Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202) INTERNATIONAL RESCUE COMMITTEE CENTRAL AFRICA REPUBLIC SEMIANNUAL REPORT INTEGRATED HEALTH CARE, PROTECTION AND WATER, SANITATION, AND HYGIENE (WASH) INTERVENTIONS FOR CONFLICT AFFECTED POPULATIONS IN OUHAM-PENDE AND NANA-GRIBIZI, CENTRAL AFRICAN REPUBLIC AGREEMENT NO: 720FDA18GR00202 REPORTING PERIOD: OCTOBER 1, 2018- MARCH 31, 2019 PRESENTED TO: THE USAID OFFICE OF FOREIGN DISASTER ASSISTANCE Collaborating Partner: Agency Headquarters: International Rescue Committee/CAR International Rescue Committee c/o Mohammed Chikhaoui, Country Director c/o Erika Pearl, Program Officer Tel: +236 72136704 Tel : +1 212 377 4019 E-mail: [email protected] E-mail: [email protected] SUBMITTED: MAY 16, 2019 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202) I. Executive Summary a) PROGRAM TITLE: Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham-Pende and Nana-Gribizi, Central African Republic PROJECT NO: 720FDA18GR00202 AGENCY: International Rescue Committee COUNTRY: Central African Republic CAUSE: Health and Protection PROJECT PERIOD: 12 months (October 1, 2018 – September 30, 2019) b) OBJECTIVE: Improve access to and quality of local health care system and protection services for the affected populations in the prefectures of Nana Gribizi and Ouham Pende BENEFICIARIES: Total number of beneficiaries targeted: 89,753 direct beneficiaries, including 27,109 IDPs Total number of beneficiaries reached to date: 75,379, including 22,613 IDPs LOCATION: Central African Republic, Ouham Pende and Nana Gribizi Prefectures Bocaranga: Zaguindi Health Post, Koui Health Center, Sangami Health Post, Mbotoga Health Center, Bocaranga District Hospital (Ouham Pende) Ngaoudaye: Kosse Health Post, Boko Health Post, Kollo Health Post, Nzakoune Health Post, Kowone Health Post, Ngaoundaye Hospital (Ouham Pende) Kaga-Bandoro: Kaga-Bandoro Health Center and MINUSCA and Lazare IDP sites (Nana Gribizi Prefecture) 1 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202) Introduction The security situation has improved in Bocaranga sub-prefecture since the deployment of Central African Armed force in the city of Bocaranga in January 2019. In Koui and Ngaoundaye sub-prefectures, the security situation is relatively calm despite the presence of rebel groups in the area. No major incidents have been reported against humanitarian partners in these sub-prefectures since the beginning of this project in October 2018. As a result of this improvement in the security situation, some Central African refugees are starting to return from Chad and Cameroon to their villages. According to the OCHA report of March 19, 2019,1 532 households returned between October 2018 and March 2019 to Bezere in Bocaranga sub-prefecture. IRC programs were suspended for a two- week period in early March 2019 on the Koui-Sangrelim axis. As a matter of fact, General Sidiki, the leader of the 3R armed group, restricted access from Makounzi Wali to Koui (Bocaranga Prefecture) to all members of the government, MINUSCA and NGOs beginning March 4, 2019. As a consequence, all humanitarian actors active in Koui suspended their activities pending political discussions between 3R and the government. During this time, the humanitarian community (represented by OCHA) and local authorities were also advocating for access to Koui. On March 12, a meeting was organized between General Sidiki and the humanitarian community; General Sidiki consequently granted NGOs access to the Koui-Sangrelim area. In Kaga-Bandoro city, tensions continue to be exacerbated between the ex Seleka armed group, located north of the bridge over the Nana River, and the auto defense groups (GAD), located south of the bridge. Several robberies of civilians and humanitarian by armed groups, especially on the axis from and to Kaga-Bandoro city, were regularly reported. Along with other INGOs in the area, the IRC occasionally timed its field movements to those of MINUSCA patrols to gather information on the security situation and thus to ensure the staff’s safety, to regularly monitor security incidents and to comply with the IRC’s rigorous security procedures. This did not impact the IRC’s activities. In October 2018, a Hepatitis E outbreak was declared in Ouham Pende prefecture. 140 cases were confirmed and 2 deaths reported. Under the coordination of the WHO, partners were mobilized to provide support to the districts affected by the outbreak in terms of treatment, community mobilization, logistics and WASH support. The IRC supported the health districts of Ngaoundaye and Bocaranga by providing health staff for pediatric services and assisted community health workers in conducting community mobilization sessions to prevent the spread of the outbreak and promote best hygiene practices. On February 7, 2019, a fire broke out at the MINUSCA IDP Camp not far from the IRC mobile clinic. The IRC mobile clinic in the MINUSCA Camp was partially burned, although not structurally damaged and plastic sheeting melted due to the heat. The fire was due to a bush fire near the IDP Camp and nearby shelters burned very quickly due to the dry season. Luckily, there were no serious casualties (or burns). The mobile clinic was closed on February 8, 2019 and service provision resumed the next day. II. Summary of Activities A. Health Number of beneficiaries targeted: 89,753 beneficiaries, including 27,109 IDPs Number of beneficiaries reached: 75,379, including 22,613 IDPs From October 2018 to March 2019, the IRC has supported 12 Ministry of Health (MoH) heath facilities, including five in Bocaranga/Koui, six in Ngaoundaye, and one health facility and two mobile clinic sites in Kaga-Bandoro. The IRC provided basic health services, including curative consultations, reproductive health, health education, hygiene promotion, the expanded program of immunization, provision of essential drugs and capacity building to MoH health staff through formal and on the job training to enhance quality of care. With 75,379 direct beneficiaries reached thus far, the IRC has reached 84% of its expected beneficiaries over a six month period, meaning it is well on track to meeting its target. Of those reached, 15,850 were children under 5 years old, representing 21% of total beneficiaries reached. 1 OCHA, Rapport de visite de suivi de la situation humanitaire au village Bezere, 19 March 2019 2 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202) Sub-Sector 1: Health Systems and Clinical Support As mentioned above, the IRC contributed to addressing the most urgent primary health care gaps in the 12 MoH health facilities and two IRC mobile clinic sites. IRC health staff reinforced health facility staff capacity through monthly technical support and direct supervision to ensure that consultations were carried out according to WHO / MoH protocols Technical supervision focused on the provision of quality basic emergency services such as outpatient consultations, life-saving emergency referrals, antenatal and post-natal care, immunization activities and community mobilization. The IRC health staff provided refresher training for 54 health staff on BEmONC (Basic Emergency Obstetric and New Born care) and treatment protocols for malaria, diarrhea, and respiratory tract infections. The table below shows the number of health workers who participated in the training. Training topics Male Female Total Treatment protocols for malaria, diarrhea, respiratory tract infection 12 health 12 (4 24 workers midwives and 8 matrons) BEmONC 19 health 11 (4 30 workers midwives et 7 matrons) Total 31 23 54 Curative consultations: During this reporting period, 28,989 outpatient consultations were performed. This represents approximately 40.3% progress rate on the IRC’s total target of 71,804 expected outpatient consultations annually. As explained in the “Challenges” section below, some activities were delayed due to the late signature of the MoU between the Health District (in Ouham Pende) and the IRC. During the reporting period, the IRC-supported health facilities saw 12,491 consultations in Ouham Pende prefecture, 16,498 consultations in Nana Gribizi prefecture and 46.5% of them concerned IDPs. 13,336 consultations concerned children under 5 years old representing 46% of total consultations. Progress against target in Progress against target in Nana Gribizi Ouham Pende 4500 6000 4000 5000 3500 3950 3724 3724 3724 3724 3724 3724 3000 3603 3545 4000 2259 2500 2259 2259 2259 2259 2259 3000 2000 2968 2100 1500 2000 2432 2655 1700 1000 1600 1940 1000 1489 500 1007 0 0 Oct Nov Dec Jan Feb March Oct Nov Dec Jan Feb March Targets reached Targets reached The number of consultations in Nana Gribizi was below the target for the first three months before it picked up from January through March 2019, which may be related to the low availability of pharmaceuticals in all facilities for