Madagascar

Madagascar has a precarious healthcare system which has been weakened by repeated crises. Life expectancy at birth is only 65 years for men and 68 for women. In high-risk areas, and especially in the south of the country in Androy Region, the mortality rate for children under five is 74 per 1,000 and only 1 % of the population has access to basic water and sanitation facilities.

For many years, Madagascar has been dealing with diseases with high epidemic potential, such as plague and measles. Since late 2022, the country has seen a resurgence of malaria and this was the primary reason for people seeking a consultation in Bekily and Amboasary districts in 2023. More recently, cholera and mpox have also put the country on alert.

Through the paediatric surgery programme, people with maxillofacial lesions, scarring resulting from burns and congenital defects are operated on and monitored by the Médecins du Monde teams. A mental health and psychosocial support (MHPSS) component was introduced in 2021 to help patients with social reintegration following surgery. In 2024, we performed visceral surgery on 43 children, treated 125 children during three reconstructive surgery missions and trained 26 healthcare workers in surgical procedures.

A cholera epidemic was declared on 2 February 2024 in the Comoros, a few hundred kilometres north-west of Madagascar. Médecins du Monde supported local communities and organisations in several regions to try and prevent the epidemic from spreading. Between March and May 2024, we prepared stocks of cholera kits for 3,000 people, trained 53 health workers and reached 705,850 people with awareness-raising activities.

In response to the mpox epidemic, Médecins du Monde started a project to support the Malagasy Ministry of Public Health in dealing with the potential spread of the epidemic within the country. We supported 228 healthcare facilities and 519 health workers, provided medical equipment and reached 630,000 people with awareness-raising activities.

The devastating impact of cyclones Batsirai and Emnati is still very noticeable in southern areas of Madagascar. Apart from the destruction of homes, crops and infrastructure, these disasters also caused heavy flooding leading to the spread of disease. In response to health and nutritional needs, Médecins du Monde helped to deliver two projects – a food security programme and an infrastructure rebuilding project.

In Madagascar, national programmes rarely respond to the health needs of sex workers, who are at greater risk of violence, sexually transmitted infections including HIV, and early and/or unintended pregnancies which may lead to unsafe abortions. Médecins du Monde is leading a project which combines a public health response and a human-rights-based community approach, together with advocacy work to influence national health policy. In 2024, 6,538 sex workers benefited from services provided by Médecins du Monde and 96 health workers were trained and educated about the specific rights and needs of sex workers.

In 2017, Médecins du Monde France launched a sexual and reproductive health programme which sought to reduce maternal mortality by improving prevention and management of unintended pregnancies. The programme adopted a rights-based approach and involved a community component, a medical component and an advocacy component which aimed to promote young people’s right to choose. In 2024, this programme supported 12 public health centres providing basic care, including four with maternity services. We also trained 80 local fokontany chiefs, 200 community workers and 9 religious leaders in sexual and reproductive health and rights and provided training for advocacy in this area.