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woman cared for in delivery room, health
Better-equipped hospitals, improved access to healthcare facilities, better trained staff, the upcoming introduction of universal health insurance: since 2007, AFD has been supporting the Comorian authorities through the PASCO project, an ambitious program aimed at supporting the health sector.

The Comoros, a small Indian Ocean nation of islands between Madagascar and Mozambique is among 19 priority countries receiving French aid.  With 45% of the population of 800,000 below the poverty line, the archipelago’s health services are struggling to meet people’s needs.

Progress in the area of maternal health

France was among the major industrialized nations at the 2010 G8 Muskoka Summit to confirm its commitment to health care among women and children, for whom health indicators were the most alarming.

AFD has been supporting the Comoros’ efforts to shore up the health sector in particular, for the past 12 years, particularly via the PASCO project, which was rolled out over three phases.

The first, from 2007 to 2013, focused on improving basic services and financial access to obstetric care. The third-party payment system for obstetric care, introduced as a pilot project, was expanded during the second phasebetween 2013 and 2016. At the same time, training for healthcare professionals was improved, through the development of new programs for paramedical staff.

Improved regional coordination

Launched in 2016, the third phase sought to ensure the results obtained so far remain here to stay, and added new national priorities, such as providing care for non-communicable diseases, which are on the rise.

The goal is also to better coordinate regional healthcare, as was done for serious burn victims, who received urgent care at the Mayotte hospital thanks to medical evacuations.

The PASCO project has succeeded in adapting to the development of the country’s healthcare sector, while continuing to support the Ministry of Health on human resources issues, healthcare services and funding,” says Anne Roos-Weil, AFD project manager for health and social protection.  


The results have been promising. During the first two phases, five hospitals were renovated and equipped with additional medico-surgical equipment. Five medically equipped ambulances and maintenance kits were purchased. Access to healthcare for pregnant women improved significantly with the establishment of a subsidy system for obstetric care. 

These achievements have led to a significant rise in the number of visits to health facilities and marked improvements in maternal and child health indicators. Between 2007 and 2017, the infant mortality rate decreased from 93 to 69 for every 1,000 infants and maternal mortality rates fell by 20% between 2007 and 2015.

Still, “many challenges remain,” says Anne Roos-Weil. “While the Comoros have now committed to establishing universal health insurance, we must enhance public trust in the healthcare system and improve health services. The PASCO experience provided us with the perspective we need to accomplish this and forge ahead with the next phases of support in this sector.”

On the strength of the PASCO project and its achievements, France is moving to expand its health cooperation with the archipelago with the France-Comoros Development Plan, signed in July 2019

A few key figures from the PASCO project:

  • €26.6 million invested in the Comorian healthcare system since 2007; 
  • Over 40 health facilities improved;
  • 21,000 pregnant women benefited from facilitated access to medical care during their pregnancy thanks to new system of subsidized obstetric care;
  • Delivery rates in health facilities rose from 49% in 2012 to 76% in 2017; 
  • The infant and maternal mortality rates fell respectively by 26% and 20% between 2007 and 2015.

Further reading