Editorial Note A country cannot develop without a healthy population.

From the beginning of the project, the vision of USAID/ Santnet2 and its 16 implementing partners was to promote community health through the implementation of Kaominina Mendrika (KM) salama in 800 communes by 2013. The KM salama implementation process has focused on community-based health services since March 2009 to change knowledge into action. Since March 2009, more than 3,000 community health workers (CHWs) have been trained to offer community-based health services to the population living in very remote areas that are more than 5 km from the nearest health center. These services include family planning (FP) and nutrition and community-based integrated management of childhood illness (c-IMCI) for cough, diarrhea, malaria, and pneumonia. This second edition of the Bulletin Ezaka Mendrika was produced to demonstrate the community-based activities that promote the health of project beneficiaries. This edition includes success stories that illustrate the c-IMCI and FP activities in communes in the south and southeast. I encourage you to read and learn from the CHWs best practices! Volkan Cakir, Chief of Party
Second edition, June 2010

Bulletin Ezaka Mendrika

Olga, a child health community worker, depicts common diseases for children under five in the village of Androangambe, Enakara Ambony-Ranomafana.
Olga Thophilinat Razafindrabefanindry lives in the fokontany of Androangambe, a remote village in the commune of Enakara Ambony, in the district of Ranomafna, a 2-hour walk from the basic health center of Taolagnaro. In March 2010, she attended a 5-day training on c-IMCI. This training consists of treating diseases in children under five, mainly simple cases of pneumonia, diarrhea, cough, and fever. Before the training, she was a CHW involved with the nongovernmental organization ASOS Sud, a USAID/ Santnet2 implementing partner, to promote nutritional activities with mothers. To diagnose malaria in a child, Olga uses a special tool known as a rapid diagnostic test (RDT) to make sure that the child is really infected with malaria. During only one month of activity, Olga treated 17 children. Ten of them had a fever.
USAID/Santnet2: Olga is a very dynamic CHW.

Olga is a good model for all CHWs trained by the USAID/ Santnet2 project. Her practice is one among many best practices that should be developed on a large scale.

She used the RDT to check these childrens malaria status. Seven of them tested positive for malaria. Olga has produced her own job aid to remember all the lessons she received at the training on the use of RDT. Thanks to this job aid (shown above) that Olga uses every day for her checkup activities, she has memorized how to check the results of the tests before treating the disease.

USAID/Santnet2: The RDT is a tool to diagnose malaria in children.

Whats News?
1- The midterm review workshop, organized by USAID/Santnet2, was held on 2729 April 2010 at the Grand Restaurant de Chine -Tsiadana-Antananarivo. More than 200 participants gathered at that 3-day meeting to review all the activities that had been accomplished so far and the objectives for the upcoming months. 2- A new system of data transmission is being set up from the beginning of May. USAID/Santnet2 has taken up a new initiative to ensure rapid data transmission from the field through text messages. The data flow from the field would be faster and more precise with this technology.

USAID/Santnet2: Olga lives in a very remote village that can only be reached by foot. USAID/Santnet2: Olgas job aid. USAID/Santnet2 is implemented by RTI International and its partners

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FAMILY PLANNING ACTIVITIES IN THE COMMUNE OF SAHASINAKA

Working materials for CHWs

The commune of Sahasinaka is located 52 km from Manakara. It is divided into 12 fokontany. Eight of them are located more than 5 km from the primary health care center. Each remote fokontany has one child health CHW and one maternal health CHW. In total, 16 CHWs are providing community-based FP services and c-IMCI. Sahasinaka has 17 Social Development Committee (SDC) members (two are in charge of quality and one of the supply point) engaged in promoting community health. The map below illustrates the availability of CHWs covering fokontany in Sahasinaka.

IEC tools

Management tools

The commune of Sahasinaka has 16 working CHWs. Eight of them are maternal health CHWs who offer FP services to couples. The other eight offer c-IMCI services to children under five. The commune health center provides long-term FP methods, including Implanon, intrauterine devices (IUDs), and permanent FP methods for women. CHWs provide short-term methods such as pills. In one month of community-based FP service delivery activities, 5 couples chosen female permanent FP methods for women, 11 chose Implanon, 2 couples chose IUDs, and 7 couples chose pills.

Timeline of KM salama Implementation Process in the Commune of Sahasinaka

Introduce KM salama Train SDC members Draw plan Sign contract Train Level 1 maternal health CHW 1519 Feb 2010 Train Level 1 child health CHW

Nov 2009 18 Nov 2009

1112 Dec 2009

2526 Jan 2010

26 Jan 2010

Mar 2009 1519 Feb 2010

Second edition, June 2010

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USAID/Santnet2 is implemented by RTI International and its partners