Tsiraiky Abotono has never taken a vacation.
Day after day, for 15 years, he has kept watch over his village, Andravindahy, in southwest Madagascar. Abotono, 56, is one of the thousands of community health volunteers who provide basic health care services to the country’s rural areas. His absence would be missed. To reach a health center, people would have to walk for two hours across cactus fields under a burning sun. Like other community health volunteers, he provides short-term family planning methods, prenatal care, and diagnosis and treatment of simple cases of diarrhea, pneumonia, and malaria.