The Community Health Training Programme in Ambolomadinika, Ikongo

[Seulement disponible en anglais] Summary

Feedback Madagascar and Ny Tanintsika continue their successful reproductive health training programme across the rainforest corridor from Ambohimahamasina (see ‘History' for details of the programme in Ambohimahamasina) to Ambolomadinika, a part of Madagascar even more remote and neglected. Its great need for assistance was highlighted after initial visits to the area in 2002, and confirmed in more detail through a preliminary study of the area.

The project was launched in July 2003 with a junior doctor and socio-organiser. It is composed of two types of training; on reproductive health and disease prevention.

Choice of sites

Due to the size of the commune of Ambolomadinika, the project started by targeting the four Fokontany covered by the preliminary study; Ankarefobe, Antaranjaha, Tsarakianja and Ambolomadinika, where the population's appetite for development had already been wetted during the preliminary study. Having completed trainings in these villages, the programme is expanding to other nearby villages.

Technique

Having learnt from experience and from the evaluation of the reproductive health programme conducted in Ambohimahamasina, it was decided to alter the project's approach; rather than carrying out one training per village, to divide the trainings into different themes and to carry out one theme per week per village. This approach is found better suited to villagers' time constraints and to their concentration spans, and hopefully should have a longer lasting effect.

The ten themes for reproductive health trainings are :

  1. Interpersonal communication.
  2. The techniques of communication.
  3. Creating a (theatrical) sketch.
  4. Sexuality and puberty.
  5. Problems related to sexuality (teenage pregnancy, unwanted pregnancy, abortion, sexual services).
  6. Alcoholism and drugs.
  7. STIs/AIDS.
  8. Abstinence.
  9. The methods of protection for young people and adolescents.
  10. Responsible decision-making.

Various techniques are used to stimulate sessions (Question/reply, role plays, brain-storming, etc.) and debate is encouraged around the subjects raised. Due to demand, exercise books and pens are distributed to those requiring them.

The themes for disease prevention trainings are :

  • 1. Prevention of diarrhoea and other common diseases
    • 1.1 Diarrhoea :
      • 1.1.1 Hygiene and sanitation.
      • 1.1.2 Clean water.
      • 1.1.3 Teaching the mix of ORT (Oral Rehydration Treatment)
    • 1.2 Malaria :
      • 1.2.1 Use of mosquito nets and other methods of prevention.
    • 1.3 Respiratory Infections : Prevention
    • 1.4 Parasites
      • 1.4.1 Bilharzia
      • 1.4.2 Filariose.
      • 1.4.3 Cysticicose.
  • 2. Food security :
    • 2.1 Nutrition for women and children : goitre and others.
    • 2.2 Vegetable growing.
    • 2.3 Grain storage.
  • 3. Safe motherhood and child health :
    • 3.1 Vaccination programme and health carnet.
    • 3.2 Services available at the health centres, breastfeeding and family planning.
  • 4. Dental health

Therefore, a total of 14 sessions are held in each village.

Children in the village of Tsarakianja so thin and severely malnourished that they can barely stand up, and villagers in Ankarefobe fetching water in a muddy pool of water on the edge of ricefields.


Results so far

The dynamism and enthusiasm of participants, and their interest in the project, is great news for Feedback, with large turnout for trainings, and numbers increasing. Our close collaboration with the local and traditional authorities has contributed to the behaviour change noted since the start of trainings, for example in terms of village cleanliness and personal hygiene. Request for certain accompanying measures from villagers, such as the sale of underwear (not used by most villagers due to their high cost). This request was granted, and the project now sells underwear at cost price to villagers!

However, there are always difficulties encountered, particularly bad weather and the inaccessibility of project sites (villages can become cut off when rivers' water levels increase during heavy rains, and the rainy season is a major problem especially for toilet construction). Being a malaria and bilharzia-endemic area also means that sickness amongst field staff is common.