Since gaining independence from France in 1960, the Central African Republic has repeatedly experienced political crises. Following the civil war in 2013, the living conditions of the population have deteriorated massively and the healthcare system has collapsed. The staff of numerous health centers had to flee. As a result of looting, many health facilities now lack medicines as well as urgently needed medical materials and equipment. As a result, maternal and infant mortality rates are among the highest in the world and neglected tropical diseases (NTDs) such as leprosy, filariasis, Buruli ulcer and worm diseases are finding a fertile breeding ground.

This situation affects the people in the Sangha Mbaéré health district in the southwest of the country particularly badly, as they live in remote areas and are often far away from the nearest health stations. This includes the ethnic group of the Aka, who live as semi-nomadic hunters and gatherers in the tropical rainforest in the Congo Basin. Deforestation of the rainforest is massively restricting their habitat and forcing them to change their traditional way of life. They are openly discriminated against and the vast majority have no access to healthcare due to their low purchasing power.

With our project, we enable neglected people - especially the marginalized Aka - in the Sangha Mbaéré health district to access urgently needed healthcare. The focus is on the early detection and treatment of neglected tropical diseases and the health of pregnant women, mothers and their children. A voucher system gives disadvantaged women the opportunity to take advantage of free prenatal examinations and to give birth to their children under medical supervision. In addition, a transportation and treatment system is being set up to ensure that FAIRMED also reaches people living in remote areas and enables them to receive often life-saving treatment in emergencies.

Our local employees also ensure that the 34 healthcare facilities in the project area are equipped with medicines and medical supplies as required and provide training and further education for healthcare staff. In addition, they educate people about how they can improve their own health and promote their self-determination - especially that of the Aka - by enabling them to actively participate in the management of the local health facilities, among other things. To this end, FAIRMED works closely with the local health authorities.

The main objective of the project is to improve health care in Sangha Mbaéré and to empower the disadvantaged groups living here. To achieve this overall goal, the project pursues the following specific objectives, which will be achieved through the activities listed below, among others:

Strengthen community activities and health facility competencies to combat neglected tropical diseases and promote mother and child health

• Community actors (traditional healers, community mediators and people from indigenous peoples' organizations) and health workers are trained in the detection and treatment of neglected tropical diseases with skin lesions (leprosy, frambösi, Buruli ulcer) and sleeping sickness.

• The voucher system promotes mother-child health, including the treatment of obstetric emergencies in the health institutions supported by the project.

• Recognition and treatment of skin NTDs (leprosy, framboesia, Buruli ulcer) and sleeping sickness is ensured among the population of the project area.

Strengthen the management committees and the cooperation between FAIRMED, the national programs and the district to ensure the sustainability of the services offered and the fight against NTDs

• The management committees and the health district are strengthened.

• Training-related supervision and inter-sectoral cooperation are effectively strengthened.

Supporting the ethnic minorities of the Aka and Peulh communities in asserting their right to health

• The marginalized minorities (Aka and Peulh communities) are included in the decision-making bodies (health facility management committees).

• The relevant authorities address complaints of abuse by disadvantaged groups (including gender-based violence). Participation and co-determination of disadvantaged groups in all bodies is guaranteed.

• Lobbying the relevant authorities to ensure that the subject of civil rights is taught in depth at school.

• Carry out mass awareness campaigns on the civil rights of minorities. Training local authorities on minority rights.

• Sensitizing disadvantaged groups for their integration into various decision-making bodies.

• Organizing marginalized groups so that they can better represent their interests.

Better quality of health care is ensured

• Awareness-raising and mobilization campaigns on various health issues in the villages.

• Development and introduction of the voucher system: The voucher system gives disadvantaged women the opportunity to take advantage of free prenatal and postnatal examinations and to give birth to their children under medical supervision.

• Strengthening the skills of those responsible for health in the health facilities to ensure good management of the health facilities

• Establishment of a transportation and treatment system for medical emergencies: Procurement of a vehicle and 2 motorcycles that can be used to transport patients to the nearest health facility.

Correct and effective control of NTDs is ensured

• Implementation of active case finding and treatment of neglected tropical diseases by health workers. FAIRMED health workers visit the various communities. They will actively search for cases of NTDs such as leprosy, buruli ulcer, frambozia, etc. They will actively look out for cases of NTDs such as leprosy, buruli ulcer, frambozia, etc. and start treating patients on the spot.

• Collaborate with traditional healers and other partners on proper treatment of NTDs.

• Provide health facilities with essential medicines to treat neglected tropical diseases.

The health facilities are supported in hiring enough qualified health personnel and paying them appropriately

• Doctors, nurses, midwives and auxiliary nurses are employed with the support of FAIRMED and appropriately remunerated according to the guidelines of the United Nations Office for the Coordination of Humanitarian Affairs (UN-OCHA).

All FAIRMED projects are implemented in cooperation with the local official agencies and with the inclusion of the population on the ground. The regional FAIRMED country offices are staffed exclusively by local employees. With this approach, and aided by consistent monitoring, problems can be identified in a timely manner, causes can be analysed, and methods and objectives can be adapted where necessary. The direct integration of health ministers and partner organisations also ensures that projects can be transferred at a later point and continued without the support of FAIRMED.

The direct beneficiaries of the project are the 93,932 people in the catchment area of the supported health facilities; the indirect beneficiaries are around 149,976 people in the entire district of Sangha Mbaéré. An important target group are the highly marginalized and disadvantaged indigenous Aka, 11,271 of whom live in the project area.