Young people need strong support and guidance during the period of change that is adolescence. This support can come from family, school, and healthcare providers.
However, the availability of this support does not always equate to access.
Youth in Madagascar commonly don’t know where to find health services. Some are afraid or ashamed to approach a healthcare provider; they fear that their problems won’t be taken seriously, or that the healthcare provider will reprimand them. Youth also face real and perceived shame and judgement from their communities. As a middle school student confided, "If we go to a health center, the community immediately thinks we are pregnant."
These are obstacles that two NGOs — Projet Jeune Leader (PJL) and FISA — have been working to overcome.
Since 2013, when PJL Educators first started providing knowledge, support, and advice to middle school students in Fianarantsoa, they have drawn upon the expertise of partners who are familiar with the unique needs of young adolescents.
"If we go to a health center, the community immediately thinks we are pregnant." - Middle school student
Among these close partners is FISA Madagasikara. This Malagasy organization offers health care services for all ages, from general consultation and care to sexual and reproductive health services, including family planning.
FISA Madagasikara has been an important partner to PJL's comprehensive sexuality education program. With 50 years of experience in sexual and reproductive health, FISA has improved access to health information and services, including family planning, in Madagascar by bringing their services to remote regions and towns, increasing the number of health centers, and partnering with a wide range of other organizations.
At PJL, we have collaborated with FISA to provide advice and care to young adolescents through a referral ticket system. In a confidential counseling session with a PJL Educator, a student can receive a referral to a partner health center – including FISA – where they can access free or low-cost care. We also conduct a special workshop for students at the end of middle school, led by a PJL Educator as well as a healthcare provider. FISA staff in Fianarantsoa have been involved in this program for over 9 years.
As Ms. Edmée from FISA Fianarantsoa — one of PJL's first and closest partners — shares, "[The partnership between PJL and FISA] has helped many adolescents access healthcare without fear because the guidance from the PJL Educator builds their confidence. The ability of a healthcare provider to provide youth-friendly care is also important, because for example even if the PJL Educator doesn’t come [to the health center] with the student, there is already a referral ticket [to youth-friendly services] that has built trust between the PJL Educator, FISA, and the student."
This demonstrates the importance of building a comprehensive network of services for youth.
Education alone, or medical services alone, are not enough to fully meet the needs of youth. When young people have questions, fears, illnesses, or concerns, they need both knowledge and guidance from trusted educators, AND caring healthcare providers who can prioritize their care. It is only through comprehensive and integrated services that young people will fully realize their right to sexual and reproductive health; a right that is guaranteed to every individual — including youth — in Madagascar since January 2018 through Law 2017-043.
There is still a long way to go to meet young people’s demand for these services, but we are already starting to see the impact of our efforts. A middle school student wrote to us: "I will not hesitate to approach a health worker and I will not be ashamed. I have to be confident because that’s what we learned.” Another middle school student shared, "I used to be afraid to go to the health center, but now that the PJL Educator is here, I am not afraid anymore."
Ms. Edmée says it best: “PJL and FISA’s work is complementary and ongoing. If we only provide health services without education, young people won’t know where to go. The challenges will persist.” Together, PJL and FISA are working towards a future in which all young people have a trusted educator providing comprehensive sexuality education, and in which all health centers provide inclusive, youth-friendly support and care. “Achieving a goal is not so difficult when two different entities work together,” emphasizes Ms. Edmée.
