Summary

State-provided health facilities in Madagascar are seriously underfunded, with the nearest community health centres being up to a 25km walk away from many isolated villages. Access to clean water sources and adequate sanitation infrastructure is practically non-existent in many rural communities, and as many as 1 in 3 children die before their 5th birthday due to easily preventable diseases.

Project Salama builds on Azafady's years of experience in the field of community health: over the past decade Azafady has responded to overwhelming demand from rural communities for access to safe water sources and adequate sanitation facilities with participatory education sessions about the causes of poor health, provision of infrastructure including wells and latrines given identified need, and training for community health workers.

The Malagasy government has adopted the World Health Organisation's WASH - ‘Water, Sanitation & Hygiene for All’ - initiative to guide their efforts to eradicate illnesses linked to poor hygiene. The WASH initiative includes participatory education sessions focused on three themes: protection of water sources, hand washing, and use of latrines. Azafady has been elected to be the coordinator of WASH in the Anosy region and Project Salama is implemented within the WASH framework. Azafady is also trialing a new approach called CLTS – ‘Community-Led Total Sanitation’ – developed by the Institute of Development Studies and endorsed by the UN, Water Aid and WASH Madagascar, which is expected to further promote sustainable behaviour change with regards to good hygiene practices.

Project Aim

To create sustainable improvements in health for priority rural villages through community education and capacity building in line with the WASH strategy, provision of water and sanitation infrastructure given identified need, and local institutional development.

Objectives

1. Communities have access to information and understand the causes of common diseases and simple preventative measures.

2. Communities adopt improved health practices, facilitated through the construction and use of water and sanitation infrastructure given identified need.

Principal activities

Community education
Each community completes the PHAST (Participatory Hygiene And Sanitation Transformation) education process in line with the WASH framework, led by Azafady's health agents. PHAST ensures the participation of local people in the recognition of community health issues and their causes. Azafady's agents then work with communities to identify appropriate solutions to their specific problems.

Provision of infrastructure 
Access to water and sanitation infrastructure essential for the adoption of good health practices is practically non-existent in most villages in Anosy. Azafady's health agents and construction technicians work with communities that have completed the PHAST process to construct wells and latrines which are then locally managed. 

Training and capacity reinforcement  
Community-elected WASH committees are established and trained to manage the infrastructure which is built, and rules of use are determined by the community. 

Case Study

Celestine lives with her husband and 6 children in the village of Beandry, located 10km from the nearest road in the foothills of the Anosy mountains. The health situation in Beandry is severe: the community lacks access to clean drinking water and adequate sanitation infrastructure, with as many as 3 in 10 children dying before their 5th birthday from preventable diseases including diahorreal illnesses.

When Celestine hears that Azafady's health agents will be coming to Beandry to facilitate some participatory hygiene and sanitation training sessions she's very happy. She's keen to attend the sessions to learn how she can improve her family's health as she's particularly worried about her little 2 year old son who has had an upset stomach for several weeks now and is losing weight. When Azafady's health agents arrive in Beandry they gather together community members for several awareness raising sessions.

In the first sessions that Celestine attends they learn about the causes of diarrhoeal illnesses and the importance of good hygiene practices like washing hands before eating, as well as adequate sanitation like safe faeces disposal and clean drinking water. Celestine makes the connection between her family's hygiene practices and her youngest child's ill health, and resolves to ensure that their hand washing habits improve. In the following sessions Azafady's health agents facilitate discussions about how the community of Beandry can address their health problems. Having considered their lack of facilities for safe faeces disposal and lack of access to clean drinking water, the community decides that they need some sanitation infrastructure – a communal latrine and a properly fitted well – and requests that Azafady assists in constructing and installing them. At this point Azafady's health agents encourage the community to set up a WASH (Water, Sanitation & Hygiene for All) committee to promote good hygiene practices in the community and ensure the proper maintenance of any new sanitation infrastructure. Celestine is eager to be involved and volunteers to be a member of the new WASH committee, along with 9 other motivated community members.

When Azafady's construction team come to Beandry to assess the viability of constructing a communal latrine near the village's primary school and installing a fitted well, Celestine is pleased to welcome them and very excited when they say that the construction can go ahead next month. Along with her fellow WASH committee members she visits many households in Beandry to tell them the good news, and to make sure they know about the importance of good hygiene practices like hand washing. Over the next few weeks the WASH committee are busy encouraging the community to gather their contribution to the new sanitation infrastructure: digging the pit for the latrine, and obtaining locally available materials including gravel and sand. When Azafady's construction team arrive with a group of international volunteers to complete the project, the whole community turns out to greet them!

Azafady's construction team install the fitted well, and then work alongside the community and the international volunteers to complete the communal latrine. Azafady's health agents also conduct a few interactive hygiene education sessions with the international volunteers for the children from the village's primary school, particularly about the importance of washing hands before eating, with a short play, song and practical hand washing demonstration. When Celestine's 8 year old son and 7 year old daughter come home from school they're excited to tell her what they've learnt, and determined to wash their hands as she'd told them before.

The whole community benefits from the new sanitation infrastructure, and Celestine is happy that her family is now more healthy: they have a source of clean drinking water, access to a communal latrine, and are in the habit of always washing their hands before eating. Celestine's 2 year old son is better now and appears to be putting on weight. Her family do not suffer from diarrhoeal illnesses as much, and her older children can attend school regularly so their educational performance improves. Celestine is proud to be a member of the local WASH committee that has been part of bringing about such positive changes in Beandry, and she continues to enjoy her role encouraging good hygiene practices in the community and maintaining the new sanitation infrastructure to make sure these positive changes last for years to come.