In Madagascar, the most vulnerable gain access to health care through community health

In a rural municipality of Ambositra, people have to travel at least 2 kilometres to reach the nearest health centre. It’s an obstacle course, especially for children and mothers. Avotra, a mother of four, remembers the terrible lack of follow-up for her first three pregnancies. “The health centre was too far away and I didn’t make much money to consult periodically,” she says.

To bridge this distance, community sites have gradually been established in the most remote areas of his region. The Improved Nutritional Outcomes Project (PARN) has been set up, thus allowing to hire nearly 11,000 community health workers.  Their role is to monitor and provide unpaid care to the mother and child under 5 years of age in these remote hamlets. By definition, a community worker is a person who volunteers to promote health in a village. He/she monitors the health of the pregnant, breastfeeding or postpartum mother. He/she tracks the health of children under 5 through weighing, measuring and diagnosing malnutrition. We have treatments for children diagnosed with mild diseases or malnutrition. “In cases of complications, we transfer them to the nearest health centre,” says Nirina, community health worker.  The health worker also provides nutrition education to the beneficiary communities.

“The existence of the community site near the villages has improved practices: more and more pregnant women, mothers and children under 5 seek health care,” he continues. A community site receives an average of 250 children.

With funding from the World Bank, UNICEF is providing technical assistance to strengthen the health system in regions where the Improved Nutritional Outcomes Project (PARN) is being implemented. It is about providing free access to medication and care for the mother and child. Support also improves the national information system, as well as the coordination, bottom-up planning and management of different resources at regional, district and peripheral levels.