Formative research to explore care-seeking perceptions and practices among low-income caregivers of young children in Analamanga region

Title: Formative research to explore care-seeking perceptions and practices among low-income caregivers of young children in Analamanga region
Principal Investigators: Lauren Rosapep
Timeline: April 2020 – December 2020


SHOPS Plus Madagascar has worked with the government to increase the private sector’s capacity to deliver high quality health products and services through activities that can be continued by local stakeholders, with emphasis on reaching the poor—especially those residing in Analamanga Region.

Although Madagascar has seen significant health achievements in recent decades, gaps persist. Barriers limiting the use of health products and services continue and some Malagasy caregivers still do not seek treatment or advice outside the home for their sick children. With significant challenges in the public sector, many clients--including the poor-- rely on the private sector to meet their health needs. This is true also for caregivers who seek sick child care, with 32% going to the private sector according to Madagascar’s most recent DHS survey.

Although the DHS data reflect the important role that the private sector is playing in Madagascar, they were collected over ten years ago and do not provide nuanced information on caregivers’ current motivations and preferences for health care, and whether and how private, for-profit clinical providers are seen as an accessible source of care by the poor.


SHOPS Plus will address this gap in understanding by conducting a formative study to examine:

  • Health seeking behaviors and motivations of low-income caregivers in Madagascar’s Analamanga region;
  • How for-profit, private health facilities are currently serving and reaching poor clients;
  • Whether for-profit, private health facilities are interested in expanding services to poor clients; and
  • What for-profit health facilities need to better reach and serve low-income clients?


SHOPS Plus is using qualitative methods to collect data from private providers and caregivers. In-depth interviews will be conducted with a selection of ten private providers working in lower-income districts of the Analamanga region, as well as interviews with 40 caregivers who live within the close vicinity of interviewed providers. The provider interviews will allow researchers to learn about the current ways in which private for-profit providers seek to engage and cater to poor clients. The caregiver interviews are intended to provide insight into whether and how lower-income caregivers who live within the vicinity of private providers see these providers as a viable and appealing source of care for themselves or their children.

The findings of this study will help SHOPS Plus, government stakeholders, and local private partners inform and fine-tune their support for increasing access to priority services, especially among the poor.

Status: Ongoing
Date of last update: October 2020

Learn more about our work in Madagascar and child health.



Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is a five-year cooperative agreement (AID-OAA-A-15-00067) funded by the United States Agency for International Development (USAID). This website is made possible by the generous support of the American people through USAID. The information provided on this website is not official U.S. government information and does not represent the views or positions of USAID or the U.S. government.

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