Central African Republic

The oft-forgotten Central African Republic has endured 40 years of civil strife, economic crisis and military coups. In particular, the isolated northeastern Vakaga Prefecture has been the scene of clashes between rebel militias and government forces, forcing massive numbers of people to be displaced from their homes. In the wake of this violence, communities in the Vakaga continue to live in fear and poverty, with few resources and little government support. Working with community members in the regional capital of Birao and in remote locations scattered across the province, we are supporting an integrated program of primary health care, psychosocial support and community health education. The goal: Provide care now while strengthening the CAR’s capacity to provide for its people.

Where: Vakaga Prefecture
People Impacted: 57,000

Context

Often overshadowed by media attention on its northern neighbor Darfur, the Central African Republic (CAR) is a country suffering through a forgotten humanitarian crisis. The CAR is roughly the size of Texas but has only 300 doctors, who work mostly in the capital of Bangui, a five day drive from the Vakaga Prefecture during the dry season and only reachable by flight during the wet season. The people of Vakaga have suffered enormously due to a withered economy, and both internal and cross-border conflicts. In 2006, most of the region’s population fled clashes between government forces and rebel militias. Many were killed, women and children were raped and abused, homes, crops and public facilities were burned and looting was indiscriminate. In the wake of this violence, traumatized communities in the Vakaga returned home but continue to live in fear and poverty, with few resources and little support.

Primary Health
Our grantee has teamed up with the CAR Ministry of Health to strengthen its rural health capacity by providing intensive training for its health staff and traditional birth attendants, and renovating and supervising the Birao Regional Hospital, which serves 57,000 people and was virtually destroyed during the repeated attacks on the town.

Improving the community’s access to much needed medical care, especially for women and children, is essential in the short term. With a newly refurbished emergency room, laboratory, maternity & pediatrics ward, and newly restructured medical units, the Birao Regional Hospital, whose dwindling staff once performed fewer than 100 procedures a month, now averages 1,000 monthly consultations.

In the long term, the program’s focus on providing local health workers and the hospital management committee with the equipment, knowledge and support they need will ensure the continuation of such essential care and the strengthening of local capacity for the future development of the Vakaga’s health system. Improving local partners’ skills and knowledge base increases their capacity to provide quality health care and to independently manage the hospital in the future. The hospital management committee recently took a first step toward that independence; after consulting with regional officials and Birao community leaders, the management committee, in collaboration with our team, agreed to implement a cost-recovery scheme. The cost of care, €0.15 per consultation and treatment, is a very small but cumulative investment in the long term success of the hospital.

This program has been integrated with a previous water and sanitation project to provide safe drinking water and prevent water-borne illnesses.

Psychosocial Health
Assisting a community’s recovery from the trauma and psychological damage of an internal conflict is one of our core activities. In the Central African Republic, our supported program helps communities rebuild on a personal and communal level. Working in close partnership with the Birao chapter of the Organization of Central African Women and the local community, MAC has supported the construction of community centers, which reestablish social links between different social and ethnic groups living in Birao.

The centers reinforce community ties through:

The creation of safe community spaces
The organization of discussion groups, community health education workshops, and recreational and cultural activities
The provision of individual psychosocial support and monitoring, including home visits and neighborhood outreach
The teaching of various educational classes: literacy and mathematics for women, remedial school courses for children who have not had access to school and former child soldiers, carpentry, agriculture, sewing, and metal work
Outreach to vulnerable members of the community, including former child soldiers, orphans, and women suffering from gender-based violence
The reinforcement of local capacities for sustainable psychosocial support by training community leaders and members in psychosocial support, protection and community building

With three classes taught each day and between 60 and 90 daily visitors, the centers are a beloved part of the Birao community. Following our commitment to local capacity building and sustainability, our grantee spent the last year transitioning the Center to the Organization of Central African Women’s full managerial control. Using income-generating activities and minimal transitional funding, the women’s collective will soon operate the Center independently.

Community Health Education
Through Community Centers, our grantee works with local NGOs, like the CAR Youth Association for the Fight again AIDS, to run culturally sensitive health education workshops in the local Arabic dialect on hygiene, prevention of HIV/AIDS and sexually transmitted diseases, gender-based violence, and antenatal and postnatal health care. The value of preventive health education cannot be overstated if done in a culturally acceptable way. Moreover, these projects develop trusting relationships with the members of the community, enabling at-risk individuals in need of further support to be identified.