Pressing for sanitation and hygiene to become a national priority in Madagascar

Date: 5th June 2020

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Interview with the Global Sanitation Fund Programme Manager

By Hoby Randrianimanana

ANTANANARIVO, Madagascar – For the past 10 years, Dr Rija Lalanirina Fanomeza has led a sanitation programme in Madagascar, known as Fonds d’Appui pour l’Assainissement (FAA).

He is a doctor by training and a public health specialist with over 20 years of experience in the field of planning, management, implementation and monitoring and evaluation of public and community health programs, particularly maternal and child health.

As the FAA has been stepping up to intensify its effort to provide sanitation and hygiene support in the fight against the COVID-19 outbreak across the country, he provides an overview of the work of the programme, which has been supported by WSSCC’s Global Sanitation Fund, and shares his views on its recent interventions in response to the coronavirus.

WSSCC: The Fonds d’Appui pour l’Assainissement (FAA) has been working in Madagascar for the past ten years. Reflecting on those years, what can you say about the progress achieved in sanitation and hygiene, particularly in the campaign to end open defecation?

Dr Rija Lalanirina Fanomeza, Programme Manager of the Fonds d’Appui pour l’Assainissement: Overall, the journey has not been easy because sanitation and hygiene, especially the open defecation free (ODF) campaign, has been chronically underfunded. Insufficient funding for sanitation and hygiene has left alarmingly large numbers of people exposed to a range of health threats – not only deadly infectious diseases such as COVID-19, but also maternal and neonatal death, malnutrition and poor access to safe menstrual hygiene.

Despite that, we have managed to achieve some progress, particularly in rural areas where we have seen remarkable behaviour change, both at the community and household level.

What we plan to do next is to reinforce institutional triggering, ensuring sustainability and empowering community leaders to initiate local actions, including helping with infrastructure upkeep, supporting the vulnerable and running field activities independently.

WSSCC: What challenges have you and your team faced in your work during the past ten years?

Dr Fanomeza: We have encountered a number of challenges, including weak sanitation and hygiene systems in some of the regions where local authorities lack enough resources, and difficulty in sustaining results due to financial, political, and environmental crises such as floods, droughts and water shortages.

Other challenges include difficulty getting the full support and engagement of stakeholders such as the private sector, civil society, and other local partners.

WSSCC: Can you explain the remaining gaps between urban and rural areas in terms of access to sanitation and hygiene services. For example, 15% of households in urban areas have access to basic sanitation whileonly 4% in rural, and for hygiene, access to basic hygiene in urban areas is 38% while the rural it is 18%.

Dr Fanomeza: The gaps are mainly caused by the socio-economic crises I mentioned earlier. They are also caused by rapid population growths in some areas, overshadowing gained results.

The limited number of organizations and programs working directly in sanitation and hygiene, compared to other sectors of social development, such as public health, education and population welfare, is another factor contributing to the gaps. To reduce those gaps, Madagascar needs to boost funding efforts, both public and private, and find ways to engage more actors in the field.

WSSCC: You have run FAA since 2010. What have been the most memorable moments?

Dr Fanomeza: Witnessing the pride of communities when showcasing their ODF achievements is something I always cherish. They often request our visit to their villages to see the results. I am particularly touched by those moments because they show that our hard work has paid off.

Discovering innovations emerging from the communities is another highlight that has moved me. Innovations contribute to strengthening our activities– triggering and follow-up – and improving the quality of our products such as fly-proof latrines and handwashing stations.

WSSCC: How has the current COVID-19 outbreak affected the work of FAA and its contribution to the road map Madagasiakara Madio 2025?

Dr Fanomeza: Preventive measures such as social distancing have disrupted our schedules. For instance, all our activities related to the ODF campaign have been suspended. Since we can not meet with our local technicians, we regularly schedule phone calls to get updates on the ground, conduct follow-up and provide instructions for ongoing activities.

If the state of emergency is extended for a longer period of time, it will surely have an impact on our programs and subsequently the road map MadagasikaraMadio. It would, however, be difficult to predict the extent of that impact given the uncertainty surrounding the evolution of the outbreak.

WSSCC: What lessons can we learn from the COVID-19 pandemic in order to be better prepared for the next pandemic in Madagascar?

Dr Fanomeza: First, we see in this pandemic that more attention is paid to the WASH sector, particularly to sanitation and hygiene. All stakeholders should seize the current outbreak tofight to make sanitation and hygiene a national priority andshould stand together to make that happen. We should also reinforce existing WASH programs, and everyone – public, private and civil society –should contribute to them. We have learned that our healthcare system is fragile, so we need to reform and update it in order to ensure a better response capacity if ever we face another pandemic.

Lastly, we have seen that national unity and discipline are lacking in the country in this pandemic, so that is something we need to strengthen through overarching and continuous civic education campaigns.


In addition to the FAA, Dr Fanomeza has managed several other projects in the community health sector as well as in the WASH sector, through which he worked with donors and partners such as USAID, UNICEF, African Development Bank, and the World Bank.

He has also contributed to the development of several national framework policies and documents including, among others, the National Community Health Policy, the National WASH Policy, WASH Guidelines, the WASH Sector Program, Madagascar Madio 2025 Road Map, the National CLTS Guide, and the National Protocol for ODF Verification and Certification.

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