Madagascar

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. 

Child Health

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.

Malaria

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.

Diarrheal Disease

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

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.

Malnutrition

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.

Contraception

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.

HIV/AIDS

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

Donors

• U.S. Agency for International Development
• The Global Fund to Fight AIDS, Tuberculosis and Malaria
• Private foundations and companies

Partners

• 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
• MSH/MIKOLO
• JSI/MAHEFA
• HNI
• SAF FJKM
• SALFA
• FAA/MCDI
• INSPC
• Country Coordinating Mechanism
• Peace Corps
• ENDAOI
• Diorano Wash
• MCSP
• Serasera Fanantenana
• COMAGO
• Association of Doctors
• Association of Pharmacians
• Plate forma HINA
• BPCN
• PHE
• CRS