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Friday, 27th May 2022

Long-term thinking: how building the capacity of health workers can be critical to community recovery and resilience

By Ana Luiza Gomes Domingos

Over the past few years, Madagascar has suffered from climate crisis and hunger, exacerbated by the COVID-19 pandemic. Following severe drought in 2021, in the first few months of 2022, southern Madagascar has seen back-to-back cyclones, destroying homes, schools, health centres, and crops. The country, 61% of whose population lives in rural areas1, faces a devastating food crisis due to income losses, high food prices, and high poverty rates. Of the three million people living in Madagascar’s Grand Sud, nearly half are in need of urgent food support. 

Between January-April 2022, approximately 1.42  million people in Southern Madagascar are estimated to be in Crisis or Emergency food insecurity levels2

A new report from the Global Network Against Food Crises1 showed that increased humanitarian assistance played a crucial role in averting a potential risk of famine. However, despite all efforts, food security in Madagascar's Grand Sud remains a pressing issue, with the demand for nutritional support continuing to rise. 

In reponse to this persistent issue, working in partnership with community health workers and rural health centres, SEED has implemented a community-centred approach to food distribution in response to this worsening situation. The Emergency Food Distribution Programme supports the recovery of children aged 6-59 months with moderate acute malnutrition (MAM) or severe acute malnutrition (SAM) in southeast Madagascar. To support immediate relief, SEED provides children and families with a combination of ready-to-use therapeutic food (RUTF) and protection rations, including rice, beans, and oil. During each distribution, caregivers also receive information sessions on nutrition, breastfeeding, and water, sanitation, and hygiene (WASH) to enable them to promote the long-term health and nutrition of their families.

The number of single-mother households in the region exceeds the national average3, and cultural expectations restrict women’s access to already-limited employment opportunities. Women are finding it increasingly difficult to support their families' health and livelihoods, and a lack of awareness around family planning further exacerbates these challenges. 

 As a response, another critical point of SEED's action is family planning. The aim of this work is to enable women and girls to make informed decisions about when, and if, they choose to have children. In collaboration with the Ministry of Health and local health centres, SEED has trained 190 community health workers, who are now conducting home visits with women and girls in the project's 95 villages to increase awareness of and access to family planning services. Regular family planning users can access services directly from the community health worker, whilst new users are supported to visit the local health centre. 

SEED's intervention model focuses on building the capacity of health centres and community health workers, which has already contributed to the project’s success. When speaking to the SEED team, community health worker Masy Charlotte highlighted the increasing value women are placing on health workers at the community level. With 10 years of experience as a community health worker, she stated SEED’s family planning training helped her to develop her skills even further, and she has already increased access to family planning services for many women and girls in Sarisambo, one of the 10 communes supported by the project.

A mother and her malnourished child visit the health centre to receive treatment

Aloïssa, aged 22, is just one of the 1,400 women who have accessed contraception services from SEED’s family planning outreach. Due to misinformation about contraception, AloÏssa had been hesitant to access any family planning services. However, after receiving a home visit from a SEED-trained community health worker, she learned the importance of family planning and the impact it can have on her life. AloÏssa immediately visited her local health centre and chose to use the implant. She has remained in contact with the community health worker, and stated that she would like to continue with this contraceptive method until she is ready to have a baby. 

Besides the direct benefits of the interventions, we also have experienced a positive change in community members' trust in health centres, resulting in improved health-seeking behaviour. 97.8% of surveyed project participants indicated they were more likely to approach the health centre because of SEED's Emergency Food Distribution Project.

“People are coming to the health centre for issues beyond malnutrition, and this is the impact of SEED’s project because community members learn that there are other services to access as well at the health centre apart food for malnutrition” – Health centre staff member at Ampasy Nahampoana

An important lesson we have learned is the urgency of moving quickly in emergencies, as was the case in the early rounds of SEED's Emergency Food Distribution. But we also need long-term thinking and action to tackle the root causes of hunger and promote sustainable change, community recovery and resilience.



  1. Food Security Information Network (FSIN). Global Report on Food Crises, 2022.

  2. ACAPS. (2022). Madagascar: Food insecurity crisis in the Grand Sud regions (May 2022). Available at: dagascar_food_security.pdf (Accessed: 23 May 2022)

  3. Conseil National du Recensement de la Population et de l'Habitation. Troisième Recensement Général de la Population et de l’Habitation (RGH-3), Madagascar, 2020.