Our community health programme delivers health education and services in order to enable couples to make their own reproductive health choices, as part of our integrated Population-Health-Environment (PHE) approach.
We currently work across 50 remote villages in the Velondriake and Belo sur Mer areas of southwest Madagascar, with counselling and health products provided through outreach clinics and networks of local women trained as community-based distributors of contraceptives. We facilitate a diverse range of peer-led educational activities including school workshops, youth club sessions, radio campaigns and interactive community presentations in order to support the uptake of services and the sustained adoption of healthier practices.
Unmet family planning and health needs
We work with some of the world's poorest and most isolated coastal communities, whose access to health services is severely limited. The unmet health needs of Madagascar's semi-nomadic Vezo fishing communities are particularly acute, with clinics located up to 50 kilometres away from some villages. Public health centres are chronically under-staffed and under-stocked, and the country is regressing on progress towards Millennium Development Goal 5; achieve universal access to reproductive health.
Less than a third of Vezo women are using contraceptives, despite up to 90% wanting to be able to plan their pregnancies. This leads to high fertility rates, inadequate birth spacing and poor maternal and child health outcomes, with Malagasy women facing a 1 in 45 lifetime risk of maternal death, and almost 1 in 5 children in the regions where we work dying before their fifth birthday. Addressing unmet reproductive health needs can reduce maternal and child mortality by up to 30% within this context.
Our community health programme, called Safidy, meaning "the freedom to choose" in Malagasy, has been developed in direct response to the unmet family planning needs of Vezo communities. It upholds their reproductive rights by offering couples the information and contraceptive options they need to freely choose the number and spacing of their births. The programme also encompasses maternal and child health education and services, and aims to improve sanitation and hygiene practices.
Our community-based model
We started providing health services by running outreach clinics in remote villages, and these still continue in some areas. In order to scale up service delivery, we also train and support local women to offer community-based health services, providing them with supplies at cost price to sell within their villages at the nationally fixed and very affordable retail price for a small income, in partnership with Population Services International. This sustainable social enterprise model is currently enabling us to reach more than 20,000 people across 50 remote communities along Madagascar’s southwest coastline.
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Our rights-based approach to family planning empowers couples to make their own reproductive health choices. Our network of community-based distributors offer counselling and products including condoms, contraceptive pills and hormonal injections as well as mosquito nets, water purifying solution, diarrhoea treatment kits and antenatal medication. We also partner with Marie Stopes Madagascar’s mobile outreach teams to offer long-acting reversible contraceptives on a quarterly basis, and our community-based distributors in the Velondriake area have been trained to provide antenatal and postnatal education.
We facilitate a variety of peer-led educational activities to support the uptake of health services. Activities target people at all stages of the behaviour change process, from raising awareness to influencing attitudes and encouraging the sustained adoption of healthier practices. Messages and activities are specifically tailored for various demographic groups, profiled according to gender and age range. Radio programmes, promotional merchandise, interactive village presentations, youth club sessions and school workshops using theatre, sports, music and film address health topics ranging from sexual, reproductive, maternal and child health to water, sanitation and hygiene.
Part of an integrated approach
Safidy is a key component of Blue Ventures’ integrated Population-Health-Environment (PHE) approach, which addresses the interconnected challenges of poor health, unmet family planning needs, gender inequality, food insecurity, environmental degradation and vulnerability to climate change in a holistic way.
This integrated model is underpinned by our educational village outreach tours, which engage communities in topics including family planning, maternal and child health, sanitation and hygiene, sustainable fisheries management, alternative coastal livelihoods and marine conservation. Combining health and environmental messages in this way enables us to reach broader audiences, for example, informing men about family planning by relating food security to reproductive health.
We empower couples to make their own reproductive health choices, and equip them with the skills to manage their resources sustainably. Gaining access to family planning services improves maternal and child health outcomes, allows girls to delay their first pregnancy until after they have completed their education, and affords women more opportunities to become economically active. Couples are supported to plan and better provide for their families; improving food security, boosting local conservation efforts and enabling them to create their own paths out of poverty.