Healthcare improvements in rural Madagascar 

In some parts of the world, healthcare is not as easy as going to the local clinic. Particularly in rural areas, implementation of health initiatives and the collection of data on patient outcomes of these efforts is extraordinarily challenging. Toward the critical goal of equalizing global health care access, a team of researchers completed a study to gather data in rural Madagascar about the changes affected by the implementation of a health system strengthening (HSS) intervention. 

The team acquired data over 10 years from a group of >1500 households in the Vatovavy Region of Madagascar using surveys, local health workers and facilities, and healthcare coverage and utilization. This type of survey, which follows the same group of people over a long period of time, is called a longitudinal study and eliminates the variability that comes with a random sample of people. The researchers found that the HSS resulted in positive health outcomes, including an overall decrease in mortality, an increase in the use of healthcare services (particularly from mothers and children), and a decrease in distance to and cost of healthcare. This result held despite political turmoil, environmental catastrophes, and disease outbreaks including the COVID-19 pandemic during this time. Interestingly, the study also revealed that outcomes and access to healthcare declined across the rest of Madagascar during the same time period. 

Data collection is a critical first step towards improvement of health outcomes, particularly in rural areas where the general level of access to medical care is unknown or incomplete. Not only is Madagascar’s minister of public health the co-senior author of the study, but the project is expanding to study a region of more than 1 million people next. The authors’ lofty but important goal is to achieve zero preventable deaths, and such studies are critical for the continuation of global healthcare initiatives that aim to bring treatment to rural areas. 

This study was led by Andres Garchitorena with corresponding author Zely Arivelo Randriamanantany and Matthew Bonds at NGO PIVOR in Ranomafana, Madagascar and Harvard Medical School in Boston, MA.

Managing Correspondent: Olivia Lavidor

Press Article: Building Stronger Health Systems Saves Lives, Madagascar Experiment Shows (HMS news) 

Original Journal Articles: Changes in child mortality and population health following 10 years of health systems strengthening in rural Madagascar: A longitudinal cohort study (PLOS Medicine)

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