The island nation of Madagascar, off the east coast of Africa, may be best known as the world’s largest vanilla exporter and a prime location for eco-tourists. But in spite of its rich resources, Madagascar’s economy is still largely colonial, and very little industry and infrastructure exists within the country. As a result, Madagascar is financially challenged. More than 70% of its population is malnourished and only a little more than half has ready access to primary health care. 1
PSI/Madagascar was founded in 1998 to help vulnerable and low-income people gain access to essential health products, services and information. Since then, its activities have expanded to include programs in HIV/AIDS, malaria, reproductive health and child survival.
Child Survival, Diarrheal Disease, HIV, Malaria, Reproductive Health
PSI/Madagascar estimates that in 2008 its products and services helped avert:
Given a low prevalence of HIV in general public, PSI/Madagascar specifically targets high-risk groups. These include sex workers (SW) and their clients, mobile male populations and sexually active youth aged 15 to 24.
In 2001, PSI/Madagascar launched its flagship franchised network of private clinics branded Top Réseau with the support of the Bill & Melinda Gates Foundation. The project aims to improve reproductive health behaviors among sexually active youth and most-at-risk groups through quality sexually transmitted infections (STIs) case management and the promotion of consistent condom use. In 2006, Top Réseau began offering voluntary counseling and testing (VCT) services, and by 2008 received more than 6,000 VCT clients.
PSI/Madagascar offers a wide range of programs, including:
The Global Fund and USAID/PMI helps fund PSI/Madagascar’s distribution of long-lasting insecticide treated nets (LLINs) at heavily subsidized prices through community sales agents and the private sector. PSI/Madagascar also coordinates with the RBM partnership to coordinate free LLINs distribution campaigns. As a result of these joint efforts, LLIN coverage has dramatically increased in Madagascar. Between 2004 and 2008, ownership of LLINs has increased from 20% to 85%. Malaria-related mortality and morbidity have decreased sharply also.
In October 2008, PSI/Madagascar worked in close collaboration with the Ministry of Health and other stakeholders involved in the fight against malaria to launch Actipal, an affordable artesunate combination therapy (ACT) for children under 5. PSI/Madagascar received funding from UNITAID, the Global Fund and USAID to increase access to high-quality yet affordable ACTs when resistance to chloroquine has reached high levels in Madagascar.
Through its social marketing activities, PSI/Madagascar is responsible for approximately 50% of current modern contraceptive use in Madagascar. Products include Protector Plus condoms, Pilplan low-dose combined contraceptive pills and Confiance three-month injectables. These products are highly subsidized to ensure affordability to low-income clients.
PSI/Madagascar has worked closely since 2006 with the MOHFP and NGO partners (MSI, SALFA) to re-introduce the IUD and to promote Implanon inserts. Selected Top Réseau providers received training in one or both of these long-term methods. In 2008 PSI received a multi-million dollar grant from a private foundation earmarked for the promotion of these methods. In 2008 alone, trained providers inserted more than 2,800 IUDs and 450 Implanon inserts.
More than 60% of Madagascar’s population lack access to potable water, putting them at significant risk of diarrheal disease, including cholera. Nearly annual cyclones worsen risk, and diarrheal diseases are among the top three causes of morbidity and mortality among children.
In response, PSI/Madagascar collaborate with CARE and the U.S. Centers for Disease Control and Prevention to produce, market and distribute a sodium hypochlorite solution (Sûr'Eau) for point-of-use treatment of drinking water. USAID and UNICEF funded national expansion of the program, and more than 1.2 million bottles of Sûr'Eau were sold in 2008 – enough to treat approximately 2.4 billion liters of water.
Men and women of reproductive age with special emphasis on high-risk groups such as commercial sex workers, their clients, and sexually active high-risk youth (HIV/AIDS); women of reproductive age (family planning); households with children under five and/or pregnant women (malaria and safe water)