Field Note January 27, 2018

An Essential Challenge


The trek to Ambohimanga du Sud (ADS) is comprised of 65 kilometers of dirt road. It requires motorbikes, skilled motorcycle drivers, and a full eight hours of traversing precarious mountainsides, mudslide-like hills, devastated bridges, and small wooden rafts to cross the Ampasary river. Almost 90,000 people live across the five northernmost communes in the district, and ADS serves as a crossroad for people from the other four communes when traveling south.

One medical doctor and two nurses are all the clinical staff that are serving the most populated commune in the northern part of Ifanadiana District, in a health center that was built during the French occupation (circa 1940). The equipment is as old as the building itself, and there are serious shortages of essential medicines due to the commune’s inaccessibility. Medical evacuations to the main district hospital (situated in Ifanadiana’s administrative center) are extremely difficult, and most patients in need of urgent care are carried by relatives on foot for however long it takes them to walk the 40 miles we traversed on motorbike.

This year, the start of direct support to the commune of Ambohimanga du Sud is one of PIVOT’s strategic priorities:


Expansion map from PIVOT's Strategic Plan (click to enlarge).

It is a huge challenge. The commune’s isolation creates challenges related to supply chain, medical evacuations, personnel supervision and technical support. It will require us to experiment with new ways to build a strong health system in enclaved areas such as ADS, finding creative solutions to overcome the logistical burden of transporting medicines, supplies, and people along the route.

It is an inspiring challenge. It will push us to innovate in order to find new ways to work side by side with communities, and bring answers to chronic issues related to geographical barriers. It will allow us to document and share new experiences that we hope will contribute to similar work being done by similar organizations around the globe.

It is a beautiful challenge. Improving health conditions in ADS commune will have a direct influence on the four other communes of northern Ifanadiana District. Equipping the existing health center to serve as a rural hospital – well-equipped and well-staffed – will allow patients to access decent medical care and decrease the needs of references to the distant district hospital. Instead, patients who have experienced trauma or are facing complicated pregnancies/deliveries will be able to rely on ADS’s facility for quality care. And improving the implementation of supply chain policies will ensure availability of essential medicines, better immunization coverage, and more women enrolled in family planning programs.

It is an essential challenge. We believe deeply that having access to quality health care is a fundamental human right. While PIVOT has already made huge strides to provide coverage for Ifanadiana District’s population, we know there are many who we have not yet reached. We see our intervention in Ambohimanga du Sud as the key to the northern half of the district, which will unlock access to care for the 90,000 people there who need it.