World Health Worker Week: Community Health Volunteers Save Lives in Madagascar

World Health Worker Week: Community Health Volunteers Save Lives in Madagascar

A community health volunteer explains the use of pregnancy tests to a client.

This World Health Worker Week (April 2-8), we honor the health workers around the world who work every day to improve health in their communities. This photo essay illustrates the important role that community health volunteers play in strengthening Madagascar's health system.

Community health volunteers (CHVs) play a critical role in providing primary health care services in Madagascar, especially for rural populations who live far from health facilities. In many areas of the country, CHVs often collectively offer services to more people than health centers do. CHVs are important extensions of the Malagasy health system, particularly for women and children.

As of 2016, the USAID Mikolo Project, led by MSH and funded by USAID, supported nearly 7,000 CHVs across 506 communes. They fill a critical gap in human resources for health in support of the Ministry of Public Health’s efforts to improve health care in the country.

[A CHV provides reproductive health education.]A CHV provides reproductive health education.

Guided by Madagascar’s national community health policy, CHVs are selected by their communities. They are trained and supported by their nearest health center and USAID Mikolo to provide a range of family planning services, including provision of contraceptive pills, condoms, Depo-Provera or Sayana® Press, and counseling on natural methods.

USAID Mikolo intervention areas have seen a steady increase in new and continuing family planning users over the past four years. The number of referrals made for long-acting and permanent methods of family planning rose by nearly 2,000 between 2014 and 2016.

The CHVs meet monthly at health centers to resupply medicines and commodities, submit service statistics, and receive supervision and support.

[A CHV demonstrates proper breastfeeding technique with her baby.]A CHV demonstrates proper breastfeeding technique with her baby.

When women give birth, CHVs teach basic breastfeeding techniques and give instructions on exclusive breastfeeding for the first six months for adequate nutrition. They also follow up on the immunization status of newborns and actively participate in vaccination campaigns led by the Ministry of Public Health.

[CHVs promote the use of bed nets to prevent malaria.]CHVs promote the use of bed nets to prevent malaria.

CHVs play a major role in preventing and treating malaria, especially in children under five. They promote the proper and consistent use of bed nets, test children with fevers for the illness, and provide children with confirmed cases with antimalarial medication. As a result, USAID Mikolo has achieved significant declines in child malaria cases in its intervention areas.

CHVs also provide maternal and newborn health care, including antenatal referrals and counseling, referrals for delivery and follow-up, referrals of newborns with complications, and child health services such as growth monitoring, and prevention, diagnosis, and treatment of malaria, pneumonia, and diarrhea. 

[Two CHVs weigh a child during a monthly growth monitoring session.]Two CHVs weigh a child during a monthly growth monitoring session.

CHVs also organize growth monitoring and promotion sessions in communities each month. Teamwork is important as CHVs have other personal duties, and it takes time to weigh and measure hundreds of children in a single day. On average, two volunteers serve each village, and the USAID Mikolo Project strives to strengthen their ability to deliver comprehensive and integrated services for both women and children. CHVs provide mothers with information about proper nutrition practices, the importance of vaccines, and how to prevent illness.

[A CHV from Ankazobe, Analamanga region, is sensitizing a mother on the importance of immunization and is preparing to give the polio vaccination to the children.]A CHV from Ankazobe, Analamanga region, is sensitizing a mother on the importance of immunization and is preparing to give the polio vaccination to the children.

In March 2017, USAID Mikolo partnered with the Ministry of Public Health and several other development partners to organize a polio vaccine caravan across the country. Polio has re-emerged in Madagascar within the last five years, and CHVs’ efforts to promote polio vaccine provision are extremely important to eradicating the disease.

[A CHV demonstrates how to use a handwashing device.]A CHV demonstrates how to use a handwashing device.

CHVs also play a vital role in implementing behavior change communication activities, including promoting proper handwashing and sanitation practices. As a result, USAID Mikolo has witnessed a decrease in the number of diarrhea cases in children under five, and an increase in the number of children who have received treatment. There were more than 66,000 cases of diarrhea treated in health centers and by CHVs in project intervention areas in 2014, and nearly 102,000 cases in 2016. CHVs treated 22 percent of those cases in 2014, and 31 percent in 2016, showing continuous improvements in treatment rates.

[A CHV checks a pregnancy test.]A CHV checks a pregnancy test.

CHVs promote antenatal care by referring clients to the nearest health center and tracking pregnant women in their communities to ensure they understand the importance of antenatal care. If a woman is unsure if she is pregnant, a CHV can provide an instant pregnancy test, initiating early antenatal care among women who are pregnant, and family planning use by women who are not. The number of pregnant women referred to the nearest health facility by CHVs for and receiving antenatal care increased from approximately 10,000 in 2014 to more than 30,000 in 2016.

Photos by Samy Rakotoniaina. Text by Samy Rakotoniaina and Aishling Thurow.

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