News

Mobile clinics deliver last-mile reproductive health care in Madagascar

26 March 2021
Author: UNFPA
A pregnant woman en route to deliver her child at Regional Reference Hospital of Ambovombe in Androy region, Madagascar. Trips by cart can sometimes take the entire day. © UNFPA Madagascar

AMBOVOMBE, Madagascar – Ambovombe is a landlocked district in southern Madagascar, where only about half of health facilities are accessible year-round because of poor roads and challenging terrain. And even if one could get there, the cost of transportation is too high, resulting in 61 percent of births taking place outside of a health facility, according to a 2018 survey.

“The working conditions were not easy. I have traveled hundreds of kilometres to visit isolated villages hidden in the vastness of the Androy region,” said midwife Dally of the Regional Reference Hospital of Ambovombe, recalling her early days in the region, which covers nearly 20,000 square kilometres. “Some women in labour try to reach the hospital by cart and the trip sometimes takes a whole day. This results in complications during deliveries, stillborn babies and pre- or post-partum haemorrhages and infections.”

When COVID-19 struck, even more patients stopped going to health centres, and Dally’s maternity team – three midwives and a few volunteers  – was stretched thinner still.

If women and young people would not go to her to exercise their reproductive health rights, Dally would have to go to them. So she did. 

No one left behind

For five months, two mobile clinics covered more than 10,000 kilometers to serve 59 remote localities in seven districts. More than 14,000 people benefited from pre- and postnatal consultations, family planning services, sexually transmitted infections (STIs) screening and treatment and educational sessions. 

The mobile clinic staff in Bekitro, a village stop on their five-month tour of the sprawling Androy region. © UNFPA Madagascar

“Children, women and men with their health booklets [medical records] in hand were eager to take advantage of the services available,” said Ida, a midwife from another locality’s hospital team who accompanied a mobile clinic to the small village of Bekitro. “Everyone was happy because the long-awaited moment had finally arrived. I will never forget their feelings of hope and joy expressed through their eyes and faces, which motivated me despite the difficulty during the trip.”

Volunteer community agents mobilized the village with megaphones and loudspeakers to draw the large crowd. The mobile clinics, an initiative of the Ministry of Public Health in partnership with UNFPA and supported by funding from Japan, served everyone who came, mostly women and girls between 15 and 49 years old.

The clinics also traveled to the commune of Beraketa, where Volana*, 35, was one of 2,120 people treated for an STI. In southern Madagascar, sexually transmitted infections are common, mainly due to the belief that a boy only becomes a man after contracting one.  

“I was so ashamed of my illness that I was afraid to go to the doctor and I had no money to treat myself,” Volana said. “Thanks to this mobile clinic, I received the necessary care and medication free of charge. It is with great joy that I will finally get rid of this burden."

Family planning keeps futures open

At 16, Noria is in the ninth grade in Ambahita. “Many girls of my age are victims of early pregnancy and have had to drop out of school,” she said. “I have been urged to go for family planning to avoid getting pregnant, but as I am in class all the time, I have not had time to consult the doctor. Moreover, I am ashamed and I don't dare talk about it to anyone, even my parents.”

Mobile health care workers provided family planning services like injections in Ambahita. © UNFPA Madagascar

The mobile clinic showed her that family planning is a universal right and presented her with contraceptive options. Now, she is “happy to have this opportunity that will allow me to finish my studies and follow my dreams to the end.”  

*Name changed for privacy

  

  

Madagascar
Population : 28.4 mil
Fertility rate
3.9
Maternal Mortality Ratio
335
Contraceptives prevalence rate
41
Population aged 10-24
32.4%
Youth secondary school enrollment
Boys 70%
Girls 0.97%

Related content

Events
The LSE Global Health Initiative hosts this public event with UNFPA Executive Director Dr. Natalia Kanem, who will discuss how sexual and reproductive health and rights and bodily autonomy are foundational to equality, prosperity, peace and sustainable development. Dr. Rishita...
News
On January 27, the number of coronavirus cases reached a staggering 100 million worldwide. Earlier, on January 15, deaths attributed to the virus numbered two million. Those aren’t the only figures heading in the wrong direction: The pandemic is endangering the health and well-...
News
Once a month, Nolwazi Myeni receives a message on her mobile phone notifying her that family planning services are available despite the pandemic-related lockdown.

Pages

We use cookies and other identifiers to help improve your online experience. By using our website you agree to this. To learn more, including how to change your settings, see our cookies policy.

X