48IV-G0001 Madagascar: (AVIA)

Anosy Villages Integrated Actions Development Program


Proclaiming Christ’s love for all and His call to serve, drawing upon the full range of community resources to give the poor the tools they need to build and sustain healthy lives, families and villages.

AVIA is the name of an exciting new holistic village health program in Madagascar.  The word AVIA means “Come” in Malagasy.  It stands for “Anosy Villages Integrated Actions”

Here’s what you can do now to support this ministry:

1.  Pray for God's blessings on AVIA and the people of the Anosy Region in southeast Madagascar. 

*Click here to open the detailed April-June, 2009 quarterly report on AVIA activities

*Click here to access July, 2009 report by the United Nations on the humanitarian situation in Madagascar.

*Click here (http://www.panos.org.uk/?lid=29563) to access a website providing life stories from the Anosy region of southern Madagascar. In their own words, the indigenous people of Anosy, the Antanosy, describe their lives in the face of climate change, food insecurity and rapid development due to mining. The stories are from four communities: Petriky; Ambinanibe; St Luce and Ilafitisignana and were recorded by community members and staff from a locally-based partner, Andrew Lees Trust, for Panos London. Panos promotes the participation of poor and marginalised people in national and international development debates through media and communication projects.

*A report below from missionary nurse Pat Bentsen emphasize the critical need in the Southeastern Anosy region for the services that AVIA provides.

From: Patricia Bentsen [mailto:mccabe515@yahoo.com]
Sent: Wednesday, April 29, 2009 11:50 AM
Subject: News of Southeastern Madagascar

MADAGASCAR: On the slippery slope to hunger

JOHANNESBURG, 28 April 2009 (IRIN) - Florine Zafy, who runs the health centre in Sampona, a tiny town in the Anosy region of southern Madagascar, has become as desperate as the parched landscape: three consecutive years of drought and meagre harvests have put thousands in the area on the slippery slope to hunger, and the children usually go first.

Mothers and children are at the frontline when malnutrition weakens the immune systems, Zafy said, and "at this point the problem is becoming critical". She started screening children in mid-March and by the end of April had already identified some 90 severely malnourished under-fives. "It's been getting worse and worse for a while now," she commented.

Besides a chronic lack of water, the south also suffers from a shortage of health staff and treatment supplies. Some 15,000 Malagasy in the Sampona area depend on Zafy's centre and she runs it pretty much on her own, a situation not uncommon in the region.

With the chances of good rain in the south of the huge Indian Ocean Island highly unlikely, she has little reason to believe things will get better anytime soon. "There are already so many cases that it is difficult to cope," she said, opening the clinic door to some 30 mothers and many more children waiting for screening and treatment that day.

Worried mothers of hungry children

"I am afraid for my children now because I can't feed them," Siza Matavy, who had brought her children for screening and was first in the queue, said. One child was already on a treatment called Plumpy'nut, a high-protein, high-energy, peanut-based paste provided to health and nutrition centres by the UN Children's Fund (UNICEF), and she hoped the other two might benefit too.

"We don't have much land that we can [cultivate]," Matavy said. Poor rains and more mouths to feed as her family expanded over the past years meant constant hunger, increasing under-nutrition, and rising worry about the future.

Sazy, 22, a single mother of three who had just walked seven kilometres to bring her children to the clinic, was next. Visibly emaciated, her 12-month-old daughter was referred to a hospital for admission and free treatment, "But it is impossible for me to go," she said.

Although transport for the 25km ride to the hospital would probably not cost more than the equivalent of US$1, and the hospital would reimburse her, she simply did not have the money to pay in the first place, and also could not leave her other two children unattended.

Sazy's desperation is echoed across southern Madagascar. At a health centre in Ifotaka, also in the Anosy region, another worried mother, Sitrapoe, told the media that she had sold her family's last asset, a goat, in December 2008 and now had nothing left. Her nine-month-old daughter was screened and found to be severely malnourished.

Running on empty

This depletion of wealth - no more than a wafer-thin buffer against abject poverty to begin with - and deepening vulnerability was common in the drought-affected south and, more so now than in previous years, was a major concern, said Zo Roabijaona, Director of the government's Early Warning System (SAP) in the region of Androy.

"Lack of rain is at the heart of the problem ... [but] the drought used to occur every 10 years, then every five; now we have drought every year," he said.

In the past, communities had managed to build up resilience and had been able to cope with an occasional bad harvest, but three consecutive years of poor rain meant their assets were gradually being sold off to feed families and had by now been depleted.

By December 2008 SAP had sounded the alarm, warning that some 400,000 people were living in food-insecure districts, so this was by no means a sudden surge, Roabijaona said - the problem had become chronic. What UNICEF had called a "silent emergency" - the nutrition crisis - had lingered, and had become progressively worse for some time now.

A nutrition survey in April by the Ministry of Health, the National Nutrition Office and UNICEF, in five districts of the Anosy and Androy regions, indicated that global acute malnutrition rates in children under the age of five had reached "serious" levels and were edging towards "critical".

According to UNICEF, over 100 health facilities were equipped to treat severely malnourished children, but with Madagascar's resources overstretched, its health services overwhelmed and the numbers of malnourished children climbing, this was not enough.

"Additional financial resources are absolutely critical for us to be able to address the threat that the current drought poses to the survival of children," said Bruno Maes, the UNICEF Representative in Madagascar.

Alarm over the worsening drought, the aftermath of two recent cyclones that brought widespread damage and flooding, and the ongoing political turmoil, prompted the humanitarian community in Madagascar to make a joint "Flash Appeal" for $36 million on 7 April, but barely $1 million in commitments has been made to date.

2.  Learn more about AVIA by viewing the introductory film below.


More description of the project, its budget, and giving options follow below.

3.  Make a Financial contribution to AVIA: GHM account #48IV-G0001. Review the options and use “Donate Now” button on this page, or send a check with designations as desired to our address below.

4.  Ask GHM for an AVIA speaker to present at your congregation or service organization.

Thank You

Global Health Ministries-AVIA
7831 Hickory Street NE
Minneapolis, MN  55432
Tel:  763-586-9590
Email: ghmoffice@cs.com
Website:  www.ghm.org

*Interview with Agnes Rasamimampianina, National Supervisor for Anosy Villages Integrated Actions Development Program. Click on black arrow point (bottom left) to play video.


I. Background

The Lutheran Church in Madagascar operates one of the largest health care systems supported by Global Health Ministries: 8 hospitals, 22 health centers and 14 clinics. GHM finances numerous project and all shipments of medical supplies and equipment to Madagascar in collaboration with SOA (Salfa Overseas Assistance), with total annual grants and allocations averaging nearly $130,000 over each of the last five years for such projects as Rural Clinic Support, SEFAM (School of Nursing), Continuing Education and Residencies, Pharmacotherapy services for the mentally ill, purchase of equipment and vehicles. Short-term missions for training and consultation in surgery and nursing curriculum development have also been financed in recent years. There is an unusually faithful, gifted and generous community of former Madagascar missionaries and their families who insure by their prayers and contributions that support for the Malagasy health ministry is sustained.

Since the fall of 2006 representatives of this community began discussions with Global Health Ministries about establishing a program in which the varied interests of donors might be met through contributions to a single program. Following board review in October, the Madagascar Village Development Project was approved to encompass our traditional health emphasis along with water projects, schools, nutrition, evangelists and economic development. Modeled after an existing SALFA project called "Mahafale Villages," the program appropriately broadens GHM's definition of "health" and creates new and exciting opportunities to collaborate with the ELCA and its on-going, parallel investment in this concept in Madagascar’s Tandroy region.

II. The Assessment Process

It was decided in the Spring of 2006 to send a survey team to Madagascar to work with SALFA to develop plans for the program in more detail. Tom Berkas, a former missionary to Madagascar was sent by GHM to Madagascar in July 2007 to do some initial interviews and help with planning for the subsequent September visit of the other 5-member volunteer assessment team. The GHM survey team visited Southeastern Madagascar in September 2007 and met with SALFA leadership to carefully develop an effective and accountable plan of implementation to address what we learned are the urgent needs of our Malagasy brothers and sisters in Christ. We worked together to organize 21 on-site visits and 49 interviews with key organizations involved with health, development and evangelism work (church programs, government programs, NGOs, etc) so that we may build on and integrate existing efforts in this area.

After the information was collected, the assessment team and local partners reviewed the findings of the assessment to facilitate the full participation of all parties concerned to help develop a “common road map”, and identify potential goals, objectives, timeline, and budget to achieve this in a collaborative, sustainable manner that builds on SALFA’s holistic community development in the southern region of Madagascar.

III. How Integrated Village Development Will Work

Briefly, the program will operate on a ten year time frame with a definition of "health" that goes far beyond its traditional preventative and curative dimensions to also include education and evangelism, sanitation and clean water, improved agricultural practices and small business development. A traditional public health outreach team will provide education, clinical services, referrals and immunizations, but will also conduct assessments of village "health" in the other areas mentioned and engage the involvement of other Church branches dealing with development and agriculture, as well as established local NGO's in health, nutrition, economic development and sanitation to address identified needs. Projects that may be aided through financial support will become proposed budget items for each year of the program.

The team will move from one village to the next within the Anosy region (North and West of Fort Dauphin) in this process, and will begin with the Toby Nenilava in Fort Dauphin and the Manantantely Bible School as both objects of the program's services (as model "villages") and as collaborator/assets in bringing their respective contributions to village health in the region. There is growing consensus among those involved in third world development initiatives that this "holistic" or "integrated" model of service is more effective than those that have a single focus. In addition, such a model provides donors a good way of satisfying a variety of charitable interests with a single gift. This, indeed, was part of the motivation for originally exploring the development of this approach.

The program began to be implemented in 2008. We would appreciate the opportunity to update you on this program periodically in the near future. It promises to be a dynamic and exciting initiative, and an addition we can celebrate to our ministry and its long history of mission in Madagascar. Please pray for God's blessings on this ministry, that it will be found faithful to our calling to proclaim Christ’s good news by continuing his healing ministry in the Anosy Region.

IV. Program Budget for 2009

Gifts made to AVIA will be applied where most needed to complete the annual budget. You may also select any of the budget line items below to designate your gift. Enter the designation in the "donate now" box when requested, or write AVIA followed by the designation on your check.

Donate Now

Donated to Date
Balance to Raise
I. Human Resources
1.1 Personnel
1.1.1 Regional Coordinator
1.1.2 National Supervisor
1.1.3 Nurse Supervisor
1.1.4 Extension Agent
1.1.5 Driver
1.2 Health Expenses
II. AVIA Office
2.1 Office furnishings
2.2 Electricity and Water
2.3 Office Supplies
2.4 Communications
3.1 Equipment
3.2 Medical Supplies
3.3 Medicines
4.1 Outreach
4.2 CARE Water Project
4.3 Toby Health Committee
5.1 Outreach
5.2 School Graduation Kits
5.3 Health expenses for students and families
5.3.1 Consultation
5.3.2 Dentistry
5.4 Bed nets
6.1 Project CURE
6.2 Recruitment of Primary Health Care team members
6.3 Sarisambo Village Survey
6.4 Primary Health Care at Sarisambo
6.4.1 Outreach
7.1 Training of Toby Shepherds and Manatantely Students and Spouses
7.2 Training of Manambaro Staff
8.1 Restoration of Public Health Center at Manambaro
8.2 Restoration of Toby Nenilava
8.2.1 Patient Housing
8.2.2 Latrines
8.3 Restoration of Manatantely Bible School
8.3.1 Restoration of Student Housing
8.3.2 Restoration of Director's Housing
9.1 Gas
9.2 Vehicle Maintenance
10.2 Construction Supervision (MSADDA)
10.2 Audit
Donated to Date: 12-10
Balance to Raise


Donate Now


V. Volunteer and Material Assistance Needs for 2009.

No volunteer or material assistance needs have been identified for 2009.

VI. Click on this line of text to watch a PowerPoint overview of the AVIA Integrated Village Development Program. A separate viewing page will open.