Isolated communities in the coastal tropics are some of the most under-served populations in the world when it comes to healthcare. Around a quarter of women in the regions where we work report an unmet need for family planning: they would like to space or limit their births but are not currently using modern contraception. Poor health can restrict the ability of communities to engage in marine resource management and is often a pressing priority that communities would like to address.
In response to this important challenge, we collaborate with respected health partners to increase access to services and develop health promotion initiatives tailored to meet the needs expressed by coastal communities across a variety of different contexts.
Our community health programme in Madagascar is known locally as Safidy, which means “choice” and reflects our commitment to advancing reproductive rights. Launched over ten years ago, it now covers all four of our conservation sites along the island’s west coast and serves more than 45,000 people.
In close collaboration with partners including USAID Mikolo and Mahefa Miaraka, we train and support local women to offer community-based family planning and other health services within the Madagascar Ministry of Public Health’s national health system. These community health workers offer counselling and products including condoms, contraceptive pills and injections as well as mosquito nets, water purifying solution and oral rehydration salts for diarrhoea. They are also trained in the management of childhood illnesses, how to refer women for maternity care, and in the promotion of simple health-enhancing behaviours including exclusive breastfeeding. Long-acting reversible contraceptives (implants and intra-uterine devices) are offered by Marie Stopes Madagascar, whose outreach teams visit our sites on a regular basis.
In the Comoros, Mozambique, Tanzania, Kenya, Indonesia and Timor-Leste, our technicians support our marine conservation partners to assess the unmet health needs of coastal communities and identify appropriate health agencies with whom they can collaborate to address these needs.
We facilitate diverse peer-led community outreach activities that encourage critical thinking about health-related behaviours and help to foster health-enabling social norms. Interactive theatre workshops, storytelling sessions and small group discussions engage men, women and young people in topics ranging from maternal health to seaweed farming and fisheries management.
Our holistic approach encourages broad community participation, for example, opening up discussions about family planning with men by relating food security concerns to reproductive rights.
We enable people to make their own family planning choices, increasing their access to vital health services while equipping them with the skills they need to manage their natural resources sustainably.
Gaining access to family planning services improves maternal and child health, allows girls to delay their first pregnancy until after they have completed their education, and affords women more opportunities to be economically active.
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 way to climate change resilience.
This community health programme is a key component of our PHE approach; a holistic way of working which reflects the connections between People, their Health and the Environment. PHE entails the integration of family planning and other community health services with natural resource management, biodiversity conservation and alternative livelihood initiatives.
Having demonstrated the value of this approach, 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 agencies, 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.
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