USAID Mikolo Project Celebrates Five Years Strengthening Madagascar’s Health System

{Photo credit:  Samy Rakotoniaina/MSH}Madagascar Health Minister Mamy Lalatiana Andriamanarivo speaking at the USAID Mikolo end-of-project eventPhoto credit: Samy Rakotoniaina/MSH

The USAID Mikolo Project has ended after five years of strengthening community health in Madagascar, including improving quality of care and achieving significant gains in maternal and child health.

The project held its culminating event in the southwestern town of Tulear on May, 3 alongside representatives from the Ministry of Public Health (MOPH) and USAID. USAID Mikolo Project Director John Yanulis opened the ceremony, thanking USAID and the MOPH for their tireless collaboration and dedication to the project.  

“During the past five years, our interventions have touched nearly 5 million people in 3,584 Fokontany (villages), in eight regions of Madagascar,” Yanulis said. The project served those living more than five km from a health facility.

Health Minister Mamy Lalatiana Andriamanarivo recognized the “transformative legacy” of USAID Mikolo’s work in improving Madagascar’s health system. “The Mikolo Project is the one project of many in Madagascar that truly responded to the situation and should be the model for all future health projects,” he said.

[USAID Acting Mission Director Chris Milligan]{Photo credit:  Samy Rakotoniaina}USAID Acting Mission Director Chris MilliganPhoto credit: Samy Rakotoniaina

USAID Acting Mission Director Chris Milligan noted the contributions of USAID and the Mikolo Project to further strengthening Madagascar’s health system. "I'm thankful to Management Sciences for Health and its implementing partners for leaving a valuable legacy to the country's health system,” he said. “I also want to pay a tribute to devoted community health volunteers for their engagement. They are an integral part of the USAID Mikolo Project's success.”

The end-of-project event included a field visit to remote communities so attendees could see the work of community health volunteers (CHVs) supported by the project, distribute healthy household certificates, and commend the communities for their hard work in improving health.

[Health Minister  Mamy Lalatiana Andriamanarivo and USAID Mikolo Project Director John Yanulis (both on left) speak with community members during a field visit.]{Photo credit:  Samy Rakotoniaina}Health Minister Mamy Lalatiana Andriamanarivo and USAID Mikolo Project Director John Yanulis (both on left) speak with community members during a field visit.Photo credit: Samy Rakotoniaina


[MSH Health Programs Group Vice President Catharine Taylor (left) speaks with community members during a field visit. ]{Photo credit:  Samy Rakotoniaina}MSH Health Programs Group Vice President Catharine Taylor (left) speaks with community members during a field visit. Photo credit: Samy Rakotoniaina

Since 2013, USAID Mikolo, which was implemented by MSH with partners Action Socio-sanitaire Organisation Secours, Catholic Relief Services, Institut Technologique de l’Education et du Management, Dimagi, and Overseas Strategic Consulting, Ltd, has worked alongside the Government of Madagascar to strengthen the capacity of the national health system, particularly at the community level, to deliver high-quality health services along the continuum of care.

Over the life of the project, USAID Mikolo achieved significant gains in maternal and child health:

  • 2,987,746 children were registered for growth monitoring and promotion activities

  • 302,158 children under five with pneumonia were taken for appropriate care

  • Continuing users of family planning increased from 66,465 in 2014 to 150,557 in 2018

  • 130,250 children under five with diarrhea were treated with oral rehydration therapy by CHVs

  • The treatment rate for confirmed malaria cases in children under five treated with artemisinin-based combination therapy (ACT) by CHVs increased from 58% in 2014 to 93% in 2018

  • ACT stock-outs decreased from 20% in 2014 to 5% in 2018

  • 118,664 women were referred by CHVs for antenatal care

  • Facility-level deliveries increased from 50,192 in 2015 to 115,148 in 2017

Additionally, the project, in partnership with the MOPH, introduced and scaled up innovative interventions, tools, and approaches, such as a mobile health application to improve the quality of CHV service delivery and reporting; a CHV peer supervision program to improve quality of care, reduce the human resources gap, and improve CHV motivation; a community-based commodity logistics management system, an epidemiological surveillance approach that incorporates community-level data to more rapidly respond to malaria outbreaks; Savings and Internal Lending Communities to increase access to credit and  economic empowerment of community members; and a series of approaches to assure, improve, and sustain the quality of community-based health services delivered by CHVs.

Overall, the gains made over the past five years have helped to build a stronger and more sustainable health system that is responsive to the needs of Madagascar’s population. Through close collaboration and coordination with the MOPH, the project is able to effectively and efficiently transfer ownership of the activities, programs, tools, and materials over to the Government of Madagascar and its partners.

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