EZAKA MENDRIKA BULLETIN

I
n this editorial note, I would like to pay tribute to community stakeholders who actively participated in the community-based health services offered through interventions supported by the five-year USAID/Santnet2 Project in 800 rural communes. I would like to congratulate more than 12,000 community health volunteers who, with the support of the Project and various implementing partners, have risen to the challenge to deliver lifesaving services and improve maternal and child health. Thanks to your tireless efforts and skills, millions of children under five years old have access to community-based malaria, diarrhea, and pneumonia services. More than 585,396 children were treated at the fokontany level without having to walk long distances to access basic health services. Every day, more and more families can decide on the number of children they want. 164,091 women of reproductive age have access to a wide range of contraceptive methods. I want to seize this opportunity to recognize the courage and engagement of each community actor involved in this challenge to improve the populations health in remote fokontany. From now on, achievements of community health volunteers and primary health centers are complementary. This complementary care is in effect for children under five as well as for family planning services. Community leaders, acting through Communal Health Development Commissions (CCDSs), demonstrated their responsibility by mobilizing communities to build more than 3,500 locally made community huts and 25, 258 latrines, to fight against defecation in the open air in 1,041 villages, and to better organize health evacuations in 6,388 fokontany. A total of 1,272 newborns and 3,471 mothers were evacuated through this community system. There is now tangible evidence that community-based health services contribute effectively to improvements in the rural populations health community engagement is an essential key for any changes to occur. However, the continuation of refresher training for community actors and the promotion of local governance still require external support. These are essential elements for the sustainability of the community health system implemented by the Project. I am confident that community-based services as well as supervision of community workers will continue. Finally, I urge all stakeholders to strengthen the community health system in Madagascar. The US Government through USAID is pleased to support the Malagasy people in the health field, and this support will continue in the years to come. Santnet2 is one of the flagship projects of primary healthcare integrated base community of USAID/Madagascar and put in work by RTI International. During the five-year life of the project, the objectives were: improving child survival, maternal health and nutrition reduce unwanted pregnancies and improve reproductive health behaviour prevent and control major infectious diseases improved access to water and sanitation reduce the transmission and impact of HIV / AIDS

1. Contribution to reaching project achievements :

Community case management of Fever, Diarrhea and ARI

Fever Diarrhea ARI

Santnet2 is engaged with: 16 ONGs implementation partners 16 regions, 72 districts, pop. 11 million 5.758 fokontany located more than 5 km of a health facility (CSB) 800 Communal Commission for development of health (CCSD) 11,413 community agents (AC) all the leaders of the 800 KM salama (in roughly by municipality) 1,100 religious leaders 1,051 young leaders 400 trainers and independent supervisors working with UNICEF partnership WHO, WB, MSI - M, PSI

Community case management of Growth monitoring and promotion (GMP)

2. Community appropriation of project activities: Community engagement to change its long years reality
-Resource mobilization for WASH activities led by communities -1,041 villages ODF 164 communes (or Fokontany) drafted an action plan related to WASH -Empowering women: 12, 000 community evaluation meetings held with one million of participants including 500,000 women

3. After Santnet2, what will continue ??

Witness of community actors willing to continue :
- P i e r r e t t e Razanajaza, manager of the supply point of the rural commune of Mahasoabe in the district of Vohibato: I will always try to meet the populations needs, with PSIs support since I know how important the availability of products is for populations health. - Charles Rafanomezantsoa, mother health CHV in the fokontany of Tomboarivo, rural commune of Ambohimahazo These women place their trust in me all this time. I cannot let them down. And anyway, nothing should prevent me from continuing because I still have the products they need. If necessary, I will get supplies in Ambositra to keep up the work. - Ravaoarimino Holilalaina, a young leader in the commune of Ambatomena, district of Manjakandriana: We cannot stop something that we have started. We will continue our youth mobilization by creating our own funding.
Continuation of the supply of health products by PSI to prevent stock out of products among communities. PSI expect to ensure supply of 805 identified supply points during the intermediate period as supply points are of private management. The PSI distribution team will continue to supply these SP before indentifying the new zones to be covered for the next project.

Community case management of FP services: The number of FP users recruited and served by CHVs has increased over the years.

Improvement of Access to hygiene and sanitation: Presence of Wash-friendly CHVs/CCDS members

-Meetings and activities followed up sustained by community leaders -Development of action plans after community meetings every six months.

KM salama with CHV/CCDS Wash friendly KM salama without CHV/CCDS Wash friendly

Change in the number of latrines built

Reduction and prevention of HIV/Aids transmission

Number of target groups sensitized

-Satisfaction of community needs through local capacities: - Construction of 3,552 community huts - Setting up community evacuation system in 6,388 fokontanys located in more than 5 m from CSB. These systems could help the evacuation of 3,471 pregnant women and 1,272 new born. - Setting up health mutuals in 4 districts with an increase in the number of enrolled since January 2012

CCDS members will continue to supervise implementation of action plans

An increase in the number of people screened among MARPs group:

Rudolph Thomas,

Mission Director USAID/Madagascar 2009-2013

AFTER FIVE YEARS, SANTNET2 IS PROUD OF ALL ACHIEVEMENTS

Fiscal year

CHV and young leaders will continue to conduct awareness raising to populations in all KM salama communes on STI/HIV/Aids prevention. Sex workers and MSM will continue to get in touch with health services.

Final Edition June 2013

The USAID/Santnet2 project is implemented by RTI International