Antananarivo – After the Batsirai and Emnati cyclones hit Madagascar’s south-eastern Vatovavy region in February 2022, Toky Rabemaharo suddenly found himself and his community cut off from basic health services. “Being able to attend a health centre was an unattainable luxury for us,” he recalls.

The consequences were devastating: “I lost my wife, who was pregnant. Several other people in our community also died,” Rabemaharo says. “But today, thanks to mobile clinics that provide free care, we now have access to this luxury again.”

Among the regions hardest hit by the two cyclones, Vatovavy and neighbouring Fitovinany are rebuilding their health systems to better cope with these recurring extreme weather events. With funding from the Italian Ministry of Foreign Affairs and International Cooperation, the World Health Organization (WHO) has rehabilitated 13 of the 20 health centres that were completely or partially destroyed last year, seven of which are already operational.

« Health services were restored »

Since June 2022, 20 mobile clinics have also been making daily rounds in hard-to-reach areas. Thanks to funding from the United Nations Central Emergency Response Fund, the deployment of these mobile clinics has enabled approximately one million people to access curative health services in places where there were no longer functional health structures.

"The intervention of the mobile clinics has made a considerable contribution as they have enabled the restoration of health services, especially vaccination services, in basic health centres during the cyclone emergency, and have also covered areas that are usually inaccessible to health services, as well as isolated localities and villages," says Dr Yasmine Laetitia Lydie, Secretary General of Madagascar’s Ministry of Health.

« The mobile clinics have made it possible to strengthen epidemiological surveillance, the detection and reporting of cases of vaccine-preventable diseases.”

Across the country, the Batsirai and Emnati cyclones caused more than 300 deaths, destroyed or damaged more than 150 health structures, depriving 800,000 people of access to health care. In response, teams of two to three health professionals have been trained to travel with their medical equipment from village to village by car, motorbike, dugout canoe or on foot, depending on the accessibility of the localities. On site, they attend to patients in houses that are made available to them by villagers.

"The mobile clinics have made it possible to strengthen epidemiological surveillance, the detection and reporting of cases of vaccine-preventable diseases such as polio and measles, as well as cases of maternal death and gender-based violence,” adds Dr Lydie. “They have also facilitated the vaccination of many children who had missed routine immunizations because of the inaccessibility of health care after the cyclones."

Trained to manage emergencies

In preparation for Cyclone Freddy in February this year, 17 doctors and laboratory technicians from the Fitovinany, Vatovavy and Atsim Atsinanana regions, where cases of water-related diseases had been reported after the Batsirai and Emnati cyclones, were trained to better manage emergencies and blood transfusion services. In addition, people living in at-risk areas were invited to join eight shelter sites that were set up for their safety before the cyclone hit.

Drawing lessons from the 2022 cyclone season, during which stocks of medicines were destroyed, WHO also built a storage warehouse for medical materials in Manakara to serve the three regions of the greater south-east. The Organization has also provided health kits with medicines for malaria and diarrhoeal diseases, among others.

In addition, the Organisation helped deploy epidemiologists in each of the country's 23 regions and set up a system to collect data on diseases with epidemic potential. The digitisation of the disease reporting system has enabled real-time monitoring of the health situation, helping health authorities to respond more quickly.

Strides towards resilient health systems

"Through all of this support, we have made strides towards our objective of strengthening the country’s health system to make it resilient in cases of emergency, such as during cyclones,” says Dr Laurent Musango, WHO Representative in Madagascar. “Above all, we remain committed to improving primary health care structures that serve the local population."

This year, before Cyclone Freddy hit, teams of health workers were permanently present at each of the eight shelter sites to deal with any possible illness or epidemic. Despite the torrential rains and extensive flooding caused by the cyclone, no cases of diseases such as cholera were recorded in the country.