Since 2024, Doctors Without Borders/Médecins Sans Frontières (MSF) has been facilitating essential health care access to remote communities in Bambari, a town in the Oaka region of Central African Republic (CAR), where violence is causing the collapse of health facilities and health care.
CAR has one of the lowest rates of health care coverage in the world, with only six doctors for every 100,000 people, and half of its health facilities are not fully functional, according to the World Health Organization (WHO) in 2022. These shortcomings have a real impact on people’s lives in CAR, where the life expectancy at birth was just 53.3 years in 2019, one of the lowest in the world.
Reinforcing health care infrastructure
“Apart from poor medical coverage, insecurity, distance, lack of knowledge, the dilapidated state of the roads, the cost of transport, and endemic poverty severely restrict communities' access to health care in a country where seven out of 10 people live below the international extreme poverty line, ” explained Solomon Matlanyane, MSF project coordinator in Bambari. “In Bambari, certain areas are hit particularly hard. Since December 2023, we have rebuilt the Ngakobo health facility following looting during clashes in 2022, and it is now a functional health site for communities.”
The construction of a maternity ward at the Kidjigra health site allows MSF to extend our activities. “MSF also completed the Tongolo building at the end of 2022,” said Matlanyane.
Health centers supported by MSF are facing serious shortages of medicines and essential equipment. “We are ensuring that patients who do not have the means to get to the regional hospital in Bambari, which is almost 40 miles away, have access to care,” explained Matlanyane. “In addition, in collaboration with the Ministry of Health, we are providing comprehensive care for malaria and malnutrition, routine vaccinations, and comprehensive care for survivors of sexual violence in Kidjigra and the Tongolo project.”
Two community-based health care sites have also been established in Digui and Wogra, providing person-centered care for malaria, diarrhea, and uncomplicated respiratory infections, as well as screening for malnutrition, first aid for survivors of sexual violence, and emergency psychological support. The sites also provide referrals, including to Bambari Regional Hospital.
Support from within communities
MSF is also working with trained community health workers who live in the village to raise awareness on how to handle health issues. This helps people avoid delays in accessing consultations and identify danger signs for referrals to the health center as soon as possible. The aim is to reduce mortality and morbidity in the community.
Another health need is care for survivors of sexual violence, which is a public health emergency in CAR. An MSF report released last November found the number of sexual violence victims treated by our teams across the country tripled from 2018 to 2022.
“Even though efforts are being made to reduce sexual violence in the area, the numbers of patients I see are alarming,” said Julienne Pousselemé, one of the MSF community workers in the village of Wogra. Julienne provides survivors with the morning-after pill and psychological support, as well as referrals and monitoring. In the last two months, she has referred 10 survivors to the MSF-supported Ngakobo health center.
“We treat between 1,500 and 1,700 patients a month,” said Dr. Boris Béranger Pamatchi, the only doctor on staff in Ngakobo. “The center exists thanks to what MSF gives us. With the six services we have, we are meeting the needs of the people.”
MSF also provides reimbursement for the cost of transportation, which is another barrier to accessing health care for patients from Bambari.
“We receive patients from around Bambari who are referred to us by motorcycle,” said Dr. Narcise Stéphane Ongtiga, who is responsible for treating survivors of sexual violence at Bambari Regional Hospital. “The referral [system] has been very well received by the community, as it improves their access to care, particularly for the most vulnerable, and helps avoid patients being ‘lost to follow-up’—those who arrive just for the first treatment and then never return for their [next] appointment.”
In a country with inadequate infrastructure and equipment, and frequent shortages of medicines and vaccines, more organizations need to step up in helping the most remote communities. MSF is calling for other humanitarian organizations to scale up activities across the Ouaka region and to facilitate access to care for the most vulnerable people.
