Santénet2 in Madagascar: A Personal Account


You Heard Us and Came: A Personal Look at How RTI Is Improving Health Care in Madagascar — Part 3

The following feature article is a personal account by Volkan Cakir, Santénet2 chief of party for RTI. Cakir and a Santénet2 colleague spent three days hiking through the Madagascar mountains to experience what a typical Malagasy goes through to receive access to health care. This is the third of three articles about the journey. You can read the first article here and the second article here.

Traveling along the national highway
Traveling along the national highway

On the third day, we started our hike at 7 a.m. under a blue sky. The sunny day was most welcome by our group. The journey started by climbing, following one switchback after another for three hours. We arrived at Fizono, a community with a water turbine to produce electricity. The community health workers (CHWs) and community leaders presented the "community health services" hut, constructed by the community using local materials. They also proudly shared information with us about the local evacuation system they have instituted.

Anyone in need of medical evacuation is eligible to use this service. In emergency cases, CHWs and community leaders are alerted and a locally made stretcher is prepared. The entire population bands together to cover the evacuation cost. Since the inception of this system, the community has experienced an average of one medical evacuation per month.

In Fizono, Federlin (a child health CHW) and Kirosiny (a mother health CHW) were proud of their services and pleased with our visit. Their service performance was similar to that of the previous CHWs we had encountered. However, there was one major difference between this visit and the previous ones—the child health CHW was out of ACT (medication to treat malaria).

A Malagasy villager
A Malagasy villager

Because their commune (Mahalevona) and district (Maroantsetra) are remote, the community supply point was experiencing stock-outs of this vital health commodity. CARE field workers had worked with colleagues from the social marketing program to address the issue. Health products were shipped by boat instead of by road. A higher volume of ACT can be sent this way, and the transportation time will not depend on weather nor be limited by poor road conditions.

The next day we arrived in Mahalevona, a large town with a 2-km-long main street. After lunch, we met with the mayor, community leaders, newly appointed CSB doctor, the community supply point representative, and four CHWs. The CHWs and community leaders were proud of their commitment and community services. Once again, though, the stock-out of ACT was a problem with immediate effects (the inability to treat sick children) and long-term effects (hurting the credibility of CHW services).

On Monday morning, our last day, we went to Maroantsetra where we met with CARE staff and the child and mother health CHWs attending refresher training.

Volkan Cakir poses with Santénet2 workers
Volkan Cakir poses with Santénet2 workers

It was very rewarding to be able to observe tangible results from the efforts deployed by more than 700 persons working directly or indirectly to achieve Santénet2's goals in 800 communes and 6,500 remote fokontany in Madagascar.

During this journey, I saw communities that are committed to improving their life quality and development actors who are committed to reaching out to people living in remote areas to build their capacities. The capacity, commitment, and compliance triptych constitutes the building blocks of Santénet2's success in turning knowledge into practice, which is the RTI mission.

A systematic observation shared by CHWs and community leaders alike was how content they were with our visit. One community leader said we had disproved a Malagasy proverb that states, "People from remote villages are calling the name of the king in Antananarivo, but he does not hear us." The community leader said, "You heard us and came."

Read part one of the series here.

Read part two of the series here.

Learn more about our work in the Santénet2 project and our other projects in global health.