Politique Nationale d’Engagement Communautaire pour la Santé et le Bien-Être 2023-2030

Objectives

The National Community Engagement Policy for Health and Well-being of the Central African Republic, covering 2023–2030, provides a national governance and strategic framework for placing communities at the centre of health and development. It seeks to replace a predominantly top-down, facility-centred model with an inclusive, person-centred approach in which communities are beneficiaries, partners and agents of change.[1][2][3]Its vision is that, by 2030, all Central African communities will have universal access to community-based health services and care and will participate fully in integrated, multisectoral development for health and well-being.[4][3]

• Strengthen community voice, authority, ownership and participation in identifying needs, planning, implementing, monitoring and evaluating health and development action.[5][3][6]
• Reduce morbidity, mortality and disability, including through better preparedness for epidemics and other unusual public-health events.[3][6]
• Advance universal health coverage, Sustainable Development Goal 3, primary health care and equitable access to quality services, in alignment with the National Health Policy 2019–2030 and National Health Development Plan 2022–2026.[7][8][9][4]
• Address health determinants through coordinated action on education, nutrition, protection, water, sanitation and hygiene, environmental conditions, livelihoods, gender equality and social inclusion.[10][5][6]
• Deliver an integrated minimum package of promotive, preventive, curative and rehabilitative services across the life course, including maternal, newborn, child, adolescent and reproductive health; immunisation; nutrition; infectious-disease control; non-communicable disease prevention; and community-based surveillance.[11][12][13]
• Protect the right to health and promote equity, gender equality and inclusion, with explicit attention to women, children, people with disabilities, older people, poor households, minorities, Indigenous and nomadic communities, and other marginalised groups.[14][15]
• Prevent and respond to gender-based violence and harmful practices affecting women and girls, including sexual violence, early marriage, early pregnancy and female genital mutilation.[16]
• Strengthen institutional and regulatory capacity, inclusive community dialogue, community-health workforce capacity, access to supplies, safe water and sanitation, investment in community action, and functional community data and monitoring systems.[3][6]

Implementation

Implementation uses a multisectoral, decentralised community-health model built around three interacting levers: populations, service providers and influencers.[5][17]It combines community health workers and relays with traditional, religious and community leaders, civil-society organisations, local authorities, health personnel and other sectors, so that services, dialogue, surveillance and accountability operate from national level to villages and neighbourhoods.[1][18][19]The Ministry of Health and Population is the institutional anchor, while political and administrative authorities provide local leadership and proximity supervision, supported technically by health facilities and higher-level health managers.[20][21][19]

• Establish and revitalise village primary health-care committees and multisectoral dialogue bodies at commune, sub-prefecture, prefecture, regional and central levels, with procedures defining composition, roles, relationships and functioning.[18][17][21]
• Coordinate action through interministerial structures and partnerships involving health, education, environment, sanitation, agriculture, livestock, protection and development actors, alongside donors, non-governmental organisations, professional associations and communities.[20][19]
• Recruit community health workers transparently and participatively through village and neighbourhood committees, reserve at least 50% of positions for women, and ensure that workers operate within their own communities.[22]
• Train, equip, supervise and motivate community actors and local authorities through initial and continuing training, practical learning, management tools, collaborative supervision, financial and non-financial incentives, recognition and support for income-generating activities.[22][20][11]
• Deliver household- and community-based health promotion, screening, basic treatment, referral, follow-up, product distribution, sanitation action, risk communication and participation in public-health campaigns.[12][13][23]
• Maintain referral and counter-referral links between community actors and health facilities, including referral of pregnant women, unvaccinated children, suspected tuberculosis, severe childhood illness, severe malaria, diarrhoea, respiratory infection, hypertension and diabetes cases.[24][12][23]
• Operate community-based surveillance through active case detection, notification of epidemic-prone diseases and rumours, contact follow-up, reporting of unusual events, and alerts on maternal deaths, deaths of unknown cause, mass deaths and unusual animal deaths.[25][21][13]
• Hold monthly primary health-care committee meetings and community monitoring sessions, document community selection of workers, report activities back to communities, conduct satisfaction surveys and social or community audits, and strengthen complaint, feedback and grievance-management mechanisms.[17][21]
• Develop standardised community data-collection and reporting tools, with transmission pathways connecting community workers, local authorities, health facilities and districts; integrate performance indicators within the 2023–2027 strategic operationalisation plan and use evidence, operational research and innovation to improve implementation and revise policy.[26][21][19][27]
• Mobilise and pool public, external, non-governmental and local resources; finance local development plans and community-health workers through local authorities; support community insurance and dedicated budget lines; and progressively increase health financing towards 15% of the state budget in line with the Abuja commitment.[26][19]

Monitoring & Evaluation

The policy envisages a functional, flexible monitoring and evaluation system for community engagement, using community-level data, standardised collection and reporting tools, and new information technologies to inform implementation, learning and policy revision.[6][26][21][27]It recognises major pre-existing weaknesses, including the lack of standard tools, defined data flows, consistent use of community data for decision-making, and an integrated monitoring system for community-based interventions.[2]

• Develop a monitoring and evaluation framework with performance indicators within the multi-year strategic operationalisation plan to track implementation changes, good practices and gaps.[26]
• Establish integrated reporting routes linking community health workers, associated health facilities, administrative authorities and health districts; separate links are also envisaged between schools and school authorities.[21]
• Use monthly primary health-care committee meetings, community-based monitoring meetings, participatory follow-up, supervision and systematic feedback to communities to coordinate and assess local action.[20][17]
• Conduct social and community audits of health problems and unusual public-health events, including maternal deaths in communities, deaths of unknown cause and mass deaths.[2][21]
• Strengthen complaints, feedback, grievance-management and community-satisfaction mechanisms as elements of reciprocal accountability between communities, service providers, influencers and authorities.[2][14][21]
• Integrate community-based surveillance into service delivery, including notification and active detection of epidemic-prone diseases, reporting of rumours and unusual events, contact follow-up, and alerts concerning abnormal livestock or poultry deaths.[11][13]
• Support surveillance and continuity of care through household registration and updating of births and deaths, identification of unvaccinated children, tuberculosis and HIV treatment follow-up, and tracing of people lost to follow-up.[12][28][29][30]
• Apply accountability arrangements across national, regional, local and community levels, so that actors meet their responsibilities and interventions respond to communities’ needs, demands and rights.[14][15]

The policy identifies assessment across governance and leadership, human resources, service delivery, medicines and supplies, information systems, financing, mobilisation and engagement, and risk communication.[31]It also supports document review, routine and survey-data analysis, functionality assessments, bottleneck analysis, operational research and external evaluation of performance-related incentives.[31][11][21][27]However, the supplied text does not provide a complete numerical indicator matrix, consolidated reporting timetable, named monitoring institutions, evaluation methodology or surveillance targets.[3][6][26][23]

Costing & Financing

The policy calls for more effective, equitable and coherent financing of community engagement through public resources, external development assistance, non-governmental sources, pooled funds, local resources and innovative financing mechanisms.[26][19]It identifies a persistent financing deficit in the absence of a multi-year plan for resource mobilisation and pooling, a dedicated national and decentralised community-engagement budget line, and sufficient external-donor financing.[2]

• Increase investment in community engagement and promote free community-based care at the point of use.[6]
• Finance local development plans, income-generating activities, community health-worker support through local authorities, motivation for coordinating authorities, essential materials and community initiatives.[20][11][26]
• Establish a dedicated nationwide budget line for community-engagement programmes and improve use of local development plans to identify funding opportunities.[2][19]
• Integrate mandatory community health-insurance schemes and pool financial resources while using locally available community resources.[26]
• Progressively increase health financing to 15% of the total state budget, consistent with the Abuja commitment referenced in the policy.[19]
• Use financial and non-financial incentives, including performance-related incentives, community recognition and support for income-generating activities, while recognising limited fiscal space.[20][11]

Available economic context indicates that households bear 51% of total health expenditure, while economic slowdown, COVID-19 and insecurity have constrained public and household capacity to invest in health.[10]Gross domestic product growth was reported as 0.9% in both 2020 and 2021, and 71% of the population was reported to live below the poverty threshold of 1.90 US dollars per day.[10]The supplied text provides no total programme costing, budget envelope, unit costs, expenditure forecast, quantified funding gap or detailed financing allocation.[26][19][27]