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PSI/Madagascar
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Program
Focus: |
HIV/AIDS, malaria, reproductive
health,
child survival |
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Target
Regions: |
Nationwide |
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Target
Population: |
Men and women of reproductive age with special emphasis on high-risk
groups such as commercial sex workers, their clients, and sexually
active high-risk youth (HIV/AIDS); women of reproductive age (family
planning); households with children under five and/or pregnant
women (malaria and safe water)
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| 2006 Estimated Health Impact: |
Episodes of malaria averted: 3 million
(explained)
Unintended pregnancies averted: 215,000
(explained) |
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Products: |
Genicure ulcerative STI treatment kits since 2004
PaluStop treatment kits for uncomplicated childhood
malaria since 2003
Cura-7 urethritis treatment kits since 2002
Super Moustiquaire long-lasting insecticide treated
nets since 2001
Top Réseau franchised network of youth-oriented
clinics since 2001
Sûr'Eau safe water systems since 2000
Protector Plus condoms since 1998
Pilplan oral contraceptives since 1998
Confiance three-month injectable contraceptives
since 1998 |
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Local
Collaboration: |
The Ministry of Health and
Family Planning; the Ministry of Energy and Mines; "Comité
National de Lutte Contre le SIDA" (National AIDS Control Committee);
USAID; The World Bank; UNICEF; JICA; GTZ; CARE; ADRA; UNC; SantéNet;
AIDS Alliance; ITEM; and INSPC. |
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Current
Donors: |
The Global Fund To Fight AIDS, Tuberculosis and Malaria
The World Bank via local organizations
UNICEF
U.S. Agency for International Development
(USAID) |
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| Year Program Began: |
1998 |
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Project Activities and Highlights
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HIV/AIDS |
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Top Réseau Youth Friendly Clinics
In 2001, PSI/Madagascar launched a franchise network of youth-friendly
private clinics branded Top Réseau with the support of the
Gates Foundation in one large city. Subsequently, PSI received additional
support to expand the social franchise program to four other urban
areas: Antananarivo, Antsiranana, Tolagnaro, and Mahajanga. The
project aims at preventing STI transmission and unwanted pregnancy
by improving STI case management, and promoting consistent condom
use and modern family planning methods among sexually active youth.
Top Réseau clinics are promoted among young people looking
for confidential, quality, affordable, and youth-friendly services.
To date, PSI/Madagascar has trained and incorporated 184 doctors
from 123 existing private clinics to provide STI curative and family
planning services. PSI encourages effective STI prevention counseling
through continuous provider training and a variety of educational
tools. The Top Reseau network is supported by a strong youth peer
educator program to attract new clients. In 2005, Top Reseau clinics
reported more than 41,000 clients. With PSI/Madagascar support,
in 2006, selected providers will begin offering voluntary HIV counseling
and testing.
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Behavior Change Communication (BCC)
PSI/Madagascar’s approach to reducing the transmission and impact
of HIV/AIDS is to specifically target high risk groups who have
the greatest potential to serve as core transmitters and bridge
populations. These include commercial sex workers (CSWs) and their
clients, mobile populations, and sexually active high-risk youth
aged 15 to 24. Activities include a peer education program with
17 CSW peer educators in 5 major cities. The program provides counseling,
education and income generation through condom sales. Mobile Video
Unit (MVU) and interpersonal communication (IPC) activities target
clients at military encampments, truck stops, bush-taxi stations,
and mining towns. Activities designed to promote delayed sexual
debut among youth and to reach sexually active youth with STI/HIV/AIDS
prevention messages are also implemented. The Ahy Ny Safidy “It’s
My Choice” BCC campaign includes radio spots, a weekly radio show,
and 4 TV talk shows to raise awareness and encourage discussion
concerning safer sexual choices, delay of sexual activity, abstinence,
faithfulness, and partner reduction.
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Products and Treatment
PSI/Madagascar markets STI prepackaged treatment kits for syndromic management
of urethritis (Cura-7) and genital ulcers (Genicure). In
addition to quality antibiotics, the kits also contain easy-to-understand
(even for low literacy populations) product information, partner notification
cards, and condoms. Since 2002, PSI Madagascar has trained 1,685 doctors
and paramedics in syndromic management of STIs. PSI/Madagascar distributed
more than 14 million condoms in 2005.
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Malaria |
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Insecticide-Treated Nets (ITNs)
PSI/Madagascar launched the long-lasting insecticide-treated net
Super Moustiquaire in response to the high malaria burden
in Madagascar. The program targets pregnant women and children under
five, who are particularly vulnerable to malaria. Super Moustiquaire
is pretreated with insecticide and requires no retreatment for at
least 21 washings (about three years). Since 2003, PSI/Madagascar
has received funding from the Global Fund that allows the sale of
the net at the highly subsidized price of $1.50 to consumers (versus
the cost of approx $6 to procure). More than 1.1 million ITNs have
been distributed by PSI in Madagascar so far. |
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Anti-Malarial Treatment Kits
PSI/Madagascar distributes PaluStop Zazakely and PaluStop Zaza, two pre-packaged
anti-malarial treatment kits intended to aid the effective home management
of uncomplicated malaria in children under five. With funding from the
Ministry of Health and the Global Fund, PSI is able to sell the kits at
the highly subsidized price of just $0.02 to consumers. In 2005, PSI/Madagascar
sold nearly two million doses of PaluStop. |
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Reproductive Health |
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Family Planning
PSI/Madagascar covers approximately 50% of the current contraceptive use
in Madagascar. This is achieved through the social marketing of Protector
Plus condoms, Pilplan low-dose combined contraceptive pills and Confiance
three month injectables. All products are highly subsidized to ensure their
affordability to low income clients. To date, more than 1,500 private and
public sector doctors and midwives have been trained in family planning
counseling and service provision. Public and private sector health providers
are regularly visited by PSI/Madagascar medical detailers who explain about
and promote PSI supported products including for FP. In 2006, selected
private providers from the Top Réseau network will be (re)trained
in IUD insertion. |
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Child Survival |
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Safe Water
Some 75% of Malagasy do not have access to clean drinking water, exacerbated
by nearly annual cyclones. Diarrheal diseases are among the top 3 causes
of morbidity and mortality among children. In response, PSI/Madagascar
collaborated with CARE and the Centers for Disease Control to produce,
market, and distribute a sodium hypochlorite solution under the brand name Sûr'Eau for
point-of-use treatment of drinking water since 2000. Funding from USAID
and UNICEF allowed national expansion of the program. In 2005, some 700,000
bottles of Sûr'Eau were sold, enough to treat up to one billion litres
of water.
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Future Plans |
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•Extend ARH franchise to two new cities
•Launch VCT in selected ARH franchise clinics
•Launch IUD
•Explore introduction of Oral Rehydration Salts and a Diarrhea Treatment
Kit
•Explore introduction of micronutrient supplementation
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PSI/Madagascar sells its products at non-traditional
outlets where they are easily accessible to low-income
and vulnerable people. |
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