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Since 2010, AFD has been addressing numerous health problems in Madagascar by helping improve the system, with priority given to the most vulnerable populations: women and children, but also residents in the most remote areas.

Since the institutional crisis in 2009, there has been a sharp decline in a number of indicators: one of the highest malnutrition rates for the under 5-year-olds in the world, maternal mortality which has not changed for over 20 years, and child mortality, which has been on the increase for several years. In Madagascar, the health sector faces a number of difficulties which can account for the following facts:

  • Low quality of healthcare provision;
  • Unequal nationwide distribution;
  • Numerous barriers to access to healthcare, from a financial, geographical and cultural perspective;
  • Low level of public financing;
  • Inadequate management of the system.

The implementation of the Joint Health Sector Support Program (PACSS) started in October 2010. It aims to strengthen the availability, accessibility and quality of healthcare, by specifically targeting maternal health. The project also aims to improve the organization and management of the health system. The project comprises four actions to achieve this:

  • Strengthen health service provision, by improving its quality and availability, particularly in rural and remote areas via, for example, incentive measures;
  • Increase the use of services via pilot tests aiming at reducing the financial barriers to access to healthcare by creating systems to fully or partly cover costs;
  • Improve human resources management;
  • Build capacities for planning, budgeting, implementation, monitoring and follow-up.

Since the project was launched in 2010, it has allowed:

  • The allocation of additional financing for all the country’s health facilities at a time when there has been a sharp reduction in the State budget;
  • Doctors to set up practice in remote areas;
  • The preparation of a human resources development plan in the health sector;
  • The training of doctors (obstetrics) and nurses (anesthesia);
  • The financing of incentive measures for doctors and paramedics working in health facilities in remote areas;
  • The strengthening of regional laboratories.
Project start date
Project end date
7 years
Duration of funding
Financing tool
12 000 000
Financing amount
Ministry of Public Health