Health System and EPI Program

In 2004 the country began de‐centralizing its health system. Immunizations are delivered through 22 regions, 111 districts and 2,392 public health centers. Vaccination is part of the minimum package of activities in each center.

Immunization is a key strategy in Madagascar’s Plan de Developpement du Secteur Santé et de la Protection Sociale 2007‐2011. The national Expanded Program of Immunization, which is located in the Immunization Department, Maternal and Child Health Directorate, General Secretariat, Ministry of Health and Family Planning, was launched in 1976. There is an Inter‐Agency Coordinating Committee which provides oversight for the EPI Program.


Over the period 2006-2011, Gross National Income (GNI) in Madagascar increased from $290 to $430 per capita. According to the WHO/UNICEF-Joint Reporting Form (JRF) Database, Madagascar has spent an average of $2 per infant from 2006-2011. From 2006-2009, government expenditures increased from $677,525 ($1 per infant) to $2.9 million ($4 per infant). In 2010, government expenditures only constituted 5% of the overall cost and reported values decreased $2.5 million (a $3.66 expenditure decrease per surviving infant). Madagascar has doubled its government expenditures in 2011, spending $911,352 ($1 per infant) and contributing 23% of the program’s total cost.

Click to download Madagascar's 2006-2013 Reported Government Expenditures on Routine Immunization updated 09/2014


Madagascar is a semi-presidential representative democratic republic, whereby the president is head of state and the prime minister is head of government, and of a pluriform multi-party system. Executive power is exercised by the government. Legislative power is vested in both the government and the Senate and the National Assembly. The Judiciary is independent of the executive and the legislature.

The parliament has two chambers. The National Assembly (Antenimieram-Pirenena/Assemblée Nationale) has 160 members, elected for a four year term in single-member and two-member constituencies. The Senate (Sénat) has 90 members, 60 members elected for a six year term, 10 for each province by provincial electors, and 30 members appointed by the president.

At the moment, Madagascar has a Congrès de la Transition and a Conseil supérieur de la Transition. Its 346 members (256 in the Congrès 90 in the Conseil superior) were appointed in 2010. Presidential and parliamentary elections are planned in Madagascar for 8 May and 3 July 2013, after previously having been scheduled separately for various dates before finally being merged in May 2011 and postponed to September 2011, May 2012 and November 2012.

Immunization-related Legislation

Section II (Economic, Social and Cultural Rights and Duties), Article 19 of the 1992 Constitution of Madagascar states: “The State shall recognize every individual’s right protection of his health, starting from conception.”  Decree 2003‐1162 (Organisant la Médecine d’Entreprise), Article 13, Chapter II, states that medical providers for corporations must offer preventive care to their beneficiaries (workers and their families). 

Madagascar drafted an immunization decree in early 2012 in order to clarify the structure of the EPI program and its activities as well as to create a sustainable way to fund the program. The decree was redrafted into a law in June 2012. This draft law will soon be submitted to the relevant ministries (MoH, MoF) before being submitted to Parliament for approval.

Madagascar’s progress on immunization legislation here

Showcasing Madagascar's Progress in 2013

Right click to view full-sized image in new tab

Program Activities:

  • April 2012: the EPI team drafted an immunization decree.
  • May-June 2012: Madagascar organized and hosted a legislative workshop to discuss and edit the draft immunization decree. Peer exchangers from Congo and DRC also attended and actively participated. The draft decree was revised and turned into a draft immunization law as a result of the workshop.
  • November 2012: Peers from Madagascar attended the "Workshop on Legislative and Financial Strategies for Immunization", held in Kinshasa, DRC. The participants presented, discussed and reviewed their legislative projects with peer exchangers from 5 other SIF francophone African countries.

View All Program Activites Here