Riding on the back of a motorcycle taxi, Pamela Yetinzapa passes through the gates of hospital gates Bria Regional University Hospital (HRUB) with her baby swaddled on her back. She’s traveled 25 kilometers from her village Boungou 1, because her child is malnourished. “The hospital seemed too far away to walk there while carrying the baby,” she explains. “I went to the health center in my village, which suggested this solution: the motorcycle taxi driver took us to Bria for free.”
Bria sits in Haute Kotto, a vast, remote province in southeastern Central African Republic, 580 kilometers by road from the capital, Bangui. Health centers here are scare and and difficult to access — roads are poorly maintained and high travel costs put care out of reach for many people.
Doctors Without Borders/Médecins Sans Frontières (MSF) manages the pediatric department at the Ministry of Health-run (MoH) hospital. To make health care more accessible to residents living far away, MSF funds and organizes motorcycle taxi transportation for certain patients, and supports six smaller MoH health facilities closer to where people live.
A lifeline for children in Bria
The pediatrics department serves children up to age 15. In 2025, the pediatric ward treated 11,375 pediatric emergency cases, facilitated 25,605 outpatient consultations, and provided care to 1,722 patients with chronic diseases, including children living with HIV, tuberculosis, diabetes, asthma, sickle cell disease, and epilepsy. The ward has 64 beds, with 20 more added during peak malaria season (May to November).
MSF teams also support hospitalizations, intensive care, neonatology, and malnutrition services, along with radiology and the laboratoryPatients requiring surgery are flown to MSF’s surgical project in Bangui.
Bringing health care closer to communities
In 2025, the hospital received 1,184 patients referred from health centers and malaria clinics — open during the peak malaria season — across Haute Kotto. The health centers are managed by the MoH with MSF support: training staff, donating medicines monthly, and paying salary incentives.
When someone who lives near one of the health centers but far from Bria becomes ill or injured — with severe malaria, complicated malnutrition, or snake bites, for example — the health center arranges a motorcycle to take them to the hospital. MSF pays the driver when they arrive. Some patients come from villages near Bria, such as Danbatro, just 7 kilometers away. Others travel much further. “A patient arriving from Ouadda must travel 205 kilometers along a rough dirt road — a day-long journey by motorcycle,” explains Guillaume Mongeau-Martin, the lead physician.
The long journeys are grueling. Some routes require crossing a river by motorcycle, and the conditions can worsen a patient’s state — often a child carried by their mother — and some patients arrive too late.
“Sometimes mothers first try to treat their children with traditional remedies and advice from a traditional healer,” explains Yvan Bilim, a supervising nurse. “For a fracture, for example, people sometimes make their own splints out of tree bark.” Finding a motorcycle and fuel adds further delay.
Barriers beyond distance
Beyond these delays, other barriers prevent some patients from being referred at all. “Some are simply unaware of the option to be transported by motorcycle for free,” says Arlette Sandrine Zounoua, a midwife who cares for survivors of sexual violence. “Victims of sexual violence often don’t know about this option. This problem is exacerbated by their reluctance to discuss their situation and risk being stigmatized. Some even set out on foot or by bicycle,” she explains.
In response, MSF has stepped up community awareness efforts. Nurses from certain health centers also travel to Bria for training in caring for victims of sexual violence. They receive care kits containing pregnancy tests, emergency contraception, guidance materials for caring for survivors, and referrals information for protection and legal services.
In 2025, MSF expanded support to remote health centers in Ouadda and Yalinga, and to health posts in Mbihi and Kpava. Women’s health services are also being expanded, including care for sexual violence survivors and family planning.