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Improving Health Services, Products, and Practices in Madagascar

Santénet aimed to improve the health of the Malagasy population by increasing community demand for and access to health products and services. Santénet focused on improving the quality of health services in national priority areas of nutrition, malaria, HIV/AIDS, STI prevention and control, family planning, reproductive health, and child health.
Santénet worked with national health partners, including the Ministry of Health and Family Planning and local health authorities, to support Madagascar’s increasingly decentralized approach to public health. Focusing on a range of interventions in maternal and child health, nutrition, reproductive health and family planning, malaria, HIV/AIDS, and sexually transmitted infections, the project increased access to quality health services and products, generated demand in communities across the country, and strengthened public and nongovernmental entities working in the health system.
Santénet brought about the convergence of the public health sector, private sector, civil society, and households by improving the country’s capacity to provide high-quality care and by mobilizing communities to promote awareness of and access to high-quality health care. This strategy worked effectively to improve health indicators in maternal, child, and adolescent health; HIV/AIDS; and malaria prevention and control. The project increased demand for health care by expanding capacity building, health awareness, and nutritional services to specifically targeted remote and underserved communities, including environmentally sensitive areas, where mothers and children are particularly at-risk and underserved.

Santénet used an integrated package of approaches and tools at the community level to enhance demand for, access to, and quality of health services. These included:
Champion communities (kaominina mendrika): a social mobilization approach that relies on broad-based civic engagement, setting short-term achievable objectives, ongoing and inclusive performance management, and use of rewards to motivate communities.
Ankoay: Youth outreach and peer education implemented in partnership with the USAID-funded Health Communication Partnership.
Red cards: an innovative tool for youth for resisting peer pressure, encouraging self-confidence, and supporting abstinence and other healthy behaviors.
Samia mitondra telo (“Everyone invites three”): a communications approach that uses radio and personal networks to enhance demand for family planning services.
Health finance cooperatives: an innovative local health insurance scheme to support both individual and collective health prevention and curative services.
Quality assurance system: a system of standards and tools to improve community-based health center quality.
Project Results
  • 8 million mothers and children benefited from Mother and Child Health Weeks, a campaign to help Malagasy build the habit of semiannual visits to health facilities.
  • 440 NGO supervisors and vitamin farmers trained on increasing the production of the newly-developed orange-fleshed sweet potato and the importance and high vitamin A content of the variety.
  • Encouraged 1,447 scout troops, student associations, and other youth groups to get involved in HIV/AIDS prevention through the Ankoay tool which is now seen as a best practice by the National HIV/AIDS Control Committee.
    o 70 stylists and 20 hair salon directors were trained, allowing them to in turn train 1,280 students per year to apply the approach in their workplaces.
  • In collaboration with the Ministry of Health, the team strengthened and expanded the network of community-based health agents from approximately 600 to 6,850 throughout the 303 communes implementing the Champion Communities approach.
  • After establishing a quality assurance program, the project trained 98 doctors, nurses, midwives, and assistants from a number of sites, including the Institute for Inter-Regional Paramedical Training, and supervisors from the central level.
  • With strengthened health care management, use of quality health care services expanded in the 303 targeted communes: the prenatal consultation rate increased from 38 percent to 63 percent; the rate of tetanus vaccines during pregnancy increased from 32 percent to 68 percent; and the rate of children under one year old who were completely immunized rose from 43 to 65 percent.
  • Santénet successfully scaled up community health approaches and achieved impact in some 300 communes in Madagascar.
Project Duration: 2004 -2008


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