Real lives

Real lives


Meet community health worker Bonespérance

UNICEF Madagascar/2011/Corbett
© UNICEF Madagascar
"The most important thing I do is education," says Bonespérance

Bonespérance has been a community health worker for more than five years, elected by local residents in her village in 2006. It is a job that she is proud of, and for Bonespérance, the importance of her role is clear.

“Many women here need help to look after their children better, to help them understand why vaccinations are important, and to help them learn how to keep their children healthy,” she explains. “I am happy to do this job, because it is something that improves the lives of other people, and at the same time I am also learning and gaining knowledge.”

Bonespérance is part of a country-wide network of community health workers in Madagascar, who work in remote places to help bring basic health education and treatment to isolated communities. Their activities are key to expanding and promoting access to health services across Madagascar.

Bringing healthcare home

In the south west, communities like Tsimafaitse are frequently cut off from markets, towns and other villages by a lack of roads and sheer distance. Tsimafaitse is more than 250km from the nearest hospital. In these districts pregnant women die too often as a result of complications in childbirth and from pregnancy-related causes that could be avoided and treated; and children continue to die from illnesses that are both preventable and curable, such as malaria, diarrhoea and respiratory infections.

To tackle this community health workers like Bonespérance, are trained with support from UNICEF, to make basic, yet effective health services available to children and women in their homes. Across Madagascar, UNICEF is scaling-up an initiative known as the Integrated Management of Childhood illness - at community level (IMCI-c), enabling health workers to provide community-based approaches to dealing with health issues. The initiative focuses on managing the most common illnesses among children under five; and encourages key household practices that promote childhood development.

UNICEF Madagascar/2011/Corbett
Bonespérance (right) at work overseeing Plumpy'doz distribution

To date in 2011, UNICEF has supported the training of over 4,500 community health workers in IMCI-c, and aims to have trained 7,000 by the end of the year. In Madagascar, where health centres often lack equipment, medicine and qualified staff, transferring primary healthcare functions from professional personnel to community health workers is a cost-effective way to improve the health of many people who would otherwise not have access to health facilities. Such work can, however, be challenging.

“There are women that I see who change their habits, who practice family planning and who want to learn about how they can improve their children’s health,” says Bonespérance. “But there are still those who I have to keep visiting again and again. The most important thing I do is education, passing on messages to mothers to help them care for their children better.”

Detecting Malnutrition

“Life here is not easy. We don’t get much rain and harvests are often poor,” explains Bonespérance. For this reason much of her work also includes activities related to nutrition. In semi-arid southern Madagascar, persistent food insecurity puts hundreds of thousands of children under-five at risk of severe malnutrition, and across the country, 50 per cent of children suffer from stunted growth. Today, Madagascar ranks sixth among countries in the world with the highest rates of malnutrition.

Working with community health workers, UNICEF is reinforcing screening mechanisms to detect malnutrition in children under five. In April 2011, UNICEF and its partners carried out a mass screening of 260,000 children in southern Madagascar; and in September 2011 launched a campaign that aims to distribute Plumpy’doz, a supplementary food rich in vitamins and minerals designed to help prevent malnutrition, to 20,000 children aged 6 to 36 months in the south west. Both are major achievements that would not have been possible without community health workers like Bonespérance.



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