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Addressing Emergency Obstetric Care and Sexual Gender Based Violence (SGBV) in Central African Republic

Background

Over the last 10 years, CAR has experienced at least four coups. In March 2003, General Francois Bozize took power and established a new government after a war which lasted almost six months. This war generated internally displaced populations, destruction and looting of the public infrastructure. Currently the country is facing an emergency that UN has described as “the world’s most silent crisis.”

The most affected areas are the districts of Ouham, Ouham-Pendé, Nana-Gribizi, Ombella-Mpoko, Kémo and Bangui where about 2,2 million people (70% of the population is living). During the armed conflict, hospitals and health centers, including emergency obstetrical care were destroyed and looted. According to WHO assessment of May 2004, only one third of the health facilities were rehabilitated. Another consequence of the war was the systematic sexual abuse of women and girls. Only in Bangui, more than 5,000 women were sexually abused and are still without psychological support or medical treatment for physical trauma such as fistulas.

The health status of women in CAR is negatively influenced by various interlinked factors. The following available indicators confirm the severity of the crisis:

• The average age for first sexual relations among girls is 14 years, and contraceptive use is low (7%);
• Consequently the rate of child pregnancies is as high as 40%;
• The coverage of prenatal care in the rural area is 42%, and only 47% of all deliveries are assisted;
• The tetanus antigen coverage among pregnant women is 61% in urban areas and 50% in rural areas;
• The HIV/AIDS prevalence of pregnant women is 15%, with a 35% transmission rate to the child;

As a direct consequence of many of these indicators, maternal and infant mortality are respectively very high. Between 1995 and 2000, the maternal mortality ratio increased from 680 to 1100 per 100,000 and the infant mortality from 97 to 131/1 000.

Objective

With this project WHO intends to create conditions which improve the health situation for women by proving basic knowledge to the communities, improving the skills of health workers in reproductive health and consequences of sexual and gender based violence (SGBV) and offering them better conditions of work.

Strategies

The project will focus on the main affected areas of Ouham, Ouham-Pendé, Nana-Gribizi, Ombella-Mpoko, Kémo and Bangui. It will be implemented in close collaboration with the MOH, UNFPA and national International NGO working in the affected areas

Proposed Activities

• Promote Education, Information and Communication (EIC) among adolescents on safe sex.
• Raise awareness on the use of contraceptives and provide condoms.
• Train TBA and other community health workers on safe delivery.
• Provide delivery kits to TBA to increase the coverage of assisted deliveries.
• Support two referral hospitals in the affected areas on emergency obstetrical care including caesarian.
• Organize refreshment training courses for doctors, nurses and midwifes in charge of obstetrical care at the hospital level and management of survivors of victims of sexual abuse.
• Provide PEK kits to support the survivors of victims of sexual violence.
• Provide reagents, equipment and training for blood testing to ensure blood safety.
• Collect qualitative and quantitative data on SGBV in the affected areas.
• Advocate and sensitize community leaders in prevention and support of survivors of victims of sexual abuse.
• Provide medical and psychosocial support to the victims of sexual abuse.

Expected outcomes

• Teenage and unwanted pregnancy reduced and awareness on safe sex improved among the population.
• Community leaders sensitized and cooperation the better women health.
• Skills of TBA, community health workers, nurses and doctors s on obstetrical care and SGVB management issues improved.
• Bloody safely activities implemented and HIV transmission reduced.
• Referral hospitals technically prepared for obstetrical emergency interventions.
• Conditions created for the reduction of maternal and infant mortality.

Budget