Odette and one of her Community Health Worker colleagues with their personal phones, which they use to communicate with their health center – when they have electricity and credit. © UNICEF/UN0790223/Ramasomanana
“About a year ago, a man in our community severely burned himself when he tried to rescue his children from a burning building near the goldmine, where he worked. He was only treated with local medicine, like medicinal plants, before we were contacted three days later,” Odette remembers. She is one of the Community Health Workers in a small village near Maevatanana in northern Madagascar and has worked in her role for over 20 years.
“In response to our call, a district doctor came to visit the man and asked him to receive proper treatment at the district hospital. The man declined. We contacted the leader in our village to help convince the man, and only then did he change his mind. He went to the hospital and survived,” she added.
Odette exemplifies an issue present in many developing countries: across Africa, an estimated 80 per cent of the population use traditional medicine to treat ailments, according to the World Bank. The World Health Organization (WHO) defines traditional healing as “the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures”.
“During COVID, no one wanted to go to the hospitals because they were scared to get COVID. Then, when doctors came to the village to vaccinate people, no one wanted it because they were scared to die. Only a few people got vaccinated. Many others even thought that the vaccine itself will give them COVID,” Bernadette says. She is a health care worker in the same region as Odette. “There were rumors in our village that someone died from CVO,” she added. Covid-Organics, or CVO, is a herbal tonic touted as a cure for COVID-19. Despite warnings against using untested remedies for the virus, many African countries had ordered and promoted the drink.
A pillar in the community
Traditional remedies and solutions can be at odds with modern medicine, but they are a pillar of many communities in remote places that feel forgotten by modern institutions owing to the lack of infrastructure and services.
Despite delivering results of varying quality, traditional healers are often integral members of their communities and local culture and heritage. They thrive in places where doctors are few and far between – in Madagascar, only a fraction of the population has geographic and financial access to health facilities. The widespread presence of traditional healers is deeply rooted in many parts of the developing world, including in Madagascar.
Some remedies from traditional healer have been found to be effective. For instance, some studies indicated that herbal treatments for shingles used by healers in Uganda were effective. As such, UNICEF has supported the transformation of primary health care from traditional primary (clinical) care to a people-centred, community model that emphasizes health promotion, disease prevention, greater access to services through home visits and continuity of care in its Health Systems Strengthening Approach. But regulation, safety, effectiveness and evidence-based use are core to this approach.
Those who fall sick in remote communities may have to walk for hours or more to reach medical help. Getting around is tough: Madagascar has some of the least developed infrastructure and one of the least developed road networks in the world.
Bernadette and her daughter standing in front of their hut. She trained her daughter to become a Community Health Worker in the hopes of retiring soon. © UNICEF/UN0790222/Ramasomanana
However, digital tools offer several opportunities for healthcare in Madagascar, offering solutions to overcome the current challenges related to limited access to healthcare services, inadequate infrastructure, and shortage of trained healthcare professionals in some areas. Some of the opportunities include:
Telemedicine: Digital tools such as video conferencing and mobile health applications can facilitate remote consultations, diagnosis, and treatment of patients. This can improve access to healthcare services for patients living in remote areas or those who have difficulty traveling to healthcare facilities.
Electronic Health Records (EHRs): EHRs can provide healthcare professionals with access to patients' medical histories, medication histories, and other important health information. This can improve the quality of care and reduce the risk of medical errors.
Mobile Health (mHealth) Apps: Mobile health apps can help patients manage their health, monitor their conditions, and access health information. These apps can also help healthcare professionals track patient progress and provide remote care.
Health Information Systems (HIS): Digital health information systems can facilitate the collection, analysis, and reporting of health data. This can help healthcare professionals identify health trends and develop targeted interventions to improve health outcomes.
Medical Training: Digital tools can be used to provide medical training and education to healthcare professionals in remote areas or those with limited access to training. This can improve the quality of care and help address the shortage of trained healthcare professionals in some areas.
A potential path for collaboration?
UNICEF, with the support of Twilio, is planning to work closely with community health workers who have access to more people in remote communities across Madagascar and can help raise awareness of the benefits of modern medicine while acknowledging traditional practices. The goal is to strengthen health systems by designing and deploying digitally-enabled solutions used to enhance the quality and reach of vital health information and services for the most disadvantaged children and their families. The opportunities provided by digital tools in healthcare in Madagascar are significant and can help improve access to healthcare services, quality of care, and health outcomes for the population.