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In Ngaoundaye, in the north of the Central African Republic, on the border with Chad and Cameroon, there are just two doctors for every 200,000 inhabitants.
The lack of essential services combined with population displacements linked to violence and recurring conflicts between armed groups, has led to malnutrition. Since August 2022, Action Against Hunger teams have been working with the health authorities to respond to the crying needs and the lack of players to meet them.We are providing health care, including mental health care, treatment of severe acute malnutrition, and psychosocial support to local communities.
The sub-prefecture of Ngaoundaye and its eponymous capital are located in the province of Ouham Pendé, one of the most fragile in the country. Between 2021 and 2022, humanitarian needs in the province have increased by 34%, due to displacement caused by armed clashes. Today, Ouham-Pendé is classified as an emergency, with 30% of its population suffering from food insecurity and almost 464,000 people in need of humanitarian assistance. A nutritional survey carried out by our teams in 2022 revealed a 2.1% rate of severe acute malnutrition among children under five, above the emergency threshold of 2% set by the WHO.
In response to these problems, Action Against Hunger is supporting local health centres and health posts to provide medical and nutritional care for children under five, monitor pregnant and breastfeeding women and guarantee their access to sexual, reproductive and maternal health services. In four months, more than 10,500 people were screened for undernutrition, 1,589 children under the age of five were referred to a health facility, 210 children suffering from severe acute malnutrition were treated and 1,355 pre- and post-natal consultations were carried out.
At the Ndim centre, eight-month-old Le Meilleur has just had his follow-up medical check-up and received his outpatient treatment for severe acute malnutrition. His mother Amandine looks after his biological brothers and sisters and other children in her care. The family of eight survives by working in the fields and selling firewood, but despite the best efforts of Amandine and her husband, there is only one meal a day.
“We eat what we pick, mostly mushrooms and caterpillars. The children don’t get enough to eat and there isn’t always enough money to take them to hospital when they fall ill,” says Amandine.
Like many of the carers of malnourished children, Amandine did not know what malnutrition was, let alone its causes or how to prevent it. Alongside Le Meilleur’s nutritional care, her mother benefited from awareness-raising sessions on the disease and advice on good care and feeding practices to prevent it.
“When we arrived, people didn’t know what malnutrition really was,” explains Dr Stanislas Hyango, nutrition and health programme manager for Action Against Hunger in Ngaoundaye. Only one health centre among those we supported dealt with this illness. In the other health centres, malnourished children were treated like any other patients. We trained the medical staff, raised awareness among the population and continue to do so with the community relays that we have trained to raise awareness and carry out screening in the villages“.
In addition to the Ndim health centre, Action Against Hunger also supports the therapeutic nutrition unit at Ngaoundaye hospital, which cares for children suffering from severe acute malnutrition with medical complications who require 24-hour care. Our teams also work at the Bang and Doko health centres and at the Kossé and Nzakoun health posts.
Poverty and lack of medicines complicate access to healthcare
The health posts, located every six or seven kilometres, bring healthcare closer to the people in an area where the road infrastructure is difficult or non-existent, but the issue of financial accessibility is a major obstacle for many households.
For Stanislas, it is necessary to address the combined factors of poverty, cost of care and accessibility of medicines. “They prefer to treat themselves at home and only come to the centre when complications arise. And then, even if they manage to pay for the consultation, they don’t necessarily have the money to buy the medicines, which are sometimes unavailable, or they have to get into debt with relatives“.
While the Central African Republic is promoting free healthcare for children under the age of five and pregnant and breast-feeding women, the difficulties in obtaining medicines in the Ngaoundaye area are distorting this directive: “The health centres sometimes have to buy medicines locally because the free ones don’t arrive. Unfortunately, they have to ask patients to contribute financially so that they can continue to care for patients and provide treatment“. To remedy this problem, our teams provide free treatment for malnutrition and pre- and post-natal consultations.
But action does not stop at the doors of health centres; the fight against malnutrition begins with prevention and is waged within households and villages. This is why Action Against Hunger teams have trained 25 community relays from the villages supported to carry out awareness-raising and screening in their communities.
In the same way, local leaders were made aware of the issue and infant and young child feeding (IYCF) groups were set up. In four months, 6,353 people have attended IYCF awareness-raising sessions. The sessions focus on the importance of breastfeeding the child within hours of birth, exclusive breastfeeding up to 6 months, food diversification from 6 months and continuing breastfeeding until 24 months or more. They sometimes touch on other essential family practices too, such as vaccination and deworming of young children.
Although the IYCF groups mainly target women of childbearing age, whether pregnant or already mothers, their awareness campaigns and those of the community relays are also aimed at men, who are often the decision-makers in their households.
“That’s our big battle,” sighs Stanislas, “we try to invite men, but it’s still rare for them to accompany their wives to antenatal consultations or to care for their malnourished children. The women listen to the messages we pass on in the health centres. But if they can’t have a word to say in front of their husbands, and if those do not listen to their wives, it’s hard to hope for change.”
Strengthening the voice and the decision-making power of women and adolescent girls in matters relating to their health, their dignity and the health of their children is one of the key areas of work for the Action Against Hunger teams in Ngaoundaye. This involves raising awareness of sexual and reproductive health and rights, gender-based violence, mental health and psychosocial support.
To date, 226 people – 127 women and 99 men – received information about sexual and reproductive rights and gender-based violence. 133 patients accompanying malnourished children and 244 pregnant and breastfeeding women have taken part in awareness-raising sessions on mental health. Among these women, 7 patients and 30 pregnant and breast-feeding women were identified as being in psychological distress and as such received individual support from psychosocial workers and/or from a psychologist deployed in the area by Action Against Hunger.
“We’re going to start holding discussion groups with our protection programme manager, with men on one side and women on the other. A man can listen to a woman but, when it is his wife, he often considers that she is there to obey him, according to what our patients tell us. So we really need to create spaces where women can be listened to on these issues,” concludes Stanislas.
About the project
The project run by Action against Hunger in Ngaoundaye, entitled Programme global de réponse aux urgences nutritionnelles, is funded by GAC (Global Affairs Canada). It aims to provide health and nutrition support to 22,000 people. At the same time, complementary mental health and psychosocial support activities – such as individual follow-up of people in psychological distress – are being made possible thanks to funding from the Swedish International Development Cooperation Agency (SIDA).
Central African Republic
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