In Madagascar, many people live in remote, rural areas where the nearest health facility is several kilometers away and difficult to reach due to poor transportation infrastructure and extreme weather hazards. Community health volunteers (CHVs) play a critical role in bridging this gap by bringing primary health care services closer to people, particularly women and children under the age of five. Along with making home visits, CHVs conduct community education sessions on healthy practices, hygiene, and preventive behaviors and facilitate referrals to health centers for specialized services or complex cases.
The Accessible Continuum of Care and Essential Services Sustained (ACCESS) Program, funded by the US Agency for International Development (USAID) and implemented by Management Sciences for Health (MSH) and its partners, supports more than 20,000 CHVs across 14 of Madagascar’s 23 regions. Through a community-based approach, ACCESS is committed to bringing essential care to the last mile and reducing maternal and child mortality. With the program’s support, CHVs receive training, guidance, and tools to meet the health needs of their communities, including family planning, malaria case management, vaccinations, and other essential health services.
Meet CHV Koto Jean — Milenaka, Tuléar II District, Atsimo Andrefana Region
In the rural village of Milenaka, Koto Jean is committed to educating his community, particularly couples, about the importance of family planning. Through awareness-raising sessions, home visits, and personalized counseling, he has informed many households about the benefits of family planning, and his guidance has contributed to improvements in family health within his community.
CHVs have helped contribute to an increase in contraceptive coverage from 34% in 2019 to 50% in 2024 in ACCESS-supported regions, as they have brought vital family planning services to remote and underserved populations.
The community views me as a champion in raising awareness about family planning. I love the way they trust me.
CHV Koto Jean
Meet CHV Mamy Hery — Amboletra, Antsalova District, Melaky Region
After serving as a CHV in the Amboletra community for 12 years, Mamy Hery met the performance criteria outlined in the national Community Health Program Guide to be promoted to “Community Relay.” In this role, Mamy helps supervise CHVs (particularly those new to their role) and supports health centers. ACCESS provided Mamy with training and an all-terrain bicycle to ensure he could carry out the many responsibilities that come with this important job.
I take my role as a Community Relay very seriously. I support CHVs with management tools like registers, stock cards, and monthly activity reports, and I ensure effective communication between the health center head and the CHVs who often live miles away.
CHV Mamy Hery
Meet CHV Jeanine — Tetezambaro, Toamasina II District, Atsinanana Region
For more than 20 years, Jeanine has played an integral role in improving primary health care in her remote village, located miles from the nearest health center. She focuses on children’s health, including monitoring their growth; providing nutrition advice; educating parents about the importance of vaccination; and treating common illnesses such as simple cases of diarrhea, pneumonia, and malaria.
CHVs like Jeanine have played an important role in preventing malnutrition by educating pregnant women and new parents and integrating this topic into primary health care services. ACCESS reached more than three million children under the age of five with nutrition-related interventions between 2021 and 2024.
Being a CHV is a privilege and a calling. I’m a grandmother, but I’m not ready to retire. My mission continues as long as I have the strength to care for sick children.
CHV Jeanine
Meet CHV Lynda — Djamandzar, Nosy Be Prefecture, Diana Region
Lynda has seen significant improvement in her work with the introduction of the CommCare mobile app. This technological innovation assists Lynda and other CHVs in diagnosing and managing common childhood illnesses, provides guidance on family planning, and facilitates the referral of severe cases to health centers. The app also streamlines the reporting process, reducing errors.
As a result of this improved efficiency, Lynda can now devote more attention to her patients.
At first, I was apprehensive because I had never used a smartphone before. But after receiving the ACCESS-supported training, I found that the CommCare app makes our work much easier.
CHV Jeanine
Meet CHV Mamololona — Belobaka, Mahajanga II District, Boeny Region
For 22 years, Mamololona has provided essential care to her remote community in Bealoy. Mamololona’s steadfast dedication to saving lives and the skills she learned during her training have allowed her to become a respected CHV in her community. She hopes to inspire young people to follow in her footsteps.
CHVs — The backbone of Madagascar’s health care system
CHVs like Koto Jean, Mamy Hery, Jeanine, Lynda, and Mamololona are the backbone of Madagascar’s health care system. Often working under challenging conditions with limited resources, they are the first points of contact for medical care and provide essential services and health education to people who may have otherwise been left behind. With support from ACCESS and the Ministry of Public Health, their work helps empower communities with the knowledge they need to improve health outcomes, even in the most remote parts of the country.
This material is made possible by the support of the American People and the United States Agency for International Development (USAID). The opinions expressed herein are those of the authors and the ACCESS program and do not necessarily reflect the views of USAID or the United States Government.