Two countries in Africa’s Sahel region, Chad and Mali, demonstrate the challenges that fragile countries often face with regard to health services.
The maps below show that areas reporting a large number of armed conflict events coincide with those with the highest concentration of underimmunised children. The Sahel region faces multiple security threats together with other pressures such as climate change and population growth. The large number of refugees and internally displaced persons are pushing health systems’ capacity to their limits.
Chad and Mali: geography of immunisation and conflict
Sahel region: DTP3 immunisation rates
In both Chad and Mali, conflict is challenging the Alliance efforts to strengthen health systems and reach underimmunised children. An estimated 600,000 underimmunised children, representing around 15% of those missing out on childhood vaccines in the two countries, live in conflict areas.
Despite this, the overall vaccination coverage around conflict areas is comparable to the non-conflict areas, thanks to government and Gavi support. However, this is in largely because most conflict events take place in urban areas, where vaccination rates are historically higher than in sparsely populated rural communities.
Focusing on conflict areas will be critical to achieving higher vaccination rates and stronger health systems. While the number of children vaccinated in Mali has increased from 79,000 in 2001 to more than 2 million today, progress has stalled because of conflict and population movement. This trend is especially marked in large urban centres like Bamako.
Encouragingly, in some conflict areas (see map below), the government and Alliance partners are managing not only to maintain but in a few cases even increase immunisation rates. However, further efforts will be needed to address the impact of fragility on vaccination across the country.
Mali: variations in DTP3 vaccination coverage
Mali has wide variations in immunisation coverage rates, both across the country and within its cities. This underlines the need for tailored strategies to reach the underimmunised.
 Fund for Peace. “2018 Fragile States Index.” Pages 25-6. http://fundforpeace.org/fsi/wp-content/uploads/2018/04/951181805-Fragile-States-Index-Annual-Report-2018.pdf
 Data source : Fraym
 Data source : Fraym