Period Poverty in MadagascarOn May 28, 2019, Madagascar celebrated Menstrual Hygiene Day and ran a menstrual health workshop to formally begin combating period poverty.

What is Period Poverty?

The difficulty of women living in poverty, or on a very low income, face when trying to access menstrual products is referred to as period poverty. The cost of menstrual products and the financial burden is also factored into the definition. Period poverty affects women around the globe and can impact things like a woman’s ability to attend school or work. According to the American Medical Women’s Association, due to a lack of education about menstruation, two out of three girls in other countries may avoid going to school.

How Periods and Poverty Connect

According to the African Development Fund, ”the absence of economic infrastructure,” including water, sanitation, education and basic health services, among others are closely connected to poverty in Madagascar, specifically in rural areas. A 2019 helpdesk report by Kerina Tull of the University of Leeds Nuffield Centre for International Health and Development reported that menstrual hygiene management includes women’s ability to:

  • Change sanitary products as often as needed;
  • Access adequate disposal facilities as well as the necessary sanitation, such as soap and clean water; and
  • Find information, without fear or discomfort, about how to manage their menstruation.

In Madagascar, poverty can be a barrier to accessing both sanitation and education. UNICEF reported that only about 10% of people in Madagascar uses basic sanitation facilities. Of the rural population, UNICEF reported that only 36% can access “improved water sources.” For every three children in Madagascar, UNICEF reported that only one completes primary education, and families pay for 40% of the continuing costs of education.

Combating Period Poverty in Madagascar

While some girls can begin menstruating at the age of 8, schools in southeast Madagascar often don’t teach about menstruation until students are 13 years old. This education can come too late for some girls.

In March 2019, SEED Madagascar worked with Mpanazava Eto Madagasikara (MEM) to celebrate Menstrual Hygiene Day and run a workshop on menstruation. Around 50 women between the ages of 10 and 23 in Fort Dauphin, Madagascar talked with SEED staff about the reproductive system and puberty. The workshop ran for three hours. It addressed topics like pregnancy, while also debunking some myths about menstruation, such as common beliefs about the age everyone gets their period.

When asked about products used during menstruation, most participants spoke about how “single-use” items such as tampons were unaffordable and that they often used square pieces of cloth or “reusable pads.” Participants were encouraged to share what they had learned at the workshop with other members of the community. The workshop was referred to as a “first step” to combating period poverty by improving the information available to women in Madagascar about their period.

Period poverty is an issue that impacts women globally. In Madagascar, poverty can make it harder for women to access necessary sanitation as well as education about menstruation. The workshop SEED Madagascar and MEM ran in 2019 are a hopeful step toward combating period poverty in Madagascar.

– Melody Kazel
Photo: Flickr

Homelessness in MadagascarMadagascar is an island of abundant resources and wildlife, yet remains one of the poorest countries in the world. The African country experiences high rates of poverty and vulnerability since it gained independence in 1960. It possesses a complex history of poor leadership, inadequate infrastructure and economic colonialism that continues to negatively affect its population today, specifically resulting in an issue with homelessness in Madagascar.

The Causes of Homelessness

Its geographical location off the Southern African coast makes Madagascar susceptible to natural disasters, such as severe hurricanes, floods and droughts. Unpredictable weather persists, not only destroying homes but also leading to detrimental effects on food supply, health pandemics and overall quality of life. More than 50 natural disasters have impacted Madagascar’s homelessness rate in the last 35 years.

For example, in 2019, a cyclone killed two people and left 1,400 people homeless. Two years prior, an even more powerful storm left 247,000 people without shelter. However, some villages like Antanandava rallied together to rebuild as a community.

Chaotic weather patterns also impact the key drivers of economic growth namely, agriculture, fishing and forestry. While agriculture can sometimes reap the rewards of extreme weather, like heavy rain on crops, droughts on the other hand dry up rice plants, leaving workers with a much lower income. According to a 2017 study, this inconsistent economic growth creates patterns of financial insecurity and failure to diminish the homeless population in rural communities.

Unequal Housing

While some are able to rebuild their homes after a disaster, others are left destitute. More than 65% of the population lives in rural areas, where poverty is significantly higher than in urban regions and where most of the working-age populace resides. Homes in rural communities are mostly built of local materials such as cheap wood or mud, leaving thousands of individuals homeless after one intensive environmental hazard. Southern and coastal areas are usually the first to get hit by a weather crisis, damaging homes instantaneously. This creates a widespread housing shortage and results in the displacement of many Malagasy people.

Solutions

In an effort to fight this consequence of poverty, homelessness in Madagascar has become a priority in the eyes of the World Bank Group which partners with other organizations to offer aid. The organization currently invests a combined $1.28 billion across all 15 of its programs working to reform multiple sectors of Madagascar, including energy, education and health crises. The WBG, in collaboration with the Country Partnership Framework, has created economic objectives to accomplish in its plan for 2017-2021. Some initiatives include strengthening households living in poverty and upgrading means of transportation and energy. In 2019, over 783,000 Malagasy families’ incomes stabilized, allowing them to start businesses and secure their residences.

In addition, aid from UNDP began in 2015 and the long-term goals include ending all poverty, generating universal access to clean water and nurturing sustainable communities. Achieving these goals will ensure that families will gain new homes of their own and be able to maintain them.

Homelessness in Madagascar is a complex problem with many economic and domestic factors contributing to the issue. It continues to be an urgent threat to the lives of its citizens, creating harmful short- and long-term effects. However, with the improvements made thus far, the future for Madagascar is hopeful.

– Radley Tan
Photo: Flickr

PIVOT Data in Madagascar Is Improving HealthcareBABSON PARK, FL Madagascar has one of the poorest healthcare systems in the world, spending $14 USD on healthcare per capita. This is well below the average of $94 USD per capita spending on healthcare in the Sub-Saharan region. The PIVOT organization has taken a data focussed approach to help improve the healthcare systems in Madagascar.

After working in Rwanda with Partners In Health, PIVOT founder Matt Bond saw the importance of statistical analysis when it comes to long term change within a healthcare system. Bond aspires to have a lasting impact on Madagascar’s health system. In addition, he develops interventions that can be implemented across the world to help improve health conditions. With the support of the Harvard Medical School, PIVOT focusses its efforts towards interventions that have significant statistical results within Madagascar’s medical system.

Madagascar’s Healthcare Challenges

PIVOT has established its goal to improve accessibility to healthcare facilities. Around 60% of the population lives more than three miles away from a medical facility. Additionally, many communities are unable to access medical treatments due to the uneven distribution of medical professionals and supplies. This issue is highlighted with the current COVID-19 pandemic. As of May 19, 2020 Madagascar has confirmed 322 cases of COVID-19. Madagascar has a Healthcare Access and Quality index rating of 29.6 out of 100This is well below the sub-Saharan average rating of 40 out of 100. A healthcare system with such a low rating may struggle with the increased demand for medical attention. Madagascar’s government has set a strict curfew in order to reduce the spread of COVID-19, however, the healthcare system will still be challenged by the pandemic.

The Data

The initial studies conducted by PIVOT began in 2014, with 8000 subjects to be followed up with every 2 years. The study collected data on over 840 variables, from basic demographics to access to healthcare. The long term studies aim to identify changes in mortality rates and access to medical resources. In addition, this extensive study required collaboration with the National Institute of Statistics of Madagascar. The results indicated maternal mortality rates to be one in 14, twice the estimated previous national Madagascar health predictions.

Astrophysicist Jim Herrnstein, helped Bond found PIVOT and their data focussed approach to healthcare in Madagascar. Herrnstein believes that the scientific method used to back PIVOT’s interventions highlights which projects are beneficial to the overall health of Madagascar’s population. The data suggest that single-layered interventions such as providing mosquito nets are important. However, it does not offer widespread and long term solutions. Initiatives such as hiring and training healthcare workers have decreased maternal mortality rates and increased delivery care accessibility by 20%.

The data collected is not just based on Madagascar’s population; PIVOT also researches and tracks environmental factors that can affect health and well-being. These studies focus on the environmental factors that contribute to malaria rates, childhood diarrhea and access to healthcare. The environmental terrain is an obstacle itself when it comes to healthcare access. Between 60-70% of Madagascar’s people will travel between three to six miles by foot to reach medical facilities. Additionally, only 34% of the population has access to clean water, which contributes to the rates of communicable diseases.

The Results

Within the first two years of operation, PIVOT has made a substantial impact on Madagascar’s healthcare system. The data suggests that access to healthcare for fever-related symptoms has increased by over 25 percent in areas where PIVOT has established interventions. The use of maternal health services has increased by 63 percent, and the overall use of healthcare facilities by Madagascar’s population has tripled.

PIVOT has proven the importance of using data to support healthcare interventions in Madagascar. The organization’s scientific approach has allowed them to target specific elements within Madagascar’s healthcare system to most effectively improve the medical environment. PIVOT continues to track the population’s well-being and use of medical facilities to ensure their programs continue to benefit the health of Madagascar’s population. 

Laura Embry

Photo: Flickr

poverty in MadagascarMadagascar is the fifth-largest island in the world and boasts an array of natural resources. Despite this, poverty in Madagascar ranks among the highest in the world. Due to an upturn in the economy, things may be looking up, but there is still much work to be done before conditions truly improve. Here are 10 facts about poverty in Madagascar.

10 Facts About Poverty in Madagascar

  1. The majority of people in Madagascar live in extreme poverty. Currently, 75% of the population of Madagascar lives on less than $1.90 per day. This means that three-fourths of the 25.6 million inhabitants of Madagascar live beneath the international poverty line as defined by the World Bank.
  2. Children are among the hardest hit by poverty in Madagascar. More than 80% of those under 18 in Madagascar live in extreme poverty. Additionally, UNICEF declares that chronic malnutrition affects almost half of children under five, with stunted growth being a major concern.
  3. Extreme poverty pushes children in Madagascar into child labor. Approximately 5.7 million children, about half of the population under 18, participate in labor of some kind. Many of these children work instead of attending school. One in four child laborers perform work that is potentially damaging to their health.
  4. The island nation’s unique and isolated geography is also a contributing factor to poverty. For the country’s rural poor, who largely subsist on farming and fishing, climate change has been particularly detrimental. Water levels continue to rise, and Madagascar’s location makes it very susceptible to cyclones. These factors lead to drought and food insecurity in the already poor nation.
  5. Though 80% of Madagascar’s residents live in rural areas, the country is not currently able to sustain itself. Madagascar has to import 15% of essentials like rice and milk. Slash and burn farming techniques and over-farming has led to deforestation on a large scale. Only 10% of Madagascar’s original rainforest is still intact.
  6. Madagascar’s poor infrastructure also negatively affects its economy. Of the more than 30,000 miles of roads in the country, only about 11% are paved. Many of these roads become impossible to pass during the nation’s rainy season. Furthermore, railroads are not in much better shape; there are two unconnected lines in poor condition.
  7. Despite the aforementioned woes, Madagascar has seen rapid economic growth in the past few years. 2018 saw a growth of 5.1%, bringing with it a two percent increase in per capita income. Sectors such as exports, transportation and finance drive this economic growth. However, poverty continues to decrease at a slow rate: only about three percent since 2012. This slow rate most likely results from the majority of population working in agriculture, an industry that has not quite caught up with modern trends.
  8. Water scarcity and sanitation is a significant problem in Madagascar. Only about half of Madagascar’s population has access to clean water. In places with limited access to water, women and girls often bear the brunt of the work of having to collect it. This time-consuming and physically difficult work hinders their ability to attend school and earn income. In Southern Madagascar, 90% of houses lack basic sanitation needs. Open defecation is common, leading to the prevalence of waterborne diseases such as diarrhea.
  9. WaterAid is an organization that seeks to give everyone across the globe access to clean water, toilets and proper hygiene, including those in Madagascar. The organization launched its water, sanitation and hygiene plan (WASH) in Madagascar, and coordinated with local authorities to improve conditions across the nation. The National Action Plan, launched in 2017, hopes to reduce growth stunting in children under five by nearly 10%, and also aims to increase access to drinking water and proper sanitation, to 65% and 30% of households, respectively.
  10. SEED Madagascar is a non-governmental organization (NGO) that works specifically in the Anosy region of Southeast Madagascar. The organization creates projects related to education, community health, environmental conservation and sustainable livelihoods. All of SEED’s programs are suggested by the people of Madagascar themselves. Ideally one day, they will independently create and implement projects. In one such project, a 20,000 liter rainwater harvesting system placed on the roof of a primary school in Ambandrika provided clean water for 144 school children and 750 members of the wider community. Additional benefits of SEED’s work include allowing more time to create marketable goods as well as more time to care for children.

Poverty in Madagascar is widespread, and the situation will not improve if it is ignored. Economic growth and organizations like SEED Madagascar and WaterAid are taking important steps, but the issue must continue to be addressed.

– Joshua Roberts
Photo: Flickr

Economic Growth in Madagascar
Despite Madagascar’s 74 percent poverty rate in 2019, the small African country has one of the fastest growth rates in the world. GDP growth hovered around 5 percent in 2018 and 2019 and projections determine that it will remain at that rate in 2020 and 2021. Public and private investments in infrastructure, mining, energy and tourism helped drive the country’s recent economic growth. However, poverty still remains high, especially in the more than 60 percent of the total population that works in agriculture. Increased economic growth in Madagascar is drawing international investors to open businesses in the country, creating jobs and stimulating further growth in the developing nation.

Current State of Business

The main industry in Madagascar is agriculture. About 80 percent of Malagasy work in agriculture and approximately 86 percent of that number are in poverty. In addition, the country relies heavily on vanilla exports. The African nation is the world’s largest vanilla producer. Transitioning out of agriculture and diversifying the economy could help spur development. In 2017, the Economic Development Board of Madagascar helped reform the business climate to encourage outside investors to expand to the country. This also entailed fighting against corruption and money laundering. With Madagascar improving the business environment, international businesses may see potential in expanding to the island nation.

International Mining

Mining is yet another area driving economic growth in Madagascar. Madagascar is rich in natural resources such as oil, gas and ilmenite. There are more than one million jobs related to mining in the country. Additionally, 30 percent of export revenue comes from mining. Madagascar is abundant in ilmenite, zirsill and monazite. Rio Tinto, an Anglo-Australian company, is one of the large-scale mining companies. About 90 percent of Rio Tinto’s employees in 2018 was Malagasy. Although mining tends to be part of land degradation, Rio Tinto agreed to restore wetlands and biodiversity to its previous state after it completes mining.

Tourism Growth Resulting in Hotel Developments

Tourism remains an important industry that helped increase economic growth in Madagascar. More than 250,000 people visit the country annually to bring in $748 million in tourism revenue. The tourism industry grew by 20 percent in 2016 alone. Hotel development is one growing sub-category that could potentially add jobs to locals, particularly those seeking higher pay than they receive in the agriculture industry. The Economic Development Board of Madagascar stated that 11 percent of total employment is related to tourism.

More than 70 percent of visitors to the country stay for two weeks or more, expressing the value these visitors place on the economy. International hotel chains took notice of the increased demand for hotels in Madagascar. Radisson Hotel Group planned two hotels and one apartment complex in the country in 2019. All three buildings should open in 2020. Marriott International is opening hotels in many African countries, and one country on its list is Madagascar. Hotel and tourism growth could promise more jobs to Malagasy.

Clean Energy for the Future

The energy sector has even greater importance than tourism. Only 15 percent have access to electricity, which is one main impediment to economic growth in Madagascar. This holds back the country due to energy being one foundation to a developed economy. Schools, hospitals and other buildings require power to function at their maximum potential. As a result, the government of Madagascar set its goal high with the challenge of attaining 70 percent of electricity access by 2030. The country is already making progress to reach this goal. The country’s largest employer, Groupe Filatex, is building four solar power plants that will generate 50 MW.

As of 2019, Madagascar’s total capacity was 500 MW. Groupe Filatex employs more than 15,000 people and will add more jobs in the future to meet the high demand. Lantoniaina Rasoloelison, Minister of Energy and Hydrocarbons, explained that the country’s energy policy for 2015-2030 supports the transition to the energy mix for electricity and lighting. This will include 80 percent of renewable resources.

Growth Ongoing

International investors such as Radisson Hotel Group and Marriott International took notice of economic growth in Madagascar within the last two years. Three sectors seeing growth in the country are tourism, mining and energy. Additionally, the government’s goal of increasing electrification is a good next step to growing the country into a developed economy with less poverty and increased livelihoods. The addition of more jobs to these industries could reduce poverty.

Lucas Schmidt
Photo: Flickr

10 Facts About Sanitation in MadagascarOn the island of Madagascar, only 10 percent of the population utilizes proper sanitation. Fortunately, a number of humanitarian organizations are restoring hope for millions by providing improved services to underprivileged communities. Keep reading to learn more about the top eight facts about sanitation in Madagascar.

8 Facts About Sanitation in Madagascar

  1. UNICEF determined that to boost effectiveness, the best approach to providing sanitation is inter-sectoral solutions. This means that each community takes the solutions into its own hands. Communities are encouraged to build latrines in public places and use water from a centralized water kiosk. Water systems such as pumps and boreholes are some of the instruments that individual communities constructed. Such water equipment has provided 570,000 people in Madagascar with safe drinking water. In addition, 2.5 million people now have access to proper toilets, significantly reducing the rate of open defecation in the country.
  2. Water and Sanitation for the Urban Poor (WSUP) is a group that works to improve sanitation. Through a consistent effort to form strong partnerships with the national government and national water utility, WSUP was able to make a significant change. WSUP reports that 1.16 million people now have improved access to water, 1.35 million people have better access to sanitation and 2.83 million people received hygiene training.
  3. In 2018, WSUP started the Water and Development Alliance (WADA) with support from the Coca-Cola Foundation and USAID. The WADA project focuses on constructing sufficient facilities and institutions to deliver and administer sanitation services and water adequately. So far, the initiative has raised $5.3 million and counting.
  4. charity: water has worked in Madagascar since 2017, funding large, piped systems in the Menebe and Analamanga regions. To date, the group has improved clean water access for 104,598 people in Madagascar.
  5. In 2018, one-third of schools in Madagascar did not have working toilets. UNICEF is working to install toilets in a number of schools, with separate facilities for girls and boys. This is critical to ensure that more girls stay in school when they are menstruating. The organization has also built water points at schools, promoting clean handwashing among students.
  6. WaterAid reports that more than 8,000 children die from diarrhea annually due to unsafe water. Along with these losses, 1.8 million Malagasy children face stunted growth due to a lack of necessary nutrients in the drinking water.
  7. USAID reports that 58 percent of Madagascar inhabitants lack immediate access to potable water. Meanwhile, 50 percent of all Malagasy families survive with inadequate sanitation facilities.
  8. WAGGGS provided a group of 25 girls in Antananarivo, Madagascar, the opportunity to attend an advocacy workshop. After attending the workshop, the women are now better equipped to improve their communities and advocate their learned skills to others throughout the area. With this valuable information, these women can teach others and help provide access to proper sanitation.

These eight facts about sanitation in Madagascar highlight the need for improved access to clean water as well as toilet facilities to improve the well-being of citizens across the country. However, with help from the international community and aid organizations, progress is on the horizon.

– Cleveland Lewis III
Photo: Wikimedia Commons

 

Six Facts About Women’s Health in Madagascar
Madagascar is the world’s second-largest island country off the coast of East Africa. It is also among the poorest countries in the world with a poverty rate of over 75 percent. This poverty rate has inevitably affected the accessibility and quality of health care and the consequent overall health of Malagasy women. These are six facts about women’s health in Madagascar.

6 Facts About Women’s Health in Madagascar

  1. Maternal mortality rates are high. With 335 deaths per 100,000 live births, Madagascar falls well below the average among Sub-Saharan Africa, which stands at 534 deaths per 100,000 live births. On the other hand, it is well above the worldwide average of 211 deaths per 100,000 live births.
  2. Maternal health clinics often do not have adequate access to necessities or properly trained health professionals. Only 19 percent of health care providers in Madagascar have an education in the basics of emergency obstetric and neonatal care. Only 56 percent of primary health centers have electricity and only 53 percent have access to clean drinking water.
  3. Malnutrition is a problem among mothers in Madagascar. According to a study in 2018 by BMC Nutrition, 17 percent of Malagasy mothers between the ages of 18 and 45 suffered from maternal malnutrition and 38.3 percent of pregnant women suffered from anemia. More than 76 percent of Malagasy women have abnormally little weight gain during pregnancy.
  4. USAID is working to help. With its 12,000 volunteers armed with training and medical supplies, it works to provide for maternal health clinics in rural areas of Madagascar. It has even invested in mobile clinics or groups that travel to areas that have no easy access to health care to reach women and mothers with no other options.
  5. Another organization reaching out to women in Madagascar is Jhpiego, formerly the Johns Hopkins Program for International Education in Gynecology and Obstetrics. Across the 815 health clinics it supports, it has aided in more than 130,000 births and provided care to 679,000 new mothers.
  6. Female life expectancy in Madagascar is increasing. In 2019, the female life expectancy among Malagasy women was 68.68 years. While they still rank low in comparison to the 2019 worldwide average of 72.6 years, they have come a long way in the past few decades. With an average rate of increase of 0.83 percent each year, they have greatly improved their life expectancy which stood at 45.73 years in 1970.

These six facts about women’s health in Madagascar show that with one of the world’s worst poverty rates, women in Madagascar are struggling to maintain their health and find safe places to deliver their children. However, groups like the Jhpiego are working to reach out to the women who need help the most in Madagascar. As a result, many women are receiving prenatal and antenatal care for the first time as well as access to health clinics with experienced health care workers. Overall female health in Madagascar is improving and USAID and Jhpiego show no signs of stopping their aid to women’s health in Madagascar.

– Amanda Gibson
Photo: Flickr

10 Facts about Living Conditions in Madagascar

Madagascar is one of the poorest countries in the world, still affected today by the aftermath of colonization and political violence. A history of conflicts has left most of its populace impoverished. These 10 facts about living conditions in Madagascar show some of the larger issues the country is facing, as well as what the future holds for the island.

10 Facts About Living Conditions in Madagascar

    1. More than two-thirds of the population in Madagascar lives below the poverty line, with most living on less than $1.90 a day. Three-quarters of the population live in rural areas, and only 13 percent of the population has access to electricity. The country has one of the lowest Human Capital Indexes in the world at 0.37.
    2. In 2009, Andry Rajoelina led a coup that overthrew the elected president at the time. Ever since then, the political system has been accused of corruption. The judicial system in the country is both slow and weak, and this hampers other systems of the government as well as the business sector.
    3. Madagascar is no stranger to natural disasters, and the island experiences three or four devastating cyclones each year. Cyclones cause massive structural and property damage. Madagascar is one of the countries most at risk of natural disasters in Africa. In 2016, a drought caused food shortages that caused widespread starvation, and this still affects the citizens today.
    4. Problems that plague children in poorer nations are unfortunately just as present in Madagascar. The country has the world’s fourth-highest rate of malnutrition, with 50 percent of children growing up stunted or undergrown. Education is in just as poor a situation. In 2012, approximately 1.4 million children dropped out of school because of political unrest in the region, and the numbers have struggled to rise since. Now, Madagascar has the fifth-lowest education rate in the world.
    5. Eighty percent of the population of Madagascar is employed in the agricultural field. Despite improvements to the economy in some areas, this sector has grown smaller by 0.8 percent every year since 2014. Most farmers are unable to use modern technologies, and weather shocks make farming difficult. However, Madagascar has an excellent climate for growing certain crops like clove and vanilla. Vanilla exports have increased significantly since 2017.
    6. Madagascar is the fifth-largest island in the world. It has a landmass of 587,000 square kilometers and 25.5 million inhabitants. The island is also rich in natural resources, including graphite, coal, quartz and salt.
    7. Madagascar has one of the largest numbers of endemic species on the planet with more than 250,000 on the island. But since the 19th century, the rainforests in Madagascar have been depleted by 80 percent. Eighteen million people in Madagascar depend on natural resources: 80 percent of the population uses the forests from everything from food to medicinal remedies. Conservationism aside, the deforestation in Madagascar represents a threat to the way of life of the people who live there.
    8. In more recent years, Madagascar’s economy has been slowly improving. The economy grew by 5.2 percent in 2018 and has seen similar growth these last five years. Inflation was at 8.3 percent in 2017 but went down to 7.3 percent the next year.
    9. The situation for Madagascar may seem bleak, but aid is currently being provided to multiple of its sectors. Some 12,704 schools have received grants in order to purchase new equipment, and 5.1 million students were also provided with much-needed study materials. Recently, 600 schools helped bring meals to 103,608 children, helping to combat the widespread malnutrition in the country.
    10. Between 2015 and 2017, multiple reforms designed to help the business climate have been implemented, and they have shown results in creating new entrepreneurs. Second Integrated Growth Poles and Corridors Project (PIC2) serves to reduce barriers around investing and business creation. So far, 400,000 businesses and business owners have benefitted from this, and there was an 85 percent increase in the number of new businesses in 2017.

– Owen Zinkweg
Photo: Flickr

Malaria in Madagascar

The citizens of Madagascar live with the constant threat of Malaria. An entire population of almost 26 million is at risk. There is no time of day or season of the year that is able to provide respite from this relentless threat. The country’s damp climate and excess of water provide the perfect habitat for mosquitoes and an ideal breeding ground for Malaria in Madagascar.

Malaria is a life-threatening disease transmitted through female mosquitoes that carry deadly parasites. Symptoms of the disease range from shaking, high fevers, body aches, and fatigue to convulsions, coma and death. Though Malaria is preventable, countries that face high levels of poverty, such as Madagascar, often do not have adequate resources to stop the illness.

So, What’s Being Done?

The following are three methods the government of Madagascar, with the help of various organizations and foreign aid, has implemented to treat Malaria in Madagascar.

ITNs
Insecticide-treated bed nets (ITNs) are one of the primary resources responsible for the prevention of Malaria. These nets drastically reduce the risk of exposure to Malaria for individuals and families sleeping under their protection. The insecticide used to treat these bed nets not only kill various insects, including mosquitoes, but it also repels them from households. If high coverage is achieved, then it has been found that the number of mosquitoes will even decrease from within the area, as well as have a reduced life-span.

One focus of USAID’s President’s Malaria Initiative (PMI) in Madagascar is the mass production and distribution of ITNs. When the program began in 2009, only 57 percent of households had at least one ITN as protection against Malaria in Madagascar. This number has drastically increased, and as of 2016, 80 percent of households now have one or more ITNs. This increase is largely due to the number of ITNs distributed throughout the country by the PMI and a variety of other donors. As of 2017, almost 4 million ITNs were produced and distributed to the people of Madagascar.

IRS
Indoor residual spraying (IRS) involves treating the insides of dwellings with insecticide to prevent mosquitoes from entering buildings. Dwellings, surfaces, or walls treated with IRS kill mosquitoes upon contact. This is another preventative measure taken to cease the spreading of malaria-carrying mosquitoes. In 2016 alone, the PMI project, Africa Indoor Residual Spraying Project, treated and sprayed over 310,000 structures in 2016 alone. In turn, this provided further protection for almost 1.3 million people.

Protection for Women and Children

Children are the most at risk to contract Malaria. In fact, Malaria is one of the top causes of death for children in Madagascar. It is responsible for the passing of almost 200,000 infants each year.  The threat of Malaria in Madagascar begins long before birth for children. However, as pregnant women and unborn children are especially vulnerable. Pregnant women have decreased immunity to Malaria. This makes them and their children almost three times as likely to contract Malaria and other illnesses and infections.

Along with other methods, there are two key treatment and prevention strategies that Madagascar, with the help of various organizations and aid, has implemented specifically for pregnant women:

  1. The Administration of Intermittent Preventative Treatment in Pregnancy (IPTp)
    Starting in 2014, Madagascar modified its policy to match with the regulations of the World Health Organization (WHO). Their intention was to administer IPT pregnancies to expecting mothers early on in their second trimester of pregnancy. This was in conjunction with giving monthly doses until the date of delivery. Coverage of women who received initial IPT pregnancies has slowly increased since the implementation of the program. The amount rose from around 30 percent in 2011 to almost 40 percent in 2016.  On top of this, the 2018 malaria operational plan, funded by PMI, expects to administer IPTp to 106 out of 114 health districts, an increase from the previous 93 that were covered.
  2. Insecticide-treated nets (ITN) from Antenatal Clinics
    Using the aforementioned ITN is the primary source for prevention against Malaria, especially for children and expecting mothers. Furthermore, this preventative measure is critical for pregnant women who might be unable to travel monthly to an antenatal clinic. Close to two-thirds of women visit antenatal clinics at least once during their pregnancy. However, part of the WHOs strategy in Malaria prevention during pregnancy is giving away an ITN in their prevention and treatment package. Thanks to efforts such as these, as of 2018, 69 percent of pregnant women slept under the protection of an ITN.

Malaria is an increasingly critical problem plaguing Madagascar. Between 2016 and 2017, Madagascar had one of the highest increases of Malaria cases in all of Africa. In 2016 there was close to 472,000 reported cases of Malaria in Madagascar. This number increased to almost 800,000 in 2017. Despite a rising number of cases, however, the government of Madagascar is working earnestly to continue to develop programs and projects with the hope of eradicating Malaria forever.

– Melissa Quist
Photo: Flickr

Health Outcomes in Madagascar

Off the coast of Mozambique, 80 percent of Madagascar’s population lives in extreme poverty. In these conditions, malnutrition thrives, increasing the population’s susceptibility to diseases that are no longer fatal elsewhere, like tuberculosis and diarrhea. USAID estimates that 100 children in Madagascar die daily from common preventable diseases. One NGO, PIVOT, is trying to make a difference in health outcomes in Madagascar.

Health Care in Madagascar

In 2014, Madagascar boasted the lowest reported per capita health spending in the entire world, $13.56. Even though the 1948 Declaration of Human Rights declared health to be a basic human right, 50 percent of children suffer from chronic malnutrition and one in seven children die before the age of five in Madagascar. Further contributing to poor health outcomes in Madagascar, the country’s national health policy often demands that patients locate drugs and the money to pay for all services before seeking treatment.

Such a policy, with no possibility of delayed payment, often disincentives impoverished people who need care from seeking treatment. Health policies like this, coupled with poor a transportation infrastructure, make delivery and distribution of medical care and supplies very challenging. In rural villages in Madagascar, community health clinics are often a two to 12 hour hike depending upon the village. For those struggling with illness, such a hike is often not an option.

PIVOT’s Solution

In southeastern Madagascar in the Ifanadiana district, PIVOT “combines accessible and comprehensive health care services with rigorous scientific research to save lives and break cycles of poverty and disease.”After they establish a model health system in this district, they hope to export it to all of Madagascar and eventually resource poor areas all over the world.

Located in a mountainous rain-forested area in the Vatovavy-Fitovinany region of southeastern Madagascar, the Ifanadiana district is home to over 200,000 people. In 2014, Ifanadiana’s mortality rate for children under the age of five was more than double the rate for the rest of the country — coming in at 1,044 per 100,000 live births. PIVOT selected the Ifanadiana, saying, “if we can do it here, we can do it anywhere.”

Partnered with the Madagascar Ministry of Health, Partners in Health, Centre Val Bio and Harvard Medical School, PIVOT began in January 2014 to establish a model health district in Ifanadiana. While many of these partners seem logical, dealing with humans has been a change for Centre Val Bio, formerly a biodiversity research lab who was central to establishing the Ranomafana National Park in Ifanadiana. Madagascar is known for its extreme biodiversity; species live there who live nowhere else in the world.

Targeted at improving health outcomes in Madagascar, PIVOT’s model health district consists of a clinical program within a tiered system of community health centers, regional centers and hospital care. Their clinical programs include Emergency, Patient Accompaniment, Malnutrition, Tuberculosis, Maternal Health and Child Health. Within this clinical structure, PIVOT is pursuing an aggressive data collection program. The health indicators they are focusing on are focusing on Maternal Mortality, Under-Five Mortality, Lifetime Fertility, Composite Coverage Index and the Percentage of People Covered by PIVOT.

As of 2017, PIVOT was reaching 37 percent of the Ifanadiana district. By 2018, they were covering 61 percent of the population and as of 2019, 70 percent benefited from their services. PIVOT hopes that 2022 will mark complete coverage and a total implementation of Ifanadiana as a model health district under PIVOT’s protocols. PIVOT’s own data suggests that from 2014 to 2017 they oversaw a decline in both the maternal mortality rate and the under 5 mortality rate. The maternal mortality rate declined from 1,044 to 828 and the under 5 mortality rate fell from 136 to 114.

Working with the Ministry of Health, PIVOT is helping to implement pilot fee exemption programs. According to their data, only one-third of patients accessed facilities where point-of-service fees were in place; however, with the introduction of fee exemptions the use of healthcare increased by 65 percent for all patients, 52 percent for children and 25 percent for maternity consultations. The fee exemption pilot program cost on average 0.60 USD per patient. Currently, external donor support is essential to the survival of these programs.

Due to a successful democratic election in 2014, international sanctions were lifted which in turn opened the door to increased health spending from national and international sources. PIVOT seems to be making a difference in the Ifanadiana district, and hopefully their revolutionary model health district will spread to the rest of the country reshaping health outcomes in Madagascar as a whole.

– Sarah Boyer
Photo: Flickr