By Lison Garrel, Safidy (Community Health) Programme Coordinator, Belo sur Mer
My involvement with Blue Ventures started at the beginning of 2013, with a two-month mission to Belo sur Mer on Madagascar’s west coast. The aim: to conduct an assessment of reproductive health needs in order to explore the feasibility of replicating the Safidy programme in the Belo sur Mer area. For this, I was looking to collect baseline data about sexual health knowledge as well as access to and uptake of family planning services. After gathering some information from the district medical inspector, commune mayor, village leaders and health workers, it was time to directly consult the local communities about their health needs!
I coordinated with the Safidy team in Velondriake to develop a survey, recruited and trained two local surveyors, then did some initial piloting with them and Emmanuel (Blue Ventures’ community organiser in Belo sur Mer). Our small team was finally ready to start work, but then tropical cyclone Haruna swept along the coast, forcing us to delay our plans. As soon as the wind weakened, however, we were able to get started in Belo sur Mer… It must have been funny for the villagers to see me running between houses in the rain, gathering completed forms and overseeing the surveyors’ progress!
With a lot of good will and everybody’s efficient work, we managed to consult more than 250 people across 7 villages. The last of these communities was called Andika sur Mer, which we reached in our pirogue, setting off early in the morning as the tide was coming in. Andika is a small village with about 350 inhabitants, situated between mangroves and the sea, and protected by sand spits; it was paradisical, apart from being a scorching 35°C!
After meeting with the village leader and receiving his approval for our study, we surveyed the men before they went out fishing. Following a mid-morning tea break with mokari (small fried rice cakes), we then set about surveying the women of the village. Our strategy was to survey one household in every five but between the houses, cooking huts and abandoned lean-tos, it was like being in a small labyrinth! Fortunately the local surveyors managed to navigate their way around the village, and we ended up finishing early. This gave me time to meet Andika’s traditional midwife with Emmanuel accompanying me to translate.
We discovered that the traditional midwife advises women not to use contraception because she’s afraid that it can cause sterility or illness. These misunderstandings were reflected in our survey results, with 40% of people saying that they believe contraceptives can cause sickness. Such lack of knowledge combined with poor access to reproductive health services leads to low levels of contraceptive use, particularly in remote villages like Andika where only 4% of women reported using contraception.
In all of the villages that we visited, I was struck by the huge unmet need for sexual health education and family planning services. Community leaders, men, women and youth were open to discussing these issues with us, and were very eager to work with Blue Ventures in order to improve their health. The mayor of Belo sur Mer was particularly keen to collaborate, having seen the Safidy programme in action on a recent trip to Velondriake, and knowing how valuable those community-based health services would be for villages in the Belo sur Mer area.
Now fast forward to June, and it’s with great pleasure that I’ve returned to Belo sur Mer as the Safidy programme coordinator! I’ve spent my first few weeks meeting with partners and stakeholders, so we should be ready to start activities very soon. Local women will shortly be recruited and trained to act as community-based distributors within their own villages; offering family planning advice and a variety of contraceptives including condoms and pills. We’re also going to organise village outreach tours and other educational activities in order to raise awareness about health and environmental topics, and to encourage positive behaviour change.
I’m really excited to be back in Belo sur Mer, leading the development of the Safidy programme based on the findings from our baseline research. This represents the first replication of Blue Ventures’ integrated Population-Health-Environment approach beyond the Velondriake area, and it feels great to be working with the conservation team in a way that supports local communities to live more healthily and sustainably alongside their unique marine environment.
Blue Ventures has been working in the Belo sur Mer area since 2009. Conservation activities focus on marine protected area establishment in partnership with the Madagascar National Parks service, as well as locally managed mangrove reserves and crab fisheries monitoring in partnership with ARDA. Health partners in the Belo sur Mer area include MAHEFA, SARAGNA, Marie Stopes Madagascar and Population Services International. For more information please see this press release.