Strengthening Community and Municipality Co-Engagement for Better Basic Health Services
Executing Agency:SAHA « Soa Afafy Hampahomby ny ho Avy »
Implementation Dates: December 2020 - June2025
Grant Amount: $489,500
Frame and Challenge
Madagascar’s epidemiological profile remains comparable to many low-income countries with a high communicable disease burden. Almost 30 percent of all deaths in Madagascar are still attributable to preventable infectious and parasitic diseases, affecting disproportionately the poor. Madagascar has the fourth highest chronic malnutrition rate in the world with 42percent of all children 0‐5 years of age stunted (MICS, 2018). Overall, utilization of services is unevenly distributed across locations and is marked by substantial income/wealth inequality. Coverage of essential health services is low and immunization coverage has also decreased in recent years.
Geographic access to health service is also a challenge, as numerous communities are seasonally isolated for months at a time because of inaccessible roads and particularly during the rainy season. Even those communities with a health center suffer during this season, since referrals to hospitals are impossible, replenishment of drugs is slower, and supervisory visits are virtually non-existent. Geographic access is of importance to maternal mortality and morbidity outcomes, where Madagascar fares poorly. The number of people served by a health facility has gone down by nearly 47 percent in rural areas. In addition, nearly 78 percent do not have the ability to transport patients to hospitals for further treatment.
The COVID-19 pandemic has negatively impacted the service delivery of essential services and health and nutrition outcomes in the country. Some estimates (done by the Global Financing Facility and based on the Ebola experience) show that utilization of services could decrease leading to an increase in children mortality (by 18%) and maternal mortality (by 12%), reversing some progress made on health-related human capital outcomes.
Strengthening Community and Municipality Co-Engagement for Better Basic Health Services Project (CMC-HEALTH) aims to improve the quality and utilization of basic health care services through collaborative social accountability mechanisms in target municipalities of Madagascar. The project’s interventions will focus on a twofold objective:
- Testing, iterating, adjusting, and institutionalizing a joint citizen-health management monitoring mechanism to assess health services performance aimed at increasing service utilization and quality. The mechanism’s design will build on lessons learned and on problem-driven applied political economy analysis. Health committees and health users will be mobilized to assess service performance, jointly with key stakeholders, including Municipal Health Development Committees and Management Committees of health centers.
- Strengthening the linkages between municipal and health sector planning through the adoption of concerted action plans and a participatory budgeting process at the municipal level, based on universal health coverage policy standards (quality, spatial coverage, increased access to care, diseases prevention). The project will help local actors identify and target specific issues through collaborative social accountability mechanisms, with an emphasis on inclusive participation of the local population and vulnerable groups, and on reinforcing the link between municipal consultation organs, such as Local Consultation Structures.