Madagascar: Our Impact

 {Photo Credit: Samy Rakotoniaina/MSH}A USAID Mikolo-supported Community Health Volunteer makes a home visit.Photo Credit: Samy Rakotoniaina/MSH

Madagascar experienced a surge in malaria cases in 2015, particularly in the southwestern regions, despite the Ministry of Public Health’s efforts to combat the disease. Interventions such as insecticide-treated bednet distributions and indoor spraying proved insufficient to deal with malaria in rural areas.

A Step Toward Universal Health Coverage in Madagascar Story and photos by Samy Rakotoniaina and Alison Baggen In rural Madagascar, people have limited access to savings programs or credit. This impacts community health when people cannot afford to pay for health care. In partnership with Catholic Relief Services (CRS), the USAID Mikolo Project promoted the creation of savings and internal lending communities (SILCs) at the Fokontany (village) level to encourage individuals and families to regularly save income and to provide them with access to credit on favorable terms.

{Photo credit:  Samy Rakotoniaina/MSH}Photo credit: Samy Rakotoniaina/MSH

Half of children under the age of five in Madagascar are chronically malnourished: 24% suffer from moderate malnutrition and 26% from severe malnutrition, according to the 2012-2013 Millennium Development Goal Survey. Children in rural areas suffer disproportionately because they are often cut off from resources and information, and are typically far from health centers that support family health. Community health volunteers (CHVs) like Grancie Cicie help close the gap.

{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.  

A mother asks a SILC group for a loan to pay for the treatment of her sick baby.

Throughout Madagascar most families struggle with financial instability. Eighty percent of families work as farmers generating seasonal, unreliable income. In southwestern Tulear II District, the arid climate puts even greater stress on a farmer’s income.

{Photo Credit: Samy Rakotoniaina}Lynda Razafiharilalao, a Malagasy community health volunteer, shows various modules of the mHealth app to a fellow volunteer.Photo Credit: Samy Rakotoniaina

In rural areas of Madagascar, community health volunteers (CHVs) are instrumental in improving maternal and child health services. Their activities include raising awareness on healthy behaviors, child growth monitoring, family planning counseling and services, and treatment of simple illnesses, such as pneumonia, diarrhea, and malaria. As CHVs are part of Madagascar’s health system, their activity reports feed into the national health information system.

{Photo Credit: MSH}Community members discuss plague response.Photo Credit: MSH

Bubonic plague is endemic in Madagascar. Typically, the country experiences 400 to 600 cases of the disease each year. However, in 2017 the plague also took the pneumonic form. Between August 1 and November 26 there were 2,417 confirmed, probable, and suspected cases of plague, according to the World Health Organization (WHO). More than three-quarters of the cases were clinically classified as pneumonic.

 {Photo courtesy of Sherri Haas}MSH staff at the Global Digital Health Forum 2017.Photo courtesy of Sherri Haas

Management Sciences for Health’s work across the digital health spectrum was shared at the Global Digital Health Forum 2017 (GDHF 2017) in Washington, D.C. December 4-6, 2017. The GDHF is the premier global conference on the use of digital technology for health in low- and middle-income countries. MSH is an Advisory Board Member of the Global Digital Health Network and contributed substantially to development of the conference. The theme this year was The Evolving Digital Health Landscape: Progress, Achievements, and Remaining Frontier.

{Photo Credit: Samy Rakotoniaina}Photo Credit: Samy Rakotoniaina

The entire population of Madagascar is at risk for malaria, and severe malaria is among the top five causes of death in the country, especially among young children, for whom the disease is a major killer of Malagasy children under five years of age. In this age group the national mortality rate is 7 percent, though this rate varies throughout Madagascar’s 22 regions; ranging from less than 1 percent in the central highlands to almost 11 percent in the coastal regions.

Fanamamy Retsilaky receives a prize from the Ministry of Public Health for his contribution to the fight against malaria.Photo Credit: Samy Rakotoniaina.

Madagascar has seen a strong upsurge in malaria cases over the past two years, particularly in the southwest, despite the Ministry of Public Health (MOPH)’s eradication efforts. Malaria-carrying mosquitoes seem almost invincible despite the use of insecticide-treated bed nets and indoor spraying. As a result, communities have become more engaged in prevention activities in order to protect themselves from the deadly disease.

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