In response to these interconnected challenges, we have developed a holistic approach integrating community health services with local marine management and coastal livelihood initiatives.
Our distinctive style of working has emerged through conversations with our partner communities, who have challenged us to appreciate the ways in which the health of people and the environment are intertwined.
We learned that people in Velondriake, Madagascar’s first locally managed marine area, had pressing unmet health needs that were limiting their capacity for longer term environmental stewardship. We also saw that, as a field-based environmental organisation working in these isolated communities, we were ideally positioned to address these unmet needs by developing cross-sector collaborations with health organisations.
We started incorporating reproductive health services into our fisheries management initiatives with partner health organisations in 2007. Since then, we have expanded this programme to serve over 45,000 people across more than 75 communities along Madagascar’s west coast. From seaweed aquaculture to maternal and child health, our interdisciplinary teams now work closely together to coordinate their activities and identify meaningful synergies between all of our programmes.
We engage communities in discussions about a variety of environmental and health topics through interactive theatre and facilitated storytelling sessions. Exploring the connections between different themes enables us to broaden our reach, for example, getting men talking about family planning and involving women in fisheries management.
Our holistic way of working reflects the relationships between people, their health and the environment. This health-environment approach enables people to make their own family planning choices, improving their health while equipping them with the skills they need to manage their natural resources sustainably.
As our experiences in Madagascar demonstrate, this approach can be implemented with ease through cross-sector partnerships that combine the complementary expertise of environmental and health organisations.
In Madagascar we are finding that integrating family planning with local marine management initiatives and alternative livelihoods is helping couples to meet the immediate needs of their families; they are able to work and earn more, they experience greater food security and better health, and they can focus on longer-term priorities. As well as enabling communities to engage with natural resource management, these improvements in community well-being map help foster greater resilience to climate change.
In the Velondriake LMMA, where we have been implementing this health-environment model since 2007 with health partner organisations including Marie Stopes Madagascar, the proportion of sexually active women of reproductive age using modern contraception has increased more than five-fold from 10% to over 50% while the general fertility rate has more than halved. Following recent community elections, women now constitute 38% of the Velondriake LMMA’s general assembly (up from just 13% previously and now rivalling political structures in the west in terms of inclusiveness).
Following the successful development of our health-environment approach in the Velondriake LMMA in 2007, we have since replicated this model further north along the coast: in Belo sur Mer from 2013, in Maintirano and the Barren Isles from 2015, in the Tsimipaika Bay from 2017, and in Mahajamba Bay from 2019. Having demonstrated the value of integrating community health services with local marine management initiatives, we are now sharing our experiences with like-minded organisations in the Comoros, Mozambique, Tanzania, Kenya, Indonesia, Timor-Leste and beyond.
We are also supporting the growth of a national learning network in Madagascar, bringing together health and environmental organisations to facilitate cross-sector partnerships. We’re offering technical advice and mentoring to marine conservation organisations embarking on collaborative initiatives with health organisations including Marie Stopes Madagascar, proposing learning exchanges and training workshops, convening meetings to share experiences, producing technical resources, and collating both quantitative and qualitative results data to communicate to a variety of stakeholders.