Blue Ventures has become a leader in the population, health, and environment (PHE) community through its work with the remote, semi-nomadic Vezo people living along Madagascar’s southwestern coast. In a new short documentary, The Freedom to Choose: Empowering Communities to Live With the Sea, Blue Ventures describes how their approach has helped the Vezo respond to the combined challenges of resource scarcity, poor reproductive health, and unsustainable livelihoods.

The Vezo “depend entirely on the marine environment for food and income,” says Vik Mohan, Blue Ventures’ medical director and the film’s narrator – over 90 percent of adults are fishermen. Meanwhile, health services are sparse at best. Going to a clinic could mean walking as many as 50 kilometers (31 miles), leaving women without regular access to family planning and other essential services.

When Blue Ventures first arrived in the region, the population was set to double in 10 to 15 years, even as maternal and infant mortality rates were “extremely high.” Under pressure from this rapid population growth and a changing climate, essential fish stocks were degraded – and the lack of any real alternative livelihood in the region only exacerbated the situation, says Mohan.

Initially, Blue Ventures’ goals were exclusively environmental: to establish a locally-managed marine area, called Velondriake. But in “direct response” to community demand, Mohan says, they soon added voluntary family planning services. Importantly, Blue Ventures didn’t just support multiple interventions, they integrated their outreach efforts, so community members coming to learn about fishing would learn about family planning, and vice versa.

Although not mentioned in the film, Blue Ventures also found itself in a disaster relief role. Cyclone Haruna, which struck last February, was the biggest storm to hit Madagascar in decades and Blue Ventures was able to deliver emergency aid when no one else could. In an interview with ECSP last year, Mohan said the experience taught the group the value of building trust and developing relationships with vulnerable communities, both of which become critical when disaster strikes.

More Than the Sum of Its Parts

This holistic approach has earned Blue Ventures strong buy-in from the communities they serve, and that in turn is bringing real results. In just six years, contraceptive use among women in Velondriake increased more than five-fold, and the fertility rate declined by a third, according to the film. On the environmental side, families have begun farming seaweed and sea cucumber, giving fish stocks a chance to replenish, and Blue Ventures has made a point of including women in deciding when to close areas to fishing – a traditionally male-dominated realm.

Building on success in the Velondriake area, Blue Ventures has been bringing their services to other communities in the region. The question of how to expand an approach that is so community-centric is a pressing one in the PHE community, and while success stories exist, they aren’t as widespread as many would like. Blue Ventures’ growth could help build an evidence base for PHE integration that can convince donors – often driven by more siloed interests – to fund more cross-sectoral programming.

As Blue Ventures shows, cross-cutting PHE projects are more than the sum of their parts. A holistic approach to development builds buy-in, trust, and a powerful network that can be leveraged to support communities when and where they need it most.