Miandrivazo, Madagascar – Dina Fulgence Ratolojanahary was resting in the shade with friends when he first met Ms. Yrogerette. The community health worker (CHW) had come to his remote village to discuss a new project called Tanora Mitsinjo Taranaka’ (“young people looking after their legacy”) – or TMT.
“Supported by the chief of our village, she shared the usefulness of antenatal care at the health center, especially for us young parents,” Ratolojanahary said. “This information left me wanting to know more since attending a health center is not a habit in our family.”
Yrogerette’s conversation with Ratolojanahary and his friends is part of larger work being done by MCSP to train CHWs to reach first time and young parents (FT/YPs) and those who influence them with key health messages. In collaboration with the Ministries of Health, Youth and Sport, and Population, MCSP designed TMT to be implemented by CHWs given how persuasive the cadre has proved to be in positively influencing these groups.
Like most CHWs, Yrogerette had always worked with mothers and children under five. However, MCSP additionally trained her on TMT to guide young parents like Ratolojanahary to the health center for services. Equipped with TMT booklets and invitation cards, MCSP-trained CHWs act as a referral system linking communities and health centers.
Across 16 regions in Madagascar, MCSP has trained 75 CHWs like Yrogerette and 20 community actors from the Ministries of Youth, Education, Communication, and Population in TMT. The Program has also trained and supported 32 health care workers to provide adolescent-responsive health care in 11 facilities.
The results of these efforts are tangible: more than two-thirds of invitation cards (72% of 1,430) distributed by CHWs to FT/YPs resulted in visits to the health facility. Moreover, community-based distribution of adolescent-friendly health services to clients aged 10–24 increased from an average of 35 clients to 76 clients per CHW.
In 23-year-old Ratolojanahary’s case, the meeting and materials Yrogerette shared peaked his interest at a critical time: his 17-year-old wife was one-month pregnant with their first child. The day after their first encounter, Yrogerette returned to visit Ratolojanahary and his family, this time with the TMT booklet in tow, which the young man read eagerly.
The information motivated him to take his wife to the health center for an antenatal care visit soon after. “The booklet is certainly designed for young people like us with information that concerns us,” he said.
After his wife was examined at the health center, she encouraged Ratolojanahary to go, as well. His experience with the health care staff was so positive that he, in turn, encouraged his family and friends to seek care there. Ratolojanahary has even explained the content of the TMT booklet to his friends who cannot read.
“I was surprised to learn that some of my friends refused to go to the health center just for fear of an injection. And they also forbid their wives to go, let alone their babies,” he said.
But Ratolojanahary is determined to change this thinking in his community, and is a powerful reminder of how far positive messages can spread in the right hands. “I would like to serve as a role model for other young parents. When my 3-month-old baby was ill, I personally took him to the health center myself,” he said.
At MCSP, we know that FT/YPs face unique risks that we must meet to help prevent child and maternal deaths. Women under age 20 are twice as likely to die in childbirth as women over 20, for instance, and these elevated risks extend to the lives of their children. Those born to adolescent mothers have a 34% higher chance of neonatal death and a 26% higher risk of death by age five.
In Madagascar, MCSP is innovating to meet the unique needs of this underserved population, and changing a generation’s mindset in the process. Our TMT efforts have increased both male involvement and FT/YP visits to the health center.
“I understood that caring for our descendants is crucial,” Ratolojanahary said. “The TMT booklet helped me understand that.”