Country Overview

  • The resource tracking tool is operational
  • Draft immunization law complete and under stakeholder consultation
  • Technical advocacy group established

Expanded Program on Immunization (EPI)
The Madagascan EPI is in the Immunization Department, Maternal and Child Health Directorate, General Secretariat, Ministry of Health and Family Planning (MOHFP).

Government Spending on Immunization
Over the period 2006-2013, Madagascar’s Gross National Income increased from US$280 to US$440 per capita, increasing 57 percent in eight years. According to the WHO/UNICEF Joint Reporting Form (JRF), the Malagasy Government spent $1 on routine immunization per surviving infant in 2006. By 2013, this figure had risen to $3, reflecting a 300 percent increase. While increasing in absolute terms, the government share of total routine immunization expenditures dropped from 13 percent to 6 percent over the period. Caveats: Reporting for JRF Indicator 6500 is complete but there are inconsistencies across the JRF financial indicators. The data nonetheless suggest that Madagascar has progressed towards country ownership of its immunization program.

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

Tracking Expenditure Flows
Spending on EPI is mandatory within the Ministry of Finance and Budget. The government uses a Monthly Activity Report (rapport mensuel d’activité, RMA) to track expenditures from the health district level.

The Madagascan EPI completed the SIF Budget Process Tool in September 2012.

Legislation for Sustainability
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). 

Established in February 2012, the Multi-Institutional Drafting Committee finalized the draft immunization law. The Committee then incorporated provisions from the Latin American & Caribbean Model Law and input from DRC and Congo-Brazzaville government peers, during a legislative peer exchange workshop the following June.

At a follow-up workshop in November 2012, government peers from DRC, Congo, Cameroon, Mali, and Senegal all proposed amendments to Madagascar’s second draft, which the Malgache drafters incorporated.

The Prime Minister (who was simultaneously the Health Minister) delivered a formal speech on the status of the draft law at the GAVI Sub-Regional Working Group for Eastern and Southern Africa in November 2014.

Domestic Advocacy Network
There is a Technical Advocacy Group for Sustainable Immunization Financing in Madagascar.

Major SIF Program Efforts

  • December 2014: Senior Program Officers from Cameroon and DRC co-organize the Francophone Africa Peer Review Workshop on Sustainable Immunization Financing. Government peers from DRC, Congo-Brazzaville, Madagascar, Cameroon, Mali, and Senegal participate.
  • November 2014: Senior Program Officer shares SIF experiences at Second Annual meeting of the Gavi Sub-Regional Working Group for Eastern and Southern Africa.
  • May 2014: Senior Program Officer participates in Gavi Joint Financial Review of the Malgache EPI.
  • November 2012: Senior Program Officers from Cameroon and DRC co-organize the SIF francophone Africa legislative peer review. Government officials from Cameroon, Mali, Senegal, DRC, Congo-Brazzaville and Madagascar participated.
  • June 2012: Senior Program Officer accompanies DRC peer exchangers to a study tour of Madagascar’s draft law.
  • November 2011: Senior Program Officer organizes advocacy & legislative workshop which included MPs and officials from Ministries of Finance & Budget and Health & Family Planning.
  • June 2011: Senior Program Officer and Program Director organize a second SIF parliamentary briefing.
  • February 2011: Senior Program Officer organizes first parliamentary briefing.
  • December 2009: Senior Program Officer and Program Director conduct introductory briefings with government counterparts.