NEGLECTED HEALTH ISSUES
FACING YOUNG PEOPLE IN
MADAGASCAR
In 2012 Madagascar YMCA facilitated youth-led research among 516 young people aged
15-25 as part of the Act2Live Youth Health Initiative, being implemented in six countries
across sub-Saharan Africa. The research, carried out over two months, was aimed at
engaging young people from three districts: Antananarivo (urban), Carion (semi-urban)
and Morarano (rural), to establish which health issues were being neglected and the
quality, availability and accessibility of youth-friendly healthcare services.
INTRODUCTION
Young people were actively involved in the design
infections (STIs) are by far the biggest neglected
and implementation of the research to ensure full
health issue for young people in all three areas.
ownership over the project. Neglected health issues
Violent acts such as assault, battery and rape were
were defined as those ignored or assigned little
also big concerns for young people in urban and
importance by the government, NGOs, healthcare
semi-urban areas, while in rural districts dermatosis
systems, local communities, or young people
was more prevalent as a neglected health concern.
themselves. The results have provided a baseline for
work carried out under the Act2Live Initiative from
Positively, there appears to be a high level of existing
2012-15 funded by the Swedish Mission Council
health care provision in the communities which
and Sida.
young people are knowledgeable about; however
they are still not regularly accessing these health care
The research has shown that sexually transmitted
services due to factors such as the costs involved.
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KEY FINDINGS
TOP THREE NEGLECTED HEALTH ISSUES BY REGION
Antananarivo (urban)
STIs
77%
Assault,
battery
& rape
Malaria
20%
2%
Carion (semi-urban)
STIs
63%
Assault,
battery
& rape
Dermatosis
26%
9%
Neglected health issues
An average 65 per cent of young people across
all districts cited STIs as their most neglected
health issue, with it being most commonly cited
in urban areas. STIs were felt to be neglected due
to their sensitive characteristics, and that young
people are ashamed if they suffer from them. This
embarrassment as well as limited finances mean
that young people do not seek relevant treatment or
testing for these diseases.
Violent acts such as assault, battery and rape and
the ensuing health impacts were a serious concern
in urban and semi-urban areas, with an average of
23 per cent of young people across these areas
citing them as a neglected health issue. Specialist
treatment and referrals for victims of these violent
attacks, particularly rape, were found to be almost
non-existent. This lack of appropriate treatment
means that young people affected by violent attacks
are often ignored and left untreated.
Dermatosis was a neglected health issue for young
people in rural areas (21 per cent), and semi-urban
areas (nine per cent). It was noted that this issue is
often a result of stress.
Depression and anxiety were also highlighted as
neglected health issues in Morarano (12 per cent) as
very few sufferers visit health centres for treatment
and appropriate drugs are rarely available. It was
also felt that depression and anxiety can have further
health impacts as they can frequently lead to alcohol
and drug abuse. Oral diseases were also noted as
very common in Madagascar, but due to lack of
equipment, means and competence, these cases are
often neglected by health personnel.
Morarano (rural)
STIs
Dermatosis
Depression
& anxiety
54%
21%
12%
Awareness of health issues
Young people had varying awareness of health
issues, particularly in relation to sexual and
reproductive health. When questioned about who
should be treated in the case of contracting an STI,
more than half of young people responded that only
they needed to be treated, rather than themselves
and their partner.
Women were found to have higher knowledge than
men with 56 per cent of young women identifying
their partner as also needing treatment, compared
to just 37 per cent of young men. This gender bias
could show that women are more concerned about
their sexual health than men.
When asked what advice should be provided for
young people interested in their health, around half of
young people said reproductive health information,
followed by life skills.
Risk taking behaviour
The research revealed that there are three key
behaviours putting young people’s health at risk.
These are the failure to consult health services when
they are ill, early sexual relationships, and the use of
self-medication.
The majority of young people use paracetamol to
treat a range of symptoms. It is cheap and large
amounts can be bought easily on the black market
and illicitly from grocery stores. If paracetamol does
not work, then young people tend to try antibiotics
but with little regard to the correct dosage or
duration.
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98%
of young people want to
see health care services
targeted specifically at the
needs of young people
Availability of health services
Basic health centres were found to be functional
in all the areas surveyed. Ninety-five per cent of
young people knew of a health centre in their area.
Distances to the nearest centre were not too far,
with 67 per cent saying it took less than half an hour
to get there, and 27 per cent saying it took less
than one hour. Eighty-eight per cent agreed that the
timetable of services was easily available.
It was found that girls are more likely to be aware of
the programme of activities at health centres than
boys, with 83 per cent compared to 70 per cent. This
was suggested to be as a result of the Madagascan
gender norms that means women look after the
household and children (including health), while men
do the daily work.
When asked what services are on offer at the health
centre, almost half say they attend for consultation
and to receive treatment. They are also aware that
services such as screening and counselling are
available.
Barriers to health care
Regardless of the positive feedback around
availability of health care, there are still barriers in
access to services. Young people identified a need
for more youth-friendly health care services as 98
per cent of young people interviewed said that
they wanted to see health care services targeted
specifically at the needs of young people.
Money is the single biggest barrier preventing young
people from accessing health care services – 61
per cent gave a lack of money as the top reason
why they would not access a health centre if ill. A
further seven per cent reported a fear of shortage
63%
of young men did not
think their partner would
need treatment if they
contracted an STI
of medicine, again linked to financial barriers
as when health centres run out of stock (which
happens often), they have to order it from expensive
pharmacies in major cities, which adds to the cost for
patients.
Other barriers to access to healthcare services
noted were fear of a doctor, noted by 19 per cent
of young people. Four per cent of young people felt
that they would heal without treatment, and four per
cent found health centres too remote and difficult to
access.
The research also found that there is a shortage of
skilled health workers which is being combatted by
training community agents to form an extension of
the health service. Whilst this system is improving
the situation, it could work better. For example,
community agents are scattered throughout villages,
but health workers don’t have an up-to-date list of
where, so are unable to provide any co-ordinated
onward training or support. There is also no
performance recognition system for community
agents, leading to problems of motivation.
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RECOMMENDATIONS
Healthcare services
Open days dedicated to young people should be
held at health centres to encourage attendance.
Numbers of youth-friendly health facilities should
be increased through collaboration with the
Ministry of Youth and Sport and provision of
sensitisation training to health centre personnel as
well as counselling and information, education and
communication (IEC) techniques. The links between
community leaders and health centres should be
strengthened to better utilise community agents.
Risk-taking behaviour
Instigate an IEC activity highlighting the harmful
effects of using medicines without prescription,
and work with the National Order of Doctors
and Pharmacists on stopping the illegal sale of
medicines. IEC campaigns on STIs targeting
young men and unmarried young people must be
reinforced, as these groups are least likely to seek
treatment.
Addressing financial barriers
Financial barriers to accessing healthcare services
could be combatted through the development of
community micro health insurance (MHI) schemes
specifically for young people. Young people
should be encouraged to build up a group in
their community to facilitate the development of a
MHI scheme. A framework and guide should be
developed and shared with these young people, as
well as education on the benefits of services offered
by the health centres to encourage them to join.
PROJECT DASHBOARD
ACT2LIVE: AFRICAN YOUTH HEALTH INITIATIVE
Goal
Relevant, quality
health information
and services
respond to the
specific needs of
vulnerable and
marginalised groups
of young people in
six sub-Saharan
African countries.
Implementing
partners
Technical
partners
Duration
3 years: 2012 – 2015
This material/activity has received financial support from the Swedish Mission Council
and Sida. SMC/Sida does not necessarily share the views and opinions presented here.
Responsibility for the content rests solely with the authors.
For more information contact
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