Background  

Conflict in the Central African Republic continues and the country remains highly unstable. Fighting between the opposing Séléka and Anti-Balaka factions has resulted in thousands of deaths and displaced millions. The situation in the capital Bangui – where international forces are stationed – is more stable, but frequent skirmishes and widespread crime mean that tensions remain high. One in five people have been displaced from their homes due to continuing armed conflict in the region. Essential infrastructure and public services are on the verge of collapse and are inadequate to meet the needs of the population. Medical facilities and services are limited and face extreme pressures. This is the context in which both the national health system and EMERGENCY must operate.

Since the beginning of EMERGENCY’s collaboration, the Complexe Pédiatrique public hospital in Bangui saw 46,233 surgical outpatient consultations, carried out 12,380 surgical interventions, and admitted 5,158 patients. It saw 76,803 general medical outpatient consultations and admitted 8,495 patients on other medical grounds. In 2017 alone, the hospital saw 44,000 children. 1 in every 4 children admitted to intensive care was under one year of age.

Surgery at the Complexe Pédiatrique

Following a coup d’état in March of 2013 – and upon invitation by health authorities – we began working in the public paediatric hospital that is the sole reference point for paediatric provision in the entire country: the Bangui Complexe Pédiatrique. The hospital was at the centre of a precarious healthcare system further weakened by conflict, the effects of the coup, and an exodus of medical staff.

From the outset, we assumed co-managerial responsibility for the running of most aspects of the hospital, from the surgical area and first aid, through to intensive and sub-intensive care units. We also began to collaboratively manage all support services: laboratory, diagnostics, sanitation, logistics, and administration. Working closely with local staff, our doctors and nurses quickly re-established two operating theatres and immediately began providing war-related and general surgery. With security conditions slowly stabilising, war-related admissions and surgeries became less frequent, and the focus gradually shifted to general emergency surgery. From June 2016, we broadened our work at the Complexe Pédiatrique to include management of the following departments: A&E, Outpatient, Intensive and Post-Intensive Therapy, Pharmacy, and Radiology.

Today, the Complexe Pédiatrique is the primary point of referral for critical paediatric patients from facilities throughout the country. The quality of medical provision at the Complexe Pédiatrique has improved since our collaboration began. Mortality in the ICU has fallen from 26% to 11% and in the post-operative ward from 5.5% to 1.6%.

Training Medical Professionals

In a country where there is only one doctor for every 100,000 people, we also aimed to contribute to the development and long-term sustainability of the national healthcare system. With this in mind, since 2015 we collaborated with the Faculté des Sciences de la Santé (Faculty of Health Sciences) at the University of Bangui in order to relaunch academic courses that have provided training for a new generation of doctors and nurses. Every three months, over 90 students are trained in nursing, and more than 70 in medicine. Overall, more than 300 students qualified in medicine and nursing during 2017.

Our involvement has strengthened the Complexe Pédiatrique, helping in turn to strengthen the national healthcare system as a whole. The success of the model has been recognised by the Central African Ministry of Health and the international community.

Transferring Operational Responsibility

In the space of 5 years our involvement transformed the Complexe Pédiatrique, and catalysed the reconstruction of the national health system. Thanks to the active participation of local and international institutions, all of the hospital’s services – including the distribution of medicines – are available absolutely free of charge. The universal right to free and high-quality healthcare has always been a core component of EMERGENCY’s humanitarian work.

Having acquired clinical and administrative autonomy, we agreed with local authorities the timeframe for a gradual handover of operational responsibility. Until this process was fully finalised, we continued to supply and staff the hospital as required in order to guarantee complete functionality and uninterrupted care. 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 EMERGENCY’s absence, thus ensuring its financial viability.

On 30 June 2017 the handover was finalised, and operational responsibility for the facility was transferred to the Central African Ministry of Health. Witnessing the event were senior representatives from the Central African Government, including 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 families. It was an important moment for all those who have worked tirelessly and in challenging circumstances to ensure the project’s success.

Our work in the Central African Republic continues with ongoing activities at our Bangui Paediatric Centre. We are also continuing to support the National Blood Bank, the only facility capable of collecting and distributing blood throughout the country for life-saving treatments.

The Bangui Complexe Pédiatrique is co-funded by the Italian Agency for Development Cooperation.