According to the World Health Organization (WHO), more than 1.6 billion people have no access to basic care due to crises and weak health services. That is approximately 22 percent of the global population. Many crises can reduce access to basic care including drought, famine, conflict and population displacement.

Marisa Peters ’20 went to Andasibe, Madigascar on a fellowship and worked in an area that could be classified as a fragile and vulnerable setting. Peters said that most of the houses were more of makeshift shacks and everything was very underdeveloped. One of the biggest problems residents had was getting around because of mountainous terrain and the roadways were not well made.

Most people did not have access to public transportation, so it would take them two to three hours to reach the medical clinic from the village. Due to this long trek, people would put off going to the clinic unless absolutely necessary, which in some cases could be too late.

The majority of preventable maternal deaths and deaths in children under five occur in fragile settings, according to the International Institute for Management Development. Peters witnessed many children suffering from malnutrition, recounting that one of the children brought to the clinic appeared to be a tiny two to three-month-old, but actually was eight months old.

The WHO plans to continue working in countries with fragile settings to strengthen health systems. They plan to better preparing their healthcare providers to detect and respond to outbreaks, provide immunizations, and other high-quality health services. Mobile health may make healthcare more accessible through mobile devices such as phones and tablets. They are looking to make this a worldwide project as they have already had some successes in a few countries.

Peters discussed a medical literacy program which entails educating the community about nutrition and providing supplies and vaccinations. The student and a translator would go door to door and talk with residents about nutrition and various illnesses such as heart disease, diabetes, and the common cold.

The village had other programs in place to help improve health, including one to increase water sanitation by building water pumps to reduce the number of cases of water-borne diseases.