The car slowly parked into an empty area near the health centre in Bebedjia, a village in the Logone Oriental region in southern Chad. It was the second week of a long field mission, and after having visited numerous health facilities, we were bracing ourselves for more devastating stories.
In Bebedjia, the health centre is a very small one. No running water or electricity here, but the majority of deliveries happen at night. We naively asked how the medical staff could help women give birth without electricity in the middle of the night.
A nurse frowned and looked at us as if the question did not make any sense: “We use the phone”. He must have read in our dumfounded glances that some more explanation was needed: “like this…we light the torch of the telephone, hold the phone in the mouth to free the hands and proceed to delivery. Just as simple”, he says, smiling. This was his daily routine and somehow he got used to it.
The health centre, however, is not far from Bebedjia’s brand new hospital, “built with oil money”. From 2010, the government initiated major investment projects and mainly on infrastructure such as specialized health care institutions, hospitals, health centres, schools and universities. While this infrastructure was needed, most of the projects were poorly resourced.
Why did not they come earlier? The smiles are embarrassed, eyes modestly turned away. “It's expensive,” finally replies one of them
The big and brand new building of Bededjia is a hospital only in name, as some of the most basic medical equipment is missing. One of its two operating theatres is empty, the other very summarily equipped. “We furnished it ourselves, retyping equipment from other hospitals in the area,” say staff members.
Even closer to the hospital, virtually adjacent to the big building, another health centre saved from the closure in 2015 by a donation of drugs by the Regional Pharmacy Supply (Pharmacie Régionale d’Approvisionnement-PRA). On the day of our visit, we meet a dozen pregnant women aged between 16 and 36 who have come for their ante-natal check-up. They came on foot, some from as far as 15 kilometres.
For all but one, it was the first health check in more than five months of pregnancy. Why did not they come earlier? The smiles are embarrassed, eyes modestly turned away. “It’s expensive,” finally replies one of them. But are they aware of the risks involved in carrying a pregnancy without any health check. They are very aware of it but cannot afford to pay for medical examinations and medications, they only come in cases of extreme necessity.
In Chad, these pregnant women, like the general population, pay the high price of austerity measures taken by the government. Since 2015, the country has been facing a serious economic crisis, mainly due to the sharp fall in the price of crude oil. To cope with this, the government has implemented drastic and indiscriminate austerity measures that reinforce existing precariousness and vulnerabilities while creating new ones. In this context, Chad loses sight of sectors that should remain priorities even in times of crisis: health and education. With the advent of the economic crisis, funding was slashed and the health budget in 2017 was cut to half the level of 2013.
The budget and spending cuts applied across the board and affected all key budget lines including investments, current transfers, material assets and services and health workers’ salaries. In addition, in August 2017, a ministerial ordinance reduced the categories of emergencies covered under the free emergency healthcare programme from 45 to five but in reality patients still need to pay for emergencies covered under those five categories because of the lack of equipment and free medicine.
On 16 July, Amnesty International launched a report to highlight the consequences of the austerity measures on the population’s economic, social and cultural rights.
The Chadian population, already one of the poorest in the world (186th rank out of 188 according to the Human Development Index for 2016) is paying a high price for these measures in a country that is sorely lacking qualified health personnel: 2 per 10,000 inhabitants against the 23 recommended by WHO.