Interview with Léodégal Bazira, WHO representative

Central African Republic, one of Africa's poorest countries, has been facing unprecedented health problems since the onset of military mutinies in mid-1996. Health Infrastructures have all but collapsed, in the face of successive cash-strapped governments' ability to care for its 3.8 million nationals.

One of the most pressing concerns remains the health of mothers and children. The UN Children's Fund says, "The main social indicators regarding children and women, namely under-five child mortality, maternal mortality, malnutrition and HIV/AIDS prevalence, have been deteriorating markedly in recent years."

Moreover, the UN World Health Organization says vaccination coverage still only revolves around 50 percent.

Health workers have also suffered from the conflicts and, like many of the country's other civil servants, are owed around 48 months' back pay. Patients are unable to afford consultation fees, which are used to cover running costs at many hospitals. This has led to worsening health delivery for the needy and poor working conditions for staff, WHO says. Given this situation, IRIN spoke to DR Léodégal Bazira, the WHO representative in Bangui, on 9 March. The following are excerpts of that interview.

QUESTION: What is the mother-child health situation in the Central African Republic?

ANSWER: The CAR is emerging from a troubled 10-year period in its history during which the health system was not saved from destruction, [...] and even during this period part of the personnel even fled the conflict zones.

The Central African Republic is coming out of this period, yet it does not have the capacity to rebuild its system of health. As a result, the health indicators are down because most of the population does not have access to basic health services and also because health services have not been fully habilitated. This has translated into the fact that most health indicators have worsened quickly.

Of the indicators that demonstrate the deterioration of this situation, the maternal mortality rate has gone from 948 deaths for 100,000 live births to 1,355 for every 100,000 births in 2003. Infant mortality of under five-year-olds closely mirrors this trend, rising from 137 deaths [for every 10,000] in 1995 to 220 per 10,000 births in 2003. This indicates a significant deterioration of the indicators. We can add to that life expectancy which, according to the last general population census carried out in 2003, shows that the Central African Republic each year has been losing half a year on its life expectancy since 1988.

Q: What chance is there of reducing these high death rate in both these cases?

A: If tomorrow we were to reach the stage where all the pregnant women could quickly receive medical care during pregnancy and childbirth, mortality would be reduced drastically. Just as if tomorrow we could reach a 90 percent vaccination coverage for infants at birth, we could save thousands of children who would otherwise die.

Q: How has the WHO helped the Central African Republic improve its health delivery system?

A: WHO acts on several levels: initially by giving direct help primarily in four of the most significant areas; to reinforce the capacity of a given country [to deal with its health problems]; reduce maternal and infant mortality; fight against diseases, starting with HIV/AIDS, malaria and tuberculosis; and finally communication for behavioural change so that people can avoid diseases.

Moreover WHO acts on another level, which is that of advocacy so that donors can help the CAR meet its needs. It consists of urgent help to restore basic minimum health services and longer-term help to restore health services fully. Recently, this plea was taken to diplomats accredited to the CAR but resident in Yaounde by presenting projects that were not financed in the health and humanitarian sectors so that they could mobilise essential resources for the re-establishment of minimum access to the basic services.

People in the north of the country, confronted with insecurity, presently lack medical care - which the WHO intends to provide for vulnerable people in the area. We are in close consultations with NGOs that operate in the area from whom we receive their needs assessments, according to what we hope to provide because they are already on the ground, in particular MSF-Holland [Médecins Sans Frontières]. We are in contact with this NGOs so as provide it and with drugs.

Q: Some UN agencies complain that the responses they have received to urgent appeals for the CAR are receiving less donor attention. What is the case for WHO?

A: We cannot say that we have not received anything but it has not been as much as we had requested. In general, what we have received has met less than 30 percent of the desired needs, and WHO is faced with the same situation as other UN agencies in terms of response.

When we only receive part of what we have asked for, we try to make do. Of course, under these conditions, we cannot meet the entire request made to us and we are obliged to establish priorities among priorities.

Q: Is there any chance that the CAR will meet the Millennium Development Goals in this domain as set by the United Nations?

A: It is not too late to hope this can be obtained, especially if the country receives massive aid to rehabilitate its medical service and to provide quality health care to most of its vulnerable people.