Over the last fifteen years, health indicators in Madagascar have deteriorated, with rates of mother and child mortality far from objectives initially set by the Sustainable Development Goals (SDGs). To contribute to reducing mother and child mortality, GRET participated from April 2014 to the end of March 2017 in the “Project to support mother and child health in Madagascar” (Pasmi) in the regions of Itasy and Bongolava.
The consortium, made up of NGOs Action contre la faim (ACF), the French family planning movement (MFPF), Handicap international (HI), Santé Sud and Médecins du monde (MDM), the project leader, worked on three complementary components to optimise access to sexual and reproductive healthcare: community-based awareness-raising to encourage people to avail of healthcare; strengthening of community health centres’ capacities, in order to improve healthcare staff’s skills; and lastly, supporting local healthcare authorities to monitor activities relating to mother and child health.
Strengthening the community-based healthcare system
As part of this project, funded by the Agence française de développement (AFD), GRET conducted training activities for 119 malnutrition prevention healthcare staff members. It also contributed to strengthening the community-based healthcare system by training 187 community healthcare workers and re-boosting the community healthcare policy at commune level (activation of communal community-based healthcare commissions; identification of 15 communal coordinators in charge of maintaining links between the community, the community healthcare centre and the community healthcare workers).
Once trained, the healthcare workers were supported by coordinators to conduct awareness-raising activities (mass events, group meetings, home visits) on mother and child health in 209 villages spread over 18 communes, reaching 175,000 people – including 137,000 pregnant women having received adequate information on pregnancy monitoring, labour and care of newborns.
Removing financial barriers to healthcare
Lastly, to test strategies making it possible to remove barriers for access to healthcare, GRET also piloted contribution-based welfare funds to cover transport costs in case of emergency referrals, especially for pregnant women, from the community healthcare centre to the regional hospital. “When this improvement to the service is made with strong commitment from the commune, together with collection of contributions within the fokontany (villages) and reinforced promotion among the population, contribution rates can increase significantly (as high as 41 % in 2016)”, says Christiane Rakotomalala, head of the Health programme for GRET in Madagascar.
This initiative was developed in four communes, in consultation with the Malagasy ministry of Health, in order to ensure the development of a system that could be included in the country’s national strategy for universal health cover. Until January 2018, GRET will be conducting research work to document the lessons learned.