By Guy Hubbard
ANTANANARIVO, Madagascar, 8 November 2010 – Volatiana Rafaramalala sat in the community hall of Ankazotoho Anosimahavelona, a neighbourhood of nearly 11 000 people, on the outskirts of Madagascar’s capital, Antananarivo.
|VIDEO: 29 October 2010 - UNICEF correspondent Guy Hubbard reports on efforts to support Madagascar's weakened health services for mothers and children. Watch in RealPlayer|
Ms. Rafaramalala had brought her six-month-old daughter, Sanda Anna, for a check-up, immunization and vitamin supplementation provided as part of UNICEF’s bi-annual Mother and Child Health Week here. Her baby hadn’t been feeding and had lost a lot of weight. The health workers measured Sanda’s arms, checked the elasticity of her skin and found that she was severely malnourished. Volatiana said she, herself, hadn’t been eating and could no longer produce milk for Sanda.
“I have a big problem,” she added. “I’m not married and I have a baby, and I can’t afford to buy food. I live with my parents and my mother is really sick.” The health workers referred her to another centre for further tests.
Poor health services
Unfortunately, Volatiana is not alone in this struggle to provide basic necessities for her child. People are getting poorer by the day in Madagascar, and there is no real safety net for them. The country is in the midst of a political and financial crisis, following last year’s violent coup. Funding cuts by international donors have hit the social welfare system, especially health services, hard. Meanwhile, the suspension of international trade agreements has devastated the economy.
|© UNICEF video|
|Volatiana Rafaramalala has her six-month-old daughter Sanda Anna checked by health workers in Ankazotoho Anosimahavelona, near Madgascar's capital, Antananarivo.|
Over the last year, more and more health centres have been forced to close their doors, depriving local populations of vital services. Centres that have remained open tend to be under-stocked and understaffed; many lack antibiotics and other medicines, such as the life-saving drug oxytocin, which is used in childbirth.
UNICEF Representative in Madagascar Bruno Maes said the crisis has profoundly weakened basic health services, leaving parts of the system in danger of collapsing.
“We are seriously concerned about the erosion of essential health services and the county’s capacity to provide for the basic needs of the population, especially amongst the most vulnerable and difficult to reach children,” he explained.
Most vulnerable are hardest hit
UNICEF and its partners launched Mother Child Health Week at the end of October despite the dire circumstances and the withdrawal of government support. While mothers were encouraged to bring their children to health centres, teams of outreach workers brought health services to more than 4 million people.
|© UNICEF video|
|Arm-circumference measurements reveal that Volatiana Rafaramalala's baby, Sanda Anna, is suffering from severe malnutrition.|
Leading the outreach team in Ankazotoho Anosimahavelona was Mirana Ramantsoa, a young health worker from the capital who was concerned about the growing number of children like baby Sanda who suffer from malnutrition.
“What I’ve noticed through this crisis is that the most vulnerable have become even more vulnerable” said Ms. Ramantsoa. “Even the middle class have themselves become vulnerable.”
Treating the symptom
Nutrition checks are now a standard part of the door-to-door outreach done during Mother and Child Health Weeks (as is immunization against measles for children under the age of five). At the Mahamasina Sud Health Centre, nurses carried out a comprehensive examination on Sanda. They realized that she was too malnourished even for therapeutic food; her digestive system would not be able to cope. The nurses explained that the baby now needed a hospital.
Sanda is expected to recover, but doctors and nurses here are merely treating the symptom. The underlying cause is the decline of the economy and of the social welfare and health systems. Even with efforts like Mother and Child Week, families in Madagascar will continue to suffer and until a resolution to the crisis is found.