A/HRC/45/34/Add.1 peoples to health care and to protect their pharmacopeia. The Decree requires health facilities to provide health care free of charge to members of impoverished indigenous communities and provides for the protection of indigenous peoples’ traditional medicine. 37. The draft national action plan for 2020–2023 includes the following activities: vaccination campaigns; campaigns to encourage indigenous peoples to consult local health structures; prevention campaigns against sexual and gender-based violence and certain illnesses such as yaws; training of indigenous health workers; procurement of medication and birthing kits for health centres visited by indigenous peoples; training of health-care professionals against discrimination; mobile clinics to provide access for remote indigenous groups; and construction of wells and sanitary infrastructures in indigenous communities. 38. Indigenous peoples in Sangha Department repeatedly raised lack of access to basic health care as a major concern. In Sangha, the Special Rapporteur directly observed that the health care provided, to indigenous peoples and others, was inadequate. The only fully functioning local medical clinics were run by private companies involved in logging and conservation. For example, the medical clinics in Pokola and Kabo were run by CIB as part of its Forest Stewardship Council certification obligations. The Pokola clinic offered free consultations for both Bantu and indigenous populations. Because State-run clinics are scarce and often ill-equipped, such private clinics are under significant pressure. 39. Indeed, the main State-run hospital in Ouesso was in a state of desolation at the time of the visit: it was flooded and it lacked running water, toilets (except in the maternity ward) and other basic equipment for sterilization. 13 Only a few medical staff, including the Director, were paid on a regular basis. While the Director gave assurances that indigenous peoples came to the hospital and were treated free of charge, this was contradicted by some of the testimonies collected from indigenous peoples living nearby and by UNFPA, which indicated in a study that the legal provision ensuring gratuity of care for indigenous peoples was rarely respected.14 40. In addition to lamenting the prohibitive cost of medical consultations and the scarcity of health-care centres, indigenous peoples complained about stigmatization and discrimination in health-care facilities administered by Bantus. Some indigenous women, for example, told the Special Rapporteur that health workers had referred to them as “dirty” when they arrived at the hospital. Most indigenous women gave birth at home, either by choice, because they were deterred by the cost of care in health facilities or by the stigmatization they feared they would encounter or because the distance to the nearest hospital was too great. Several indigenous women interviewed said they had lost a child after giving birth at home due to a tetanus infection caused by the use of dirty instruments by a community midwife. UNFPA reports that 99.8 per cent of indigenous women give birth at home or in the forest and that 65 per cent of them give birth without any prenatal consultation.15 41. The Government indicated that it was working to reduce prejudiced attitudes among health personnel and indigenous peoples. It recognized that the low turnout of indigenous women at the hospital could be explained by the fear they may have of being ill-received by medical staff. The Minister for Health and Population spoke of initiatives to recruit indigenous peoples as health personnel, in particular indigenous traditional midwives, to improve the experience of indigenous women in the health system. Such initiatives remain exceptions, however, and UNFPA has recommended that more efforts be made to train and recruit more indigenous traditional midwives.16 42. While indigenous peoples continue to rely on their traditional medicines, their exposure to other population groups has increased their vulnerability to diseases and 13 14 15 16 The Minister for Health and Population indicated that this was unfortunately the case for many hospitals in the country. A joint United Nations and private-sector maternal health-care project in Sangha and Lekoumou Departments was about to result in the refurbishment of the main hospitals, including the one in Ouesso. UNFPA, Biomédecine, savoirs et pratiques autochtones autour de la grossesse et de l’accouchement dans le département de la Sangha(2018), p. 32. Factsheet shared by UNFPA during the visit. UNFPA, Biomédecine, savoirs et pratiques autochtones, p. 32. 9