In this article, we summarize how it was possible to increase the number of outreach sessions to reach zero-dose children in the sparsely populated regions of Chad.

More than 31,000 children were vaccinated with four antigens in three historically lagging provinces over a period of three months, by financing additional vaccination strategies in a targeted manner. This equates to an average of ten percent of the annual coverage target per province (for both BCG and Penta 1 and 3) with on average over 23 percent of those vaccinated being zero-dose children.

In order to reach all eligible populations, we have been implementing targeted funding of outreach strategies in eight low-performing health districts (i.e. districts exhibiting a low number of vaccination sessions).

The aim was to improve the total number of outreach sessions, increase the number of children vaccinated in outreach strategies, immunise zero-dose children and facilitate financial support to beneficiaries.

The support involved financing the implementation of eight additional sessions per health centre across 142 health centres. The method opted for was to make the funds available beforehand and to proceed with justification following implementation of the interventions. These interventions have enabled us to obtain the following results in the wake of a 3-month pilot:


Increase in BCG and Penta 3 coverage via outreach strategies: The Chari Baguirmi province has a particularly high yield due to its population density and the time period selected (corresponding to the weekly market period)


Contribution of outreach strategies to reaching zero-dose children per health district

The pilot results demonstrate the contribution outreach strategies make to reaching eligible populations. We observed that a high proportion of zero-dose children lived in low population density health districts. Targeted financing of outreach immunisation strategies is better at reaching these areas and therefore has a high impact on immunisation coverage and equity -something we should generalise for other projects and interventions.


Gedeon Ndakmissou & Nils Turner