The island of Madagascar is one of the poorest countries in the world. Located off the east coast of Africa, its climate regularly causes a wide range of natural disasters with devastating health consequences. A series of socio-political crises has also contributed to the Malagasy population’s deteriorating living conditions. As a result, the country faces a large number of healthcare challenges.
Maternal mortality and nutrition indicators have continued to stagnate over the past decade. Maternal mortality is 498/100,000, well above the Millennium Development Goal target of 149/100,000, and half of all children under five years of age are stunted.
PSI Madagascar was founded in 1998 to help priority populations and those with low income gain access to essential health products, services, and information. Since then, its activities have expanded to include programs focused on child survival, malaria, reproductive health and HIV.
PSI/Madagascar estimates that in 2016, its products and services helped avert 830,297 DALYs, including, by health area:
- 310,458 Malaria DALYs
- 42,522 HIV DALYs
- 299,061 FP DALYs
- 167,373 MNCH DALYs
- 10,790 WASH DALYs
PSI/Madagascar’s family planning programs also provided 945,116 couple-years of protection.
Although Madagascar is one of the few African countries to show a decline in the under-five mortality rate in recent years, that figure still remains high. Out of every 1,000 live births, 62 children will die before their fifth birthday. Malaria, diarrheal diseases, and respiratory infections claim the most lives, while chronic malnutrition affects large swathes of Madagascar’s population, leaving 47.3% of children stunted.
PSI Madagascar is working to improve the health of Malagasy children under five. The children’s health program aims to increase the availability and use of proven life-saving health and nutrition interventions. The coverage of these interventions has expanded to include the four main childhood diseases that are considered part of the integrated management of childhood illnesses package: pneumonia, diarrhea, malaria, and nutrition.
PSI Madagascar is a central partner in the operation of the fight against malaria in Madagascar. With the financial backing of “The President’s Malaria Initiative”, “Global Fund to Fight AIDS”, “Tuberculosis and Malaria and Unicef”, PSI contributes significantly to the reduction of malaria-related deaths among the general population and vulnerable groups (pregnant women and children under 5) by distributing, at no cost, long-lasting mosquito nets through mass campaigns, prenatal consultations, and services at public health centers. By assisting in the national effort to eliminate Malaria, PSI uses social marketing to advertise certain mosquito nets (Supermoustiquaire®) distributed by commercial retailers.
The program also contributes to the treatment of Malaria by improving community level access to quality ART (Artemisinin-Based Combination Therapies) for children under five and increasing the availability of Rapid Diagostics Tests at affordable prices for the vast majority of the population. These tests, solely administered by trained personnel, are reliable and fast.
Diarrhea remains the second-leading cause of infant mortality, and only about 38.9% of the Malagasy population have access to safe drinking water. To address this gap, PSI Madagascar markets a well known and convenient point-of-use water treatment product named Sûr’Eau. Between 2013 and 2017, more than 11 million bottles of Sûr’Eau and 200 million tablets of Sûr’Eau were sold – enough to treat approximately 20 billion liters of water. During 2016 to 2017, in the Atsinanana region, PSI gave 193 local health care centers and 101 primary schools WASH kits (2 containers of water, soap, and sȗr’eau tablets). Additionally, 383 teachers were trained on the implementation of school WASH programs. The Revolving Fund was established to address the supply of tablets in the region and develop the National Guide on “CSB Friends of WASH.”
PSI Madagascar began its diarrhea treatment program in 2009 with the Point-of-Use Water Disinfection and Zinc Treatment Project (POUZN). The project’s objectives were to increase access to pediatric zinc, in combination with oral rehydration therapy, for caregivers of children under five and to improve caregivers’ knowledge about the treatment. Two sets of diarrhea treatment kits (one strawberry-flavored and one orange-flavored) were distributed respectively to the private sector and to community health workers. Now funded by the U.S. Agency for International Development (USAID), these prepackaged diarrhea treatment kits are available at an affordable price and remain one of the most effective ways to treat diarrhea.
Pneumonia is the fourth leading cause of death and the number one disease prevalent in Malagasy children. In line with the Global Action Plan for the Prevention and Control of Pneumonia and with support from USAID, PSI Madagascar employs social and behavior change communications for the prevention and protection of pneumonia in children under five and distributes a prepackaged pneumonia treatment at the community level.
In Madagascar, 47.3% of children under ﬁve are stunted. As much as 50% percent of children who are six to 59 months old are anemic. Only 13% of children who are six to 23 months old receive a diverse, nutrient-rich diet. Malnourished children are very vulnerable to diseases such as malaria, diarrhea and pneumonia. Similarly, incorrect treatment of diarrhea increases the risk of developing a state of chronic malnutrition. Micronutrient interventions are ranked as one of the most cost-effective interventions in all health and development activities.
In February 2013, with UNICEF support, the National Nutrition Ofﬁce, the Ministry of Health and PSI launched an 18 month-long pilot project using social marketing to increase the consumption of micronutrient powder (MNP) among target populations. The project focused on household fortiﬁcation of complementary foods for children aged six to 23 months to tackle high levels of anemia and micronutrient deﬁciencies. Included were the promotion of optimal infant feeding practices with emphasis on food diversiﬁcation using innovative communication strategies and the distribution of a locally branded micronutrient powder called Zazatomady. This nutritional supplement had previously been proven to reduce anemia rates and other micronutrient deficiencies in infants and young children. The product was distributed through trained community health workers for a nominal cost of US$0.1 and social franchising channels in private clinics for the cost of US$0.5. The model was closely monitored for sustainability, so that the results can feed into the national scale-up plan. The integration of a nutrition intervention will also enable PSI Madagascar to address the four major childhood causes of death in the country.
In 2016, with USAID funding and in collaboration with the National Office of Nutrition and the Ministry of Public Health, PSI expanded Zazatomady’s household food fortification program to the Vakinankaratra region. From January to December 2017, more than 15,000 children used Zazatomady and 11,246 mothers received nutritional advice through home visits led by Community Agents.
To help reduce unwanted pregnancies, abortion, maternal mortality and infant mortality in Madagascar, PSI/Madagascar has implemented a program offering a wider range of high-quality modern contraceptive methods and services.
Products include Pilplan-branded oral contraceptives, Confiance-branded three-month injectables, and generic implants and intra-uterine devices (IUDs). Pilplan and Confiance are accessible through community health workers and pharmacies as well as through drug shops. The insertion of long-term methods is a service available through private providers. Since 2006, PSI/Madagascar has worked closely with the Ministry of Health and NGO partners such as Marie Stopes International and local NGO SALFA, to promote IUD and implant use. Selected Top Réseau providers received training in insertion of one or both of these methods. In 2008, PSI/Madagascar also received a multi-million dollar grant from a private foundation for the promotion of these methods. From 2008 to 2016, PSI/Madagascar distributed more than 184,212 IUDs and 36,747 implants.
Given the low prevalence of HIV in the general Malagasy population, PSI Madagascar direct HIV risk awareness efforts towards high-risk groups, including female sex workers and their clients, men who have sex with men, and sexually active youth aged 15 to 24.
PSI Madagascar aims to improve reproductive health behaviors among sexually active youth and most-at-risk groups through quality treatment of sexually transmitted infections, case management, voluntary counseling, and testing of HIV services. PSI/Madagascar offers a variety of interventions in the HIV prevention program, including:
- Peer education through high-risk group peer educators and youth peer educators
- Mobile video units (MVU) sessions to deliver health messages to rural and other priority communities in an entertaining and interactive format. Each MVU team consists oftwo or three well-trained young men and women, audio-visual equipment and an all-terrain vehicle.
- Prepackaged treatment kits to manage sexually transmitted infections
- U.S. Agency for International Development
- The Global Fund to Fight AIDS, Tuberculosis and Malaria
- Private foundations and companies
- Ministry of Public Health
- Ministry of Education
- Ministry of Water, Energy and Hydrocarbons Ministry of Youth and Sports
- Ministry of Social Protection of the Population and the Promotion of Women
- United Nations Children’s Fund (UNICEF)
- Roll Back Malaria
- National Office of Nutrition
- National AIDS Control Committee
- The University of Antananarivo
- SAF FJKM
- Country Coordinating Mechanism
- Peace Corps
- Diorano Wash
- Serasera Fanantenana
- Association of Doctors
- Association of Pharmacians
- Plate forma HINA
- Lessons Learned from the Introduction of the Levonorgestrel Intrauterine System (LNG-IUS) in Zambia and Madagascar
- Introduction de Mise a L’Echelle Sayana Press Madagascar
- Scaling Up Community-Based Access to DMPA-SC in Madagascar
- Factors Associated with Modern Contraceptive Use Among Women of Reproductive Age and Unmet Need in Madagascar
- Strategies, Approaches and Tools Used to Introduce Next Generation Injectable Contraceptives in Resource Poor Settings
This workshop set out to identify different service delivery models share strategies and best practice, explore how DMPA-SC is being used within the wider method mix, and ultimately develop action plans for strengthening high quality DMPA-SC programming and implementation in participants’ respective countries.
- Measuring Equity: Implementers’ Approach to Assessing How Well Social Franchising Reaches the Poor
- Fever Case Management Mystery Client Study Questionnaire
This mystery client study questionnaire is used to assess provider adherence to fever treatment algorithms for malaria test-negative clients. It has been refined through studies in multiple malaria-endemic countries and is available in English and French.
- Fever Case Management Client Exit Interviews
This client exit interview questionnaire is used to assess provider uptake of diagnostic testing and provider treatment practices stratified by reported testing status. It has been refined through studies in multiple malaria-endemic countries and is available in English and French.
- Sexual Practices of Men Who Have Sex with Men (MSM) in Madagascar (WEPED432)
MSM are a vulnerable population with a high prevalence of HIV (14.8%) and low HIV testing coverage (16.5%) in Madagascar. This study aims to examine barriers and motivation to HIV prevention, specifically on HIV testing, and condom and lubricant use among MSM in order to refine behavior change communication and programmatic strategies.
- Do anti‑malarials in Africa meet quality standards? The market penetration of non quality‑assured artemisinin combination therapy in eight African countries
This paper uses national and sub-national medicine outlet surveys conducted in eight study countries (Benin, Kinshasa and Kantanga [Democratic Republic of the Congo, DRC], Kenya, Madagascar, Nigeria, Tanzania, Uganda and Zambia) between 2009 and 2015 to describe the non-QAACT market and to document trends in availability and distribution of non-QAACT in the public and private sector.