Central African Republic
The political situation in Central African Republic (CAR) continues to be delicate. Earlier this year, Faustin-Archange Touadéra became the country’s first democratically elected president since the military coup in 2013. President Touadéra has so far struggled to bring to fruition his administration’s priorities: unity, reconciliation and disarmament of armed groups. Sectarian violence continues to plague the county and is likely to escalate further as the French SANGARIS forces are withdrawn. The ex-Séléka, anti-Balaka, Lord’s Resistance Army and other armed groups make the security situation in the country unpredictable and volatile. This in turn is adversely affecting food supplies and leading to important population displacements.
CAR has one of the lowest life expectancies in the world and ranks as the second least developed country globally in UNDP’s Human Development Index. The necessity for humanitarian assistance, especially healthcare services to meet basic needs, is evident. This is particularly so in rural areas where there is an absence of government structures, health facilities that lack supplies and a severe shortage of trained health staff. The Central African Republic has a turbulent history, yet the last decade has seen an unparalleled crisis on political, security and humanitarian levels. The current situation is described as “extremely critical” by OCHA: and estimated 2.3 million people are in need of aid in the country, more than 390, 000 people are internally displaced and a further 467, 000 refugees have fled the country. The displaced are the hardest to reach and are particularly vulnerable to malaria, one of the primary causes of death in CAR.
The international community saw the successful elections earlier this year as an indication that the humanitarian situation in CAR has and will continue to improve; as a consequence, donor budgets are reduced.This is contrary to observations carried out by The MENTOR Initiative and all humanitarian partners in the country. In a recent report, MSF writes about the situation as follows: “If CAR was one of our patients, we could say that it’s out of the emergency room, but still in need of intensive care. Discharging it now would have tragic consequences”.
MENTOR implements health care projects in the north-west of the country. This area is severely affected by past and current conflicts and represents one of the most challenging emergency situations in which to work in Africa today. MENTOR provides health services to the population in the prefectures of Ouham and Ouham-Pende, working closely with its international partners OFDA (Office of U.S. Foreign Disaster Assistance), DFID ( Department for International Development), UNICEF, and Common Humanitarian Fund. Each project is run in close conjunction with the Ministry of Health and other health partners operational in these prefectures.
MENTOR has built an innovative network of community healthcare workers which allows the provision of essential healthcare directly to even the most isolated communities, essential in this remote region which lacks most basic infrastructure. Since 2008, this network has allowed MENTOR to navigate the perpetual violence and insecurity, reaching areas that other NGOs struggle to access. Through daily consultation with communities, MENTOR is able to access risks and adjust how and where to deliver support. Community healthcare workers are recruited directly from displaced and host communities, ensuring that they are trusted, respected and welcomed into communities in a way that outsiders would not be. In cases of population displacement, the community health workers move with their communities, allowing healthcare provision to continue.
Community healthcare workers are trained to provide a package of health services: health education, diagnosis and treatment of the most common diseases including malaria and diarrhoea, screening for malnutrition, iron supplement and malaria prophylaxis for pregnant women. Their ability to identify patients with other diseases (such as respiratory infections) and/or severe symptoms of malaria and diarrhoea enables them to be transferred (using local motorbike taxis) to health facilities which are better equipped to address more serious cases. MENTOR’s community approach has been developed in close collaboration with the Ministry of Health and is fully in line with national heath policy strategies in CAR. In addition to the community healthcare network, MENTOR also provides support to a number of health posts to improve referral level health care by ensuring that the posts are supplied with appropriate medications and staffed sufficiently where state provision or support from other health partners is lacking.
Using this combination of approaches, nearly 550,000 consultations have taken place since the current humanitarian crisis started in March 2013. Of these, more than 263,000 cases were children under five years with a confirmed malaria diagnosis. Without the appropriate and timely treatment provided by MENTOR supported health care workers, these children would have been at high risk of death. In parallel to the very successful clinical results of the community based approach, very important extensive health education has been carried out to promote prevention against the most common diseases and to encourage early treatment seeking. Different approaches are applied through sensitisation activities carried out directly by the community health workers in their village, coupled with targeted training of influential people in the communities (including women’s groups and youth clubs) as well as large scale health promotion campaigns (with film projections, football matches, quizzes etc.).
Recently, MENTOR has taken on the responsibility of leading a consortium of three international NGOs (including International Medical Corps and Cordaid) funded by the UK Department for International Development to improve health care to 460, 000 people across four prefectures. Find out more about the consortium here.
The Way Forward
MENTOR remains committed to delivering health services to the most vulnerable and will continue to identify health facilities to support, as well as supervising and setting up CHW networks and coordinating activities with other NGOs. MENTOR hopes to continue operating alongside each of its partners to provide the emergency health provision that the region desperately requires. At the same time, there will be a continued focus on efforts to build up the resilience of the area, through further training of local staff and strengthening local health structures. The CAR should still be considered as an emergency setting, and MENTOR will continue working to reduce the disease burden and build up the country’s health system capacity for as long as is necessary.