#HealthWorkersCount for Improving Community Health

At separate levels of Madagascar’s health system, two health workers are partnering to champion the health of mothers and their young children.

Meet Dr. Rakotonandrasana Thierry: medical doctor, community leader, and pioneer.

Dr. Thierry was the head of health facilities in Madagascar’s Matsakabanja commune from 2014 to 2015. While leading the Centre de Sante de base, or CSB, Dr. Thierry found that pregnant women and their children under age five in his commune — around 3,000 in total — weren’t able to regularly access the care they needed to be healthy.

While the CSB provided adequate services for those who needed them, the community was not choosing to access care. For example, although the CSB had a routine vaccination day each month, children remained unvaccinated because their parents did not bring them to receive care.

To solve this problem, Dr. Thierry dedicated his time to forging a link between two levels of Madagascar’s health system: community health volunteers (CHVs), who worked directly at the community level; and the CSB, which organizes health activities at the commune, or regional, level.

Dr. Thierry’s staff coaches a CHV in providing counseling for a pregnant woman during an ANC visit.

Parents and their children received some basic care from one of the 24 CHVs in their community, but these volunteers could only provide limited support.

Dr. Thierry’s idea was to make health services easier for mothers and their children to access by integrating CHVs into routine CSB activities, giving them the support they needed to succeed.

Dr. Thierry decided to set aside Thursday as the day when CHVs accompany pregnant women to the health center for their antenatal care (ANC) or for their children’s vaccinations. Spreading the word about the event ensured more women successfully completed their ANC, as well as increased the number of children in the commune who received the needed vaccinations.

Two CHVs participate in a CSB staff meeting to expand their skills and knowledge.

Dr. Thierry chose to use the same day as a time to increase the CHVs capacity through on-the-job coaching for those who came in with their patients.

Dr. Thierry also supported CHVs by including them in monthly CSB staff meetings so they are more aware of CSB activities and resources, and made regular visits to CHV sites to provide personal supervision and support.

One of these CHVs was personally invested in improving access to services for mothers and young children.

Meet Dorette: wife, mother, and community health volunteer.

Dorette is married with three sons who are now 8,14, and 18. A few years ago, her youngest son, then two and a half, nearly died from malaria. When he was in critical danger, Dorette brought her son to the CSB for health care and he was treated by experienced staff just in time to save his life.

For Dorette, the experience was too close — it shook her to her core. As a result, Dorette began to look for ways to serve mothers and their young children in her community.
Dorette’s moment came in 2012, when the MAHEFA program began recruiting health volunteers in her Fokontany.

Dr. Thierry teaches Dorette how to use family health cards to improve the services she provides to patients.

Dorette is on the front lines of crisis when panicked mothers and sick children need her, but she is also a critical link for families to access further care through the CSB and for children to grow up to become healthy adults.

Dr. Thierry presents his innovative strategies to the Matsakabanja.

Because of Dr. Thierry’s innovative strategies to enable Dorette to connecting her patients with services, Dr. Thierry was recognized by the Director of the District Health office. Today, he has been promoted to become part of the district training team responsible community health, where his insights will continue to benefit Dorette and her fellow community health volunteers.

Dr. Thierry and his team, including Dorette and another CHV, proudly stand outside CSB, all working towards the same goal: saving lives.

Together, these two dedicated health professionals are serving the people of Madagascar by ensuring some of the most vulnerable citizens, women and young children, have better access to life-saving care. Their two roles — leader and volunteer — are essential elements in a well-coordinated, effective community health system that meets the needs of its members, one patient at a time.

The community health work JSI led under the MAHEFA project continues under the Mahefa Miaraka project, a new USAID-funded initiative to strengthen the local public health system’s capacity to manage community health activities and to support community health volunteers (CHVs).