Chad: improving maternal health

Title Improving maternal health in Chad
Description With funding from Guernsey Overseas Aid and Development Commission, Cyan is supporting Guinebor II Hospital to improve maternal health for women in north N’Djamena, Chad. The project delivers community awareness trainings, training hospital midwives, providing hospital care, and advocating for improved standards.
Status  Implementation
Dates  Start: September 2014; End: August 2017
Implementing partner  Cutting Edge Foundation / Guinebor II
Location  Chad
Sector  Health


When the project started in 2014, Chad was significantly off track from reaching its Millennium Development Goal 5 target (MDG5) of a 75% reduction in the Maternal Mortality Ratio (MMR) by 2015, and had the third worst MMR in the world. A woman in Chad had a 1:15 chance of dying from a maternal cause in her lifetime.

Chad’s Human Development Index is positioned at 183/187. Latest figures state that doctor to population ratio is 1:25,000 (2013)[1], maternal death rate is 856 per 100,000 live births (2015)[2], and only 22.7% of births are attended by a skilled health personnel (2010)[3].

Women in the project location are generally illiterate, have many pregnancies and are at risk due to the poor maternal health care provided in Chad.

[1] WHO World Health Survey 2013

[2] MDG indicators

[3] MDG indicators


The Guinebor II community hospital is an NGO registered with the Chad government. It was established by the US-based Cutting Edge Foundation in December 2010 at the request of the Ministry of Health for Chad. Guinebor II and another similar sized hospital 7km away serve the population of north N’Djamena (17 villages; around 18,000 households).

The hospital provides medical training as well as on-going delivery of general medical services. This is achieved through the primary health care clinic, pharmacy and basic laboratory, with 34 beds for medical, surgical, obstetric and paediatric in-patients. A new maternal health centre was opened in 2015.


  1. Community awareness: community midwifes will run workshops in the community stressing the need to access the hospital for antenatal care and delivery. Over the three year period, the aim is to have 1,000 women educated and ready to both advocate for and access good antenatal care and practice safe birthing.
  2. Service delivery: The hospital will continue to provide comprehensive emergency obstetric care at a high standard. As the number of women attending the hospital for antenatal care and birthing increases due to the community awareness activities, we expect to see a corresponding decrease in maternal deaths and obstetric complications in the area. It is anticipated that the hospital will see at least 3,700 births over the course of the three-year project.
  3. Capacity building: 18 midwives will be trained from a mixture of existing hospital staff and students from local midwifery training schools. The improvement in quality of the midwives training will lead to an improved standard of care at the hospital and among other health providers as the midwives take up jobs in hospitals around the country.
  4. Advocacy: As Guinebor II becomes a model hospital it is hoped that it can serve as a template modelling good practice, and through regular meetings with the health authorities’ lead to improved policy and practice on maternal health.


Key achievements from the second year of project implementation (2015-2016) :

  • New forms for the management of antenatal care and birth have been put into use and are enabling an improved management of pregnancy, labour and birth.
  • By the end of Year 2, community awareness programmes have made major improvement in women’s understanding on: Nutrition and its prevention of anaemia, malaria and its prevention, preparation for birth and what to do to improve progress of labour.
  • Number of women attending antenatal care has increased from 2,147 in year 1 to 2,749 in year 2.
  • Women are more aware of the indicators of when pregnant women can go to the hospital, antenatal sessions, labour care and when there are signs of alert. InYyear 2, a total of 1,532 births took place at the hospital and Caesarean sections continue to take place. 24-hour care is available when necessary.
  • There was an increase in the uptake of family planning.
  • Five midwives have received training on obstructed labour and post-partum bleeding (2 modules)
  • Nine midwives have received training on eclampsia (1 module)
  • Since June 2016, four Guinebor midwives have completed training on post-partum haemorrhage
  • The hospital is able to provide treatment for cases of HIV, purchase and provide all necessary drugs and materials required for surgery, delivery and antenatal care.

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