Madagascar

• People in need: 1.6 million¹
• People targeted: 1.2 million (among which 479 000 malnutrition severe acute and moderate expected)
• People in need of health assistance in Grand Sud Flash Appeal: 700 000
• Requirements (US$): 7.5 million

Context

In Madagascar, the repeated outbreaks of large-scale and serious epidemics, particularly in connection with hydro-meteorological and environmental risks, highlight weaknesses in the health system’s emergency preparedness, response and resilience capacities.

The chronic crisis caused by the drought in the Great South, combined with the shock suffered by the population of the Great Southeast following the passage of cyclones have reduced the population's ability to meet certain basic needs in affected areas, especially those relating to health. For the Integrated Food Insecurity Classification (IPC) for May 2022 to April 2023, there will be approximately 479 000 cases of severe- and moderate acute cases of malnutrition. From September to November 2022, more than 1.2 million people were projected to be in crisis (IPC phase three), as a result of the 2022 crop season being delayed by cyclones and storms, and damaged by the resurgence of migratory locusts and the fall armyworm. This indicates that a very large proportion of the population will remain in crisis and emergency situations, and that without concrete and effective action, the situation is expected to be aggravated in the upcoming periods. The following districts will be IPC 3 PC: Ikongo, Farafangana, Vangaindrano, Betroka, Betioky Atsimo,Beloha, Tsihombe, Ambovombe and Amboasary Atsimo. According to the Flash Appeal 2022, 1 100 000 people are in need of assistance.

The first half of 2022 saw a marked improvement in outpatient consultations in the Great South, and a fairly high attendance rate (35%) in the Great Southeast (Source DHIS2). As of November 2022, approximately 6% of the total population had been vaccinated against COVID-19, with an expected target of 11.94% for June 2023, as per current projections. Despite the strategies already in place, robust interventions need to be implemented to achieve a successful attendance rate, by targeting the vulnerable and high-risk populations. The involvement of leaders and communities will be crucial in this process.

In addition to COVID-19 and the above-mentioned health-related risks, disease outbreaks such as malaria, polio and the pneumonic plague were ranked as high priority in the national risk mapping exercise conducted in July 2022. The need to strengthen preparedness and response capacities was also noted as an urgent priority for ensuring the health system’s resilience and reducing mortality rates.

Emergency response

WHO’s work will focus on strengthening preparedness and response capacities to prepare for and respond to health consequences related to disasters and other public health events, with a focus on disaster-prone regions. The aim will be to contribute to reducing the risk of death and limiting excess morbidity and mortality for the population. Interventions will be carried out jointly with the Ministry of Health’s operational teams as well as in collaboration with national and international NGOs and other health partners, and the Institut Pasteur de Madagascar (IPM), including through sub-contracting grants.

WHO’s response will reinforce the strategic and operational coordination by supporting the setting up of the Public Health Emergency Operating center (PHEOC) at the regional level for rapid decision-making and actions. Disease surveillance will be enhanced through the Integrated Disease Surveillance and Response (IDSR). Supporting mobile clinics and health facilities will be crucial and emphasis will be placed on risk communication and community engagement activities. Finally, logistic and operational support will be provided to Rapid Response Teams (RRTs).

To ensure accountability, activities will be monitored and evaluated in national and regional operational coordination meetings that will involve the Incident Manager, the Health coordinator and the M&E officer. Communication will also be maintained and reinforced between the WHO Country Office, the Regional Office and the WHO headquarters.

Strategic objectives

Key activities

• Set up the PHEOC at regional and central levels
• Ensure capacity building activities and provide supplies
• Ensure the development and implementation of a preparedness and response plan at the regional and district level
• Organize the health sector revitalization workshop and sector performance assessment
• Organize regular health cluster and inter-cluster coordination meetings
• Support Risk mapping levels and the implementation of the National Action plan for health security
• Continue to implement IDSR and offer related training
• Support contact tracing and investigation
• Support entry points priority activities (training, supervision, provision of supplies)
• Support community engagement and risk communication activities
• Provide necessary capacity building support for RRTs and support their logistical needs
• Support surge recruitments
• Deploy RRTs
• Continue polio response
• Ensure logistic and operational support for the implementation of activities
• Procure and preposition necessary supplies in the high-risk areas
• Continue implementing Risk Communication and Community Engagement (RCCE) activities and organize Knowledge, Attitude and Practice surveys
• Support the strategy of intensification of vaccination
• Ensure the implementation of critical activities of the communication plan

Funding requirements 

Overall country funding requirements, including COVID-19, by pillar (US$’000) 

Success stories

Mobile clinics providing lifesaving supplies following Cyclone Batsirai

The Batsirai cyclone is just one recent weather event that has reduced Madagascar’s ability to meet certain basic needs in affected areas, especially those related to health. To provide access to vital health services to populations affected by the cyclone and those living in the country’s most remote areas, the WHO has helped implement mobile clinic activities. Following their launch, and particularly in response to the cyclone, WHO saw increased participation and community adherence in hard-to-reach areas. There was an increase in the number of people seeking health care, with approximately 300 consultations taking place - more than double without the mobile clinics.

For more information

Dr Gilbert Kayoko | Team Leader | WHO Madagascar | tshifuakag@who.int

Dr Bintou Konate | Surveillance Officer / Acting Team Lead | WHO Madagascar | bintouk@who.int