We recognise the links between poor health, population growth, environmental degradation, food insecurity and vulnerability to climate change.
We are witnessing how population growth, caused largely by an unmet need for family planning in the under-served areas where we work, is contributing to unsustainable natural resource use, damaging the environment and deepening poverty.
As a holistic response to these interconnected challenges, we have developed an integrated Population-Health-Environment (PHE) programme in Madagascar, offering couples access to family planning and equipping them with the skills they need to sustainably manage their natural resources.
Safidy is the community health component of our integrated PHE programme operating in the Velondriake locally managed marine area on the south west coast of Madagascar. It encompasses sexual, reproductive, maternal and child health as well as water, sanitation and hygiene.
Safidy currently works across 40 remote villages, combining clinical services with information and products provided by a network of community-based distributors, and a diverse range of educational activities delivered through mass mobilisation events and village outreach tours.
By integrating community health into Blue Ventures’ portfolio of programmes alongside marine conservation and coastal livelihoods, we have found that we are able to achieve our health and environmental objectives more effectively.
Sexual and reproductive health
Before we started providing sexual and reproductive health (SRH) services in Velondriake, women and couples had to walk 50 kilometres through spiny forest or set sail for several days to reach the nearest family planning clinic, effectively rendering such services out of reach for most people. As a result, most girls were pregnant before their eighteenth birthday and women were having an average of seven children each. Not only was this often not through their own choosing, it was also negatively impacting on maternal and child health.
Safidy, which means “choice” or “freedom to choose” in Malagasy Vezo, takes a rights-based approach to reproductive health. It responds to our partner communities’ expressed unmet need for family planning services by providing women and couples with the information and means to freely choose the number, timing and spacing of their children.
Caroline and Fanja explain what happens at a
Safidy reproductive rights training session for community-based distributors
Thanks to the Safidy programme, all women and couples in Velondriake now have access to high quality SRH services close to their homes. Outreach clinics and community-based distributors operate across 40 remote villages located along the coast and inland in the adjacent spiny forest. Training of community-based distributors is provided in collaboration with Population Services International, and long-acting reversible contraceptives are regularly offered through our partnership with Marie Stopes Madagascar.
There are multiple benefits to providing these SRH services in Velondriake. Increasing access to family planning is empowering women to choose the number, timing and spacing of their births, which helps to improve maternal and child health outcomes, and enables them to spend more time engaging in community and livelihood activities. Over the past five years, the proportion of women in Velondriake using contraceptives has increased fourfold and the birth rate has reduced by one third. The consequent slowing in population growth has the added benefits of increasing community resilience, as well as improving food security and supporting local conservation efforts by decreasing pressure on natural resources.
Dr Vik Mohan explains how Blue Ventures is integrating family planning
with marine conservation in Madagascar
Maternal and child health
Complications during pregnancy and childbirth account for 21% of all deaths in women of reproductive age in Madagascar. Nine in ten women give birth at home in Velondriake, and only 17% are assisted by a trained attendant. Almost one in five children in Velondriake die before their fifth birthday due to preventable and treatable illnesses, while less than 3% receive their full course of childhood vaccinations.
Lack of access to even the most basic maternal and child health (MCH) services means that mortality and morbidity levels are high.
In response to this situation, the Safidy programme includes a MCH component, with antenatal and postnatal care being provided to all pregnant women across 40 villages through our network of outreach clinics and community-based distributors. We are also working with local government health centres to ensure the availability of safe birthing facilities and the full course of childhood vaccinations.
Water, sanitation and hygiene
Diarrhoea is the leading cause of death among young children in Velondriake. Lack of access to fresh water in this arid region of Madagascar causes significant difficulties for coastal communities. Open defecation along beaches is the norm, contaminating fish stocks and water sources.
The Safidy programme is tackling these major challenges in several ways. Firstly, new wells have been drilled in order to increase access to safe drinking water. Secondly, water purification products and oral rehydration salts are being made available through our network of community-based distributors. Thirdly, villages are being mobilised to improve their sanitation practices through community-led total sanitation (CLTS) activities.
CLTS is a participatory approach that promotes sustained hygienic behaviour change by motivating whole villages to initiate collective action that reduces open defecation. It minimises reliance on external assistance by focusing on local resourcefulness and leadership, building the capacity of communities to take responsibility for protecting their own health.
Community health education
The Safidy programme includes a rich and diverse range of community education activities, using innovative and culturally appropriate social marketing methods, with the aim of promoting healthier choices and facilitating sustained behaviour change. Our popular football tournaments and other mass mobilisation events are key to raising awareness about important health issues. To date, more than 6,000 people across Velondriake have attended these “FISAbol” tournaments.
Village outreach tours are another vital component of the Safidy programme, complementing our clinical services as well as the information and products offered by our network of community-based distributors.
Each tour goes to 20 villages every two months, reaching over 5,000 people through formal education workshops in schools, special after-school sessions for youth, and community meetings in the evenings using music, film, drama, games and interactive presentations.
The tours engage community members in a variety of topics that include family planning, maternal and child health, sanitation and hygiene, sustainable fisheries management, alternative coastal livelihoods, and marine conservation. These educational activities underpin Blue Ventures’ integrated Population-Health-Environment (PHE) approach that empowers coastal communities to live healthily and sustainably with their unique marine environments.
Combining health and conservation messages in this way enables us to reach broader audiences, for example, informing men about family planning and engaging women in sustainable fisheries management. It also enables communities to better understand the connections between different issues, to the extent that over two thirds of the population in Velondriake now appreciate the links between population growth, reproductive health and food security.
Blue Ventures' integrated PHE approach was showcased
in the BBC's Indian Ocean series presented by Simon Reeve
Community health reports
|Safidy programme year 5 report
(2012) - contact us
|Safidy programme year 4 report
(2010-2011) - contact us
|Safidy programme 3 year summary
(2007-2010) - contact us
|Safidy programme year 3 report
(2009-2010) - contact us
|Safidy programme year 2 report
|Safidy programme development plan
|Safidy programme year 1 report
|Pushing against an open door:
establishing a family planning service
in Andavadoaka (2007)
|Blue Ventures' Population, Health
and Environment factsheet
2013: The women are waiting -
conservation through reproductive
health service provision
(Population Matters Newsletter)
| 2013: Time to embrace integration
(International Lifestyle Magazine)
2012: Integrating family planning service
provision into community-based
marine conservation (Oryx) - contact us