In Madagascar, utilization of public health services is low, particularly among poor women and their families. Increasingly, the private sector is stepping in to expand use of family planning and reproductive health services.
Madagascar’s geography of highlands, deserts, forests, and poor quality roads makes it difficult for people to access public health care. Only 31 percent of the population use services provided at basic health centers. Government medical supplies are prone to stock-outs and entirely unavailable in some areas. Family planning initiatives in cities have met with some success, but there remain significant gaps in access to quality family planning services. Though contraceptive prevalence has risen, the rate remains around 30 percent for all women of reproductive age. Given high fertility rate, with just 44 percent of live births attended by a skilled birth attendant, the maternal mortality rate in Madagascar is high, at around 478 per 100,000 live births, and it has stagnated in recent decades.
As the public sector struggles to serve the health needs of its citizens, the private sector has increasingly stepped in. SHOPS Plus is working to leverage the potential of the private sector to address maternal child health and family planning and reproductive health issues in Madagascar.