Adapting to the new world: Coronavirus in Madagascar
On Friday 20th March, the Malagasy Government confirmed the first three cases of COVID-19 in Madagascar. For weeks, we had been watching with apprehension as the pandemic spread across the World, hoping it never made it to our shores. Madagascar is one of the poorest countries in the world, and the healthcare system reflects this. Although many of those who work in healthcare here are tireless, brave, and incredibly caring, they face chronic shortages of medicine and equipment. When the virus arrived, there were only seven oxygen machines in the country and one doctor per 5,000 patients (compared with one per 357 in the UK)1.
SEED Madagascar has always been a mix of Malagasy staff and international staff. Hiring from the UK, US, Europe, and elsewhere gives us the facility to capacity build with national staff, whilst providing often young internationals with a unique experience here. With a ratio of about 70:30, we normally have around 25 international staff in the country at any time.
The Coronavirus pandemic presented our international staff with a tough decision: stay, and be cut off from family and friends at risk back home, or leave, feeling like they had given up on a country and people close to their hearts. With consular aid and medevac availability likely to reduce, insurance, and other concerns, most chose to return home and continue working for SEED remotely.
Although this change was abrupt and difficult, our work continues. Our 77 national staff remain on the ground, our projects are continuing, and are more important than ever.
Lockdown in Madagascar
Madagascar in the time of Coronavirus is in one word, quiet. In the early stages the Government moved fast, closing the borders long before some countries in Europe. Early public health messages in the form of text messages, radio broadcasts, and posters were clear and concise, emphasising symptoms, handwashing, and preventative measures. As most international arrivals travel through the capital, Antananarivo, the authorities were able to confine most of the early vectors, and it took a while before cases were reported in some regions. This was both a blessing and a curse; although it gave us more time to prepare and confirmed cases remained miraculously low, it also meant that Coronavirus was taken much less seriously here than other diseases. If you can see malaria running rampant through your town, with several family members contracting it and some deaths in the community, why would you be as concerned about a disease that (at the time) had killed nobody in Madagascar and confirmed cases were fewer than 100?2
Nonetheless, the schools were closed, with restaurants, bars and businesses placed on reduced opening hours if allowed to open at all. The soundtrack of daily life in Fort Dauphin, raucous kids in school playgrounds and upbeat Malagasy pop music blaring out of roadside bars, faded into silence overnight. Imported goods, particularly in regions isolated from the capital, slowed down and prices of staples like rice and oil have risen dramatically. However, in a country like Madagascar, there is only so far a lockdown can go. Many people live in small houses without the space to self isolate. Livelihoods, fragile at the best of times, are further threatened in the current context. With the tourism sector disappearing in a flash and unlikely to return for a while, many who were formally employed are now completely unpaid. Most produce is carried by hand from rural villages into towns for sale, before sellers walk back again. Markets are heaving, with no space for physical distancing, and people must buy food fresh without the luxury of stockpiling or refridgeration. Handwashing, although an effective preventative measure, is difficult when you have no access to running water or soap.
Increasing community preparedness
Confirmed cases began to rise slowly, with a high probability of undetected cases in the community. Madagascar began the pandemic with only one laboratory capable of running tests for Coronavirus. With transport between regions disrupted, and regional flights cancelled, there is often a significant delay between a test and a result. Countries like Madagascar do not have the means to rapidly scale up virus testing. So, it's no surprise that at the time of writing there have only been 22,000 tests carried out in total3, on Madagascar's population of 26 million.
SEED Madagascar reacted swiftly to use our limited resources against COVID-19. Our priorities have been to provide clear, accurate information and protective face masks to communities, focussing on the most vulnerable. We've distributed hundreds of posters, run regional radio broadcasts and a social media campaign, provided handwashing stations and thousands of masks. Madagascar is a big country (around the same size as France), with poor road connections, particularly in the southeast. We used our existing network in rural areas to communicate the health messages further, and reach people isolated from governmental support. Protective face masks were initially very difficult to find in Madagascar, so we supported local makers to sew cloth designs based on a simple pattern, providing a livelihood as well as protective gear (contribute towards our Coronavirus response in Madagascar here). We're coordinating our response with partner organisations, including the regional COVID-19 Operational Command Centre.
Even while Coronavirus has dominated the headlines and demanded a lot of our attention, our existing programmes must continue. Livelihoods are still needed, general public health care is still a concern, and an environmental crisis still looms on the horizon. The impact of an entire generation being out of school for months will be felt more severely in Madagascar than in richer countries, where remote learning is easier and education levels were higher to begin with. With this in mind, we are continuing to run our programmes in Madagascar, and we think it's more important than ever. We are still here.
Some of our usual activities, like mass mobilisation events and cross visits, have had to stop while it is unsafe to do so, and we are evaluating every activity carefully before beginning. Nevertheless, our team in Madagascar, supported remotely by international colleagues, has had great successest in the last 3 months. Our reforestation project, Ala, recently completed 17km of firebreaks in the remote Sainte Luce forests, ready for the windy season. In education, our construction team finished building Ranomafana Lycée, the only upper secondary school in an 80-kilometre radius. Project Safidy has launched a new social media platform for sexual and reproductive health rights. Our beekeeping sustainable livelihoods project, Renitantely, has been delivering financial management training to small groups of rural beekeepers, and our lobster fisheries project is making serious progress toward a locally managed marine area in a new community.
As with many other charities and NGOs around the world, we are already experiencing funding difficulties. With businesses and large funders feeling the impact of the pandemic, and governments looking at changing aid priorities, this problem is likely to grow. We have already lost a major source of funding for a combined health and education project due to start this year, so we must continue to ask our generous supporters for help.
Adapting and growing for the future
We've also begun to consider what happens next, and our work will look like after the pandemic. New projects in sustainable livelihoods, public health, and even food production might be needed. If, as some fear, Coronavirus does not die out entirely but becomes an endemic disease, we may need to permanently change how we operate.
The sudden, global supply chain disruption and logistical problems have led some countries to consider being less reliant on imports and air travel. Working from home, once a rarity even in the tech industry, suddenly became the norm for millions. At SEED, we've found it difficult to work remotely (with returned international staff working from their homes across the globe), but not impossible. With the right foundations and mindset this could become more viable still in the future.
One of our objectives is to build local capacity and reduce our dependence on international staff. The current crisis has provided an opportunity to accelerate this, with far fewer international staff in Madagascar. National staff have taken on new responsibilities and rapidly learnt new skills, and haven't missed a beat. Whilst we're disrupted as an organisation, it is worth considering: what else can we transfer to national staff? This will reduce our vulnerability to future crises of this kind, increase local empowerment, and move us closer to our ultimate goal of long term development in the region.
This is also an opportunity to look at what we've achieved as an organisation in our 20 years here, and to reflect on where we would like to go in the next 20. We are proud of what we've done so far, but we have so much more to do. For an organisation like SEED, the job is only complete when it has built sustainable, local capacity to the point that it is no longer needed. Whatever the future holds for us, it is clear that we have an opportunity arising from the crisis, to grow and improve.
- Data from World Bank (https://data.worldbank.org/indicator/SH.MED.PHYS.ZS)
- Total cases did not rise above 100 until April 11th; first death in Madagascar reported May 17th (Source: WHO/CCO data).
- 22,788 tests as of 2nd July 2020. CCO Madagascar (http://cco-covid19.gov.mg/fr/statistiques/)