Central African Republic

WHO AFRO

Central African Republic

People in need: 3.4 million¹
People targeted: 2.4 million
Requirements (US$): 8 million

Context

Since the beginning of 2022, the epidemiological situation in the Central African Republic (CAR) has been dominated by several diseases with epidemic potential that have not spared any region. Until November 13, CAR recorded multiple diseases with epidemic potential, including measles, pertussis, yellow fever, COVID-19, canine rabies, mpox and vaccine-derived polio.

In addition, the country continues to face other diseases that are the main causes of morbidity and mortality, including malaria and diarrheal diseases.

Beyond the country's poor epidemiological profile, attacks on the health system continue, with 19 attacks experienced in 2022. Moreover, according to the Multisectoral Need Assessment (MSNA) 2022 report, one third of households are more than an hour away from a health facility and nearly 40% are unable to pay for their care. As a result, CAR has one of the highest death rates in the world, at 11.76 deaths per 1 000 inhabitants according to the World Bank. A quarter of these deaths are among pregnant women. With the lowest coverage of qualified health personnel on the continent, one-third of women in CAR continue to give birth at home without medical assistance.

Transhumance, armed conflict and epidemics, coupled with food insecurity, will reduce the ability of households to access health care and further weaken CAR's health system.

In addition, as of 2022, there are at least 505 000 internally displaced persons (IDPs) in CAR, who require urgent assistance. Of these, 141 000 live in IDP camps and 364 000 live with host families. 744 000 CAR refugees were also registered in neighboring countries. Compared to 2021, the number of newly displaced people increased in 2022, while the number of returnees decreased.

Emergency response

WHO and partners will continue to support CAR to scale up and sustain infection prevention and control, infectious disease surveillance and investigation, point of entry surveillance and genomic surveillance and to strengthen the national laboratory system’s capacity for laboratory confirmation of outbreaks. The health information system’s capacity to generate reliable data in real-time will be strengthened and risk communication and community engagement will be enhanced for more effective management of the infodemic and enhanced community adherence.

Emphasis will be placed on ensuring the continuity of quality essential health services during health and humanitarian emergencies. Investments made in recent years in terms of the construction of health facilities, donation of medical materials and equipment and vehicles will be strengthened to establish a resilient health system.

The response to epidemics and humanitarian crises will continue to benefit from the technical expertise of the existing human resources of the WHO country office, as well as those of the regional office and headquarters. Staff will be brought closer to the areas of intervention through the WHO sub-offices.

Strategic objectives

Key activities

Conduct risk and vulnerability assessments, and develop a multi-hazard plan and contingency plans for priority risks
Conduct in-action reviews, after-action reviews and simulation exercises
Train RRTs in 7 regions and deploy them for outbreak investigation, risk assessment and situation analysis
Reinforce routine immunization, and national infection prevention and control strategy (IPC)
Construct IPC/WASH facilities (triage units, water storage units, incinerators, latrines and showers) in targeted health facilities
Prevent sexual exploitation and abuse
Strengthen capacities for timely detection, rapid reporting and confirmation of all outbreaks and other health emergencies
Develop and implement an efficient and sustainable system for the transport and transfer of samples in all sectors
Establish a regular supply of quality reagents and consumables for laboratories
Strengthen biological diagnostic and sequencing capacities of reference laboratories (LNBCSP and IPB)
Support the Transforming African Surveillance Systems (TASS) project will further strengthen this priority
Ensure the response to health crises and outbreaks is implemented in accordance with the standards of the emergency response framework
Strengthen the capacity of the public health emergency operations center (PHEOC) by making it more functional
Provide medical equipment, laboratory equipment, essential drugs and kits for the response to outbreaks and health emergencies
Strengthen Risk communication and community engagement
Deploy mobile health teams in difficult-to-reach areas
Making available functional storage facilities that meet the standards
Implement research activities
Develop and implement a maintenance and quality assurance plan for the laboratories of the different sectors
Strengthen the coordination of humanitarian actors through the health cluster and other mechanisms in place in the country

Funding requirements

Overall country funding requirements, including COVID-19, by pillar (US$’000)

Success stories

WHO AFRO
Bangui, December 2022: Workshop for development of Operational National action plan for health security (NAPHS) and case Investment.

Integration of COVID-19 vaccination with other immunization campaigns boosts vaccination coverage

The Central African Republic (CAR) Ministry of Health and Population has worked to integrate its COVID-19 vaccination campaign with other immunization campaigns in response to the COVID-19 pandemic. One of the goals of the program was efficiency as a single team and budget can be used for several interventions, thereby optimizing available resources and delivering several services effectively.

The objective set by the National Plan for Vaccination Deployment was to vaccinate 70% of the target population (3 921 000 inhabitants) by 31 December 2022. To achieve this, the Ministry of Health and Population, with the support of partners, therefore opted for the integration of COVID-19 vaccination into all public health activity packages and the intensification of vaccination campaigns.

The COVID-19 vaccination campaign was integrated with several activities, including polio campaigns, routine immunization and livestock immunization. This innovative integration approach has led to an exponential increase in vaccination coverage, which rose from 15% in February 2022 to 50% in December 2022.

CAR confirmed its first case of COVID-19 on 14 March 2020. Despite the restriction and prevention measures put in place by the government (containment, closure of gathering places, systematic screening, isolation of positive cases, etc.), existing data show 15 330 positive cases and 113 deaths recorded as of 4 December 2022. For a country prone to a glaring lack of financial, human, material and infrastructural resources, it was especially necessary to find innovative strategies like these to control the epidemic.