This series of debates organized by the French Institute of Madagascar in 2020-2021 proposes to think about health together and differently by focusing on four themes illustrating four approaches to health: rights-based approach, inclusive and participatory approach, integrated approach and "One Health" approach.

Given the low supply and quality of health services, which are also difficult to access for the majority of the Malagasy population for financial reasons, health remains a priority issue in Madagascar in order to achieve the sustainable development goals (SDGs) of the 2030 Agenda. The period of renewal that Madagascar is currently undergoing with the development of new five-year plans at the national and sectoral levels for health constitutes a unique opportunity to effectively prioritize the sector and obtain a consensus from all stakeholders on the priorities and approach to be followed.

This project, led by the French Institute of Madagascar in conjunction with its partners and supported by the Fonds d'Alembert, aims to move towards this consensus by bringing together health actors (intersectoral and health-specific state officials, public and state health service providers, educators, academics, civil society, technical and financial partners, etc.) to think about health:

  • together, with a focus on four themes that illustrate four appropriate approaches (rights-based approach, inclusive and participatory approach, integrated approach, and "One Health" approach) to strengthening health systems that need to be addressed in Madagascar if health is to be improved,
  • otherwise, through the sharing of experiences from other countries brought by experts who would help to have a different perspective, while ensuring that the avenues of reflection can respond to local realities.

Exchanges should promote convergence of points of view for the strengthening of the health system, enrich and strengthen the common vision on the CSU to facilitate its implementation, promote awareness and responsibility on health issues that are not often addressed and yet crucial and enhance the health interventions of French actors in Madagascar.

Agenda of the debates

1) Health and environment : population at risk, urgent actions to be initiated
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(integrated approach and One Health approach)

Tuesday 17 November 2020 from 8:30 am to 5 pm
Download the detailed program

One in five deaths is caused by exposure to pollution, according to UNICEF. If the awareness of the leaders and the population is beginning to emerge, it is necessary to quickly take measures to identify, limit and reduce the threats that weigh on the population, in particular, the most vulnerable. In this context, the French Embassy, the Collectif des Citoyens et des Organisations Citoyennes (CCOC) and UNICEF organized, at the French Institute of Madagascar, the Day of Citizen Debate. Bringing together many actors working for the preservation of the environment and the improvement of health in Madagascar, this day allowed to draw up an inventory of the impact of the environment on health.

2) Giving young people a future through the control of adolescent and youth sexual and reproductive health (ASRH)
(rights-based and integrated approach)

Scheduled for May 2021

Through the experience of a country that has succeeded in its demographic transition, we will understand the challenges of the demographic dividend, while the presentation of the Malagasy community's view of fertility and marriage should lead us to reflect on how to change the situation; if the current approaches are mainly aimed at young people, are we effectively targeting people who can influence greater use and effectiveness of ASRH and bring about long-term change?

A series of testimonies will support the reflection for a better orientation of ASRH strategies.

3) Valuing users' rights as a driver for improving the quality of care
(inclusive and participatory approach)

Scheduled for June 2021

Today, users are not sufficiently considered in the health system. While the film by Transparency International Madagascar and the IPS survey conducted by the World Bank, which will be presented during the first debate, will support this observation, the panellists from different backgrounds will present avenues of reflection to ensure that the patient is, as he or she deserves, at the heart of the health system. Another debate will then be organized around the status of doctors, whose low salaries are often invoked to justify the practice of corruption. Is raising salaries the solution? Sharing the experiences of other countries that have resorted to this approach will shed new light on the issue and provide an opportunity for further reflection. A workshop on health democracy will then be conducted based on the testimony of the ARS Mayotte, with reflection groups on the feasibility of setting up health democracy in Madagascar. A photo slide show will illustrate the way in which Malagasy citizens envisage "ideal" health.

4) Universal Health Coverage (UHC) as a vector of solidarity and security for the population
(rights-based approach)

Scheduled for Sept-Oct 2021

Initiated in 2015, the CSU has been slow to be put in place. Through the sharing of experiences of a country that has successfully made its way to the CSU, it will be a question of moving forward in the implementation of the CSU by defining it:

  • the appropriate risks and mitigation measures to ensure that the process of implementing the CSU is transparent and inclusive, thereby facilitating public acceptance,
  • measures to be taken to ensure that a mechanism for monitoring, follow-up and evaluation of the CSU is put in place in a spirit of accountability, so that the system is effective and the population has confidence and is encouraged to use the CSU and its services,
  • the steps to be taken to ensure that the population and all stakeholders accept the principles and mechanisms of solidarity that must be effective in the CSU.

A play in Malagasy and French will present the obstacles to joining the CSU.

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Project leader: Dr Charlotte Dezé, Regional Advisor in Global Health (Madagascar, Comoros, Seychelles, Mauritius).