Central African Republic
GaneshAID supported the Central African Republic in zero-dose identification and Gavi application development — one of the world's most fragile health contexts, where conflict, displacement and system fragmentation create severe immunisation equity gaps.
Key Immunisation and Health System Challenges
The Central African Republic (CAR) is one of the world's most complex humanitarian and health contexts. Prolonged armed conflict has severely disrupted health service delivery, displaced communities, destroyed infrastructure and created large populations of zero-dose children who have never received any vaccine. Health workers face serious security constraints, and routine immunisation services are difficult to maintain consistently.
Zero-dose children in CAR are predominantly concentrated in conflict-affected zones and displacement camps, as well as in remote areas where service delivery was already fragile before the crisis. GaneshAID's technical assistance supported the Ministry of Health and EPI in building an evidence-based analysis of these gaps as the foundation for Gavi funding.
In conflict zones, zero-dose barriers include insecurity, service irregularity and population displacement. GaneshAID's analysis framework differentiates these typologies to ensure programmatic interventions are context-specific and operationally feasible.
GaneshAID Support in Central African Republic
Zero-dose child identification and barrier analysis
Primary and secondary analysis responding to all key analytical questions from Gavi's Zero-Dose Analysis Cards ("identify" section). Additional qualitative data collection conducted where the country context required it. Analysis covered geographic coverage gaps, demand-side barriers, supply-side constraints and systemic factors — differentiated by community typology (conflict zones, rural, urban informal, mobile populations).
HCD ideation sessions for tailored solutions
Interactive ideation sessions facilitated in-person and/or remotely using Human Centred Design methodology. Sessions brought together Ministry of Health staff, EPI teams, NGOs, local CSOs and humanitarian actors to co-design new, tailored and sustainable solutions directly addressing identified barriers to reaching zero-dose children. Documentation of minutes, action items and follow-up assurance throughout.
Gavi funding application development
Development of a complete set of prioritised, sustainable programmatic interventions reflected in: (1) Theory of Change for Gavi investments; (2) the supporting country application narrative; and (3) the submitted work plan, budget and Monitoring & Learning Plan. All applications developed under Ministry of Health leadership with full EPI stakeholder engagement.
Operational Contributions and System Improvements
As part of an eight-country zero-dose programme, applications were developed successfully under the leadership of the Ministry of Health, with full engagement of EPI stakeholders including NGOs, local CSOs and humanitarian actors. The participatory approach built national analytical capacity beyond the immediate application cycle.
Ministry-led applications
All applications developed under Ministry of Health ownership — national propositions, not donor-driven products.
Differentiated barrier analysis
Zero-dose typologies and barriers identified by context: conflict zones, rural areas, urban settlements and mobile populations.
HCD-validated solutions
Tailored programmatic interventions co-designed with national stakeholders and validated through participatory ideation.
Partners and Ecosystem in Central African Republic
Part of an eight-country zero-dose programme
This engagement is one of eight countries where GaneshAID provided participatory technical assistance for Gavi funding applications. The multi-country programme covered EAF, HSS, CCEOP and FPP funding streams, building a replicable model for equity-focused zero-dose programme design across fragile and low-resource contexts.