MADAGASCAR Yesterday Today and tomorrow “ A dream for a better health and hope for a real developpement ”

Madagascar is aware that only healthy children can guarantee economic and social development

Up to mid 70s, Madagascar was: The country of « moramora » means « there is no need to hurry », limited foreign exchange, and a shy population. Some characters distinguish it: The mother is the center of the family To have children was the main goal = a marriage is blessed with many children The national priority = high emphasis on birth rate The national priority = high emphasis on birth rate (1st Republic) Up to mid 70s, Madagascar was: The country of « moramora » means « there is no need to hurry », limited foreign exchange, and a shy population. Some characters distinguish it: The mother is the center of the family To have children was the main goal = a marriage is blessed with many children The national priority = high emphasis on birth rate The national priority = high emphasis on birth rate (1st Republic) - The slogan of that period was to fill the stomach without worrying about the quality of food: malnutrition was linked to malediction. - - The slogan of that period was to fill the stomach without worrying about the quality of food: malnutrition was linked to malediction. - Health centers were only used as a last resort. - Most of mortalities are linked to sorcery.

Mid-80s to late 90s: were the black decade of the economic bankruptcy for the country Explosion of several epidemic diseases: measles, diphteria, diarrheas, respiratory infections, malnutrition, malaria, plague Also an increase of new problems: stress, smoking addiction, self-medication, sexual violence

The government with the support of partners began new strategies to address health programme needs: - Launch of vaccination campaign (EPI) - Basic Health care Policy - Family Planning (FP) - Malaria prevention campaign - Essential drug policy - Community participation and cost recovery

Strategic planning of wide intervention coverage with particular approach in remote areas

Implementation through active participation of various partners (UNICEF, USAID, UNF, ACDI,WHO,CDC Atlanta, JICA, etc…) who conducted field visits to assess the progress

Since 1998 to 2004 intensifed interventions in public health to reinforce the health system: Institutionalization of the cost recovery system ( FANOME ) and support for indigent people Increase basic health service coverage for communes (to bring health care closer to the people)

And above all child survival : - Greatest vaccination Campaign AVA - FAOBE – FAV - HIAKA -mass vitamine A campaigns for children -extension of Nutritional rehabilitation centers CRENI and launch of baby friendly hospital initiatives HAB -launch HEALTH CARD -developement of safe motherhood programmes MSR - SR -extension of AIDS prevention programmes, PMTCT -Promotion of BEDNETS for MALARIA prevention -Improve DIARRHEA treatment with ORS

Programme priorities for the MOH-FP: P.1. Organization and administration: improve the number of qualified staff P.2. Access to quality health services: health coverage P.3. Maternal and Child health: EPI, IMCI, Safe motherwood P.4. Nutrition program, vit A campaign P.5. Fight against communicable diseases: malaria, Filaria, leprosy, tuberculosis. P.6. HIV/AIDS programs : VCT, MTCT, HIV care, blood safety P.7. Health promotion P.8. Family Planning: increase of FP, RH sites.

Madagascar is on the right road towards improving the health and wellbeing of the Malagasy population. There is still much to be done. However, through continued partnership, we shall achieve our dream where the majority of people die of old age

The whole country presents its gratitude towards every partner

Thank you for your patience and kind attention The Malagasy people greet all of you.