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.

  • 16%
    of women’s deaths are maternal deaths
  • < 30%
    of women use contraceptives
  • 31%
    of the population access services at basic public health centers

Madagascar’s geography of highlands, deserts, forests, and poor quality roads makes it difficult for people to access public health care, even though it is free. Only 31% of the population use services provided at basic health centers. Government medical supplies are prone to stockouts 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. Up to 21% of maternal deaths are linked to giving birth, with just 44% of live births attended by a skilled birth attendant. Though contraceptive prevalence has risen, the rate remains under 30%. It is estimated that 19% of married women have unmet need for family planning.

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 existing health issues. The project focuses on expanding access to and use of priority family planning and reproductive health products in Madagascar.

Program Components

Collaborate with Private Companies

A corporate partnership assessment, completed by SHOPS Plus in 2016, identified potential opportunities for the health sector to partner with telecommunication companies, extractive industry groups, and other large employers to expand corporate social responsibility initiatives for health. The assessment also identified suitable banks to expand the scope of USAID’s Development Credit Authority loan guarantee program. In the coming year, SHOPS Plus will move forward with key opportunities for collaborating and partnering with the private sector to promote health initiatives in Madagascar.

Increase Provider Access to Finance

SHOPS Plus is working with AccèsBanque Madagascar and Baobab Bank Madagascar (formerly Microcred Banque Madagascar) whose core target groups are micro, small- and medium-sized enterprises. Together, the project and the banks are exploring and piloting low-cost loan products suitable for clinics, hospitals, pharmacies, and provider networks in Madagascar. The project also works with the banks to support the use and monitoring of USAID’s Development Credit Authority (DCA) loan guarantees for clinics. The DCA is a credit guarantee program that encourages lending to businesses—predominantly micro, small, and medium enterprises. The guarantee serves to stimulate commercial investment in health care to improve access to and quality of services. 

Strengthen Government Systems

SHOPS Plus is working to identify ways to strengthen the government’s commodity, logistics, and supply system (SALAMA) to ensure efficiency and sustainability. SALAMA is the only public sector pharmaceutical wholesaler in Madagascar, with sales totaling approximately 9-15% of total pharmaceutical purchases. The project will work to strengthen the client-supplier relationship between SALAMA and the Pharmacies de Gros de District (district pharmaceutical storehouses). 




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.