Friday, October 24, 2008

Madagascar: Government's Ambitious Healthcare Project

Madagascar has embarked on a major campaign to reduce maternal and infant mortality, but malaria, respiratory diseases and diarrhoea, a consequence of the lack of access to clean water and poor sanitation, remain among the biggest causes of child deaths.

Every eight minutes a child younger than five years dies in Madagascar, mostly from easily treatable or preventable illnesses.

Dr Hajaharifidy Rasolofo, head of the Sabotsy Namehana health clinic, a town about 17km from the capital, Antananarivo, told IRIN: "Respiratory diseases and diarrhoea are the main causes of death here. Poor sanitation is a huge problem and so is malnutrition ... [it] is the quality and the quantity of food that children receive."

In 2008 the government launched a Mother and Child Health Week, to be held every six months, as one of government's most ambitious health care initiatives. The initiative aims to provide a health care package that includes vaccinations, vitamin A supplements, deworming tablets and insecticide-treated mosquito nets, and is especially focused on pregnant women.

Nirinia, 28, a mother of four, told IRIN at a mobile clinic a few kilometres from Sabotsy Namehana: "The vitamin supplements given to my children here are very important. My children are not often sick, but I want to protect them against diarrhoea."

In health week the mobile clinic provided medical assistance to more than 200 women in one morning, and expected to treat nearly 1,500 women in the course of the week.

The programme also hopes to give more than 90 percent of children under five a dose of vitamin A. According to Micronutrient Initiative, an NGO dedicated to supplying vitamins and minerals to the world's vulnerable populations, if children in vitamin A deficient populations receive the vitamin, their survival rate improves by about 23 percent.

"Vitamin A deficiency compromises the immune systems of approximately 40 percent of the developing world's children under the age of five, and leads to the deaths of as many as one million young children each year. Hundreds of millions of children are at increased risk of disease and early death. Vitamin A deficiency increases susceptibility to malaria and diarrhoeal disease," the Micronutrient Initiative website said.

About 18 million of Madagascar's 20 million people live in malarial areas and the distribution of the mosquito nets is aimed at reducing the about 17,000 malarial deaths each year.

Access to clinics is a huge obstacle to the provision of health care: about 60 percent of the people live five kilometres or more from the nearest health facility; many others, especially in coastal regions, are more than 40km from clinics.

During Mother and Child Health Week mobile units are dispatched to remote areas, but for the other 50 weeks of the year communities are largely isolated from health care.

The government hopes to halve maternal and infant mortality by 2012, but their efforts are being frustrated by a lack of qualified health care workers. "It is true that there are not enough nurses here in Madagascar," Rasolofo said, "And that is a problem for healthcare in the country."

It is true that there are not enough nurses here in Madagascar. And that is a problem for healthcare in the country

Madagascar, one of the world poorest countries, has a rapidly growing population and the government is also trying to make access to family planning facilities easier.

The Sabotsy Namehana clinic offers family planning and the popularity of the service is indicated by the long queues that formed during the Mother and Child health initiative.

"We have had a very successful sensitisation programme here, people have been very receptive to this," Rasolofo said. "People here are also better educated, and it is easier to convince people to use contraceptives than it is in rural areas."

Madagascar has already shown some success in reducing child mortality: in 2006 there were 58 deaths in the first year of life per 1,000 live births, compared to 98 in 1993 and 74 in 2003, according to the WHO.

"Mothers and children are the most precious members of our society," Madagascar's prime minister, Charles Rabemenanjara, said at the launch of the health week on 20 October. "Mothers because they are the source of life, and children because they are the future."