SEED Madagascar

Held annually on the 17^th of October, the International Day for the Eradication of Poverty is a global observance aimed at fostering understanding and dialogue between people experiencing poverty and the wider society.¹ The 2024 theme, ‘Ending Social and Institutional Maltreatment: Acting Together for Just, Peaceful, and Inclusive Societies’, highlights the need to address systemic injustices that contribute to ongoing poverty, such as barriers to healthcare access and education.¹ This day offers an opportunity for governments, organisations, and communities worldwide to unite in the shared mission of eradicating poverty.

In Madagascar, limited government investment in health and under-resourced infrastructure have created significant barriers to healthcare access, particularly in rural areas. With just 0.14 hospital beds and 0.20 doctors for every 1,000 patients,^2,3 and nearly half of the population living more than 5 km from local health centres,⁵ access to care remains severely restricted. Limited resources for healthcare facilities and low health literacy among the population put significant pressure on healthcare workers to meet the needs of surrounding communities. Additionally, insufficient electricity supply in 75% of local health centres further complicates the delivery of consistent care. These systemic barriers reflect the broader obstacles highlighted by the 2024 theme for the International Day for the Eradication of Poverty, underscoring the need to address institutional challenges to foster a more just and inclusive society.

SEED is committed to improving access to healthcare in southeast Madagascar by focusing on community-led, sustainable change in rural areas like Ambinanibe, where limited resources and health knowledge pose significant barriers. Through efforts such as Project Votsira and our ‘Water, Sanitation, and Hygiene (WASH) and Solar in Health Centres’ initiative, SEED works alongside community members to develop sustainable solutions that improve access to quality healthcare. In light of these efforts, the International Day for the Eradication of Poverty serves as a reminder of the critical need to ensure that everyone, regardless of their location or circumstances, has the opportunity to access quality healthcare.

Healthcare Access in Ambinanibe

Ambinanibe, located in the southeast Anosy region of Madagascar, exemplifies the healthcare challenges faced by rural communities. Situated just under 10 km from the town of Fort Dauphin, Ambinanibe is characterised by its rural setting and limited access to essential services.

The local health centre in Ambinanibe serves a population of over 6,000 people, with many community members walking more than 5 km to access its services. Despite the dedication of its three staff members, infrastructure challenges and resource limitations affect the quality of care available. A small solar system powers the storage of vaccines and medicine, leaving the rest of the health centre without electricity. As a result, staff must often provide nighttime care in low-light conditions, leading to potential delays in treatment during critical moments, which can negatively affect maternal and child health outcomes. These barriers to healthcare are intensified by limited access to health information, which contributes to the persistence of preventable illnesses and adverse health outcomes.

SEED’s Commitment to Equitable Healthcare in Ambinanibe

Communities understand their health needs better than anyone. To ensure projects in Ambinanibe are sustainable and effective, SEED is working with community members, local health centre staff, and the Ministry of Health to address the challenges they face in accessing quality healthcare. This collaboration focuses on delivering essential maternal and child health education to the community while working with the local health centre to strengthen staff capacity, improve infrastructure, and provide essential medical equipment. Together, these efforts aim to tackle the barriers that prevent the community of Ambinanibe from accessing quality healthcare.

Project Votsira’s community education programme aims to improve maternal and child health outcomes in Ambinanibe by delivering bi-weekly education sessions at the local health centre. To ensure the sessions meet community needs, the health centre staff work closely with community members to identify priority topics. For example, after eight malaria cases were reported in one morning, local health centre staff requested education sessions to support malaria prevention. During these sessions, practical and sustainable methods were discussed, including planting citronella (a natural mosquito deterrent), keeping windows and doors closed at night, and promoting the use of mosquito repellent. On top of malaria prevention, other key topics include breastfeeding practices, common childhood illnesses, STI / HIV awareness and prevention, and nutrition. The sessions, which are led by SEED’s Senior Community Liaison Officers in collaboration with health centre staff, are held on days when antenatal services are offered to further engage pregnant women and mothers visiting the health centre. This structure, along with the influence of word-of-mouth promotion, has led to over 700 community members attending the education sessions in Ambinanibe from July to October 2024. This attendance rate highlights the community’s desire to learn more about maternal and child health, and reflects ongoing efforts to safeguard their well-being by utilising services offered at the local health centre.

Phase V of Project Votsira will continue working with local health centre staff to ensure maternal and child health education is delivered to the community in Ambinanibe. Adapted to align with community needs, the education sessions will have an increased focus on nutritional information for pregnant women, newborns, and young children, as well as the role of breastfeeding in the health and development of infants. Sessions will also take place in local villages and will be followed by household visits from community health workers, enabling participants to discuss any health questions or concerns in a more private setting. To foster sustainability of increased healthcare capacity, SEED will partner with the Regional Ministry of Health to provide technical training workshops for the healthcare staff. These workshops will cover protocols such as Emergency Obstetric and Neonatal Care Services, as well as Infant and Young Child Feeding practices. In addition to this training, essential medical equipment, such as a birthing bed and suction cup for childbirth, will be provided to the local health centre, supporting staff in providing more effective care to women in labour in Ambinanibe.

To further support improved health outcomes in Ambinanibe, SEED is implementing the ‘WASH and Solar in local healthcare centres’ pilot project. This initiative aims to improve health outcomes for community members by enhancing WASH infrastructure, facilitating additional professional training for local health centre staff, and electrifying the health centre. Solar energy will be installed to provide consistent access to electricity, offering a crucial resource for staff to provide consistent night-time healthcare. Other infrastructural improvements include the construction of five gender-segregated latrines, a menstrual hygiene management facility, and the installation of a clean, reliable rainwater harvesting system. To foster sustainable ownership, the local health centre staff will receive training on WASH practices and maintenance of the solar system. These infrastructural improvements, along with staff training, will provide the community with an improved healthcare facility, spurring positive changes in health outcomes in Ambinanibe.

A Commitment to Eradicating Poverty

SEED's Project Votsira and ‘WASH and Solar in Health Centres’ initiative exemplify how addressing infrastructural and knowledge-based barriers can create a lasting impact driven by the community. Access to healthcare is a fundamental right,¹ and SEED is committed to working with communities in the southeast Anosy region of Madagascar to empower them in overcoming barriers, such as limited access to quality healthcare services and low health literacy, which can perpetuate poverty. As we commemorate the 32^nd International Day for the Eradication of Poverty, let us come together in our commitment to foster a just, peaceful, and inclusive society that is free from the constraints of poverty.

References

1. SDG Knowledge Hub (2024) International Day for the Eradication of Poverty 2024 https://sdg.iisd.org/events/international-day-for-the-eradication-of-poverty-2024/ [accessed 19/09/24].
2. Satista (2024) Healthcare Indicators – Madagascar https://www.statista.com/outlook/co/health-indicators/madagascar [accessed 19/09/24].
3. World Data (2024) Healthcare in Madagascar  https://www.worlddata.info/africa/madagascar/health.php [accessed 19/09/24]
4.  International Monetary Fund (2023) Social Spending and Outcomes in Madagascar https://www.elibrary.imf.org/view/journals/018/2023/035/article-A001-en.xml#:~:text=Education%2C%20health%2C%20and%20social%20assistance%20spending%20in%20Madagascar [accessed 19/09/24].
5. USAID (2024) Global Health – Madagascar https://www.usaid.gov/madagascar/global-health [accessed 19/09/24].
6. SEforALL, Powering Healthcare in Madagascar: Market Assessment and Roadmap for Health Facility Electrification https://www.seforall.org/publications/powering-healthcare-in-madagascar-market-assessment-and-roadmap-for-health-facility [accessed 19/09/24].
7.  INSTAT & UNICEF (2019) Enquete par grappes a indicateurs multiples – MICS Mada, 2018, Rapport Final https://mics-surveys-prod.s3.amazonaws.com/MICS6/Eastern%20and%20Southern%20Africa/Madagascar/2018/S [accessed 19/09/24].