In Madagascar, utilization of public health services is low, particularly among poor women and their families. Clients, including the poor, increasingly rely on the private health sector to meet their health needs, particularly for family planning and child health products and services. SHOPS Plus is working to leverage the potential of the private sector to address these needs.
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 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 plays a key role in filling the gap. Exact statistics vary, but according to the Ministry of Health and professional association statistics, the private sector appears to comprise approximately one-fifth of the primary care facilities in Madagascar and approximately one-half of first-level referral hospitals. SHOPS Plus is working to leverage the potential of the private sector to address the priority health needs of the population of Madagascar, particularly for child health and family planning.