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 their 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 25,000 people across more than 60 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 opportunities for cost-sharing between all of our programmes.
We engage communities in a variety of environmental and health topics through small group discussions, interactive theatre workshops 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 is often referred to as “Population-Health-Environment” (PHE) because of the way that it reflects the relationships between people, their health and the environment.
The PHE approach empowers people to make their own family planning choices, upholding their reproductive rights 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.
We have presented the results of our holistic model worldwide including at the Woodrow Wilson Center, the World Conservation Congress and the International Conference on Family Planning. It won the St Andrews Prize for the Environment in 2014, the Excellence in Leadership for Family Planning (EXCELL) Award in 2013, and the Buckminster Fuller Challenge in 2011.
In the Velondriake locally managed marine area where we have been implementing this PHE model since 2007 with partner health organisations including Marie Stopes Madagascar, the proportion of women of reproductive age using modern contraception has increased more than fivefold from 10% to 55% while the general fertility rate has fallen by over a third. Following recent community elections, women now constitute 38% of the Velondriake general assembly (up from just 13% previously and now rivalling political structures in the west in terms of inclusiveness).
Couples are empowered to plan and better provide for their families; improving food security, allowing women to play a more active role in fisheries management, and bolstering local conservation efforts. Coastal communities are able to live more healthily and sustainably with their marine environment, building social and ecological resilience to climate change.
We developed a PHE programme in the Velondriake area of southwest Madagascar from 2007, and replicated this approach further north along the coast: in Belo sur Mer from 2013, in the Barren Isles from 2015, and in Ambanja from 2017. Having experienced the immense value of integrating community health services with our marine conservation initiatives, we are now supporting partners in Madagascar, Comoros, Mozambique, Tanzania, Kenya, Indonesia and beyond to adopt this approach.
We are advancing the development of a national PHE network in Madagascar, bringing together health and environmental organisations to facilitate cross-sector partnerships. We are offering technical advice and mentoring to various environmental organisations starting to implement collaborative PHE 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.