April 2016—A panic-stricken woman burst into the community health volunteer’s hut in the village of Tanambao Marofototra in southwestern Madagascar with her newborn baby boy in her arms. Terrified, she explained that her child was severely ill. He was having trouble breathing; his lips were beginning to turn blue.

The health worker quickly diagnosed a respiratory infection and told the local supervisor of a nearby community health care mutual that a baby with short and cramped breathing had to be evacuated to a health center in the larger town of Morondava, four miles away.

The supervisor entered information about the baby into his log book and summoned the ambulance driver. No sooner did they arrive at the health center than the baby was referred to the regional reference hospital to receive treatment.

The ambulance that carried 18-day-old Mahazomaro and his mother Salalasoa (who both use one name only) is a cycle rickshaw, big enough to accommodate two people. The driver was specially trained in driving and maintaining the ambulance cycle rickshaws.

This emergency transportation system has proven very efficient in Morondava as the local supervisor and ambulance driver are able to attend to any emergencies.

The emergency rickshaw is financed by a community health care mutual, Fifampitsimbinana Ho Salama (FHS), in Malagasy, an association established by USAID in small communes in Morondava in late 2013. The association provides participating families with free or heavily subsidized health care services at the health center, including emergency evacuations, depending on each family’s financial means. Families must pay a monthly contribution of ariary 300, or roughly 10 cents.

Members of the mutual elect a management committee to run daily operations. Local people are also demonstrating ownership of the system by regularly paying their contribution to the mutual.

Little Mahazomaro was discharged from the hospital a few days after arriving. He was fully healed and his mother was thankful to the USAID project for saving her son’s life.

“The child would have almost certainly died from respiratory infection if he hadn't arrived in time at the hospital,” said Dr. Celine Raharisoa, chief physician of the Morondava regional reference hospital.

The community health care mutuals are part of USAID’s five-year Madagascar Community-Based Integrated Health Project, which runs from 2011 to 2016. The project is designed to provide basic, quality health care to isolated populations in six north and northwestern regions of Madagascar. To date, 3.5 million people have benefited from the project.

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