Program Description (Background) / Description du programme (contexte)
In 2025, project implementation at Minawao camp was significantly constrained by funding shortfalls, resulting in the prioritization of lifesaving activities. These constraints affected multiple sectors and contributed to the spontaneous movement of some refugee households out of the camp, as well as to nearby towns, in search of livelihood opportunities. Such population dynamics reduced coverage compared to initially planned targets. Despite these challenges, UNHCR and ECHO co-funding played a critical role in mitigating service gaps, particularly by sustaining access to secondary and tertiary care and ensuring continuity of essential health services. In parallel, strong engagement by government authorities, especially the Ministry of Public Health, allowed these financial constraints to be leveraged as an opportunity to advance the transition of Minawao CMA (Centre Medical d’Arrondissement) management to the MoH, through the Mokolo Health District, in line with national health system strengthening and sustainability objectives. In 2026, IMC will work in close coordination with UNHCR and other donors, including ECHO, to implement the action “Strengthening Health System Sustainability and Local Ownership at Minawao CMA.” This initiative will support the continued delivery of quality health and nutrition services while consolidating the progressive transfer of management and operational responsibilities to the Ministry of Public Health through the Mokolo Health District, thereby strengthening local ownership, financial sustainability, and long-term resilience of the health system serving both refugee and host populations.
Objective:
To ensure the continuity and quality of integrated health and nutrition services at Minawao CMA while progressively transferring managerial, technical, and financial competencies to the Ministry of Health, strengthening institutional capacity, safeguarding access for vulnerable populations, and promoting sustainable, government-led service delivery.
Transition Toward Government-Led Management and Cost Recovery
In response to these constraints, stakeholders accelerated the transfer of management and administrative responsibilities of Minawao CMA to the Ministry of Public Health, represented locally by the Mokolo Health District. Preparatory work involving the Mayo-Tsanaga Divisional Office, Mokolo Health District, UNHCR, and IMC resulted in a jointly agreed roadmap, which is currently under implementation. A key milestone of this roadmap was the introduction of a cost-recovery mechanism for services at Minawao CMA. Initially planned for August 2025, implementation was postponed to November 2025 following consultations with refugee representatives to avoid a sudden and harmful transition. While cost recovery is now in effect, the government continues to provide free support for essential public health programmes, including nutrition services, malaria care for children under five, HIV, tuberculosis, vaccination, community-based services, and selected components of Universal Health Coverage (UHC). A dynamic list of vulnerable and indigent refugees, identified by UNHCR together with Ministry of Social Affairs (MINAS) through community-based mechanisms, remains fully exempted from service payment. These people’s access to free primary, secondary, and tertiary care is maintained, with costs reimbursed to the facility within available budgets. IMC ensures effective coordination of these resources to sustain equitable service delivery for both refugees and surrounding host communities.
Participatory Governance and Community Engagement
The transition underway at Minawao camp reflects a broader shift from full humanitarian dependency toward increased resilience and self-reliance. Within this process, the health sector plays a significant role. Preparatory consultations with local authorities, refugee representatives, and host community leaders clarified the contributions expected from all actors, including UNHCR, the community, the Ministry of Health, and implementing partners such as IMC. Participatory governance structures, namely the Health Committee (COSA) and the Management Committee (COGE), have been active in guiding this transition. Regular dialogue through these platforms has helped identify priority interventions related to capacity strengthening, administrative systems, financial management, and service quality. The outcomes of these consultations have been integrated into the project work plan, ensuring a jointly owned and structured pathway toward a self-managed and sustainable CMA serving both refugees and host populations.
Strategic Orientation of the 2026 Action
The 2026 project will focus on ensuring continuity of quality health and nutrition services while consolidating Minawao CMA’s transition toward autonomy. The action will strengthen existing health system structures to sustain achievements to date and support the gradual reduction of external institutional support. Parallel efforts will promote refugee self-reliance, including linkages with income-generating activities, while prioritising protection for vulnerable groups, particularly indigent pregnant women and children under five.
As UNHCR’s implementing partner and lead agency for health and nutrition in Minawao camp, IMC, while mobilising complementary resources from other donors, will ensure effective implementation of the jointly agreed roadmap and alignment with national health policies. IMC will provide continuous mentoring and coaching throughout the transition process and remain ready to support the progressively autonomous CMA in addressing emerging challenges until full responsibility is assumed, in line with national health facility standards. IMC acknowledges that the transfer of responsibilities to the Mokolo Health District may present significant challenges, particularly from a financial perspective, given the limited visibility of stable and sustainable funding for 2026 onwards. In this context, IMC has deemed it necessary to commission a consultancy to assess the financial and operational sustainability of Minawao CMA and to estimate the level of resource support required to ensure its continued functioning. The study, scheduled for completion in the first quarter of 2026, will provide clear projections on the future viability of the CMA under coordinated implementation arrangements and will outline practical recommendations across different scenarios identified by the analysis. The findings will be shared with all partners to inform coordinated decision-making and strengthen support to the transition process throughout 2026 and beyond.
As Minawao CMA transitions toward full MoPH-led management, Accountability to Affected Populations (AAP) should be embedded in the public health system, owned and managed by the Ministry of Public Health through the Mokolo Health District and Minawao CMA. In this context, International Medical Corps will not act as an implementer of community-based feedback and response mechanisms, but will play a mentorship and facilitative role, supporting institutional capacity strengthening and system consolidation.
IMC will provide targeted technical accompaniment and training to Minawao CMA management teams and its governance structures (COSA/COGE), and to district teams on i) providing and sharing timely and accessible project information, ii) establishing accessible and trusted feedback channels, iii) ensuring safe handling of feedback and complaints, iv) differentiating approaches for general feedback, non-sensitive complaints, and sensitive complaints, v) documenting, tracking, and closing feedback loops in a timely and transparent manner, and vi) the principles and good practices of community feedback and complaints management. This will be done by using IMC’s CBFRM framework illustratively as a reference model to support learning and system design. However, the final structure, tools, branding, and operating procedures of feedback mechanisms will be defined, owned, and managed by Minawao CMA and the Mokolo Health District, in alignment with national MoPH policies and existing government feedback channels. As part of this mentorship approach, IMC will support the CMA in community communication around AAP and feedback mechanisms to ensure that population are well informed and will support joint community consultations led by the Minawao CMA and district to strengthen understanding of community preferences, access barriers, and trust dynamics related to feedback mechanisms. These consultations will help validate existing channels, ensure they are appropriate and accessible to different population groups, and build institutional capacity to adapt or expand mechanisms in the future, including in newly served or previously underserved areas. This will also help to structure handover and closeout process by ensuring that IMC branding information is replaced by CMA/MoPH information on materials. In addition, IMC will also encourage Minawao CMA to use existing channels MoPH mechanisms (1510) and support the district in the harmonization and coordination of these channels, ensuring communities clearly understand where, how, and for what type of issues feedback can be raised.
For safeguarding and sensitive complaints, IMC will continue to provide technical mentorship to Minawao CMA and district team on handling, ensuring alignment with referral pathways and national and inter-agency standards, without managing or retaining cases. This approach will ensure a safe, accountable, and locally owned AAP system that supports service quality, equity, and trust throughout and beyond the transition process.
