Isolation and lack of infrastructure are major challenges faced by coastal communities managing marine resources in Madagascar. This leads to limited or non-existent access to basic health services, which is a fundamental human right. Sustainable management of marine resources is difficult to achieve when people are not healthy so MIHARI, Madagascar’s network of coastal communities governing locally managed marine areas (LMMAs), is linking up with health partners to address this issue.
Health challenges in and around LMMAs
LMMAs are areas of coast and ocean managed by coastal communities, often in highly isolated areas. Such isolation, together with limited transport infrastructure, often restricts the ability of health service providers to reach local communities and may limit the quality of those services provided. Nevertheless, the provision of accurate health information and quality health care is recognised by the World Health Organization as a fundamental right: "The right to health includes timely access to acceptable health care of sufficient quality and affordability."
Unmet community health needs can restrict the ability of community members to engage in management efforts in the first place. Therefore, MIHARI believes that healthy people can contribute to healthy ecosystems.
Mr. Lahiniriko Yolaude Jean René, President of a LMMA in Anakao, southwest Madagascar, tells us about the situation in his region:
"There are not enough doctors. As for Anakao, there is only one CSB (public health centre) with midwives but no doctors. There is also a lack of medicine, so people must go to the city of Toliara to access treatment. Sailing takes four or five hours, and travelling by motorboat takes three hours. Most people have to do this to get treatment, especially those from the smaller villages which have no formal health service providers at all. This is a very significant problem for coastal communities. Many people die trying to access health services."
MIHARI is a network of communities managing marine and coastal resources: the network exists to support communities in their management efforts, but it does not have expertise in community health promotion. MIHARI is therefore associating itself with another network that can help MIHARI members to increase access to health information and services in and around LMMAs, thereby advancing the sustainability of local marine resource management efforts while improving the health of LMMA communities. This other network specialises in bringing together health and environmental organisations to implement joint initiatives.
A cross-sector solution
Population-Health-Environment (PHE) is a holistic approach that reflects the connections between people, their health and the environment. It integrates family planning and other health services with community-based natural resource management efforts, often through cross-sector partnerships, in order to achieve sustainable development.
Madagascar is among the places in the world where we can find the characteristics that inspire a PHE approach. The island holds a very rich biodiversity, and more than half of the population lives less than 100 km from the coasts in remote places which are difficult for health service providers to access. Following a rich history of PHE initiatives in Madagascar, the PHE network was established in 2014 to connect health and environmental organisations with the aim of advancing PHE partnerships across the country. Many members of the PHE network are also members of MIHARI, and the two networks are now working closely together to support their members to collaborate; increasing access to health services in and around LMMAs, and integrating community health promotions efforts into environmental outreach activities.
Natasha, a LMMA community member from Antanimanimbo near Belo sur Mer on Madagascar’s west coast, testifies about the changes brought about by a PHE initiative in her everyday life:
"Since I’ve started to use family planning, my household is running smoothly and I’m able to do activities that generate income for my family."
Similar results have been observed in the Velondriake LMMA on Madagascar’s southwest coast, where MIHARI network member Blue Ventures has been implementing a PHE initiative with health partners since 2007. Blue Ventures’ medical director Dr Vik. Mohan recounts the story of Irene, from the village of Tampolove:
“As a result of being able to delay having another child until she is ready, Irene’s been able to engage in seaweed farming and earn an income. She’s now able to provide for her son and pay his school fees, and this economic independence has boosted her confidence greatly. She’s a passionate advocate of family planning in her village, where we’re seeing more and more women engaging in marine resource management efforts.”
The proportion of women using contraception in the Velondriake LMMA has increased more than fivefold since 2007 to over 55% today, and the proportion of female representatives within the Velondriake General Assembly responsible for governing the LMMA has increased from 13% to 38% following the most recent community elections.
Collaboration between PHE and MIHARI networks
This year, the PHE network was invited by MIHARI to participate in our regional forums. The aim of this invitation was to foster collaboration between PHE and MIHARI network members, and to highlight the notion inextricable links between human and ecosystem health.
The network outreach officer, Nantenaina Andriamalala, found this participation in the forums to be beneficial for raising awareness of the PHE approach among conservation organisations and LMMA communities:
"I enjoyed the forums. They provided opportunities for sharing experiences, confronting ideas and finding solutions to common LMMA issues. Thanks to the MIHARI forums, the PHE network was able to inform the NGO partners of the MIHARI network about the existence and benefits of the PHE approach and the existence of our network. These events provided the opportunity to connect health partners with conservation organisations as we invited many health partners to the forums to present what services and opportunities for collaboration they can offer."
He also highlighted the overall purpose of this intersectoral vision:
"Above all, the primary objective of participating in the forums was to raise awareness among communities that when we discuss conservation, it is necessary to have a more comprehensive vision and to address the inextricable links between community health and the environment. Communities are well aware of what is happening to them but the challenge is linking their conservation efforts with health promotion. Many partners came to the forums including PSI, Mahefa Miaraka and Marie Stopes Madagascar. The PHE network can encourage health partners to collaborate with MIHARI members and enable MIHARI to open up to new horizons other than conservation, thanks to the intersectoral characteristics of the PHE network. Thanks to the forums, we were able to understand more about the health problems faced by LMMA communities."
Meanwhile, Vatosoa Rakotondrazafy, the MIHARI network national coordinator, stresses the importance of working with the PHE network to achieve MIHARI’s objectives:
"Very often the expectations of LMMA managers for MIHARI go beyond the fields of action for the network, such as building infrastructure, donating equipment, and increasing access to education or health services. Recognising that community conservation and health go hand-in-hand, we are happy to be linking up with the PHE network to see how LMMA communities can be informed about and realise their right to health."
Forums are certainly the first step towards a long-term collaboration. Next steps are likely to include the PHE network connecting health partners with LMMA communities, facilitating partnerships between health agencies and conservation organisations that support LMMAs within MIHARI network, and also encouraging the incorporation of new components into MIHARI’s scope of work in order to address the multifaceted challenges faced by LMMA communities.