Improving Community Health Services

In Madagascar, maternal and child health issues are persistent–10 women die each day as a result of pregnancy or birth-related complications and 100 children die each day from preventable causes.

The country is predominantly rural; around 64 percent of its total 25 million inhabitants live in rural areas, where their communities are known as fokontany, or villages. These communities are tightly knit groups of families who know each other well and share resources, as well as a cultural identity. Most fokontany are anywhere from two hours to more than a day’s walk from the nearest basic health center, or Centre de Santé de Base (CSB).

What does it take to make a difference in these communities? Problem solving people like Dr. Yvette Ribaira.

A Problem Solving Person

Dr. Ribaira is a medical doctor who has devoted 25 years of her life to public health. She describes herself as a problem solving person who’s always trying to find evidence-based solutions to challenges she encounters, whether professionally or personally.

Unlike many women, Dr. Ribaira says she didn’t encounter resistance to her advancement as a woman in public health, although she recognizes this situation may be different for those in other career paths.

Together We Are Capable

For the last twelve years, Dr. Ribaira has been focused on community health through her work with John Snow Inc. (JSI). She now leads the USAID Community Capacity for Health Program which is known locally as Mahefa Miaraka or “together we are capable.”

The program works to strengthen the skills of community health volunteers (CHVs) who serve the women and children of each fokontany. These volunteers are the foundation of Madagascar’s health system and provide essential services that are reducing the number of women and children who die from preventable causes.

The program currently works with nearly 10,000 CHVs, around 4,500 of whom are women, who ensure that communities have the care they need close to home and act as a link to the rest of the health system in areas that previously had no access to care. Because they are members of the community, they are in a unique position to inform and engage their fokontany in adopting healthier behaviors.

The program has also introduced innovations that have made women and children in every fokontany safer and healthier, including introducing a drug called misoprostol, which prevents post-partum hemorrhage, and chlorhexidine, which prevents newborn umbilical sepsis. “Having innovations [like misoprostol and chlorhexidine] and having the government adopting these innovations – the Mahefa Miaraka program really contributes to saving lives in Madagascar,” Dr. Ribaira said.

They Can Choose Their Life

Out of all she’s done for her country, Dr. Ribaira is most proud of her work as an advocate for the health and well-being of all communities. She believes all people, especially young women, have great potential to learn and succeed, as she has.