Gloria Obaje is a nun and a nurse at the Siriri health centre in Bossangoa, Central African Republic. ‘Siriri’ in the local Sango language means ‘peace’ and this is exactly what Sister Gloria tries to provide for her patients, a welcoming space where they can find some peace of mind and empathy, fundamental elements for quality care. For almost two years now, as head of this health facility, she has been doing her best to improve access to quality care, not only for the people in her area, but also for those in other health care areas, and from January 2023 also thanks to performance-based financing (Pbf).
“If there were no free care for the most vulnerable, many people would not be able to survive,’ he says. ‘The need and demand for services is very high, some patients come from far away, often on foot, to benefit from free treatment at the health centre I run.”
Located in the heart of Africa, the Central African Republic (CAR) is one of the poorest and most fragile countries in the world, despite its wealth of natural resources. With a population of around 6,100,000, it ranks 188th out of 191 countries in 2023 in terms of human development index and, as the World Bank reports, has one of the highest poverty rates in the world: almost 7 out of 10 people are extremely poor (65.7% live on less than USD 2.15 a day). The living conditions of the population in some areas in particular, such as Bossangoa, are very harsh, mainly due to the lack of access to essential services, which are still lacking in resources and quality. ‘In our own small way, we try to ensure that services are free of charge and long-lasting. But I really hope that the needs of the people will be listened to and taken into consideration by the health authorities,’ adds Sr Gloria.
This is why it is crucial to support the Ministry of Health and Population (MSP) in the implementation of national policies and strategies aimed at strengthening and improving the capacity of the health system without burdening patients, especially the most vulnerable. One of these strategies is performance-based financing (Pbf), which aims to promote better efficiency and effectiveness of health systems, while promoting self-management by health facilities (FOSA). Thanks to an intervention financed by the European Union, Doctors with Africa CUAMM is adopting the Pbf strategy in the districts of Bossangoa, Bangassou and Ouango Gambo, helping to guarantee free treatment in 41 FOSA.
The Pbf strategy aims to address structural weaknesses in the health systems by ensuring that health facilities receive resources commensurate with their performance (based on registered needs and care provided). In this way, health centres can meet their operating costs and patients, especially children, pregnant women and other vulnerable groups such as displaced persons, can access health services free of charge.
Specifically, the action supported by the EU and implemented by Cuamm aims to support the delivery of the minimum package of activities (Pma) and the complementary package (Pcs), defined by the Ministry of Health and Population, related to sexual and reproductive health, maternal, neonatal, child and adolescent health and nutrition (SRMNIA-N) and at the same time to bring the services closer to the population through community health strategies, also in order to strengthen the referral system.
Sister Gloria and her team do their utmost to offer first aid and essential services to all, even to patients who are not recipients of the funding strategy, at least until they can find a way to meet the necessary medical expenses. Only through this valuable daily work, from the bottom up, and with everyone’s contribution, will it be possible to respond to the need for peace and develop our capacity to take care of each other, starting with the neediest and the most fragile and broadening our outlook to include everyone.
