Dr Vik Mohan Safidy Community Health Programme: Development Plan (2009-2011) The Safidy programme is a key component of Blue Ventures’ integrated Population-Health-Environment (PHE) approach that empowers coastal communities to live healthily and sustainably with their marine environments. Safidy has been operating in the Velondriake locally managed marine area on the southwest coast of Madagascar since August 2007. This plan to expand sexual and reproductive health services across Velondriake is for 2009 – 2011. Level 2 Annex Omnibus Business Centre 39-41 North Road London N7 9DP Tel: +44 (0) 207 697 8598 Email: [email protected] http://goto.blueventures.org/communityhealth Blue Ventures Conservation Report © Blue Ventures 2009. Copyright in this publication and in all text, data and images contained herein, except as otherwise indicated, rests with Blue Ventures. Keywords: Family planning; sexual and reproductive health; population, health and environment; Velondriake; Madagascar. Recommended citation: Mohan, V. (2009) Safidy Community Health Programme Development Plan: 2009 - 2011. Blue Ventures Conservation, London. 1 Blue Ventures Conservation Report Table of Contents Background ............................................................................................................................................................. 3 Objectives ............................................................................................................................................................... 5 Implementation plan .............................................................................................................................................. 5 Objective 1: Deliver a weekly family planning clinic in the village of Andavadoaka ....................................... 5 Objective 2: Establish weekly satellite clinic in two additional villages, providing access to clinic services in all of Velondriake’s villages ............................................................................................................................. 6 Objective 3: Broaden the range of contraceptives offered to include long-acting reversible contraceptive methods .......................................................................................................................................................... 7 Objective 4: Identify and tackle barriers to the use of contraception in the target population ..................... 7 Objective 5: Work with local, regional and national stakeholders to ensure the programme meets the needs of the population, aligns with the national agenda, and collaborates wherever possible with the work of other agencies ................................................................................................................................... 8 Objective 6: Develop and implement a strategy to promote safer sex practices within the target population ....................................................................................................................................................... 9 Objective 7: Communicate the progress and achievements of the programme to stakeholders, the medical and conservation communities, and the wider public .................................................................................... 9 Objective 8: Generate sufficient funding to ensure the financial security of the programme over the next three years (2009-2011) with a view to expansion beyond Velondriake ..................................................... 10 Monitoring ............................................................................................................................................................ 11 2 Blue Ventures Conservation Report Background With an average fertility rate of more than 5 births per woman, and nearly half of the country’s population under fifteen years of age, Madagascar has one of the fastest growing populations in the world (INSTAT, 2005). Currently, only one in five women in union has access to contraception (US Census Bureau, 2008). The importance of addressing unmet family planning needs is clearly recognised by the government of Madagascar as well as by NGOs working within the country. A considerable commitment has been made by the government to address the challenge of providing reproductive health services. This effort has seen impressive results, particularly in urban areas, with increasing numbers of women gaining access to contraception. Few of the country’s less accessible rural areas, however, have so far benefited from this progress. In addition, Madagascar has experienced significant increases in the incidence of sexually transmissible infections (STIs) in recent years, even in geographically isolated areas due to the increasing mobility of people within the country (Donnelly, 2004). Current HIV prevalence in Madagascar is under 2%, but this is predicted to rise if appropriate measures to prevent an HIV epidemic are not taken (Donnelly, 2004). The remote coastal village of Andavadoaka is situated on the arid southwest coast of Madagascar, approximately 200km north of the regional capital, Toliara. Its inhabitants belong mainly to the Vezo ethnic group, a semi-nomadic people with close cultural ties to the marine environment, for whom fishing is the main livelihood, both for food and income. The region has very limited public infrastructure, and road access to Andavadoaka and neighbouring Vezo villages is very difficult. Communities depend on travel by traditional pirogues (sailing canoes) to travel between villages, with transport restricted by wind and sea conditions. Owing to their isolation, access to sexual and reproductive health services is very limited. Initial research revealed the average fertility rate in Andavadoaka to be higher than the national average, with anecdotal reports suggesting high levels of untreated STIs. Vezo communities are struggling to provide for their growing families, with overfishing and destructive fishing practices threatening the marine environment upon which their livelihoods depend. Ensuring access to family planning services and empowering couples to make their own reproductive health choices offers them a way of living more healthily and sustainably with their marine environment. Blue Ventures, a marine conservation organisation based in Andavadoaka, therefore established a family planning service for the village in August 2007, in direct response to the community’s unmet family planning needs. Following the successful launch of the clinic in Andavadoaka, the service received widespread demand for expansion of its scope to incorporate neighbouring Vezo communities along approximately 40km of coastline. Meeting this demand is considered a major priority for the region, and this has led to the elaboration of a plan 3 Blue Ventures Conservation Report to expand Blue Ventures’ sexual and reproductive health programme to reach 24 further villages that are currently working together to develop the Velondriake locally managed marine area (LMMA). This document summarises the strategic plan for the expansion of Blue Ventures’ sexual and reproductive health services to reach all 25 villages in Velondriake. 4 Blue Ventures Conservation Report Objectives 1. Deliver a weekly family planning clinic in Andavadoaka 2. Establish weekly satellite clinics in two additional villages, providing access to clinic services to all of Velondriake’s villages 3. Broaden the range of contraceptives offered to include long-acting reversible contraceptive methods 4. Identify and tackle barriers to the use of contraception within the target population 5. Work with local, regional and national stakeholders to ensure the programme meets the needs of the population, aligns with the national agenda, and collaborates wherever possible with the work of other agencies 6. Develop and implement a strategy to promote safer sex practices within the target population 7. Communicate the progress and achievements of the programme to stakeholders, the medical and conservation communities, and the wider public 8. Generate sufficient funding to ensure the financial security of the programme over the next three years (2009-2011) with a view to expansion beyond Velondriake Implementation plan Objective 1: Deliver a weekly family planning clinic in the village of Andavadoaka Current position A weekly family planning clinic is now firmly established in Andavadoaka. Patients requiring access to this service outside normal weekly clinic hours can also be seen by Blue Ventures’ medical staff on an ad hoc basis. The clinic is run by Blue Ventures’ medical officer and a trained interpreter, with good regular attendance and a high profile within the community. Proposed actions Continue to ensure the delivery of this service, through support of and regular Ongoing communication with Blue Ventures’ medical officer Ensure the continued use of effective interpreters in the clinic, through supporting and training the interpreter, and identifying and training possible additional staff to Ongoing assist with interpreting work 5 Blue Ventures Conservation Report Objective 2: Establish weekly satellite clinic in two additional villages, providing access to clinic services in all of Velondriake’s villages Current position The Velondriake area comprises 25 villages along the southwest coast of Madagascar, all within 25 km of Andavadoaka. Velondriake villages are working together cooperatively, with the support of Blue Ventures, to manage