transport vaccines - sometimes even no vaccinators. The government receives money for car rentals and US$10 per vaccination team of two people per day. A typical campaign lasts three days.
Photo: Phuong Tran/IRIN
|No more form-filling for vaccinators in Chari Baguirmi, which allows respected, but illiterate, village leaders to be vaccinators|
While GPEI's Rosenbauer pointed out the lack of political will and buy-in as longstanding impediments to eradicating polio in Chad, Gamatié told IRIN President Idriss Deby Itno is steadfast in cracking down on corruption. "[The president] explicitly said [in a recent meeting]: 'We have seen behaviour of local health staff that goes contrary to government action... It is the responsibility of the minister of health to take charge so that there is no longer this type of behaviour.'"
Role for regional governors
As of February, polio vaccination funds are sent to regional governors to increase their involvement - and oversight - of polio activities. No more costly trips for supervisors from the capital into the field, said Gamatié.
"Progress is being made," he told IRIN. "More and more, [decentralized] financial oversight committees are becoming operational; more and more authorities are involved, [and] national staff are sacked for mismanagement."
Government coordinator Djimrangar told IRIN regional financial committees should improve oversight. Starting in 2010, the government has started investing more money in health education for all vaccination campaigns.
There were 66 reported cases of polio in Chad in 2009, 15 of which were in the N'Djamena region. The virus causing polio is highly infectious; once it invades the nervous system, it can cause total paralysis in a matter of hours. WHO considers even one reported case an outbreak.
The health district reporting the most cases was in the Chari Baguirmi region, which has a population of 621,000, according to the latest census. It is suspected of being the origin of the latest polio outbreak, in April 2008.
WHO's Gamatié said polio vaccinations in Chari Baguirmi started one week earlier than the nationwide campaign - to allow enough time to reach all the children, some of whom have not been vaccinated in years. Vaccination plans and maps were drawn up for the first time.
One village vaccinator per village
The cases reported here in 2009 were "just the tip of the iceberg", WHO polio coordinator Mohammedi told IRIN. "Those cases were accidental discoveries. During vaccinations, we saw children who were paralyzed who may have been infected with polio." Twenty of 59 WHO designated health "catchments" do not have functioning health centres, he said.
WHO is piloting the recruitment of one village vaccinator per village - about 3,000 for Chari Baguirmi - rather than using roving vaccination teams that were required to be literate.
"What is important for a vaccinator is not so much that this person can read and write, but rather that the community respects them. Ideally, we can get the village chief. There is no missing children this way because the vaccinator lives right there," Mohammedi said.
The government receives 10 US cents per child vaccinated (proved by finger markings) rather than getting money upfront per vaccination team.
Once a village completes its vaccinations, a supervisor reviews progress. If a village vaccinated at least 90 percent of its under-five children, the vaccinators are paid.
"There is no reason we cannot wipe this virus out in the next six months," Mohammedi told IRIN. "Or even sooner."