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

Karen Kasmauski/MCSP

MOMENTUM is partnering with almost 40 countries to disrupt the status quo, 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 best-in-class, 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 by improving access to family planning services and maternal health care, preventing and treating common childhood illnesses, vaccinating the population against COVID-19, and strengthening safe surgical care.

Helping First-Time Parents Plan Their Families

Thirty-one percent of Malagasy women between the ages of 15 and 19 have begun having children.1 Becoming a parent for the first time can be hard, especially for young women; many young women are removed from family, school, and social support networks, and must also navigate caring for their own health while learning how to care for a newborn. To help first-time parents in 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 family planning services. This includes counseling first-time mothers and their partners on family planning using an “aspiration-based” approach, which helps parents plan their families based on what they want their future to be like. MOMENTUM also identifies the gaps, opportunities, and barriers to health care that first-time parents often face when seeking care through the private sector or through services in their communities. The project incorporates feedback from youth on household visits and in public and private sector services to make sure that the health care they receive is responsive to their needs.

Karen Kasmauski/MCSP

Improving Maternal Health Care

In Madagascar, 392 out of every 100,000 mothers die2 because of a delay in or lack of use of maternal health care services.3 A major contributor to maternal mortality is that over 60 percent of Malagasy people live more than 5 kilometers from the nearest health center.4 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

Preventing and Treating Common Childhood Illnesses

In 2021, there were 304,000 children in Madagascar who had not received even a single dose of the essential vaccine that prevents diphtheria, tetanus, and pertussis.5 MOMENTUM Country and Global Leadership is supporting the national Expanded Program on Immunization to reach these “zero-dose” children and others who are being missed with routine childhood vaccinations. MOMENTUM is also working with Madagascar’s government to integrate management for childhood illnesses into treatment at basic health centers.

Karen Kasmauski/MCSP

Helping Infants and Young Children Recieve Crucial Nutrition

Two out of every five Malagasy children are chronically nutrient deficient for their height and age,6 but little is known about the cause. MOMENTUM Country and Global Leadership is conducting research to address this gap and understand how various cultural beliefs and practices, barriers, and motivations contribute to nutrition for infants and young children.

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.7 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


  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. World Health Organization, United Nations International Children’s Emergency Fund, United Nations Population Fund, The World Bank Group, and United Nations Population Division. Trends in Maternal Mortality: 2000 to 2020. Geneva: World Health Organization, 2023.
  3. Andrianantoandro, V.T., Pourette, D., Rakotomalala, O. et al. Factors influencing maternal healthcare seeking in a highland region of Madagascar: a mixed methods analysis. BMC Pregnancy and Childbirth 21, 428 (2021).
  4. United States Agency for International Development (USAID). “Madagascar: Global Health.”
  5. Immunization Agenda (IA2030) Scorecard. “ African Region: Madagascar.”  Accessed: January 27, 2023
  6. Institut National de la Statistique (INSTAT)[Madagascar] and ICF. 2022. Enquête Démographique et de Santé à Madagascar, 2021.
  7. Johns Hopkins University Coronavirus Resource Center. “Madagascar: Overview.” Accessed February 17, 2023.

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