By Christo Rasoloniaina, health education officer, Belo sur Mer, Madagascar
One month after my arrival in Belo sur Mer as the new health education officer, we organised a review training session to regroup all of the women working as community-based distributors (CBDs) of contraceptives. These days spent with the CBDs enabled me to discover how dynamic they all are, with a real thirst for knowledge!
It was their third training session about reproductive health and family planning, although this time the meeting place wasn’t Belo sur Mer but the small village of Ankevo sur Mer, which is located halfway between Belo and Morondava, so convenient for all of the CBDs to get to. Dophine, the CBD based in Ankevo, welcomed us with loads of watermelons which grow inland during this season!
One year ago Blue Ventures organised a meeting in Ankevo to look for literate women motivated to improve their community’s health. Dophine who was chosen by the village as she was already helping at the nearby clinic during national vaccination campaigns.
She was actually absent during the meeting, and was surprised but delighted to find out about her community’s request. Now she has been trained to offer contraceptives (condoms and pills) in her village, and it’s not only Ankevo sur Mer but also people from neighbouring inland communities who come to her for these services.
During two days in Ankevo, we revised all of the contraceptive methods that the community-based distributors are trained to offer, as well as basic maternal and child health advice such as promoting exclusive breastfeeding for the first six months following birth.
According to Clémentine, the CBD chosen by the village of Antanimanimbo, now that contraceptives are available in this village and women do not have to walk to the clinic (far and sometimes difficult to access during the rainy season), they use methods like the pill more regularly.
Rodia, the young CBD based in Belo sur Mer, also told us about how she is increasing her village’s access to family planning; since she has been validated by local health centre staff to offer contraceptives, most of her female relatives and broader entourage come to her for family planning, when previously they were ashamed to go to the clinic.
As an addition to the monthly follow up support that we provide to each CBD in their village, these quarterly review training sessions allow for them to share experiences and discuss challenges together.Sharing tents and cooking together in Ankevo helped to create a strong solidarity between the women. Even for the coffee break there was no question about them leaving someone behind in the meeting room if she was finishing her exercise; instead, they waited and then all went together!
As part of the training session, we reviewed the CBD’s consultation records and monthly reports. Filling in these templates can be difficult for some women who have low levels of formal education and aren’t accustomed to keeping written records, but these documents are essential to ensure that they are distributing contraceptives safely.
Lauralette, the CBD from Begamela village, almost abandoned her position because she was scared not to be able to fill in these documents. I comforted her and said that we are all in the same team. Then, during the training I was pleasantly surprised to see her asking questions when things were not clear! She told me, “even if I left school early, I want to understand this CBD work”.
There’s no doubt that this small group of women are motivated in their roles as CBDs and are becoming more competent with their reproductive health knowledge. The next big step will be to learn how to offer injectable contraceptives, which provide 3 months of protection and are very popular in rural Madagascar! The training will be held in a few months time, in partnership with MAHEFA.
On the final evening we did a night projection in Ankevo village, with CBDs presenting the contraceptives (pills and condoms) that they offer, and also the long-acting reversible contraceptives (implants and intra-uterine devices) that Marie Stopes will offer next month during their visit to the Belo sur Mer area. We’re looking forward to welcoming them, and extending this service to our partner communities.