Central African Republic: Score Justification Summary

2026

1.1 Antimicrobial resistance (AMR)

1.1.1 AMR surveillance, detection and reporting

1.1.1a National plan for AMR priority pathogens

Score: 0

The Central African Republic (CAR) does not have a national AMR plan for the surveillance, detection, and reporting of priority AMR pathogens.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the CAR has developed its national action plan to combat AMR, along with an operational action plan, the budget for which was being finalized (p. 16). ¹ However, the country does not have a national antimicrobial stewardship plan based on the "One World, One Health" approach (p. 16). ²

According to the WHO Tracking AMR Country Self Assessment Survey (TrACSS) 2022, the CAR has neither developed nor implemented a AMR National Action Plan. ³ A 2024 research paper titled "Monitoring progress on Antimicrobial Resistance (AMR) response in the World Health Organization African region: Insights from the Tracking AMR Country Self-Assessment Survey (TrACSS) 2021 results for the human health sector" also pointed out that the CAR had not reported having an AMR National Action Plan. ⁴

There is no evidence of such plan on the Food and Agriculture Organization (FAO) legal database, the WHO library of AMR national action plans, the official page of the Government of the CAR, or the website of the Ministry of Health and Population. ⁵ ⁶ ⁷ ⁸

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

The Central African Republic (CAR) has a national laboratory that can test for priority AMR pathogens. Nevertheless, there is no evidence it can test all 7 + 1 priority pathogens.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), priority and multidrug-resistant pathogens are not identified by national authorities, but multidrug-resistant pathogens are detected in national laboratories, namely the Pasteur Institute of Bangui (IPB) and the National Laboratory of Clinical Biology and Public Health (LNBCSP) (p. 18). ⁹ According to the JEE 2018, the IPB is the reference laboratory for the detection of prioritary diseases (p. 23). ¹⁰ It can conduct diagnostic tests for malaria, cholera, HIV, meningitis, rabies, and brucellosis at all levels, and there is capacity of molecular biology technical platforms at the national level for human and animal health through the IPB and the National Laboratory of Clinical Biology and Public Health (LNBCSP) (p. 24). ¹¹

There is no further evidence of other tests on the official website of the Government of the CAR, or the website of the Ministry of Health and Population. ¹² ¹³ The website of the IPB was not operational. ¹⁴

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no evidence that the Central African Republic (CAR) conducts environmental detection or surveillance activities (e.g. in soil, waterways) for antimicrobial residues or AMR organisms.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2018), the CAR does not have sufficient laboratories capable of detecting, isolating, and identifying antimicrobial-resistant organisms in the humans, animals, food and the environment (pp. 11-12). ¹⁵ Although the country has a non-functional epidemiological surveillance network for animal diseases, the WHO recommends the country to designate sentinel sites for environmental surveillance for infections caused by pathogens and antimicrobials (p. 12). ¹⁶

According to the Joint External Evaluation 2023, the surveillance system has shortcomings in the animal health, livestock and environmental sectors (p. 37). ¹⁷

There is no reference to environmental detection or surveillance activities on the National Health Development Plan 2022-2026 (PNDS III), the National Community Health Policy 2020-2030, or the National Health Policy 2019-2030. ¹⁸ ¹⁹ ²⁰

There is no further evidence of such on the official websites of the Government of the CAR, or the Ministry of Health and Population. ²¹ ²² The Ministry of the Environment and Sustainable Development does not have an official website. ²³

1.1.2 Antimicrobial control

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

The Central African Republic (CAR) has a national legislation or regulation in place requiring prescription for antibiotic use for humans.

The CAR has enacted the General Public Health Law (Law No. 89-003 of 23 March 1989), which set general principles related to the public health system in the country. ²⁴

According to Radio Ndekeluka, the CAR was preparing to vote a bill related to the practice of medicine in March 2025, which also aimed at regulating the medical profession by ensuring compliance with responsibilities while defining sanctions in the event of abuse. ²⁵ However, there is no evidence that such piece of legislation has been enacted yet. ²⁶ ²⁷ ²⁸

In a March 2022 Facebook post on the official profile of the Pasteur Institute of Bangui (IPB), it was stated that "although a strategic plan has been developed, it has not been implemented", and that "strengthening surveillance and the fight against antibiotic resistance is not a priority in the cooperation between the World Health Organization (WHO) and the Ministry of Health and Population. ²⁹

According to the Country Self-Assessment Survey (TrACSS), the CAR has laws or regulations on prescription and sale of antimicrobials for human use. ³⁰ According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), guidelines for the use of antibiotics based on national/local antibiograms are not issued (p. 18). ³¹

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 50

The Central African Republic (CAR) has a national legislation or regulation in place requiring prescriptions for antibiotic use for animals.

According to the Performance of Veterinary Services (PVS) (2010), the CAR does not have enforced regulations regarding the use of veterinary medications, and any breeder can obtain medications, particularly on the street (p. 116). ³² Self-medication is rife, and a decree regulating the dispensing of veterinary medicines has been pending signature since 2006. It would restrict the right to possess and use antibiotics, trypanocides, or injectable products in general to veterinarians (or even qualified livestock technicians or those under the supervision of veterinarians); to grant breeders and non-technicians only the right to use products administered orally (e.g., dewormers) or for external use (external antiparasitics). ³³

However, according to the Country Self-Assessment Survey (TrACSS), the CAR has laws or regulations on prescription and sale of antimicrobials for animal use. ³⁴ Article 58 of the Fisheries and Aquaculture Code (Law No. 20-019 of 6 August 2020) establishes that the use of non-authorized veterinary medicine in aquaculture is prohibited. ³⁵

Pursuant to Article 10 of Law No. 01-009 of 16 July 2001, which regulated the exercise of veterinarians, veterinarians working in the public sector are responsible for controlling the application of veterinary pharmaceuticals regulations, whereas private veterinarians must carry out every medical and surgical act to ensure the improvement of animal health (Article 10). ³⁶

In addition, Livestock Regulations (Law No. 65.61 of 3 June 1965) mandates that the possession, sale, or free transfer of veterinary medicinal products is reserved for pharmacist, in accordance with Article 19. ³⁷ It also states that international pharmaceutical specialties and veterinary medicines of biological origin, such as serums and vaccines, may not be imported, stored, held, sold or transferred free of charge unless they have received an approval from the Ministry of Livestock and Animal Health. ³⁸

Nevertheless, according to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), guidelines for the use of antibiotics based on national/local antibiograms are not issued (p. 18). ³⁹

1.2 Zoonotic disease

1.2.1 National planning for zoonotic diseases/pathogens

1.2.1a Laws/plans on zoonotic disease

Score: 0

There is no evicence that the Central African Republic (CAR) has national legislation, plans or equivalent documents for zoonotic disease prioritization, detection and reporting.

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) states that the CAR established a "One World, One Health" platform in 2022 and identified five priority zoonotic diseases: rabies, mpox, Ebola virus disease, Rift Valley fever, and Avian influenza (p. 20). ⁴⁰ However, surveillance is not efficient (p. 21). ⁴¹ It further adds that there are contingency plans for these diseases, but the rabies plan is under review (p. 21). ⁴²

There is no evidence of such contingency plans or the "One World, One Health" platform on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁴³ ⁴⁴ ⁴⁵ The Ministry of the Environment and Sustainable Development does not have an official website. ⁴⁶

The National Health Development Plan 2022-2026 (PNDS III) identifies and prioritizes problems related to the emergence and re-emergence of endemic epidemics and pandemics, such as communicable diseases (HIV/AIDS, malaria, tuberculosis, and viral hepatitis), neglected tropical diseases, non-communicable diseases, epidemic-prone diseases and the COVID-19 pandemic (pp. 14-15). ⁴⁷ It includes sub-program 4.2 to strengthen integrated epidemiological disease surveillance and response, including all communicable and non-communicable diseases, with specific measures to strengthen the national surveillance and response system at all levels of the health system through the promotion of New Information and Communication Technologies (4.2.1), the capacities of points of entry in cross-border surveillance and collaboration (4.2.2.), and the integrated community-based surveillance system (4.2.3) (pp. 87-88). ⁴⁸ Nevertheless, there are no disease-specific measures, and the plan is not focused on zoonotic diseases prioritization, detection and reporting. ⁴⁹

In addition, in accordance with Article 15 of the Livestock Regulations (Law No. 65.61 of 3 June 1965), the Ministry of Livestock and Animal Health must create a list of animal diseases deemed contagious, and it must include rabies, rinderpest, contagious peripneumonia in cattle, foot-and-mouth disease, glanders, anthrax, Avian influenza, Newcastle diseases, and swine fever. ⁵⁰

There is no reference to it on the National Community Health Policy 2020-2030. ⁵¹ The National Health Policy 2019-2030 acknowledges that disease surveillance is part of the Integrated Epidemiological Disease Surveillance and Response (IDSR) program, which includes immediately, weekly, and monthly notifiable diseases, and that the country faces several epidemics of vaccine-preventable and emerging diseases (p. 27). ⁵² Nevertheless, there are no specific measures or a specific list of priority diseases. ⁵³

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 0

There is no evidence that the Central African Republic (CAR) has national legislation, plans, or equivalent strategy which includes measures for risk identification and reduction for zoonotic disease spillover events from animals to humans.

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) states that the CAR established a "One World, One Health" platform in 2022 and identified five priority zoonotic diseases: rabies, mpox, Ebola virus disease, Rift Valley fever, and Avian influenza (p. 20). ⁵⁴ However, surveillance is not efficient (p. 21). ⁵⁵ It further adds that there are contingency plans for these diseases, but the rabies plan is under review (p. 21). ⁵⁶

There is no evidence of such contingency plans or the "One World, One Health" platform on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁵⁷ ⁵⁸ ⁵⁹ The Ministry of the Environment and Sustainable Development does not have an official website. ⁶⁰

In addition, pursuant to Article 12 of the Livestock Regulations (Law No. 65.61 of 3 June 1965), the Ministry of Livestock and Animal Health may, independently or in coordination with other relevant ministries, adopt any measures or implement any programmes necessary to prevent, contain, or eradicate animal diseases that pose a threat to human or animal health. ⁶¹ It can adopt measures such as prohibition of the import and export of animals, meat, and products likely to transmit animal disease, regulate the movement of animals and products, conduct and others, but there is no mention of specific multisector coordination. ⁶² Nevertheless, there is no specificity that it is focused on reducting spillover events. ⁶³

However, there is no evidence of a comprehensive plan or legislation that includes measures for risk identification and reduction for zoonotic diseases spillover events from animals to humans. There is no reference to it on the National Community Health Policy 2020-2030, or the National Health Policy 2019-2030. ⁶⁶ ⁶⁷

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

The Central African Republic (CAR) has a national plan that account for the surveillance and control of multiple zoonotic pathogens of public health concern.

It includes sub-program 4.2 to strengthen integrated epidemiological disease surveillance and response, including all communicable and non-communicable diseases, with specific measures to strengthen the national surveillance and response system at all levels of the health system through the promotion of New Information and Communication Technologies (4.2.1), the capacities of points of entry in cross-border surveillance and collaboration (4.2.2), and the integrated community-based surveillance system (4.2.3) (pp. 87-88). ⁷⁰

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 0

There is no evidence that the Central African Republic (CAR) has a department, agency, or similar unit functioning as a multi-sectoral co-ordinating mechanism dedicated to zoonotic disease that functions across ministries.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the human, animal, and environmental health sectors have jointly drawn up a list of priority zoonotic diseases in the CAR, but coordination of disease surveillance is almost informal, with the exception of rabies (p. 20). ⁷¹ It further adds that data collection tools within a multisectoral framework are not widely available, and information sharing must be strengthened and systematized at all levels (p. 21). ⁷² There is no mention of a department or agency functioning as a multi-sectoral co-ordinating mechanism dedicated to zoonotic disease that functions across ministries. ⁷³

The JEE also states that the CAR has established a multisectoral committee for the surveillance of diseases and public health events through Ministerial Order No. 119 (p. 37). ⁷⁴ However, such piece of legislation is not publicly available on the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁷⁵ ⁷⁶ ⁷⁷ The Ministry of Livestock and Animal Health does not have an official website. ⁷⁸

Pursuant to Article 12 of the Livestock Regulations (Law No. 65.61 of 3 June 1965), the Ministry of Livestock and Animal Health may, independently or in coordination with other relevant ministries, adopt any measures or implement any programmes necessary to prevent, contain, or eradicate animal diseases that pose a threat to human or animal health. ⁷⁹ It can adopt measures such as prohibition of the import and export of animals, meat, and products likely to transmit animal disease, regulate the movement of animals and products, conduct and others, but there is no mention of specific multisector coordination. ⁸⁰

The National Health Development Plan 2022-2026 (PNDS III) does not mention any body with such remit that operates across ministries. ⁸¹ There is no reference to such body on the National Community Health Policy 2020-2030, or the National Health Policy 2019-2030. ⁸² ⁸³ There is no further evidence of such on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁸⁴ ⁸⁵ ⁸⁶ The Ministry of Livestock and Animal Health does not have an official website. ⁸⁷

1.2.1e Presence of One Health strategic plan

Score: 0

There is no evidence of Central African Republic having a One Health Strategic Plan in place. ⁸⁸

1.2.2 Surveillance systems for zoonotic diseases/pathogens

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 0

There is no evidence that the Central African Republic (CAR) has a national mechanism (either voluntary or mandatory) for owners of livestock to conduct and report on disease surveillance to a central government agency.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), tools for collecting, reporting, and notifying notifiable diseases are being deployed using the One Health approach (p. 38). ⁸⁹ There is no mention of specific mechanism for livestock owners to report on disease surveillance to a central government agency. ⁹⁰

Pursuant to Article 16 of the Livestock Regulations (Law No. 65.61 of 3 June 1965), owners of livestock are required to immediately report it to the Mayor, who will take the necessary emergency measures and immediately notify administrative authorities and the Ministry of Livestock and Animal Health. ⁹¹ Suspected or infected animals must be isolated from other animals, including their carcasses. ⁹² Nevertheless, there is no reference to any notification mechanism used by livestock owners to notify the authorities. ⁹³

There is no further evidence of such mechanism on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁹⁴ ⁹⁵ ⁹⁶ The Ministry of Livestock and Animal Health does not have an official website. ⁹⁷

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no evidence that the Central African Republic (CAR) has legislation or regulations that safeguard the confidentiality of information generated through surveillance activities for animals (for owners).

According to a 2022 Reference Term for the Legal Assistance for Strenghtening the Legal Framework Relating to Digital Transformation, the CAR has a draft law on the protection of personal data that provides for the creation of an authority responsible for monitoring the processing of personal data (p. 4). ⁹⁸ It further adds that "since this bill has not yet been adopted, this legislative gap poses a high risk of abuse, in addition to undermining trust in the digital space and preventing system interoperability, which is a crucial aspect of digital governance". ⁹⁹

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), at the regional level, laboratories have limited capacity to detect, isolate, and identify antimicrobial-resistant organisms in humans, animals, food, and the environment (p. 17). ¹⁰⁰

Law No. 18.002 of 17 January 2018, which regulates electronic communications in the country, does not have specific provisions for the safeguard of the confidentiality of information generated through surveillance activities for animals. ¹⁰¹ The Livestock Regulations (Law No. 65.61 of 3 June 1965) do not mention any confidentiality of the information generated through notification. ¹⁰²

There is no further evidence of such mechanism on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ¹⁰³ ¹⁰⁴ ¹⁰⁵ The Ministry of Livestock and Animal Health does not have an official website. ¹⁰⁶

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

The Central African Republic (CAR) does not conduct surveillance of zoonotic disease in wildlife, poultry and livestock.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the surveillance system has shortcomings in the animal health, livestock and environmental sectors (p. 37). ¹⁰⁷

In accordance with Article 15 of the Livestock Regulations (Law No. 65.61 of 3 June 1965), the Ministry of Livestock and Animal Health must create a list of animal diseases deemed contagious, and it must include rabies, rinderpest, contagious peripneumonia in cattle, foot-and-mouth disease, glanders, anthrax, Avian influenza, Newcastle diseases, and swine fever. ¹⁰⁸ However, there is no mandate to conduct surveillance activities for wildlife, poultry and livestock. ¹⁰⁹

The National Health Development Plan 2022-2026 (PNDS III) identifies and prioritizes problems related to the emergence and re-emergence of endemic epidemics and pandemics, such as communicable diseases (HIV/AIDS, malaria, tuberculosis, and viral hepatitis), neglected tropical diseases, non-communicable diseases, epidemic-prone diseases and the COVID-19 pandemic (pp. 14-15). ¹¹⁰ It includes sub-program 4.2 to strengthen integrated epidemiological disease surveillance and response, including all communicable and non-communicable diseases, with specific measures to strengthen the national surveillance and response system at all levels of the health system through the promotion of New Information and Communication Technologies (4.2.1), the capacities of points of entry in cross-border surveillance and collaboration (4.2.2), and the integrated community-based surveillance system (4.2.3) (pp. 87-88). ¹¹¹ However, there is no mention that the country condcts surveillance of zoonotic diseases in wildlife, poultry and livestock. ¹¹²

There is no further evidence of such mechanism on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ¹¹³ ¹¹⁴ ¹¹⁵ The Ministry of Livestock and Animal Health does not have an official website. ¹¹⁶

1.2.3 International reporting of animal disease outbreaks

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

The Central African Republic (CAR) has a mechanism for reporting notifiable diseases to the World Organisation for Animal Health (WOAH).

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2018), the Animal Health Directorate is the WOAH Contact Point, and there is a well-functioning exchange mechanism between the body and the WOAH (p. 29). ¹¹⁷ In addition, there is a system for reporting animal diseases to the WOAH in place (p. 11), which operates electronically through the WAHIS and ARIS2 software used by the Focal Points for sharing data with the WOAH. ¹¹⁸

Nevertheless, it recommends the country to strengthen notification capacity by formally establishing and defining the terms of reference for the members of the National IHR Focal Point and establishing a mechanism for notification procedures to the WOAH, and developing and disseminating standard operating procedures for the approval and notification of any potential public health emergency of international concern to the WOAH (p. 29). ¹¹⁹

1.2.4 Animal health workforce

1.2.4a Number of veterinarians per 100,000 people

Score: 1.34

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 5.18

1.2.5 Private sector and zoonotic disease

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

The Central African Republic (CAR) does not have a national plan on zoonotic disease. Other legislation, regulations, or plans do not include mechanisms for working with the private sector in controlling or responding to zoonoses.

Moreover, pursuant to Article 16 of the Livestock Regulations (Law No. 65.61 of 3 June 1965), owners of livestock are required to immediately report it to the Mayor, who will take the necessary emergency measures and immediately notify administrative authorities and the Ministry of Livestock and Animal Health. ¹²² Suspected or infected animals must be isolated from other animals, including their carcasses. ¹²³ Nevertheless, there is no specific reference of further mechanisms for working with the private sector in the control and response to zoonoses. ¹²⁴

There is no further evidence of such mechanism on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ¹²⁵ ¹²⁶ ¹²⁷ The Ministry of Livestock and Animal Health does not have an official website. ¹²⁸

1.3 Biosecurity

1.3.1 Whole-of-government biosecurity systems

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no evidence that the Central African Republic (CAR) has in place a record, updated within the past five years, of the facilities in which especially dangerous pathogens and toxins are stored or processed, including details on inventories and inventory management systems of those facilities.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2018), pathogen collections are kept in central reference laboratories that handle identification, namely the National Laboratory of Clinical Biology and Public Health (LNBCSP) and the Pasteur Institute of Bangui (IPB) (p. 18). ¹²⁹ However, there is no mention that the country has a record of the facilities in which especially dangerous pathogens and toxins are stored or processed, including details on inventories and inventory management systems of those facilities. ¹³⁰

The JEE 2023 states that each laboratory facility keeps its pathogens in registers, but those register are not always up-to-date (p. 26). ¹³¹

There is no further evidence of such mechanism on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ¹³² ¹³³ ¹³⁴ The Ministry of Livestock and Animal Health and the Ministry of National Defense and Army Reconstruction do not have official websites. ¹³⁵ ¹³⁶

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is no evidence that the Central African Republic (CAR) has in place legislation or regulations related to biosecurity which address requirements such as physical containment, operation practices, failure reporting systems, or cybersecurity of facilities in which especially dangerous pathogens and toxins are stored or processed.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), regulations regarding biosafety and biosecurity in the Central African Republic are weak, and they remain limited to a few directives, in which the implementation is not well-controlled (p. 26). ¹³⁷ Even though some laboratories have microbiological safety stations, not all are certified, particularly in the animal health sector. ¹³⁸

As per the Biological Weapons Convention National Measures Database, the CAR has biosafety measures for genetically modified organisms (GMOs), which are incorporated in Articles 40 and 41 of the Environmental Code (Law No. 07/018 of 28 December 2007). ¹³⁹ It further adds that the CAR has a specific legal framework governing the licensing and inspections of individuals and facilities working with biological agents and toxins. ¹⁴⁰ However, there is no mention of such requirements related to especially dangerous pathogens and toxins on Law No. 07/018 of 28 December 2007 or Law No. 62/350 of 4 January 1963, on plant protection, as both laws incorporate provisions related to GMOs. ¹⁴¹ ¹⁴²

In accordance with Article 55 of the Environmental Code, the Ministry of the Environment and Sustainable Development must approve a list of harmful or hazardous chemical substances and products whose production, import, export, storage, transit and circulation in the country is prohibited or subject to prior authorization. ¹⁴³ Moreover, Articles 40 and 41 state that the development, production, storage, handling, transport, use, transfer, or release of any Living Modified Organism must be carried out in a manner that prevents or reduces risks to human health and the environment, and every individual or body, public or private, has the obligation to take the necessary measures to ensure an adequate level of protection for the safe transfer, handling, and use of Living Modified Organisms resulting from modern biotechnology and which may have adverse effects on conservation. ¹⁴⁴

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no evicence that the Central African Republic (CAR) has an established agency responsible for the enforcement of biosecurity legislation and regulations.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), regulations regarding biosafety and biosecurity in the Central African Republic are weak, and they remain limited to a few directives, in which the implementation is not well-controlled (p. 26). ¹⁴⁵ There is no regulatory framework for biosafety and biosecurity, and monitoring of hazardous biological agents is not carried out in the facilities where they are handled and/or stored (p. 27). ¹⁴⁶

As per the Biological Weapons Convention (BWC) National Measures Database, the CAR has biosafety measures for genetically modified organisms (GMOs), which are incorporated in Articles 40 and 41 of the Environmental Code (Law No. 07/018 of 28 December 2007). ¹⁴⁷ Nevertheless, there is not an established National Contact Point for implementation of the BWC, or mention of an agency responsible for the enforcement of biosecurity legislation and regulations. ¹⁴⁸

It further adds that the CAR has a specific legal framework governing the licensing and inspections of individuals and facilities working with biological agents and toxins. ¹⁴⁹ However, there is no mention of such requirements related to especially dangerous pathogens and toxins on Law No. 07/018 of 28 December 2007 or Law No. 62/350 of 4 January 1963, on plant protection, as both laws incorporate provisions related to GMOs. ¹⁵⁰ ¹⁵¹

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no publicly available evidence that the Central African Republic (CAR) has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2018), a clustering of pathogens in a limited number of structures has not yet been considered (p. 18). ¹⁵⁴

The JEE 2023 does not mention actions to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities, in which each laboratory facility keeps its pathogens in registers, but those register are not always up-to-date (p. 26). ¹⁵⁵

There is evidence that such actions have been taken on the Biological Weapons Convention National Implementation Database. ¹⁵⁶ There is no further evidence of such mechanism on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ¹⁵⁷ ¹⁵⁸ ¹⁵⁹ The Ministry of Livestock and Animal Health and the Ministry of National Defense and Army Reconstruction do not have official websites. ¹⁶⁰ ¹⁶¹

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 100

The Central African Republic (CAR) has the capacity to conduct Polymerase Chain Reaction (PCR)-based diagnostic testing for the Ebola virus. There is no evidence that it can conduct for anthrax.

According to the International Atomic Energy Agency (IAEA), the Pasteur Institute of Bangui (IPB) can doncut PCR-based diagnostic testing for the Ebola virus. ¹⁶² Additionally, the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) states that the country uses diagnostics tests such as PCR, but there is no specification of which pathogens can be tested (p. 35). ¹⁶³

1.3.2 Biosecurity training and practices

1.3.2a Biosecurity training using a standardised, required approach

Score: 33.33

There is no evidence that the Central African Republic (CAR) requires biosecurity training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. However, there is evidence of biosecurity and biosafety training being provided on an ad hoc basis.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has assessed training needs and identified gaps in biosafety and biosecurity training, but has not yet implemented comprehensive training aligned with defined roles and responsibilities (p. 27). ¹⁶⁴ Overall, laboratory personnel are insufficiently aware of international best practices in biosafety and biosecurity to work safely and responsibly. ¹⁶⁵ There are functional training structures, such as the Faculty of Health Sciences (FACSS), the Faculty of Sciences (FS), and the Higher Institute for Rural Development (ISDR), but there is no specialized structured training in biological safety and security is organized in the country, as well as no training programs in biological safety and security. (p. 27). ¹⁶⁶

Nevertheless, in January 2025, the Pasteur Institute of Bangui (IPB) organized a training course on biosafety and biosecurity in partnership with the WHO and the National Laboratory of Clinical Biology and Public Health (LNBCSP). ¹⁶⁷ The course included participants from the IPB, the National Blood Transfusion Center (CNTS), and the LNBCSP, which combined theorical courses, practical exercises, and experience sharing. ¹⁶⁸ The initiative targeted critical issues such as the rapid detection of pathogens, the secure management of biological waste, and the safe transport of infectious materials, and by training biosafety focal points from key national institutions, it aimed at contributing to the implementation of best practices and the strengthening of safety procedures in the country's laboratories. ¹⁶⁹

There is evidence of such biosecurity training requirements on the Biological Weapons Convention National Implementation Database. ¹⁷⁰ There is no further evidence of such mechanism on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ¹⁷¹ ¹⁷² ¹⁷³

There is no evidence on the Environmental Code (Law No. 07/018 of 28 December 2007) or Law No. 62/350 of 4 January 1963, on plant protection. ¹⁷⁴ ¹⁷⁵

1.3.3 Personnel vetting: regulating access to sensitive locations

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no evidence that the Central African Republic (CAR) has regulations or licensing conditions that specify that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to drug testing, background checks, and psychological or mental fitness checks.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has a shortage of people qualified in biosecurity (p. 27). ¹⁷⁶ It recommends the country to develop and implement a biosafety and biosecurity training plan based on the "One Health" approach, as well as a plan for personnel at risk in biological safety and security (p. 28). ¹⁷⁷ There is no mention of regulations or licensing conditions. ¹⁷⁸

The Biological Weapons Convention National Implementation Database, the CAR has a specific legal framework governing the licensing and inspections of individuals and facilities working with biological agents and toxins. ¹⁷⁹ However, it does not present any evidence of requirement for background check for personnel. ¹⁸⁰ There is no mention of such requirements related to especially dangerous pathogens and toxins on the Environmental Code (Law No. 07/018 of 28 December 2007) or Law No. 62/350 of 4 January 1963, on plant protection, either. ¹⁸¹ ¹⁸²

There is no further evidence of such regulations on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ¹⁸³ ¹⁸⁴ ¹⁸⁵

1.3.4 Transportation security

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

There is no evidence that the Central African Republic (CAR) has publicly available information on national regulations on the safe and secure transport of infectious substances (specifically including Categories A and B).

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country does not have a secure transport system for infectious substances or agents (p. 27). ¹⁸⁶

In January 2025, the Pasteur Institute of Bangui (IPB) organized a training course on biosafety and biosecurity in partnership with the WHO and the National Laboratory of Clinical Biology and Public Health (LNBCSP). ¹⁸⁹ The course included participants from the IPB, the National Blood Transfusion Center (CNTS), and the LNBCSP, which covered critical issues such as the secure management of biological waste and the safe transport of infectious materials. ¹⁹⁰ Nevertheless, there is no reference to any regulations specifically related to the safe and secure transport of such substances. ¹⁹¹

There is no evidence of such regulations on the Biological Weapons Convention National Implementation Database. ¹⁹² There is no mention of such requirements related to especially dangerous pathogens and toxins on Law No. 62/350 of 4 January 1963, on plant protection, either. ¹⁹³

1.3.5 Cross-border transfer and end-user screening

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no evidence that the Central African Republic (CAR) has legislation or regulations in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential.

Pursuant to Article 57 of the Environmental Code (Law No. 07/018 of 28 December 2007), the Ministry of the Environment and Sustainable Development, in collaboration with other relevant ministerial departments, is responsible for controlling and monitoring the import, export, production, use, and internal movement of hazardous substances and products, with the exception of agropharmaceutical products and similar specialties. ¹⁹⁷ It further adds that the control and monitoring procedures are defined by regulation. ¹⁹⁸ Nevertheless, there is no evidence of such regulations on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ¹⁹⁹ ²⁰⁰ ²⁰¹

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) states that the country does not have a secure transport system for infectious substances or agents. ²⁰² It adds that the Ministry of Health and the Population has an ad hoc service responsible for ensuring health screening at specific points of entry for identified risks (cases of Ebola virus disease, COVID-19, yellow fever, and monkey pox) and there are some tools, such as travel logs and thermal flashes, for screening travelers at certain points of entry and collecting data are available, although very limited (pp. 60-61). ²⁰³ However, there is no mention of any legislation or regulations in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential. ²⁰⁴

Decree No. 23.149 of 6 June 2023, which established legal barriers in the CAR border, does not provide for cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential. ²⁰⁵

There is evidence that such regulations on the Biological Weapons Convention National Implementation Database. ²⁰⁶ The Ministry of National Defense and Army Reconstruction does not have an official website. ²⁰⁷

1.4 Biosafety

1.4.1 Whole-of-government biosafety systems

1.4.1a Biosafety laws/regulations

Score: 0

There is no evidence that the Central African Republic (CAR) has in place legislation or regulations related to biosafety.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), regulations regarding biosafety and biosecurity in the Central African Republic are weak, and they remain limited to a few directives, in which the implementation is not well-controlled (p. 26). ²⁰⁸ Even though some laboratories have microbiological safety stations, not all are certified, particularly in the animal health sector. ²⁰⁹

As per the Biological Weapons Convention National Measures Database, the CAR has biosafety measures for genetically modified organisms (GMOs), which are incorporated in Articles 40 and 41 of the Environmental Code (Law No. 07/018 of 28 December 2007). ²¹⁰ It further adds that the CAR has a specific legal framework governing the licensing and inspections of individuals and facilities working with biological agents and toxins. ²¹¹ However, there is no mention of such requirements related to especially dangerous pathogens and toxins on Law NO. 07/018 of 28 December 2007 or Law No. 62/350 of 4 January 1963, on plant protection, as both laws incorporate provisions related to GMOs. ²¹² ²¹³

In accordance with Article 55 of the Environmental Code, the Ministry of the Environment and Sustainable Development must approve a list of harmful or hazardous chemical substances and products whose production, import, export, storage, transit and circulation in the country is prohibited or subject to prior authorization. ²¹⁴ Moreover, Articles 40 and 41 state that the development, production, storage, handling, transport, use, transfer, or release of any Living Modified Organism must be carried out in a manner that prevents or reduces risks to human health and the environment, and every individual or body, public or private, has the obligation to take the necessary measures to ensure an adequate level of protection for the safe transfer, handling, and use of Living Modified Organisms resulting from modern biotechnology and which may have adverse effects on conservation. ²¹⁵

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no evicence that the Central African Republic (CAR) has an established agency responsible for the enforcement of biosafety legislation and regulations.

As per the Biological Weapons Convention (BWC) National Measures Database, the CAR has biosafety measures for genetically modified organisms (GMOs), which are incorporated in Articles 40 and 41 of the Environmental Code (Law No. 07/018 of 28 December 2007). ²¹⁷ Nevertheless, there is not an established National Contact Point for implementation of the BWC, or mention of an agency responsible for the enforcement of biosecurity legislation and regulations. ²¹⁸

It further adds that the CAR has a specific legal framework governing the licensing and inspections of individuals and facilities working with biological agents and toxins. ²¹⁹ However, there is no mention of such requirements related to especially dangerous pathogens and toxins on Law No. 07/018 of 28 December 2007 or Law No. 62/350 of 4 January 1963, on plant protection, as both laws incorporate provisions related to GMOs. ²²⁰ ²²¹

1.4.2 Biosafety training and practices

1.4.2a Biosafety training using a standardised, required approach

Score: 33.33

There is no evidence that the Central African Republic (CAR) requires biosafety training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. However, there is evidence of biosecurity and biosafety training being provided on an ad hoc basis.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has assessed training needs and identified gaps in biosafety and biosecurity training, but has not yet implemented comprehensive training aligned with defined roles and responsibilities (p. 27). ²²⁴ Overall, laboratory personnel are insufficiently aware of international best practices in biosafety and biosecurity to work safely and responsibly. ²²⁵ There are functional training structures, such as the Faculty of Health Sciences (FACSS), the Faculty of Sciences (FS), and the Higher Institute for Rural Development (ISDR), but there is no specialized structured training in biological safety and security is organized in the country, as well as no training programs in biological safety and security. (p. 27). ²²⁶

Nevertheless, in January 2025, the Pasteur Institute of Bangui (IPB) organized a training course on biosafety and biosecurity in partnership with the WHO and the National Laboratory of Clinical Biology and Public Health (LNBCSP). ²²⁷ The course included participants from the IPB, the National Blood Transfusion Center (CNTS), and the LNBCSP, which combined theorical courses, practical exercises, and experience sharing. ²²⁸ The initiative targeted critical issues such as the rapid detection of pathogens, the secure management of biological waste, and the safe transport of infectious materials, and by training biosafety focal points from key national institutions, it aimed at contributing to the implementation of best practices and the strengthening of safety procedures in the country's laboratories. ²²⁹

There is evidence of such biosafety training requirements on the Biological Weapons Convention National Implementation Database. ²³⁰ There is no further evidence of such mechanism on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ²³¹ ²³² ²³³

There is no evidence on the Environmental Code (Law No. 07/018 of 28 December 2007) or Law No. 62/350 of 4 January 1963, on plant protection. ²³⁴ ²³⁵

1.5 Dual-use research and culture of responsible science

1.5.1 Oversight of dual-use research

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that the Central African Republic (CAR) has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential or dual-use research.

According to the Biological Weapons Convention National Implementation Database, the CAR has developed policies related to the oversight of life sciences, and there are national competent authorities that conduct a risk assessment of research activities involving genetically-modified organisms (GMOs). ²³⁶ However, there is no mention to research related to especially dangerous pathogens, toxins, pathogens with pandemic potential or dual-use research. ²³⁷

Pursuant to Article 39 of the Environmental Code (Law No. 07/018 of 28 December 2007), the scientific exploration and exploitation of biological and genetic resources of protected zones must be carried out under conditions of transparency and close collaboration with international research institutions, local communities, and non-governmental organizations, in which the terms of collaboration between researchers and national research and production institutions, including modern biotechnology, shall be established by regulation. ²³⁸ However, there is no reference on an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential or dual-use research. ²³⁹

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) does not mention such assessment. ²⁴⁰

There is no further evidence of other tests on the official website of the Government of the CAR, or the website of the Ministry of Health and Population. ²⁴¹ ²⁴² The website of the IPB and the Pasteur Network were not operational. ²⁴³ ²⁴⁴ The Ministry of Scientific Research and Innovation does not have an official website. ²⁴⁵

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no publicly available evidence that the Central African Republic (CAR) requires the oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

According to the Biological Weapons Convention National Implementation Database, the CAR has developed policies related to the oversight of life sciences, and there are national competent authorities that conduct a risk assessment of research activities involving genetically-modified organisms (GMOs). ²⁴⁶ However, there is no mention to research related to especially dangerous pathogens, toxins, pathogens with pandemic potential or dual-use research. ²⁴⁷

Pursuant to Article 39 of the Environmental Code (Law No. 07/018 of 28 December 2007), the scientific exploration and exploitation of biological and genetic resources of protected zones must be carried out under conditions of transparency and close collaboration with international research institutions, local communities, and non-governmental organizations, in which the terms of collaboration between researchers and national research and production institutions, including modern biotechnology, shall be established by regulation. ²⁴⁸ However, there is no reference that it pertains to research on especially dangerous pathogens, toxins, pathogens with pandemic potential or dual-use research, or research conducted outside of protected zones. ²⁴⁹

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) does not mention such requirement. ²⁵⁰

There is no further evidence of other tests on the official website of the Government of the CAR, or the website of the Ministry of Health and Population. ²⁵¹ ²⁵² The website of the IPB and the Pasteur Network were not operational. ²⁵³ ²⁵⁴ The Ministry of Scientific Research and Innovation does not have an official website. ²⁵⁵

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no publicly available evidence that the Central African Republic (CAR) has an agency responsible for the oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

According to the Biological Weapons Convention National Implementation Database, the CAR has developed policies related to the oversight of life sciences, and there are national competent authorities that conduct a risk assessment of research activities involving genetically-modified organisms (GMOs). ²⁵⁶ However, there is no mention to research related to especially dangerous pathogens, toxins, pathogens with pandemic potential or dual-use research, or specify which authorities are responsible for overseeing research. ²⁵⁷

Pursuant to Article 39 of the Environmental Code (Law No. 07/018 of 28 December 2007), the scientific exploration and exploitation of biological and genetic resources of protected zones must be carried out under conditions of transparency and close collaboration with international research institutions, local communities, and non-governmental organizations, in which the terms of collaboration between researchers and national research and production institutions, including modern biotechnology, shall be established by regulation. ²⁵⁸ However, there is no reference that it pertains to research on especially dangerous pathogens, toxins, pathogens with pandemic potential or dual-use research, or research conducted outside of protected zones. ²⁵⁹

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) does not mention such agency. ²⁶⁰

There is no further evidence of other tests on the official website of the Government of the CAR, or the website of the Ministry of Health and Population. ²⁶¹ ²⁶² The website of the IPB and the Pasteur Network were not operational. ²⁶³ ²⁶⁴ The Ministry of Scientific Research and Innovation does not have an official website. ²⁶⁵

1.5.2 Screening requirements for providers of genetic material

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no evidence that the Central African Republic (CAR) has legislation or regulation that requires the screening of synthesized DNA (deoxyribonucleic acid) against lists of known pathogens and toxins before it is sold.

Pursuant to Article 39 of the Environmental Code (Law No. 07/018 of 28 December 2007), the scientific exploration and exploitation of biological and genetic resources of protected zones must be carried out under conditions of transparency and close collaboration with international research institutions, local communities, and non-governmental organizations, in which the terms of collaboration between researchers and national research and production institutions, including modern biotechnology, shall be established by regulation. ²⁶⁶ The legislation also includes recombination of DNA as modern biotechnology. ²⁶⁷

Article 56 mandates operators, manufacturers, or importers of chemical substances and products intended for commercialization to first provide the Ministry of the Environment and Sustainable Development with the information contained in their register relating to the composition of the substances and products placed on the market, their volume marketed, and their potential effects on humans and the environment. ²⁶⁸ However, there is no specific mention of a requirement for screening of synthesized DNA against list of known pathogens and toxins before it is sold. ²⁶⁹

There is no evidence of such requirements on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ²⁷⁰ ²⁷¹ ²⁷² The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) does not mention it either. ²⁷³ There is evidence that such regulations on the Biological Weapons Convention National Implementation Database. ²⁷⁴ The Ministry of National Defense and Army Reconstruction does not have an official website. ²⁷⁵

1.6 Immunization

1.6.1 Vaccination rates

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 0

There are not official foot-and-mouth disease (FMD) vaccination figures for livestock in the Central African Republic (CAR) publicly available through the OIE database.

In 2019, the Central African Republic reported data on border precautions, movement control, monitoring, general surveillance, and disease notification measures relating to foot-and-mouth disease (FMD) in cattle. ²⁷⁶ However, there are no available vaccination figures, nor is there reported data for the period from 2020 to 2025. ²⁷⁷

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

The Central African Republic (CAR) has a national immunization plan, which includes measures specifically aimed at overcoming geography and gender barriers to vaccination.

The National Vaccination Policy (PNV) (2020), enacted by the Ministry of Health and the Population, has the goal of contributing to the reduction of morbidity and mortality due to vaccine-preventable diseases in the country, with the specific goal of increasing the accessibility of immunization services to all target groups (p. 10). ²⁷⁸ The PNV includes strategies specifically aimed at overcoming inequalities in vaccination, particularly to newborns, babies, and pregnant women. ²⁷⁹

In addition, the CAR has implemented the Expanded Program on Immunization (EPI) since 1979 (p. 6). ²⁸⁰ In September 2020, the Ministry of Health and Population published the Guidelines on the EPI to provide clear direction to all administrative levels and stakeholders involved in the programme, with the objective of improving the quality of immunisation services. ²⁸¹ The plan covers poliomyelitis, measles, maternal and neonatal tetanus, yellow fever, meningitis, vitamin deficiency, helminthiasis, and malaria (p. 7). ²⁸² It also includes advanced strategies involving mobile units deployed to health areas not covered by the EPI or to locations with limited access by local health centre teams (p. 8). ²⁸³

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) states that there is mass vaccination against measles, and several vaccination campaigns against diseases with epidemic potential such as meningitis, polio, yellow fever, and others (p. 30). ²⁸⁴

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 100

The immunization strategy of the Central African Republic (CAR) includes measures to address vaccine hesitancy and build public trust in vaccines.

The National Vaccination Policy (PNV) (2020), enacted by the Ministry of Health and the Population, states that vaccination should be accepted as second nature and actively demanded by the population, emphasising the importance of immunisation for both children and adults and promoting ownership of the national vaccination schedule. ²⁸⁵ It highlights that advocacy, mobilisation, and information efforts should target families, including fathers and caregivers, while considering literacy levels and cultural barriers (p. 13). ²⁸⁶ The policy further recommends prioritising traditional communication channels, such as religious, community, and other local leaders, alongside modern media, including national and community radio and mobile phones. It also calls for the involvement of schools in awareness campaigns and the integration of vaccination-related content into the curriculum, particularly to reach young girls and future mothers, with a focus on tetanus vaccination and immunisation for their future children (pp. 13-14). ²⁸⁷

The CAR has implemented the Expanded Programme on Immunization (EPI) since 1979 (p. 6). ²⁸⁸ In September 2020, the Ministry of Health and Population published the Guidelines on the EPI to provide clear direction to all administrative levels and stakeholders involved in the programme, with the objective of improving the quality of immunisation services. ²⁸⁹ The plan includes vaccines against poliomyelitis, measles, maternal and neonatal tetanus, yellow fever, meningitis, vitamin deficiency, helminthiasis, and malaria (p. 7). ²⁹⁰ It notes that communication for development is based on four complementary strategies: advocacy, social mobilisation for broader participation, behaviour change communication to inform and influence knowledge, attitudes, and practices among target groups, and social and behaviour change communication to engage and empower community leaders, opinion leaders, and social networks, with the aim of influencing social norms regarding vaccination (pp. 9-10). ²⁹¹

The guidelines also outline specific measures, such as preparing strategic communication plans, mapping vaccine-hesitant groups, and effectively coordinating communication activities with local partners during programme implementation, among other actions. ²⁹²

1.6.1e National advisory group for immunization strategy/plan

Score: 0

The Central African Republic (CAR) does not have a national advisory group (NITAG) that provides technical guidance and advice on the immunization strategy to the government.

According to the World Health Organization (WHO), the CAR does not have a NITAG. ²⁹³ The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2018) does not mention a NITAG, but mentions the Technical Support Committee for the Expanded Program on Immunization (CTAPEV). ²⁹⁴

According to the National Vaccination Policy (PNV) (2020), enacted by the Ministry of Health and Population, CTAPEV is responsible for overseeing recommendations and all aspects of policy implementation. ²⁹⁵ The CTAPEV’s mandate includes examining and approving operational action plans of the Expanded Programme on Immunization (EPI), approving the implementation budgets of these plans, and monitoring the execution of planned activities, preparing technical documentation for audits, producing periodic reports on program implementation, and proposing measures to improve programme performance to the Inter-Agency Coordination Committee. ²⁹⁶

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is no evidence that the Central African Republic (CAR) has an immunization programme for influenza.

The National Vaccination Policy (PNV) (2020), enacted by the Ministry of Health and the Population, has the goal of contributing to the reduction of morbidity and mortality due to vaccine-preventable diseases in the country, with the specific goal of increasing the accessibility of immunization services to all target groups (p. 10). ²⁹⁷ The PNV includes strategies specifically aimed at overcoming inequalities in vaccination, particularly to newborns, babies, and pregnant women. ²⁹⁸ There is no mention of influenza. ²⁹⁹

In addition, the CAR has implemented the Expanded Program on Immunization (EPI) since 1979 (p. 6). ³⁰⁰ In September 2020, the Ministry of Health and Population published the Guidelines on the EPI to provide clear direction to all administrative levels and stakeholders involved in the programme, with the objective of improving the quality of immunisation services. ³⁰¹ The plan covers poliomyelitis, measles, maternal and neonatal tetanus, yellow fever, meningitis, vitamin deficiency, helminthiasis, and malaria (p. 7). ³⁰² There is no mention of influenza. ³⁰³

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) does not mention influenza. ³⁰⁴

In September 2024, the Pasteur Institute of Bangui (IPB) announced it had started a sentinel surveillance program with international partners related to influenza, which found multiple strains circulating in the country, and stated that local genetic diversity underscored the need to align vaccines with circulating strains and revisit composition as needed. ³⁰⁵

1.7 Climate change adaptation and vector transmission

1.7.1 Health system resilience

1.7.1a Strategy/plan for resilience of health system

Score: 0

There is no evidence that the Central African Republic (CAR) has a strategy or plan to develop a health system that is resilient to the challenges that climate change and changing seasonal weather patterns pose, that includes the threat of infectious diseases.

The National Health Development Plan 2022-2026 (PNDS III) identifies and prioritises several challenges within the healthcare system, including deficiencies in health system resilience in relation to quality norms and standards for infrastructure and equipment, healthcare service coverage, the ability to meet population needs, the supply and distribution of medicines, and the overall capacity to respond to public health emergencies. ³⁰⁶ The plan seeks to strengthen resilience, including by improving epidemic preparedness and response capacities. However, it does not include specific measures addressing the challenges posed by climate change and changing seasonal weather patterns. ³⁰⁷

The National Community Health Policy 2020-2030 and the National Health Policy 2019-2030 do not include such considerations either. ³⁰⁸ ³⁰⁹

The National Gender and Climate Change Strategy 2023-2030 (2023), enacted by the Ministry of the Environment and Sustainable Development, includes goals to develop a livestock strategy resilient to climate hazards (p. 28), and reinforce strategies to combat climate-related diseases (such as pneumonia, cancer, climate-sensitive diseases, and others) (pp. 38-39). ³¹⁰ However, there is no reference to developing a health system that is resilient to the challenges that climate change and changing seasonal weather patterns pose. ³¹¹

In addition, the Initial National Climate Change Adaptation Plan (2022), enacted by the Ministry of the Environment and Sustainable Development, does not include measures to develop a health system that is resilient to the challenges that climate change and changing seasonal weather patterns pose. ³¹²

There is no evidence of such strategy on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) database. ³¹³ ³¹⁴ ³¹⁵

Early Detection

2.1 Laboratory systems strength and quality

2.1.1 Lab capacity for detecting priority diseases

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 0

There is no publicly available evidence that the national laboratory system in the Central African Republic (CAR) has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the national laboratory system allows for nucleic acid amplification tests, bacterial cultures with antimicrobial susceptibility testing, and sequencing capabilities or access to them (p. 34). ³¹⁶ The coutry uses diagnostic tests such as molecular biology (PCR), Enzyme-Linked Immunosorbet Assay (ELISA), and rapid diagnostic tests (RDT) (p. 35). ³¹⁷

However, the website of the Pasteur Institute of Bangui (IPB) was not operational. ³¹⁸

2.1.1b Plan to conduct testing during a public health emergency

Score: 50

The Central African Republic (CAR) has a national plan. However, there is no evidence that it includes considerations for testing during a public health emergency, which includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing.

The National Health Development Plan 2022-2026 (PNDS III) includes strategic orientation No. 8, which is focused on strengthening the country's capacity to prepare for and respond to epidemics, disasters and other public health emergencies, taking into account the links between human health, animal health and environmental health, as well as the need for a "One Health" approach (p. 76). ³¹⁹ Under this strategic orientation, there are measures to strengthen coordination structures for responding to epidemics, public health emergencies, and other disasters at different levels of the health system, including the "One Health" approach (4.4.1) and develop appropriate mechanisms and strategies for responding to epidemics, public health emergencies, and other disasters to reach hard-to-reach populations (conflict zones, nomads, etc.) (4.4.2). ³²⁰

It also has other measures, such as reforming the integrated epidemiological surveillance and response system (2.5.1), strengthening the capacities of stakeholders in the management of epidemics and other disasters at all levels, pre-position emergency kits at all levels (2.5.2), strengthening the integrated epidemiological surveillance system, including community-based surveillance, using new information and communication technologies (tablets, digitalization, etc.) (2.5.3), implementation harmonized standards and protocols for the management of emergencies and humanitarian crises, taking into account the continuum of care (4.4.1), and increasing the capacity of health providers to respond to emergencies and disasters at all levels (4.4.2). ³²¹ However, there are no measures that are specific to increase testing. ³²²

2.1.2 Laboratory quality systems

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 0

The Central African Republic (CAR) does not have a national laboratory that serves as a reference facility which is accredited.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the Pasteur Institute of Bangui (IPB) undergoes accreditation and uses the ISO 15189 standard (p. 34). ³²⁶ Nevertheless, there is no evidence that it is accredited to ISO 15189 or CLIA (p. 34). ³²⁷

In July 2025, the IPB announced through its Facebook profile that it had completed an external quality assessment programme from the WHO for detection of influenza viruses, including COVID-19, using RT-PCR with attainment of full score. ³²⁸ It also got recognised by the WHO related to its national reference dedicated to measles-rubella (by serology) and yellow fever (by seroloy and PCR molecular diagnosis), and it has been working towards ISO 15189 accreditation. ³²⁹

I propose a score of 0 rather than 1. The Pasteur Institute of Bangui is not clearly accredited to ISO 15189 or CLIA based on available public information ^{330, p.34}. It is recognized as a reference laboratory by the WHO and is reportedly working toward ISO 15189 accreditation ³³¹.

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

The Central African Republic (CAR) has a national laboratory that serves as a reference facility which is subject to external quality assurance review.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the Pasteur Institute of Bangui (IPB) and the National Laboratory of Clinical Biology and Public Health (LNBCSP) participated in regional and international external quality control programs, while district laboratories participated in external quality assessment programs (p. 34). ³³²

In July 2025, the IPB announced through its Facebook profile that it had completed an external quality assessment programme from the WHO for detection of influenza viruses, including COVID-19, using RT-PCR with attainment of full score. ³³³ It also got accredited by the WHO related to its national reference dedicated to measles-rubella (by serology) and yellow fever (by seroloy and PCR molecular diagnosis). ³³⁴

2.2 Laboratory supply chains

2.2.1 Specimen referral and transport system

2.2.1a Nationwide specimen transport system

Score: 0

There is no evidence that the Central African Republic (CAR) has a nationwide specimen transport system.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the CAR does not have an integrated sample transport system, but programs, such as tuberculosis and HIV/AIDS, support specimen transport through both public and private means (p. 33). ³³⁵ It further adds that there is no system for transporting samples from intermediate zones/districts to national laboratories, and only ad hoc means of transport exist (p. 34). ³³⁶ There is an occasional air transport provided by partners, namely Doctors Without Borders and the WHO, and there is on-site resources and private transport that are used for transportation; however, the system is not formalized, funding is insufficient and the laboratory referral and counter-referral system has shortcomings (p. 34). ³³⁷

A 2018 study titled "Evidence of human leptospirosis cases in a cohort of febrile patients in Bangui, Central African Republic: a retrospective study, 2012-2015" concluded that "suboptimal sampling, transportation (from remote field sites and between laboratories) and storage conditions" hindered diagnostic efforts. ³³⁸

The National Strategic Plan for Laboratories 2021-2025 (2020), enacted by the Ministry of Health and the Population, acknowledged problems in transport and routing of samples and results (p. 22), and it included a strategy to implement a safe and standardized system for the collection, storage, and transport of samples (p. 31), as well as to develop, validate, and disseminate a capacity-building plan for laboratory diagnostics facility staff in the use of safety and biosafety equipment and sample transfer (p. 32). ³³⁹

There is no evidence of such system on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) database. ³⁴⁰ ³⁴¹ ³⁴²

2.2.2 Laboratory cooperation and coordination

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no evidence that the Central African Republic (CAR) has a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak.

The National Health Development Plan 2022-2026 (PNDS III) includes strategic orientation No. 8, which is focused on strengthening the country's capacity to prepare for and respond to epidemics, disasters and other public health emergencies, taking into account the links between human health, animal health and environmental health, as well as the need for a "One Health" approach (p. 76). ³⁴³ Under this strategic orientation, there are measures to strengthen coordination structures for responding to epidemics, public health emergencies, and other disasters at different levels of the health system, including the "One Health" approach (4.4.1) and develop appropriate mechanisms and strategies for responding to epidemics, public health emergencies, and other disasters to reach hard-to-reach populations (conflict zones, nomads, etc.) (4.4.2). ³⁴⁴ However, there is no evidence that it includes measures to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak. ³⁴⁵

The National Strategic Plan for Laboratories 2021-2025 (2020), enacted by the Ministry of Health and the Population, does not mention rapid authorization or licensing of laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak. ³⁴⁹

2.3 Real-time surveillance and reporting

2.3.1 Indicator and event-based surveillance and reporting systems

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

The Central African Republic (CAR) is conducting event-based surveillance. However, there is no evidence on its frequency, or whether it has been conducting indicator-based surveillance and analysis for notifiable and novel infectious diseases.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the existing rapid response teams in the country use a multisectoral approach to organize and carry out verification and investigation missions for health emergencies (p. 37). ³⁵⁰ However, the time to confirm public health emergencies must be reduced from more than one week to less than 72 hours through prompt interventions targeting surveillance and health laboratories. ³⁵¹ It also recommends expanding event-based and community-based surveillance across all sectors and at all levels to ensure effective detection of public health events as the system is weak (p. 37). ³⁵²

According to a 2023 paper titled "Evaluating event-based surveillance capacity in Africa: Use of the Africa CDC scorecard, 2022-2023", the CAR has an event-based suerveillance system in place. ³⁵³

In December 2024, 60 community members, including 23 women, from various villages in the Ouango-Gambo district received training to serve as Community Health Workers (CHWs). ³⁵⁴ The training, delivered under the REDISSE IV/RCA program funded by the World Bank, focused on signal reporting techniques, including both indicator-based and event-based surveillance. The initiative supported early detection of human, animal, and environmental health threats to enable a rapid response, improve access to real-time data, enhance analysis and intervention, and strengthen One Health structures at the local level. Information collected is transmitted electronically to the central level via SMS using tablets, with all data stored on a central server accessible to stakeholders at all levels, allowing real-time consultation and decision-making. ³⁵⁵

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

The Central African Republic (CAR) has an IHR focal point for reporting notifiable diseases to the World Health Organization (WHO) within the set timeline.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the CAR has designated an IHR national focal point, which regularly shares information with the WHO contact point, as well as with other focal points from the sectors affected by the IHR and Technical and Financial Partners (p. 14). ³⁵⁶ Nevertheless, the National IHR Focal Point is not formally designated, thus the terms of reference and standard operating procedures (SOPs) governing its operation are not defined. ³⁵⁷ It also lacks access to information and authorization to share it with the WHO and stakeholders in other sectors covered by the IHR, and the human, financial, infrastructural, and logistical resources to ensure the implementation of the IHR (2005), and thus global health security, are insufficient. ³⁵⁸

2.3.2 Interoperable, interconnected, electronic real-time reporting systems

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

The Central African Republic (CAR) operates an electronic reporting surveillance system at both the national and the sub-national level.

According to the WHO, the community-based epidemiological surveillance system in the CAR is reinforced by an electronic surveillance mechanism operated by 70 trained community relays equipped with smartphones featuring the Auto-Visual AFP Detection and Reporting (AVADAR) application. ³⁶⁰ This “auto-visual” detection tool, developed by WHO Africa with support from the Bill & Melinda Gates Foundation and the World Bank, enables the identification of suspected cases and facilitates their referral to treatment centres. ³⁶¹

In December 2024, 60 community members, including 23 women, from various villages in the Ouango-Gambo district received training to serve as Community Health Workers (CHWs). ³⁶² The training, delivered under the REDISSE IV/RCA program funded by the World Bank, focused on signal reporting techniques, including both indicator-based and event-based surveillance. ³⁶³ The initiative supported early detection of human, animal, and environmental health threats to enable a rapid response, improve access to real-time data, enhance analysis and intervention, and strengthen One Health structures at the local level. ³⁶⁴ Information collected is transmitted electronically to the central level via SMS using tablets, with all data stored on a central server accessible to stakeholders at all levels, allowing real-time consultation and decision-making. ³⁶⁵

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 0

There is no evidence that the electronic reporting surveillance system in Central African Republic (CAR) collects ongoing or real-time laboratory data . There is no evidence that the data can be disaggregated and analysed by age, ethnicity, and other factors.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the CAR has scaled-up the District Health Information System (DHIS2) to health regions, although its use is still low (p. 38). ³⁶⁶ The document further adds that the country has a minimal data analysis and health information team at all levels, and even though the analysis of epidemiological surveillance data is systematized at the district level, it does not occurs at all levels (p. 38). ³⁶⁷ It recommends the country to create a digital platform for sharing real-time data between different sectors, including with partners and internationally (p. 38). ³⁶⁸

According to the WHO, the community-based epidemiological surveillance system in the CAR is reinforced by an electronic surveillance mechanism operated by 70 trained community relays equipped with smartphones featuring the Auto-Visual AFP Detection and Reporting (AVADAR) application. ³⁶⁹ This “auto-visual” detection tool, developed by WHO Africa with support from the Bill & Melinda Gates Foundation and the World Bank, enables the identification of suspected cases and facilitates their referral to treatment centres. ³⁷⁰ There is no mention whether it is ongoing or real-time laboratory data, or whether it is disaggregated. ³⁷¹

In December 2024, 60 community members, including 23 women, from various villages in the Ouango-Gambo district received training to serve as Community Health Workers (CHWs). ³⁷² The training, delivered under the REDISSE IV/RCA program funded by the World Bank, focused on signal reporting techniques, including both indicator-based and event-based surveillance. ³⁷³ The initiative supported early detection of human, animal, and environmental health threats to enable a rapid response, improve access to real-time data, enhance analysis and intervention, and strengthen One Health structures at the local level. ³⁷⁴ Information collected is transmitted electronically to the central level via SMS using tablets, with all data stored on a central server accessible to stakeholders at all levels, allowing real-time consultation and decision-making. ³⁷⁵ There is no mention whether it is disaggregated. ³⁷⁶

2.3.3 Wastewater surveillance

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within the country. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 6 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.³⁷⁷

In December 2017, routine environmental surveillance was implemented in CAR, restricted to 4 sampling sites in Bangui; 6 additional sites were gradually opened in 2019. ³⁷⁸ A research paper from 2026, states that "routine environmental surveillance is conducted through twice-monthly sampling of wastewater collected in Bangui, the capital city, and a few other towns" and "wastewater was collected from collection sites sampled twice a month", however the paper also says that it is based on "analysis of stools and wastewater collected from November 2021 through October 2023 in the CAR". There is no further evidence whether this surveillance is currently ongoing.³⁷⁹

Moreover, in 2025, the WHO reported that following the identification of three circulating variant poliovirus type 2 in the country, Central African Republic has faced challenges in its epidemiological surveillance, limiting its ability to swiftly detect and respond to outbreaks. These gaps have driven the country to implement a comprehensive response plan to enhance vaccination and surveillance efforts, but there is limited evidence on this plan.³⁸⁰

2.4 Surveillance data accessibility and transparency

2.4.1 Coverage and use of electronic health records

2.4.1a Common usage of electronic health records

Score: 50

Electronic health records are not commonly in use in the Central African Republic (CAR), but there is evidence they are used.

A 2022 World Bank document states that "Existing paper forms and registers have been revised and streamlined and rolled out in 12 districts so far alongside the new District Health Information System 2.0 (DHIS2), which has been piloted in Bangui. The country’s ambition is to roll out DHIS2 in all areas of the country. However, key challenges persist including poor internet connectivity, low staff capacity for data collection and use, a weak culture of data quality, and insecurity" (p. 14). ³⁸²

In addition, the CAR has a Digital-Health Transformation Unit (DTU), under the purview of the Ministry of Health, to execute its mission towards developing a resilient health system with a focus on digital health, infrastructure and capacity. ³⁸³

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no evidence that the national public health system has access to electronic health records of individuals in the Central African Republic (CAR).

In December 2024, 60 community members, including 23 women, from various villages in the Ouango-Gambo district received training to serve as Community Health Workers (CHWs). ³⁸⁴ The training, delivered under the REDISSE IV/RCA program funded by the World Bank, focused on signal reporting techniques, including both indicator-based and event-based surveillance. ³⁸⁵ Information collected is transmitted electronically to the central level via SMS using tablets, with all data stored on a central server accessible to stakeholders at all levels, allowing real-time consultation and decision-making. ³⁸⁶ However, there is no mention whether the national public health system can access individual health records. ³⁸⁷

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) does not mention whether the national public health system has access to electronic health records of individuals. ³⁸⁸

There is no evidence of such measures on the official websites of the Government of the CAR, or the Ministry of Health and Population. ³⁸⁹ ³⁹⁰

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no evidence that there are data standards to ensure data is comparable in the Central African Republic (CAR).

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) states that the CAR should scale-up the use of District Health Information System 2.0 (DHIS2) and the dashboard to improve real-time monitoring and make it interoperable and interconnected between the different sectors involved in the implementation of the IHR (p. 38). ³⁹¹ There is no mention of data standards. ³⁹²

There is no evidence of data standards on the official websites of the Government of the CAR, or the Ministry of Health and Population. ³⁹³ ³⁹⁴

2.4.2 Data integration between human, animal and environmental health sectors

2.4.2a Data sharing mechanisms

Score: 0

There is no evidence that the Central African Republic (CAR) has established mechanisms at the relevant ministries responsible for animal, human, and wildlife surveillance to share data.

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) states that the epidemiological surveillance data report is shared between key IHR sectors. and the District Health Information System 2.0 (DHIS2), being deployed in the health regions solely for human health (p. 38). ³⁹⁵ In addition, the surveillance system has shortcomings in the animal health, livestock and environmental sectors (p. 37). ³⁹⁶

In addition, the CAR has established a multisectoral committee for the surveillance of diseases and public health events through Ministerial Order No. 119 (p. 37). ³⁹⁷ However, such piece of legislation is not publicly available on the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ³⁹⁸ ³⁹⁹ ⁴⁰⁰ The Ministry of Livestock and Animal Health does not have an official website.

2.4.3 Transparency of surveillance data

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 0

There is no evidence that the Central African Republic (CAR) makes de-identified health surveillance data on infectious diseases publicly available via reports on government websites.

There is no evidence of such reports on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁴⁰¹ ⁴⁰² ⁴⁰³

2.4.4 Ethical considerations during surveillance

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

The Central African Republic (CAR) has legislation that safeguard the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities.

Law No. 24.001 of 25 January 2024 (General Personal Data Protection Law) established a comprehensive legal framework for the safeguarding of personal data in CAR. ⁴⁰⁴ It includes provisions to protect sensitive data, such as racial origin, political opinions, genetic and biometric data, and health information; such as the requirement of consent to process such data. ⁴⁰⁵

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

There is no evidence that the Central African Republic (CAR) has legislation or regulations that safeguard the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities.

According to a 2022 Reference Term for the Legal Assistance for Strenghtening the Legal Framework Relating to Digital Transformation, the CAR has a draft law on the protection of personal data that provides for the creation of an authority responsible for monitoring the processing of personal data (p. 4). ⁴⁰⁶ It further adds that "since this bill has not yet been adopted, this legislative gap poses a high risk of abuse, in addition to undermining trust in the digital space and preventing system interoperability, which is a crucial aspect of digital governance". ⁴⁰⁷

Law No. 18.002 of 17 January 2018, which regulates electronic communications in the country, does not have specific provisions for the safeguard of the confidentiality of information generated through surveillance activities for animals. ⁴⁰⁹ The Livestock Regulations (Law No. 65.61 of 3 June 1965) do not mention any confidentiality of the information generated through notification. ⁴¹⁰

There is no further evidence of such mechanism on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁴¹¹ ⁴¹² ⁴¹³ The Ministry of Livestock and Animal Health does not have an official website. ⁴¹⁴

The Central African Republic (CAR) has not ratified the African Union Convention on Cybersecurity. ⁴¹⁵

2.4.5 International data sharing

2.4.5a Cooperative commitments or agreements within regions

Score: 0

There is no evidence that the Central African Republic (CAR) government has made commitments via public statements, legislation or cooperative agreements to share surveillance data during a public health emergency with other countries.

There is no further evidence of such mechanism on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁴¹⁶ ⁴¹⁷ ⁴¹⁸ The Ministry of Livestock and Animal Health does not have an official website. ⁴¹⁹

There is no evidence on the Radio Ndekeluka, Jeune Afrique, and RFI. ⁴²⁰ ⁴²¹ ⁴²²

The country's adherence to the International Health Regulations (IHR 2005) serves as a primary legal and operational commitment. As a signatory, Central African Republic is obligated to notify the World Health Organization (WHO) of public health events that may constitute a public health emergency of international concern. This legally binding framework necessitates the sharing of surveillance data with the WHO but does not specify provisions to share with other countries. ⁴²³

2.5 Case-based investigation

2.5.1 Case investigation and contact tracing

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 0

There is no evidence that the Central African Republic (CAR) has a national system in place to provide support at the sub-national level to conduct contact tracing in the event of a public emergency.

The National Health Development Plan 2022-2026 (PNDS III) includes strategic orientation No. 8, which is focused on strengthening the country's capacity to prepare for and respond to epidemics, disasters and other public health emergencies, taking into account the links between human health, animal health and environmental health, as well as the need for a "One Health" approach (p. 76). ⁴²⁴ Under this strategic orientation, there are measures to strengthen coordination structures for responding to epidemics, public health emergencies, and other disasters at different levels of the health system, including the "One Health" approach (4.4.1) and develop appropriate mechanisms and strategies for responding to epidemics, public health emergencies, and other disasters to reach hard-to-reach populations (conflict zones, nomads, etc.) (4.4.2). ⁴²⁵ However, there is no mention of support at the sub-national level to conduct contact tracing in the event of a public emergency. ⁴²⁶

There is no reference to such system on the National Community Health Policy 2020-2030 or the National Health Policy 2019-2030. ⁴²⁷ ⁴²⁸

There is no further evidence of such on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁴²⁹ ⁴³⁰ ⁴³¹

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is no evidence that the Central African Republic (CAR) provides wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended, particularly economic support and medical attention.

The National Health Development Plan 2022-2026 (PNDS III), the National Community Health Policy 2020-2030 or the National Health Policy 2019-2030 do not mention such services. ⁴³² ⁴³³ ⁴³⁴

There is no further evidence of such services on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁴³⁵ ⁴³⁶ ⁴³⁷

There is no mention of such services on the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023). ⁴³⁸

2.5.2 Point of entry management

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no evidence that the Central African Republic (CAR) has a joint plan or cooperative agreement between the public health system and border control authorities to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of a public health emergency.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the activities of the points of entry are taken into account in the strategic focus of surveillance and in national health crisis preparedness plans, although no assessment of the capacities related to the points of entry has been conducted (p. 60). ⁴³⁹ It adds that the country does not have a multisectoral public health emergency plan for points of entry, and there are no standardized operating procedures for border staff (p. 61). ⁴⁴⁰ There is no mention of a joint plan or cooperative agreement. ⁴⁴¹

Additionally, the legal regulatory framework for coordinating actions between public health officials and security authorities is nonexistent (p. 49). ⁴⁴²

The National Health Development Plan 2022-2026 (PNDS III), the National Community Health Policy 2020-2030 or the National Health Policy 2019-2030 do not mention such agreement or plan. ⁴⁴³ ⁴⁴⁴ ⁴⁴⁵

Decree No. 23.149 of 6 June 2023, which established legal barriers in the CAR border, does not present any regulation specifically regarding the public health system and border control authorities. ⁴⁴⁶

There is no further evidence of such joint plan or cooperative agreement on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁴⁴⁷ ⁴⁴⁸ ⁴⁴⁹

2.6 Epidemiology workforce

2.6.1 Existence of applied epidemiology training program such FETP and FETPV

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

The Central African Republic (CAR) has applied epidemiology training program available in the country, and there is evidence of resources provided to send citizens to another country to participate in applied epidemiology training programs.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), multidisciplinary and multisectoral human resources are available and trained to conduct epidemiological investigations, including in Health Emergency Rapid Response Team (EIRUS) and Field Epidemiology Training Program (FETP) (p. 37). ⁴⁵⁰

In addition, there is a training program for basic-level field epidemiologists, and the training program for intermediate-level field epidemiologists started in September 2023 (p. 41). ⁴⁵¹ Furthermore, for the training of advanced-level field epidemiologists, health professionals from the Central African Republic are being trained at the Cameroon Field Epidemiology Training Program (CAFETP) as part of a collaboration agreement with this sub-regional institution. ⁴⁵²

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 0

There is no evidence that the field epidemiology training programs explicitly include animal health professionals or that there are specific animal health field epidemiology training programs offered, such as FETPV.

In addition, there is a training program for basic-level field epidemiologists, and the training program for intermediate-level field epidemiologists started in September 2023 (p. 41). ⁴⁵⁴ Furthermore, for the training of advanced-level field epidemiologists, health professionals from the Central African Republic are being trained at the Cameroon Field Epidemiology Training Program (CAFETP) as part of a collaboration agreement with this sub-regional institution. ⁴⁵⁵ There is no mention of animal health. ⁴⁵⁶

2.6.2 Epidemiology workforce capacity

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 0

There is no evidence that the Central African Republic (CAR) has at least 1 trained field epidemiologist per 200,000 people.

According to the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET), the Advanced FETP aims to reach the goal of 1 field epidemiologists per 200,000 inhabitants in the Central African Republic. ⁴⁶¹

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the CAR has a qualified health workforce that includes physicians, nurses, midwives, public health specialists, occupational health specialists, biomedical technicians, biostatisticians, pharmacists, veterinarians, laboratory specialists, wildlife specialists, environmentalists, and field epidemiologists (p. 39). ⁴⁶² However, there is no reference to the number, or if there are at least 1 trained field epidemiologist per 200,000 people. ⁴⁶³

Rapid Response

3.1 Emergency preparedness and response planning

3.1.1 National public health emergency preparedness and response plan

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 0

There is no evidence that the Central African Republic (CAR) has an overarching national public health emergency response plan in place which addresses planning for multiple communicable diseases with epidemic or pandemic potential.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country does not have a multi-risk response plan, even though it has the necessary funding and infrastructure for preparedness and prioritizes Universal Health and Preparedness Review (UHPR) activities to strenghten emergency preparedness (p. 45). ⁴⁶⁴ In addition, the incident management system is not systematically applied in the event of declared health emergencies, and standard operating procedures are either nonexistent or inadequate for emergency response (p. 46). ⁴⁶⁵

It further adds that the country has contingency plans for Ebola, mpox, rabies, Rift Valley fever, and Avian influenza (p. 20). ⁴⁶⁶ Nevertheless, such plans are not available on official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁴⁶⁷ ⁴⁶⁸ ⁴⁶⁹

There is no evidence of such plan on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁴⁷³ ⁴⁷⁴ ⁴⁷⁵

The National Report on Climate and Development for the Central African Republic (2024), published by the World Bank, states that the CAR has a National Strategy for Disaster Risk Reduction (p. 36), but such plan is not available on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁴⁷⁶ ⁴⁷⁷ ⁴⁷⁸ ⁴⁷⁹

The National Gender and Climate Change Strategy 2023-2030 (2023) and the Initial National Climate Change Adaptation Plan (2022), both enacted by the Ministry of the Environment and Sustainable Development, do not include public health emergency measures related to multiple communicable diseases with epidemic or pandemic potential. ⁴⁸⁰ ⁴⁸¹

3.1.1b National public health emergency response plan published in past 3 years

Score: 0

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country does not have a multi-risk response plan, even though it has the necessary funding and infrastructure for preparedness and prioritizes Universal Health and Preparedness Review (UHPR) activities to strenghten emergency preparedness (p. 45). ⁴⁸² In addition, the incident management system is not systematically applied in the event of declared health emergencies, and standard operating procedures are either nonexistent or inadequate for emergency response (p. 46). ⁴⁸³

It further adds that the country has contingency plans for Ebola, mpox, rabies, Rift Valley fever, and Avian influenza (p. 20). ⁴⁸⁴ Nevertheless, such plans are not available on official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁴⁸⁵ ⁴⁸⁶ ⁴⁸⁷

There is no evidence of such plan on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁴⁹¹ ⁴⁹² ⁴⁹³

3.1.1c One health principles by covering multiple threat types

Score: 0

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country does not have a multi-risk response plan, even though it has the necessary funding and infrastructure for preparedness and prioritizes Universal Health and Preparedness Review (UHPR) activities to strenghten emergency preparedness (p. 45). ⁵⁰⁰ In addition, the incident management system is not systematically applied in the event of declared health emergencies, and standard operating procedures are either nonexistent or inadequate for emergency response (p. 46). ⁵⁰¹

It further adds that the country has contingency plans for Ebola, mpox, rabies, Rift Valley fever, and Avian influenza (p. 20). ⁵⁰² Nevertheless, such plans are not available on official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁵⁰³ ⁵⁰⁴ ⁵⁰⁵

The PNDS III acknowledges the inexistence of multisectoral coordination mechanisms (p. 50), and presents measures to reinforce the legal framework of coordination and partnerships (p. 78). ⁵⁰⁹ Nevertheless, there is no mention of multiple threat types, such as antimicrobial resistance, zoonotic disease spillover, biological accidents or deliberate acts. ⁵¹⁰

There is no evidence of such plan on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁵¹¹ ⁵¹² ⁵¹³

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country does not have a multi-risk response plan, even though it has the necessary funding and infrastructure for preparedness and prioritizes Universal Health and Preparedness Review (UHPR) activities to strenghten emergency preparedness (p. 45). ⁵²⁰ In addition, the incident management system is not systematically applied in the event of declared health emergencies, and standard operating procedures are either nonexistent or inadequate for emergency response (p. 46). ⁵²¹

It further adds that the country has contingency plans for Ebola, mpox, rabies, Rift Valley fever, and Avian influenza (p. 20). ⁵²² Nevertheless, such plans are not available on official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁵²³ ⁵²⁴ ⁵²⁵

The National Health Development Plan 2022-2026 (PNDS III) includes strategic orientation No. 8, which is focused on strengthening the country's capacity to prepare for and respond to epidemics, disasters and other public health emergencies, taking into account the links between human health, animal health and environmental health, as well as the need for a "One Health" approach (p. 76). ⁵²⁶ It covers diseases with epidemic potential, namely malaria, HIV, neglected tropical diseases, cholera, meningitis, measles, tetanus, rabies, and COVID-19 (pp. 38-39). ⁵²⁷ However, there are no specific measures for health emergency response, or outlines disaster management measures. ⁵²⁸ Therefore, there are no considerations on health equity. ⁵²⁹

The PNDS III incorporates the principle of universal health coverage (p. 74), and identifies major disparities in education, health and nutrition access, as well as geographic disparities (p. 63), and includes equal health access as a value (p. 74). ⁵³⁰ It includes a measure to increase the vaccination coverage and equity (3.3.2), and has a goal to reach 70% of healthcare facilities with qualified healthcare personnel who meet standards and are equitably established to provide quality healthcare services and care by 2026 (p. 118). ⁵³¹ In addition, there are mechanisms for identifying and considering the needs of vulnerable populations, particularly those living in conflict zones and nomads (p. 88). ⁵³² It also mentions pregnant women and children under the age of five, who are more vulnerable to malaria (p. 34), and involves the Ministry of Gender Promotion, and Women, Children and Family Protection in a role of integrating awareness-raising and promotion activities for family health, and socio-economic support programs and increasing the availability and quality of care and economic well-being for vulnerable households (p. 149). ⁵³³ Therefore, there are no considerations on health equity. ⁵³⁴

There is no evidence of such plan on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁵³⁵ ⁵³⁶ ⁵³⁷

3.1.2 Private sector involvement in response planning

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

There is no evidence that the Central African Republic (CAR) has specific mechanisms for engaging with the private sector to assist with outbreak emergency preparedness and response.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the Public Health Emergency Operations Center (COUSP), which is under the purview of the Ministry of Health and Population, handles public health emergencies, which operates with a single technical officer supported by auxiliary staff, including a secretary and a few agents responsible for handling calls on the hotline created for this purpose (p. 44). ⁵⁴⁴ However, COUSP does not have a manual that includes a description of the structure and standard operating procedures governing its operation (p. 45). ⁵⁴⁵ There is no evidence that the private sector participates or support COUSP. ⁵⁴⁶

The National Health Development Plan 2022-2026 (PNDS III) accounts for the private sector to donate for its implementation, but there is no evidence that it is specifically towards assisting with outbreak emergency preparedness and response. ⁵⁴⁷

There is no evidence of such mechanisms on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁵⁴⁸ ⁵⁴⁹ ⁵⁵⁰

There is no evidence of such mechanisms for emergency preparedness and response on the National Gender and Climate Change Strategy 2023-2030 (2023), the Initial National Climate Change Adaptation Plan (2022), the National Community Health Policy 2020-2030 or the National Health Policy 2019-2030. ⁵⁵¹ ⁵⁵² ⁵⁵³ ⁵⁵⁴

3.1.3 Non-pharmaceutical interventions planning

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 0

There is no evidence that the Central African Republic (CAR) has a policy, plan or guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has no standards or resources for implementing hygiene services, and there are no standards for reducing patient overcrowding (p. 54). ⁵⁵⁵ In addition, healthcare facilities do not have isolation areas. ⁵⁵⁶

It further adds that the country has contingency plans for Ebola, mpox, rabies, Rift Valley fever, and Avian influenza (p. 20). ⁵⁵⁷ Nevertheless, such plans are not available on official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁵⁵⁸ ⁵⁵⁹ ⁵⁶⁰

The National Health Development Plan 2022-2026 (PNDS III) presents measures to prevent infections, strenghten surveillance and coordination systems, as well as promote community-level measures. ⁵⁶¹ However, they are not focused on the implementation during an epidemic or pandemic. ⁵⁶²

There is no evidence of guidelines for the implementation of NPIs during an epidemic or pandemic on the National Gender and Climate Change Strategy 2023-2030 (2023), the Initial National Climate Change Adaptation Plan (2022), the National Community Health Policy 2020-2030 or the National Health Policy 2019-2030. ⁵⁶³ ⁵⁶⁴ ⁵⁶⁵ ⁵⁶⁶

3.2 Exercising response plans

3.2.1 Activating response plans

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 0

There is no evidence that the Central African Republic (CAR) has a national emergency response plan, or that it has completed a national-level biological threat-focused exercise in the past year.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country does not have a multi-risk, multi-sectoral plan, and it lacks emergency disaster funds in the event of a health emergency (p. 14). ⁵⁷⁰ In addition, there is no simulation exercise for the health emergency response plan, which, is non-existent at the decentralized level (p. 14), and there are no plans to conduct simulation drills (p. 45). ⁵⁷¹ It also recommends the country to conduct simulation exercises to test and strenghten the surveillance systems's public health emergency detection, alert, and response capabilities. ⁵⁷²

There is no reference to a national-level biological threat-focused exercise in the past year on the WHO's Annual Report for the CAR 2024 (2025). ⁵⁷³

In August 2024, the Ministry of Health and Population announced cases of mpox in Bangui, and implemented measures in collaboration with other ministerial departments to contain and control the spread of the epidemic in CAR, such as active search for cases and contacts in the community, free care for confirmed cases, strenghtening epidemiological surveillance, recommendation to wash their hands regularly, avoid contact with bodily fluids, and other measures. ⁵⁷⁴ However, there is no evidence it was part of a broader plan. ⁵⁷⁵

There is no evidence of such plan or exercises on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁵⁷⁶ ⁵⁷⁷ ⁵⁷⁸

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

The Central African Republic (CAR) has identified a list of gaps and best practices. However, there is no evidence it has developed a plan to improve capabilities.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country conducted two risk assessments using the Strategic Toolkit for Assessing Risks (STAR) tool of the World Health Organization (WHO) in 2017 and 2019 (p. 44). ⁵⁷⁹ A risk mapping update was carried out in December 2022 as part of the priority identification for the development of the Health Security Action Plan (2023-2024), with the participation of all "One World, One Health" sectors and taking into account communities, in which anthropogenic health risks were identified during the risk assessment (p. 44). ⁵⁸⁰

It identified several hazards, such as floods, drought, tornadoes, storms, forest fires and bushfires, anthropogenic risks, such as development of industries and new technologies, conflict-related risks, population exodus and transhumance, uncontrolled urbanization and demography, and health-related, such as epidemics, malaria, HIV/AIDS, waterborne diseases (p. 44). ⁵⁸¹ In 2023, the CAR conducted a national workshop to pool the capacities required under the IHR as well as a performance of veterinary services (PVS) using strategic risk assessment tools for the human health, animal health, and environmental sectors. ⁵⁸²

There is no evidence of the Health Security Action Plan on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁵⁸³ ⁵⁸⁴ ⁵⁸⁵

3.2.2 Private sector engagement in exercises

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no evidence that the Central African Republic (CAR) has undergone a national-level biological threat-focused exercise in the past year.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country does not have a multi-risk, multi-sectoral plan, and it lacks emergency disaster funds in the event of a health emergency (p. 14). ⁵⁸⁶ In addition, there is no simulation exercise for the health emergency response plan, which, is non-existent at the decentralized level (p. 14), and there are no plans to conduct simulation drills (p. 45). ⁵⁸⁷ It also recommends the country to conduct simulation exercises to test and strenghten the surveillance systems's public health emergency detection, alert, and response capabilities. ⁵⁸⁸

There is no reference to a national-level biological threat-focused exercise in the past year on the WHO's Annual Report for the CAR 2024 (2025). ⁵⁸⁹

There is no evidence of such exercises on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁵⁹⁰ ⁵⁹¹ ⁵⁹²

3.3 Emergency response operation

3.3.1 Emergency response operation

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

The Central African Republic (CAR) has an Emergency Operations Center (EOC) in place.

COUSP, established in 2022, is located within the premises of the Ministry of Health and Population and is housed in a fenced building comprising seven compartments. ⁵⁹⁴ The facility includes a dedicated crisis meeting room and three offices assigned to the coordinator, administrator, and IT specialist. ⁵⁹⁵ The COUSP serves as a central hub for the coordination, preparation, and response to public health emergencies, operating in collaboration with the technical departments of the Ministry of Health and Population and relevant partners. ⁵⁹⁶ The centre plays a key role in public health emergency management in the CAR, ensuring communication across all levels of the system in accordance with the International Health Regulations (IHR 2005). ⁵⁹⁷ It performs essential functions to support decision-making, operational implementation, and multisectoral collaboration. ⁵⁹⁸ The COUSP is equipped with information and communication technology infrastructure that meets required standards and has an internet connection; however, it lacks an independent website or email system (p. 44). ⁵⁹⁹

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is no evidence that the Emergency Operations Center (EOC) in the Central African Republic (CAR) is required to conduct a drill for a public health emergency scenario at least once per year. There is no evidence that it has conducted a drill at least once per year.

However, COUSP does not have a manual or standard operating procedures (p. 45). ⁶⁰¹ In addition, there is no simulation exercise for the health emergency response plan, which, is non-existent at the decentralized level (p. 14), and there are no plans to conduct simulation drills (p. 45). ⁶⁰² It also recommends the country to conduct simulation exercises to test and strenghten the surveillance systems's public health emergency detection, alert, and response capabilities. ⁶⁰³

There is no evidence of such requirement or exercises on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁶⁰⁴ ⁶⁰⁵ ⁶⁰⁶

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no evidence to show that the Emergency Operations Center (EOC) in the Central African Republic (CAR) has conducted within the last year a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency/scenario.

In July 2024, the Pasteur Institute of Bangui (IPB) alerted the Ministry of Health and Population about confirmed cases of mpox detected on samples from patients in the Bangui 2 Health District. ⁶⁰⁷ In August 2024, the Ministry of Health and Population announced measures to contain the spread of the epidemic in the country, including active search for cases and contacts in the community, free care for confirmed cases, strenghtening epidemiological surveillance, recommendation to wash their hands regularly, avoid contact with bodily fluids, and regularly reporting cases to the Public Health Emergency Operations Center (COUSP). ⁶⁰⁸ However, there is no evidence that it was activated within 120 minutes of the identification of the public health emergency. ⁶⁰⁹

In July 2025, the World Health Organization (WHO) and the Ministry of Health and Population, through COUSP, carried out a joint mission at the PK24 Hospital for Major Endemic Diseases with the objective of evaluating and improving the quality of care provided to patients, as well as to stranghtening existing systems to ensure the safety of care. ⁶¹⁰ The initiative marked a step in strengthening COUSP's capacity to respond effectively to the mpox epidemic. ⁶¹¹ However, there is no evidence that COUSP is capable of activating such response in 120 minutes after the identification of the public health emergency. ⁶¹²

There is no evidence of such capacities on the official website of the CAR, or the Ministry of Health and Population. ⁶¹³ ⁶¹⁴

3.4 Linking public health and security authorities

3.4.1 Public health and security authorities linked for a biological event

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no evidence that the Central African Republic (CAR) has either carried out an exercise to respond to a potential deliberate biological attack event or enacted standard operating procedures, guidelines, memoranda of understanding (MOUs) or other agreements between the public health, animal health, the private sector and security authorities to respond to a potential deliberate biological event.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country does not have a multi-risk response plan, incident management system is not systematically applied in the event of declared health emergencies, and standard operating procedures are either nonexistent or inadequate for emergency response (p. 46). ⁶¹⁵

There is no evidence of such exercises or guidelines on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁶¹⁶ ⁶¹⁷ ⁶¹⁸

3.5 Risk communication

3.5.1 Risk communication planning

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 0

There is no evidence that the Central African Republic (CAR) has in place, either in the national public health emergency response plan or in other legislation, regulation, or strategy documents, a section detailing a risk communication plan that is specifically intended for use during a public health emergency.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has a national policy on community engagement and human resources at the central and decentralized levels for the health and well-being of the population; and emergency-related activities are implemented under the IHR on an ad hoc basis (p. 56). ⁶¹⁹ The Risk Communication and Community Engagement (RCCE) technical group maintains good collaboration with the CAR community media network in the dissemination of health-related messages and other emergencies, which is corroborated by the Charter of Good Conduct on Media Coverage in the Context of COVID-19 and Other Public Health Crises in the Central African Republic (p. 56). ⁶²⁰ In addition, communication stakeholders also rely on community leaders and community health workers as part of community engagement (p. 56). ⁶²¹

In addition, risk communication is carried out by non-specialized professionals conducting activities on a case-by-case basis, and there are listening centers in health districts (p. 57). ⁶²² Nevertheless, hotlines must be operational. ⁶²³ There is no reference to a communication plan or specific sections related to communication measured to be undertaken during a public health emergency. ⁶²⁴

The National Community Health Policy 2020-2030 (2019), enacted by the Ministry of Health and Population, stated that the CAR established the procedures for emergency management in the country's health facilities, but these texts have not been implemented, and structural, logistical, operational, and financial weaknesses are delaying the development of emergency response capacity in the CAR (p. 14). ⁶²⁵ However, there are no specific sections detailing a risk communication plan that is specifically intended for use during a public health emergency. ⁶²⁶

The National Health Development Plan 2022-2026 (PNDS III) places a significant emphasis on communication between the various levels, and provides for the development of a communication plan to describe the areas of work and priority actions to be implemented to support its implementation (p. 99). ⁶²⁷ However, it is not focused on the use during a public health emergency, and most measures related to communication are related to the development of healthy lifestyles for the population. ⁶²⁸

There is no evidence of such communication measures for public health emergencies on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁶²⁹ ⁶³⁰ ⁶³¹

The National Gender and Climate Change Strategy 2023-2030 (2023) and the Initial National Climate Change Adaptation Plan (2022), both enacted by the Ministry of the Environment and Sustainable Development, do not include communication measures to be used during a public health emergency. ⁶³⁶ ⁶³⁷

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has a national policy on community engagement and human resources at the central and decentralized levels for the health and well-being of the population; and emergency-related activities are implemented under the IHR on an ad hoc basis (p. 56). ⁶³⁸ The Risk Communication and Community Engagement (RCCE) technical group maintains good collaboration with the CAR community media network in the dissemination of health-related messages and other emergencies, which is corroborated by the Charter of Good Conduct on Media Coverage in the Context of COVID-19 and Other Public Health Crises in the Central African Republic (p. 56). ⁶³⁹ In addition, communication stakeholders also rely on community leaders and community health workers as part of community engagement (p. 56). ⁶⁴⁰

In addition, risk communication is carried out by non-specialized professionals conducting activities on a case-by-case basis, and there are listening centers in health districts (p. 57). ⁶⁴¹ Nevertheless, hotlines must be operational. ⁶⁴² There is no reference to a communication plan or specific sections related to communication measured to be undertaken during a public health emergency. ⁶⁴³

The National Community Health Policy 2020-2030 (2019), enacted by the Ministry of Health and Population, stated that the CAR established the procedures for emergency management in the country's health facilities, but these texts have not been implemented, and structural, logistical, operational, and financial weaknesses are delaying the development of emergency response capacity in the CAR (p. 14). ⁶⁴⁴ However, there are no specific sections detailing a risk communication plan that is specifically intended for use during a public health emergency. ⁶⁴⁵

The National Health Development Plan 2022-2026 (PNDS III) places a significant emphasis on communication between the various levels, and provides for the development of a communication plan to describe the areas of work and priority actions to be implemented to support its implementation (p. 99). ⁶⁴⁶ However, it is not focused on the use during a public health emergency, and most measures related to communication are related to the development of healthy lifestyles for the population. ⁶⁴⁷

The National Gender and Climate Change Strategy 2023-2030 (2023) and the Initial National Climate Change Adaptation Plan (2022), both enacted by the Ministry of the Environment and Sustainable Development, do not include communication measures to be used during a public health emergency. ⁶⁵⁵ ⁶⁵⁶

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has a national policy on community engagement and human resources at the central and decentralized levels for the health and well-being of the population; and emergency-related activities are implemented under the IHR on an ad hoc basis (p. 56). ⁶⁵⁷ The Risk Communication and Community Engagement (RCCE) technical group maintains good collaboration with the CAR community media network in the dissemination of health-related messages and other emergencies, which is corroborated by the Charter of Good Conduct on Media Coverage in the Context of COVID-19 and Other Public Health Crises in the Central African Republic (p. 56). ⁶⁵⁸ In addition, communication stakeholders also rely on community leaders and community health workers as part of community engagement (p. 56). ⁶⁵⁹

In addition, risk communication is carried out by non-specialized professionals conducting activities on a case-by-case basis, and there are listening centers in health districts (p. 57). ⁶⁶⁰ Nevertheless, hotlines must be operational. ⁶⁶¹ There is no reference to a communication plan or specific sections related to communication measured to be undertaken during a public health emergency. ⁶⁶²

The National Community Health Policy 2020-2030 (2019), enacted by the Ministry of Health and Population, stated that the CAR established the procedures for emergency management in the country's health facilities, but these texts have not been implemented, and structural, logistical, operational, and financial weaknesses are delaying the development of emergency response capacity in the CAR (p. 14). ⁶⁶³ However, there are no specific sections detailing a risk communication plan that is specifically intended for use during a public health emergency. ⁶⁶⁴

The National Health Development Plan 2022-2026 (PNDS III) places a significant emphasis on communication between the various levels, and provides for the development of a communication plan to describe the areas of work and priority actions to be implemented to support its implementation (p. 99). ⁶⁶⁵ However, it is not focused on the use during a public health emergency, and most measures related to communication are related to the development of healthy lifestyles for the population. ⁶⁶⁶

The National Gender and Climate Change Strategy 2023-2030 (2023) and the Initial National Climate Change Adaptation Plan (2022), both enacted by the Ministry of the Environment and Sustainable Development, do not include communication measures to be used during a public health emergency. ⁶⁷⁴ ⁶⁷⁵

3.5.2 Public health systems communication

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

The Central African Republic (CAR) has actively and regularly shared messages via online media platforms to inform about the public about ongoing public health concerns in the past year, including during active emergencies.

In July 2024, the Pasteur Institute of Bangui (IPB) alerted the Ministry of Health and Population about confirmed cases of mpox detected on samples from patients in the Bangui 2 Health District during an active mpox emergency. ⁶⁷⁶ In August 2024, the Ministry of Health and Population announced through its website measures to contain the spread of the epidemic in the country, including active search for cases and contacts in the community, free care for confirmed cases, strenghtening epidemiological surveillance, recommendation to wash their hands regularly, avoid contact with bodily fluids, and regularly reporting cases to the Public Health Emergency Operations Center (COUSP). ⁶⁷⁷ However, there is no evidence that it was activated within 120 minutes of the identification of the public health emergency. ⁶⁷⁸

In September 2024, the IPB published on its Facebook page about rumours that it was conducing DNA tests within its laboratory. ⁶⁷⁹ The IPB emphasized that a TikTok video had been manipulated to create misleading articles to misinform the public, and they strongly condemned these acts of information manipulation and strongly encouraged the public to always verify the origin and veracity of the information they receive. ⁶⁸⁰

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no evidence that senior leaders in the Central African Republic (CAR) have shared misinformation or disinformation on infectious diseases in the past two years.

There is no evidence of such remarks on the Radio Ndekeluka, Jeune Afrique, and RFI. ⁶⁸¹ ⁶⁸² ⁶⁸³ There is no evidence of such remarks on the official website of the CAR or the Ministry of Health and Population either. ⁶⁸⁴ ⁶⁸⁵

3.6 Access to communications infrastructure

3.6.1 Internet users

3.6.1a Percentage of households with Internet

Score: 0.08

3.6.2 Mobile subscribers

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 0

3.6.3 Female access to a mobile phone

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 76.67

3.6.4 Female access to the Internet

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 79.17

3.7 Trade and travel restrictions

3.7.1 Trade restrictions

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no evidence that the Central African Republic (CAR) has implemented restrictions on export or import of medical goods due to an infectious disease outbreak in the past year.

There is no evidence of such restrictions on the Radio Ndekeluka, Jeune Afrique, and RFI. ⁶⁸⁶ ⁶⁸⁷ ⁶⁸⁸ There is no evidence of such restrictions on the official website of the CAR or the Ministry of Health and Population either. ⁶⁸⁹ ⁶⁹⁰

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no evidence that the Central African Republic (CAR) has implemented restrictions on export or import of non-medical goods due to an infectious disease outbreak in the past year.

In April 2025, the Corbeau News Centrafrique reported that the government of the CAR was considering banning the import of frozen products to boost the local market and address healthcare concerns. ⁶⁹¹ According to the report, authorities pointed to the health risks associated with imported products, which were often poorly preserved or come from opaque channels, namely frozen fish from Asia, Brazilian chicken, and European ready-made meals. ⁶⁹² However, there is no evidence that this ban was either implemented or based on international recommendations or strutured decision mechanism involving specific scientific evidence. ⁶⁹³

There is no evidence of such restrictions on the Radio Ndekeluka, Jeune Afrique, and RFI. ⁶⁹⁴ ⁶⁹⁵ ⁶⁹⁶ There is no evidence of such restrictions on the official website of the CAR or the Ministry of Health and Population either. ⁶⁹⁷ ⁶⁹⁸

3.7.2 Travel restrictions

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no evidence that the Central African Republic (CAR) has implemented inbound or outbound travel restrictions due to an infectious disease outbreak in the past year.

There is no evidence of such restrictions on the Radio Ndekeluka, Jeune Afrique, and RFI. ⁶⁹⁹ ⁷⁰⁰ ⁷⁰¹ There is no evidence of such restrictions on the official website of the CAR or the Ministry of Health and Population either. ⁷⁰² ⁷⁰³ The Ministry of Arts, Culture and Tourism does not have an official website. ⁷⁰⁴

3.7.2b Risk-based approach to international travel-related measures

Score: 0

There is no evidence that the Central African Republic (CAR) uses a risk-based approach to international travel-related measures.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has not conducted a strategic risk assessment to designate points of entry as part of the national risk assessment (p. 60). ⁷⁰⁵ In addition, the country lacks a national multisectoral mechanism to apply a risk-based approach to the strategic management of international transport, including prevention, detection, investigation, response, and recovery measures. ⁷⁰⁶

There is a specific Ministry of Health and Population service is in place to ensure health screening at points of entry for specific risks (Ebola virus disease, COVID-19, yellow fever, and monkey pox), and there is a functional system in place at the international airport and ports allows for effective sanitary, phytosanitary, and veterinary checks upon entry and exit from the country. ⁷⁰⁷ In addition, there is screening services and systematic temperature checks for all travelers entering the country, but there are no specific provisions to transport or isolate sick travelers to designated points of entry. ⁷⁰⁸ There is no mention whether their entry is restricted. ⁷⁰⁹

There is no evidence of such approach on the official website of the CAR or the Ministry of Health and Population either. ⁷¹⁰ ⁷¹¹ The Ministry of Arts, Culture and Tourism does not have an official website. ⁷¹²

Health System

4.1 Health capacity in clinics, hospitals and community care centers

4.1.1 Available human resources for the broader healthcare system

4.1.1a Doctors per 100,000 people

Score: 0.55

4.1.1b Nurses and midwives per 100,000 people

Score: 1.13

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

There is no evidence that the Central African Republic (CAR) has a health workforce strategy in place, which has been updated in the past five years, to identify fields where there is an insufficient workforce and strategies to address these shortcomings.

The National Community Health Policy 2020-2030 identifies that the human resources situation in characterized by a quantitative and qualitative insufficiency and a disparity in distribution (p. 14), but it does not present measures to address these shortcomings. ⁷¹³

The National Health Policy 2019-2030 recognises the importance of developing human resources in order to improve the provision of healthcare services in the CAR and notes that the country does not currently have a dedicated human resources policy or plan for the health sector (p. 42). ⁷¹⁴ The most recent available human resources data, from 2018, recorded 7.3 basic health workers per 10,000 inhabitants, comprising 0.8 general practitioners, 2.4 other health professionals, 2.5 nursing professionals, and 1.6 midwifery professionals (p. 42). ⁷¹⁵ The policy establishes Strategic Orientation No. 5, which focuses on the continued recruitment of qualified health personnel and their equitable deployment across regions. This orientation includes measures to advocate for large-scale recruitment based on identified needs, prioritising regions with the greatest shortages and local health facilities (health centres and health posts). It further prioritises posts related to maternal and child health, reproductive health, and health prevention and promotion programmes. In addition, it calls for the decentralisation of posts for disaster preparedness and response to public health emergencies, the development and implementation of measures to protect staff against occupational risks, the introduction of retention measures for staff in the field, and the regionalisation or contracting-out of posts to correct disparities between regions (p. 56). ⁷¹⁶

Moreover, the National Health Development Plan 2022-2026 (PNDS III) highlights that human resources for health face enormous challenges, including the low production capacity of qualified healthcare personnel, the absence of an investment and development plan for healthcare staff accompanied by an implementation framework, insufficient recruitment, and persistent staff shortages, among others (p. 53). ⁷¹⁷ To address these challenges, the plan sets out Strategic Orientation No. 5 for the development of human resources in the health sector, which includes measures such as strengthening the production and management of human resources for health, reinforcing the protection of healthcare personnel, and implementing the Strategic Plan for the Development of Human Resources for Health. ⁷¹⁸ However, the plan does not specifically identify the professional fields where personnel shortages are most acute, nor does it provide targeted strategies to address these shortcomings. ⁷¹⁹

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) recommends the establishment of a multisectoral human resources development plan, accompanied by a priority action plan, as well as a strategic plan for establishing a multisectoral workforce under the IHR. (pp. 40-41). ⁷²⁰

4.1.1d Health system capacity for essential health services

Score: 0

There is no evidence that the health system in the Central African Republic (CAR) has sufficient capacity to deliver essential health services.

The National Health Development Plan 2022-2026 (PNDS III) states that the health status of the population in the CAR is characterized by still very high mortality and morbidity rates, with a predominance of communicable diseases and an increase in non-communicable diseases (p. 32). ⁷²¹ There is a low overall availability of health services across the country (p. 41), in which the overall operational capacity of services shows weakness in tracer elements at the district level and only 29% of health facilities have all essential equipment (p. 42) and no facility have all the essential medicines (p. 44). ⁷²²

The National Community Health Policy 2020-2030 identifies that the country is heavily dependent on foreign aid, in which approximately 5% of health expenditures are covered by the government (p. 15). ⁷²³

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has a viable and operational ehalth service delivery system at all levels of the health pyramid (p. 50). ⁷²⁴

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

The Central African Republic (CAR) does not have a plan to ensure continuity of essential health services during a public health emergency.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has not yet developed a strategy or plan for the continuity of essential health services and there are no formalized guidelines or standards for continuity of service during emergences (pp. 51-52). ⁷²⁵ However, the package of essential health services is maintained during emergencies and approaches targeting vulnerable population groups has been developed, enabling access to healthcare services (p. 52). ⁷²⁶

The National Health Development Plan 2022-2026 (PNDS III) has a goal to improve the supply, use and continuity of quality health services ensuring patient safety (p. 77). ⁷²⁷ However, it is not linked to continuity during public health emergencies. ⁷²⁸

There is no evidence of such approach on the official website of the CAR or the Ministry of Health and Population either. ⁷²⁹ ⁷³⁰

4.1.2 Facilities capacity

4.1.2a Hospital beds per 100,000 people

Score: 22.85

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 0

There is no evidence that the Central African Republic (CAR) has the capacity to isolate patients with highly communicable diseases in biocontainment patient care units or patient isolation rooms located within the country.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), neither healthcare facilities nor airports have isolation areas (pp. 54; 73). ⁷³¹ Most isolation zones that were in place during the COVID-19 pandemic no longer exist (p. 53). ⁷³²

In December 2023, the WHO reported it had supported the CAR in containing a measles outbreak in the country, particularly through the procurement of medicines and medical supplies. ⁷³³ Due to the outbreak, the Bangassou District Hospital modified the patient flow at the triage level, and directly sent suspected cases to isolation. ⁷³⁴ However, there is no evidence whether this was widespread or occured on an ad hoc basis. ⁷³⁵

In May 2020, during the COVID-19 pandemic, CAR started the construction of a new reception and isolation center for patients to support the only center located within the grounds of the Amitié Hospital, which was overwhelmed in terms of reception capacity. ⁷³⁶ Concurrently, the United Nations Multidimensional Integrated Stabilization Mission in the Central African Republic (MINUSCA) handed over a temporary COVID-19 isolation and treatment center to the Haute-Kotto prefectural authorities. ⁷³⁷

In February 2022, the African Development Bank Group loaned USD 14.7 million to the Central African Republic (CAR) to improve its testing capacity, increase the number of beds to treat serious cases in Bangui, as well as support the transformation of a hotel and a hospital into isolation centers with a capacity of 200 beds. ⁷³⁸

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

There is no evidence that the Central African Republic (CAR) has either demonstrated capacity to expand isolation capacity in response to an infectious disease outbreak in the past two years or has developed, updated or tested a plan to expand isolation capacity in response to an infectious disease outbreak in the past two years.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), neither healthcare facilities nor airports have isolation areas (pp. 54; 73). ⁷³⁹ Most isolation zones that were in place during the COVID-19 pandemic no longer exist (p. 53). ⁷⁴⁰

In December 2023, the WHO reported it had supported the CAR in containing a measles outbreak in the country, particularly through the procurement of medicines and medical supplies. ⁷⁴¹ Due to the outbreak, the Bangassou District Hospital modified the patient flow at the triage level, and directly sent suspected cases to isolation. ⁷⁴² However, there is no evidence that it increased the country's isolation capacity. ⁷⁴³

In September 2024, the United Nations Children's Fund (Unicef) launched an appeal for USD 58.8 million to address the growing mpox crisis in six African countries where children were the most affected, including the CAR. ⁷⁴⁴ The response included provisions to ensure that smallpox isolation centers accommodate children and women in family care, but there is no evidence that it increased isolation capacity in the CAR, or the percentage of the appeal that was directed towards the country. ⁷⁴⁵

There is no further evidence on the official website of the CAR or the Ministry of Health and Population either. ⁷⁴⁶ ⁷⁴⁷

4.2 Supply chain for health system and healthcare workers

4.2.1 Routine health care and laboratory system supply

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 0

The Central African Republic (CAR) does not have a national procurement protocol in place which can be utilized by the Ministries of Health and Agriculture for the acquisition of laboratory supplies and medical supplies for routine needs.

Pursuant to Article 31 of the Public Procurement Code (Law No. 08.017 of 6 June 2008), contracts may be awarded through invitation to tender or by direct agreement, in which open invitiation to tender is the general rule, and the use of any other procurement method must be exceptional. ⁷⁴⁸ In addition, Article 44 establishes a framework for framework agreements that allow contracting authorities to meet recurring annual needs for supplies that cannot be precisely forecast in advance. ⁷⁴⁹

In accordance with Article 5, the provisions of the Public Procurement Code are applicable to public service contracts and delegations awarded by private legal entities acting on behalf of the State, a local authority, a public legal entity, a state-owned company, a company with a majority public financial stake, a public body, or an association formed by one or more of these public legal entities, as well as public service contracts and delegations awarded by private legal entities or mixed economy companies, when these contracts benefit from financial support and/or a guarantee from the State. ⁷⁵⁰ However, it is not specific for the acquisition of laboratory and medical supplies, but rather a general framework for public procurement applicable to public entities. ⁷⁵¹

4.2.2 Stockpiling for emergencies

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 0

There is no evidence that the Central African Republic (CAR) has a stockpile of medical supplies (e.g. MCMs, medicines, vaccines, medical equipment, PPE) for national use during a public health emergency. There is no overarching national public health emergency response plan, and there is no plan to ensure equitable distribution in an emergency.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country does not have a multi-risk response plan, even though it has the necessary funding and infrastructure for preparedness and prioritizes Universal Health and Preparedness Review (UHPR) activities to strenghten emergency preparedness (p. 45). ⁷⁵² The incident management system is not systematically applied in the event of declared health emergencies, and standard operating procedures are either nonexistent or inadequate for emergency response (p. 46). ⁷⁵³ In addition, there is no mechanism for supplying medical supplies in the country, and no plan or procedures for organizing the management of health emergency logistics have been developed (p. 47). ⁷⁵⁴

Nevertheless, a mechanism for managing the supply chain in emergency situations is being developed, and a budget is allocated for medical equipment stocks for the Health Emergency Rapid Response Team (EIRUS) project (p. 47). ⁷⁵⁵ Moreover, resources and personnel are allocated to the logistical management of the delivery and receipt of medical supplies at the central level. ⁷⁵⁶

The National Health Policy 2019-2030 presents an intervention to improve stocking conditions of essential generic medicine (MEG), vaccines, reagents and blood products and other inputs at all levels of the system, as well as their geographical availability by creating regional MEG distribution depots in the 16 prefectures (p. 58). ⁷⁵⁷

There is no further evidence on the official website of the CAR or the Ministry of Health and Population either. ⁷⁵⁸ ⁷⁵⁹

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is no evidence that the Central African Republic (CAR) has a stockpile of laboratory supplies (e.g. reagents, media) for national use during a public health emergency.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), there is no mechanism for supplying medical supplies in the country, and no plan or procedures for organizing the management of health emergency logistics have been developed (p. 47). ⁷⁶⁰ In addition, the availability of laboratory supplies, such as reagents, is limited, and there is shortage of those supplies (pp. 33; 35). ⁷⁶¹

There is no further evidence on the official website of the CAR or the Ministry of Health and Population either. ⁷⁶⁴ ⁷⁶⁵

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no evidence that the Central African Republic (CAR) conducted or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency.

There is no further evidence of such requirement on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁷⁶⁶ ⁷⁶⁷ ⁷⁶⁸

4.2.3 Manufacturing and procurement for emergencies

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 100

The Central African Republic (CAR) has a mechanism to procure medical supplies for national use during a public health emergency.

Pursuant to Article 46 of the Public Procurement Code (Law No. 08.017 of 6 June 2008), direct contracting without formal competitive procedures in cases of extreme urgency not caused by the authority or force majeure or unforeseeable events requiring immediate intervention is permitted to streamline procurement. ⁷⁶⁹

In accordance with Article 5, the provisions of the Public Procurement Code are applicable to public service contracts and delegations awarded by private legal entities acting on behalf of the State, a local authority, a public legal entity, a state-owned company, a company with a majority public financial stake, a public body, or an association formed by one or more of these public legal entities, as well as public service contracts and delegations awarded by private legal entities or mixed economy companies, when these contracts benefit from financial support and/or a guarantee from the State. ⁷⁷⁰ However, it is not specific for the acquisition of laboratory and medical supplies, but rather a general framework for public procurement applicable to public entities. ⁷⁷¹

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

The Central African Republic (CAR) does not have a mechanism to procure laboratory supplies for national use during a public health emergency.

In accordance with Article 5, the provisions of the Public Procurement Code are applicable to public service contracts and delegations awarded by private legal entities acting on behalf of the State, a local authority, a public legal entity, a state-owned company, a company with a majority public financial stake, a public body, or an association formed by one or more of these public legal entities, as well as public service contracts and delegations awarded by private legal entities or mixed economy companies, when these contracts benefit from financial support and/or a guarantee from the State. ⁷⁷³ However, it is not specific for the acquisition of laboratory, but rather a general framework for public procurement applicable to public entities. ⁷⁷⁴

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

The Central African Republic (CAR) has a system for national and subnational levels for emergency logistics and supply chain management, which covers specific considerations such as cold chain maangement for vaccines.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), vaccines are accessible and distributed throughout all districts in the country, in which vaccine supply coverage reaches 88.6% of health districts (p. 30). ⁷⁷⁵ Additionally, there are stock management tools available at the national level with effective vaccine maangement reports. ⁷⁷⁶ There are four distribution hubs, six 4 x 4 vehicles available, and cold chain equipment is being installed (p. 30). ⁷⁷⁷ It recommends the country to ensure the maintenance and deployment of the cold chain at the operational level (p. 31). ⁷⁷⁸

Moreover, an emergency supply chain management mechanism is being developed, and resources and personnel have been allocated to the logistical management of the delivery and receipt of medical supplies at the central level (p. 46). ⁷⁷⁹

4.3 Medical countermeasures and personnel deployment

4.3.1 System for dispensing MCMs during a public health emergency

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is no evidence that the Central African Republic (CAR) has a plan, program or guidelines in place for dispensing medical countermeasures (MCM) for national use during a public health emergency.

The World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023) recommends the country to develop and implement a medical countermeasures plan related to health emergency logistics management and the supply chain at the national and intermediate levels (p. 47). ⁷⁸⁰ In addition, there is no mechanism for supplying medical supplies in the country, or plans or procedures for organizing the management of health emergency logistics (p. 47). ⁷⁸¹

The document also mentions the existence of a Sub-sectoral policy (2023-2030) for the supply chain of medicines and other health products, but such policy is not available on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁷⁸² ⁷⁸³

4.3.2 System for receiving foreign health personnel during a public health emergency

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 0

There is no evidence that the Central African Republic (CAR) has a public plan in place to facilitate workforce surge in an emergency.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has not established a plan defining procedures for sending and receiving personnel in emergency situations (p. 46). ⁷⁸⁴ Although the country has a dedicated Emergency Response Team (EIRUS) for health emergencies, there is no national staffing surge plan in place or under development. ⁷⁸⁵

The National Health Policy 2019-2030 presents an objective to decentralizing positions for disaster and public health emergency preparedness and response (p. 56), but there is no reference to a public plan to facilitate workforce surge in an emergency. ⁷⁸⁶

There is no further evidence of such plan on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) Database. ⁷⁸⁷ ⁷⁸⁸ ⁷⁸⁹

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no evidence that the Central African Republic (CAR) has a public plan in place to receive health personnel from other countries to respond to a public health emergency.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country has not established a plan defining procedures for sending and receiving personnel in emergency situations (p. 46). ⁷⁹⁰ Although the country has a dedicated Emergency Response Team (EIRUS) for health emergencies, there is no national staffing surge plan in place or under development. ⁷⁹¹

The National Health Policy 2019-2030 presents an objective to decentralizing positions for disaster and public health emergency preparedness and response (p. 56), but there is no reference to a public plan to receive health personnel from other countries to respond to a public health emergency. ⁷⁹²

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no evidence that the Central African Republic (CAR) has a public plan in place to redeploy existing health personnel within the country.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), human resources, given their availability across the country, remain limited in terms of quantity and quality, and the shortage of qualified personnel is more acute in decentralized areas, recommending a multi-sector mapping of personnel involved in IHR implementation activities would help ensure staff networking and management in the relevant sectors (p. 40). ⁷⁹⁶

The National Health Policy 2019-2030 presents measures to advocate for massive recruitment based on needs, prioritizing regions with the greatest shortages and local health facilities (health centers and health posts), prioritize positions related to maternal and child health, reproductive health, and health prevention and promotion programs, develop and implement measures to protect staff against occupational risks, provide staff retention measures in the field, and regionalize/contract positions to address disparities between regions (p. 56). ⁷⁹⁷ However, such measures are not detailed

4.4 Healthcare access

4.4.1 Access to healthcare

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 75

The Constitution of the Central African Republic (CAR) explicitly guarantees citizens' rights to medical care. However, it is not explicitly guaranteed free.

Pursuant to Article 47 of the Constitution of the Central African Republic (2023), the right to health is guaranteed. ⁸⁰¹ Article 53 further states that everyone has the right to a healthy environment, and the State shall ensure the protection of the health of the population. ⁸⁰² However, it is not explicitly guaranteed free.

4.4.1b Access to skilled birth attendants (% of population)

Score: 11.76

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 93.46

4.4.1d Coverage of essential health services through universal health coverage

Score: 10.42

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 82.97

4.4.1f Rate of mortality amenable to health care

Score: 100

4.4.2 Paid medical leave

4.4.2a Guaranteed paid sick leave

Score: 66.67

The Central African Republic (CAR) guarantees paid sick leave for workers. However, there is no evidence that mental health problems are covered.

Pursuant to Article 134 of the Labour Code (Law No. 09.004 of 29 January 2009), in the event of non-occupational illness or accidents duly certified by an approved physician, employers are required to pay compensation equivalent to the worker’s full remuneration for the duration of the absence, provided it falls within the normal notice period. ⁸⁰³ Furthermore, where the worker has been hired under a fixed-term contract without a clause relating to notice, the calculation of sickness benefit must follow the provisions established by ministerial order of the Minister of Labour, issued after consultation with the National Permanent Labour Council. ⁸⁰⁴ In accordance with Article 135, workers’ rights during paid sick leave are safeguarded, including seniority entitlements, mobilization compensation, and automatic reinstatement to their positions. ⁸⁰⁵

4.4.3 Healthcare worker access to healthcare

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no evidence that the Central African Republic (CAR) has issued legislation, policy, or a public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency.

There is no evidence of such committments on the National Health Development Plan 2022-2026 (PNDS III), the National Community Health Policy 2020-2030 or the National Health Policy 2019-2030. ⁸⁰⁶ ⁸⁰⁷ ⁸⁰⁸

There is no evidence of such legislation, policy or statements on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) database. ⁸⁰⁹ ⁸¹⁰ ⁸¹¹ There is no evidence on the Radio Ndekeluka, Jeune Afrique, and RFI. ⁸¹² ⁸¹³ ⁸¹⁴

4.5 Communications with healthcare workers during a public health emergency

4.5.1 Communication with healthcare workers

4.5.1a Existence of system for communication during a public health emergency

Score: 0

There is no evidence that the Central African Republic (CAR) has a system in place for public health officials and healthcare workers to communicate during a public health emergency.

The National Health Development Plan 2022-2026 (PNDS III) includes initiatives to strengthen the country’s capacity to address emerging epidemic and pandemic diseases, including strengthening mechanisms for integrating and coordinating interventions to combat both communicable and non-communicable diseases (4.1.4), reinforcing the national system of surveillance and response at all levels of the health system through the promotion of new information and communication technologies (4.2.1), and reinforcing structures for coordinating responses to epidemics, public health emergencies, and other disasters across different levels of the health system, explicitly incorporating the One Health approach (4.4.1) (pp. 87-88). ⁸¹⁵ However, there is no mention of a communication system in place. ⁸¹⁶

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the CAR has not established multisectoral mechanisms to promote the implementation and funding of risk communication and community engagement (p. 57). ⁸¹⁷ There is no reference to a communication system in place for public health officials and healthcare workers to communicate during a public health emergency. ⁸¹⁸ Additionally, the Public Health Emergency Operations Center (COUSP) facilitates communication at various levels of the system and has information and communication technology infrastructure that meets standards and includes an internet connection, but does not have its own website or email service (p. 44). ⁸¹⁹ Nevertheless, there is no reference to communication systems in place. ⁸²⁰

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is no evidence that the Central African Republic (CAR) has a system in place for public health officials and healthcare workers to communicate during a public health emergency.

The National Health Development Plan 2022-2026 (PNDS III) includes initiatives to strengthen the country’s capacity to address emerging epidemic and pandemic diseases, including strengthening mechanisms for integrating and coordinating interventions to combat both communicable and non-communicable diseases (4.1.4), reinforcing the national system of surveillance and response at all levels of the health system through the promotion of new information and communication technologies (4.2.1), and reinforcing structures for coordinating responses to epidemics, public health emergencies, and other disasters across different levels of the health system, explicitly incorporating the One Health approach (4.4.1) (pp. 87-88). ⁸²⁴ However, there is no mention of a communication system in place. ⁸²⁵

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the CAR has not established multisectoral mechanisms to promote the implementation and funding of risk communication and community engagement (p. 57). ⁸²⁶ There is no reference to a communication system in place for public health officials and healthcare workers to communicate during a public health emergency. ⁸²⁷ Additionally, the Public Health Emergency Operations Center (COUSP) facilitates communication at various levels of the system and has information and communication technology infrastructure that meets standards and includes an internet connection, but does not have its own website or email service (p. 44). ⁸²⁸ Nevertheless, there is no reference to communication systems in place. ⁸²⁹

4.6 Infection control practices

4.6.1 Healthcare-associated infection (HCAI) monitoring

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no evidence that the national public health system of the Central African Republic (CAR) is monitoring for and tracking the number of healthcare associated infections (HCAI) that take place in healthcare facilities.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), there is no monitoring or evaluation of HCAI that take place in healthcare facilities (p. 54). ⁸³³ In addition, the country does not have a national surveillance program or a national surveillance system for HCAI (p. 54). ⁸³⁴

There is no evidence of references to HCAI on the National Health Development Plan 2022-2026 (PNDS III), the National Community Health Policy 2020-2030 or the National Health Policy 2019-2030. ⁸³⁵ ⁸³⁶ ⁸³⁷

There is no evidence of such activities on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) database. ⁸³⁸ ⁸³⁹ ⁸⁴⁰

4.6.1b Infection prevention and control programme

Score: 0

There is no evidence that the Central African Republic (CAR) has an infection prevention and control (IPC) programme in place nationally.

The National Health Development Plan 2022-2026 (PNDS III) states that IPC measures are common practices in healthcare faciliteis aimed at protecting healthcare workers and users from infections in medical settings (p. 43). ⁸⁴¹ However, only 14% of these facilities comply with all of them, with the least frequently implemented standard measures being the use of infection control guidelines (49%) and proper storage of infectious waste (55%). ⁸⁴²

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the CAR has no active IPC programme based on the WHO minimum requirements, and there is no operational IPC plan with a budget allocated for IPC activities (p. 53). ⁸⁴³ Although improvement plans are developed, including reminders on standard and additional precautions, not all hospitals have adopted IPC guidelines that regularly monitor and provide feedback on compliance of healthcare practices with IPC standards. ⁸⁴⁴

4.6.1c National plan to ensure a safe environment in health facilities

Score: 0

There is no evidence that the Central African Republic (CAR) has a plan to ensure a safe environment in health facilities nationally.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), although there are hygiene and safety committees that discuss hygiene issues in healthcare facilities and monitor infection and prevention control (IPC) activities, there are no standards or resources for implementing hygiene services or reducing patient overcrowding (pp. 53-54). ⁸⁴⁸ In addition, the country has neither defined any standards to ensure the safety of health facilities nor conducted safety and operational assessments of health facilities (p. 54). ⁸⁴⁹

There is no evidence of measures to ensure a safe environment in health facilities nationally on the National Health Development Plan 2022-2026 (PNDS III), the National Community Health Policy 2020-2030 or the National Health Policy 2019-2030. ⁸⁵⁰ ⁸⁵¹ ⁸⁵²

There is no evidence of such plan on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) database. ⁸⁵³ ⁸⁵⁴ ⁸⁵⁵

4.7 Capacity to test and approve new medical countermeasures

4.7.1 Regulatory process for clinical trials of unregistered interventions

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

The Central African Republic (CAR) has a national requirement for ethical review before beginning a clinical trial.

According to the World Bank and the African Union Development Agency (AUDA-NEPAD), the pharmaceutical regulatory authority does not authorise clinical trials, but to carry out a clinical trial, it requires approval from the committee of ethics or the institutional examination board (p. 22). ⁸⁵⁶ ⁸⁵⁷

However, there is no evidence of such legislation on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) database. ⁸⁵⁸ ⁸⁵⁹ ⁸⁶⁰

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

There is no evidence that the Central African Republic (CAR) has an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics.

There is no evidence of such expedited process on the World Bank and the African Union Development Agency (AUDA-NEPAD) report, or the website of the AUDA-NEPAD. ⁸⁶¹ ⁸⁶²

However, there is no evidence of such expedited process on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) database. ⁸⁶³ ⁸⁶⁴ ⁸⁶⁵

4.7.2 Regulatory process for approving medical countermeasures

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 0

There is no evidence that the Central African Republic (CAR) has a government agency responsible for approving new medical countermeasures (MCM) for humans.

According to the African Union Development Agency (AUDA-NEPAD), the Department of Pharmaceutical Services, Laboratories and Traditional Medicine (DPLMT) is the regulatory authority for the CAR responsible for approving pharmaceutical products. ⁸⁶⁶

However, there is no evidence of DPLMT's remit or statute on the official websites of the Government of the CAR, the Ministry of Health and Population, or the Food and Agriculture Organization (FAO) database. ⁸⁶⁷ ⁸⁶⁸ ⁸⁶⁹

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is no evidence that the Central African Republic (CAR) has an expedited process for approving medical countermeasures (MCM) for human use or recognition of approval decisions taking place elsewhere during public health emergencies.

There is no evidence of such expedited process on the World Bank and the African Union Development Agency (AUDA-NEPAD) report, or the website of the AUDA-NEPAD. ⁸⁷⁰ ⁸⁷¹

Commitment to International Norms

5.1 IHR reporting compliance and disaster risk reduction

5.1.1 Official IHR reporting

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Central African Republic has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁸⁷⁵

5.1.2 Integration of health into disaster risk reduction

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 0

There is no evidence that the Central African Republic (CAR) has a standalone national disaster risk reduction strategy for epidemics and pandemics, and there is no evidence of a national risk reduction strategy.

According to the World Health Organization (WHO) Joint External Evaluation of IHR Core Capacities of the Central African Republic (2023), the country does not have a multi-risk response plan, even though it has the necessary funding and infrastructure for preparedness and prioritizes Universal Health and Preparedness Review (UHPR) activities to strenghten emergency preparedness (p. 45). ⁸⁷⁶ In addition, the incident management system is not systematically applied in the event of declared health emergencies, and standard operating procedures are either nonexistent or inadequate for emergency response (p. 46). ⁸⁷⁷

It further adds that the country has contingency plans for Ebola, mpox, rabies, Rift Valley fever, and Avian influenza (p. 20). ⁸⁷⁸ Nevertheless, such plans are not available on official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁸⁷⁹ ⁸⁸⁰ ⁸⁸¹

There is no evidence of such plan on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁸⁸⁵ ⁸⁸⁶ ⁸⁸⁷

5.2 Cross-border agreements on public health and animal health emergency response

5.2.1 Cross-border agreements

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 100

The Central African Republic (CAR) has cross-border agreements, as part of a regional group, with regards to health emergencies.

The CAR is a part of the Lake Chad Basin Polio Eradication Plan 2024-2025, which also involves Cameroon, Nigeria, Niger and Chad, focusing on synchronizing vaccination campaigns, sharing data, and implementing interventions for mobile and cross-border populations. ⁸⁹⁴ As of 2025 there was early evidence that the establishment of real-time data-sharing mechanisms under the project had started. ⁸⁹⁵ Polio retains its status as a Public Health Emergency of International Concern (PHEIC) as of November 2025.

While the CAR has been a member of the African Union since 25 May 1963, this does not necessarily mean that there are specific agreements in place in the event of a public health emergency. ⁸⁹⁶ On 15 July 2022, the African Union published its Revised Statute of the African CDC and its Framework of Operation; pursuant to Article 3, Member States will receive support to the implementation of early warning and response surveillance platforms, as well as preparedness and response systems, declare Public Health Emergency of Continental Security (PHECS), promote partnerships and collaborations among Member States to address emerging and endemic diseases, pandemics, and public health emergencies, implement capacity-building measures in public health, including through medium- and long-term leadership, field epidemiological, public health emergency and laboratory training programs, and others. ⁸⁹⁷

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 100

The Central African Republic (CAR) has cross-border strategies, as part of a regional group, with regards to animal health emergencies.

While the CAR has been a member of the African Union since 1963, this does not necessarily mean that there are specific agreements in place between countries in the event of a public health emergency. ⁸⁹⁸ In 2019, the African Union Inter-African Bureau for Animal Resources (AU-IBAR) enacted the Animal Health Strategy for Africa 2019-2035, which includes the goal of promoting the establishment of early warning, emergency response mechanisms and disaster fund for animal resources at national, regional and continental levels. ⁸⁹⁹ It includes goals to adapt emergency preparedness and response framework guidelines, train and simulate exercises at regional and national levels, establish regional response teams and mechanism, and establish a continental-level disaster fund. ⁹⁰⁰

5.3 International commitments

5.3.1 Participation in international agreements

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

The Central African Republic (CAR) has signed and ratified the Biological Weapons Convention.

The country ratified the Biological Weapons Convention on 25 September 2018. ⁹⁰¹

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 0

The Central African Republic (CAR) has not submitted confidence building measures for the Biological Weapons Convention in the past three years. ⁹⁰²

The CAR has never submitted confidence building measures for the BWC. ⁹⁰³

5.3.1c Submission of UNSCR 1540 reports

Score: 100

The Central African Republic (CAR) has provided the required United Nations Security Council Resoultion (UNSCR) 1540 report to the Security Council Committee established pursuant to resolution 1540 (1540 Committee).

THe country submitted the required document on 27 August 2019. ⁹⁰⁴

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 25

5.3.2 Voluntary memberships

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

The Central African Republic (CAR) is not part of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP), the Australia Group, or the Proliferation Security Initiative (PSI).

The CAR is not a member in the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction. ⁹⁰⁵ CAR is not a member in the Australia Group (AG) or the Proliferation Security Initiative (PSI) either. ⁹⁰⁶ ⁹⁰⁷

5.4 JEE and PVS

5.4.1 Completion and publication of a JEE assessment and gap analysis

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 100

The Central African Republic (CAR) has completed a Joint External Evaluation (JEE) and published a full public report in the last five years.

The CAR conducted a WHO Joint External Evaluation (JEE) in 2023, and published it in 2024. ⁹⁰⁸

5.4.2 Completion and publication of a PVS assessment and gap analysis

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

The Central African Republic (CAR) has neither completed nor published a Performance of Veterinary Services (PVS) assessment in the last five years.

In 2010, the CAR completed and published a PVS assessment. ⁹⁰⁹ However, there is no evidence of a PVS assessment conducted in the past five years. ⁹¹⁰

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

The Central African Republic (CAR) has neither completed nor published a Performance of Veterinary Services (PVS) gap analysis in the last five years.

In 2010, the CAR completed and published a PVS assessment. ⁹¹¹ However, there is no evidence of a PVS gap analysis conducted in the past five years. ⁹¹²

5.5 Financing

5.5.1 National financing for epidemic preparedness

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 0

There is no evidence that the Central African Republic (CAR) has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years.

The Budget Allocation Reports from 2023, 2024, and 2025 do not provide a detailed breakdown of health investments. ⁹¹³ For the first quarter of 2023, the country allocated CFA 23,100 million (USD 41.6 million) to the health sector, of which only 7.21% was executed. However, the allocation was not disaggregated to indicate whether any of the funds were directed toward improving capacity to address pandemic or epidemic threats, as the budget was divided only into personnel, goods and services, transfers, and investments (p. 14). ⁹¹⁴ The subsequent reports for 2023, 2024, and 2025 maintained the same structure. ⁹¹⁵

The Budget Allocation Report for the second quarter of 2025 disaggregated health allocation for products, equipment and medical supplies, ambulatory services, hospital services, public healths ervices, unspecified health investments, and research and investments in the health sector (p. 14). ⁹¹⁶ However, there is no reference to improvement of capacity to address pandemic or epidemic threats. ⁹¹⁷

5.5.2 Financing under JEE and PVS reports and gap analyses

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

There is no evidence that the Joint External Evaluation (JEE) report from the Central African Republic (CAR) allocates or describe specific funding from the national budget to address the identified gaps.

The World Health Organization’s (WHO) Joint External Evaluation (JEE) of IHR Core Capacities of the Central African Republic (2023) undescores that the country has financial resources allocated to several sectors concerned by the IHR, even if these are not specifically dedicated to its implementation, and that the country has been involved in the process of establishing a fiduciary unit in the form of a well-coordinated unit, which would promote transparency and financial orthodoxy in the management of public funds (p. 11). ⁹¹⁸ However, it adds that the establishment of a budget coordination and planning mechanism between the various ministries and departments concerned by the IHR would enable more adequate implementation of the IHR (p. 11), and that funding allocated to activities related to IHR implementation remains insufficient (p. 12). ⁹¹⁹ There is no specific mention of allocation or specific funding from the national budget to address the identified gaps. ⁹²⁰

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

The Central African Republic (CAR) has neither completed nor published a Performance of Veterinary Services (PVS) gap analysis or PVS assessment in the last five years.

In 2010, the CAR completed and published a PVS assessment. ⁹²¹ However, there is no evidence of a PVS gap analysis conducted in the past five years. ⁹²²

5.5.3 Financing for emergency response

5.5.3a Emergency public financing during a public health emergency

Score: 100

The Central African Republic (CAR) has a publicly identified special emergency public financing mechanisms and funds which the country can access in the face of a public health emergency.

The World Health Organization’s (WHO) Joint External Evaluation (JEE) of IHR Core Capacities of the Central African Republic (2023) states that the country has financial resources for public health emergency response, but lack of planning coordination mechanisms at the sectoral level may hinder these responses (p. 11). ⁹²³ In addition, administrative and financial procedures have been developed for each partner for the distribution of resources needed to implement the IHR, but there are no mechanisms to facilitate the disbursement of funds for all sectors. ⁹²⁴

In addition, the CAR has access to the World Bank's Health System Support and Strengthening Project. ⁹²⁵ It also has access to the International Development Association (IDA). ⁹²⁶

5.5.4 Accountability for international commitments to address epidemic threats

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 0

There is no evidence that senior leaders in the Central African Republic (CAR) have made public committments to improve the country's domestic capacity to address pandemic or epidemic threats by requesting support to improve capacity.

In August 2024, the Ministry of Health and Population shared the country's experience in containing the emergence of the mpox epidemic, while the Director of the Department of Health and Population presented the Lusaka Agenda, which was adopted in 2023 and aims to promote greater efficiency in health investments, better optimization of resources invested in the health sector, both from external funding and from major initiatives such as the Global Fund and the World Bank, and better prioritization of interventions by focusing on high-impact interventions. ⁹²⁷ However, it is focused on the efforts that have already taken place. ⁹²⁸

There is no evidence of such committments on the official website of the CAR, or the Ministry of Health and Population. ⁹²⁹ ⁹³⁰

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that the Central African Republic (CAR) has requested financing or technical support from donor to improve the country's domestic capacity to address epidemic threats in the past three years.

In September 2024, the Pandemic Fund Board approved a USD 128.89 million to support 10 countries impacted by Mpox, including the CAR. ⁹³¹ The support is focused on bolstering the country's and regional's capacity in critical areas, like disease surveillance, diagnostics, laboratory networks, and health workforce, while addressing the immediate challenges posed by mpox. ⁹³²

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 0

The Central African Republic (CAR) has not fulfilled its full contribution to the World Health Organization (WHO) within the past two years.

According to the latest available statement of the World Health Organization (January 2025), the CAR had still outstanding amounts in its assessed contributions for 2024 and 2025. ⁹³³ In 2024 and 2025, the assessed contributions amounted to USD 11,480, in which the country paid USD 5,740 each year. ⁹³⁴ The country had an outstanding balance of USD 5,740 in 2024. ⁹³⁵

5.6 Commitment to sharing of genetic & biological data & specimens

5.6.1 Commitment to share data and specimens in emergency/non-emergency research

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no evidence that the Central African Republic (CAR) has a publicly available plan or policy for sharing genetic data, clinical specimens, and isolated specimens along with associated epidemiological data with international organizations or other countries that goes beyond influenza.

In accordance with Article 55 of the Environmental Code (Law No. 07/018 of 28 December 2007), the Ministry of the Environment and Sustainable Development must approve a list of harmful or hazardous chemical substances and products whose production, import, export, storage, transit and circulation in the country is prohibited or subject to prior authorization. ⁹³⁶ Moreover, Articles 40 and 41 state that the development, production, storage, handling, transport, use, transfer, or release of any Living Modified Organism must be carried out in a manner that prevents or reduces risks to human health and the environment, and every individual or body, public or private, has the obligation to take the necessary measures to ensure an adequate level of protection for the safe transfer, handling, and use of Living Modified Organisms resulting from modern biotechnology and which may have adverse effects on conservation. ⁹³⁷ However, there is no specific requirement for sharing genetic data, clinical specimens, and isolated specimens along with associated epidemiological data with international organizations or other countries that goes beyond influenza. ⁹³⁸

There is no evidence of such plan on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁹³⁹ ⁹⁴⁰ ⁹⁴¹

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no evidence that the Central African Republic (CAR) has not shared samples in accordance with the PIP framework in the past two years.

There is no evidence that the CAR failed to share samples in accordance with the PIP framework on the Advisory Group Annual Report fo the Director -General (2024). ⁹⁴² There is no evidence that the country failed to share samples on the official website of the World Health Organization (WHO). ⁹⁴³ There is no evidence on the Pandemic Influenza Preparedness Framework: Annual Progress report, 1 January – 31 December 2024 (2025) either. ⁹⁴⁴

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no evidence that the Central African Republic (CAR) has not shared pandemic pathogen samples during an outbreak in the past two years.

There is no evidence of such plan on the official website of the CAR, the Ministry of Health and Population, or the Ministry of Economy, Planning and International Cooperation. ⁹⁴⁵ ⁹⁴⁶ ⁹⁴⁷

Risk Environment

6.1 Political and security risk

6.1.1 Government effectiveness

6.1.1a Policy formation

Score: 25

6.1.1b Quality of bureaucracy

Score: 0

6.1.1c Excessive bureaucracy/red tape

Score: 0

6.1.1d Vested interests/cronyism

Score: 0

6.1.1e Corruption

Score: 24

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 0

6.1.2 Orderly transfers of power

6.1.2a Orderly transfers of power

Score: 0

6.1.3 Risk of social unrest

6.1.3a Risk of social unrest

Score: 25

6.1.4 Illicit activities by non-state actors

6.1.4a Risk of terrorism

Score: 25

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 0

6.1.5 Armed conflict

6.1.5a Presence or risk of armed conflict

Score: 25

6.1.6 Government territorial control

6.1.6a Government territorial control

Score: 0

6.1.7 International tensions

6.1.7a International tensions

Score: 0

6.2 Socio-economic resilience

6.2.1 Literacy

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 44.74

6.2.2 Gender equality

6.2.2a UNDP Gender Inequality Index score

Score: 0

6.2.3 Social inclusion

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 14.58

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4 Public confidence in government

6.2.4a Public confidence in government

Score: 0

6.2.5 Local media and reporting

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6 Inequality

6.2.6a Gini coefficient

Score: 57

6.3 Infrastructure adequacy

6.3.1 Adequacy of road network

6.3.1a Adequacy of road network

Score: 0

6.3.2 Adequacy of airports

6.3.2a Adequacy of airports

Score: 25

6.3.3 Adequacy of power network

6.3.3a Adequacy of power network

Score: 0

6.4 Environmental risks

6.4.1 Urbanisation

6.4.1a Urban population (% of total population)

Score: 61.96

6.4.2 Land use

6.4.2a Change in forest area (percentage points)

Score: 70.64

6.4.3 Natural disaster risk

6.4.3a Natural disaster risk

Score: 0

6.5 Public health vulnerabilities

6.5.1 Access to quality healthcare

6.5.1a Total life expectancy (years)

Score: 13.36

6.5.1b NCD mortality rate

Score: 28.53

6.5.1c Population aged 65+

Score: 98.24

6.5.1d Tobacco use (% of adults)

Score: 100

6.5.1e Level of adult obesity (%)

Score: 100

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 48.66

6.5.2 Access to potable water and sanitation

6.5.2a Access to potable water

Score: 36.91

6.5.2b Access to at least basic sanitation facilities

Score: 13.88

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 0

6.5.3 Public healthcare spending levels per capita

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 1.27

6.5.4 Trust in medical and health advice

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50

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Table of Contents

Prevention

1.1 Antimicrobial resistance (AMR)

1.1.1 AMR surveillance, detection and reporting

1.1.2 Antimicrobial control

1.2 Zoonotic disease

1.2.1 National planning for zoonotic diseases/pathogens

1.2.2 Surveillance systems for zoonotic diseases/pathogens

1.2.3 International reporting of animal disease outbreaks

1.2.4 Animal health workforce

1.2.5 Private sector and zoonotic disease

1.3 Biosecurity

1.3.1 Whole-of-government biosecurity systems

1.3.2 Biosecurity training and practices

1.3.3 Personnel vetting: regulating access to sensitive locations

1.3.4 Transportation security

1.3.5 Cross-border transfer and end-user screening

1.4 Biosafety

1.4.1 Whole-of-government biosafety systems

1.4.2 Biosafety training and practices

1.5 Dual-use research and culture of responsible science

1.5.1 Oversight of dual-use research

1.5.2 Screening requirements for providers of genetic material

1.6 Immunization

1.6.1 Vaccination rates

1.7 Climate change adaptation and vector transmission

1.7.1 Health system resilience

Early Detection

2.1 Laboratory systems strength and quality

2.1.1 Lab capacity for detecting priority diseases

2.1.2 Laboratory quality systems

2.2 Laboratory supply chains

2.2.1 Specimen referral and transport system

2.2.2 Laboratory cooperation and coordination

2.3 Real-time surveillance and reporting

2.3.1 Indicator and event-based surveillance and reporting systems

2.3.2 Interoperable, interconnected, electronic real-time reporting systems

2.3.3 Wastewater surveillance

2.4 Surveillance data accessibility and transparency

2.4.1 Coverage and use of electronic health records

2.4.2 Data integration between human, animal and environmental health sectors

2.4.3 Transparency of surveillance data

2.4.4 Ethical considerations during surveillance

2.4.5 International data sharing

2.5 Case-based investigation

2.5.1 Case investigation and contact tracing

2.5.2 Point of entry management

2.6 Epidemiology workforce

2.6.1 Existence of applied epidemiology training program such FETP and FETPV

2.6.2 Epidemiology workforce capacity

Rapid Response

3.1 Emergency preparedness and response planning

3.1.1 National public health emergency preparedness and response plan

3.1.2 Private sector involvement in response planning

3.1.3 Non-pharmaceutical interventions planning

3.2 Exercising response plans

3.2.1 Activating response plans

3.2.2 Private sector engagement in exercises

3.3 Emergency response operation

3.3.1 Emergency response operation

3.4 Linking public health and security authorities

3.4.1 Public health and security authorities linked for a biological event

3.5 Risk communication

3.5.1 Risk communication planning

3.5.2 Public health systems communication

3.6 Access to communications infrastructure

3.6.1 Internet users

3.6.2 Mobile subscribers

3.6.3 Female access to a mobile phone

3.6.4 Female access to the Internet

3.7 Trade and travel restrictions

3.7.1 Trade restrictions

3.7.2 Travel restrictions

Health System

4.1 Health capacity in clinics, hospitals and community care centers

4.1.1 Available human resources for the broader healthcare system

4.1.2 Facilities capacity

4.2 Supply chain for health system and healthcare workers

4.2.1 Routine health care and laboratory system supply

4.2.2 Stockpiling for emergencies

4.2.3 Manufacturing and procurement for emergencies