Summary
State-provided health facilities in Madagascar are seriously under-funded, and for many rural people, a visit to the nearest Communal health post could mean a 50 km round trip on foot. Nationally, less than 45% of the population have access to a safe drinking water source, locally, it is closer to less than 10% who can access clean water or sanitation infrastructure. Communities lack information and education about the causes of disease and of good health practices generally. As a result diarrhoeal diseases, malaria, respiratory and sexually transmitted infections are rife. Millions of man hours are lost every year. In the Anosy region, the isolation of communities and high levels of malnutrition make these problems even worse. As many as 3 in 10 children in this region die before reaching the age of five, from easily preventable illnesses.
This project builds on our eight years of experience in the field of community health, during which time we have responded to overwhelming demand from communities for clean water and access to healthcare facilities by constructing infrastructure, providing a mobile doctor to remote villages and educating communities about the causes of poor health.
In 2002 the government of Madagascar adopted the WASH -‘Water, Sanitation and Hygiene’ - initiative of the World Health Organisation to guide their efforts to eradicate diseases linked to poor water and sanitation. The WASH initiative educates communities in three major themes: hand washing, protection of water sources and use of latrines. Azafady was elected to be the regional coordinator of WASH in the Anosy region.
In 2005 the Community Health team began the pilot for Project Salama which integrates community health education based on WASH with infrastructure provision and training for community health workers. This approach has been shown to sustain local behaviour change and the benefits of this for communities. WASH was incorporated into the MAP strategy for poverty reduction in 2006 and the Salama Project was funded for a further two years in January 2007.
Project Aims
To contribute to the achievement of the Madagascar Action Plan Commitment 5 (Health), challenge 8 ‘to provide safe water and promote widespread use of hygienic practices’ which aims to implement the WASH programme in all communes and provide access to drinking water for 65% of the population.
To contribute to the achievement of the Madagascar Action Plan Commitment 5 (Health), challenge 1 ‘to provide quality health services for all’ which aims to provide rural areas with access to medical advice and support.
Purpose
To create sustainable improvements in community health and relieve poverty for villages most in need within five communes in the Anosy region, through education, development of community health institutions and provision of infrastructure given identified need.
Objectives
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Communities in five communes have access to information and understand the causes of common diseases and simple preventative measures.
Communities adopt improved health practices including construction and use of water and sanitation infrastructure.
Community health workers including rural midwives, community pharmacy committees and water committees are trained and operating, ensuring communities are more self-sufficient in matters of primary health care.
Principal activities
Community education
Each community completes the Participatory
Hygiene and Sanitation Transformation (PHAST) education process, led
by our community health agents. PHAST enables the participation
of local people in the recognition of community health problems and
their root causes. Visual communication aids are used to get
messages across as many participants are illiterate. Our agents
then work with communities to develop solutions to their specific problems. Educational
workshops in village schools, where they exist, reinforce these messages
with the next generation.
Provision of infrastructure
Infrastructures which are essential
for the adoption of good health practices are non-existent in most
villages. Our community health agents and construction technicians
work with communities who have completed the PHAST process to design
and build infrastructure such as closed wells, barrages and sanitation
units which will then be locally managed.
Training and capacity reinforcement
A community-elected committee
of volunteers is established and trained to manage all the infrastructures
which are built, and rules of use are determined by the community. Rural
health practitioners including traditional midwifes and community pharmacists
are trained in techniques of diagnosis, treatment and care so as to
support villagers in their health care needs when access to a Communal
health service (CSB) is impossible.
