PSI

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.

1. 1. Source: “Primary health care: back to basics in Madagascar,” World Health Organization, June 2008. http://www.who.int/bulletin/volumes/86/6/08-010608/en/index.html

Health Areas

Child Survival, Diarrheal Disease, HIV, Malaria, Reproductive Health

Health Impact

PSI/Madagascar estimates that in 2008 its products and services helped avert:

• Total: 358,310
• HIV & TB: 28,629
• Reproductive Health: 118,402
• Malaria Control: 180,228
• Child Survival: 31,051

Health Interventions

• HIV Risk Perception
• Sex Workers
• HIV Counseling and Testing
• Men Who Have Sex with Men
• STI Treatment
• Male Condom
• Female Condom
• Basic HIV Care and Prevention Package
• Oral Contraception
• Intrauterine Device (IUD)

Improving Health in Madagascar

HIV

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:

• Peer education with SW and men who have sex with men (MSM) peer educators.
• Mobile Video Units (MVU) that target high-risk clients at truck stops, bush-taxi stations and mining towns.
• Ahy Ny Safidy (“It’s My Choice”) campaign with radio spots, a weekly radio show and TV talk shows to raise HIV awareness.
• Gasy Band Cool, an integrated HIV/STI prevention campaign that uses edutainment targeted at mobile male populations.
• STI prepackaged treatment kits to help manage urethritis (Cura-7) and genital ulcers (Genicure). The kits also contain easy-to-understand product information, partner notification cards, and condoms.
• Doctor training. Since 2002, PSI Madagascar has trained more than 2,000 private doctors and paramedics STI management.
• Condom distribution – more than 17 million branded and generic condoms in 2008.

Malaria

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.

Reproductive Health

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.

Safe Water

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.

Target Populations

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)

Latest News

Although PSI is a nonprofit organization, it continually measures its effect on diseases and evaluates outcomes from its programs. For example, PSI/Madagascar uses a metric called Disability Adjusted Life Year or DALY to measure health impact in the countries it serves. Monthly Health Impact Reports are available at www.psi.org/research/healthimpact.htm.

Resources

• Contact Info
• PSI/Madagascar web site
• Fact Sheet: PSI/Madagascar
• Franchised Youth Clinics Motivate Behavior Change in Madagascar