Providing communities the opportunity to express their health needs: In the context of the Kaominina Mendrika (KM)

During 2012, almost 350,000 people were able to express themselves at community assessment meetings in 3,417 fokontony in the KM salama salama approach, Santnet2 is committed to communes more than half of the participants at these meetings were women. providing health services that fulfill the needs of beneficiaries through community contribution. Some of the needs expressed at the assessment meetings include better access to health services; continuous availability of health products; and Access to services that respond to these needs is a satisfactory provision of health services, including the work environment. universal right and a real possibility. In the communes of the Anosy region, the communities have held their second community assessment meetings. It is very important to persevere in this process in order to have continuous improvement in the quality of health services. How do we make this happen? Santnet2: Community work in building CHW hut in Ambohimanarivo, Tsivangiana By offering the community the opportunity to express their health needs: Listen to the voice of the people when they communicate their health needs. This demonstrates the value of citizen participation and respect for democracy. To start this process, organize periodic community assessment meetings in each fokontany where every citizen can participate: men, women, and young people at any social level; and where the community can freely express their expectations based on their definition of quality and put forward their suggestions for improvement. Contributing to poverty reduction by facilitating It is very important for the community to define access to health services : quality for themselves and evaluate the quality of Ny fahasalamana no voalohan karena! health services in relation to their needs, and then discuss their expectations and suggestions for improvement. These expectations and suggestions are then brought to the Communal Health Development Commission for discussion. While many problems can be resolved in the fokontany, others require the support of the commune and these community assessment meeting allow for the commune to hear the voices of all the people. By raising awareness and empowering people: Introducing the community to the idea that they can address their own needs is a process of gradual, Santnet2/ Community hut in Lavakorana, Amboditavolo endogenous awarenessan approach that develops local capacity to reduce poverty. Local partnership The community needs to be placed at the center of its problems where it will make a conscious choice A partnership exists between service providers and the community. Because the community itself is involved in to actively define its needs and solutions. organizing health services, community members are more The community has the freedom to choose the satisfied with the quality of services offered. They are also decision-making mechanisms to meet its own needs. more motivated to use these services. By adopting local initiatives, the community feels able to make changes. This is the lever that gradually shifts the community toward taking responsibility In 2012, care for children under five, pregnant women, and couples seeking family planning services has increased. and local empowerment. Health huts illustrate local initiatives to improve The Communal Health Development Commissions and the communities work together to provide local governance of the quality of health services! health service quality. In two-thirds of the community assessment meetings, the community expressed the need to construct or rehabilitate huts for community health workers. They appreciate the work of the CHW but they want a place to have confidential services. Currently, 3,001 health huts have been constructed or are under construction in the 5,758 fokontany

Editorial

The communitys free expression is essential to having services that meet its health needs. From this fundamental step, local initiatives emerge to solve health problems!

Empowering people through local initiatives that solve health problems:

Community hut built by CHW in Ankarefo, Anosibe Ifody

Community response
Activities that improve access to health services: continuous coaching for community health workers, provided by local supervisors; organization of and timetables for services offered; signs and posters with information on health services offered, community organization of emergency evacuation of sick people and women in labor . . . Activities that improve the continuous availability of health products: leveraged funds, a monitoring and forecasting system for the supply chain, price transparency . . . Activities that improve the work environment for community health workers: infrastructure for and maintenance of health centers, construction/rehabilitation of health huts and equipment for community health workers, public recognition/appreciation of community health workers . . . Communities have gone beyond their limits and problems. They have taken charge of the situation. Particularly noteworthy is the construction of health huts for community health workers. In 2011, 351 health huts were constructed. This year, 3,001 health huts have been constructed or are under construction.

Testimony of Benot, mother health CHW in Leonkasina: The construction of the health hut in my village has attracted more women, especially those who want to choose a contraceptive method. Previously, these clients were limited; for a client to receive care in my own home is not always easy. It is necessary to be conscientious about privacy The model health hut in Bevala, Marovato commune, Tsihombe district The Bevala community health workers are well housedthey are benefitting from a health hut that resulted from community participation. With awareness-raising from the Communal Health Development Commission (CCDS), the residents pooled their resources to construct a very modern health hut, constructed with concrete walls and a sturdy roof. In addition, the community health workers participated on a rotating basis to prepare the site. In the Marovato commune, 95% of the communes fokontany have constructed a community health hut for their health. In the fokontany of Leonkasina, commune of Nohariandava in the Brickaville district, the health hut for the community health workers is the result of contributions from everyone. The community health workers in the fokontany of Leonkasina have been working since July in the new community health hut. This hut is the result of collaboration among the fokontanys residents (approximately 300 people), who are very satisfied with the health services provided by the two community health workers. This is the seventh community health hut constructed in the nine fokontany of this commune. The majority of the huts are constructed by hand, using local materials growing in this part of the island. In these huts, the community health workers keep their materials and dispense medicine. There you can always find their work smocks, scales for growth monitoring, sharp boxes to safely store used needles and other sharp tools, etc...

Santnet2/ Volkan Cakir with CHW in Marofinaritra,Maroantsetra

where the KM salama approach is implemented. This figure demonstrates the communities awareness and their willingness to truly take charge of their own health. th In this 10 edition of the Ezaka Mendrika Bulletin, produced on a quarterly basis by Santnet2, the project encourages listening and community involvement in improving health. We present an overview of the value given to the voice of the people for solving local health problems. Once again, we invite you to read and to share our information with those around you. The chief of Party

SN2A model of CHW site in Ambia,Ihosy

Volkan Cakir 10th edition, October 2012

SN2/A model of community hut in Ambalasaona,Toamasina II-

Santnet2 is funded by USAID and implemented by RTI International