HIV testing rate (percentage who know their status)
proportion of antiretroviral need met
maternal deaths per 100,000 live births
Madagascar stands out in Africa due to its particularly restrictive abortion law and a high level of resistance to any relaxation of the law. Nevertheless, many abortions are regularly performed illegally by many women.
Madagascar, a large'scale humanitarian project
Pregnancy and births : alarming indicators
On the island of Madagascar the healthcare indicators are alarming, especially those relating to sexual and reproductive health (SRH). The maternal mortality rate is 426 per 100,000, 46% of births are attended by qualified healthcare staff, 39% of births take place at a healthcare facility, attendance at antenatal appointments is 56.7 %, antitetanus coverage for pregnant women is 47.9%, use of modern contraceptive methods among sexually active 15-19-year-olds is 38% and 8.3% of obstetric fistulas are in women under the age of 20. Complications of abortion include haemorrhages, failure to expel the foetus, retention of the placenta, uterine rupture and infections, and are the second leading cause of maternal mortality in Madagascar (16% of maternal deaths).
36% of women have had a live birth before the age of 18 (Madagascar ranks 13th in the world)
Several diseases with epidemic potential are found in Madagascar. In particular, plague is prevalent – Madagascar is the second most affected country after the Democratic Republic of Congo. The disease is endemic and has intensified since the 1990s, manifesting itself in three different forms – bubonic, pneumonic, and septicaemic. There is an average of 1,200 suspected cases per year, of which 300 are confirmed. The mortality rates are around 8% for bubonic plague and 16% for the pneumonic form. In late 2017 and early 2018 a major outbreak of pneumonic plague affected most of the country, especially the capital, Antananarivo, and the port city of Toamasina. In 2018 and 2019 the country experienced a measles outbreak which resulted in over 1,000 deaths, mainly in children under the age of five.
Public health budget reduced against the vital need for humanitarian assistance
Malagasy health policy and the country’s healthcare system are based on a health budget which represented 7% of government spending in 2018. Just 3.3% of GDP is allocated to health. Healthcare facilities and equipment are deteriorating, the lack of forecasting of human resources requirements means the latest budget allocations are inadequate. In addition, 54.8% of the population lives more than 5km from the nearest medical facilities.
Our activities in Madagascar
In 2017, Médecins du Monde France, a humanitarian organisation working in healthcare, launched a sexual and reproductive health (SRH) programme. The aim of the programme is to help to reduce maternal mortality and morbidity associated with the lack of access to good SRH services, especially among 10-24-year-olds. We work by strengthening the role of civil society and public institutions active in the field of sexual and reproductive health in Antananarivo.
This project aims to improve the prevention and management of unintended pregnancies, taking a rights-based approach and involving three main elements:
- a community element, in partnership with local organisations, which aims to strengthen the capacity of young people to take control of their own health;
- a medical element, which aims to improve the accessibility and quality of SRH services tailored to meet the needs of teenagers and young people at seven Basic Health Centres;
- an advocacy element, which aims to promote the right to choose for teenagers and young people in relation to SRH.
Did you know?
The community element of Médecins du Monde’s sexual and reproductive health programme is being implemented in partnership with three national youth organisations (Tanora IRAI, Tanora GARAN’TEEN and Tandem) and one national NGO (ASOS).
Through Operation Sourire, children with maxillofacial lesions, scarring resulting from burns or congenital defects of the autonomic nervous system are operated on and monitored by MdM teams in Madagascar.
These surgical campaigns take place four or five times a year in Antananarivo and around the country.
Médecins du Monde was one of the first humanitarian health organisations to work on HIV in Madagascar, beginning in 1994. In 2017, informed by its experiences in other countries, MdM France directed its strategy towards strengthening projects run by local organisations. The aim was to combat HIV by establishing a ‘Community monitoring centre on access to HIV treatment for key populations’.
The monitoring centre operated until 2019 in the five largest cities in Madagascar (Antananarivo, Mahajanga, Toamasina, Antsiranana and Toliara) and collected over 15,000 questionnaires.
These were analysed to identify the main barriers to access to care for patients infected with HIV. These barriers included misconceptions, the stigma around HIV/AIDS and a lack of training for healthcare staff. The conclusions of the analysis were shared with actors involved in tackling AIDS at the national and international levels and should help to guide policy-making and funding decisions in this area.
In addition, Médecins de Monde’s partner organisations (AFSA, Ainga Aides, Mad’Aids and Solidarité des LGBT) received capacity-building support in project management, advocacy and data collection and analysis.
Apart from the regular healthcare programmes, Médecins du Monde also remains alert to respond to emergencies linked to adverse weather events, especially cyclones, as well as disease outbreaks and conflicts which may potentially lead to violence. Thus in 2019 we supported the Ministry of Health during the deadly measles epidemic, mainly by organising training on managing complications for health centre staff in several regions of Madagascar.
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