Bringing It All Together for Madgascar

Background:  The experience of three international NGOs has been harnessed to implement innovative program approaches in a new USAID-financed integrated community health program, “MAHEFA”, in Madagascar. MAHEFA will work in 9 of the country’s 22 regions, with a total population of 4.2 million (20% of the total population) bringing MNCH services to rural communities (more than 5 kilometers from health facilities) through the training and support of 7000 community-based health workers. The objective of the program will be to mobilize communities to take responsibility to improve their own health status.

Purpose:

To describe the approaches being implemented to improve accessibility to MNCH services in underserved rural populations.

Strategic approach:

MAHEFA conducted a barrier analysis to guide development of approaches for feasible and desirable changes for 15 key behaviors. In addition, a needs assessment to identify the issues and obstacles related to transportation challenges for health workers, commodities and severely ill patients is being conducted. Joint analyses of the results and multidisciplinary coordination at all levels will lead to participative planning and collaborative programming.

Findings: This paper will present the findings from Menabe Region, including results from barrier analysis interviews with 1350 respondents and additional ethnographic research. If results from the barrier analysis and ethnographic research demonstrate the necessity for additional information on certain behaviors, then TIPS (trials of improved practices) will be conducted. The strategies to address transportation and other barriers to behavior change will be described and any early results shared.

 

Conclusion: Multiple approaches to address obstacles will be used at household and community-level to minimize the barriers and to encourage and facilitate positive behavior change among those needs MNCH services.