In 2017, in less than two months the plague infected 1,240 people and killed 124 across urban and rural areas of Madagascar (source: service d’urgence et riposte epidémie et catastrophe, ministry of health, October 24, 2017). While the country typically sees a few hundred cases of the plague each year, the current outbreak is particularly concerning due to its already significant infection rates and unusually high proportion of pneumonic cases, which are more deadly and transmit easily from human to human. An extensive and timely response is critical to combat the plague and prevent further spread.
Madagascar’s plague season started earlier than normal and was particularly deadly and widespread. Plague occurs annually in this country, with cases usually emerging between October and April, usually in remote, rural locations. Typically, Madagascar sees about 500 plague cases a year. That year, within the first two months there were already more than 1,500 cases. The majority of cases from the outbreak were the less common but more easily transmitted pneumonic plague and centered in urban areas.
The USAID Community Capacity for Health program, locally known as Mahefa Miaraka and implemented by JSI Research & Training Institute, Inc., played a key role in Madagascar’s national plague response, led by the Ministry of Public Health. Mahefa Miaraka provides training to a network of more than 10,000 community health volunteers in some of Madagascar’s most remote villages. These volunteers have been trained to identify and respond to plague cases and raise awareness about the disease in their communities. Mahefa Miaraka also works with national and local government actors to strengthen Madagascar’s health system and policies, driving toward self-reliance.
Because of JSI’s expertise working at every level of Madagascar’s healthcare landscape, Mahefa Miaraka is especially suited to partner in the fight against plague and is working at each level to support Madagascar’s plague response.
AT THE NATIONAL LEVEL
Since the start of the current outbreak, JSI’s Mahefa Miaraka staff members took part in national-level committees set up by Madagascar’s Ministry of Public Health and the World Health Organization. During plague response meetings Mahefa Miaraka staff strategized with government and other development partners.
AT THE REGIONAL LEVEL
In affected regions such as Boeny, in western Madagascar, where both bubonic and pneumonic plague cases were reported and treated, critical actions are being taken, including setting up roadside health checkpoints designed to validate the health of passengers traveling across Madagascar via buses or taxis. Mahefa Miaraka provided material support to medical teams working at checkpoints, and staff members have also volunteered their time to help run the checkpoints.
In addition to assisting with health checkpoints, regional plague prevention efforts included sharing information via television and radio, holding public hygiene, cleanliness, and sanitization events, and establishing regional and district level crisis units.
JSI’s Mahefa Miaraka program contributed to sharing public health messages on the radio, and Mahefa Miaraka staff participated in both regional and district level crisis unit meetings and plague response activities.
AT THE DISTRICT LEVEL
District-level crisis units—typically made up of non-governmental organization staff and local government representatives including mayors, district heads, village heads, and medical inspectors and their teams—managed the plague response at the grassroots level. In districts impacted by plague outbreak, these units worked on treatment strategies, while in unaffected districts they focused on prevention.
Training sessions organized by the district crisis unit for local trainers are especially important as they empower government health agents by providing them with accurate information and serving as a forum for asking questions, debunking rumors and quelling fears. The Mahefa Miaraka program is providing material and technical support to roll out plague response training activities from district to community levels.
AT THE COMMUNE LEVEL
After a government health agent received training on plague prevention, identification, and treatment, they in turn trained community health volunteers in their areas. Community health volunteers are often the first to respond during health emergencies.
AT THE COMMUNITY LEVEL
Trained community health volunteers and village heads led community health campaigns about plague by hosting awareness-raising sessions and community cleanups.
In the village of Analamamy, community health volunteer Pelandrova educates local community members about plague symptoms and what to do in the event of a suspected case.
In the commune of Antongomena Bevary, village head Marcel Randriana speaks before a crowded marketplace about plague and the importance of eliminating fleas.
Following a plague awareness-raising session, the Antongomena Bevary women’s group acts to clean up the market to prevent fleas and rats. Minimizing human contact with rodents and fleas is key to controlling the bubonic form of plague.
The Mahefa Miaraka program also contributes to plague prevention efforts by transporting supplies, translating plague messages into local dialects, and distributing informative posters. Mahefa Miaraka is ensuring the health of its own staff by instituting daily temperature checks at each activity office.
Community health volunteers post plague information in the village of Analamamy.
At Mahefa Miaraka’s Mitsinjo district office, all staff and visitors receive a temperature check before entering the building.
USAID’s Mahefa Miaraka program, along with other USAID projects, is working hard to support an integrated approach to plague management and prevention. By working together with the government of Madagascar at the national, regional, district, commune, and community levels, Mahefa Miaraka is strengthening Madagascar’s response to plague.
– In the Mangabe commune, a community supported by Mahefa Miaraka, two young girls stand outside a health center. Their community is engaged in plague prevention and hasn’t seen a case yet.
Photos: Melanie Borcover & Mamy Raharidina