The Central African Republic is one of the poorest countries on the planet. Since attaining independence in 1960 it has been in a state of constant instability and today, according to the United Nations, occupies last place in the Human Development Index rankings.
In March 2013, a coup d’état overwhelmed the country, causing it to plunge into chaos. The consequences for the population have been enormous. The nation has been consumed by unprecedented insecurity and violence. Children are among the main victims and 1 in 5 people have been forcibly displaced from their homes due to the armed conflict in the region.
Essential infrastructure and public services, which have always been inadequate, are now on the verge of collapse. The already fragile health system is facing extreme pressures. A lack of medicines, equipment, and, above all, of qualified health personnel are some of the main factors that preclude responsiveness to the needs of the population.
Since the rebel attack on the capital, Bangui, the EMERGENCY Paediatric Centre (operational since 2009) remains the only active paediatric facility and activities have become even more intense.
Shortly thereafter, the Director of the Complexe Pédiatrique of Bangui (CPB), the only paediatric hospital in the country, requested our help in order to guarantee the continued provision of surgical services in the city.
At the time, only 2 paediatricians and 2 paediatric surgeons were working at the Complexe Pédiatrique; in a country where 50% of the population is under 18 years of age. As a result of the conflict, most health personnel have left the country in order to escape the violence and looting of facilities.
In 5 years our support has completely changed the hospital, by guaranteeing the right to free and high quality health care as well as by triggering a reconstruction process of the National health system, in collaboration with local and international authorities.
In April 2013, a surgical team was sent to re-open and renovate the two operating rooms and the whole surgery department which comprehend also the sterilisation room and the intensive care ward, transforming the hospital into a core component of the national healthcare infrastructure. After devoting the initial weeks exclusively to war surgery, we initiated an emergency surgery program for trauma, fractures, burns, and victims of road or domestic accidents.
Upon our arrival, it was clear that the hospital had been damaged by years of neglect. We found scooters parked in the operating theatre, staff cooking in the sterilisation area, and chickens walking around the wards. Hygiene standards were very poor, and many patients succumbed to minor infections.
We are committed to ensuring the highest hygiene and cleanliness standards in the hospital. Our cleaners have cleaned walls, floors, and every surface of the hospital. Logisticians repaired machinery, wiring and sterilisation machines, and ensured that ventilators and monitors were fully functional.
Even today, the lack of qualified personnel is one of the major challenges facing the national health system: there are only 250 doctors throughout the Central African Republic. Since 2015, we have collaborated with the Faculté des Sciences de la Santé of the University of Bangui. Thanks to this partnership, we have fully trained and accredited 14 paediatric specialists. Furthermore, we have trained 90 nursing students and over 70 medical students every month since February 2016.
A core element of the project is the training of doctors and nurses (according to international standards) and the creation of a new, integrated university-hospital system. Training is a fundamental component of all EMERGENCY projects because it allows us to meet the immediate needs of the population, and to contribute to the future of the country’s health system.
Thanks to the positive results obtained over the years, we have expanded the scope of our project. At the request of the hospital management, we have assumed responsibility for the major activities within the facility: the emergency room; the intensive and sub-intensive care departments; the triage area; as well as logistical and auxiliary services such as the laundry and the laboratory. In 2017, we started to support also the remaining wards.
During this period, we have committed ourselves to respond not only to immediate health needs, but also to promote the development and effective functioning of the entire national health system.
Ineffective hospital management hindered the provision of an effective service. Together with local staff, we have developed a new administrative and management system; introducing patient care protocols, diagnostic service supervision, cleaning and sanitising of rooms, maintenance of hospital premises, and the ordering and distribution of medicines.
Faced with the absence of an extensive health network which can provide healthcare for people throughout the Central African Republic, we have established a referral system for patients from isolated and rural communities. The Complexe Pédiatrique has become the reference point for paediatric patients throughout the country, finally ensuring high-quality standards of care. Where in the past treatments had associated costs, healthcare services provided by EMERGENCY are absolutely free of charge and available to all.
Our collaborative project at the Complexe Pédiatrique in Bangui was complex and full of new challenges, such as the co-management of a public hospital at the heart of an entire health system. In addition to the numerous patients treated, our working method has aimed to provide a long-term and sustainable perspective: an approach which has proved very fruitful.
The new governance system and the strengthening of local management competencies have improved efficiency and healthcare outcomes within the hospital.
The economic resources that the Complexe Pédiatrique continues to receive are the result of relationships of trust that, over the years, have been built between the hospital, the Central African Ministry of Health and, above all, the international community.
Today, the Complexe Pédiatrique has acquired partial autonomy – both managerial and clinical – and it is therefore time for the hospital to enter a new phase. The hospital still requires financial support, but full autonomy must be a priority. In a public hospital it is desirable that management be localised, as an integrated part of the national health system. In order to achieve this, we have agreed a timeframe for the gradual and definitive transfer of operational responsibility to local health authorities, which involved also the Italian NGO Medici con l’Africa CUAMM, that from July will support the hospital.
In recent months we have begun the transition process to transfer all the necessary skills to manage the hospital independently to our local counterparts. Thanks to the support of the Italian Agency for Development Cooperation, we left to the hospital all the necessary to guarantee the functionality and the continuity of the care in the next months. We have also ensured that the funds promised by institutional donors for the management of the Complexe Pédiatrique over the next 3 years will remain available to the hospital, even in the absence of EMERGENCY, ensuring its economic viability.
On 30 June, the handover was formalised, and operational responsibility for the facility was transferred from the director of the hospital to the Central African Health Ministry. There to witness the event were senior representatives from the Central African Government, the Minister of Health, officials from the Italian Agency for Development Cooperation, ambassadors from Italy and the European Union, and, most importantly, our patients and their parents.
It has been an important and exciting moment for those of us who have invested a great deal of energy in this project. On numerous occasions we have been required to work under significant pressure, but the difficult conditions never pushed us to leave the country. During the coup, when many other organisations chose to withdraw, EMERGENCY felt it necessary to remain.
The Italian Agency for Development Cooperation (AICS) has reiterated the importance of the Complexe Pédiatrique as the fulcrum of the Central African health system, and has supported our work since October 2015. With an invaluable contribution of one and a half million euros, the AICS co-financed the training of local Central African staff and the implementation of healthcare services within the hospital. More recently, the support of the AICS has been essential during the delicate transition phase.
Our commitment in Central African Republic continue. From July 2018, we will be more involved in the Paediatric Centre, in order to guarantee a complete treatment to the chronic illnesses. Starting from December 2017 we are committed to create a first filter for all those diseases that, if neglected, bring hundreds of children in critical condition to the Complexe Pédiatrique. We will continue also our support to the National Blood Bank, the only facility able to collect and distribute blood sacks to the whole country.
Jeremy is 15, he comes from Bambari, one of the Central African Republic provinces, around 400 kilometres from the capital Bangui. He was coming back by moto with a friend when suddenly another moto hits them. The crash, the din and the fear. Jeremy wakes up soon later and his leg is wounded. Every movement is painful.
Where Jeremy lives there are no health facilities that can operate on him. Few hours later, he is referred to the Complexe Pèdiatrique of Bangui, the only hospital that can take care of him.
Enrico, our surgeon, welcomes Jeremy and brings him to the operating theatre. As soon as the staff leaves the room, Enrico reassures him. “Nothing serious, it’s only a compound fracture. You just need to be patient and perform physio and rehabilitation exercises”.
During these two months, his mom has never left him. Today, Jeremy, with the help of crutches is able to walk and soon he will return back home. “The doctors have been so nice with me. But I’m looking forward to going back to school with my classmates”.
Good luck Jeremy and enjoy school on the behalf of all the EMERGENCY STAFF!
people in the Central African are in need of humanitarian assistance
of the population are children under the age of 18
partially or totally functioning facilities across the country: around 34% of the total, for an average of one clinic every 1.832 km2
red codes per day
surgical operations from the beginning of the activities
A&E visits in 2017
In 2013, the CPB was able
to handle around 10,000
residents in Paediatrics
students trained each month in Nursing since 2016
international staff involved from 2013
national staff working today at the CPB
the total cost of activities from 2013,
of which 39% comes from institutional donor funds
and 61% from EMERGENCY funds
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within the projects AID 11293 and AID 10894.
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