Madagascar’s population of nearly 15 million is growing by about 3% every year. The percentage of eligible women using modern contraceptives has risen from 5% in 1992 to 10% in 1997. The 1997 Demographic and Health Survey showed that the under-five child mortality rate was 162 per 1,000, and the growth of over half of the nation’s children was stunted from malnutrition. Madagascar is also one of the poorest countries in the world, with a gross domestic product of US$260 in 1999. For over a decade (1992–2002), the Ministry of Health and district health teams in the Fianarantsoa and Antananarivo regions, in partnership with donors and nongovernmental organizations (NGOs), have supported the implementation of community-focused interventions. These activities have successfully mobilized communities and linked them with quality services for reproductive and child health.
The Population, Health and Nutrition Center of USAID’s Bureau for Global Health and USAID/Madagascar commissioned documentation of Madagascar’s Family Health Program (Jereo Salama Isika) and its successful mobilization of communities. Lessons learned would inform programs in other regions of Madagascar, as well as in other countries. The documentation team was led by BASICS II and included one team member from Advance Africa to cover reproductive health issues. Various implementing agencies, especially John Snow, Inc. and LINKAGES, played key roles in planning the activity and educating the documentation team about the historic evolution of Madagascar’s program.
Madagascar was selected for documentation of results because its Family Health Program is community-focused and integrated and was rapidly scaled up. In addition, the program had evidence of success. Several partners supported the program with the MOH, including UNICEF, World Bank, USAID, private voluntary organizations, and NGOs.