We partner with the government and organizations across Madagascar to improve health care for women, children, and communities.

Karen Kasmauski/MCSP

MOMENTUM is partnering with nearly 40 countries to accelerate progress and advance USAID’s work to save lives and improve health outcomes for women, children, families, and communities in all of their diversity. MOMENTUM brings together specialized technical and country expertise through six distinct yet integrated awards with the depth and breadth of experience to spur reductions in maternal, newborn, and child mortality and morbidity.

Four MOMENTUM projects—Country and Global Leadership, Private Healthcare Delivery, Routine Immunization Transformation and Equity, and Safe Surgery in Family Planning and Obstetrics—work in partnership with the Government of Madagascar and local organizations to improve the health of Malagasy women, children, and communities.

Learn more about our programs in Southern Africa

Helping First-Time Parents Plan Their Families

By adolescence, 31 percent of Malagasy women have begun having children.1 To help first-time parents in the urban areas of the Vakinankaratra region plan their families and space births, MOMENTUM Country and Global Leadership is partnering with the Malagasy Lutheran Health Department to increase access to and use of voluntary family planning services. This includes counseling new mothers and their partners on family planning using an aspiration-based approach, which prioritizes parents’ goals for their future. MOMENTUM is also working to identify the gaps, opportunities, and barriers first-time parents can face when seeking health care through the private sector or through community services.

Karen Kasmauski/MCSP

Improving Maternal Health Care

Delays in care or unavailable care contribute to Madagascar’s national maternal mortality ratio of 392 deaths per 100,000 live births.2 There are several reasons for this, including that over 60 percent of Malagasy people live more than five kilometers from the nearest health center.3 MOMENTUM Country and Global Leadership is providing technical and capacity strengthening assistance to the Ministry of Health and other partners in Madagascar so that more women can give birth safely. MOMENTUM supports the Government of Madagascar to deliver high-quality, evidence-based interventions that address gaps in the current health system.

Karen Kasmauski/MCSP

Community-Based Interventions to Prevent and Manage Malaria

Malaria is endemic in Madagascar, where up to 100 of every 1,000 people contracted the disease in 2021.4  Malaria in pregnancy is a serious condition for both mother and fetus that can lead to anemia, low birth weight, stillbirth, and maternal death.5 Building on experience introducing community distribution of intermittent preventive treatment (also known as IPTp),  MOMENTUM Country and Global Leadership is supporting the Government of Madagascar to strengthen prevention and care for malaria in the Vangaindrano district. Community health workers are being trained and supported to offer IPTp and identify and manage simple malaria among children and adults, with referral to facilities for more complicated cases. After training, health workers will be able to administer sulfadoxine-pyrimethamine for eligible cases and manage cases of uncomplicated malaria on-site.

Karen Kasmauski/MCSP

Supporting Nurses, Midwives, and Health Workers

In Madagascar, there is only one qualified midwife per 10,200 people, creating a dangerous situation for maternal health care.6 MOMENTUM Country and Global Leadership is supporting Madagascar’s Ministry of Health to apply the evidence and key actions outlined by WHO and the United Nations Population Fundto influence national decision-making that favors investments in nurses and midwives. Additionally, MOMENTUM is supporting national-level policy dialogue to engage nurses and midwives to discuss challenges to their work and potential solutions.

In addition, MOMENTUM Country and Global Leadership is supporting Madagascar’s Ministry of Health to accredit private nursing and midwifery schools starting with assessments using the Educational Capacity Framework. This also includes reinforcing quality education by developing simulation labs for skills development and working with preceptors to facilitate clinical rotations for students. MOMENTUM Country and Global Leadership is also supporting Madagascar’s Ministry of Health providing technical assistance to update the Health Workforce Strategy and Implementation Plan and improve the Human Resource Information System in the health sector.

Karen Kasmauski/MCSP

Preventing and Treating Common Childhood Illnesses

In 2021, 304,000 children in Madagascar had not received a single dose of the essential vaccine that prevents diphtheria, tetanus, and pertussis.7 MOMENTUM Country and Global Leadership is working with the national Extended Program on Immunization to help reach children who are being missed with routine childhood vaccinations. MOMENTUM is also working with Madagascar’s government to integrate management of childhood illnesses into treatment at basic health centers.

Karen Kasmauski/MCSP

Helping Infants and Young Children Recieve Crucial Nutrition

In the first 1,000 days of life, nutrition lays the foundation for lifelong health. Two out of every five Malagasy children have chronic nutrient deficiencies,8 but little is known about the cause. MOMENTUM Country and Global Leadership is conducting research to address this knowledge gap and understand the role of cultural beliefs and practices, barriers, and motivations in feeding infants and young children so that they can receive the nutrition they need.

Kate Holt/MCSP

Supporting Private Drug Shop Operators to Improve Health Access for All

To improve access to those seeking care for sick children and those in need of contraception and family planning services, MOMENTUM Private Healthcare Delivery is supporting drug shop operators to integrate best practices for child health and family planning.

MOMENTUM is building and testing an integrated curriculum for Integrated Community Case Management and Family Planning (iCCM/FP) to provide greater access to these services through private drug shop operators. The curriculum will be used to train approximately 100 Malagasy drug shop operators in the Analanjirofo and Atsinanana regions of Madagascar. MOMENTUM will generate insights on the feasibility, acceptability, and effectiveness of training this group of providers to inform and finalize the iCCM/FP curriculum as an open-access resource to be used by pharmacy and drug shop operators across Madagascar.


Vaccinating Malagasys Against COVID-19 and Strengthening Pandemic Preparedness

MOMENTUM Country and Global Leadership partners with the private sector to broaden access to COVID-19 vaccines. The project also works to understand the causes of low COVID-19 vaccination rates; as of February 2023, less than eight percent of Madagascar’s population had received at least one dose of the COVID-19 vaccine.9 MOMENTUM addresses reasons why COVID-19 vaccination services may be perceived as inconvenient, complacency about the severity of the pandemic in Madagascar, and specific rumors or disinformation.

From August to October 2022, MOMENTUM Routine Immunization Transformation and Equity also supported widespread and equitable access to COVID-19 vaccines in Madagascar. This included providing technical support to the government’s 100-day COVID-19 vaccination campaign.  MOMENTUM also collaborated with USAID Madagascar to identify approaches to reach rural populations and high-priority groups with COVID-19 vaccines and worked to understand the drivers of vaccine hesitancy to create guidance on how to increase demand for COVID-19 vaccination.

World Bank / Henitsoa Rafalia

Strengthening Surgical Safety for Maternal Health Care

MOMENTUM Safe Surgery in Family Planning and Obstetrics is working in Madagascar’s Atsinanana region to improve access to and increase the safety of surgical maternal health care, including identifying and addressing gaps in capacity and equipment available to surgical teams. MOMENTUM is also utilizing social and behavior change strategies to help surgical teams improve the quality of Cesarean sections.

Karen Kasmauski/MCSP

Interested in partnering with us or learning more about our work in Madagascar? Contact us here or check out our Southern Africa Regional Reference Brief.

Learn more about USAID’s work in Madagascar.


  1. Institut National de la Statistique (INSTAT) [Madagascar] and ICF. 2022. Enquête Démographique et de Santé à Madagascar, 2021. Antananarivo, Madagascar and Rockville, Maryland, USA : INSTAT and ICF.
  2. Andrianantoandro, V.T. et al. 2021. “Factors Influencing Maternal Healthcare Seeking in a Highland Region of Madagascar: A Mixed Methods Analysis. BMC Pregnancy Childbirth 21:  428.
  3.  United States Agency for International Development (USAID). “Madagascar: Global Health.”
  4. Madagascar Ministry of Public Health. Plan stratégique national de lutte contre le paludisme, 2018–2022. 2018.
  5. Bauserman, M. et al. 2019. “An Overview of Malaria in Pregnancy.” Semin Perinatol 43 (5): 282-90.
  6. United Nations Population Fund, WHO, and International Confederation of Midwives. The State of the World’s Midwifery 2021. May 5, 2021.
  7. Immunization Agenda 2030. “African Region: Madagascar.”.
  8. Institut National de la Statistique (INSTAT)Madagascar and ICF, Enquête Démographique et de Santé à Madagascar, 2021.
  9. Johns Hopkins University Coronavirus Resource Center. “Madagascar: Overview.”

Your privacy and security are very important to us. Please be aware that MOMENTUM Knowledge Accelerator does not collect personal information when you visit our website, unless you choose to provide that information. However, we do collect some technical information about your visit. Read our Privacy Policy.