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By Hoby Randrianimanana
ANTANANARIVO, Madagascar – Sanitation and hygiene partners are placing an increased emphasis on improving hygiene services as a first line of defense in curtailing the spread of coronavirus in Madagascar, where a surge in the number of cases is feared to overwhelm the public health care system.
As of 1 May, 128 cases of COVID-19, and no deaths, have been reported in Madagascar, according to the World Health Organization. After a recent increase in confirmed cases of coronavirus, the country’s COVID-19 task force, Centre de Commandement Opérationnel (CCO), is raising concern over the potential spread of the virus, which could be exacerbated by the response capacity of a public health system.
According to Madagascar’s Minister of Health, there is one doctor per 10,500 people, one nurse per 8,400 people and one midwife per 15,000 people. Only 25% of Basic Health Centers meet basic surgical standards and many permanently lack medical supplies.
The Multiple Indicator Cluster Survey (MICS), conducted by UNICEF and Madagascar’s National Institute of Statistics (INSTAT), shows that only 18% of Madagascar’s rural population has access to basic hygiene services, compared to 38% in urban areas and 23% nationally, raising the prospect of poor hygiene, exposing Madagascar to even greater risks during the current pandemic.
With the support of WSSCC, an effort has been launched to mitigate the risk. The Fonds d’Appui pour l’Assainissement (FAA), WSSCC’s Global Sanitation Fund-supported programme in Madagascar, together with the Ministry of Water, Sanitation and Hygiene, has distributed 150 handwashing devices with soap to communities in need, along with 1,000 posters and 2,000 flyers promoting handwashing.
Dr Rija Lalanirina Fanomeza, FAA Programme Manager, describes the actions as a first, rapid response to tackle the urgent needs of the sector.
“The goal is to raise awareness in the communities about COVID-19 and to promote handwashing with soap as a precautionary measure to mitigate the spread of the virus,” says Dr Fanomeza.
At the moment, Antananarivo and Toamasina are the two regions of Madagascar with the most COVID-19 cases. The government and partners are currently working on response strategies and containment plans for other regions.
According to Dr Fanomeza, FAA is contributing to, and is a member of the e-Cluster COVID-19, a platform gathering all partners in the sector, which works to provide strategic support and resources to COVID-19 response efforts.
“The platform is now defining a common strategy and its members are evaluating their resources and contribution capacities to respond to Coronavirus,” says Dr Fanomeza.
Fighting COVID-19 through teaching of good hygiene practice
With the handwashing devices and promotional materials distributed by FAA and the Ministry of Water, Sanitation and Hygiene now available in communities, local leaders are entrusted with the task of informing community members about Coronavirus and how to prevent it.
Rakotarivelo Serge is a 39-year-old Gendarme in the Commune of Alasora, one of the areas where the handwashing devices are positioned. He says the role of law enforcement during this outbreak is to raise awareness about the virus in the community.
“We visit all fokontanies in our jurisdiction every day and inform people about Coronavirus and show them how to prevent it, using the posters and flyers we received from the Ministry and partners,” says Mr Rakotoarivelo.
Stationed at the entrance of a local market, 58-year-old Ralisera Andriamanana Lalaoarisoa, from Mendrikolovana, is in charge of teaching shoppers how to wash their hands before entering the premises.
“As a community organizer, I can see firsthand how important and helpful these devices are, now that the virus has reached the community. We are advising our community members to keep their hands clean and not touch things with their dirty hands. So they definitely need to wash their hands regularly to avoid getting infected or infecting others,” says Ms Ralisera.
Ms Ralisera also talks about how the handwashing devices provided by WSSCC/FAA help people save on water, which is not free for many.
“In my own household, for example, we are using an old oil container to store water,” she says. “We tip it whenever we need to wash our hands, which is quite inconvenient but, using a device like this with a tap, we have better control over the amount of water we use. It would be ideal if every household had them,” says Ms Ralisera.
Another beneficiary, 35-year-old Rasoa Olga, says she was pleasantly surprised to see the handwashing devices at the market.
“Having them in a public place like this is very timely as they help protect against the virus. As far as I know, the virus spreads when people have poor hygiene and make close physical contact. Now I feel more confident about going out when I have to shop for supplies,” says Ms Rasoa.
Asked about household hygiene, Ms Rasoa says her family already practices good handwashing and body cleaning habits, even though they do not have running water and have to fetch it from a public water tap stand. She says they use water from a well for washing.
Strengthening supportive actions around hygiene in the regions
While Coronavirus has not yet reached the majority of regions in Madagascar, Dr. Fanomeza of FAA says the programme, together with the Ministry of WASH, is already working to develop response strategies to better prepare for a potential outbreak in those areas.
At the same time, he says, “the programme has instructed all implementing partners to comply with social distancing rules while keeping in touch with all stakeholders at the community level.”
“We have also encouraged them to join the local task force fighting against COVID-19 and to contribute actively in the promotion of COVID-19 prevention measures, particularly handwashing with soap,” says Dr Fanomeza.
Dr Fanomeza further reveals that WSSCC/FAA plans to distribute the same amount of handwashing devices and promotional visuals to each region where the programme is implemented to support local effort to mitigate the spread of COVID-19.