Extra Mile Initiative (EMI)

Taking advantage of community structures, partnerships, and project resources already established under existing activities, EMI expanded upon activities aimed at increasing awareness of and access to FP services. Improvements in FP were pursued through a combination of community planning, identification of the economically poorest families not able to utilise existing FP, expansion of existing community-based distribution schemes, and information, education, and communication (IEC) materials.

EMI's core strategy involved embedding the project not only in the local health system and the communities it serves, but also in the local government. Specifically, CARE linked its work to the commune health centres; for example, CARE trained health staff how to use Cycle Beads (a tool to help those using the calendar or Standard Days method) and guided them in organising and implementing FP education and service provision in the communes. Joining together with the communities themselves, the EMI trained a system of citizen volunteers to provide their own villages with information, and, in the case of Community Health Agents (CHAs), contraceptives. Finally, Social Development Committees (SDCs) had been charged with supporting basic services such as health and education but - according to EMI organisers - lacked training, guidance, and/or funds to do so. Thus, CARE offered each SDC training by providing basic information on FP and maternal/child health; building capacity in such management and oversight actions as participatory, transparent supervision, tracking, monitoring, and reporting; and ensuring good governance through, by example, communicating responsibilities related to gender and human rights issues.

Reproductive Health, Population.

One of CARE Madagascar's largest project zones includes over 50 rural communes, many of them largely inaccessible due to mountainous terrain, lack of roads, and frequent flooding and cyclones. Rural residents must travel long distances by foot to reach rural health centres, where lack of resources, infrastructure, and personnel limit the availability of basic services. Not surprisingly, then, food insecurity and rates of malnutrition are high, and family planning indicators reflect this paucity of health information and services: a baseline survey conducted in the zone in 2003 found that 76% of births occur at less than the optimal spacing; over 20% of women of reproductive age (WRA) have no knowledge of any type of contraceptive method, and less than 30% of WRA have ever used any type of contraception. Approximately 40% of both men and women cited lack of information about family planning methods and services as a main reason for not using them.