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Testimony of Dr. Jocelyn, President of the AMC-MAD

A story of care and commitment in the heart of Madagascar

A facility supported by the community

In January 2006, thanks to the support of Santé Sud, I was able to realise an ambitious project: setting up a community medical practice in the rural locality of Mahalavaolona in the Bongolava region, where access to healthcare had been extremely limited until then. My wife and I began by converting a house made available to us by the community into a medical practice, to meet the immediate needs of the community. The local people soon saw the positive impact of our presence and rallied round to build a proper building, marking the birth of our first medical centre.

The development of the services and infrastructure of the Community Medical Practice

Over the years, our business has grown, leading to the need to expand our premises. In 2016, we extended the practice to meet growing demand and recruited a midwife to expand our gynaeco-obstetric services. Today, the practice continues to grow, with a new extension to further improve our infrastructure.

The support of partners such as Santé Sud, Aide Odontologique Internationale (AOI), DataSanté and the local authority has been crucial. Thanks to their funding, we have been able to modernise our premises by adding a sterilisation room, tiling the buildings, installing running water and creating areas dedicated to patients and carers. Community collaboration remains at the heart of every stage, with regular consultations with village notables to ensure that our actions are in line with local needs.

My commitment to the community extends beyond my medical practice. Although I live close to the tarmac road to give my children access to better schools, I visit the practice at least three times a week. The ties I’ve forged with the local population and the mutual trust we’ve built up mean that, even though I’ve suggested that another doctor should replace me so that I can be there more often, the local people have insisted that I stay.

Today, our practice serves around 8,000 people within a 25 km radius, with 200 outpatient consultations and 30 antenatal consultations every month. We continue to meet the challenges of rural healthcare, from common illnesses such as influenza, pneumonia and malaria to specific needs such as maternal health.

We have incorporated innovations to improve our services, such as obstetric ultrasound with VSCAN, which will be introduced in 2023, enabling us to refine diagnoses and offer better care to pregnant women. In addition, our collaboration with DataSanté, initiated in 2009, has enabled us to digitise our medical records for optimal patient follow-up.

Finally, our site is also a training ground for future doctors. We have recently welcomed trainees from Laval University in Canada, enriching our experience while reinforcing medical skills in rural areas.

AMC-MAD, the association of community doctors in Madagascar

Since 2018, I have been the president of the Association of Community Doctors of Madagascar (AMC-MAD). I recently began my second 5-year term.

Our association has 56 members, all of whom are or have been community general practitioners (MGCs) in rural areas.

The association’s main objective is to create a network of MGCs, to encourage the exchange of practices and to strengthen skills in order to offer ever-higher quality care to rural populations.

The aim is also to promote the importance of community medicine to institutional partners and the healthcare system, and to encourage the installation of new MGCs in villages that are too far from quality care.

In this way, the association aims to position itself as a specialist in the community dimension, which is essential for establishing strong links with communities.

For several months now, it has been a partner in the Bien Naître project, run by Santé Sud. This will enable AMC-MAD to develop its skills in project management and planning. It is also a great opportunity to strengthen its skills in administrative and financial practices, as well as in programming and implementing activities.

We need to defend community health in Madagascar

My story shows how collaboration and individual commitment can transform access to healthcare in rural areas.

Thanks to the initiative of Santé Sud, the support of DataSanté and the mobilisation of the community, a simple doctor’s surgery has become a real health centre.

It reminds us that community health is a collective responsibility: by pooling our efforts, we can make a real difference.

What’s more, my experience shows that practising community medicine as a private practice is possible and sustainable in rural areas of Madagascar. It’s a response to the medical deserts that exist in the most isolated regions of our country, and one that it would be very interesting to develop further in the coming years.