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Removing Health Care Barriers and Empowering Communities in Madagascar |
Health services are scarce in many parts of Madagascar. The Analamanga region surrounding the capital, Antananarivo, contains almost 50% of the country’s skilled health workforce but only 15% of the population. The rest of the health professionals are dispersed across Madagascar’s other 21 regions.
Nevertheless, the country’s new poverty-reduction strategy, the Madagascar Action Plan, sets out some ambitious goals for improving health outcomes by 2012, including cutting the infant mortality ratio in half, the maternal mortality ratio by 40%, and the reported number of malaria cases by 75%.
To assist the government of Madagascar in meeting these goals and expanding the benefits of health services, RTI is leading implementation of the U.S. Agency for International Development’s (USAID’s) Santénet2 project (2008–2013).
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| Women and children in Madagascar face high mortality rates due to malnutrition. [Photo: Catholic Relief Services] |
“Our goal is to help the Malagasy tackle these barriers by putting communities in control and making the health systems accountable to them,” said Chief of Party Dr. Volkan Cakir.
The project will strengthen community-level health service provision and address bottlenecks in the Ministry of Health and Family Planning’s (MoHFP’s) strategy to decentralize the national health system.
Specifically, RTI will seek to help the MoHFP and communities fill the service gap by enhancing and scaling up training of community health workers, expanding public demand for services through information and education campaigns, and linking the community health centers to a reliable supply chain of health commodities. In the first year, the project will target 200 communes, ultimately reaching out to 900 across Madagascar.
Santénet2 will also shore up weaknesses in the national health system through activities aimed at strengthening the quality assurance system for local health facilities; updating the curricula and teaching methods at medical schools; integrating and improving monitoring of the drug supply programs for malaria, childhood illnesses, and sexually transmitted infections (STIs); and promoting data-driven resource allocations using a national health management information system (HMIS).
Gender issues also play a role in Madagascar’s poor health. Cultural practices that favor men in household decisions about food consumption contribute to women’s undernourishment and, consequently, lower birth weights and higher infant mortality.
Santénet2 will promote gender equity at every step in the project. Local partner Dinika sy Rindra ho an’ny Vehivavy (DRV) will conduct gender sensitivity and programming training for project staff, as well as conduct assessments of project activities’ impact on gender equity and recommend remedial measures.
“Through raising awareness and leading by example, Santénet2 seeks to involve Malagasy women in family and community health planning so that fewer women and children die from preventable causes,” said Cakir.
Additional partners include IntraHealth, PSI, CARE, and Catholic Relief Services.
More information:
Jeff Sine, e-mail jsine@rti.org
rti.org