Madagascar

COMPLETED PROJECTS

Child Survival:

Betioky Child Survival Project (BCSP) (1996 - 1998)

Toliara Province Child Survival Project (TPCSP) (1998 - 2002)

CURRENT PROJECTS

Toliara Region Expanded Impact Project (TREIP) (2006 - 2011)

In 1996, MCDI was awarded a USAID Planning Grant to design a four-year child survival project in the Betioky Sud district of Madagascar’s former Toliara Province. The Betioky Child Survival Project (BCSP), approved for funding in 1998, included as its primary intervention areas: an Expanded Program for Immunization (EPI), breastfeeding, diarrhea, HIV/AIDS and birth spacing. A cost-extension grant (2002-2006) was approved for an expanded geographic area, where the aforementioned interventions as well as malaria and Acute Respiratory Infection (ARI) interventions were implemented. This project, the TPCSP, benefited 40,743 children under-five and 78,349 women of reproductive age but it continued to support limited activities in the original Betioky Sud District while focusing primarily on the populations in Toliara II District.

The TPCSP utilized a community health approach, worked to improve the quality of health facility services, and supported the district-level Ministry of Health and Family Planning (MSPF) in training, supervision, HIS and health planning. The primary goal of this project was to reduce morbidity and mortality among children under 5 years of age and to improve the health status of women of reproductive age.

Based on the 2004 health facility assessments, dramatic improvements in health workers’ skills in Toliara II were documented. For example, in 2002, only 21% of children with cough or difficult breathing were correctly classified according to the IMCI algorithm, while in 2004, this figure was 82%; the percentage with fever who were correctly classified increased from 13% to 76%. There is reason to believe that these improvements were due to TPCSP-led training for facility-based workers in IMCI.

At its 2004 midterm evaluation (MTE), the TPCSP demonstrated success in the areas of pneumonia case management, diarrhea case management and knowledge of danger signs, breastfeeding, immunization coverage, and birth spacing. The TPCSP was also effective in discouraging harmful common practices such as feeding ashes to newborns before breastfeeding. As of 2004, achievements in the program’s malaria component were not comparable (final evaluation results are pending), although there was some improvement in all objectives from the baseline. This shortcoming can be attributed largely to delays in the Ministry of Health and Family Planning’s adoption of a national policy on malaria and not to the programs’ community-based approach, which was successful in other interventions. Following discussions with USAID permitting MCDI to proceed without waiting for the finalization of government policy, activities began in early 2005. Based on the numbers of ITNs sold, chloroquine distributed and training provided as of the end of 2005, it can be concluded that the objectives had been met by 2005.

According to the MTE, it was the project’s “innovative and cross-cutting approaches to community mobilization and BCC” that were the basis of its successes. These approaches include the recruitment and training of community health workers (CHWs) in household and community integrated management of childhood illnesses (HH/C-IMCI), the VISA mothers program (where mothers are trained to support other mothers in the community in adopting healthy behaviors), and the child-to-community approach to health promotion. The project utilized a broad array of channels for community mobilization and the communication of BCC messages, including CHWs, TBAs, local radio, school teachers, and health festivals.

In 2006, MCDI was awarded a five-year Expanded Impact grant to scale up its successful project to the entire southwest Toliara Province. The Toliara Region Expanded Impact Project (TREIP) is focusing on the household and community component of the integrated management of childhood illnesses (IMCI) to complement government and donor efforts to strengthen facility-based services. TREIP’s intervention areas are: breastfeeding/infant nutrition, malaria, diarrhea and immunization. Except for immunization, the chosen interventions are suitable to community case management, which has proven to be an effective approach under the TPSCP.

TREIP has the following objectives:

*Improve breastfeeding practices in mothers of children 0-5 months

*Improve feeding practices in mothers/ caretakers of children 6-23 months

*Improve malaria prevention practices of pregnant women and mothers of children 0-23 months

*Improve malaria care and treatment-seeking behaviors in mothers of children 0-23 months

*Improve diarrhea prevention and treatment practices in mothers of children 0-23 months

*Expand immunization coverage of children 0-23 months and pregnant women

*Expand community and household IMCI in the project region

*Strengthen the capacity of communes

*Strengthen the capacity of the Regional Health Office and the District Management Team in program planning & design, program management, supervision and quality assurance

In addition to the community-centered approach to IMCI, the project supports refresher training for clinical workers in IMCI, as well as enhanced supervision of clinical workers to reinforce the training. TREIP is establishing links between communities and health care facilities by instituting monthly reporting and supervisory meetings between CHWs and health facility personnel, and it is facilitating outreach visits by health facility supervisors to TREIP area communities.