Madagascar: Our Impact

 {Photo credit: MSH staff}A clinical aide from Madagascar's Atsimo Andrefana region attends an in-person workshop.Photo credit: MSH staff

Since the start of Madagascar’s COVID-19 outbreak in March of this year, ensuring the continuation of routine health care services has been a challenge. Restrictions on movement and travel have forced health providers to adapt and identify innovative measures for providing quality primary health care in the midst of an epidemic. While in-person training and clinical capacity-building exercises have been curtailed, a timely switch to virtual training and mentorship has helped the Ministry of Public Health (MoPH) and the MSH-led, USAID-funded ACCESS program meet these challenges and ensure the continuation of essential health services for women and children in remote regions of the country. When the onset of the epidemic threatened the deployment of 118 clinical aides in Atsimo Andrefana, Vatovavy Fitovinany, and Atsinanana regions, ACCESS and the MoPH rapidly developed and hosted virtual trainings and orientation sessions. These clinical aides—doctors, midwives, and nurses recruited to provide critical ongoing support to health facilities—help staff to implement activities needed to improve the quality of care, manage and integrate services, and strengthen data collection.

 {Photo credit: Samy Rakotoniaina/MSH}A mother and her child sit under their bednet in Vohipeno, Madagascar.Photo credit: Samy Rakotoniaina/MSH

While progress against malaria in the last 20 years has been significant, many people continue to suffer and die from this preventable and treatable disease. Malaria is among the leading causes of child mortality in Africa. In 2018, nearly 900,000 children in 38 African countries were born with a low birth weight due to malaria in pregnancy, and children under five still accounted for two-thirds of all malaria deaths worldwide.

 {Photo credit: Samy Rakotoniaina/MSH}A community health volunteer in Madagascar shows the mobile phone she uses to record patient health data.Photo credit: Samy Rakotoniaina/MSH

On January 17, 2020, the US Agency for International Development (USAID) transferred a significant amount of essential medical equipment and supplies to Madagascar’s Ministry of Public Health.

 {Photo Credit: Samy Rakotoniaina/MSH}A USAID Mikolo-supported Community Health Volunteer makes a home visit.Photo Credit: Samy Rakotoniaina/MSH

Madagascar experienced a surge in malaria cases in 2015, particularly in the southwestern regions, despite the Ministry of Public Health’s efforts to combat the disease. Interventions such as insecticide-treated bednet distributions and indoor spraying proved insufficient to deal with malaria in rural areas.

A Step Toward Universal Health Coverage in Madagascar Story and photos by Samy Rakotoniaina and Alison Baggen In rural Madagascar, people have limited access to savings programs or credit. This impacts community health when people cannot afford to pay for health care. In partnership with Catholic Relief Services (CRS), the USAID Mikolo Project promoted the creation of savings and internal lending communities (SILCs) at the Fokontany (village) level to encourage individuals and families to regularly save income and to provide them with access to credit on favorable terms.

{Photo credit:  Samy Rakotoniaina/MSH}Photo credit: Samy Rakotoniaina/MSH

Half of children under the age of five in Madagascar are chronically malnourished: 24% suffer from moderate malnutrition and 26% from severe malnutrition, according to the 2012-2013 Millennium Development Goal Survey. Children in rural areas suffer disproportionately because they are often cut off from resources and information, and are typically far from health centers that support family health. Community health volunteers (CHVs) like Grancie Cicie help close the gap.

{Photo credit:  Samy Rakotoniaina/MSH}Madagascar Health Minister Mamy Lalatiana Andriamanarivo speaking at the USAID Mikolo end-of-project eventPhoto credit: Samy Rakotoniaina/MSH

The USAID Mikolo Project has ended after five years of strengthening community health in Madagascar, including improving quality of care and achieving significant gains in maternal and child health. The project held its culminating event in the southwestern town of Tulear on May, 3 alongside representatives from the Ministry of Public Health (MOPH) and USAID. USAID Mikolo Project Director John Yanulis opened the ceremony, thanking USAID and the MOPH for their tireless collaboration and dedication to the project.  

A mother asks a SILC group for a loan to pay for the treatment of her sick baby.

Throughout Madagascar most families struggle with financial instability. Eighty percent of families work as farmers generating seasonal, unreliable income. In southwestern Tulear II District, the arid climate puts even greater stress on a farmer’s income.

{Photo Credit: Samy Rakotoniaina}Lynda Razafiharilalao, a Malagasy community health volunteer, shows various modules of the mHealth app to a fellow volunteer.Photo Credit: Samy Rakotoniaina

In rural areas of Madagascar, community health volunteers (CHVs) are instrumental in improving maternal and child health services. Their activities include raising awareness on healthy behaviors, child growth monitoring, family planning counseling and services, and treatment of simple illnesses, such as pneumonia, diarrhea, and malaria. As CHVs are part of Madagascar’s health system, their activity reports feed into the national health information system.

{Photo Credit: MSH}Community members discuss plague response.Photo Credit: MSH

Bubonic plague is endemic in Madagascar. Typically, the country experiences 400 to 600 cases of the disease each year. However, in 2017 the plague also took the pneumonic form. Between August 1 and November 26 there were 2,417 confirmed, probable, and suspected cases of plague, according to the World Health Organization (WHO). More than three-quarters of the cases were clinically classified as pneumonic.

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