Linking Population, Health, and Environment in Fianarantsoa Province, Madagascar

Making the Link POPULATION REFERENCE BUREAU LINKING POPULATION, HEALTH, AND ENVIRONMENT IN FIANARANTSOA PROVINCE, MADAGASCAR by Kathleen Mogelgaard and Kristen P. Patterson or more than a decade, development practi- Samantha Cameron, Ny Tanintsika tioners and communities in Fianarantsoa Fprovince, Madagascar, have been involved in community-based projects that link family planning, health, and environment efforts.1 Since the early 1990s, a range of approaches that combine family planning and/or health interventions with environment and rural development activities have been implemented throughout Fianarantsoa province, making it one of the richest centers of such programming in Madagascar and the world.2 This brief explores the evolution of cross- sectoral approaches and projects in Fianarantsoa, outlines ongoing challenges to effective project The commune of Ambolomadinika lies on the eastern side implementation, and highlights opportunities for of the central forest corridor in Fianarantsoa, where forest strengthening and expanding collaboration. It is cover is shrinking by approximately 2 percent per year. based on a review of published literature and project documents, and interviews with over 20 practitioners, technical advisers, and funders in Fianarantsoa and throughout Madagascar, cross- Madagascar and the United States (see Acknowl- sectoral approaches are being incorporated into edgments, page 12). broader development approaches and local planning efforts. And perhaps most significant, a growing Fifteen Years of Cross-Sectoral number of practitioners in the environment and Experience health sectors have indicated in interviews that they Early cross-sectoral initiatives in Fianarantsoa support and promote these initiatives because they province had several goals. Natural resource man- believe that coordination can yield better results and agers recognized that the conservation and manage- provide more benefits to communities than when ment of natural resources could be undermined by the services are provided separately. Furthermore, high fertility rates. Many also believed that address- the experience and dedication of these practitioners ing health needs—among the highest priorities in has positioned them to capitalize on new opportu- communities—would lead to greater trust between nities within the development community and the development partners and the community, and a national political context to refine and expand greater community willingness to participate in cross-sectoral approaches. conservation activities. Health practitioners recognized that partnerships with environmental projects Demographic, Socioeconomic, and operating in rural areas could reach previously inac- Ecological Context cessible and underserved constituents. Fianarantsoa is among the poorest of How successful have these projects been over Madagascar’s six provinces and has the second- the past 15 years? Evaluations have demonstrated highest number of people.4 Access to potable progress in reaching new audiences, fostering water, the consumption of water and electricity greater community involvement, and promoting per resident, and the rate of spending per person programmatic efficiency.3 Increasingly in are the lowest among all provinces.5 2 PRB Making the Link 2006 Fianarantsoa’s total fertility rate is higher than rural residents.7 In addition, the crash of the the national average (5.7 children per woman vs. global coffee market in the mid-1990s severely 5.2 nationally) and its contraceptive prevalence affected the livelihoods and long-term food secu- rate is lower (11 percent of women in union in rity of the region’s residents. Fianarantsoa use a modern method of family plan- Furthermore, during the country’s socialist era ning, vs. 18 percent nationally). Children’s health (1975 to 1990), the government promoted a pro- is of particular concern in the province, with infant natalist population growth policy and open access mortality rates, child anemia, stunting, and wast- land rights, which encouraged a population boom ing all slightly higher than the national average.6 and the cultivation of previously unused land.8 In Colonial policies dramatically altered tradi- 1991, the government adopted a national popula- tional cropping and land tenure systems, some of tion policy, which recognized the benefits of and which (such as the production of coffee for need to promote family planning at all levels of export) yielded mixed benefits to Fianarantsoa’s society.9 The country’s politically turbulent transi- tion to democracy in the early 1990s led to a Cross-Sectoral Projects in Communes Along Fianarantsoa’s gradual integration of Madagascar into the global 10 Central Forest Corridor economy. Nevertheless, real per capita income declined almost 50 percent from 1972 to 2002,11 dramatically increasing poverty among rural Malagasy, including those living in Fianarantsoa. Rich ecological diversity is found within the Ambohimiera ■◗ province. Fianarantsoa contains some of the country’s most popular national parks (Isalo, Ambalakindresy Ranomafana, and Andringitra). In 2005, Manandroy ■ ■ Tsaratanana Fianarantsoa hosted more tourists than any other Ranomafana ■◗L 12 National Park province. A 500-km long moist forest corridor harbors extraordinary biological diversity, con- Project Ranomafana tributing to Madagascar’s designation as one of Name ■◗L Kelilalina ■ ■ 13 ICDP Androy the world’s “biodiversity hotspots.” This forest (1991–1997) ■ Salohy Soloarivelo Razanajatovo, Ecoregional Initiatives Fianarantsoa provides numerous ecosystem services such as ◗ EHP (2000–2005) watershed protection and soil erosion prevention, ✖ MGHC FIANARANTSOA which support agricultural activities and biodiver- (2002–2005) Tolongoina ◗✖L sity maintenance within and beyond the forest. L Champion Commune— Manampatrana Most cross-sectoral activities in Fianarantsoa Cycle 1, Maromiandra have been implemented in and around the central Integrated ✖ (2005–2006) ✖ forest corridor that lies between Ranomafana and Ambatofotsy Andringitra national parks (see map). This ✖ 280,000-hectare central corridor, measuring 200 Ikongo ■✖L kilometers long and only 4 to 5 kilometers wide Ambinanindovoka Ambolomadinika in some sections, experienced a 1 percent to 2 per- ✖ cent annual forest cover loss between 1990 and ✖ Mahazony 2000. Additional losses could further threaten bio- ✖ Ambohimahamasina ◗✖ diversity and the ecosystem services relied upon by Sendrisoa L Miarinarivo regional communities. L Evolution of Cross-Sectoral Andringitra Approaches National Park Approaches linking family planning and other health interventions with natural resource man- agement activities in Fianarantsoa province have evolved and expanded over time. The evolution Population Reference Bureau Population, Health, and Environment in Madagascar 2006 3 of these cross-sectoral efforts can be grouped into the international development community, and three phases (for a detailed account of the projects practitioners successfully solicited support from in these phases, see the Appendix on page 8). private foundations. Two major cross-sectoral Phase 1, 1990-1998. In the first phase, projects, the Environmental Health Project cross-sectoral efforts accompanied Madagascar’s (EHP) and Madagascar Green Healthy adoption of a 15-year National Environmental Communities (MGHC), were started in commu- Action Plan (NEAP). The early years of the nities located along the central forest corridor in NEAP focused on implementing integrated con- Fianarantsoa. servation and development projects (ICDPs) The innovations and successes in the second associated with Madagascar’s national parks, phase generated momentum for communication, including Ranomafana National Park. The outreach, and advocacy to expand these Ranomafana ICDP, initiated in 1991 by the approaches. Unfortunately, the destabilizing Natural Resources Office of the United States effects of the eight-month nationwide political Agency for International Development (USAID) crisis of 2002 disrupted this momentum; practi- mission in Madagascar, included economic and tioners had to focus on maintaining field activi- social development interventions in addition to ties in the context of weakened rural health care biodiversity conservation activities.14 In 1995, services and declining household incomes in USAID Madagascar’s Health Office added a fam- Fianarantsoa.17 Nevertheless, in this phase effec- ily planning component to the project.15 tive tools and organizational partnerships for Individuals involved in the Ranomafana ICDP managing cross-sectoral programming were devel- learned to develop strategies to implement com- oped (see Box 1, page 4). munity-level interventions across sectors, such as Phase 3, 2005-present. As the funding for creating networks of community-based distribu- the second phase’s projects drew to a close in tors of contraceptives in rural areas and designing 2005, a third phase has taken shape. This phase is effective community-based environmental educa- marked by the end of private foundation support tion programs. After the ICDP ended in 1997, for integrated work, and the gradual embedding many of the Malagasy who worked for the ICDP of cross-sectoral initiatives into comprehensive went on to establish or work for NGOs that were development programming. This shift is largely engaged in cross-sectoral projects. supported by USAID Madagascar in the imple- Phase 2, 1998-2005. The second phase mir- mentation of its integrated strategic plan, which

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