The Central African Republic – A fragile centre: Emergency preparedness through national, regional and One Health approaches

Abstract

The Central African Republic (CAR) faces persistent public health emergencies driven by constrained health systems capacity, recurrent outbreaks and its geographic position at the intersection of six high-risk countries. Cross-border mobility, ecological interconnectedness and limited multisectoral coordination amplify vulnerability to epidemics and pandemics. Strengthening emergency preparedness in CAR has implications beyond national borders, given its central role within a highly connected regional epidemiological landscape. A structured qualitative policy analysis was conducted using peer-reviewed and grey literature (2015–2025). The analysis followed a three-stage framework: problem definition, identification of policy options and comparative evaluation. Three policy pathways were assessed using five criteria: technical feasibility, political and institutional feasibility, financial sustainability, responsiveness to cross-border risks and alignment with One Health principles. Three policy pathways were identified: national system strengthening, regional integration and a hybrid One Health model. National approaches improve domestic capacity but are insufficient for transboundary risks. Regional approaches enhance coordination but depend on sustained institutional alignment. The hybrid model demonstrates the strongest overall performance by integrating national capacity, regional cooperation and multisectoral coordination. Emergency preparedness in CAR requires a shift from nationally bounded strategies to integrated regional and multisectoral systems. A hybrid One Health model provides the most feasible and sustainable pathway to strengthen outbreak detection, preparedness and response.