In response to these interconnected challenges, we have developed a holistic approach integrating community health services with marine conservation 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, thought that fish stocks would collapse without increased access to family planning. We also saw that, as a field-based environmental organisation working in these isolated communities, we were ideally positioned to address this critical unmet need 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.
The PHE 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 family planning 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 which may open the door to climate change resilience.
We developed a PHE programme in the Velondriake area of southwest Madagascar from 2007 and have since replicated this approach further north along the coast: in Belo sur Mer from 2013, in Maintirano and the Barren Isles from 2015, and in the Ambanja and Ambaro Bays from 2017. Having demonstrated the value of integrating community health services with local marine conservation 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 advancing the development of a national PHE network in Madagascar, bringing together health and environmental organisations to facilitate cross-sector partnerships. We offer technical advice and mentoring to marine conservation organisations embarking on collaborative PHE initiatives with health organisations, 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.