Twenty-seven year old Madeleine Bienvenue, like many women in her community, knew very little about maternal and child health. Now, married with five children, she has educated herself on maternal and child health with help from her MAHEFA-trained community health volunteer (CHV) Louisette. Fortified with this knowledge, Madeleine now serves as a care group household for her village in Ambanja, in northern Madagascar.

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“I had my first child at the age of 14. My parents were too poor to take me to the hospital for regular pregnancy checkups and I had to give birth in my village. Fortunately, everything went well.”

But Madeleine admits that she wasn’t doing enough to ensure her children’s health. “I neglected immunizations, missed regular check-ins because the dispensary was too far, and did not respect the standards for breastfeeding. All this I admit because I was ignorant.”

To make things painfully worse, Madeleine lost her three-year-old daughter to typhoid several years ago. “It had been misdiagnosed and neglected because we believed that she was poisoned or that someone has cast a spell on her. It was really time to wake up and take care of my children the way I should.”

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“I decided to see a Louisette, a CHV from my village that I had met during a polio vaccination campaign earlier in the year. The treatment she gave my child cured him in just three days.”

“From that point on, I felt confident in her abilities to provide health services and I was relieved to have found her. I referred many other mothers from my community so that Louisette could care for their children too.”

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“The arrival of Louisette was a true blessing. Despite some critics, deep down I knew she was right. The proof: she saved my child. I wanted to help in what she was doing.”

Louisette suggested that Madeleine serve as a Care Group household, in which Madeleine would sponsor three other households in her fokontany as they work towards the adoption of positive health behaviors while emphasizing the benefits she has seen in her own life from adopting these behaviors.

MAHEFA’s behavior change empowerment (BCE) strategies encourage the adoption of positive health behaviors. The Program offers a range of locally adapted strategies including the Care Group approach. To qualify, a Care Group individual or household must “adopt” a minimum of three families with whom they work for at least a month to encourage positive behavior change.

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“I share useful information and practices related to maternal and child health to mothers in my community. For example, I describe the proper positioning of the child’s head for breastfeeding and other good practices to prepare mothers for when their baby is born.  It’s important.”

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To acknowledge the efforts of Care Group mothers and/or fathers or families, MAHEFA instituted a recognition system that includes the distribution of stickers to those who are successful in helping other families overcome barriers and focus on positive motivating factors.

The involvement of other community members in behavior change activities has enabled many CHVs to dedicate more time to improve the quality of their service delivery. In addition, it allows them to devote more time to house visits (when necessary) giving more interpersonal support to potential clients. As Louisette describes, “the Care Group approach allows me to spend less time organizing awareness raising session while reaching even greater numbers of community members.”

The USAID-funded Madagascar Community-Based Integrated Health Project, known locally as MAHEFA, was a five-year health program implemented by JSI that provided basic, quality health care to isolated populations in six north and northwestern regions of Madagascar. The program’s overarching goal was to increase the use of proven, community-based interventions and essential products among underserved populations of Madagascar.

All photographs by: DDC Madagascar/JSI

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