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This is a reported practice gap, not a measured national referral-flow result.", "tags": [], "territory": "Central African Republic public referral design", "title": "Formal referral design and reported practice gap", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.sante.gouv.cf/sites/default/files/2024-07/Politique%20Nationale%20Sant%C3%A9_2019-2030.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "declared_in_2012_project_appraisal_document", "mapping_group": "decision_rights_and_autonomy", "mapping_id": "candidate-mapping:CAF:decision-autonomy:historical-pbf-facility-accountability-design", "source_projection_ids": [ "country-improvement-source:CAF:world-bank-pass-pad-2012" ], "support_state": "candidate_supported", "target_slot": "historical-project-pbf-facility-contracting-and-verification", "target_view": "autonomy", "typed_fields": { "accountability_design": "Independent verification and community satisfaction mechanisms were specified", "boundary": "This is a 2012 project design, not evidence of current facility discretion or accountability practice.", "facility_role": "Health posts, centres and specified hospitals were to contract for agreed services", "purchaser_role": "Performance purchasing agency contracted and verified service delivery" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank, Central African Republic Health System Support Project PAD, 2012.", "country_ids": [ "CAF" ], "coverage_domains": [ "autonomy", "decision_rights", "governance", "hospital_organization", "networks", "primary_care", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "World Bank PAD PDF pages 45, 47 and 51, PPA and independent-verification sections." }, "material_id": "material:51d61703d3ed4d5a6a7137b3", "notes": [ "Do not infer current PBF coverage, payment practice or provider authority from this historical project design." ], "origin": "candidate-analytical-mappings", "period": "Project appraisal 2012", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "b2fa8f90fe61e3e603ee053a3394c47efd1833c15363e570d4a1902fb63c42af", "page_count": 81, "response_sha256": "b2fa8f90fe61e3e603ee053a3394c47efd1833c15363e570d4a1902fb63c42af" }, "statement": "The 2012 appraisal specifies contracting and verification relationships for participating PBF facilities. It cannot establish present facility financial autonomy, the current purchaser or project continuation.", "tags": [], "territory": "Health System Support Project areas and participating facilities", "title": "Historical PBF contracting and accountability design", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://documents1.worldbank.org/curated/en/931331468230967990/pdf/665740PAD0P1190Official0Use0only090.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "reported_in_2023_public_expenditure_review", "mapping_group": "time_and_reform", "mapping_id": "candidate-mapping:CAF:time-reform:historical-pbf-introduction-and-expansion", "source_projection_ids": [ "country-improvement-source:CAF:world-bank-public-expenditure-review-2023" ], "support_state": "candidate_supported", "target_slot": "historical-pbf-introduction-and-2016-expansion-record", "target_view": "reforms", "typed_fields": { "boundary": "The historical review record does not confirm current coverage, continuation or effects.", "expansion_record": "Review reports extension in 2016 to regions 2 through 6 and about 40 percent of the population", "reform_record": "PBF reported as introduced in 2012, with earlier arrangements in some regions from 2009", "scope": "PPA contracting of posts, centres and district or regional hospitals for RMCH services" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank, Central African Republic Public Expenditure Review in Key Human Development Sectors, 2023.", "country_ids": [ "CAF" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "hospital_organization", "networks", "primary_care", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "World Bank PDF page 64, section 5.7." }, "material_id": "material:e1d7727f597e59f4a3247273", "notes": [ "Do not present historical expansion or coverage as current PBF reach, payment policy or facility autonomy." ], "origin": "candidate-analytical-mappings", "period": "Historical events reported for 2009, 2012 and 2016; review published 2023", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "a79d4fe678ded19bbe517687969471ebbc11657375d0e651556a7f81b6bc8bfc", "page_count": 106, "response_sha256": "a79d4fe678ded19bbe517687969471ebbc11657375d0e651556a7f81b6bc8bfc" }, "statement": "The expenditure review records PBF introduction and later expansion, including a historical estimate of population coverage. It does not establish that this design or coverage remains current.", "tags": [], "territory": "Specified PBF health regions and contracted facilities", "title": "Historical PBF introduction and expansion record", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://documents1.worldbank.org/curated/en/099022124104597734/pdf/P17540712b26bb0131bc091590a1d855540.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "observed_in_2024_retrospective_local_facility_study", "mapping_group": "delivery_and_referrals", "mapping_id": "candidate-mapping:CAF:delivery-referrals:kemo-local-pbf-implementation-observation", "source_projection_ids": [ "country-improvement-source:CAF:ngouyombo-pbf-kemo-2025" ], "support_state": "candidate_supported", "target_slot": "kemo-fourteen-facility-pbf-before-after-observation", "target_view": "delivery", "typed_fields": { "limitations": "No confounder control, risk of overreporting and no national generalizability.", "observed_measures": "Staffing, equipment, infrastructure and selected maternal and child health indicators", "period": "2017-2018 compared with 2019-2020 after local PBF implementation", "setting": "Fourteen convenience-sampled facilities in Dekoa and Mala, Kémo Health District" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ngouyombo AD, Woromogo SH, Doyama-Woza RH, et al. Pan African Medical Journal. 2025;52:14.", "country_ids": [ "CAF" ], "coverage_domains": [ "authoritative_review", "facility_data", "governance", "hospital_organization", "primary_care", "reform_history", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": null, "institution": null, "locator": { "description": "Article PDF pages 3, 5, 8 and 9, Methods, Results and Limitations." }, "material_id": "material:b4de20761040f5a2d7bb2de6", "notes": [ "Keep the local retrospective association separate from causal national PBF, provider-network or referral claims." ], "origin": "candidate-analytical-mappings", "period": "2017-2018 and 2019-2020 comparison; data collection June 2024", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "2ac72797bf326d4b032aa9d27fd6f9195831ca5414d52c61f6aec3a4ae88d1e5", "page_count": 13, "response_sha256": "2ac72797bf326d4b032aa9d27fd6f9195831ca5414d52c61f6aec3a4ae88d1e5" }, "statement": "A 14-facility Kémo before-and-after study reports local changes after PBF implementation, but its design and sampling do not support national delivery-system or referral-performance conclusions.", "tags": [], "territory": "Dekoa and Mala sub-prefectures, Kémo Health District only", "title": "Local Kémo PBF implementation observation", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.panafrican-med-journal.com/content/article/52/14/pdf/14.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "reported_in_2018_ministry_list_and_observed_in_2025_herams_categories", "mapping_group": "relationships_and_networks", "mapping_id": "candidate-mapping:CAF:relationships-networks:public-hospital-and-private-clinic-observation-boundary", "source_projection_ids": [ "country-improvement-source:CAF:public-hospitals-list-2018", "country-improvement-source:CAF:who-herams-operational-status-2025-05" ], "support_state": "candidate_supported", "target_slot": "historic-public-hospital-list-and-2025-private-clinic-category", "target_view": "public-private", "typed_fields": { "boundary": "Neither source gives comparable ownership, beds, visits, admissions, workforce or expenditure shares.", "denominator": "1,083 HeRAMS-evaluated units reported through 31 May 2025", "private_evidence": "HeRAMS separately reports private-clinic facilities within a 2025 operational assessment", "public_evidence": "A 2018 Ministry document is explicitly a public-hospital list" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministère de la Santé et de la Population, Hôpitaux publics, 2018; WHO, HeRAMS operational-status report, 2025.", "country_ids": [ "CAF" ], "coverage_domains": [ "authoritative_review", "facility_data", "hospital_organization", "market_structure", "networks", "ownership", "primary_care" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": null, "institution": null, "locator": { "description": "Ministry list PDF pages 1 to 4; HeRAMS PDF pages 10 to 12 and 22." }, "material_id": "material:4e7dea93e6cd519581e8f965", "notes": [ "Keep the source dates and denominators distinct. Do not calculate public-private shares from non-comparable lists and categories." ], "origin": "candidate-analytical-mappings", "period": "Ministry list dated 2018; HeRAMS data reported through 31 May 2025", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "3d2d5f221443eb71786f1af6589f0f1d43fcb552cfdb6fa69ef4ee367eb72ee5", "page_count": 4, "response_sha256": "3d2d5f221443eb71786f1af6589f0f1d43fcb552cfdb6fa69ef4ee367eb72ee5" }, "statement": "A historical Ministry list identifies public hospitals, while the 2025 HeRAMS assessment separately categorizes private clinics. The available sources do not support a public-private delivery-share estimate or a market-concentration claim.", "tags": [], "territory": "Central African Republic provider categories", "title": "Public-hospital and private-clinic evidence boundary", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.who.int/fr/publications/m/item/central-african-republic-status-update-report-2025-05-operational-status-of-the-health-system" }, { "kind": "source_reference", "source": "Hôpitaux publics", "url": "https://www.sante.gouv.cf/sites/default/files/2022-04/hopitaux_publics.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "declared_in_2020_policy_and_reported_in_2021_to_2023_system_reviews", "mapping_group": "actors_and_functions", "mapping_id": "candidate-mapping:CAF:actors-functions:public-system-level-roles", "source_projection_ids": [ "country-improvement-source:CAF:national-health-policy-2019-2030", "country-improvement-source:CAF:world-bank-public-expenditure-review-2023", "country-improvement-source:CAF:who-uhpr-national-report-2023" ], "support_state": "candidate_supported", "target_slot": "central-regional-district-public-system-roles", "target_view": "functions", "typed_fields": { "boundary": "These are policy and review descriptions, not a current audit of each level's decision space or implementation.", "central_role": "The review describes central design, coordination and supervision of general sector policies", "district_role": "Thirty-five health districts are described as managed by district management teams", "emergency_governance_context": "The 2021 UHPR reports a multi-stakeholder emergency-preparedness review and coordination difficulties", "regional_role": "Seven health regions reported to monitor and implement central policies and provide technical support" } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministère de la Santé et de la Population, Politique Nationale de Santé 2019-2030, 2020; World Bank, Public Expenditure Review, 2023; WHO, UHPR National Report, 2023.", "country_ids": [ "CAF" ], "coverage_domains": [ "actors", "authoritative_review", "decision_rights", "governance", "government_responsibilities", "hospital_organization", "primary_care" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": null, "institution": null, "locator": { "description": "Policy PDF pages 34 to 35; World Bank PDF page 50, section 5.2; WHO UHPR PDF pages 4, 10 and 12." }, "material_id": "material:fe8402d4cba46abc4f8756c2", "notes": [ "Do not represent these role descriptions as a current complete decision-right matrix.", "Keep the UHPR emergency-preparedness coordination evidence separate from routine system authority." ], "origin": "candidate-analytical-mappings", "period": "Policy period 2019-2030; reviews report 2021 and varied historical inputs through 2023", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "grey_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "a9e5999318e65a97641a0fd49d20f1430e0e3df3f629d9de86d7f5f24d8bae0b", "page_count": 68, "response_sha256": "a9e5999318e65a97641a0fd49d20f1430e0e3df3f629d9de86d7f5f24d8bae0b" }, "statement": "The policy and expenditure review describe a three-level public system in which central, regional and district actors have differentiated design, implementation, support and management roles. The UHPR separately reports emergency-preparedness coordination difficulties. 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