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Friday, 31st January 2020

Project Mitao: Collaborating with stakeholders in a sustainable approach to sexual and reproductive health

By Kirsty Solomons and Katie Humphries

At SEED, we support a range of organisations to respond to the most critical needs of communities in the Anosy region. Project Mitao, Phase I has now come to a close, but we will continue to strengthen partnerships with healthcare providers, civil society representatives, and community leaders to achieve our mutual goals.

In rural Anosy where 97% of the population live on less than $1.90 a day, over 50% of young people have never attended school (Healy, 2018). These factors leave the population ill-equipped to protect their sexual health. In response, Project Mitao delivered a sexual and reproductive health and rights (SRHR) education course to rural youth, whilst conducting research investigating the spread of STIs and HIV. To address a lack of coordination in the region, Project Mitao brought together key stakeholders in a series of roundtable meetings attended by actors such as healthcare providers, ministry officials, civil society representatives, teachers, and community leaders.

Initial roundtable meetings kicked off in Mahatalaky, a rural town in Anosy, with lively discussions about the biggest problems facing the region. Key issues arose, such as the lack of information for young people and a disbelief in the existence of HIV. A significant challenge facing the region was the burden on local health services to deal with the surge in STIs, with one doctor in Mahatalaky serving over 8000 people. Healthcare providers discussed issues such as low staff numbers and a lack of equipment, whilst the Ministry of Public Health representative raised concerns over stock supplies, following several months where HIV tests had been unavailable.

Although HIV and STI testing and treatment should be free, frequent stock-outs cause us to change the cost of these services.

Health Centre Manager, Mahatalaky

These meetings also provided an opportunity to present findings from Project Mitao’s research. Key findings demonstrated the need for a holistic SRHR intervention, with a quarter of young people reporting that they had experienced STI symptoms, yet only 7% of those receiving treatment. Furthermore, SEED’s research highlighted that only 6.1% of survey participants from the Mahatalaky commune have ever been tested for HIV. The high prevalence of STIs likely reflects low condom use in this population, with just half of the surveyed young people saying they used a condom in the past three months.

 Once key issues were identified, later roundtable meetings focused on the creation of a coordinated regional strategy to address the sexual and reproductive health needs of young people in Anosy. Stakeholders discussed a potential ideas for activities, such as mass mobilisation events and screening videos about STIs in the town square. Longer term aims surrounded larger issues, with community leaders pledging to end child marriage in their respective boroughs, and a school headmaster advocating for increased sexual health education for his students. Ideas soon became reality, when the key stakeholders held a mass HIV testing campaign and facilitated a contraception provision day hosted by Marie Stopes Madagascar.  

These roundtables have provided a crucial platform for informed discussion, effective collaboration, and increased support for SRHR in Anosy. Furthermore, the involvement of stakeholders has informed Project Mitao’s research and activities, ensuring that SEED maintains an up-to-date understanding of sexual health needs in the region. Project Mitao Phase II will continue to collaborate with local, regional and national stakeholders to deliver sexual and reproductive health education to young people, increase the capacity of local healthcare services, and deepen our understanding of SRHR in the Anosy region. This network of stakeholders will form a significant part of future SEED community health projects and their coordinated actions will leave a lasting impact in rural Anosy.