I accompanied our Mission Director on a field trip to northeastern Madagascar in January 2012, where a USAID partner, Santenet2, is implementing a mother and child health and family planning program.
One of the villages that we visited was Amboanio, where poverty is rampant after the closing of a cement factory that used to provide jobs to the local people. Amboanio is in a remote, poor rural area where access to health care is more than inadequate: the nearest health center is 5km away, and the main hospital another 40km from there.
In 2010, the USAID-funded Santenet2 program launched a community-based system that helps to identify danger signs in pregnant women and newborn children. It also arranges for their medical evacuation in case of an emergency.
One of the first beneficiaries of this system in the village was Marie-Ange, a fisherman’s wife, who was pregnant in 2010 and started having labor pains when she was in her eighth month of pregnancy. “In March 2010, I was pregnant again with my child—this one, Bertrand. I had a miscarriage two years ago. My water broke but then labor stopped. The community health worker took me to the local health center—it’s a one-hour walk—where the chief physician recommended that I go to the hospital. My father and the Mayor arranged for transportation up to the central hospital,” she said. Marie-Ange was evacuated to the main hospital, using a rural bus paid by the community through a social solidarity fund. She went straight into the operating room, and her life and her baby’s was saved.
This community-based emergency medical evacuation plan, established under USAID/Santenet2’s “obstetrical and neonatal care” program, works through a Solidarity Fund that is run by a Social Development Committee (SDC). Participating village residents contribute a small amount on a monthly basis. The Fund pays for necessary medical evacuations, using rural taxis called taxi-brousse. One member of the SDC, Samsoudine Ben Said, said: “I’m the Deputy Mayor of Amboanio, and at the same time a member of the Social Development Committee (SDC) that is comprised of representatives of the community at all levels, I mean villages, churches, transporters, local dignitaries. I want to make it clear that referring a patient to the hospital is a decision to be made solely by the physician at the health center. There’s no fixed amount for financial contributions to the solidarity fund. Those who have more money contribute more, and those with less money contribute less.” The SDC enters into an agreement with local transporters that provide regular transportation services between the commune and the main town. Fuel is paid out of the solidarity fund, and the patient reimburses after she is healed.
It is very simple: Marie-Ange’s life was saved thanks to community mobilization. The entire community is now much more aware of the need for emergency services and advance planning.