Community Emergency Evacuation System

Editorial In Madagascar, eight women per day die from complications during pregnancy before, during, or after deliveryand the rate of infantchild mortality is still high. The population often face barriers that limit access to health care, and in the case of pregnant women and newborns, a lack of access to appropriate emergency care is one of the causes of the high maternal and infant mortality rates. These barriers include weak decision-making powers on the part of women, insufficient and inadequate means of transportation, weak communication systems between the villages and the basic health facilities (CSBs), and hard-to-reach health facilities. The issues that cause delays in accessing health services can cost the lives of women and newborns. In the Kaominina Mendrika (KM) salama communes, Communal Health Development Commissions (CCDSs) and community health volunteers (CHVs), along with the CSBs, have been mobilized to address obstetric and neonatal emergencies. Santnet2 efforts have improved community organization and built CHV and CCDS skills for a community-level response in recognizing danger signs and risk factors that require an emergency referral to appropriate health facilities. The CHVs educate families on increasing the use of health services, thus saving lives. Depending on community needs and the availability of local resources, these communities have established local transportation systems to take patients to health facilities. Solidarity funds or household funds have also been set up for this purpose. In this 11th edition of the Ezaka Mendrika bulletin, we would like to share with you examples of these communities commitment and initiatives to develop their own way to deal with emergencies. We also invite you to read about specific cases where lives have been saved. For 2013, I wish you a very happy New Year. I extend my hope that all children and women continue to have access to health care and remain healthy, wherever they are. Volkan Cakir Chief of Party, USAID/SANTENET2 To deal with medical emergencies and obstetric and neonatal complications in pregnant women and newborns, the Santnet2 Program integrated a new component into their package of community activitiescommunity mobilization by community actors (CHVs and CCDSs) for recognizing danger signs in pregnant women and newborns and establishment of an emergency evacuation system at the fokontany level, to transport patients to the CSB, or from the CSB to the nearest hospital. The communities integrate the organization and establishment of an evacuation system into their action plan: the community defines the mode and means of evacuee transportation according to local capacity and needs, and depending on the type of access the fokontany or commune has to a health facility. The communities also set up a solidarity fund or household fund, based on the need for evacuation and patient transfer. The communities define the nature of these funds, taking into account the populations ability to contribute. The members of the funds define the amount, frequency of contributions, and statutes for managing fund disbursement for emergency cases, as well as what types of cases will be covered. This community involvement means that the population (fokonolona) are taking charge of health emergencies. Achievements to date: The communities are committed to quickly taking charge of obstetric and neonatal emergencies, making sure that patients arrive at the health center in time. The population recognizes the danger signs that require emergency evacuation. Out of the 800 KM salama communes, 399 communes with 1 951 fokontany have a transportation system for these emergencies. 2335 lives have been saved, including 917 pregnant women and 315 newborns in remote and 1 103 disparate communities. Community involvement in the management of obstetric and neonatal emergencies in Amboanio-Boanamary in Mahajanga II The community alerted Lucie Florentine, the fokontanys CHV,and she started the evacuation process. Marie Ange was admitted to the Boanamary CSB after 20 minutes and received necessary interim care. Then she was evacuated to the Androva hospital, arriving in time to receive a successful cesarean section. Marie Ange and her son Bertrand are doing wonderfully today. Marie Ange was 24 years old and in her 36th week of pregnancy. Her water had broken, and she was presenting with intense contractions and general fatigue. For the villagers of Amboanio (rural commune of Boanamary de Mahajanga II), it takes an hour to walk to the nearest health center, so they USAID/Santnet2: had already set up a transportation system with the support of their CHV, the CCDS, and the brush taxi serving the nearby villagesthe taxis fuel was paid by the community solidarity fund, maintained through the contributions of everyone over the age of 18 in the village.
USAID/Santnet2: Marie Ange nursing her baby at the hospital Marie Ange and Bertrand at 11 months

USAID/Santnet2: Volkan Cakir ( Betsileo clothes)

Testimonial from M. Ratsimba, a community member in the fokontany of Tsiefa, commune of Ambondromisotra,

The rural commune of Vohilengo, better equipped for emergency evacuations Vohilengo, a rural commune in the district of Fnrive Est, is remote and inaccessible by car. Access to health care is very difficult. Through mobilization efforts by community leaders, including the CCDS and the CHVs, the commune is committed to facilitating transportation for sick people to the CSB. They are using traditional chairs constructed from bamboo called filanjna. Each fokontany possesses one for use during emergencies. The men of the fokontany of Fandalazina can assemble the mats for the filanjnain only fifteen minutes, and the patient can be transported to the CSB by four men. In most cases, communities are using local resources such asfilanjna, carts, and canoes, and they have set up solidarity funds to cover the costs of the evacuations (meals for the men who transport the patient and medical expenses). Symphorose Botou from the nongovernmental organization (NGO) ODDIT supports the population in this initiative, along with the CHVs and CCDSs of the Vohilengo commune.
USAID/Santnet2: Transporting a pregnant woman to the CSB in Vohilengo

We are proud to have implemented the emergency evacuation system for pregnant women and newborns experiencing obstetrical and neonatal emergencies as well as for other emergency medical cases. The mutual aid already existed before; however, the system established has improved it because it follows the action plan developed by the community. Although our CSB in Tomboarivo is 5 kilometers away and the hospital is 10 kilometers from our fokontany, the community is ready to transport the emergency evacuation cases by filanjna, and the money collected by the Fokonolona can meet the needs of the people helping with the evacuation and cover the medical costs. More than 10 individuals are always ready to accompany the evacuees whenever an emergency arises.

Obstetric and neonatal emergencies are treated in time at health centers inVatovavy Fitovinany
This community has overcome difficulties in evacuation cases where medical costs need to be covered and patients need to reach a health facility quickly. The improvement is a result of awareness-raising efforts by CHVs concerning obstetric and neonatal danger signs as well as reinforcement from the CCDS in terms of monitoring the implementation of the community action plan. After developing an action plan, the community carried out doable actions, small but significant, to create their method of health evacuation, using local materials. All the fokontany in the 19 KM salama communes of the Vohipeno, Manakara, and Mananjary districts have a functional emergency evacuation system. In the fokontany, families contribute to a solidarity fund, called haram-bary, to cover the transportation costs for children and pregnant women showing danger signs. The contribut ions may be in-kindoften riceor monetary. The fokonolona determine how the fund is to be managed. Support from the commune, through the CCDSs, consists for the most part in facilitating the application of established community conventions regarding the operation of the emergency evacuation system. Commune ofSakoana:The collected funds are disbursed directly to patients and patient escorts for costs related to evacuations and do not need to be repaid. Communes of Ankarimbary, Vohindava, and Vohitsinjo:In some fokontany, the collected funds are available as a loan, to be repaid after the patient has recovered, within a specified period of time. The majority of fokontany use a filanjna or canoe as their transportation system. The NGO ASOS supports community actors and the population in these 19 communes.

USAID/Santnet2: Emergency evacuation system,fokontanyof Ankaramalaza, commune of Ivatana, district

USAID/Santnet2: Emergency evacuation

system,fokontanyofTanandava, commune of Ivato,

11th edition, January 2013

Santnet2 is funded by USAID and implemented by RTI International