Informing by Example: Madagascar Health Worker Teaches Her Community About Family Planning

 {Photo credit: Fanja Saholiarisoa/MSH}Community health worker, Celestine Razanabao, receiving a couple for family planning counselling in Manandriana village, Madagascar.Photo credit: Fanja Saholiarisoa/MSH

Although the remote village of Manandriana in southern Madagascar is six kilometers from the nearest health center, the local population’s health has improved in recent years because of community volunteers like 50-year-old Celestine Razanabao.  

She is one of Manandriana’s two community health volunteers trained by the USAID|MIKOLO project. Funded by the US Agency for International Development (USAID) and led by Management Sciences for Health (MSH), USAID|MIKOLO works in nine of Madagascar’s 22 regions to empower the Malagasy people to adopt healthier behaviors and access integrated family planning, reproductive health, maternal, newborn, and child health, and malaria services.

Razanabao, who has been engaged in community health services for 20 years, received training in July 2014 for five days on child and maternal health services, including prevention of illness, family planning counseling, hygiene sensitization, and referral services. She offers family planning packages to women of reproductive age in the village and surrounding settlements and can point to herself as an example. She is a mother of three and all of the pregnancies were planned.

Madagascar has an unmet need for family planning of 19 percent among women aged 15 to 49 who are married or with partners, according to the UN Department of Economic and Social Affairs, Population Division. Family planning has become a government priority in recent years because of high levels of poverty and the inability of those with large families to care for them.

Efforts by 26 trained community health volunteers, including 18 trained by USAID|MIKOLO, in the commune of Talata Ampano where Manandriana and 12 other villages are located, have improved family planning coverage in the region. Jeannine Bakoliarindimby, chief of the local primary health center, said 74 percent of 3,245 women of reproductive age in the commune now use family planning compared to 52 percent in 2010. This is higher than the national figure of 30 percent, according to the UN.

Razanabao has discussed contraceptive choices with 340 women. She has served about 140 women a month with contraceptives that she purchased from the commune supply point. Each community health volunteer sees an average of 29 regular family planning users each month.

Simonette Raherinihoavy Nomenjanahary, one of Razanabao’s longtime clients, said she appreciates Razanabao’s pleasant and open manner. She said:

She is a very good advisor and she has everything we need in terms of medicines.

Arthur Andriarinoro, a father of two who accompanies his wife to her appointment with Razanabao each month, said the community is aware of the importance of health volunteers in the village:

Spacing pregnancies matters for many households because of the [potential] cost of life. We no longer have to worry and can access services nearby.