Madagascar’s Health Information SystemMadagascar’s exotic flora and fauna belie a broken and underdeveloped health information system. According to the World Health Organization (WHO), the probability of dying by the age of 5, per 1,000 live births in Madagascar is 50.24. The problem is not only a lack of access to health care but also lags in timely information, which prevents Malagasy people from taking proper precautions against infectious diseases.

Although 77% of Madagascar’s population is literate and 57% have access to mobile phones, people in the rural areas are still hampered by low literacy rates and a lack of a proper telecommunication system. Consequently, people share the majority of health-related facts orally, leading to the rampant spread of misinformation. In an effort to debunk myths and reform Madagascar’s health information system, a local NGO called Doctors for Madagascar, initiated a project that utilizes a unique tool for its success: singing.

Beginning of the Project

In 2018 and 2019, the measles epidemic in Madagascar caused more than 200,000 cases and over 1,000 deaths. During this time, health workers observed a deficiency of knowledge among rural people in southern Madagascar about measles vaccination.

To dispel the false rumors circulating, Doctors for Madagascar teamed up with local singer/songwriter Ebera to start the “Singing Sensitization” project as a medium of “getting accurate health information to isolated, rural communities in the country’s south.”

Free live music performances took place in places such as markets so that it could reach as many different demographics as possible. The song “The Measles” by Ebera became vastly popular among the rural Malagasy people for its educative lyrics and lilting tune.

The lyrics contained all information from verifiable sources such as the WHO and the Malagasy Ministry of Health. The song warned — “measles — they’re lethal” and advised them to take their children to the hospital if they showed symptoms like coughing, sneezing, vomiting, or diarrhea, instead of bringing them to “a shaman or a witch.” In addition, the song also urged villagers to get the measles vaccination as it would help protect them better against the disease.

Melodies During COVID-19

The success of “Singing Sensitization” during the measles outbreak in Madagascar encouraged the NGO to continue its project during the COVID-19 pandemic. During the first wave in 2020, songs focused on the importance of wearing masks, washing hands regularly with soap and water as well as social distancing. The productions also placed emphasis on the origin and spread of the virus.

According to the WHO case study, these performances were conducted sporadically “at eight to nine locations each month (or bimonthly in each village) in Ampanihy until August 2021.” The infrequency was a result of compliance with social distancing rules proposed by the government.

The Song of Victory

Conveying facts through songs sung in local dialects has proven effective especially since the performances conclude with an informative Q&A session, where health workers address additional questions and concerns.

This created trust between the villagers and the health workers. The project members often held focus group sessions and informal interviews with “community leaders, health care workers, and local health authorities” to understand how much the villagers had learned and retained as well as identify what was lacking in their knowledge, WHO case study reports.

The team modeled additional performances based on these discussions, focusing on filling the “knowledge gaps” and denouncing any inaccurate information.

Additionally, these discussions helped the “Singing Sensitization” team infer that the reach of their performances was approximately 60–70%, with “a positive uptake of the initiative by the local population,” WHO case study reports.

Making it Large Scale

Singing Sensitization” has greatly helped in improving rural Madagascar’s health information system. As of now, the biggest challenge is getting funding, recruiting more local performers and expending time and energy on translating lyrics into different local languages.

Nonetheless, the team wants to expand its project and take it to other “hard-to-reach” rural communities. One of their goals is to introduce a radio network for easier and wider transmission of information.

– Anushka Raychaudhuri
Photo: Flickr