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SEED Madagascar

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Project Votsira

A health education project in Fort Dauphin increasing women's access to quality sexual, reproductive, maternal and child health information.


  • Status: Fully Funded
  • Date: 2012/13 – Present
  • Target population: Pregnant women, women of reproductive age, women with children under five, community elders
  • Location: Fort Dauphin, Anosy Region, southeast Madagascar
  • Project Partners & Stakeholders: Ministry of Health, local government health agents

Why is it important?

The Malagasy health system remains chronically under-resourced and under-utilised. At just $22 per capita per year (WHO, 2014), government expenditure on health is amongst the lowest in the world, severely limiting affordable services and leaving many people with no access to reliable and accurate healthcare information. This reinforces a cultural reliance on traditional and informal healthcare options, and leaves pregnant woman in an ill-informed and vulnerable position regarding their and their babies' health.

In Madagascar, 12 women die every day from complications related to childbirth (Save the Children, 2015) with a lifetime risk of 1 in 47 – nearly 100 times greater than the 1 in 4,600 risk British mothers face (UNICEF, 2012). Although child mortality rates have significantly reduced in recent years, work is still required to bring incidences of common childhood illnesses under control: acute respiratory infections, diarrhoea, and malaria are responsible for 27%, 15% and 12% of under-five deaths across Madagascar respectively (UNICEF/WHO, 2014). Widespread chronic malnutrition compounds the difficulties in both preventing and treating these illnesses, and in the remote Anosy region where SEED works, further problems arise due to low immunisation uptake; just 43% of children receive all of their childhood vaccinations, compared to the national average of 62%.

Malagasy women are over 55 times more likely to die from maternity related causes than women in the UK

UNICEF, 2012
A votsira focus group in progress

What we're doing

Votsira's approach to community health emphasises the need to work with traditional health advisors to share modern health information, ensuring it becomes embedded within the fabric of Malagasy society. With limited access to healthcare facilities, women and mothers often turn to elders, friends and relatives for advice. During the Votsira programme SEED has comprehensively mapped the healthcare needs of the women of Fort Dauphin, and designed a series of community-based educational courses in collaboration with trained Malagasy doctors and public health professionals. Ongoing evaluation has shown this is an effective way of disseminating information and encouraging positive behaviour change.

SEED partners with the Ministry of Health to train government agents (GAs) on delivering these sessions to local women identified as having limited access to formal services and low literacy levels. SEED works with these GAs to develop their knowledge and skills to better enable them to disseminate accurate and comprehensive health information to their communities. The Votsira project monitors the government agents for efficacy, provides top-up training throughout the project, and supports them in visiting particularly vulnerable households. As established members of their communities in long-term roles, the training of government agents ensures the sustainability of the information base and helps build a supportive local context for improving maternal and child health in Fort Dauphin. We have contributed to the international body of learning through publication of peer-reviewed articles on our findings throughout the project.

Votsira recently concluded Module 1 of Phase 3, which disseminated a healthy pregnancy and birth preparedness courses to 11 communities across Fort Dauphin. Over two years, the course equipped women and community elders with essential information on antenatal visits, breastfeeding, HIV and sexually transmitted diseases, contraception, birth complications, sanitation, and birth preparedness. With this additional information and support, mothers will be enabled to make informed choices regarding their pregnancy and birth, avoiding harmful and dangerous practices, and safeguarding the health of woman and child.

Check out our video to hear the stories of beneficiaries and GAs involved in Module 1

Votsira is fully funded for Module 2 – a child health initiative – launched in July 2017. Following a similar model to Module I, the project will focus on the development and implementation of a Child Health Course in partnership with local health experts and stakeholders. GAs will be trained and subsequently supported to deliver the course, covering a range of subjects including the causes, symptoms and correct treatment of the three most prevalent common childhood illnesses – diarrhoea, acute respiratory infections and malaria – alongside issues of good nutrition and home hygiene practices. Through focus group sessions, individual household visits and the dissemination of Information, Education and Communication (IEC) materials, Module 2 aims to significantly reduce the impact and incidence of childhood illnesses in Fort Dauphin. Over 2 years, the project intends to reach over 2,000 mothers and elders, improving the health of an estimated 4,000 children under-five.


Logo: James Tudor Foundation

Current funders: James Tudor Foundation, Souter Charitable Trust, Cotton Trust, SMB Charitable Trust, Gloag Foundation, CB & HH Taylor Trust, Coles-Medlock and Joyce Green Association
Previous funders: The Silver Lady Fund, Oakdale Trust, Eleanor Rathbone Charitable Trust, Clark Mitchel, Tula Trust