Improving maternal and child health in Madagascar

In Madagascar, there is a high rate of maternal mortality, which has remained at around 478 deaths for 100,000 live births for two decades, and neonatal mortality has been rising over the last five years (26 for 1,000 live births). Similarly, the malnutrition rate among the under-fives is one of the highest in the world: 53% suffer from stunted growth. Eight women currently die every day from childbirth. Several reasons can account for the fact that the country is lagging behind: political crises, inequalities between regions, low level of public budgets allocated to health (USD 20 per capita), barriers to healthcare, underuse of health services, and generally deficient management.

The support for maternal and child health project (PASMI) has been implemented since 2013 and aims to increase the availability, accessibility and quality of maternal and child health prevention and care services. In addition, this project aims to contribute to improving the availability of the drugs and equipment required for treatment. The project is based on two components for this purpose:

• Strengthen the quality of maternal and child health services by: Training for management and healthcare staff for obstetric care, family planning (fitting of IUDs, such as coils, or subcutaneous contraceptives), but also for support and supervision; Upgrading infrastructure and facilities; Awareness-raising for the population, mainly to change hygiene and nutrition habits, but also to change practices and promote, for example, prenatal consultations, even if there are no apparent complications.
• Improve the availability of drugs and health equipment by: Supplying these drugs and equipment for maternal and child health, such as syringes, dressing, compresses, etc.; Supporting the SALAMA central medical store for the storage and transport of drugs; Ensuring their quality.

A total of 303 community officers and 205 health staff have been trained under this project. In addition, several healthcare institutions have been supported for their refurbishment, equipment and training of their staff:

• 28 basic health centers (the smallest scale in Madagascar’s health system. There is one per district);
• 23 community general practitioners’ surgeries;
• 5 district or regional hospital centers.

The number of beneficiaries of this project is estimated at 778,958 people out of a population of 1.4 million, divided between the two municipalities covered by the operation (Itasy and Bongolava).