Political instability makes development and implementation of national health care policies difficult. CAR's military mutinied three times in 1996, resulting in considerable political turmoil. UN peacekeepers maintained stability in the country from 1998-2000. Since the removal of UN peacekeepers the national government's inability meet its payroll has triggered two further unsuccessful coup attempts.

The government of CAR has very few resources to commit to the health sector. CAR has a national debt of $928 million, and a debt to exports ratio of 455 percent. Diamonds are the country's main source of export earnings, but widespread smuggling limits the government's ability to gain tax revenues.

Lack of education impedes behavior change programs in CAR and will make it difficult for the nation to escape from poverty. Less than half of CAR's population is literate; although other sources report higher literacy rates, UNAIDS estimates adult literacy in CAR at 26 percent.

CAR is challenged by a high disease burden. The HIV prevalence rate in CAR is about 13 percent. Malaria is endemic throughout the country, and the WHO estimated in 2000 that malaria is responsible for 777 deaths per 100,000 children in CAR aged 0-4. In the same year WHO estimated tuberculosis mortality in CAR at 65 per 100,000.

Sources: UNAIDS, United Nations Statistics Division, Forests Monitor, IRIN

Source: UNAIDS, World Bank

Demographic data contained in this section was obtained from the following sources: The Population Reference Bureau’s 2009 World Population Data Sheet was used for total population, life expectancy at birth, infant mortality, fertility, birth rate, death rate, % of married women 15-49 using modern methods of contraception, % of population 15-49 with HIV/AIDS in 2007/2008, and the GNI PPP per capita (2008). Literacy rates were found in the Population Reference Bureau’s publication 2005 Women of Our World. HIV prevalence data for 2001 and 2003 was obtained from the UNAIDS Barcelona 2002 report; HIV prevalence and orphan data for 2005 was obtained from the UNAIDS Report on the Global AIDS Epidemic 2006. Data on the % women who have discussed AIDS prevention with their husband or partner can be found in ORC Macro and USAID’s Women’s Lives and Experiences: Changes in the Past Ten Years (Research Findings from the Demographic and Health Surveys). Childhood malaria mortality data was accessed in 2003 from the United Nations Statistics Divisions’ Millennium Indicators. Tuberculosis data was obtained from the United Nations Statistics Division’s Millennium Indicators: MDGInfo 2006. In some cases information was unavailable.

CAR has five regional hospitals, 14 provincial hospitals, and 65 health centers. The two most important hospitals are the National University Hospital Center in Bangui, and the American Lutheran Church Missionary Hospital in Bouar.

Sources: WHO, International Planned Parenthood Federation

Centre National de Reference des MST et du SIDA

Key personnel:

• Gerard Gresenguet is the director of the CNRMST and CAR's National AIDS Control Program.
• Francois-Xavier Mbopi-Keou.

National University Hospital

The two largest bilateral donors in CAR are France and Japan. Aid from France covers most government expenses, including the salaries of civil servants, and aid from Japan averaged $20 million a year between 1996 and 1998.

Source: Forests Monitor

Entity	Project Title	Diseases	Primary Category	Secondary Category
International	Anti-Herpetic Treatment of Genital Ulcer: Effect on HIV and Herpes Shedding (ANRS 1212)	HIV/AIDS	Drug Development	Prevention
	French National Agency for Research on AIDS and Viral Hepatitis (Study Chairs: Laurent Belec and Philippe Mayaud. PI: Gerard Gresenguet). This...
International	Multi-Sectoral HIV/AIDS Project (World Bank)	HIV/AIDS	General
	The World Bank reports that "only 12 percent of the total cost of US $5.8 million planned for HIV/AIDS and STI programs was available in 2000, and...
International	Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)	HIV/AIDS,Tuberculosis	General
	In August 2003, the GFATM signed an $8.2 million grant agreement with the Central African Republic to help improve the care of people with HIV/AIDS...
International	African Development Fund	HIV/AIDS	General
	The African Development Fund (ADF) has approved a grant equivalent of $8.352 million US to finance a project in support of the implementation of the...

1. A grant to help fight malaria and TB in the Central African Republic is awaiting grant agreement signature. $10.6 million have been allotted to fight malaria.

   Source: GFATM